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13 OSGOOD - BUILDING INSPECTION 1! y (>c .2 V fL MIAIISTINfIld omo APPROVER BY m WFM=POOR MD A:PIl RW BKM GRANTkD CITY OF SALEM W.rd Is PlOWY LoesMd M tomtlm of ft, mde0YMd4 Ys No_ fta"m Is P opwly LOOM In b CmiMaa.on Ann? Yo No Permn to: BU LDNG PERMIT APPLICATION FOR: (Circde whmumw p ) Roof. roof. I nftH Skft Conwm Dsok, Shed, Pool, PLEASE FILL OUT LEGIBLY a COMPLETELY TO AVOID DELAYS N PROCESMQ TO THE INSPECTOR OF BUILDINGS: '. The urdwsoml herby applies for a Perron to build aocor&-gto ft foMoairp Ownsrs Noma Address A Phone /� o sue, S �— F/26-i 7c-// —3�� Archnsst's Name Address A Phone f Mechanics Name Address A Phone f I wMr a.n pupm d eullaYg4 AMWw a buldnp9 N.dwUrq,for how ararry srna..7 wra arruiq two err Amb~ Ed "Aled ©9 Sara. ire �� T�s fII�iD I�pR Tm PENALTY oP Pmum DEscaNRION OP Wm ro BE pina ti MAIL PERMIT TO. ' > r 8°JPIIOIIf18 �O!!O � 3 I aJAOkddV --' z Z� O31NYd9 l r#.43d NOLLVOOI err � 9 Ol jmmmd UOd NOILVorm" CITY OF SALEM9 MASSACHUSETTS PUBLIC PROPERTY DEPARTMENT 120 WASHINGTON STREET, 3RD FLOOR SALEM. MA O1970 TEL. (978)745-9395 EXT. 380 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 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,S 150A. The debris will be disposed of at: �JO,'�A Location of Facility �/ 7 L 2�f AVpatuxi/of Permit Applicant Date FULLY complete the following information: (PLEASE PRINT CLEARLY) Name of Pemri Applicant Firm Name,if any Citi& 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 ca S 150A, and the building permits or licenses are to indicate the location of the facility. CTfY OF SALEM BUII DWO DEPART1vB;'IiT Holum R LICENSE F]ff arrow Pkast Pest ]OB LOCATION ,.,13 0,5 G1 TE EPHOW PAES�Nf>,dAII 4�!O ADDRESf���I/✓��� • The ewnm.eracMdm Of-Mmeow9cd'wm eraeaded w brcfide eweet-at:eMPied f^'tN6O G[TWO Umb a kis and so allow sudt lomeownen to erpa an bdhi W IK bba vbo dou not powers f llecaft,provi"thes the owner ad d aupsrrfoot. DgDqncmOFHONEOWib Pewoo(s)wbo cwm a pond d WW co wbkh hcMe resides or baends 1D mWk oO"MCh Ihm k�k . intended to et.a oot a two ftmW dwtMng rttadad a dcu oa dwd suwca l ���nsldetsd farm struenmt A pcnm who eotawvets=am t m owhaot IQaa a twtry POW .bmnowm. Sv*-b meownd'aT+allsubetdttotAeBu�din` ada bntldlodWss�~ Buildbe�Olfieid.thsa Lelslre be tespomtbk to aD snd►wmrk polaerad �• Tht wWmipcd-bovowne mntrnes mgo=%MV for m=PH=m wl*t n start BtrOd 9 Code md other sppBobk goo k-lows,rda and rePUdg eL The ww asip cd'homwwnd'arti8es thM mideasurds tin of Sakm Bnildloi Depoowt. minittrws bopccuon proesdwef ad rest ' and that�mm*wia said Ptooedmet d ycqWnzma HOWOWM'S SIGNATURE APPROVAL OF BMDING DWE See aha side fa stars code HOMEOWNER'S EXEMMON Tic code Sutes daC -uq homeowaa paforminj work fa s boildb�raadi�iegied1 M — - - exempt ftm dw poMamr of tbi eeedom (SM+low 7ey.0-1lansial of Coasuroetkm Sapavi w**O provided to b a bcmeowna a Wga s price(s)foe bbe a do.sacb w=k tbss rA&bo®eowaa efcad!emt MWW bon.wownas wbo we ibb cramp im we i uwwt dat tbey are axmbg die pcgondbdlda aU _ supavim(pee Appeodfr Q.Rula and Re=ubnbxss for IJ=osioe Coca rmcdom Sgesvbass.Socd m .2.24 7bb b&of awwterMIS CA=vtmft Is serious pab)6a. dw boseowa=Ass inhumed pcu ma in dds can yow Bard eamm p wood spahm ik muxxmed pofom n llwwid va Ikcased Supavim 7be bomeow mer swim=as sopervfsW r ab TLowML To emore dm dw homeowner b My aware otMw mpomr3bMdM nmq oomramdtfsu uegabR a paw of the pami{eppliodm d+n dK bounowna oddly Om b&Wn sndasands dw tespousibumn eta oVavbm You mq cars to amend aid adopt rifts knakadfiadam fisr un b►your commm*&