6 CLARK AVE - BUILDING JACKET c -- W4 RECEIVED
INSPECTMNALSERV
$ 22 ►v AUG ►2 A ►i:
The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code,780 CMR SALEM
' Revised Mar N)/l
Building Permit Application To Construct, Repair,Renovate Or Demolish a
One-or Two-Family Dwelling
This Section For Offici se Only
Building Permit Number: Dat pplied:-
8
Building Official(Print Name) Signature Date
SECTION l:SITE INFORMATION
1.�p�ty Address 1� 1.2 Assessors Map&Parcel Numbers
L 1 a Is this an accepted\street?yes x no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq It) Frontage In)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.(J.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone?
Check if yes❑ Municipal❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record: Hoan Vo
9 Sa lie lnn MA.
Name(Print) City,Slate,ZIP
6 Clark Ave. 978-745-8736 Nhatoi24@Comcast.net
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK(check all that apply)
New Construction Existing Building❑ Owner-Occupied ❑ I Repairs(,) ❑ 1 Alteration(s) ❑ Addition ❑
llemolition ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work': S
o+ v a.IG. Sol0.r
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item "' Estimated Costs:
Labor and Materials) Official Use Only
I.Building 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical ❑Standard City/Town Application Fee
❑Total Project Cost (Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ L169:
5.Mechanical (Fire
Suppression) $ Total All Fees:$
Chcck No._Check Amount: Cash Amount:_
6.Total Project Cost: $��t�s ❑paid in Full ❑Outstanding Balance Due:
C.wa t,l. Li , v .
SECTION 5: CONSTRUCTION SERVICES
5.1 -Construction Supervisor License(CSL)
J1C UY%4e,s f:)he-rfV -ay'1 License Number Expiration Date
Name of CSL Holder
,l kal n S l f ^.t List CSI.'type(see below) U
No.and Street I ft^��CIICC �' type Description
Sa �S 14A 0l-1C)w U Unrestricted(Buildings u to 35.000 cu.ft.
City/Town,5 l4""/_IP R Restricted 1&2 FamilyDwelling
M Mason
RC Roofin Coverin
WS Window and Siding
_ SF Solid Fucl Homing Appliances
f13 IV1Fal W.DICIY'�VIUtv�'S21�fA! 1 Insulation
Tel" hone Email address r"1 D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number E lira!on Date
HIC Cotn any Name or HIC R gistranl Name
4C 3 �n8 Z . yy�aS00-r .VLVIVL+solar.
No.and Street Email address CF>yvt
ProYo LTT" $t}IDOI} 'Ig13053o1c5
Cit /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 Issuance of the building permit.
Signed Affidavit Attached? Yes..........A No...........❑
SECTION 7s:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize V11/I11-t Sfl jCLr
to act on my behalf,in all matters re to work authorized by this building permit application.
0 7/31 /14
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER!OR AUTHORIZED AGENT DECLARATION
By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information
contained inth p lion is true and accurate to the best of my knowledge and understanding.
Print +Ow �s r sized Agent's Name(Electronic Signature) Date
NOTES:
I. 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 eov/dos
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"
{;J uvont. solar 4931 North 300 West
Structural Group Provo,UT 84604
P: (801)234-7050
Scott E. Wyssling, PE
Head of Structural Engineering scot[, sslin wy gL7a vivintsolar.com
July 31, 2014
Mr. Dan Rock, Project Manager
Vivint Solar
24 Normac Road
Woburn MA 01801
Re: Structural Engineering Services
Vo Residence
6 Clark Avenue, Salem MA
AR#3200821
6.375 kW System
Dear Mr. Rock:
Pursuant to your request, we have reviewed the following information regarding solar panel installation on
the roof of the above referenced home:
1. Site VisitNerification Form prepared by a Vivint Solar representative identifying specific
site information including size and spacing of rafters for the existing roof structure.
2. Design drawings of the proposed system including a site plan, roof plan and connection
details for the solar panels. This information was prepared by the Design Group and will
be utilized for approval and construction of the proposed system.
3. Photovoltaic Rooftop Solar System Permit Submittal identifying design parameters for the
solar system.
4. Photographs of the interior and exterior of the roof system identifying existing structural
members and their conditions.
