6 LAURENT RD - BUILDING INSPECTION (2) CITY OF SAiFm
PUBLIC PROPERTY
DEPARTMENT
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130w,.44NGW N Sr2Em•Sk.Fx MwStA04:5kT13 01970
TeL.978-73S-9S9S 9 Fix 971-740.9U6
HOMEOWNER LICENSE EXEIM"ION
Please Print
Date o�
Job Location I a"renE 94 .
Home Owner Address
Home Owner Telephone 9 1 b
Present Mailing Address to Lai,ron l i
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 City of Salem
Building Department minimum inspecti nn-p�rocedures and requirements and that he/she
will comply with said procedures requirbrrlon
HOMEOWNERS SIGN ATL
APPROVAL OF BUILDING INSPE OR
See other side for state code
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CrrY OF SALEM
PUBLIC PROPRERTY
DEPART%IENT
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Construcdos Debris Dkp"at Affidavit
(reyuiml for an demolition and lonovadon wort)
(n.=onW"with the d%dt ed doss of the Sets Building Cod@.730 C►iR section It 1.5
Debug,and the provisions of MGM a 44 g Sk
13WWtB Pantit N _ is issued with dw condidoa that the dcbris resuidng toss
this wort shall be disposed of in a property licensed wage disposal facility as defined by%IGL a
lil.S15"
The debris will be transported by:
teams of haWM
rho debris will be disposed of in :
(ayes of hurray)
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PUBLIC PROPERTY
DEPARTm&NT
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AZPI.ICATION FOR THE REFAM RENOVAn0rL_ r_'nNrroU nQm
DEKOLI'I'ION.Olt CHANGE OF USZ OR OCCII ANCv_ FOR ♦>,IY ANCI l UG
1.0 an INFORMATION
Locadon Na"m IkAft
---
---- ----------- ------ -
Properly is bcdsd In a:C n@WvM0n Arse YM tJ Hftft DkM YM ^�
[Addrescc
ONMERSP INFORMATION
Owael of Landt� �' 0. 4 Nq- So'R7� Law-endaphor»:
3.000M U7 THlS SECTION FOR WORK IN E7CiLNp 9tJILpINps ONLY
Addhim t.xistkg
Renovskm ✓ Number of Storks Renovated
Change in Use NOW.
jDemolition lusting
Appro)dm*o year of Area per flow(at) Renovated
construction or renovation
of existing building New
Brill Description of Proposed Work:
QQP1ace Siding Uow- �°Cch
Ir�S�al� 112� S �rv� door
fLeiliace -t acci1 bg3a12c4S � n
--- -- ---Mail Pertnd to - - -
W1,ae is the aarent use of the BOOM? S �r
Material at Bu~ it dwaNnp.now many unit? d
NN Ina&AMV Conte b Lash Asbeabs?
Arditcft Name
( t -
A*Vsn and Phone
modwMa Name
Addmas and Phone HIC PAO*atton S
Canavuedon SUPS Lkenae E
Es*rA%d Cost of P Pemdt FM Cala-Agm
Panmit Fes i Zs Es*naead Cost X$7161000 RaaldaMW
- -- - - EsdmA od Coat X$41/51006 Commndal --- -An A&Mnd S6.00 In ad&W m an
Adngnhdra"darns.
Make aura that am flews are proparb and kipibly written to avoid delays in Proeesslnp.
The undwstpned does hereby apply for a Bufldinp P klo-t Ym to Un above stated
spgdO gwm Sipped under Penally of PWAO
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