8 TAFT RD - BUILDING INSPECTION I i"9E lPPR
OVE{) BY TiiE
5 r' EAOt pT .S1=W0 GRANTED
IT� OF S LEM
N9. Date
y fK! Ward
i � F
Zoning District
Is,Proporty Located in Location of n�
ta,Fllat'oric District? Yes_No Building
Rroperty Located In z
he Consa'rvatlon Area? Yes No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roo Reroof, Install Siding, Construct Deck, Shed, Pool,
-Repair/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
Address & Phone PT
Architect's Name
Address & Phone f _
Mechanics Name FI-nl/nl� C�Aj AGrw5
Address & Phone �l IVOETIaAI(9 9/16* 4
What is the purpose of building? 461vilvnpq L—
Material of building?^ (n )UU 10 If a dwelling, for how, /many families?
Will building conform to law? Asbestos?_A16
Estimated cost c> C0 city License k i ob state uc9m a 71119
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Sign lure of Ap _tic t
SIOMED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE i
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OF•SAUEM. MASSACHUSET"PS
v6� PUBLIC P ROl�ERT`''�PEPARTM ENT
® 120 WASHINGTON STREET, 3RD FLOOR
SALEM,MAO 1970
= TEL. (978)745-9595 EXT.380
s4
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 III, S 1/550A.
The debris will be disposed of at: M,506
Location of Facility
4situAre 6ofP em Ap' icant
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
Name of Permit Applicant
Firm Nam�e/,if any ,l
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 cHI, S 150A, and the building permits or licenses are to
indicate the location of the facility.