2 RAYMOND TER - BUILDING INSPECTION (2) What is the currant use of the Budd' ?
how ma units?
Ma
terial a Building? Ifdwelrng, many
`Ft? Asbestos?
Will doBuilding orm
Conf to Law? S
Architect's Name
Address and Phone
Medtanws Name
Address and Phone
Construction Supervisors license# HIC Registration
Estimated Cost a Project$� Permit Fee Calculation
Parma Fee S Estimated Cod X$71$1000 Residential
-- - - Estlmated Cost XSt1/:1000 Commercial—
------- - -An Additional$5.00 is added as an
Administrable charge.
Make sure that an fields are properly and legibly written to avoid delays in processing.
The undersigned does hereby apply for a Building Permit to build to the a to
specifications. Signed under penally of perjury
Date
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PUBLIC PROPERTY
DEPARTMENT
ra..mF�ssv�•,••,w
MAYM 130weamrw Ms�sr•Sum 4nsrns 01970
APPLICATION FOR THE REPAIR RENOVATION, CONSTRUCnON,
DEMOLITION, OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING
STRUCTURZ OR BLUING
1.0 SITE INFORMATION
Location Name: 8uildkW
Property le located in a:Conservation Aare YM UQ HlsWft Distrlrt YM
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: Co UA4A0( cif
Address:
Z
Telephone:
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use Now
Demolition Existing
Approximate year of Area per floor NO Renovated
construction or renovation
of existing building New
add Description of Proposed Work:
---—- ---Mail Permit to: ---- -
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CITY OF SALEM
G PUBLIC PROPERTY
DEPARTMENT
Kj.Nc�.GY Nw•ry
MAYOR 130 WASONGTON snWWr•SALfi3k ASLU31v M 01970
TEL 978-73S-9S"* FAX 971.740.984
HOMEOWNER LICENSE EXEIMMON
Please Print
Date
Job Location
Home Owner Address
Home Owner Telephone — S
Present Mailing Address
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 dwellin& 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
"homeownee'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 "homeownee'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 SIGN
APPROVAL OF BUILDING INSPECTOR
See other side for state code
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SA1 EM;W.019770
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