5 GREENWAY RD - BUILDING INSPECTION (2) 'PI*NSiMIIIST-SE44LIB#ND APPROVED BY T44E
ASPEMW PWR TD A PERMIT SWIG GRANTED
CITY OF SALEM f\�
No. I \ Dam v 1 \\
ri �c wand
_ Zoning District
Is Piopwty Located In Location of
VW Nlatoric DbMa? Ym No aaUldins
Is fiopeAy Located in `
Vu Coneenration Ann? Yes—No 41/
Permit to: BUILDING PERMIT APPLICATION FOR:
(Circle whichever apply) _-I roof, Install Siding, Construct Deck, Shed, Pool,
epam 9 , , 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 accordwig.to the following
specifications:
Owners Name
Address & Phone S xtr?
AfebiteAts-Name
Address & Phone ( )
Mechanics Name
Address & Phone ( )
WhO Is In pxpm it b N*W .ref i3F
MWIaI a blrlldrtg? i.I/oa) ft-'ea ajwxi� If a dws",for h=mrty famllm?
wo b A ft cmfonn to law? ye-f Aebegos?
F..smnw cost �o� City U MM« seta Uatw.«
J.O Baiiis Improvement
Lie. 9
Sign�f Applicant
SIGNED UNDER THE PENALTY,
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
��E'eoLWCC �aF/�/�'' J �2'i r-6'LEJ' /Gl'tu0ed
MAIL PERMIT TO: � ��'A k 0�
.t.
i
No. �� �- ��
APPLICATION FOR
PEI!FWr TO
LOCATION
PERMIT'GRANTED
L2l ���19✓1 19
APPROVFD
Win,,., v
INSPECTOR OF BUILDINGS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON VMM, aRD FLOOR
6ALa;M,MA 01970
TEL.(976)7454595 EXT. Soo
FAX (979) 740.96"
STANL.EY J. USOVIC7, JIL
MAYOR
DWOSAL OF DEBRIS AFFIDAVIT
In accordencc with the provisions of M(X c 40,S34,I aclmowlcdge that as a condition
of Building Pamit 0_ .all debris resulting from the commncb m achy
governed by this Building Permit sW be disposed of in a properly licemed solid-waate
disposal facift as deEued by MCIL c ll;,S130A.
The debris will be disposed of at
Locatie6 Of Faerlity
Slgoaeme o Permit Applicant Dam
FULLY complde the following information;
(PLEASE PRINT CLEARLY)
Name ofPemit Applicant
Firm Name,if slay
S• 6'�6•;Jor�9Y ��. �i9c.�m, �ir9 �r97D
Address,City do Sub
The above statute regwm that debris from the demolition,renovabOn,rehab or other
alteration of blaring or structure be disposed in a properly-licensed solid-wage disposal
facilitf as defined by MQ,cIQ S 1 BOA, and the building pants or Iicenap we to
indicate the location of the facility.
_ s
• W l a OF SALEM .
BLWING DEPARTMENT
HC1aOWNER UtENSE EXEMPTIOW
Pkne Pat
DA g L-F O y
JOBLOCATION S 6'•esEr�uiar ��, �/�« /1l lJ'920
HOMEOW M ,:�l
AUMM
Hol�aivl (97,f), 7 —,-7--7 5
TaEP111OW
pRfs�rMAa.>r►oADDRE�s •f'�� •
TVA eurnss.esaemptioi d-U=WwWf Wes emcaded to bwbW9 ewawa-+P+pkd dw6Niv 4TM
Uain a leis and to albw such Umeowoas to CWIX sa b&AdW,,las Wm wbo does ZN pees&
Name.provided the ie ew�er'aet d .
DEF24TMCFHCMEO NM
• Pcrsoo(s)wIq owm s parcel d Lad w wbkb behbe asides a brtads to tsskk.op wbk4 there k,R Y .
inmAw to b%a an a two Lam dwelgaL amdr d a deudwd moames wcc�y fo sub as w AOw
fum atr cwm A peuaa who murwo rust thm om bum b a tworyar paled sbas Wbe ooadidm d
a homeowaa. Suds-lwmeow•rd'shaIIsubn*to the Bmlditr{Offreb% baoapubia�
Bwldbt Official.that Uffla be ngcmbk ao all ands work pafeatoed
The to�dasiSnad`boareowad assurrrts responsibilfq lot eomplianes w the state B Coded '
otha appgcabk Sees by4iws,mks=d lcguLtkaL
Tat wWcm ud lwvm wnu-=rofms that Wan undastanda the aq of Salem Bdiiet Depntaaasd
mm muo irrsp=m p o=dmea and mgtmetacros and that blsbs wi l comply wilb acid pomdwa d
HONWVMER'S SIGNATURE Z����
APPROVAL Of BUIIDING WSPECTOR
Sec otka sdefot mu code
HOMEOWNER'S EXEMPTION
Tic cc*naves*w 007 bamwcxr=gttSwm,na for wrhhb a bona*p m*G tex1.1 "be
cm*bom the pruddoa otth4 seedon Omiton 31044-llocaslag of Csostuw d"Snpavbxt.
provided that b a kn mwma aKwga+!paw W for line io do.such wc*.tbS si 4l m n 'R a""left
MwW th
homww am who ma this cmmpdco we iorwate that they we�d w msyoedbMdm ad
superrrsot Get Appe°dh Q.Rules and Regubtloa far LiecnshrS Ceostrwetbs Soperviwts,See t
.1.2* Mds beak of swwcm a chn resulu in"Tim peobkms.pad="W"the honeosrna Mraa
uriliecmed peraosit In thb cuc yom Baud eatmot pioaod against the mW3ocmed pawa as it would veldt
ll=wcd Sopanisec. 7ba bomeowwa swing as apervMw r wNisale eestooshla. .
To ennoe that the hoeoeoanct b!oily aware of Wba respomibAkle4 uaaaq eom�des tuna:as past
of dfe pcumil apply dm that Ac bomeowna mnw tlm bLWA ar dumn ada the uespaosibulds da
anpetvbot Yoo may an to amend and adopt sues a*wmkwdfAW=for tat In yew eons.