9 TURNER ST - BUILDING INSPECTION * c
i�E fiif�iidflg flPPROVED BY T 4E
Ii ,Sp �GA PFfIOA Tp A PEANUT.13FJNG GRANTED
CITY OF SALEM
No.! ZED O� .+ aq Date VL /
o �.�• i a
Ward
i�r�,rnnaon' F Zoning District
Is Property Located in Location of
the Historic District? Yes_No_ Building fE�
Is Property Located in
the Conservation Area? Yes_No_
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Dec , Shed. Pool,
Repair/Replace, Other: T-P i., �A 1 2 ° laz 3�4L
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 9 le-, LIA (5�
)
Architect's Name
Address & Phone ( 1
Mechanics Name 5�� �/ c /ail Y A:3,)
Address & Phone ��^ �LN 4 it a 144 /c
What is the purpose of building? 4 St dl?rn cL j
Materiel of building? U G� ��c r If a dwelling,for how many families? 2
Will building conform to law? ]Ile S Asbestos? wo
Estimated cost 13�City License : State 'cane rf 5 y ?l^
pp Home Improvement
� ! i 3 / Lic. 1
Signat re of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE II
(I/c, t,4 /S�✓e�q _ ice- r� �� 7� � , �� v r ��
MAIL PERMIT TO: ti ors v f ,
l t.: 2-cq - to S 3 S 2-4 1 5li t j ri
i
Lln
D a
c
' 4 O 31 C)AT&i li `P;
,i64P^� ^i)�+^:r .. .3:..� ` hfElw -t'�r �,Ft,;,liE, 1�1"a9d`"it ;'�"�bt�3�`._ 1'.1^J�'- f•E�'n� i"�s &;r;f"rs:.' u4..'a."
cc iihhFF.+ S; qq �w _toga P A,.T.O $Tu SO�i^9a'A�d �' J u� "..7l i.,..l la{. M��:411k.,i'....� T O^,w.P ..,«W� a .. '�C , r
d � ,� l i:u��ki ro' ; � 7 . ''1 r
✓dry
_ _ rwsadXaa�"a1 mi.�.� '°xwti�.` �� ' _ uu.ur^�c•��,:,
suIq lv , gu wmitrw r
1 '
License.
LAT
1 ? N6rnJ40, S CONSTRUCTION S PER SORION S
-, B�rtfi 085425 yyy
04/z0/1953
! r 0�30%Z007
;. ST."»• R 425 ft Tr. 85
� l 1
85
WO�OEDBC PAL
R
YOR RIDG€=J;p `
} ' ME 03909"z�G ,,.
administrator
--
�o CITY OF SALEM9 MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
SALEM, MA 01970
'.G TEL. (978)745-9595 EXT. 380
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 150A. //
The debris will be disposed of at: LJO < /`� u -e /'I ^l �6�c e,S—1 ee-, ✓�(a ..
s-J u � C
Location of Facili
Z4�;� 1/ � /a . Z,l G3
Signaiure of Permit Applicant Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
f7e � ft� RY-
Name of Permit Applicant
Firm Name, if any
J5 r" Z'laJ'ei ( r7'
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 cIII, S 150A, and the building permits or licenses are to
indicate the location of the facility.
L
(forrtmonwaaft o/ 11la66ae"aft
a• c� nn
2eparlmaef al,JJJ d,iaf 1+eeia.aL,
600 Wa1i 11m
02 111
Cor-mrssona
Workers' Compensation Insurance Affidavit
- trs,.vt..rrve)
with.a principal place of business at:
/Ca, l4 03S- ,) 6
tcanaw✓taq
do hereby'certify under the pains and penalties of perjury, that:
() 1 am an employer providing worker' compensation coverage for my employees working on
this job. )
/� J � � CI' IIt
InsurancCompany Policy dumber
I am a sole proprietor and have no one working for me in any capacity-
1 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 periorming all the work myself.
I uneenuno that a cool of die uatement vie be i,aroeo m tart once of Inwti{aw++r of the DIA,IV corerate +eAficadon MW" Ukee to eaeure
coK are a reoarec unaer Section 2SA c(MGL 15 2 on k)o to the iroe>,don of er>nirtm ot"iies eonustint of a fine of w otrb 1.500G0.nah f ont
ytaes'iraruommtnt v K0 ar ei i ""iLiei in the form of a STOP WORK ORDER /and a Arse of S 100"a 47Y ate+nt m
Signed this Z y �/ day of �OC
building Ot:partn ent
uccnsce/�crr�ittet
)ysa .jccnsing boas
LC CSeieetmens Office
i ,ulth Department
i