8 PATTON RD - BUILDING INSPECTION 7
44*146 MH T-BE FILET.*W'APPROVED BY T44E
t
.=P 0'PFWR T- -ING GRANTED
PERMIT BE
CITY OF SALEM
No. Date IQz - 'Ll
Ward
A
\gfgmNec7j°. Zoning Distract
Is Property Located in Location of
the Historic District? Yes—No— Building <Z' CCk? Ao r�
Is Property Located in
the Conservation Area? Yea—No—
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
Repair/Replace, Other: S\r\le a
PLEASE FILL OUT LEGIBLY & COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the following
specifications:
Owner's Name
Address & Phone -7 41
Architect's Name
Address & Phone
Mechanics Name
Address & Phone
What is the purpose of building? S Ie
Material of building? If a dwelling, for how many families?
Will building conform to law? Asbestos?
Estimated cost C City License # State License #
Home Improvement
Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO:
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CTTY OF SALEM
BUILDING DEPARTMENT
HOMEOWNER LICENSE E}ETION
Please Prr9
DATE L'0-21 003
JOB LOCATION g P�� �" ✓ d
ADDRESS
HOMEOARh3t
TELEPHONE
PRESENT MAILING ADDRESS q y c1
The current exemption of"homeowners"was c-mended to include owocroccapled dwCMMgs ofT TWO
Units or less and to allow such homeowners to engage an individual for hire who does mat possess f
license,provided that the owner Oct as supervisor.
DEFIDIITION OF HOMEOWNER:
Person(s)who owns a pw=1 of land on which hclshc resides or hntcndss to reside,on which there is,a is
intended to be,a one to two family dwelling,attached or detached sanctum axrssM to such we sudkc
farm structtms.A person who constructs more than one home in a two-year period shall not be considered
a homeowner. Such`homcowiel' ahaR rubmh to the Building Ofiidal,on a foam aoccpuibk m ffie
Building Official,that brJshc be responsible to all such work performed tinder the building p=tL
The undersigned`bomcowner"asswnes ruportsibilhy for compliance with the State Butltfimg Code and
other applicable goes by-laws,TWO and rcgulatiom
The tndtnigned"homeowner certifies that hdshe understands the City of Salem Building Dcpwvaml.
minimmu inspection procedures and requirements and that hlshe will comply with said ptoc edmes and
rcquirm►ern
HOMEOWNER'S SIGNATURE ._SAC 4 x A �
APPROVAL Of BUILDING INSPECTOR
See other side for state code
HOMEOWNER'S EXEMPTION
The code states that "any homeowner performing work for which a building permit is required shall be
exempt from the provisions of this section (Section 199.11-licensing of Construction Supervisors),;
Provided that is a homeowner engages®person (s)for hire to do.such work,that such hotaeowna shall act
as strpansa•'
MWy bmreowncrs who use this exemption are unaware that they arc assuming the iespoatib'tities of a
supervisor(see Appendix Q,Rules and Regulations for liccusing Construction Supervisors,Seetjw
1.15} 7bi lack of awareness often resuhs in serious problems,particularly when the horxovrrna bites
urjkcnsed perwm In this emse your Board cannot proceed against the tracensed pa;on as itwottld with
licensed Supenisor. The bomcoe-ocr acting as supervisor is nkimatcly responslbIL
To ensure that the homeowner is fully aware of hiller responsibilities,marry exmnmtUddics regime;as PA
of the pernrit applic2tim4 that the homeowner cenify that heishe tmdersrandv the responsibilities of a
supervisor. You may care to amend and adopt sui h a formlccrtifieation for Use in your eommU'dV-
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