52 LEACH ST - BUILDING INSPECTION (2) • i COY �
I4.*Mill!WT13EfIL{G-ANO AWAROVED BY T44E
MPECTDR .PFROR TD A PERMIT.BFMG GRANTED
CITY OF SALEM
���No.� '� ',\ Date �O
Ward
Zoning District
Is Property Located In Location of
the Historic District? Yes No BuildingIs Property Located in
the Conservation Area? Yes No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
Repair/Replace, Other: R-P96,2L v-
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 y v//ry
Address & Phone
Architect's Name
Address & Phone
Mechanics Name t
Address & Phone
What Is the purpose of building? �� s��// i fir✓,
Material of building? n If a dwelling, for how many families?
Will building conform to law? Y',11 Asbestos?
Estimated cost d o City License S state License 4! s' Off'/
Bone Imrovement
Lic. If
SI nature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO: A,'we c!
.t
1 1
No.
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
19
AP ROV�
INSPECT614 OF BUILDINGS
v
s
1
1 PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, aRD FLOOR
SALEM. MA 01970
TEL (976)745-9595 EXT. 880
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 consmiction activity
governed by this Building Permit shall be disposed of in a properly licensed solid-waste
disposal facility,as def ned by MGL c III,S 150A.
The debris will be disposed of at
Location of Facility
,
Sigoatum of Permit Applicant Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
'eliLl�ee ", ,--o-cev
Name of Permit Applicant
. i
Firm Name,if any
p
Address,City&State
The above statute requires that debris from the demolition, renovation,rehab or oth a
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.