46 PHILLIPS ST - BUILDING INSPECTION -PL-A"SIdbST-DEffLfG-ANO.APPROVED BY T*IE
W5PyXTDR PF fl TD A.PERMIT f:JNG GRANTED
CITY OF SALEM
No.z 31 4 ON
*';, Date (-
n y:yy A
Is Property Located in Location of��[[��
the Historic District? Yes_No� Building 7� P�rU
Is Property Located in
the Conservation Area? Yes_No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof s all Sidi Construct Deck, Shed, Pool,
Repair/Replace, er:
PLEASE FILL OUT LEGIBLY & COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the following
specifications: I
Owner's Name <t nke
Address & Phone �-1 I"o C S� - Mg) -)k[ (2X 7
Architect's Name
Address & Phone L 1
Mechanics Name
Address & Phone ( 1
What is the purpose of building? �eS 1
Material of building? (, ara o) If a dwelling, for how many families? S�
Will building co form to law? Asbestos?
Estimated cost# ,OL'X - City License N A State icense q
�� �\ Borne Improvement �---
o Lie. i
Sigg ur Applicant
SIGNED NDER THE PENALTY$2�,,
Cr- 119 OF PERJURY
DESCRIPTION OF WORK TO BE DONE
Q,,4- gf(
MAIL PERMIT TO: 7ln A/1',
No. 231— 2cso 3
APPLICATION FOR
PERMIT TO
LOCATION.
PERMIT GRANTED
Ic/B f a`3
AP OVFD
INSPECTOF17OF BUILDINGS
co OF SALEM. MASSACHUSE77S
v6 PUBLIC PROPERTY DEPARTMENT
I20 WASHINGTON STREET, 3RO FLOOR
< SALEM,MA 01970
E. TEL. (978)745-9595 EXT. 380
G FAX (978) 740-9846
STANLEY J. USOVICZ, JR.
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
p34,I acknowledge that as a condition
the Provisions of MGL c 40, S
In accordance with ,
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, S150A
The debris will be disposed of at: ty
Location of Facility
G
1 ermtt plicant ate
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
Name of Lit
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.
CTI'Y OF SALEM
B=ING DEPARTMENT
HOMEOWNER LICENSE EXBOTION
Please Prim
DATE N
JOB LOCATION q( Lk f
HOMEOWNER l0 �� ► I. Sy
ADDRESS \
TELEPHONE
PRESENT MAMING ADDRESS
The ewrent exemption of'homwwnas"was extended to include owocr-occupied dwc]Hojs of TWO
Units or less and to allow such homcowmn to engage an individual for hire who does not ptasesa a
license,provided that the owner set as supcMwr.
DEFINMON 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 to two family dwelling,attached or detached swcmu acoessory to such mu aadlar
farm srucnres.A person who concocts more than one home in a two-year period stall mt be cansideted
a homeowner. Such"homeoviTaf shall'submit to the BuB&q 01564 on a form a=cptable 10 ma
Building Official,that Wshe be responsible to all such work performed under the building perm.
The rmdusigred`bomwwncr"asnu na responsibility for compliance with the State BuDdmg Code tad
other applicable goes by-laws,rules and regulation
The undcrsigmd'homeowner"certifies that he/she understands the City of Salem Building Dcparnnmt
nurumwn uzpation Procedures and requirements and that hlshe comply with sand proms wA
ie4 G
HOMEOWNER'S SIGNATURE
APPROVAL OF BUILDING INSPECTOR
See other side for state code
HOMEOWNER'S EXEMPTION
The code states that: "arry homeowner performing work for which a building permit is required shall be
exempt from the proNisions of this section (Section 109.1.1-Licensing of Construction Supervisors);
provided that is a homeowner engages a person (s)for hue to do.such work,that sreb bomeowner shall ad
as supervisor•"
Many homeowners who use this exemption are unaware that they arc asstaning the;esponsibilida of a
supervisor(am Appendix Q,Rules and Regulations for Liocnsiog Construction Supervisors,Settiw
2.15} 7 his lack of awareness often rcsulu in serious problems,particularly when the horwowr=bau
unlicensed Pe mm In this case your Board cannot proceed against the traccused pam. as h avuld witL
T1x homeoxocr actin as su ,visor is ultimata mpousIW
licensed 5 isor, y
It �n 8 Pe
To ensure that the homeowner is fully aware of hither responsibilities,marry eomrnwIlIies regime,as part
of the permit application,that the homeowner certify that hcJshe understands the responsibilities of a
supcnisor. You may care to amend and adopt such a form/ccnification for use in your commtmity.