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1 RANDALL ST - BUILDING INSPECTION (2) CITY OF S.XLEM PUBLIC PROPERTY DEPARTMENT K,.roclL"ORMA L .MAVM 130wA9u«GWM S 1M•SAI M MALiAONMM 01970 7ki 976743-9S"*F.3c 976-740.98" HOMEOWNER LICENSE EXEMPTION Plea"Print Date 1 D Job Location �d rl ! S 7 , LPm rn 7} 217 70 Home Owner Address C ] Home Owner Telephone 9'79 - 514- 68U , Present Mailing Address S cvna- S S 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 belshe 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 CTTY OF SALEM PUBLIC PROPRERTY DEPARTMENT ?L��'r t�C 7.�e LV::JIi S 7ST�inti 11.1tJ1�1itr.►t1t:.� Construction Debris Disposat AtAdavit (re1omd FM all dsnwlitios and sptovatift wort) Is xeonknos with the shm edition d dw Stan Builth"Cods6 7W CNIR saation It i.S Debris.ad dw provisWm of MCL a Oq S$4 tltot dw doWs fives * is issttsd with dM aoadtdas result6tj 8uiidia{l4nr,tit _ ,his wort shall be disposed of in s properly licensed vasa disposal fbellity as defined by WIL a li1.1119" The debris will be tsanRxwwd by: rZA IS , rho&-bris will be disposed of in : Montt ul fa►dety) .♦tt -- - -EITyOFgEM - - PUBLIC PROPERTY DEPARTI4 EINT KI]MFJLEV ORMC L Mnvaa 120 WASMNGrON 517FHr• may,MwttaUlLSh'1lS 01970 141:978.745-9595 0 F&%.976-740-98" APPLICATION FOR THE REPAIR. RENOVATION, CONSTRUCTION. DEMOLITION, OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING STRUCTURE OR BUILDING- 1.0 SITE INFORMATION Location Name: 1 �anc r17A Building: Property Ad11d11ress: 61970 �AI '� © 11775 Property Is located in a; Conservation Area YM N Historic District YM 2.0 OWNERSHIP INFORMATION 2.1 Owner of Land _ Name: p'j,;C ym Address: A RaAA U 5-1 / S am rY13+- OIL? -70 Telephone: cl 78'- 5 3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY Addition Existing Renovation Number of Stories Renovated Change in Use New Demolition Existing Approximate year ofArea per floor (sf) Renovated construction or renovation g q0 6a cJ New of existing building . Brief Description of Proposed Work: sherd-r-ak n -1 Ice>/; I I c1,al, ng oe us�v�avW J retrnov iia Q non �eanv�q waM s `�i�encr yoa�� 'hq 1no-�u,U w� S�V� _Mail Permit to: -- - ec� What is the current �Ient use of the Building? j Material of Building? S'�— if dwelling. how many units? Win the Building Conformto Law? Asbestos? �D Archhed's,Name 5^ J1 'I Address and Phone 'k RaM 's YV h ( ) Mechanlc's Name Lt Address and Phone Construction Supervisors License# HIC Registratlon# Estimated Cost of Project $ ST- Permit Fee Calculation Estimated Cost X$7151000 Residential Permit Fee S Estimated Cost X VIM"Commercial - An Additional $5.00 is added as an Administrative charge. Make sure that all fields are property and legibly written to avoid delays In processing. The undersigned does hereby apply for a Building Permit to build to me above stated specifications. Signed under penally of perjury XA& �""� Date f `. OI A N CI