1 ABBOTT ST - BPA-2005-225 ROOFING w
qPU M IM ST13E 44W9 AD APPROVED BY 144E
ASPECUIR PRIOR TD A_PERMIT BMG GRANTED
CITY OF SALEM
Warder_
Zoning Dlshlal
Is PMWy Coated in Laeasian of q
Me X1,,22
Hhbrlc Dblhct? Yw No x DaildinD / �+U J-4
Is Property Located In
: ft ConsNVaWn Anis? Yew No
Permit to:
BUILDING PERMIT APPLICATION FOR:
(Circle whichever apply) Roof,(Reroof Install Siding, Construct Deck, Shed, Pool,
Repair/Replace, Other:
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build accomkig;to the.folk)wing
specHk:atkms:
Owners Name LC y11P n A 214)/ C
Address & Phone 7
Architect's Name
Address & Phone
Mechanics Name /� J G ✓v S} J C�/ a
Address & Phone �� � ( 7�iJ 0--
What is the Purpose ct o sdW / 00
mm"al buMdYq? Aim ")D h a dwaftV,for how a"famem? r
WIN 1 111 n to law? m f Aa mme? f L D
Edmated coati 3 7D P qty Lkmm r Slab umm e
Lie. I
`
Signature of Appli
SIGNED UNDER THE PENALTY'
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO: / 11AAD L T a- 591 1. L I ,I& D KZd
1
No. 0�
APPLICATION FOR
PERII<T TO
LOCA N
PERMIT GRANTED
g/ 3d�O ,9
AP vo
INSPECTORlOF BUILDINGS
CITY OF SALEM
BUIIAIIdG DEPARTMENT
HOMBOWNER LICENSE E?�I�IIOlQ
Plwe Psis
DATE
XBLOCATIOM 1 � �_,9 G 2�T A- .
i1aWEowlm(
HOIv>£OWI
72 e � "�7 -q
TELEPHONE
p GADDRFlf—:1;Q cc).
The avnmewmptlon C(nomeowoead'was exscaded a bwiude ewoa•gxnpied dwen6p otTNO
thft a ko end b&Row seek)!otneowners to cwp an bWWidud.lor bbl,who dtta NO pain•
lieesm p,o+;eed 6et x 4mm Set d snpecvi@M
DEFllanom OF HomEow 'M
Pcnm(s)who owns s pored of lad on wbk6 6ekbe?aides a brads to midR an w61&ton k or k
intatded so be,s an so two 5mily dwcln,ensdtod as dctadted n?nceea seccda7 b saes the ee'I
farm soucwm A palm who constructs mom t m ane home In a two-yew pcFW SW ttosbe oonsidal,d
a boateowner. So*mmnwwud' shallsobmdl so the Building OdtCUL CID �boudbe�bk�*4
Bwlding Odicid,that uAft be?aponak m all snch weds paketoad
The wtdersiptcd lwmwwnd'asswna nn9mumbiliq fa==Pliwtee wi&*t Suse snip Code d
wher apoable Sao bp-kws,roles and tedolatkntt
The wAosip ed-howeow nce eertiLa dm hdshe wde?stands dm Ciq of sakm Bellini Depoart
=mum brpecum pmoedwa and?eqw=mms and that lt/sht will ptooedtoa d
tegdtsateal.
HOMEOWNER'S SIGNATURE
APPROVAL OF B=ING INSPECTOR
Sec ober side for Scott Code
y
HOMEOWNER'S EXEMPTION
The code sues that 'wly h=wcwna perfwuft imA for wrbieb a baD&V pamh b te1-1 dd M
cxrnipl$o®the PUVL leas of ibis sccdaa(.4ertlom sj.a a-l3aasio=d Coauttaetba Saperviaaae
pmvW d eu b a bomeowma eap&a p person(s)for ldm io do.sob wsd4 tb0 r;ad bosaeowaa del oN
pip who ase Oda aa:MOM arc iaawac that they ins aamabs tlta Isposaib0tia do
s'rPcrviau(see Appcad>s Q.7taka sad RaBulatba fol 3letosia=Ceoststaetlaa Er♦er+�faOea,�
L2* Ibis lads d awwromss edea rwhs in senora problems.peekola>�w Lea she boneosraet bdsat
aaikcased pasoaa In this east yam Bald cwvm proved mains the miSaaaea papsi as itwoule wid
lietuw Sapm". The bome"t acsiaf as seperrbw b ahbadell 2!sSrftAlk
that the homeowna L swan etu4m sespoa:ib dek soap ooa�det :aapsA
To Comm �'
of a w permti appihadoa4 that the bomwwna ocn*that bashe tmdasm&dw lespoosbaw"do
sopavbm You may ase to mend and adopt sad a losmtcedf calm for ass in ym ccmmft.
PUBLIC PROPERTY DEPARTMENT
120 WAfMIMGTOM STREST, 3RD FLOOR
SALEM.MA O t 070
TEL (976)740-S595 EXT.3610
FAX (976) 740.96"
STANLEY J. USOv1C7, JR.
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the provisions of MGL c 40,S34,I acknowledge that at a condition
of Bmft Permit M_ all debris resulting ftm the construct m activity
SDYaned by this Building Permit shelf be disposed of in a properly licensed son&waf<e
disposal facility.as defxW by MGL a Ili,S13M.
The debris will be disposed of at: lj o rz � N
LocationofFacility
SiPaWm OfPezai Appycs Datb
FULLY complete the following infomatm
(PLEASE PRINT CLEARLY)
Z N/-�i�1� � l�y C�Q✓L
Name ofPennit Applicant
Firm Nam%if any
Address,City d<state'
The above statute requires that debris from the demolition,renovation,rehab or other
alteration of building or sbuctu m be disposed in a properly-licensed soki&v/We disposal
5ciHW w&Tuned by MGL cIII, S I SOA,and the building permits or Been are to
indicate the location of the Leri*.