296 HIGHLAND AVE - BUILDING INSPECTION i J
r OVED BY T44E
T REMO GRANTED
�IT OF S EM
Date 10'(o—U3
i
Ward
\ Zoning District
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BUILDING PERMIT APPLICATION FOR:
Permit to:
(dircle whichever apply) Roof, eroo Install Siding, Construct Deck, Shed, Pool,
Repair/Replace, Other:
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 O (A QtAJ —
Address & Phone P1bgL, k1Q AOL ( 76 ) 5-,60-A16e
Architect's Name
Address & Phone ( )
Mechanics Name �Anl�l�2 Crr� /'sk�T GAS
Address & Phone /✓a2 WQ 6r
What Is the purpose of building? (' MmL2UAL
kAWrial of building? Z ockl- If a dwelling,for how many families?
Will building conform to law? Ak 5 Asbestos? /VD
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Si ature of Apo,icfiht
SIONEQ. UNDER THE PENALTY
OF'PERJURY
DESCRIPTION OF WORK TO BE DONE
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MAIL PERMIT TO: a9/. 1ll&, LA&JO Aut '5wten_
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OASO BA, J.
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�o CITY. O .'. 1..EM� MASSACHUSETTS
S PUBLt ROPERTY DEPARTMENT
a 5' 120 WASHINGTON STREET, 3RD FLOOR
'• '� SALEM, MA O 1970
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. n
The debris will be disposed of at: -�� Y GnCin - �� bribY
Location of Facility
Si ature of PermitkAp licant Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
Name of Permit Applicant
<-TAmou- Cny (cn�rn�cRzi�
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, S 150A,and the building permits or licenses are to
indicate the location of the facility.
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