7 SCOTIA ST - BUILDING INSPECTION -PL-*M-VWT-BE fiL{-�-1f/O A?PROVED 8Y T*IE
WSP,EC.TDR PFWR Tp A.PEHNUT B NG GRANTED
CITY OF SALEM
No. l '7A0� ,y��`' P.'�, ?s� Date 0`
N �.
hINB
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: 62„y)t4 A,'/-
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 A
Address & Phone S �T(/� ST
Architect's Name
Address & Phone 1 1
Mechanics Name Itt D5 CS�i?tivai
Address & Phone CO ' sue (92,b 7 y
What Is the purpose of building? Q-r c�
Material of building? L.ic> If a dwelling,for how many families? /
Will building conform to law? Asbestos?
Estimated cost 5,y c)0 City License# N A State License
Cam. -79Fs r7 Home Improvement
Lic. #
ignatu Applicant
SIGNE NDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
i
I
MAIL PERMIT TO: /V'
i,
•t
No. ook
APPLICATION FOR
PERMIT TO
LOCATION,
PERMIT GRANTED
ATROV�D
V//2nau
INSPECTOR OF BU DINGS
CARTER & TOWERS ENGII�EFRItiG 'G:ORP.
J060M o. CARTER. PNONKM - 0 FANlVIEw AVENUE
RfN�TNRY LM %UWnV" t YIC CMa:on"=Rt
SWAMPSCOTT.MASS.01907
Tot.39240"
SGoT�p
I
1 I i
No . - i To the Scrr/ S� ✓i✓i5
and T-f :z,—s�,cex
Gam.- F
a T 1O I hereby ceRify that I have examined
• i the premises and all easements,
LoT Z encroachments and buildings are
D«k
located on the ground as shown.
ae, E N further certify that the buildings showy
conformed to the zoning laws of
" Poot
e rha . when constructed
further certify that this property
locate ' he
6 52/s F esta ished fir rd
sz S } 90 ph D.Carter L.S. #9387
VOTE; This oertif20 is based ort the
location of survey markers of..otbers, and l.E P aF
ioN
does not represent a property survey.
To bq used fbr.-ldortgagd purposes only.
Plot plan of land in
. �111 Or
Belonging to,4 �rAXt.rS T. ¢/114,ele J/91 A.4ivCo �� bsi>•rl �
g DAYID
Scale 30 fit. to an inch
• ? Nv IOe/.Q
Date40
sreo!
sue4
" —Y OF SAIPEM. tYLFDDAvnv�,� + . ..
PUBLIc PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
SALEM,MA 01970
TEL. (978)745-A595 EXT. 380
aye 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 MR.c III,S150A-
The debris will b '
of at: c9 h -S�C7`� A,1
Location of Facility
Signature of P plicant Date
FULLY complete the following information:
(PLEAS CL Y)
Name of t Applicant
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 CM, S 150A and the building permits or licenses are to
indicate the location of the facility.
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