4 LANGDON ST - BUILDING INSPECTION u.
Y VED BY Tw
IIQR D'' PIBFWR GRANTED
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CITY OF S .EM
Dft
Imatiam or
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h 9n Ma9 Yes_No_
BUILDING PERMIT APPLICATION FOR:
Permit to-
Prole whichawr m*) Roof. Romd, Install Siding, CorWbW Dick, Shad
RepalNReplaae, Other: .
PLEASE FILL OUT LEGIBLY A COMPLETELY TO AVOID DELAYS IN PROD
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby► applks for a pwmk to build accor
ding to the toNowNhp
spoollicationm
Owner's Name �c c'
Address a Phan 4 la nc,d o Sfi fv'7&•y -7gD a 9 b i
ArohkoWs Name
Address 3 Phan I y
Mechanics Name -,
Address & Phan f Ir
Whig Y eo PaPou d nuxg! j ,
w a1 04 N a dw@Mv,for now nwW kmAw?_ � h •i
WN bAdkq emdoaa b hsw9 �3
.j47) J —ah U0o r N A sea. • �:
ass rye y
L1c. � 11 rr o
Signature of Appdcsrit
SIGNED UNDER THE
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
I
MAIL PERMIT TO•
No
PERMR TO APPLICATION
FOR
LOCATION
-tj
- s�
PERMIT GRANTED
.
APPAOV f D
INSPECTOR OF BUILDINGS
s
CITY OF SALEM
B=ING DEPARTMENT
HOMEOWNER LICENSE mManON
Please Pm
DATE / 3 to y
JOB LOCATION l®
HOlv>EORR3ER T L� iz� dQo S� S� "?�• l�/D
ADDRESS
HOMEOWNER 9 - -74 0
TELEPHONE
PRESENT MAl1.1NG ADDRESS
The cwrcat exemption of"homeowners"was eNadded w include owoewoewpied dweMip dTWO
Urdu a ka and to allow such homeowners to engage an individual for Lice wbo doa na posws a
Iiccnse,.pmvidcd tbm the owner ad as super AW
DEMMON OF HolvZOWNEL'
Person(s)who owns a paml of land on which he/she resides or intends to reside,on whkhhO Is
or k
ded inten to be,a one to two Fanny dwelling,attached or dctaChed smrram&C=55M to
e=dAw
farm svucwm A person who colLmu s more than one home in a two-year period sball sot be eonsidned
a homeowner. Such"homeov=r shall'subndt to the BuDding Official,oa a form&=cptabk tot A
Building Official,that irishc be tcsponnbk to all such work pcformcd tondo ft building permk
.Thc undensip d'homamr er"assumes respoTmbility for compliance with the State BuB&g Code and
othu applicable goes by-laws,rules and regoblicut
'Ibc undaaip d'houwvwner"anises that hdshe und=n-.nds the city of Salem Bwldmg Dcpwumc t.
minimum inspation pro=dwts and rcq»ircmcnu and that Nshc will comply with said ptoocdttres atad
rcgWrcmcm
HOMEOWNER'S SIGNATURE"S Z�L o/CyP
APPROVAL OF B=ING INSPECTOR � -e/t
Sec Otter side for State Cade
HOMEOWNER'S EXEMPTION
The code state that.• "aM homeowner performing work for which a buDding permit is required shall be
exempt from the pto+isions of this section (Section ltl�.l]-liaesieg of ConstNeIL U Supesvisori);
Provided that is a homeoNrer engages a pctson(s)for hire to do.such work that such bomeowm dtall ad
as svpervisat
WT bomeownets who e this eatmption it are mwan that ihry an as=ring the Rspans da
supervisor (tact use
Appendis Q,Rules and)zcgulstions for Uecnsing Construction Supervisors,Seetiaw
.2.14 TMs lack of awarciless often results in scriom probk=L%parneularly when the Domeawser bans
urtikaucel pem m In ibis case your Board ca mot procecd against the tat CMwd person U it wtruld wft
licensed Supersisor. 71re bomewbtr acting as supuvisor b ultisoatdy responsible.
To cnskvc that the homeowner is fully aware of hV=rrspom-abilities,many eotmnwtides raga as pacer
of the permi4 sppliodoA that the homemvmr ecrtify that Wahe tmderatards the respimsfbiiides of t
supcn isot. You may cart to amend and adopt sail a lmmVccnV=tim for use iA your eaumUlCIV.