9 NORTHEY ST - BUILDING INSPECTION (4) v
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1dttSTeEffiz-E jAfPROVED BY T44E
11�,Sf?ECJAJ3 f IA TO;A PEAWT.S,EWG GRANTED
CITY OF SALEM
No\Q)��—�� �5 <`` � 5� Date
Is Property Located In Location of `\
the Historic District? Yes No i/ Building p�yM t
Is Property Located in
the Conservation Area? Yea_No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) eepairtlRep:loa:'62,�err�:
o , SidiConstruct D Shed, Pool,
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 AU_An�
Address & Phone 9, �0(,Tge-1
Jo ST _ SAckwl,Mf1 (RY°6) B52 428
Architect's Name �ti I'�e oA; r1 M'Z Z Co Q�X�
Address & Phone n% t 2.-ia '7gR2
Mechanics Name �J `Cc� lam, --AA /I ..
Address & Phone `R>v >�J��^�'�S � ��ai c n 1 cm- (p(o7
M ,
I
What Is the purpose of building?
t
Material of building? Gloat) If a dwelling, for how many families? {
Will building conform to law? V cS Asbestos?
�j
Estimated co st° OZ9 fl city License # N �' StateJJ M _��
� iEiil�� E
Boma Improvement
Lie. iCS oSfG9491
Signature of pplicant
SIGNED UNDER THE PENAI<VtV �111���,� I'
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
EI
1 I
^1 , `y
Rjj 1
II �
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MAIL PERMIT TO: E
m it
yi.
APPUCATION FOR
PERMIT TO
LOCATION
0
PERMIT GRANTED
Q.
2-6
AP VFD
INSPECTOR OF BUILDINGS
W PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
SALEM,MA 01970
TEL (976)745-9595 EXT. 360
FAX (078) 740-9646
STANLEY J. USOVICZ, JR.
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the provisions of MGL c 40,SK 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 defiled by MGL c III, S 1150A
The debris will be disposed of at: aS'1 D
Location of Facility
Signature of Permit Applicant Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
Name of Permit Applicant
Firm Name,if any
P�t'x
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.
'a C✓/re . .Ir/e .�..'4ieella .
BOARD OF BUILDING REGULATIONS .
Licenser CONSTRUCTION SUPERVISOR
'k. Number CS 084944 `x
Bl"hdg" 02/09/1974 ` E ,
i 02/091200j �' (f
no 84944
CHRISTOPHER J,TILLI1AgN
500 COLOMBUS AVEStPT#1;'"
n BOSTON,fMA 02118% ^- a
t MiniStrator, {t:
C SEGOND FLOOR PLAN
»-b U
SOE ELEVATION a REAR ELEVATION y
i
1�
o
SIDE ELEVATION
n RRST FLOOR PLAN
The WM GROUP