1981, 01-30 Permit: 81A-1008 InspectINSPECTION RECORD
ADDS
DATE
REMARKS
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2
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A
N NUMBEq
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APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
aoe OREss
EIVN CT -
CK SUBDIVISION
Z. Mkxl u+ s�sQGC/i�BT& pHONN
CIZSEZ44f2
2
OWNER
a CS way —ROTH
ADDRESS
S. 1612.4 Pt8RBT
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBERS 0,7,54.3 — 1,71.
CONTRACTOR
4. SgmC
ADDRESS
£anma
DESIGNER
6' ADDRESS
CHANGE OF WE FROM
O.
TYPE O pEW
7. OF 11ldd�d
WORN LD.
8.
DE ;CRI rE WORK
VALUATION
9.
ZIP
PHONE
Actual Set Backs In Feet
North 150011 35 lEast 15 IW.kt
Iia of Parcel�
ZIP
T P.yCand.
PHONE
ZIP
O«dwncy
IV,- PR
Oy.k DNo RIO R.q d.
Valuationi 00
Par Floors OnA(O r Storks.
finikfinishedBasementnt Unlln. Sawmenl
11o4— —
Main r
TO
qru of ON W
gmi�on Ft.
0 ALT. 0 AD'N.
PLMB. 0 MECH.
0 RPL.
0 M.H.
000aL
0 OTHER
o. Sr. 1RosmkR IN . of/w�llingk
e.6 I . Fvot qpd.
I ✓
CERTIFICATE
A'a.
of EXEMPTION
1 g ch v2Z
SOURCE Y GAS
UTIelTIES
ELECTRIC
Enum. Obt.
Lowtton (Aron)
WATER
SEWER
P bll rknlP
❑Private V
USE CODE
I hereby certify that I have read and exerstittect this appllcalnui nod have read the 'NU I<.)' provisions
OR reverse side, end know the seine to be true and c ect All pruvlclons of laws and .rlrnances goy)
type of work will be complied w th whether specified here., o t. l ne granting o ,1 does not
to give auth ity t violate or cannel thens of y tl ,te or local law 4 4 r.onstJJJ...��� t
perform f. trucLo.r a ECT REERSE SIDE FOR REQUIRED INSPNS
DATE r1I '27.181f] SIc;N aPl :A�I_
SPECIAL APPROVALS • SPEC
IAl L CON
DITIONS:
NAME OATH Arr., • '4I ` -r-rkozo
r
included
rning this
presme
n or she
FEES COLLECTED
S'ngle
Building
Plumbing
Mach.
P lan Check
B PA
Mobil N ma
Otba IBP Ity)
TOTAL f
PERMIT NUMBER—"
$l p — 1eeB
n2 •34900%
•34900,
•349008
H •500 8
10059
01-2S-81
9 6479