47 OSGOOD ST - BUILDING INSPECTION (2) o r,�
-PL-*"SI*1�6f�9Ef�L{ +4ND OVEfl 8Y TirIE � `
r" .hWEM �WC+ GRANTED
CITY OF SA;LEM
No��
s� 1 111
f
Is Property Located in Location of �/ f
the Historic District? Yee,_No Building /7 j � 0d'*'
is ft"ity LocsW in
lM 00rM v Wqn Ana? Yw.' No /1
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, hed Pool,
Repair/Replace, Others
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROCEIllift 'i
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the following
specifications:
ownsr's Name
Address & Phone 47 ���oo� �� j� 7
Archltect's Name
Address & Phone j 1
Mechanics Name
Address & Phone L 1
What Is Br purpose of bulldbq? `�-
tt d&W of per? lc9 00 I a dwOM,for how many lama"?
ww twiidinp cord to law? Asbestos?
Estimated cost OD .O c' C ty Ucaw Y N $1 M
Hoaa Isptoaaarnt 7
7 Lie.
Signature of Applicants;, I i
SIGNED UNDER THE PBN#W , if
if OF PERJURY
DESCRIPTION OF WORK TO BE DONE
AL
I
MAIL PERMIT TO
RIp
'�' L� Ol176
r
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
2-6
AP A VFD 7
INSPECTOR OF B ILDINGS ®
s
T
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 9RD FLOOR
SALEM,MA 01970
--* 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
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 150(A.A.
The debris will be disposed of at "� v
Location of Fac'
Signature of Permit Applicant Date
FULLY complete the following information:
(PLEASE
/I PRINT CLEARLY)
Name of Permit Applicant
Firm Name, if any
Address, City &Stale
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 cM, S150A, and the building permits or licenses are to
indicate the location of the facility.
CTfY OF SALEM
BURRING DEPARTMENt
130Iv1E0WNER LICENSE E?m'no N
Please Pripp�--
DATE
IOBLOCAMOK �2 s-boo S S ^
HOIMEOWt>FA `��`e- .
HOWOWNFjt
TELEPHONE
PRESENTMAD-WG ADDRESS iCJ�te-
The aatap e+ampdon of"bomwwaerC was c munded to iMlude oxocroccupied dwelttep of T w()
Uniu or less and to allow such homtow-ncts to engage an individual lw biro who dca not posstla S
liccnse,.pruvidtd that the.osraer act fts supervisoa
DEFazr nONOFHOWOWNM
Person(s)who owns a paml of land on which he/she midcs of intends to ruidt,on svlddtm laamdl's
rounded to be,a one to two family dwelling,anached of duached sauctwcs od abat!�be st andaed
ur
farm struawm.A pm-on who constructs mom than one home at aft� P�
a bomtow=. Such`homcow•ixf amD'subu&to the Bu33ding on a lam*=cpbk to*A �
Building McW,that lulshc be nspotmblt to all such work pafotsotd tudcr the butldutg Pcrmk
'T'hc tmdcnigncd`bomcowm"asFamcs tcspown'bility for complimtce with tht State Budding Code W d
other applicable goes by-laws,TWes amdregttlstiont.
The undcasigtxd"homeavmer"cerd5ts that hdshe undcTmn s the City of Salem Bwkfmg DepwWaat.
minimvrn inspwtion prxcdttres and nisi and that Nshc tvtll comply with said P1O
require.tne K
HOMEOWNER'S SIGNATURE
APPROVAL OF BUILDING INSPECTOR
i
See otber side foe state code
NOM ON"ER'S EXEMPTION
The code sustcs that.' `any homeowner performing work fin tivhich a building perntit is required shall be
exempt from the prm'isious of this action (Section 11.1.1-Uccosing of Construction SuperAwrtt);
provided that is a honxu A ntr engages a person(s)for hire to do.such wank.that such henmeoaaer sbau 84
as v
Many bonxosvricrs who use this exemption art unaware that they arc Lwmu%g the?tsPOMI M df ~
Tsupcn•isor
(sec Appeodis Q,Ruin snd Regulations for 1;ecnsieY Coosiruetion Suptrviwrs,5eetiat•
4 71zis lack of vvwmcss often Tcsnlu it serious problems,particularly'when tht bmoeownn bins
unlicensed persam. In ibis terse your Board cannot proceed against the milteensed person as$would Brill
licensed Supcnisor. Tbt bomeonvtr SCIIMZ as svpuvisor b intimately rtcsponslbk.
To enswc that the homeowner is My aware of him resposLnbilities marry commtmitia requrrt;as pat
of the pcmur sppllemdon,that the homeowtui Certify that Wsht understands the rtsponsbititia off.
supcnisor. You may cart to amend and adopt such a form/ee tifrotioa for tut In yatr eommtmiq.