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56 BELLEVIEW AVE - BUILDING INSPECTION The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF Massachusetts State Building Code, 780 CMR S Revisedd Mar Mar 2011 Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling �V This Section For Official Use Only L.f) Building Permit Number: Date p lied: (— Building Official(Print Name) Signature Date rrri j SECTION 1: SITE INFORMATION IV r,(�) 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers S l�eJl�v eta! AuP rG IA 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 ft) Frontage(ft) 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: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal ❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: —Tbm � Uhd&- Cag,*11 -SCt(em, mA ()IC1 ] © Name(Print) City,State,ZIP S(n A-Iteutew AVQ- `) 7iF- ?VY S97 No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) 07 Alteration(s) WT Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work': IMZInQ C= Spl} � E ` VIGIES r SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1. Building $ 1. Building Permit Fee: Indicate how fee is determined: 2. Electrical $ ❑ Standard City/Town Application Fee ❑Total Project Cost (Item 6)x multiplier 1-S,2 7Sx 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (14VAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees: $_.._ r� Ch&k-No--/ Check Amount: Cash Amount: 6. Total Project Cost: $ a /S ❑ Paid in Full ❑ Outstanding Balance Due: rnI:�-tt_6o oa Rt iA slZ-� SECTION 5: CONSTRUCTION SERVICES 7 5.1 Construction Supervisor License(CSL) es-m`7 33 S C— 0r 1- (r I/' 2 O �cZy License Number Expira ion Date Name of CSL Holder /1 ,noe � �� List CSL Type(see below) �No. and Street Type Description IP nn J ©[ q'70 U Unrestricted(Buildings u to 35,000 cu.ft.) ��( •' R Restricted l&2 FamilyDwelling ty Ci /Tow ta�t�ZIP'/,, M Masonry , x RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances (-9 / $-7YI- (9 qcW I IInsulation Telephone Email address D Demolition 5.2,R, is/t�ered(�Home Improvement Contractor(HIC) / r'r �H JeocJ tce- HIC Registration Number. E pirat on Dale HIC Com IlS vami[C R — ntName No.a St eet Email address aCev�, n�4 l�) R.7o �7k- 7ql- oN�� 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 Issuanc f the building permit. Signed Affidavit Attached? Yes .......... No........... ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner of the subject property,hereby authorize A � A .)Pled KP 5� to act on my behalf, in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) I Difte SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION By entering my name below, [hereby attest undeathem s and penalties of perjury that all of the information contained inthis application is true and accurate t,of my knowledge andunderstanding._5 /3 b Print Owner's or Aut rized Agent's Name(Eldctronic Signat re) Date 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 www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 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" Phone: 978-741-042 4 A Grade Fax: 978-741-2012 Above Slum 1982 www.a-aservices.com A&A SERVICES 115 North Street . . / Salem, MA 01970 Date: J 6 Work Specifications for Roofing Project Name: I tiM G L A t OAA C"� C-i Address: �(v j J etU City: S State: Zip Code: Ol T 7d Areas to Be Re-Roofed: SG I �C lud i'O e:q dcX i, /CN1 Roof A eas Excluded from Re-Roofing: Pull Permit with Community as Required. V'*�_Waste disposal is included using either dump truck or dumpster. If dumpster is utilized (site location: 12C, as agreed to by the home owner), it will have plank stock put under dumpster as //_"property protection. V Tarp house from fascia board to ground and beyond to protect house from falling roof shingles. A&A Services makes every attempt to protect home, decks, driveways, landscaping, and shrubs. Due to the heavy weight of roofing shingles coming off the home we cannot be responsible for damage to /landscaping and shrubs. Cam Strip roof of LITr0 1w4yers of roofing shingles. CY/ Inspect roof deck after removal of shingles for any rotted wood. If any replacement is needed, the first 32 sq.ft. is jn ded. For any other repairs: 