2 1-2 MASON ST - BUILDING INSPECTION (2) \ Y IIY
qPWG~4K APPROVED BY T44E
MPEClL1Fa PWR TD A.PEBMIT BEING GRANTED
CITY OF SALEM
—\ \ Did. iz 's c
ww
Is Property Laoatad in Lz=rl6 of
Me a Mft Diatrkt? YM NO X Drildioa �/
Is Properly Located in
• me Camnvallon Ann? Yak_No
Permit to:
BUILDING PERMIT APPLICATION FOR:
(Circle whichever apply) Roof, Reroof, Install Siding, struct Shed, Pool,
Repair/Replace. Other
PLEASE FILL OUT LEGIBLY A COMPLETELY TO AVOID DELAYS IN PROCESSMKi
TO THE INSPECTOR OF BUILDINGS: '
The undersigned hereby applies for a permit to build accortkig.to the folio"
specifications:
Owner's Name � tJ\ 1 SS
Address a PhonX 2 M f r S 6 N S T-
Architect's Name Alder
Address & Phone
Mechanics Name
Addrm & Phone 3Z 1 (97d) P-3 /G7 9
Whet Is s»p qmw a te~ iCQ�d' ✓� S/�a:— �9�� �' P
ma m or tarldMq? a. 20 of Karlwasyrg,ror how m"htinaee?
WIN 4rl ft cads,to law? Ambe"? /"/U
rsrlltaled coat /S" cay umm o etab ,► �'S'�0 971
�s JTe�, Um *fwdu Ie*roveraene
Llc. d /Z<.5-.S6f1
re of Wicant
SNOM UNDER TM PENALTY
OF
DESCRIPTION OF WORK TO BE DRONE /f77
MAIL PERMIT M.
S°ommif18 O t om3 ill
r�
O4AOdddV
MiNYNJ.unu3d
NOLLVWI
boa NOLLvorm r
ti
600 W.4416 Sfaa.f
Ja.1p 1 GoeeA Qal� Xumg.a& 02111
cee.eeesf .
Workers' Campenutia lawman AffidWk
• • whirs Prbm*W ph= d badas'o au
do hersby'cer* under t)e pains aad pomildsf of parjay, dma
Isan employer pnrAding worlims' compensation covep/s for my si wleyow working on
Insurance
I sees sole preprieror and have no ens working fdr nos In arty copeck►.
0 1 am s seie proPrkmr, general contractor or homeowner (drde oss) and bmM MNd do
ConMc&on listed below who haw the following workers' cemlpenastion peRedm
' Ce�� inwnnis Coeayaty/p Nondgr
Convaaor Insurance Cotnpstry/Fe Nv"W
Conasaor insurance Compaq/iaolky Numbw
O I am a homeowner performing all she work myself.
•1 veew""ow a aq wf Oi"mum WE M for►row a ar Olin A le•adcaaaea of ON M IV rarwate am 00 66aa a emn
ro•waar r Nowed.ear Smut ISA d MGt 152 ran We w or Wommine of aipillr oeaade ca+winr d a Sm of a.aai 1•I= swor am
+wn'�Wa.+�erve a yt ar dN woaw o in On lore wf a STOP WORK ORDER ar a few of S MAG a ae aeafsc aaa
Signed this • d,)+ of
.i rmMe t iiufla of psrxn.S' [
Licensinf Eoarc
Selecaraens Office
^atlth Gcpsrmer;
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e
s`dry;w�'sw'`,, � / .c G,rorge W... Mc/ntyr'e m
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C.Z2/¢
,'Ian with., Cert
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S. d w oA S 6-8-s 30'M Po
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Subdivision of Land ) 00�. S N
Shown on plan 8165 `
Filed with Cert. Of 'Title ITo . 3697 rt) �E�, � el� N3/u�i�
South Registry, District of Essex County
'X�g L-9 r
R'EcmvED AND FILED
'Separate cert/fieates of Pit m iss / With Certificate No P ��
for .(ats...l,_.22_.adj ,_ e s Copy of rt,ofp✓an
'!J the Court Q/1
_ ..y VINO 'RMS R T/ON OFF(C£
.......... .
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