7 WINTER ST - BUILDING INSPECTION ,
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APPROVED BY T44E
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'LUSPECTAF.11+ Rn. :J0 PFt 11T liElT1G GRANTED
CITY OF SALEM
No\ �� � Dete--J /
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Is Property Located In Location of �� �
the Historic District? Yes_No Building z 6✓(4oz—ax S% .'
Is Property Located in
the conservation Area? Yea_No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Sidi, Construct Deck, Shed, wool,
Repair/Replace, Other: �oA:-1-2cts e•- FI'GIL—n
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROCESSINIS
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the following
specifications:
Owner's Name
Address & Phone 3 7yS 97R3 .
Architect's Name D'4w tD/Z-7x6C
Address & Phone sly J)r(2bY 37-, S,L4M OM 79o:5- 3330
Mechanics Name t
Address & Phone 3 J'�4�n�t C aT- 2Ys- y7.23 ,
What Is the purpose of building? QBS/�Ecc a/ six (o.vdalM/Nrvw. !>nrT� r.
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Material of building? � It a dwelling,for how many families? 6 I
Will bulding conform to law? f Asbestos? �6 Ri a
city License M N A state License« 0 Y 3 7 - i I�
Bw Emproverant
Lice
Signature of Applicant
SIGNED UNDER THE PENT ++1 ,
OF PERJURY IIulur
DESCRIPTION OF WORK TO BE DONE
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MAIL PERMIT TO: J�/' -J e* �C'Y'J SICl ?f;
APPLICATION FOR
PERMR TO
LOCATION L /
PERMIT GRANTED
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AP�V�D
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INSPECTOR OF BUILDINGS
CITY OF SALEM� MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
SALEM, MA O1970
TEL. (978)745-9595 ExT. 380
FAX (978) 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.
The debris will be disposed of at:
Location of Facility
�. L 3 •�5� G`
Signature of Permit Applicant Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
Z. ( O/C
v
Name of Permit Applicant
Firm Name, if any
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 cIII, S 150A, and the building permits or licenses are to
indicate the location of the facility.