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2 LEE ST - BUILDING INSPECTION (4) 4 IN-4A lMffiT-OE f VD lUED-A APPROVED BY T44E Y .II�,S,PECT B ,PFWR TO A.PEAMIT BENG GRANTED CITY OF SALEM �No. .t. Date 7- 19 '0y 3 Wand \ ?mrmap' Zoning District Is Property Located In Location of the Historic District? Yes_No Building .2 t s y 5)4 Is 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, e al Replace, Other: 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 ,1/an.� Il,�., ;,J ,,, rC 7 , Address & Phone 2 G r 5r, Architect's Name Address & Phone f ) Mechanics Name L,tiC-. Address & Phone ( �71�) 1-9-S yp What is the purpose of building? Material of building? Cvo e N If a dwelling, for how many families? / Will building conform to law? �//c5 Asbestos? Estimated cost 3A5100 .cai City License# State License Horse Improvement Lic. If /S'b 5?� Sign re of Applic SI ED UNDER THE PENAL OF PERJURY DESCRIPTION OF WORK TO BE DONE f 20.vI` MAIL PERMIT TO: _4 U No. APPLICATION)FOR /PERMIT TO gh� Fro,,7L LOCATION PERMIT GRANTED /,g 1s AP V D Z _ INSPECTOR OF BUILDINGS J PUSUC PROPERTY DEPARTMENT 120 WAsmimaToN STRER, aRD FLOOR SALEM,MA O1 i70 dr TEL (978)74S-a395 ExT.960 FAx (97S) 740-Y94a STANLEY J. USOVICZ, JIL MAYOR DISPOSAL OF DEBRIS AFFIDAVIT In accordance with the provisions of MGL c 40,S34,I acknowledge that as a colmtiou of Building Permit 0 all debris resulting iYDm&a 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 i50A. The debris will be disposed of at /L©/'vt>� 5! Laced=of Facr'lity c Si store of Pe t Apphca� Date (PLEASE PRIW CLEARll L ) om Name of Permit Applicant Firm Name,if ay Address,City&State The above statute requires that debris from the demolition.renovation,rrhab or odw aheradon of building or structure be disposed in a properly-licensed solid-waste disposal facility as defined by MM cIII, S 150A, and the building pamita or licenses are to indicate the location of the facility.