24 SOUTH ST - BUILDING INSPECTION (3) i
r
IKAAM- M"STIBE fH-*D-ANO APPROVED BY T+IE
&SPECT.kDR PRIOR TO A PERMIT BEING GRANTED
CITY OF SALEM
- � -
No . � �C��. ..� i.,T^\ Date T
� I� ward
Zoning District _
Is Property Located In Location of
the Historic District? Yes_No_ Building
Is Property Located in
the Conservation Area? Yes_No
BUILDING PERMIT APPLICATION FOR:
Permit to: Pbaj
(Circle whichever apply) Roof, Reroof, Install In Construct Deck, Shed, Pool;
Repair/Replace, Othert
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
Owner's Name
Address & Phone if S,nfrl f,_s, (� i .rs M71 - _
Architect's Name
Address & Phone
Mechanics Name Ata 0 c-- 0 C dry
Address & Phone ( )
What is the purpose of building?
Material of building? If a dwelling, for how many families?
WIII building conform to law? Asbestos?
Estimated costt J City License# State License #
Home Improvement � L5�
J Lic' # Signature—a of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DE�SCRIPrTION OF WORK 0 BE DONE
MAIL PERMIT TO: �� ��
1.
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
APPRROV y�
INSPECTOR OF BUILDINGS
i
I -
4
CITY OF SALEM
BU=ING DEPARTMENT
HONMOWIERUCENSEVOYO 014
Pkase PM
DAIS �I-
• N01!w>EOWRit'A �
ADDRM
os9'F <I Ze,
Ta�llol$
pRESE►iT MARV.0 ADDRESS
was cxtade6 w i:wIw&owvct.ocn+pkd dwalep dTWO
• The nmci.cx'mW°O°�-bomeowxA �inallY�dua1�Due w1a dos aol pones tt
Units a kss and m allow such borneownaa to engAge
L'«anc,,prwidcd that the ewer set�auperviaar.
DUVMIWCFHOAEOWMe
Pcnon(s)wbo owns a pared at land on which Wsbe resides or iraends to reside.oa,vldeD k
intended m be,a arc to two family dwelfing,attached ea detadKd saucaaa S=c=M 10 loftung' t=b mMcW W
farm swacnaes.A pcnan who cortstrocts atone then one home in on s fosn am—bk 1D dt
a bomeow•na. SucD-ltomwwtte>" shalt svbrttit D su&workj radar lDe> Po
Building OffWA that bchhe be aspottsibk to aU tudt work pafaarard
The»ndcrsigmd-bomcawne asstmia responsibility for wmpliana wtilt the State Bull ft Code sd
orbs aRUcabk goa by-Iffws.ruks and usubdoM
The mdmipad-hetrcovrna"ardfm that Won tmdaststds t w City of Sakm Bu%ft Dgwu= g.
minim mu becct on pmczdma and rsquiicros and that h/shc will comply w>t>t said P10OD&IIs and
requuemeM
HOMEOWNER'S SIGNATURE
APPROVAL OF BVII.DING INSPECTOR
See outer sde for state code
HOMEOWNER'S EXEMPTION
The code states that: 'any homeowner performing wmk for which a bulldatg permit is tequhod sbaB ba
exempt from the pwo isions of this section (Section 10paa-llakosiag d Constrnetioo SapUT%Qj*
Provided that is a homeowner atgaga at perwe(s)for hire to do.such WCAC.tMt so&homtowaer sM8 act
as supevim !
bomeowners who on this cxs they assmubg + Ba da
M mption arc iumware that are the
superrasor(see Appcoda Q.Rules and Regulations for Vcr Dsiog Cooatruetiou Superrbom Seelteat
.2.14 This lack of awareness oilat tcsula in scriotm pivbii: pardcubtrV wb m the k meowuerbbw
unlicm persons. In this case yom Board cannot proceed agahtat tM w0cc tt ed pa*ost as it woubl wl&
1'tansed Suprnisa Ttx 6omeo+rocr acing as aupctviaor(a aldmate� tsaEowBsN,
To ensure that the homeowner b fully aware o1'WhearetponnbMilc .mwT eomnmddes nqobw,as
of the rmi a licati that the 1
Pc 4 pP o4 homeowner csrtify that he/she tadersartds the respousibithia da
supervisor. You may care to amend and adopt such a foradocnifiatian for use is ym cmanindW.