16 OCEAN AVE - BUILDING INSPECTION IT
t i�t4klQS 9oA! M ffL*D., 31 A?PROVED BY T+IE
Fy 1,W.fx1ri-R ,PFWR TD,A.PERMIT.I3EWG GRANTED
4 y i lir
1 sPITY OF SALEM
M..� 3 ` OiNVO,
No. `"VU - DatepWard
a\X Zoning District
Is Property Located In / Location of
the Historic District? Yes_No V Building ((g o cp It, A�
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: V-\ 4--cJn(-jn re mr)�.e l t D\�Vr N1D j rL�
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 ec�llPPr\ c�lCdhC� � 1( a.u -A k-�vrn�
Address & Phone Av-Q-- R)P')
\
Architect's Name a 0 t"A CD
Address & Phone ( )
Mechanics Name 4
Address & Phone ( )
What Is the purpose of building? S -e.
Material of building? If a dwelling, for how—Infiny families?
Will building conform to law? o Asbestos? Tl tl
Estimated cost 3,OOO-O� City License# to License #
Home Improvement
Lie. f
<— 3o`'� Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
t II'�-C�A er� rcirM CA 2l" c
MAIL PERMIT TO:
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co CITY OF SALE:M9 MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
q
120 WASHINGTON STREET, 3RD FLOOR
a a ;'• 1Qa SALEM, MA 01 970 -
TEL. (978)74579595 EXT. 380
FAX (978) 740-9846
STANLEY J. USOVICZ, JR. -
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
In 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
governed 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: t�0 r� S SZ c r r1
n Location of Facility
,Yr 1
Signature of Permit Applicant 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 cIII, S150A, and the building permits or licenses are to
indicate the location of the facility.
i
i .
CTTY OF SALEM
BUILDING DEPARTMENT
BOMEOWNER LICENSE EXEia'IION
Please Prig
DATE 0 a� 03
JOB LOCATION
HOMEOWNER JC.�a-r� �
ADDRESS
HOMEOWNER l t 1�� 1 �S" (2
TELEPHONE O
PRESENT MAil.ING ADDRESS
The cwrcrrt rxcmpdon of"homww=C was extended to include owocroccupied dwdGogs of TWO
Units or less and to allow such homeowners to engage an individual for biro wbo does na posseta a
license,provided that the owscr act as supervisor.
DEFINITION OF HOMEOWNM*
Pcrson(s)who owns a panel of land on which he/she resides or intends to reside,on wilich
to surcb useuse is,Or
and is
g,
intended to be,a one to two family dwellin attached or detached strucnzRs accessory
farm structures.A person who constructs more than out home in a two-year period shall not be musidend
a homeowner. Such"homcoWir f shall'submit to the Building Official,on a form sazptabk to ffit:
Building Of5cW,that bclshe be Tesponnble to all such work performed under the building pctmk
The undersigned`bomcawner"assumes responsibility for compliance with the State Building Code trod
other applicable goes by-laws,rules and tegulatiaaL
The undersigned"homeowner" ccrtMcs that hdshc undcstards the City of Salem Building DgwuncA.
minimum inspection pmceducs and requirements and that lJshc will comply w-itb said procedures and
my,,;,r,r,+e
HOMEO WNER'S SIGNATURE
@Q-��
AFPROVAL OF BUILDING INSPECTOR
See other side for state code
HOMEOWNER'S EXEMPTION
The code states that.' "any homeowner performing work ftrr which a building permit is required shaD be
exempt from the provisions of this section (Section 1t19.1.1-Icrosing of Construction Supervisors);
Provided that is a homeowner engages s person(s)for hire to do.such work,that sveh homeowner dhall act
as supervisar."
many bomeowners who use this e_xcmpdon are unaware that they an asswnurg the responsibilities da
supmisor(see Appendix Q,Rules and Regulations for Licensing Construction Supervisors,Sectin
2.1 7 Lis lade of Ewarrness ooftenresrilresultsin serious problems,particularly when the horneownabast a the unlicensed as it wvnld with
unlicensed .rsom In this case your Board cannot proceed against i�a
Pc
licensed Supcnisor. Tbc homeowner atYfng as superviwr b uitimatdy responsible.
To ensure that the homeowner is fully swarc of hither n�-ponsr'billAIM many communities regaim as peat
of the permit 2pplic2don,that the homemvner certify that helshe understands the responsibilities der
super%isor. You may care to amend and adopt Sur h a forngcertifimtion for use in your commrndq.