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30 NORTHEY ST - BUILDING INSPECTION %- . lll� ^� � `� �" ��/� / "(O(nSGn!/` � " . 47� � i [t �-- � �t414?S9YAiiSi'�EfiLf��IVfl APPROVED 8Y �+iE �a .f��S,p,EC�QFi ,PF3J�A TP.1#_PEAMIT �,�WG GAANTED � ��� CITY OF SALEM � � :°T�; _ �,D O� No. � ,�,.`' ' Date �� \ �^ 9 .. J3 ar, s�`.� d�cl \�',� \"etr�..�o�� Is Property Located in ,✓ — Location of O � the Historic Distnct7 Yes No Building Is Property Located in the Conservation Area? Yes No BUILDING PERMIT APPLICATION FOR: ' Permit to: (Circle whichever apply) Roof, Reroof, Install Sidin�Constr�uct D�eck, Shed, Pool, RepaidReplace, 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: - � / � Owners Name �L�'d, � ���`� � Address & Phone .3� �"�` Z��� )dl� (l l0) � /7' �S$Z ArchitecYs Name l/� �A,tl_�,1� Address & Phone � (:Itrnn S�'� ��� 0 1 /��'�� � Mechanics Name -� Address & Phone ( 1 What is the purpose of building7 l Jf��-• �' SC.T'eP.n ��1^�� Matenal of buildingT GohG('e-(��II a dwelling, for how many families? 0\ WIII building confortn to law9 �'� Asbestos? Estlmated coS � �� clty Ucense n N P' State License # Hooe Improveme t �i��,{�""` ` ' Y \ `\ \ �y.�q�� D )� 'VJ� �� i`-`'`'`� Sig unat re of Applicant ��� � SIGNED UNDER THE PENALN OF PERJURY DESCRIPTION OF WORK TO BE DONE MAIL PERMIT TO: �vw a ,n�-i 1 1 • � No. ���- �� f APPLICATION FOR . PERMIT TO e� ��c `C�n 5�n��7- X rees. �9� �P/' �9� LOCATION f}����`�/ 3� .�.lo r'll��, /f�9/� � PERMIT GRANTED 9/�n�� �a A�ROV�D _ E� INSPECTOR OF BUILDINGS � ; C�Tr oR lw�su�. MwsswcMuserrs Pu�uc P�orsRrr osr�rw�t ' � �m w�w�NanoM s+wu+r aw r�oo� a�sr�w►o�s=io �csm�sNsw oR a+a ' ►�a trn1��s� st.�s�r��s. .�w. DalOSAL dt D�tl�AFl�AvR b�eoo�+�ea�t!r piovl�iear a[]ItL s�4 xK I �t�t r�oo�Itio� a[srilai�ldc r .�arw s..M�So.s.ao.�uedo.,e�► /e�'�t�!►�Y D�O���!iW!r�ewi dia a p�e�r 1k+d iolii�w dl�perl�r d�de�t b�r�Ici���!l01� � �tb.a.6d..v�1t e.d�oMi d rr l����Sl�w-e ( c�r`�h^� Laerfat dl�aiNq► G� a� � �,..��� �. 1RN.Y eampl.e.�.bnoMte�io�m.tloe �LEAS�P�II�TI'CL.EARL� � Tlor� �T°�I� N�.�rr�,� Fim N�it�► � � � �� ,+e�c�►a sew 'fi.�ow�.n�in��e a.eri�eo.m.e�moutio�naov,daa�ah�r a ah� �olb�'I�ty a�bt�patl i�t pop�rly�Ne�ed�o�bw�w di�po�l 6aXg�drQo�/b�r 11KIt.e�11J0� ma mt bmld4y p�miti cr geeow ur� ia�c+n�1oea�ta��11o1ily. GITY OF SALEM, MASSACHUSETTS • � PUBLIC PROPERTY DEPARTMENT 120 WASMINGTON STREET, 3RU FLOOR SALEM, MASSACMUSETTS 01970 STANL[Y J. UfOVICZ. JR. TELEPHONE: 978-743-9593 E%T. 380 Mwrort F�x: 978-740-9848 HOMEOWNER LICENSE EXEMPTION Please Print. n� �� 0� Job Location __�n y Vo�(`�n:2t-( S�. Home Owna Addteas . . .�ti� Home Owner Telephone-�-��. - a2 9' Present Mailing Address.:. .s.i.m-� ' . ... .ta.. ... ..n .. .. <i. . 't . . The cuaent exemption of"Homeowners"wae extended to include owneo-occupied dwellings of two Uniffi or le,ss and to a11ow such homeowna�ra�to engage an individual for hire who does not posaess a license,provided that the ownet'acts as supervisor, . _,� s�:-= � , '� DEFINITION OF HOI�OWNER .:, . . . ��x Person(s)who owna.a parcel.of Iand oa wluch he/sha resides or inteuds W;eside, oa which there ia,or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use andlor fazm structunes. A peison who,conatructa more than one horae in a two year period shal) not be considered a homeowner. Such "homeowner"shall submit to the Building Official,on a form acceptab(e to the Building Official, that he/she be responsible for all such work performed under the Building Pemiit. The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable by-Iawa and regularions. The undersigned"homeowne�'certifies that he/she understands the City of Salem Building Department minimum inspecrion procedures and requirements and that he/she will comply with said procedures and req►u�. