21-23 BARSTOW ST - BPA-2005-664 ROOF REPAIRS �4.�ttPSddlliST�E fH.f� A?PROVED BY T44E
.UNS,PXT,OR PFaiIb71R TD A PERMIT BEING GRANTED
\ CITY OF SALE
No.� � Fct. ,�� �\ Date
Is Location of
Property Located in
the Historic District? Yes—No Building -A3 3A/Z5-rt)O Sj,
Is Property Located in
the Conservation Area? Yes_No X
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, In�iding, Construct Deck, Shed, Pool,
Repair/Replace, her:
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 -TO NA) %(r
Address & Phone 3 l pz.57al�J 146-(f tt -a
Architect's Name
Address & Phone
Mechanics Name
Address & Phone L 1
What is the purpose of building?
Material of building? If a dwelling, for how many families?
Will building conform to law? Y e S Asbestos? /v d
Estimated cost,/LI, UUc `cG City License# N P' State License#
Home Improvement
J _J� Lie. f
Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE I
/� _�.Qd
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MAIL PERMIT TO:
No.
t
1
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
AP ROVfDD
77
L
(INSPECTOR OF B LDINGS
o CITY OF SALEM9 MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
1 Ma SALEM, MA 01970
TEL. (978)745-9595 ExT. 380
FAx (978) 740-9846
STANLEY J. LISOVICZ, 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, IS150(A�. /�_ I g
The debris will be disposed of at: —Az{L y PG�('i l,bbi 7«C.C/p E' (,SWG ad C04)
Location of Facility
11L /_ al-�
Signature of Permit Applicant Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
N MuI1/�7S
Name of Permit Applicant
Firm Name, if any
a3 &,62_sTD�') s.� 0 . 4-1 a
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 cIII, S 150A, and the building permits or licenses are to
indicate the location of the facility.
sly ..♦
QTY GF SALEM
BU=INGDEPARTMM
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