159 FORT AVE - BUILDING INSPECTION 14llftlSIAUST-SE flLf�iND APPROVED 6Y T44E
.WSPZCTLIR,PRIOR TO A PERW B,E W G GRANTED
CITY OF_SALEM
No
+s Date
r it
Ward
Zoning District
Is Property Located in Location of
the Historic District? Yes No Building _jam �T .41�
Is Property Located in
the Conservation Area? Yes No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Sid' Construct Deck, Shed, Pool,
Repair/Replace, Other: t ,) t►5►7rDuS
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: 1-If r
Owner's Name Jab- ct Latuw
Address & Phone 676) 771 - l gz(o
Architect's Name
Address & Phone f
Mechanics Name
Address & Phone
What is the purpose of building?
Material of building? I bnp If a dwelling, for how many families?
Will building conform to law? 4S Asbestos? 00
Estimated cost OC70 City License r State ucwm k
Roam Isprovestent
Ur. 0
IS R
i ature f Applicant
GNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO:
L-
No.
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
19
APP "D
r
INSPECTOR F BUILDINGS
l ••
bll Y OF SA EM
BUIlDING DEPARTMM
HONMOWNERLICENSEEXF OM014
please Pam
DATE _
]OB LOCATION
AD VZW
HOMEOWI� 5 -77
TIIFP1101ida '
pp��hdAn.II�iG ADD1tESs /S 7 I-i ld ? ��
TAe c�tat.occmptioo ed'hvmeow "was cxwndcd m arrchak v rawa.oewpied dwalhw OFT"
O
wu a ka and 10 anow saA wMaw•nas m CnSw an bdiv"Joff hoe who does not prows
li¢wc,.Fvvi"tam the ewsw so as sapervism
DEFlr nWOFHONEOW1>M
Pcnm(s)who vww s puma d bud on which bdsbe miles a lntendt m reside, my 10 tads ssw sadly
cfi0we o4 wig
intcr�ded m b,.a one m two family dwcgm&amdwd a&lad"Structures m
farm svvcwm A persm wbc constroett moat thm oat home in s two-yar Paid Steal not ix contidasa
a bouwowma. Such IwmtO`% f shall subm h to the BurB64 OJfid4 oa a hM
Building offs 4 that bclshc bt rrspvns%k to an md►work pafvatnW mda the baudba pmv&
Tht wWcsipicd'boawowne assurrws respons;bWV for =IPnw=with taw Suss Bu9dt coat w d '
other appgc bk Sam by-bwt6 rules sad ttfubdw&
Tbc tv,ders;PW ho n wm_mrufies that he/she rcwiasuud+tiro a4 of Salem Bttik9mgDepatrsd
mt Sues and utrcaw that Nslw will wmQly wi0►said p tmd
mia;mmn bzpwj promd
HONWWNFR'S SIGNA
APPROVAL OF BVII DING WSPECTOA �
Sec otba sae for sett code
1
PUBLIC PROPERTY DEPARTMENT
• - - 120 WAsNINQToN STREET, 9RD FLOOR
SALEM,MA O 1970
TEL (976)74B-9595 E71T. 360
- FAX (976) 740-9646
STANLEY J. USOVIC7, JR.,, '
MAYOR
DISPOSAL OF DEBIM AFFIDAVIT
In accordance with the provisions Of MQ,c 40,S34,I acknowledge that as a ca &dm
of Building Permit 0 all debris resulting from the consbuction activity
governed by this Building Permit sW be disposed of in a propedy licensed soh&waste
disposal facility, as de$ned by Mt3L c nL S150A.
The debris will be disposed of at IJo 7t,T A S r C�tF C,A,J i I (L1Csy
Location of Facility '
of P fi Applicant Date
(PLEASE PR CLEAR
Mr following
Name ofPermit Applicant
Firm Name,if any
/6-7
Address,City&State
The above statute regains that debris from the demolition, renovation,rehab or other
alteration of building or Anwture be disposed in a properly-licrased solid-waste disposal
facility as defined by MCI ca S 150A, and the building permits Or licenses are to
indicate the location of the facility.