8 OLIVER ST - BUILDING INSPECTION '*L>Z1NB1Mtl6T�E APPROVED 8Y 771E
JMSPZC=PRW TD A PERMIT BEING GRANTED
CITY OF_SALEM
No. s oats
w.m
� zarrq oLnI�I
Is ROP"L00ftd in
MN 6 Maic Did"? Yar_No Location of ,(
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Is Propwly t oc&W In �/�
trrs Carsmeban ANO YM NO
Permit to:
BUILDING PERMIT APPLICATION FOR-
(Circle(Circle whichever apply) Roof, �4roef. Install Siding, Construct Deck, Shed, Pad,
Repair/Replace, Other:
PLEASE FILL OUR LEGIBLY i COMPLETELY TO AVOID DELAYS IN PROCESSILiYG
TO THE INSPECTOR OF BUILDINGS: '•
The undersigned hereby applies for a permit to build accort aig.to the following
spedfloatkxrs:
Owner's Name
Address d Phone >? 11V'q6 S 876 L 7 45 yo y j
Architect's Name
Address & Phone
Mechanics Name " • MDj�
Address & Phone n Q Cnxjn h1G
What Is tat pqP it tnrrdl W
MatrI.I of buNdlg4 n.dwatwq,for now rrwry dmass4
Ws bulking caMam to Isw9 AMesbs7
eatrlrat.a 0" 2: ►W'Co CRY-, r awN • " C5am
c�a Lam. 136f Ob gj4 '
Signature of AppWW0t
emm UNDER TNE PW"LTY'
OF PERJURY
DE= OF WORK TO BE DONE
b
MAIL PERMIT TO:
No.� o
APPLICATION FOR
PERNT TO
A
LOCATION
PERMIT GRANTED
19
Ir (/ VfD
INSPECTORA OF BUILDINGS
rusuG 1`110FIXTY UNPANnUM
ISO VA MI"WeR a1""MT.io Sm FLOOR
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1116 Ana IMM"W .a"
MOM CVD�AFFMVU
la wft tba paabboa dMM 014 U4 I d w a a omMm
dsam ft pwmao .Adddara~am lea aoeatriodn "ft
lm=Wbit Sb M ftPwzk Ad be 81 a d!a a*or*sOmm"""No
d vmd bows r aa4oal by mm o lm So"
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F[ALY oaaoplala dtia llOowil� •
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Mc��k�n
ram.arra®it epp�ba.e .
Adkm%CW
nw atom am w:aqua abet&blia 4am tbs d®o :movado�nbab a odes
Sarno im otboa ft w Owma In dbpoad is a popoiyy-doomd ft"W"dfgoad
heft ar Maad by UM cA SIR&Rod ed bmi ft pan"a li000aw am d
iodfar s.loeado.d�a�.
• l..oanfnofuualfslflt o f I•I-/a`�achuuEfe
2eP.alwaal
n/ ��/
600 y W.1.16a Jf asf
Ja.IsslCaaesef Aeolm, .u." 021/1
Casnesowf '
I ' workers' Compensaan lnmrance Aftevic
1, N .
. . w1*4 pr6upal place of bo daeis ae:
do hareby'cesfy under v)n pains soil pos iUm of petlafp, thm
() I am an emplorir yrovidtni workers' compensation coveralls for my siaplopeas wotkbe m '
Insurance Compaagr Policy Nuaaber
1 aces a sole proprietor and have me one working fir an In MW eaoadq.
1 am a sole proprietor, general cormracsor or homeowner (dreh one) and halls hind dsa
contractors lined below who-haw the. fc4lowing workers' cosnpetssatleq peacho;
S i 606k �cv �rui
air insuranis Company/Po Numbw
Convocz r Insurance Comepamy/Po Number
Cosmraaer Insurance Comspaey/Polky gumbar
() 1 am a homeowner performing all the work myself.
•I,aeaauee ace,caq.f 06 aaawoes r.e►a forwareae 0.r Ofiee in brM*saara of are M he terarap.ervAnden am Ott Nfrao a aava
C~Mr n rroaree cow Sala SSA of FILL 15 I can kid r ow iaeenfoo of arbWnu oeaads cero.int al a 4e al w 04190 uWw am
rera•vasrueovorm a tin in ghe Fenn of a STOP WORK ORDER sues far of 5100.00a sot ap4t oe.
1A
Signed this • day of
r
:ictrscti'Fermiuee eaulding Department
Licensing Ecarc
Seiectmens Office
wealth Depar:mer!
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