185 FEDERAL STREET - BPA B-05-856 -P1I,*iNS1d ST-9E fILf$dNdL>t APPROVEO BY T44E
A5Pf=DB PRW TD.A.PERWT BEING GRANTED
CITY OF SALEM
No.��` 'y Date
yj
Ci�2le�out-
Is Property Located in Y' Location of
Ow Hisloric District? Yee VNo_ Banding F-LW-4.L.—
Is Property Located In
to Conservation Area? Yes No v
BUILDING PERMIT APPUCATION FOR:
Permit to:
(Circle whichever apply) Roof Install Sidi g, Construct Deck, Shed, Pool,
epaidReplace, ther: a�.•c,�Yt�2a H
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:
Owners Name e ke2ki,e
Address & Phone G/� Ae,G( i, & w1 1 i 935 O0-1
Architect's Name
Address & Phone I 1
Mechanics Name
Address & Phone
Whtl Is the purpose of txdldkV?
mdww of bum rtgT )1t10W4t,JdPvc n a dwelling, for how nmy famines? 2
WI9 building conlpm to law? Asbestos?
Esdmmt9d cod d60-�Cily licensee N A State 27
at
Barge Iaproveawnt
T 1 2�' Fes- Lic.
Sig ure of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRI/PT,.IIC OF WORKTO BE DONE
/fu✓r!lr�� /CL�GU /?�, /Cf'/—�fY(fh //lrfG
MAIL PERMIT TO: PILL- Pr ei< - d.P
- - - - -
No �� _��
APPLICATION FOR
PERMIT TO
; Ali9J. r� i l�lT�ufN 112kT4
LOCATION.,
186'-
;I
f
PERMIT GRANTED -�
APPROVfO
�4,14
rPfCTOR OF BUI S
Board of Building Regulations amid Standards
' HOME IM ROVEMENT CONTRACTOR
Re i_WHOn:_1. 8201 -
007
DETAILS GLEA
_ , TEPHEN _
�158 HALE STREET�"'� G(...� r�rF'✓
.�r...w
BEVERLY,MA 01915 Administrator "
Licerme CGONSTRUCTION 6UPEFM$6K
'NV' iMre CaR7:: 08W2¢Ye ""
pMttA ;Q$t281t9E16 �," � �
Expin�s.0 fil2fp7 1 Tr no 88122
' 158 HALE STr
BEVERLY,�MA4:01916 �� Commlallon� -i �
l
a CITY OF SALEM9 MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
Ulu 120 WASHINGTON STREET, 3RD FLOOR
SALEM, MA O 1970
TEL. (978)745-9595 EXT. 380
FAx (978) 740-9846
STANLEY J. LISOVICZ, JR.
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the provisions of MGL c 40, S34, I acknowledge that as a condition
- - - ofBuilding-Permit# - -- ,-alldebns-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, S 150A.
The debris will be disposed of at: / Ov L
Location of Facility
Si a of Permit Applicant bife
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
Name of Permit Applicant
f!G
Firm Name,if any
Au°
Address, City & Stat r
The above statute requires that debris from the demolition, renovation, rehab or other
alteration of building or stricture be disposed in a properly-licensed solid-waste disposal
facility as defined by MGL cM, S 150A, and the building permits or licenses are to
indicate the location of the facility.
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