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8 MILK ST - BUILDING INSPECTION (2) iAt iiftf6T13E fiL-E—P d APPROVED BY T44E MP 13 ,PRJOR TO A PERMIT BEING GRANTED CITY OF SALEM 2 p�C� "' \No. J / ' ! F r't L �\ Date o © L' \�eC/MINB q (e-z f Is Property Located in Location of the Historic District? Yes_No Building 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: 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: p Owner's Name t�.0Qte1r Address & Phone M% ik i v-A-C Architect's Name Address & Phone ( ) Mechanics Name =- Address & Phone n What is the purpose of buildings? (r 2 l Material of building? M6A 1'LO If a dwelling, for how many families? Will building conform to law? Asbestos? mn t. e- T ID Estimated cost I�0 . City License # N A State nAzf, Home Improvement Lic. / Signatur of A licant SIGNED UNDER THE PENALTY OF PERJURY DESCRIPTION OF WORK TO BE DONE el 40 MAIL PERMIT TO: D Lne- d`n h 0I176 No. _yZpp� APPLICATION FOR PERMIT TO LOCATION PERMIT `GRANTED APP INSPECTOR OF BUILDINGS „ Mr f ; 6 �epailmual or.7adaafriaf�eeia.nlf 600w-1-Vlm jaines I Cameoes L>oslott, d+aacf twlff 0.21 11 Corrmrss*w Workers' Compensation Insurance Affidavit with.a principal place of business at: pyldI/Uddd-tA A f Chr,a.,t.,a4f do htreby'cerzify under the pains and penalties of perjury. that () 1 am an employer provid' g workers' comp.�`�'t n cove ge for my emplplloy sp working on this job. `.I f9t �YS• Insurance Co pang Policy Num r 1 am a sole proprietor and have no one working for me in any opacity. () I am a sole proprietor, general contract or homeowner irde one) and have hired the contractors listed below who have the fo owing workers' compensation policies: Contractor Insurance Company/Policy Number ir,' Contractor Insurance Company/Policy Number Contractor Insurance Company/Policy Number () I am a homeowner performing all the work myself. i unoeruana wt a cool of the weertrtnt wa be icry aroeo to the Orrce e1 Imeatitavons of the DI►, 1w co+crate+reification an.tt»t(arawt to aeeure co• ate v rrvirea unaer Section 2 SA of MGL 15 2 cm lean w the inooppon of crtrrinal ot"em consttunt of a fee of w wi 1.500.00&W ar tans rem• iearuorxnant n.tro x civi txrultio in the lortn of a STOP WORK ORDER arse a fine of S 100-00 a an apigt eae. Signed this day of S0 D 3 ' centre/Fcrnitue building Departs ent licensing board seiectmens Office Health Department OF SALEM. VIASSActtvar- � i = {� PUBLIC PROFE:.?TY DEPARTMENT • • 120 WASHINGTON STREET, 3RD FLOOR < y SALEM,MA01970 s TEL. (978)745-9595 EXT.380 FAX (976) 740-9846 _ iTANLEY 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# M :aw 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 $ d3 Signs of P t cant Date FULLY complete the following information. (PLEASE PRINT CLEARLY) Name of Permit Applicant w nAw o1.� - uC Firm Name,if any 6119 76 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 cM, S 150A, and the building permits or licenses are to indicate the location of the facility.