58 PERKINS ST - BUILDING INSPECTION — F-JriL 1
PUBLIC PROPERTY
DEPARTMENT
KIMBOU-SY DRISCOIL
MAYOR 1?0 WASHINGTON STREET♦S -N.F14,�rA15ncHl:SEI'iS 01970
Ixi 978-745-9S95 • FAx 97&740.9846
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: r— ° Building:
Property Address:
Property is located in a; Conservation Area Y/N_V Historic District Y/N �L
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: J
Address:
Telephone: _ g
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
of existing building I New
Brief Description of Proposed Work: hee�� f
��oo� boCAfds ctn� �u�rd h lra;� lY
--------- - -- --
Mail Permit to: / S �I� (VnPO
What is the current use of the Building? LI
'
Material of Building?w!od if dwelling,how many units?
Will the Building Conform to Law? Asbestos? min
Architect's Name
Address and Phone
Mechanic's Name
Address and Phone
Construction Supervisors License# HIC Registration#
Estimated Cost of Project$�_ Permit Fee Calculation
Permit Fee $� 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 to build to the above stated
specifications. Signed under penalty of perjury X #4
Date (4-9-0
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CITY OF SALEM
/� "' • PUBLIC PROPERTY
DEPARTMENT
KIMBERLEY DRMOLL
MAYOR - 120 WASHINGTON STREET•SALEM MW.�' A�HI:St:T15�1970
1Vi 978-745-9595• FAx:979-740-9846
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code,780 CMR section 111.5
Debris,and the provisions of MGL c 40,S 54;
Building Permit# is issued with the condition that the debris resulting from
this worst shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
1 11, S 150A.
The debris will be transported by:
(nam of hauler)
The debris will be disposed of in :
,A)"NA
(none of faculty)
(address Of facility)
sisnature of pernut applicant
date
dclxisalr.Juc
CITY OF SALEM
I PUBLIC PROPERTY
DEPARTMENT
KIMBERLEY DRISCOLL
MAYOR 120 WASHINGTON S`rREEI7♦SALEM,MASSACHUSETrS 01970
TEL 978-745-9595 ♦ FAX:978-740-9846
HOMEOWNER LICENSE EXEMPTION
Please Print
Date(2(2 , nn �
Job Location Sq Y6✓/11 o S s SoL2 IVA 0,/y jr
Home Owner Address�-r[ ,
Home Owner Telephone 97 00 7
Present Mailing Address St- sale-07 A19 q
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
APPROVAL OF BUILDING INSPECTOR
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.