10 LEMON ST - BUILDING INSPECTION V
-ptmSMWT-9E F&W94 ND APPROVED BY T44E
Sp==POW TD A.PEMIT BEING" GRANTED
CITY OF_SALEM
No.
it
\ ♦ _
is Pmpwty Located in Location of
tlta HWAAc Maim? Yew No_� Building /r(J ��Cr�cor✓ S�
is Property Located to
the Qrserwtlon Ana? YM No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, (Construct Deck, Shed, Pool,
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:
Omer's Name �- I � � �� \ " u
97 —� NV- s/ft35
Address & Phone !O b.ema y S4-r em
Architect's Name
Address & Phone f
Mechanics Name F";4 V✓'DO to a+� �i�/�c�oiS� mie.
O/BKIo
Address & Phone ZOX,?a5,LJS" d Lfhr I (n 4a• 004QG2
what a the p apoae a tN dwl o?
M"W a 1MM ? W06C� B a dwWNq,ior how many lamilim?
ww wodkq cotlomt to law? `f S Aat>oatoc?
Eawttated cog city Lkeree r N A stata ucwtaa a CS 917 0/
Some Imprave"I /
Signature of Appli t
OF PERJURY
PENALTY
DESCRIPTION OF WORK TO BE DONE
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MAIL PERMIT T0: • /�• fax 2.2S6�,_G� TFv eb r�/.� 0/�8 6
1
- 1
No.
APPLICATION FOR
PERwr TO t7
LOCATION;
y
PERMIT GRANTED U
2006
AP ROVfD
IqoPEGTOR O UILDINGS
n*Comntoa IVedth ofMOUMMUSM;
Depanhnesf cif ln&ifr(d A=Mdarfs
Offlo dfhwsdswlm
6"WoaJilig"&"W
Boston,MA aill
Workers'Compensadon Insannee A®davits BWMaz ContndonmechidanwPfattnben
ADDi cmd InRgM*doa Plnfae Prime L lbly
Name E� tr zrv; ,.�- �a�iccz!orT,2Z�n
Address: PO. 3o X aaJ`Cv
CSty+/Statel7iPe G,/ f{�- �1=9' ^ Phase* 97 L G 9a-oda�
�am,employ aTOMWI. t4�bon'
a voesd oo�trae�or and 1 TYPO
N oomCo
®ploy'aaa(aiBaad/arP��al• bsvabbadAaaot�Centa�tim
2.❑ I am a sob I Mprielor a parota6 Sadao die smebed stet= 7. Rif
ship and blare no cmpbyced Thee mb-ooahuloar Mro L ❑Dens Moo
wodft l4r ma i•aft aPa1F . Waaamapon 9•. Q addtlion
(No wodzw coup,nomraooe 9 ❑ e eoippr�tioa'm0 id'
regniied}. Mein if ive ` �d�eh 10.❑Mecpial repairs or additione
3.❑ Iamabomwwlw doing ap.walk right of p Mal' 11.QPi®biagma6soradditiona
mywK Pie wo&W camp, a 132,�1( iei �ieluvtiao 12 Roofrepaur
masraaaamgniref}jt, empby«i LDpwodooit
ioam> tees r 13.0 Otba
;Any gglkaat Ad dub boas/t=0 do es a}toe«"m bd=+MAs 0*00 map.. -04 rouar mbia�(or
NOMIMA aWWOft*6i1a�vtt.'-0.ti aa
abraddAwmtadeatt¢�`aatiimaedsA iAw Submit aatvattidna suck
tCaolrrtisttatdadtaYtaa'�mdrddaa.add81aaa1drtdewioatreaseaaht aovaeten011hobviodn'aaa¢po"invarnudim
IosAw"WhIrdr wkprv(lbSwardogs►eoatpsuawinbrnawwfdr+pdidofr(* BdvwIsflrpaftaiadjofalas
ImtaaooeCampmyNatnz �0�»me�cn
Polity t or Ses-ioa.Lia s. ?ill;C4 0 WC qm ,2g,3 7 Exp mil=Date 6
lob Site Addmw /O 4.0,7&? ,Sf (Yty/$mOdLip cSa�em� /1�JA•
Aftwh s caP2 of the waters'eompmandon policy dedwatfos pap UMowlq tba poiley nt:mhw and expiration date}
Fadare to Sesame covaa�e so required miler Secdon 25A ofMGL a 132 can lad to ilia impwidoa ofesimind penalda of a
flan up to SI-S00.00 and/or one-year i aprisoususcA as well ar civil pouldso in she form of a STOP WOM ORDER and a Sue
ofup to S2J0.00 a dry agaioat de-viola w. Be abitad gut a copy oftbta zMgmant maybe 6uwaNe i b cite Office of
Iovatigation of the DIA fa hourance covasee vaifiadm.
