47 FEDERAL ST - BUILDING INSPECTION iA4iS EfiLf#�iidD '11fPAOYED BY T44E
IAISpJCJC�F PICAP A PT i3EWG GRANTED
CITY OF SALEM
No. �'�btQ yw � Data L �
•C :s:t# k.
'ta
M
Is Property Located in Location of
the Historic District? Yes_No_ Building 77
Is Property Located in
the Conservation Area? Yes_No _
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof,(Aeroo Install ®rSiding, Construct Deck, Shed, Pool,
Repal apace, Othecjws
PLEASE FILL OUT LEGIBLY & COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the following
specifications:
Owner's Name _�0,U A2.t-c-C �y�t�to r S�� L c
Address & Phone 7 7 T�I�L S�' Ma) 70
Architect's Name
Address & Phone L )
Mechanics Name
Address & Phone L )
What Is the purpose of building? 6`5;F yC Es
Material of building? If a dwelling, for how many families?
Will building conform to law? Asbestos?
Estimated cost! Z city Licenser N fa state License rf
Boma Improvement v L
Lic. I eA,
Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
S1?rti1Gt,�
rZ00'Fr rJ6,�51 DI tJG.
MAIL PERMIT TO:
No
APPLICATION FOR
PERMIT TO
.'.�-%4
LOCATION
PERMIT GRANTED
7� / 03 ,s
APPROVED _ ..
INSPEq.TQR b F BUILDINGS
r
OF SALEM,- MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
12
120 WASHINGTON STREET, 3RD FLOOR
it SALEM, MeA 01970
TEL. (978)745-9595 EXT. 380
�qt> 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.
The debris will be disposed of at:
Location of li
Signature of Permit Applicant ate
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
Name of Permit Applicant
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 cHI, S 150A, and the building permits or licenses are to
indicate the location of the facility.