64 TREMONT ST - BUILDING INSPECTION (2) What io"cunwt use�7 M dweMnO.how
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Make age fields an prop«b 04 MOW wrlftan b avoid delays In �
The vWsWwd does spy apply for a fl A*q PwnA Oa
do stated
s,Ococxdo"e6 stoned under wwv of pwj" patst `3
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ALALS CrrY OF SALEM
,a PUBLIC PROPRERTY
DEPARTMENT
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p' addktam
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dpltt afasm poloa pt hM 1 I.Q P��ar aditlm
myseht[No workaa•comp• a 15%f ft aid we have as
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f In �eetra..garrub4a•t mown sown
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Innnaaco Compeoy N&nW
Policy Nor SoIRInt Lie,A,
lol Sits Addmw Fxphdoo!4
Attack a copy of the werkara•eomWaaatloe tab CRYMAWZ
P"q declaration page ohow the policy aaraaler AM expiration go secure aoveage Ad MW&kW under dlq�
fine up b 11,100 oo aad/ar Semta 2JA of ItOi.a 112 aas le b the of t�"NNW ate
Of up to f250.40 a a y well to civil paoaltly is rly fog of a S70!•WORK ORDER and a fins
Inveatitladoy o DDIA for-f the rioh� ge erilltaa t aa,c�of thin wtemem may be forwarded to the OHta of
/Jo hereby Caal/)r tAe
Pon oJoer/Yry/Aar rAe/a/orantlow prar!/e/ L opal ewroei
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0, 'ICI4 Yla 0Ah1 DI aW Mrlte 4!AL erf4 4 bI rel�fere�by clip at'lewa 0•�yd
City W Town:
---------------
Iuuinp AuthorityPermttlLkew d
(e4eb one):
I. Board of Harlon 2 BuUdlal Department
6. Oiler 3. Cih t lrowa Clerk 4.6lcatrfaal faspeeter 1.Plumbic Ina pttlor
Coataat Perms;
-� CITY OF SALEM
} t ` i PUBLIC PROPRERTY
'"�� DEPARTMENT
11C WASI I NGi ON S iREET •SALVM.MASSACHL,,L VI S:01C
TFI:978.745.9595 ♦F.":978.74C 9M
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 730 CMR section 111.5
Debris, and the provisions of MGL c 40, S 54;
Building Permit # _ - --
is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
111, S 1.50A.
The debris will be transported by:
— — wame of hauler)
I'lie debris will be disposed of in
(name of facility)
)ad.'resa of faalay)
. . � _CaILLI'J J i)C[Illt[dt,iLt C.IX
':a[C .—..-.
PUBLIC PROPERTY
b "W DEPARTjuL*gT
DMR CHMGZ.�g
�Q'�Jti Ot B n*.nrnrs
1.0 SM WFOlWATMN
Lapdon Nunae
PropeftAddrow- - - _ .
Pr P ft Y boated In a;Carsenypb Anre YM Me�lorb pied YM
2d OWNER&M IWORM MM
11 Owner e/Land
�r e,.�-Vn yro",
Telaplrone; '1 � 3
3.00 SECTION FOA 1MORK IN
�1lIG EUII.DINOE ONLY
Addd=
Rerwvatbn E**&V
Number of 3torlee Renovated
Change In Uae
Demobtbn New
Approximate year of
COA +ctlon or renovabon Area per Roar(30 Renovated
a/existirp buitdirp
New
9cal gescripbcn of Proposed Work:
.L
Mad Permit to: --- - -