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11 SHILLABER ST - BUILDING INSPECTION y,o 0 1al-*MS*WTM3E f4L-el3 ildfl APPROVEO SY T44E .WSPECTDR PRIDR TD A PERNUT BEING GRANTED CITY OF SALEM Date -7' 1 3-d Ward Zoning District Is Property Located in / Location of the Historic District? Yes_No V Building Is Property Located in the Conservation Area? Yes NO BUILDING PERMIT APPLICATION FOR: Permit to: (Circle whichever apply) Roof, stall Siding, Construct Deck(Shed)Shed, Pool, Repa r/Replace, they: 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 Spre: Address & Phone Upnr 3t- (Q713► 7r{5=g/q? 6a1�e"- vv4A- Architect's Name Address & Phone Mechanics Name Address & Phone What Is the purpose of building? 510 fil P_ Material of building?_Wnj- \f A14 If a dwelling, for how many families? Will building conform to law? Asbestos? Estimated cost + /�`` City License x State Li B T f i o 0 o Boas Isprovownt Lie. i Signature of Applicant SIGNED UNDER THE PENALTY OF PERJURY DESCRIPTION 9F WORK TO BE DONE r k l ©v, STa4 a�4 6 ` k 2 MAIL PERMIT TO: v ) No. _ APPLICATION FOR PERMIT TO LOCATION PERMIT GRANTED 19 A7P OV�D INSPECTO OF BUILDINGS-- CITY OF SMMd �. BUIIDINGDEPARMvM f HQ,vmow R LICENSE Em'110N Pkaw Prbtt DAYS - 1 7-L =I=AT"l (J�vk4 - nF HORr¢AWI� - - ADOW* --------------- ( � I PRESENTMAMW, GAMMM Srtl^3 P �S i0ove Tke cwtcrtfxempdop of-Mmeowq=C was emmded m bcludc 0r-OFwpled.dwdtlep oftTm l)nits or kas udyiovided b allow snot Domeownera to engaie m bdh�idWllot bbs who doa smt powes� . . thm the ewwer at as wrcrvieaa DEFOCTMCFHOMEOWNM on wLSeh Lckhe resides or bue>ds ro resdde.en wNcA sae f�a 4 Pcaoo(s) K owns a "m f dwc amdwd m dctsded tutr="�So nxb m sadM intended m!e.s one rs two family u nw perW sbA swt be c9nslderad farm strtuuaes.A Per+ct who cor►structs more tan cm bomc in a two- �>t a bemeowaer. Sao.Wo. nVcrtmbkwall sods work perfmmed miler dtc bo"dtog pooft Btu'ldbts O1Ticial. . m.undmipwd-homeowner'aw=x s respordbift fm amp w�9t the suit Bt11d6><Code tad other appbcabk goes b}-laws.raks and re=ula =& e tmdersigned'boaicowd'n colma that bdsbe a9 of salon Bnndbo tdw= Est. Th minimtoa bLvwdon pmadma aril rc acmcros and that hhbe will why wM�P00 and HOMEOWNER'S SIGNATURE APPROVAL OF B=ING INSPECTCO)R___14 Sac otha side fm sage code k . ...t ✓" AIN PUBLIC PROPERTY DEPARTMENT w 120 WASHINGTON STREET, 9RD FLOOR ' SALEM,MA 01870 TEL (878)745-SSSS EXT.380 FAx (87e) 740-894o STANLEY'l USOVICZ, JR., MAYOR DISPOSAL OF DEBRIS AFFIDAVIT In accordance with the provisions of MGI,c 40,S34,I aclmowledge that as a condition of Building Permit 1�_ .all debris resulting from,the cons ncti(n activity governed by this Building Permit shalt be disposed of in a properly licensed solid-waste disposal facility, as defined by MOL c IlL S150A. The debris will be disposed of at Location of Faeft Signature ofof P Applicant ? (�0-4 _�� APP � Dam FULLY complete the A)HOW oS M&Mation; (PLEASE PRINT CLEARLY) el,ve� Name of Permit Applicant Firm Name,if any Address.City dt State — The above statute requires that debris from the demolition, renovation,rehab or ottier alteration of building or structure be disposed in a properly-licensed solid-waste disposal facility as defined by MQ,c1II,S 150A, and the building permits or licenses ate to indicate the location of the facility.