119 LAFAYETTE ST - BUILDING INSPECTION • i
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IDA AEINVI GRANTED
G-� CITY OF SJ.EM
No. 046
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BUILDING PERMIT APPLICATION POR: '
' Pem1R t0:
(Ckft whm*m apply) (j;i� Raid, InaWl Siding, Cot WW.Dft. Shad, Pool.
R.p.1dR.pbo.. otlar:
PLEASE FILL OUT LI UMV A COMPLETELY TO AVOID DELAYS W PRO0§9W1r
TO THE INSPECTOR OF SUILIEN(3S:
hsreby appft. for a pa mit to build aawm* g to Mte foNawMq
Owner's Name _A - $ Fri SC
Address A Phone 1
Amhkwft Name -
Addrm a Phew
Medtanlcs Nama
ll*hn a Phana
V"to"pupm al 011MdI10T Lj'(v /0 0
mdum a, Aa ml_ S h 1 nyq%c S pad 0 g for how mwq toman4
web"*oadons a twn AftdW_, A/ 0
coot. 1, aT.,,_cp uo.nM r N p` awo Uo F�.
/a? 33-7 X
Signature of A~
SIGNED UNDER THE Prl
DESCRIPTION OF WORK TO BE DW OF PERJURY
Sfrr SOD rE rO0
MAIL PERMIT TO:
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PQSUC PROPERTY DEPARTMENT
1 2d WASNIN .TON STREET, 9RD FLOOR
SALEM.MA O 1970
TEL. (970)743-9395 E%T.390
FAX (979) 740-9846
STANLEY J. USOVIC7, 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 g .all debris resulting from the construction activity
governed by. this Building Permit sW be disposed of in a properly licensed soH&waste
disposal f rift.as defined by MCIL c III.S 150A.
The debris will be disposed of at
Location of Fability
AxsiPamra of"mit,40icaw Date
FULLY complde the following infom show
(PLEASE PRIMP CLEARLY)
Name of Permit Applicant
LI Er Z 1e0 74``/I/y
Firm Name,if my
a°( � ne-rbrook 11llyjare /(��sS
Address.City k 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 MQ,c1II.S 150A, and the building permits or licenses are to
indicate the location of the facility.