8 OUTLOOK HL - BUILDING INSPECTION (3) 4PLOSOWNI lA94M APPAOV69 BY UK
WPAC IN PIER TO A`f!P.A W OlJIiKi OMWIED
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Rmp MAN PILL OUr LAL.Y A OONKEF IL.Y TO AVOW 0M AY6 M PROCl
TO THE INSPECTOR OF BUILDINGS:
The [ elp'st'—NnW applies for a, p�artnk tto_bwld a000r ft to the.kNowi�q
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CITY OF SALEM
BUUMING DEPARTMENT
HOWBOWNEA UCENSE DMYOT1ON
Plow HIS /
DAZE o L
IDBLOCATIGN
' ' Hobgowrmi � �rJ�( oUr� /�il/ G /e�✓1 .
HOIv)EOpR� 79-7 C�/S
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PRESEN MALING ADDRESS �i2 M e.
The cwrcm,exemption of non wvwwrwms--adcdwb1chA9--
DEnNrnoNCFHCNEOWNM
Pusan 0)wbo owns a Forcd of bad oo whkh bchba"side a bueads m reside.oo M4lY .
intendedne to to be,a o twe lard'dwdlin5,attadted a Wnm+s
deudod ae b uft wnsidoed
farm svucwra.A person wbc tanstn m mme tlma eae home in a two-ym p�M sHO sal
a homeowner. S�`lwv��,bk*aU aaeh woh paknoid pmk
Building 0ificial. .
The mdvsiged'bomeowner•wsatmtes responstbilip,ftn=ZPU=wilt the State Dalldltq Code and
other appgcabk goes by-laws%wks and regttbdoft
l tmdcaigard•bomeowttd =050 tha tm
t Wdm da rands the of Sakan B said id paciedwa �d .
minimw pt
n b4cWnn ocsdmes wad regtitremems and that hhha WW eampV with
rcqvi�
HONZOWNER'S SIGNATURE Al
APPROVAL OF BUILDING C'I OR
See other side for sat code
r
HOMEOWNER'S EXENIMON
The code states lbW 'WW homeowner perfami q.iodt for vvhith a buii&4 permit b nxid ed shaD ix
cscmpt from the ptnistoas ohbis section (Section 709.Ll r Jecosiof of Cosatratettos Sspervboro;
Provided tbst b a Lomeowna c ftm"p persao(s)for Lire to do.such w edr.tbat such homeowmar Amn as
MwW borneowam who use this exetnptics are imawart em they an&wambS the psyomfiom".dS
supav+wt(sea Append!:Q,Ruks and ReSulsttoos for Lies Dais=Coodrretba Sapesvbots�Seeders
.125} Tdb lads of awwcwu of em mr hs in scr;mn problcros.'psr$euhrft w'hea tot bcmwwsa bb"
unliewed pcnomi >A thb case yom Board wmot procnd aSaitst dre mutocated pa�os as ltwwld Md
licensed Snpcnisa 71me boamwmer saint as sopervbor b oidasul tssLow .
To cuwae that the hcnwowrar b fuN wwart of hlMa aspansibMtk%=Ww cmmmada sg&%.m past
of the permit appliotioq that the homeowner certify that hLWw mreessnrd i the respousbWdes eta
supavbor. You rtatr we to amend and adopt such a*nnkuntfrotias Im tree is yom=u mmip.
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rusuc rworaw"U"Awrmo T
120 YWaMtReTaR vmffxr 3 D ftAoR
TEL(978)748-95 s) t(aT.Sao
FAX (0`78) 740 0"
STANLEYJ..T(!!ov( = JR.; - _-.-.-_- --
MA
DIP0M 0F DEBRIS AFFIDAVIT
Is wowdaaoe wilt do povi6=afUM c Ia S34 I aclmowledls dw m a 000didoa
of Bol ft Permit l .an ddbsis read ft lam dw omow dm udft
swamad by&b Paeatit sbafl be dWpoa d of in a papuly Noaosed=BdAmft
swoad may,d ddhued by MM c n%31ML
7m debeia wail be ajepo.ed a[at: 19
. Loeados a?Faeili4r
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ofPemtitApp
FULLY wmpb"the fbnowins i haudm.
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ef. .4 ?14d�o
Name ct'Peamb ApAcm
Fig Namsr if soy
UGC/Addms4 Sub
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Mw above Altule requires dmt debris Am dw demohdc ,mwv&dM rehab or odrr
altaadan debml or Muctme be disposed in a papely-licaosed solid waste disposal
hammy by cUL SOA,sad dte bu(U ft pamiu or lieemsaa ate to
indl W do locadom of do beaky.