68A WHARF ST - BUILDING INSPECTION IKAMIItfST-BEffL{H;1W APPROVED BY T44E
INSPECTOR ,PFMIR TP A_PERMIT B,EWG GRANTED
CITY OF SALEM
N
No.� �:tt� ..L �`,\ Date
ic
Ward
Nx�° Zoning District
Is Property Located in Location of cam`
the Historic District? Yes_No Building
Is Property Located in
the Conservation Area? Yes_No X
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, ero stall Siding, Construct Deck, Shed, Pool,
epair/Replace, ther:
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 ljas� I"', •` tarty
Address & Phone A 2fr -71/T
Architect's Name [
Address & Phone ( )
Mechanics Name
Address & Phone 1 ( )
What is the purpose of building? nnP .dt-q �T Material of building? If a dwelling, for how many families?
WIII building conform to law? Asbestos? r]
Estimated cost 1 b L City License # State License # c S UPS 7 Home Improvement root/cY
Lic. I `G/
—'— gnature of Applica
SIGNED UNDER T E PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO: h I'S 0 yea- (�S 5
No.
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
A RO 4D
INSPECTO F BUILDINGS
4
1
�y
0
PUBLIC PROPERTY DEPARTMENT
120 WASNINGTON STREET, 8RD FLOOR
SALEM. MA O 1970
TEL. (978)745-9595 EXT. 380
FAX (978) 740-9646
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,S150A.
The debris will be disposed of at
p Location of Facility
Signature of Permit Applicant Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
Name of Permit Applicant
Firm Name,if any
G ujv� ,- S, 1,4, A.4 Cr 15 7 0
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 ca S 150A, and the building permits or licenses are to
indicate the location of the facility.