Based on the above information we have evaluated the structural capacity of the existing roof system to
support the additional loads imposed by the solar panels and have the following comments related to our
review and evaluation:
Description of Residence:
The existing residence is typical wood framing construction with the roof system consisting of 2 x 8
dimensional lumber at 16" on center with 2 x 4 collar ties every 48". The attic space is unfinished and
photos indicate that there was free access to visually inspect the size and condition of the roof rafters. All
wood material utilized for the roof system is assumed to be Spruce-Pine-Fir #2 or better with standard
construction components. Our review of the photos of the exterior roof does not indicate any signs of
settlement or misalignment caused by overstressed underlying members.
Stability Evaluation:
A. Wind Uplift Loading
1. Refer to attached Ecolibrium Solar calculations sheet for ASCE/SEI 7-10 Minimum Design Loads
for Buildings and other Structures, wind speed of 100 mph based on Exposure Category "B" and
32 and 18 degree roof slopes on the dwelling areas. Ground snow load is 40 PSF for Exposure
"B", Zone 2 per (ASCE/SE17-10).
2. Total area subject to wind uplift is calculated for the Interior, Edge and Corner Zones of the
dwelling.
vivi t. solar
Page 2of2
B. Loading Criteria
10 PSF=Dead Load roofing/framing 40 PSF=Live Load (ground snow load)
5 PSF=Dead Load solar Panels/mounting hardware
Total Dead Load=15 PSF
The above values are within acceptable limits of recognized industry standards for similar structures.
Analysis performed of the existing roof structure utilizing the above loading criteria indicates that the
existing rafters will support the additional panel loading without damage, if installed correctly.
C. Roof Structure Capacity
1. The photographs provided of the attic space and roof rafters show that the framing is in good
condition with no visible signs of damage caused by prior overstressing.
D. Solar Panel Anchorage
1. The solar panels shall be mounted in accordance with the most recent "Ecolibrium Solar
Installation Manual", which can be found on the Ecolibrium Solar website (ecolibriumsolar.com).
If during solar panel installation, the roof framing members appear unstable, deteriorated,
structurally compromised or deflect non-uniformly, our office should be notified before proceeding
with the installation.
2. Maximum allowable pullout per lag screw is 235 Ibs/inch of penetration as identified in the
National Design Standards (NDS) of timber construction specifications for Hem-Fir (North
Lumber) assumed. Based on our evaluation, the pullout value, utilizing a penetration depth of 2
1/2', is less than what is allowable per connection and therefore is adequate. Based on the
variable factors for the existing roof framing and installation tolerances, using a thread depth of 2
1/2" with a minimum size of 5/16" lag screw per attachment point for panel anchor mounts should
be adequate with a sufficient factor of safety.
3. Considering the roof slopes, the size, spacing, condition of roof, the panel supports shall be
placed at and attached to no greater than every fourth roof rafter as panels are installed
perpendicular across rafters and no greater than the panel length when installed parallel to the
rafters (portrait). No panel supports spacing shall be greater than four (4) rafter spaces or 64" o/c,
whichever is less.
4. Panel supports connections shall be staggered to distribute load to adjacent rafters.
Based on the above evaluation, it is the opinion of this office that with appropriate panel anchors being
utilized the roof system will adequately support the additional loading imposed by the solar panels. This
evaluation is based on information supplied to us at the time of this report and current industry standards and
practices.
Should you have any questions regarding the above or if you require further information do not hesitate to
contact me.
