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`d A r Tom)Oitwis area(Sq F2) Y w ' "-(utcludtng gauge finish )Gross living ram(Sq Fc} m U dk
i -abi tibit v[Dorn�aurtt:A(iim6er of fireplaces Number of 6edraams 4V.
Number of4¢thrwms: Number of hnlflbuths
Type of'hetiting system ' NumberWd h Type of L'oalmg system EnLioxd Open
CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
construction Debris Disposal Affidavit
(Ieyuired iur all demolition and renu\atiun \cutk)
�I
In accurdance t\ith the sixth edition of the State Building Code, 750 C•hIR section 111'5
Dcbtis, and the provisions ofAIGL c 40, S 54;
Building Permit r is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal I•acility as defined by MGL c
I11. S 150A.
The debris will bo transported by:
Nit s�c� ( _f t✓ i
I name ut hauler)
Ile debris will be disposed of in
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