18 PICKMAN ROAD - BUILDING INSPECTION 18 Pickman Rd.
Plans must be filed and approved by the Inspector
prior to a permit being granted
CITY OF SALEM
No. , / (� / Ward -.
HISTORIC DISTRICT? Y N Date
IF FOR SIDING, HAS ELECTRIC 9 Home Phone
PERMIT BEEN OBTAINED? Y N Bus. Phone f7
Lor. pr
APPLICATION
FOR
PERMIT TO , i
U
/N 1/D f' w cz (777 _
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the
following specifications:
Owner's name and address /001
Architect's name
Builder's name < < c
Location of building, No.
Rd
What is the purpose of building?
If dwelling, # of units? `, Material of bldng?
Wo
Will building conform to law? S Asbestos? �,�
V -:
Ir
Estimated cost City Lic.OState Lia#s
Signature of Applican �����
SIGNED UNDER THE PENALTY OF PERJURY
DESCRIPTION OF WORE TO BE DONE
� O3C113 �
H- 5 Al IJN L r-s
d az 2- L4
(1-3 � Th �a� rQ
Mail Permit to:
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3 •r `�y�, � 1 �,�t t I 4
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wgkra
APPLICATION FOR
PERMIT TO ROOF
'
REROOF OR INSTALLI : SIDING
Location /2f c
PERMIT GRANTED
10,1/3
App vad
/Dc-"-f �111 9 lnspeolr
7LO rt��
APPOINTMENT FOR FINAISaeem F-vte Department. APPOINTMENT FOR FINAL
INSPECTION MUST BE Fi-%e Prevention Suaaalr INSPECTION MUST BE
MADE AT LEAST ONE WEE 48 Lafayette Street MADE AT LEAST ONE WEEK
AHEAD...................—.......... Saeem, Ma 01970 AHEAD..............--.-----------------
(508) 745-7777
FFFIRE DEPARTMENT CERTIFICATE OF APPROVAL FOR BUILDING PERMIT ..
In accordance wd th the p.,cov-4:.64on 6 o6 the Ma,64achu,6e#t� State Bui.Cd-i.ny Coda
and the Saeem F-1,te Code, applicatLon .44 he�Leby made 4or approvae o4 p-ea.n.6
and the 4:,64uance o4 a ce4ti.4-icate o4 approvae jot a bu td.ing permit by the
Saeem FZte Department. (Rei. Section 113. 3, Ma44. State Bldg. Code)
Job Location:
Owner/Occupant: ge-5W.
Eeectr.Zcat Conthaetor:
N F
F-vee Suppte44ton Contractor:
patun.e
Apoil
Applieartt: �_ Phone
Add-%".6 o4 a C.L-ty or �>
Appttcnt: Town:
a.
APpnovaC date: `v
Certi4tcate o4 approvae t.6 hereby granted, on approved ptan6 on 4ubmlt-ta2
o4 project detaZZ. 6, by the Satem F.Lre Department. Ale p-ecut,6 are approved
4oteey 4or -LdentL,6tcat.Con o4 type and .2ocati.on o4 44,%e p4otec .Zon dev.ice4
and equipment. AZe ptanb ane 4ubjer-t to approvae o4 any othu authoa,ity
having jun i, dZctLon. Upon comptet. on, the appt .cant or 4"ta to t(4) 4hale.
reque6t an in4peetion and/Or te6t o4 the 4-ite protection dev.ice4 and
equipment. ( ** FOR ADDITIONAL REQUIREMENTS, SEE REVERSE SIDE ** )
0 New con.6t4uetlon.
0 Property eocation ha6 no compliance with the prov4,6ton4 o4
Chapter 148, Seeti.on 26 CIE, M.G. L. , ne.P.ati.ve to the
Z"ta2atLon o4 apptoved 4.iAe aeaun devtce4. The owner o4
th.i.6 property 44 requ Umd to obtain eomplLanee a4 a
conddtion o4 obta.ining a Buieding Perm.Lt.
Prope�%ty Location .4.6 .tn compliance wdth the paovt,6torv6 04
Chapter. 148, Section 26 CIE, M. G. L. '' // , / j
ExptAat.ion date: �� l9� l/y a k
LkS� S49natun.e o4 Fite 04itciaZ
Fee due: under. 7 , 500 Sq. Ft.
7 , 500 So. Ft. or Q.azger - $415. 00 Form 987 (Rev. 10/90)
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:' i o arpraval by any o4nr
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Q I'LAXS ARE AP PRO ED JLELY FOR IDENTIFICATION OF
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