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FORT AVE - BUILDING INSPECTION , �L�NINT�E APP�IIOYILO i•Y ZiIE AMR v A`!lNfw Ana fLRAwb CITY OF SALEM Do, N'a-3-04 Vlhld �q Olwlol M pf"Ub uo�in Ywtim of b WWAft OYMot7 YM No X a.uas.a IM PloPwb Lou"in b OwM0MOM ANO yet.1t Paffnk ID: R Pl APPNCATM PM (CYob wlfidwm apply) Roof. Rwod. how smft Como" Dl* DW 4 Pool, R a ol m • OMfar: se�6o-.�e �.�tdwy. . .Cen6.m\ {Zrw PLUM PM.L ONr L OMY A OONPUM.Y TO AMOp OR AYi N PIIOOMfffrq TO THE INBPETOR OF KMJ MgB ' Tha undws*W h«aby apon for a psm* to bukd a000rd%la Mfa.1clo p Ok~s Nafna I) % C'2 Adds A Phom -7 H 5-5DCPo AMhbc'a Nd Uy &e.,,.6 Ad*m A Pla hew L 1 M9dwN= NAIr1A 1v rQ�aEe aa\ p l i� Ad*m A Phone .6,ov �Oyu/t- F Lis12z12r `7 5 3� YrtwfNwMA.po..aeutllpr VZe\ x�,��, 1� �G� �h.� 33 c.Y;Z..Z R md"of f q► G l cam. [4AP OO \ N■dwaroI for Aar war MwMt? W fnr*q ooufM a MW E0tIA CIVLbM• WAIDUlo • cs Q3'a6 - \� d Applio c IAfN DO PMNALTY' OP POM N T OMMt:IMP1IDM oP wiol rD=o U-wu� ZA ci©,.Jkro;SiQ= MAIL Ply 1 „''�L Vy VI 0 -iol— it A�Cat V, �'^ r r ', v � Y-- _, ✓� � � - ; � � _ . . - �� � ..: . //��ff,�.., �� ,a.�, m .T'..n,ir•.. >.-• , � ..r1M" �. ,. ., �_� �a� �� J _ coflLgip/tYfd o��IhLldaclthhls�d i .. q � .1JePtd...,�.�.11tulriel..�atsd. ' boo wa ujim Sbed bar�aa 1 Q...ti Setelve. Musel m& 0.2111 r Workers' Compenn" Inmranee AffWwk Ip TVA . . . Willa prindpal ph= of business as; do hereby'cerdy under jr)w paiva and penildes of p f.m dmu (� 1 am an emph*W providing workers' eompeandeo covepbe for my employees working on dik • �raV e��h� ' 1'�-l o'3c9�{-c�`{o��-5030�. Insurance eampatq Po Number 1 am a sole propriesor and have so Duet working fir me in any ooadq. 0 1 am a sole proprietor, general contrac mr or homeowner (drde one) and how hied the contractors listed below who-have then following workers' cornpenssdon po6den Contractor Insurance Gampany/Folley Number Contraaw Insurance Company/po No Contraaer Inswance Company/Polity Number 0 1 am a homeowner performing all the work myself. •I raseova"am a caef of"&mom we at far.rees ■ Yn Office A bradtaeera e/#4 M br ca.wap nrlhaiw are are host eel elan co.ratr r rrerw.row Seth ISA s/MGL 112 can kid wow ireanis of obiom.oasis termini N a her of as 041,NO muter ew tram'wwwormse a vt a deli owwwo in gore bus eh a STOP WORK ORDER ase s iw of S to0Ac a aw ariw ss• Signed this . �ln L .� day of �a, !J .ictrseti'Fennhtet eulldnng Department !i Ctruinf E03re Selectmen Office riaslch Depanmer,- --eFCC Yet _ epa ape ape 17c rUM6M MOPM fT DOW"WaR x 120 voiNuaf"aR111f1► >MO Rmo "Lift MA0/e;0 ' TO61 a �eaM�is s�o STMasr��>� JL. - - �sAt.aEn�tsA�svrt ba�000ldasoe WSW ma poddor d11Q.a Iq 1 aa�ofnle��t r advdmbsplomk eaedYloa I III III am to d�b9t pia • pima IW b "ft apt�4►.r did tij�If�.a��dla a pltl�lbtored so�iwub • �.el�6da vn be dlfpe..1 dah _ nID"M£�: d!`fd ft 9 a[l�miApplleaf� . OqJAUPSW IdffeM dltl l*Appifart •TyyfXA�CLr.T\. SfGWVIC�l �WC/ Pin?UK flaw ITO � ^ `, VM4 F N O-W>S-y Adim%Cky&Beth 13a Am 8=0 M*w dW dl&*an foe dmoldM itornioYbin r Aw aM m"dben o w rtrow v be dttpeea4 la a �•dWIMWbyHsi,dMtIMAatfddwbwlftpmoaano m— bag*da b o"dda d�llg►. 1 /dcF = 6 irvcfe�s r (t� GrAy w;9Tc-?t i�uinP u j� m ' �Q d Cf -3o X r RI r I L I m N I �!{i�� 1'�.r�vK/z6cl�D DooR