52 LEACH ST - BUILDING INSPECTION fla1iN61N1�8�'�9E Lf$�Id13 P OVED BY T44E r"
.. JUS 1 1Q8 �7D .P. I EWC GRANTED
�.1.
\ CITY OF SALEM
NOC\a\ J� Dada D
Is Propngr Located in Location of
1haHlatodoDletdot? Yas,_No Building
IS PMPWtY LOGNIAd in
:. Vie Corravatl4n Area? Yak__No
BUILDING PERMIT APPLICATION FOR: '
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
Repair/Replace, Otherr,
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROCf3iNNO
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the following
specifications:
Owner's Name Sri a g ) SE4r` vcJ d
Address & Phone '&A'��
Archnect's Name
Address & Phone ( )
Mechanics Name eau' L 4:;, g:&- � ,I
Address & Phone i"P eam _ s- 9z MA S�e?3-1331 f l'
I5 ;"
' was 1.m.purpose
e- 4e:e-.e•77�,_
md"of WNW N a dwaNkq,for law many famlAa7 ! •t=.
WN b AkIng oaxdomt to law? �� Atbagoa4
Earnaad Dotal. 90 �y uorw r N 0` slaw uc rw r d 3
Ham L�rc�snt I
Lie. 1
Signature of A plicant
SIGNED UNDER THE P ` , I
OF PERJURY
DESCRIPTION OF WORK TO BE DpNE
I
aur•.,r i� �
� I
I, MAIL PERMIT TO, ✓�
r' le
1'p
It
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
y/ /oq zd
APP VfD -
INSPECTOR Or BUILDINGS
s
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
SALEM,MA O 1970
TEL. (976)745-9595 EXT. 380
FAX (976) 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: - ; d lri� IXX� S'f�� ���Xl
Location o Facility `/
Signature of Permit Applicant- Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
Name of Permit Applicant
Firm Name,if any
Address,Ciey&State l
The above statute requires that debris from the demolition, renovation,rehab or other
alteration of building or structure he disposed in a properly-licensed solid-waste disposal
facility as defined by MGL cI1L S 150A, and the building permits or licenses are to
indicate the location of the facility.