4 SCENIC AVE - BUILDING INSPECTION ti
1 "L411'IMsimlU T-eEf4L-F- N, 4PPROVED BY T*IE
m5fi,E D ,. . WR TP FJN,A.PEROT G GRANTED
a PF ,w. ,
f CITY OF SA'LEM
I6 -63
N9. U� �� ���5i Date
� 5 r
s.t. a a Ward
Nro Zoning District
Is Property Located In Location of
the Hlstgnc District? Yes_No_ Building <�
Is Property Located in
the Conservation Area? Yes No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
Repair/Replace, Other:
PLEASE FILL OUT LEGIBLY & COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the following
specifications: n
Owner's Name (r"t A?/,s
Address & Phone
Architect's Name
Address & Phone ( )
Mechanics Name
Address & Phone ( )
What Is the purpose of building?
Material of building? If a dwelling, for how many families?
Will building conform to law? Asbestos?
Estimated cost City License # State License #
Boma Improvement a n�
Lie. i
t^/-/�1•J1 gS�l afore of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO:
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CITY OF SAum
BUILDING DEPARTMENT
HOMEOWNER LICENSE EX00TION
Please Prim
DATE
SC \
oN IOB LocAn ev"
HOMEOWNER
ADDRESS
HOMEOWNER
TELEPHONE
PRESENT MAILING ADDRESS
The cwmp exemption of`homeowners"was emended to include ew tr-occupied dwelvap of TWO
Units or less and to allow such homeownas to rngage an'individual for hue wbo does not ptxtwa a
litxnse,provided that the.owner act as supwAser.
DEFINITION Of HOMEOWNER:
Person(s)who owns a parcel of land an which hdshe resides or intends to reside,on which there is,or is
intended to be,a om to two family dwelling,anached or detached structums auessM to suob use tmd1w
farm strucam.A person who constructs mom than one home in a two-yew period sball not be considered
a homeownet. Sucb`homcownd' shall'submit to the Budding Official,on a form acmptabk to ffie
Building CdBcW,that Waco be responsible to all such work pafonned under the building pami6
The undersigned`bome wner"assumes respormbility for compliance with the State Building Code and
other applicable goes by-laws,rules and regulations.
The tmdcnignod"homeowner" oertMes that hdshc undestands the City of Salem Building Depwwaeal.
minimwn b sptc-ion procedures and requirements and that hishc will comply with said ptocedum a>d
rcgWrc xuL
HOMEOWNER'S SIGNATURE
APPROVAL Of BUILDING INSPECTOR
See other side for state code
' EXEMPTION
HOMEOWNER'S
The code states that "any homeowner performing work for which a building parttit is required shall be
exempt from the provisions of this sccrion (Section 11)9.1.1-licensing of Construction Supexvisors)
Provided that is a horneommer engages a person(s)for hue to do.such work,that such boumowaer drab am
as supwisa.'
Marty horneowrters who use this UYmption are tmawarc that They are asswnm the g ?espetssr ih'nes d es
supervisor(set Appcodu Q,Rules and Regulations for I;cinsing Coostrucdon Supervisors,SectiN
.2.14 This lack of avwme_ss often results in serious problems,particularly when tht horncos =bast
unlicensed pewns. In this azc your Board=mot proceed against the unlicensed person as itwvdd wl&
licensed Supcnisor. Tbc bomtonvcr acting as supervaor it ultimately responsible
To ensure that the homeowner is fully aware of hM=responsibilities,Tarry eorrurronities regime;as pari
of the permit application,that the homemner ecrnfy that hcJsM understands the responsibilities des
supe»ism. You may care to amend and adopt such a fortr✓ecrtification for use in your commvmtty.
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