27 PICKMAN ST - BUILDING INSPECTION -a
ry
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pMNO GRANTED
CITY OF SA�EM
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suna rG PERMR APPLICATM FOR.
Permit to
(CkcN WhMover apply) Roof Ingaq SWft Ca WJM.Dock. Sh14 Pool.
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PLEASE FILL OUT LMKY A COMPLETELY TO AVOID DELAYS W PROGNNIM
TO THE INSPECTOR OF BUILDINGS:
The Wlbfl*W hw@Y aPPIim. for a permit to build accwft to the We....spsomcaftw
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Owners Name -2L&0# 7- 210/2erklez
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Address A Phone
MeohoMa Name EV7&Vo04IYES � ,
Addrea A Phone 1'� &00k PRfVZ7 LYn/NE&A 7M
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SKiNED UNDER TN
DESCRIP110N OF WORK TO BE DONE OF PERJURY
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CrfY OF SAlEM
BUMDING DEPARTMENT'
iiamEOWNFR LICENSE D0IZO14
Pkase Pry
JOB LOCATION
• , liOlrMEOWIiFR
ADDRESS
' NOMEOWI�t
TELEPHONE
PRESENT MAII.ITIG ADDRESS .
The cwrcr4.cn7*c n of-h ners"omeow was cxu ds ndcd w blclu orrvcr ocwpfed dwcllhip dTWO
Uniu IN less and is slow ouch Aomcowners to engage on individual for bin who does aot POMU 1
Lanse,.yrovicw t x.*C.owou ad as supervber.
DEpiN1 noN OF HOMEOWNEk
Pc wn(s)who owns a parcel of land cn which bclsht resides cr irucads tc tcside,on wldcfi is .
inraded to be,a one to two f nu dwclliug aasc}Kd m dciscrcd od sba3 m be considered
farm suucmes.A pctson wbo commucu n me than one home in a two-?on form• setsPable co nt
a homeowner. S that bcJOc tcsponsibsh-Zk W all such work performed mdea the building permM.
Building Official, .
The undcniptcd-bomcownci asstana tupon-'biliV hn compliance with the state Building Code w d
otha applicable goes by-few%nia and tegule OM
The tmdasipd-homeowrcr=65cs that WOK rmdastards the City of Salem Bnlldmg Department.
mi M=ij s on procedures and regtureuherus and that Nshe will comply with said pcooedura and
regt»renre�i
HONMEOWtER'S SIGNA 4
APPROVAL OF Bli11DING INSFS:C'I
Sec other sat fot stau code
I
HOMEOWNER'S EXEMPTION
The code skates tbaC 'ary homeowner performing wmk for which a buDding permit is requb shell be
exempt from the pm+isions of Ibis section (Seetloo 309.1.1-licensing of Counructioa Superv{sots)
Provided that is a knwowrter engages a person W for hire to do.such wor1S that suet kmeowaer shaD act
as Sgavivae
Mary bomeowncn who use this cxctnjm are iut WM that thry arc assuming the TC90malmsks are
n7ervisor(sec Appcodb Q,Rules and Regulations for Liowslug Coostruetfon Supervisoea,See"
L24 This lack of awa wwa of=nsnits in sctk=pmbkms,particularly wben the hon e"=bb"
unlicensed persoas. In this east your Board cannot proceed apim the w0ccased peuoa s h would wl&
licensed 5 iser. The bomeonver scsin as w uhf res s
'�' � g pervbor d mste� . Eoo ibk.
To ensum%w the homeownct is fully aware of hUha nmponnbiBtles,mwq crommmddes require;w ptst
of the permil appli2doq that the homeawnet«rufy that he/she tmderstuds the responsibllitics of
super iwr. You may on to w=W sad adopt stub a foraAcnificatioo for the in yokv c=ummn*,
Y
�. PUBLIC PROPERTY DEPARTMENT
• 120 WASMIN6TOH STREET, 8Ro FLOOR
SALEM,MA 01970
TEL (978)745-9595 EXT. 980
FAX (076) 740-9646
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 fiom the construction activity
governed by this Building Permit sbalk be disposed of in a properly licensed soH&wsm
disposal facility,as defined by MGL c III,S150A.
The debris will be disposed of at:
Location of Facility
Sigoatlue of Permit Applicant Dabs
FULLY complete the following iafomultiojL
(PLEASE PRINT CLEARLY)
Name of Permit Applicant
Firm Name,if any
Address,City&State
The above statute requires that debris from the demolition,removadon,rebab or other
alteration of building or structure be disposed in a propaly-licensed solid-Waste disposal
facility as defined by MGL cIII, S 150A, and the building permits or licenses are to
indicate the location of the facility.