22 BARNES RD - BUILDING INSPECTION �iF1'i 1i 1 � 1
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VEO BY T44E
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. �� �f'4EINt;3 t3RANTED
.CITY OF SALEM
AP
Is Peopoty LoGrAd In iaeation of
n.raa10 obbW Yss_No ✓ atuas�a f(L
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Lamed In
Me CaromtYgn Mal Yee No
BUILDMG PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof. Rmd, Install Siding, Constnwt De Shad. Paul.
RspeldReplace. Other:
PLEASE FILL OUT LEGIBLY A COMPLETELY TO AVOID DELAYS W PROON"
TO THE INSPECTOR OF BUILDINGS:
The undersVied hereby applies for a permit to build actor ft to the kdw& q
OwnsesName
Address & Phan. �)a 101, fY1fl (q�81
Amhhs&s Name
Address A Phone
Madmics Name Lu
Address & Phone a'
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rdww d b~ oz)olcd N e dwdYq,Ion how.my an ft? i
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�S nature &-.'plant ^;
SIGNgD UNDER THE P1610",
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
t (j-
MAIL PERMIT
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No
APPLICATION FOR
PERwr TO
LOCATION
PERMIT GRANTED
APPAOv�h�� .
INSPECTOR OF BUILDINGS
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City of Salem Ward
No\L
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App) I-ATION
Foe
PERMIT TO BUILD ADDITION, MAKEALTERATIONS OR NEW CONSTRUCTION
IMPORTANT•Appftant tO cOinp11ete all-items in sections:4 14 I14 N,and DG
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•�� �F-Y1P:S �� - o°Isr�7
L _ AT 9.00ATIONI. /1PI 6ng11
LOCATION l 3 )o easel AND (C r r�e LC-1.
.OF BETWEEN -- �' aaamsmr�^ c sTxmn
...
BUILDING sueowaoN LoT_.BU=-SIZE
I. TYPE AND COST OF BUILDING-AN 8PP1kwft dWyPate fafft A4'D
D. PROPOSED USE FOR
-DEMOUTIOW USE MOST RECENT USEA. TYPE OF IMPROVEMENT .. .. - floPnalaa1a1a1
1 ❑. N""drq
1e Q !rnVaa..awuarar
2 ❑ AddM*nlawailawm.en fflw0rdnw 19 CbudL oaw Mhomw
h.,M,'Widda47anRr.Pw0.131 13 2DQ *W'WW. >
3 Aaawmn ISro 2 aoow) - d udb _ —� 21 Q Pap'* amp
s ❑ paw wPwrnot to[3 Enw:wahOWL WdWWANY — 22 Q=Sw www1 nie w9nP -
S C3 wmLo-vP.m�Yanil'Aad.ne!l anrr aPner -
dunaaoaWdignPan0.13) 15 ❑ Graf 24 Q_QWXWb@*-0 ob 1
❑ �aown9 VabralbN ie 13 Cron 23 0 adwoa1®Y
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2e., :-Sd�PPI.ftry.0ur Puwftwrl
7 ❑ FPurnrww* 17 Omw•STOW .. 27 ❑.Sbnr..aae1+la
B.OW[�M EASWP 26 3 Trai bnwa
82 Priww jrOmduaL=rPW&MM MOM* 29 ❑-0ow•spaor7
vkg*AOM alc1 -
9 Q p Oft wil'WK so&or bca PmAA1enl .
. u d buk%N9& Q.17P0 nPPw•99PL
IOm►erY1 Npatedewdl DesuOe idM 0 ho PewL -
C.COST nw.iiie arPo.badly oui0ig r,aapuL awOew.w adn I sear 0*19-n0i oola9a.
a e� �n Prxnolaaba:PaAv99�brdeeai�nem now.iaraaldfca CW6'4 afo ou�q
10. Cold bwwanw+ �— -- sJ�' lJ�•�% y nawm PlanL 11 we 01"j' n99�i6n9r:Pea9dan9b.w"rvapwd &
TOb �Pr��
niueooYL'-ada+
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t M'raKl.rr midNai9
dr aw1 Waif.rU
11.T6MtCOST OF IMPROVEMENT
II. SL7.ECTED CHARACTERIS_'17CS QF.BULLRING -For new buildings and adddlons,comPieft Parts E L;denalibnn.
c ate on af�rfs J 8 M,ad others skip to IV
F.PIa1C§lE TYPE OF NEATUG R EL G. TYPE QF SEWAGE DLSPOSAL L TYPE OF MECKANWAL
E. p TYPE FFRAME lr-/ 40.lnyjf.Pao`ca.ann vwowW w9��a■
30❑_: hI"OLm W 35 Ga.