4x8 sheets of plywood removal and replacement will be billed at $w per sheet. The charge for resheathing deck with 1/2" of plywood (go over existing roof deck), if needed will be $ per sheet: Planking replacement is billed at $_per linear ft., and carpentry r pairs at $ �er hour. (epl tip rAQ�Pl �(ub(ts�(� Cat i vL1N ( i ytCltc�°cf Install GAF storm guard leak barrier 6' up roof from edge of fascia board (code calls for 3'). A&A Services is dedicated to using extra ice dam protection in our unpredictable New England weather. GAF storm guard leak barrier/ice dam protection material is a flexible membrane that sticks to the roof deck to prevent it from moving when shingles are installed over it. This membrane self-seals when nails are driven through so water cannot leak through it. Install GAF storm guard leak barrier 18" in from edge of rake (eave areas of the home). This prevents Cwind-driven rain from penetrating the edge of your roof and causing leaks. IrAAgv Buyer Initials: ' 'Date: �C repl. Prshk#eMan� f3ocv wsKdol� w�d1 �+ 1 y f Susit ( sl��ged k�tt�cf�Ros�'� vb�ar� r Iq 15s1n13 / 1 f FePJA-cam j Pr' 0FSK'W�--e6S oN 5i�e IZON�- CL� t'.'i►4J,:)W)/SalvRye 1 {girl 666 F;o r" Z:\A&A Common Folder\Referrals\Referral Kits\Roofing\Roofing Specifications Sheet-Jan. 2015(2).docx �) T J 3+ A Gr Phone: 978-741-0424 Abovee Fax: 978-741-2012 Since 1982 www.a-aservices.com A&A SERVICES 115 North Street • U • • Salem, MA 01970 LR Install GAF storm guard leak barrier 36" in valleys of home and at any roof penetration such as chimneys, exhaust vents, vent pipes and skylights for added protection against leaks. L�l Install F-8" drip edge to perimeter of the roof deck. Drip edge helps support the roofing shingle at all edges of the roof, manages water flow off roof and into gutters, and also protects against wind-driven rain /penetrating the edge of the roof. Available in 3 colors: Mill (Aluminum), Brown, a ite: G� Install GAF deck armor to remaining area of the roof that is not covered with GAF storm guard. GAF deck armor adds another layer of protection against leaks from wind-driven rain. It being extremely breathable, lets moisture escape from attic space and helps preserve your roof deck. V/'_�Install GAF ProStart starter shingles at perimeter of roof. This is important because the starter shingle has additional adhesive which prevents the first row of shingles from blowing upward in heavy winds. r�� 9'/Re-flash h�mttey: remove and dispose of old flashing, cut into mortar with grinder approximately 8" up chimney, feed new lead into newly cut mortar joints, install lead in a step-flashing manner, and run approximately 4" onto roof deck. Seal all edges with Geocell sealant. Lead is used as a flashing material on chimneys because it is very pliable. Lead flashing molds to uneven surfaces and stays in place for / years. 21 Install aluminum vent pipe boot with rubber gasket around all vent pipes and then seal with Geocell / sealant. This application prevents leaking around vent pipes. X Z_ /d Replace or C'/Cu n For & Install ( Broan roof bathroom exhaust vent(s) with adapter and seal /with GeoCell. aru Fort f ©F �t CovinfLC c� t/P�J} �,oSC: ('N �('ff i LzY Ventilation is a requirement for long-term roof performance and warrantee validation. It will reduce energy consumption and create a healthier and more comfortable home environment for you. A&A Services will utilize the following type of ventilation system for your home: Gable Vents: Add: • Utilize Existing: • Expand Existing: Soffit to Ridge: (Soffit Vent as Intake) Add: Type: • (Ridge Vent as Exhaust) Cut in as required and add GAF Snow Country Baffled Ridgevent to ridge(s). Location: tAlluminum Slant Static Roof Vents: # Location: rj mechanical Ventilation electrician Not Include 1. # 1 YPe 5 Location: M --,:�i4tp W Buyer Initials: h,, Date. Y'ec-G ; Kevin j�ltrrj (T�l1ooEGlectri� Forwiht^� Z:A &A Common Folder\Referrals\Referral Kits\Roofing\Roofing Specifications Sheet-Jan. 2015(2).docx P -;Orw �+ Phone: 978-741-0424 AGade Fax: 978-741-2012 Above smce 1982 www.a-aservices.com A&A SERVICES 115 North Street • • ' • �}rC�16(�f Salem, MA 01970 C37/� Install GAF Roof Shingles Style: Color: '— UMi