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9 OCEAN AVE - BUILDING INSPECTION f1lr leiMW "m F6 QN0 OVED BY T4IE r. . J�LS,1��1lGA .BEWf3 GRANTED `{; CITY OF SALEM Dab fM Wdado D „ Y«_No Location of WrW M PiWmly Loo.Md in :• ft Co mm a"n MM? Ye__No BUILDING PERMIT APPLICATION FOR: Permit to: (Circle whichever apply) Roof, Rer9gk Install Siding, Construct.Deck. Shed, Pool, epalN epla , Other. PLEASE FILL OUT LEGIBLY A COMPLETELY TO AVOID DELAYS W PROOReg" TO THE INSPECTOR OF BUILDINGS. The undemigned hereby applies for a permit to build according to the folbwkp spedficatlonr / Owners Name Address S Phan 69a4w Architect's Name Address 3 Phone ( y Mechanics Name )01 60 o��, Address d Phona�., � ! q,. Whit Is rN pupoN 01 buNtJllq? D�� / H?i r'`: ..uxl MrMId a buYdn04 dwNMq,for how mo hmaM7 wN O A*Q oonrorm b 1wY? Mbwoo4 �; Ednwud ooa-j4,4p CRY uor 0 �l ignat of APWAnt SIGNqD UNDER THE OF PERJURY DESCRIPTION OF WORK TO BE DONE MAIL PERMIT T0: 100A)91, 0 , .. ^ APPLICATION FOR PERMIT TO 2�air �i iei, C�� Y LOCATION PERMIT GRANTED AP/PAO&VfD INSPECTOR-OF BUILDINGS , s e R i MORRISON REMODELING AND REPAIRS LIC N 133293 F 63 Cross Lane BEVERLY,MA.,01915 (978)927-2005 LICENSED INSURED HIC Lic no: 133293 978-927-2605 Beverly, MA, 01915 FAX TRANSMISSION: FROM; Gary Morrison PHONE: 978-804-9597 TO: Tom St. Pierre PHONE: 978-740-9846 ' #! OF PAGES INCLUDING THIS ONE: 3 MESSAGE: i Tom, j' Here is the CSL license we discussed yesterday so you can issue the permit to me for 9 Ocean Ave. Salem. I appreciate your flexibility. If you have any questions, please:call me j on my cell phone 97 -804-9597. �J�l Thank you, I' Gary Morriso i it Ij DAxE RETURN FAX NUMBER: 978-927-2005 I' i w cv o N Cq BOAS? 0 .B s .:8 U -' License. CONSTRUCTION SLAP.€R1fISt Number:' CS 085175 Birth. ate 01110/1964 0120O7 Tr. no: 55 Restrlb€e : 00 JONATNAN W GOODti�'ftN �-- 4-8 RQ81#VSON "E BRAINTREE, iViA -02'1 U Admirnsiratar b t � w o v l .,yy � l--.�....a- � = r .r. a-%a€ >...,z'Fw •x ,,,,.:y-" s ;.r4.- .y . -:E—.ue .+�:} � a Oo- 35,O00 cf enclosed space (MGL'C '{12 S 6OL) 1A - Masonry only fG - 'I A 2 Fantiily Homes ailtiire to - possess e curt6dt editfon of the '. fillassachuseds State Building Code is cause for revocation of this license. h L . DIG SAFE CALL CENTER: (888) 344-7233 Com,,manuirAk 01I 1.1 w6aAcLai S �JaparGaual o/.ladr�eiel�reeia r�t . 600 //1aryw�►"LIL m SL,,d names x Gnwess &,I , u.A.& 02111 Carnassaar Workers' Compensation Insurance Affidapit I, �AzQur it9��Is9�l A �11210 . . witha principal place of business at: do htreby'ccrtify under she pains and penalties of perjmya that: 1 am an employer providing workers' compensation ccvera=e for my crsaployees working an this jo . Ulr' o© U5-91uol Insurance Company Policy Number I am a sole proprietor and have no one working for me in any capacty. () I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following workers' compensation polices: Contractor insurance Company/Policy Number Contractor Insurance Company/Policy Number Contractor Insurance Company/Policy Number () I am a homeowner performing all the work myself. I vn00%,,c we a coon o!"a,imnm wo be icn aroed w d+r Once e1 Ww*3oonc of drr DIA 1P cv. ate recSkadon OW ex laailr od aueare co.arare of rrdarro unow Srccion 25A of MCL 15 2 can kid co du iTOGWon of crv"nai eennon eonaucint d a rar of no 04 I,MXLW+nd«doe ream'irnNne"rnrn(of yr at[iri oenallitl u+e loan o!a $TOP WORK ORDER and s w of S 100.00 a asr api" ant. Signe this day of O ..ic ,see crn�ittcc "ouilan€ Gepa rent 'icertaing Ecare Seiectmens Office r,c:lt:h GcQ:r*mcr:• PUBLIS PROPERTY DEPARTMENT 120 W/�91NGTON STREET, 3RD FLOOR SALEM,MA 01970 TEL (978)745-9595 EXT. 380 FAX (978) 740-9646 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,S115L0A. T The debris will be disposed of at W � / Z %�S�� L� ®V�L�, A" Location of Facility 4-3 Sr of Permit Applicant Vale FULLY complete the following information. (PLEASE PRINT CLEARLY) (2& �Yo�'�'o�1�1 Name df Permit Applicant lb,0AZ&Oa &ZLO Firm Name,if any 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.