94 ORCHARD ST - BUILDING INSPECTION 1 A"S1dttST--BE ff Y1i/D ?PROVED BY 7+4E
11PECJL pI1D3 P`A! PEAICAJT B,EWG GRANTED
CITY OF SALEM
No. Ctf7�2b0� Date
Is Property Located in Location of n/�
ld
the Historic District? Yes_No
Building
�/ 7 L ✓C�iig /
Is Property Located In
the Conservation Area? Yes_No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct D�k, Shed, Pool,
Repair/Replace, Other: 3 "1 � �o � o/rnM =/^.
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
Address & Phone �7 /7! J�Flvr.('� - IL`��� F) 99-
� � 5
Architect's Name
Address & Phone j 1
Mechanics Name
Address & Phone ( 1
What Is the purpose of building? ////�T/�F
Material of building? l�nnCV If a dwelling,for how many families?
Will building conform to law? `/IDS Asbestos? IAI�)
Estimated ccoost 000'�Ity License# N P' State License #
Boma Improvement X
CJ e. r i Signature pplicant
C K Z��18 SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO:
No. i t{���c�L(
APPLICATION FOR _
PERMIT TO
LOCATION
PERMIITIGRANTED
19
APP O rD
SPEGTOR bF BUILDINGS
OF SALEM. MASSACHUSETTS
* PUBLIC PROPERTY DEPARTMENT
g' 120 WASHINGTON STREET, 3RD FLOOR
SALEM, MA 01970
TEL. (978)745-9595 EXT. 380
�q 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,S150A
The debris will be disposed of at: (� f-
Locaticrn of Facility
Signature 60erinfit Applicant Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
Name of Pert6it Applicant
l �
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, S 150A, and the building permits or licenses are to
indicate the location of the facility.
CITY OF SALEM
BUILDING DEPARTMENT
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE
JOB LOCATION �` ��/`LhA✓Y/ r57/-
HOMEOWNER
ADDRESS q (
HOMEOWNER / b — r) Y( �/'D ' /n
0 5
TELEPHONE
PRESENT MAILING ADDRESS -S/4 ME
The current exemption of"homeowners"was extended to include owner-occupied dwellings of TWO
Units or less and to allow such homeowners to engage an individual for hire who does not possess a
license,provided that the owner act as supervisor.
DEFINITION OF HOMEOWNER:
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is
intended to be, a one to two family dwelling,attached or detached structures accessory to such use and/or
farm structures. 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 to all such work performed under the building permit.
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and
other applicable goes by-laws,rules and regulations.
The undersigned"homeowner"certifies that he/she understands the City of Salem Building Department
minimum inspection procedures and requirements and that h/she will comply with said procedures and
requirements.
HOMEOWNER'S SIGNATURE
APPROVAL OF BUILDING INSPECTOR2
See other side for state code
1
HOMEOWNER'S EXEMPTION
The code states that: "any homeowner performing work for which a building permit is required shall be
exempt from the provisions of this section (Section 109.1.1—Licensing of Construction Supervisors);
Provided that is a homeowner engages a person(s)for hire to do such work,that such homeowner shall act
as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a
supervisor(see Appendix Q,Rules and Regulations for Licensing Construction Supervisors,Section
2.15). This lack of awareness often results in serious problems,particularly when the homeowner hires
unlicensed persons. In this case your Board cannot proceed against the unlicensed person as it would with
licensed Supervisor. The homeowner acting as supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of hither responsibilities,many communities require,as part
of the permit application,that the homeowner certify that he/she understands the responsibilities of a
supervisor. You may care to amend and adopt such a formtcertification for use in your community.