11 CLEVELAND ROAD - BUILDING JACKET 11 Cleveland Rd.' �
v
Plans must be filed and approved by the Inspector
prior to a permit being granted
CITY OF SALEM �y
No. 7,931 Ward
HISTORIC DISTRICT? Y gd Date (=�7 -j1
i
No.r- P �7 Ward
APPLICATION FOR
PERMIT TO ROOF
REROOF OR INSTALL SIDING
LOcado0 // l \�3
PERMIT GRANTED
19 gy
Building In ctor
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CITY OF SALEM
�C In accordance with the Massachusetts State Building Code, Section 108. 15, this
G'�M SaOy
CERTIFICATE OF INSPECTION
is issued to R. C.. P. 9. OF 1305TONI / ST,. ANNE" S SCI]O(:1L
Y TFlhfqST.. ANNE' 5 I 'RF;T iH
that I have inspected the premises known as
located at
h011. C1_Ei:VELFiND STREET in the city of Salem
County of Essex Commonwealth of Massachusetts. The means of egress are sufficient for the fol Io wi ng
number of persons:
BYSTORY
Story C
a ,tv ory Capacity Story C.t a tt r Capacity
BY PLACE OF ASSEMBLY OR STRUCTURE
Place of Assembly - Place of Assembly
or Structure Capacity Location or Structure Capacity Location
NON ShIOI;EFd' E3 F OCIM SQ 1 1.ST FLOOR
B:LN('iO HALL_ 450 ;.'.'ND F'I._OOR 3 NON SMI.-)K1:NG ROOMS 5 LOND FLOOR
r 'E,1.-1997 10/0 J. /J.997 J.0/01. /1998 � l�
Certificate Number Date Certificate Issued Date Certificate Expires uilding Official
`. The building official shall be notified within ( 10) days of any changes in the above information.
'3 COMMONWEALTH OF MASSACHUSETTS
as�sv CITY OF SALEM
APPLICATION FOR CERTIFICATE OF INSPECTION
Date /C) -/5 - Y 7 (x} Fee Required $ 75-
No
5-
No Fee Required
In accordance with the provisions of the Massachusetts State Building Code, Section
108. 15. I hereby apply for a Certificate of Inspection for the below-named premises
located at the following address: /
Street 6 Number C �e V f L/d,o d I tc-E
Name of Premises S7- /�NN F 's
Purpose for which Premises is used J5�9`js 1. L',; c ! ion/ 5
License(s) or Permit(s) required for the premises by other Governmental Agencies:
License or Permit Agenc
r
Certificate to be issued to: 5 c- X.v..l E 5 Gfi o o
Address: // c c-v /.enl
Owner of Record of Building:
Address: a/ a / Co .�,An.n,J fo,,.a/7Z 4 vR C,T„J
Name of Present Holder of Certificate:
Name of Agent, if any...
,
Signature of Perso, to whom Certificate TITLE
is issued or his/her authorized agent
Date
INSTRUCTIONS: Day time phone #
1. Make check payable to: The City of Salem
2. Return this application with your check to: Inspector of Buildings, City of Salm
Building Department One Salm Green Salm. MA. 01970.
PLEASE NOTE:
1. Application form vith required fee must be submitted for each building or structure
of part thereof to be certified.
2. Application S fee must be received before the certificate will be issued.
3. The building official shall be notified within ten (10) days of any change in the
above information.
CERTIFICATE #��-q 11 EXPIRATION DATE: �O I S 77
Li ✓r o ,A
a 'rl C�
PERIODIC INSPECTION REPORT
This form is to be completed each time a Periodic Inspection is made. At the time
a new Certificate of Inspection is issued, a notation indicating that the fee has
been paid will be made to Application Form prior to the new Certificate of Inspection
being issued. Any changes since the last inspection are to be added to the file card
of the premises. / /'
Street S Number / GC( 6 VF ( e s l
Name of Premises
Certificate to be issued to:
Address n
Owner of Record of Building /< C
Address arol 0,040e, Al 11
Purpose for which premises are used
Changes since last Inspection (required on file card also)
I. AJ� J F r�C.s n �4if
z.
3.
4.
5.
Date Order Issued:
Order Issued To: Address
Date Violations Corrected:
REMARKS:
I have this day inspected the above premises, and the same conforms to the pertinent
requirements of the Massachusetts State Building Code and the rules and regulations
pursuant thereto.
Date Building Offici
Certificate I Date Issued:
Date Expires:
Recommended Next
Inspection: