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171 NORTH ST - BUILDING INSPECTION AIRING GRANTED CITY OF SALEM -�J�► DIU s t 7 O Y RWWIY LoMrd In umatim of ft Hd to ol~ Y.�No� a.tusos / 77 0onr M Am YLIa� BUE.DI N I PERMIT APPLICATION FOR: Ponnkto Aft whi&~apply Roof PAW* lWd Oft Co $WW.Dsok,®Pool, RspaldRsplaos. Othsr.• PLEASE FILL OUT LEN KY A COMPLETELY TO AVOID DELAYS W Pno TO THE INSPECTOR OF BUILDING& The UmlervoW� hwaby appla for a permit to bWW a000r*V to ft fokswlllq i r owllsra Nam. Ad* M 6 PhWW 17 ! /V'o/Z S 7- ( ?M 71 5 Alohltnf's NNW Msohankx Nanls -4 Addmu & Phons ( 1 j NO lots p p Milern S oI'L!kq Mdedd d' A -49 /�n nQ 9 a dwNr 9 for lww wmw to din! i wr boft MR in low yPS ,u.e.rorr t )o qy Uoww• N p► ltlft UWW• Sipnatula of Appkonit SIGNED UNDER THE FI�II ' OF PERJURY DESCRIP110N OF WORK TO BE DONE " pC ai .. MAIL PERMIT T0� Y• �b 1 r is tin J ' ' a .-.- . ...,r, ' Y t s e. a n. .. +.. nc. '..r....R. •r. h: ,ln..,s.. ... 4 1 r. • P4 x h 5 wh`hI"f 1 ' r 4i" ,. « A J Ali Nt PUBLIC PROPERTY DEPARTMENT 120 WAsmmaTON STREET, 9RU LOOK SALEM,MA 01970 TEL (978)745-9595 EXT.380 FAX (978) 740.9646 STANLEY J. USOVICZ, JR. MAYOR DISPOSAL OF DEBRIS AFFIDAVIT In WX*rdM=with the provisions of MGL c 40,S34,I aclmowledge that as a condition of Building Permit g .all debris resulting from the construction activity governed by. this Building Permit shall be disposed of in a properly licensed soh&waste disposal facility,as defined by MGI,c 1%S150A. The debris will be disposed of at Location of Facility Signature of Permit Applicant Date FULLY complete the following infom>atim. (PLEASE PRIIPI'CLEARLY) Name of Permit Applicant Firm Name, if any 17 ( No2TN 5 T— 'YfF letil Address,City k State The above statute requires that debris from the demolition, renovation,rehab or other alteration of building or structure be disposed m a properly-licensed solid-waste disposal facility as defined by MGL cIli, S 150A,and the building permits or licenses are to indicate the location of the facility. CITY OF SALEM BUnDING DEPARTMEW AONMOWNER LICENSE M ri01N Pkaso Print DATE S 7 0 JOBLOCATION aO,¢owrm� 7 / N©rz Lk ADDRESS TELEPHONE PRESENT MAILING ADDRESS 171 "was ccnctkd w include o rocr.oceopied dweSep cCTW0 The=Tcm n rnrytion of"homeowxrs bore who dos not poswtr t Units m less and m allow such bomeownaa to rngage an itdiridual. liOerhx,.Provhded tga.*c.owner ad as superviwr. DEnNMON OF HOMEOWNEk, oa.vLkA these l>;a 4 Person(s)who Owns a Pawl of bud on which Wshe resides to uuends w reside, yes nre k me sodlk intended w be,s one tc two fanAY dwelling anadxd or dctadhed=vcwa od�aaA be tlnsidtd farm sauc=vL A person who euthswas mme than one hams in a two-? Pa' Such"homcownd' shaII subndt w the Buhldin8 Offiaal,tm a loan atzcpmbk b 6s s bomeew•na. tuda the b Aldbg pa=L Building Official,that bclshe be responstble to au such work paforraed The unde3signed-bomcow l="am=cs respoan'bility tot r=Pliarr.'c with the Stan Building Code=d other applicable goes by-laws,ram and regubdom The"dc",Vrd_homco = ccrti5es that hdshe tmdastands the Cky of S> li minimum kVwuon proadma and tcgttircmcros and that hlshc will cotttply Tcqub=M& r HOMEOWNER'S SIGNATURE =�— APPROVAL OF BVIIDING INSPECTOR Sec otba sde for Stan code rr. HOMEOWNER'S EXEMPTION The code stare that• 'am hcnmwrur performing work for wbicb a buDding permit is required sbali be cxcmpt from the prvsisiont of ibis sccdon (Section 10P.Ll-Licensing of Cosutmilm Supervisosa provided%bat is a homeowner cnpaga i person(s)tot hire to do.such work that such houtem m shall a4 of arrpQtlsa." MM borneowners who use this excn;C=arc In vm*mt they we RUWWMS the a[f supervisor(era Appcndia Q,Rules aad Regulations for Umnsing Coostrucdon SuperAsms,Seellm m4 This lack of swamu s ctkn ns ilu in scrions pmbkms,particularly when the hameosvn WrU unlicensed pew= In ibis case your Board cannot proceed agsbm the mrlieeaxd per{ou a k,%vold wldt licensed Supenisa. Tbc bomeonvcr acting as superbor hr wwmstsdr resEwosibib To enswc that the homeowner is fully aware of hMmrrcapon_n'bilities,starry eomstnuddes req*%aspal of the permit appl'tMdoq that the homeowner Certify that Wahe wrdasrands the responsibilida der supenvor. You nary can to w mrtd and adopt such a foru✓csrtificadon for un in your eooutudq