38 HILLSIDE AVE - BUILDING INSPECTION (2) 1 �
y 1
ILllNSil H T13E fIL£9-iiIrN0 APPROVED BY T44E
.IAI;aP CT-R .PRMR TA A_PERMIT B,EW G GRANTED
CITY OF SALEM ` �\
No. � ll ;� �*
�, "b Date
Ward
Zoning District
Is Property Located in Location of
the Historic District? Yes Nov Building
Is Property Located in
the Conservation Area? Yes No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof,(" eroo , 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 according to the following
specifications:
Owner's Name � D S �D�
Address & Phone y/1LS/D
chitect's Name
Addres Phone I �
Mechanics Na e
Address & Phone If����
What Is the purpose of building? 4cs%DFxjGC
Material of building? It a dwelling, for how many families?
Will building conform to law? Yz_j Asbestos?
Estlmated cost City License N State License k
Borne Improvement �J. _
Lic. / GnWCfi+
Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO:
No.
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
/off 19
AP �O D
INSPECTOR OF BUILDINGS
A
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1a
I �
QTY OF SALEM
Bu=u%DEPARMAM
HONMOWNERUMSEVE&110N
Pinsc ptit � �
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,osi,ocATioH 3g �/•t�s��E- �E �c�/ /��.
1,OUEOWM
. ADDRF3}
TELEPHM
"XgWrMALWO ADDRESS—.: -
TAe CU"Td,mmptioti Of- mmrowwr was utnded to btclude owoct�cai W dwcl"v e[Tiwo
lhtln a hss and to allow snch DomeoMnna to cigaye an .�bite w�Lo don slat panes• .
liecme,.ptttvided thm tag*W1147 act ea wrendgF
DEFCafIMOFHOMEOWSM
Person(s)who owtu a ptaeel oT btad oa whld►hehbc resides m intends to tesidg,oe wttkh bt .
intended to be,a one to two!amt dwelt&amdted a dendted strttcttoes a�So" h eonsSdeted
farm wucwm A pcnm wbc consvuas ubcm than one htmtc ba a two-�a!rW a��to Das
a bovagu)ldbg f S"Wft be me �k IQ au suds wok po*cmed mda is g pa=L
Bwlding Oifuiat, b ,
The wtdasigned'hmneomta"assttnte tcspottstbilip 3m wmptimcc wifit m State Btt mg Cods od
rnha appgcabk goes by-brm.Met;=d ugulenottL
The ta,dt ,,pled-ttooteow'ad"teydSet ttw hdshe mdaststds the Cro of S•kf°BOft DepmmM.
minimtsa inspatitrn prazd>ms and
tt:gtwcmcros and that hhim vq=MVV wi dt staid p=dma ad,
nqwmmaa
HOMEOWNER'S SIGNATURE
APPROVAL OF B=DdG WSMCTOR
Stee other sidt fm state code
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