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PLEA=PU OR LAMLY A ODYPLwMy TO AV=D"VS N PIgO�Ir
TO-TM INSPECTOR OF SUILDNM-
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CTTY OF SAlEM
BUI DINGDEPARTMENT
HOMEOWNER LICENSE EDMOTION
Pkasc P►at
DATE -7 O q
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• ADDRESS q7 9
NOA�Oa'I�t
TELEPHM $'�Jew,', MA C�l,9�o
PRESEt�i WING ADDRESS ��1l c� '
The
cmrem exemption of oet
"l%=.maws"was extended to include owocr-occupied dweMip afTWO
Unix er less and to allow such bomeowms to=pge an itdivrdual for hire who does not posses 8
u=mc..Fmhded thn the owner act as supervbor.
DEF'A11TlON OF HOMEOwNF]L
Person(s)who owns s pw=l of land on which he/she tesidcs or wends to tsside.em+vlodh kAA .
intended to be,a one to two family dwelling stsacKd or detached Ou"mcs od shall not be wnsidcted
farm==mars.A Person who coruvvns mwre them one home in a two-? p�
s homeowtsa. Such nwn mv,ncr shag anbndt w the Building Offxi4 on a form ac=ptebk to As
Building Official,that hdshe be tcsponsrbk to all such Wc*pafarsmed order P
The tmdenigned"hov=wncr"asshvnes rrsparmbilk for comFlianec with the Stan Building Code U d
other appGcabk goes by-laws.rides amd tegubtioms.
The undersigrrd-homevwnex"=ffka that hdshe undvshatds the City of Safer°Bm'le5ng Depaone:K
minimhan intPe::ti prvee
on d ums and tegrnremcnts and that 1Jshe will comply with said vo�urs and
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HOI�OWNER'S SIGNATURE � �,
APPROVAL OF B=ING INSPECTOR
see other sde for start code
NOMEO"ER'S EXEMMON
The code sutes tlaC 'any homeowner performing work for.which a buDding permit is mgdmd slap be
exempt from the pm+isiow or bit section (Section 70*.11-licensing of Construction SuptrdwrQ
Provided that is a bomeowster engages at person(s)for hire to do.such work That suet bos ww=dM ad
as supervistt'
Matey bornwwnca wbo Ise this exemption are imawan that they art ustmaing the TmonsiEaw"Ica
supervisor (set Appcodb Q,Rules and Regulations for Licensing Coostrwcdm Supervisors,Secd.m
Li4 This lack of awareness often nsulu in serious problems,pariLab y wbm tht borocow•rerbba
unlicensed perwm In Ibis east yom Board carrot proceed against live r accused perpn as h would via
licensed Supmisar. The bomemvcr&ding as supervisor is ohisnsttiy r Srmspsia,
To ensure that the horneownct is fully aware of hVnerresponnbiEdes,mmry eommmdtins tegdM.aspssn
of the pcnrll application•that the homemrner certify that he/she understands The tespoaw1bilides eta
supervism. You may cart to amend and adopt such a formlecnffkzdm foc me in Ym exm axe ft
PUBLIC PROPERTY DEPARTMENT
;• 120 WAsHIN4TON VMZKr, aRD FLOOR
SAI U.MA 01870
TEL (978)748-8388 EXT. 380
FAX (676) 740-8848
STANLEY J. USOVICZ, JR.
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the provisions of MGL c 40,SA I wlmowledge that as a cmdidon
of BuildiuS Permit d .all debris resulting fiDm dw cousumctim„tiriey
govemed by this Building Pemrit shaft be disposed of in a pinpedy licensed solbd-wasts
disposal facility,as deftned by M(X c 1%S1?0A.
The debris wiD be disposed of at: S/fw S"p N
Location of Facility
I N- O (I
Si of Applicant Date
FULLY complete the following
(PLEASE PRIM CLEARLY)
Name of Pc mit Applicant
Faro Name,if my
Address,City tit State
I
The above statute mp ms that debris flvm the demohdan.renovation,rehab or other
alteration of building or Anwhut be disposed in a properly-licensed solid-waste disposal
facility as defined by W L.cnL Sl50A, and the building permits or licenses are to
indicate the location of the facility.
