13 BOARDMAN ST - BPA-2005-103, U2, 5 WINDOWS • 1
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APPLICA ION FOp
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PE MIT GRANTED
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CERTIFICATE OF OCCUPANCY ;,' y :'
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DATE:
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PLANS MUST BE FILED AND APPROVED BY THE
INSPECTOR PRIOR TO A PERMIT BEING GRANTED
Location of Building /3 /3ocl{ !21r 12
Building Permit Application For:
(Circle whichever applies) Roof, Reroof, Install Sid' ct Deck, Shed, Pool
Addition, Alteration, epair/Replac , Foundation Only, Wrecking
Other:
PLEASE FELL 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:
Owners Name: �l//_SDi1 Mel�l/�l�eU Contractor: (7nristnnnar znrzg
Street l3 &Vrd"I) Cit,, ,�2JWY Streetl15 North StraatCity Calam
State. Ate_ Phone State MA Phone(978) 741-0424
Architect: City of Salem Lic# 14 0 5
Street City State Lic#0 5 7 7 3 3 H1P# 101609
State Phone ( ) Homeowners Exempt Formes n1o.�
Structure: (please circle) Single Family, Multi Family# Other � �n - �{ CJ�Ji i J
Estimated Cost of job $ o� bn _
Will building confirm to law? es no
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Descri
ption
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Description of work to be done: .
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SERVICES
Drawings miffed: es no Mail Permit to: 115 NORTH STREET
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Si of Xplific-ayon,SIGNED UNDER THE PENALTY OF PERJURY
CONSTRUCTION TO BE COMPLETED WITHIN SIX (O MONTHS OF PE1tMIT ISSUED DATE
Department use only: Perms ning Map/Lot
Permit fee$
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