45 MARCH ST - BUILDING INSPECTION I
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CITY OF SALEM
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Permit to:
BUILDM PERMIT APPLICATION FOR:
(Circle whWmw apply) Roof, Rero"of�-Anatall $Idlng, Cona rm Dads, Shad, Pool,
RspaidRapa�aa.
PLEASE FILL OUT LEGIBLY 41 COMPLETELY TO AVOID DELAYS W PROCESSMIG
TO THE INSPECTOR OF BUILDINGS: '•
The undWsWW hereby applies for a permit to build aocomMq.to ft fdlowirp-
Owners Name
Address Q Phone 95 W(wc L,
Architect's Name �� C
Address Q Phone
Mechanics Name
Address Q Phone J^ p ( )
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Siptature of Applicant
SIGNED UNDER THE PENALTY.
OR PERJURY
DESCRIPTION OF WORK TO BE DONE L `
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MAIL PERMIT
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/ CITY OF SALEMV MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
SALEM, MA O1970
TEL. (978)745-9595 EXT. 380
40 FAX (978) 740-9848
STANLEY J. LISOVICZ, 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: J Via+ L)c,S
Location of Facility
Signature of Permit Applicant Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
QA,n I o VVkN' rhS�
Name of Permit Applican
Firm Name,if any
01 7Y`(�Yc� �i e r4 r o A( � t �i �15 L�
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,S150A, and the building permits or licenses are to
indicate the location of the facility.