23 HERBERT ST - BUILDING INSPECTION (3) CrrY OF SM.EM
PUBLIC PROPERTY
DEPARTMENT
Mama 130 wAvaNGTM STUM•SAUNK NwvACHLWM 017M
71=i M7454S9S•Fan:978.740.9"
HOMEOWNER LICENSE EXEMPTION
Please Print
Date
Job Location t
Home Owner Address & C—WLI
Home Owner Telephone
Present Mailing Address C �
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 o of SaI6
Building Department minimum inspection procedures an requi hents d that he/she
will comply with said procedures and ui ents.
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING INSPECTOR
See other side for state code
CITY OF SALEM
PUBLIC PROPRERTY
DEPART-VENT
...vim a at '�a..►IL
sWom Ile 111%9
TA;v7WW)m•E.%m 96,740.9W
Construction Debris Disposal Affidavit
(required for all danwlition and renovation work)
In mconiance with the sixtb edition of the Stars Building Code.7110 CNIR section 111.S
Debris.ud the provisions of vtGL c 40.S 341
Building Permit N _ . _ is issued with the condition diet the debris resulting ftm
this week shall be disposed of in a property licensed waste disposal fbcility as defined by.%iGL c
111.S 110A.
The debris will be transported by:
tnanw of haWw) v� `�� 763
Pha debris will be disposed of in :
(name ut't'xduy)
11.4-1
CrrroF-SALEM-
PUBLIC PROPERTY
DEPARTMENT
130 VASwic 1w s,na•s N ►owssns 01•M
APPLICATION FORTH! Rp lIL RZNOYATION CONDUCTION
DILMOLmort OR CHANGE ruszoltgca, m�.
. �.o xr�INFORMATIoN
Lacallon NarrNe Sumft
---- Property Address:- �-5T 14L�T.v�
Properly Is loeabd In a:Caravallon Am Y mWaft DIWW
2.0 OWNERSHIP INFORMATION
11 Owna►of LmAd
Namw. c
Address; S3 c L&RKs wad vw(� o l 3 8
TeNphorw.
rBT!THIS SECTION FOR WORK IN "iff Ida fWILDINGs ONLY
` Number of Stories Renovated
se N"
Existing
year of Area per ROW(at) Renovated
constructlon or renovation
of existing building New
Brie�fnDescription of Proposed Work:
--- -- ---Mail Permit to. -
What Is
1M GYrent use al the Buildings What dweNkq.how"M Yflftf7� .
Material of swing~
AsbNbsT
wul the wdinci Conftm to um?
ArchNeWs Naane ( )
Addrw and Phom
Madw,ws Narne
Adds"and Phone HiC Rego+d
Cow �P'r"f'°"U/","�"/dam>n
Eat(matad Cod of Prood Psmdt FN Caloulrtlon
EsfYnated Coal X i71i1000 Residst"
Perm*Fee EsrinaOad Coat X i41/i1a0@ Camnarua�---
-- — _
An Addilional:6A0 is added as an
Adminiatadve dtarge.
Make sue than all Items are property and l * Mign to avoid delays in processing-
The undersigned do"Eby apply for a Building Permit to build to 1-1 above S:✓" /
speeiiiadom Signed under penally of perjury
Date
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