28 MONROE RD - BUILDING INSPECTION IMAM IftST19Ef#UEJ lO APPROVED By T44E
.WSP1= R PFWR Tp A.PERMIT BWIG GRANTED
Q CITY OF_SALEM
N /
No.\�l) Date
i�
s: a
it ward
Zoning District
Is Property Located In Location of
the Historic District? Yes No Building
Is Property Located In
the Conservation Area? Yes No
Permit to; BUILDING PERMIT APPLICATION FOR:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Dec Shed, Pool,
Repair/Replace, Other:
PLEASE FILL OUT LEGIBLY& COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the following
specifications:
Owner's Name ,��� <1,4&M�Tad
Address & Phone l`kRd&L f9�P� Z-5-2670
Architect's Name
Address & Phone If
Mechanics Name
Address & Phone ((�
What Is the purpose of building? :Oi l,& fd
Material of building? (2j6nn d_b/ //JZ(-4 y If a dwelling,for how many families?
will building conform to law? Asbestos? It /T
Estimated cost a,5aQ0 city License it State License it
>V \\ ames improver ant - \ '
J ) Lie. / W.
ig ature of A pk 6ant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
ug,
i
MAIL PERMIT TO: olvn,el
i
No.
APPLICATION FOR
PERMIT TO
LOCATION
d ' Y/t�"e4l-oe /t�Y�I /J
,
PERMIT GRANTED
�o�oy ,9
AP ROV�D
INSPECTOR OF BUILDINGS
.«.
1
QTY OF SALEM
BUI DINGDEPARTMM
liMaOWNER LICENSE E)MOM0N
Pk=Pda
DATE-IL DAII—IL a
IOBLOCAT10ti
HOMEOwHIM
ADDIMO
HOMEO'WNa g 7-k
Tbc a r+,cwMdon of-LomeowWr was exmaded w b chidt*+Doric+dwclvl�p OtTwp
Units a kis"Sao albw such bomeawaers to awr an indirrdtall hire wLo does am panes•
ga me,.provided tbm the owma ad m"Faviaas
DEFftgrlOAI DF HOMEOWH= w reside m whkh there$ar Y
Pcrsoo(s)wbo owns a paccl of land an which bclabc resides w b�uads my to suck rase amd s
inmrded w be,a am w two lamilF dwclhii.*=died a dctadwd taroctwa sba1 aolbc onnsldamd
farm sttvcwm A perm wbo coravum imam 11mn anc home in a two- a OW�tk toms
a bouKowmac. SuCb-hom "me a mV subm*w the Budding OITd4 as s dee ��
to
Building OffW4 that Wow be respombk to aV s»ch work pa�OOd
The undasipwd'bomeowtxr•ammrs mponsibi I im C=PBrre with the State BtdMg Code and
other appBcabk goes by-laws.ruts and rep hdom
The wWmipud-homeowDe=dfms that Wft wdaswids oho C54 of Salon saw pv dw d
n&jmwm kjpwdon pro=dwea and ngxd ems and that IJsho wlli comply with aid ptooedtoa ad
regmaa`N o
HONIEOWM.S SIGNATURE
APPROVAL OF BUIIDING DMMCTOR
See otha ode for sine code