3 FREDERICK STREET - BUILDING JACKET 3 Frederick St.
x.
. Plans must be filed and approved by the Inspector before a permit will be granted.
No. ` 67 V City Of Salem Ward
car..
Is Property Located in the
Historical District? Yes_ No d
R Home Phone
Is Property Located in a ,
Conservation Area? Yes_ No Jo'�ciw.x Bus.Phone#
APPLICATION
FOR
PERMIT TO CONSTRUCT POOL, DECKS AND SHEDS
Salem, Mass.,
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit>build accord'ng to th following specifications:
Owner's name and address ���L7/i✓ �✓�Z
Architect's name
Mechanic's name and address
Location of building, No.
What is the purpose of building?
Material of building? ;,Z ,e//A4a/1
If a dwelling,for how many families?
Will the building confor o the requirements of the law? �S ��
Estimated cost GO. 00 C ractors Lie. No. 6k!q AJe (L-
Si- of applican
1 r Si nder the Penalty of Perjury
.L. CP x- X / IX �EMARonS 'sty
No. 7 Ward
APPLICATION FOR
PERMIT TO CONSTRUCT
SWIMMING POOL
Location 3 Freer- 1'64 ,5 -
PERMITGRANTED r �/
Jv19 7�/
Approved
Building Ins p for
-�o
.�_
o-- -o_76- 7=3�--
0003 FREDERICK STREET 482-06
GIS#: 18724 COMMONWEALTH OF MASSACHUSETTS
Map = 10_ t
Block .,� CIT �Q�F SALEM
Lot: 10154 A 1/ 0 "
Category. •,�' IREPAIR/REPLACE��`� Ae �F�
Permtt:# �48M6 , BUILDING PERMIT
Project# ;fJS 2006 0980
Est Cost 1$14,000_00 '
Fee Charged ` I$ 98 00 `r
,Balance Due '$.00 PERMISSION IS HERESY GRAN' ED TO:,
Const Class: Contractor., License:
Use Group
HOME DEPOT Home Improvement Contractor- 126893
�LotSrze(sq ft) 12075
rZor mg .» • ; w OJyner MONTANEZ EFRAIN
I�� Anp)i^na t rr::AFF )EPOT
Pnrts Lost AT. 0003 FREDERICK STREET '
Dig Safe# __J
ISSUED ON: 01-Dec-2005 AMENDED ON. EXPIRES ON.- 01-Jun-2006
TO PERFORM THE FOLLOWING WORK. ,
482-06 INSTALL VINYI.SIDING TO PORTION OF HOUSE TJS
P+DS'1"f'I-IIS CA:yR.D SC?IT Ic'Vit, 'nF�r1TI+;O1Vi TIiE`STREET- "•
Ele_ctr4c Gas I iutr 1, ngBuilding
Underground: -. Lndcrgtcund:
Service: Meter. Footings:
Roush. ,' ;?l:"6 Rough: SLC.S06?oomi Rouglti'="(t2 - j(1,1Foundation:
t cr t'zt /. yz 1:5 rqn y rams
Final , - -... , ». Final: Bou hFramc:
�.—.�Fireplace/Chitmtey:�
D.P.W. — Fire-, �— Health
_ •Insulation:
Meter: `=3' Oil.,.
