6 VICTORY RD - BUILDING INSPECTION � ,: •
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fLiM/6itll�6*f3Ef�L£ P110OVE�Y T44E A !;
JALSIP. =611,ffif1DRF3 7D' .P. IEINC GRANTED
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CITY OF SALEM
y�� J .'� Data No.
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is Pmperty Located in Location of 1
the Historic District? Yak_No_ &landing
Is Property Coated In +
Me Carwrvalon Are? Yaa_No V
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Sidin truct D
S ; ed, Fool,
VRepair/Replace, Othe I-6 PLEASE FILL OUT LEGIBLY&COMPLETELY TO A ID DELAYS IN P,ROCEtI{ Ia
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the following
specifications::
Owner's Name I nDmits Ccfivn/i4, Cl-�"l
Address & Phone l V! c7a7eY ep Sa(ewe (97e)
Architect's Name
Address & Phone \
Mechanics Name 7, cw\ O L�
Address & Phone
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What Is the purpose d building? -- ?
Matedd d bu kWV? n a dwAM,for how many famine?
WW bulldirg cordorm to law? Aahedoa?
Edmated cost`/9D 0, cny umm r N �'' State uowne M
1.
Hama Iaproveeent
i rA\ Signature-of Applicant
SIGNED UNDERTHd PlgN4Wl
I
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
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� Tijil MAIL PERMIT TO ,
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APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED'
AP7.1iOVFD
INSPECTOR OF BUILDINGS
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CTPY OF SAUX
BUILDING DEPARTMENT
IiOIvIF,OVTIdFR LICENSE E?�'I70N '
Please Prat
DATE ���D � Q
IOBLOCAnON
. • Nol�owlmt � � V! c�,e y �� Stele�•-, .
ADDRPSE
TEIEPHOM /
PRESENT W ILNG ADDRESS
The cw.T=g cNcmpdon of"bomtawners"was c-Nuuded to include owoeroccuPkd dwfN V CrTM
Units or less and to slow such bomeow=s to engage an iTd'mdualfaa biro who does toot POOH t
L'ecnse,.ymvided that the owner ad as superviwt•.
DEM;rn0N of HONEOVI SM,
which hcJslu resid
or b
Person(s)who awns a parcel of land on es ar rounds 10 reside,anwhlt3r k
inicndod to be,a otte to two family dwelling,attached or dcucltod smrrd cs SCOMM
f od shall twt be eorutdered
farm mucr=.A person who construes mom than out home at at� Pc^
a homoo m=- Such"homeow-r-f shall'submit to the Bulding on a form acmptatk to tl e
Building Meal,that hdshc be nspoTmblc to all such work paiorsaed tmda the building p=ft
The undmipcd'bomcrnrnta"mwnrs respombility for compliar=with the State Bn9dmg Code w d
othu applicable goes by-laws,Hiles and rcgulatioM
The undersigned`homeowner"corti5cs that hclshc undue City of Salem BnWing Dgwvoca.
minimum irapction proczdures and rgtiucntcnu and that WX wM comely frith said ptoa&ues m d
nqwT=KMM
K�
HOMEOVINMIS SIGNA111RE
APPROVAL OF BUIl.DING INSPECTOR
Sec otber sde for start C06C
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HOMEOWNER'S EXEMPTION
The code states that: "aT homeowner performing work for.vhich a bru'ldmg permit is required shall be
cxcmpt from the prmisionS of this sccdon (Section 1Up]-Ilicensiop,of Construction Superrbort);
Provided%bat is a bomcowacr engages s person (s)for h'uc to dO-S%A work that sueb bomeawaa slrap tee
Many bon.== rcu wbo use this aTmpdon are i owvm c%bat they arc=ssmning tht=ponsibilroes df
supervisor (eec Appcodia Q,Rulen and Rcgulstions for UcznsinY CoosiNCtion Superriwr$,SeclieQ
.2.14 This lack cf awareness ofica nsOu is serious problems,pw-dculariy when the homeowner bare{
Wkcnsed pers m In ibis case your Board m mot proceed abairrtst the nr Ucctssed person as tt world wft
licensed Super isCT. The bomcowocr suing as supervisor.bt ohlmately renpoosibiL
To ensue that the homeowner is fully aware of Mfhu rcpon_nbilities,marry commm ides regrme;as peal
of the perm9t appliczoon,that the homeo vner ecrnfy that hdshe undcrsrards%be responsrbilitia oft
supcniwr. You may cart to amend and adopt sui b a fonrJani'w26on for use in yarn eotrtmu ft-
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