5 HILLSIDE AVE - BPA 04-1078 REBLD STAIRS Y UN
IQR W UWQ $GRANTED
CITY OF SALEM
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BUILDWG PERMIT APPLICATION FOR:
Permit to
(Carole whichever apply) Root, Reroot, Install Siding. Comma.Dock. Shad. Pool,
epalr/RWWt�Oth---------------
er.
PLEASE FILL OUT LEMBLY A COMPLETELY TO AVOID DELAYS W PROC
TO THE INSPECTOR OF BUILDINGS:
The undereliped hereby applies for a permit to build according to the tollewMe®
Owner's Name
Address& Phm " tw mr 7¢d -o¢`1
Arohitads Name
Address 3 Phan
Madmics Name
Address d Pharw
wrw Is the pupae it Pti v v L: wT '
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WE burdiq oodm.v b hw7 O 1
Ewn�.d ooM. 50-�.�py LMw„n• N A 8hM
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. Signatu
SIGNP,D UNDER THE
OF PERJURY
DESCRIPTION OF WORK TO BE DME
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TO;. 1-+ t�i-SiD
MAIL PERMIT
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No.' � ��v
AppLICATION FOR
PERW TO
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PERMIT GA7i'ED
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jjj6PECT—ORIOF BUILDINGS 1
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CITY OF SAiMA
BUILDING DEPARTMENT
HOMEOWNER LICENSE EMOTION
Pkase Prix
DATE iro O
JOB LOCATION H ,« ram �9,ns►
HOMEOWM
ADDRESS q
HOMEOWN13l 4�g 7`�0 6��9 ' •
TELEPHOW
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PRESENT MAILING ADD d Cu 1�
on of"honneowuers"was extended to include owocrocu,Fied d+relds gs o(Tw
The cunaa cxemPd for bye wbo does DO Posses S
Units a Iess and to allow such bomcowr=to mga fe an i�dividnd.
litxnse,.prvvidcd tbsa the owner ad as supervisor
DEF"MON OF Hod-I:
Peron(s)who owns a paned of Lad as which hchhc naides a Wcnds to Teske.an wM&6M 1>+
of b
inrerded to be,s arc to two farru'ly dwelling,suadrtd or dctadKd sa ucty M71 aol be oonsid w
farm soucaves.A pcnm who constructs more than ox home in a two-y Pa'
o
md
c0vIme shalt subndt w the Bulding ONKi4 oa a fotm seocpabk tq fbs
s homeowner. Such`hom tads dse buildioi P
Building OMdA that bc)shc be nspoasbk to all such work patontwd
TM undersigned"bomwwttt:t asswnes responsibility for comPrw=with the State BuBdhg Code w d
other appBcable goes by-laws,nda and rcgttlal wL
homeowner"=a m that hdshc undo vm&the City of Salem Bw'ldmg Deparoaft.
Ttu w,dasigned" wab said roadtioa and
minimmn insPecdon pro mdurm and rcgtmcatcnis and that hlS1K WIU
requircm
HOMEOWNER'S SIGNATURE
APPROVAL OF BUILDING INSPECTOR
See other sde for slate code
ya.
HOMEOWNER'S EXEMPTION
The cods states that: 'any homwowner perfoiinuig wmlk'for whicit a binding permit is regtiued ahaD be
exempt from the prmisions of Ibis section (Section 3QPXl-licensing of Constructim Superybore
Proh�i��a LamcO%ma engages a persoo-(s)for hire to do.such wwk t mt such Lameowsa dta1l ma
Merry bomeownea who'tise this exemption arc ienLat they an ring the Tcvons%M*m tit
supervisor(sec Appcodh Q,Rules and Regulaiioor for l iecoaing Conatruetioo Supervisors,Seesism
.2.24 This lack of awareness often rcrulu in scrim probkms.pardc-ob v when the homeowaerhitsa
unlicensed pcoM In Ibis ease your Board cannot pmeecd agabm ihe.mtliornsed petson as it"AA wit
licenscd Srsuprnisor. The bomeonvcr acting as supctvlsor i uhhual*. rnponsr?lL
To enskec that the honwowner is Mly aware of hVt=tespoumbilities,many eomranm$ia ftgohe..a past
Of the permit applicztiort,that the homemvner certify that behhe understands the nespotssbffldes tit
supcnisor. You may care to amcad and adopt sui b a f wiccrtidtotioet for on in your cmm=lq.
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