44 LARCHMONT RD - BUILDING INSPECTION (2) irL201161A11WOR VIANwOM APPWVGD eY US
CITY OF SALEM
�� �� �, s 2woit
we
onmdol c 01�b1o17� YM Ne� 1a17/!aa lo� �f�/ � �k ✓C�/ �R�7�K�
Y Plgw1w Lomm In
: In Comwvalon ANO Yee_No
Pennk to.
BU LDMIIi PIMW APPIJCA M POI%
_ Wft
�1
(CMole Miiolwver apply) RoofRrp@WR*Ra phphm Olhar C.h � Pool.
v�>4 P � P�
PLEASE ML OUT LWMY i COMPLETELY TO AVOW DELAYS 0 PROO 11
TO THE INSPECTOR OF WJ LOINOS: '
The i he eby 4pDws for a pwmk to bukd a000rdiog to ft lallow4p
01~4Nallla
A*ftn A Phorw N Y Gz? c R 7(r1 7 q�;- - •4 S-7S
AmhkWs Nuns
Address a Phone j
Meohsnb Nanw
Address A Phew ( 1
w o ibis prpoM a NNW . (o I= e'si afc
kWWA d M~ W 0V J Pr4Ake I a dnbl& how m"---
wN boom mdam to W? e-s �� U
Edrium=d Z Ooo qy Ul r OAb UN M r
ftm
INK SWahn of A~
S IN in Pa"TY,
OF PORAW
DUC PrloN/OF WON(TO U om /
-P,:�oY
MAIL PERMIT �i��
\� r N -'
•� "
• }...
.'ih4".,
..;ill • ..
1 �
0
;;.
F
4 (r
L �.
�� . � �
t
ruouc rm0rxNF l DCFAltrm IT
LIM 120 VW MINWM &Mffl T,aam FLoo11
SAL K MA Of*70
TaL (978)749-MOB Ur.soo
FAX (W78) 740410"
STANLa YM J.
Lftov=Z. .I'' - ----- — ---
UMAL Od+DF.Bltl$AFFIDAVIT
la wmdmm with the poviaioma of UM c 4%S34 I aclmowWp dw r a ooOM=
dBmlft Permit t -A debda n=WmS ibm the comabocdom&Wft
JDwamd by d& Pmmat"be dLpoaed otin a pvp*Bcowd aolfgwaay
d Pod tim ty,u detlmsd by UM a A SISOA.
The dabda wM be dLgwnd atat:
Locadm otFoa ft
a >moo
ofPe>mitAPPli M
FULLY ca®ph to the tbamint mfomaW=
OLBASE PRW CLEAMT)
dame atPamit ApPHoW
Phm Now.if=W
Addlar,city&state
The above atadlte tegoim that debris fiom the demoNdM mmavadM rehab or other
akaadom otbml ft or ebucon be d gwnd in a poperly_mco=W solid- Um
aqxw
Aw ty 0 ddbW by UGL ciQ S130k and the bulldiot pamift or He m m m to
is cd6 the bead=of the Leahy.
bia J OF S/'l{.EM
BUII DING DEPARTMM
H0vME0WNEA LICENSE EXDdAO?I
Pkm Pdn
DA lO L
DLOCATION y L4
�
. � , itot�Awtist �CL � ��� ��oar �. �,� . •
A
'H � 7 9- 7 L4 t
Tn.»
The emra-.cwmom a`Aomeowncrf was ca WW m belude ewoet-99esptea dwa6v ftff"
thin or lem and m allow am&bormeowrros m c pp sA bidfrtdw*r lobs who axe sot Pmeeaa a
Iiocme,.powcded aoAe.wner'.es..w�sr.�ir.a .
DErvancNOFHONEDOMM
penoo(s)wbo owm a peal of land on wWcb behhe mides or 1:990155 m eesidr OR whirb*ms k
intended m lot.•one m two fmUF dwelffin�aasetwd oe deudwd stneensa�am7 m wd the ardlitr
firm sa wwm A penon who cetstrtets emre Ilan one home ins twe-yea P010d SW sotbe eomtaasd
a boawowma Sv*nwmtow ne shalt rabndl m the Buildiad OJfmbk OR a fertp se the
BWI ft Odidd.that khiw br mqo=-bk to all nub week pub=od w da the bait *PtwnL
The mulasipud I meow mer un mm usponnbiliq foe eompft=Whitt a state Btu Code ttd '
other appocabk jots by-laws.mks and ie=oLdom
The wA=iprd-hoowvwnd'ocra5a that hehh wmkmmds the aq of Ssleas Bnitd6K Depoartaa
minimum inspection pmccdmes ad mgi&cawms mad that Wsbc WM tomoy with seid ieooedm mad
eegraemmt /� �"✓,�/�
HOMEOWNER'S SiGNAT1AtE ��°Yi�u/.Vn.+,��
APPROVAL OF B=ING DISPECTOR
See otba sde fox Sam code
Of e
NOTm EOWNERr3 EXEMPTION
The code natcs tine 'arq bomcowaa paformb g t o*for whkb a boD ft yasoit is regobed d d M
• eaemyA bom the Povisiam of*b secdom (Saba lipaj-1Jctnslmg of Cwstrecdon zero vis"
provided that a homeorrrKt er�ss�peraao(�for hbe to do.such tvor7�thsd aireb Ho®etPssaet shag obi
as sapavimat• '
MM bomb vAw me Ode cmmptiom arc iostrate to they as-wmbg die PVCcdWWu oft
supw (am Appeodh Q#Ruks sod Resubtkas tar LlocosioS CaossrwCass SvPwr&am scc*G
This U&of anatneat olkm rwhs Is ecrias po)ksm.Plr&v 4 w Lea the ioraeorrae bb"
urdkemed persoma In thhz ease yom Bald earmot ptooeed a jabst the mimed palm ao llwwla Va
iktarod Saprnisor The bomevawa swing as sur.0 r it wk%mw -*!lapnsML
To ease dst the}araeorvncr k Falb nwe ofldAma toponsibATdes.rearq av regahv:as pul
of am permdl applksdon,that the homcorvna ocift"bWw wAaamda the rapwaibUldw at*
supavbm You mq eats to amcod and adopt sueh a lormPocnVAWM Ssr um hs yoor eo®1gti