35 WINTHROP ST - BUILDING INSPECTION (3) ro
14-4M1MT9E'RWm94ND APPROVED BY 774E
ASPEE,CTDR PROR TD A.PERW BEWG GRANTED
CITY OF SALEM
No.l
Data c�
�- Zoning D13W
Is PMPWtY Loceted in Location of
tha Hftft Didrid? Yaa No_ Bniidins g J r� s%
a PrOP"Localad in
on consmalon Ana? Yaa No
Permit to:
BUILDING PERMIT APPLICATION FOR:
(Circle whichever apply) Roof, Reroof, Inmall Siding, Construct Deck, Shed, Pool,
Repair/Repla , Oth ICU//yhmc
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS: '
The undersigned hereby applies for a permit to build atxorcLlg,to the following
specifications:
Owner's Name 5 �2 — & -;e A411116
Address & Phone J.S 110 1'ti r�/2op ST( 1(0'-7-
Architect's Name
Address & Phone
Mechanics NameI1J
Address & Phone �/5 t 7V6yoy n ST ( W 6 79-5 7G
L j0P-4f
What is sr Piapoaa al bidltlMg7
mdww of bulking? VA)UL 1 k)i A B a dwNNg.for how many famasa?
we b A ft conform to law? Ambastos?
Edmoo coo 00(5 My Lk:ww• Slab Umm•
Baas I�roasant
Lie. / /2
Signature of Applicant
SIGNED UNDER THE PENALTY'
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
w//y/y
MAIL PERMIT TO:
y �O,QG�,C/v ✓�� .
' t
* M
APPLICATION FOR
PERMT TO
LOCATION
PERMIT GRANTED
19
APPROV D
INSPECTOR OF Bu LDINGS
l.ommoruu of/ ��a��,1a�c�J�d
�a�uattad BeAve, 02111
Caeewaoew
Workers' Compensasim isouranu AMMwk
1,
- wld►.a PAN*W place of badman an
3�/ S LQLE VOOA ST
do hereby'cerdfy under t1se paint and pasties of perjerys doss
0 ��mwlftw p�dlni workers' coapsasatim; covepde for my eiasUyees woekbe w:
:yt/ t7 f1C /y lrimE. 4SUR1a,(1c6=` a2rv�r✓vcz9��gv �
insuraem CampNW p Number
1 am a sole proodesor and have no one working fir me in MW npacky.
() 1 am a sole proprietor, general contractor or homeowmr (drde one) and haw Nni tin
contractors listed below who-have the following workers' cosnpensadon pe5chn
C mnewr inwnnta Comps wlipe uasber
Comracwr Insurance Cvvnvavvy/PollcylN
Conoseror insurance Conspasy/po Number
() 1 am a homeowner performing all the work myself.
i-Wwwef ew s Car ff AL AMMM we N fen.srf d a dr 06n A bme4jeo a of dM MA M fomrap.wlandee sae an Mov o Am n
ef.frarr ar rffwrf feNr fffie SSA ff WA 1 S2 gin 1eN M rh nwed.f of oba6m efsudr,eerwint e(s bed•W41.tf7OM uWer am
+rar7'wrera,r.e.ra a to•drt searia w do hmm et s STOP WORK ORDER see s it of s 10CAO a der apba nc
Signed this . day of _ ✓�uf `�fd 7
:ieerseei'Fereniutt Bmiafng Deparzrac c
Licensing Eosrd
Seieamens Office
=eslch Deparmen-
epe ape epe Tic
PUBLIC PROPERTY DEPARTMENT
120 WASMINOTON BTREBT, aRD FLOOR
SAI.EN,MA 01 B70
TEL. (978)745-9595 EXT. 3e0
FAX (Y76) 74"645
STANLEY J. USOVICZ, JIL
MAYOR
DISPOSAL OF DEBRE AFFIDAVIT
In accordance with the pmvisiona of MGL c 400 S34,I w3mowledge that as a condition
of Bmlding Permit 0_ .all debris resulting from the congn>ct c m aaryty
govaned by this Building Permit shell be disposed of in a properly lieeaaed soli&waft
disposal facility, as defiDed by WX c nX SLS"
The debris will be digmed of at �J L/s C� 7VLcl Crjlj i
Location ofFacility Tit�pi?C � 7�7�� � 0�607
Signature ofPmmit App i Date
FULLY complete the following M&MU&M
(PLEASE PRINT CLEARLY)
Name ofPamitApplicant
JL-Pe 7
Firm Nana,if any
ST 11,06eec s72w , 1n4 016,07
Addrw,city&stag
The above statute m Rm that debris from the demolition,rmovation,rehab or other
alteration of bmlding or structure be diVosed in a
pTopaly-licensed solid-
a.defined me
fadhty by M(rZ cIII, SISOA, sad the building permits a liceosp sea to
indicate the location of the facility.
AT-HOME Installed
S-FO ''V ' Siding and Windows
Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR License or registration valid for individul use only
Regist"n 126893 before the expiration dale. If found return to:
Board of Building Regulations and Standards
Expkdlon• B 3/2006
a;rw One Ashburton Place Run 1301
t YPer _$ipi(ilement Card Boston,Mo.02108
y i
THE Home Depoi,J�ltfstg —
BUNROEUN CHMGSI}Y+.r '
3q20000BBOALLEiiIARKW'IG#20
/1LTANTA,GA 30339
Administrator
Not va8d without aignalui _
R