10 MESSERVY ST - BUILDING INSPECTION (2) 4L1tfIB*WT-SEf la-E tJD APPROVED 8Y T44E
MPZCT B PWR TD A.PEBMIT BEING GRANTED
CITY OF SALEM
No. '� Date 15
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Is Property Located In Location of ry C
the Historic District? Yea—No Building t o /"fSSe L'Vz �
Is Property Located in ✓
the Conservation Area? Yes No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
Repair/Replace, Other.6b%11/z,?�-ern i/?fe/&47f 000rr
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:
1
Owner's Name kicko-Y-J ` Ul it io'm 520'YO.C1 0
Address & Phone (0 MesSeV, t. S�' Scflem 698 ) 711(-OY60
Architect's Name
Address & Phone I )
Mechanics Name
Address & Phone /I J J L )
What is the purpose of building? l4 S la l(l n 5 UCt /h roots
Material of building? If a dwelling,for how many families?
will building conform to law? Asbestos?
Estimated cost $6000. 0 d City License x N A State License rt
e /\ Bate Improvement�' 6 v v
/r Lie. I rAF
Signature of Appli t
SIGNED UNDER THE-PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
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MAIL PERMIT TO: \n Q
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APPLICATION FOR
PERMR TO '
4
L�JOCATION € 1
PERMIT GRANTED
APPROVED
S ECTOR OF UILDINGS
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t
CITY OF SALEM
BUnDING DEPARTMENT
HOMEOWNEPt uaNSE EmemON
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TELEPHONE
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farm suacaoa.A ptnon wbo ematruets mm firm sac hums ka a Wwyeat POW
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HONWDWMM*S SIGNATURE
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APPROVAL OF B=DING INSPECTOR L
Sec other side for sam code
HOMEOWNER98 EXEMPTION
The code sm-m NC'w hoateowaa pafaia(np IkA far whkh a Boni yamn w lea -
' exempt Lom the ptovirioms o[thb recdom(Sectioe 70'.1.it-1Jaeaaloi of Gestnretkn Sepervlao�� .
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ikeared Super►m. 71e homeowler aging ao ouperrbor l eh`Jnwid neajoroslNtti .
To mum that the bomeowma is hRy aware ctWba tespanssSbMdn.mmq ooma�des uegnir�as part
Of the PCTM%sppllado%that the bom mama caft that he/she dersran I dha sespoasibodss ds
rtrpevbor. Yoe mq coos to amend wad adopt saeb a fmmlardliodw In use In yoer oomm w*&
,
o CITY OF SALEM� MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3Ro FLOOR
1 SALEM, MA 01970
TEL. (978)745-9595 EXT. 380
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-Pemvt-#---- ,-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; S 150A. _ d
The debris will be disposed of at: WO/t��e � / ) rr G
Location of Facility
Signature of Permi plicant Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
ff i V 1 G Yl raCC�
1
Name of Permit Applicant
Firm Name,if any
rU "01e5SerV1/ S� Sc fm MA--
Address, City& Sta e
The above statute requires that debris from the demolition, renovation,rehab or other
alteration of building or stricture 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.