19 MADELINE AVE - BUILDING INSPECTION gPWWB~*EfiLt NHm AiPPMVGD By im
JW==PWR Tp A PlAWT WING ORAWb
CITY OF_SALEM
No. DOI
Ward
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BINLI NG PERM APPUCATION FOR:
P11111i<t0:
(C.Irtae YYhlCfleller apply) ROOF. Renwf, Inatak Skimp, CO mbW Do* Shady POOLRapairAReplaa, Other. 3 SYpS014 Pa�G�I
PLEASE FILL OUT LEML.Y A COMPLETELY TO AVOW DELAYS N PROCEBfNp
TO THE INSPECTOR OF BUILDINGS:
The underaipned herby applies for a permit to buNd aowr& p.to the.tWwinp
speoffloalims:
Owner's Nerne 1qx 1 G
Addnes a Phone ,c9 14121 0 <.nJ 19as- lf-9) 7Vq PS:� —
AmhkoWs Nwme
Address a Phone J ( )
Mechanics NameICl4'A?
Address a Phone Si0/I''1
What is No pWm a buYdrq? 3 L�oS ,0 eRG fit
wrww or bt/dYg4 If a dwsiYp,for how m my hnOn?
WE bLm ft oar 1 10 hw9
Eamm om 4 34 6 cM uo • shM uo o, 6
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of Amkm
BNMiO LNr>DNI Tm PENALTY'
OF PwuuRY
DESCRIPTION OF WORK TO W DONE
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11
MAIL PERMIT M. )h/f
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Workers' Compensation Insurance Affidwis
1, &CIVQ2!? Cjack�OKl
. . wish.a Principal piece of t>o:inas ac
do hereby•cerdry under she paints and penihies of perjerys sham
1 am an employer providing workers' cosnpensasiea coversis for my eiupleyesa werklog oa
shls JoL
Insurance Co n mW Peligr Number
L
I an a sole proprietor and have no ens working fdr me In say opeelq.
() 1 am a sole proprietor, general contractor or homeowner (circle one) and hews hired do
contranors listed below who-haw she; following workers' compensation poBdesi
Comrocsor InsuranEe Company/PoBW Numisr
Contractor Insurance Compsny/Po Nuanbsr
Contractor insurance Company/Policy Number
() I am a homeowner performing all the work myself.
•I rns.nrana wat c•.l of tliia auweaw va M ferwaro.d mom ORe.A Lvvw*nwe.f dr OM Isr Cove Tdetaaw ano On{ire+won
co.ararc b r#ARat anon fac*w ISA sf MGL 1 S I can ka.ie sw ir4.Mi.a sf pirinar osawb corr.wK ./a Tale el w tsi I.f00.ea)wNw am
Team'iswoomy'M a vs a aua4le ' the kem of a STOP WORK ORDER mo s lrw.f S 100A0 s es►ap9at ow.
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Signed chit I der of
.iccnact/Fcrmittet oml6ln` Deparcn.ent
ucensinf Eeare
Seieccmens Office
�ellth 6e�anmert
.pe, 17c
PN68UC PROPERTY DEPARTMENT
120 WASHINGTON Sfl1EaT,3RD FLoon
SALEM,MA O1 S70
T[L.(976)745-SS95 EIR,360
FAX (678) 740-9e4S
STAMXV J. USOvICZ, JIL.
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
In wcordtoce with the provisions of MGL c 40,SK I aclmowle*that as a condition
of Bw1dinS Permit d .all debris resulting from the cons&wfim activity
by this BuildmS Permit abaft be disposed of in a properly licensed so>id waste
disposal fa' t .as defmad by M(R,c nL S150&
The debris will be disposed of at G'. � 4dLL d 6eaQj-`¢
Location of Faa ty
SrtylatlaeofPermitApplicant' � Date
(PLEASE PRM CLBA mfasmation.
Recl-141-',o wdoD�uagv
Name of Permit Applicant
�tJO y�l3 c/2�� �o-✓S"I GcvG7/�./i/
Far Name,if airy
Address,City&State /r/
The above statute requires that debris from the demolition,renovation,rehab or odw
alteration of baild'ing or sbucdae be disposed in a
facility as defined by MM CM S130A,and the licosa or ao -waste disposal
indicate the location of the facility. �8 Pia or liceosea one to
�F
MORTGAGE INSPECTION
PLAN IN
SALEM, MASS.
REID LAND SURVEYORS TO CARLSON MORTGAGE COMPANY, MARTHA
365 CHATHAM ST., LYNN, MASS. A. LIVERSAGE AND THE TITLE INSURANCE
COMPANY INSURING THE PREMISES.
I CERTIFY THAT THE DWELLING IS LOCATED
AS SHOWN AND CONFORMED TO THE ZONING
SET BACK REQUIREMENTS OF THE CITY OF
SALEM WHEN CONSTRUCTED, OR IS
EXEMPT FROM VIOLATION ENFORCEMENT
N/F UNDER M.G.L. TITLE VII CH. 40A SEC. 7.
JACOB W. WILUR INC.
1
L. C.
.� .. LOT 613
} 8170± S. F.
N/F DECK o
SCAPAROTTI ci °'
N/F
1 STORY ANEZIS
WOOD FRAME
019
15't
i1
rl
81.70'
19 MADELINE AVE.
01, HEREBY, CERTIFY TO THE BEST OF MY KNOWLEDGE NOTE: THIS PLAN WAS PREPARED FROM A
THAT THE PREMISES SHOWN ON THIS PLAN ARE NOT LOCAT- TAPE SURVEY AND IS INTENDED FOR
ED WITHIN A SPECIAL FLOOD HAZARD AREA AS DELINEATED MORTGAGE PURPOSES ONLY. OFFSETS SHOWN
LS
HE MAP OF COMMUNITY #250102-B PREPARED BY THE ON OR SCALED FROM THIS PLAN, ARE
RAL EMERGENCY MANAGEMENT AGENCY OR ITS APPROXIMATE ONLY AND SHOULD NOT BE
ESSORS DATED 8/5/85, PANEL 5 , ZONE C USED TO DETERMINE PROPERTY LINES.
URTHER CERTIFY THAT THIS INSPECTION WAS PER-
ED IN ACCORDANCE MATH THE "TECHNICAL STAND- SCALE: 1" = 30' DATE: SEPT. 13, 1996
FOR MORTGAGE LOAN INSPECTIONS" AS ADOPTED
HE MASSACHUSETTS ASSOCIATION OF LAND SURVEYORS BOOK: PAGE: CERT.#36331
CIVIL ENGINEERS.
IS CERTIFICATION DOES NOT INCLUDE SHRUBS, WALLS, CONTROL P96-909 L
ESOR DRIVEWAYS AS THEY DO NOT ALWAYS INDICATE $LS
ERTY LINES.