The URL can be used to link to this page

21 SETTLERS WAY - BUILDING INSPECTION (2) { 4INST-BE f*D4AND APPROVED BY T44E .jnPECTD13 ,PFM0J3 i_D"A PERMIT BEING GRANTED CITY OF SALEM O� NO� �C-VOI.I �r�`t' •� �i3}\. Date -2L s N6 W Is Property Located in Location of the Historic District? Yes_No Building 1G Is Property Located in 2 S 414 the Conservation Area? Yes No BUILDING PERMIT APPLICATION FOR: Permit to: (Circle whichever apply) Roof, Reroof, Install Sidin Construct Deck, Shed, Pool, Repair/Replace, Other: lc.hPi j Cev&t_f 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 �fJ 22�LL �iLe� lL Address & Phone Zl cf'e 41,c:"L S (j 59Y- SI) Ce, Architect's Name Address & Phone L ) Mechanics Name Address & Phone r� ) What is the purpose of building? /t z 5 Material of building? /yc)L>� If a dwelling, for how many families? Will building conform to law? C ej- Asbestos? Alb Estimated cost /0 Do City License ff N A State Lic nse # cj Home Improvement Lic. # I l L X Signature of Applic SIGNED UNDER THE PENALTY OF PERJURY DESCRIPTION O/Fj WORK TO BE DONE /7 O/teslJ L'i 1 c F1'1/ MAIL PERMIT TO: rr '1 No. 22`L 2-0©L-k APPLICATION FOR PERMIT TO LOCATIOM PERMIT GRANTED 2- APPROVED INSPECTOR OF BUILDINGS �o OF SA LEM5'MASSACHUSETT5 IL PUBLIC PROPERTY DEPARTMENT 120 WASHINGTON STREET, 3RD FLOOR , A SALEM,MA 01970 '?r TEL. (978)745-9595 EXT. 380 4arnr� 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 S150A. The debris will be disposed of at: N0 n Pl M � Location of Facility Siermit App t Date S� FULLY complete the following information: (PLEASE PRINT CLEARLY) V"L �� Name of Permit Applicant cam/` PO nT S-ens(w S Firm Name,if any 2� Se crt S w � SAct 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 clII, S 150A, licenses and the building permits or are to indicate the location of the facility. ��T�m 6Q� a aco3 /,S e Q� LJ G.PIL_ /nVo/✓ems 6ui/dint c.- / l�[1�I}/ — (focrrnmonLUsAhno/ /llassacftf e 9 _ ,.,L. 1 o/.J,+iaf i+cciau+la boo WaJ:a,,1an.31raa1 Barnes J.Catrwoell a1on, assaeluwW 021 11 Co dwssrona Workers' Compensation Insurance Affidavit (ay......e.pee� _ . with.a principal place of business at:. (rhrneauntr) . do hereby certify under the pains and penalties of perjnrYa that: () 1 am an employer providing workers' compensation coverage for my employees working on this job. Insurance Company Polio Number --,-am a sole proprietor and have no one working for me in any opachY- () I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following workers' compensation policies: Contractor Insurance Company/Policy Number Contractor Insurance Company/Policy Number Contractor Insurance Company/Policy Number () I am a homeowner performing all the work myself. I understand that a covr of chic sutemtat wit be iorwaroed to the Offce of 1m 6gaoons of the DID.for co+ zfc•`eAhCadan and CM(ante to aed"" co erasr m reoureo under Section 25A of MGL 15 2 can lead to the intoo3nion of crirnisui oenatdes corastint of a fine of wo mi 1.500.00 aedlor one rtan'irarudnn+ent v.trt as eiei "mimes in the Iorm of a STOP WORK ORDER and a face of S Io0.00 a am atarot me. Signed this . day of 2. Licc ec/Fcnniuee building Gepartnsent Licensing board Selectmens Office He2ith Department - - ;_co00 X4C_ 404, 40S� `0° Z�c I TG Vtnirl" CG'✓*kf�.G� 1NfL��% .. i iON Cr:LL. . � , . . License: CONSTRUCTION:SUPERVISOR } fi 'I Numbeii CS 085458 ;' Birthdate 01/.1.5/1966 h EX{ur¢s 01I1512007 Tr.no: 85458 • Restricted '00: �� PAULV'DESTEFANO- i/ I: 21 SETTLERS WAY` Z4 � SALEM, MA 01970•' Administrator F A