243 NORTH ST - BUILDING INSPECTION 1:,
!!A VLVBEING GRANTED
G�0 CITY OF S�EM
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Location of
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BUILDING PERMIT APPLICATION FOR:
Permit to:
(Grow whW~apply) Roof. Reroot. Instal SidI . Constnwt nf7 Deck. Shed,
R . Other:
PLEASE FILL OUT LEGIBLY A COMPLETELY TO AVOID DELAYS IN PROD
TO THE INSPECTOR OF BUILDINGS:
The unclorsignmi hereby applies for a permk to build according to the tolwwNp
Owner's Name �G �! f! fi l3 P�cQ n ✓ � �
Address A Phone (S N T/0
Amhkmds Name
Address d Phone ( t
Meohanlo Name
Address d Phone
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Signature of Appllmnt
SIGNED UNDER THE `
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
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MAIL PERMIT TO• r
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APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
INSPECTOR OF BUILDINGS
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M:Y OF SAIMd
B=ING DEPARTMENT
liClaOWNM LICENSE.DMaT1ON
Plan Prig
DATE S /o d
IOBIOCATIGN
ADDRESS
14ONEOWNEfI
TELEPHONE y/ c
PRESENTMAIl.WG ADDRESS 7 y /J �' 1 S�
The cur erd& on of"homeowDaC was mended to include a"D T-oewyied dwtMlDp dTWO
Units or ku and to allow such homeowners to engage an individual foe hue who does aot poaws tl
uce sse,.providcd that the ewoet act as supervisor:
DEFiNMON OF HOMEOWNBL,
Person(s)who owns a pm=l of land on which he/she resides or intends to reside,on tseasawhiehht itr
intended to be,a one to two family dwelling attached of dctadted strucnns uM 10
farm mucwmL A person who constructs mots than one home in s two-year PcrM shall not be considead
s homeowaet. Such`homeowad• shall'subndt to the Building Official,0n s form&=gtabk 10'&A
ona d mtder the building
be tmbk to all suds work P�
Building Official,that hclshe tsspo paf
8
win liana with the State Bung Code rod
tmdasi 'homcawnsr"asswncs obi' for p
The grad resPon• lrty .
other applicable goes by-laws,Hiles and rsguhttiw&
The tmdasigned"homeowna"crTacs that he/she tmdvstartds the City of Salem Building Dcpmvma.
minimum inspc.'tion procedures and rcquimmcnts and that WgK will comply with said Vomdtues rind
HOMEOWNER'S SIGNATURE
APPROVAL OF BUIIDING INSPECTOR G1 �
Sec other side for state code
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HOMEOWNER'S EXEMPTION
The code sutcs that `any bomeowner performing work for which a building permit is meshed sl aD'be
exempt from the prmisiotts of ibis section (Section 111f.1.1-licoSieg of Coustruetlon Suptrviwrt)
Provided tbat is a homtc%ner engages a person(s)for biro to do.such work,that such homeowner shall trot
as Supffyism7
any borneowners wbo use this cxcmption are ioum=that they arc asSmubg the tespvrmbilitits der
supervisor(see Appcndh Q,Ruler and Regulations for Uctusing Coostrvetioo Supervisors,Seetiaa
2.13) This lack of swarcneu often nsulu in scrims problems,par-dwlarly when 13he horue0wrrrb3na
unlicensed persom in this case your Board cannot promcd agairat the milieeused pa;on as it wtatld wi&
Ilanud Super .isor. Tbc bomt"wr adiag as Supervisor ib ultimate responsible.
To cusum that the bomeowncr is fully aware of Wher respowlbi aims many eommuudties regime;as pat
of the permit applic2dou.that the homeowner certify that Wshc understands the responsibilities of a
super%isor. You may care to amend and adopt sail a lbrmlccnific 6w for nse in your eoMMIGIq,