Ilr A"Ay car*adwA#Pffbw&"PmAidw 0001 7 dw*0 asfanaa/oa prvvllel obow is vsw sal eanset
Sinatme par
Fh=#: 9�Y�G9 a- cXao a
0DIe1d aso Do ad wrLre Ga/Ab any b Ar coasplerel f+p dip oiar:Na gdielei
City or Towns 2trmMniteaae p
Inalag Authority(circle one):
1.Board of Health 2.Building Department 3.CMy/rows Clerk 4.Electrical inspector &Plumbing Inspector
6.Other
Contact Perron: Phone N:
Information and Instructions
cmopea„tioa for their COVICy es.
ag La
damac>a Gcsws obi 1S2 requires ill amplupiW lool��!�0� �MAW any�of bk%
m smile,impHA is deemed a ...mew palm 4f
or odter 6wl coft,or my two or mo[e
An AMPION is of wfbce
defined as"m iodiv L p� �s Q[a deocarad m41aYW or�s
d the forepovot wort it ti joid attapriss, aewciaaon at orbs kpl alit$m4*ug mplo& mWenq
reedver err trmtee Dias iadividpaL p' and wbs residss thaei�err the oaapad oC>biF''
owner of a dwelffii boUW bavias not name thsa ices err* an at d dw ftg bome
d boats d ssother whs®p>of!�>&c te do maiMICIAMMIC4,&II mot bemn ofsack®PioYmalOe deemed a be as atspicW
or as the ts�orbm'IdiafWnUSM
MGt.ahaP00t 132.12Sa6)go so=&A-gva7 date or local i�&per sra♦wkYltol/t1K iswane�or
renewal d a lkaJanm or pawk to oPa"a _er to eaodmet bdldtar V tke oomm wwedlb f »
OMCM dmmpUM wtlb the ivanow swamp re9
tiosally,M®.ebaPmr f 23C(?)snits"Neit6ar�e°° no mY of ils poftd
erica into my tontt 4 tar the paftsmce of➢*99 work cot$aotxpmble evtdeace of ooarpliaaes w�the iosso:anee
ti dthis chapter�avebaapteseatedtsthasst0oei4t•»
APP aMdavk campy',by the bous*map*to yaw smttttloa asd,if
Pleare fgoot t66 workers oomph es) phone mrmbaG)>>mi w their eatiEdta(s)of
necessary,wPpb' )t�a(ly�or LimAad 1,hbft Pal"U -p'��no cmpbyea omw tam me
mania era Limited us no " iara saes. if as l=or 6rdaabial
mbxvo
moors�Kejr a requzgm He advised&M a dathW me tie a�davlG MW&Mdavit sboaN
Accidmti is coagrmatios of imarsnee oavaap or Some is being wV00A sot tea D of
S110 m Youbme my qna� the Err or rf yw aro regaieed to obtain s workeas'
Convessatinpo�jq pbssa call the DeplR6nad d the asmber llsld b� Seltinnaed'companies s6oald eater their
��ontha IPPMPr!gft Has.
CRY err Tows Olddsk & ace at the Ices icon
late ad prmtad legibly. The Depztmlt ties pro•iiW .space �
place be son the the affidavit is aomP
of the affidavit for you to fill in the even 1>,e O®ce of Imrestiptiom bat in contact you regam�i 16e
please be sore to a in the permit&nw uomber wbkh w�be used a a reference comber 6r Adidoa.an aPplicaot
tad mad submit=,*Is pamNECOMaPp5cadm is any tam Yesr+need only submit one affidavk indieatmg raarent
under"Job Site A&bue»&a applicad sbmid write"all loadom a ' : (ohy err
policybift=» copy &O said") bsea o�ei*atrupo1 GE' aeiv aidavit�®wed oat aeh
yew.W t ss proof tbst a valid afiIdIvdtbm <is b Ms for cm mk not rdawd.to any business or eamma�cial vmuue
ear.w6e+'e s home cant err atieer is o6taiaing b �this st8dsvit
(La.a dos Name or p�to bum leaves ete.)said pawn is NOT regoaed emV
would low to thank you in advance for your cooperation and should you have any q�mV
The Office of htvestipo m its a call
please do not hesidts
The Depa<uncuet addressh tekP6one and fa nsmba
The Commonwealth of Massachusetts
Department of lndasUW Accidents `
OMa of fnvestfpdons
600 Washington Strad
Boston,MA 02111
TeL #617-7274900 ext 406 of 1-877-MASSAFE
Fax#617-727-7749
Rcvisod 5-26.05 www.mm.gov/dia
i
CITY OR SALSM, MASSACNv$ETTS
PtJBUC PROPERTY DEPARTMENT
110 WA9N'MMUM *M96T, US Fume
9ALI M. MA99ACHUSCM 01970
T9LEPNONE: 970-745.9898 MM. 390
RAm 979-740.9949
Salem Bni! n.n.....a...__.
1JlO�i�� hPAlw�
In accordance with the provision of MGL c40 3 34j a condition of your
Building Perntit is that the debris resulting from this worst shall be disposed
Of in a propedy licensed solid waste disposal facility as defined by MGL
Chapter III. S 150 A.
The debris will be disposed of in:
A a mo vie b;S 0a c 2 ax ation of Facility) 7 a _
Signature of Applicant
Date
a�
6 _'` ;r3'•- � BOARD OF LDII GULAi IO1
G REGULATIOI
License: CONSTRUCTION SUPERVISOF
f
Number: CS 081701
Birthdate: 05/29/1955
EXpites: 05/2% 9%2008 Tr, no: 2276
Restricted: 00
NIALL T MCGUIRE
150 HAYDEN RD
GROTON. MA 01450 G`
Commissioner
Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registration: 1321 TO
Expiration, ,j"1/29/2006
1 ype: Private Corporation
EAGLE ENVIROMENTAL CONTRACTORS INC.
NIALL MCGUIRE
150 HAYDEN RD. _
GROTON, MA 01450
Administrator