14 LATHROP ST - BUILDING INSPECTION fWINt31MtlST9EfIW94A9 APPROVED BY T44E
MISP MS.PRIOR TD A PERMIT BFWG GRANTED
a l\ CITY OF_SALEM I
No\ \� _ v� \ Data ,5/0y
i
\ ri` Ir Ward
Zoning DlsMO
Is Properly Located In Location of
tM FNetoric Dwrlel7 Yw Noy aairdina /L �y
Is Property L.ocdod M
"W CWMrAMW Area? . Yew No
Permit to: DING IT BUIL PERM APPLICATION FOR:
(Circle whichever apply) R proo , Install Siding, Construct Deck, Shed, Pool,
1NRep foe, 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 accordwig•to the following
specifications:
Owners Name
Address A PhoneO�
Architect's Name —�
Address A Phone
Mechanics NameCd�
Address & Phone t--(4-T7l'Sr 1�&-62(el
WhO IS ore purpose of Z tw o-f/C_-I
mdww of OuYdnO? lit./ J® n a dwe 'for how mmy NMI"? 2
wa bril m cmform to law? `/CS Aabaetos? 1V J
tEetlmued coat CMy Ucarae r sf a Uo r >SCE
5s raprova t �f
P J Lie.
��e5� SIGNED UNDER THof E PENALTY'
�33 OF PERJURY
DESCRIPTION OF WORK TO BE DONE
R '
MAIL PERMIT T0 6eo;-ap /JGLI1 bj
6)1833 y
No���
APPLICATION FOR
Wr.TO
///y� PEyLR/� /
.ber
LOCATION
PERMIT GRANTED
19
AP)" Gt
INSPECT OF BUILDINGS
CronmoaardaLik o/ 1//8Mac"ffe
� •1Japaar!weala�.7ad�dria/��•
w.e�lse slnel •
Aaaas 1 c.eeanr Q-A, ///dewd.sed; 021/
coaleaan.
worken' Compensadn louraltc. Afnaavit
. . whtb.a Principal place of buslaoss so
do herebp'cersdyr undo t)t paint and pewhiee of pw*y, shoo
() Ia an anpl"w Providing workerae compemssion covers fs for my siraolryeea weekbss w
Insurance Can xF Poliq "saber
1 an a�sale proprieser and have no one working fir me in my opudgs
() 1 son a sole propriesor, general contractor or homeowner (drele one) and haw bind die
contractors lined below who-bnm she following workers' comnpensstim po6dass
Comrseser Insuonde Company/Po Nuarbo
Contractor Insurance Company/Po Number
Contractor insurance Comnpany/Pokyr. Numabo
O 1 am a homeowner performing all the work myself.
•1 vaswal"MA a GM d#4 awalew v be for.areee a dw pace 61 b.valawea 0/die MA Mr carware.wiinew a"e1e MM U ware
comsev M reewn 25 Wa 152 an Mae M ew irwreiee 1/orbs* agamin eonaednn of a sea el a M i0 1. 0:00 swoon oaa
+ere•' ,,d der the lens*is STOP WORK ORVE see a 6w el s 100.40a our as"ML
Signed this . day of
.icerseei'Fcffnhtee iiuJdrnf DepartrbVitnt
ucensinf Eoare.
Seiectmens Office
=rslth Deparmer:
7.- ' -41FCC. "5 : = see apr qpe 77r
I
PUauc PROPERTY DEPARTMENT
IZO WA3NI"W M STRKAT, 3aDFL.00R
SAL[M.MA 01 S70
TEL (979)745->i 95 E7R.360
FAX (974) 740-9/4O
STANLEY J. USOVICZ, JIL
MAYOR
DISPOSAL OF DEBRX AFFIDAVIT
In accordance with the provisions of MGL c 40,S34,I aclmowle*that as a oandidm
ofBmlding Permit g all debris rssnitmg fim the consfacbm activity
governed by this B1lilding Permit sW be disposed of in a propaiy hceosed solid-wub
disposal facility.as defined by WX c BL 3130A.
Tie debris wM be disposed of it 2c"On QdV
Locatica ofFact'W' y
FLML lete the fouowing Wmudon,
(PLEASE PRIRr CLEARLY)
Name ofPamit Applicant
Fim Name,if any
Address,city dt Stan
Tie above statute requires that debris 5om the demolition,renovation,rrhab or other
alteration of bm7dmg or shuctme be disposed in a properly-licrosed solid-waste disposal
facility as defined by MQ,cM S1S0A, and the building permits or licemm are to
indicate the location of the facility,