140 HIGHLAND AVE - BUILDING INSPECTION (4) a+
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AddrMt and Photo
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Addrm and Phone HiC Registration isCaNgudion SuPetviaree Lkertae d
Eatimated Cat d WORM* ,Gb a Permit FM Calar
Permlt Fee _sCI�
Esdinsod Coat X$741000 Residential
Estimated Cost X$41/:1000 CoemmdaL
An Additional$5.00 to added as an
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Make sun than an fleids are Properly and krpibly written to avoid delays In Prooasina
The undersigned does hereby apply fbr a SufldUp Pow&to bu d to the above stated
specglgtlons. Signed under penally Of PwN+ry
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PUBLIC PROPERTY
DEPARTMENTDINCULL
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r�ppLiCATI IN FOR THE REPAUt R$NOVA'I'IQN CONSTRUCTION,
DEKOLITIO&OR CHANGE OF USZ OR OCCUPANCY yQR ANy yMffl G
STRUCMR! OR BULLING
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2.0 OWNERSHIP INFORMATION
11 Owner of Land
Name: Sq✓e( io �,
Addreas: W/o filch z �
Telephone: F3! 3
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9 THIS SECTION FORWORKIN EXISIMM BUIUMNOS ONLY
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Number of Stories Renovated
Change In Use New
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Existing
e yew of Area per ffam (sf1 Renovated
or renovation ,
uilding / S New
lion of Proposed Work: jUcw � T dau A nr til rrI hd4w : 9e
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--- - ---Mail Permit to: 5a✓crrr a {ra lG�W /`f 6 L144 hrwl f}►'+e, xlwP ,, by
CITY OF SM EM
PUBLIC PROPERTY
DEPARTMENT
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HOMEOWNER LICENSE EMMPTION
Please Print
Date
Job Location r
Home Owner Addceas x e -
Home Owner Telephone —
Prescm Mailing Addreee
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 a license.provided that the owner acts as P
DEFINMON OF HOMEOWNER
Persons)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 dwellin& 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.
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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 requi ements.
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING INSPECTOR
See other side for state code
CITY OF SALEM
4
PUBLIC PROPRERTY
DEPARTMENT
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Construcdon Debris Dispossf Affidavit
(rcyuimd tot all damotition and ewwvadam Walt)
In aeconlanos with the sixth edition alto Sots Buildins Cods 730 MR saction 111.5
oari%had the provisions a(M. GL a A S A
gWkird f em b p _ _ is issued with the aond[tion duet the dcbvis rauttht01toa4
this wok shall be disposed of in a properly liaaucd waste disposal fbcility as defined by%!(it..a
111. ! 15OA.
The debris will be transported bY:
rho ckbds will be disposed of in :
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