Final:
House# Smoke:
Treasury:
Nater: IAtarm:
ISewer. Sprinklers:
THIS PERMIT MAY BE REVOKED BY THE CITY OF SALFM UPVI LA'I'IONt F AI Y ITS
RULES AND REGULATIONS. tnti�
Signattu"e: --'�
Fee Type: lA' . ReceiptNm', Date':^ad: 'Check No Amount:
„- t.;:Bl1lLDINO _ S$t'nY�x; t.CC-200(i001U4' t1+ 111)ec.05 F I0388,c,r€.a' tir - 199.00- - - -- ' P
S-,r�t
1 - y
Upon C(Pr°0 "'tt„i'y Ga ttit r : ±!c'-3c•'Call
7
fw
. 385
"LL i
1„t'u',a.'e..T �p,� {"z,•T!"l r.eF :� ` ^,� ;2�(+'7 � &3?,:'+ rw`^i.i�{-,.i , ;:.i..��
GeoTMS®265-Des Lauriers Mumci aI Solutions,Inc.tl p
rscYE AD
CITY OF SALEM
BUILDING PERMIT
APPLICANT COPY
! Hze THIS PERMIT NOT VALIDUNLESS
CITY OF SALEM BUILDING fn PROPERLY RECEIPTED BY CASHIER
A SALEM, MASSACHUSETTS 01970 PERMIT
04 VALIDATION
E�
APPLICANT
.a. DATE_August 15 PERMIT NO. 3'rn-_ '_PFIi I MPniC1 ADDRESS
(M0. pE T IC01.T R•S LIf.E MSFT
PERMIT TO _ (�.AE1Rt}q](•} ESTIR PRD11 l7 1 STORY nyal 15 NUMBER OF
lirvf OF IMPp OVEMENiI NO. IPRBPOSEO USE[ DWELLING UNITS
AT (LOCATION) 3 Frederic 3t. Ward (r ZONING
(NO.) [STREET) DISTRICT Mi
BETWEEN Witchcraft Halahts Scho01 AND Relleviem AVe
ICp OSa STpE ETI
ICRO55 STREET[ -
sueorvlsmN .P1EerDOnt Park LOT 154 BLOCK SIZE T?�0993
BUILDING IS TO BE FT, WIDE BV FT, LONG BY FT, IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP ,BASEMENT WALLS OR FOUNDATION
nv� F�w..a ,a.� ITYPEI
REMARKS: COnstruct new One family dwelling
..
------------
Call for Permit to Occupy
AREA OR
VOLUME ESTIMATED COST 5 400000 PERMIT
:CUBIC/SOUARE FEET) FEE S
OWNER
ADDRESS "�J "'-'w13.� ��. Peabody, ,4as9. �nvP Nar>•.a .
T OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. -
MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE
INSPECTIONS REQUIRED FOR
ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FORELECTRICAL, PLUMBING AND
1. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS.
3. PRIOR TO COVERING STRUCTURAL QU1RED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL
MINAL INSPECTION
TI TO LATHE FINAL INSPECTION HAS BEEN MADE.
]. FINAL INSPECTION BEFORE
OCCUPANCY.
POST THIS CARD SO IT IS VISIBLE FROM STREET
BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS
I I I
BOARD OF HEALTH GAS INSPECTION APPROVALS FIRE DEPT, INSPECTING APPROVALS
I
OTHER CITU ENGINEER 2
WORK 0 K SHALLNOT o PROCEED UNTIL THE PERMIT WILL BECOME HULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ONJT HIS CARD
INSPECTOR HAS APPROVED THE VARIOUS WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE CAN BE ARRANGED FOR BY TELEPHONE
STAGES OF CONSTRUCTION. PERMIT 15 ISSUED AS NOTED ABOVE. OR WRITTEN NOTIF I CATION.,,
N
IEA; : pw mis No......�� .... ........... ....
V CITY OF SALEM . . F1:1 1 =
.,, . .. .�F , _..,..::, otti..............................
LO ELECT110 L �t45-630?IT tion
a Wiring Inspector.. ,^ the lsuil
r- 745-6300/745-6301
ro permit No a3a!...
Date.../0.-�?.,3-'9 J......-
you are hereby rwsified thatd�
m .. ..... electrical instalb
ranted to�lo/7tl�S..:., ... ......
Permit is hereby g C -
//// ...... ' ..... .Street at............ ........................... ..
to ' stall Electrical work at.T • -
Occupied by..............
awned .e h�1,.C....t??.... -tion m
accua
ect to the laws of the Cam-noAwealth,Ordinances will be rtadp
is permit is granted su City Electrical Department•
City of Salem
and regulations of
U L
Z 11111011.. .......... ......
