125 MARLBOROUGH RD - BUILDING INSPECTION (2) f
IK:AMiNUST-BE fill:—E Jfl APPROVED BY T*IE
.1WFXTp13 .PRWR TP A.PERNllT B,EMIS GRANTED
1 CITY OF SALEM
No) ` -Us Nil P
lSt� ..� 'i,\. Date '
Ward
� CrmNE�y� Zoning District
Is Property Located in Location of
the Historic District? Yes_No_ Building
Is Property Located in
the Conservation Area? Yes No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed,, Pool,
Repair/Replace, 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 > k)T-i4 ✓y LJ i u eis,4 e, i
Address & Phone 195 '74q- 32,0 5
chat ct's Name
Address & Phone ( )
anics Name
Address & Phone ( )
What is the purpose of building? cS 4-OE Q Fo rr S/Z1 X--A-G(57
Material of building? WOO P If a dwelling, for how many families?
Will building conform to law? Asbestos?
Estimated cost 700 ad City License 0 State License #
\ Home Improvement /
Lic. :
Signatur f plicant
SIGNE NDER THE PENALTY
OF PER URY
DESCRIPTION OF WORK TO BE DONE
90 iC O R—r( 8-- "c 061) &44CO
MAIL PERMIT TO:
No\�
APPLICATION FOR
PERMIT TO
9k g 5z
LOCATION
PERMITGRANTED
Au 19
APPROV�D
INSPECTOR OF BUILDINGS
r
CITY OF SALEM
BURMING DEPARTMM
iioNMOWtEA UCEtNSE mmvno*s
i
DATEM�—
HOMEOWNM
�soMEOvrrml
TELEPHOH9
PRESENT MAILII?G ADDRESS
bomwwms"was extcndcd to Ircludc ow•ou-o�c+*d.dwen:p dTW�O
The cc ku and w&U of its bits who does as poses A
Unix a kss and t 9te� �10�an mdMdual .
liecmc,.prwided .
DEFT CrM OF HONCOWSM
Pcnon(s)who owns a petal of land on which bdshe resides or intends to tesidk on whkhht 1>l�
intc Aed w be,a one w two family dwcllin&snadwd or dctadted sttncw" AA not be ev mdetad
farm strucwM A person wbc constructs atone than oat home in a two-y PeAOd
s bomcowaet. Sucb"bom vine O&V subnut to the Budding Official.on a focm secepubk b t4s
Build(ng Official,d o bdshc be rrsponstbk to aU such work paformed radar the peTk
The undcrsiptd-bomeowM"asstmws mspormbility for complisna witht!►e Stau Bat>tgrtg Cods and
othar applicabk Sots by-brws,rules 3md m8WzboM
h. { ardba that heft tmdastarsfs the City of Salem Bnildiag Deparaaatl.
Tbs tmdersignra- w with said pwadwa w d
. minimwo inspation proad>ms and regtnrcatems and that h/shc wiU >�
nqwmmcmL
HOMEOWNERS SIGNATURE °
APPROVAL OF BUILDING INSPECTOR
Sec otba side for smu code
I
HOMEOWNER'S EXEMPTION
The Code stales lam 'any homuowner perfonniuS wodc for which a building permit is sba8 be
Cumpt from the prwisiatts of this section (Section 1U91.1-lensing of Conatraetim Supervbort,;
Provided that is a hamemma cagaga p person(s)for him to do.mA wok lb"sud homeowner Ad aQ
• as supaviao�' •
Many bomeowners who use this exemption are imawax that they an asses the Icspoq aU
Supervisor(tee Appcodb Q,Rules and Regulations for 13ocnaiog Cooarruction Soperriwts,Secdaa
.2.24 This lack of awwwmu often xsutts in serious pmbkms,pardeobrly wben tht homeowner bbo
W ieensed pawns In this can yom Board eanrwt proceed spbw the w Sansed person u M vmm vm
lictused Strprnisor. Tee howeewoer acting as supayfsor fa ohia»reI7 reago"FAL
To Came that the homeowner b fully aware of hM=responsibildes.Twiny eotmnu ides teq&%a
of the permii application,that the homeowner certify that hc/ahe undersu idW the sespousibllities of a 1
super m. You may care to amend and adopt such a foradecttifreati=tint=t is yoor eatmtanup.