5 OLIVER ST - BUILDING INSPECTION jA#STeEfiL+G,-w0 APPROVED BY T44E
ANSPEXT,GR ,PMOR TD.A.PERMIT.B,EING GRANTED
CITY OF SALEM
.;r 0
Date
f
Is Property Located In / C)l l Location of 1�
the Historic District? Yes v No_ Building �C—'�- ,
Is Property Located in C�R IV G
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:
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 I�►�I`cot( 1 >�f1�GI�
Address & Phone ��I I/et2Q SDI t�''� T� MP-) 7qO - J!77�{
Architect's Name
Address & Phone
Mechanics Name
Address & Phone f
What Is the purpose of building? pp ?
Material of building? 10 Ore)rA If a dwelling,for how many families?
Will building conform to law? Ve 5 Asbestos? ,A fl
Estimated cost 2f 10O. po City License # NJ 14 State License #
Home Improvement � ��
Lic. /
Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
O d Yl e e ivt
C to V-4
P 6[JA S CrrC e
MAIL PERMIT TO:
No. (�
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
APPROVED
CTOR OF B LDINGS
aCITY OF SALEM9 MASSACNUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASNINGTON STREET. 3RO FLOOR
SALEM. MASSACNUSETTS 01970
STANLET J. UEOVICZ. in. TELEPHONE: 970-745-9898 EXT. 380
MAYOR FAX: 978-740.9848
HOMEOWNER LICENSE EXEMPTION
Please Print.
Hate s3 —I ,3 -0 (o
Job Location
Home Owner Address. e
Homo. Owner Telephotys D q77�F
Present Mailing Address
The currgnt moon of"Homb°wnere wag,ab=W to include OWIM-occupied
dwellings of two Units or leas and to allow such homoo to Engage an individual for
him who does not P01111 ,a license,provided that the ow as Visor.
DEFINITION OF.HOMEOWNM:.
Person(s).who owns a pao dAf land on which he/she resides or'
which them is,or is intended to be.a one or two mtead to reside,on
structures accessory to such use and/or fang shun�dwelling
attached or detached
than one home in a two ear P who C0 more.
Y period shall not be considered a homeowner. Such
dUmeownef 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
PermiL
The undersigned "homeownef"assumes responsibility for compliance with the State
Building Code and other applicable by-laws and regulations.
The undersigned"homeowner"certilles 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 requirement.
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING INSPECTOR
See other side for state code
r
The Coda states that "Any Homeowner Pig
work for which a Building P�is
The Cc a sum
be exempt Crow Protons of this section(Section 109.1.1 —Licensing
of Constnictition Supam80Tb�'provided that a Homeowner engages s person(s) biro to
do such work,and that sorb Homeowner shall act as Supervisor.
who use this exemption are unawam that they are assuming the
Many Homeowners s Rules and Reguladons fer LkW&g
responsibilities of a Superviection .151App Q.
Construction Ste•Section 2.1 S� This lack of awareness often results in sesrous
when the Homeowner hires unlicensed persons. in this case Your
problems.Particulmiy the unlicensed person slit would with a licensed
Board cannot proceed responsible.
Supervisor. .The Homeowner acting as supervisor i}
of .
To ensure that the Homeowner is fully aware of his/her Nlities.many
a of the Permit Application the Homeowner cffdfY that
CO mmunities require.the bilities of a Supervisor. On the last page of this issue is a
heJshe uriderst�used you��to amend and adopt such a
form cturantlY
f��8eation for use in Your community
R� ���Izoor