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36 RAYMOND RD - BUILDING INSPECTION , 3 Cle- fL11i1is-MWT-Ef&404Nr1D APPROVED By T;mE WP=101 PRIOR TD A_PERMR t3&ING GRANTED i CITY OF SALEM No. 1 Data Ward Is Property Located ti Location ft Hhfodc DMhcf? Yas No_ DaildinD jC C�J/Pi Is Property Loaded In lha Corm MWM Ann? Yes No Permit to: BUILDING PERMIT APPLICATION FOR: (Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool, Repair/Replace, Other. PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROCESSING TO THE INSPECTOR OF BUILDINGS: ' The undersigned hereby applies for a permit to build accorcLig.to the following specifications: Owner's Name Address & Phone a'15-e j 6 Architect's Name Address & Phone ( I Mechanics Name— Address & Phone/&` S ((Wll Y8/-c�alJ What is am papra a tadldkrg? mdWW of tu~ n a dwaw.g,for how many farness? wa buAft omform to law? Asbaatos? E*naml coat City Lkam s Ststa Um"N Dsaa Izprawr t Lie. / Sign ure of Applicant SIGNED UNDER THE PENALTY, OF PERJURY DESCRIPTION OF WORK TO BE DONE MAIL PERMIT TO: /� 5 �©tftise ctiPls-ts ,C,� )c, .7L a APPLICATION FOR PER ff TO LOCATION } PERMIT GRANTED VFD INSPECTOR OF BUILDINGS 1. v- U* PUBLIC PROPERTY DEPARTMENT 120 WAxmmaTom 6TRK T, 3RD FLOOR SALLM.MA 01 S70 TEL.(978)743-SEES EXT. 360 FAX (97S) 740-SS46 STANLEY J. (JSOVICZ. JR. MAYOR DISPOSAL OF DEBRIS AFFIDAVIT In accordance with the Provision.ofMGL c 40,S34.I aclmowledge that as a cc n"m of BWdinS Permit M .all debris resulting from the owmMuctm s(tvity governed by this Building Permit sball be disposed of is a properly licensed soH&waata d>simll flcr7ity.a.de$nad by MQL c Il;S150A. The debris will be disposed of at i/i�,r/�� /�� 4�5 Location OtFacafty S Applicant Date FULLY complde the following information; (PLEASE PRINT CLEARLY) zz Name ofPermitAppticimt Firm Name,if say Z�a��Sy Address,City dt Stater The above statute requires that debris firm the demolition,remvation,rehab or other alteration of building or structure be disposed in a properly-licensed solid-waate dispoaal fac k as defined by MGL tiff, S I BOA. and the building permit:or licenses ere to indicate the location of the facility.