13 GARDNER ST - BUILDING INSPECTION r/
"PLA SdWU T-BE ffL-E� APPROVED BY T*IE
UWS.PECTD-R ,PF1IOA TD A PERMIT BEING GRANTED
CITY OF SALEM
oxvrr a:
No\ �� ��u� Gc�:�` ..� �i�\ Date
Ward
>�j a
Zoning District
Is Property Located in Location of
the Historic District? Yes_No Building � � h p/S>�
Is Property Located in
the Conservation Area? Yes No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, eroof 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 A/e AltilL7kt W 1— 61 e K i !4c✓ l
Address & Phone J. N 2 U m c� R S
Architect's Name
Address & Phone N o ( )
Mechanics Name
Address & Phone ( )
What is the purpose of building?
Material of building? R a u F If a dwelling, for how many families? e�
Will building conform to law? Asbestos?
Estimated cost 1.��� City License# State License #
Home Improvement /f
' Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
R-P IRrir, 1F
MAIL PERMIT TO:
t.
APPLICATION FOR
PERMIT TO
kP,ro or z
—�—
LOCATION
l ) 17Sr9hP/ iL '
PERMIT GRA TED
L/ 6�l 19
APEYR�VFD
INSPECTO OF BUILDINGS
i
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
SALEM,MA O 1970
y TEL (976)745-9593 EXT.360
y FAX (976) 740-9646
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 Permit shall be disposed of in a properly licensed solid waste
disposal facility,as defined by MQ,c III,S 150A
The debris will be disposed of at: p N P
Location of Facility
Signature of Permit Applicant Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
/1�tiJNn7"h. c17 - .L e. IZ 1 a v
Name of Permit Applicant
N 0 �-/ P
Firm Name,if any
tgCZAR 6Nc3' P' ST A _M IAA .
Address,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 cIII, S 150A, and the building permits or licenses are to
indicate the location of the facility.
CITY OF SAIEM
BUILDING DEPARTMENT
HOMEOWNER LICENSE MMOTI01d
Pkatc Prig
DATE
IoeLOCATIOIi
AD>R
-HOIME0�1Ria g 2 y /
PRESENT MAILING ADDn>:ss ? '� ►� R I) N �'�� s . S!� �-r'lvc /n r1
• The caror cxempuo�of"hon�'�'was extcnded to b,elude oKocr�vie0 dwdYep dT9V0 '
Uaiu m kss and to atbw much boracaw+Kaa to engagc m individtt!1lba h6c,rbo goes as poaeat 1 .
OCCUR..F+vvidtd tm.*t owner set as wporrbar.
DEFIN1T p CW HOMEOWtWL to taside,a►ww&there k,ark
Pcnm(s)who awns a past of land on which bdshc asides m inu rdr MM to tycD taw ardlOr
intaAed to be,a one tc two famOY dwcMn&saached m dcudb, rwo od"am be waWattd
farm savcnaes.A pent who ennsu.0 moa than one hams in a two-ycsr paa
a homwwaa. Such 1=eoa'net" sha11 mubn*w the Building Offacitl,on a foam tea:ptsbk to tlra
Building Official.OW bclshe be nspombk to all muff work pafonscd WAU the building PUML
TM undasigmd`bomeowne aas�vm responstbtlrq for wmplvmcz w6tt tlae State Building Code tad
otha applicable goes by-lam,ruks and>eguls6 aL
The tmdenigned'hogwownte ard5a that hdshe rmdaaands the C*of S'm >DVWVNK
minimum bzpccd=pr=duas and regtmemcnts and that hlshe will wmPpl7�
rcqWmmcOL
HOfaOwNFR'S SIGNATURE
APPROVAL OF BVIIDING INSPECTOR
See otter sde for stem code
I �
HOMEOWNER'S EXEA'MON
The code states that: 'any homeowint performing work for which a building permit Is tequd sbal be
c..cempt from the prmisiom of ibis section (Scniou 10P.Ll-Umsiog of Comm"Supt
is rritor�
Provided that a honmewsta engages a person(s)for hire to do.such wcdt.tbot nwh bomwwma t3raD an
as sgffvi '
Mara bonwowmers who use this nampLkm are ivawaie that they an asstattfog*A"Vonsum"a[a
rupervitor(sa Appcodir Qr Rules and Regulations for Vesosing Coostruetioa SupervboM$eedast
Lin This lack of awaxaess olkn resohs in sctiom problems,par dco"wbta do bomwwna bbaa
unli= . persoac In this ease your Board cwvmt prooeed agairut iht wOceased petfom es k would wilt
liansed SupcnimF. Tbt bomeon•oer suing as superv4or b oldssat*resZroos�N,
To ensum that the homeowner Is fully aware of hi/ha respondbi8ties,=wW oommmdda ttgot as pat
of the permi4 applieadoq that the homemvner ccrdfy that he/she wWastanft the tesponsibilida ate
supervisor. You may art to anmW and adopt sudt a f Wccnif=tias jog me is your fir.