2 LAURENT RD - BUILDING INSPECTION (3) • I
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'PL*NS1WlW*EfKMW*N0 APPROVED BY IM
MAPJECM PWR TO A PERMff BEING GRANTkD
/ CITY OF_SALEM
Date
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Ward
in
Location of
he Hidofic DWrict? Yea Phi
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Permit to:
BUILDING PERMIT APPLICATION FOR:
(Circle whichever apply) Roof, Reroof, 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 undersoed hereby applies for a permit to build accortLig.to the following
specifications: //
Owner's Name 4n'nlifczej CAI
Address & Phone JI Ce-daln 0j" Nlirz, 3gODL3
Architect's Name
Address & Phone f 1
Mechanics Name tsca�gc Qua cue�t
Address & Phone /S? �cac .1`t✓/. h6dW A.. f7V 177/6 6
What Is vw pzpae a ?
Md"Of talldln0? Rf-i cA n a dweb ,for how many fambw?
WN talking conk m to law? Aetwetos? _A d
Eetlmewl coat d 0 CRY uca a Slab Licetra N r S r 7/K 9 7�
Howe Iwrovs t
Lie.
Signature of Applicant
SIGNED UNDER THE PENALTY'
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
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1A.sfG� ai-Q cQ� cN
MAIL PERMIT TO:
APPLICATION FOR
�j/n PERM TO
/T
,r,16 8�i fHvo„_ 1
LOCATION
j / e, Wien
PERMIT GRANTED
is
AP vfD
INSPECTOR OF BUILDINGS
#`1
PUBLIC PROPERTY DEPARTMENT
1 20 wASMINQTpN aTRELT, aR0 FLooe
SMXM,MA O1 Y70
TCL. (676)745-MOM Err.seo
STANIJCY J. UfOVICZ, JaL FAX (9741) 740.98"
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the provisions of Mt';;,c 40,S34,I acknowledge that as a condition
of Building Permit N_ .all debris resutCag liom the cousbuedw s fy
governed by this Building Permit shaft be disposed of in a propaiy licensed solid-wasto
disposal facility,ss defined by WX c IlL S1501A.
The debris wi71 be disposed of it Z
Locafm of Faci ty
Si Permit Applicant Daft
FULLY cmWlcft the following hx&mn&dm.
(PLEASE PRIM CLEAR
�tsorgc r- Jc�<�✓1@//1
Nave of,8eamit Apphamt
Film Naafi if stay
, �z //�4<Q,411--
Address,city at Saps
The above statute requires that debris fin the demolition,renovation,rehab or od w
alteration of buik ft or structure be disposed in a properly-licensed solid-waste disposal
facility as defined by MQ,cA S130A, and the bLdIding pamits or licW sin to
indicate die locadon of the Lcility.
r
BOARD OF BUILDING REGULATIONS I
License: CONSTRUCTION SUPERVISOR
i Number. CS 074974
Birthdate: 1128/1951
a- EXPinss: 1,1282004 Tr,no: 6022
Restricted: 00 i
GEORGEJ QUEENAN - 1
183 PLEASANT STD '
MARBLEHEAD, AAA 01945
Administrator