35 GALLOWS HILL RD - BUILDING INSPECTIONr
V ;.
NS ini;,',ik
A. ;
1 n::
� t
fL'f1�f1611AbST'BEm ppm—VED BY Tw r,
JdSI'ELLC�FI oIAR�JDE .REWf3 GRANTED
CITY OF SALEM
Dft
Location Of
1W WMab DWdd?h Y�s�No mondial 3S C,;*11 1uj hill
N Pmopoty Loodw in
memo CO NWAdgn Am? Yams_No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Rarcof, Install Siding, Construct.Deck, Shed, Pool
Repalr/Replace. Othar.'
PLEASE FILL OUT LEGIBLY A COMPLETELY TO AVOID DELAYS IN PROC K""
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the following
speciflcatlons:
Owners Name e, e, -t 1 arena
Address & Phone IS Galloia� A// fR 0 7 ys C-7�.
Architect's Name
Address 3 Phone
Mechanics Name Oregh
Address & Phone
Whd Is Mw p Apm d b~
L�MrW of bmrlm/mmp? M a dwolYlp,for how nary famm"?
WN km*v conform lO law? !! l
A
f nmm>Jad aod Coy uoa #N r
some LRmweamat
Lie. f IrYr� ,
ature of Applicant
SIGNgD UNDER THE P1111111110"'
OF PERJURY U
DESCRIPTION OF WORK TOO/BE DONE/ ]
{ ;a
;i
MAIL PERMIT TO: (xlfo.r✓J dill
ra
Y Y'
JL
.}. • '" ter... !•.
No.
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
APP Vf D
INSPECTOR OF BUILDINGS
s
• .
CITY OF SAUX
B=ING DEPARTN04T
IiU E.0WNER LICENSE E)10N
Pkaso Pry
.JOB l OCATION
. ' Hohgowlmt 35 ��I �u.� . /1r.2� P� •
ADDRESS
HOMEoivm 7 Y / / Y S— 2L
TEl EPHOM
PRESENT MA LW.G ADDRESS -
The cw ad c.%em0ogj of'homcowacre was cmcnded to include tnroetwewpied dwelm'P o[TM
Uniu or less and to allow such homeowners to engage an iTd'mdusl for lfim who dtra not posses f
Umnse,.prmvidcd tbm the owtsei act as superviwe.
DErWMON OF HOMHOWNM*
Pcrstm(s)who owns a pulml of land on which he/she resides a intends to reside,on whkh Iffim kr
internded to be,a am to two fondly dwclliag,attached of dctachtd suumm a
farm suvcwm A person who construcu more,than out home in a two-year Pclod sho na be consldead
a bomcowtter. Such`homeowaef shall•submit w the Building Of KK on a ftntm X= tabk 10**
Building Official,that bcJshc be tcspon%bk to all such work paforsncd wda the hOdmg pa=k
Tbe undasigncd`bomtowncf ass==rC!TMnbility for comPliartcc withthe Stale BnD&g Code nod
otha applicable goes by-bMS,rult s and TegulatiM&
The tmdasigncd-homeow•rra"ceracs that he/she unda=nds the City of Salem BwWzgDeParoasl
minimum inspection procedures and MQUITrIntnu and that Nshc will comply with said prooc&m and
rtxltrvtarc a
HOMEOWNER'S SIGNATURE --
APPROVAL OF BUILDING INSPECTOR
See rather side for state code
HOMEOWNER'S EXEMPTION
The code states that• `any homeowner performing work for which a building permit is regimed sbaS be
exempt from the prmisions of Ibis section (Section 31*.11-llecusiog of Conauvctiou Supervisors ;
Provided that is a LomeovMc,engages a person (s)for hire to do.such work,That sueb homeowau shall so
as sqayi�
MET knxvw=u wbo use this ca�cn on are unaware tbat they an anulvi rg the?tspomibillm ofa
stitper.. . (see Appcndh Q,Rules and ReVistious for]UcLnsiog Coostrucdon Soperv6osa,Sectha
,2a Ibis lack of awa=css oficn nnilu in serious problcmt,part9eulAY whoa the bombownu bird
Uriianse. persons In tbis ease your Board m mot proaxd against the wiliecas. person m It world�
Hawed Suprnisor. 7u bomtewbcr&ding as superviwr b uldaoatej rnpooslbit
To enure that the hcmeowner is fully swam of hither nspon sibli lies,many cer=wities regnae:as pal
of the perm3t applieddoq that the homeowner certify that Wshe tndmtands The Tcsponsibilida eta
supcnisor. You may cart to amend and adopt such a formlonlTwtioa for we in yrnv cm IQ,