32 RAYMOND RD - BUILDING INSPECTION a. Y
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fLA �VINS� %ffL+--B� A;PPROVE0 BY T44E
1MPECTD8 .PFWR TD,A.PERMIT.BFJNG GRANTED
CITY OF SALEM
No.-ILo- p . '� � Date O
�A�C/piryg "•��
Is Property Located in Location of r J J
the Historic District? Yes_No_ Buiiding 3L Lq7�1/
Is Property Located in
the Conservation Area? Yes_No _
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Sidi 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:
Owner's Name .2f1vr d 1,na,pd l/
Address & Phone ,3�An nA)rf 2d My ) 7�5--�91 .5
Architect's Name
Address & Phone
Mechanics Name O(yA1 9AN04
Address & Phone 4iel,4jeot S 4*, ( )
What is the purpose of building?
Material of building? If a dwelling, for how many families? /
Will building conform to law? Asbestos?
✓Estimated cost 25 L70 , 00 City License # N P' State se #
Home Improvement
Lic. ' Sgniaiure of Applicant
C AS N SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORKTO BE DONE // /
>?olacP e)4-t A l C- eC C GIn�C
�1 Map Oleo :17/ /lam
MAIL PERMIT TO:
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No. 2-0,r)
APPLICATION FOR
PERMIT TO
Po
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&j zh?,ld "cin(Q
LOCATION
PERMIT GRANTED
03 2-e)
APR VFD
V/Gf.�T�ra
INSPECTOR Oly BUILDINGS
OF SAL,EM,- MASSACHUSETT5
PUBLIC PROPEkTY DEPARTMENT
120 WASHINGTON STREET, 3Ro FLOOR
yp SALEM,MA 01970
A TEL. (978)745-9595 EXT. 380
�A FAX (978) 740-9846
STANLEY J. USOVICZ, JR. -
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the provisions of MGL c 40,S34,I aclmowledge 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,S150A.
The debris will be disposed of at:
Location'Of
of Facility
2sr 03
'91 nature of Permit Applicant Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
fT,rl ��'•tceA-1
Name of Permit Applicant
Firm Name,if any
'?z i2a4,,M01J0 �9-7a
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.
CITY OF SALEM
BUILDING DEPARTMENT
HOMEOWNER LICENSE EXEMPTION
Please Prim
DATE ZSS 0 n /
JOB LOCATION �i 2 8� �IdVIO Ak Y�Y
HOMEOWNER L3 Z— pa4Li Me Ak
ADDRESS
HOMEOWNER 27L 3
TELEPHONE D
PRESENT MAILING ADDRESS
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 act 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 to 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 to all such work performed under the building permit
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and
other applicable goes by-laws,rules and regulations.
The undersigned"homeowner"certifies that he/she understands the City of Salem Building Department
minimum inspection procedures and net) Bents and that h/she will comply with said procedures and
requirements.
HOMEOWNER'S 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 109.1.1—Licensing of Construction Supervisors);
Provided that is a homeowner engages a person(s)for hire to do such work,that such 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 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
licensed Supervisor. The homeowner acting as supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of hi/her responsibilities,many communities require,as part
of the permit application,that the homeowner certify that he/she understands the responsibilities of a
supervisor. You may tare to amend and adopt such a form/certification for use in your community.
`"`
MORTGAGE SURVEY
PL4N IN
� AALPH ' �J�•
SALEM, MASS_ !� : IAM
;E � .
Afro LAND suAUEMRS
365 CHATHAM ST., L M. MASS S°
,g iH R. R a
'4PPro�`• �oez�:on SEee{'a�[ A,ce
.ePf '9sea Z,� i
N�F coO x
VaSi Fako)oau/os
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TO SALEM FIVE MORTGAGE CORP. Ra/o,3a rcd
DAVID C. 8 ANNE MARIE COLEMAN
AND THE TITLE INSURANCE COM-
PANY INSURING THE PREMISES.
I CERTIFY THAT THE DWELLNG IS
LOCATED AS SHOWN AND CON-
FORMED TO THE ZONING LAWS OF / 11
THE CITY OF SALEM {�, O L !y O
WHEN CONSTRUCTED.
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Or As;my CERTIFY 70 TfE BEsr ar my �ypn� NOTE THIS PLAN WAS
7 PREPARED FROM A
NAT 7FE R9F� A3' .CNN �V 7NM PUN ARE NOT TAPE SURVEY AND IS INTENDED FOR
LOCATED NITK7N A FZOOD HAZARp AWA AS DEZI/ MI MORTGAGE PURPOSES ONLY. OFFSETS SHOWN
a' 7IE NAP of C ITY AW50YO4� Y 71E ON OR SCALED FAO# THIS 0 FAEPAAE7 B PLAN ARE
FEDERAL DERGENCY MM4 &Ska/T A6E wr Q9 IT'S
such a47ED 9/5/84 PANEL 5- . ZONE C . • APPROXIMATE ONL Y AND SHOULD NOT BE
I Fw7A&? CERTIFY nor 7HIS IA[4P rrjzw NAS PER- USED TO DETERMINE PROPERTY LINES.
AW� N n A"�Y SCALE I'= a
77E/MOMOW SET75 AM=ATrON OF LAND .RYEYo9S OATS Male1, /2, 19 92
i°`V CIVI< ENBIASAS. BOOK 7Co�i'BPAGE a23 CERT,OF7NI5 CEArIPICAr70N OOFS NOT INCLlmE s NALL^�
rY LrAFS AAAi.�7Fz Wr Do NOT� In #
NArs mzcArF CONTROL P9P-o 9,0 A.
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