21 THORNDIKE ST - BUILDING INSPECTION (2) Kim
1.
VEa BY
Jil�$WOR 05 P61111f T AMQ GRANTED CITY OF SALEM
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Ilr FIMab OWdcl'! Yo_No_ /j
IM PIWEtY LooaMd in
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Permit to: BUILDING PERMIT APPLICATION FOR:
'
(Chic whin ~apply►) Root. Reroof. Install Siding. Construct,DwK Shed, Pool,
Rsp ddRsptaoe. Other:
' PLEASE FILL OUT LEGIBLY A COMPLETELY TO AVOID DELAYS IN PROS
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permk to build according to the t NwA*q
Ownses Name m^�
Address a Phone � ( ZT6 3O�S(�
Amhitact's Name
Address & Phons L y
Mechanics Name
Address A Phan
Whd In to pupw if Ilo alp ,
MWNW at tlllldllp4 pa dwarf g.for now many Oman?
wN bUl ft oolwam b JW ! i
t;M Ul o N A 8Wo ■//�/�J ti:
ao.. rrsv....ae
fI Signature of Ap �i mt
SIGNF,D UNDER THE
OF PERJURY
DES�RBPTION OF WORK TO BE DONE
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MAIL PERMIT TO� a ! kf
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No �� Q `A
APPLICATION FOR
PERWr TO
LOCATION
PERMIT GRANTED
AP
INSPECTOR OF BUILDINGS
t
PUBLIC PROPERTY DEPARTMENT
120 WASNiNOTON ST!!E6T, 9RD FLOOR
SALEM,MA 01970
TEL (976)745-9595 EXT.980
FAX (978) 740.9846
STANLEY J. USOVIC7, JR.
MAYOR
DISPOSAL OF DEBRIS AFFDAVff
In accordance with the provisions of MGL c 40,S34,I acknowledge that as a condition
of Building Permit 0 .Adebris resulting from the construction activity
governed by this Building Permit shall be disposed of in a properly licensed solid-waste
disposal facility,as defraed by MGL c III,S1SOA.
The debris will be disposed of at
Location of Facility
Signatum of Permit Applicant Date
FULLY complete the following information:
(PLEASE PRIMP CLEARLY) ��I/'
204ji- • �ni`N1oVI f
Name of Permit Applicant l
Firm Name.if ray
a ► -T�a► I)V,
Address,City dt 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 MM ca S 150A, and the building permits or licenses are to
indicate the location of the facility.
CITY OF SALEM
B=ING DEPARTNSENT
HOMEOWNER LICENSE DXElaTION
Please Prat
DATE � f
JOB LOCATION 1 0 y' i21
. HOk>f.OR'IgA .
ADDRESS
HOWOWNM
TELEPHONE n
PRESEn mAnvc;ADDRESS a e
The cw•md cKemption cf'bomtaw=C was r-%ended t;1mluidt*wocr-ompkd.dwcM tip d f iVp
Uniu a ku and to allow such homwwners to engage an indindual for bite who does rill V ' - a
liccnse,.p vacd tha the owsxr act as superviuw.
DEMMON OF HOMEOWNER
Pctaon($)who owns a pm=l of land on which bdshc raids or intends to reside,on whkhho key
intended w be,a arc to two fanny dwelling,attached of detached struc=vs scecsmy
farm mucw=L A person who constructs more than one home in a two-year period sbaU not be considered
a homcow•mr. Such'homcop'rf shall•subnm to the Building 015CUl,on a form seccptabk 10*4
Building Official,that bolshe be tssponnbk to all such work paformed wAw the building pam L
The undcrsigncd'bomwwmr"assumes respon.'bilhy for complies=with the State Building Cock tad
oiha applicable goes by-laws,rules aad tegulatiemL
The undasigned'hou=w'na"=65es that hdshe undcstanda the City of Salem Bm'ldmg Depamuna l.
minimum inspcation pmccdum and tcquitcmcms and that IJshc will comply with said pcoeedcua sad
tcquirta�rit. � � J
HOMEOWNM'S SIGNATURE
APPROVAL OF B=ING WSPECI'OR,
Sec other side for sure code
' 1 f
HOMEOWNER'S EX NITTT,ON
The code states that: 'aT homeowner performing work for-,vhicb a building permit is requrrod sbalt be
cxcmpt from the provisions of this section (Section l09 l.]-lictosing d Construetitro SupetYisots);
Provided than is a honrewner engages a person(s)for hire to do.such work lhai sueb homeowner shaD act
as avpcnsa .
My bon.wowmn who use this mmpuan am unaware that they an asstanimg the mspo>mbititiei Cc&
svpervisor(set Appcndl%•Q,iRulu and Regulations for Umosing Coosrrvetion Supeayisora,Seedw
.2.14 This lack of swatcneu often restdu in scriow problems,pattiwlwiy wbcn the bomeowmbbu
urtlicrnscd pcnoni In ibis rase your Board earmot proceed prnan a tt world w$1t
liemsed Supcnisgr. 71)e LOt e"Ver acting as superviw is nitlwatep mpoosibla,
To assure that the homeownct is ful}y aware of hin=rnpon_n'bilit'ses,many earnmtaddes mqu' ;a pal
of the pertrdt spplimtion,that the homeowner ccrnfy that hclahc tatderstatd6 the responsibilities eta
supervisor. You may cars to wneW and adopt such a fomVccnificatia►fm tilt in your CD=mmlQ.
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