46 MOFFATT RD - BUILDING INSPECTION (2) 'PLJvn1A"w4K q%dNld 1D A/MOYEO 8Y Im
PI�1 TD A`.!1lJJIINI!lEE1NINi LiRANT�D
CITY OF SALEM
ortr /i / a y
.:/ Ord—ZZ.- _
a 14"Emy Loci d to ioaatIm of [f�
Me NYrmb D~ YM No V/
b PApwly Loorbd to /
Mac AIrr9 . YM No
Psnnk to: BuLam pmw APPLJCATm pm
(ChW WltWN wr apply) ROOF, Pm Irw N 8Wft CmWW Do* &we Pool,
ROpwd wpkm OtlwK: aF L /Auff .,....
PLEAU PNLL ONr LNI my a aowLan LY TO AVM D■.AYNi NN PROClNINIO
TO THE INSPECTOR OF&ALDIN08:
hereby @pow bra pomtk to build aocordrtp.to ft.bNOrd ,
0~8 Nv P EL d- 'pl," kb dvilt y Wrry
Address a Pla V(, W-791 -7`I1 -�,1 3q 3
At~s NWO
Addmn a Phone ( 1
tt adMics Now RhA&rtr A16 rw-l4n-o,
Addren a Phone �5' 130-L u m� 5 t , 7`f S" TY S5-
S�glc wi, �vrl'
wti a Me PAPrrr at borer~ S r'.;a/ F Frvv•
kubm d lridti 17 iA i n r� N a drrrliq,tar horn mw b~
m bdom oa*m 10 kw?
ENWAled cart �QTQ OQ_atv uo r QrM Lwmn@m r 1141 7c
a!A~
Nll�i®iNNM THE PR"TY'
OF PNU NIY
DEBCRIP110N OF WORK TO NNE DONE
1�n L d D R .�b l�c,/G
P j 7T
MAN. PBiMITTOLtiY
co Gob �6rrrh�rv�.
IZI
C CoennsostunraQA of� � •
wo W.Ai.#Sind
1c....i V...J.6 02111
ee.ae..ar •
Workers' CamPe2wsin Iafalrsaee Af mbWk
�4 %LT r il?v�
.. wMN orUcdpl PLse of bml w M
4 5' i3 rfi L o � l�, ��-• Skew wl
de her0y*Csr* undo q PAW,d poli"m of Is epys dM
O 1 aIw as ewayleger Prinvift w rkme compsmadw cevePt a for MY ei"001160 w dit M
abi bk
Insworm CAMPW
I an a%..M Pr&prlea.e and have se one working fir nrs M s4 otesdW
O I am a " oropriews general cor mcuw er hoeawwraer (drds am) and halve bird dal
comaracron Ibed Miocr who•b.m chi faipowisg workers` comPsumdOR PON"
Inwwnia Cmagren►R
Conarseaw insurnsee ComonAN e
aq man"
In
Conaaeerr uwance CoMpauy/
() I am a homeowner Performing all the week mY"ff-
•I.roar"wu a ewc of ei.a..aa.on be I.rvana. to w Win A 1w.Mrwwe d.r OIA It eww"a i^ ir�e M I ol"am n Who rY.r..r
0 won
c.wrap r rawarn aa.o f.d..2fA d WA I S 2 cs.I.ae n w wwmda.d.iiri.s foals..rrwMr
nary wrw.r.ai a ala.dd&OAW i.Yw bm d low of STD/ WORK ORDER am a a r ICCA a Move�a
Signed chk . v S der of
:iccrscei crmitcss -uits1nt Department
licenaint Ecsrl
Seleeumm Office
:;eslth Geparmer,:
sea epc ape 77s
ruRuc rm2FIN Y LAWARTMENT
120 vamimum smzwrT sR0FLOOR '
SAL IK KA 01 S70
TaL_(278)745-half ELT.sS0
FAR UFM 7404 "
MAYOR
DLSPOBAL OF DEM AFFIDAVIT
ID&= dw=wilt the PovW=cf UM c 40.334►I acimowWp mat r a cmM=
of Bml ft Permit/ .A ddxfs rem Dom to cmoo dioa mcdvft
pvaaed by this Bm'Wiaj Famit abd be diapond of in A peopa*Hamad soNd waala
digmsd$ciHty.as de>fosd by Imo.a 1%3110A..
1ba%7
dabds wlII be dLpwed alert: lkel�
Lowden ofFacOW
S�odmeolPamitApplkaat Data
FLILLY=EASE PPRRDIT CL ift anA
-(� 0 nL-%2T. t
IJame d7u mb AnAo t
61-0_ [1 Gh P .
Fits Nam%if a w
Ad*omk City et Stine
11e above swAs regoh m that dabria feom the demolidM r xwodm rehab a odha
aituW=of buU ft or*act Ee be diapoted in a pmpaly_ solid-watts disposal
Salty r dedoW by lr GL WX SIMA,sad the bml ft pamit or itccamu ate to
ia&de the location of the fie0i y.