17 HARDY ST - BUILDING INSPECTION fL�M6�AtlSIr�EfKA94NiD AfPHOVEO BY T4IE
m pjX=PRIOR TDA.PERMIT BEING GRANTED
CITY OF SALEM / 1
Data
is ply 1pGWAd in Location of
na'- W 'c 015t1w Yw+No X aa1]dina 7 �7
Is P o wly Locew In
ow C nwason Mal YM No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
Ralw/Replace. Other.
PLEASE FILL OUT LEGIBLY i COMPLETELY TO AVOID DELAYS W PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the following
specillications:
Owner's Name
Address a Phone ' 0 + s, f 6Ig 1 e,-7-1 ' 2„
Architect's Name
Address 3 Phone S I
Mechanics Name
Address 6 Phone f I
MAW Is to PWPoM it bWI0Yg9
M"W a tlWld V? N a o+*0Q.for tow many Ismias4
will bL"V corllann to law? Asbestos?
Eallmmated poet g D City lica"e N A ahb oenM e
Rana Lwtooswant y I2—az-_
UUU l/ LIC. 0
Signature Of AppIICBfIC_
SKIWED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
a�H6�ar
MAIL PERMIT T0:
No.
APPLICATION FOR
PERYT TO
Co.uarzy� s.�/L/oa2 ba��-X,
LOCATION
/7 k�WW ST
PERMIT GRANTED
Zy, 200�
APPROVED
1 OR OF BU NGS
® CITY OF BALK NO MASSACNUSUTTS
• PUBLIC PROPERTY DEPARTMENT
120 WASHINOTON STnSST. 3na /Loon
SALSM. MASSACNNSSITS 01970
_. . . TiLiPNON[: e170-748-9eer$ In. 380
HOMEOWNER Man zxKMM0jq
piear$#tint.
Dew
Job Location ( 'I 4 A-e-q-( S�
�QirnarAddteu. s�,�.�
Ha"0" rTdglbM
Addroall 3Pc €:
Th0 .
dwdHnp w�•ati'Xcmaowa,,,r•,,,,a��iwclnd.o�L��
a�f hft Ufa ar laws and to allow for
in
aue� WSW an dlY3dnal
hive who does not poaaea a Neeoa,Peovidod that m»alpaeviaar
DEFwnc)N OB WNBR.
pawn(al w ho ova a paaoela[hmd on whkk M4arhe/ahr ee�ida ar interlda b
Mcl than ce wo b tot uch ro bed a arse a two fin*dw own edbcls� debohW .
stracturee accaaory to each aaa and/or St>a
than ana bona in a Ewe►year period ehaQ not onside rand bbomi nw�mare
"homeowner"shd submit to the Building Off$ i,ao a Lam Ming
Permit thit hdahe be responsible for ap such work Pwgxmed under the BuiilldenS
The aaderaigoW wnowIIe armies Debility for aomptimm with the State
Sm'lding Code and other applicable by6lM and may.
The uodernipw"homeown se catfies that WASBuilding Departanent minimum i the City 0f SW=
PrOcedurn and
will comply with said procedures and requireingib and that heJshe
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING INSPECTOR
Sea other side for stata Code
wtieh a Buildio�P�d is
_ PS*O- t� loo.l.l —Liema�f
MOW"D axamPt tO
Oawagonk Pdw AR°"'�°t�ome� a °�a�for 6�+
dbao �°� Houmvmw sba>i ad sr�°�'�• the
do W& ata wwwm that&SY=9 ,
Mha oia this f9d for I icambt
mdaus
otsots Ste' 11� t� otaM OMM OOM ra�ld is
IN � � bits a tir peeso°a. in this saw YOW
it a►a dd�t a lieaosd
thr ARaO� rloosbla�
Boa{d - Ttii antic acth>R�; �°ldO°'°�
HomeoMaa is fiilll►xa othialhsr 'lidaa' " cabti that
To a ya a otth�Paem>t �bA issue it s
heldM dw
Yoa aasr ea3s 00 yp°°d and dope
Locml` ..
r
� `I�Isaer
CITY OR SALUNg MASSACHUSxTTS
PUBLIC PROPtRTY 09PARTM04T
120 va"IM "ll 8"99T, 30o Fula*
S"EM. M"SM MUSaTM 0167O
Ttl4P11OMti s7&749-96/4 WM. 380
PAM 970-74O•0N4
Dre6ds Dlsuealr• per••••
Ia accordance with the PcOvisions of MGL c40 S A a condition of your
WdinS Permit is that the debris resulting from this wont sha11 be disposed
of in a properly licensed solid wasW�isposal faeollity as defined by M(3L
Chapter UL S 150 A.
Thqe/debris will be disposed of in:
{'v vrere/s D�
(i.ocadon of Facilrty)
- ZL C'
Sim of Applicant
/°a
Date