39❑ Oj 41 p.P*V1fi0epaewa',61o.1
31 Wood Yw+a 37 ❑ �Y .,. M 0 TM 4❑ No
32- Shcu*abs 3B,fl co.I ti TYPE WATER SUPPLY .Mle9rwPTr,awwrA-
39 Q ReNrnoad oPw.. .. .,2. Pmfe=Vm0*=wAwW 46 Ty, '4►13 No
J.DIMEmlow '
45 N"a10Cf a M: DEMOLITION OF STRUCTURES:
49. Tay Sa "a fbW area '
a:aowa oazea an ne a Has°Aw mw from Historical Commission been received
for any structure over fifty(5p)years? Yes_ No_
50. Taal Hoer area.sa IL
"W96ale Number
K NUMBER OF OFFBTRErt pApKING SFAOEB
51. Erebm ;PestC f�W:
5z a.mM. - AAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED?
L ernnpres ORu53. It
Yes No
®eCtric
Sf.;11u'laara na SaR�6r.
am�aee paw uV%AJ trflATION FOR THE ABOVE MUST BE ATTACHED
BEFORE A PERMIT CAN BE ISSUED.
N. COMPLETE,THE FOLLOWWG;
Hato--D•lsfrict't Yes_ NoV— (N Yes,please.enclose
AlOcumentation:lreurtdsL.cw .,..
Conservation Areas !'Yes.—
Has Fue Pleverhpon approved and stamped Plans or applicabphhsp yam_ ib
Is property lOwtedinbhe SRA district? Yes_ Np_r
CmPh with 2orAg? Yes__ No_ (If ft endose4IoaFd0t.Appea1 dam)
Is lot grandlathaW:;y" No_ (UM submh documeritatiarVif no,subrrM Board of Appeal derision)
Wriew corishcoori,.tws.theDaPer Routing Slip been enclosed? .Yew Np`,
Is Architec ual Aoceas Ord approval required? Yes_` ftZ (b yes,submit dohxrmenla6pm)
Massachusetts State Conhactor Licenses Salem Llcetae
Home tmprorerrient Contractors Homeowners;Exwo tDrM of appSable) Yes_ Np
TRUCTI0N.T0 BE.COMMENCED WITHIN SIX16)MOPIIM OF ISSUMCE OF BUILDING PERMrr
COMTRUC71ON IS TO BE COMPLETED BY: 8 an externion is necessary,please submR
in writing to'he�Pectcr'itY g`t ,
V. IDENTIFICATION• To be completed by all applicants
Nos
h. 'gemiea•Mnee;aver.W.amrr Wcaa TaNA
Like" :�
2
utdo
3 _ LiosarNa. .
AChaa W
6Pruer
I hereby cw*plat the Pro wericis of record and tlfal.4haveDeen
as his Bumoraed aoem ano we sidiamed by pre owner to make tkiaappicaborh
!Slgnawre of appkcam laws of phis'
I �
DO NOT WRITE BELOW THIS LINE
VL VALIDATION
9
Permit number �#qq ��
BukWQ
Permit ssued 18_
Permit Fee S Fro GiaQig
t.rrs�q
Cerdcate of Occupancy OCMPNIry load
Approved by
Drain Tie 3 �'�-_-�...��-��
_j
Plan Review Free S i
NOTES AND Dab•(For department use) I
PERMIT TO BE MAILED TO:
DATE MM ED:
Construction to be Started by. Canwleted by
VI ZONING PLAN EXAMINERS NOTES ,
DISTRICT
USE
FRONT YARD
SIDE YARD
SIDE YARD
REAR YARD
N07ES
SITE OR PLOT PLAN•Fa ApPlicattt
ON
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
6ALEM,MA 01970
TEL (978)745-9595 EXT. 380
FAX (078) 740-9846
STANLEY J. USOVICZ, JR.
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the provisions of MGL c 40,S34,I acknowledge that as a condition
of Building Permit# ,all debris resulting from the construction activity
governed by this Building Pemrit shall be disposed of in a properly licensed solid-waste
disposal facility, as defined by MGL c M S 150A
The debris will be disposed of at :�("L-z
cation of Ficilitf
G p salt ate
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
Name of Permit Applicant
Firm Name, if any
Ap
City&State
The above statute requires that debris from the demolition, renovation,rehab or other
alteration of building or structure be disposed in a properly-licensed solid-waste disposal
facility as defined by MGL ca S150A, and the building permits or licenses are to
indicate the location of the facility.