8 LEMON ST - BUILDING INSPECTION (2) 00 6-6
14 AI IWUSTIIE f#WB4jN9 APPROVED BY T44E
11111SPECIDR PIWR TD A PERMIT wNG GRANTED
4 f\�
CITY OF_SALEM "
No v,�l Date 2 6 0
s
War!2—
Zorwng District
Is Property Located In Location of
the Historic Distdet? Yes No ✓ Smilding
Is Property Located in
the Cmmmatlon Area? Yea No J�
Permit to:
BUILDING PERMIT APPLICATION FOR:
(Circle whichever apply) Roof, ero Install Siding, Construct Deck, 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 accorcLlq to the following
specifications: /
Owner's Name 1, cA fi t 4 F l a H I7 o I f
Address & Phone e vr, n n if 7781 7 Lf S- r-f 3 z 6
Architect's Name
Address & Phone
Mechanics Name
Address & Phone If
What Is die purpose of building? t}wet•1:n�
Msterlel of Now If a dwelling,for how many sambas?
WBI b ROV cordorn to law? Asbestos?
Estimated cod S Oo. o o City Licanee N state Licerme e
Rama <apro.uant 0 /�
Lie. if r at;.'- 4 l "0J,.�
Signature of Applicant
SIGNED UNDER THE PENALTY'
DESCRIPTION OF WORK TO BE DONE OF PERJURY
MAIL PERMIT TO:
1
No��\\' _
APPLICATION FOR
PERMIT TO
LOCATION
V l---i/�DH ✓'/ U�
PERMIT GRANTED
.77/d 940 19
AP 0VFD
INSPECTOh OF BUILDINGS
crrx of SAiEm
Bu iNriDEPARm4ENI
HOUBOWNER UCENSE E)'11O
• r
Please P"
DATE � i n 14
1oBLocAT1oN
HOMEOWt(ER
ADMMM
HOMEOWNER %741 -7 q '-I 3 6
TELMM0149
PRESEWrMM..u.GADDRESS 6 e.moh . .
The cw.mm vwmpdon of-ban.nowqclC was uunded to bwbde owoeroCwPW d"'Olm dTWO
Unlu or ku and to allow such bomeow Om to engage an bsiiviAsll rat Wm who doer sssi pones•
I;Ccne,.pmvided tbss the owner ad ss su"Mem
DEF24MMOF MOWML•
Penn(s)who owns s psnxl of hwd on wbld►bdshc msides or baeads to reside.on Cm �wbkhht 1aa
imtaided to Ec,t am to two fang dwclliot aosdi d or dcadsd saucnns xy l oot b oonsiOK
farm svucwM A persm wbc constructs more tlmn c bomc b►a two-ynr PC4�
ad
s bonKowmr. Such Im eowircr shall submit to the Budding Oif CK an a fW*&=gtsbk W*6
Building OMc4 that bdshe be aspansible to all such work podammd taida to bundba PUMIL
Tm tmdasigncd-bomww=C Mum MPons+bift for==PHW=with the state Bo9dt Code wd
atha appgcabk goes by-laws.nda and ngWadm&
The tivA",,PW_hovteOwm_ocr dfia tba hdshe w4u=nds the Ciq of Salem BeWbq Dqwumft.
minimmo bupcW.pmacdma smd mgvi a w and that Wshe will coorply
ie9ub=NCNL f�
HO1v1EOWMR'5 SIGNATURE V.,
I
APPROVAL OF B=ING INSPECTOR
Set tuba side for suu Cade
HOMEOWNER'S EXEMPTION
The Code skua ibW •any h=wowncr performing Wvdk for which a boiltlb*permit is nnobed in
exempt from the pv%Uiont of this secdon (Swim I0pla-13etaslug of Conaennsioa Sopcvim
Provided that S•homeowata cntaSa p persoo(s)for hbe a do.catch woelt,tha aiteb bomcowac ibaH iast
as swaviNK;, .
MM bmneownm who the ibis exemption are inmwane*a*q an the;c9omibilm"sea
ropartwr(see Appcodia Q.Ruin and 7tcgulatiow for IJccosioi Coostntedon Snpervisoes,Seeden
.2.24 This lack of swascnen clan asuhs in scrims pobicmt•pardeuLvs,wbea to bomeowac bbaa
urJk=wd perwM In tMs case your Board carmot proceed aSabst tbs tailiesmed papa as ft wall wfs
liaenud Svpctisqr 7Le bomevw'scr actin=to supety" d nidwwt*tss�atsbiL
To twurt drat the hotntowner Is tally aware of hilba tesponsibilides,mwv oommmdtfe s ttq.Le;up"
of the perms{appliodmy that the Twtnwwtta eerdlyr that he/she mtdaswr the tesponsibuldn eta
supavba. Yw may can to amcod aid adopt subb a knakadfication for use is yom owunnuft.
PUBLIC PROPERTY DEPARTMENT
• 120 WAfHINOTON STREET, 9RD FLOOR '
SALEM.MA 01870
TEL (878)748-S595 EXT. 380
FAX (878) 740.8846 1
STANLEY J. U80VKZ, JR.
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the provisions of MQ,c 40,S34,I acknowledge that as a condition
of Building Permit 0_ all debris resulting from the construction activity
governed by this Building Permit shaft be disposed of in a prOPaly licensed solid-wsm
disposal facility.as defined by M(3L c III,S150A.
The debris will be disposed of at: P m4 k s J <
P /^� Location of Facility
I - Vh yw1. -7A / a Lt
Signature of Pe>mit Applicant Dam
FULLY complete the following inbxnation:
(PLEASE PRINT CLFARLy)
Name of Permit Applicant
Firm Name,if my
yL- er&i.sn Sq-. .SreIe, A
Address,city dt state
The above statute requires that debris from the demolition, renovation,rehab or other
alteration of bralding or structure be disposed in a properly-licensed solid-waste duposal
facility as defined by MM cIII, S 150A, and the building permits or licenses are to
indicate the location of the facility.
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