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68 PIERPONT ST - BUILDING INSPECTION (3) 14--AM10tST-BEffLf� APPROVED BY T44E WSPECTDR ,PRIDR TO A PERMIT.B,EWG GRANTED CITY OF SALEM No. I Z2 l'l^ ©O LAF � Date P Is Property Located in Location of the Historic District? Yes_No_ Building 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, Repair/Replace, Other: �os51"'1-1 �22 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 Jw .4 e 1�S�o S Address & Phone �9 RerAmY, L OW) 57 2---5'37 7 Architect's Name Address & Phone ) Mechanics Name 4 Address & Phone What is the purpose of building? Material of building? 4,e o'f/ If a dwelling, for how man f WIII building conform to law? y P 5 Asbestos? Estimated cost d(O •,02 City License # N P State License # (-'-)rS IA Home Improvement Lic. nature of Applica SIGNED UNDER THE PENALTY OF PERJURY DESCRIPTION OF WORK TO BE DONE ( e X leC SAP S 94V MAIL PERMIT TO: No. Z o� APPLICATION FOR PERMIT TO LOCATION PERMIT GRANTED T' AP OVED t INSPECTOR'OF SUILDINGS t y coary OF SALEM. MASSACHU5ETT5 v6 PUBLIC PROPERTY DEPARTMENT 120 WASHINGTON STREET, 3RD FLOOR a, yp SALEM,MA 01970 �Sr = TEL. (978)745-9595 EXT. 380 �Grmu FAX (978) 740-9846 STANLEY J. USOVICZ, JR. MAYOR DISPOSAL OF DEBRIS AFFIDAVIT In accordance with the provisions of MGL c 40,S34,I aclmowledge 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 II/I,S150A. The debris will be disposed of at: /�D 5 �f Y r�y ` L""'� Location of Facility SZ* Ature of P Applicant Date FULLY complete the following information: (PLEASE PRINT CLEARLY) Name of Permit Applicant Firm Name,if any Ad , 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 cM, S 150A, and the building permits or licenses are to indicate the location of the facility.