4 MOULTON AVE - BUILDING INSPECTION (2) ,-3 '0 0
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IMST-9f fiL'E { A?PROVED By T44E
l�Sp1=CT.PA PRH)R TPA PERMIT.BEMG GRANTED
CITY OF SALEM
.g� Date
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Is Property Located in Location of /`rl
the Historic District? Yes_No_ Building too,
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Is Property Located in
the Conservation Area? Yes_No_
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
Repair/Replace, 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
Address & Phone °► 7� 6 (Z 771 ' TZ/
Architect's Name
Address & Phone ( I
Mechanics Name Pclra5 CreJr `c - ��y Lc,Z-42 c.4 `/
Address & Phone -il6-L�4a S7 iG e ��ab�Y I� � -r3 / -7 6 73
What Is the purpose of building? Hdr� -
Material of building? If a dwelling,for how many families? n/r
Will building conform to law? Asbestos?
Estimated cost V 444Cfty License# N A State 'cane #
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Home Improvement
Li`` X S n re o Applicant
SIGNED NDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
a li,
MAIL PERMIT TO:
1
i
No.
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
w4� LC
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APR T D
INSPECTO OF BUILDINGS
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CITY OR SALEM9 MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STRSST. 3RO FLOOR
SALIEM. MASSACNUSETTS 01970
STANL[V J. USOVICS. JR. T[L[►NON[: 978-745-9595 EXT. 380
MAYOR FAX: 978-740-9844
Salem Bui1_Jna P0Xi wnt
1_kbtis YNs 1 Roan
In accordance with the provisions of MGL c40 S 54, a condition of your
Building Permit is that the debris resulting from this work shall be disposed
of in a properly licensed solid waste disposal facility as defined by MGL
Chapter III, S 150 A.
The debris will be disposed of in:
a ZS, C G t (Location of Facility) ��G Ica �C .
Signature pplicant
Date
CITY OR .,SALEMq MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET. 3RO FLOOR
SALEM. MASSACHUSETTS 01970
STANLET J. USOVICs, JR. TELEPHONE: 978-743-9895 EXT. 380
MAYOR FAX: 978-740.9846
HOMEOWNER LICENSE EXEMPTION
Please Print.
3 Wr
Job Location - UG �o�
Home Owner Address
Home Oww Telephotp — 17_ _ !
Preaeot Mailing Addteea d v
The current mre Wd=ot"HomaownffC wawa Waded to inchule owner-occupied
dwellings of two Units or Ion and to allow such to engsge ao individual for
hire who does not poasM a license,provided that the ownije- as sups rvisOr.
DEFIMTION Of HOMEOWNER..
Person(s)who owns a pwd 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
Stnutures 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
"lmmeowner"shall submit to the Building Officiai,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"certi8a that hdshe understands the City of Salem
Building Department minimum inspectio Procedures and
will comply with said procedures and requirements and that he/she
J i
HOMEOWNERS SIGNATURE i
APPROVAL OF BUILDING INSPECTO �ia—rid
See other side for state code
HOMEOWNER9 EXE"noN
The Code states that: "a►Y gomeowaer perform8
wotir for which a Building Permit's
xFired shah be exempt from the provisions of this section(Section 109.1.1 —Licensing
of Construction Supa vis m)+provided that a Homeowner engages a i�en0(s)for hue to
upeviisor-
do such work and that such Homeowner shall act as S
assuming the
Many Homeowners who use this premption are unaware and R gu s��for Licensing
Icapowilit►es of a Supervisor(see Appendix l%sck of awanaeas often nwlb in serious
Section 2.15� This
Conlihvction Sup�m pawns. in this case your
problems.particularly when the Homeowner boas unlicensed it wouldP th a licensed
Board armor PWcW4 the unlicensed P •m •ble.
sot.
Supervi ,The Homeowner acting as � - 6
To ensure that the Homeowner is fully aware of his/her abilities.many
Tommune di require.as,a Part of the Permit Application. the Homeowner certify that
On the last page of this issue is a
helshe understands the maPO°°lbiUtica of a Supervisor• and adopt such a
You may care to amend
form currently wed by several towns.
Pause in your community
formlceatificatiot!.
RA0 b I to I sae s