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2B HART WAY - BUILDING INSPECTION (2) CITY OF SALEM ,p0„ al PUBLIC PROPRERTY a, DEPARTMENT Idt►.ne uo.,�aarr.,netstaor•sata�*da.aaemrtsa� Tars WW45-M o Pas.fDti 4&"% wit MW Comptmaisdoa luarmw Af Mr#i sRhumbows Bepdars{� Name i ,+ � c g�, Ciry/StitdZim Are yN Y votpleyari CLek she t.Q l ass a mploy.r wkh DL70 pond eoetraetor and i �� ®tpteyer(ihR and/or pn►dme). ind d o aob.00maaoea d. Q N^�oadaa 2.p I as a cola psapleasr ar porosm• the utadhd that t 7. [ WbS abty and have m employe" ob4 m oom haw A Q D.molidaa Working dsr me in way capacity, m'Comp.iannaaea(Ntn worhra'comp,iaataanoe a ooepanda.and is ' ❑ ddttlot end] haw etan6ed shah tQQ Eleeaiat tepetn ar addhlona J.❑ I sot a homeowaar dotsg atl workf as�apelea par UKH, 11.Q phsmlriog ar add<daeeinsummog ]U7"m DID comp f S 0 wor oor m I2.Q Rooyy��te wnrkta� lj.p Othae 'wpm•a+�..a....*:.r�'.rs�`i�n�d~wrer o.r r.r.a.tr.raass�axh� e��a CCa+erNeateasy.iabe..srrr :eer�iler dwr.r�.ar.atlre+�t.�,werreirklae.ty.r raaarefrese.aaa,atse rrr M~�pow khtotwsa lAf*nXnta an`aWPhWW r1.r bOrevf/Gsj wtrAat'e..year d a/a r„aesJy, ,q, eea s fey.rt+a1. n idhalJar,dr Inauraan company Namt_ —F— f Policy 0 or Saltine.Lie.a. � j a (� Pspirsdon Date d 3 O q Job site Add<et Attach a copy of the workmat eootpaaadon Faihunr to steure coven y Pofh Nth(shtwhq the poitay another sad oaptradee dab} A requited under Section 25A of It4(R,a 152 em tad to the impoaitioa of aimiaal pYalda of fine up to S I.J00.00 anWar oaayar imp Wnm=K y well as c"paoaWa@ is the farm of a STOP WORK ORDER sad a line of up to 32J0.00 a day.pint the violum; ge advised s that a copy Of" atetmeot may be forwarded to the Ogg"of Investigations of the DIA for insurance coverage vetillCadoa /do be..b� b rtnla rAe an/oew./afo olPer/ary rAtt rAt!w larreeNaaOrovl/d olere 4 ont an/corral d p QQTeld use amyl Do not write in rA4 eat,to be eowiltu/by dly a ltaw gh*A f City w Town: PermltR.lcew d Issuing Authority(drab oats I. Board of Heiltk L Bulldlag Department ). C(ty/Towa Clerk 4. Electrical Inspector J. Plumbing Inspector & Other Contact Penodu `-� CITY OF SALEM PUBLIC PROPRERTY DEPARTMENT .NAU;r P Lh I'!`RiMa?I1. 120 W.t9RlV(-.*i0NS:REET 15.{UM.N1MN'ACNL>Lt l50191Z Tet.:97&74i-9595 * Fl-t:979-7.1G9W Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5 Debris, and the provisions of MGL c 40, S 54; Building Permit # - - -_ is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c 111, S 1.50A. The de ris will be transported by: /1 ame of hauler) I'lIle debris will be disposed of in (name of facility) luddress of tucilay) datU' of ;)dCILIC )t).l�ant i .iatc ,r- - BOARD ofkfuit dlNg RE(3IM.A71ON6m4 ckwns.: eonsrR�acrta�st�Rv�sci NFoOlog or c RTOAYOft Sr W pFl3 { R^ Key ROCdO J FES? ROOCO FmtA 1, . , 12 EL4ERtON a . " zz_; lo y.k ? 1 5 �F ii i � k � _ f t u a ..E PUBLIC PROPERTY DEPARTj%MNT Wrae AMICAILQIS FOR t30'�wt�,M�• �:tr'tr sKry�+ccansoaas elm�Its f7►7�leQ D '�jJ�! OR B m.nn= 1.0 XTN INFORMATION • Laeatlon Nwm 7fj� [�utldr� Frooerly is beNee Ina;ConwvMlpl Area YM t�Inleeb Olefhx YM E FORMATION 3ACOMPLQTt THIS sECT10N 111143R MiLi6IE1i 7L61NOS ONLY Additlon Rerma*m Fid" i/ Number of Storlea Renovated Change in use Demolition New Approximate year o/ Exwkv e®n or renovabon t?"'o e l Area per floor(sf) Renovated at exietirq buildup New add©*Scription of Proposed Work: Mad Permit to. What is tie corm t use o1 the suk"7 how msty GuK�-®1 k dwNln4 AsbaSt"7 �--- os d Cadonn to haw? Arahtmft Narro / MON and Phoo c� w EEI MO&Anwti NanM c coo tea` / bdrees and F'ttotls Ljcer►as ®, G/�� HIC��0n d /3 Cam SWONkms ®� tco o.n�F"CaioWsft ewffwod Cod of Est>tnIftd CAd 7c=71SJOW R - p«"Fos f 2 ` ESWnalsd Coat X:t U:1oo0 Caern�*ll--- 0 ° M Adder S&OO is added as an A*ndrJaimd"ah IP6 make woo that an A"are Propwy and Wg"ven to avoid delays'nP*Csssbvo The una"�does hKeby,Ovy ttx a euuaa+o p�to to the above stated Signed under penalty of WPO - ap.uliwiar�•. oaa n �1 N \ . g ` 4 d at . V