16 HARDY ST - BUILDING INSPECTION (3) fL�M�6ilAtl6T�EfILf$�1ND APPROVED BY T44E
MSPFL'It1B PRIGR TD A.PERW ama GRANTED
CITY OF SALEM
Dau
Wad Imo_
Is Property LocatW In Location of
the Hhtoric Dbtftt?- Yes ✓No_ Doi2diog
Is Property Located In
the Cenalon Area? ym
Permit to: No
one
BUILDING PERMIT APPLICATION FOR:
(Circle whichever apply) Roof, Install Siding, Construct Deck, Shed, Pool,
Repair/Replace, Other:
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS: '
The undersigned hereby applies for a permit to build accorWg.to the following
specifications:
Owners Name
Address & Phone l 0-2) -7 N c r "
si�rcx.Cs�r
Architect's Name
Address & Phone
Mechanics Name
Address & Phone t
Whet is In FmPm is O m**? LA O CV-LJ-
mAWW of wow �k7 o cpa- I a dW$ft,for taw mmy lamaes? 1
Wa b kkq Qonforrn to law? �.f p,S Mb@dos? No
I Edkno W ooet� /Jno Clly LlcerMe a SO�eleL//kwrAe• I _
` ate 1Wq101trnt �JU L97 Qi/1. OMC�
Signature of ign Applicant
SIGNED UNDER THE PENALTY,
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
( (Yta n -S c�scL)
4-��
MAIL PERMIT TO: '��e
S mino V U01.03dSN1
04 O dV
at
IWO
031NVU911Wd3d
NOLLV00I
0113mu3d
&Kw NoLLvanddv
PUBLIC PROPERTY DEPARTMENT
120 WA5HI"aTON VMXWr, aRD FUWR
f sALiM.MA O 1970
T[L (979)745-MDd EXT.360
FAX (079) 740De46
STANL.EY J. UfOVICZ, .Nl.
MAYOR
DISPOSAL OF DEBRX AFFIDAVIT
In accordance with the provisions of MGL c 40,S34,I aclmowledge that as a condition
of Bmlding Permit d .aD debris resulting from the cmd ucdom,army
governed by this Building Permit shah be disposed of is a propaly Hceosed solid-waste .
disposal facility.as defied by MGL c HL S1SOA.
the debris wM be disposed of at c crt D-nF�r
location dfFaeiMy
Sigoatl m OfPamit Applicant Da
FULLY complete the JoUowinS
(PLEASE PRW CLEARLY) mtr»on.
-V�e-v Orvfll
Name ofPamitApplicant
Film Nsme,if arty
—L � c� rcLel
Addreas,City k Stste
The above ablate requires that debris from the demolition,renovation,mhsb or other
ahaation of building or sbuctlme be disposed in a properly-licmaed solid-waste disposal
5cifity as defined by MM cM S150A, and the building pamita or ikearaea are to
indicate the location of the facility.
CITY OF SALEM
BURDINGDEPART1v M
HOMEOWNER LI(MNSE E)MO'AON
plem Fda
DALE
105 LOCATIOlT
TE L PHOW
PRESENT 1MAll.WG ADDR>N! :::�—)Q rllY
Ike ea,a-camptsoa d'bomeowoere wu exwndcd w brhrde 4m r4pWrkd.4,wdfip slTW0
Lhdu a leo od a9 aAow sack bomcowsas b�sm bdfvid�d.ist bfa trko doe sot posses 1
unease,.p,ovtEed�rt�e,r.v".c+s.ursr,�iss� _ .
DEFADTION W HOIAOWII
• Pcrsoo G)srlq own•psrod d had oa wkkfi ke/sbc reside a bueads to tz:ldR op�dsas gL a Y
intended is be.a one a me fsadb dwcMr46 avadad a dcudred Murnae OCCCUM
1 wad iWft
fum taucnaa.A peaoa wbc wnstruets MOM Ib m eac home bt s twolm Paled sba
a bmacwaet Sails`wmcv%we shallsubu&to the Buildag OSCIAL ea a lbrsp ti"
Boi ft OffW4 that kels a bt mporw%k to sA wd►wok pafamW miler*A Wilding Pasta
The mrdcrigm d-bmmowne mama nspamtbMW fa compft=wlth*A Sutc Bdlft code d '
aLha eppvabk goes by-laws.roes ad tegubduL
The mrdasiped-bmwwnu-ardSa that Wft mWamr rAs the City of Salem Bolding Depoart
m muu b sp=d=prazdma aro rege mans and*0 hlsbs wM wmp19 Wi*said Pmc ms sag
rego mucla
HOMEOWNER'S SIGNATURE 0-1
APPROVAL OF BIWING DWECI'0!t
See otba side for sate code
HOMOWNER'S EXEMI-MON
Mm cods states tbsc 'any bomowim perfortahtg.rods for wrbicb s boiltt pemk ls Iml , dd M
cxcatpt ftm do pmvwm Cribb Occdost c5ectloo 7e�.7.a-13anato;.c Csmatrsaetbs a.�a v1asA;
pmvided do b a ho®eowrae cWja s pesos W for bbe to do.wcb wcdg.tbst MKS" F mom wac dHO M
MM bomeo• wo wire we this exemption We iaawwt to tbey we womlH*ae vesyonsm"m at& .
ruperim(am Appcods Q,Robn and Itesrlatba for Liocnstall Ceostswesbs Espea&*M See"
Tbb Le#of swammu m%m umdu in setias problems.pw'dc°1a wbca tbt boneowav bbw
ard�pcm m b t h can yow Bard cuaM proceed 95&tm the mt9oemea peps as It world w!�
1k cased Sopenieor. 71e bomcow scr wing as mpervb.w la sblt s1e�ses .
To easme that dw hannownet is totb aware d ldAsr aapoarl Mdf s-ttasq to=Mmmes nq&%.r psut
of sAe ptrmit applivdo4 that the bomcawssa COMI that bwa msdesands tba respoasbnmu ds
supetvbm You vM can to amend and adopt saelt a tnakerti}iatim i m tta Is yesar oonm®1