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45 REAR BROAD ST - BUILDING INSPECTION
i fL1NGIANKININIdNID APPROVED BY IM POM TD A'�V=W IIIEaNO ORAWb CITY OF SALEM No:�\� Dab—LWod ADIs Ramp Loomd Dp nn ft H Moft 0idd@4M YM N0 Lt]/!ae �� b Plainly Loaded in Is Cannwlon Am? Yw No BINLIMI PINT APPLACATUON FM • Psnnk to: (CWID wfrfoNNver sppy) Rod. Rsroof. Inald SMft ConWW Do* Sheds Pool, Rspwdwpmm Otllsr: 25WL e STe Pam_ PURR PLL OLR L OMLY A COYPLEf MY TO AVOW 0"V8 N PROOlitrl0 TO THE INSPECTOR OF BUILDINGS: ' hereby appYM for s pemk to bukd eooadkq,to ft.loNorwp O~B Name Address A Peow cDAJ sT Mahk G Nerve Address A Phan ( 1 Msolwdm Name Address A Phorm ( 1 wo Is ow p mpm it bl~ MMON a bulhrdr N fa dwernp,es raw amM Uniee4 _ wfa bidq aolftm to rew'r EdWoW=d a © — ph uon 0 o Y sbr.umn o ° 3 F am bpnvmmt ..a gavko.rn ltlONm INONI TIN PENALTY' OF P*YINIY DESCAIP110NOF WORK TO W DIM n _ eir� d-leY�%� ✓lMArnl r/ZdaJQ �fe_,/JS A-=✓ls�i,�/2 .�ecar�d+ � Se I fl P St�J(e S�c MAIL PERMIT TO• Y � . ' dh i ,,., 1. . �� l.o+nmo/urfuaNt Of !//als �I boo Ulas�i..Sa..i �a a J Cornea 8.4,- Mu..A.Ai 021 l 1 tees..... pp Workers' Compensatdois iamana Affidavig -4 _ W f ��9-air `1• ��c �� . - • whAa prbadpi place d budmtis act do her0y*cerft under tin paint and pewit" of pwf.@W, shin ' () i am an employer providing Workene compemdoa covepEe tow my sigloyeea werkig w . dati !.k Inswon" Compesw P Nrnnbor I am a sob prop.kw and haw no am workho fir nes in sew opedq. () I am a sek prepriesseo general cesa reesw or homeowner (drek nag) and Iwo bird des cc - icters lbud below wbo•baw obi following workout eonspen:a.den powdot • Gnvaeaw Inwrsnex Comysq/t' N.rnrYew Conersaw Insurance Compawy/po N Coaasaer Insurance Qmvpawy/Foft Number () I am a homeowner performing all the worst myseN. •1 awewAaae saw a can►of di a mom.e be fwn roe. ■ dw Olin A ta.w I MW of dr M 6W ea.arap Mukadan a.e eM ldro w NO" cawrap a reoeaeo eeew fecdu SSA of WA t I caa km w w bwwe of ob bw Naas e.nredarr el a sae of u wi a MOM"NOW ar read:.ara.r.ane a% a der a.Aae in dK Iam of a STOP W ORK ORDER ate s far of S ICCAC a ear ardw ase. Signed this . day of D c tD A 0(,PAA !]n�a /J � :utrseei'Fermittee ju►Idin( Department ucrnsinE Ecard Seiectmem Office =ealth Deparmer' -.ccGC "4 � : eQe eQe epe 77! ruNua rRvraaerr DtrARTmoff 120 NU MINW" 9"907,aRm FLOWN SKsw MA otno TaL (978)745-MOS [aT.3So FAX (WM 7404M" MATCO DISPOSAL OF DEBRIS AFFIDAVIT la aocaedaooe vim 6@ povidcmr afmM c 40.SK I aclmowledde that as a caoM m Of DwiftPermit/ .A ddbeb mahmS tam coo comet wd m and ft VMW by 131uldbap Permit abotl be&pond of is a prcpeely l osond molid-wr t dbpod h ci&y.as ddkW by UM c DL$13" Mw ddzb w M be Agmed of se _j 4 ) 1p A,t),eit Locmum ofFaaft "el — NA��2J2 l0 6 6 S*dmo of Pe>alit Applieaatt Dafr OUASE PRIId CUM . »i IL�FfiH .l- !qC f1 Name ofPe>mit Applip� Fiem IVam�,dauy► Addmm City A State IU above#Wale rega m that ddwk from the denolidM reoovsdm rehab or collar alteration of bmldmd or Muctme be digmW in a pepaly-Hem med MaNd waleswam LcMy u defioW by MOL cJX S130A,and the b(nldint 1andto or He==ate to i 6cm the beadw of tbo feebly.