18 BARNES CIR - BUPA-2004-174 SIDE LEFT & BACK OF HOUSE -PL-*NS-Mt0ST-BE f UEG-ANO APPROVED 8Y T44E
.LMP9L3''DB ,PFWB TPA PERMIT 13EMG GRANTED
CITY OF SALEM
No. I -Z004 Date
"INK,
Is Property Located in Location of
the Historic District? Yes_No Building $ Pjarmi S 6r'Jd.
Is Property Located in /
the Conservation Area? Yes No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
epair/Re 1 , ther:
PLEASE FILL OUT LEGIBLY & COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the following
specifications:
Owner's Name J 05WA\ Q>00j 'e aV
Address & Phone Iy5 (q'18)_ 1`lS - 4 S_3Z
5CAe a . 0191Q
Architect's Na
Ad & Phone �
Mechanics Name Rm tAo►,-%2. Se_rutcu . Zr-,C
3H5 G-cti-tN.w oa( S
Address & Phone LA )d('c e.S�er . I f.O (4n ) `i 11 -31Zg
What is the purpose of building? S ti a< < pc.w t 1:1
Material of building? If a dwelling, for how many families?
Will building conform to law? Asbestos?_
Estimated cost —1 0 D City License # N P' State Lice se
C<� �5f 8 z- Rome Improvement
Lic. I Signature of Applicant
JZ`l 014SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE 11 ''// rr `
11 I CA ir\ l0 jk C41
j
�h
MAIL PERMIT TO: tv-tn"nwm d,
i
No. LA
APPLICATION FOR
PERMIT TO
LOCATION: /
PERMIT GRANTED
APP 6V�D
INSPECTOR OF BUILDINGS
""' OF SALEM,- MASSACHUSETTS
���k PUBLIC PROPERTY DEPARTMENT
r2° 120 WASHINGTON STREET, 3RD FLOOR
90 SALEM, MA 01970
TEL. (978)745-9595 EXT. 380
�pmru 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, S1150A.
The d ri will a disposed of at: Kz���ili
i a.� a us k
Location of
Signature of Permit Applicant Date
FULLY complete the following information.
(PLEASE PRINT CLEARLY)
Lyzrkr,
Name of Permit Applicant
Firm Name,if any
O U�
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 cM, S 150A, and the building permits or licenses are to
indicate the location of the facility.