36 NORTHEY ST - BUILDING INSPECTION (2) � N
liY:
/QeI''
cc G!
-PL-Atllt3iN!!S44`9E WOVED BY T44E «j
JAISIL�A MAIMDfgLI ,BEING GRANTED
CITY OF S ILEM v:
No. \�_��v� ow
ft Nlitaio DW inYes_No_ Building Locatlon of 3 No Arh Sr.
Is PMWW Located In
Ow CoawnaIgn Am? Yo_No
BUILDING PERMIT APPLICATION FOR: '
Permit to:
(Circle whk�tever apply) Roof Rero f Install Siding, Construct_Deck, Shed, Pool,
epaldReplace, thew•.
-------------
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROC*.$Ift
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the folbWing
specifications:
Owners Name /� 1 CAAel `- Cu ivrV LL.Y
Address & Phone Aloft r�f,y z r— vs 4 Y b
Archftect's Name
Address & Phone j 1
Mechanics Name
Address & Phone
'I .IlJI
What Is#0 papow o1171Yldllq?
md"at 6uYdlnO? I a dwefty.for how many Ian*n?
WN b LAft cawam to law? y r'j 1�
Edmatad coat. 3 G v 0 Clly u0mm r N p' t WAS uowm M
Now lmpra�nt
Ue. f
X Signature of Applicant
SIGNED UNDER THE
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
'Lrs
-----------------
{
dI ,
MAIL PERMIT TO: o� ;
,I j.aA iilV'
1
11�1 �{ a[I'N'• I
. ._
Immog
li
No.•�\� ���
APPLICATION FOR
PERMIT TO
LOCATION /
PERMIT GRANTED
20
INSPECTOR OF BUILDINGS
s
r^
CITY OF SAum
BUIl DING DEPARTMENT
EONMOWNER LICENSE EXBOM01d
Please Piet
DATE
IOBl.00AMCN 3 �0 NG2 cy
i�orgowNElt 3C� /yortrh s�
ADDRESS
HOMEOv'Nfll q 2 J�L S Li Ll .�•/
TaEPHONE
PRESENTMA1LNGADDRESS �lb /t/UR1�i�y ri
The narcnt cttmption cf"hOmWwDcre was c.Nncnded to uicludc oirocr-9c=Ptcd dwcMIDP CCTWO
Uniu ar kss and to slow such homcowmn to cngsgc an udridual for hive who does I". 'q i
U=nse,.prwrded thm the owou Oct as superv6w.
DEFa;rnoN OF HOMEOWNER
PCMD($)who owns a pw=l of knd on which hclshc resides or intends to reside,on whkltcSSM'a�its .
inicnded w be,a om to two family dwelling,snachcd or attached sauctu= od sha11 not be wnsidusd
farm sovc u.A person who construcu mom than one hcmc in as � �P oaaforma bktoto
a homcowtiKr. Such`homwW rxi shall' ubmit to mx Binding onacd wAat the building P=-
Building Meal,that hdshc be nspotutbk to all such work paf
The imdcsigrxd`bomcawr er"amnancs rcspor��bility for wmpliance wi h tht State Bvild'mg Code sad
othu appBcblc lots by-laws,nits and re•gulntiw&
The tmdcrsipcd"hovwowricr" mrdScs that hcJshc undcstarda the City of Sakm Bm'ltiing Dcpwvnc l
minimum inspecJon proctdtics and rcgtmcmcnu and that hlshc wiU comply wnh said Vro=dwts
rcqui=v-V s.
HOMEOWNER'S SIGNATURE
APPROVAL OF BUIl DING INSPECTOR
Sec othcr sdc for 5=Cade
HOMEQN"'ER'S EXEMPTION
The code states that "my homeowner performing work for which a but764 permit is=qub-cd sl a be
cxcmpt from the proNisions of this sccoon (St tior 11.1.1-Lansing of Construction SupervisoT7�;
Provided that is s homcovmcT engages a person (s)for hat to do.such work,that sueb bomecw nt shaD ad
as SUptrvlSltf w.
i M bonwowners wbo use this txcmpdon art imawan tbat they wx usmming tht TesponsrbM6u da "
supaylsor (see Appendix Q,Ruks and lZrphiions for Vamsiog Construction Supervisms,Seedm
m4 7tis lack of awareness often Tatrlu in serious prob)cmS,pardeulMt wbrn the boncownnr hint
uTJkrnsed pcnons. In ibis case your Board cannot proceed agaatst the wZccustd person as it world w ft
liaucd Supcnisor. 71vt bomconvtr scimZ as supervisor 6 Wmateiy reapoosibia,
To ensure that the homeowner is fully aware of hVk=rtsponvibilities,m zM commurdlies Tegaat;tl pat
of the permit applimOm that the homem mT arrify that hcJshe tmd==nds The Tesponsibluda eta
super ism. You tray cart to wT=A and adopt such a lornr/ocnMcation for use in your em:nnnp.
W--& PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
SALEM,MA O1970
TEL. (976)745-9595 EXT. 380
FAX (978) 740-9846
STANLEY J. USOVICZ, JR.
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
Ia 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
govemed by this Building Permit shall be disposed of in a properly licensed solid-waste
disposal facility,as defined by MGL c III, S 150A.
The debris will be disposed of at: AJ10 S oc- �jyttjn y
Location of Facility
Signature of Permit App cant 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.