259 HIGHLAND AVE - BPA-2005-187 REPAIRS 14dl!NS1A lST9Ef*:E94 D APPROVEfl BY 774E
ASPE1=118 PRWR TO A PERMIT BEING GRANTED
1�1\ CITY OF SALEM
No. \ Debx
Zoning Distilct
Is PmPWtY LOC416d in Location of
fro HWodc DlatdW Yes Saild
No mUdins Zsq th 6�1L/J�iO-gUr�'
Is Property located In
B»Cornemation Maa? Yas No_
Permit to:
BUILDING PERMIT APPLICATION FOR-
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
Repair/Replace, Other: «� eex 7- 4�e4l,fz s
S2� pro P41SRL
PLEASE FILL OUT LEGIBLY if COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build accomkig.to the following
specNications:
Owners Name ��- �ti�
Address & Phone 1 ( G [Leedr NA 0 (SDS'S 7-?
Architect's Name
Address & Phone ( )
Mechanics Name /1&41�/< /��,
Address & Phone _ -5
W W Is no prapoea of iwll mV
mdWW cl EuYding? B a dwalNtg,for how mmy famllm?
wa bAft cantam to law? Aaeaetos?
coat 30,0�`Zi _ Cly Lkerre r stab Uarw r QY�SZ S"
� /� Horan I�roeamt
s-ad Lie.
re of Applicant
SIGNED UNDER THE PENALTY,
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO: � ' P e a
No.
APPLICATION FOR
L PERWT TO
LOCATION
PERMIT GRANTED
19
VFD
INSPECTOR OF BUILDINGS
PUBLIC PROPERTY DEPARTMENT
120 WA{MINCTON VMKWF, !RD FLOOR
SALKH,MA O 1970
T[L (978)740-9595 EAT,3e0
FAX (978) 740.96"
STANLEY A USOHIC7, JIL
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the provisions of MIsL c 40,S34,I aclmowledge that as a condition
Of BmunB Pamit g all debris resulting liam the cm&moc j=activity
governed by this Building Permit shall be disposed Of is a prapaly licensed soH&wafts
disposal facility,as defined by WX c D.S150A.
the debris will be disposed of at
ofFaciilIty
ignatars of emit App ' Dab
FULLY complete the following k*uma&n;
(PLEASE PRINT CLEARLY)
6� � Z/, /�
Name of Pauli tAppHmo
el
Firm Name.if any
Addnas,City&State
The above S= to regains that debris from the demolition,renovation,rehab or other
alteration of baild'mg Or Mx'tan be disposed in a properly-licensed solid-waste disposal
facility as defined by MQ,ca S150A, and the Wilding pamits or licenses aae to
indicate the location of the facility.