58 MEMORIAL DR - BUILDING INSPECTION -PL-*NSldtt T-REffLfG-AND.APPROVE0 BY T+IE
IA 3#ZCTP1-3 .PRIDR TP A_PERMIT 13FING GRANTED
CITY OF SALEM
No.Z.fo9-Z0C1y ,e`` "� '�ys\ Date /f 4
s
Is Property Located in c Location of
the Historic District? Yes_No Building ffM,w191e1k1 �)Q
Is Property Located in
the Conservation Area? Yes_No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof roof, Install Siding, Construct Deck, Shed, Pool,
epair/Replac , 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 �<�e,/ zvcklel
Address & Phone a 7 MC,4,0fl1A/ bt- ( 5>1J1 7 y/ 3ya%
Architect's Name
Address & Phone ( )
Mechanics Name
Address & Phone ( )
What is.the purpose of building? '
Material of building? If a dwelling,for how many families? Sl 1 )bue-
Will building conform to law? Asbestos?
Estimated cost d f'90 City License # N k State License
Z�Dr Bosse Improvement
Lic. i
483s Sig ature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
/�e 2 i ie l4rfel e y
MAIL PERMIT TO: l l qz-Ub-1 P-C � S—r
No. 2(0 9_Z0Oy
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
APTAbVFD
f
INSPECTOR OF BUILDINGS ;
xt
L CITY OF SALEM
BUII..DING DEPARTMENT
HOMEOWNER LICENSE E} ENPTION
Please Prild
DATE 2q�— I S- Q�
foBLOCATION
HOMEOWNER
ADDRESS
HOMEOWNER Ot
TELEPHONE
PRESENT MAILING ADDRESS SnS 6Y�`
The mien exemption of"homeowners"was e.Nnended to brlude owner-occupied dweltiop of TWO
Units or less and to allow such homeowners to engage an u&"dual for hire who does not postoess a
license,provided that The owner act as supervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a pm=1 of land on which he/she resides or intends to reside on which there i;or is
intended to be,a one to two family dwelling,anached or detached stru wm atxessM to such We and/or
farm strucnaes.A person who constrocLs more than one home in a two-year period shall not be considered
a homeowner. Such"homemAme sball'submit to The Building Official.on a form aaxptabk to the
Building Official,that Wshe be responsible to all such work pmfOnued miler the building permk.
The undersigned"bomeowner"amunes responmblIny for compliance with the State Bolding Code and
other applicable goes by-laws,rules and regulatioms.
The undcsigned"homeowner"cati8cs that hdsM and the City of Salem Building Departtaait.
rr=mmn inspection procedures and requtmnents and will comply with said ptacedims and
rcgmrenrems.
HOMEOWNER'S SIGNATURE
APPROVAL OF BUILDING INSPECTOR
See otber 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 1".1.1-l iceosiog of Construction Supervisors);
Provided that is a homeowner engages a person(s)for hue to do,such work,that such homeowner shall act
ash.
Many homeowners who use this exemption are unaware that they are tastnnutg the tetponsib'd=ar a
supervisor(see Appcodh Q,Rules and Regulations for licensing Construction Supervisors,Seetiw
.2.34 This Lndc of awareness often rrsulu in senous problems,parocuhrly whrn the homeowner Lust
unlicensed persons. In this case your Board cannot proceed against the unlicensed pesos as it avdd with
licensed Supervisor. The homeov+ver acting as supervisor h oltimatdy responsible.
To ensure that the homeowner is fully aware of hi4m rrspounbilities,many communities requim as part
homeowner« that he/she understands the responsibilities of a
of the permit application,that the homem certify
super ism. You may care to amend and adopt such a fonivocnification for use in your eommump.
{o?
i OF SALEM.- MASSActIv' ci
PUBLIC PROPERTY DEPARTMENT
• • 120 WASHINGTON STREET, 3RD FLOOR
< SALEM,MA 01970
TEL. (978)745-9595 EXT. 380
FAX (978) 740-9646
;TANLEY J. USOVICZ, JR.
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the provisions of MGL c 40,S34,I aclmowledge that as a condition
of Building Permit# ,all debris resulting from the construction activity
governed by this Building P ermit shall be disposed of in a properly licensed solid-waste
disposal facility, as defined by MGL c.Ia,S150A.
The debris will be disposed of at. .�54 t 1 .Si iJ F I e�4 if'' may
Location of Facility
/1 0
Si tore of P t Applicant Date
FULLY complete the following information.
(PLEASE PRINT CLEARLY)
N ame of Permit Applicant'
i
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.