8 MILK ST - BUILDING INSPECTION (4) iA14iS�:fILf��idD A?PRovE{3 t3Y T44E
If�SJiEC7L pt p 3 rp 4 PEA111T.13EWG GRANTED
CITY OF SA"LEM
No.37-2c>0� 7/1 v 3
Date--*!--
5
Is Property Located In Location of
the Historic District? Yes,_No_� Building R M I
Is Property Located in
the Conservation Area? Yes_No_y-
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, S"d, Pool,
Repair/Replace, Other: ire Iyw ZjLj Q . uWm s .
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
Address & Phone
Architect's Name
Address & Phone n 1
Mechanics Name b --
Address & Phonehn�wn� Us(l f3 ( 1
What is the purpose of building? "—""d— 4'0 vyw4• ���'�`^
Material of building? fAr71-o d If a dwelling,for how many families?
Will building conform to law? Asbestos? NOT Q
Estimated cost j1�ov 61 I,,- City License# N A State Lic
Rome Imprair sent
Lic. i tjz�
3S— Signatu e o Appl nt
SIGNE UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
/l•1//Y��INI� �/!AJ ��Y '
to
MAIL PERMIT TO:
{
NO. 37 -20 � .�
APPLICATION FOR
PERMIT TO /
Y�l orNL/urtr
LOCATLON;
PERMIT GRANTED
1s
APPROVfD
INSPECTOR CP BUI INGS
City, qf Salem, Massachusetts
Fire Department
�qyu� 48 Lafayette Street
29 Fort Ave.
Robert Turner Salem, Massachusetts 01970-3695
YtT e Dan
Chief Tel 978-744-1235 Bureau
f
978-744-6990 Fax 978-745-4646 978-745-7777
FIRE DEPARTMENT CERTIFICATE OF APPROVAL FOR A BUILDING PERMIT
IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE
AND THE SALEM FIRE CODE, APPLICATION IS HEREBY MADE FOR THE APPROVAL OF PLANS
AND THE ISSUANCE OF A CERTIFICATE OF APPROVAL FOR A BUILDING PERMIT BY THE
SALEM FIRE DEPARTMENT. ( Ref. Section ��1}}13.3 of the Mass Bldg. Code)
JOB LOCATION:
OWNER/OCCUPANT: 1 _ d V W• GE F IrOWI A.
ELECTRICAL CONTRACTOR: T>0 --,o
FIRE .SUPPRESSION CONTRACTORc.
SIGN ATANT q OF; PHONE 0:
�J Lf
APPLICANT: / )l. �O !
97
ADDRESS-OF ' / CITY OT
APPLICANTa
M n TOWN: --
APPROVAL DATE:, ` ` b
Certificate of approval is hereby granted, on approved plans Jr submittal:of
project de'taiI ' by `the''SALEM FIRE DEPARTMENT. -All plans are approved solely
for. identfication;of type and location of fire.protection devices and equipment
All plans are subject to approval of any,`other authority having jurisdiction..
Upon-completion, the applicant :or installer(s) shall request an inspection and/or .
test of. the -fire protection devices and;equipment. (ADDITTIONAL REQUIREMENTS, . .
SEE REVERSE
NEW CONSTRUCTION.
r PROPERTY LOCATION HAS NO COMPLLINCE;WITH THE PROVISIONS OF
CRAFTER 148, SECTION 26 C/E"MaG L:; .RELATIVE TO THE INSTALA
TION_OF APPROVED FIRE ALARM DEVICES. THE OWNER OF THIS PRO
-
PERTY' IS REQUIRED TO OBTAIN COMPLIANCE AS A CONDITION OF
:OBTAINING.A`BUILDING'PERMIT.
PROPERTY LOCATION IS IN COMPLIACNE WITH THE PROVISION OF CHAPTER
148; SECTION 26 C/E, M.G.L.
EXPIRATION DATE: O
SIGNATURE OF FIRE OFFICIAL
FEE DUE: UNDER 7,500 SQ. FT. $30.00 FORMA 81 3/9.8
7,500 SQ. FT. OR LARGER- $50.00
CITY OF SALEM
BUILDING DEPARTMENT
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE
JOB LOCATION O YVVL V I� o
HOMEOWNER
ADDRESS t�
HOMEOWNER
TELEPHONE
PRESENT MAILING ADDRESS
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 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 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 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,rules and regulations.
The undersigned"homeowner'certifies that he/she understands the City of Salem Building Department
minimum inspection procedures and requtrem is and that h/she will comply with said procedures and
requirements.
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 unaware 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 persons. In this case your Board cannot proceed against the unlicensed personas 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.
OF SALEM,- MASSACHUSETTS
3 PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
SALEM, MA O1970
r ✓ TEL. (978)745-9595 EXT. 380
�prma 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, S 150,�A..
The debris will be disposed of at: ')0- It l
Location of Facility
Si of Permit plicant Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
RoG
Name of Permit Applicant
W t6
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 cIII, S 150A, and the building permits or licenses are to
indicate the location of the facility.
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