8 OSBORNE ST - BUILDING INSPECTION r �k. 0:
fi ,`PPROVE0 BY T44E
D
i , PEGTQB PIER P\!} .P. T B,EWG GRANTED
E IT 1 OF $ LEM
No. i , /✓�/ %xr' .t '� �� Date
Ward CJ
..xx Zoning District
I\�m E
Is Property Located In Location of `/ DSN� Sk
the Historic District? Yes_No X Building O
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: C�47-&ige- A-+ -i C
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 1-,i>klP (lU. Ruv e-�c A.)
Address & Phone
Architect's Name
Address & Phone ( )
Mechanics Name
Address & Phone ( l
What is the purpose of building?
n/ O,GQ
Material of building? Wcook Gtiez+-goo k If a dwelling, for how many families?
Will building conform to law? yp< Asbestos? fv Q
Estimated cost City License # State License #
Bone Improvement
r Lic. / =4/ti
Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
PU14-iAjcx_ 5; 1,ec-I- (�oGV tNsc/PoL-heA, 4.,r S-,r.,,av
MAIL PERMIT TO:
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CITY OF SALEM
BUILDING DEPARTMENT
Ii0MEOWNER LICENSE EXEMPTION
Please Prim
DATE —
JOB LOCATION -�—
Hol�owrmz
ADDRESS —7
HOMEOWNER79)a
TELEPHONE
PRESENT MAILING ADDRESS
The narcrd e.-,cmpdon of"homeowners"was vncnded to include owoeroccupW dwdGop of TWO
Units or less and to allow such homcawnaa to cngage an individual for lire who does not posts a
license,provided rhea the.owou act as supervisor.
DEFINITION OF HOMEOWNER
Person(a)who owns a parcel of land on which helsbc resides or intends to reside,on which that it Or is
intended to be,a om to two family dwelling,attached or dctadted smxtwcs accessory to umb UK andke
farm strucum.A person who constructs more than one home in a two-year period SW m be considered
a homeowtia. Such"homco mrf shall'submit to the Building Official,on a form acccptobk to*A
Building Official,that Wshc be rupormble to all such work Pcribnacd urda the building Petnk
.Thc undersigned"bomcownct ass mms responsbility for compliance with the State Building Code tmd
otha applicable goes by-laws,rules and regulatiom
The undcnigrted"homcowner" mrti5es that hdshe undnsands the City of Salem Building Depmumm
minimum kzpmuon procedures and requirements and that hlshc will comply with said pr mdwa ttttd
rcquinm coo Q
HOMEOWNER'S SIGNATUREi/
APPROVAL OF BUILDING INSPECTOR
See otber side for state code
A
HOMEO"ER'S EXEMPTION
Tic code states that "airy homeowner performing work for tivhich a building permit is rexlubtd sbaD be
exempt from the prmisious of this section (Section 109.1.1-Uccusing of Construction Supervisors);
prodded that is a homeowner engages a person(s)for hire to do.such work that suet homeowmx shalt ad
as supavisoc."
Many bomeowncn who use this exemption are unaware that they arc asswaing the rcgoastbt'6'tiea Ora
supervisor(sec Appcodia JQ,Rules and Regulations,for Liccnsiog Construction Supervisors,Secti n
.2.14 This lack of awareness often results in serious problems,particularly when the horoeownerbhu
unlicensed persons. In this case your Board cannot proceed against the unliornsed person as it would wi&
licensed Supcnisor. The homeo.roer sling as superviwr is vWxastely responsible.
To ensure that the homeowner is fully aware of hi/her responsibilities,marry communities tegkme;as past
of the permit application,that the hornwwner ecrrify that hdshe tmdcmunds the rssponsibiHties at
supcnisor. You may care to amend and adopt such a forrr✓ccrtbr=6on for use in your cOmmrmiQ.
�o OF SAL,EM- MA
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RO FLOOR
i. gp SALEM,MA 01970
i d• ,
TEL. (978)745-9595 ExT.380
FAX (976) 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
resulting from the construction activity
of BuildingPermit# all debris res g
a properly licensed solid-waste
' osed of m Y
governed by this Building Permit shall be disposed P P
disposal facility,as defined by MGL c III,S1ff 50A.
The debris will be disposed of at: Location
,
Location of Facility
Signature of Permit Applicant Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
Guk�2 w ; hj�X-�•1
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 c1II, S 150,6 and the building permits or licenses are to
indicate the location of the facility.
I