48 SCHOOL ST - BUILDING INSPECTION (2) CITY OF smym
PUBLIC PROPERTY
DEPARTMENT
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HOMEOWNER LICENSE EXEMPTION
Please Print
Date
Job Location
Home Owner Address .;yC.4.a0
Home Owner Telephone �W- 7y/ —7y3Y
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.
DEFINTPION 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 hetshe 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 anLf
ements.
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING P CTOR
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See other side for state code '
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PUBLIC PROPERTY
DEPARTMENT
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APPLICATION FOR THE REPAIR. RENOVATION CONSTRUCTION
. DR rIOLITION.OR CHANGE OF USE OR OCCIJPA Cy FOR ANY EXISTIN13
STRUCTURE OR HADING
O SITE INFORMATION
Location Names 8 S'�, Building:
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Property is looted in a;Conservation Aron YIN Historic Dh kt YM
2.0 OWNERSHIP INFORMATION
2J Owner of Land
Name: J' / R��s�a
Address:
Telephone: 3 y
3.0 COMPLETE THIS SECTION FOR WORK IN EYIBXM BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use New
Demolition Existing
Approximate year of Area per floor (sf) Renovated
construction or renovation
of existing building New
9def Description of Proposed Work:
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---------Mail Permit to: --- -
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Wtwt is the current use of the Building?
Material of Building? IL� It dwelling,how many units?
WiN the Building Conform to Law? �5 Asbestos? Xr'
Architects Name
Address and Phone ( )
Mechanies Name
Address and Phone
Construction Supervisors License 0 H lion N
Estimated Cost of Projed$ Permit Fee Calculation
Permit Fee S Estimated Cost X$7fi1000 Residential
Es*naWCostX$ili$I000Ccmmwcla
An Additional $5.00 is added as an
Administrative charge.
Make sure that all flelds are Properly and legibly written to avoid delays In processing.
The undersigned does hereby apply for a Building Permit to uild to the above stated
speciflcall". Signed under penalty of Perjury
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