26 SABLE RD - BUILDING INSPECTION (2) -BE ffLf� APPROVED By T44E
,WS,P XT.DR .PIRLOR TD.A.,PERMIT.BFJNG GRANTED
CITY OF SALEM
;tea:
No. � y H:` �\ Date
ZCS -0 3
1 .
i4s Z? -
N%DOac�"
Is Property Located in Location of
the Historic District? Yes_No Building �`6 Sg d/z //q
Is Property Located in
the Conservation Area? Yes_No ly
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, onstruct Dec 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 //aac
Address & Phone c2ra S'a ale at Z 62-9 1 77y- "79
Architect's Name
Address & Phone L 1
Mechanics Name
Address & Phone 7ary�.� Od / /�7. (f�La242 - 1-5-. 7
What is the purpose of building? ev/A
Material of building? Ooaf If a dwelling, for how many families? S.
WIII building conform to law>yc r Asbestos? s/hw
Estimated cost ao SOO- City License a N A State License S C'S O a 9/ZT
LIB 1 R 3 g $41 r^ Home Improvement
Lic. 1 jJ7S 73 /
g I -2ooy YSignature of Appba
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO. Uf -5 Qi:2
No.
APPLICATION FOR
PERMIT TO reh St,�
LOCATION /dq
Ad
PERMIT GRANTED
7! l7 lO-3 19
APP ED
%�J�3
INSPECTOR O BUILDINGS
t
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r � I
CITY OF SALEM
BUILDING DEPARTMENT
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE Q�
JOB LOCATION; :�M Q S0"Nn S I
HOMEOWNER xl�� L C T^ C yQ(P In') NM Uf f�
ADDRESS
HOMEOWNER 5T �
TELEPHONE
PRESENT MAILING ADDRESS n G�
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, Hiles and regulations.
The undersigned"homeowner'certifies that he/she understands the City of Salem Building Department
minimum inspection procedures and requirements and that h/she will comply with said procedures and
requirements.
HOMEOWNER'S SIGNA //�� �
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 10.9.1.1—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 care to amend and adopt such a form/certification for use in your community.
OF SALEM,- MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
r2° ° 120 WASHINGTON STREET, 3RD FLOOR
a j; yA SALEM, MA01970
TEL. (978)74'5-9595 EXT. 380
�G> FAX (978) 740.9846 -
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 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. I
The debris will be disposed of at: -�� C F\
Location of Facility
mit Applicant Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
Name of Permit 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 cIII, S 150, and the building permits or licenses are to
indicate the location of the facility.
�a OF SALEM; MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
a � .
SALEM,MA 01970
s TEL. (978)745-9595 EXT. 380
�4mru FAX (976) 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: 'Lr r' �?% s
Location of Facility
7 —/7— 03
Signature of Permit Ap Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
_DLz/
Name of Pernut 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 cHl, S 150A, and the building permits or licenses are to
indicate the location of the facility.
fi / Y4
!7f vGf7z710/LWt.Q O Q69QC LC3BLL6
n W c� Qn rr
�ePnrlrrsanl o/.Jadar'iriaf�cciar.nL'
600 LUasLglon—31 ..I
James J.Camooell &lon, 9W .act L.lfs 02111
Com mssorw
Workers' Compensation insurance Affidavit
with.a principal place of business at:
4'4 �7
. . (thyRure/aq)
do hereby certify under the pains and penalties of perjury, that:
O 1 am an employer providing workers' compensation coverage for my employees working on
this job.
(iris nG� . :r ✓� CCQ — ?5-1 1,721 fi
Insurance Company Policy Number
1 am a sole proprietor and have no one working for me in any opacity.
O 1 am a sole proprietor, general contractor or homeowner (circle one) and have hired the
contractors listed below who have the following workers' compensation policies:
Contractor Insurance Company/Policy Number
Contractor Insurance Company/Policy Number
Contractor Insurance Company/Policy Number
O I am a homeowner performing all the work myself.
1 unaensand QUt a copy of this Statement ws'R be forwarded to the Orrice of Irrvesdtaoom of the DIA for coe sse rrrikaton and coat facture ED'%core
coverate x reoureo unarr Section lSA of MGL 15 2 can lap td the imdoYYon of crirninm ovotties con'dtint of a fine of oo tai 1.500-00 andtW one
ytars'irsorucnment a•,a as cfyi otnaltio in me form of a STOP WORK ORDER ano a foe of S 100.00 a an avawt me.
Signed this , 7- 17_ r: 3 day of
Licensee/Permittte Building Department
Licensing Board
Selectmens Office
Health Department
TO VERIFY COVERAGE INFORMATION CALL: 6 17-727-4900 X403, 404, 405, 409, 375
BOARD OF BUILD REOULATIOI�
License: CONSTRUCTION SUPERVIS t!;
Number. CS 029124
Btrthdsb: 06�08%958 � �'
ExPit":0SM , /' Yr.no: 2660
Resirletad: 00 .
DARRELLJ GONYEA r ram`
6 TOWER RO
MAGNOLIA, MA 01930 Administrator
7A,19mmommaloc g���aaaaa/ur aA3
Board of Building Regulations and Standards' -
HOME IMPROVEMENT CONTRACTOR
Registration: 117575
Expiration: 10/20/2004
Type: DBA
0 NYEACONST
DARRELL GONYEA
SIX TOWER RD.
MAGNOLIA,MA01930s
`'i i ,'".!` ;- i `I ;... _+_'Y_i_ _..r-•`7 - -- -',.,�. • !_ _•_jam : _ L—•
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TARTER & TOWERS ENGINEERING CORP.
Joseph D.Carter
6 FAIRVIEW
Professional Engineer ` T , AVENUE
SWAMP
Registered Land Surveyor 10j d,4$ Tel. 59
D MASS. 01907
(, Tel, 2-8386
N�f SAca�t �
38•� ••
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70
f
7Go35 F N'. SAixr V ass.
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16,4. t To theSAM 5 shd�d(s 8na�
and ITS I;TLC— �s✓iLeRs
hereby certify that I have examieed
'Du1ELLW4 fJ"Z6 the premises and all easements,
l /encroachments and buildings are
located on the ground as shown. I
further certify that the buildings shown
iS,} �wnJ;E conformed to the zoning laws of
,p 1 S9 wAl �(SASS when constructed.
I further certify that this property
' — IS. rj'a1%OF located in
r��' �.y estab `flood a
E� JOSEPH N
ors H Josep D. Carter R.L. . #9387
Dv.-C���I'1 pQ �-p,t / rsTea��e
F43lLk• VOC� J 0 Y61 s00 9N� SURVby Cl i
CIVIL ENGINEERING PERCOLATION, TESTS ` _ SEWA ISPOW 'DESIGNS'-:
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