77 SUMMER ST - BUILDING INSPECTION �f
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CITY OF S.U.EM
PUBLIC PROPERTY
DEPARTMENT
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HOMEOWNER LICENSE EXEMPTION
Phase Print
Date 0 L- 30, 30
Job Location �� S✓"' J r fv7z4,
Home Owner Address ,,.y, j f g
Home Owner Telephone -7- 3 - 3 -6 4
Preserd Mailing Address _ ,T 'V"vr, ee— r 169
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 a ' provided
possess license,pro that the owner acts as
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 dwellin& 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.
The undersigned "homeowner"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 mel rets.
HOMEOWNERS SIGNATL
APPROVAL OF BUILDING INSPECTOR G
See other side for state code
CITY OF SALEM
PUBLIC PROPRERTY
DEPART%
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Construedon Debris Disposst Affidavit
(requimd for all deatoWion and smovation work)
l =Ordano w iih ohs sixdb edidos o[dw Stag Building Coda 7W C11dA section t 11.S
ocbris,and dw provisions of MGL a 40.9 S4
gWldiq pw* _ _ is tuna with the condition that the debris restating dross
This work shalt be disposed of in a property licaumd waste disposal fbaillty as defined by WIL a
I The debris will be transported by:
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rho Qcbris will be disposed of in :
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AlPI.ICATION FOR TU RZtAUL RZNOYA'Ti= MARE irrrrM
DZr[OLITION.OR CAANGZ O)r tJ3t OR OCCIJlA itrrv_ FOR ANY g11T_QMG
STRUCTURE OR DIDLDMG
1.0 an INFORMATION
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Ropolh le boded in a;Conse va lon An»lm Hislarla Otstrlat
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ERSHIP INFORMATION
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L040UPLETE THIS SECTION FOR WORK IN EYIailelo BUILDINGS ONLY
Addition Exiatlnp
Renovation Number of Stories Renovated
Change in Use New
Demolition Existing
Approxirnate ( �
construcdon or renovation Area per floor s Renovated
of existing building New
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add Descripdon of Proposed Work:
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(u �IC L $ � /) 7 p i�/�Yr c((/ ov
--- - ----Mail Permit to: - - -
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VIN the SMOV C&OWM to l a nlr
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AddreM and Phan
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Address and Phone H� �
ConsinadW SuPWAB a l.icer»e -
maMd Coat d Projsat!� SAD� _ Peens Fee Caisimm
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Ps rn Fee! EaWnsted Coat X$7faODO ResiderM d
- -- — Es*naOrd Coat X$4141006 Conrnardd -- -An Addltlonsi$Lao M added as an
Administreilve dtsrpa. '
Make was Mat a,fields an Propwly and wow witten to avoid delays in procsssin%
The ueMkndwsWrrd does hwe"apply for a Sulidkq Permit build to If1e atww atatad
spestl SW
ad Sed under pWmft OfPOINNY
Date D > 30, 07
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