78 LINDEN ST - BUILDING INSPECTION IT
irL�M61i11!!6t'DE VED BY T44E e,
AMPb II�B R D�PIMo
ZI QZNR GRANTED it
CITY OF SALEM
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BUILDING PERMIT APPUCATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
Repair/Replace. Other.
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROO288ft
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the folbwinp
spedfications:
Owner's Name 'e5lbs, �r -
Addrm & Phone
Amhkect's Name
Address & Phone
Mechanics Name
Address & Phone
What Is tha plapoM q buaEne4
rcdwl of '+ M a dwarMq,for how maim ramaw?
WE bWk&V Oordo law? r ml so Aabaaba? !'
ElOrdbd coat. CRY uoalw r N p` stall tJoarw M e_ '0 8/93g'
Ha.a Lpson.one
Signature of AppliDlInt
SIGNgD UNDER THE
OF PERJURY
DESCRIPTION OF WORK TO BE DpNE
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g� `S-zE g l' 'Walt-r / kO .,v'P,yim c' AaLa 27f
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"; MAIL PERMIT TO• S TrtiH, 0 "iV ' c/o
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APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
APP OVfD
INSPECTOWOF BUILDINGS
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w PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
SALEM,MA 01970
TEL (978)745-9595 ENT. 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, S150A.
The debris will be disposed of at o (�
Location of Facility
Signature of Permit Applicant Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
E e- 'cI4-Ir r-i C--r9
Name of Permit Applicant
dLI� 5S y�tt�i r 1�i�i�S -74- &„/?V roe
Firm Name, if any
-l°,�AN L cr --
Address,City&State
The above statute requires that debris from the demolition, renovation,rehab or other
alteration of building or structure be disposed in a properly-licensed solid-waste disposal
facility as defined by MGL cIlL S 150A, and the building permits or licenses are to
indicate the location of the facility.