9 PEARL ST - BUILDING INSPECTION CITY OF SALEM
PUBLIC PROPERTY
DEPARTMENT
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MAYOR 1 0WAsmNGTom bl EEr*SALE %L%nAcHLsEmo197o
Ta-97&70S-9S9S 0 FAx:978-740.99"
HOMEOWNER LICENSE EXEMPTION
Please Print
Date s a?
Job Location `l loe -L s*� - 19;>6
Home Owner Address' L C A 0/
Home Owner Telephone 2 A ) !P .s-5 4/ - oo R 3
Present Mailing Address 9 <�=L J i-- SAc-� 0i 9 D o
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 requirements.
HOMEOWNERS SIGMA
APPROVAL OF BUILDING INS CTOR
See other side for state code
CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
120 WAS11rNG'.0!VSJREET *SAL F.M. MASSA(a It il:CIS:I,)n
TF1:978.745-1595 • FAX:978.74G9846
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CNIR section I11.5
Debris, and the provisions of vIGL c 40, S 54;
Building Permit # _ ., .— is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as define by v1GL c
I I I. S 150A.
The debris
/will be transported by:
(tame of hauler)
Hie debris will be disposed of in
�L�,LrS�Ct.O
(name of facility) -
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PUBLIC PROPERTY
DEPARTMENT
Y.I.�OfEpbY D�LSCUIl
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Arri ICATION FOR THE REPAIR RENOVATION. CONSTRUCTION.
D&MOMITION. OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDING
co SITE INFORMATION
Location Nam« aumrw
properly is located in s;Conservation Mee YM Historic Digrkl YIN
2.0 OWNERSHIP INFORMATION
9.1 Owner ct Land
Name: S d,-,l
Address: /rr,d
Telephone: 7 8 J'-
`7 —ad Pi
3.0 COMPLETE THIS SECTION FOR WORK IN EXLSXLMG BUILDINGS ONLY
Addition Existing 3
Renovation Number of Stories Renovated
Change in Use New
Demolition Existing
Approximate year of Area per floor (st) Renovated
construction or renovation
of existing building New
RryPr Description of Proposed Work:
-- Mail Permit to:
What is the Current use of the Building? Qsy PA u
Material of Building? IfelUng.how many units?
Win the Building Conform to Law? Asbestos?
Architeas Name
Address and Phone
Mechanies Name
Address and Phone
Construes Supervisors License e C Regis don
Estimated Cost of Project= Permit Fee Cala+latlon
Permit Fee i 3 --� Estimated Cost X i7Is1000 Residenfial
Estimated Cost S4141000 Commwclal-------__ -. . ..
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 for a Building Permit to build to the above stated
specifications. Signed under penalty of perjury
Date s �
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