46 SCHOOL ST - BUILDING INSPECTION (2) -PL-*NSIMIST-SEf lx-E Nrfl APPROVED BY T44E
dSIP.IJ=CTDB PWDR TD.A.PEAIT t3,EING GRANTED
CITY OF SALEM
No. :t '� Date l3o 06�
Is Property Located in Location of
the Historic District? Yes No_ Building /��p cSCi rCl�
Is Property located in
the Conservation Area? Yes_No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding�onstruct Deck, .Shed, Pool,
Repair/Replace, Other. nl A9ora Y 2ePa«3
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
Address & Phone 9LP � chod CSf 0A 19JIN- 4W1
s.. Architect's Name
Address & Phone 1
Mechanics Name
Address & Phone
What is the purpose of building?
Material of building? If a dwelling, for how many families?
Nil building cont7060
law? G� Asbestos?
Estimated cost city License M N A State ucer" M
Base Improveaent XOigohture
t r4Lic. / of Applicant'
SIGNED UNDER THE PENALTY
OF PERJURY
i3EyLRiPTiOiv OF rVORri r3 cs:: D --
4r;-1 7z f Yn C
MAIL/PERMIT TO: e�;7LV", - � � �42 •��y
I
T _
No.
APPUCATION FOR
PERMIT TO
l
IAc� 1 Jeom d krP-S
LOCATION
PERMIT rGRANTED
APPROVED
OWISOECTOR OFU3UILDINGS
n i
r
CITY OF SALEM, MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
IZO WASH INGTON STREET, 3RD FLOOR
SALEM, MA O1970
TEL. (976)745-9595 ExT. 380
FAX (978) 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 a S 150A.
e.
The debris will be disposed of at: /��,—����L! r r cu
Location of Facility
Signature of Permit Aliplicant Date
FULLY complete the following information:
(PLEASE PRINT
CLEARLY)
c/vc%/- Jl,s ;' �
Nam of Permit Applic//oo �
t
� z
)
Firm Name,if any ( /
Address,City dt 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.
z
•
CITY OF SAiEM
BIWING DEPARTMM
xal.OWNER IICFNSE EMOMON
Pkaae PAU
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PREMf PfrMAUMM ADDRUI_
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fie,paovaed dwt�e dw.er.a...upa..k.a •
DEnNIIp]O!'1 CF HO M EOW SM
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farm nrwuet A pram wbc oorntroets mac them cmLoma bn a twerym p�Ad
dad
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othu sppliobk Sots k-kwa,rides ad rePbd=L
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raq�ft
HOWOWM'S SIGNATURE Q
APPROVAL OF BULDING WMCPOR v
See abet side for mu cods
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HOMEOWNER'S EXEMPTION
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exeagri from the pto�iaioaa of thb secdon(Seetlm llp&-11ocnsl*S d GmtnKlku SopervberA;
rrovtaoa th.t b a homeawaer enpSe.peraop W to hits to do.aucb wwit,Clot avcb bo®eow,er ahatr rat .
mwW botgeo. =vbo we thb camom we"wets that they we awasubg doe larjandWWW its
superrbm(one Appeadb Q.Rnles and ReSwimikoe for ltesnsloS Cemtnmdm Srpar tsoM Saetm
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urjkcaxd pcneac !n thb aaaa yom&rod caTmot pmcmd apta the mutoemeo peeps n it u via
liecascd Sapa vim. Tito bomcowmer acting sJ supoodsar it r hfasole�nrpsaW� .
To non om tls hom avv im b fuib swore ctU#hw vczpowibDhlc%oaasq aom®mtidea tagoVR as litat
of am pcmdt appikodon.that the bomeawaer caft drt bcWw mtdetsaada the nspmsibD>dn ate
tos io
. Yor erTe to amend and atteb a fotadbettlfieatfos ibr your
supervbx taq adopt