179 OCEAN AVE W - BUILDING INSPECTION (2) What is 00 aumtt usa at tee BuiidhV? �—
MaWW a Bu**V? sec c+ If dwe&gl,hoW W
Wfr me B dwv coftm to Law? Asbaatos4
Ar~s Name 1
Addreas and Phone
May's Name
Address and Phww HIC RapWraUon•
consbuc*m Supenhm l cerms g
Eewnaed Cost a Projsat
SO G' Parmlt Fee C,al om
Pem+it Fee i 2�_ Estlrrratsd Coat X i741000 Residential
EsIMnaUd Cost X$411*1000 COR"ArcWL — —An Additnal i6.00 is added as an
AdrnWAdn Na&Arg&
Make sure that as fields am property and Iegibiy w~to avoid delays In P=Usln0.
-ra undersigned does hereby ap*far a Building Permit to buUd to the abAva stated
speakW om Signed under penalty Of pwiuw
Date �l'1
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EI'I'�OF�LEn
PUBLIC PROPERTY -
DEPARTME►�1T
.urutay nmr�
Nwaoe 130 WAsabo 1. m 3ruw•SmAak.%LuL OR36TR 01970
11e:M7464M•rAsM74OMM
APPLICATION FOR THR REPAIR RZNOVATIAN cONrtrQ>r>cnQ
DEr EOLTTION.OR CRQGZ OF USZ OR QMMANCY Fog • gy r.n_vMN
STRUCTIURZ OR B&ULM 11 G
1.0 Orm INFORMATION
Location Name
Oe e7�
Rope ty Ie lorded in a:Qmwervadw Area YitY Hletorle ptstrtat YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Nam« iJ e
Addrose: !?9 Gc�� �- Cv s
Telephone: C/?y r= 3,?_
OACOMMUN THIS SECTION FOR WORK IN E7ILSIWp BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change In Use New
Demolition �sting
Approximate year of Area per floor(sf) Renovated
construction or renovation
of existing building New
floe!Dftwpfi9n of Proposed Work: r
--- — ---Mail Permit to: -
L
CITY OF SALEM
PUBLIC PROPERTY
DEPARTMENT
Hwrot 130 WASIONG ON b1W=•SuEr.�IA4AOIL'SERS 01970
11 i 978-74S-9S9S*Fox:979-740.9&4
HOMEOWNER LICENSE EXEMPTION
Please Print
Date
Job Location
Home Owner Address
Home Owner Telephone
Present Mailing Address
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 dwelling, 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 regulations.
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 tss
HOMEOWNERS SIGNATURE G
APPROVAL OF BUILDING INSPECTOR ✓I
See other side for state code
CPPY OF SALEM
PUBLIC PROPRERTY - - --
DEPARTNaM
11'7.%2N::0m3uV&iuea. vs�t»w.t�1a::9
Construction Debris Dkposat Afgdsvit
(required to all denwlidan and eenovadoa work)
In monhum w ifi the sh&edition of die Sets Suiidins Coder 7110 CNIlt satins 111.11
Debris,utd the provisions of V. GL a 40r S$4
9uildle{Permit N _ _ is tnua wilt the condition fiat dw debris resorting foal
chit wank shall be disposed of in a property licensed waste disposal facility as dented by.%IGL c
ltL.S15"
The debris will be transported by:
rho&-bris will be disposed of in :
M+mr uY fa.�Gty)
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