Nail locations vary by shingle and roof slope. It is critical to fasten the shingle in the proper locations in order to achieve desired performance and meet warranty requirements. DAII nails that will be used on your roof will be barbed or rough-shanked nails and will be resistant to corrosion. In most applications, shingles will receive 6 nails and all nails will be long enough to penetrate min. 3/4" into the roofing deck. (Using 6 nails per shingle and utilizing ProStarter shingles at rakes and soffits upgrades the wind rating of your roof to 130 mph. L`f Install GAF Timbertex premium ridge cap shingles with approximately 8" exposure. These shingles add the finishing touch to the peak and/or ridges of your home. They are also designed to handle some of the toughest areas of roof protection. TimberTex ridge cap shingles are much thicker and have self-sealing adhesive that seals each shingle tightly and helps reduce the risk of blow-off. ❑ Install GAF Seal-a-Ridge Cap Shingles with approximately 5" exposure to ridges. GY Clean off roof with blower to remove any debris. Clean out gutters of any roofing debris. Rake clean all work areas. Leaf-Blow the perimeter of work areas. Go over grounds with magnetic rake to pick up any loose nails. Please note: you may want to cover your attic belongings due to roofing debris sometimes falling through the gaps in the roof deck. That cleanup is not included. Q ' This is a safety equipment project. We value our help and are concerned for your liability. a Supply owner with partial leftover bundle of shingles to have in the future if needed. 6lY'� ­A&A Services is a certified GAF installer. We follow all Massachusetts building codes and GAF manufacturer's installation requirements. By doing so, your roof qualifies for a 50 year non-prorated `.warranty from GAF. See warranty for more details. f1Y' Massachusetts Law requires contractors to warranty their work for 1 year against installation defects. A&A Services offers warranties for their roofing work for 10 years against installation defects. If any problems occur at any time, A&A Services will come out free of charge to evaluate and help our customer through any manufacturer's warranty claim. Miscellaneous: tS fe,Au CAI scr�ny 5' Buyer Signature Salesman yo u Ar Signature c�e F=i� LL. Date: -- 7 � Buyer Print Salesman Print Z:\A&A Common Folder\Referrals\Referral Kits\Roofing\Roofing Specifications Sheet-Jan. 2015(2).docx Til- -30w A & A SERVICES, INC. A&A SERVICES 115 FORTH STREET. SALE.ML ALA 01970 • • Telephone'.197R1 741-0424, Fac 1978) -141-2012 Contractor Registration No. 101609 Construction Supervisor No.CS057733 Federal DIN: 04-3090162 CUSTOM REMODELING AND IMPROVEMENT AGREEMENT BIT er s) Name Date of C ntr t i w S Ruver(5) Street Address. City,State and Zi Code Da Ime Tele hone Number Evenin Tele (lone Number Mobile Tele hone Number E-Mail Atltlress d The Buyers)listed above Hereby jointly and severally agree to purchase the goodsagreement and/or a services catio s the accompanying specification sheets.in accordance with the prices and terms described on the front and the reverse of this agreement and any specification sheets').hardby agrees t and BuyedS)have repueSte that such goods a services be installed tl or Agreement t oral Buyer's address listed above.ABA Services.Inc.('Contractor"a cereby agrees o install or cause to he installed a the products or services listed in this Agreement at the Buyers)ed as d written above.This Agreement represents o cash sale in goods and services.The Buyers) agree to pay in cash the cost of the goods and services purchased as tleschhetl herein,regardless of timing or approval of any financing Buyers)may seek for their purrch�ase. ./ /y[(fLC'�-��/" Purchase Price:q,���'''��r`s`,�J i, n �/�C� eL�'r.4'`/✓ Est. Starting Date: V Down Pa,..Tt:� ]�(�Y� /�GC`r -3 t /\ Est.Completion Date: n� / 8 Cas Amount Due on Stan of Job. A/* 4� 0 eck , Credit Carla Amount Due on of Completion: r! 7 3 No. Amount Due on of Completion. / _`—_— Expiration Date: Balance Due on Upon Completion: CVC Code: It is agreed and understood by and between the parties that this Agreement, front and back and any addendum, constitute the