19 RAYMOND RD - BUILDING INSPECTION s 4k}QSIW:16T-BEfiLE�`APPROVED 8Y T*IE
MP CT.D13 ,PF,10A TP.A PERMIT BEING GRANTED
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CITY OF SALEM
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No. �D10 �.: :`� '� �� �. Dateg/C9�
�q�Q/p11V60�a
Is Property Located in Location of
the Historic District? Yes_No Building
Is Property Located in
the Conservation Area? Yes No_
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) (,RoW Reroof, Install Siding, Construct Deck, Shed, Pool,
Repair/Replace, Other:
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: 1j
Owner's Name &r ��� tl tl�SO�
Address & Phone l art y wi- ,d h 222 ti S -�s t(�)I
Architect's Name
Address & Phone
Mechanics Name
Address & Phone
What Is the purpose of building?
Material of building? If a dwelling, for how many families?
Will building cc form to law? Asbestos?
Estimated cost_city License # N A State License#
Home Improvement
Lic. f
ignature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO�fBEDONE
MAIL PERMIT TO: �GI k y yam?o n d U�G�
No. Q�
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
APtP/ OV, D
INSPECTOR OF BUILDINGS
s
Fy
4
1 I
CITY OF SAL,EM, MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WAsHjf4gTON STREET. 3R0 FLOOR
SALEM. MASSACNUS[TTS 01970
STAMLtV J. utoV1CZ. JR.MwroR TELEPMONt: 97e-748-9595 EXT. 380
FAX: 970-740-9946
HOMEOWNER LICENSE RXEWn0N
Please Print
Date 3a
Job Location ,,,. 6
Home Owner Addreea.
Tel
Home Owner ephosle -
Preaeru Mailing Address, S.oc"
The
"Hon
��f two Ubaitm of
a oR leas "Owmd ne C wall such�to include o
a'nar-accupied
hire who does not Possess a license,provided that the o tO engage an individual for
.v as Visor.
DEFINITION OF HOMEOWM
Person(s),who ow
a Parcelof laud on which he/ resides or in which there is,er is i�rtded to�a one or two family dov intends on
s��+ to ellhit hW or
such detached
elY use and/or farm. ahuctura. A than w one home in a two ear person who er. Such
b more
Y period shall not 6e considered a homeowner.
"homeowner"shall submit to the Buildingo�'IIOf Such
Official, that he/she be Official,on a form acceptable to the Building
Permit responsible for all such work performed under the Building
The undersigned"homeowner"assume$responsibility for compliance with the State
Building Code and other applicable by-laws and regulations.
The undersigned"homeowner"certifies that heshe
Building Department minimum i u�erstand$the City of Salem
will comply with said inspection procedures and requirerrlenta and that he/she
Procedures and requirements
HOMEOWNER
S SIGNA
TURE G
APPROVAL OF BUILDING INSPECTOR
Sex other side for state code
I j0Mz Its Mp PION
g work for which a Building Permit is
The Code states that' "Any Homeowner performm Section 109.1.1 —Licensing
be exempt from the provisions of this suction(Section pGraou(s)for bits 10
reqHomeowner enPPs
shall a Hum
cued Provided that
of construction Supervisors);Homeowner shall act as SuPC1'"r�•
do such work�� unaware that they are assuming�
Homena,IIes who use this exemptionOj Riild and geguiations for Lich
I expo ilities of a Supevisor(S00 APP�hack of awareness often results m serious
rib. M Section 2.1 S). In this case your
ConstnticuPns when�Homeowner hires unlicensed P�°�
pensed
roblems. the�cansed person a'',�i�,t�`w,o�uldyiespo�b with a hc
Superv►sor, '�Homeowner aft a$ of u f
aware of hislber tea bilitiM many
To ensure that the Homeowner is hilly hcation,tf7at the Homeowner comfy
as a part of the Pecmit,•4PP the lass PZV of this issue is a
communities ro4 he ibilities of a SuPe" 0°
heJshe undest by several towns. You MAY Care to amend and adopt such s
form currently urwtity.
formlcer i cjdon for use Yo. ,
i
R� bl='� sows'
CITY OF SALEM, MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINOTON STREET. 3RD FLOOR
SALEM, MASSACNUSETTf 01970
STANLEY J. U80wjCE. JR. TELEPHONE: 978-745-9895 EXT. 380
MAYOR FAX: 978-740.9646
Salem Buildlna Deosrtma.+�
Debrla DbDWW Form
In accordance with the provisions of MGL c40 S 54, a condition of your
Building Permit is that the debris resulting from this work shall be disposed
of in a properly licensed solid waste disposal facility as defined by MGL
Chapter III, S 150 A.
The debris will be disposed of in:
v J�If-P SPo>a (Location of Facility)
Signature of Applicant
Date