7 BAY VIEW CIRCLE - BUILDING JACKET cI V C-L-EE: MOOR
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No. 10301
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co r CITY OF SALF— M1 MASSACHUSETTS
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BOARD OF APPEAL
3
120 WASHINGTON STREET, 3RD FLOOR
SALEM, MA 01970
TEL. (97$) 749595
A�'crvyiyeW�� Fax (97$) 740-0-9$4fi ' pppp cc eDt'
STANLEY J. USOVICZ, JR. 2V� �1Z�UV�U2 pp221AG1 tS�,C�
MAYOR 01/27/2003 08:27:00 OTHER Pg 1/3
- -- - - - --- -- -- -
DECISION ON THE PETITION OF MICHELLE GALLANT REQUESTING A SPECIAL
PERMIT FOR THE PROPERTY LOCATED AT 7 BAY VIEW CIRCLE R-1
A hearing on this petition was held on September 18,2002 with the following Board
Members present: Nina Cohen, Nicholas Halides, Joseph Barbeau and Bonnie Belalr.
Notice of the hearing was sent to abutters and others and notices of the hearing were
properly published in the Salem Evening News in accordance with Massachusetts
General Laws Chapter 40A.
Petitioner requests a Special Permit to operate a home business (Massage Therapv)for
the property located at 7 Bay View Circle located in a R-1 zone.
The provision of the Salem Zoning Ordinance which is applicable to this request for a
Special Permit is section 5-3 (2) (8), which provides as follows:
Notwithstanding anything to the contrary appearing in this Ordinance, the Board of
Appeal may, in accordance with the procedure and conditions set forth in Section 8-8
and 9-4, grant Special Permits for alterations and reconstruction of nonconforming
structures, and for changes, enlargement, extension of expansion, of nonconforming
tots, land, structures, and uses, provided however, that such change, extension,
enlargement of expansion shall not be substantially more detrimental than the existing
nonconforming use to the neighborhood.
In more general terms, this Board is, when reviewing Special Permit requests, guided by
the rule that a Special Permit request may be granted upon a finding by the Board that
the grant of the Special Permit will promote the public health; safety, convenience and
welfare of the City's inhabitants.
A. Special conditions and circumstances exist which especially affect the land, building
or structure involved and which are not generally affecting other lands, buildings or
stuctures in the same district.
B. Literal enforcement of the provisions of the Zoning Ordinance would involve
Substantial hardship, financial or otherwise, to the petitioner.
C. Desirable relief may be granted without substantial detriment to the public good and
Without nullifying or substantially derogating from the intent of the district or the
purpose of the ordinance.
The Board of Appeal, after careful consideration of the evidence presented, and
after viewing the plans, makes the following findings of fact:
2003012700062 800051);1:61
01/27/2003 08:27:00 OTHER Pe 2/3 -,
• t
DECISION ON THE PETITION OF MICHELLE GALLANT REQUESTING A SPECIAL `
PERMIT FOR THE PROPERTY LOCATED AT 7 BAY VIEW CIRCLE R-1
pagetwo
1. Petitioner Michelle Gallant appeared and represented herself at the hearing.
2. Ms. Gallant would like to conduct massage therapy out of her home
3. Petitioner submitted a letter signed by 13 neighbors in support of the petition.
4. There was no opposition to the petition.
On the basis of the above findings of fact, and on the evidence presented at the hearing,
the Board of Appeal concludes as follows;
1. Literal enforcement of the provisions of the ordinance would involve substantial
hardship on the petitioner.
2. The relief requested can be granted without substantial detriment to the public good
and without nullifying or substantially derogating from the intent of the district or the
purpose of the ordinance.
3. The Special Permit granted can be granted in harmony with the neighborhood and
will promote the public health, safety, convenience and welfare of the City's
inhabitants.
Therefore, the Zoning Board of Appeal voted 4 in favor and 1 in opposition, to grant the
relief requested, subject to the following conditions:
1. Petitioner shall comply with all city and state statues, codes ordinances and
regulations.
2. All construction shall be done as per the plans and dimensions submitted and
approved by the Building Inspector.
3. All requirements of the Salem Fire Department relative to smoke and fire safety shall
be strictly adhered to.
4: Petition granted for a period of 3 years.