entire understanding between the parties, and there are no verbal understandings changing or modifying any of the terms of this Agreement.Buyers) hereby acknowledge that Buyers)has read the front and the reverse of this agreement and has received a completed,signed and dated copy of this Agreement,including the two attached Notice of Cancellation forms.on the date first written above.Buyers)also(i)acknowledge that they were orally informed of their right to cancel this transaction;and(if)request thermally be contacted via their telephone numbers or emall,as listed above,in the event Contractor believes Buyerfs)would be interested in any additional quality products or services of Contractor. DO NOT SIGN THIS CONTRACT IF IT CONTAINS ANY BLANK SPACES. A&A Servic Inc. Bulver(s)�--p- Signature , l v/J Signature Pnnt Name Pr�i It Name Signature Print Name You,the Buyer(s), may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction. See the following Notice of Cancellation form for an explanation of this right. ARBITRATION,The cotipacbr no I,.homeowner nereby mutually agree In advance that in the event ender pang nos a Dispute concerse lnis preaml.eiPerper,may suorrvl such dispute lox private arGvalion unite whitlt has been aporov00 iry Nil$eueary of toil Executive OMw OI Consumer ANays one Business Regulations one rM1a olner oany shall be reguiree to submit l0 such aberaeonasproys MG.L c.102A. eus cnnv ul gna l✓i in 1�5: .,� 1 onto. oritc� eTaN N T/ OF CAI NC TIO Dale pl Tranaacvon NOTICE they ranwl loos rtansaclipn,without any penally oil pale o1 Transaction uv may cancel has 4ansaclion.wilM1oul any penally Or obligeuon.wiNin lhr / fro anove Bate. Il you cancel,any propeM traded in, obligation.within lnread one as lrom toil anove Dale I'vou lance.any progeny hatleo tn, any p9yments trade yyu tl¢r Nil Contract Or Sale.one any nagoliable insleumenl executeC any 0aymenl5—a.by uuleet11.COnrtcl or Sala.Tom any negotiable insrrumem execNeO by You will be relumee minin 10 says loll owing receipt by me Seller Of your cancellation notice, by you will Im Rlumee vilhin 10 guys Idlow�ng receipt by Ire Seller W your cencallalion notice. and any security tmerasl awing out Or me transaction will be ca ell N.If You cancel.You must and any secunly Interest arising out OI me Transaction will be cancelled.II YOU cancel.you must available an the Seller al your residence.and subs mmuly In as good rendition as wren nave availunge to the Seller at your residence,ens substantially in as goad candl cos,as when ag ved.any goods offered to you untler Ibis Contract or Sae:or you they.H you wish comply reconed,any gets delivered to you under this Contract or Sale:or you rreµ 11 you wren.comely win The moru troly o1 the Seller regarding the oil n shioment of the goods s the Sellers Troth the anti'made o1 the Salley regarding the mouth shipment of the goads at the sellers expense and risk m k.If You do the goods Tosiablerto the Seller antl the Softer does not pick expense s.id rasa:.Il you do rake Ine goods available to the Seller and me Seller does not pick them up mtho factorial of the date of your demse d Cancauaem you mayrelain or Theories If them rip widen 20 onyx ono¢dale of an,Notice of eancanahon you may retain or..a--of gores slow;any fearer oaiganon.If you cox to maker the goods avauabl¢to the sonde or If Yriu the good.- any canner obngalam.n you rest I.make Ile goods.-,'able to me seller nr o agree torewm The gmostothe Seller and fed To do so,thenYm N remain liable for pertomnce of you agree to return are goods a the Seller and an to do so then you remain liable mr peedrmonco all obligations under the Central To cancel this Tranaaaon mail car deliver a signed and oared of an oFlop a ms uMenna contrast.TO mnceuhis hansacton.msa or delete,a super and dated aovr of be anallatmn notice or any The,wrinern nova.or send a mIe semd¢a. cepv dr The an¢fladon nonce or any Omer wmlen noes.or mind a telegram Ica sA de 115 North Street,Salem MAt119]O.NOT LATER THAN MIONI GHT OF / 11I Nurlh SlreeLSalem MA.1 all NOT LATER THAN M IDsJmHT OF UF $HEREBY CANCEL THIS TRANSACTION Y I HEREBY CAI'.CEL THIS TRANSACTION Consulrer s Signature Date Consume,0S ma _nerd'.. Certificate