Loading...
27 GRANT RD - BUILDING INSPECTION c 14--OMIttiST13E+fL+G-ANO APPROVEO BY T*IE 1US.PECT0R P8WR TD A PERIINT BEING GRANTED CITY OF SALEM Date n -o, e Ward \DncrmNe�°'� Zoning District Is Property Located in Location of / �� the Historic District? Yes_No Building �7 t�tp�rj Q� Is Property Located in / the Conservation Area? Yes_No y BUILDING PERMIT APPLICATION FOR: . Permit to: (Circle whichever apply) Roof, ;rof Install Siding, Construct Deck, Shed, Pool, Repairce, 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 according to the following specifications: /� Owner's Name Pl-ftuP RAM A)&-1onl Address & Phone /9-2 644k l 901 52f ( ) 2VV-5636 Architect's Name Address & Phone ( ) Mechanics Name %l4� CExjyC 1/z&1-04 J, Address & Phone 446oV IWI� ( )3.31-/109 It What is the purpose of building? Material of building? If a dwelling, for how many families? l' Will building conform to law? Asbestos?_ A `6 Estimated cost C City License# A Ap State ' ense # Home Improvement U Lic. i 01nn f Sig ature of Ap i t SIGNED UNDER 91E PENALTY OF PERJURY DESCRIPTION OF WORK TO BE DONE �(1 �4(rL�0�0(iSil+U6 �-L19'1s�.eSDt',Qco,{ ixrs7,A-LL IC��w���l s�r� cfi cad rrc6 l�✓�� MAIL PERMIT T0: �� �Jatt/1 �!� 2C4/?olo No.�L- v� APPLICATION FOR PERMIT TO Cif>>2 v d LOCATION � ? 61-c'11 G/ PERMIT GRANTED 71/ Z© e-1 19 APPF / D ,J Yh� INSPECTOR OF BUILDINGS x =PUBLIC PROPERTY DEPARTMENT 120 WASHINGTON STREET, 3RD FLOOR SALEM,MA 01970 TEL (976)745-9595 EXT. 360 FAX (078) 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 defured by MGL cc 114 S150A The debris will be disposed of at: f3 L Location of Facility YPA4 PaXA4 r of Permit cant Date FULLY complete the following information; (PLEASE PRINT CLEARLY) q ' t Name of Permit Applicant T&A-Im nu (ukWt� S Firm Name,if any 9 A10 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 clIl, S 150A, and the building permits or licenses are to indicate the location of the facility. �.], COlRrnO,LfUflLL OffaloaCJ #d � JJ.paata,.at�.11ifllf�aa.r.la• . ».ra 1 umoow U.d... M....Le A oZ l i i Carrasao. r Workers' Compauatioa lasarance Affidwit ue..wow.iratN . . wiih.a principal place of businen ac . . . >7-- towa•ee•ra.r do hereby'certily under the pains and pensh3es of perJary, Zbm (�1 am an employer providing workers' compensation coverate for my employees working M this job. Insurance Company Policy Number c 1 am a sole proprietor and have no one working for me In any capadq. 0 1 am a sole proprietor, general contractor or homeowner (circle one) and haw hired she who-ha"listed below who•ha the following workers' compensasieo POUCIM Contractor Iruurant:e Compasry/Policy Number Contractor Insurance Comparry/Policy Number Contractor Insurance Company/Policy Number 0 1 am a homeowner performing all the work myself. • I oreeeneam raw a czar of ehu we,m,me vei be for..arad r dw Office of Y,.eedrawwe of ow D1A for ce.erate•aAindom a w am Na,n r rears eomare x rewred.veer Secien 25A d MGL 152 can kid r am ireoa.iew of vireim>t ee.aeka eeraodni 0(a tome 01004 I.S00.00 a.Yr ON ream'iaereowrnng a A as eri panswe in the Ions of a STOP WORK ORDER arse a low of S 100.00 a an awbot we. Sirrie this , A//) day ofAA � 6 �' �•� ;ices eei Fermin a Euilcinf Deparcnee' t Licensing Eeare Seieetmens Office -�r:lth Deparmen- . cOr _ epe 1�pc• ape• 77c