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17 FLINT ST - BUILDING INSPECTION (3) CITY OF SM.EM PUBLIC PROPERTY DEPARTMENT KIlMEiLfiY n�w•n� NAroa 130 wAS W=M SIMM•SAUZIK N&%U34L M 01970 4 7Va:978.745-9S"9 FAx 979-740.96" HOMEOWNER LICENSE EXEMPTION Please Print Date �; a 0 0 Job Location 4 n T Sr Home Owner Address Home Owner Telephone 4 Present Mailing Address 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 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 requirements and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE T APPROVAL OF BUILDING INS CTOR See other side for state code CITY OF SALEM PUBLIC PROPRERTY DEPARTMENT a�t t. A%wm tic vr..9 ::ot►5aeer•a•usn.N�vpt u.r��a,:ar. T1a:v7NaiaS9! •F.nc 97W�G9W Construction Debris Disposs t .Affidavit (required for all demolition.and renovation work) In aceoniaace with the sixth edition of the State Building Code.7S0 CNIR section 111.5 OeMs,and the provisions of M. GL a 40.S 5* 0uildinS Permit N _ is issued with the condition disc the debris resulting f m this wok shall be disposed of in a properly licensed waste disposal facility as defined by U. GL c l l 1. S 130A. The debris will be transported by: 4e rho debris will be disposed of in : al 6 f> ht�me of ia.aGty) EITr©F PUBLIC PROPERTY DEPAR'I11��1T 77 KI\ACM CV DRISCO 1 MAYOR 130 WASMINGTM STIEW•SAtbyX%UAou;sars01970 Trw 97a.UMM•PAM 97a.740.9Ne APPLICATION FOR THR REPAIR. RENOYAn-( N_ CONSTRUCTION Dw- OLM—ON, OR CHANGE OF USR OR OCCUPANCY. FOR ANY EXISTING STRUCTURE OR BUILDING 1.0 SITE INFORMATION ' Location Name: / t,, Building: Property Address.- Property Is located In a:Conservation Area YM _Historic Digrld YM 2.0 OWNERSHIP INFORMATION 2.1 Owner of Land Name: jc- T �S c Address LT"=phww. (Ne S 17174Z 3.000MPLETE THIS SECTION FOR WORK IN E]IlSLNti BUILDINGS ONLY Addition Existing Renovation JNumber of Stories Renovated Change in Use Now. Demolition Existing Approximate year of Area per floor (af) Renovated construction or renovation of existing building New 8dd Description of Proposed Work: 2P6 fa 4rzi j�V C / O Mail Permit to: o /�/e What is the current use of the Building? Material of Building? it dweluM how many units? WiU the Building Conform to Law? Asbestos? - Architeas Name Address and Phone Meeba Wo Name Address and Phone Construction Supervisors License N HIC Registration 0 Estimated Cost of Projed i od- od Parma Fee Caleulatlon Permit Fee S °5`O5`�111L Estimated Cost X S71$1000 Residential --- Estimated Cost X$11/S1000 CommercW— An Additional $5.00 is added as an Administrative charge. Make sure that all flak[@ are properly and legibly written to avoid delays in processing. The undersigned does hereby apply for a Building Permit to build to the above stated ,� specifications. Signed under penalty of Perjury Date a Qo of N a y A d - --