69 TREMONT ST - BUILDING INSPECTION pL."Sli Wjr BEfNSD#ND APPROVED BY THE
JdSj=W PAIDR TDA.PEBWT A91NO GRANTED
CITY OF_SALEM
No./ /' b \ oa1°
is Property Locew in Location of
ON mi lode Dkidw Yea NO ftu inv ryg Tf�wcAti�
Is Pmpwty Locdad in
ft Conssrvsban Ana? Ym No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) I. Rer f, Install Siding, Construct Deckk, Shed, Pool,
lice. Other: 1 h-14�'P- 2F_ fw0y' "
PLEASE RLL OUT LEGIBLY air COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS.
The underag-ad hereby applies for a permit to build according to the following
specifications:
Owner's Name A �L
Address & Phone
Architect's Name
Address & Phone ( ( f t
Mechanics Name iJo,0iE� I t. jt `c0.,n
Address 6 Phone 1 SL4�r
W1Ml Is OM plapow 01 buiWkp?
m"W 01 buYdtttp? PjC08 n a dwal M.for now many tami�W Z
WW h6mv aim to law? S AsbmM? /t/U
E46rdm cost 0� 0) Cay ucarw r N A elate Lloanaa S`Of C8r 79
a60 Y na 7aPro....nc y
S' ure of,Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRWTION OF WORK TO BE DONE
73 2AL) S�Gy s
I45� Vl� CRY �Y14. a9r� — 1�< �)vo! 91c,
MAIL PERMIT TO-
No. 9 -D
APPLICATION FOR
PERW TO
LOCATION
PERMIT GRANTED
APPROVED
4"rOR OF BUILDINGS
J
• C
M Conunarwtaltb ojM4tsachWd9p
Depm�a=W ofh&j;ft dAo Mmft
6"WarJiteOM Skad
Boasoat,MA OLII
mutter uzzot✓dy.
Wor)teW Compenudon lumnce A®davth Baden4CoatnctOMMe4ddao Mza&bus
Nstme A r h
Address: 4. -,
(Sty'/Stato3pe f 9�008 - phan S3 2
An FOR an C1eeh thf ppaoprlato bast' -
1.❑ Irma .. ,. . .r: , Qlama T"WafP��edk
ea4>oya wsth Para oaa0aetar and I
eaglsyem(�and/or Parham$• baveUd d s w—adaMaonss f` ❑New eostetracdoa
2 I am s a sle puoprieacr a psrtaet6 and an the aomw sheet t 7. '-Ramodelina
sad bate as These
�P �bY'a~ have !1 ❑DemoHtba
waskii ,lwmsitaxWespeft wohgi'ooa¢itmatmca
(No wodkete'aamo,iasoasp . S. ❑We ate i aotpa I Q BYI ft adddou
ragahed}-� ofilobit iirye 10-0 Elea*d npdts or a&W=
3.0 I=ahomeawmr doing BeWak ritof4 11.0 Plenums rgdmCOraddidono
�Ph eodsni'coma a 132,�1( �►elisvens 12so&@L�
Roofnpab
im�ouegaw"t, m4byeei[I
. ,..� • 13
1 . .1
i ;Na�,rra�a.ea.lm.s.uomiat4e•ara.bast.waese.tw�►°°�..m.youoy�uo.c
Ifamwras wtM�Ai�vit iedlati�at�1(w ache 4�adt�d a.�►°�oo�ebonid�kwaait�snr�naioao���artdtl4Ybai'�mt�rLO�d�lortr3rtilow.ieareoeMri/�YwAoe oesPf�f�tloa
f alb tarplsrntllat trOnrflbur swrkra'eis�pssaadaa 1h►a4 I►ddna is all Pmft ard,&&sfAr
b�irmeruta
Insurance CoagmyNsmx
Fo ft 0 or Self-ins.Lin p Elykadon Dale
Job Sill Addrm Chyme
Attach a W of the workers►oompassdon Polley declaration pap Wowba the pailey uumher and esplt adoa date),
Fa7me b Sewall coves ss" s ngokW mda Secdoa MA of MOL a 152 east had In the lido,ofalaumd penaides of s
fine OP a s1,Jaaao and/or onarcff imprboRROM a well a del psanhia is rho form of s STOP WORK ORDER and s fine
off to S230.00 a day apassto the viohux Be abviaed shags oopy ofdhir statement maybe 9xwesded 10 the Ofike of
btvadgadoas of rho DIA for inmtaaca aovaap vaificadoa
/le kerb) salOsa t<!q sjprj"dot AN/afwnmkx prav*d tr arl csrrtcs
s96C17
Phone O 4 (40
QOfefd as m6t, Di eat wnQar Gs 1Adr airq b by rowpfsu/bl ells aighw aolrfal
CMy or Towns Pamwa vest p
Iasiag Authority(cirde oae)s
1.Board of health L Budldlna Deputmeat 3.Clty/I'own Clerk 1.
