0044 SCHOOL STREET - BPA-08-523 CITY OF $mmm
PUBLIC PROPERTY
DEPARTMENT
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HOMEOWNER LICENSE EXEMPTION
Please Prlet
Date
Job Location NCI SdAme q <S� • �,, Pe rn ?4
Home Owner Address y 4 �;4,1 ec'P /fit /
Home Owner Telephone 97R - S90 -�3'f/d
Presad Mailing Address q q & . M 157'rIp rrl M
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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.
f
I 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
g
Permit.
The undersignedhomeowner"assumes responsibility for compliance expo ty phance with the State
4 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___ZL4-h�
See other side for state code
I
CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
n.v�tat air 'tam+'a►.
t!Crmtcv::.YitYBEST•iucu.AAWLIt u*0a%0r.
Construction Debris Dispose[ Affidavit
(required for all demlition and nawvadde worst)
is mcordance w ith the six&edition of the State SuMns Cods*7SO CUR section 11 I.S
Debris.and the provisions of M. GL a 44 9 A
Building petit N _ _ is issued with dw condition that the debris resulting has
this wait shall be disposed of in a property licensed waste disposal fbeility as defined by%4GL e
111, 915"
The debris will be transported by:
rho&-bds will be disposed Orin :
t o aanr of raa(aty)
:AR
PPDTMENT
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133LUIZEM On
. �.o aerE INFORMAnoN
UMMIlan Name y S c.\nov-Q S �. t3Wktlr�
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2.0 OWNERSHIP INFORMATION
Ll Owner of Land
Name: CliItota vvo M0PA�r1kJ�FLp
Address: JyV
1,5 o -&r M A 7 d
9 7 8 — S 9 o - 3 41/a
&D COW LUB THIS SECTION FOR WORK IN MUS71Wp BUILDINGS ONLY
Addition ExIadrg a
Renovadw X Number of Stadee Renovated
Change in Use New
DemoGtlon ExistingApproximate year of Area per Aoor(st) Renovated
constructlon or renovation
of existing building New
Wat Description of Proposed Work: R
� y sd-aw r,ZO-e-
Mail Permit to: HU S�i �{ S� #1 S m f 01970 -
WttsR is tt+s saran use d the BuildGg4 r .
Mat rtat ofBu�7 ulovt� n Asbw1067 Rio
wo so quac v cormm to Low?4
AtcrAods NlaM ,
Address and Phone
modonies Noma
Address and Phom HtC Reptstratlor►
Construdbn gugovmas Liesnw i
End Cod at wood a 2 O� F errnr Fw Caia+Mtlo
EWkoated Cost X$71$1000 R"WNA d
Permit Fee i Eaytna0ad Cost X it1/i1oo6 Camnsrda4
An AddNkWW$5.00 k edded as an
Admkftrodw dwga
Make sun that aU fields an Wopatt►and Ispibly yr Man to avoid delays In Ding.
The undersigned does h by My for a BuUdinp Permit to boles to the above stated
sgone Sipped under Penally Of PefWq
Data /° 7
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