14 MANNING ST - BUILDING INSPECTION i�L7tNSiNliSfi9EfW*8-1W0.AffROVEO BY 744E
JAI:PFCILtR pWR TD.A.PEAMIT JBFMC GRANTED
CITY OF SALEM
No . r��� \ Date
Is Pmperty Located In Location of / t 1 ,-
ft Historic District? Yak__No V &d1ding 7Yak__
Is Property Located In
tlw Conservation Afea? Yea No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, 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 according to the following
specifications:
Owner's Name
Address & Phone /�==1 n4
Architect's Name
Address & Phone
Mechanics Name
Address & Phone f
What is the purpose of building?7tS
Mat"of building? l fl a dweYing,for how many famAies?
will Wang conform to law? 19 D/ Asbestos?
Estimated cost 4 ZOP0 Cny Uoenee r N A State Ucense e
Ike Isprovment
I'i`' i Signauiti of Applicant
(� SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO: W� JA
170.
APPLICATION FOR
PERMIT TO
J. // 9X9 54�i0
LOCATION,
PERMIT GRANTED
2.0
AP OV ..�D
..
INSPECTOR OF-BUILDINGS
r
CITY OF 3ALEMq MASSACHUSETTS
I • PUBLIC PROPERTY DEPARTMENT
120 WASNINQTON STREET. 3RD FLOOR
SALSM. MASSACNUSETTS 01970
TELE►NONS: 976745-9995 EXT. 380
FAX: 97e-740-9E4e
HOMEOWNER U MSE RXF31MON
Pktase Print.
nee
Job Location �� ✓Lll ti h�, S �w/ �
Home Qwnac Addmm
S � � Z
The current won of"Homeownwe was,extended to include dwellings of two.Uai>ar Of less and to allow such am "for
him who does not possep a licensq,provided that the owuet� as sllpeavia�
DEFINITION OB,H011dE NWIM
Person(sl.who ow=a pa cal-of bend on which he/she resides or intends to ms* �
Which there�Orr,
r is inteadea to buq,a one a two
fanuiY dui .
structures to �i wed a detached
such use
than one horse in a two year period shall not �who COAL°tee
"homeowner"shall submit to the Buildinghomeowner. ouch
Official, that he/she be �°�on a fowl acceptable to the Building
Permit responsible for all such work performed under the Building
The undersigned"homeowner"assumes responsibility for compliance with the State
Building Code and other applicable by-laws and regulations.
The undersigned"homeowner"certifies that he/she understend#the City of Salem
Building Department minimum inspwdon Procedures and requirements and that he/she
will comply with said procedures and requirements.
HOMEOWNERS SIGNATURE
J
APPROVAL OF BUILDING INSPECTOR
See other side for state code
IIOiAOIN�t MO
M wner perform`�for which a Building Paz*is
The Code states tbst: ttotta � ..of this ae.d.(Section 109.1.1 - g
r Can a c be examPt vided that a Homeo�r MOPS p� to
do so ����Homeowner shall ad as 5
IvlanY HomowncnI who use this ex4Ww Rules nd Licmmi
Qj and us
rcapjm-biytiaa of a . ( 0.1A TW lack of awaraow often teanits in sane Your
Constnt S omeowoerbins unlicenmed Pas=& In this case
p 'O the wHicased PC 4 i �it world with n ible. d
le
g y .TMi Hom°c"m°r as °0r � �
caner is fWly aware of MAW i ities,manY �
cc"
Permit
To ensnn that the Homed bcstio®. the Homeowner
communities mquir% a Pao of the APp tin tfi last pav of this issue is a
ilities of s Super �� a
fotm 1y tired by sevaial towns. Yon * * L such
formlce8csda4_f use in your commututY .
r
R�✓ `I Sol Zoe r