47 LIBERTY HILL AVE - BUILDING INSPECTION (3) 44AM1AtIST13Ef♦ AB4M APPROVED BY T44E
JNSPJ 7=1 PRIGR TD A PERMIT BMG GRANTED
I CITY OF_SALEM
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ward -77 —
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ft Nlatork �InYet No Ba17Ain6 Building of
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ervetlon rea9 YM No
Permit to:
BUILDING PERMIT APPLICATION FOR:
(Circle whichever apply) ao=@e�, install Siding, Conruct Deck, Sid, pool,
epair/Rep ce, 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 accordcig,to the following
specifications:
Owner's Name �k74�ee(
Address A Phone y7 1-,1,6 y// t/E On
Architect's Name
Address & Phone If
Mechanics Name
Address & Phone f
Whet b the FnPm of er tnu? L'&AAN)5
MdWW of mangy I a dw.wrg,for taw many fwnMn?
WIN b eking cadoen to iew9
AraEasloa7
Etwnated coat aoo. °O CRY UCW"a Shb Lkww e
T Bone I�sv cant
Lie.. A�Signature of Applicant
SIGNED UNDER THE PENALTY'
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO N 1
No.\ �
APPLICATION FOR
PERWT TO
LOCATION
PERMIT GRANTED
19
APPRQV�D .
G � z��
INSPECTOR a BUILDINGS
Yw-
w J
Wl1 VF SALIEM .
BUBMINGDEPART1v1W
HOMEOVI NSL LICENSE MMOMO1N
Pkm PAN
DAn4U
MO LOCATION
• HOMEOWM 2
Anump
•HO#�OWNEit
MMiRTMAII.>r1OADDRF�
The emroa,e><cmptioo a-Lomw+�oa�-.ras wcadce�o b,duds ewoer+pesPk.dwe1iP OtTm
Udu a less wd b albw aoeh�omeownaa w�sn brlivWyllat hlss woo does Tot ptw t
lkcme..Pavvided thaa>at:ewasi act d wFea.baa .
DEFR9rMOFHOMZOWNM
• Peraoo(s)wbo ot+w•psral d bad as whkA hehhc resides a Ltuads w tesidR oa.rhkhAsae k,ac Y
buaided a b%a am to two famib dweMsaL studmd or d AMW ssrtsM"aooeaap w oath ntt sa i t
farm straesaat.A petaaa who cortstrstea ttwrc thm amc ltorat in a two-year period sbaV trot be oomidd ,
a boawowaer. Sad►`Iwnnowm' O=V a&n&w the Basldinf Oliid d,m a lbrsp w ft
Bwl ft Olf,&L that bLWw be ngwA%k w al sods wok pa"wA tmda the bouftg �
The wMiampad`homeowner assttrnes resparurbMV fos wmPlbaoo wlf the sate BNM%Cade w d '
other aWScBbk`o%brbwa,rout acedte=ubdom
Tbc wtdenipsd`b= vwmr certifies to Wft w&Mw ds fe Cid of Salem Bulkbtg DWwa a.
tnin9mwsf inspection proccdwa snf ngrmcmcros and that hhbc wM Wes'with aid ytoadme d
mqwrmcm
HOMEOWNER'S SIGNATURE 1r1 L GiI A,
APPROVAL OF B=ING INSPECTOR
Sec other adc for sate Go&
HOMEOWNER'S EXEMPTION
The code sum ftt •sM homeoww performing tiodt fa whkb a Wiling patch is q sbal M
• t:w*from 1M pnvanon,s of tbb section,(Senian,]f*.L%-3Jocesint of Coma ctke Smpts--batO
proYidCd 1ha[�{i bomleO�Miler t7llaip�peraeo W for bbtt Ica dm.s11cb wttrlt.tbi!AYb b0®Oowier anal!84
MW botoeowmets Mho me thin c mmptloo arc j=w&R that*q an nownin,g dw(e gonsibliltis de
rapavi oe(see Appeodls Q,Rules and Re=ubtiotu for Lioenatof Ceost wLee del - 'A raM.bb"
1YJ} 7Lh bolt of awaemmu cfka tcsibs in,sc*w ptobkms.psnkuhrb
Urikaaed persomc In,thb case yaw Board caumot proceed spins;tat, pofoa s hwomld via
lktwcd Sopat+iwr. 71te boaaeowfer acting"super+Iwr b OWNW6resjowlYi�. .
To mans 1Ms ISM h MOWner 33 ltitib sWate of IAfbCF uapant%MdCs,MWV aommam ida ngAIM-U pat
of the panel application,tints the botoeownar ecrdly rim bLva understands the response bilhts are
s*nnkcrdfiotims fear van its yomr
Yon cum to amcad and siest ��®�
ntperviw� Y mq adopt
PUBLIC PROPERTY DEPARTMENT
I2O wASNINOTON STRES7, aRO FLooR
SALEM,MA O 1970
TEL (976)740-9595 Err. 360
FAX (*76) 740-954E
STANLEY J.USOVICZ, JIL
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the Pmvisiom of MQ,c 40,S34,I acknowledge that as a ccoditicn
of Bmlding Permit g_ .all debris resulting from the Congmctiam acdyty
govenud by this Bui777
lding Pemrit sW be disposed of in a properly licensed solid-waate
disposal fee ty,as deBmd by M(3L c DL S1-%A.
The debris will be disposed of
ofFact'Lt' y ``�
fief/ZGOo 1�=2�v / U .i� r \
Signature of Permit Applicant Date
FULLY compkde the folbwing information;
(PLE ASE PItIIJi'CLEARLY)
Name of Permit Applicant
Firm Name,if any
Addreaa,City do 5we
The above statute requires that debris from the demolition,renovation,mhob or other
alteration of building or structure be disposed in a properly-licensed sokid-waste dispoaak
facility as defined by MU cjM S 150A, and the building permits or licm are to
indicate the location of the facility.