3 IRVING ST - BUILDING INSPECTION (3) • 1
gKWIISiM WISEfILfB41ND APPROVED BY TW
JULDECM PRW TO A PST JWNQ GRANTED
CITY OF_SALEM
No�� Dab
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zoNnp Dmid
Location of
Mw a k1m Dktm?„ Yca ma banding 3_ i (Zy r IV G si-
lo Propnly lncrfrd in
su C rdena lon Ann? Yak_No X
Permit to:
BUILDING PERMIT APPLICATION FOR:
(Circle whichever apply) Roof, Remof, stall Siding, Construct Deck, Shed, Pad,
RepaidReplace,
PLEASE FILL OUT LEl;MBLY&COMPLETELY TO AVOID DELAYS IN PROCESSM
TO THE INSPECTOR OF BUILDINGS: '•
The undersigned hereby applies for a permit to build accor&ig,to the following
spec"Intlons:Owner's Name ANbjz&k) N41CGHT
Address & Phone i2) lkyt/'e' 7S7 (tf7'i '/75 - 4SI5
Architect's Name
Address a Phone //��
Mechanics Name U u AJ H Pok~4
Address A Phone A REEuwt)o_n ST 671 ) 5/ 9 -5 7&
'I.LJ 02CESrE2
VON is are purpora or baargz
md"d bu➢ W Y
UTA/V L S\lI Ilv C I a dwMlrq.for how mmy hmNrr7
wa kdem ocif '. to law 1 ES Ad)@"?
Elrsltlsd coat� , UU city umm r sms ucross r
Lio. ,.
Sigr"re of AX*cpffi
SINNED UNDER PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
I^/S, C
4LL- VlJvyj_ Sl b1AjCT dti OHOLC AuSE
MAIL PERMIT TO:_ BUNROEUN CHHOUY
HOME DEPOT
a COBURN RD.
TYNGSBORO,MA. 01879
APPLICATION FOR
PEFWT TO
LOCATION
PERMIT GRANTED
19
AF7 VfD
iNgPECTOROF BUILDINGS
f
I -
. � - �aatntortnfftl� ��11fL10aChffdtlt/ .
- � •1J.P.af.a.rd e��ileietrlef�eek�•
eoo w.Ai ffae Aed
iss es t eesasea j der Md A.& 02111
coname.
workert' Comperwdon Insane Affidsvk
-1, T i �H N 01Ay
- • wh*l.a prindpl place of bosbou an
do 1lerebyca* under tlta pains and p ldoa ed poil.Wa Liao
i) 1 ass an employer providing workers' eompemnien cavera/s fair nq►dnplol so woeklog en
tbi lair. .
Insurance Cbn*W policyilnwmi.r
I an a sele proprfessr and haw so ens working fir me IA atq opadw.
() 1 am a sole proprletar, general commacsar or homeowner (drds ores) and ions lid on
censwesors listed below who-have thi fcillowiog workers' connperumft n V0Sdesi
Coswaaor InsuwuvEs Cempimylftft Number
corraaaw Insursnce Company/Foley N
Cosnsriasr Insurance company/poft Number
() 1 am a homeowner performing all the work myself.
•I•adwauw ns a ter/of ii mmwo o.e at fwwwM&ow Wit.A bvsetasms d dw a1416 fer ca"WaP.v11c9dM a"OR h&M r saaew
swam a r~ts.naa fociaa 21A of WA 112 can kid r aw Womod n of eiders&ends torwdmt 618 aq d w M 1 JMM odor eer
na1'wwaawrsnt a yt a eat a.rds rAt fwrn of a STOP WORK ORDER and s hu of f 100A0 a am apbtsr.
Sigwed this • day of r
.icerscci'Fcrmitcee oullding Department
Licensing Ecard
Seiectmem Office
�eslth Depsrmer'!
. . _ ;,• - . _ - -.ce�.r , a � _ spa ale ape 775
rumurp r MP=ff UWAW MMff .
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DUWOQAL OF DMX AFP=VA'
b aeoeede wtb 90; R 'am dMM 0106 SK I sdmowbdde dW�a eas�daa
d8dmbs Fr mk• .d ddob nsdbF dos•do em - iiytoa uddly
an+ d by db PWA d and ba�offs a plopaslr goad eoild sao
dte "hdit.m dedbed by bM o 1%BLU L
13e de6efe..m b.efepoeed det 3�f 5 ��.t�n,w one Csi, ����r�
Loe.de.dFsdNW
ofPeemit Deb
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Name dPeemit Appiiaaet .
AM Nm%Maw
3 Y� C6�ACCgoq ST, AjG x'CCS�€ .4
AddtM CIW t 10e1e
MW Am ebmb ngai =d W debris dom do demolldo4 nmovedoe,rdmb a odor
alpeades e[bafldb>j a edseaaa>K dlepoed is a popadr-linseed ioli�aaele dtepoMl
fYa'>iq►ee dedsed by 1tf8.�813QI�esd do bm7d(gp peemib a Noaoen a.4
Woo do bodes e[do haft.
41