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DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the provisions of MGL c 40, 554, I acknowledge that as a
condition of Building Permit V all debris resulting from the
construction activity governed by this Building Permit shall be disposed of in
a properly licensed solid was*_e disposal facility, as defined by MGL c III,
S 150A.
The debris will be disposed of at:
location of facility
* ` Signature of Permit applicant D e
Fully complete the follocing information:
(Please print clsrly)
Robert Marsh
a
l
l
/`Gebeeral Contractor
N oo-w 455
iY�11 iit�w ita�w
P.O. Box
Firm Name, if any
P.O. Box 455
Tom, MA 01883
Address, City b State
The above statute .eOuir=_e that debris fro'i the demo'_'_tion. renovation, rehab
or other alteration of building or structi;.e be disposed of in a properly
licensed solid waste disposal facility as defined by MGL cIII . 5150A and that
building permits or licenses are to indica.'-a the location of the facility at
Residential A Commercial :• Industrial
Robert Marshall & Sons Inc.
General Contractors :•
(978) 750-4585 Fax(978)750-4647
P.O.Box 455
LICENSED Topsfield, MA 01983 INSURED
3
- BOARD OF;iuiLDING REGULATIONS ;
_ Icense: CONSTRUOTIONSUPERVISOR
-F Number: CSy, 080063
Birthdays. OS/18/1961
-.o s uc ion• EXDires 05/18/2006 Tr,no: 21692 f
i i
Rests sd 00
Qt s .a i
ROSERT•E MARSHALL ' ° 'S
.30 SURREY a LUN'TO SF,,IELD,*MAf0198'3
rMW
Board of Building Regulations and Standards %
HOME IMPROVEMENT CONTRACTOR 1
Registt'etiabt 11,6708 !
Expira sa hQ/2006
ltsCorporation
! ROBERT tdARSHAI.L 8 SONS-INC
5 7
_RQBERT, MARSHAif.-
' 250 NORTH ST.UNIT A 1s"�._ - �
DANVERS,MA 01923 '
Administrator
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