1980, 08-05 Permit: 80-7880 InspectINSPECTION RECORD
OWNER
LOCATION
1 " '
CONTRACTOR TYPE OF WORK
NSE W FINAL INSPECTION:
SET BACKS
DATE REMARKS:
V- %PI* Ate
TLEv
P ICANT:COMP
JON ADORES!
I. E. /2115" 23 0-1, AOMORI-
3ktdv3LaroeW)oJusuivlsmo • ny
- PRESS HARD TO MAKE 3 COPIES
450I -Gr- 87 u-14 NE.1 pef-
ADDRESS
E albe 13,15 Z3 9-0 5ibKhkE..
CONTRACTOR
A 4oLpt.c.e. B, DOW -AH -1y
- ADDRESS
25-5 04.ur.r4d CT 1801<AI*
DYIONER
6. ADDRESS
PWONE
.5-401/ZP
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUIABER/S z/54/ - 2 334 # 33
ZIP
PHONE
559-Z1)%
AMC SC PaCki Falt
Nor. IS0111/ 5
Zo CHNI11.11on
Size of Parcel
ZIP
44203
V-14
occupancy
05 -1
sponewrao
°Y,, ON. 8 RNIA.
WiONE
MOW.. Area Sp.
5 21, .. f
FSL
t62LO
Nse
/24,
'ran 3
ZIP
90
CHANGE OR 050 PROM
4.
TO
c.o.... of Deco.
FROM. Basement
Bilsoment
TYPE 0 SEW
7, or
WORK
b000 5)** vi0100
geALT, 0 AWN. 0 RP, 0 I.E.
0 PUSS. 0 tRECIi. 0 ALK. 0 POOL
KERIRDEL 14,4/14M/00NIN8 OOP MOE DELI, 411,11044r
19050.A1191110$1 11 90 STING 90 14,0400-
ELECTRIC WATER l_aittic..
a aVrtNANSgURCE1 OAS
„, „
11
No. name
No. 5100)0*No. Rooms
1
CERTIFICATE
of EXEMPTION
gnu, olol. !Location Wee/
No. of °wooing
5.00. 1 Roc d.
FOES COLLEC990
OWIIII0111p
Publ. CPU.. VI"
USE CODE
1 110101)4 ,,,,,,rly fhof I tfo, read PIA C,11,1,1,,,d 1/115 01,11Iltdc•ri, , , ..1 i 1, all 11,cc -NO CR', ' provc‘cOns InCluded
on 'svelte 0101, trui kuow 1110 05)10 to he 11111.11111 c,,,,, t cic c,. c ,.. , c,cc, . .' ..$ . , . i i,iil,,, ouvernInci )h,)
typo at 5001) wc11 be compiced with 0110010) WECciteci i.c .cc r. ... , Lccc ct.0,1.141 , , c ,104,R 110101.0RM
to give authority to violate or cancel 111. 1,10.611/1/. 11, cu, .,the, 1.1c. ,cr lot al law rcc,c1 cc , .K1111.11100 ," 111.
performance Of construction. SEE REVERSE SIDE 0014 REDUIREO INSPECTIONS
4tiedo&obet
ACME CONDITIONS:
OATS 2.2. 3 -01 00.1 -O--AG_ -.ES 42243 005/033 ',' 34(0
DATE 0). APPLAATION
SPECIAL
NAME
PA, Muth.
�
t ilmsis fr•et-OcHtto
H P4.4L5 IV01"11141,4..
7.;
Snipe $-
1 7.Y
Bugging
Plumbing
blogb
Plan Check
SEPA
Mobile Horne
0105) (Specify'
!PERMIT MAMMA - 1
ts3- 78So I
G2• .9800
• 9800 k
• 98008
• 000 8
0 4 .9
o7-28-80
5 1.979
TOTAL S
•,i 11‘41 400,