11-13 STEARNS PL - BUILDING INSPECTION �L9kftS�dl(!$T�E f{L{.{,'�,AfPROVED BY T44E
WSPECToR ,PWR TP A_PERMIT .BANG GRANTED
CITY OF SALEM
No. /10�-0 �:� •� �.y}\ Date
Is Property Located in Location of
the Historic District? Yes_No Building
V
V
Is Property Located In
the Conservation Area? Yes_No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) nstall Siding, Construct Deck, Shed, Pool,
Repair/Replace ther:
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 e 1
Address & Phone
Architect's Name
Address & Phone f
Mechanics Name 4
Address & Phone /� f
What is the purpose of building?
If a dwelling, for how many families?
Material of building? 1, DjC9(�
Will building conform to law? Asbestos?
Estlmat S C� City License# N A State License#
Home Improvement
Lie. i
re of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
0�
MAIL PERMIT TO: T 0,r l��
1
i
No. :77/
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
1��2e Zo EQ�
APPROVED
1
PECTOR OV BUILDINGS
F
l�
1
CITY OF SALEM��MASSACHUSETTS
�PUB
,LIC PROPERTY DEPARTMENT
120 WASIIINGTON STREET. 3RO FLOOR
SALEM. MASSACNUSETTS 01970
STANLEY J. UEOVICZ, JR. TELEPHONE: 976-743-9395 EXT. 360
wwvow FAX: 976-740-9646
HOMEOWNER LICENSE EXEMPTION
Please Print.
Date 4 6
Job Location — S v� �G C
Home Owner Address !�P
Home Owner TeleplW*
Present Mailing Address:. n^e
The current exemption of"Homeowners"w:1
dwellings of two Units or leas and to allow as exuded to include owner ied
h such homed to engage an individual for
ire who sofa not Possess a license,provided that the ow*"
as supervisor.
DEFINITION OF HOMEOWNER .
Person(s).who owns apancel_of land on which he/she which or intends to reside,on
which there is,or is intended to be,a one or two f
structures accessory to such use and/or farmamity dwelling, attached Or detached
than one home in a two ear structures. A person who constructs more
y 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.
The undersigned"homeowner"certifies that he/she understands the City of Salem
Building Department minimum inspection procedures and u'
will comply with said procedures and ��and that hNshe
ts.
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING INSPECT
See other side for state code
vz-W
HOMEOWNERS,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 I arson09A.1 )Licensing
of Construction Supervisors);provided that a Homeowner engages a person(s) for hire to
do such work and that such Homeowner shall act as Supervisor.
exemption are unaware that they are assuming the
Many Homeowners who use or(. ee Appendix
Q�Rules and Regulations for Licensing
responsibilities of a Supervisor(see 5). Thin serious
Construction Supervisors.Section 2.15). This lack of awareness often results
problems, er hires unlicensed persons. In this case your
Particularly when the Homeown
unlicensed person 0 it would with a licensed
Board cannot proceed against 'tily responsible.
Supervisor The Homeowner acting as supervtam
is full aware of his/her 'bilities,many
Homeowner Y that
To ensure that the Hom Application
st the Homeowner certify
communities require. as a part of the permit of
on the page of this issue is a
he/she understands the responsibilities Y a Supervisor•care to amend and adopt such a
form currently used by several town.
You may
form/certification for use in your community
R� G I;o I yao s
I
CITY OF SA"My MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASNINOTON STREET, 3RD FLOOR
SALEM, MASSACNUSETTS 01970
STANLEY J. USOVICZ, JR. TELEPHONE: 978-745-9593 EXT. 380
MAVOR FAX: 978-740.9848
WA Bu3ldlnt: Dee9dM nt
DebPl! D1.1nBss1 f ii'
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: J
(Location of Facility) l e 2'1
1
of Applicant
` c
Date