34 UPHAM ST - BUILDING INSPECTION DATE: I/(?- 06�
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W , PLANS MUST BE FILED AND APPROVED BY THE
INSPECTOR PRIOR TO A PERMIT BEING GRANTED L
ratio ilding
Building Permit Application For:
'(Circle whichever applies) Roof, Reroof, Install Siding, nstruct Deck hed, Pool
Addition Alteration, Repair/Re ce, Fo bon Only, Wrecking
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:
Owners Name-.--&Y-D n l-Orizp, Contractor: Chr; stnnhar Znrzy_
Street3.l 142Qm ca City Street 11 5 North gtraat City_salam
State.MA Phone State MA Phone(97,g)_7 1-0424
Architect: City of Salem Lief{ 14 0 5
Street City State Lic#0 5 7 7 3 3 HIP# 101609
State Phone ( ) _ Homeowners Exempt Form Yes no
Structure: (please circle(Si�ulti Family# Other
Estimated Cost of job $_/3, a3�a
Will building confirm to law? es no
Asbestos?_yes vl� no
Description of work to be done:
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Ln.S+rz I l 2 x i � Oec,l(, on 3 Q' -Pico r-
Drawin miffed: yes . no Mail Permit to: 116 NOSE STREET
X
Signature of Applicatio ,SIGNED UNDER THE PENALTY OF PERJURY -
CONSTRUCTION TO BE COMPLETED WITHIN SIX(6) MONTHS OF PERMIT ISSUED DATE
Department use only: Permit# Zoning Map/Lot
Permit fee$
COMMENTS:
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