» p ,� { datt of �p[�!'.h Oir.r t(t,s,cAarl
Fee paid .....d.�.... ...'� ..... . �
> e or permit becomes void. will no be 1111106 yntd
Work must begin within ton days this T1014e is toosived and it ttant Ps
J cMlxmed at law 24 Itovs beton
W ayoction 1s dewed.
c
-J Issued by
a ... ............. ........................
of %tan,'\ ftasar4usje sCASH CHECK N
q FIRE DEPARTMENT•FIRE PREVENTION DIVISION
�J"399-
u v�rT 48 Lafayette Street Fee Paid
�cryfNgtl Salem, Massachusetts
(608) 746.7777 Aug. 19, 1994
CERTIFICATE OF COMPLIANCE )Dat)
In accordance with the provisions of Chapter 148, G.L. as provided in Section 26E and/or 26F smoke detectors have been approved
within residential occupancies as applicable.
Owner: Madeline Pyburn
(Fdl Deme of person,firm or corporation granted permit)
Smoke detectors have been installed and are approved for type and location as per current codes
as of this date.
SMOKE DETECTORS REQUIRE ANNUAL MAINTENANCE AND CLEANING
Y40ne Family Dwelling
Type of Occupancy: 0 Two Family Dwelling
❑Condominium Unit N
at 3 Frederick Street
(Give location by etreet end number,or describe in ouch a roamer ee to protide adequate identification of location)
110
NOTICE: Certificate is NOT VALID, for sale or transfer _y � -A.A.4014M.
00,
�-
of real estate, 60 days after date of issue (� (s+g �netore �ermu) e�
�•� mne)
Form 081A(Her.8/84)
MAP 10 THE COMMONWEALTH OF MASSACHUSETTS DATE: 08/25/94
LOT 0154 CITY OF SALEM
SUFF
CERTIFICATE OF MUNICIPAL LIENS
REQUESTOR: TINTI, QUINN 8 MERRY
IT IS HEREBY CERTIFIED FROM AVAILABLE INFORMATION THAT HEREINAFTER
:STED ARE ALL TAXES AND ASSESSMENTS WHICH ON THE ABOVE DATE CONSTITUTE LIENS
J THE PARCEL OF REAL ESTATE SPECIFIED IN YOUR APPLICATION DATED : 08/25/94
SCRIPTION : ABOUT 0012075 SQUARE FEET OF LAND.
THE AMOUNTS NOW PAYABLE ON ACCOUNT OF SUCH REAL ESTATE: SO FAR AS
]EY ARE FIXED AND ASCERTAINED ARE ITEMIZED BELOW. ANY AMOUNT NOT
3CERTAINABLE IS SO STATED.
)CATION OF PROPERTY : 0003 FREDERICK STREET
)ME OF PERSON ASSESSED: PYBURN MADELINE T
-----------------------------------------------------------------------------
JNICIPAL LIENS YEAR: 1995 YEAR: 1994 YEAR: 1993
----------------------------------------------------------------------------------
aX PRELIMINARY 831. 10 FULL 1662. 21 FULL 1565. 10
3T HALF/QTR DUE 415. 55 391. 28 178. 36
JD HALF/QTR DUE 415. 55 391. 27 178. 36
tD QTR DUE . 00 439. 83 604. 19
-H QTR DUE . 00 439. 83 604. 19
:WER LIEN DUE . 00 . 00 . 00
)TER LIEN DUE . 00 . 00 . 00
-AL ESTATE IST PAID . 00 PAID 391. 28 PAID 178. 36
-AL ESTATE 2ND PAID 391. 27 PAID 178. 36
:AL ESTATE 3RD PAID . 00 PAID 604. 19
-AL ESTATE 4TH PAID . 00 PAID 604. 19
iAT/EXEM . 00 . 00 . 00
:WER LIENS . 00 . 00 . 00
)TER LIENS . 00 . 00 . 00
)JUSTMENTS . 00 . 00 . 00
[FUNDS . 00 . 00 . 00
:T 831. 10 879. 66 . 00
ITEREST 3. 82 54. 14
:MANDS 5. 00
iTAL AMOUNT PAID . 00 782. 55 1565. 1.0
ITEREST RATE PER DIEM . 16 . 34 . 00
iLANCE DUE 834. 92 938. 80 . 00
-----------------------------------------------------------------------------
(PAID SEWER USE CHARGES: . 00 INTEREST: . 00 INT PERDIEM . 000
!PAID WATER USE CHARGES: . 00 INTEREST: . 00 INPERDIEM . 000
I HAVE NO KNOWLEDGE OF ANY OTHER LIENS OUTSTANDING.
