13 MARCH ST - BUILDING INSPECTION VEO BY T44E
AZ5WE , :10, GRANTED %!�..
r :,;:
CITY OF S�LEM
No. = -
oa o
4..r
b Plamly Loamd in Location Of
• Nw lsMoAo D4tdG? YN�No� �� 13 �'/� �T;
VW
Cmraiwsgn AM? YaL_No
BUILDING PERMIT APPLICATION FOR:
Pwmk to:
(Chb whbhwer apply) Ro Install Sid�o, natruct Qsdc, Shad, fool.
spaldRepla e. or
PLEASE FILL OUT LEGIBLY i COMPLETELY TO AVOID DELAYS IN PROONOW
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby appdss for a pwmk to build according to the follewirp
speoil'icatiors: ` .
Owner's Name Ml✓V(VIQi �\$C ,
Address A Phone 2 l 3 k+2(11 JD 2 �4- rat (o3q 1001
Amhitede Name '
Address 3 Phone t
Mechanics Name
Address A Phone
NCI,;
md"G1 Onsdig4 N s dwM-u,for how mmy hmrn7 '
Mir 0Adk:0 b Irk
ErsnMad coat. qly LIoMw• N p` s+a.Lbrw r 5 t:
ra.a i�ro.r.n ,
Lie.
S t of
FZD UNDER THE P�
OF PERJURY
DESCRIPTION OF WORK TO 8E DONE
\_-
y,; v o
li .. MAIL PERMIT TO� r i `��,•� \Sc�. - r
(,3Q —l�a �
1 M"
m
No.\i��
APPLICATION FOR
AAl
LOCATION
PERMIT GRANTED
APP
INSOtC-TOR40f BUILDINGS .
s
t..i
k Commonwuata 01 /I ,ackeffi
6 t ��/
JJtpa.{at.nt 0/.7.6�14ia(J�«iata�
600 Waa allm-31mal
�amesxQa+ooN I)oalew, /l/.ataehaaaw 021 It
corrmss,on.
e \ Workers' Compensation Insurance Atrldayit
. . with.a principal place of business at:
rrat/,�.aw,a+.l
do hereby'ctrtify under the pains and penalties of Perimy, th=
1 am an employer providing worker' compensation coverage for my employees working an
this job.
1 /5Z6
Insurance Co parry Poliq dumber
1 am a sole proprietor and have no one working for me in any capacity
() I am a sole proprietor, general contractor or homeowner (circle one) and have hired the
contractors listed btiow who have the following workers' compensation polices:
Contractor insurance Compatty/Polity Humber
Contractor Insurance Compatry/Poficy Number
Contractor insurance Company/Policy plumber
() I am a homeowner performing all the work myself.
I vnetnuno wt a Goer of chit a Ivnv e wG bt ior..areeo w raw orfct el kmTSkjLvm of dw DIA lei co.erare +erwcaean ano Mat b1hat m neert
co.srarr ai reWrto umtr Seccon 2SA of MOL 152 can kaa to cM ineo+xion of a+*'nai oerwun eorwdnt of a Riot Of ao 041 SOOGO WWW oaw
rear'ir..xaennwnt W xv M eiri ot"Icw in the loan of a $TOP WORK ORDER ane a few of $100.00 a ON ara'nst rut•
Signed this
!o day of r �U
Liccns cet building Depar-tr. en[
Ucensing E.oare
Seiectmens Office
re<fLh Gep:r'mcm
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, SRD FLOOR
SALEM,MA 01970
TEL (976)745-9595 EXT. 880
FAX (979) 740-9646
STANLEY J. USOVICZ, JR.
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the provisions of M(3•L 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 E`Z :1)1S 6c'4kA LjwrJ (M,
Location of Facility
of Permit Applicant ate
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
Name of Permit Applicant
f1ja,kdo-� fis S c
Firm Name, if any
2 k v 4' �
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.
l
✓/ie Pa-nvv,ou,.ea�.!/c °�`��ac/avav-lta Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registration: 104546
Expiration: 7/14f2004
Type: Private Corporation
SHELDON FRISCH DEVELOPMEN
Ne(don Frisch
218 HUMPHREY STREET _
Marblehead, MA 01945 ��--•' �-�„i
Administrator
�It¢i90�1L)l1dlW/P-4��� 6`✓� UIdC�d
BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR
Number: CS 051135
Birthdate: 07/14/1955
Expires:07/142004 Tr.no: 26125
Restricted: 00
SHELDON W FRISCH
PO BOX 811 -
MARBL.EHEAD, MA 01945 Administrator