24 CLIFTON AVE - BUILDING INSPECTION (8) gPL*NS1*VST'9EfR&04A9 APPROYEO BY 774E
ASPECM PWR TD A PERMIT BFJNG GRANTkD
CITY OF_SALEM
No. \ Dab
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Is PmpeAy Locaw In / Iaeation of
ma Hl mft oktrlcl? Yes No ✓/ building 2 �
fM Cwmmtlon Arm? Yu—No V
Permit to:
BUILDING PERMIT APPLICATION FOR:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
, 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 aocorcLig•to the following
specifications:
Owner's Name
Address S Phone 7 Certnr A tenAu 3 Scz�gm R-W) -744 577�
Architect's Name U/A
Address 6 Phone f
Mechanics Name Lc _ icu,n �falh & Rurn�ng £55ex Gil,. Cry �
Address & Phone f
What Is Nw purpon of t~ r e
Malerlal of buNdrp? Iom:n ra N a dwW",for raw mmy famaaa?
WNI t>trk"conform to law? Aabeaos? V�c,
Edm\�eeW cold $40,000 cuy um"x swo um"N
17 � �6 b®a Ieprova t
Lie. I
S-Is Of Applicant
ED THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
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MAIL PERMIT TO: A i Jta d CAI n t;a4 r C?a rk y- ,
� m f� on to
t
No.
APPLICATION FOR
PEROT TO
LOCATION
PERMIT GRANTED ��
99
AP ovfD
INSPECT INSPECTOKOF BUILDINGS ;
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CrrY OF SALEM
BUII ING DEPARTMENT
HOMEOWNER LICENSEE AON
Pkase PAN
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]kcxn prwidcd tbathe omm add ogervism
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s bomwowma. Sad►`lwmeow•a f shaft m*mjt m the Bu0dim{OlTxK m a aama �� to M
Bttiklbs Odseial.ilnt bclsiw be respansbk to aD sncb work pafaraed aada tba bofld5per� .
The wxknipwd'bvmww=r artmws responri%0lW for compftm wkh the State BA ft Code Md
other appbobk pa br-brws,rnka sod tt=ubd=L
The mi&Mpwd'Aoa�ardLa that wft the aw of Salem Salldimg Dgwomnd
rmiaimmm mspccuc m pmccdsres and req ' and that blslw wal�wM toil pmaedme tad
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HobMOWKML*S SIGNAom-7RW
APPROVAL OF BUILDING DNIMMOR
Sm otter sadc for sera code
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HOTWEOWNERr3 EXEMP'I'IONI
Mgt cc&sutcs thw •wT hcvxowna perfarr&.iv*for ahieb s buDdbq p umk is regdred SW be
exempt from the pta+9stons oft &seedan ( COWD lfi?JJ 7.t IJCCostod d Canmraetiws:sape Am*•
provided to is s hemeawna cWgm s pcnm(si fat Idm to do.sach wcdr.this Itch hmmsowzm dwN at
.Ilvparj/aa' .
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sapuviwt(Ice Approdh Q,Roles end Replatiom for Lkcosio,g CaosriveISM EaperdWM Escdm
• .Z3'J} Ibis htt#of svnterws adlat mstdts 61 series problems,p�eols�'w�a de batneowsst buts '
anikcmed pcnom In this ease yew Bard c mot proceed spto dts to�9ocmee petpn m k world Ift
ikased Sapwdow. 7bs boom wcr saint as wpavbw Y_hi mase1F*esjowalL .
To rsam that rho hcmwwn alsfiftmmctU%ampandbOdMvmqcommwManqftnpa
of ds prrWI spplkadm that tls Iameowaw cc"*thn b&Wa m dersmds tha nspmsbuldq do
supavLor. Yoo msry care to artsad and adopt rates s forat/oertilitatios!ts tss is your eommatd�
PUauC PROPERTY DEPARTMENT
12O WASHlN6TON 5MKWr, aRD FLOOR
SAL[N.MA 01870
TEL (279)7454MOG EAT. 360
FAX (076) 740.96"
STANLEY J. l)SOVKZ. JR.,
MAYOR
DISPOSAL OF DEBRZ AFFIDAVIT
In accordance with the proviaiom of MGL c 40,04,1 wbwwledge that as a 000diticn
of Bmlding Permit 0 .aIl debris remdtmg Rom the m acpygy
govaned by this Bu&ft Permit shall be disposed of in A properly ficausad soH&wasts
disposal facility,,ss degwW by MC c 1q S150A.
Mw debris will be disposed of at 2 �f l',Ir`Almon AMU' g ,SdIQm
Location ofFacfty I
Si p _ 2�
APPh ate
bkmndM-
(PLEASE PRtRr CLEARLY
Name ofPc mit Appheaot
Firm Name,if any
-7 Qv- h g- v-Q Sa pm
;aj—k a City&Sterne
The above statute requires that debris from the demolition, renovation,rehab or other
alteration of bluldiag or sbtucdrre be disposed in a properly-licemed SOH&waste disposal
5cifity as defined by MGL cIII, S130A, and the building permits or licaysa are to
indicate the location of the facility.
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