Ve trulyyours, tNOFnagy�
c
�Pk Y
O GVI y
Scott E.Wyssl PE ° so
MA License N . 50 90 ECISTEPti
FFSS10NAl
vivant. solar
6 Clark Ave, Salem MA 01970
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The Commonwealth of Massachuse tVED
sib �SPEOJONAL SE SEE ITY OF
Board of Building Regulations and Standards `'ALEM
Massachusetts State Building Code, 780 QMR DDpp Revised Mar 2011
Building Permit Application To Construct,Repair,Renovate�t cinliliRa 40
One-or Two-Family Dwelling
This S,ecGon For,Officiai Use Only
Cq Building�P+ermit Number: Date Applied:' _ >
Building Official(Print Name) Stgtature
SECTIONI:SITE INFORMATION
1 1.1 P perty Address: �� , _Assessors Map&Parcel Numbers
Is this an accepted street?yes no Map Number Parcel Number
l.la
L ZoningInforma6on: Property Dimensions:
Zoning Disuict Proposed Use Lot Area(sq ft) Frontage(it)
1.5 Building Setbacks(it)
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?Check if yes❑ Municipal❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIPr `
2C .1 wnert of Record:
YO . s� M A 0�9
T/�1 �l�l
Name(Print) a City,State,ZIP
P1�tQ� AVM g7Sl-71r5=st7� I�I�at�l 2�
No.and Sim Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED.WORIO(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work .-
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Estimated Costs:
Item "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 x
3.Plumbing $ 2. Other Fees: $ -
4.Mechanical (HVAC) $ IList:
5.Mechanical (Fire S ression $ Total All Fees:$
u
Check No Check Amount: Cash Amount:
6.T al Project Cost: $ 3 S Q-: ❑Paid in Full ❑,Outstanding Balance Due:
1 -
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supew%or I icense'(CSL)
License Number Expimtion Date
Name of CSL Holders Cl + iZ u i)5
00 List CSL Type(see below)
No.and Street " Type Description
U I Unrestricted(Buildings no to 35.000 cu.ft.
R I Restricted 1&2 Family Dwelling
City/Ibwn,State,ZIP M I Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Bunting Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
No.and Street Email address
City/Town,State ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(NLG.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 Issuance of 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
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) Date
SECTION 76-OWNEW OR AUTHORIZED AGENT DECLARATION
By entering my time below,I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
Print Owner's Autho ed Agent's Name(E onic Signature) 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
wtivw:mass.yol, v.'ooa Information on the Construction Supervisor License can be found at www.niais.gov/dps
v/dns
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 halfibaths
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"
J / `° , OT'Y OF SALEM, MASSAOR)SE TB
� BUILDING DEPARTMENT
120 WASF fNGTONSTREET,3"D FLOOR
TEL. (978)745-9595
FAX(978)740-9846
KIMBERLEY DRISCOLL
MAYOR T}IOMAS STRERRE
DIRECTOR OF PUBLICPROPERTY/BUILDING COMMISSIONER
HOMEOWNER. LICENSE EXEMPTION
PLEASE PRINT:
Date
Job location AV r—
Home Owner Address
Present Mailing Address If
The current exemption of"Homeowners"was extended to include owner-occupied dwellings of two
Units or less and to allow such homeowners to engage an individual for hire that does not possess a
license, provided that the owner acts as supervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or
is intended to be, a one=or two-family dwelling, attached or detached structures accessory to such use
and/or farm structures. A person who constructs more than one home in a two year period shall not be
considered a homeowner. Such "homeowner"shall submit to the Building Official,on a form acceptable
to the Building Official, that he/she be responsible for all such work performed under the Building
Permit.
The undersigned "homeowner"assumes responsibility for compliance with the State Building Code and
other applicable by-laws and regulations.
The undersigned "homeowner"certifies that he/she understand the City of Salem Building Department
minimum inspection procedures and requirements and that he/she will comply with such procedures
( and requirements. �J
X' HOMEOWNER'S SIGNATURE
f v APPROVAL OF BUILDING INSPECTOR
OTY OF SALEg A ASSACH(J[SE m
BuiiDDmDEPAramm
120 WAMCMNSUMT,3"RDOR
1kL(978)745-9595.
PAX(978)740.9846
R rMR FRl.F]'D1ji8Q71,j,
MAYOR TrR AS STAMM
Deo;Cr a oPPuaucPxoPER7Y/BtnDmaam=om
Construction Debris Disposa/Affidavit
(required for all demolition and,renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR, Section 111.5 Debris,
and the provisions of MGL c40, 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 deposit facility as defined by MGL c 111, S 150A.
The debris will be transported by.
SlAiEND U S
(name of hauler)
The debris will be disposed of in:
(name of facility)
(address of facility)
Signature of applicant
L4 -2 ( - 1ce
Date
l �1
sS\ The Commonwealth of Massachusetts e
=v7PECT10 ALS
Board of Building Regulations and Standazds SALEM
T Massachusetts State Building Code,780 CMR �p 1 ppp
Building Permit Application �ev ylapll
U�\ ation To Construct, Repair,Renovate Or Detil
( �Yis'M 2` 1 h
b 6 One-or Two-Family Dwelling
l This Section For Official Use Only
n Building Permit Ntmtber Date lied:'..
