90 ORNE ST - BUILDING INSPECTION �-APPS9a W T-BEf4L AfkPROVED BY T44E
1USPEX-1 R PFWR TD.A PERMIT 13FJNG GRANTED
\ CITY OF SALEM
NO2V Y V 3t. "�_ �\ Date G'
Is Property Located In / Location of
the Historic District? Yes_No_ Building
Is Property Located in
the Conservation Area? yes_No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, 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
Address & Phone 7K- 6 /f 3
Architect's Name / kligm to Lf/Z
Address & Phone
Mechanics Name w n,
Address & Phone �! C .'/1 � .
7 7 C
C/r .n P
What is the purpose of building? f e_4 r
Material of building? L4 /c)-y` N If a dwelling, for how many families?
Will building confgpn to law? " Asbestos?
r •
Estimated cost b City License # N A State License k
Home Improvement V --
I/►, �.
Ignatur of Applicant
SIGNE UNDER THE PE ALTY
OF PERJURY
DESCRIPTION OF WORK TO/ BE DONE1
n crr /r/it1l f-rZ 74;' P.,,v 7�u�C� �CJrJ�9�.s f
AIL PERMIT TO: 11
No.�j� �O
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
SAP eZ/ 2.W
AP P OVFD
rR
ECTOR OF 60ILDINGS
i
1
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BOM%MA 02111
TeL #617-7274900 at 406 Of 1-877-MASSAFB
Fa i 0 617-727-7749
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