12 HARDY ST - BUILDING INSPECTION (2) �L�tflSiMli6T�EfILfB--AMID APPROVED By T44E
.II>I ZCTDB PFWR TD.A PERMIT aFJNG GRANTED
CITY OF SALEM
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No. �v .� Dale 2 2 ()�
Is Property Located In Location of
the Historic District? Yes No Building / z ff/f 1W V ST
Is Property Located in
the Conservation Area? Yak_No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
Repair/Replace, Other: 9PPOv4 7r
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 P��L�P (syuaouL�
Address & Phone
Architect's Name fII(N" 6 I`1a I.ask� Y
Address & Phone B� /� KriSi1 ti'7 S7, rif4 -811C* 1D (791 ) 6))—�Z2�
Mechanics Name ®WUZ2
Address & Phone ( 1
What Is the purpose of building? � lOu7/AL
Material of btdlding? If a dwelling,for how many families? Z
Will btdiding conform to law? Asbestos? (h.lMouxO
Estimated cost Ctty ucww* N A state tu 611oZg Z
0Md lie Loproveinent
7 / Lit. / thEX
Plot Sig at f Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
COjL<Qvci a (�d(lAe1ZJ 0f J 7*/Zd AeI4 p6W l 'lNr� .r7s�
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664L fo(Z )5T rGR
MAIL PERMIT TO-
No. Z-Y--6�
APPLICATION FOR
PE
R
M
IT TO
I
LOCATION i
PERMIT GRAN ED
213
APPRO46
ECTOR oF BUILDINGS '
o CITY OF SALEM9 MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASH INGTON STREET, 3 R D FLOOR
1. Jp SALEM, MA 01970
TEL. (978)745-9595 EXT. 380
FAX (978) 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 defined by MGL c III, S 150A.
The debris will be disposed of at: I-"Jim 0'A
Location of Facility
Ali,
Signs ermit Applicant Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
P91LIP Gjazvu cr
Name of Permit Applicant
CNeR liuy P2vP+�eTi�S LGG
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.
BOARD OF BUILDING ULATIONB I!
RV
ON-SUPEISOR`
u ; CQNSTRUCTI
Humber -�_
04024
dot f)411Tf1 55 23185
1y `s Tr,no:
E,x+Pna-p4t,�t71
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7.
PHILIP GOUZOULE EtC
50 AN
R LES R D; MA
nna� a�✓lfaeaac�uuedd y i
Iatims and Standards 4+'
�. Board of Building R� t CONTRAC�R'
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