9 WINTER ISLAND RD - BUILDING INSPECTION G✓�_�� CITY OF SALEM
PUBLIC PROPERTY
DEPARTMENT
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130 WAWNC"STU"•Snu+x M&UACHMM 01970
Ta-978.74S-9S9S*Fnx:970-74&9&4
HOMEOWNER LICENSE EXEIMMON
Please Print
Date o �
Job Location 9 r✓%qi ev �� �•� �! !�
Home Owner Address Ste»+e
Home Owner Telephone -7 g 5 o 6 S G
Present Mailing Address 9
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 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 fort 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 requirements and 'that he/she
will comply with said procedures and requirements.
HOMEOWNERS SIGNATURE CZA,-, O
APPROVAL OF BUILDING INSPECTOR
See other side for state code
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C;IT`Y-OF�XLE,ti -
PUBLIC PROPERTY
DEPARTMENT
NArae
TEL-97e-74S•9S9S•FAW M740480
APPLICATION FOR THE RElAHL RENOVATI N CONSTRUCTION
DEMOLITION, OR CHANGE OF USE OR OCCUPANCy FOR ANY EMIN
STRUCM- Z OR BUILDING
1.0 SITE INFORMATION
Location Name: 9 W:nr^ev 151 S
_ _ PrOpeny Address: _
property Is bested In s:Corawvadon Ares Y/N -,)r _Hletorio obbid YIN
12.0 OWNERSHIP INFORMATION
2.iOwnerotLand �iyh �C'GeviL y�
Name: �n Pete✓/e h
Address:
Telephone: 9 2 r 7 41S O&S
K3.0,�COMPLETE THIS SECTION FOR WORK IN EYIS.LNG BUILDINGS ONLY
Existing
Number of Stories Renovated
se New
Existing
Approximate year of Area per floor NO Renovated
construction or renovation I
of existing building New
Met Description of proposed Work:
/ 1 P/Ja//',$ •ram see+ +.✓o//
-- - -- Mail Permit to: r✓ yeN FS/.� /c'/� - — -
What is the current use of the Building? If dwelling,tww many units?
Material of Building? Asbestos?
W o the Building Conform to Law?
Architeds Name A
Address and Phone
Meehanie's Name
Address and Phone
C HIC Registration fr
onstnration Supervisors License 0
Estimated Cod of Projed i
000 permit Fee C CUMM al
permit Fee i � Estimated Cost X$7/$1000 Residential
Estimated Cod X i11/i1000 Commercial
- An Additional$5.00 is added as an
Administrative charge•
Make sure that all fields are property and legibly written to avoid delays in processing:
The undersigned does hereby apply for a Building permit to build to the above
stated
Signed specilicatlons. S ned under penalty of perjury & " /�%�'�`�v'
Date
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