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!\ Fire'Depar"tment
48 Lafayette Street
• 29 Fort k
Robert'W.Turner Salem,'Massarlfasetts 01970-3695 R
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Q e{ 'Jit978-744:1 0 z Bureautiw
.978-744.6590 z > `jaX 97&745-4646 ; fl
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FIRE DEPARTMENT CERTIFICATE OF APPROVAL 'FOR A BUILDING PERMIT
14
IN ACCORDANCE WITH THE PROVISIONS OP THE MASSACHUSETTS STATE BUILDING CODE #
AND THE SALEM FIRE CODE, APPLICATION IS HEREBY MADE FOR THE APPROVAL'OF PLANS
'AND THE ISSUANCE OF A CERTIFICATE OF APPROVAL FOR A BUILDING 'PRNMIT BY THE
SALEH�FIRE DEPARTHM. ( Ref, Section 113.3 of the Mass. Bldg. Code)
+ JOB LOCATION: )
'. OWNER/OCCUPANT: plot
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ELECTRICAL CONTRACTOR:'
FIRE SUPPRESSION CONTRACTOR:
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w+� y
rM1e -' AYPLICANTt i PHONE /:
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ar SIGNATUBE OF �78 7 C3
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ADDRESS OF O=
APPLICANT: ' _ (0 1 (�Yjf1 �� � � e' �� 'CITY OT �! Q
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APPROVAL DATE: ! ° �.;`
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Certificate of approval is,hereby granted,�on approved Plans, oraub"mittal of w
V ,
project details, by the SALEM FIRE DEPARTHM. All plane are approved solely
for identification of type .and location of Ira protection devices and equipment g
All plans are subject to approval of any other authority having jurisdiction. , '
Upon completion, the ,applicant ,or Installer(a) shall requent an°inspection and/or '
test of the fire protection devices and equipment. +(ADDITTIONAL' REQUIRBMENTS, '^
SEE REVERSE SIDE e+►o) q,
r
NEW CONSTRUCTION. s yz
1' PROPERTY LOCATIONaF�iAS:NO COMPLI N'CE WITH THE PROVISIONS OF
;'• CHAPTER 145, SECTIONa263C/E, M.G.L. , RELATIVE TO THE INSTALA-
TION OF APPROVED FIRE AL1RM DEVICES. THE 'OWNER"'OF THIS PRO 6: 1j
PERTY IS REQUIRED'TO OBTAIN COMPLIANCE AS A CONDITION OF
OBTAINING A BUILDING PERMIT. «' `
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PRQPFRTr LOCATION IS IN COKPLIACNE SIII'H TH$ PROVISION OF CH.�PIER r
145, SECTION 26
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1n compliance with the provision of Section 113.5 of the yassachusetts:�
State Building Code, and underVguidelines agreed upon by the Salem Bldg. *.
Inspector and the Salem Fire Chief, the applicant for a building permit
shall obtain the Certificate'of"Approval (see reverse side) and stamped 1
plan approval from the Salem F•iere Prevention Bureau.
Said application and approvalvis required before-a building permit may,�be, p
issued. . The Massachusetts State -Building Code requires compliance 01
approval of the Salem Fire Department, with reference to provisions of ,
.articles d and 12 of the Building Code,-the Sales Fire Code, Massachusetts
General Laws, and 527 Code of ;Massachusetts Regulations. ; ;
The applicant shall submit thisiapplication with three (3) sets of plans
drawn in sufficient •clarity, fa obtain stamped approval of the Salem Fire .
Department. This applies for all new construction, substantial ? ;
alterations, ichange of use and/or occupancy, and any other approvals ti{
required by the Massachusetts General Laws, and the Salem Fire Code.
Exception: Plans will not be required for structural work when the ,
proposed work 'eolbe, performed under the building permit will
MJ, in the opinion: of the Building Inspector, require,al,
plan to show the`.nature and character of the work to be
performed. `
Sotice:p Plans are normally required for fire suppression systems,
a fire alarm systems, tank ins,)'allat ions,- and Fire Code
requirements. r
Under the provisions'of "Article 22 of the Massachusetts State Building
Code, certain proposed projects may not require submission of 'plans or
complete compliance` with' new"construction requi resents.,• In 'these
`cases, provisions`of: Article 22,° Appendix T, and Tables:appl'icable
shall apply. This section shall not„ however, supersede the
provisions outlined in-the Salem 'Fire Prevention Regulations, Chaple r
-11 148, -4GL, or 527 Code of Massachusetts Regulations. " All permits fo
fire code use and/or, occupancyt shall apply for the entire strycture; c;, '.
a .x.
fire alarm and/or smoke, detector Installation 'shall "apply to the �
entire structure based upon current requirements as'per Laws and/ors`
Codes, but ,the existing Structure may comply with regulations
applicable for existing structures.
Notice: Sub-contractors may also be required to file individual t�
applications_forta Fire Department Certificate of .tpprovhl ,
for the area qF their work. Such sub-contractors shall He
an Application,to"Install with the Fire prevention Bureau
prior to commencing any work for-''those sreas, applicable.
. ,