7 PEARL ST - BUILDING INSPECTION (2) CITY OF SAI.EM
PUBLIC PROPERTY
DEPARTMENT
Kiarow-RLEY ORECC"
MAYOR 120 WASNINOTON STREET
c..eu NASSAafl'SET7S 01970
TT1-978-735-9S9S* FAX 978-7-10-98"
HOMEOWNER LICENSE EXEMPTION
Please Print
Date
Job Location TPo-f 5�
Home Owner Address -1 f m r\ -A
Home Owner Telephone 4 k ?41 - Ll 0-a-4
Present Mailing Address 1 PI—A r t T;;a Sa J r r�
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 them 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 requirements.
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING INSPECTOR
See other side for state code
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PUBLIC PROPERTY
DEPARTMENT
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120 WASUNGWM SMMW 0 Se1.Uk%WACM3k 13 01970
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LiCATION FOR THE REPAIR. RENOVATION. CONSTRUCTION.
D&MOLITION. OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUII.DING
1.0 SITE INFORMATION J
Location Name K) 0--)
property is located in a;Conservation Arss Y/N \-/ Historic 13Is41d Y/N
2.0 OWNERSHIP INFORMATION
2J owner of Land .
Name: VeI�t G v u
Address:
—? -Ile c_
Tekphane:
3.0 COMPLETE THIS SECTION FOR WORK IN EXISMNQ 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
tide(Description of Proposed Work: �
T�D x 1 6
Mail Permit to:
What is the current use of the Building?
how many
F dwelling,how dwelli un'Rs?'
Material Of Building? �� `/ 2 S Asbestos? N o
Will the Building Conform to Law?
Architect's Name �`)
Address and Phone 1 kf c c \ c ( )
Mechanics Name
Address and Phone HIC Registration
Construction Supervisors License to
Estimated Coate —� Permit Fee Calculation
$1/
Penna Fee$ Estimated Cost X i71:1000 Residential
Estimated C04X a1/411000 Ccmmwcia�--
An Additional$5.00 is added as an
Administrative charge.
Make sure that all fields are properly and legibly written to avoid delays in processing.
The undersigned does hereby apply fo►a Building Permitoy ild to the e s
specifications. Signed under penalty of perjury
Date
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