SPECIAL PERMIT GRANTED
September 18, 2002 Nicholas Helides CSC
Board of Appeals
2003012700052 BOOM Pg;62
01/27/2003 08:27:00 OTHER Pg 313
DECISION OF THE PETITION OF MICHELLE GALLANT REQUESTING A SPECIAL
PERMIT FOR THE PROPERTY LOCATED AT 7 BAY VIEW CIRCLE R-1
page three
A COPY OF THIS DECISION HAS BEEN FILED WITH THE PLANNING BOARD AND
THE CITY CLERK
Appeal from this decision, if any, shall be made pursuant to Section 17, of MGL Chapter
40A, and shall be filed within 20 days after the date of filing of this decision in the office
of the City Clerk. Pursuant to MGL Chapter 40A, Section 11, the Variance or Special
Permit granted herein shall not take effect until a copy of the decision, bearing the
certification of the City Clerk that the 20 days have elapsed and no appeal has been
filed, or that, if such appeal has been filed, that is has been dismissed or denied is
recorded in the South Essex Registry of Deeds and indexed under the name of the
owner of record or is recorded and noted on the owner's Certificate of Title.
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I hereby certify that 20 days have expired
from the date this instrument was received,
and that NO APPE-At. has been filed in this
office.
A True CopA oee ,�
ATTEST., CIT"; Gi_`_^.i{, Salem, Mass.
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�,{'tr i l rN din i co CITY OF SALEM, MASSACHUSETTS
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BOARD OF APPEAL �(..?t1 S OFFICE
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[ + yF 120 WASHINGTON STREET, 3RD FLOOR
`� SALEM,MA 01970
TEL.(978) 745.9595
FAX (978) 740.9846 q _ -
agtc(y STANLEY J. USOVICZ, JR.
MAYOR
4, � ° 20�30121��063 7.00 OTHER 1
01/27/2003 08:27:00 07HER Pg 1/1 DECISION OF THE PETITION OF JAMES SULLY REQUESTING A VARIANCE FOR
THE PROPERTY LOCATED AT ONE SOUTH MASON 183 NORTH STREET
+9' Ott J Vii;r a=7
A hearing on this petition was held September 18, 2002 meeting with the following Board
f1 4 ''ri Members were present: Nina Cohen Chairman, Bonnie Belair, Nicholas Halides,Joseph
Barbeau and Stephen Harris. Notice of the hearing was sent to abutters and others and
notices of the hearing were properly published in the Salem Evening News in
accordance with Massachusetts General Laws Chapter 40A.
At the request of the petitioner the Salem Board of Appeal voted 5-0, to grant leave to
Biu withdraw this petition without prejudice for a Variance from the Salem Zoning Ordinance
7-5 Signs, t0 install an off-street parking sign on the roof of the building for the property located at 83 North Street
f 1 r i f�3.0
!Ji GRANTED LEAVE TO WITHDRAW WITHOUT PREJUDICE
SEPTEMBER 18,2002 1,
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Ntna Cohan Chairman s,
WIS
Board of Appeal
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} A COPY OF THIS DECISION HAS BEEN FILED WITH THE PLANNING BOARD AND
,
THE CITY CLERK
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Appeal from this decision, if any, shall be made pursuant to Section 17 of the
f',1 Massachusetts General Laws Chapter 40A, and shall be filed within 20 days after the
date of filing of this decision in the office of the City Clerk. Pursuant to Massachusetts
General Laws Chapter 40A, Section 11, the Variance or Special Permit granted herein
•r'.':'r`.:'`:. Shall not take effect unr'.!a Copy Cf the decision bearing the Certl,n.ativi,ofthe i,.f Clerk
that 20 days have elapsed and no appeal has been filed,or that, if such appeal has
been filed,that it has been dismissed or denied is recorded in the South Essex Registry
of Deeds and indexed under the name of the owner of record or is recorded and noted
on the owner's Certificate of Title.
Board of Appeal fJ a V 2 12002
Date
I hereby certify that 20 days have Somd
from the date this instrument Was"N6d,
-RPE4L-lias-been ftfed In ihl
h
office.
ATrue COP" S�
ATTEST—CITY CLERK, Saiem, Mass.
