60 MASON ST - BUILDING INSPECTION (2) CITY OF SALEM
PUBLIC PROPERTY
DEPARTMENT
KIlM�! DR15t:W1
MAYOR 130 wASNINGTON STREET•SAIFx MASSACHUSErM 01970
1k1:978-745-9595* FA7c 97&740.9&16
HOMEOWNER LICENSE EXEMPTION
Please Print
Date
Job Location �6'-- _ -- -------_.
Home Owner Address 6 114112 5 e>/1/' .5% SAG t-Ikt • M fJ , 619 76
Home Owner Telephone 977- 979--77,6-9
Present Mailing Address Co N P5 an/' s-9- oq c c-m
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.
HOMEOWNERS SIGNATURE 6;-' gyp-, �
APPROVAL OF BUILDING INSPECTOR
See other side for state code
CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
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Construction Debris Disposal affidavit
(required Cur all demolition atul renovation work)
In accordance with the sixth edition of the State Building Code, 7S0 Cb1R section 111.5
Debris, and the provisions of M. GL 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 .1GL c
111. S 1.50A.
The debris will be transported by:
�N�27H s/ot �1BTiNG
name of hauler)
I'lic debris wilt be disposed of in :
t./e:u�ne of facility)
1ld.:res. ai f�ciLt;q
♦i_L:Ibt� ')( :�:Ill:(..l'�7.IC1.7t__ _ _
"a PUBLIC PROPERTY
DEPARTI4IENT
Kl.u5F3lsr ORISC v
NAvot 130 WwvuNGTnm�%b w T♦&mj %LuAcHLsL,-m o1970
Tu-978-74&9S93♦FNp M74045"
APPLICATION FOR THE REPAIR RENOVATION CONSTRUCTION
DEMOLITION. OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING
STRUCTURE OR BUILDIN
1.0 SITE INFORMATION
Location Name: / 6-� Al 13uilding:
a
Property Is located In a: Conservatlon Aron Y/N Hk tarlc OMM Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name:
Address:
Telephone: 78-
3.0 COMPLETE THIS SECTION FOR WORK IN BUILDINGS ONLY
Addition Existing 2iZ
Renovation Number of Stories Renovated
Change in Use New
Demolition Existing
Approximate year of Area per floor (sf) Renovated
construction or renovation
of existing building New
Scief Description of Proposed Work: O R O FR p -To R C ltj o vE
(PO/L45
— -----Mail Permit to: ----- _--
hat is the current use of the Building? I�QMC gA19 LTPAR l/�� a2 �'vr
W
Material of Building?t,1/0 oJP It dwelling. how many units?-2%
Wail the Building Conform to Law? Y Asbestos?
Architses Name �—
Address and Phones
Mechanlds Name
Address and Phone
Constnution Supervisors License HIC Registration p Permit Fee Cftlatlon
�—
Estimated Coat of Project S
Permit Fee S Estimated Cost X i7/51000 Residential
Estimated Cost $t1/51000 Commeroial----------- -
An Additional$6.00 is added as an
Administrative charge.
Make sure that all fields are property 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 7 (2 0
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