16 SUTTON AVE - BUILDING INSPECTION i
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I9!11116I OST-0E f#UEP D,A?PROVED BY T44E
,WPEXTO-R ,PF. .13 T-0 A.PERMIT BEING GRANTED
Zg'7 CITY O„F SALEM
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Is Property Located in Location of / ,�^ /�
the Historic District? Yes_No k Building /(� Su iI on/ A yFE
Is Property Located in
the Conservation Area? Yes_No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) nstall Siding, Construct Deck, Shed, Pool, ,
leopa*Eplace, 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:
Owner's Name 0-5iff li7r� ��IS (7 V
Address & Phone 1l v ro y A y F _ 19 7a� y `6 4_
Architect's Name
Address & Phone L )
Mechanics Name E
Address & Phone ( )
What is the purpose of building?
Material of building? If a dwelling, for how many families?
Will building conform to law? Asbestos?
Estimated cost /L �d City License n N P' State License #
Rome Improvement X
c. ' 1 naturd of joliddht vp
(ems SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO:/6 Ste, l t b/Lr A U�
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No. ZCD F
APPLICATION FOR
PERMIT TO
I5 -'A , o�
LOCATION
�k S4 AI vQ
PERMIT GRANTED
S/
1 o -5
APB VfD
INSPECTOR OF BUILDINGS
CITY OF SALEM
BUILDING DEPARTMENT
AOMECIWNER LICENSE E)MWTION
Please PM
DATE SST !oi noes 3
JOB LOCATION �� cSy o rU V
HOMEOWNER 5A 1M.
ADDRESS HOWOVMM 9 7 F 7 q 1/�
e, 773
TELEPHONE
PRESENT MAILING ADDRESS
The c urent.exempdon of"homeowners"was c acnded to include owner-occupied dNelfivp of TWO
Units or less and to allow such homeowners to engage an individual for hire who does not posan a
license,provided that the owner act as supervisor.
DEFINITION OF HOMEOWNER:
Person(s)who owns a parcel of land on v:hich he/she resides or intends to reside,on which there it,Of is
intended to be,a one to two family dwelling,attached or detad)td smxttucs accessory to R ch use and/or
farm structtues.A person who constructs more than one home at a two-year period shall w be considered
a homeowner. Such"homewArn ' shall submit to the Building Official,on a form able to the
Building Official,that he/she be responsible to all such work performed under the building p=odL
The mmdcsigned"homeowner"assumes responsibility for compliance with the State Building Code and
other applicable goes by-laws,rules and regulaliouL
The unticnigned'homecwner"certifies that he/she undcrnands the City of Salem Building Dcpwvnatt
minimum inspection procedures and requirements and that hlshc will comply with said Procedures tmd
requirements. n
HOMEOWNER'S SIGNATURE_pj :OS
APPROVAL OF BUILDING INSPECTOR
See other side for state code
J
i
HOMEOWNER'S EXEMPTION
The code states that "any homeowner performing work for which a building permit is MuI ed shall be
exempt from the prmisions of this section (Se, ion l 9.1.1-Licensing of Construction Superrisor�;
Provided that is a homeowner engages a person (s)for hire to do,such work,that sucb bomeowner chap ad
as supervisor:
Many bomcowners who use this excmptian are imawarc that they are assuming the tesponsrb rti s ara
supervisor(ace Appeodix Q,Ruks and Regulations for Licensing Construction Supervisoa,Secom
.2.14 This lack of awareness often results in serious problems,particularly when the boroeowr er bores
unlicensed persons. In this case yore Board cannot proceed against the unlicensed person u it would with
licensed Supenisor. Tix bomeor ver acting as supervisor b uhImatdy responslW
To ensure that the homeowner is fully aware of hi4vtr responsrbilities,many communities ngtme;as PA
of the permit application,that the homeowner certify that hdshe understands the responsibilities of a
supervisor. You may care to amend and adopt such a form/ccrtification for use in your tumt»ty.
co ' OF SALEM.- MASEACHUSETTS
3� a PUBLIC PROPERTY DEPARTMENT
° 120 WA,SHINGTON STREET, 3RD FLOOR
� p SALEM,MA 01970
1 �s ✓ TEL. (978)745-9595 EXT.380
�ayra FAX (978) 740-9845
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:
Cf2o2� e occJ �
Location of Facility
/ b )-003
Ps2jgn�jo emnt Applicant Date
FULLY complete the following information'
(PLEASE PRINT CLEARLY)
Name of P t Applicant
Firm Name,if any
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.