62 LEACH ST - BUILDING INSPECTION (2) 'PL111NS1ANT13EfO A04M APPROVED BY 774E
,WSPECIiL1A PIG R TD A PERMIT BRING GRANTED
CITY OF_SALEM
No. � v \ Dab
Weld --
Z*ft Dlabld
Is PAY LOCabtl in Location of
dw HWalo DMod? Ym No
Is Property
i Ca1NMabon in
Uorr Am? YM NO (/
Permit to: BUILDING PERMIT APPLICATION FOR:
(Circle whichever apply) Roof, Reroof, Install Sidi , Construct Shed, Pool,
Repair/Replace, 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 accorckig.to the.following
specifications:
Owner's Name �2t rA4./o
Address & Phone L&x}C d- 211 ( Z2 5 G'2,?d
Architect's Name
Address & Phone ( l
Mechanics Name
Address & Phone
Whet Is sw purpose a bidldkig7
mdum of WNW rr n a dwaft ,for how mmy famaes?
WIN haft oonfam to law? A
Esfintled aost&GAL ° qly Ll==r aft u0me N _
Ltc. ®eas A
Signature of App non
SIGNED UNDER THE PENALTY'
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
FA�✓�C�_ 2�si h's2C P, 9i�� l�o�er�e{�
MAIL PERMIT TO: (rO� &uz S/
.t
No��\
APPLICATION FOR
PEFWr TO
LOCATION
PERMIT GRANTED
19
AP VfD
INSPECTORIOF BUILDINGS
CCIY OF SALEM
WnMI dG DEPARTMEHr
HOMEOWNEIL UCENSE F 'r101'i
lrJnwe i I
JOB LOCATION 1P4c
ADWXW
•HO�1v1EOWl� '�1�— b��b . .
TELMMONg
Tee earned vmmp m of-Um ownaf was cmnded w bachAt owneear enpkd dwsl"r arrwo
Utdin a tde and w allow sol bomeowm=to made a►btdlvldwO*r bits Teo down■ot Pia d
liocmc..prwidra drat ewaes ad as squThsa
DEFDaPIONOFHOWAMMM
Pcsoo(s)wbo co a pawl of bwd m wbkb bLWK naida Orb
bacAW to bw,a aim a two bxft dwcllln&suadmd a deudwd tsaaetwes may ti ash rate a 11lt
firm stracumL A pcnm who cortstrnets mote t m sac bcmae In 9 rwa-year Pcrlcd aM not be cmmWkod
a bomwwsa. Sv4lwmwwaef A&m bmh to rlm BoDdius 01rxi.L=*A ban � *
Bw7diof Odte4 Rat bcldte be nspotm'bk to ill snob weak pafaamd
The wttkrsiptcd`wmeowtd asswnes respvn%ft for wmpii> =wth Im Surf BnO ft Code ad
other applltabk soa by-Lws,tags and tesa6daaL
Tee wtdasip ed-eomavwaes"=dsa to Wft wttics+arwis rim aw of salsa Bali Dgwoo fs.
mmimwa inspection proocdwes wad togtdmamms and*0Idfbt:will comply with acid ptomdtaef d
tegtdrtmeal
HOMEOWNER'S SIGNATURE
APPROVAL OF BUILDING WSPECIOlt
Sac sea side for star code
HOMEOWNER'S EXEWIC—MO Y
The code states*W -wW>cnwo.nrperrwmbg.io*for teas aullaq yamxlinqubea,uu W
the p
c,umpt from udsi ss ort h seedon (Seedou lty l h-licensing ofCowstracdom Supervisore
provided that L s Lomeowma cWges p peraaa(s)ioc bim to do.n a wcdi6 t m�hotaeowwer siaall isl
as swavbm:,
MWbmucwwwawho we this cro:now are wavan ihst they are asam bg ifx raposiftim aft
supervyw(see Appcndls Q.Rules and Reguisifoos iw Licensing Comamc iow Soperrisess,Sm*m
.2.14 M lade d owwraws mica asulu ba seriom probhems,pmiko" w dal . eo.rae bb"
urikeaud penom In this cue yaw Board amrot prooeod against the wawcv e0 paw ss it of wld
licensed Svp crAwF. 71e homeowner aging es supeevbw r wbds wt*stem
To casvre 9=the homeowner is tally aware vM%a nsrponnibiities,mmp oo,des mqvba as pull
Of do permit appliodM that 4n bomeawrnr Mn*dot b"M mrdesanda tiro sesponsibUM"or*
supavism You may care to amcad and adopt rA S a twmAccrdfiatSm In are is yoer eommvd�
G
PUSUC PROPFJFrY DEPARTMENT
120 WASNINOTON aTR9aT, 3RD FLOOR
SAL",MA 01870
T[L. (878)748-S595 EAT. 380
FAX (678) 740-96"
STANULY J. USOVICZ, JIL
MAYOR .
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the pmvisions of MGL c 4%S34,I wimowledge than as a condition
ofBmldigg Permit# .all debris resulting from the owNbuctim Wkwy
governed by this Building Permit sW be disposed of is a propaly liceund solid-was0s
disposal fidE y,sa defned by Mtn.c 111,SIM& .
The debris we'll be disposed Drat:4 Sei C �� /� �j� �K �°,l,/r
,v t2�
L"Adw
ofFacl'hiy.
Sigmtlue ofPamit A#phcad 162
FULLY complete the following intoimation;
(PLEASE PRIM CLEARLY)
f4vaS �/J i
Name ofP=mit Appliew
Far Name,if any
r
Address,City&.Stare r
The above statute regains that debns from the demolition,rmovadon,rehab or other
alteration of building or structure be disposed in a Propaly-licensed solid-wmte diapoasl
facility as de5aed by WIL cIM SI50A, and the building pamits or licenses are to
indicate the location of the facility.