4 ORCHARD ST - BUILDING INSPECTION mv
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CITY OF STEM
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BI/DMq 1101411111 APPLICATION FOR:
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PLNM PILL OUT L ZONLY i OOYPLEMY TO AVOID DM AV=MP -001100
TO-THE INSPECTOR OP BURDMOB;
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CITY OF SALEM
BUIIDING DEPARTMM
HOMEOWNER LICENSE UMOTiON
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DATE 6 '�_p � •
JOB1 OCATION << GleCf1 ><a S j 5>l� �' �'0
ADOM4
•HOMEO*M
PRESENT MA�.1NG ADDRESS � �•� � S
steer--�i •
Tht cm Md cxempoon of homeowu="was c ►ended w b't'v&oaoeroewpkd dvrel0ega dT9V0
Units a las and w allow such bomeown=w aigage an mdfiidu�l ios hot srbo doa aot postts+s si
L•eomt,.p wMtd tbsa the owser set ss supervbw-
PcnM(s)wh MHO pw=l or t to reside,oa wltkb thas k a is
• Person(s)who owns a parcel of bud oa wbieh bt/she taida or bxctds �n>c6 tee andl�
intaded to bt,a one to two bndly dwclrm&anadied or dctsdwd sutretma mod 1 aol lx eottsid w
farm suucanes•A purer wbo constructs more than oac home in s two y a fb
a bomeowner. Suds-homcoa'nt>" sbaV submit w the Budding Official.on s lotnt sea pobk w ttia
Buildiag Offuial,that bdshe be tespombk w all such work pakrMed mad'r the Ding pout
The imdasigmd-bomtovntet"ass�mtes MPomtbiliq'ror comPtis�with the start Bn�ng Code and '
other appgcabk goes by-bras,rules=d regola6w&
T. tmde+si..d-bomeowtm-catiba thA he/she imdaswnds the C(ty of Sakm Balding Departtaat.
minimum ittspertion proadtva and tegtatwmnu and that ltlshc wW comply wi*said ptooedtoa aad
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HONZOWNWS SIGNATURE
APPROVAL OF B=ING INSPECTOR
Sec other side for saa code
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HOMEONVNER'S EXEMMON
The code stater 11= 'arty hotneowacr performing-k*for tvhicb a buDdtng iPcrndt Is Tcqdnd slag tie
mempt trum the provisions of this section (Scniou 10Y.].1-1Jaosiag of Cooatruetioo Sopervimo.
Provided that is a horneownu cngages a person(s)for Wm to do.such work that Birch Losewwaee slog aft
as supavisaG'
Mara honreowncts who use this mmPlon are ivaw9rs em they are asstuttistg the?tea eta
svpervi=(tee Appcodia Q,Rules and Regulations for 1.1musiog Cooairuetfots Superdws%Secdaa
.2.24 This lack of ewarrness oftm nnft in scrioos problems.laroeubrb wbea*t horatawna bbig
unliecn . pemmts In tMs case yom Board overt proceed agaimsi the wdkcmed palost a k woum WI&
I'neentsed Super+isa. The homcwever adiag as soperviwr Is oldmwt*rslEMII NL
To eusme that the honneowrrcr is MY awwt of hVt=rezpeaslbMd4m,many eamm>adtia retpdst;as pat
Of the permil applimdM that the homww na certify that h0she undamoda the respons;%Wdes aft
supmisor. You may can to wricad and adopt so&a*mWcxnV=doa Loa un is yom eoamotdq,
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