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63 GROVE ST - BUILDING INSPECTION (2)
.4 W I A+.4 'kit* Tk. Olt! i's !%C,k kw*1$I 1i--A w. jAk. LL w 03 ink LU cn CL- / 3 s DA29: Cx � Cltp of a`adfPmfr :o1aS2;arbU!9Ett2 PLANS MUST BE FILED AND APPROVED BY THE INSPECTOR PRIOR TO A PERMIT DZING GRANTED Loaaioa of adwlag A 3 6/—'U C S r' Building Pertiit Application For. '(Circle whichever applies) Roof.Remf. Instal Siding,Conshuct Dods,Sbed,pool ' AddidM Ahenuion.RepaldReplaoe,Ftwgdation Only,. Wsdring Other: PLEASE FELL OUT LEGIBLY& COMPLETELY TO AVOID DELAYS IN PROCESSING To the Inspector of BtWdiggs: ' The tmdmsigned htaeby applies for a permit to build aaording to the touowing opociftsdoos Owttterti Nast; Qr�}/LS`Q,c/ !gyp FZ Contractor. ' 4112 E (, �f sages �l'wf! + CityC! StratlR 3 /gtt! City t( ��y sure Phone Om_ qg 193 sute1414 Phnoo a1v a1. Irll a Ambism: City of sales uq g U 7 Street City State LkrM ��S Y wont (9 Hoseowsen Ettespt Pwws� 'yC' no Struftm(please dtde) Single Family. Multi Family/ Otha Estisased Cant of job S 6gl8fttfe1 3, ®©� Will building oo nra to 1 w. '* m Ad mim?_ya ><,p DeKdpehn of work to be done: OW5744eC7 W/4 L-C p95 �9.y Dnwio Su�� no Mail Prsr>iit to:Z=lBrsC��l Srgware APP -4IGNIM UNDER THE PENALTY OF PEfUURY CON UCTION T B OMPLETED WITHIN SIX MONTHS OF PERMIT ISSUED DATE Depanmmt tm only: Permwo ym4ps T Permit fee S CONIlffi1TS: ° CITY OF SALEMV MASSACHUSETTS 'L PUBLIC PROPERTY DEPARTMENT 120 WASNINGTON STREET, 3RD FLOOR SALEM. MA O1970 TEL (978)745-9395 EXT. 380 40 FAX (978) 740.9848 STANLEY J. USOVIC2, JR. MAYOR DISPOSAL OF DEBRIS AFFIDAVIT In accordance with the provisions of MGL c 40.S34,I w3mowledge that as a condition of Building Permit III all debris resulting from the construction activity governed by this Building Permit all be disposed of in a properly licensed solid-waste disposal facility,as defined by MGL ellL 1 bSOA'. o _ n� The debris will be disposed of at: `"`�-'� / r 1` Q( Location of Facility �h -7 Signature of Permit Applicant °�— Date FULLY complete the following information: (PLEASE PRINT CLEARLY) T-(60V o ( -e to i6 A/ Name of Permit Applicant Firm Name,if any Address, City dt 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, SISOA, and the building permits or licenses are to indicate the location of the facility.