26 BARNES RD - BUILDING INSPECTION 44W SUM lM#NAM4ND APPROVED BY US
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Permit to: 9lNLDWO POW APPLICATION FOR:
(Chle whbwm apply) Roof. Rwwl Install Sidirfp, �Constrfrct D@* Shed, Pool.
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PLEASE FILL OUT LEOIDLY i COMPLETELY TO AVOID DELAYS N PROCESIMNg
TO THE INSPECTOR OF BWLDINGS: '•
hereby applin for a permit to build aocofds:%to the.tkwkfp
Owners NameP11ch`� r l�Pr1 art
AddressaPhone a4 BtirYfec &I ZLfr Ook' S�
Architect's Name
Address A Phone
Mechanics Name
Address d Phone ( 1
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HOMEOWNERS S1GNA"I"
APPROVAL OF BUILDING 1NSPECi'OR
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HOMEOWNER'S EXEMIMON
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CITY OF SALEM,, MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
J 120 WASHINGTON STREET, 3RD FLOOR
SALEM,MA O 1970
TEL. (978)743-9593 EXT. 380
40 FAX (976) 740.9846
STANLEY J. USOVICZ, JR.
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the provisions of MGL c 40, S34,I aclmowledge 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.S 150A.
The debris will be disposed of at: �J((�/yl `�7 -t -(—
Location of Facility
Si emut Applicant Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
AQ v't( .T NcAfo
Name of Permit Applicant
Firm Name,if any
2& �Hr��s f2d S,9te�1
Address,City dt 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 cIII,S 150A, and the building permits or licenses are to
indicate the location of the facility.