270 LAFAYETTE ST - BUILDING INSPECTION (2) i
i
fLOMIMWOKMiMND APMIOY$D SY IM
mumm PON TO A`:V=W SEND GMWkD
CITY OF SALEM
w�a
ZW"oba"
to Plapav Lao"in toustsaim of
w plaawhr
:� b OmrMn�aen MM? . YaR�No
BULORM PMW APPUCATM PM
Pamlt 10:
Pft whWWmr aft) Roof Irow SWft ConWW Dank, Shado Pool,
ONW.
PUMM POUR UMMY a CDYPLS M.T TO AVOW DRAYS N PRO�0
TO THE INSPECTOR OF BUILDINGS:
Tha undwWgmd hsrsby appft for a parmt to baud a000rditlo ft iniorrlspumommm
rp
OiAR 6 Name QA (L- A N CRiQ
Akl m a Phone 2'7o LAr AYETr> (q�k1 ae i - 0,�q8
Aohk@Ws Noma
Addles a Ph" r �
l�Asohan1 Name 3u N e H FfO uv— l4o M c-: bEPL5T
AftUa Phone �J4� GREENwoob, ':Sr- 07Y) S(59, -57&(o
YMo is Nfa PaPoM it b~
AI�In1Y al b laP N a dwaI g for how ajM W~
Wa bm"omftm 10 kw!
Egad ao�t Y'027U08 p►r 1loriM a amb uloww.•
mass
i i
mt
us. 5s � J�
SWom of AppkW
tioMo ns PINALTY•
OF PORAMY
DIESCRP1 OF WORK TO W DONE
�EPLACE L0 ffvbOk�S
r� STKk cTL r F ,
BUNROEUN CHHOUY
MAIL POW To. � HOME DEPOT
4 COBURN RD.
TYNOSBORO,MAL 01879
w
rusuc rRorlNTT OWARrMOff
LIMB 120 VAMINGM OPMan am FL0011
srALol.wA of rlio
Tn.(SM 740-44120 OLT.ago
n FM (OM 740400441
sTANLEM L
usovW& t. - --- --
DISMAL OF MW MMAM
In woordagos wa ft poridogs e(MM C.4%SK I acbw*io*that as a coodidos
at?Bm7d6ss Permit r .aII debds r�esold:R Sam.t6s oosvebliedoa aedty►
VMuW by dds BvDft Pewit eb a be dlspossd e[ia a peo�aryr licensed soiibTa ante
dbposal hCMWq as dedood by)AM a IIL SIM&
Min debris willbe d6posed o[at 3 4 5 G Z ( ' '
_ Loeadon aaTFael�gr
<Fc
Sfpapag otPemkAppiiaet Dan
FOLLY compien So 8nowfuS foho stioo:
OULM PRDM CXJWM )
�lnty' C H
Nan mit Ht ofPa App
HoMAu-
Pima N=%i[aoy
� L4s G2C-EN�oo S VJoZCtSTeTC
Addre.,cry t Snn
Min AM stamis requires brat debris Sam the demolition,reoovauoq,rgbab or admr
siteaden d bm ft or sttnctme be disposed A a properfy-bcrosed solid veto d qmd
Bd ily as defined by MM dlL SISOA,and the b ul ft peaile or tieaoen see to
Mew 69 loesdoa Of 69 Sway.
�o,naioaroaaftl�[�maldaChYf.�/
boo waaa�La�aa,>raed .
+a�n Conine
Mu .at.& 02111
Workers' CompemAw Imwanoe Affldavk
.. wi#j.a pr6dpd pose of bedmaa ain
frig 016ir-
x
do hareby'terwy under pates and penal"o/oaetwo AM
O a.46 arwieyw pievubwf wwbq s'.caapeamw covepde for nq dtylhreea work4 as
�r/�t✓2 iG9/V omE.mot SURAPCc=` s2rnr�v�2 9��gq �
iwaapanq
I awe a "is proprteax and have no owe working fir nm In any capodq.
O 1 am a " propriemr, general couirs, sir homeewrw (drels om) amd,kew tdred dre
ammaors Ibaad blow wbe•baw ski fegw*ft workes' c , I nawlew pwaid
' ComrataK laawranto CoraPawEr/
Cowasesur laaunnce Cotupaq/ o N
Coaaatxor )owrance Compaq/to N •
0 1 am a homeowner performing A diw work myrdf.
.I v"WHOM wr a SM of 06 wwnme a at Ono- -nq w On Olin A IevoAgaw .a!w WA aer tonraw on"aer M Now w man
aa.enra r rrarwae.Deer feriae ifA d Mrd 152 tan lane wow i+w dw of a bWm owaie cMwiar d a aaa d a w4 UNM etl/w aoa
+ean'wraraenreet a to add mode in w iwn d a STOP WORK ORDER aw a for of f 100A0 a as apba nt,
Signed this . _ daraof Q
:actracti'Fermiuct Sifi iof Dep rtnaent
�v Eoard
Stkctmem Office
:;talth Deparzmtrs
404 405, 405, ?7c
r mUG rmwpW TY LMPAWMKNT
Uu 120 VO M1NGM VMKKT,aRD FLAOR
IALSK MA 01970
TIL. (978)748.9595 [2T.ago
_ FAX (WM 740418"
T/PIiaY MAYOR{n 4 cz. JR., - - --- - ---- —--
DISPOSAL OF DE M AFFIDAVIT
In Accmdamoe wig the piwidomr of NM c 40,SK I aclmowwiWp dw a a omdlom
of Bml&a Pf:raoR B .aII Mail mW t>K Loom the emomcdm aedvity
pvuzWbYM@BmlftPe>mit shall be&Pond of in a popat;r Dceneed
digmW hCOW,as ddhW by UM a IM 815ft
Tile deb&wrDt be divoead of at S 4 S `�jz)ar7 tv 1v DOB ST , y f oa c c-sTt--r,
Locahom of Faai ft
SiSsfte ofPwU*App Dab
FULLY complom the foDowhlS mfomodom:
MEAD PRW CLEARLY)
-E->tnt-j C NHO"v
Name afPamit AppHemme
Pb�C- b Ear
Fam Name.if amy
�YS GR�=E-�JLN� � W 0ZcesT
AddNE4 dry&StW
Mw above atatuoa rsgWm that ddoia from the damolidM roovadM rdmb or o3mr
aitaadom of or Wucdae be
batld'm3 m a
dupwed propaiy-hcamed w1id..vd0e diapoat!
Scfl ty m ddbW by MOL cUL SI-V&and the buaft Pam"or He==ale to
indicate the location of the hmTltj.
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