426 LORING AVE - BUILDING INSPECTION (2) '"3"IMST-11E fIL*D~ APPROVED BY T44E
JMSPZCIDIR,PRIDR TTI A PERMIT B,EWG GRANTED
�, �
CITY OF SALEM
No
Date
ward
Zoning District
Is Property Located In Location of /
the Historic District? Yes No Building (`
Is Prapnty Located In
time Conservation Area? Yea No
Permit to:
BUILDING PERMIT APPLICATION FOR:
(Circle whichever apply) Roof, Reroof, nstall Siding, Construct Deck, Shed, Pool,
Repair/Reply , er•.
PLEASE FILL OUT LEGIBLY dr COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS: '
The undersigned hereby applies for a permit to build accord-agto the following
specifications:
Owners Name .S l, y- Z A /3 L ,f C j(/
Address & Phone YV 6 G r r nj� A'vC f57� )
Architect's Name
Address & Phone f
Mechanics Name
Address & Phone 3 M f brsc)1v A t/ ��ooC��Kv (57X) 373- (oY5�
Wile!is time Purpose of building? e.
Malarial of bulldW U/ It a dwelling,for how many families?
Will building conform to law?_�BLS Ast>astos7_- f�/t�
Estimated cost 5 cr 616 MY Ucenw• state loans e 6 3 eras
Halea I""Vewent
(JU Lit.
Signature of Applicant
SIGNED UNDER THE PENALTY`
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO: Ric r D 1 M/901SoN 3 1'71f o o-lol A v r=
60'OvLfLA1W9 "' -5
y
1
No. U�
APPLICATION FOR
PERT TO
LOCATION
PERMIT/GRANTED
19
APPrFD
t„
INSPECTO OVI filDINGS
PUBIC PROPERTY DEPARTMENT
120 WASMINOTON STRECT. 3RD FLOOR
SALaN.NA 01970
TEL.(976)74"595 EM 360
FAX (976) 740.9S4S
STANLEY J. USOVKZ, JR.
MAYOR .
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the provisions of MGL c 40,S34,I w3mowledge that as a condition
of Building Permit S .all debris resulting ftm&e consarucum wbvgy
VYGI ed by this Building Permit shaft be disposed of in a properly Hcenaed solid-wasea
disposal facility,as defined by M($,c III S150A.
7be debris will be disposed of at:
Location of Facrlity
Signature Permit Applicant Date
FULLY complete the following m&nnsbm
(PLEASE PRINT'CLEARLY)
PIc OAS,0. 9 m fiolsa,,,
NameofPeamit Apphcw t
R, C J
Firm Name,if any
Address,City A Si-
ate-The above statute regmres that debris from the demolition,remvation,rehab or other
alteration of building or structure be disposed in a properly-licensed solid-waste disposal
5cility ns&Tmed by MIL cM S I50A, and the building permits or licenses ne to
indicate the location of the facility.