34 PHILLIPS ST - BUILDING INSPECTION I
`PL•/t(+ 1d0ST13E f$�NrD PROVED BY TiiE
a 1l�IS�'FS.7l AJ IDR D�9#P BFJNQ GRANTED
v CITY OF SALEM
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In Property Located in Location of
Me Historic District? Yee_No Building `
is Properly Located in
Rn Cormervaggn Area? Yee_No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Sidin Construct Deck Shed, Pool,
Repair/Replace, Other:
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROCESIMNG
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the following
specifications: ''//
0mv er's Name '2h � )
Address & Phone �Jl,�s ICi 7uh 43�5 .
Architect's Name 060f)pl^
Address & Phone �5-0n?e C<S. eahMrl� j 1 `—
Mechanics Name
Address & Phone
What Is the purpose el WNW
Material of buk Uq? a dwaYYq,for how many ramilles? ,,,. ... ` ,
z
Will bulldnp cordorm to law? S Ad"os7
Eetbnated coat i�/ ° CRY Lkmm e N A State License M_
ame, Improvement Lie. .!
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Signature of Appllesrit
SIGNED UNDER THE PIdNI
- OF PERJURY
DESCRIPTION OF WORK TO BE DONE
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MAIL PERMIT TO: ffz1#,11,YJS .52
ilia,
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APPLICATION FOR
PERMIT TO
CDC 57Tb� �ec. ��
LOCATION
3y 6,�l���s
PERMIT GRANTED
0/b 14 2-0
API OV D
to
TN—SPECTOFIKOF BUILDINGS
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CITY OF SALEM
BIMDING DEPARTMENT
IiCla0WNER LICENSE E?mNIPTION
Please PM
DATE ±" — - t
lOB LOCH
ADDRESS
lloMEowrmt q7�715 -1732i'S
TELEPHONE �// /
PRESENT MAIl.ING ADDRESS 'JL 0/7/�!/O �
The narcnt cNcmpdm of"homeow=C was r-%UTbdcd to include o.rocr-Q=plcd dwcmip dTw'O
l)niu a leis and to allow such bomcow=s w engage an individual Sot but wfio don not posses
limim,.yruacd em the owuet act as superviwr.
DEFINMON Of HOMEOWNER:
Person(s)wbo owns a pm=l of land on wbieh bc/she resides a i cr&to rtside,an'wlticir 0=ll s of is
intcndcd to be,a one to two family dwelling,anached a dctachtd suuct>acs od b vst ridged
farm s�rucwm&A person who constructs more.iharr one home in a two-? ay on a form&=Vmbk W
a bomcowucr. Such`homcow shlT submit io tlx Bu9d4 Offi681.
Building OfScW,that luJshc be rssponsible to all such work paformed under lht buAdmg pauk
The tmdcrsipcd'bomcosmer asnum teryonnbilityfor compliW=withthe Su Bmldmg Code smd
other app£rabic lots by-laws,tries and rcgplatious.
The undesiptd'homeo -=" ccr%Mcs that ht/she undevw&the City of Salem BwWmgDe mv=K.
minimum k spwtion pmcrd=and rcquim=w and that Wshc will comply whb said procedures nod
rcQui==a ,/
HOMEOWR S!S' SIGNATURE i'.�
APPROVAL OF B=ING INSPECTOR
See otber sdc for smu colt
f
HOMEOWNER'S EXEMPTION
The code stags that• "arty homeowner performmj-.,ork for ,vUcb a bm'lding permit is req»and sbaD be
exempt from the prvv ions of this sccdon (Section of Construction Supetviwrs);
provided that is a hontvAmer engages a person (s)for h'ue to do.such work,that such botmeow=shag ad
as sttptsvisa
ivlany bonxcrm as wbo use this mmpdon arc imaware that thry arc asswring the tzsponsr'bi!'roes aft w
supayisvr(sa App<ndis Q,3tuio and Rcguistions for Licznsiny Conriruction Superviwra;$eiyiN
• .I.iS} This lade of awareness often renilu in serious problems,paztieuiari�when the bomeowae burs
unlicensed pctsoiii In this case your Board earmot proceed agaasst the urilierascd person as itwvulrl.ri�
lianscd Supervisor. 7be booxo+,ver adiny a supervisor b uldanstely responsiblR I
To ensure.that the homeowner is fully aware of hiq=responnbilities,many commmiides requay as pact
of the permit appliee60r4 that the homeoNvner CtTdly that hcJahe UndcrStan U tbt responsibiiitia df
supcnisor. You may can to amend and adopt sua a Sormlccnif=ation for me in yom cm=mmQ.
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
SALEM, MA O1970
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 150A.
The debris will be disposed of at: "51r )l'rIYIQS�/�7/
Location 6f Facility
Signature of Permit Applicant Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
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 cM, S 150A, and the building permits or licenses are to
indicate the location of the facility.
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