282 HIGHLAND AVE - BUILDING INSPECTION (3) JVon
PLANSIMTOE f7L194AD A4s4PROVED BY 774E
AMPMEIR PWR TO A_PERd11T BANG GRANTED
CITY OF SALEM
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Permit to: BUILDING PERMIT APPLICATION FOR:
(Circle whichever apply) Roof, Reroof, 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 accordwig.to the following
specifications:
Owner's Name U{t (f—( 6-4r\
Address & Phone V�
Architect's Name
Address & Phone
Mechanics Name
Address & Phone ( I
What Is to prpm of bW *jg?
mdWW of bWkNng? H a dwaft ,for how many f=Mm?
WIN bukkq COMM,, to law? Asbestos?
Ed nwM cost d — qty Ucw a Slap e
Hasa
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Signature of Applicant
SIGNED UNDER THE PENALTY'
OF PERJURY
DESCRIPTIO F WORK TO BE DONE
MAIL PERMIT T0:
i
APPLICATION FOR
PERIAI<T TO
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LOCATION
PERMIT GRANTED
19
APT GVFD
INSPECT BUILDINGS
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CITY OF SALEM
BUILDING DEPARTIAM
HCla0WNER LICENSE E)mvnoN
Plwe
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HOlrjE0W1� \\ e C� I�� P
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PRESENT IdAnZM ADDRE_ L <,
7bt Cwmpdoi d'tomeow me was, w bch&ew "r-oFm+p dwd4p @CTwo
tWo cc ksa and to allow sock bomcvwoas to cwv an bmgvw l for bin wkv doe am pow a
ikcme..pivvidrd thin t w ewer am as mpa vhW.
DEnNmomOFHOMEOW9=
Parson(s)w bo owns a pmxl of Lod on whkb Ldahe inside a k9ts&to teskkk OR whirs t o=k,er k
(marled w be,a one to twv k*db dwcMrj&a chW a dwdwd mucnve amesa7 tv me!tat WAA r
farm svvctio L A ptneu who eon mco mine tlan om tome in a twaycv PceAd"ambe tomidaad
a homwwmr Sv&`homeowner'shalJmtmdt to the Boi ft OftK m a tbrtp *4
Btu7dbg OW4 do bLWw be usporAk to ill=cb wak pafvrmod vide the bull pa ti mL
Ma tm knip ed obameownd'awwm respons%ft for=mpliw=wide tht Stitt BvW%Codead
other appSobk goes by4ov a,ndes and tatuindom
7be wA=ipad'hvmeowncr nabs=that he/she mdasun b the M of Sakaa Be Mg Depmrome•
n=mmn bnpecdm proccdme and etgemm m and that hhbe wm=Mpv write aid Poodmet d
req�
HOMEOWNFRT SIGNATURE
APPROVAL OF BlI11DING WSPECTOA
See wha side IN snte aside
HOMEOWNER'S EXEMPTION
The cods svtes tbse 'wW banwowna perfwmbS-k*for whkb a buD ft petmh is tsgsdted sbal to
C=MFe teem the peuddems mf Ibb sects m (Swl=DOF.U—.3Jcsmaimg of Commmilea Soperviawt
provided that is a lomwwsm cnpgo;pm=W for Abe to do.such wcdc,l sst aiteb bo®cowaer shall eat
Mara bomeowmns who we this oo mp Sm are imawan thm thry sn assmtrbtS the V90D lbMas GfG
snpavltmr(see Appendia Q,Ruks and Replallow for 3Jocmsing Cmmsuwedm SyerskaM SmC*u
3.3!} Tbts b a cf swarenom adka mdu in aeriow problems.pud mb*wLe°tAe boneowaer Mtaa
mml persem b»bts an yoga Bard a n of proomd apiam the muK.smeo perpa m itwonld wldl
Ikcased Sopanisor. Tbs bomeow mer acting su supervlwr r srMkaai treapwiN< .
To ensue thm the hosaeowna b gully swan of islllerrespoMMIties,=ww ootmam¢das ngw6%.as past
of am permii applimdm that the lwmeowner am*Om b&Ww msdarsanda d w;;=fait"do
smp w,plam Yost m9'an to amemd amd adopt aai*a kneed a Nicallm IN am io 7 m eom wmlW.
PUBLIC PROPERTY DEPARTMENT
120 WAsmima ON STREET, aRD FLDOR
SALKU.MA O1970
TEL.(976)745-9595 EXT,360
FAX (976) 740-98"
STANLEY J. USOVICZ, JIL
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the provisions of MGL c 40 S34,I acknowledge trot 9a a condition
of Bm7ding Permit S_ .aII debris resulting ficni&a conaucbm wb ty
governed by this Building Permit sbali be disposed of in a properly licensed goa&waate
dispOaal fiWI 4Y,as defiled by M( L c n%S130A. .,:
The debris w M be disposed of ak
Location of Fm-*
i ofPenait APPlicant —
Date
FULLY complete the following information;
(PLEASE PRW CLEARLY)
�
Name ofPe®itApp
Fhfm Name,if my
Address,City&Stater `J
The above Statute requires that debris from the demolition,renovation,rehab or other
alteration of building of ativcture be disposed in a properly-licensed solid-waste diWW
defined defi as
�+ byMQ,c III, S 1 BOA, and the building permit:or liceoaeS are to
indicate the location of the facility.