3 1-2 WARNER ST - BUILDING INSPECTION IKAMlft6T-BE f -E9-Aid0 APPROVED BY T+IE
W,SPWTDR PRIDFI TD A.PERMIT BEWG GRANTED
\� > CITY OF SALEM
No.\ (�`JV \ ``� �''*�� Date 6 cy-oy
Ward
\ �mNED'��t• Zoning District
Is Property Located in Location of
the Historic District? Yes_No JL/ Building 4j� -,7
Is Property Located in /
the Conservation Area? Yes_No G L
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Sidin Construct Deck, Shed, Pool,
Repair/Replace, Other:. - / 4-ery 411 d R&ce
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 /9-A"i e
Address & Phone J LA1,1 RJ18(Z JS - (71 7ql-'89�)
Architect's Name /t/.q
�/�
Address & Phone / " A- ( )
Mechanics Name Ageg C',0n1��0,4
Address & Phone /o col.,;41 d -oaAe Rom= (9/11--) 7W-Aa K-
What is the purpose of building? // am 41+
Material of building? (,vnok If a dwelling, for how many families? 4
Will building conform to law? - Asbestos? An
Estimated cost `4e 2!0,00 City License # State License # O� 3IKZR
Home Improvement
Lic. I '+
Signature of Applicaff
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
A qVa) 211 O/Ak of, )fAl e ,�a r i9 Base sii ,Qn
nJf L� ,Ue4, %1/
ZnJ„l /�I1P n/ aA,11- 44 .7A5/ I
r
MAIL PERMIT TO: /h (0�0niA � R� S�irle
•t.
No.\ ^101- , J"A
APPLICATION FOR
PERMIT TO
LOCATION �.
r
PERMIT GRANTED
�/ AV'L 19
1
AP G�OV�D
INSPECTOR O BUILDINGS
i
PJBI-19 PROPERTY DEPARTMENT
120 WASHINGTON STREET, 9RD FLOOR
SALEM,MA 01970
TEL. (978)745-9595 EXT.960
FAx (976) 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 MM c III,S 150A
The debris will be disposed of at: A h. a A
Location of Facility
d- I
' Signature of Permit AWlicant Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
Name of Peradt Applicant ��
firm Name,if any
Jo ro(On,, ILI CuiO�Q Y 7
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.