0006 GALLOWS HILL R0AD - BPA-08-735 • I
N0.
APpLICdTION FORPFAWTO
_
LOCATION
PEIMIT GRANTED
_ �• 1'l• wh 19 •
APPROVfD
7lNSr!ETp0�j OF BUILDINGS -
CERTIFICATE OF OCCUPANCY .
YES
NO �• �
1 ' •
i!
DATE:
Citp Of "Z)aE TI, aq;5arbU5Ptt5
PLANS MUST BE FILED AND APPROVED BY THE
INSPECTOR PRIOR TO A PERMIT BEING GRANTED 1 l
Location of Building to bo l loy\/j I-�t 11 hoad.
Building Permit Application For:
Circle whichever applies) Roof, Reroo Install Siding onstruct Deck, Shed, Pool
Addition, Alteration, epair/Replace, Foundation Only, Wrecking
Other: t
PLEASE FILL OUT LEGIBLY & COMPLETELY TO AVOID DELAYS IN PROCESSING
To the Inspector of Buildings:
The undersigned hereby applies fo'r1a permit to build according to the following specifications: n 1
Owners Name: Ann L 1 Il fl I Yl Contractor: A 9,A jeryiu51Uhn5 Zbr-7
Street r-a(l O(A)12 .16 11 ed Cite fn Street I� Nnr( h 5F. City Ism
State Phone 61s) M l j - 5UP State M R Phone- N 7 9) 7H OH oZ l {
Architect: CityofSalemLicq IH05
Street City State Lic n 57 HIP# 1 D I(o 09
State Phone ( ) Homeowners Exempt Form_yes---Vll no
Structure: (please circle) Ingle Famil Multi Family# Other
Estimated Cost of job S 7�a, b
Will building confirm t law? yes no
Asbestos?_yes 200
Description of work to be done:
5 3c��Ira
A&A SERVICES, INC.
Drawin Si bmitted:_yes no Mail Permit to: SALEM, It 01970
% �o7ai�a1-0424: .
X WWW.A-AS TRV `�S'F
Signature of Application,SIGNED UNDER THE PENALTY OF PERJURY
CONSTRUCTION TO BE COMPLETED WITHIN SIX MONTHS OF PERMIT ISSUED DATE