6 HARTFORD STREET - BUILDING INSPECTION r
6 Hartford St.
I
6i 1) Jgx
Plans must be filed and approved by the Inspector
prior to a permit being granted
CITY OF SALEM
.10. A� Ward
HISTORIC DISTRICT? Y N ,6 Date
� q
IF FOR SIDING, HAS ELECTRIC ° Home Phone
PERMIT BEEN OBTAINED? Y N sBus. Phone
APPLICATION
FOR
PERMIT TO SoEC'-, VC-- a 'Co0 1!�- V7+
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the
following specifications:
Owner's name and address r
Architect's name �r
Builder's name
Gso--rTk (Z'
Location of building, No. �—
What is the purpose of building?
If dwelling, # of units? ot-11 2 Materialofbldng? W O 0
Will building conform to law? �S Asbestos? 1c)
Estimated Cost d City Lic.# State Lic.# d
`—` # o`t5
o e mpr ment ice e �, l03
Signature of Applic;:01
NED UN TH PENALTY OF PERJURY
DESCRIPTION OF WORK TO BE DONE
bI a c u a �"� 7�1-
Mail Permit to: � r �,
No. �l-9 ward
APPLICATION FOR
PERMIT TO ROOF
REROOF OR INSTALL SIDING
Location
PERMIT GRANTED
19Q
Approved
lora-t 11 np Insp ctor-
one M '^�ne " SClf� �$, '>^z 5147 P Vi
MASSACHUSETTS
OF1?dDUSTI'>l :CC_.IL1E"*7T5
X00FINGT;)N STREET
t3SiC d, ."usSAC II+1SETTS 02111
WOR`iErUS' C-0\iM-dSAsITONI LeSLT:A;NrC_l UF'II)AVIT
ta<racrr ncrmiaet,
lv"A a .i:]IF:1C«i 62" 4i
:lo hcrtuv c:.^.i-v. under th9.' pami til-'. ,es of ptaurY. rhat;
AM an ..M.Not'cr pfoyJam ly' t:l )rKGrS curnocnsailon coverag-C for rn[V emoioyccs working on thii
(JV{t���(}�{,�'{✓�l,rft.'GYfifiL�IF�i.S"LC.-.+/..�,-�' } ':3( �l /�`-f 1..�" j ��t/a'!�-,.�„�,
lrtsuril. Uomoanv YPoiicy Nurnoct
3m n soie U",UnctGL �.tid hll s�- L:nc "R'Oricln for mr, r
! ams I.`. vroprlctor�p,ct E^Yj cc rr acoor homeowner (Gude one' and havt r1Ued :hc C.^vriCf3StofS I{SLed ISCioW
who hive (he foi{n+ tng wcrzzEYr rc rt±?ss X)�ta ani[ nnec voiiei=:
i
zrn^ ci r'^arra zor / :nituanec C.ornpanyir-ol'i&.. Number
AMC er —,tor insuratne: omoanvil'olux itiumoer
ICat fwGnL:aC'LCr u lira;.GL '�.Urapinvl p0lic1' Numoct
Am a i:Qrn€3,,YnC[[ 'r'ei::�tSP 2i'V astht. 'work rrivxeff.
A*OT rit"t :o 2wz#C t:-m „''-=.:s ;Z-.�,:,to t*s w�^ tmoiav f+ermnx to da mt[nieasaee,caastruettoo at reptn w lld oo t
cwe<i:na a.'nea mm, tnt lire- utrt•=a a❑ W;t,= the isemeo., tiw rrsldC or as "C Imunpl sppuritaaat mcresa -M oat gnatralty
_ons.etrca to tK cmviavers" gz LAC ' Act 0:1- C- 152,.:&"x if°)), zppttcxuea by. catero'.+atf for s i,etwe
or Frtm,t may rwci,zcc:a v itzt,{ g%afut at:.s , .;p7a)ct s:n2tt mt, Warktts' Compeaxnuoa Act,
,:::Se,^, r (!'1:P c:ny.4'O! tFi;f !rf ti'-. ,tfl; N S '3'i-'.'.=_:Ywt��yC 2,'+. :,P.c i.S o.^.J�^.tet?:Or aP.tl USiPi2+ft[®tlenti i�lT tt at lt7a ul?11tt fOr(L t'Cr'ltt
;^.z IL1kfC to aCtU:[ ccv✓ ' ze 15A t f Incl. .X., Cat1 ICla to v"C Im V01ta:4n of ertmin, p mafvm
;an. Lne G! S Sync OF uo to it 50u,PD art::14t trnpiaonmtent o, 4G tG one vtaa vw C]W 9tnuuv u"1 inc corm qt 3 Stop *Work Ceder Ina s
.1 100.00 ? u?Y atzr, t mc.
t/
;vpc
is day of 2�
.1
:. -ce LitcnsoriPermissor