103 MASON ST - BUILDING INSPECTION (2) fL�11s1NgsT9E44W"ND APPROV Efl BY 77iE
ASPECT' 1 PWR TD A.PFJ3W BEING GRANTED
CITY OF SALEM
No. � � \ Dab
Ward
�- Z*ft 131311M
Is PMP"LocaM in Location of
ma HWAt 13111dot4 Yss No_ soi7dioa o 7� M
Is PFOWW Lacded In
r dW Co�AMR? Yes NO_
Permit to: BUILDING PERMIT APPLICATION FOR:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, J� Pool,
Repair/Replace, Other:
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS: '
The undersigned hereby applies for a permit to build aocordwig,to the following
specifications:
Owner's Name c�C,t f� N1 LT\(\ SC)
Address & Phone /0) A i '90 61 f 7h_C9j Nb
Architect's Name
Address & Phone I
Mechanics Name
Address & Phone c I t
What Is tlW FffPM a aildp ?
mamm or txrldMg4 W04 n a dwoft for how My WON?
WM tsA*Q as tM fo Isw7 S AsDwMe4
EdlnWod Cost ®o, Clly LksNee N So"LICW M•
■LC. rfro....nt �nA.<c
Lic. i 2
Signature of Applicant
SIGNED UNDER THE PENALTY'
OF PERJURY
DESCR1IPTI\ON OF WORK TO BE DONE l
th 'shs � �12�✓�c, /Ivy �O�, R �d-�(`.
MAIL PERMIT TO:
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CITY OF SALEM
BUIIDINGDEFARTMENT
HOMEOWNEIL UCENSE E7MOMON
Plan Air
DAM ODLO-( II
lWLOCATION n(03 MaSon ST
• Hg1vffON►lia JSL_Z l`�z Son` CA-.
Tnxram
MtSFxrMAnA?oADDRES= l�� Ma�c7lt
The cwmm.oampelao d-bMwWoere wo esacndea U I I I ewoerw"=wd Owesiv ar m
Udu a lea.md a allow sneh bomeowm=m a,PP am bavWW,la Mm wmo Boa am powea a
lime. mvWcd,motewwww'sm..mra'V M
DFFD�ATIONOFHOh�ffAWl� .
Pawn 0)who oww a parcel d WW w whkh bdobt mWo a beads m takft m tbees L w It
buaAW m be.a one m two lardy dwdb&amdrd a dwdW mucmma 7 b web tat aadirt
farm sovewm A pawl wbe m wtroets more them ome home in a twayev Paiod shoo am U medda"
a bomaowaa. Smeh 9romeowmf sha4 a A,I m the Bmldinj O)>xK m s"aatept bk m
Bm'ldbg odreisi.that belshe be respcmbk to sa tulle wok pafcr mod nnda tho boil pa=L
.rm wmknipwd`homwwod'aw mrs tespottrbility fa complfs=wide the sate Daft Codee d
otha an§abk joss by4ovi%nin sad re=obd=L
rm widenip w-hamwwnd ezrtifies thm ht/sM=dc suLds tme OW of S*lc=Bdtdbg Deprood.
nurjmmm bmpwj=pmadwu and ng*cmems and thn bhbe wo wmply wi&sold pom mot ad
tegdrememL
HONWWMIS S1GNA711RE \!\/ L
APPROVAL OF BUIIDING DWECTCR
Set otma sdc fa state code
HOMEOWNER'S EXEmMON
Inc CC&states that •wV Twmsowaer perforating vivA fa vdd&a boD ft patnk is teq l l &I to
cxcmpt from the promons of ibb section (Stctba 34pld-Banning of Comtruedon Sapavume
•
provided tab a bomeowaa eagaga p person(p)for bbtt to do.such wvdt.that sites baaaeowaa diaD t�
at suporiaa�• .
Maq homwwnm wba=a this efanopdon aft i6wMWe tntt they are awombil dw I'syoststt UM do
supayym(see Appcndia Q.Rnlss and Repubtkw for lintming Construction Sope>rvi em Seetm
iYJ} Tbfs Leif of sws7craa cfim nwdu in•edam problems,pede°lar�Wb=dw howeoaa bbw
unikca+od pc soot b ft east yom Bead afmot proesed apkm the wed pafoo s ilwould win
ikeaed Svparisar The bomeve r*ding as supctvlsw f .
To ensue dw the hamevwna is tat swae of U%w fesponeibmdCI6 twgr eomatrmiitia tetptbs;as past
of the permit*ppikBdoa.tint fltc homwwna ecn*dot bwww mdosmfcda dw fripomtbWas are
stfpavbos. Yon may aft to wncad and adopt sums for nkcrtiiiatim tbs has tm ytftw con®14.