19 JUNIPER AVE - BUILDING INSPECTION pL.AMMWT..9E f4Lg94019 ,APPROVED BY T44E
=p.FC=PAIOR TDA.PERAUff A91NG GRANTED
CITY OF SALEM
No.
s:
is Property Located in Location of
tlw Hlatorb Dw id? Yw NO_ Building
is Prop"t ocam in
Ora Cornervadon Am? Yw No
BWLDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
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
cell ,si - 3k7 - s�Fry
Address & Phone �9 �u may✓ -_ 1 $1 Sa S-o 123
Architect's Name
Address & Phone ( 1
schanics Name
Address & Phone �v �c PAI� (6 i 71 `E-7 Q- 509/
Who is Rr purpoaa of
MOW of Widirip? \1)u CA B a owe",for row many fambas?
WN Wkkg oodomi to law?—*___ ? r 0
EaWraM ooJ °a 0 CRY Lkarra r N A stew a NPr
Lit. f Sign ure o 'cant
S ED UNDER THE PENALTY
PERJURY
DESCRIPTION OF WORK TO BE DONE
o c
MAILPERMITTO: )dI' -'
No. /
APPLICATION FOR
PERWr TO
LOCATION
a
PERMIT GRANTED
y 2.0 o 6
APP 0
VFD
I�IAIQTOR OF B NGS
CITY OR SALUNg MASSACHUSMTTS
P%JBUC PRCPXRTY OtPARTMiNT
110 %V"b@IM4"I$ STOtR. 3AO P1Aoos
SALA M, 14ASSACHUSCM 01970
Ta"P"CN/t 07&749-9696 UT. 300
FAX: /78•740•!Na
3alen,81Ld�n* nt
Debris Dls w�� p•••m
Es accordance with the provision of MCrL cop 3 54, a condition of your
HuildinS Permit is that the debris resulting from this work shall be disposed
Of apter 130p �licensed solid wasteidisposal facility as defined by MGL
A.
Mw debris will be disposed of in:
(Locadou of Facility)
o4f4ApvHcant
i
Date
CITY OR 9ALEMg, MASSACNYSETT!
PUBLIC PROPERTY DEPARTMENT
120 WASNINOTON STR[R ano FLOOD
SALam. MASSACMUS" 01970
T[LEPNONa: 978.745-9595 Gn. 980...__ ._I FAX. 975-740.9846
HOMEOwm I• msz EXEMPTION
Plem Print.
Daea 6
Job I.acation /1 �l U A.
Homt QMner Addrm.
Ham!Owner TelephW 5 7 s x as P o• a 3
Pteteot Ms�Addtesa lw ,. 1 �„� .
Th0 current at"Jicmeownera"was mden ed to include ownw-occupied
hue who does not a lee and to allmv aa4 m�a pn iadjvidual for
P�a provided that: es star
DEFJJ IMJDN IM H011QBOWm: M'
Person(51 who owns a pared of land oe<which]Wdm nodes or intends to node` on
which there*err is intended to bet a ont♦or two family dwelling/attached or detached
structures accessory to such use and/or firm etruehm. A pecan who more
than one home in a two year period shall riot be considered a homeowner. sub ,shall submit to the Building OfilciA on a form
O®cial. "he/she be responsible f�all such worst ale to the Building
Permit. performed under the Building
The undersigned"homeowner"assumes responsibility for compliance with the State
Building Code and other applicable by-htws and regulations
BaWPW"homeOwme certifies that he/she understands the City of Salem
g Department minimum inspection pros and
will comply with said procedure u and that he/she
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING IN ECT
See other side for state code
Y
f ti
which a ButWmt Pa[ID�is
e�a state that "My H S wadc(won 109.1.1Tt
-Licensini
t�abanfto a a)
fot bits to
Swank Provided tit s Homaoaoa mid
Of and*A wc14 i s .
by
we unaware��am dw
ims
Many Hmww�who um this ext o di Q,RWO and Re�OOi far I &wrio
litles of a Supa�(we h&Of aanawa ofim comb
in:a�
Cow Ste,Seettos hues unlieaoaad Pafm& 1n this cane your
Patticvl�Y wd dw c°�pOW'ar it world �
SnPavie°6 TBoard � °°°°v°° act 8!' sor
was is &ft awas of bisAW bi dcs.many that
To ensiue that the as a�of the 1'a�mit App> t �a�0NV dye is a
ul""
aomm `tie of a SupaM suh s
the and
wv"towns. You may
belabe undsc: ! h cae oo amend adopt
form .
used b7!.R
fotm/c ��c»i°m your c�tY
dAO 6I I sao