15 GREENWAY - BUILDING INSPECTION iM.tMN6*WT'SE'FILM94AD APPROVffl 9V 744E
ASPECTAA PWR TD A PERMW RMG GRANTED
CITY OF_SALEM
No � \ Dab
• i .
Werd
Zoning Distriet
Is Prop"Locom In Location of
RN Aistmic District? Yes No ba"Iaa lS GKEEN w Ati`
Is Property Locdsd In
UN Cormarmbon Area? Yolk—_No �
Permit to:
BUILDING PERMIT APPLICATION FOR:
(Circle whichever apply)Install Siding, Construct Deck, Shed, Pool,
Repair/Repla . Other: C�,Ib t 4)Ez s -f �(o o per ov G
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS: '.
The undersigned hereby applies for a permit to build acconLig,to the following
specifications:
Owner's Name f ,URTis bi f4crg,
Address & Phone lS C 2FEN w AY k�6fl b (9 1 7YY S8%Z
Architect's Name
Address & Phone ( 1
Mechanics Name
Address & Phone 1�F What lstfrePrepoeectpldldirrg? CPLPrCC- C49fouETS 4mo -S(NK i4yD 610"e¢a61-_ pry.
Material of fig? WOOD R a dweb .for tow n my fsmaes?
Wa t>t,UN mft m to law? YES Mbeetos? N
Edmst d cat 13 a d c) Clly Limea 0 0
Baran Lrprowsommt
Ue. /
S' ature of Kant
ED UNDER THE PENALTY'
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
ICCH0VE do 0 OAK CA81x16-TS /97/D ,eF�GACC W /TN ,(�Ecv.
ADI> DrsHc0A5HrR A"P 6A'e131q6E blsposAca /yap i3115C
CA&( PE'7S To EciNE �Z sIAE of s7aVC' -r- -
MAUL PERMIT TO: Gu2TIs 1J H t Tc'
is 6ReC1VV✓RY R�
SAi— r A
l519 > �
No `
APPLICATION FOR
PERMMT TO
LOCATION
PERMIT GRANTED
19
APP7fD
INSPECTOR BUILDINGS
PUSUC PROPERTY DEPARTMENT
120 WASHINGTON STREET, SRO FLOOR
SALEN.MA 01 S70
TEL (979)745-9335 ExT.360
FAX (978) 740-9846
STANLEY J. USOVIC:r JR.
MAYOR .
DISPOSAL OF DEBRZ AFFIDAVIT
In aecor&wc with the provisions of MG'L c 40,S34.I aclmowledge that as a caption
Of Bmlft Pamit 0_ .in debris muff ng fmm the cmftuctcm wbvxty
govaned by this Building Pamit shall be disposed of in a properly licensed aOlid-waste
disposal Awift as deRoed by MOL c IM Gl5a&
The debris wiU be disposed Of st T(ZA sv( c;46,N E?- S
Locadon of Faefty
ZO Z oo`/
r of . Applicant
Pine
(PLEASE PRIM CLEARLY) .
�V(LTIS W6'llT �=
Nave ofPan t Apphcaot
Film Name,if say
lS � 2GEMwA ( (�D SAL_r rlf� OAF ? c�
Address,City dt State
The above statute requires that debris from the demolition.remvsbM rehab or other
ahaadon of banding or Mwtm W disposed in a properly-licensed solid-waste disposal
facility as defined by MU cIII,S I50A, and the building pamits or licenses into
indtcafe the location of the Lcifity.
CITY OF SALEM
BUUMINGDEPART1v M
HOMEOWN LICENSE E MOMON
Phan Pdn
DAU LL 'D 2O0Y
)MIOCAT10N
. , NOiv�O'iPt� IS' Cyr e�cu�Y fop O
ADIb7 MP
TE3 EMM
PRE.SE•NT MAII.D�iG ADDRE3f /S CJ�t EN c�lh Y .� � �W y,���. •
• The CYInOm.Catap�a d-bomeownett'wsa aacadee tD bichide e,roetwpid ^^�.�T�
UWu w iea and to aibw aaeb b mmmum 10 vWp OI bidiridgi lae bhg who dae am powm a
lieama..Fwided dm ie wowed as wrervism
DEFOCTMCFHOMEOWHM
• Pcrsao(�)wbo owner�pool d bud w wbbj►bchbe aside a Luetda to teab'Js.m�& ftoo� ft
buoded to be.m Doer a two m dweMaL aaadud m&ad"tta►teaars� SO be t
farm rwwwm A pen=wbo wrav eu nose 4m�me bome k a twolm periodaw
a bomwwaa. Suds-iwmw%=f ehaIIsubndt to ties BuDdimb Olt+dd.�w� fs
Buildbg Odie4 that behhe bt nsponAk so aD mch wok pafatoad
The mdasipad`homownd au m u tespota%Mv for=Tft a with ft State Baft Code tat
otba appBobk foes by-hmP4 nin ad tegobdom
The mdasipad-homwwnd"ozrtiLe tlet Wft svdasu &Ox CiW of Salem DWI&g Dgwand.
minimtam iropatioa proccdme atd aq ' tbas blalx"triah umpiooedioa atd
HOMEOWNER'S SIGNATURE I
APPROVAL OF BMDING UMPECTOIt
Sec other sdc fm=a code
HOMEOWNER'S EXEmr-nO-N
The code sous*at 'wiy lwmeownu performb4-,ko*fa wbkb a boD tbti permb is ttIabed aba/M
cxemp from the pruvWors cl d&secdor(Samar 363.iS-13eesslrg d Cemnwdom SrpuAswil
provided tbtt is a 3omewrrta cilia�persco W for hba to do.str:b woelr.lbrt sire3 bo®eowaer tiny in
a svpavLa�' •
fAIMbo=WWACUwbo=9 Itch oaMPdoo arc mswme 1&d tbey We aamadnS the PSOM t Md"do
supavbw(sm Appcodbt Q,Rub and 7teSutstbis for Vussting Gooenwdem Erptss**M Eaedaa
,1.)0} 7Ws U&of swwcnen afkanROM In acrious problems,patkolar� W tteo llooeocvM M S
unitecmed rjwm In this case yom Bard c I I ptooesd apbt tba millamed perwa n llw0 w!d
Iletww Sopenisa. 7%q bome"r sdtas of apervbs r rMfaNe�!e�or#Ma. .
To comn dm the twmeewuu is fully aware d hllb•responcibM*%6 rostp oomsr�Qda a pm
of the peradl appltodo4 that the basownu ccrdly am bgww tmdasands do respousbbulds eta
supavbm You ary ors to amcod mad adopt sa&s form k crM=dm ib as io 7m eom®rdIW-
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