12 LINDEN AVE - BUILDING INSPECTION f1.1tNSiNli6T9E flLf8400 APPROVED BY T44E
1WSPZC1DB PPMR T I A PEANUT BEING GRANTED
CITY� OF_SALEM N
Date
{. I
� I
�i ward
Z06ng District
Is Property Located in Location of
the Historic District? Yes No Building
Is Property Located in T
the Conservalkm Ares? Yee_No_
Permit to: BUILDING PERMIT APPLICATION FOR: /
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
Repair/Replace, Other:
PLEASE FILL OUT LEGIBLY✓i COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS: '
The undersigned hereby applies for a permit to build accordwig.to the following
specifications:
Owners Name J1 iyfITHHN ct/ l? lyack
Address & Phone N (rrM 9 ") ! - R533
Architect's Name
Address & Phone nIf
Mechanics Name I'c i s Wh e Q J,11An1s,1v R.S
Address & Phone 3 119 11vlS v /( li yi
What Is 90 Purpose of building? a�.
Matelot of building? Ltiovd N a dwelling,for how many famles?
WIN building conform to law? L/ /"�70 Asbestos? )V6
Ealhrlated cod G S0 Clty License e 03 abarJ Mine Claw N S 3 baao
Brea Ioprovawent
O� Lie. t// 6 S
Signature Applicant
SIGNED UNDER THE PENALTY,
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
yIV
MAIL PERMIT TO: 3
.t
No.
APPLICATION FOR
PERMIT TO
44 e-/3
cif l��r
LOCATION
P RMIT GRANTED
1l-)
AP OVFD
INSPECT OF BUILDINGS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, !RD FLOOR '
KU",MA 01670
TEL (676)745-9365 EXT.360
FAX (676) 740.6846
STANLEY J. USavIC7, JIL
MAYOR
DISPOSAL OF DEBRM AFFIDAVIT
In accordance with the pmvia m of MGM,c A S349 I aclmowledge that as a con&m
of Bmlding Permit N .all debris rmdtmg Dom the constubm wpm,
govemod by this BuildimS Permit shall be disposed of is a properly liceoaed soH&waste
disposal facility.as defined by MGL c IM SIM&
The debris will be disposed of at
Loud=of Fserlfty
Signature AppHcaoat Date
(PLEASE PRINT C LEARHY)L
Q �
ki C � *r) 7 J KI /�f D/SQn/
Name ofPerutk Applic(mt
Firm Name,if eray
3MOblse�-,,j Ao Gr C=1-/9n(z) ItZo.�s 6i�3�
Addreak city d<Sate
The above statute negmm that debris BOm the demolition,rmovati(m,rehab or other
alteration of b>ilding or stnrchn be disposed iu a properly-licensed solid-wwe disposal
facility as defined by MM cIff, S 1 BOA. and the building pamits or licenser are to
indicate the location of the facility,