COLLEC --Gl/Fz -- -----------
COLLECTOR 0= TAXES r=- THE crry- cr- SAL-.EM
DEL REALTY. INC. . 5067745655 P. 03
:. ;,c i f: TOWER`~ ENGINEERING CORP.
-..... -• -' a FAIRYIfiW AVENUE
$WAMP,scQTT,m^SS.01907
,.,,,..,•' :,•.••,`• T01. 592.9700
f
Cartifiacl. Plot Plan of Land
aznr Mn
ul Lc.r 20— �4 N vernber T5,1 1Q91
u
1
GS^
I'
='T' u 'Phis certification
applies to building
' set back requirement.
only.
L, u,.: I. u1 Iful l<l1.ng Insp.
_•., ,�t ln,Cu �::1n::CCuCCI.On
�„ 1,, . ilil; II:•' I II:IVt uaIIIIIICti
w tat ri shuwn.
l , d,..l la: Luildingi $hoan
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.,11 -1 :LII;, 1;.J MP4 s1111OUN y JOuFy
IUCaI,II IR the ( MATER
crk( ICL.i. 4741
CATV OF SALEMBOARD OF.,I—YNSORS WORK&VALUATION SHEET
PROPERTY L.D- DEED AI MISC. PROPERTY ADDRESS RECORD-OWNER AS OF JAN I -PRIOR OWNER U1ND DATA TYPE. AREA
1D ADD" 6713 ar >AM. OD03 FREDERICK STREET rIsUNME S to Si• 2075.00
LIrt
01Sk 'tot 11501 QM`" PTBURN MADELINE T ,a— 0012075 m —:.w,
f_,r�
sup. 1966 «tI"Me T> 1"a"Nte110.00 W —ml
:DDDc aw. 101_«Ila 5 CONGRESS ST .Ia�+"" OSD m< _."I
.ReW 011 mA s'."o. 3230 alzl'im' DANXER5 NA 01925 w m"t Ri o arl
d Yalre.7•. 4/1 n. OAU 1 ay taA>,o"..ITT ELL IOTT E sai ruinmRe mr a,I
COST DATAOTHER APPRAISAL DATA 61462
Orf, 1992 ra ATTIC: I BUILT-INS: I PORCHES ICa1y: ,57RUC:URE: BEDROOM DATA: I PROPERTY DATA: IY IxAAY..
Y+ADa.
LW. 1990 rs pAEN- sI"DaD rM IAs fmDe .W NIo. 1 falamNr. fif(wtmorse m Is 5
^L I WMS Y
ORRDE 3 mI�t RN. m\ID01r.PDR HF MTai \n MD"\ fTlpir FL 3 Tr V 140,,7 m NEIIAMD
IYoa Dy'u. _w: me mx \a ouwH \ar DUA'.e>A. �i oiflYw TrI CosrItA UEF rs� SB389
f Tt! T ry mD—ny 1"Fa1DM xf YCODE In kY«+ _Emlo"'"Ofi' x[r RTm Ke ib ISvuwR<LS C06T
IDOACUD. S m•I BASEMENT: Imc srY IfeMEA th tRSNYl �i,IYR�. TI OMER WD. al 'M6E vuuE 73178
Ls mi.�u •x•.tF . \al mwun _\miwF.aEY. _:,;TOPOGRAPHY: APPRAISERS COMMENTS: AiAc
N �mp""m mi N"t;D• �"tl uNw \ii •ECCE —\ml W-Mu —mrm_SLMER Eft EDGE
N ; Lc enlu. Rr AAEA •A, `oMm m>Smona
OBSOLESCENCE: 1-in SCHOOL
D0..ms
•FY. hl ;m;IJNR WIMOIJMR nt DUY rif 1111E _M21FEF fL
