403 LAFAYETTE - BUILDING INSPECTION -PL-tflS1ftfST13Ef4L+0-*ND APPROVED BY 744E
,WSPZj;JDB PRIDA TP A.PERMIT BEING GRANTED
CITY OF SALEM
No.- -�—� :t Date
Is Property Located in Location of
the Historic District? Yes No_ ins
Is Property Located in
the Conservation Area? Yes No_
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroo , Install Siding, Construct Deck, Shed, Pool,
Repair ace, Other:
PLEASE FILL OUT LEGIBLY &COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the following
specifications:
Owner's Name ��
Address & Phone
Architect's Name
Address & Phone L
Mechanics Name
Address & Phone
What is the purpose of building?
Material of building? If a dwelling,for how many families?
Will building condorm to law? Asbestos?
Estimated cost City License x N A state License R
Rom improvement t ✓ e f 1
Lic.
Signaftire of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESC ON OF WORK TO BE DONE
e 11�34�
MAIL PERMIT TO: i (/h O/l
No. ��v
APPLICATION FOR
RMIT TO
LOCATION" /
� G &S'
PERMIT RANTED
AP ROVfD
ECTOR OF BUILDINGS
4
c 1
CITY OF SALEM
BUILDING DEPARTMENT
HOMEOWNER LICENSE E? EMYI70N
Please Pry
DATE C7(�
JOB LOCATION �'7 y� � CA P )
HOMEOWNER `\Cti✓11 � _
ADDRESS ^
HOMEOWNER
TELEPHONE
PRESENT MAILING ADDRESS
The Owrent,cmmption of`homt owvas"was octended to include owmr-ae"Pited dwcMop o[TWID
Units or less and to allow such homeowners to engage an individual for hire who does not posses;R
license,provided thaw the owner ad as soPerviwr.
DEFIl'ITfION OF HOMEOWNER
Pcrson(s)who owns a parcel of land on which he/she resides or intends to*elide+on which is1 .
intended to be,a one to two family dwelling,atmdkcd of dctadred mucmes od shall ml h considered
farm structures.A person who constructs more than one home in a two-yearp�
a homeawma. Such"homcoWiut" shall'subnnt to the Building 015621,on s form seceptabit to*A
Building Official,that Wshe be rcryonsibie to all such work perfOTIPA tinder the badwg pemlL
The undasigrxd`honrmw'ncr"assumes responsbility for compliance with the State Building Code tmd
otha applicable goes by-laws,rules and rcgu121SOM
The undenid"hotncow•nef"Ocrafics that he/she undcsra
gru n&the City of Salem Bulldmg Deparumml.
minimum Vopation procedures and rcquirrcm M and that hlshc will comply with said procc&ves rind
HOMEOWNER'S SIGNATURE �`7 G I� �t f
APPROVAL OF BUILDING INSPECTOR C
See other sde for stau code
HOMEOWNER'S EXEMPTION
The code slates that "any homeowner performing work for which a building permit is required shall be
exempt from the proNisionts of this section (Section 109.11-Uccnsing of Coustrucdoo Supervisors);
provided that is a homeowner engages a person (s)for hire to do,such work,that such homeowner am act
8s SapeNrfQ.�
Many bomeowners who use this exemption an i nawarc that they are&wwuistg the Trsj)ow%t"h$es are
nTcrvior(see Appendix Q,Ruin and Regulations for Ucrusiog Coostruetion Supervisors,Seetjat•
.2.24 This lack of awareness often restilu in serious problems,particularly whrn the homeowsw hires
unlicensed persons. In this case your Board cannot proceed aphi%the,tmlieeased person as it'%Vdd eri&
licensed Suprnisor. The hOoleQ%-Der seting AS supervisor is ultimately responslbIL
To ensure that the homeowner is My aware of Idnwr rmspon_sibilitles,Horny eornmutdties rapine;as part
of the permit applicetim that the homemvner certify that he/she tmde stands the respon sibilitics of a
supervisor. You may care to amend and adopt such a form/certification for»se in your eornmt®p.