237 NORTH ST - BUILDING INSPECTION i
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DATE: O S
�itp of 'q)afem, saa!�E;arbu5ettS
PLANS MUST BE FILED AND APPROVED BY THE
INSPECTOR PRIOR TO A PERMIT BEING GRANTED
Location of Building -7
Building Permit:Application For:
jCircle whichever applies) Roof, Reroof, Install Siding, Constnrct Deck, Shed, Pool
Addition, teratio Repair/Replace,Foundation Only, Wrecking
Other. :t
PLEASE FELL OUT LEGIBLY & COMPLETELY TO AVOID DELAYS IN PROCESSING
To the Inspector of Buildings:
The undersigned hereby applies for a p
ermit to build according to the following specifications:
Owners Name: 1 a`C Contractor:
Street /V d '4. City s l uA Street. City
Stater/ Phone ("t"D 2 IS- I Ti;5- State Phone(
Architect. City of Salem Lic
Street City State Lic# HIP#
State Phone { Homeowners Exempt Form_/es no
Structure: (please circle) Ingle Famil Multi Family# Other
Estimated Cost of job S l01000 2A
Will building confirm to law?-L-yes no I U
Asbestos?_ _yes.no Ckk LrLewv-,
Description of work to be done: ( (�
y-`'70L Qn/"' Ny-- U a94--�cy,- i C n`o�v�p C Co clan s -
S 4-ELL.1 -�kdoa-�.kA 4"2 I a't- \J
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Drawings Submitted: es no Mail Permit to:
X
Si f icatton,SIGNED UNDER THE PENALTY OF PERJURY
CONSTRUCTION TO B&CO`\MPL\ETED WITHIN SIX(6)MONTHS OF PERMIT ISSUED DATE
Department use only: Permit'# v `u�JZoning Map/L 1.
Permit fee$
COMMENTS:
A
CITY OF SALEM, MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
! SALEM, MA O1970
TEL. (976)745-9595 ExT. 380
Is 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,S1150A. ( p
The debris will be disposed of at: �j 0V "`S`t�2 �t�w�. ( ,, _ S 8- n scvNF
Location of Facility j SeLk dvV
G a os�
ignature ermit Applicant tDate
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
\saDQs" IUCOVAL
Name of Permit A0plicant
NIA
Firm Name,if an
� � 7
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 cIll, SI50A, and the building permits or licenses are to
indicate the location of the facility.
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