450 Highland Rich's Dept Store Titg of 681em, 4 tto
B��C u��ilU Fee Due$10.00
g FIRE DEPARTMENT• FIRE PREVENTION BUREAU Ck.# � Cash
48 Lafayette Street Rec'd by:
Salem, Massachusetts 01970
APPLICATION FOR PERMIT (Date)
To: HEAD OF FIRE DEPARTMENT
In accordance with the provisions of the Mass.General Laws and/or the Salem Fire Code,application is hereby made for a permit to
install approved fire alarm devices.
Location: 5`D `v � G Owner: ,��c��o 4 -A�
Installer: / Tel# 0
Installer's Address License#
Type of Occupancy:
— LIST TYPE AND LOCATIONS OF DEVICES ON REVERSE SIDE, OR PROVIDE PLANS. —
Installation subject to final inspection and filing of Certificate of Completion, by 'nstaller:Inst * must be present.
I
Date of approval: cd
(Signature of Applicant)
Date of expiration:
(Address)
Form#81F(Rev.1/83) DO NOT WRITE BELOW THIS LINE
'ADDRESS: TYPE OF OCCUPA CY : __,
1 2 3 4 5 6+
Condo Mere Itl TIME:
4th-FLOOR PUBLIC WAY: 4th-FLOOR APARTMENT 4th-FLOOR APARTMENT ZONECORRIDOR: ;
FRONT. REAR:
3rd-FLOOR PUBLIC LVAY: 3rd-FLOOR APARTMENT 3.rd-FLOOR APARTMENT �UfJ
CORRIDOR: #.
FRONT: REAR:
2nd-FLOOR PUBLIC WAY: 2nd-FLOOR APARTMMNT
CORRIDOR: 2nd-FLOOR APARTMENT ZONE #:
0 ,
1st-FLOOR PUBLIC WAY: 1st-FLOOR APARTMEN
CORRI DORT 1st=FL00R, APARTf�IENT ZONE
RONT: REAR• .
3ASEMENT: BASEMENT, SPECIAL.+
: KEY ,KEEPER: ZONE :
'ANEL LOCATION: HORN AND LIGHT: SILENCE SWITCH :
SPECIAL LOCATION: �
SPECIAL EQUIPMENT: SYSTEM VOLTAGE:
AC DC BATT.
SD- Smoke detector RR-HD=Rate of rise HD IC= Inter-connected
HD- Heat detector FT-HD=Fixed temp. SS- Single station