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Project information Valuation* Type of construction Occupancy group Existing: Proposed (use for new construction or changes): Number of units in building (multifamily only) Total number of buildings (multifamily only) Finished square feet Unfinished sq ft Number of floors Is a fire sprinkler system installed? Yes No Is building over 4,000 square feet or 20 ft high? Yes No *The value (rounded to the nearest dollar) of all equipment, materials, labor, overhead, and profit for the work described. Notices Associated permits: Separate permit applications are required for plumbing, mechanical, electrical, fire sprinkler, fire alarm and/or fire line permits associated with this building permit. Expiration of application: This application is valid for 180 days after it has been accepted as complete. Inspections required: Approved city inspections must be completed before the work performed is enclosed. Terms and conditions Correct information: I hereby certify I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. Copyright release for government entities: I hereby grant permission to the City of Salem to copy, in whole or part, drawings and all other materials submitted by me, my agents, or representatives. This grant of permission extends to all copies needed for administration of the City’s regulatory, administrative, and legal functions, including sharing of information with other governmental entities. Indemnity: I, the permit applicant, shall indemnify, defend and hold harmless the City of Salem, its officers, employees and agents from any and all claims arising out of or in connection with work done under this permit. Owner permission: I have the legal right or permission from any property owner whose property is affected by the work covered under this permit to: 1) enter the property; 2) perform the work covered under this permit; 3) leave structures on or in the affected property. The issuance of this permit shall not be construed as permission or a grant of a legal right to enter upon or remain on any property affected by the work covered under this permit. Electronic signature certification: By attaching an electronic signature (whether typed, graphical or free form) I certify herein that I have read, understood and confirm all the statements listed above and throughout the application form. I agree (initials): ______ Authorized Signature: ______________________________________________________________________ Print Name: _____________________________________________ Date: ________________________ Not using Internet Explorer? Save the file to your computer and email to eplans@cityofsalem.net. Commercial Building Permit Application-4/18/2019 IAS Code(s): 4.2.1.1.5.5.1.3 Page 2 of 2 20 114776 00 BP 3225 STATE STREET City of Salem Building & Safety Division 35/35