1 OAKLAND ST - BUILDING INSPECTION (2) What is the current use of the Building?
Material of Building? ���� If dwelling. how many units?
Will the Building Conform to Law?
eS Asbestos? d
Architect's Name
Address and Phone 1
Mechanic's Name
Address and Phone
Construction Supervisors License# HIC Registration p
Estimated Cost of Project$ Permit Fse Cak ulatkxr
Permit Fes i Estimated Cost X$71$1000 Residential
Estimated Cost X$111$1000 Commercial
An Additional $5.00 Is added as an
Administrative charge.
Make sure that all fields are property and legibly written to avoid delays In processing.
The undersigned does hereby apply for a Building Permit to build to the above stated
p�
specifications. Signed under penalty of perjury /
Date
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PUBLIC PROPERTY
DEPART'IMF.►�IT I
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MAYOR 130 WA.%H wzcw 5nFFr 0
s—:Mwsucrusri-rs 01970
143:9711-745.9595 * FAx 97&74e.gs"
APPLICATION FOR THE REPAIR. RENOVATION. CONSTRUCTION
DEH_ OLITION. OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING
STRUCTURE OR BUII.DING
1.0 SITE INFORMATION
Location Name: Building:
Property Address.
Property Is located in a;Conservation Area Y/N Historic District Y/N 1r-I
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name:
Address:
Telephone: 9 " — � cf S — S//� 7
3.0 COMPLETE THIS SECTION FOR WORK IN EXLq lNrs BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use New
Demolition Existing
Approximate year of Area per floor (sf) Renovated
construction or renovation
of existing building New
Brief Description of Proposed Work:
- — - Mail Permit to: --
CITY OF S.U.EM
PUBLIC PROPERTY
DEPARTMENT
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wvaa t 3owAWNC"S"M♦&AUK NAQAaassM 01970
TEL M745-MS•FAX.M74e-9846
HOMEOWNER LICENSE EXEMPTION
Pigs" Print
Date 7
Job Location
Home Owner Address
Home Owner Telephone S= �75i 7
Present Mailing Address C,,y/W e
The current exemption of"Homeowners"was extended to include owner-occupied
dwellings of two Units or less and to allow such homeowners to engage an individual for
hire who.does not possess a license,provided that the owner acts as supervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on
which there is, or is intended to be,a one or two family dwellin& attached or detached
structures accessory to such use and/or farm structures. A person who constructs more
than one home in a two year period shall not be considered a homeowner. Such
'homeowner"shall submit to the Building Official,on a form acceptable to the Building
Official, that he/she be responsible for all such work performed under the Building
Permit.
The undersigned "homeowner"assumes responsibility for compliance with the State
Building Code and other applicable by-laws and regWations.
The undersigned "homeowner"certifies that he/she understands the City of Salem
Building Department minimum inspection procedures and requirements and that he/she
will comply with said procedures and requirements.
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING INSPECTOR
See other side for state code