78 MOFFATT RD - BUILDING INSPECTION (2) yyN
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-PL4}$IMIST$Efii.{-f-i� ;Af9ROVED BY T*IE
V LNSPWTD13 Pi WB TP A.. ..PEkMjT.13FJNG GRANTED
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CITY OF SALEM
rJ Xo,N r}
No. 7->01 —200k-A �• � `i��. Date
S
\'�AdCrmNE
Is Property Located in / Location of
the Historic District? Yes_No Y Building 1 uJ7 Th7t uc�_
Is Property Located in
the Conservation Area? Yes No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, eroo Install Siding, Construct Deck, Shed, Pool,
Repair/ ace, 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 mO�Ur�c e- L.Ovc 1^ard
Address & Phone �nc,7�
Architect's Name
Address & Phone ( 1
Mechanics Name 4
Address & Phone
What Is the purpose of building?
Material of building? If a dwelling, for how many families?
Will building co1orrn to law? Asbestos?
Estimated cost 0 0 City License p N A State License p
Borne Improvement x
�� . �Lic. /
Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO:
't
No.30`1- o y
APPLICATION FOR
PERMIT TO
LOCATION,
PERMIT GRANTED
APP V�D
7
INSPECTOW OF BUILDINGS
to
OF SALEM., MASSAcnvanL
PUBLICPROPERTY DEPARTMENT
• ^ 120 WASHIN6T6N STREET, 3RD FLOOR
• SALEM,MA 01970
TEL. (978)745-9595 EXT.380
' qp FAX (978) 740-9846 .
;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
govemed by this Building Permit shall be disposed of in a properly licensed solid-waste
disposal facility,as defined by MGL c III, S1150A.
The debris will be disposed of at: 'Location
n of cibty i —
Location of Factlrty �—
G1 , �1�3
4qsigaa�twm�re_of Permit Appli Date
FULLY complete the following information.
(PLEASE PRINT CLEARLY)
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
B=ING DEPARTMENT
130MEOWrNER LICENSE EXEmpTION
Please PrW
DATE rrrr
JOB LOCATION cr�t G 1
. HOMEOWNER
ADDRESS
HOMEOWNER q g
TELEPHONE
PRESENT MAILING ADDRESS SLr-
The amrent exemption of`homeowners"was extended to include owner-accupted dwelGnp of TWO
Units or less and to allow such homeowners m engage an individual for hire who dos not poafefa a
license,.ptovnded that the owner act as superriwr.
DEFINITION OF HOMEOWNER
Pcrson(a)who owns a pw=l of land on which he/she resides or intends to reside on which au l0
m
intended to b Tw
e,a one to o family dwelling,attached or detailed swcuaa h st anddered
far structtaes.A person who constructs more than one horse in a two-y pmoil shad not
a bomeowaa. Such"homeowner shag submit to the Bulding Offieis1,on a form aCccPt1bk to 69
Building Official,that Wshc be raponsibk to all such work paformed miler the building pall.
.Thc undersigned`homeowner"asstmtes taponsibiliry for compliance with the State Building Code and
other applicable goes by-laws,rules and tegulatwms.
The tmdcsigned*homeowner"oatifies that he/she unndasrards the City of Salem Building Departmma
minimum inspection procedures and rcgnnrcmenu and that hlshe will comply with said ptoadau and
requircumft
HOMEOWNER'S SIGNATURE ��9//
APPROVAL OF BUILDING INSPECTOR
Sec otba side for state code
HOMEOWNER'S EXEMPTION
The code states that.' "any homeowner performing work for which a building persnit is rnqubW shall be
extmpt from the pra isiow of this section (Section 10P.1.1-Lcensiny,of Construction Superviwts);
provided that is a Domeowner engages a person(s)for hire to do.such work,that sueb homeowna d6au act
as supaviswr"
Many bomeowncn who use this exemption arc unaware that they an assuming ft?esponsrbibRies d a M
supervisor(eee Appcodh Q,Rules and Regulations for Licensing,Construction Supervisors,Seefiaa
.2.14 This lack of awareness often ttsults in serious problems,particularly wbem the hvmeowaa bird
unlicensed persons. In this mu you Board cannot proceed against the wibeeased pawn as it wtwld with
licensed Super ism. Tbc bomeos vcr acting as supervisor is uttimsteiy responsible,
To ensure that the homeowner is fully aware of hi/itcr responsibiBties,many eommrudlies rsgame;as ptut
of the permit application,that the homeowner ecrdfy that hdshe kmdastands the responsibilities eta
supcniwr. You may cart to amend and adopt such a form/ocrtification for use in your armmity.