23 MAPLE ST - BUILDING INSPECTION PL*N 11Atl6T13E 44W91IND APPROVED BY THE
ASPECIDR PWR TD A PERMIT BEING GRANTED
CITY OF SALEM
Dab
Ward-7L—
�, ZCr*V DlsMct
dro MIMIC DWdd?� yes—No �/ Location of
ftlni],dIn ;Z3 Mural¢ f4-.
Is Property Located In
the CWM WVa* r Ana? Yak_No j
Permit to:
BUILDING PERMIT APPLICATION FOR:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, pool,
RepaidReplace. Other:leap va�e k ��
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROCESW40
TO THE INSPECTOR OF BUILDINGS: '
The undersigned hereby applies for a permit to build acconLiq to the following
specifications: / �t,�
Owners Name I<ey, � '�'� cu 'r/
Address & Phone �� /1itA JAL ' J-� . (p7P) `7 yS-- ti?-K/
Architect's Name
Address & Phone
Mechanics Name
Address & Phone n
Whtl b ftre Pupwe of b~ reS n a
f omm of buYdtrq? tl a dwaft for how mopy fmnaes?
wo b Aft owtorm to law? �Q� Aetrastos?
Egmawl coal U UO Cqy Um=0 stab Lamiss hwrommmeat
/11
S ture of Applicant
SIGNED UNDER THE PENALTY,
OF PERJURY
DESCRIPTION OF WORK TO BE DONE /
MAIL PERMIT TO._.a �� / Gf✓1� J 4
No.
APPLICATION FOR
PERMT TO
/
LOCATION 1
PERMIT GRANTED
e
APP OVfD
`�
INSPECTOR BUILDINGS
' I
CITY OF SALEM
BUIIAING DEPARTMM
HOvIEOWNM LICENSE VORMON
Plea Fda
DATE � a -io� � •
IOBlACATIQI � 3 jvJG� r� C�C�=�.
ADUMW
TFIRPBOW
PAESENf MALMO ADMM �S,gv�?X-
The emrcrs.exrsptiao d`homeownad"was crncadet!w bnchde or, r-sFevpw dwcfpiv arrwo
Uala ar kaa cd a slow sad bomwwm n w WWP ce bowl w*g bin ww doss aotpov t
lk m fmvidrd aunt the w+ m"at os wpervissa
DEFV4TIONOFH0Nf A)WN=
Pcnee(s)who owes a pww d land as wbkb hie be resides a kuesds w tesi ft as vddeb*an k,w k
irvaded w he,a otte w tov hnkBy dwclffioL smdad a deadod st xwu mmc�7 to seek tie WAAlf
farm svvcwm A pence wbo eonswets mom tone cme bomc fn s ewCI=period shall sot be C"ddasd
a bomemm. Sveb lwmw%mct"shaIIsubmdt w the Building OJl> m s lhrip seeoepabte is 7k
Bur']dlq OdwiaL tlat k/Ow be nxpom%k w aD snob wank pafoemed ardor the bafldiod pw=L
.Thc undasiped-bomwwme asnvnu tesponn'bmv for compf =wbut w Sate Banff Code a d '
otha app6abk`ocs by-kwa,wla sod rephrd=L
The mdersfp W-Nmmmne eerafm that Wft mdastatds the CiW of Sskm Bsildb g Dgwu at
mWmms bopwdcm proadmes sad rcgii m and tout bhbc will=44 with Mid A tuna
HOMEOWNER'S SIGNATURE
APPROVAL OF BMDING INSPECTiEI
Sec other side fm sate code
J
f i
HOMEOVYNER'3 EXEMPTION
The cods sues sbaC 'srq boateow'ner Pe i,ivA fa wbkb a baD ft pumb it 3egabed ANEW
• exempt from she pa+iciom dsbis cetttoo(Sct:sioa�09dJ-13amstat d GnsenKt{o�Eepervfeee�; .
prodded dar is a bomeowaa eapjp!Pasco(�)fbe Idrs so do.ntcb worst,sbal siseb bo®eowaee td+ai!aQ
MM bomarwma wbo we this erampdoo we ioawau tm sbey we ammub g*A xavoulblum do
cupavitos(ace ApPcodfs Q,Rules and Re=mbsioa InLlocoaimi Ceoaer+MiM Eopentaoeac sael(N
.2.24 Tbb butt of swa wwo mica usults is ocsioa poblamr.pw*ab wLea 69 boneA OM Mr
unDccmed persooa In Ws case your Bald earatot prated&Saba sba w Io .eo p�oa as llwwld w!S
liaaced Sttpo�isa. T►c 6oureon7cr adlnf o apervtaw b nhi�le�!t+
To canes that she horaevwmcs y fully swwae d biAmr uspmaibAisie.soap oommw�de tegdta;as purl .
of the pcmdt appltotioat Oat du bomeowna catify that b&Wa andecsmde d w uapooablM N dtt
sapavb= you may can to uacnd ad adopt we5 a furmk=dfkmd=f N vm to Pw oom®ca l*
"' ' PUBLIC PROPERTY DEPARTMENT
120 WWxmmaTON STREaT, 3RD FLOOR
&M",MA 01 B70
TILL(979)74S-S595 EXT.360
FAX (979) 740-96"
STANLEY J. USOvICZ, .JIL
MAYOR .
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance With the Pmviaic=ofMGL c 40,SM,I scimowledge that as a ca mdWm
Of Mding Permit g .all debris resulting&in the man achvity
governed by this Building Permit shag be disposed of ina properly licensed solid-waste
disposal facility,a defined by MOL c Ili(,S150A.
The debris will be disposed of at
Location OfFaciMy
1`2
Si of Permit Applicra De S
(PA SE PPRRINTT CLEARLY) mEosmah°n`
Est . N.
N offtnthApplicaat
2—
Nmi%
' iv
a? /%cfyk f V J,4 (per /1 .
� ? a
Y
Address,City et state
The above statute requires that debris from the demolition,renovation,rrhab or other
alteration of building or stru tin be disposed in a -licensed so waste as defined by MGL ca S 1 BOA,and the b�ildmg peraub or so s e
indicate the location of the facility.
-g
r ` -
/
v2em,
N
J ..
I
MIT _ N
-� -
Al
s
I
as � -
I
ab I
I
33 a y 3 Q
F--=
III CMM:KOEN MEUSSA RerW U.SA DanWM reth NftHv:Plana Door A PWn Door Sedx SCWO-ba
�OEN MELISSAROM NYMW A PlWn Door DGW e/14M4
P 1