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40 MEMORIAL DR - BUILDING INSPECTION IM--OMWOST-9E ftLfS-AfID AP431ROVE0 BY T44E .=PfXT.0FR Pf31.0A T-O.A .PEBMIT.B,EWG GRANTED CITY OF SALEM co u a: No. � Date ll 0 NG Is Property Located In Location of (� the Historic District? Yes_No_ Building L-y Q I�VL�, (7(Z Is Property Located in D7 AQFi the Conservation Area? Yes No BUILDING PERMIT APPLICATION FOR: Permit to: (Circle whichever apply) Roof, Reroof, Install Sidin Construct Deck, Shed, Pool, Repair/Replace, Other: tad 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 2 Address & Phone U y--) LJY--c70L.5?1 JVO / l -c-010 /2/ %}l Architect's Name Address & Phone ) Mechanics Name E Address & Phone ) What is the purpose of building? ,- Material of building? Woo D If a dwelling, for how many families?_ Will building conform to law? Asbestos? Estimated cost City License # N A Slate License # 00 Home Improvement 2::LOL 7 / Signature of Applican SIGNED UNDER TI-Iff PENALTY OF PERJURY DESCRIPTION OF WORK TO BE DONE MAIL PERMIT TO: 1 No. 1"13-2 oo© APPLICATION FOR PERMIT �TO/ LOCATION PERMIT GRANTED ArP OVFD a INSPECT R OF BUILDINGS OF SALEM- MASSACHUSETT5 PUBLIC PROPERTY DEPARTMENT 120 WASHINGTON STREET, 3RD FLOOR a � SALEM,MA 01970 s TEL. (978)745-9595 EXT. 380 '�arnru FAX (978) 740-9846 STANLEY J. USOVICZ, JR. MAYOR DISPOSAL OF DEBRIS AFFIDAVIT In accordance with the provisions of MGL c 40,S34,I acknowledge that as a condition of Building Permit# all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid-waste disposal facility,as defined by MGL c III, S150A. ,\ The debris will be disposed of at: Location of Facility Date Signature of Permit Appli FULLY complete the following information: (PLEASE PRINT CLEARLY) �a 13 7- Name of Permit Applicant Firm Name,if any Address, City & State The above statute requires that debris from the demolition,renovation,rehab or other alteration of building or structure be disposed in a properly-licensed solid-waste disposal facility as defined by MGL cM, S 150A, and the building permits or licenses are to indicate the location of the facility. CITY OF SALEM BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please Print DATE JOB LOCATION y G HOMEOWNER /r� I; 13 E /4lw ADDRESS HOMEOWNER 9700- 75— �S�I TELEPHONE —T nn PRESENT MAILING ADDRESS C/A1 The cement 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 act 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 to two fancily 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 to all such work performed under the building permit The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable goes by-laws,ndes and regulations. The undersigned"homeowner"certifies that he/she understands the City of Salem Building Department minimum inspection procedures and requirements and that h/she will comply with said procedures and requirements. Y HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING INSPECTOR See other side for state code HOMEOWNER'S EXEMPTION The code states that: "any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1—licensing of Construction Supervisors); Provided that is a homeowner engages a person(s)for hire to do such work,that such homeowner shall act as supervisor. Many homeowners who use this exemption are tmaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules and Regulations for Licensing Construction Supervisors,Section 2.15). This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persona In this case your Board cannot proceed against the unlicensed person as it would with licensed Supervisor. The homeowner acting as supervisor is ultimately responsible. To ensure that the homeowner is fully aware of hither responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a supervisor. You may care to amend and adopt such a form/certification for use in your community.