69 BOSTON ST - BUILDING INSPECTION (2) l4.dlifPSi►14iStmOE oEO4,*Die-,PPROVE-D BY T44E r
IAIS�P CTAJ3 ' R D';y#.P.Eft T BFJNG GRANTED
\� 1 CITY OF SALEM
No.\ V\ V —O� VA Date 2 z
Is Property Located In Location of
the Historic District? Yes No Building 69 -00SI-0/1 S12 Fr
Is Property Located In
the Conservation Area? Yee_No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, CoPf truct.Deck, Shed, pool,
Repair/Replace, Othen 'Ae�l/in,4"7icw
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROCI DING
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the following
specifications:
Owner's Name
Address & Phone �tv0 E'Y ST j7b1l 6 3 9— /i?k3
Architect's Name
Address & Phone If i
Mechanics Name h��• ediv���?i�U� GJOi2lr1 1p /Nii��
Address & Phone
What Is the purpose a building? �5 ;Cle v ri / do 1= Wr i 6 y
Material of building? I-06 c d f--rZ a dwelling,for how many families?
;;11pi
will building conform to law?
AabestOs?
Estimated cost. City License e N A State Llow" N �
}(ill�h
HOIe inprovs nt AAA
SignatLic. I xure ol Applicant "•SIGNED UNDER THE PENAW—y IN
OF PERJURY
DESCRIPTION OF WORK TO BE DONE d o&i pL a r-e 9,0 7- y/U 6- it
srn�p �u; �Nrer,,o/v wA-! �cr����
i
fi li
r ,.
C' e-eA A/ - v �fJ .�c; r/J6S� S72�
MAIL PERMIT TO: ''
No.
APPLICATION FOR
PER�mrr TO
All
LOCATION -
PERMIT GRANTED
AP VF-D
INSPECT R OF BUILDINGS
{o CITY OF 5ALEM9 MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
• • �"e,4)WASHINGTON STREET, 3RD FLOOR
SALEM, MA 01970
PPq TEL. (978)745-9595 EXT. 380
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, S150A. e-
The debris will be disposed of at: 4924ANEV eA-vu 210
Location of Facility
Signature of Permit Applicant Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
Name of Permit Applicant
Firm Name,if any
/O t--//v Den! S 7-12
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 cIll, S 150A, and the building permits or licenses are to
indicate the location of the facility.