14 SCOTIA ST - BUILDING INSPECTION fL�Ms VHO BY T*E
AENQ GRANTED
.CITY OF SALEM
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MALMO PERMIT APPLICATION FOR: '
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(Carole whlchewr apply) Roof, RoW, Install SWXI, CwWM.De* Shad, Poll,
RepoldRophoa. Other.'
PLEASE FILL OUT LEGIBLY A COMPLETELY TO AVOID DELAYS N PWOWW r
TO THE INSPECTOR B I. of u Lalloa
The untlersomcl hereby applies. for a permit to build accord ng to the bNewing
Owmws Name
Address A ftm L C tl , L, 01)7 t1L 0 V Gi
Architect's Name
Address 3 Phone ( 1
Mechanics Names .�
Address A Phone
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SIGNgD UNDER THE
OF PERJURY
DESCRIPTION OR WORK TO BE DONE
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MAIL PERMIT TO. /
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Cn;y OF SALEM
WADING DEPARTMM
HOMEOWNER UCENSE MMaTION
Please Prat
JOBHOMEOWHM
iocAnoN
ADDRESS
TELEPHOM
PRESENTMAILWG ADDRESS
on as -------------------
-Tientowm was t= ded to include owser�occupkd dwty"v otTwo
The aarad.rxcmpd " *r bite wbo don toot paws a
Unlu a]as and to allow arch homeowners to CWF an utdi+idayi
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Iccuvyruvided ttw the swsa act as superviws.
DEFW1770N OF HOMEOWNFJt an wbkht wt I;w h
Person(s)who owns a pw=l of land on wbieb hclahe resides or iruends u reaidt,my to tart tat s7dlar
intended w bt.a one to two family dw"gng,araclaed or detached smscnvrs od sbaU not be tsr►sidered
farm sovcwm A person wbo constructs mars than ont bomc in s tvro y PeA
Sueb`homcoa� shalt submdt to the Butldiag ofkcb .oa a form s�ptebk to*7
a boraeowaer. order the buUdmg paatlL
Building OSu4 that brJshe be tuporutbk to sU soedt work ptzfonatd
The tmdcrsigntd'bouxowncr"asswm tzsponsnbility for campllw=wilt the State Bmnt>3ag Code mad
other applicable goes by-law6 rules sad njuladooL
The undcsigncd"homeownd'=-dS s that hdaw undasrards the City of Sak=Bnildmg Dgwumd.
oa arcs and rcq ' rds and that Vsht WW comply with said proabma and
. minimwa iraspati procul
rcquireaa�t.
1 L�:
HOMEOWNER'S SIGNATURE
APPROVAL OF BLMMING INSPECTOR
Sa otber side for State code
HOMEOWNER'S EXEMMON
The code states thaC 'any homeowner performing work for which a building permil is mgnmd slmfl be
e. from the isiems of this section Section 1 .] — 'censin of oosuuet'urnpt Pm' ( g9 a. L g C ion SnPeTvltori).
Provided that is a homemmer cn Pr ea a person s for bae to do.such that sireb
Y,88 . Pc ( ) w'mlt, bomeopaer shall
. tlr allpQVlaa� _
• Many bonwowtncra who use IMS exemption are umware that thq are asswuing the rC90 Ica
rtrpervisor(see Appcodls Q,Rules and Regulatiow for Liceuaiog Coustruet{on Superdsors,Sec*G
.3.33} This lack of swaroms often xsulu in serious probkms,particularly when the bomeowner%W
urike ued peram In Ibis ease your Board cam of proceed agaaat the milieeased person w k wtadd w ft
licensed Supevisor. 71pe bomeo+rocr acting as supervisor is ultfmatelbr rsyEoos ,
To ensue that the homeowner Is fully aware of bAcr rcrponnbMiles,marry c min dS=reep he,w pant
of rye permil application.that the homeowner certify that lu she UrA=Starrds the responsibnwas of s
supervisor. You may are to amend and adopt such a formlccnTiiation for on in yav eonummk,