155 MARLBOROUGH RD - BUILDING INSPECTION VED BY Tm
iiEWAPW D P. BEWR GRANTED
CITY OF SA�EM
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a AGWIV Lid In Location of �sS/Y1RiP/8�/ i
on m m Woo~ YM,_No_ ulmins s—g hm X O/?4r
M Fivao Low"in -��r
h CW@W4@*n Ann? Yc4_No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Carole whW~apply) Roof. RerooL Install Siding, Construct_Deck, Shad Pa
RspaldRoplace. Other.
PLEASE FILL OUT LEGIBLY A COMPLETELY TO AVOID DELAYS IN PROCBBM
TO THE INSPECTOR OF BUILDINGS:
The undersigned hwWW applies for a permit to build according to the fops"
Owner's Name /1897;�75
Address & Phone (976 f 595'-oB 951.
Architect's Name
Address 3 Phan ( )
Me&mics Name
Address 3 Phone
whr N Me pmpow of MANW
mdulm d b/dnp4 r a dwadnp,for how many kndlm?
WN b AdW oodoml b low? �i
t nNpd am. 5�"/3-0, ph Umm• N p` WAD Uo •NOW
/�lr Me. Ia*swaaoat Lie.
' Signature of Applicant
SIGNqD UNDER THE �~
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
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s
MAIL PERMIT T�
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it
3 4e
APPLICATION FOR
PERdQf TO
AV/A LOCATION
PERMIT GRANTED
INSPECTOR OF BUILDINGS
x
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M;.y OF SAUX
WADING DEPARTMENT
HOMEOWNER LICENSE uManON
Plcase Rat
DATE ;.��O"
IOBLOCAnON �S� `Y19RCBOROUgs1 /TOAC
HOMEOWNER 155 IYIAR<�jprou�Li ifv cJ�r�em �a
ADDRESS
HOMEOWNEit 978 — S9�-C789eZ
TELEPHONE / (7 /�)
PRESENT MAU-NO ADDRESS /�SS Inx�463 21-ell h See�ry' /� el.
The ntrrw.cxcmpdon of'homcowncrC was rmunded to bxludc owocrwccupkd dwcM'P CtTWO
Uniu or ku and wallow such homco ms to crgage an irdividual for bite who does cal posses a
hccnse,.prwkkd thm the owau act as supctviw ..
DEFR4MON OF HOMEOWNER
Pcrsou(s)who owns a pm=l of land on which bdshc usidcs or bucnds to mide,on whkhh*h��
inicuded w be,a one to two fanny dwcl$4n SUDditd or dctadred mumru accessory
flo farm srructurm A person who corw"cu mote than one homc in a two-ycar pt2iod shall sot be considered
a homcow=. Such"homcov=r sh—A rabnnt to OK Budding Offidal,Qua form scscptabk to**
Building Official,that bc/shc be nspoTmbk to all such work pcformcd under ft bunding prrmL
.Tm undcniptd"bomeowncr"Mums rupoTLqb1Ihy for compliance with the State Bnild'mg Code and
othc applirablc goes by-lava,ndes and rcgulatiomt
The undcrsigncd"houwuw•n="ccrdfics that he/she undcsrards the City of Salem BwldmgDcpauoat.
minimum i Vop on pruzduru and rtq,&cmcnts and that blshc will comply witb said procedure and
requkcmccns.
HOMEOWNER'S SIGNATURE G<. •� �/° �1
APPROVAL OF B=ING INSPECTOR
See Otbcr sick for state code
HOMEOWNER'S EXEMPTION
The code sutcs that.• `any homeowner performing work for tivMch a building permit is rcqui ed Ad be
cxcmpt from the pravisiow of this scction (Scoion 70*.L3-Uccosiag at COnItitretiOn Supervisors);
providcd that is a hamewrncr cngages a pctsm (s)for hire to do.such work drat sucb homeowaa dmU act
Mm7 bonuowrtas wbo tssc this cxcnption are unaware tbat thcy arc Lwwrmg ft ZcsposssbBi6es da
supervisor (sa Appcodia•Q,Rules and Rcgulations for Untm ng Coosimcdon Supexvisom SeC14%
2.15� This lads of ewarrness oflcn ruults in scriotss prvblcros,particular'whm the bmnwwaabbs
uy2kensed persom In this case your Board carutol proceed agairM the tailDcmwd pc;an a it'%VM wft
liansed Supcnisor. The bomcon'otr acting as superviwr b uWmstd rtspoo5
To ensum that the bomeowncr is fully aware of hinter=ponsibilitiea,many eotttmwides regime;a pal
of the permit spplic2tiM that the homcmvner certify that hclshc cmdemands the Tcgxmsbilities eta
super .isor. You may care to amend and adopt Seib a formlccrdf=tim for ttse in yom e q.