FlREFLKES ;
N ' , I.Y1
O ;ttoN. 5 Hi FIREPLACES: PLUMBING: scaDE _Iir ... FL f,l{Au.n, mi as ROOF M
P. j PRIMARY STRUCTURE IIIDUM01 iml.m In Ma _\n um'.Fl _en;csm;mR as aFI FUEE
N ;COIN'. 1 ,e WWI ,\;f Wf 1 1T OYYIiv \T o;ll FL all,DDFWmMRr xx al e.oOEf
mM 100- M Orf"ns _owlsm In "ea•+.e 2036
h EA«A YDu svNE rol°f't"D \m MoOnDR In suvi»s
�to»s*• _ry Ls AM;m me In MISC.IMPROVEMENTS: 1 wra'D
iDD»nr .Y rD;DamR Da;YOItlHIN Hi lcmt Ix AAA AAAAAAAAAAAAAAA AAA AAAAAAAAAAAAAAAAAAAAA I Z Z ZZ ZZ �ro.C.Ee, 439
ADDITIONS: ' ROOF: YouriAulN lar uN;R .Est A Z Z
�aumrU 75653
IY.rtA m Fa" 5_arlu' rn RAR �mI A Z Z OEWemanDN
;ro"sr.z aE Au1Lx _a> ;Amok" lv o"I'm _IT A ZZZZZIZ IFu"°ac mmioss.3783
Isw..It aA ^� 4_arI GARAGES: %DPW ;R A A Rcuro.lorw 71870
S.At as LS r,I\'DEME \,(tCom In A A IY;Y.IYR.UTLL
• •fesov..! Ea FUEL: ' IMG \u�IiRR _\T A A IRCNDi MFPDV 71E70
U Sn.s en 11.E-0 3 a RAR RAR In A A iw.o vAL
IDE 58389
_
An mea 0MM IU coat Ia A A MISC.ooSr
r A 71900
CCINr.• aml Li. Im YEEIR. W YD6M. 1M A
HEATING-MC: I>CODe \« r.00Dt Ir A A I;csa 1 .015
F RL♦ ��r\ ."rCOOE 9_-;M mu HS ONIR \a A A YMil2IDwD 58400
J Dunt at CPLAc 'aI an RAR Irl A A iIMFFr;RM 73000
WsR.i w tow CODE _ n``Iawe .« WADE Ht A A rorN.cos+Awe 1314DO
�sr.i ea sow wrz —\aIYDNA. •.r %DEM. me AAAAAAAAAAAAAAAAAAAAAAAAllZZAAAAAAAAAAAAAAA IFam'.. D 58400
132 Dr(Ls \slaeeaE nA .eoDE ntI L 2 IME..rRMw.74BDD
/ODS a\{ro�uroA noeMFw ., u"^t _a\I I222 IDArzsYe
•DORMERS: ANNUAL DATA: 'Ant RASE ,Ai ;SUE Moe
Q
;mm,. nEI VNDE N;N6. O lO I m;mE H.I DMDe Im S«F 1vFE I
�aFR'. m\jOmsRFA O nil<DrFR. \MIs9ElR —\r. BUILDING DIMENSIONS: SCALE: X'1:1D 1-1:10 !con.AL 1314DD
I.O.me „fi YRRG ReA D_1m— Iml� QHS O 42X24X42X24 IYR.YAL
�<rNE ar>ADDRa"I2 O I'll,Nrb1W Is, urrumR roc D 6XSX6X5 co"R Vol
I"o.w ern DATA STATUS: !PORCHES: El 4X3X4X3 Ir;»U+Awe 131400
4SOMR �MIA \Isis 1 \ri wrr w" \a IoA+E T1/17/93
rs _,SID \l,MEA 30 \n I•D.PC ure 1
m"m. DTIc Im a"A"lV S Ht NEW OWNER:
BUILDING PERMIT DATA: 2 3 nYreR
�NR 061591 xM YF N> »wE
AMMrA 379 m Am no
iL vn. 40DQD xN TI no ADD.