No: A044298 THE COMMONWEALTH OF MASSACHUSETTS _ EXECUTIVE OFFICE OF LABOR AND WORKFORCE DEVELOPMENT i 11 DEPARTMENT OF LABOR .STANDARDS : wy 19 S"rAmrORD STREEr, BosroN,MASSACFIUSE'rTS 02114 DELEADER CONTRACTOR LICENSE A& A SERVICES, INC. 115 NORTH STREET SALEM MA 01970 LICENSE: DC000440 EXPIRES: Saturday,June 25,2016 IN ACCORDANCE WITH M.G.L. CH. 111, § 197B(b)AND 454 CMR 22.03,THIS LICENSE IS ISSUED BY THE DEPARTMENT OF LABOR STANDARDS TO THE CONTRACTOR ABOVE FOR THE PURPOSE OF ENTERING INTO OR ENGAGING IN DELEADING WORK. I THIS LICENSE IS VALID FOR A PERIOD OF ONE YEAR. THIS LICENSE MUST BE MAINTAINED BY THE CONTRACTOR WHEN ENGAGED IN DELEADING WORK IN ACCORDANCE WITH M.G.L. CH. 11 I § 197B(b)(2)AND 454 CMR 22.03, WILLIAM D.MCKINNEY,DIRECTOR -- r'//.r �e��urrnr���r///.�r'-�/rr�ur/r r•/G Cyl Massachusetts -Department of Public Safety —� Office of Consumer Affairs&Business Regulation �l Board of Building Regulations and Standards 4';;==TOME IMPROVEMENT CONTRACTOR C"n'tru=: oul= . +ur t jRegistration: 101609 Type: License CS-057733 ,Y,_. �.�Expiration: 6/26/2016 Private Corporation }' CMUSfOPHER 7t4) 4&A SERVICES, INC 115NORTHST Ple 18 Salem MA 01970% Christopher zorzy :. 115 North Street Salem, MA 01970 Undersecretary ^' ���T— Expiration Commissioner 05/26/2017 ' I IA&A SERVICES, INC. 115 NORTH STREET SALEM,MA 01970 CITY OF S�1I.E:tii, AXSSACHUSETTS BUMD12NIG DEPART.IENT • p 130 WASHINGTON STREET, 31°FLOOR �o s TF - (978) 745-9595 FAX(978) 740-9846 KIMB Rt FY DRISCOLL MAYOR THOatAS STTIERRE DIRECTOR OF PUBLIC PROPERTY/BUILDING CONLNaSSIONER Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information C Please Print Legibly Name (BusimxssOrganizatiorvindividwtl): yy� Address: II l- L)()eull S n n City/State/Zip: Phone #: I — 1 -d ya y A�rk,you an employer?Check jhe appropriate box: Type of project(required): l.L111 1 am a employer with L\ 4. ❑ I am a general contractor and 1 6. New construction employees(full and/or part-time).' have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7• Remodeling ship and have no employees These subcontractors have S. ❑ Demolition working for me in any capacity, workers'comp. insurance. 9. ❑ Building addition [No workers'comp. insurance 5. ❑ We are a corporation and its l0.❑ Electrical repairs or additions required.] officers have exercised their P 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.0 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' Il.❑ Other COMP. insurance required.] 'Any app"'am'hot chtn:ks box#1 must also fill out the section below showing their workers'compensation policy information. 'I f=ownen who submit this affidavit indicating they are doing all work and then hire outside eommemrs most submit a new affidavit indicating such. :Contmeton that cheek this box must attached an additional sheet showing the name of the sub-contractors and thew workers'comp.policy information. 1 am as employer that is providing workers'compensadon Insurance jot my employees. Below is the policy and jab she informatiam 1 Insurance Company Name: M-9A v e��e►� Policy #or Self-ins. Lic. Expiration Date: Job Site Address: �9 IPl)t'-W A y-e City/State/Zip: Q Je m uI/�i� Q' q 7 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 S250.00 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. l do hereby certify at er the pal. and penalties of perjury that the information provided above is t a//e and correct i anar tr " Date: �p Phon #: Ojfcial use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Aulhority (circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other _ Contact Person: ___ Phone#: ,< CITY OF SAL.EM, INL-1SSACHUSETI'S BUILDING DEPART-NI&NT \ � 120 WASHINGTON STREET, 3iO FLOOR TEL (978) 745-9595 FAX(978) 740-9846 Ij.-,tBFRi FY DRISCOLL MAYOR THomAs ST.PMRRE DIRECTOR OF PUBLIC PROPERTY/BUILDLYG CONLMISSIONER 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 11 L5 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 hedebris will nbee�transported by: (name of hauler) The debris will be disposed of in ,AA,6 1 r (name of facility) �0 E6) (a)aW iMeli o btil� 0 l ^ q (address of facilit ) V I I / G ✓+ SaleoA V>1a X Cl� 0 � 9 r7o signature of permit applicant dat JcbrivlT.Jce