98 RUSSELL DR - BUILDING INSPECTION . 1
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CITY OF SALEM
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PUMU!LL OUT U10MLY a COMPUDI LY TO AVOW 0M AV8 N PR0W�
TO THE INSPECTOR OF BULDIN(i8:
Dhereby apMaa fora pamik to bukd aocord%to ft.lmlo-1
OMNnrb Name l� ��D
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Address a No ( 1
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• Wi J OF SALEM
BUMNGDEPARTIv M
liMMOWNEIL UCENSE MMOMO'N
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IOBLOCATION L--2� �cJSSP�/
HOMEO' M
ADMMW
HONTMWM ` 7 7 7 J r/Oj C
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PRESENTMAn.D?G ADORES=
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The c m m c..Ooo of-bumtawi?M "was cxuWa w r-""Oa dTWO
UaWu cr lest nd 0 allow mcb bmoeow DM w CnPVg an bWWAW*gb'MWW dace MMPONM&
.ymvided toss the ewma act as wPervfsm
DEFIrfffM OF HOMEOWHM as Pena(s)who owns a parcel of land oa which btddw resides or itvcr&w teslde.an w So fiidNh h,nteh tote swdl b
end tone
inted be,a o to two finit dwclgn&suadad a dctad"muctwesor
nol be coosldnd
farm swacotres.A pcnat who constructs m=than one home in a ewo-ym poled
a bomeowm. Stilt jwmcovmf O&V subn*to the B uDd3ng Ofm:bl,CDs fbM atzcPWft to tlstt
Bw1ding 011icid.tbat WOM be nspmmbk w all salt work paknoW ttnda dtc buildba Wm
TM undersipcd'bcvwaw=f Mumes respormbWq fat=npnw=with the Stase Bttilft Code ttd
aLha appGobk goes by-laws,tttla aced ter&SoM
Thc ttndcrsigned-Mmwwnet"ct!Mfm that Wshc wdostards the Ciq of Salem Bnildlog Depwoust.
n=mttm inspavon procsdwa and retl*=xms and that Wshc va=9V with said prooedma wd
regttirmta
HONMWNER'S SIGNATURE
APPROVAL OF BUILDING INSPECTOR
Sec other side im Me code
P
HOMEOWNER'S EXEMPTION
The cods hats tbw •any homeowner pafa riq wmk for v Aieb a bailfmt paw*is nqoted sa W
cnzvt from the po+iswta of this secdon (Session 30YA.1-IJaoslot of Connnmim Supavinro;
provided that is a horneowna enpeja i person(S)tot Mm to do.such wesk tba sir&bonwowaa*M atS
as x9adsme.
MwW borneewm=who sae this caemp3oo are ivmwm to tbcy are asstontat the ftwousbown.da -
sapavim(sec Appeodb Q,Ruks and Retulatlooa tot LiocOslDg Coosimcdom SupervboM Eaedaa
.2.24 Ibis bu#cf swamies d}ka nn tts is serious probkms.pardeuhrly w'hm d a homeowner bb"
unliaased persons In this ease yoeo Bwrd tarmot posed aSanal ft muxemeo papa at ftwould wlt
licemw Sapa►isa. The boumwbcr saint as supervisor b oldaste�sssEosnNfa,
To etuurt that the limneowncr b fldbr sward of h1Ata responsrbAltia,mmy oosommddes raluhs;as past
of the pcmdl applkadM that d►c b meowna cadiyr that behtte urAern reds the respaasibnma eta
supavbw. You may care to anmA and adopt suib a totm/ardfmdon fix un in yom coommdOr
rvsuc rmwup TT D[FAIrrmu T
120 VAUNINOM INTaaaT osan FLOOR
swLsw to of a►ri
M.(979)749-MOB OLT.aW
FAX (s741)740 0"
=TAN aLrMAr dR'• - - --- - — - - -
DLSPOM OF DEBRS AFFIDAVIT
In accordance with&a povidma ofMM a 4%SK I admowledp that a a ccnditim
otBAft Permit/ .a3&b&reaaft from the contraction aclf *
"mad by We Bm'l ft Permit be disposed of m a popatbr licmaed aolidavasb
d*wd 8dliey.as&dmd by MM c E%III-%&
The debda.vID be diapered dad � .
o
. Loca>am atFaa'ligr .
atPermit Applicant Dad.
FULLY complete ere fonowies bhmratio@L
OULASB PRDfr CLEARLY)
T-C Y ✓�_ Q� � 5
Name ofPamait AppNont
Pha Name,if mly
� (3 eu�ss-e ( ( fir. � �,,, VAAJI�-
Add<e..City!stab
The above sWW requires dial debris foam the donohoM r ooranoq rehab err odmr
akwWm ofbmlft or airncum be diapered in a propaiy-Hcenaad solid wab diaponl
Sa7Ry a.dewed by MOL cIR SIR&and the brrrWmj' palnia or Hcomme are to
hmseatr 66 bcadm of the ha9b.