37 INTERVALE RD - BUILDING INSPECTION �C cat
14AMiftfST-9EflLf94*1410 APPROVED BY T44E
,=PEX3-0.R ,PWR T-0 A .P.ERMIT.I3EW G GRANTED
CITY OF SALEM No. �—q N —2DO ��`' or+ ��ys� Date9 / 03
Is Property Located In Location of _
the Historic District? Yes_No Building
Is Property Located in
the Conservation Area? Yes No,-
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construc Deck, Shed, Pool,
Repair/Replace, Other: 17e6y
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: r /
Owner's Name G G1 -` Pwr��/ ��-
Address & Phone 37T1/7-eirl?l114G/C UZI 74'0 6V V1
Architect's Name 41'4" oakelq+ �9x ` .9g-!�`
Address & Phone
Mechanics Name
Address & Phone ( )
What Is the purpose of building?
Material of building? /I / � If a dwelling, for how many families?
Will building conform to law? Asbestos?
Estimated cost 0 &60 City License # N A State License #Cs • 0.2 47�1
Home Improvement
Lie. I X
Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO: R 7 S�6FW W/9 4/9 0
i
No. Z.9 q -Zoo y
APPLICATION FOR
PERMIT TO
�q• l(� �lJ�// sec/L _ _
On .�¢a t� m �C f�✓tis�
LOCATION.
PERMIT GRANTED
APR ED
INSPECTOR OF BUILDINGS
r
REGIS'CRY: ESSE-r So�TH
TITLE REFERENCE: Bk 17956 K�69
PLAN REFERENCE: PiAn 800k- '
�)An /7
,26 T
q9q3 * s IV
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DV7-i5.RVP1,6 P64 D
This plan was not prepared from an instrument survey. MORTGAGE INSPECTION PLAN
Offsets and distances shown should not be used to
establish property lines. I
LOCATION 93 2 Tn-der UAL&- ReAd
This plan is intended for mortgage purposes only. _ SA}em MA
I certify that the structure shown on this Plan SCALE: ��1 '3d DATE: or o!a '03
VV AS in conformance with zoning setbacks
in cffcct at the time of construction. ` CERTIFIED TO:
o.�—_
CAMERON BROTHERS INC. Job No.
11 Touro Ave. Medford, MA (781) 324-9566
Y OF SALEM. MASSACMU:r-
PUBLIC PROPERTY DEPARTMENT
• ". I20 WASHINGTON STREET, 3RD FLOOR
< y SALEM,MA O1970
TEL. (978)745-9595 EXT.380
Gry� FAX (978) 7401 .
iTANLEY 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# I 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,S150A.
The debris will be disposed of at: �Location of Facility
Signature of Permit Applicant Date
FULLY complete the following information.
(PLEASE PRINT CLEARLY)
Name of Permit Applicant
Firm Name,if any
�/ N/A � ST S�GG/�✓ /�9 0/9�0
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 c1II;S 150A, and the building permits or licenses are to
indicate the location of the facility.
7-0
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s29parinual o1.Jad,astriaf�eefaanL+
boo whim
fames I Catttaod C�slon, ///syac�iaarW os 1 11
Corry s,
Workers' Compensation Insurance Affidavit
with-3 principal plate of business at:
do hcreby'certify under the pains and penalties of perjury# that%
() 1 am an employer providing workers' compensation coverage for my employees working on
this job.
Insurance Company Policy Number
1 am a sole proprietor and have no one working for me in #try capadty�
() 1 am a sole proprietor, general contractor or homeowner (circle one) and have hired the
contractors listed below who have the following workers' compensation policies:
Contractor Insurance Company/Policy dumber
Contractor Insurance Company/Policy Humber
Contractor Insurance Company/Policy ?lumber
O I am a homeowner performing all the work myself.
I unorr&una wt a coot of ttin wse t wii be ion aroea to Um OrtKt el Irrvestitaoons of the DIA for toverate Yt1WKatiort ana Nat fame w ltewe
cosrarr v reourro unaer Section ISA of MGL I S 2 can feaa w the:noo don of cri": ' oenrti"core "s of a Iw of w te-i LSC70 C0 an4 tx ont
years' :^.xwa (v vo X ciri "wid form of in [he fo of a STOP WORK ORDER ana a f+u 100.00 a aat sts+nt tM.
Signed this ., day of
.Licensee/FcrmaLte building Depamr.,ent
U censing Board
Seieesmens Office
Healrh Department
Board of Building Regulations and Standards
� { HOME IMPROVEMENT CONTRACTOR x.
Registration: 139424
Expiration: 7/16/2005
Type: DBA
SILVA REMODELING {
ORLANDO SILVA
11 MAY ST.
SALEM,MA 01970
i Administrator
�� ✓lee �»ammtavu �✓�,ttooa�u0e�16
} BOARD OF BUILDI G REGULATIONS a.
License CONSTRUCTION SUPERVISOR -
{. Number: CS 084761
i Buthdate:`06/18/1969
Expires:,05/16/2007 Tr.no: 84761
00
ORLANDOJ SILVA:
11 MAY ST -'^ f
11 i SALEM, NIA 01970 Administrator