IwARm 8 f« fa no PROPERTY DESCRIPTION-
,caYHL1:01) fa xU fb P6 L R
�Pv.M.�62392 Mt :« mz029 SV 8 FREDERICK ST1131
'AEYInm fA> A.. to �4
W100 i/N E 12 8.5'/SE 1 D 1.2'
y✓1Y _Ntr. CERTIFICATE ISSUED
qq ! DATE September 13, 1994
CITY OF 9 ` i SALEM, MASSA HUSETTS 01970 BUILDING. PERMIT -
CERTIFICATE OF OCCUPANCY
GATE Awust 15 IB >� PERMIT NO: ;7g_01
APPLICANT_ni + l`) SIPYH l`•1 ADDRESS_ Jn ;Tnwl PO .S.
1X0.1 I RECTI ICONTX'S LICCNSEI
PERMIT TO _ Wnntrucn D•1 �:dM inI ) STORY n¢1C11 i ng NUMBER OF
IT•PE OF IUPROVEME.I. LL DWELLING UNITS
XO• IPPOPOSED VSE)
AT (LOCATIONI "�3r2B61er1c'St`:= Ward 4 ZONING
I x0.1 (SIPEETI DISTRICT r1
BETWEEN Tittchcraft Heights School AND Beiieview Ave.
ICR055 STREET) (CROSS STREET)
SUiiDIVIS 10N 2lerpont :ark LOT 174 BLOCK LOT �'T•07=
BUILDING IS 70 BE FT. WIDE P• FT. LONG BV FT. IN HEIGHT AND SHALL•CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE:
REMARKS: Ln-t-UCS: new One fanj.ly dweijjnt
AREA OR1
Kul
'I.•gy�c�7f{1 -�
VOLUMESII AYYDE
C RIC SOUARE FEETI a�i�W}IIII
OWNER 'h1'1n .%lnnjL drElv�Ive'n ern vrrlvoloe'nbvlbeilvellvern va-,n ve�lvan vr-nv�Elo
G TO BE POSTED ON PREMISES
ADDRESS J "CiI'� � '='E'`�nYo :')3S9• SEB�ItE�'ERSE-SIOE fAOq CONDITIONS OF CERTIFICATE
r
DEPARTMENTAL APPROVAL FOR CERTIFICATE
of OCCUPANCY and COMPLIANCE
To be filled in by each division indicated hereon
upon completion of its final inspection.
BUILDINGS Permit No. 379-91
Approved by Leo E. Tremblay Date 9/13/94
Remarks
PLUMBING Permit No.
Approved by Dennis Ross Date 9/6/94
Remarks
ELECTRICAL Permit No.
Approved by Al Falowski Date 9/6/94
Remarks
OTHER Permit No.
Approved by_ Date
Remarks
OTHER Permit No.
Approved by Date
Remarks
1
cny-OFF
PUBLIC PROPERTY
DEPARTMENT
MAYOR 121 WASUMMrN SrU-FT•RUALK A%nACHLSLI-M 01970
'/
U,wj—O/ 11ei 978-73S-9S9S*PAM 978-740.96"
APPLICATION FOR THE REPAIR, RENOVATION, CONSTRUCTION.
DEMOLITION OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDING
_ 1.0 SITE INFORMATION
Location Name: G7NK p y Building:
Property Address:
3 �� edeazlck sf sa /n � •
Property is located in a; Conservation Area YIN Historic District Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land N/c p I TO/vC Z
Name: / a.L� Cr✓�U��
Address: 3 e cI a2-;cL S/—
S a� '7
Telephone: 3 Q
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use New
Demolition Existing
Approximate year of Area per floor (sf) Renovated
construction or renovation
of existing building New
Brief Description of Proposed Work:
Mail Permit to: &A.-P 0 avn C,/ i
What is the current use of the Building?
Material of Building? 11L)CX) If dwelling, how many units? S/NS fit.
