169 OCEAN AVE W - BUILDING INSPECTION -PL-At0S If W T13EffLf� APPROVED BY T44E
.WSPECTDB PF" TD A.PEPAWT BEING GRANTED
CITY OF SALEM
No. V 3, '� Date 05
1\
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Is Property Located In Location o�
the Historic District? Yes No-k— Building
Is Property Located in
the Conservation Area? Yes No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Cgqnnstruct Deck, Shed, Pool,
Repair/Replace. Other: 16 rJ
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
Address & Phone IA 9 D4P*A F L �S�L!789 �yb 038b
Architect's Name /Jld-
Address & Phone j )
Mechanics Name
Address & Phone
What is the purpose of building?
Materiel of building? 1ZW,0eIJ If a dwelling,for how many families? �n L
Will building conform to law? LS Asbestos? /yd
Estimated at � ' Q City Licenser N P' State license
l as
�0Y'7� Lie. Improvoent �A - �ii�a�,t../
Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
l ZX 20 I�G�U rro ,a►
MAIL PERMIT TO: I4 G Ct FO S 4o,, 0Cear1 Ave- Wes*r
APPLICATION FOR
PERMIT TO
csi.VeL.c. STtYe'� RF.6.0 .4DD/T/oN
LOCATION
PERMIT GRANTED
S-
APP OVfD
ECTOR BUILDINGS
MGnTGAGE INSPECTION
BAY STATE SURVEYING ASSOCIATES
234 CABOT ST.,BEVERLY MA
LACATION SCAM ___h7r4 NOTES:
SCALE ; I" =30 FT DAfE ...... l6 /2
•This is a Mortgage Inspection survey and not an
----- ----/pj------ instrument survey,therefore this plot plan is for
REFERENCE • BIS_IOO I............... mortgage inspection purposes only.
E 5S 6:X___So._O(S'j-_____________ _This survey is based on survey marks of others.
___________ ___________________________ ^Bushes,shrubs,fences and tree linesdo,not
To ST_�vEl-1 necessarily indicate property lines
({�YJ___G�r� 24Tt vE __ f/JjG _ _ ,In my professional opinion the building(s)are not located
The location of the building(s)as shown,either complied with the in the special flood hazard zone,as defined by H.UA'.
local zoning set backs at the time of construction or is exempt Whenever an offset is f'±or less,an instrument survey
from violation enforcement action under Mass.G.L Title Vfl is recommended to determine prop.lines.
Chapter 40A Section 7. •0 own are approximate by tope surve .
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PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET. 3RD FLOOR
SALEM. MASSACHUSETTS 01970
STANLEY J. USOVIC2, JR. TELEPHONE: 978-745-9593 FXT. 380
MAYOR FAX: 978-740-9846
HOMEOWNER LICENSE EXEMPTION
Please Print.
Date S e� 05
Job Location 0 Ce A^ A JeA1x IL ' P
Home Owner Address _ 169 O(li e-!, ukv e Q2 1 es C
Home Owner Telephone 9-I e> "i '1 D o 25o
Present Mailing Address , I,69 nC24r\ theeate, We -c
The current exemption of"Homeowners was extended to include owner-occupied
dwellings Of two Units or less and to allow such homeownas to engage an individual for
hire who does not possess a license,provided that the owner acts as supervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intend-to reside,on
which them is,or is intended to be,a one or two family dwelling,attached or detached
structures accessory to such use and/or farm structur . A person who constructs 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 he/she be responsible for all such work performed under the Building
Permit.
The undersigned"homeowner"homeowner"assumes responsibility for compliance with the State
Building Code and other applicable by-laws and regulations.
The undersigned"homeowner'certifies that he/she understands the City of Salem
Building Department minimum inspection procedures and requirements and that he/she
will comply with said procedures and requirements.
C HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING INSPECTOR
See other side for state code
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