17 LAURENT RD - BUILDING INSPECTION (5) a
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.pL* r{NISTeEfflx-E 4lddD A?PROVED BY CIE
j0pjCTDB ,PFWJI TP A PERMIT BEING GRANTED
CITY OF SALEM
DateNo
6� IGS
it
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) 4R ;;;gnstall Sidin Construct Deck, Shed, Pool,
Other: re,13�;r `lees 70 `641NT06M
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:
Owner's Name -C' Z-apo,wa-e.-
Address & Phone l l j ' A -ZW L 3376
Architect's Name
Address & Phone ! 1
Mechanics Name '
Address & Phone !�
What Is the purpose of building? R e S 'jchce,
Material of building? If a dwelling,for how many families?
Will building conform to law? Asbestos?
Estimated cost (: G D 0,o v City License k N P' State License M
rF
core Improvement
Lie. /
Signature of A licant
SIGNED UNDER THE PENALTY
OF PERJURY
nCRIPTION OF WORK TO BE /DONE, 77y
(eat/ iy �4+�ravv IOGa�cOl AN� ,repa;j 1 P6MW , ft)CLA) ^�Wb
n Iicr� wal b k` + w;nduu1 Iv,sk)lu�
l Sae 'S � -� �i i YC�14Cfrnt
Sr •ci0 apyouN o-� ()iA,4 w i v�5}el�cG
MAIL PERMIT TO:
No� '
APPLICATION FOR
PERMIT TO
x
LOCATIOW' w
PERMIT GRANTED
2.0
AP Oii�D '
INSPECTOR OF BUILDINGS
k
1
o CITY OF SALEM9 MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
1wig SALEM, MA O 1970
TEL. (978)745-9595 E%T. 380
FAX (978) 740-9846
STANLEY 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#-- , 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, S 150A.
The debris will be disposed of at:
Location of Facility
����avre� 210�105
Signature of Permit Applicant Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
Lr� �o1�Fe�
Name of Permit Applicant
Firm Name,if any
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 cIII, S 150A, and the building permits or licenses are to
indicate the location of the facility.
CITY OF SALEM
BUILDING DEPARTMW
HOMEOWNER LICENSE MMOMON
Pkam Pdtt
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fOBLOCATlA1 /7
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