73 SUMMER ST - BUILDING INSPECTION (2) :GRANTED
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(�1,` CITY OF SALEM
No. Qm — 4YA Data
Is Property Looted in Location of
Vile Historic District? Yes_No Building 7,3 , Sulu
Is Property Located in
it*ConservatIgn Ann? Yak_No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Install Siding, Construct,Deck, Shed, Fool,
RepaidReplace Other:
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROCBiIIIIINl3
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the following
specifications: ,,��AA � /
Owners Name /"/ 6Le ( '>iardl
i
Address & Phone 7 e�
Architect's Name
Address & Phone - I
Mechanics Name
Address & Phone f 1 I;' :.
I3 G+'E
What Is the pwposa cf brd~ e4 es-IdeATla
t
Material of OWk*W 64,)o 1;l 4 1 a WreM4q,for how many families?
I fi
Will conform t0 law? 7 Pk S AkbwtWill CW a?
Edmated cost. O &V C) CRY Lwow a N A stab umm 0
Lic/- Bw hpsosawnt � i;'
O . Signature of Applicant U� 1
SIGNED UNDER THE l4994
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
1/0
I W�IJi�llrj
1' N
ry i
Y
MAIL PERMIT T0: 6
JL..
L
NO.'C\Q%
APPLICATION FOR
� 71 PERMIT To
A
LOCION T
1
PERMIT GRANTED
AP OVD
INSPECT. OF BUILDINGS
or
CtY OF SAIMA
B=ING DEPARTMM
HONMOWNER LICENSE DMaMON
Please Prime
DATE �C) O
)OBLOCATJON
• HOMEOWtiFA �.J � 1 c�4,��' �r .
ADDRESS �7
TE 7HONz
PRESENT MAILING ADDRESS Z_��-41- �t
The nmcm v%croption of"bomarwverC was c.�ncrhdtd to imludc owvcr-ocuwPted dwcM'p o[TWO
who does tot is
Units a kss srd a rJlow such bomcownrra to rngage an irdirhdu?l for hire posses .
Pocnse,.pru4dcd that the owoei od as superviw[.
DEFINMON OF HOMEMOL'
Pcmn(s)wbo owns s pwvd of land on which bclshc resides or irucnds to Tceuk,on whkA Iffimk or b
intended to bc,c one to two Emily dwctling,sidled of detached saucovw ucccmmy to vxb me tolbe tandnAw
farm suvenues.A person wbo cotuttvw mono than one home in two-y poiod sho
cmd
a bomeowvct. Such'"hom00%N7se sh..V rabndt to the Bulding 015cid,of s form setzpabk 10*4
Building Official,that lulshc be tcsponslbk to all such work Pafwmcd mtda the tuBding Pa=k
The undasipied'bomcow nci nsstanes responn'b!Hq lot compliance with the State BuDding Code trod
otha applicablc jots by-laws,rules aad tegulatiom
jThe undcnipxd'Dotneow nw"cerd5cs that hc/shc undc37w&the City of Salem Building Depw=a t.
mirtimtan impaction p=d»ncs and rcgxeva tits and that Nshe will comply with said ptoadma sad
D
HOMEOWNER'S SIGNATL..��`
APPROVAL OF BUILDING INSPECTOR
See otber side for stars code
HOMEON"'ER'S EXEMPTION
The code stsics that.• `arty homeowna performing-, ov*for which a buDdiT4 permit is Tegtiuemd shaD be
exempt frvm the provisions of this section (Section 109.13-1 cuDsing of COuatruetion Supervlsori);
Provided that is a homcwvzter engages a person(s)for hbe to do.such work,that such k=mw as da ad
as w
• jyig'n'ty'ch'or'n^owncn who use this txcmpdon an tIIlawZle tba IBCy are mran Ong the mvOI>S7 des dt � .
supervisor (sec Appendix•Q,Rules aad Regulations for 1Llansing Construction Supervisor,Secti s
1.15� 7ais lack of awareness often nrOu in acTiom problems,par dcul Ay when the horaeowaer bbsS
uriktuscei persom In this case your Board cannot proceed;. phm tic Ta0crused person n it-%V%N VIA
liccwcd Supcnis�r. Tix homcon'ucr saint as supervisor b uhimsteiy t,srosiblN,
To ensue that the homeownet is fully aware of hin=responsibilities,trWV cmwuwdS=to dM-as past
of the patrdt applimlim that the homeowner certify that wshc underatarrda the Tesponsibilides of s
supervisor. You may care to amend aid adopt such a fontt/ccnYk2tim for we in your eo=mniq.
,I
c
Puekic PROPERTY DEPARTMENT
120 WASNINGTON STREET, 3RD FLOOR
` SALEM,MA O1970
TEL (976)745-9595 EXT. 380
FAX (078) 740-9646
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 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, S150A
The debris will be disposed of at: _�(�, t� 'S(dG Co/4�
Location of Facility
Signature of Permit Applicant Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
Name of Permit Applicant
Firm Name, if any
1l.>2r/, rl
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 cl3L S 150A, and the building permits or licenses are to
indicate the location of the facility.