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194-176 WHALERS LN - BUILDING INSPECTION What is tM current use of the Building? If dwelling.how many units? Malarial of BUMIng? Asbestos? Will tM Building Canft m to Law? pmhibc[s Name ( t Muhw%Ws Name Zi/�✓` �o�7flO Address and Phone Canso gupsfviwm Ucw"ar /%70 lr HIC Regbeetion ay Estimated Cod of Prol"* PerrN!Fee Caka+Mm— PermR Fee i���� Eaftated Cad X$71:1000 Realdandal Es*natad Cost X 511/111000 Cananncld An AddNWW$5.00 Is added as an AdminWft"dwga. Make an that as fields are properly and legibly written to avoid delays In processing. The undersigned does hereby a"for a Building Perng to lid to the above stated Ze�illc specatl m Signed under penalty of perjury G Date Jt �SJ�U O N s 7! y > ` � x s I, . CITY OF SALEM PUBLIC: PROPRERTY DEPARTMENT \{.;1[+J6��-�� 120 W.\.il liXli CJNSY EET 5-9595 .{ .vx:Dd.MASS978-7.\OMCNI l'1i 019IC. TF.1:978.7ir9595 *F.{-`c:978-7+G98+6 Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5 Debris,and the provisions ofMGL 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 150A. The debris will be transported by: (name of hauler) the debris will be disposed of in (name of facility) i address of f'acday) - /,-, at, Cl)tfl Oil 3nh`L f CITY OF SALEM PUBLIC PROPRERTY DEPARTmp.NT anaaelttatr a.sooei w►ram uo.astaear a TILVW45- sq FAM 4"ft lPO Wtla bW Campaeadam Inswasm MWm% BttAdtua�C Annlinett Itelbrmtadttw Name Addmmm: c Fbam Are an pl.2arr chock the apprepebae h 1.fIma m a WbyerWa 'p- 4. QIMapmraemaemrdi Typetr4afto"W"41 mpbym("a" have MW the en►eoaftmang & ❑N@w ocewaedm 2.❑ I am a nb paepebeee or paetaae• lived as the aeaohd chew,tship 7. ❑p nmp�y� Woo trd have m nm y caua Tbre ❑De oM= wocldes the me b tee r eapaelyr, wa rkwo'caomp iamm,inrtnum r!. (Ne wodma'camp irrnom 3, 13 we are a ampmaeioe and it 9. 0&AMINO addhiat required.) Ofibm 3. I am a bomeowam doing all Work dpb d been�6* IQO 001110111 repairs at� aatmvdn pm bm 11.0 obi repeia or addidooa mMK Rtb waekra' (Camp 6. 15%11(4A and we have an 12 0 Rate insulations,on n4uiead]p =WWA ROD watrhwa' rapam btaaeaner 19.0 other •ti0 war•rrerebraanOmanio.rsaa bdmiiaefyrrwtw t Neraow.e.a..�.rtar.miar tealaetle and M aaeteel..arrttwrutt. mplaw tCa+ar�eAreOrliYYraotfea�alral�tlerlYw daaraefr °raa��ee�hawdLieele/�ee�r► tahewe,ear r rrle warYata' pert rbareea lm/araemlee flat b prrlde���w//orRon'nwPo�errtfea laraly+rl orlbycst dakn b rAeooge)rr/fel rpr ►naureme Company Name ATJ/v Policy N Or SaWina.Lia BSprcaNae Date Job Site Adtraae AttacY a Cate a<W • 19,E Failure a teacake copra corpteaadoe poBey dociandm pelp(awwle f ew poMep aambar tea/aaptragee dW� requited under esenea 21A of Mot,a 112 cant load a the itopoodoe of ain"pm"W of a fate 1 to f 1,300a d and/or g t oneyew impr. so Advised as won as civil pemldro is the fort of a STOP WORK ORDI>!and a tlm fa up to ticild 0 a day+pore the violaror Bn,d,,;,� a copy of thin atatemeat may be forwarded a the OtIW of InveatiBrttioay of the DIA far inturaon coven fe vritkatioa /Ji hemp And a/Oed+�'rhr the/w/eraradowirot'//d oboes b ow owf eoi►oci IO(Jfe/ad use aaljl Da not wr/y 4 thb arty to be coarp wJy cal'ormm 0AW City or Town; Peradt/Lleeaae it bruing Authority(circle oae)t I. Board of Health L Bulldla f Department 1. Clry/rown Clerk 4. Electrical lmpector I Plumbia f iaapaetor 6.Other Contact Person � Gri-TUFSA.E� PUBLIC PROPERTY DEPART,, &NT u,.E.sro.a� 130 WASONMO snvsr.s+u,K w,uaO.,xns o1.70 TZU M7454M 0 FAXM740-9W APPLICATION FOR TM REPAIR.RF,NOYAnoN cnxMUCTIOM, DEMOLITION. OR OANGZ OF USZ OR OCCUPANCY, FOR ANY FjaSP G STRUCTURZ OR BUILDING 1.0 SITE INFORMATION Laatlon Name: S 8uiktk+g: Property Addrsr rn A74171,1 e y o W A%W Property is bcdod in s:Corawvadon Am Y/N Nkdorto t7latrlet YM 2.0 OWNERSHIP INFORMATION 2.1 Owner of Land ` Name: Address: O O aOIT Q U !V Q Ted' 'C/3 c�© D° �10/? e 3 3 3.000MPLETE THIS SECTION FOR WORK IN E aSIM BUILDINGS ONLY Addition OExisfing Renovation Number of Storiesvated Change in Use Demolition ng Approximate year of Area per floor(sQ Renovated construction or renovation of existing building INew Adel Description of Proposed Work: mr - - Mail Permit to: � tDr� SY i