8 COTTAGE ST - BUILDING SHED 4
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fLAW�IS/�A�IM� I�NEsfNAN #Io AAPFPROVE0 By THE
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J CITY OF SALEM
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Permit to: BWLDINO PERMIT APPLICATION FOR:
(Circle whichever apply) Roof, ReW. Install Sid $
RspaiNRepleoe, Other._=��o \��, POOL
PLEASE RLL-OUT LEGIBLY i COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS: '•
The undersigned hereby applies for a permit to build aocortLip.to the following'
specifications:
owners Name ST4 N le,,,y_I'
Address & Phone �7r'f1
Architect's Name
Address A Phone
Mechanics Name
Address Q Phone ( 1
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Signature of Applicant
SIONED UNDO THE PENALTY'
OF PWUURY
DESCRIPTION OF WORK TO BIE DONE
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MAIL PERMIT TO: i ""
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CITY CIF SALEM
BUIIAIIdG DEPARTmER
1i01vME0VI M LICENSE MMAPMON
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PRFSENTMALWOADORES= �A/�I !�IIS //XOd e .
'tars -.vwmjdci d-n wafi Cm wmtr-opmpw dwasio atrwo
11nin Q leafs aad to.flow Fab tomoowm=m=WP ran bdividrrl►.lor wm wbo dos rot pmsse a
llocraypawlded tbm>be 4mm..aet d wpervle.e.
DEFRdl10ti0FROt" sow
Pcrsom U)who owm ps4a1 d hvd om whka behae teslds a bucnds m Tesble,oa wait+ k .
bitendad m M. ma m two tm W dwiMag atmadad of&Asdwd etTtTervs*Cocsmy' Tolle wwldaed
farm nnw veL A pens wbo wmn cu mat tram ome boss b►a twoym POW SW
Bundbi OlfiC+ds thait b&WO bebe mponrbk to aA SO&wokpafatoed mAW� i W��
The mido�slpad'homawnd"au wnu tespomibil V I=eomplitoioe` , state Bvllft Code d
otlaa Vocabk goes by4b Tula aad TepbdaL
The im knipad'homoowne=rdfia that hchhe w4c=rds the city Of Stikm Bmilft Depeaost
muvmmm bitp=cm pm=dms and Tegm C=W and flat htsha will eompl7 with UM piooedms d
1
HOMEOWNER'S SIGNATURE
APPROVAL OF BUIIAING MPECTOA E
Sm otba ade for stain code
HOMEOWNER'S EXEMPTION
-Tne w—&nata di-C-jq homeo.rnn yu�ormi wak for art ,bind k arl r -
cxcmp Lom tTre pro+isiom of th6 seedom (Seetka 70'.L7-1JassimS d Comm"SaperviONIC
provided dw L a aomeowna enpps p pasom(s)far mm to do.s .L*port.timt ai>�Lomeowaet aoe.a
MW bonwow ma who use Us eamyJm we imawau tbat they we assmalg On pesyomtI Mato ds _
supavism Gm Appeadh Q,Pines and lteplatloa far IJerosing Coostrscilm S•pervlwts,l@e1a
i]'J} This Ldr of n+arerrev caea rwlts is serious problems.psideuu"v"Lea dw ltoseowaa Y91�aa
unikemed pcaoma lA tLls case yom Bard am,ot proceed ajalrsx the murrxmeo po�on Ga It would w!�
liaated Sopa+iagr. The 6omeswxr adh>f u super'--la dtlmMe�resjomsSflL .
To culum that the homcow ntr b fully swan ot U%cr.reapontibMdes,mop eommaoddes wsgo6a;•paal
of the penndl appiiadom,that the b mcorrma caft that b&Ww mdaamda tbs tnponshOldes a[a
agaybm You mq can to amend and adopt anddt a f akewdfatfm Sar tms in your eoo m dIV6
CITY OF SALEM9 MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
i 120 WASHINGTON STREET, 3RO FLOOR
SALEM, MA 01970
TEL. (978)745-9595 EXT. 380
00 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
j disposal facility, as defined by MGL c III,S 1
IG The debris will be disposed of at: \
Location of Facility
Signature of Permit Applicant Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
Name of Permit App ant
Firm Name,if any
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 cM S150A, and the building permits or licenses are to
indicate the location of the facility.