14 LAURENT RD - BUILDING INSPECTION (2) ftWIK#U040 p NWmovjW IIIY U&
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NV V) �C CITY OF SALEM
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Permit t0: OURD1101 PWANr APPLICATION FOR:
(CIFdo whlOf*m apply) l g df Wft Co*bVd 0@* Shad. Pool,
Rapaidi'lopleft
PLEAM PILL our LESfISLY a COYPLEMLY TO AVOID DELAVS M PROCESyq
TO THE INSPECTOR OF BUILDINGS: '
The WMIKSOW NNOW appksa for a pdrmk to bukd aoowft fo tha.toNowkp
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Address a Phans / Z v 2-e,,✓T
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AddreN a Phone
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REFERENCE: -
JFEL: RFG. 8K. 1569 PG. 273
P-A!J: Pi_. BK. 21 PL. 3c Sec, A
T_ . LYNK (-bSrAL DLSTRa pgPLOgEZ Ckf:b-r Uu►otd
I 'ERTIFY THAT THE BUILDINGS! SHOWN HEREON
ARE LOCATED ON THE GROUND AS SHOWN AND THAT NQRTGAGE INSPECTION PLAN
THEY FORM TO THE ZONINS BYLAWS OF THE CITY
OF Sk LI AT THE TIME DF CONSTRUCTION.
Or; ARE PROTECTED UNDER GENERAL LAWS CH. 481. LOCATED IN
I ALSO CERTIFY THAT THE PREMISES SHOWN ARE S %I L E `IN
NOT LOCATED WITHIN A FLOOD HAZARD ZONE AS PREPARED FOR
D€tINEATED ON THE MAP OF COMMUNITY f 45010Z Se.g
SALCr, MA., EFFECTIVE 8/s//42es 8Y I DENISE 1. HooEa
THE FEDERAL E JOHN C. HDaJEL[EMERGENCY MANAGEMENT aNCY.
SCALE: 1 "= 20' ,7vNE !o, 19%
NORTH SHORE SURVEY_ CORP.
DATE REG. PROFESSIONAL LANDS R MIT H N7 LJAIOENJ JT. 4— SiLt7N, MA
P i},
Nc.35043
CITY OF SALEM
BU=ING DEPARTMENT
HOMEOWIEitLICENSEE meno t
Plnse PrLd •
DA 6 d
ADNXW
TELEram
pp�s�h1AII.IIiOADDAES= J � <✓�✓z`n� 2D •
The ewrar.exm}Oom d`Mweownaa;'was aacnded to br lode ewoewsca rW.dwdlip adTW0
(1ai0 a test asd tt alk+w soot bomwwaas to aKyc as .�hies vhe does ass posses• .
liccvm provided tots owoer'sA Nowper�lesa
DEFDa!ONWHOMEOWNER
Ptnom(s)w►o c wm s psrai of Led oa wbkh b&Wb resida of k,Orb
intended to be,a cm 10 two ton**dweMm&smsdmd a dwdKd nracaoss scccomy to Fab m and I
farm w w m A perm w•bc constructs mace t m amc hvmc iA s tt+wym period d"W be masidw d
s bomwwmet: Sv&-nomeowme O*Zm mot is the Badimd OMCK W&w�Uht�bk l*&
Bw•l ft of ie4 that Lchhe be sepotmbk to as Fab wok pafamed
uWa*A The w�dasipwd wbmwowne assw m responnbiNgr for aamPlivae withthe Sate Boldlgp Code d
otha spocabk goes by-kws,roes and n obtiom
•cae wWc;sip od meownd boom on erg of Sokaa 3s%%gDwwvmft
minimwo inspection proesdmss req and wo==ply w•il&aid p amdma ad
r�
HOMEOWNER'S sj
APPROVAL OF BUILDING DMTCrOR-
See otha side fm state code
HOMEOWNER'S EXEMPTION
----- - -The code sutea thsc 'cry hottttow�er puforr>d .i li fa rich a ba0 paudib�egand -
essmpl Lo®the prodiians cribb secdm (Seatm lf*.U-Le:osiog of Gastroteloe•So�etvfeee�•
provided that L a bomeosrrra eopie�person(�!p b6s to do.sudt wm1r.teat sites bo®eowaes shaD sat
. o supsryt�` '
MOW bomeowrsta who we this crampoon an"Wat thst they at assm ba tat der
m7avi m(sot Appecdla Q,Ruks aced]teiuladom leer lJowslo=CooanKdm lSupardem%EWAM
.2.24 Thb btdt of a"aroress of cs wsWu In serlow pmbk=m6 pwdca tht I's win an his
tmliceased pcsont In eels am yom Berra omot proceed ajahm art paRoa as awoda.dd
licensed Supa isa. 71c bomeowwr sdlof as supervbetr Is wMla ose��ssposfblt, .
To come that the homeoxrm It Silly swan d M4w uspoudleMaes,soap aomsom�asy segiiR;as pest
Of the pamfl sppliodoq that the bou"Vona CMW that he/she orwasaods the repousbWas do
mpavLa . You mq cm to amcad and adopt sukh a faradbat f radon AN tna to your 000= a 6
CITY OF SALEMv MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
SALEM, MA O1970
TEL. (978)745-9595 EXT. 380
04& FAX (978) 740-9846
STANLEY J. USOVICZ, JR.
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the provisions of MGL c 40, S34,I acknowledge that as a condition
of Building Permit# all debris resulting from the construction activity
governed by this Building Permit shall be disposed of in a properly licensed solid-waste
disposal facility, as defined by MGL c M S 150A.
The debris will be disposed of at: �,fl I,e -n 1 a'w� Peg- �/ ,ji o L)
Location of Facility
S' 2C6r
r of Permit App 'cant ate
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
r dul" �/
Name of Permit Applicant
Firm Name,if any
Address,City& State
The above statute requires that debris from the demolition, renovation,rehab or other
alteration of building or structure be disposed in a properly-licensed solid-waste disposal
facility as defined by MGL cIII, S 150A, and the building permits or licenses are to
indicate the location of the facility.
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