37 ROSLYN ST - BUILDING INSPECTION (3) pt*NSlaffifeE fiL-E� APPROVED BY T44E
WSp.W7DB ,P=R TD A PEMT Sf'JNG GRANTED
CITY OF SALEM a
1 , a Date
Is Property located in -.
Location
of 37 �t�Sy �� 4
the Historic District? yes_No_
ng
Is Property Located in
the conservation Area? Yes_No_
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, C nstruct Deck, Shed, Poo,
Repair/Replace, Other: {rr/
� L •'„fin�
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:
** II r
Owner's Name
Address & Phone 3-7 �osl� n sm (976
/0- l�7
Architect's Name
Address & P ne 4
Mecha ' e
— f ddress& one
What Is the purpose of building?_ `�y' �P `Q
Material of building? 1vo,C If a dwelling,for how many families?_, 2.
WIII building conform to law? 4 5 Asbestos?
Estlmated cost
400 0 city License r N P' a License n
f� too n Lie. x License
Applicant
ic ant
SNEIGD UNDERTHE PENALTY
OF PERJURY
DESCRIPTION OFy/)WORK TO BE DONE
i'7 7/l
MAIL PERMIT T0: o
No. _ 7 0,6
APPLICATION FOR
PERMIT TO
rep
LOCATION.
PERMIT GRANTED
3l00 , 2-$
APP OVED
INSPECTO OF BUILDINGS
i
t y
CITY OF SALEM, MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASNINGTON STREET. 3RO FLOOR
SALEM. MASSACHUSETTS 01970
STAMLEY J. USOYICE, JR. TELEPNONE: 978-743-9393 EXT. 380
MAYOR FAX: 978-74o-9848
Salem Building Deparhmnt
Debris Dtsuosaal 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:
le- ation of Facility) t �e«
r
Signature o Applicant
d I,L
Date
CITY OF SALEM9 MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASNINQTON STREET, 3RD FLOOR
SALEM. MASSACNUSETTS 01970
STANLEY J. USOVICE, JR. TELEPNoNE: 978-745-959S EXT. 380
MAYOR FAX: 978-7409846
HOMEOWNER LICENSE EXEMPTION
Plesae Print
Date b o(n
Job Location
Home Owner Addrea.
Hoene Owner TelephW
Prea ut Mailing Ad*=:.
The current exemption of"Homeowner»wart a leaded to include owner-occupied
dwellings of two.Units or leas and to allow such bomeo to engage an individual for
hire who does not poetess A license,provided that the ow= as fir,
DEFINITION OP HOMEOWNEIL,
Person(s);who owns apeieel.of todon which he/she resides or intends to reakk on
which these is,or is intended to be,a one or two family dwelling,dtsohW or detached
structures accessory to such use and/or farts etfuft i. A pm ut who constructs in= �
than one home in a two year period shall not be considered a homeowner. Such
"homeowner"shall submit to the Building Official,on a fort acceptable to the Building
Official, that he/she be responsible for all such work performed under the Building
Permit.
The undersigned"homeowner"assumes responsibility for compliance with the State
Building Code and other applicable by-laws and regulations.
The undersigned"homelowne"certifies that he/she understands the City of Salem
Building Department minimum inspection procedures and requirements and that he/she
will comply with said procedures and requirements.
HOMEOWNERS SIGNATUREf t
APPROVAL OF BUILDING INSPECTOR
See other side for state code
HOMEOWNER�h'QTtON
The Code states that. "Any Homeowner Performing
work for which a Building Permit is
required shall be m�from the pmvis►ons of this section(Section 109.1-1 —Licensing
of Construction Supervisors);Provided that a Homeowner engages i person(s)for hire to
do such work,and that such Homeowner shall act as Supervisor.
Many Homeowners who use this exemption an unaware that they are assuming the
Rules and Regulatim for Leg
'ties of a Supervisor(ace Appendix Q' o8an results in seriow
Section 2.1 S). This lack of awareness
Constr+ret<on Swhen the Homeowner hies unlicensed Persons• In this case your
lens Particularly the unl uas it would withlicensed
Board cannot Proceed against ,,mats bto.
Supervisor. The Homeowner actmB a. >0,
To ensure that the Homeowner is fully aware of hialher bilitiea,many
hcationthe Homeowner certify that
communities requite.as a Part of the Permit App On fire last page of this issue is a
he/she�erst.n the responsibilities of a Supervisor• . such a
form currently used by seveaal towns. YOU may care.to amendand
fomalcerti8caton foe use in your community.
R� �Ifpltoos