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116 LEACH ST - BUILDING INSPECTION (2) ll I M1111 INE fl1A94ND APPROVED BY T44E JWPACrOB PM OR TD A.PEBW'Ir BXIWI LDRANTkD CITY OF_SALEM 110 �5 \ Dab Zowq omm ft WAft Did t?b a Y No of F / - �A Is PmpsAy looabd In Nn CwmwvMon Ama? YN No BUILDIMI P I Wr APPICATM FOR: Permit t0: (Ckde whichow apply) Roof, Raroof, Install 3idktp�wwuwL Do*, Shed, Pool, RopaimmspNoa. ONW. s vrr PEASE FILL OLR LEONL.Y i COMPLETELY TO AVOID DELAYS W P XMBSM TO THE INSPECTOR OF BUILDINGS. ' The unclers0led hereby applies for a pwm t to build at:cord6ip,to the kftwk Owners Name ©/�✓D� � Si � �;p� Atchibct a Name Address A Phone / ( 1 Mechanics Name pad ' /9`/d/r :l ti C- Ad*m A Phone AV 12 ul�� Q � � �Cy (9�3 1 �S��R 3 r What Is Nn pupoaa it WkIn t MNhibl of buNdtnp? N a ri - n,for how m ny bW~ wa bumv oorromi to taw? AsOsaba? Edmom OOM , �/ qy UCOM 0 ZO Z;�Z 8AIN U701N 0 SWah n of Appliom 11111MI LMLDER THE PWALTY' OF P LRMY DESCRIPTION OF WORK TO W DONE MAIL PERMIT TO• �f-tic ' d Y , . � :� • .. . _'i�r„a ,.. �. _. 6� 1 g" ,:{s;ten. N d Vg < � � �Q � � � Z o)as USUM io gmsad la.Wq ow Pw VwIS'llla Am A P4a9aP R 4R.09 I !P OP"-Mm POMR-APD&d r m powdM a4 aaaum jo ft.pMjo mm GS V AJ`SPY ter. *Mx maj s1/� ���� �7' MDWMW ftLUMCFOWOR&UD*,&T= WORMY P=d3a ammmS v� � �•�PSI?�t�!�P a4L a 3o P Ii m 'YOSIB'�a'T�M d4 P day a4 M x=d hMmg�B�Q Po=Aa AP IR'--/ d SU.PlmS3a ao RPM it as In aspopMoo4m I'►£S'Or a WN P aaopuod go emu+►aaaspao=III 11AYMMY S[ii a d0'IYSo ma Vr 'Z*UW Ifl T AZINVAS s»sorc ute) Yv� oat•mm asaa-srt(GL6) -Tu Nowu lave gnaws NOLMINSlgM Oi 1 - AMKJ vd3lG ALA MdOud onand t . � l-,oee��mmonuiuo:�lt of, �e`wachws�d • • .1JeP.al.wal a��alrcYid�aiLisis . boo W.A&O .Swat +sma 1 case+ &A., X...r6r.b 02111 Caaaaaawr ,yWar/k�en' Compensasim I�m�n==:@ Aflidelit - • witb.s Principal Place of bmrJnns an 5� � �6w Sur y • S/�` _ � � � �� . do hereby'cer* unldw v)w psius and penandias of perj.w titso () I am an empbrir priding workers' compemdm covenfe for my auplvy*w werkbq as dik Insurance Compaq raft Wumbor 1 an a sob preprisso►and haw so am working fir sna is amp opedq. () 1 am a sale proprietor, general contra e=w or homeowner (dreb ease) aad hew Mad do contractors listed below who-ha" the following worker' compessssiea peadao Contractor Insurances Company/peiiwr Naatbar Consreaw Insurance Company/Fe Ntmior Courioie► Insurance Company/policy Nuaibar () 1 am a homeowner performing all she work myself. . I vaeww"rig a CM of Ai aw.MM va be fen+ua.d a ow Office r iwa.lao"of ON turn M <wWwave.wlha.e.Me an Idre a wsra coneys at#carves~Secio SSA of MGL 152 can kin w w iipaeiaa el vkWav.eoWn wrood.n of a am of as w4IACO 0 ae.fer am ?can'iaor"OMMM a.u.add aawaia in ghe krm of a STOP WORK ORDER aw a M of S 100AC a an a dm ar. Signed chit • day of — :iccrseeiFcrmittee oenlding Department Licensing Ecarei Seiefsmem Office .-;,calth Dcpnrcrncrc -- - - r - - - — - -eeCC Y4 : = 404 apt, 405, T75