26 RAYMOND RD - BUILDING INSPECTION ETr rBP
PUBLIC PROPERTY
DEPARTm&vr
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1.0 MM INFORMATION
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F
ERSWINFORMATIONw of La"
Tam~. 9 zo old/
z.000MPLM THIS SECTION FOR WORK IN EYmxm gu Lm"S ONLY
Addition EA*"
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Renovatkm �( Number of Starks* Renovated
Chang*in Use U/ i7 Now
Demoudon X Existing
eon stru d or renovation 7 oo g Ane per Aoar(s ) Renovated
of existirq building New
Bdat Doscripdon of Proposed Work:
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--- —----Mail Permit to: C /)�
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uss of the 8uildk+69 ///1�1C ✓�� '� —
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AnNAOft Name n /
Addm M and Phone
Medwwa Name
AddnM and Pho" HIC RspW dW•
CarWuction Supeftims ~
Es1Ynslsd�of Prate s j.�000 � Permt Fee C! +Wm
Pemdl Fee f_ ' r EsWnsled Cod X$741000 Residential
_-.. ---- — EsWnayad Cod X:41/f1006 Conrnerdd -- -An iid"ond 3&oa in=Ided to an
AdndrUMative dwg&
Make sure me a,fields are properly and I gft written to avoid delays In P vc@"Irlg.
The wwwaWted do"WOW apply for a BOOM Permit to bold to the above stabd
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CITY OF SM EM
PUBLIC PROPERTY
DEPARTMENT
KIf01�w�,w-,v L
MAYOR 130 WASONGTON STREET♦SMEK WASSACHUSEr1501970
7F1:97a-7i5-9S"9 FAX 978-740-9U6
HOMEOWNER LICENSE EXEMPTION
Please Print
Date
Job Location
Home Owner
Home Ownet Telephoner of✓� -7 5 0 0
Preseat Mailing Address ?� i9 uuto�.0 - D .
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 an eq irements.
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING INSPECTOR
See other side for state code
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C1'TY of SALEM
PUBLIC PROPRERTY
DEPARTMENT
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Conscrucdos Debris Dim" Affidavit
(mtltsimd for all damlition aad rtsnovatien watt)
in=ordom with the s4di edict=d dw Sets Building Codsi,7SO CNIA sactka It 1.3
Debris`sad the provisions of CL a iq S SIC
gWldlas pa" * _ _ is issued wilb tbs eoadidos that the debris mRd&S km
this wort shall be disposed of is a property Iicuuml waste disposal Mcility as dented by WIL e
111.S 15"
The debris will be transported by:
— JUAWAN Ot tYW W)
rhe:lcbds will be disposed of in :
l uame ur f iLty)
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