10 ARBELLA STREET - BUILDING JACKET 10 ARBET T A STREE
-?� 6 y 19
Plans must be filed and approved by the Inspector
prior to a permit being granted
CITY OF SALEM
No. Ward Z — 1
con�nirt,���
s? (/
HISTORIC DISTRICT? Yiv' � � Date
IF FOR SIDING, HAS ELECTRIo
C Home PhoneS ,8 -
PERMIT BEEN OBTAINED? Y N �s�� Bus. Phone �y�r 1102
APPLICATION
FOR
t/PERMIT TO
�
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the
following specifications:
D LcnT �r
Owner's name and address /G
Architect's name
Builder's name 11 /
CC V U C,/7
QJ7
Location of building, No.
What is the purpose of building?
If dwelling, # of units? ' Material of bldng?
�fUG
Will building conform to law? Asbestos?
Estimated Cost S 7s a v, City Lie.# State Lie.# # 7 6
Home Improvement License # Al U kA--Q
Signature of Applicant,��
SIGNED UNDER THE PENALTY OF PERJURY
DESSCRIPTIONI OF WORK TOI BE DONE
�urr�ins w,��-ter S�d,^�J
1\1ew /�fie_ arj 32 'c), -
r`�cti1�c�
Mail Permit to: :��
1
No. �I I Ward
APPLICATION FOR
PERMIT TO ROOF
REROOF OR INSTALL SIDING
Location L l7 2 r be,1l ST
PERMIT GRANTED l
j S/ 19//�
Appr ed' vi
keel B 1 Inspect r
DATE: S U
w "
Citp Df a�aftm' 1RaE;5arbUa5Ett5
PLANS MUST BE FILED AND APPROVED BY THE
INSPECTOR PRIOR TO A PERMIT BEING GRANTED /
Location of Building WA S T
Building Permit Application For:
Circle whichever applies) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool
Addition, Alteration, Repair/Replace, Foundation Only, Wrecking
Other: + EMU.6-9L
1
PLEASE FILL OUT LEGIBLY & COMPLETELY TO AVOID DELAYS IN PROCESSING
To the Inspector of Buildings:
The undersigned hereby applies for a permit to build according to the following specifications:
Owners Name: J�j tCHi4421� l4 I Ay'(74�v— Contractor: AJVV SA 1401 u-E
Street /0 A!�Ig£ Z� S IfCity —&4,&9M Street k,�- G o AMC AtrQ City R,4-Cr--Wt
State_ IUI,¢ Phone (971) 74t C— (E� State /` Phone (Q7�j
Architect: City of Salem LicA
Street Cit-s. State Lic# HH'#
State Phone ( ) Homeowners Exempt Form _yes_no
Structure: (please circle) ingle Fa y. Multi Family# Other
Estimated Cost of job S ( Oc) 'o \
Will building confirm to law?— yes no
Asbestos?_yes ✓no )
Description of work to be done:
&'t4//
Drawings Submitted: __yes ✓ no Mail Permit to:g
/V/0 KA[0 Mli— �yn�
Signature of Application,SIGNED UNDER THE PENALTY OF PERJURY
CONSTRUCTION TO BE:COMPLETED WITHIN SIX(6)MONTHS OF PERMIT ISSUED DATE
Department use only: Permit# Zoning Map/Lot
Permit fee$ !�
COMMENTS:
No
APPLICATION FOR
'PERW TO
LOCATION
1D 17r44
PE MIT GRANTED
APffrpvfp Y
INSPECTO OF BUILDINGS
CERTIFICATE OF OCCUPANCY`,`
YES
NO • 4
•
R
y � �
(�ItU IIf IIIPIII, II55c�L�iLI5P 5
1\C 'i�ra, Public Prugrrig BLpIIrimrnl
*� „r 'iguilbinu Erparimznt
Wat $clrm 6rrrn -
508-745-9595 Ell. 300
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the provisions of MCL c 40, S54 , I acknowledge that as a
condition of Building Permit ?t all debris resulting from the
construction activity governed by this Building Perm:c shall be disposed of in
a properly licensed solid waste disposal facility, as defined by MOL c III,
S ISOA. _ r
i CN&+1 N�
The debris will be disposed of at: kl'u
location of facility
6.0,W x
Signature of Permit Applicant Date
Fully complete the following information:
(Please print clearly)
Name of Permit App `_icanr
Firm Nam/e, if any / n
Avg
Address . City 6 State
The above statute reouir=_s that debris from the demo! -: tion, renovation, rehab
or other alteration of building or structure be disposed of in a properly
licensed solid waste disposal facility as defined by MGL cIII . S150A and that
building permits or licenses are to indicate the location of the facility at