20 SYMONDS ST - BUILDING INSPECTION (2) CITY OF SM.EM
PUBLIC PROPERTY
DEPARTMENT
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HOMEOWNER LICENSE EXEINIP'I'ION
Please Print
Date y �•
Job Location
Home Owner Address
Home Owner Telephone 97 - -
Presant 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.
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 fora structures. A person who constructs more
than one home in a two year period shall not be considered a homeowner. Such
"homeownee'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
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 procedur and requirements and that he/she
will comply with said procedures and requi emen -
HOMEOWNERS SIGATuaR It,Al. 11A
APPROVAL OF BUILDING INSPECTOR
See other side for state code
CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
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Construction Debris Disposaf Aftidavit
(rcyuired for all demolition and renovation wont)
In accordance with the sixth edition o(dw State Building CodR,7SO CUR section I I I.S
Debris,and the provisions of M. GL a 40,S S*
Building Permit A _ . _ is issued with the condition that the debris resulting itom
this work shall be disposed of in a property licensed waste disposal Freility as dented by%1GL c
I l 1. S 130A.
The debris will be transported by:
kO4tmulerl
the&-bds will be disposed of in
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PUBLIC PROPERTY
DEPARTMENT
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TEL 971.745-9M*PAZ M74&9M
APPLICATION FOR THE REPAHL RENOYATIDN_ C_ NSTRUCTION
DE,,MOLITION. OR CHANGE OF USE OR OCCUPANCY_ FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Narrm f3uikling:
--- -- - - - -- - - - -----
Proputy le kxwted In a;Conservation Area Y Hlstorlc Olstrict
2.0 OWNERSHIP INFORMATION
4.1 Owner of Land 411,
`
Name:
Address:
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Telephone: 7LIO _ b
&0 COMPLETE THIB SECTION FOR WORK IN EYIBI1MLi BUILDINGS ONLY
Addition Existing
Renovation ANumber of Stories Renovated
Change in Use Z New.
Demolition Existing
Approximate year of Area per floor (sf) Renovated
construction or renovation
of existing building / 0 , New
Brief Description of Proposed Work:
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A I So ritiut Q— ;J ck-Q 1oC o W r�btJ
--- —- ---Mail Permit to:
What is the eurtent use of the ui►ding?
Material of Building? W� It dwelling,how many units? -
WiM the Building Conform to law? Asbestos? DI
Archited's Name
Address and Phone l 1
Mechanic's Name
Address and Phone
Construction Supervisors license d HIC Registration
Estimated Cost of Projed$ DO Permit Fee Calculation
Permit Fee: 7 'O O Estimated Cost X$7/$1000 Residential_ Estimated Cost X$11/111000 C4nwwcia4------
An Additional $5.00 is added as an
Administrative charge.
a/ Y Make sure all fields are properly and legibly wrliten to avoid delays in processing.
that
The undersigned does hereby apply for a Building Permit to build to the above state
ific d
specifications. Signed under penalty of perjury "-�
Date
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