70 VALLEY ST - BUILDING INSPECTION t -M"ST-BE fIL-E�,APPROVED BY T44E
i ,InpEX3D.R .PMDB T-O,A .P.ERMIT.BF NG GRANTED
CITY OF SALEM
Date
n
Ward
}iV
neoo- Zoning District+
Is Property Located in Location of
the Historic District? Yes_No Building ✓� ,—
Is Property Located in /
the Conservation Area? Yea_No V
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Dec Shed ool,
Repair/Replace, Other:
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 Q�(�}ItQ J Co1b2n( 1
Address & Phone 7�p 1/ ta^t ST 3A'LO"7 (99P ) L/5- ;521 79
Architect's Name
Address & Phone ( )
Mechanics Name
Address & Phone
What is the purpose of building? sw�ryel
Material of building? lam' If a dwelling, for how many families?
Will building conform to law? Asbestos?
Estimated cost $ 9G/ City License # State License
Home Improvement
Lic. /
Signature/0 Applicant
C-)r— 15q SIGNED YNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
12)110 pS ha.& -p bp ba:l f- YI bad- 14f cat,x,� d
on
MAIL PERMIT TO: U�LLE� ST SA2El'� U/ S
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CITY OF SAL•EM
BUILDING DEPARTMENT
HOMEOWNER LICENSE EXBaTION
Please Prw
DATE 0 ;)d 03
JOB LOCATION ';f p S% S yGE7h
HOMEOPf1�R 7-0 (/ J J-T SAIE�
ADDRESS ?� �q
HOMEOWNER �7Q 1F46 �6D
TELEPHONE
PRESENT MAILING ADDRESS3LV�[L✓ S% S�L�
The c ureat.etemption of"homcaw nwC was emended to include Omer-occupied dwdGo=s of TW0
Units or less and to allow such homeowners to cnpgc an individual for biro who does cot posses m
license,.prmided that the owner ad as supervise'
DEFINITION OF HOMEOWNER:
Pcnon(s)who owns a pared of land on which he/she resides or intends to reside,on wachth ism
intended to be,a one to two family dwelling,anached or detached sauctm=saasm
farm strucnues.A person who constructs mart than one home in a two-year period shall not be considered
a homeowner. Such"homtowTel" shall submit to the Building Official,on a form acmyubk to thm
Buildin Mckl,that Wax be rssponsrble to all such work performed order the building pct�t
B
The tmdcrsignud`homeowner"assww respon-nbility for compliance with the State Building Code ttmd
other applicable got by-haws,rues and regulaticmf.
The tmdcniptd"homeowner" certifies that he/she undcrostads the City of Salem Building Dcpwvm a
minimum mgction procedures and rcgrmcmcnts and that Wshc will comply with said procedures mod
requb=waS
(/
HOMEOWNER'S SIGNATURE
APPROVAL OF BUILDING IMPE ,
Sec other sae for state code
E
HOMEOWNER'S EXEMPTION ,
The code states that "any homeowner performing work for which a building permit is required shall be
exempt from the ptmisions of this section (Section 109.1.1-1icensipi rd Construction Supervisors);
Prodded that is a homeoazter cngages per-son (s)for hue to do.such work,that sucb bomeowm shall ad
.a
as supaviwa '
Many bomcow=n who use this cxcmption are unaware that thry arc aworning the tespons%ilitles are
" od'u Rule and R latiOnO for I,i¢opio Construction Su SeCOOK
surpervisor (xe Appe Q, c8° g' P°i�OTi, .
.2.14 This lack of awareness often results in serious probleias;particularly when the horneoroerrer bhu
urilicensed persons. In ibis rase your Board cannot proceed against the r Xcrosed pawn as it wadd witL
licensed Supenisor. 71rc homemrocr acting as supervisor is uhimatdy rnponsibh.
To ensue that the horocowner is fully aware of Wher respons%ilities,marry communities squire:as pan
of the permit application,that the homeowner certify that helshe understands the ssponsibitides eta
supcnisor. You may care to amend and adopt such a foMVccnifrcation for use in)"Mu eonun=AQr.