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Iloard of Building Regulations and Standards crry OF
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Massachusetts State Building Code, 780 C'NIR SALEXI
�L,,o //a't'iea'�/ I
Building Permit Application "ro C'onslruct. Repair. Renovate Or Demolish u
!)ne-or n,ry-ftmdw vtrelthiq
This Section Fur Olt Use Only
Building Permit Number. Da Ap/plied:- _
Ifuilding Official(Print Muria) Signature Dula
SECTION 1: SITE INFORAIA
L I�Pry):e���J�/bl rq`J�(� 1.2 Assessors Map urcel Numbers —
L la is ttDhhiis an acre led street? •a ✓ no Map Number I'urcel Number
I.3 Zoning Infortnutlan: 1.4 Property Dimensions:
Loniny District I'ropaseJ llsa Lot Amu Isy Ill Frontage(tt)
1., Building Setbacks(R)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:IM.G.1.c. JU,§SJ) 1.7 Flood Zone Informallon: 1.8 Sewage Disposal System:
Public❑ Private❑ zone: _ Outside Flood"Luna? Municipal❑ On site disposal s)stem ❑
Check it' 'es❑
SECTION 2. PROPERTY OWNERSHIP'
2.1 O nertof R cord
i are
'rinp / /,a q•.Slate.ZIP
(1�JC �-a3i�r lcl1C.V`�tl..t{yV�x��
No.and Street relephone &nail Address
SECTION J: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Evisling Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(i) ❑ 1 Addition ❑
Demolition (3 1 Accessory Bldg. ❑ Number of Units_ Other ❑ Spceiiy:
Brief Description of Propose Volk,: rr 3att Y44 ✓ rXvGu
o�
SECTION 4: ESTIMATED CONSTRUCTION COSTS
11e n Estimated Costs: Official Use Only
ILahur and Materials)
I. Building S I. Building Permit Fee: S Indicate how fee is determined:
'. l'Ieclrieal S ❑Standard City'Tussn Application Fee
�
❑Total Project Costs I Item 6)x tmdtiplier —,.—_ x
1 1'Ium Mitg S '. Other Fees: S
1, \Icchanical ill\ \C ) S List:._
Cu acai unyl rotas \11 Fees: _-__----
i^ ChecA Vu. lied. Amount: Cauh \mount:
n 1'01al Project Cost: i, i 000 ❑ paid in Full Cl Outstanding 11.11.utce Due:
SFA I'ION S: ('ONS'1'Rtl("PION SERVl('ES
rh -
NSupen i.sur Liccose(('St.l
r iswilldow
er P\piraliou haleheluw)____
InrestriClcd Ilit"Idin's kilt it) 15,1104)❑1. It I
_ .__.______.. I .1 it DwellinCil\irown,Slate,LII' asonkKoill ,ad 5idill
SF Solid Fucl Ilurning Appliances
I Insulutiun
1'elc hunt Pnwil adJress I) Demolition
5.2 Registered home Improvement Cuntractor(HIC)
I IIC'Regisuutiun Numlwr li\piraliun Date
I IIC C'ompaa) Nano or I IIC Itgktratt Nimu
No. mid Strives Finail uddress
CitylTown, Slate ZIP rac hone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L e. 152. 1 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes .......... o No ...........O
SECTION 7s:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, as Owner of the subject property,hereby authorize
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print U,a,er's Nane(Electronic Signature) - Date
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
Prim U,ncr i or \uthoriieJ Agent's N;ume t h.leclruolc Slgnaulrc) Dae
No'rES:
I. An Owner\\hu obtains a building permit to do his.her usvn ,wrk,or an owner who hires an unregistered cuntroclur
(tut registered in the Hume Improvement Cuntraclur IHICI Program), will 2 have access to the arbitration
program or guaranty fund under\1G.L.c. 112.A. Other important information on the HIC Program can be found at
R,W% 111A.-R •'R.1 Inrorni:niun on the Cunstruction Supervisor License can be found at Oil,
? \\'lien substantial ,wrk is planned, provide the inrunoatiun below:
Total flour area I>y. 11.) _ __.._I including garage, finished bascntent attics.Jccks or porch)
Grvsi li\ing area I iy. 11 ._._ .... _— flabilable ruunt count
\unlberof'fircl,lacei \umherof'hedroontt
i \umhcrofhalhroumt .. .. --- \umber of halt'hath'i
I)pc of heating i)itcm - \umhcr of dccks Porches
I I'nclo\cJ t\pen
\ "I ol.11 Prl,leet Square 1'Pala gl' Iim.% he •IIh91111tcd far I otal 'rajeel C o,t
CITY OF SM-F.11
PUBLIC PROPERTY
DEPART1LENT
Vwvcs I-V Wk0 wGnnlnaar• Sway WAMA0&ZWM0t9V
TM YL7+5.9s" • M.ut 979-7+6794
HOMEOWNER LICENSB EXEINMION
Flew Ms!
