9 HARBOR VIEW TER - BUILDING INSPECTION -PIj%"S*MT'-111EfKA1114019 WFIOVE-0 By THE
A&Pjg=PRIOR TDA.PEBYIT AMG GRANTED
CITY OF_SALEM
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Is Prop"1ACMd In 14Catim of;/y�� � ✓P�
rf.twtorlc ofatdw r«NO aolidiaa �j
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is PMPWV Lacew h►
1 w Consanaaan Am? Yss--:..No_
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof. Reroof, Install SW1r% Construct Deck, Shed, Pool,
Repau/Replace. Other: h j2�f 9
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The urtdersig W hereby applies for a permit to build according to the following
Owner's Named E�
Address 6 Phone Cr 46'teia,L✓P,J 'j6-Kj�4cC_ f )
Architect's Name
Address 3 Phone
Mechanics Name�--2 a^j�
Address & Phone `(5, r)(72 F,)L -cj" 2-1/z
whm is to Pufposa of tarldrfp7 � 1 ��
MMM ol bAdkV? 1,Aj d,)t) r a dwaWfq,for now many lar dm?
wW b are cordarm to lat9 /"b
E,�a/WWAdd CM d Jj Cult U09nme r N A Scala-kf rw o
/)/Sc ice' Iararc° °tvia. i X y/ a 'JSipnature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
7AJ7441 ;?>4/ A P-,).)A,-f
MAIL PERMIT TO:J9 Wc,1,e1--)2 ��✓ i�a z�� S,LP,y v�� .
No.
APPLICATION FOR
PEROT TO
LOCATION
PERMIT GRANTED
�/Ve, i3 2.00
AP ROVED
OR OF EqLDINGS
CITY OR SALSM, MASSACHUSaTTS
PUSUC PROPURTY 0[PAJtTM[NT
laa w"MING1pM arNaa7. aso ROOM
ULtM. M"aACNUtaTM OIWO
TRL9P"Ghl t 970-748-6896 ttr. 380
PAM 879-74&04"
Dabrls Diaoesd Farm
In accordance with the provisions of MM C40 S A a condition ofy our
Buddies Permit i0 that the debds regldng from t M
his wont shall be
Of in a propedy licensed solid wastddiaposd facility as defined by MC3L
Chapter III S 150 A.
The debris will be disposed of hL
/7 ----
Si of Applicant
Data
774 Condnoawdd ojhtgdaehaseft
Deparbnent ofIndrts0d Anode"
"0 WashhtaToa Sbaet
Bosfonr MA 02111
tuwtttat�as�ott!dfi
Worker'Compemdon baarance A®daft ftSh lContradonMedrida w7lambers
AppHcMd
Name how
?E3T�� �eNi �Lc%2
Addsesa: (o
( ty/state/Zia u✓PR 1"Iu P><aee* �b' z 1/a
Am you asemChid thb tippropriate hour' Type at pretest(regdred)
a w 4. Q I am a gavel oe�tselor end I
1.�-1-sbs s employQ with I 6. [1 New oonoogion
®Bbyaa w and/or partner 0 b=bkod tY usbn
2.0 1 am a sole proprietor or planer Used on the sue"diem t 7.
abip Wad bowe m eaoployeea Them sob-aoadrado a bm L ❑Demolition
[No �. insuilm
comp. S. 0 Wwi �totppntiot: � 9. Building addition
} . „ oneers their
Zak 1&0 N.kottica rgWM or additions
3.0 I amsbomeownwAciogapwo>t ofGu� M t1.QPb®bio[repaes or additions
Comp
c.132,11(� _} "bsve'no 12 ltodrepairs
MYNKi�oeregoaat}�t: r . 13.E]oma
•,W .ppuuo *daedreoallmia•rofiIgR4!«dies.bdow o.degM*."e row�pe.�tlo.polie7mfbn�tbr
tt 00MIr"a*�ftdBdavkiedie�6idm xM�s•4•.•twealraj-4666o0•6etioe•ritodenUmit•erreIDd•vk mesa
tCumncM dot dwkAdsboe'=trdrL•d.eddtdo•etded.itowmam•M•etdreb`aaaaceneeeafeiewAw'peepvoeryio daa
few sir ewpbjotbet ft provllbeg x�erbtrt'tonepsersdea bssMnuaet fi►st/d at 1Tdote b dkpdkjWest fo!sGM
lefirwerlaa•
lnemaace compaYNamx /J�
Policy s or SelMa Ltc.lr�L12 l— �S 3 3 d�a -o/ Dane:
Attach s copy of the worker'compeseudeas policy dedarsdon page OWwlag tie poney number and expiration date}
Fsftc to sear-odvelag a r e q*W Wider Salton 25A of MGL c. 132 can lead b the imposki n ofcrhnmal penalties of s
Roe up to f 1,500.00 and/or one-year®ptiso®eal,a weB a clue penalties in the tbrm of s STOP WORK ORDER and s fbre
of up b i2S0.00 s dry aphnS tbe violator. Be advised that s copy of tbb statement msy be forwarded b the Office of
Imatignion of ibex DIA for fimwmw coverage verification.
IwIumby roe ell e�&IMMOMprov 16 endarr+ees
Z6
Ftiooe 1h. �,L 22u
Odkid am WA Do Mat wrAw Gr Alt warp to bt cowplsfd by effy or ow ojLM
City or Tows Fumdvucmde r
Inning AWdhorky(drde one):
1.Board of Health L Building Department 3.Chyfrows Clerk 4.Electrical inspector S.Plumbing Inspeetor
tC Other