42 MASON ST - BUILDING INSPECTION (4) CITY OF SAI.EM
PUBLIC PROPERTY
DEPARTMENT
MAYM
120 WASUNGUM S11F=•SALEK%%ZA04L=M 01970
TFJ-*971-745.9S9S 9 FAY:979.740.984
HOMEOWNER LICENSE EXEMPTION
Please Print
Date �6 �Lp -7
Job Location 1-0- /+fad^ sy-
Home Owner Address ye/ --+ase"q sf
Home Owner Telephone ?sr/- �s£7-4 re s
Present Mailing Address to m 43, st 46d sa/f 4 o/v re/
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 inspection procedures and requirements and that he/she
will comply with said procedures and requirements.`J
HOMEOWNERS SIGNATURE C
APPROVAL OF BUILDING INSPECTOR
See other side for state code
CITY OF SALEM
PUBLIC PROPRERTY
a—,_t DEPARTMENT
\t.�StN 11C W.\il l[VI;:JN$:BEET ♦SAIF V, \t.\U.\(::It A:115::97C
TF.I:97S-7434595 • Foot:97S-74t:9B46
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CNIR section 111.3
Debris, and the provisions of MGL c 40, S 54;
Building Permit # _ _ _ is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
111.S 150A.
The debris will be transported by:_-Vn and (414 e T— vc't /1
S
(name of hauler)
7'lie debris will be disposed of in
_ Wame JI L111ty)
♦I_ :.I1:1': JI :d Cn 4lC +ha),IC lAC - --_
_ UITrOF ALEX
PUBLIC PROPERTY
DEPARTMENT
1:1•wFM w p.w.vv
�IAYpe
130WASIO ri�,MUr•1UAMk.MAMACWSkj-M0r970
MJ:MUMS"•FAX M740.980
APPLICATION FOR THE REPAIR. RENOVATir N CONSTRUCTION
DEMOLITION. OR CHANGE OF USE OR OCC'rrp.lv�'Y FOR ANY EXISTING
STRUCTCrn� OR 1 1nNQ
1.0 SITE INFORMATION
Location Name: yd ^1w5Gn S�
_ �+ NUMB.
/�/
Properly ie loeated In a:CwWWvatlon Aroe Y/N .✓ Hk t ft DWfct Y/N
EAddrew
SHIP INFORMATION
f Land
S�ip�e /ba/nven�/
Ir /'7q o/970
3.0 COMPLETE THIS SECTION FOR WORK IN E><1SIING 13UILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
a• s-
Change in Use New o
Demolition Existing
13o0
Approximate year of Sao Area per floor (sf) Renovated i3Ga
construction or renovation
of existing building Now O
9def Description of Proposed Work:
-- - -- Mail Permit to: S (� F i✓Ia�ave�✓g Yj ir9aso S� #�� / �q al
What is the Current use of the Building?
Material of Building? i.✓oo d if dwelling.tow many units?_�
Will ti1e Building Conform to law?
F S Asbestos?
Architects Name
Address and Phone rv�5 NY �Cl cj 4
Mechanic's Name r �� d�f ray e
�-7- 36d- ga7U
Address and Photo HIC Registration 0_------
Construction Supervisors license 0
Estimated Cost OfProj s So d d_ Perms/Fse Calarlation
Permlt Fee: ' d� Estimated Cost X$7/111000 Residential
Estimated Cost $11/$1000 Comrnsrclat
- - An Additional $5.00 is added as an
Administrable charge.
Male sure that all fields are properly and legibly written to avoid delays in processing.
The undersigned does hereby apply for a Building permit to build to the above stated
specifications. Signed under penalty of perjury
Date d C/
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