15 LYNDE ST - BUILDING INSPECTION (2) -1101 l IdWT-SE fiLE� APPROVE{) BY T+IE
=pZCJD?R jpWR TP.A PERMIT DONG GRANTED
CITY OF SALEM
N am` `1 i Date // c 5�
Is Property Located In Location of
the Historic District? Yes_No_ Building 17 L)/i(� TDE C�F
Is Property Located in
the Conservation Area? Yea No_
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof of, Install Siding, Construct Deck, Shed, Pool,
epair/Replac , 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: n
Owner's Name 11� /H A) A �112G11
Address & Phone W-rorjAJ Figem Ph ,
MA
Architect's Name
Address & Phone 1
Z-4"C" 2. Sia¢Arr A-4 Tt-.
X Mechanics Name
92-
CF—JT2Wt S/-
Address & Phone
What is the purpose of building?
Material of building? C l If a dwelling, for how many families? 3x� 't
will building corar to law? /GS Asbestos?
Estimated co City License M N P4' State License oHo=
�L�� Lic. Lmpao�eaeat
Lic i
C:5
X'Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE ,
MAIL PERMIT TO: rC X
No-J_�S r •
APPLICATION FOR
PERMIT TO
LOCATION,
a
PERMIT GRANTED
3/o s L
APPROVED "
INSPECT OF BUILDINGS
CITY OF SALEM� MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
l SALEM, MA O 1970
' TEL. (978)745-9595 EXT. 380
FAX (978) 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, S 150A.
The debris will be disposed of at: 01,-124 /zl A� /5 lK nG11 S c�a—t
Locahon of Facility
lgnature of Permit Applicant Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
r)iara K�uee'-ic_
Name of Permit Applicant
Firm Name,if any
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 cIII, S 150A, and the building permits or licenses are to
indicate the location of the facility.