96 NORTH ST - BUILDING INSPECTION (2) 44-* SililliSTIBE fiLfID-AftD APPROVED By TIE
,W5PECTDR,PIWR TD A PERMIT BENG GRANTED
CITY OF SALEM
No. Date s , l
ward
�°�trcrs' Zoning District
Is Property Located In Location of 1 )1
the Historic District? Yes_No ✓ Building 1
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,
lep lr eplace, 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 t kire CI alIlr'
n� �h
Address & Phone g� ��? ,�t (9A) 1<15-5x15 qj qq 6120
Architect's Name /
Address & Phone
Mechanics Name
Address & Phone I
\ what is the purpose of building?
Material of building? If a dwelling, for how many families?
Will building conform to law? Asbestos?
Estimated cost _City License a state License a
Hove Improvement
V.J Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
r-,)olri(I'M 0rp je)(In4ina IIJO k iek1ir I riiiA M/7ffl /0� vIIrmd #IoIrle)
p U �
MAIL PERMIT TO: qua ' Nt71(/1 ea f PL?/1 hYI7(
No.�—
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
19
A=
INSPECTOff OF BUIL I GS
CITY OF SAUX
BUIWINGDEPARTNIM
iioNmOW NEPP,UC.ENSEF]�i�'1ZON
Pk=NO
DATB
HOMEOWM
ADS q�8 a43-6fz
HOIEOoftm 15 -5.74MMEPHM
5
i
pRFSFNf Lt MURGAMU" Gf� 1vrrL�h � �Q_L7Ia�
The avrent.c wmocmi of'homeowwn7 wa wended to brch oak ow T-OP02 of dwel"r dTwo
Uain a kss and to aftw such komeowms to=Vp an bAWdW*f bin wbo doa na pones•
iioease,.pmvided dw the owner ad v wpa'wmn
DEM4r pig]OF HONff.OW14M ao reside.oa wkkb tkae$a is
Person 0)wbo owns a psatzl of WW ca wbieb htwK"aids a kuends b nteh the sndht
intaAW to be,s one b twa&mk dwtM aS amd"a dcudod Mumm�sba0 W& o Mdasd
farm svucwm A pcnan wbo consv=mole tm an home in s two-�a crW���bms
a bomeowm. Suds"homeow•aef• shag snbndt to the BuDdiaS Offio+aL m a the b milts pesat
Bwldiug Offd4 that bclshe be tespombk b aA ra&wwk pctfamed
The undesiped'komwwna"assivm responsi%Ift Sot compiiana whhthe Stint BvD ft Code sad '
other aWgcgbk Soes by-laws,nda smd re=oladma
The wdmsipasi"homeow'ad =d8a that he/she mZastands the City of Sakm BAWbg Depatoaat
mumm inspatias pmcedma and tequveaums and that Mahe WM�"�>aid pmeedmn sd
ma
Aj4L�L--
HONWWM.S SIGNATURE
APPROVAL OF B=ING Df5PEC1 OR
See other side for salt code
i I
i
PUBLIC PROPERTY DEPARTMENT
IZO WASHINGTON STREET, 9RD FLOOR
SALEM.MA O 1970
TEL (976)74"593 EXT.360
FAX (976) 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 constriction activity
governed by this Building Permit shall be disposed of in a properly licensed solid-waste
disposal facility,as defined by MOO a III,S150A�.. /
The debris will be disposed of at: g(o
Location of FaciW
Signature of eumit Applicant Da e
FULLY complete the following fi&mladm.
(PLEASE PRINT CLEARLY)
la ire �hr�1,�l�r
Name of Permit Applicant
Firm Name,if my
Adder,City&Stare
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 ca S150A, and the building permits or licenses are to
indicate the location of the facility.