74 BAY VIEW AVE - BPA-2005-698 1ST FLOOR REMODEL A
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,IAISp,F��� PFJIDA 7p.A_PFAM�T S,�WG GRANTED
CITY OF SALEM
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No. \J �- , �4�`.`".•t.�, i� � Date ��J �.J
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Is Property Loceted in Location of �/J
the Histodc District9 Yes No� Buildin8 �.�¢�/(J�
Is PropeRy located in ��
-� the Conservelbn Area9 Y�_No�
BUILDING PERMIT APPUCATION FOR:
Permft to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
Repair/Reptace, Other:fJ,�'/,�.�D.�r�s� ��//
�qi�R�P�/GP .t'�Ir�iP�
PLEASE FlLL OUT LEGIBLY& COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build accofding to the following
specffications: -
Owner's Name _r�l�� l�f� �/�-�
Address & Phone 7�,�JT�>i�i.�/ �� L��� 7�y_��'�
� �:• � ArohiteCt's Name
Address & Phone � �
Mechanics Name '
Address 8 Phone l �
Whet is the purpose of buildirg? �PS/ 4'�/9 �f� �
Material of d�llding4 U�Bf�� It a dweuing,tor how many tamNfes? �
WIII building coMortn to law7 Y S a�nos� 01� i)
Estlmeted cost L�Q�QQ(L_,City License 8 N P' State lJcense N
Ha�e Improvdent
Lic. i
Signature of Appticant
SIGNED UNDER THE PENALTY
OF PERJURY �i
DESCRIPTION OF WORK TO BE DONE I
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,�d� ,��� d�i� �' �s,.v��� �� �-,���t ����,� ��
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, MAIL PERMIT TO• �,��/�� i7]/5� CS���Jy/ ��i9 ��1�/�
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APPUCATION FOR
PERMIT TO .
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LOCATION�
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PERMIT GRANTED - '
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APP,ROV�D , _ � p
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INSPECTO OF BUILDINGS , w
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� . o CITY OF SALEM� MASSACHUSETTS
' � PUBLIC PROPERTY DEPARTMENT
� � 120 WASHINGTON STREET, 3RD FLOOR
� j' 70 SALEM, MA O 1 970
� �'� Te�. (978)745-9595 Ex7. 380
Fnx (978) 740-9846
STANLEY J. USOVICZ, JR.
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the provisions of MGL c 40, 534,I aclmowledge that as a condition
—_ _ o-�Builr�in�Pe�rit#� — , a�l debris Fes�ltiflg-�ot�the-construction-activi-ty-------- -
governed by this Building Permit shali be disposed of in a properly licensed solid-waste
disposal faciliry, as defined by MGL c III, S 150A.
The debris will be disposed of at: '�m�'�'s ��G �Ct��`�-.,_
Location of Facility
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Signature of Permit Applicant Date
FULLY complete the following information:
(PLEASE PRINT CLEARL�
�vs� Sf-�'��'�
Name of Permit Applicant
/�—
Fum Name, i any
. . � .. 7Y.�i�f/�/iC� i� .
Address, City &'State
The above statute requires that debris from the demolition, renovation, rehab or other
e ' sed in a ro erl -licensed solid-waste dis osal
alteration of buildin or structure b di p p y p
8 �
facility as defined by MGL cIII, S 150A, and the building pernuts or licenses aze to
indicate the location of the facility.
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. BUII.DIIdG DEPARTN�NI
HOMEOWt�A 11GENSE D�'T141d '
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E,PPROVAL OF BV�.DIDiG II�SPECTOlt
Sa oapa adc for s�e�ode
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HOMEOWNER'3 EXEMPT'ION � .
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