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14 PALFREY CT - BUILDING INSPECTION CiTro- LEA -- PUBLIC PROPERTY !' DEPARTMENT KIMMU.sroais A)L NAvoa 12o W..MNGT NSnwEr / SAUL.AtiSA0i1:5l115 01970 TEL 978-745-959S a FAX M740.96" APPLICATION FOR THE REPAIR. RENOVATION, CONSTRUCTION. DEMOLITION. OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING STRUCTURE OR BUILDING !*0 SITE INFORMATION Location Name: J l o s Building: om e — Property-Addream; -- -14 pprI Property Is located in a;Conservatlon Area YIN&i_Historic District YIN_ 1� 2.0 OWNERSHIP INFORMATION 2.1 Owner of Land _ Name: 11 ewo `s k� W n ale Address: a,jSg Fa r4-e5 q u e_ Au CXe-0,YAslle- , 1S Telephone: S 1 Lo- -5 3 1b - 4 F 3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY Addition Existing Renovation ✓ Number of Stories Renovated Change in Use New Demolition — Existing Approximate year of Area per floor (sf) Renovated construction or renovation �g ID of existing building New Brief Description of Proposed Work: ElecILriccLl kPcla-f2— PIL4Ph l� u c — rr\o, O-dd bo-+h (-oo ry,) P Lill� e-, b Mail Permit to: What is the current use of the Building? OrA it, Material of Building? If dwelling.how many units? Will the Building Conform to Law? Asbestos? Architect's Name Address and Phone Mechanic's Name Address and Phone Construction Supervisors License# HIC Registration# Estimated Cost of Project ��c c o Permit Fes Calculation Permit Fee$ Estimated Cost X$741000 Residential - - - — -.---- Estimated Cost X$I1/$1000 Commercial An Additional $5.00 Is added as an Administrative charge. Make sure that all fields are properly and legibly written to avoid delays in processing. The undersigned does hereby apply for a Building Permit to build to the above stated specifications. Signed under penalty of perjury Date 1 /7 0 7 L 0 N w 4+ \ V J O O ti '3 y a fA o6 ck w • ;n CITY OF SALEM ,+ PUBLIC PROPERTY DEPARTMENT KINIBERI.EY DRISCOLL MAYOR 120 WA.SHINGTON STREET#SALFM,MASSACHLSECIS 01970 TELL 978-745-9595 0 FAx:978-740-9846 HOMEOWNER LICENSE EXEMPTION Please Print Date 1 1Z 6-7 Job Location IL- Pkkj CL,4 �a�1E Home Owner Address a4&CcJ For s S t S Home Owner Telephone Present Mailing Address Spr- e- 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 acts 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 or 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 for all such work performed under the Building Permit. The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other applicable by-laws and regulations. The undersigned"homeowner" certifies 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 requirements. HOMEOWNERS SIGNATURE /10J APPROVAL OF BUILDING INSPECTOR C See other side for state code 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 —Licensing of Construction Supervisors);provided that a Homeowner engages a person(s) for hire to do such work, and the 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 of 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 a licensed Supervisor. The Homeowner acting as Supervisor is ultimately responsible. To ensure that the Homeowner is fully aware of his/her responsibilities, many communities require, as part of the Permit Application, that the Homeowner certify that he/she understands the Responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. 1 � Crry OF SALEM PUBLIC PltOPPMM DEPAWrMM4 T �...�onamia �a�?+saga.r,►><en�+►+w Coasuvedo. Debrb D4wat AM&vtt is aoeaedaooa wide m.a6uf.�dw a[tha stag��Ise�aaedo.tt1.! 10&"ad dr pwAdow a(SM 4406 S sst g, ndbarm o t isbum/Vft d?A COMMON 60 td d&b MMUbg swa �aiaet abaJl Da maooad of bt a popes sow vada dlaOwd Sdttgt>.daAead by!(R)1.a t tie 2I & The ddMU will b.ttampoated byt — ra.