Hodd InstallFee Due.$25.00
CITY OF SALEM
_ FIRE DEPARTMENT - FIRE PREVENTION BUREAU RecId by:.
48 Lafayette St., _ Ck.# .�� Cash
Salem, Massachusetts 01970
19
(Date)
APPLICATION FOR PERMIT
To: HEAD OF FIRE DEPARTMENT
In accordance with the provisions of Chapter 148, G. L. as provided in Sec. 10A
application is hereby made
for permission to install a HOOD & DUCT system, in compliance with
specifications set forth in N.F.P.A. Standard #96 and the
State cl for
Mass. State Building Code. A plan showing complete details
purpose for g _ ( P g P
which permit of equipment, shall be submitted for stamped F.P.B. approval.)
is requested — Restrictions: P g
As per Fire Prevention Regulations, Subject to sub-
mission of F.P.B. approved plan to Bldg. Insp. for permit.
Oaeup�ts�
1vame:S �t/1 r-ra-Aerneo4p1 4c_,lo
(Give location by street sad. or des Ibe in eu h a manner as to provide /deatiacat:on of location)
Installer �� (IR .1
Date issu �--�
—� (Signature of
Date of expiration
�,r Phone #
CITY OF SALEM Fee Paid.....:.25:00
FIRE DEPARTMENT - FIRE PREVENTION BUREAU
Salem, Massachusetts 01970
Date_ L(- X_" _S"7
PERMIT
In accordance with the provisions of Chapter 148, G. L. as provided in Sec. 10A
this permit is granted to
Installer (
Name � S
inst
per-1U
in compliance with specifications
State clearly set forth in N.F.P.A. Standard #96 and Mass. State Bldg. Code.
purpose for and based on approved which permit PP plans.
is granted
(Full name of person, firm or corporation grin
n HOOD & DUCT system
Restrictions: As per Fire Prevention Regulations. Subject to. sub-
mission of F.P.B. approved plans to Bldg. Insp. for permit.
at '�-
"I (Give location by street and no., or describe in such manner as t prowl adequate idegtltteation of location)
(Signature
" of official granting permit)
This permit will expire S - —�iC,_- Q
(Title)
W- (THIS PEIIM MUST BE CONSPICUOUSLY POSTED UPON THE PRENII.SE&) ' 4 .
Form.# 81C (9/82)