24 CLIFTON AVE - BUILDING INSPECTION (7) Yr
fLW* MW-9EfILfeaf+ND NWROVED BY TW
JWPFCMFI PRIOR TD A ,PERMIT wNra GRANTED
CITY OF SALEM .
1 \ Data F 2
i"
Ward
Zoning Dlshlot
Is Properly Located in Loeatioa of fhe A
Histaft DWdd? Ym No &&'Mina 9 N 0,14,, Avp-
Is Property Locabd In
Tire CorneneLon Area? YM No -
Permit to: BUILDING PERMIT APPLICATION FOR:
(Circle whichever apply) Roof, Remof, Install Siding, Construct Deck, Shed, Pool,
Repair/Replace, Other au4- i n{erabr-
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS: '
The undersigned hereby applies for a permit to build accordliato the following
specifications:
Owner's Name VA
Address & Phone -1 mar /,.en& r sc(2M (Qm
Architect's Name
Address & Phone If
Mechanics Name
Address & Phone
What is the pmpm it buildW
WNW of bn~ n a dweWng,for how many famaea?
Wa tarl dkV cordon to law? Asbestos? l Lnt�n ,
E*naud cost 3 OO C� qty Licerw a slate llarw e
Bamma I�sarrataeat
Lie. !
re a Applirsnt
S E DER THE
OF PERJURY
DESCRIPTION OF "WORK TO BE DONE
Q u- Pf-Jf ri ofJ.
�r
MAIL PERMIT T0:
L
No.\\��
APPLICATION FOR
PERWT TO
PNeo �12�
LOCATION
A,9
PERMIT GRANTED
19
AP 061VFD
,t?&�6
INSPECTOR BUILDINGS
re
< PusuC PROPERTY DBPARTmENT
120 WAsHjmarON ST11EaT. 9RD FLOOR '
SAL KM.MA O1 S70
TIL. (979)745-moo MIT.3e0
FAX (9741) 740.98"
STANLEY J. USOVICZ, JIL
MAYOR
DISPOSAL OF DEBRb4 AFFIDAVIT
In accordance with the Piovisiom Of M(X c 40.S34.I acknowledge tut as a condition
of Building Permit 0 .all debris resulting from the constuctiam activity
by tl»s Building Permit shall be disposed of in a pmpa*licensed solid-wuW
disposal faciMyo as defined by MOL c 1Z Sl-e4&
The debris wM be disposed of at
Location of Fecility
Sigmtum of Permit Applicant Date
FULLY complete the following infonnatbon;
(PLEASE PRDFr CLEARLY)
Nam ofrenmApplicant
Firm Name,if smy
Address,City dt Stater:
The above statute mum tut debris from the demolition.remMon,rehab or otbw
alteration of building or strncdue be disposed in a properky-licensed soli&waste disposal
ficikity as defined by MCI cj% S150A. and the building permits or ikm =to
indicate the location of the facility.
e
CrrY OF SALEM
BUIIDING DEPARTMENT
HO)aOWNEIt LICENSE EMOMON
Hum PAN
DA72 ` rr nn
JOB LOCATM,- G It T+c3 n l ei
. HOIvlEOWI C C eJo ✓ kPvgu a
ADMM
'HO�IdEOWt� �1� ���1-`f - •5�7�.� �(�F�'-��( --R9�C�
TEIM%=
PRESENT IdAII.W.O ADORES! � C�o�in✓ R.1•e Yu ,-P .. ����YY1• .
The avro-.oamo=of'home WWf was aacaded a include enoer+pWWd.AwsmiO e[Tm
Unit cr Im and m allow emb boaevwaas a agiape an bdividW,*g bits who Goes aat pones A
lim=6 provided*at t a awou ed a$wpWvlmM
DEFIrDnWOFHOlvffiOWma
Pcnm(s)who owm a paced of IaM on WW&bckbe asides a bucnds a reside.oa wlddh Awe k ee Y
buaded a be,a one a two LmOp dwctlbi&amdad a dead"structma aoorsoeY a"A vs m4off
farm strttewm A penes wbo comvaea awee than=Iwme bt a twayear Pc&A*A aat be eamidaad
s boamwo : Se+cL`iwmeowad' shaUanbrtdt m the Building 08k3d. id
Bw'ldbt oftim .that bLWx be nsponable a aUdt so work pafaemee Pwmk
The wndenipr d Immtowne Mama as asparuibft for wmplit =Wuht a Sate Da08bt Code m d '
otha appSeabk`oes by-Lwa,rda aad nepubdom
The wA=igmd 9wotwwne=rdfm that hdit wAaum ds the Ciq of Salem Ba Wb6 D9wm ttt,
minitmoo bdpatim prop 4ma and agtmemems and that Nshc wig=qv Wt aid i d
HOMEOWNER'S SIGNATURE
APPROVAL OF B=ING �
Sec otha side for saa code
HOMEOWNER'S EXEmr-nON
The cods sates the 'wly humeowma p=fw=EmS wmlc for wbkb a buUMV yaNk IS I to
exetmip Lcm the prVVWCmt of tbb section ocnioa 70pjj-1Jeccsiag of Consanwilm Sepwvbn*-0
Aorided that b a Loweowna entsjes!pew G)for bbs to do.such�tht sites bomcowaa sbaD not
MwW bomwowrdo wbo an this cmmpdoo we mawate thss they us ssem bg the VOSOmsb0ldea OCA
supaviws Gm Appcodb Q.Rules sad Regub/ba for l iocssl g Coostrucdas Sopesvitoes.SaesR
• .L70} Tbds b►da of awa:crrcsf ohea tesaahs fin scrioas paobkmr.Pertkolat�vvi�1Ls boneoeraa lid
ucikcased peaomt bt this east yom Board catmol proceed aiairat 1bc mute easao papm Y wwl0 vdd
ikcased Super%isa. Tbc bomeowt cr acting as wpavbw b oMbaai .epaslYlL ,
To cnsave that the homeovrttcr is Falb tnratc of hUher tesponsiblBties,totoq oormam�det ttgiao;w past
of an ptmdl sppBodoq that the bomeowaer artily that balsin the aespcooibum"ds
supavbm Yoo may cut to amend amid adopt saeb s*rmkud iadm lot ma in Tom commYiy'.