69 ORCHARD ST - Exterior Paint Removal g�coxwr I
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3928
JOANNE SCOTT, MPH, RS,CHO NINE NORTH STREET
HEALTH AGENT Tel:(978)741-1800
Fax:(978)740-9705
COMMONWEALTH OF MASSACHUSETTS
CITY OF SALEM
EXTERIOR PAINT REMOVAL PERMIT
Property located at : 69 Orchard Street
Owner' s Name : Bruce Nadeau
Address of Owner: 69 Orchard Street
Contractor' s Name : Homeowner
Address of Contractor:
Date paint removal will occur: 5/25/2000 - 11/30/2000
Hours Paint removal will occur: 8 : 00 am - 7 : 00 pm
This license is granted in conformity with the Statutes and ordinances
relating to Exterior Paint Removal .
Permit # : 19-00
Application Date : 05/25/2000
Permit Expires: 11/30/2000 unless suspended or revoked.
"NO ELECTRIC SANDING"
HEALTH AGENT
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CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 01970-3928
JOANNE SCOTT, MPH, IRS,CHO NINE NORTH STREET
HEALTH AGENT I�_(JT) Tel:(978)741-1800
/ Fax:(978)740-9705
APPLICATION FOR PERMIT TO ENGAGE IN EXTERIOR PAINT REMOVAL
Date: s-25-00 Property Located at: lug CCCYcrI3 5 .
Owners Name 'i ,,)cc. ti dMO
Address of Owner (if different from above) —
Telephone Number__�-LQ3_ --iun
Contractor/Name of person/agency that will perform paint removal:
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Address of Contractor — Telephone Number
Dates and hours when paint removal will occur:
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Type of Exterior Removal to be Performed-Please Describe:
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Clean-Up Procedures- Please escribe:
I have read the Board of Health " Regulation 23 Rules and Regulations". I have had the
opportunity to ask questions regarding those Rules and Regulations. I understand them,
agree to abide by them and understand that failure to do so may result in fines and/or in
revocation of my Exterior Paint Removal Permit.
Persuant to MGL,C62C,S49A, I certify under the penalties of perjury that I, to my best
knowledge and belief, have filed all State tax returns and paid all State taxes required under
law.
Signatur
Social Secruity or Federal ID#
For Board of Health Use Only
Approved by:
Date Permit Issued_T—Iorl a�
Permit #