15 LEACH ST - BUILDING INSPECTION (2) r
�L�ft1S 1011ST19E fIL{-C-1lJfl APPROVED By T+IE
1USPUTOR PF,{X11A TO A.PERMiT B,EWG GRANTED
CITY OF SALEM
No. Date
rn ,` I' r ts�I ward
� mNE Zoning District
Is Property Located in ✓ Location of
the Historic District? Yes No Building
Is Property Located In
the Conservation Area? Yes No `l
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Sidin Construct Deck, Shed, Pool,
Repair/Replace, . er:
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 e5<66a,4 f1 J�. G II-✓✓�/-+2 0
Address & Phone l BG�C/9n A�/[a. Sffi1�1 f �i �ls X37
Architect's Name
Address & Phone
Mechanics Name LC-?Qs fQln-i
Address & Phone 1/0 7-1O O Tail ?OozC
What is the purpose of building? Z-V7-e�2/d` S/d //2 U - S 67
Material of building? thlw,J L, If a dwelling, for how many families? b
Will building conform to law? Asbestos?
Estimated cost d �� tfttE2Rjj, M/10A
C ) r Q / Bowe Improvement
V Lic. i
UFO _ Signature of Ap tplica
�S SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
57/4C,-
MAIL PERMIT TO:
No.
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
-)1,2 9y 1s
APP V�D
n l/✓
INSPECTOR OF BUILDINGS
a
12/16/22 06:11 FAX Q 001
�t
^ � CITY OF LYNN
a BOARD OF EXAMINERS
�� LICENSE NO.... 3910
CLASS.. .......4 td..
Viesna Sar
.,__.._.._.............. residing at
Licensed to have Charge, Control and P
57 Southside. Aue.., .Lynn . - . .. ..is hereby
g Person As
Super.
vise Construction, Alteration or Repair Work in the
Classes of Construction as named
Signed....
CHAIRM OARO O %A S
RENEWAL FEE$25.aa LICENSE EXPIRATION 10�1� OO
LATE FEE$10.00 AFTER 0 MONTHS
• � �//ie Z06%n llfOlGIICO� D�
Board of Building Regulations Ind Stan ards
HOME IMPROVEMENT CONTRACT R
Registration: 137985
Expiration: 2112005
Type: Individual
VIESNA SAR
SAR VIESNA
57 SOUTHSIDE AVE.
LYNN.MA 01905 - _ _ Adut istraLor,_,
I
• Cammonuuenaiils of !//a�Aachws�d •
`'� •1Jep.nle.al a�.11rri.f./Ieel.'..tr• .
600 ryW..�ae,Sind
Hemet 1 aatmd � //..J.A 0211/
cwaa.aar/
Workers' Compensatim Insurance Affidavk
�Ic 511 A• SAR
i13
. . wkh-a principal place of brassiness ar
' icsase.rans ' •
do bereby•cersify under the pains and peniMes of palmy sloe
() 1 am an employer providing workers' compamadou coverage for my znWWyees workiag on
Chit Jab. .
�• ArncRicg� 2vR�cN .inS. Ca , �Z�y�3- 81yx63- �•—ay
1�nsurarm Company Poliq Number
4 b V 1 am a sale proprietor and haw no one working fdr me is any capaeky.
1 am a tole proprietor, general contractor (drds one) and have bired tM
contraecors listed below who-haw the following workers' compensation policies
Lira 12,47 Rnb 6ca7ava4 I? 61;SnW4Fe C/JA 4f, z7/Jd 9�� 3
Contractor (0;V00i Insurancs Compsmy/Poft Number
Contractor Insurance Insurance Compatry/Policy Number
Contractor Insurance Company/Policy Number
() 1 am a homeowner performing ail the work myself.
• I vso"Was ate a roe/of otie.earuae we be fo Hoed m uw Office el In now of Ow DIA for co.erste "laden ow an 611 we•warn
to.age ar neared onser Soeion 2SA of MGL 152 cm kid wow iieataiea of eriwna osaeeds cersw6nt eta rrw el w asi i•SOOAO elder aw
rear*irwroornwnt a no a chi oenowe;in the nwm a a STOP WORK ORD ER w,fee of S 100.00 a an+twee tree.
signed this • ` day of
:iccrsc 'F a Building Depammenc
uctnsing EOare
Selectmen Office
�e:lch Dt;armert
PUBLIC PROPERTY DEPARTMENT
• 120 WASNINOTON STREET, 9RD FLOOR
SALaM,MA O t G70
TEL (976)745-9595 ExT. Sao
FAx (976) 740-9846
STANLEY J. L)50VICZ, JR.
MAYOR
DISPOSAL OF DEBRL4 AFFIDAVIT
In accordance with the provisions of MGL c 40,S34,I acknowledge that as a condition
of Building Permit 0_ .all debris resulting from the construction activity
governed by this Building Permit shall be disposed of in a properly licensed solid-waste
disposal sty,as defined by MGL a III,S ISOA.
The debris will be disposed of at Af R- S /� fAGZ a y7v.
Location of Facility
a
Siewuye of fymitApplicant I Date
RILLY complete the following m&Em&bM
(PLEASE PRINT CLEARLY)
V G C S l� A. 5,1 n,
Name of Permit Applicant
Firm Name,if say
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-licamed solid-waste disposal
facility as defined by MGL cIII, S150A, and the building permits or licenses are to
indicate the location of the facility.