16 VICTORY RD - BUILDING INSPECTION (2) What is the current use of the Building? -
Material of Building? ' If dwelling.how many un'ds?
Will the Building Conform to Law? 1`� S Asbestos? A>O -
Archited's Name
1�
Address and Phone ( )
Mechanids Name
Address and Phone
Construction Supervisors License 0 HIC Registration 0
Estimated Cost of Project SBf�52�Q=�o Permit Fee CaleuWW
� Estimated Cost X$7Ii1000 Residential
Permit Fee i
-- - -- - - - -- - Estimated Coat X 314141000 Commercial-
An Additional $5.00 Is added as an
Administrative charge.
Make sure that all fields are properly and legibly written to avoid delays In processing.
The undersigned does hereby apply for a BuildingPennjt to build to the abov stated
specifications. Signed under penalty of perjury X
Date ! d
N
0
a -on
'� ' ` �
EITY-oF - L -
- S 0 �
PUBLIC PROPERTY
G X W11 d s°0 DEPARTMENT
K,.nWJU"o.,suNu.
%"VM 1301WAUUN=WS11 E
SM&K Kst»s 01970
TEL- b745-9S"•FA=M?4(1.966
APPLICATION FOR THE REPAIR RENOVATION. CONSTRUCTION
DEMOLITION. OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Name: Building:
- -- Property Address-- -- — ---- -- -- --- --- --- - - —---
(�
Properly h in a;Conservation AMS YM tV0 Histatc Distria YM y
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land _
Name: r3 C, liee, (y e-
Address: �
(J/GTvr ens b412 j. 0 76
Telephone: j
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use New
Demolition Existing
Approximate year of Area per floor (sf) Renovated
construction or renovation
of existing building New
Bcief Description of Proposed Work:
'ems ��l woo �c� r,v;ri jf s° rie i VL j e .
Mail Permit to: — N(n p&'71-7 _ - -
CITY OF SMEM
PUBLIC PROPERTY
DEPARTMENT
new oaa�ou
Vwroa 130 WABUNGTCO S 1UW•JMEK M. AUACNL3UM 0c970
TI!:972-745-9S9S•FAX.97a.74&%*
HOMEOWNER LICENSE EXEMPTION
Please Prlet /
Data ?
Job Location /lo .�"If 6110
Home Owner Address S A e-
Home Owner Telephone
Present Mailing Address Sir A . d/ 57 2 O
The current exemption of"Homeowners"was extended to include ownw-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
stntctures accessory to such use and/or farm structures. A person who constructs more
than one home in a two year period shall not be considered a homeowner. Such
"homeowner"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 procedures and r uiremen�P� P is and that he/she
will comply with said procedures and 'cements,
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING INSPECTOR
See other side for state code