6.Other Eleetrkal Iatpedor i!lambing Inspector
Coetaet Persons Phone fs
Information and Instructions
anact0mor'coffa1�� d Mok"rn cis lfa-r eq�� eal"dofbdtq
MOW e ab atAte. '
CVM
ww a iopbA otat ac wry a as my two or mas
as-as mdiv"Pusa modstb4 qta dMISMA t VWM oris aegod
the
dgte �aafa:3 ;K o� � U y�fee
accjVw ac trsates atom maivi3�a�. mP as i*a Moci "a�iae"„d*M red"d�of the Occupant sub boons
ywaa ofs da cfthoasa W c pk"➢�to do aiskwusc4 ww"cdos ae'b bat�'
jwdftbooasotaoodw. metetsabapsotbaasee rerlemptt>yttteet
atom the pounds acban'ldmi apPstd� chap���bassra or
-ewa7 daate sr keel tleesdtg taf e�
MCL dwpw 152,P$a�abtoa �a Mideast ar a eesdrsd bd~in the two.
resewd et s Aceeee Pam aldesas of easpUasa TA&the Worse" sbsp
wMataat whs bas set Yre ; aw apt dill���e
ao"-Neda the coomaoswea� of comp
'c"boallo�60 rdbousce ofpobta Aaoo1ao .saf0v�lt�"desoe
�cmeoe of din�m Uwbeap
acmud APP by Ssbo=that app�r tsyttm dtaados 24 d
•compemados afpdsvh oomp.$p .rich d wk cadAede(s)of
rieare fku & aQ m�P G) �yp,).r;�so employes w thus dw
aeoaaaty, WAV aLiomedUalift—q+eas6ipe
l united Lisbf imsrttaoe bf m ILC ar, dna bsva
mambas as patinas,a°not rpW to cwq� ° d b>bs Deparuomt of _
should
®ployae.a PolkY ati m of Womes ccveraop. A�*o is alp ad date theafIIdavlt. �
apomaeigt"bg�ae4RIUMOM of
s
b 20 dW 0r yamsimd fhe lar a dyoo nee ragoaad a oboda s �
nap mat A the combat*"below- SclFmssed �atlas their
8txaaettssihara+*a mwwnnrfga the
C W or Tows tDt!ldabi The Depattwm ba pm cd a spun at the boa=
be rare dd the sodsvit it�W"aad Printed>ly tiom ban m contact you reprd�i me��
of amp
Naas Pkaae to®oat is the event the Office �. ID addido4 as aPP
of the affidavit for You ,amber whack wM be used s n red a* ut one affidavit uWlmft=rant
Please be cone 14$p ispawmaceass wpNc�in my given year, OOty s*all bc&dOne is WW at
dist n>oK submit (,foca cry)sod mda-)ob sba Ad.&cse"the app&m tdtoabl
wn innVaws
A at3fdsvitAethseMoof�lribtat�npeslot �°ds-•Aaaswciw aafUma Md��
tawny ��s valid afpdsvd is o.file fac lhmre Petmo nos rdatad.to my Wdnm or MMIIeiai va+mre
atipacodyew.where a banal owsa a adttat Y obetmioaa paro is NOT requited a wVbe this atildsvit
(i.s.s dog Haase a P�lo btas lava der)said petttm
would MW a tbant you is advance for your caopaatioa and should you have any q
The ofoce of lmrcatipmas as a tap.
pfwa do mtbaitsta
The Dcvzuaes ad&cM cicpboee asd fa samba
The Commonwealth of Massachusetts
Depmwcnt of Indobial Accideob
0410 ot lovesdpdow
600 Washington Sftd
Boston.MA 02111
TeL #617-727-4900 Cd 406 Of 1-g77-MASSAFE
Fax#617-727-7749
Revised 5-2"S www.mm.gov/dia
iF
'Y ✓AC L/Mhil/SOK[UCgCUt b�✓N,¢QIQ/,%dl�or{p t-^ --
iMA SACHUSETTS
BOARD OF BUILDING REGULATIONS ' T
License: CONSTRUCTION -- — --
UCTION SUPE
RVISOR S R xu
4
O NBER
{ DRIVER'S(' O LICENSE Ca
x ,'�'• Number.,CS 060676 is I 923624784 LLASS REST HEIGHT SEX
�" Birllidate 09/03/1967 �.' I 09-03-1967 DM 5-09 M
UNRES
Expires 09/03/2007 Tr. no: 4436.0 109-03-2009
HARRIGAN
1 "'^" RBst�(Ctedt 00 DANIEL fl c
DANIEL R HARRIGAN f .I; 16 WARREN STREET 4 e
�� 15 WARREN ST - _ G— PEABODY,MAC
PEABODY, MA 01960 �� 01960.43030 j
Commissioner SI
f ,
a
ETE I
osHa 000561181 (�+�� € �� �°� �r4
+#I �`I . . DEPARTMENT OF PUBLIC SAFETY I
�1 License: -HOISTING ENGINEER LICENSE 1 I
r U.S.Department of tabor :. .�1 .' i '
Lccupational Safety a no Health Administration Number: HE 111010 I i�
f Birthdate: 09/03/1967
Daniel Harrigan I �
`Expires. 09/03/2007 Tr.no: 4126.0
has successfully completed a 10h0ur Occupational Safety and Heats
Trainim Course in - Restricted:'1C t i�
Construction Sat &Health I DANIEL R HARRIGAN
15 WARREN ST
�'2/�_ PEABODY, MA 01960 Commissioner
(bate)
T
CITY OF SALUM9 MASSACHYSSTT!
P'JBL'e PROPERTY DEPARTMENT
"a %V"NINC7011 STOW, 7Ne paper
!AL[M. MAasA:NUSgM 01970
TtLt►NONti 679-74"69e "T. 300
FAti 674•74O9WE
Salem Buildlns •••• ..�
Debde D�•1 p,...r
In acccubme with the provisions of MGM c40 34codtion of P trm W your
auug from this wont shall be disposed
of in a p opedy licensed solid waste'disposd facility as defined by MGL
Chapter UL 3150 A.
The debris will be disposed of in:
(Location of Facility)
Signature of Applicant
Date
ti