4C FLETCHER WAY - BUILDING INSPECTION (3) t
ft�iMT13Ef&*04AG APPROVED By T44E
JdSP=TDR PRIOR TD A PERMIT WMG GRANTED
CITY OF_SALEM
Not`1 V Date
Ward
Zordng District
Is Property Located In Location of
the Historic District? Yes No folding
Is PmPwty Located in
Bw Coneervetlon Area? Yes No
Permit to:
BUILDING PERMIT APPLICATION FOR:
(Circle whichever apply) Roof, Reroof, Install Siding, Constru eck, hod, Pool,
Repair/Replace, Other:
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build accor(Lig.to the following
specifications: ll pp
Owner's Name t C k r ,� I/� a Gt G ✓l l
Address & Phone -C e 1 � 2 f UJ�� ( \�', -�Ob
Architect's Name
Address & Phone f
Mechanics Name 10, 0 lea
Address & Phone ;�
What Is the Purpose of bulidng? ,D r <
Materiel of bAn0? II a dwelling,for how many famWes?
Will buildng cordon to law? y t Asbestos?
Esfteted cost /ZOQ city ucwm k state 6lcw"e b`7 6 G(--,`Q
II4e Iaprovemant y
d L e53 Signature of Appli t
SIGNED UNDER THE PENALTY,
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO: ��t c `�a✓t /yl/1 cP��/n
No\0�
APPLICATION FOR
PEFWr TO
1
LOCATION
PERMIT GRANTED
19
APPROV
7ro
INSPECTOR OF BUILDINGS
'Cf,fnlnofsluelaLih of�c+�ac�,uasttd .
` b .1Jep.alaa.al e��eJrdaiel./fesr�'
n 6'0o Ul.. # S1j
gala 1 uaeod ///aereAereMl 021 It
caeraessaw
Workers' Compensation Imrance Af Mn4g
.i, Cv�ce.L C T-
. . wkh.s principal place of business ac
S�, AMN 0
do bereby•cerdly under the pains and penilties of perlmy dow '
O � an cmpl"w prwidbag workers' cmapematien coveraje for my eir�lW*w working on
Insurance Canq W Polity "umber
I am a sok proprietor and have no one workbag for on in any eapacbw.
I am a so'k propriesere general concraetor or homeowner (circle osse) and hew bleed tits
contractors lined below who-have thi folkawlxg workers' compensadon poBdan
Comraaor Iruurande Comparry/P7, Numbw
Contractor Insurance Company/Policy Numbeg
Con:raaor insurance Company/Poky Numbor
() 1 am a homeowner performing all the work nryseN.
•I vaermeaee owr a Copy of ddr areearer WE be fenwroed as ew Ofae.61 br.adravew of dw DIA fer eeeerete vwaradw ON ton Ir M r sawn
ce..rarr a raav,re eneu fatierr SSA a/MGl 152 can kN a eta iw el ve eei I,SM abler eaw
tram'ieereer.rwre a%o a oA aearrie in d+e kate eta STOP WORK ORDER are a far of S 10CA0 a an apket me.
Signed is —day of J 1 �v o
_r
.icerseci Fermiuee ouildinf Gepsrzri en[
Jcfmsinf Ecare
Seieamens Office
-iealsh Deprrrler,-
- - _-_cccC Xe = ece epc, :pe, 17F
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 9RD FLOOR
y SALEN,MA 01 970
TEL (270)748-B595 CIT.SSO
FAX (076) 740-994E
STANLEY J. USOVIC7, JR.
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
III accordance with the Provisiolta of MG.c 40,S34,I acknowledge that as a Condition
of Building Permit g .all debris resulting from the construction ac(rjAy
governed by this Building Permit shall be disposed of in a properly licensed aolid-waM
disposal facility.as defted by MGI,c III,Sl.%&
The debris will be disposed of at '
Location ofFacility
(�-7 LZ 6
SigrlatlueofPeamit licaot D
FULLY complete the following infom>adm.
(PLEASE PRINT CLEARLY)
Name ofPermrt Applicant
,p-S.,
FFirm Name,if any
I�
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 dispoaai
facility as defined by MGL cIM S 150A, and the building permits or hceosea are to
indicate the location of the facility.
ii JU4-27-2004 03:56P FROM: TO:197e7409e46 P: 1
American Properties Team, Inc.
f0: Rick Madden, 4C Fletcher Way/'>•'
j FROM: Jill Tama, Property Manager
j{ RE-: Deck Replacement ((�
DATF: June 24, 2004, 2004
Plcasc be advised, the Board of Trustcus for Pickmun Park does not object w the
replacement of your deck. Please be advised. you may not change the dimensions of this
deck. A licensed contractor must replace the deck. A permit must be pulled prior to this
work commencing. A copy of the permit should be sent to me. Once the work is
complete and the Building Inspector has signed off on this work, a signed copy of the
building permit will be required as well.
As discussed, the Association will reimburse you or pay your contractor directly to install
flashing between the deck and building.
Should you have any questions or concerns, please feel fee to call me directly.
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i 500 WEST CUMMINGS PARK • SUITE 60.50 • WOBURN • MA • 01801 781.935-4200 • FAX 781-935-4289
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