6 BARNES AVE - BUILDING INSPECTION fL�tNSirlliSfi�Ef *9--AND AfPROVED BY 744E
ASPWZLIB P'P" TA A PERMIT BEING GRANTED
CITY OF SALEM
�/ / %• Date
it
Is Property Located in Location of
the Historic District? Yes No_ Building �p y��esIT^Q
Is Property Located in
the conservation Area? Yes No_
BUILDING PERMIT APPLICATION FOR:
Permit to:
(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 according to the following
specifications:
Owner's Name
Address & Phone
Architect's Name
Address & Phone j
Mechanics Name
Address & Phone
what is the purpose of iwiiding?�g ' 0 ' 11 n _ A.
Materiel of fwlk&q? U/0 0 If a dwelling, for how many families?
Will bWkkv cord to law? VP 5 Asbestos?
Estimated cost 5� (� City ucer"o N A Sttaate Ucense#
Rome Dwrover eat , 4 t J A1LIl (SY� Q-
Lie. /
Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE (�
MAIL PERMIT TO:
No. =
APPLICATION FOR
PERMIT TO
LOCATION
Go �cre_s
PERMIT GRANTED
PROV D
INSPE _TOR OF BUILDINGS
f
CITY OR SALBMS MASSACHUSItTTS
PUBLIC PROPERTY DEPARTMENT
120 WASNINOTON STRttT 3R0 FLOOR
SA"14- MASSACNUS" 01970
STANILty J. USOVIC11. in. TtLtrNONt:
MAYOR 978•745-9393 EXT.. 380
FAX: 978-740-984s
Salem BLildins Deggrtlnant
' Debrla Dlannee� god
In accordancepermi with the provisions of MGL c40 S 54, a condition of your
Building t is that the debris resulting from this work shall be disposed
Of in a properly licensed solid waste disposal facility as defined by MGL
Chapter III, S 150 A.
The debris will be disp
osed of in:
�ocadon of Facility)
Signature of Applicant
3I3i I r�l.
Date
CITY OR SALE149, MASSACMUSETTS
• PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET. 3R0 FLOOR
SALEM. MASSACNUSErrS 01970
TELEPHONE: 976-745_p599 EXT. 360
FAX: 976-740.9646
HOMEOwm LICEN8L EXEMPTION
Pkaae Print.
Date
Job Location
Hoaoe Owner Addreae.
�40wags?elapbarS 1 I
Preeaat Mailing Addtnsa:.
The current of"Homeownee"was,extended to include odual.
dwellings of taro UWa oar IM and to allow such
hire who don engage for
not posses a licaosg provided that the owner; as supetvisos
DEFINITION OP HOMEOWNER,
waas��.0or n ded Landon whic)t Willie feeides or intends to reddq on
to bq a one or two family dwelling
structures accessory to a ch use and/or!brit t�W t " A stwhoconeructs mots
than one horse in a two year period shall not be considered a homeowner. Such"homeowner•'shall submit to the Building Ot$cial,on a form
cat he/she be r aponsible for all such Work acceptable t B the Building
PermOfial, thit. Performed under the Building
The undersigned"homeownee assume responsibility for compliance with the State
Building Code and other applicable by-laws and regulations.
The unndersiPW"homeowner"certliie that he/she understands the City of Salem
Building Department minimum inspection procedures and requirements and that he/she
will com
ply with said procedure and requirements,
HOMEOWNERS SIGNATURE `
APPROVAL OF BUILDING INSPECTOR
See other side for state code
Roma "m=Dff OPi
owner pelfwaninswomb far which a Building Pamit is
The Code states thss: "'+°Y of this section(Section 109.1.1 -Licensing
wed shall he exempt ilnm the Wed
��eowna engages a pason(s)S0c hire to
of Coastcuation S»pavmsors��° shall ad as Ste•
do such work and that each Homo
this exemption are uoawaeA der!'we assu�g m0
Many H u' facLicambs
RqFIdiOW
Asa(ate Appa dbc%Rolm a
ofto results in senous
Consn+tchon Supa� OIIIM hires unh erred person in this Your
prdbkwhen the Homaowoa ,
p ind the unliemsed pa n.'as it mould with a lien .
Board �n a mp" . mspons�bla
S The Hoummer
_ 1�.,, .
awae of MOW tlttteb many ca*
To ensure that the Homeowner is t1m11y Homeowner
that
commumdos requite,as a part of the Permit Application, . this' is a
On d1i he pap hdphe undasts a die of a cat amend ad a�snme
form c Wcatly-used by several tOw°s' You may
adopt
foiwcati8catio4 fog uee in Yam tY`
R� b l so� yao s