2-5 WATER ST - BUILDING INSPECTION 9
yyhat ka go Currant use of tta aui{du+4 how�M►unA,4.. Lf��
µ*M d afoul"
we`*4 Sao*Co'd°rT m t avA t
Nclmors Name
A4*@ {and Phone
�,haNs�s Name
• I` =
'adraa and Ffi . O� � —=
catrd��',ea steenasd �= �Eadn � t ofFojd . .
pai� .X °S7A
,00 Roma"
s Y
fT � / D xs„a,000 c otine�-
penrBFee � , E.Mmdd coat
0 9p/,,,✓,r M M MWA f&00 is added as an
0 a*A dMIPL
Make sum d+d sn pmperq and WOW wMen to avdd dek+ya in p�ooaeek*
Tto unders�dace WOW WV ror a euudlno�P/e*'A buud to to above good
apt. SVied under Wm*Of
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e
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ilk
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- - .PA&a.i:..,
! PUBLIC PROPERTY
a� DEPAR'T,%k M iT •
//is�— ate' ��o'a'w,ow,,,,�•s�uo�r,,..oaanso�rra
TIL rw7e4M•Ipe V&74& pe
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ffg Iron
1-3 3FR INFORMATION
Laptlon Now h
P1'op�ki kAmled 6o e;C,aneeiva�laN YM��Fedork flat YM
a�owNtaltslw tNFORMATwN M;
it Omer of Lead
Name:
-r
'fie'
TeleptlOrw, 7
3.000MPL4 I w THIS SECTION FOR WORK IN
LDUIOR ONLY
Adddw
Renovation ��
Change in use Number of 390dee Renovated
Demolition New
Ap doproximate yew of Area per floor a&ucn or renovation fsn Renovated
of axis" hAdktp
New
wd Description of Proposed Work:
yAcci } cw�
1- have v„T
a l CU1I/ a1 e'- n.S fol. S tYl
Cl '`� >'✓ s� Mom, �.,Y,t t��� ti,�S,S
Ma—di M if to: - -
CITY OF SALEM
PUBLIC PROPRERTY
DEPAR'T11tiENT
t:neatattat amett�pty
MA
Tma WW45-M a PAta tn�a+w
wWMW Compuudas Tuarn"Alsdwft grgdarW
An
Hams i /1'1,`r_J•t�f �
6s- /sit P,v ,2d
c;cy�sklwz;� Fbm* R 7S- q7, - jag/
An ram am esgMyf- Cbeek tb ayPrepla ft ba®t
I.Eylasaempbyvewidt ° 4 pioapeed0000mdwdl [13.E3
qma
:.❑ r® (!F�oodlae p.e.tim.}• 6ay.h6d,8. wee
ship dpsaieleaer or pttemtaa ud a ds araehd sheet l , adageg
have so movibyas
woddnO aw me i"Y ed"der �� °a"' dtt(b,t
(rim«odes' m•meee !. ❑ w.am a ompmhttou sud if• hddklhrt' pl I w aoies all w«k ri °i"'Me1dood their compa 132. Ps 1! (4k aed war have asinwamq requited t �rvet Qfe a mtlas� repeisbtaenaom r
•Aastta�urdmbttaof�r.tr orses.waatww,etdtgh�whettt•
eca l arwa.tiW�r.to+triaw:.ew aydmA ft/ ==4fw eem•:e = a h t� o►
eet an ewlhyo AW b redAspsw,pe ' ter
INJewasit
Seim It d gP ft and job apt
Immmace Company Name: C—AI A
Policy N or gab'lot Lis.# i
Expiration C,
!sib 3itt Addres_ S S? DAW�/ 7
Attach a top of the warheee�cos �' S`ye^1, 111 A
Foduts to 5 co m"oven s d under to ponry dae[hratlea pair(sbawbsg the ponar aambw AM�"}
fine up to S 1,300.00 w&or�under msm a s w of Ma o. 132 au lend b the imposition of a�isind D�tt m of m
of up to 323o.00 a day against the vie >r wen a.dvo�°o to the roan of a STOP WORK ORDER end a fine
Investiiatioot of the DIA la in wanes"ov��ei� 00p of this sratameat may be forwarded to the Of!!oe of
zdoL
/Ja herell carol
/J'enear the pelop aa/peao/a4t o/Pv/rul'thar the/aforaudoa Prorlld a/baw 4&W nod eoared
O.Olold sae oh
Da elpt wr
ite 4 rh4 are
4 At be cowl/ite/bl City or AMA o led
city or TOWN:
i Wiling Authoel Permltll.lcasm
h(Circle one)
Other
1. Other of Health 2----- Department 1.Cltyfrow■pert 4- Electrical Inspector I Plumbing Im
' 6. peetor
ou"fiContact Penoa•
°.� CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
.MA10H LC WAS)IIVGiJN SiAEET♦5ALF%1,NIMN'ACIM iLCIS 019/C
TO:978-745.9595 •F.ax:978.74G9846
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
l 11,S 1.50A.
The debris will be transported by:
(name of hauler)
The debris will be disposed of in
(name ut facility)
_ _.__ iudilcesn of luiilay)
a_ :aturcotpennitapp ant --
.'.ate
CITY OF SALEM
ROUTING SLIP
NEW CONSTRUCTION L
CERTIFICATE OF OCCUPANCY C/er�aJ�/45 vnrt S)
_5 LOCATION: I L-/ cr S = DATE
APPLICANT: ZC/� 21
ASSESSORS
FRANK KULI ATE:_��,,_,,7
(93 Washington S )
CITY CLERK Q
CHERYL LAPOINTE f( � DATE:
(93 Washington Street
PUBLICE SERVICES c�
DATE: 6
(14-1 Washington Street) oor
WATER
DOTTIE THIBODEAU ATE:
(120 Washington Street)4'°Floor
CROSS CONNECT SUPERVISOR
BRIAN TH BODEAU / r DATE:
(S Jefferson Avenue)
PLANNING
rri'A.Tdo v�iv� - DATE: I3 O�—
(12u Washington Street)3id F7
CONSERVATION COMM)SSI N
FRANK TAORMINA A DATE: G J}
(120 Washington Street)Yyfffoor /
ELECTRICAL JOHN GIARDI fn 14 DATE:
(48 Lafayette Street)
FIRE PREVENTION /J
ERIN GRIFFIN s l DATE:
(29 Fort Avenue)
HEALTH n
JOANNESCOTT ° DATE:
(120 Washington Street)4°Floor
BUILDING
THOMAS ST.PIERRE DATE:4(I20 Washington Street) r
s ,
BOARD:OF BUILDiNO REGULATIONS
s `License• COWSTRU- 0 -SLIPEtTVISOR
NumC,,Sr .6895M17 rig
i1
`xQIS6e I3012Q, S Tr.no 89541 ;
.. .._ ResVktibd£ -0CT I i
MICH'AEL ZENG�A'p�-IN
65.FULLER POND,"..
MIDDLETON; MA 018 ' ,Oommiuionu.• �'.