Date
Job Laeadoe Q Uv J r✓� S��w, iVL
Ham Owner Address
Home Owner Telepboa b- 0231
Present Mailing Address -Ew YVI
The current exemption o!"Homeowncre was extended to inehtde ownar-occupied
dwellings 0f two Units err leas and to allow+such homeowners to eagags an individual for
him who does not possess a 8eenso provided that the owner acts as superviaar.
DE INMON OF HOMPOWNER
Pc=n(s) who owns a parcel of land an which hdshe raider or intends to reside, on
which there is, or is intended to be,a one or two family dwelling, attached or detached
structures accessory to such use and/or firm sWjcnwm A persoat who constructs more
than one home in a two year period shall not be considered a homeowner. Such
-homeowner"shall submit to the Building Official, on a forts acceptable to the Building
OilleiaL that hdshe be responsible for all such work performed under the Building
Permit.
The undersigned "homeowner"assumes responsibility for compliance with the State
Building Code and other applicable by6Iaws and regulations.
The undersigned "homeeowner'certifies that helshe understands the City of Salem
iuilding Department minimum inspection procedures and requirements and that helshe
.viIf comply with said procedures and requirements.
HOMEOWNERS S(GNA-rvu g
l
APPROVAL OF 9UILDfVG LVSPECTOR
See other side far state code
I
D DD �7`«
The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code,780 CMR SALEM
( Revised Mar 2011
it / Building Permit Application To Construct,Repair, Renovate Or Demolish a
u One or Two Family Dwelling
This Section For Offial Use Qnl
Building Permit Number:- D e Applied:
a
J
Building Official(Print Name) :Sig tire: . ^"""' - ate
SECTION,1: SITE IN O& TION
1.1� perty address: 1.2 Assessors Map&Parcel Numbers
Tf I1`J'Ft,,3CuCV
1.1 a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq It) Frontage(8)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone?
Public,B� Private El Zone:
if yes❑ Municipal,2rOn site disposal system ❑
:f SECTION 2 PROPERTY OWNERyS�AIPi O
. w erl1ofR orTC�1� \/'�IIIN\_ I�tL U
Name(Print) City,State,ZIP _
No.and Stre t Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK' check all that apply) '
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) Addition ElDemolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify:
BriefDesccrriptionofProposedWork': v Q "
J 1 • _4U
SECTI6N.4: ESTIMATED CONSTRUCTION COSTS _.
Item M Estimated Costs: OfficiaGUse Only'
Labor and Materials
1. Building $ g0�_ 1, Building Permit Fee $ Indicate how fee is determined: '
❑ Standard City/Town Application Tee',-
2. Electrical $ 3
❑T,otal Project Cost',(Item 6)x multiplier x'
3. Plumbing $ 2. Other Fees: $ '.
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees: $'
`Check No. Check Amount Cash Amount:
6. Total Project Cost: 1 �700- 0 Paid in Full ❑Outstanding Balance Due:
SECTION 5:'C0NSTRUCTI6N SERVICES._
5.1 Construction Supervisor License(CSL)
License Number Ex nation
Name of CSL Holder
—t-
List CSL Type(see below)
No.
and Street =.Type a: Description t
U I Unrestricted(Buildings up to 35,000 cu.ft...
0(%7o R Restricted 1&2 Family Dwelling
City/Town, State, LP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
N(l0„4 dG. I Insulation
Tele no Email a dress D Demolition
5.2 Registered Home Improvement Contractor(HIC) f b(0 On co -Z. ,2p
tV
O N Nt2A.. 7D i,U 5 HIC Registration Number Expiration Date
HIC Com any Name or HIC Registrant Name
(a(� ��t la vr� S+ S 2"aZ30tusaL
No an Street 9 70 9 Z� �C—°- mail address
City/Town, State,ZIP Telephone
SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M G.L:c 152. § 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes .........r , No ........... ❑
SECTION jai OWNER AUTHORIZATION,TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, as Owner of the subject property,hereby authorize Tg`'ep, ®, Q CK L
to act on my behalf, in all matters relative to work authorized by this building permit application.
