293 JEFFERSON AVE - BUILDING INSPECTION (4) -Ft:A iS-MOST1WfiUEG-ANG APPROVED BY T*IE
IASPfsTDB ,PWfl TP.A_PERMIT 13FINQ GRANTED
CITY OF SALEM
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No. Date
4
Is Property Located in Location of k3 TQSo� nn
the Historic District? Yes_No_ Building 7 ✓ /�
Is Property Located in
the Conservation Area? Yes No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roofj3araaL Install Siding, Construct Deck, Shed, Pool,
e air/Replace Other:
PLEASE FILL OUT LEGIBLY &COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the following
specifications:
Owner's Name �_ ,j 1 e A4,17y L
Address & Phone
f. Architect's Name
Address & Phone L 1
Mechanics Name 4
Address & Phone n !
What is the purpose of building? •1� i� CF
Material of building? L , o o {�/� If a dwelling,for how many families?
Will building corgoor/m `///to law? I-c.S- Asbestos?
Estimated cost 76�d - City License # N P State License #
Homa Improvement
c. Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO:
f �
u.
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
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EQUIPMENT LIST
m z DESCRIPTION ELECTRICAL PLUMBING REMARKS
3, _ AMP VOLT BTUS INLE
1 MOP 13INK
2 3 BAY SINK W/DRAINBOARD
3 HoT PLATE 10.0 E20N6
4 CONVECTION OVEN 20
SIS TAS4E
s s3S TABLE
7 9ALA I UNIT 7 116
8 WORIKTOP FREEZER 10 Ns
9 PANINIGRILL 30 W 206
11 YOASTER 15.9 208
1 q BACEL DISPLAY
12 sfs TABLE
1; COFFEE MACHINE 20 205
1, WORKTOPREFRIO 5 tis
1 REFRIODISPLAY CASE 12 116
1 i� DRY DISPLAY CASE N5
1 NAND SINK
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