21 CLIFTON AVE - BUILDING INSPECTION 14--A"S1IWT-0E fIL-E8 fJD APAPROVED BY T+IE
=PEXT.QA PWR TP A.PE. MIT.B,EING GRANTED
CITY OF SALEM
No. J `� 'L ��\ Date
Drys ' rl) Ward
Zoning District
Is Property Located In Location of
the Historic District? Yes_No_ Building per_—
Is Property Located in
the Conservation Area? Yes No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Sidin onstruct 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 /V24R12s-
Address & Phone
Architect's Name
Address & Phone 6 'RAwe/� [jar
�,%� ( , )
- yS��
Mechanics Name ✓ 1*,es
Address & Phone c /��lc�/ ✓ / i ') �o t� �$1�1J
What is the purpose of building?
Material of building? if a dwelling, for how many families?
Will building co forth to law? w i Asbestos?
Estimated c �$iG & City License x stat e n 6V
Home Improvement
U Lic_ i /a��/ �gnature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO:
No. Y )i
APPLICATION FOR
/ PERMIT TO
LOCATION
PERMIT GRANTED
1s
._.._ APP �D .
G
INSPECTOR F BUILDINGS
Q�
41
r
� �!I� M IIJl1
Y, CommOaUAfahk 4 .."fid
JJ.pad we 4JUMr of Aeeaad -
I'600 Ulas�iia�loc w76aal
Hama aGoad MaMAso 6 021/1
cenanesaar -
Workers' Compensation Insurance Affidayit
witb.a principal place of business at:
do hereby•centlfy under the pains and penihfes of perjury, thole
0 1 am an employer providbg workers' compensation coverage for my employees working ON
thhs job.
,i •
Insurance Company Policy Number
X1 am assole proprietor and have no one working far me 1n any capsdq►.
0 1 am a sole proprietor, general contractor or homeowner (circle one) and haw hind the
contractors listed below who-have the following workers' compensation poRtI
Contractor Insurance CompsWy/Policy Number
Contractor Insurance Company/Policy Number
Contractor Insurance Company/Policy Number
0 1 am a homeowner performing sal the work myself.
I rnowwow am a cosy of oi'o woes o wo be fon+acoed o on Of ict of MwdHooi.of Ow DU.for co.trato weAaudon sus Ow buss is Most
cowege at reaWto shoo Seeder SSA of MGL 152 can 4ad to of a aces d w W4 I.SCOM wUr w
yeses irawao.snrnt s vo o em denswo in the Iwo of a STOP WORK ORDER and s iho of 5100.00s any spina sse.
Sirned this , iJ%/i day of G
ceiFcrrnittec ouiiding Depanr ent
Lictrsin€ Eoare
Seiectmens Office
^e:lth Gepar-.mer'
- - -- - - - c _ - - - - - . =Q^ " - - ace ape _Ce 7-71
- 07e mod. �✓d�a�
S� Bard of MM"Regulation ud St..a..a.
HOME IMPROVEMENT COKWCTOR
ReplsN, 126801 -
Ei =7/21/2006
IYP ual Ik
JAMES M.BURI(E f
JAMES BURL
20 RIDGE ROAD �� r� x�i .id✓
WALPOLE,MA 0=1 ,sue
-!nry M
y1... n
TA-
too
OF BUIIWNa
I BOARD
CISTRUCTION SUPERS 'f
z s' OO8p 0
21426
;LAMES
iA
' 20 RIDGE 020 _ commbsi°"°r
WALPOLE,
f NOTES:
SHULTZ 1. This plan was prepared from record data on file at the City of
Salem, the Essex South Registry of Deeds, and a field instrument
r ,+t location survey by this office.
2. Assessors Designation: Map: 33; Parcel: 0702
55.0'
C O= 3. Zoning Designation: Residential One Family (R1)
EXISTING U
WOOD SHED 4. This plan was prepared to show a Proposed One Story Addition
to the rear of the subject dwelling.
+
5. Proposed Building Coverage: 26.5 %
A R E A < MOF
5,500 s.f.
FREDERICK
$ DEECHER
DEWSNAP
g No. 3031E
-----18-1,------ -----1--9-----
2 �,'PFcisr EO
0.0' s
w
J LIJ Op PROPOSED Op
Q O b ONE STORY^ O
r N ADDITION
'OLD PORCH " PROPOSED PLOT "
7.0 o PLAN of LAND
EXISTING �`^ O in
TWO STORY�OX `�- Z
WOODFR
DWELLING
S A L E M , M A
1 7 m
/ In SCALE: 1 " = 20' JULY 30, 2004
# 21 0
4-� 0] Prepared for:
m�1COVERED PORCH
�
55.0' O Mr. Michael E. ere N� �� 21 Clifton Avenue
Salem, MA 01970
C LI FTO N ( 50- WIDE ) AVENUE Prepared by:
DEWSNAP ENGINEERING ASSOCIATES LLP
178 LINCOLN AVENUE
SAUGUS, MA 01906
TEL.#: (781) 233 — 0595
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