62 BUFFUM ST - BPA-2007-140 DATE: e -/4-0 (a
s s
Citp ]of alp' n 1EaE;!arbUE;PttE;
PLANS MUST BE FILED AND APPROVED BY THE
INSPECTOR PRIOR TO A PERMIT BEING GRANTED.
Building Permit Application For-
`(Circle
Location of Building (p o� u Ir I r ,f
U M f'trC e�
whichever applies) Roof, Reroo Install Siding, Construct Deck, Shed,Pool
Addition, Alteration, Repair/Replace, 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; FCC P0,� ( )(C K l Contractor: C h r; a t n n h a=Z n r,o
Street l0a L 1f?7JO �I) te6City Street 115 Nnrth Straat Cily_Sa1am
State M( Phone ff) r? -1tj-- 1991 State MA Phone(978)741-0424
Architect: City of Salem Lick 14 0 5
Street City State Lic#0 5 7 7 3 3 HIP# 101609
State Phone ( ) Homeowners Exempt Form_ yes__�./no '
Structure: (please circle) Ingle Family Multi Family# Other
Estimated Cost of job S_531 0 , (DC7
Will building confirm t9law?, yes no
Asbestos?_yes ✓ no
Description of work to be done:
Reol aCe- exis-hna QSQhaI+ nocF 6h1gWr5 iLLL deven(u��(�r�
,�o glen A--,nhnl4- LhlLf4IeS
Drawing bmitted. es no Mail Permit to: 11b NORTHH SPREEET
x aer.FpR
X
Signature of Applic 'on,SIGNED UNDER THE PENALTY OF PIERJURY
CONSTRUCTION TO BE COMPLETED WITHIN SIX(6)MONTHS OF PERMIT ISSUED DATE
Department use only: Permit# Zoning Map/Lot
Permit fee S
C0MMMS:
r
APPLICIITION FOR
' PI=RMii' 'Tn
ol
LOCATION
� 2 Qv"
PE MIT GRANTEDV.
;
w4 Z
APPROVED
:
AE6—n OF BUILDINGS
CERTIFICATE OF OCCUPANCY .
YES
NO �/ ,