268 LAFAYETTE ST - BUILDING INSPECTION (3) i
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(Laval "WeE Nti APPROVED 8Y 271E
MPS PWA TO A PEa ff BIKING GRANT D
CITY OF SALEM
ward
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h Propwty LoaMd In
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PennR to:: NG BUILD POW APPLICA7101 FOR:
(ChIB whk;hewr apply) Hoof. Ruoof. IneW S*la "&M Owl Shed, Pool.
RapaWReplaoe. Other.
PLEASE FE.L Off LEGMY•COYPLEMY TO AVOID DELAYS M PROCESprG
TO THE INSPECTOR OF BUILDINGS: '
The undersigned herby applies for a permit to bW id axor tto the.Wowing
Owners Name 1,y e e7 Iu r y
Address A Phone
Architeds Name
Address A Phone
Mechanics Name 6/,111a-e
Address A Phone _ L&aed ,era ( Fr/1 lit J"R ;' 0 9
Who Is ft pwposs of kdeq? a L�� f^r.2e. �
ltd"a tN11 W 4"; zp
oo -r N a dwaw g,for how many h n~
we bul ft aaronn b We
EaaMd Gat 1;�50ZD Cay ijb • 81Mo Lm ue• `7^l `�D
sume
e��7T \�U . Iafew�aet ,� l�fl
rs / Sigplihn of A~
U�TM PENALTY'
OF PWLRW
DE8CRIPi10N OF MOO\R TO BE DONE
�ZGe ��csO t Hi> �Ke� Eva ,e
L�sh�r l /0 e za
MAIL PERMIT TO:
CITY OP SAux
BIWING DEPARTMM
HOMEOWNER UCFNSE EXWn0N
Ph=PIN
DA a D
Hoio�
ADOMM
jf
Hon,¢aa�rmt 9�f1- ��s'- �•�-� z fog � <S9s������
TaEPHOrs
pp�Si:iTl'TtdAII.11?o ADDR»s /�- ���r°<C cS,�• '�-�, vx� ��
The l- -.CWMption Cif-fameewnc f Ww oncaded to brcfidc ewocwopmvkd dwgn6p efTNo
Ucin a less and es allow saeh homeawma to aVp o►bmBYWW,IKMMVM does sot poeses•
liocm�.provided that the ewsv set w su�ee.issa .
DEFRGTMNOFHONV.OWNM
Pcsoo(s)wbo owns a pares]of find an whkkb hchhc resides or baends b teslft op wW&tkess k or k .
buanded 10 be.s cm 10 two fim2y dweMag,susded or dcuded sa+ww"OOMMM710 vxb s susdht
fam stru wm A persam who eorsowm more them me lame In s two-ycw Period sbsl)sotbe c muMusd
a bomeowaer. such lmwuwmf shsff subrrdl to Ile Building 0ifidd.
Building OffaA do bLWw be aspormbk to sp so*wok pafersoed m
.71e wWcniped`noaeowne astt mcs respansbMW for compliora wkh lbt state BWM4 Carlo m d '
otha appliabk goes by-kws,ruks and segabduaL
Mw rmdvwpcd-homoowncr acrases*al Wft wAcumAst a City of Sak=Bu%ftDgwumt.
mb immo impwdi m proecdwa mid regmbtmtms and that blahs:will comply w m am pracedmei d
rsgrdr®esa
HOIMOWM'S SIGNATURE
APPROVAL OF BUILDING WSPEtTOR
Sec otha side for on code
lr
HOMEOWNER'S EXEMPTIONt
Tic code Lutes thaC 'arq honwowner paf=nkg%iv*fa wrhkh a bnBOv permit is tegs'n, sbf tie
c.=Mp ftm dw pro+ dc=of this sccdm (Sentoo 109Jd-1Jaasinj of Comanwd m Urn vbw
provided dw is a Lomcowma aK+fa!pc nmm(f)for hhs to do.nch w ok That rxD hoaaeowaa dmm tta
mow bv=W MU wb nu this Campo®are"wne that they we atu=bg tb m do
supervisor(sea Appeodh Q.Rnks aad ReplaTlom far limoslo=Comanwdom Supwvbossr Eecd.m
.2.24 lids Jack of vwarersest cheer nsWu la uTtrA prubksm.pw%;=b3V wbmthe honeoe—ldrW
urilkeraed pcaome in ibis mm yom Board eermot proceed spbal the wOccmed pe:pa n Itwoold wlda
licensed Sapenita 71e lomew,,,er salet as syperrlaK is etd..te�r respowbiL
To mint that the homeosrna It faV awne oP M%a responsibMdes,soarp eosommmOm ngsdra;m pasi
of de pcmdt spplicadost,Tint the homww•na cuffly tbt hLWw wrAern nds the TapOoshUMN a[t
mpavbr. You may can to arread and adopt raA s ftakcndlimdom dbs man io post oommmI*
Pusuc P1toFElrry DEFAsmseatT
120 V"SHINOTOM a MKW,aaD FLOOR
eALaM.MA O t&70
TEL(978)741E-MM Ea.a!O
FAX (o7e) 7404N"
STAMLWY-dam.YL%O"=JjL.- - —
Dl.%X) L OF DEBRIS AFFIDAVIT
In WOMAamoe with the provisioma of MOL c 40,S34.I wJmowWp dw d s con"m
of Bmift Permit d .all debris resuldno feom the c mehmdm wdvW
povemed by this Buff ft Permit dud be d q=W of in a properly Hcemaad sobid'wuft
deposal faaal*y.m ddbmsd by MGL c U L S1SOA.
The debris wM be dispwed oast oI.ocahom of Facl7ity �
St,BOa Pelt APP� Daft
FULL cc®plde the followinS iuhmatiom:
OU ASE PRINT CLEARLY)
'ramo ofPumit Ap &mt
Film Nam%if sue►
Addles.City A State
The above statute rogmm that debris fmm the demolition6 rmovabom,rehab or other
altaadon of bml ft or shuctum be
dlaposed in a properly-licensed solid-waste disposal
facility as defined by MM cIX S130A,and the building P�or 1ice�a am to
indtcate the locatk m of&a facraity.