40 LAWRENCE ST - BUILDING INSPECTION (2) IMIW610WT13Efl!L-E 4ND APPROVED BY T44E
jIzP1=DB p,WR TD.A.pERMIT aMG GRANTED
CITY OF SALEM
No. / i Odle �y•�/�
\ ♦ ,
is Property Looted in Location of
Vm Historic District? Yak—No �+6
Is Property Located in
on Consenralon Ares? Yas No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, BgMof, Install Siding, Construct Deck, Shed, Pool,
Repai eplac , Other:
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 Oak
Address A Phone �fo �^'� � "� M` (`'1 1 7N4-y01�
Architect's Name
Address & Phone 1
Mechanics Name
Address & Phone f
What Is the purpose cl bWWW
materiel of buldinp? U a dwelift,for how many families?
WN buwv cordorm to law? Asbestos?
Ednoted cost l Lt). CUy Licenser N A State Lim" r
Rome Iapto•eant W"-�
Lie. I Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO-
No.
APPLICATION FOR
PERWr TO
LOCATION.
510 Z1f&jR"cc- s�
PERMIT GRANTED
Z7 20 D to
APP OVFD
P _TOR OF BUILD-MT-
CITY OR SALUM, MASSACHUSETTS
• PUBLIC PROPERTY DEPARTMENT
120 WAsNINOTON STRssT, 340 FLOOR
SAL[M. MASSACNYS[TTS 01870
TELEPHONa: 97e-745-969S ZXT. 3e0.
FAR: 97e-7409e4e
HOMEOV'M UMSE EXEMMON
Plaee Print.
Dm d0S e6
Job Location
Norne0loanarAddrese. Sala�n �,
WT.n
HOM!Owner;Tdephcxy - /� 7 yy_ya It
Pres"mm"'Addrmi. 5� 1e s ovN
The current as mrptim a["Homeownanf was extended to iuchrde owner�occtrpied
hire who don no of Ilea amd to allow awcJl engage an imividnal for
Pour a Beene%Provided that ere aupe4visor
DEFIN1TIp�108I WNER.
P (sl who o�q a paaseel.ollamd as which hdahe raiders or iaatende to nude,which there as
14 or is blaWsid to boo a o4 a two
ry such use and/or igrrns faaul7►dwd&&ebehpd or detached
than one home in a two year Period nosh not A Pmm wW is mm
Official, thatheldw submit to
the Building amid stable to the Building
Permit raponnble forallsuch wort performed under the Building
TIN undersigned"homeownee"assumes nmpmsibility for compliance with the State
Building Code and other applicable by-laws and regulations,
BPW"homeowme caatiSa that he/she understands the City of Salem
will di S Depa bnM minimum inspection procedures and requirements thathe/she
mply with said procedura and mquirem
entLHOMEOWNERS SIGNATURE
APPROVAL OF BUILDING INSPECTOR
See other side for state code
.. flOMBOWN1L�te.1*T��'QT[01
wad,fW which a Build'mt permit is
The Code states that: �' How sOdawwum(Section 109.1.1 -)rie�><
rooka ehal►be mc�� ded woa mid P�Oo(s) h°°w
�Coosbcuctwn�S k COVI yet act as SupaV+M•
so utu�aa:e��a° �
M. y Oneowna+ache me °O. R�and Re�ah�for Iacouft
C Of S g� hitat IS*°f xwff=M uOlk6wed PlerOW& b&this�
�1 �'par0 11 r why��c 'as it would w�h a l cW"d
Boyd t °Pd' a , iaa i4 'b
16.
?►". : .� r
that the Homecwna is awae of bis4m�� caps that
To
rcqdm as,a putt of dlis Pamit -dielad�of thin issue u a
hdeht+ the & you may Care to amatd and adopt nth a
form cmoY used by
YOW
`I�,IZoes
CITY OF SALEM, MASSACHUSETTS
• PUBLIC PROPERTY DEPARTMENT
120 WAsmINGTON STMKCT. 3R0 FLOOR
SALEM. MASSACNUSETTS 01970
STANLEY J. USOVICE, J11. TELE►NONE: 978-745-989S EXT. 380
MAYOS FAX: 978-740.9848
Salem Building Dee9rtn.p..�
Debris pig Form
In accordance with the provisions of MGL c40 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 waste disposal facility as defined by MGL
Chapter III, S 150 A.
The debris will be disposed of in:
(Location of Facility)
Signature of Applicant
Date
IQ