68 SUMMER ST - BUILDING INSPECTION (3) 7dL
11� OVER BY T44E
iMli6fi�EfjLt�►idDl
yT.A pR 701 .P. T f31NG GRANTED
-QITY OF SA-LEM
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No. Date iC� : l_ /T
Ward
Zoning District
Is Property Located In Location of
the Historic District? Yes_No k Building coe at,AA Ad er- 1
Is Property Located in
the Conservation Area? Yea_No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construes Deck, Shed, Pool,
Repair/Replace, Other: % , Vo
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: n
Owner's Name _ev T �1 L r KX't b..
Address & Phone taR Sciw,h,.e r S+�
Architect's Name
Address & Phone ( 1
Mechanics Name
Address & Phone ,r�
What Is the purpose of building? �AtL°� 'C6 P
Material of building? LA )ram r If a dwelling, for how many families?
Will building conform to law? \! 013 Asbestos? 40 .
Estimated cost $ 2.C%O°" Gty License# State License #
Koala Improvesent
Lie. f
Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
20 a n rn l r LA-3 6 C)CA l In O VLO- C_G V"Y1 2 JC'
MAIL PERMIT TO:
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�o CITY OF SALEM9 MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
® R 120 WASHINGTON STREET, 3RD FLOOR
SALEM, MA O 1970
' - TEL. (978)745-9595 EXT. 380
FAX (978) 740-9846
STANLEY J. LISOVICZ, 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, S 150A. r t \
The debris will be disposed of at: 8ca 2 M
Location of Facility
Si�f Permit Applicant Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
Name of Pe it Applicant
Firm Name, if any
foe) JcrMMer S-4 scdewa P d�
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.
CITY OF SALEM
B=ING DEPARTMENT
H0ME0WNER LICENSE EXM0TION
Plasc Pft
JOB LOCATION
• HOMEOWNER �C m.,o
ADDRESS
HOMEOWNER at-7 -2 A4 I O
TELEPHONE
PRESENT MAILING ADDRESS O*N fr pg
The cu rcarxcmpdon of"homeowners"was c acnded to include owneroceupkd dw0limp of TWO
Units or less and to allow such homeowners to engage an individual for biro wlto does M posses a
license,provided that the owoer W as supervbor.
DEFR;MCN OF HOMEOWNER:
Person(s)who owns a parcel of land on which he/she resides or inrcndt to reside.on which ism
intended to be,a one to two family dwelling,scathed of dctachtd strucnu s rY to
farm structures.A person who constructs morn than one home in a two-year period shall col be considemd
a homeowner. Such"homeowixti" shall submit to the Building Official,on!form sc=ptabk to*a
Building Official,that Wag be responsible to all such work performed miler the building lauk
The undersigned"bomeownee assumes responsibility for compliance with the State Building Code tmd
other applicable goes by-laws,rules and regobtiosiL
The undersigned"homeowrrcr"certifies that he/she understands the City of Salem Building Deparmtal
minimum inspection procaduns and requnrrmunts and that IJshe will Comply with said ptomd=sad
rcqubzmckVL
HOMEOWNER'S SIGNATURE
APPROVAL OF B=ING INSPECTOR
See other side for state code
I
HOMEOWNER'S EXEMPTION
The code states that: "arty homeowner performing work for which a building pernut is required shall be
exempt from the ptrnisions of this section (Sectiou A9.1.1-Lousing of CoastruelIOU Supervisors);
Provided that is a homeowner engages a person (s)for hire to do.such work,that sueb homeowner shall act
as superyim•'
Many bomeowners who use this exemption are imaware that rc they a morning the tesponstbti' da M
supervisor(set Appcadia Q,Rinks and Regulations for umnsiog Coostruetion Supervisors,Sectbm
.2.14 This lack of awareness often results in serious problems,particubuiy when the homeownerbim
unkensed persom In this case your Board cannot proceed against the unlicensed person as it'%rind wilt
licensed Supervisor. The bomemvoer aaiag as supervisor In whimately r e3poosibie,
To cusure that the homeow rkeT is fully awaie of hm=resrunbilities,many corrnntuddu requim as pM
of the permit application,that the homeowner certify that helshc understands the responsibilities eta
supervisor. You may care to amend and adopt such a foradmitification for Use in your cam wzdV.