52 SCHOOL ST - BUILDING INSPECTION r a�
44 �d `!S {di I� • � �
04
1 ,
t'fiN l - r
MSs%ffi "°BEf�L£ #Nf3 �PPFIOVEfl $Y T+IE
'+',1 IAISP AFt 1JpA 7D; # pL-It
T,.BE JNG GRANTED
CITY OF SA1tEM
t No V � _( � `s Data ✓� a�
r � r sr
� r
Is Property Located In Location of ��
the Historic District? Y6a_No_ Building �J
Is Property located In
the Conservation Ares? Yes_No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Dec Shod, 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: '1
Owners Name ^
Address & Phone 7`�j, ` 99-3
kM� (u'►) a33 -0 w
Architect's Name G1
Address & Phone I
Mechanics Name ,l
A.
Address & Phone 1 ui
..�.q 1
What Is the pApos♦Ol building?
Material of building? n a dwelling,for how any(amYles7 ...,, ...m .� lylial'j
�l�A
WIII building confodrfm to law? Asbestos?
Estimated cost - city License r N A sate LIE N l
X -
L—�Boca Improvement
Lie.
Signature of Applicant
SIGNED UNDER THE PENA'
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
is
IJ
1 P II II t If 1
•{�� MAIL PERMIT
44 ' 11
7 nitrl Vu• i! ## r� a r
ilr H�{L1 rid
Fiq
�LX
I IN
"1 4`"
{�r
�41
I
a i
�i
tx
i
' Ell 1i�
It ��dF
r1
i,,;
s
r;
p-1 a,j
'it,
y�jli 1
i
... .. _w
Ix �U $'
a .
U.
Zp W m 4f ,4
O �. LL
rL D
¢ CLU
N
cc in
i I apt
I' N 4 �55Vy'�a I,,
I �• • ' PUBLIC PROPERTY DEPARTMENT
._ 170 WASHINGTON STREET, 3RD FLOOR
SALEM,MA 01970
TEL. (976)745-9595 EXT. 380
Q'� 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 constriction 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: Nb 4�,S' k ? _
Location of Facility
Signature o�4 Permit Applicant Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
�kn � �
Name of Permit Applicant
Firm Name,if any Q l q
Sr Jt`I �M
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.
r ..
CITY OF SMMA
B=ING DEPARTNEM
HOMEOWNER LICENSE EXEW nON
Please Prial
DATE J�.. `� O
loBLocATlax 5 a ��432 5-? SUM
AOl IEOwrmt 5a 30�
ADDRFSS r�HOMEOWm 9 1� I� `p
13
TaxPHONE 1
PRESFNTMM NGADDRESS 5j- Sc.'
The CwTcU ctcmpdm.of"homcow Dcrs"was c-mtndcd to include cwvcroccupkd dwc►lints ofTwO
Units a kss and to Ovw such hom"owmn to engage an indivudual for bire wbc does not posses tit
L•ecns,c6 pm'ided that the owe"*Ka as suptrviwr,
DEF 04MON OF HONEOWNM*
Pcrson(s)who owns a parcel of]and on which hdshe resides or intends to Tcsuk,on wbkh t=c
kaaw IS
int"ndcd to be,a one to two family dwelling,auachcd or dcuehed svomwvs od shall ssM to web UKA be m a idhr
farm svucnaes.A person who constructs more than one home in a�t>� pm
a homcowver. Such"homccv-7r " sh-a'subn*to the Building on a form Z=gmbk is*e
Building McW,that hdshc be nspotmble to all such work pvformed w4a the building pcmk
The tmda ipxd`bomoowncr"L tars TMWTLn'bility for compliance with th"State Bmilding Code and
other appGr,-blc goes by-kws,riles and TegulationL
The tmdc igncd'hou=wnm"ecm8es that hdshc tmdest&the City of Salem BuildingDeparuotal.
mirtimttm inspr Lion proccdtur±and rcgturcvtcros and that Nshc will comply with said p wcdmos and requir cox3a
HOMEOWtMR'S SIGNATIlAE �1 �� �•—�
APPROVAL OF BUILDING INSPECTOR
Sec other side for start code
a
HOMEO\"ER'S EXEMPTION
The code sutu that "arry homeowner purfortning work for svhich a building permit is mq»ved shell be
exempt front the provisions of this section (Secsiov 109.11-liecosmg of Comtrtuetiou SuperASOTO..
Provided that is a honreo+aaer engages a pensm (s)for h'vs to do.such ww ,that such bomeowaa shall*a
as SUPVYL=�"
Many bomcowncrs wbo use this exemption arc unaware that they an mwning the tes2onsi'bi3'ties efs w
superrssar (Oct Appcodia Q,Rolu and Rcgolatlow for Uctwing Coostr ucdon Supervisors,Secd.m
2.14 This lack of awareness oflcn ruulu in serious problems,particularlywhen the wh hmtm orm bhu
unlicensed persom In this case yoty Board camot proceed aphm the tvilieensed pesvn as It-OVA wift
licensed Supatisor. The bourcm-D r sdinZ as saperrisor b uWmatdy respo %ML
To ensure that the homeowner is fully aware of hificr resp0u-1!tt3es,marry cornmunitles regrme;as PA
of the permit epplimtion,that the homeowner cenify that hcJshe tmdcmtwds the responsibilities ds
supen-ism. You may care to amend and adopt sub a lornVocnb1cation for use in)av eommttmq.
�E ") 10,
nn Q
i^
Y
S �
��S