212 CANAL ST - BUILDING PERMIT APP ' �.• �PPR' r r Aft
fL'/t[IS f'BE VIED BY T4IE
JIlL3PJE IQR� '. WING GRANTED �
CITY OF SAtEM
LAI
raeaeion of
on'- 'm 'n (y al4 hLl
M►I"mM Loo.bd h
cmwwr.11gn M..'r Yw�No.
BUILDING PERMIT APPLICATION FOR:
Perk to:
(Circle whichaver a") Roof, Rwroof, Instal S Inc, Construct_Dock, Shad, Pool,
Repair/Replace, Othsr, ---. ou �
PLEASE FILL OUT LEGIBLY•COMPLETELY TO AVOID DELAYS IN PROCv@W r
TO THE INSPECTOR OF BUILDINGS:
The umWsVW hmW applies for a penrrk to build according to the folfcI
OMxrsr'e Name e—J/ l l E i -4ah L
Address A Phone off, I a 60I 6 � . ` (a 7f/,L�770
Architect's Name
Address 3 Phone f )
Mechanics Nam*
Address & PhoM
-�1• i
VNwI N ft prpoN d
mdo"or buNdlg4 N•dw.Ntq,for how mmy I.mr..4
Mir b Adkq omfam blow?
E.NnMI.dlow.�__CRY Uoww• N A WAb Ub •
Lie.
ie X41iII
ature of Applicsrit
UNDER THE wool.
r OF PERJURY
DESCRIPTION OF WORK TO BE DONE
.a
.a
pb i
MAIL PERMIT TO' r
h
r 5
NO.'C _d��V�
APPLICATION FOR
PERMIT TO
Cr�,�y Sl
LOCATION
.
PERMIT GRANTED
APP
I PECTOR 6F BUILDINGS
,
CITY OF SAlEM
BUILDING DEPARTMENT
HOMEOWNER LICENSE omanON
Please Pratt
DATE �� n
30B LOCAMpN �� /I SIX c
HOMSOWm C't
ADDRESS �
momcowm
TELEPHONE ( n
PRESENTMAnJNG ADDRESS c
The etatcrd ocempdon of"howmawucrC was extended to include owoa•ocwpkd dwcMiV dTWO
Units or less and to allow such homeowms to engage an ind4vhdial for Ldte wbo doa tool poswa d
license,.provided that the oweer act as supervisor.
DEFn4rnON OF HOMEOWNM*
Pctsom(s)who owns a pw=l of land on which hdshc trsides or intends to taide,on which 1%cc b
intended to be,a one to two family dwelling attached os detached smxttaa sxusM
to farm strucwm A person who constructs most than one home in a two-year period sball mt be eonsibaed
a homeovma. Such`homcmnrf "- 'submit to the Binding Official,on a form setxpabk 10 to
Building Official,that hclshe be ntsponsible to all such work pafcnwA ttrtda the bttiltliag peradL
The tmdcrsipad'bomeowner"asrames resporunbility for comp]i with the StateBnDtfmg Code ttsad
other applicable goes by-lawn,riles and ngulatitms
The hmdcsigncd"homeowner"certifies that lulshe undcstatds the City of Salem BwWq Dgwunc i
minimum inspation pros rdttms and requirements and that Wshe will comply with said ptom&aw w d
regtti =ma
HOMEOWNER'S SIGNATURE47
/iILC�
APPROVAL OF BUILDING INSPECTOR J
Sec other side for state rode
HOMEON"ER'S EXENEMON
The code sutes that' `aT homeowner performing work fm Nvhicb a buDdiag permit is regtmmd sball be
czcmpt from the pro+'isioaS of this See (Scnion 7*1.1-liccosimg of Coastruetion Supervlror>s);
Provided tbat is a homeo mu engages a person (s)let Nut to do.suck work,that such homeowner Sham 84
Many bomeowners wbo use this cxcmption arc iumvart that they an asmdmg the tespaaS ties
supervisor (sec Appcmdh Q,Ruks amd Regvla8oms for 1,iecosiog Coostruetion SuperAsors,Secliw
.2 4 This hack of awareness often rcstlu in serious prmbkms,paroeubAY wben the horns wm Lint
unikoised persons. In iYu ease your Board cumot proceed against the wXmnsed person as it S+truid wish
licensed Supm'isor. Tbt beanwatr saint as svpervbor Is ukimst!V respomsibha.
To ensw a that the homeowner is fully Swart of lln=respobnbilides,rttarry aommtudde s req*r,'as P"
Of the peanut applimtion,that the bomemvrur certify that he/she tmderstmrds the responsibilities eta
supervisor. You may care to amend and adopt s»cb S fora✓cmifk2tiou for um in your eonmamby.
I