15 LAFAYETTE PL - BUILDING INSPECTION µ
pL."*6*Wjr,0Ef*fig4ND APPROVED BY T44E
m6p -CIOB POM TDA.PEBWT APING GRANTED
CITY OF_SALEM
No. oao fla�°l, zc�
if
IS Properly Located in Location OE
the Wdodo DWdw Yu No✓ s mi ld ns
Is Pm"dY Located inS��cm., mA0197o
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BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) cf.-Remo ._Install Siding, Construct Deck, Shed, Pool,
RepaidReplace, on
�
PLEASE FILL OUT LEGIBLY A COMPLETELY TO AVOID DELAYS W PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The underaigned hereby applies for a permit to build according to the following
specifications:
Owner's Name (J'�\\�a�- S lt-n N
Address & Phone ,13 R04C �� (�') SW'-5�2� (rah
Architect's Name yfl f�
Address & Phone . L
Mechanics Name
Address & Phone kk L 1
What Is#0 PWPOW ar txYl W E'nn C'AC'Lcti acc R Gi\ VPy —
M"W or bull WV? 1 kn�ncr o nN a dwWq,for how RWY Iami W?
WN kdd m eordorm to law? res MDasaa7 n o
EA.M.9 /, � � CRY um"r N A Slate um"#
Rome Lwammant
Li`. i I ' Signature Of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO: 1 S M✓j- 01970
No.
APPLICATION FOR
PERMIT TO
LOCATION.
PERMIT GRANTED
AP�P OVfD
OR OF WILDINGS
r
CITY OF SAL6149 MASSACHUSUTTS
• PUBLIC PROPERTY DEPARTMENT
120 WASNINOTON STNt[T. 3no FLOOR
SALEM. MASSACNVSSTra 01970
TELEPHONE: 978.745-9393 IUA 380- .—
FAX: 979-740.904e
HOMEOWNER I•IfEMSE EXEMPTION
Phan Print
Job Location 1S R-Lc, . rn,0, oka-70
Haan QWIW Addr M. err.c
HMO*"WTalapheelt 7R^-7H -S72Z �7 Stx�-�sz� cz11
Pne+ant Msi6x AddrosaGr�e
The corneas earempdos at'�iomeowner�'wM,extra"' to igcluds ownar.occupied
dwellings of two Unitr Of hlsa and to allow swk
am"se.individtull for
hire who does not pooeaa a HCO113%Provided that the owne�
as supervow.
DEFINITION OF.HO11 WWNEB,:
PersonGl who oFw a parcel-of land oB which hehbs ra was or intends to reakk on
which thane 14 or is Well"to be,a oai or two family dwelling attchod or detached
structures accessory to such use and/or Berm StrucgM A peraaa who more
than one home in a two year Period shsl not be considered a homeowner So*
O®cige"�submit to the Building O�si,on a form acceptable to the Building
Permit. be
responsible for all such wort performed under the Building
The undersigned"homeowner"assumes responsibility for wmpH with the State
Building Cade and other applicable by and rcg Wons.
The undaWVW"homeowner'certifies that he/she understands the City of Salem
Building Departmsemt minimum inspection procedures and requirement and that he/she
will co mply with said procedures and
//re t,
/lquiremen
HOMEOWNERS SIGNATURE O& — - 1�—�
APPROVAL OF BUILDING INSPECTOR
See other side for state code
P.
O��AOiNttll�
paa..
woek fas which a Building petn is
The Code state dt� "Any from the�s•puformingseation(Sactian 1p9.1.1`,�to
shall be k P�o'ndod�t a N�owna`mgag� Pam
dsnd dhat such Ho�wO°a s ad ss SupaM •
as unawssa that they aee aw�a�the
M eoamn arho use due eat, %*aea and Re�uWIcas Iscao
lmnpiauvh"°fgypenriea 'eo`up Section Z.t b ofunico eadP In�this urious
whoa the H0m°D�
ptobla .P� udlcaued Off"'a�it would b
cemtd P! 0°d . is
'The Home°"�na actors as is d�--V,
race of hislhar �°y that
CUUM that the Homoowaw is T�eow�cc".
Tcomnt�oe ae4.m 8a a P�of the.paamit APp i �last Page of this iWIe is a
d6�of a Supahsa
hot" by seveeel torn YOU niaY Ca'e to amaad a s
fotml use in yoW coattY•,
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RAJO
CITY OF SALXmq MASSACHUSSTTs
PUBLIC PROPURTY 06PARTMENT
120 WASHINOTOM STIISST, 3110 PL as
SALSM, MASSACHUSUM 01570
TNLtPMONti 074-7/5-989S C". 300
PAX3 S76•74I0•Ssds
Salem pagans De++arbowd
Debdt Disootal Fer1n
in a=rdance with the provision of MGL c4O S 54. a condition of your
Building Permit is that the debris resulting from this work shall be disposed
of in a properly licensed solid wastedispossl facility as defined by M43L
Chapter III.S 150 A.
The debris wiU be disposed of in:
(Location of Facility) Kq /1
myoSo���-, �111
Signature of Applicant
Date