13 SURREY RD - BUILDING INSPECTION -PL-*M-MWf-BE f4L-E ND APPROVED BY T44E
JI,ISpZCIjDB pWR TDA.pERMIT SEJNG GRANTED
CITY OF SALEM
Date
q- 3 ` 6 (0
s: ►�
Is Property Located In Location of
the Historic Distdd? Yes_No >3a17d�B
Is Property Located in
fhe Conservation Area? Yes No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shelf, Pool,
Repair/Repiace, 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:
Owners Name /
Address & Phone I(7 Z
Architect's Name /o �s
Address & Phone ���ti
Mechanics Name
Address & Phone //�� f
What Is the purpose of building? Poo /
Material of building? SJee�// Po H a dwelling,for how many families?
Will building cordomt to law? Asbestos?
Eonated coat �CHy License N N .A state License 0
flaw L"rovement
Lie' Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION
OF WORK TO BE DONE
6 ,15 I'ul�L�(� f�dG / Qv✓0!/� �'IOLtLr(�
� V
MAIL PERMIT TO:� ���—
.t.
No.
APPLICATION FOR
PERMIT TO
Rog
LOCATION.
3 � ,
PERMIT GRANTED
AP A-706 7
INSPECTOR OF BUILDINGS
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CITY OF SALEM
DEPT OF PUBLIC PROPERTIES
ABOVE GROUND POOL INFORMATION
PRIVATE POOLS—COMMONS
1. Private Pool—Definition
Any pool intended to be used primarily by occupants of a one or two-family dwelling. Any such
pool more than 24-inches deep or having a surface area greater-than 250-square feet (18-foot
diameter)requires a building permit before installation, enlargement or alteration.
H. Permits
Applications for a permit shall be accompanied by a certified plot plan (scale not less than I't
20') fully dimensional, showing pool location on property, relation to adjacent structures on
property, relation of adjacent structures on property, location of all fences and gate.
M. Pool Location.
No side of any pool shall be closure than six (6) feet to side or rear property lines. Pools are not
allowed on front yards without obtaining Variance from these requirements from the City of Salem
Board of Appeals.
IV. Safety Requirements
Pools will be surrounded by a fence at least four(4) feet high and no further than 25 feet from the
sides of the pool. Rail fences will not be permitted. One, Moot wide gate with closing and
locking device will be permitted.
V. Electrical Requirements
After receiving a permit from the Building Department to construct a pool, the installer must
obtain the service of a licensed Electrician to do all required electrical wiring and grounding of the
pool. License electrician is required to pull electrical permit from Electrical Department. (The
Electrical Department is located behind the Central Fire Station, 2nd floor.)
(Applic
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NF_"N STREET USA
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1
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HOUSE
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i
20' �Dnliaamm:
POOL / h
P
X FENCE
Scale 1"=20'
4 L./LJst.
SURVEYOR'S STAMP
,f
CITY OF SALEM, MASSACMUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASMINgTON STRIM 3Ro FLOOR
SALEM. MASSACNUS" 01970
TELEPNONa: 970-74S.9599 EXT. 380
FAX: 9710-74a964s
HOMEOWNER LICENSE gXEMpnoN
Plesse Print
Date+ -o ff
Job Location 3 U
Home OwBar Address-
HM40wngrTelephorp - —
Pnaeat Matlmg.Addren Sµ D
Tb°cure�emt aaremption of"Homeowners"was,a waded to include owners-occupied
dwellings of taws Uaift a<hBs and to allow ascls
hue who does not possess a license.provided that tl�e Hwy a�supervia an�duai for
DEFINI'lTON OB.H011EQgEg: •'
wown parcel-of land on which'Wd w resides Of iutenda to redde.on
a► toill such to bei,a one or two family dwelling,dWdW or detached
than one
accessory to such use and/or farm aftuchtM A person who cone ucts moan
than one home in a two year period shell rot be considered a homeowner Such
"homeowner"shall Submit to the Building Olficia4 on a form
Official, that hdahe be responsible for all such work acceptable to the Building
Permit. performed under the Building
The undersigned'homeowner'assumes responsibility for compliance with the State
Building Code and other applicable bylaws and regulations.
Building undersigned"homeowner"certifies that helshe understands the City of Salem
Department minimum inspection procedures and requirements and that hNshe
will comply with said procedures and requirements,
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING INSPECTOR
See other side fo
r state code ,
SOMEOVYN BR M—OW I-A
apt P wort for which a Builft Pew u
1-m Code states that: �Y Hotneo of this section(Section 109.1.1 —Liceasini
r sha11 be exempt fimm��.� was Psi fa him to
of bmtruction ��Homeowner shall ad a+S>�sm.
ace that they ae a =min$the
meawnwi who use this ate ftLics
M.
of a 3 us
ion.1 S� This lActc of&waves othm readb in satin
Constnwtiou s he omeowm hires UnUc�Pmom In this case Yo
Pur
'Patttcula� dye unlicensed pantos arould hh�1a'sed
Board caattot P�e°d . i4
Supt�►i The Iiomeowaar
is aware of hisilm bilit' many that
To ensure that the Homeowner fa the Romeo certify.
communittq ra4' as a part of the Peimit . On fire and o�1sm's a
1� �the hilities of a
used by sayeal towns' You may care to amend 8�
form ciarm ' uc wm�itY.
fornolcatiSca>39�4_f�.ueen►yo' .
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