63 WINTHROP ST - BUILDING INSPECTION (2) Da__:10
�5_/ PLANS NTUST BE FILED AND APPROVED BY THE
INSPECTOR PRIOR TO A PERMIT BEING GRANTED �p
Location of Buildin,a 63 W wN t 117\UA S�
Buildio; Permit Application For:
,(Circle WillchvI 27DLes) 0c-oi, Derooi, lnsialI SidL-tg, Cons^sc( Deck, Shed, Pool
ACGII!Oti A!iem2 ion. Re aLr�epl2ce, Foundation Only, P:reccmg
C'.,Lr: S A-Pt
PLEASE FILL OUT LEGIBLY & C0>1PLETELY TO AVOID DELAYS E PROCESSL'NG i
To the Ins-c-ector of Bt1!^ings:
The undersi�-ed hetreo,; applies ioi a per,rit to build according So tine following sae-.!lcations:
0waers Name': ' r! rAQ I�� ��-�UP( Contractor: Rp�$/{-
Sl l:�l/eet (03 iw�gRtl P av Sh S;reet iok Lg,.Nfo Avq� Cizy cS�l u`M.1
State WkA Phone � s,2 _ A Phone
1 9 7k ` 40 _0S+3
Architect: > {fit City of Salem Lic=
sweet City State Lim 0?+"1 ffiP-
State ?none ( ) Eomeowners Exempt Form_ no
Structure: Cpl.zse circle) Single Far ily, I(i Family= Other
Estimated Cost of job S 4p Dtla
Will building confirm to 12w? )-s no
Asbestos'. Yes no W/I _
Dtscriptioa of+York to be done:
CZEtA,Lo L 6A-4
Drawings Submitted:_}es I/ no Mail Permit to:x 90y& How _—HvtPk0V t90 ZWH
igna re of Application, SIGNF&VONDER THE PENALTY OF PERJURY
CONSTRUCTIO:ti TO BE COMPLETED WITHIN SIX (6) MONTHS OF PERMIT ISSUED DATE
Department use on!v: Pe„ait '- Zoning LL=p/Lot
Per t fee S
COH'�y'TS:
1
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ArpLICA"rION r-oH
f'I;I1MC1 'f U
F/way
I.00A-1-1014
f'GllMrr GRnNTM
nPP ovrD
INSPCCTOP. 01: BUILDINGS
i
otti of FIIPIII, II55c�L�T1I5P�#5
3 1�rr� Public Prngtrfg i9zgar1msnt
$uili)ina i9epatYmml
C4nt &altm 6rttn
5D9.745-9595 Ell. 3611
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the provisions of MGL c 40 , 554 , I acknowledge that as a
condition of Building Permit r, 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,
S 150A. O�7 I l
The debris will be disposed of at : NS
location of facility
Signature of Fermic Applicant Date
Fully complete the following information:
(Please print clearly)
)Atit -K4t iV1 i*
Name of Permit Applicant
No�SA
Firm Name, if any
Address. City S state
The above statute rea'uires that debris from the demolition, renovation, rehab
or other alteration of bu'_iding or structure be disposed of in a properly
licensed solid waste disposal facility as defined by rGL cIII , S150A and that
building permits or licenses are to indicate the location of the facility at