5A GRISWOLD DR - BUILDING INSPECTION t
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J15PXTD-R PfWJ3 TD.A_PERMIT.B,EWG GRANTED
CITY OF SALEM
No. 1(p�— �O� �:`� '���`\ Date
N%�� ...'
Is Property Located In \, Location of
the Historic District? Yes_No Building
Is Property Located in
the Conservation Area? Yes_No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
Repei#Replace, Other: � l�
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
Address & Phone 6-1� 15 /& -96b -1)le
Architect's Name
Address & Phone �/1� j )
Mechanics Name y /cia d (Se �l�eQ A 4
—o
Address & Phone ( )
What is the purpose of building?
Material of building? If a dwelling, for how man fa flies? ��tJ YJ i7
Will building conform to law? /Asbestos? C (�
Estimated cos, 7fl City License# N 1 A State License #
Home
om Improvement l / �
Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO:\XW7;�FX--
c5�6 SGl/b'ti(J
No. cavt-�
APPLICATION FOR
PERMIT TO
LOCATION.
519
PERMIT GRANTED
APP VfD
INSPECTOR OF BUILDINGS
r ,
Ailnerican Properties Team, Inc.
TO: Mr. & Mrs. Joseph Martel, 5A Gris old Drive
FROM: Jill DeSantis Property M e
P Y ana g
RE: Deck Replacement ICJ
DATE: September 2, 2003
Reference is made to your request for deck replacement. As you know, the decks are
owned by the unit owner and are therefore, the owner's responsibility to replace them.
You are; however, required to obtain a permit prior replacement and to supply me with a
copy. Once the job is completed, we require a copy of your permit, which has been
signed off by the Building Inspector as well.
You may not change the size or dimensions of your deck while replacing it. In the event
you experience any problems during this process, please call me directly at (781)932-
9229.
Should you have any questions or concerns, please feel free to call.
500 WEST CUMMINGS PARK • SUITE 6050 • WOBURN 9 MA • 01801 9 781-935-4200 • FAX 781-935-4289
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Workers' Compensation Insurance Affidavit
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witka principal place of business at:
i leaense+Walr)
do hereby certify under the pains and penalties of perjury, that:
() I am an employer providing workers' compensation coverage for my employees working on
this job.
Insurance Company Policy Number
I am a sole proprietor and have no one working for me in any capacity.
Q 1 am a sole proprietor, general contractor or homeowner (circle one) and have hired the
contractors listed below who have the following workers' compensation policies:
Contractor Insurance Company/Polity Number
Contractor Insurance Company/Policy Number
Contractor insurance Company/Policy Number
O� I am a homeowner performing all the work myself.
i unoeruana wt a coon of"wttment ww be ior.earoeo w the Otrct of imtsfKaoons of the Dla,lot cottrare teeAcadon a"vx lak"w aeeure
co.•trate v reovrta unotr Section 25A of MGL 15 2 can lead to the invos•don of crvrim, oe"tits corsutint of a rm of uo 041.S00.Q0 aebfa one _
yean' iaoroonment v.vo a,chi "wido in the loan et a STOP WORK ORDER ano arm of S 100.00 a nay araintt tne.
Sifm ed this day of
ccnsee/Fermittee building Department
Licensing Board
Seiectmens Office
He.alrh Department
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do00 X40z 404, 40e, 40°, z7c
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{o OF SALEM. MASSAGHUSETTs
PUBLIC PROPERTY DEPARTMENT
I20 WASHINGTON STREET, 3RO FLOOR
a gp SALEM,MA 01970
yam TEL. (978)745-9595 EXT. 380
�G FAX (978) 740-9846 .
STAt4LEY 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
govemed by this Building Permit shall be disposed of in a properly licensed solid-waste
disposal facility, as defined by MGL c III,S150A.
The debris will be disposed of at
Location of Facility
gna of P plicant Date
Y complete the following information:
(PLEASE PRINT CLEARLY)
S
Name of Permit Applicant
Firm Name,if any
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 cIII, S150A, and the building permits or licenses are to
indicate the location of the facility.