15 FORRESTER ST - BUILDING INSPECTION ' , ,+ I Thk,Commonwt:alth af,Mussughuagtts � ;
`1 �' _ 'x6oprd Qt Butldin�E{eguiutlons and$landar�� , _ ,MUNic'1�P,\III 1.
"`�\��� I\ Nlatiauchusetta State building Cadte,76t)CMR,T^cditirin ? USE
�' Building$emit Applictttion Tq Construct, Repair, Rengvute Or Demgliah u R�r l.�d Jcnunu t
'Th1s Section,For;OFficinl IJse Onl
i3yild)ng}Ptrrnit Nu, , Dale Appbad:< oL::' ,
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L:lu is thia'un due tad streat t es n✓ o M?!P Number, Pun�),1,,Zq
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13 PoninglnPgrmatMna' ' 14 PropertyDirnatts) np 1
ZopjnQ b1sWFt � ' � Proposed y()¢e' �� , - L.o Area lsq R); hrontugc tR) -
1:,�`,Bu1ldMig;&atbeck9'.(rU
Reyulrad ! Pipvidad qulnd ` ,� Ptavided' 3 :;Rsquir � Fmvfded ;
},6 Water SMpplyt((4O t a 40 §9¢)` 171 )oo�Il?pne Igf4rgratlant F:i I18 BeWage Dipposal System:
Zon I '' Ouulde Hood 2ono7� '
_, „Pkblly Pdvatet] �, ! r ' Checfi'IP 9I1� f`�` Municipal !On slta disposall ❑
%!SECFI N'3t PRQPBIRTYOVtNERSFhIP,'
a x I.:-
OWN a ,1t, rd
Npme(Print) Address f{�r Servtea v
slggantMiVTF)F.PhAA4 M
I
77
BECTiOty 3t bE9GEt[ IAN:OF PRO('OF,U QR yF(fhock'pB fh�R QP.Piy),t
1`74N ConstrSicllon❑ y$lC'sting Bu�ldi tg` OwnarrOct upied RapalPs(eZ" : Aliaratfoq(s) b Addltlnp ❑
i�pmolitfgn q, Accessory'Bldg Ngmba�,gFUnite Olhar ❑ Seedily,
HrIoP psc tlon of Proposed Wor
91PyCT � N 4 ,E$TI14>;gT1�1�ON$TidU;�'P1iQlV COSTB ''� :' >;.A
item i L. B tj)4d Costar r:l fi QfR�&�ji6! y
Gabor dhd Materials
-$ p,�;�.,._ '-.;p ) Build.�tg Parml Fes= ' ' id scat tiuw Pop is determined Q
1 ��ufiding � r
...... ❑Sta„dard^,City/[aWn APPIIcation Fee,
OfotpiP[glettCoaP;(Itam6)xmMitipdor <
3 P.(prirbing $ P ..w2b,
Arlytechanlgal 'cktYAG7 ' aaY }• , , � List
it
1
�,►Nechanicai+(Firo, r , $
9u` rcastonViir Tutal All Feea 3
' , �" CheckNV�'_..�C�he�k=r(mdiittt _Cush Amount._.
8,Total PraJect Cast :S, O Ppid 16 ull Q Outst nding Batun�e (Sue,
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ro
CONSIRU„GTfONSERYICES
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9m
,.Llaense Number Expimien
Detu
time of CUP
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sy
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Realrlatnitl8rTifiill .
"T, A n :ah I VIM
J_RC 140�81,wnffilll nifill.cldvifihil d`t;
il
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amemtkr
oil;f
eaWro provide
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it epplicutibn
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ORIZ )ECLARA'TIOIy
I,a :z.. m Ownerar Authorized Agent hereby" are- ..
t(tat(;Ile statements and information on the ftKbgotng nppi)catlon nro true and acctimte,ro tha.bast of my knowledge and
Date,
........ ...
..........
I Yin O ertWhd able tis n 6ufldfng permit trs do his/her own Work;of an o er who hires an unregistered wntruuor
A
deit.s L
Oros Ifvtng area(sq`FaS ' Habitable room count '
N5m6erop,firoplace� ` Number of bedrooms
. ....... .*N,u-m r bathrooms; 1l, a
_M of
'T Mll
f dir_ng2syst
uslei
Type U DbBllnjliysfiii
zi Pp,
be -substituted d6tIc t 1�
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ps
CITY OF SALEM
PUBLIC PROPRERTY
DEPAKT'.'vIENT
\I ntl: I %1:411r0 \.\II \I,
/'8--4i.934li ♦ I \Y: 'i7X.'4:_ 64 o
Construction Debris Disposal Affidavit
h (required l'or all dcnwlition and renovation work)
I In accordance \pith the sixth edition oFthe State Building Code, 780 CNIR section 111.5
Debris, and the provisions of'MGL c 40, S 54;
Building Permit it is issued with the condition that the debris resulting from
this work shall he disposed of in a properly licensed waste disposal Facility as defined by MGL c
l I L S 150A.
The debris will be transported by:
YDIM) )S rt &2f
(.name of hauler)
The debris will be disposed of'in
(] -
(mmne of facility)
6ZfZA �
(add ss of lacililvl
- igu wry of permit .q�plican
e l g AD
late