The URL can be used to link to this page

28-30 ROSLYN ST - BUILDING INSPECTION (2) L iMST-19£fiL-0� APPROVE{) BY T44E fJ 5PF&TOA ,PRWR TD A_PERMIT.BFJNG GRANTED _ CITY OF_SALEM No` �_ . \ J ``� ..L �,,\ Date 4 I\ La ' it I� Ward lt \"�omHea' Zoning District Is Property Located In Location of the Historic District? Yes_No_ Building $ 30�1 OS�y� gr � Is Property Located in i the Conservation Area? Yes No BUILDING PERMIT APPLICATION FOR: Permit to: (Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool, air/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 according to the following specifications: Owner's Name 0 `gacy-ton 6'u-Vi oarE--i Address & Phone a Sln S+- (9 40 1 0 Architect's Name Address & Phone ( ) Mechanics Name d-�Aa✓ p ►JAO/6 teG t. Address & Phone 61? 11` 401a2 (61) ) $L7- 35S y �venerr `!93 02/�r� What is the purpose of building? Material of building? If a dwelling, for how many families?9 Will building conform to law? QS Asbestos? n J Estimated cost h3000 City License# State License # ' \ Home Improvement )\ / ignature of Applicant SIGNED UNDER THE PENALTY OF PERJURY DESCRIPTION OF WORK TO BE DONE N�f Q�oo.Q MAIL PERM IT TO: 102 PWWO S�- -1�yek- M ©�Y { ry w I No. APPLICATION FOR PERMIT TO LOCATION PERMIT GRANTED /o C./ 19 AP7AOVED , INSPECTOR F BUILDINGS F- PUBLIC PROPERTY DEPARTMENT J 120 WASHINGTON STREET, 9RO FLOOR SALEM,MA 01970 a TEL (976)745-9595 EXT.960 FAX (976) 740-9046 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� A III,S150 / 1 The debris will be disposed of at l Location of Facility Signature of Permit Applicant Date FULLY complete the following information: (PLEASE PRINT CLEARLY) �vAr� ,A-. NA9lIJ«5 Name of Permit Applicant �2O pli 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,S150A, and the building permits or licenses are to indicate the location of the facility. r .�'Boardbt Building.Regulations and Standards _ NOME IMPROVEMENT CONTRACTOR Registration: 129520 -- Expiration 9/17/2005 . _ " Type-OBA . -- Nadales Remodeling ' Juen'Nadales X k r 68 Wareham Street 03 ",.-P,��„i F Medford,MA 02155 Administrator d r :-• .<� �ommOnW�sLtt� O1 �C314G/1West0 j . � . cciaaals 600 .A.11.o S4-d amet t CureoM &d, M...LA 02111 Calaneaoear Workers' Compensation Iuasrance Affidayk I, a1.aO,pLaS C/�QHoD�L,,n/G . . . withea principal place of business au 2,- ;'1 . do hemby'cerzfy under the pairs and penalths of perjury, duo ' () I am an employer providing workers' comperwtion coverage for my eenplorees workbag M 211111114. —ac FAQ (60,7) S6$ 307p • �ed�'N � r N�v 2A�J� '� Insurance Company Policy Number S 1 am a sole proprietor and have no one working for use in any capacky. () 1 am a sole proprietor, general contractor or homeowner (cirde one) and haw hired the contractors listed below who-have the following workers' compensation poQden Contractor I insurance Comparry/Policy Number Contractor Insurance Companry/Policy Number Contractor insurance Company/Policy Number 0 1 am a homeowner performing all the work myself. I rwanune mar a CM o!Ala wOmmem we be Jm Move m w One.*I k.eira-- o!dw DIA kV ce.erara ee.ikaeae aM ON lam ea Oman eo.eeap x reaure.anoer Secien 2SA a/WU 152 can kae Om she wwoadoa of eriwirm oeaade earsowar a/a rar e(w n-61 %co 0 antler one teen'inacoennrnt a%a a eiA ocLowe in the loan at, STOP WORK ORDER ana o inn of $100=3 aw ar"we. Sitmed this • day of r iccrseciFcrmiuee Building Deparm-ent t Jcen:inf Eoare Seieamens Office rie:lth Gepsrmert e04 ape• _pe• 77! L.