Bwlding Official(Print Name) .Signature - Date
SECTION,1:SITE INFORMATION ,
.r-. 1.1 PrropR�Agress: '/1pw A✓� 1.2 Assessors Map&Parcel Numbers
1.1 a Is
this an accept d street?yes /7 no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(it)
1.5 Building Setbacks(it)
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 w er'o RecA
RZAA I KI 2 �M AAA
}n
Name(Print) ,/ City,State,ZIP r
79�—�o Qa v Ulcw�tJ� � 0 Llr �6Z Pk1^9s S���,SIC•C
No.and Street Telephone mail Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied Repalrs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ 1 Accessory Bldg.❑ N C✓
Brief Descriptio of Pro osedWor :
� w "Ju0 I1fa
ev I
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Estimated Costs: ., `
I[em Official Use Only
Labor and Materials
1.Building $ logo 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Cost'(Item 6)x multiplier x -
3.Plumbing $ I Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $ Al
- Total l Fees:$ -
Su ression A
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ d p� 0 paid in Full ❑Outstanding Balance Due:
r�
SECTION 5: CONSTRUCTION SERVICES
5.1 Consirirctiod.Svper4isor License(CSL)
License Number Expiration Date
Name"of CSLHoldr (TC,', ;�'i List CSL Type(see below)
No.and Street Type Description.
U I Unrestricted(Buildings up to 35,000 cu.ft. ..
R I Restricted I&2 Family Dwelling
City/Town,State,ZIP M I Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
No.and Street Email address
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 Issuance of 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
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
By entering my n e below,I hereby attest under the pains and penalties of perjury that all of the information
contained ' s pplicatiort�is true and accurate to the best of my knowledge and understanding.
Print Own ', r Authorize ent's Name(Electronic Signature) D to
NOTES: ,
1. An OVner who oblains 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.masssov'oca Information on the Construction Supervisor License can be found at jnyA n ss.=ovt /dns
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"
c
CITY OF SALEM, MASSAaR SE TTS
BUILDING DEPARTMENT
120 WASEIINGTON STREET,3"DFLOOR
TEL. (978)745-9595
KIMBERLEYDRISCOLL FAX(978)740-9846
MAYOR THOMAS ST.PIERRE
DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER
HOMEOWNER LICENSE EXEMPTION
PLEASE
,PRINT:'�1 /
Date ,1 �pp�// (J
Job Location � -06 cIi illrv✓ ✓L lwe_
Home Owner Address-
Present Mailing Address
The current exemption of"Homeowners"was extended to-include owner-occupied dwellings of two
Units or less and to allow such homeowners to engage an individual for hire that does not possess a
license, provided that the owner acts as supervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or
is intended to be, a one--or two-family dwelling, attached.or detached structures accessory to such use
and/or farm structures. A person who constructs more than one home in a two year period shall not be
considered a homeowner. Such "homeowner"shall submit to the Building Official,on a'form acceptable
to the Building Official,that he/she be responsible for all such work performed under the Building
Permit. .
The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and
other applicable by-laws and regulations.
The undersigned "homeowner"certifies that he/she understand the City of Salem Building Department
minimum inspection procedures and requirements and that he/she will comply with such procedures
and requirements.
HOMEOWNER'S SIGNATURE
APPROVAL OF BUILDING INSPECTOR
, Z
r .
CITY OF SALEA A ASSAmUSE M
BuwnqGDEPAimffxr
120WASIMCM 7REET,32DROOR
IkL(978)745.9595,
RiMRRRi F]•1�]j��i j,
FAX(978)740.9846
MAYOR TrsMM STYMM
DntEcrcacFpuwcpxcnm/BumDDcccmmcm
Construction Debris Disposa/Afdavit
(required for-all demolition and,renovation work)
in accordance with the sixth edition of the State Building Code, 780 CMR, Section 111.5 Debris,
and the provisions of MGL c40, S 54; Building Permit g is issued with the
condition that the debris resulting from this work shall be disposed of in a property licensed
waste deposit facility as defined by MGL c 111, S 150A.
The debris will be transported by:
L Mc D r5 (��5� f
(name of hauler)
The debris will be disposed of in:
(name of facility)
(address of facility)
Sig tur f Tplicant
L_� I .ZOl �
ate