14 GARDNER ST - BUILDING INSPECTION (3) 4PbW1S11AbST9E f1Lf94jN0 APPROVED 9Y 774E
JNSPECMB PFJIDR TO A PERMIT BMG GRANTED
CITY' OF SALEM
N�
�c Ward
ZoNrq DlsMct
Ilhe „Nlstodc Dbtdct9 Yes No Location of/ (/
ft
COMOrw lan Ams? YM No
Permit to:
BUILDING PERMIT APPLICATION FOR:
(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 herby applies for a permit to build according,to the following
specfflcations: n
Owner's Name
Address & Phone S��sner fil �a P (9�B 1 7 SAY— /3 9
ArchkecVs Name
Address & Phone ( l
Mechanics Name
Address & Phone
WhM is tha pispme it b 1*1g?
Md WW of b~ n a dwaft for how many(amass?
Wa Wkkq cmkwn to law? Asbestos?
-conew T 0 V ' City LICWM M W&W UO N
Lie. f
r Signature Applicant
THE PENALTY,
OF PERJURY
DESCRI ON OF WORK TO BE DONE
MAIL PERMIT TO:
No' d� \v
APPLICATION FOR
PERI1/T TO
�prG" 5-n I/t / Ay
LOCATION
/1 64reAt,,-
PERMIT GRANTED
19
�OVfD
INSPECIrOR OF BUILDINGS
PUBLIC PROPERTY DEPARTMENT
2 12O WAsMuearcm STRsaT. aRo FL.00m
SAL IEW MA O1 S70
• TSL. (978)745-SUSS EXT.360
FAX (S79) 740.96"
STANLEY J. USOYKZ, JIL.
MAYOR
DISPOSAL OF DEBRE AFFIDAVIT
In=ads=with the provisions of M(B,c 40,S34,I aclmowledge that as a condition
of Bm7dinS Permit/ .all debris sesukmS from the co=&Qct m sft ty
governed by. this Building Pe®it shall be disposed of in a properly licensed solidrwwW
dtapoaal f mhW.as deAwd by WIL c nX SIX&
The delis will be disposed of atc7
7 na P
Location of Facility
9 b1 /0
SiPsftJV00fP4q0AWJicW Doe
May comfleft the fanowfus
(PLEASE PRWP CUWMy) meson
NamelofPeamrt AWHcw
Faro Nam%if may
Address.O dt State
The above statute requim that debris from the demolition,renovation,rehab or oche t,
aheration of building or stnecdae be disposed in a propaly-ucosed sov&wwe disposal
facility as defined by MM clM S 130A, and the building permits or licenses tie to
indicate the location of the facility.
CITY OF SALEm
BUIIAIIOG DEPARTMM
HO BOWNSRI (MiSEEXEmyTlON
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pen=(s)wim owns a pmral of WW m w'Lkh btAds reside a bueads w table.ep w+MA*A m is,a k
unaided w be.a one w two 5mt&mft&smdrd a dwdsd swetwa scc=m7 w weal m MOW
farm swwwm A pcnm who comavwa mm tiara ome Jmmc bi a two-year period*A sm be muddamd
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HOMEOWNER'S SJGNAT'URE
APPROVAL OF B1.JD.DJNG WSPECI OR
Sec otha side for=a code
HOMEOWNER'S EXEWI]MON
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cm*bom du p w4sions ci'this seedoa(S oks 1b9.1.�-1Jecettot d Coastractio n Eapea•riserd
provided that h a bomeosnmr cnMw p penao W for Um to do.suck wwsk.that such bo®eowaer d"sal
at arpcvLat' •
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supavbor. You may cart to amend and adopt raM a lmmAwdliadaa!sr tam In yaw coomml*