22 SAVOY RD - BUILDING INSPECTION (2) nq �
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CITY OF SALEM
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Date
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Is Property Located In Location of
the Historic District? Yes No Buildi
ng
Is Property Located in
the conservation Area? Yes_No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Co struct Deck, Shed, Pool,
Repair/Replace, Other: i4cJWo %,0
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: /
Owners Name //to
Address & Phone S'Avo7 (�CX � " I 2e1r- K3Cd
Architect's Name
Address & Phone 1
Mechanics Name
Address & Phone
What Is the purpose of building? �
Materiel of building? Wood If a dwelling, for how many families? 0
Will building conform to law? Y Asbestos? n/o AJ-e
Estimated cost �� d0 City License• N P' State U
Boma Improvement
Ltic. / X {I �
fgnattire- f Applicant "
SIGNED UNDER THE PEN '
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
A�.t'
I!
MAIL PERMIT TO:
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No. U � O,A
APPLICATION FOR
PERMIT TO .. _
ti� ��•�5-e lei- Clams � =3
LOCATION �6� -
�Oy".
PERMIT GRANTED
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AP OVfD
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INSPECTOA OF BUILDINGS '
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CITY OF SALEM
B=ING DEPARTMENT
HOMEOWNER LICENSE EXEMPTION
Please Prft
DATE
JOB LOCATION VoN
HOMEOWNER �/�tvt -
ADDREW
HOMEOW2�1t �7 7o
TELEPHONE
PRESENT MAILING ADDRESS "� `�"4
7'm cmrcra ctemption of"hommwncrs"was oncnded to induct owntr-oc"Oed dwellings of TWO
Units or less and to allow such homwwners to engage an individual for hire who does not pow=tit
license,provided that the owner act as supervisor.
DEFR,TMON OF HONMOWNM'
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,anachcd or detached sauctuoes scoessory 10 vxh vst andla.
farm suucrom.A person who constructs more than one home in a two-year period shall not be considered
a homcowva. Such"homeowrrrcf shall'submit to the Building Official,on It form scaptabk>o Sae
Building Official,that hdsht be respormblt to all such work performed harder the building perndl.
The umdersipxd`bomeowncr"asu Tres respotmbility for compliance with the State Btulding Code and
other applicable goes by-laws,ndes and rcgulatio=
The undersigned"homeu mer" certifies that he/she umdeslaris the City of Salem Bu Mng Departrima.
tninimunn inspation procedures and regtnrcmcnu and that Wshe will comply with said promdma WA
rcquirennetrs
HOMEOWNER'S SIGNATURE
APPROVAL OF BUILDING INSPECTOR
Sec other side for state code
r �
HOMEOWNER'S EXEMPTION
The code states that "any homeowner performing work for which a building pmTdt is required shaD be
exempt from the provisions of this section (Section 1D9.1.1-Uccosing of Construction Supervisors);
Provided that is a homtvArner engages a person(s)for hire to do.such work,that such hoxi=wner shall set
as supervisor
many horneowncrs who e this exemption arc iurawarc that they an asstaning the TcsPD=bihties Ora
use
supervisor(get Appendix Q,Rules and Regulsitiow for Lictnsiog Coos1roetion Supe rviwrs,Seet4a
.2.14 This lack of swa=ness oficn restilts in scriou5 problems,particularly when the borseosvner biM
unlicensed persons. In this case your Board cannot proceed against the milieenscd person as it avuld with
licensed Supe nispr. The home"-ocr siding as supervisor is vWmately responsibiL
To ensure that the homeowner is fully aware of hillier responLnbilities,marry communities regrwe;as part
of the permit applic2tion,that the homeowner certify that hdshe undamaids the rupousibifitics Of a
supervisor. You may care to amend and adopt such a formhxriifierdou for use in your eomnwdty.
o CITY OF SALEM9 MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
�•f 120 WASHINGTON STREET, 3RD FLOOR
SALEM, MA 01970
TEL. (978)745-9595 ExT. 380
FAx (978) 740-9846
STANLEY J. USOVICZ, JR.
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the provisions of MGL I 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, S 150A.
The debris will be disposed of at:
Location of Facility
Signature of Permit Applicant - Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
Name of Permit Applicant
Firm Name, if any
.;2�z s,q"y GAP
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 150A, and the building permits or licenses are to
indicate the location of the facility.