WILLOWS PARK - BUILDING INSPECTION (2)r -
4; d,
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fL,Mlele"V eE Lf AND OVER BY T44E
WS EtrIt�R J � k.REB , J NG GRANTED
v CITY OF SALEM
No. C\ ' Date gay
i
Is ftOPwty Loaded
In Location of
Qn Hlitado Dlstdd? s_Ye No_ suilA ng ;�/�� / //�✓ ,
Is Pmpwty located In
;r In Cwmrwjon Arm? YM_No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Sidingq,, Constnfq-Do*, hod Peol,
Repair/Replace, Other, /boo 7 /',./,� ��7A
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROCtf10
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the folkwring
specifications:
Owners Name �� ��� `I��g 5
Address & Phone t 1 I JS 700�/
Archltecrs Name l
Address & Phone ( 1
Mechanics Name )04n
Address & Phone
Whtl is the purpose of btAldMg4
mdww of b~ cvm o Zr I a dwNWq,for how many IamlUa?
WIN kdk&p cor=00
S Asbsaos?
i
EnYreafad Cqy lJcwua« N A slag lJansa« C..S
Bafaa Lpsorn ,
Lie. i
nature of Ap cant
d�I IGNFD UNDER P `
4
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
i
MAIL PERMIT TO C/o
N023-)
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
AR
(. rD
-INSPECTOR OF BUILDINGS
s
i PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 9RD FLOOR
SALEM, MA O 1970
TEL. (97S)745-9595 EXT. 3SO
FAX (078) 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 MGL c III, S150A.ff
The debris will be disposed of at: S'd'e.
Location of Facility
Signature of Permit Applicant Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
C rr ^mil 1 ,
Name of hermit Appyeant
5 LJ
Firm Name, iffiny
S f -
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 cM, S 150A, and the building permits or licenses are to
indicate the location of the facility.