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1 SCENIC AVE - BUILDING INSPECTION What is the current use of the Building? y1 » r d D - if dwelling.how many units?--4/-- Material of Building? Asbestos? as the Building Contort^to Law? � 5 Architeds Name C//R 15 �o 1 Address and Phone <� Mechanic's Name al Address and Phone HIC Registration 0 CoMbVClion Supervisors License 0 Estimated : `�O ', e-� Pam*FN CaleuWJcn Eated Coat of ProEstimated Cost X$1/$1000 Residential pemit Fee i - -- _- - - Estimated Cost X$11!$1000 Commsreiai--- - An Additional $5.00 is added as an Administrative charge. Make sure that all fields aro properly and legibly written to avoid delays In processing. The undersigned does hereby appy for a Building Permit to build to the above stated signed under penalty of PerJury specifications. g Date 6 / d - N s� 0 A o aCC6 - 96- . ------ E— ..a-- ate-- �. --- --- I� CITY OF SALEM PUBLIC PROPRERTY I�t' I /49� DEPARTMENT :CI\Illi-A LEI'!'tt llilil 1. 120 WA5rI1VGii)N STRLET ♦SALEM. MASSACI R SL VIS 0197' Trt:978J35A595 ♦F.Ax:978-74G9846 Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5 Debris, and the provisions of MGL c 40, S 54; Building Permit # __.._ is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c I 11,S 150A. The debris will be transported by: LL O �/-Sl' ---- (name of hauler) I'he debris will be disposed of in : D0 -.D Ise (name of facility) ladurcis of facility) SI�I:aIUI't U �k 11[ I)nGanl V 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 —Licensing of Construction Supervisors);provided that a Homeowner engages a person(s) for hire to do such work, and the 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 of 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 a licensed Supervisor. The Homeowner acting as Supervisor is ultimately responsible. To ensure that the Homeowner is fully aware of his/her responsibilities,many communities require, as part of the Permit Application,that the Homeowner certify that he/she understands the Responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. CITY OF SALEM PUBLIC PROPERTY DEPARTMENT KIMBERLEY DRISCOLL MAYOR 120 WASHINGTON STREET♦SALEK M,4mAcHLSETT$01970 TEL 978-745-9595•FAx:97&740-9846 HOMEOWNER LICENSE EXEMPTION Please Print Date—4z/z_ Job Location / SC Home Owner Address Home Owner Telephone 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 acts 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 or 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 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. I The undersigned "homeownee'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 SIGNATURE APPROVAL OF BUILDING INSPECTOR ALW;�:�' See other side for state code EI'1'ZOFgxLEb PUBLIC PROPERTY DEPART�fE,VT . NArot 130 Wwvunw' W sheer 0 ' �XJ4 wsuausti1a 01970 TEL M745-9S"•pAX M740.9" APPLICATION FOR THE REPAIR. RENOVATION CXIONSTRUCTION, DEMOLITION, OR CHANGE OF USE OR OCC "MA-ANCY FOR ANY EXISTING STING OR BUILDING 1.0 SITE INFORMATION Location Name: Buil: -- Property Addrew Property Is located In a:Conservation Arae YM Historic DigdCt YM A_ 2.0 OWNERSHIP INFORMATION 2.1 OWner of Land Name: Address: Telephone: q 797 - AdW 3.0 COMPLETE THIS SECTION FOR WORK IN MCIATING, BUILDINGS ONLY Addition Existing Renovation Number of Stories Renovated Change in Use New i Demolition Existing o© S Approximate year of Area per floor (sf) Renovated construction or renovation of existing building /�� New G S Brief Description of Proposed Work: O F U 60G2 Com- u C 4-- - - Mail Permit to: i -S c Jnr e c