45 MASON ST - BUILDING INSPECTION .V
�L-hN6TAl 6T�E filf—B !D A PROVED By TIE
LWSpZCTDB ,PaWfl Tp A_P.EAMIT BEING GRANTED
CITY OF 5ALEM
i No. Date 7 i8 02
Ward
f
\ Zoning District
Is Property Located In \ Location of
the Historic Dlstdct? Yes No V Building �/ />IflSo�/fe•
Is Property Located in
tl»Conservation Area? Yw No\
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
Repair/Replace, Other: •D E rnoL.,s H - Pfl 1t7I AL
I
PLEASE FILL OUT LEGIBLY & COMPLETELY TO AVOID DELAYS IN PROCESSING
i
i TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the following
specifications:
1 . & Owner's Name M s-%LE: HA Y ?2j.5>&j-7' 131NK FFALt? rRVS7
CrtowN d�3,s,
4 Address & Phone z!S MASON SZ SALgAi, lv,A, (998) 7yq-o9l1
Architect's Name f/ 1i� 1?709RA174 Co.
Address & Phone R0. Box (97,a) 75zq-_535Y
Mechanics Name HeMmE77 e0A17RAc7_1006 mAi.,g ZiENN577
Address & Phone o?0• 6ax 38 i iB70wA/ (9?8) 35�- 8553
What is the purpose utbuilding? y/
Material of building? 141000 FR F7/MS II a dwelling,for how many families? y A
SENGArn -TAX-
Will building conform to law? y� Asbestos? 'TZFn c>L VD RY LAwRonce MA
Estimated cost Y/-� ucf'o City License N State License as
Permit Pe-43��- Home ImProveeent
Lie
CV- 273� � Sign cure of Appi
3 SIGNED UNDER PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
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MAIL PERMIT T0: 6?00 4 �. �S, z{.5IwASON SY S4LEb,,
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�o OF SALEM. MASSACHUSETT5
PUBLIC PROPERTY DEPARTMENT
° 120 WASHINGTON STREET, 3RD FLOOR
} tia SALEM,MA O1970
s ` TEL. (978)745-9595 EXT. 380
+mru FAX (978) 740-9846
STANLEY J. USOVICZ, JR.
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the provisions of MGL c 40,S34,I acknowledge that as a condition
of Building Permit# all debris resulting from the construction activity
governed by this Building Permit shall be disposed of in a properly licensed solid-waste
disposal facility, as defined by MGL c III, S150A.
The debris will be disposed of at:
Location of Facility
Signature of Permit Applicant Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
Name of Permit Applicant
Firm Name,if any
Address, City & State
The above statute requires that debris from the demolition,renovation,rehab or other
alteration of building or structure be disposed in a properly-licensed solid-waste disposal
facility as defined by MGL cIII, S 150A, and the building permits or licenses are to
indicate the location of the facility.