170 FEDERAL ST - BUILDING INSPECTION S
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CITY OF SALEM
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PLem PLL OYr L INKY a OOMPL EMY TO AVM O■.AVO M IIIOO III
TO THE INVE TOR OF BLNLDUQL- '
The iridMeipned hemby apples for a pe mk to build a000iditim ft.!Flln
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DISCMI OF 1YiQIMI TO N om
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DISPOSAL OF DEBRIS APMAM
In a000e SW=wJ&the povfsbae ofMR;,a 4%SK I aclmowrb*that r a ddoa
otHm'�Ot Faedt r .an&bds natdot am ft acaa"C""t
Y�'� > Feemit Ad be digmmM offs a pop *licassed mdkj ww
dbpod iLc ft.m&sdmd by)M a In Sl.%&
1bs dabds wrlII be dfepased det Q�� Y"\ 1 Q ' oyg-�.C' 'k
Locdos d �
10• ly • 2009
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FULLY*=rub the brow ins ioAmodow
MEASBFRIDI CRMUY)
rtem.atraaedt AppBoaa;
Ffos Lima,ff mw
Amem sty s Sea
Mw above stadda ie ph s- that debea 8eom the demoliAaq rmovidoq rehab a other
&%rmdon ofbaikl'mt or stenctma be disposed in a popady-&mwW soNd vam ftad
fic ty a dedsed by I►R'f3.ca SIR&mod the bul t panft or Bosse sea a
indicam the bcadon offt heft.
CITY OF SALEM
BURDII4GDEPARTiv M
HORBOWIER LICENSE E)MOMO N
Pk=Im
DA7E
. •HOgr1EOWNER ���
ADWXW
pRE.SENtMALWD O ADDRESS
The Co"a CWMOOG of-homeowmn*was extended w bwhAt owoc,-OPWrW dwd"v OCTWO
tTnin or less and v allow such bomcownaa to awr an indfi dugl fa biR,rho dohx as pasets.
li .y w;dea t m*e owner ad as ahhpervlwa:
DEFR4rJ TI OF HCMEOW"= so reslda.oo evlSc4 dhee of b
Person O)wbo owns a pwvd of Lad ca wbkh befshe reside of iranda u is sate was of
inhcrdcd to K a one to two family dwcllbh&suadnd a daaobcd so=wu ��CMS���
farm soncnm A le tlmn pcsm wbc cmavuehs mom one bemc inOs You
s hoding o r. S OWbo/she be cspo�ashbknmap su&work paf non mda the�t i�
Building Official. •
The rmdasip d-homeowaa asrhmhe resprnhs'rV ft for wmplLnec with the State Bn9&g Code td
otba sppgcabk goes by-laws,rake and swc
The wWmiprd-bomwwfine ard5a lhc! undastds the Ciumdom ad
ty of Salem Bnik4ni De wmft.
mirumma becvoa p me cdwu and and that blsdhe will Wmply wi*Laid p
Teo
HOMEOWNER'S SIGNATllEtB
APPROVAL OF BtWINGO INSPH
Sa otha dde for sate code
. ,HOMEOWNER98 EXEAMON
The code sutes that 'wV b==waer pm forrainS wodt far wbicb o boihlinS pc w&is regoLed sba k
• exca�t 5vm the pro+isions dthis sccdos (Seetios 709.L1-13aasioS d Coastrutt{oe Supavisoss�
Pmvidcd dm is a bomeowaer c wtes p person(s)for Wm to do.such wcd6 tbat such Lomeowa"@w riot
as sapaviole
Mara bonnowners who uw Us oamptiaa we unaware that they are assmsds the levouftmil"de
svpavisoe(sec Appcodbt Q,Roks and Repinkms for l iccoslmg Coostrretfos SaperAsoM EQdN
.2.15} This lack of awwcma CAM wSults is scilmn pobkmk Psrocnhr wbea the h meoaner bb"
Uriiaased pcTsom bn tbb can your Board cwvwt proceed&Salon the mmocased paq m as kwoold via
llansed Suprnisar. 7bc bomeo+rair&bias a supervisor it altlaaase�tsstoasHlL •
To auurc that the hmaeowncr k fully aware of hilha mspmnbMties,mwW nommmddes segoiss;as past
of the peradi sppiieaamt that the komww=cr oe7ft that hcldre I a the reaper s>pmn dt
supavism. You rosy ore to aacad and adopt suet a form/«tti8otios flor we is yom coomalft