>,e dbaaMal Thm aebda will be disposed o[in: r��tariw» Siawa�a�•�ovu�a� dw r Vl l 1 V+ V111i — �`' G;t%�� PUBLIC PROPERTY Cn ► 2-4'7 DEPARTMENT KI,%IBFJU.EY DRISCOLL MAYOR 12D WASHINGTON STREET♦S.WiK MASSAcHLsLrrs 01970. TEL-97&745-9595♦FAx:978-740-9546 APPLICATION FOR THE REPAIR, RENOVATION, CONSTRUCTION, DEMOLITION OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING STRUCTURE OR BUILDING 1.0 SITE INFORMATION Location Name: Building: Property Address: Property is located in a; conservation Area Y/N zs/ _Historic District Y/N 2.0 OWNERSHIP INFORMATION 2.1 Owner of Land Name: C-S C &1174dCEN Address. yS-3 s a2i (✓�� d2c L4A/S/6 F" /V.� 2-- . Telephone: 5-16 -- 3b { 7 3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY Addition Existing Renovation Number of Stories Renovated L4 Change in Use New Demolition Existing Approximate year of Area per floor (sf) Renovated 66 construction or renovation J. of existing building New �/ grief Description of Proposed Work: _ nQ 8�x, g, 54 1� Mail Permit to: What is the current use of the Building? Material of Building? 0019, If dwelling, how many units? � Will the Building Conform to Law?�t/�S Asbestos? NrJ Architect's Name / Address and Phone l ) Mechanic's Name Address and Phone Construction Supervisors License# HIC Registration# Q• Estimated Cost of Project$ /� pyo Permit Fee Calculation Permit Fee$ ISO. Estimated Cost X$7/$1000 Residential Estimated Cost X$11/$1000 Commercial An Additional $5.00 is added as an Administrative charge. Make sure that all fields are properly and legibly written to avoid delays in processing. The undersigned does hereby apply for a Building Permit t Uild to the above stated specifications. Signed under penalty of perjury X ----�- S J 0 y � 7t � w O > c a CITY OF SALEM PUBLIC PROPERTY DEPARTMENT KIMBERLEY DRISCOLL MAYOR 120 WASHINGTON STREET•SALE MMSACHUSET S 01970 TEL 978-745-9595♦ FAX:978.740-9846 HOMEOWNER LICENSE EXEMPTION Please Print Date o . Job Location Z�44 Home Owner Address 5,1,,,E Home Owner Telephone ,2 - 7 y - p y L Present Mailing Address ;Nry"4ilzmsc� �c n uC- /1-�.9.y-;y'45 N 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 acts 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 or 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 for all such work performed under the Building Permit. i The undersigned "homeowner"assumes responsibility for compliance with the State Building Code and other applicable by-laws and regulations. The undersigned "homeowner"certifies 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 requirements. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING INSEECTOR See other side for state code 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 —Licensing of Construction Supervisors);provided that a Homeowner engages a person(s) for hire to do such work, and the Homeowner shall act as Supervisor." _ . . Many Homeowners who use this exemption are unaware that they are assuming the responsibilities of a Supervisou(see Appendix Q,Rules and Regulations for Licensing of 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 a licensed Supervisor. The Homeowner acting as Supervisor is ultimately responsible. To ensure that the Homeowner is fully aware of his/her responsibilities,many communities require, as part of the Permit Application, that the Homeowner certify that he/she understands the Responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. CT1Y OF S�1LP�t PUBLIC Pwpmw DWA rUM4T MAWS �la.s ereelido..ot="a"WOO fla,o a mes wi6 ft .df M atltw Oft tab ft Cadt 7tfl00 sea"IMS oA166mid6opsv 041-atl=444254 g �� -07 fs Moro eoed�le�m.t aib m"ba flan �woes�Il>w dl�o�ati�a poor llaew/�rw dfge.i f�a�dot Di4.� iu.sisu tr.. The dAM will e.dfopow+atfa: cm• of&Sod t*� % a(o lao