10 BUFFUM ST - BPA-2005-40 • 1
141k"S MHST-BE ffL-ED--ANG APPROVED BY 744E
-WPfXTD-R ,PRXlJ3 TO A_PERMIT BZW G GRANTED
CITY OF SALEM
� ; �\No. U F�,;� .� i��T.� Date
a�. ,r =II Ward i
9�y� Zoning District —�
Is Property Located in Location ofD C lY
the Historic District? Yes_No_ Building
Is Property Located in
the Conservation Area? Yes No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Si In , \Construct Deck Shed Pool,
Repair/Replace, Other: ��,uI r" V,rpt ��
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 /��i,11,C e ell'g-,CL Df,7171,f,/_S
Address & Phone G/'iim,Ct L) ZVI 6Z&73
chitect's Name
Address ne ( )
chanics Name
Address e ( )
What is the purpose of building?
Material of building? If a dwelling, for how many families? {I
Will building conform to law? Asbestos?
Esti at t 000,/9(j City License State License #
\ (� Home Improvement
Lic. I G d!\ Signat
u eof Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIP\TIO^N OF WORK TO BE DONE
MAIL PERMIT TO:
No.�V _
APPLICATION FOR
PERMIT TO
LOCATION
V �
PERMIT GRANTED
19
APPR,OVFD
I/ „a
fN—SFYECTOR OFL8UILDINGS