35 CROWDIS - BUILDING PERMIT APP MtJ T-BE f L-E9-A M APPROVED BY T*IE
WSP.E.GT.QR ,P1111DR TO A.PERMT.B,FWG GRANTED
CITY OF SALEM
No. Z.C"JS"-Zero(-1 hct�. '� �`�\ Date
sq
Is Property Located in Location of
the Historic District? Yes_No_ Building
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 21-�; G 9z C-4) p i S (9rN 7 7 Z ?40<11-
Architect's Name l 64Z :2:21±;2
r
Address & Phone L
Mechanics Name
Address & Phone ( )
What is the purpose of building?
Material of building? W o cr) 14 If a dwelling, for how many families?
WIII building conform to law? Asbestos?
Estimated cost !j00
co City License # N A State Lig nse #
�ODo ome Improvement
L #
s t-f Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DOME
>< z
MAIL PERMIT TO:
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No. 0S ZOO
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
AP OVfD
INSPECTOR OF BOIL INGS
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MORTGAGE INSPECTION
BAY STATE SURVEYING ASSOCIATES INC. JOB #
100 CUMMINAGnS CENTER, SUITE #316J, BEVERLY,MA., 01915
LOCATION :..SLED / '� NOTES:
f•••••••••••••••••a•••••••••••••• 1)This is a mortgage inspection survey and not an
I —,31_ 03 Instrument survey,therefore this plot plan is for
SCALE : 1" =4o DATE :3.7—............. mortgage inspection purposes only.It Is NOT to
be used to establish boundaries or for the
Q K', zz� . aP-T•49249 construction of any type of Improvements.
REFERENCE : 2)This survey is based on survey marks of others.
Q�TN„D)•STR CT 3)Bushes,shrubs,fences and tree lines do not
..... .......................
rr�S„•,•�(•OF,.g!JE ...••• necessarily indicate property lines.
4)Whenever an offset is 1'+-or less,an instrument
Gml}G MoR I Ca�� survey is recommended to determine property
TO: .......................................... .... .................................... lines,and any possible encroachments.
The location Of the building(s)as shown,either 5)Offsets shown are approximate,and are to he
complied with the local zoning setbacks at the time of used only for the determination of zoning, Not to
construction or is exempt from violation enforcement be used to establish property lines.
action under Mass.G.L.Title Vll Chapter 40A Section .
B)In my professional opinion the building(s)are not
located In the special flood hazard zone,as
defined by H.U.D.MAPff ZSO/D Z $'S gS
11 Z,06 ,
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4� I I O OO1 _ I IF THE SURVEYORS SEAL IS NOT
EMBOSSED,THE PLAN IS A COPS'
THAT SHOULD BE ASSUMED TO
CONTAIN UNAUTHORIZED ALTERATIONS.
THE CERTIFICATION CONTAINED ON
THIS DOCUMENT SHALL NOT APPLY
TO COPIES.