81E CITY OF SAEEM Fee Due$��°°
z Rec'd by: 16Z
x FIRE DEPARTMENT-FIRE PREVENTION BUREAU
3 ry 48 Lafayette St., cic.# Cash /n S(7
Salem, Massachusetts 01970 ^--> 19
508-745-7777 (fie)
APPLICATION FOR APPROVAL OF PLANS:
To: HEAD OF FIRE DEPARTMENT Form#81E. Sprinkler and/or
Standpipe System
In accordance with the provisions of the Massachusetts State Building Code and the Salem Fire Code, application is hereby
made for approval of plans for the installation of Fire Protection devices.
LOCATION:
OWNER OR OCCUPANT: Z.-C Tel. # 2 Y
INSTALLER: A' 5!2—':f -, a 'cense#
INSTALLER'S ADDRESS: ZZ'C -e 2 /r #
Plans are approved solely for identification of type and location of devices.
Installation subject to final inspection and filing of Certificate of Completion.
Date approved: Z
t
Date of expiration: Z s `� ;,jrnZplicant)
(Address)
i
Ci -t State zip n2e5l
Do not write below this line
-- — — -- _—_—.----- ——————
CITY OF SALEM Fee Due$25.00�J,�
t % Rec'd by:
FIRE DEPARTMENT-FIRE PREVENTION BUREAU
48 Lafayette St., Ck.# Cann / �
Salem, Massachusetts 01970 R 19? 7
508-745-7777 (Date)
APPLICATION FOR APPROVAL OF PLANS:
To: HEAD OF FIRE DEPARTMENT Form#81E. Sprinkler and/or
Standpipe System
In accordance with the provisions of the Massachusetts State Building Code and the Salem Fire Code, application is hereby
made for approval of plans for the installation of Fire Protection devices.
LOCATION: A/ �X � 5:1
OWNER OR OCCUPANT: Tel. # S'G�"'�
INSTALLER: -� /-4d 'cense# GIG& O
INSTALLER'S ADDRESS: -c -K/, 53'
#Plans are approved solely for identification of type and location of devices. K
Installation subject to final inspection and filing of Certificate of Completion.
Date approved: 9
nature of plicant)
Date of expiration:
(Address)
COPe C� _State dzlp n�!
Do not write below this line
--------------CITY -F ALEM --------—d--�_
O S
FIRE DEPARTMENT-FIRE PREVENTION BUREAU
48 Lafayette St.,
3 f Salem, Massachusetts 01970
1J �
508-745-7777
PERMIT TO INSTALL: Date
SDrinkler and/or Standpipe System
Owner's Name: —Lra�p
1 `
Installer's Name:
Permit is hereby granted based on approved plans,to install the system designated above. All plans are approved solely
for identification of type and location of fire protection devices. All plans are subject to approval of any other authority
having jurisdiction and issuance of a permit by said authority. Upon completion,the Installer shall request a test and file a
Certificate of Completion or Inspection.
Location: ?S
(Give location by street and no.,or describe in such manner as to provide adequate.identification of location)
NOTICE: CONTRACTOR TO REQUEST FINAL INSPECTION.
(Signature of official 966fing permit)
This Permit will expire 2 (rt
(TH6 PER IT MUST BE CONSPICUOUSLY POSTED UPON THE PREMISES.)
Form#81E-(8/81)