Will the Building Conform to Law? _ iT t Asbestos? -G
Architect's Name /7'�Oz /2 5_ c
AddressandPhone E` 12701 S7 T��NSr�w� (dip 72'
Mechanic's Name
Address and Phone Sr 5 M u i v SST w .LSP
Construction Supervisors License# C 5 �c) 9/ y HIC Registration# 1•S_)
Estimated Cost of Project$ 3 o 9 J Per ft Fee Calculation
Permit Fee$ Estimated Cost X$7/$1000 Residential
.2 Estimated Cost X$11/$1000 Commercial
r An Additional $5.00 is added as an
/ Administrative charge.
Make sure that all fields are properly and legibly written to avoid delays in processing.
The undersigned does hereby apply for a Building Permit to build to the above stated
specifications. Signed under penalty of perjury X
Date
0
N
V y
V
O �
F o V� V `o
lftffif-OE fiLEG-ANG APPROVED BY T*IE
LN3PFGJ'PA PFxill]R 1p'A.PERMIT.I3,EWG GRANTED
CITY OF SALEM
Date 0
s
Is Property Located in Location of
the Historic District? Yes_No / Building
Is Property Located in
the Conservation Area? Yes_No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) rRoofReroof, Install Siding, onstruct Deck, hed, Pool,
�ftpair/Replace, 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:
Owner's Name
Address & Phone �7, �'�<�s'i� r �T Iti�) 793 psi
Architect's Name
Address & Phone ( 1
Mechanics Name
Address & Phone S 1
What is the purpose of building?
Material of building? /.c�UrJD If a dwelling, for how many families?
Will building conform to law? 749 r, Asbestos?
Estimated cost- 3oa City License# N A. State License #
Rome Improvement
Lic. iR — 1. ignatur cant
SIGNED UNDER E P ALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
� l i
`vet—
_ / f
4/li/ZC lc e
c
MAIL PERMIT TO:
j
i
I
No.
APPLICATION FOR
PERMIT To
LOCATION. ( `
PERMIT GRANTED
2.0
APP
INSPECTOR O BUILDINGS
f
Q
H
�E'UIP�Al7t r
Hit
yn�
W
.pLjWS*"t-oEf o APPROVED BY T*E
JdSPJ:Gm PWR TDA.PEAL IT AEING GRANTED
CITY OF SALEM i
Date
Is Prop"Localad In iowtim of
ft NWa 'r WOW Yu No� Ira""m
Is Prapwy Looam In
: rr Gwmmon Asa? Y«_No
WRUNG POW APPLICATION FOR:
Perms to:
(Circle whichever apply) Roof,,R`wo SWW4 Construct Deok. Shed, Pool.
Fl INReplaoe.
PLEASE FBI.OUT LEGIBLY i COMPLETELY TO AVOID DELAYS W PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undorsiprwd hereby appim for a permit to buUd accordhg to the following
Owners Name r2A�V
Address & Phone ?� j rzEaF�(CL S- 19�85 6f
Architects Name
Address & Phone L )
Mechanics Name . �o ,
Address & Phone u—�)c2Ccf7S 9Fle
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Signature of Applicant
SW= UNDER THE PENALTY
OF PEAdURY
DESCRIPTION OF WORK TO BE DONE
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MAIL PERMIT TO. L/ C 6 A,li f&/
No.
APPLICATION FOR
PERT TO
LOCATION
3 Aa-e,
PERMIT GRANTED
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INSPECTOR OF'BUILDINGS
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JMSPFC =PNOR TD A PEBMIT BEING GRANTkD
CITY OF_SALEM
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Location of
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Permit to: BUILDING PERMIT APPLICATION FOR:
(Circle whichever apply) Roof, Retool. Install Siding, Construct Deck, Shed, Pool,
RepaidReplace, Other:
PLEASE FILL OUT LEGIBLY i COMPLETELY TO AVOID DELAYS IN PROCE89M
TO THE INSPECTOR OF BUILDINGS: '
The umliniyned hereby applies for a permit to build aocor&V.to the,followirtp
spect"cations:
Owner's Name
Address 6 Phone
Architect's Name
Address A Phone ( )
Mechanics Name
Address A Phone ( 1
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OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO:
44
No. -NN7NAPPLICATION FOR
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PERIWTO
r
' LOCATION
1 V .
PERMR GRANTED
APPROV,
INSPECTOR OF BUILDINGS