105 LAFAYETTE ST - BUILDING INSPECTION (2) qptwnlAuSTaEfmdm4 II APPROVED aY im
=00=-PWR m A`.1PJ1 W REND GRANTiD
\_ CITY OF SALEM
�• `'� �UJ Osb 10-04-bt)4
Ward
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Is Pep"Loomd in iosatIm of
ft HWft owfan ras No_ s u fm US L a.�
N R OWIV tooWd In
: b Caiso, -n *no . Yw No_
Pannk t0: BULDMIO PEfIwIR APPUCATM PM
(ChW whit *wr apply) Roof Raoof InsW gam,el,�o- Dock, shad, Pool.
Rspa lr= OMnc b����
PLEASE PN.L WT UMLY A COUPLE LY TO AVOW DELAYS N PWCO
M THE INSPECTOR OF BUWNM'
The wWwo p nd hefty spore for a mmk to buUd awwd ft to ft lolowlrq
Owrlsrs Noma S UV n j l A UVM +Q C .
Ad*m s Phone I 0 s L aA L S 1, (72)19 13 - o 13 .
AMhk@ x's Ndma
Ad*M a Phone ( 1
ftAso Win Nam.
Address A Phone ( 1
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wlaw G1, ac>a v a br mw sewn,,r.e...z n�'rt
wa�s oodom a Iwn
adftww m.I ` zonn 1,06 C"Uo • 86309 aft tlona+s o M xsS -
Sipnatwr of Appl m"
IN10�11 no PENALTY
OP PONKM
DESGAIp1tON OF VIM TO U OONE
iSowlnVP . (?AridR (Y\ ToP(,� a (�mPlRro
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MNL PERMIT TO'L, tZS.�a s S �, r
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boo WAASaim Sired
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Workers' Comperwtim Iswsraace AfRdawk
. . w101s primdpQ ai plaoll pfQ ac .
� e^,11sp >a ,�raFs� col - all - 54-43
do iaereby•certify under tjte palace and pesasldoa of par*ya, dims
() I an an employer providing workers' compensation covefa/e for my dtaployeea working on
thb W
i
Insurance Compaq raihw Numbs
YI an a sole proprietor and have no ens workbag fir trte in aMW oosdq.
() I am a sok proprietor, general contrscsor or homeowner (drde one) and kltw lid do
contractors listed below who-he" the following workers' coetpeaastlon pe9deas
01ar 6
Contractor TimranEe Compsmy/po Number
Contractor Insurance Company/Policy Number
Contractor insurance Coa+pany/Policy Number
() I am a homeowner performing all the work myself.
•1 rMrm"ON a can of 0*AMMM.n be fwwrasd a or ORcs a kwu*aawe of ae NIA 4 covers"vw"ceem and OR a ssat.
csvratr r r,oaw,a saga Svvdw SSA sf MGL 152 can We M err:rrosaba of oiwwu oeawn cwmdm of a hu of w ai 1 a"Wer Ma
ream•:saesafma ar a%o a dd serdo in Lw farm eta STOP WORK ORDER age a for of s Nf0AC a an atafcn aae.
Signed this . AA 4-LS"Y of
.iccrscciIcrtnucee iiullasnf Depa ent
Ljcensinf Ecarf
Selectmefls Office
..ieslth Depsrcmen'
- - -.ee�.r tee ` _ 90A epc ape• 175
PUSLIC PROPKIny DKPARrMa?1T
110 WASHINQTON arMOM,$no FLooN
&MAW.MA 01 Y70
TWA-1970)745-MOS Ur.300
FAX M79)7404W"
STA1eLEYhJA.Ytypy� --
CO
DISPOSAL OF DE M AFFIDAVIT
In+ccmdaoce with the pa<ovia m of MM c 409 SK I acimowlo*do m a cm&dm
of Bmldins Permit• .all debris molt mg from the oamstrocdam wdvity
pvaned by WS Bm'ldip Permit duff be disposed of in a peopaly Hcemsed sondAra m
d POW Aw ty,as defoed by M(Id,c IlL$IN&
The derma w1Tl be disposed of at: �?(
Localim ofFamlity
&Saab"Of Dab
OUMB PRW CLBA MY) .
M wrN b ►A��e;s -
Name of Pao®1t AMHcast
L )
Fnm Name.if a w
Address,City a stile --- -- - --- — - -- ---
Tie above statute mgwm that debris fmm the dmlolidM rmova iM mbab or other
altaadm of� or M so mum be disposed in ptopaty-licrosad soH&wwe diwoW
�' by dM S 130A,and the bu1Tdn13 pamiot or li.—=to
iadicatc the location of the f heft.
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LAFAYETTE ST.
PROJECT: JULIO FUENTES DRAWING TITLE: SCALE
d/b/a FUENTES MEXICAN FOOD FLOOR PLAN 31161
LOCATION: 105 LAFAYETTE ST DRAWN BY ANTINEA NOGUERA 09 30-04
SALEM, MA 617-3724291
i
BOARD OF BUILDING RE®yW[TIbNs
r lUbjmje:�C`O,NSTRUCTIQN`SUFLitlf�SfiR';�
rs NumbI C5� DBfi369 y� f
4 6xpi[es D7 607 - Tr no '86359, 3
7
►YIAR10 U FUENTES st'�-2'Ste' -// +} k
85 CENTRAL
�CHELSEA, NIR 02750 ' x x Admihishatorf , :�
4 >
3mD0IR REFRIG.
0 FIRE EKTINGUISER
FAUCET /MOP SM
REFR14
DISH TSTARLESS STEEL PREP,
WASHER TABLE
W Om
r •
FRYUTATUR x
w
N
GRILL
BATHROOM
N
N
J
CHAR-BR i 5'
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3'
HALL
3-BAY SINK
TABLE TABLE
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TABLE TABLE
0 0 0
/ /
/ COUNT R-T / H S
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3
LAFAYETTE ST.
PROJECT: JULIO FUENTES DRAWING TITLE: SCALE
d/b/a FUENTES MEXICAN FOOD FLOOR PLAN 1/411
LOCATION: 105 LAFAYETTE ST DRAWN BY DATE B
SALEM, MA ANTINEA NOGUERA 09-22_0
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617-3724191 7