1 e,1kptl G G ? 11.,x+ t-:27• i a
Print Owner's Name(Electronic Signature) Date
SECTION,7b: OWAW,,OR AUTHORIZED AGENT;DECLARATION•
By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
!yeefP.li1.3" 6)l LH�h �' •a�7 • 2I0C•L
Print-Owner's or Authorized Agent's Name(Electronic Signature) Date
K � .NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L. c. 142A.Other important information on the HIC Program can be found at
wcvw.rnass.>ov.%oca Information on the Construction Supervisor License can be found at www.mass. ov; os
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq. ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
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Salem Web GIS-Map Page
8/27/12 7:44 PM
Welcome to the City o Salem, assaWis Property Viewer
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37_nr.n _.. __ ,
�37.5 feel r._0005 N
0005 Property ID 37_0002_0
Address 7 BAY VIEW CIRCLE
370001 Land Use 101
Book and Page 12631-387
Lot Size(Arms) 0.14
97 Assessed Value $347,500.00
17 Dart �
.,
3r 47='8 i. 1> 37 0003
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Salem City Flail 93 Washington Street,Salem,MA 01970
Phone:978-745-9595
City Hall Hours of Operation:Monday,Tuesday&Wednesday 9AM-4PM Thursday SAM-7PM Friday aAM-12PM
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i CITY OF &U EM, NLA SSACHUSETTS
• BuUMINIG DEPARTsmNT
120 WASHINGTON STREET, Sao FLOOR
of T EL (978) 745-9595
FAX(978) 740-9846
KIMB Ri F.Y DRISCOLL 'IHOMAS ST.PIERRE
INA►YOR
DIRECTOR OF PUBLIC PROPERTY/Bl'II.DLNG GONINQSSIO,iEA
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
dame(BusincsvOrganiratioNlndivithnl): St7t-lV-Ex7tMS �l^U�
Address: L0 __Z e 2rl L 0V t.t
City/State/Zip: 1Ye�l� n (quo Phone #: 978 - 7 W
Are you an employer?Cheek the appropriate box: Type of project(required):
I.❑ 1 am a employer with 4. ❑ 1 am a general contractor and 1 6. ❑New construction
employees(full and/or part-time)' have hired the sub-contractors
2_MJ am a sole proprietor or partner- listed on the attached sheet.t 7. gRemodeling
ship and have no employees These sub-contractors have :3. ❑ Demolition
working for me in any capacity. workers'comp.insurance. 9, ❑ Building addition
[No workers'comp. insurance 5. ❑ We are a corporation and its
required.] officers have exercised their 10.❑ Electrical repairs or additions
3.❑ 1 am a homeowner doing all work right of exemption per MGL I I.❑Plumbing repairs or additions
myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs
insurance required.]t employees. [No workers'
comp. insurance required.] 13.❑OOta
•Any appliaoM that checks box#1 must also fill out the section below showing their woken'compatsation policy infutmation.
*I lommwmrs who submit this affidavit indicating they an doing all work and then hire outside contractors most submit a new affidavit indicating such.
=Camratam;that cheek this bolt must attached an additional sheet showing the taunt,of tht,sub turamm and their workers'tamp.policy information.
I am an employer that is providing workers'compensation Insurancefor my employees. Below is the policy and Job site
information.
Insurance Company?lame:
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to S 1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certl er the pains aannd p�enalies of perjury that the information provided above is true and correeL
Sienature: e/� �` 1%U Date: .53 • 2-7 / 2
Pho 8 '
OJjcial use only. Do not write in this area,to be completed by city or town oJftciaL
City or'rown: Permit/I.lcense#
Issuing Authority(circle one):
1. Board of Ileallh 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
CITY OF SALEM 2UNSSACHUSETTS
BUILDING DEP:IRTNI&NT
• j° 120 WASHINGTON STREET, 3AD FLOOR
TEL- (978) 745-9595
F:cx(978) 740-9846
R
KIN
LBERLEY DISCOLL
4 Y D THo.\w ST.PIERRB
DIRECTOR OF PUBLIC PROPERTY/BUIMDJG CO\LtiIISSIONER
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5
Debris, and the provisions of MGL c 40, S 54;
Building Permit # is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
111, S 150A.
The debris will be transported by:
:: ,U*j P—cy;'M 1 Nu 11
(name of hauler)
The debris will be disposed of in
(name of facility) �r�rllll
ZZ �CCd ZLL� 5 _�
(address of facility)
signature of permit applicant
Z-7 - Z-c)sz—
date