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING INSPECTOR See other side for state code HOMEOWNER3 EXEMpTi�N The Code statea that: "My Horae°�"'°er p�o�g worlc for which a Building P�mit ia ���1 y���pt�m�he pmvisions of this secdon(Section 109.1.1 —Licensing of Consuuction Supervisors);Pm�d��a Homeowner engages a Pors°n(s) for hire to do such work,and that such Homeowner shall act as Supetv►sor. Many Homeowners who use tivs exemption are unawan thac they are assuming the responsibilities of a Supervisor(see APPeII�Q�R���Regulations for Licensing Construction Superviecra+Section 2.15). This lack of awareness� �� �y� problems,Pazticularly when the Homeowner hires�°t��d��a ucenstd Boazd cannot proceed againet the unlicensed person nsible. Supervisor. The Homcowner acting as supecvisor is ultimat�ly respo . �.�_�. To ensure that the Homeowner is fu11y awaze of his/her respcinsibilitiea, many communities require, as a part of the Permit Application,tiiat the Homeownet certif�'that he/she understands the reBP°nsibilities of a Supervisor• Oa the 1�Page of this isaue is a form cuaently used by se�'eral t°`Y°s. You may care to amend and adoPt such a form/ceRiScation for use in Yuur wm�►�tY• I R� �I;o� yao s Y i �� , . GITY OF SALEM� MASSACNUSETTS • � PUBLIC PROPERTY DEPARTMENT 120 WASMINGTON STREET, 3RD FLOOR . SALEM, MASSAGMUSETTS 01970 STANL[Y J. U60VICZ. JR. TELEPMONE: 978-743-9393 EXT. 380 MAYOq FAX: 978-740-9848 HOMEOWNER LICENSE EXEMPTION Please Print Date �D 0� Job Location 3� �, Home Own�Address . o ,: Home Owner Telephone — Z Preseat Mailing Address:.2o A 9orF�.-n : .. ... . .� .-.r IY ..�.,. . .. . �.... .'�iY::t .. . . The curnnt exemption of"Homeownets��was.extendecl to include,owner-occupied dwellings of two Units or less and to aUow such hqmeowne�s�to engage an individual for hire who does not possess a license, provided that the owne�ecte as supen+isor. : ;� r ,,.- � � DEFINITION OF HOMEOWNER. . � Peison(s)who owns aparcel of land on which he/she resides or intends W reside, on which there ia,or is intended te he, a one or two family dwelling, attached or detached structures accessory to such use and/or fazm shuctures. ,4►person who,conatructa 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 hdshe be responsible for all such work performed undet the Building Petmit. The undersigned"homeownei"assumes responsibility for compliance with the State Buiiding Code and other applicable by-laws and regulations. The undersigned"homeownei"certifies that heJshe understanda the City of Salem Building Department minimum inspecrion procedures and requirements and that he/she will comply with said procedures and��eqy�rements, HOMEOWNERS SIGNATURE eu�' �/,�\- APPROVAL OF BUILDING INSPECTOR__/�n���-�i�'%Zn,,,� See other side for state code __ . r r , .i HOMEOWNElt3 E1�MpTI�N The Code states that: "AnY Home°wna p�o�g work for which a Building P�mit is �������pt from the provisiona of this section(Sxtion 109.1.1 —Licensing of Coasuuction Supervisors);Pro�d��a Homeowner engagea a Pers°°(s) for hire W do such work,and that such Homeowner sha11 act as Supervisor• Many Homeowners who ase this exempdon�R e� dan Regeuylations f�or�Licensin8 responsibilities of a Superaisor(ses APPe°�Q� P Construction Supervisots. Section 2.15). This lack of awaz'eness often resulffi in senous problems, Particularly when the Homeowner lures uniicensed Pers°�. ��s case your I Board cannot proceed a8sinst the�ml�°ens�p��it would with s licensed Supervisor. The Homeowner acting as supemaor ia ultimatFlY respons�ble. �,.s� To ensure that the Homeowner is fully awaze of his/her respcinsibiliriea,manY communities require, as a part of the Permit Application,diat the Ho a eownthis issu�ithat h�y��d��nds We responsibilities of a Supervisor. On the last P S t such a form cuaentlY ue�bY�'�t°wns. You may care to an►end and ad°P form/certification for use in Yuut comm�tY• R� �I;oI yoos :. ; C�Tr ot �w�su�, MwssweMussrrs °� Pu�.ie P�o►�Rrr Ot►Nrrwa►t � '' �m w►w�wteM srnm aw It,00s fA�s1�MAO/l�10 T�tt�171�MN aT.�!O . rac in���swa sir��sr��s. �. 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