19 1-2 WASHINGTON ST - BUILDING INSPECTION IM--A YS-MOST-BE ffifG-AND APPR0VED BY T+IE
=P 7 R ,PWR Tp.A.PERMIT 9EWG GRANTED
CITY OF SALEM
No. y6 �` Date A
Is Property Located in ,, Location of
the Historic District? Yes. No_ Building I�
-v
Is Property Located in
the Conservation Area? Yes No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Si ing, Co struct Deck, Shed, Pool,
<jTe-p-_a-i0RepIace, Other: StDiw rQ,Lh Ij 1nT-
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 �l- f rUC,Vo,
Address & Phone fi ` �x i �• J F77,L )
Architect's Name
Address & Phone
Mechanics Name fv,.b ICJ t- al - l(,cCe,�
Address & Phone ( )
What is the purpose of building?
Material of building? - 6YD"-L-4S� If a dwelling, for how many families?
Will building confor�-mj to law? �J Asbestos?
Est(mated cost + �S City Liciemn�se# N P' State License a C5 U S-316g3
� / )�7;7t X L�
Sigrfature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO:
0 q/))
No.// -O
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
APPROV
INSPECTOR OF UILDINGS
Jk Px�xu4 � !
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9OARpQF{DIILD��1 R �ULATIONS -_ -.-
1 --- --
I Llc?nse- CONSTRUCTION SUPERVISOR
Numger t$, 063693 �
i 'Bi -.---�\ .-68 ..i
Tr.no 14 1
a; 1
DEVERLY, NIA 019 �
it ,`�"m / ) -
QU 3k QgQ de0cioled space
(MGL G 112 S.60L) j
1 1A Masonry or)ty F_.. .
yG 1'8 2 Family Homes -
Failure to possess a orient edition of the
Massachuseus state Building Code
Is cause for revowuon of this licens
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( DIG SAFE CALL CENTER: (888)344-7233
Board of Bu� i�d ng Rear gWajio and S
up
HOME IM , tandards
=PROVEMENT CONTRACTOR License or registration valid for individul use only
Registration 1.45375 before the expiration date. If found return to:
ExP(ra4!°^ 1%13/2007 Board of Building Regulations and Standards
I t ZYpe t V6te Co One Ashburton Place Rm]30]
ROGERPoration Boston,Ma.02108
R A.TREMBLEY CONTRA
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OCT-17-2005 NON 09:19 AN JENKINS INS FAX NO. 1 781 245 9563 P. 01/01
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L CERTIFICATE OF LIABILITY INSURANCE °"�°""°°^
1) 2II6-3421 THIS CER FR7ATE IS-ISSUED qg A R 10/17 2005
ins InlSurance ONLY ANO CONFERS NO RIGHTS UPON TOF INFORMATION
Salemec@t Agency, Sna. HOLDER TNT CERTIFICATE DOES NOT AMEND. EXTEND OR
9 LTER THE COVERAG AFFORDED BY OEND. BELOW.
INSURERSAFFOR NO COVERAGE NAICi
ROGER A TREM4%Y CONTRACTORS, nX Be NOHIO CASUALTY GROW
INSURERS:B JYSTY IEi3URANCB
10 COLONIAL ROAD STE. M4 In RCAI'G _
EAL-0 HA 01970-
COVERAGES IN URERE!
THE P«IgSS OF INSURANCE LISTED BELOW FLAVB BEEN ISSU:O TO THE INSURED NAMED ABOVE-FOR THH POLICY P6WG.71NpICATED.NOTWITHSTANDING RNY
THE NINE MNCE A FORR00 B nTTHHEON p POLICIES CONTRACT
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710Ns O 9uCI�.HY PERTAIN.
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CLAIMS MADE X OCCUR a S 50,000
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