16 TREMONT ST - BUILDING INSPECTION Y
fL�INs V8D BY T44E
J*9QR MAPT IIEWQ GRANTED 4
CITY OF SALEM
-03
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BI�.DIN<# POW APPIZAtWN FOR: '
Pe mk to:
Ode whka ~apply) Roof. Retool, Instal Sk ft 0MsW ct Deok. Shad, Poal.
RepabrAphm. Other•. C�k � A\6 fl�.
PLEASE FILL OUT LEGIBLY A COMPLETELY TO AVOID DELAYS W
TO THE INSPECTOR OF BUILDINGS;
The undws*W hwaby applies for a pamnk to build ac wft to the lollov-
Owners Name SC�c�, cl c� ,�U C
o
Address d Phone \� �Q�� . \ \\ �, PA 1
Arahks * Name
Address & Phone
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Address A Phone 4'
wnr M on p.pom a eusa,gt
tiww a ta/iigt fr a dweAq,for how wAny rmiaut'
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�. m"� S stun AppYoant ' "
SIGNF,D UNDER THE F
OF PERJURY
DESCRIPTION OF WORK TO BE D"E
"� MAIL PERMIT TO
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CITY OF SALEM
BUILDING DEPARTMENT
HOMEOWNER LICENSE EDMOMON
Pkase Pry
DATE S - 1 K-n2 '
JOB DCAnON
. HOMEOWIiFA
ADDRE4
TE3EFHONB
PRESENT MAILING ADDRESS
oti of"honrKowncrs"was czwnded to irrludc owocr occupied dwsrRap of TW�D
The cmfent.ctempti bite wfio dos sot posses•
Units or ks and w e11ow such homeowmn to"€age sn individual.
h'ccnse,_providcd than the owner sd ss supervbor.
DEFINITION OF HONSOWNF]l on whldn there$a b
Pcnon(s)who owns a pwscl of land on which hc/shc ncsides of bucnds to reside, to such we andbt
intaAcd u be.s one 10 two family dwelling anacined or dctaddfed W=wa od sry t tsolhe a andAw
farm rmw=,es.A pawn wbo cotnsvncts mwm than mK home in a two-? rm
ood
a houKowna. Such nwmtov r= ' shall submit w the Building OMCUL OR s fonp scccpubk so'a
Building OokW,that Wshc be tcspom-bk to all such work paknaed under dne bading powL
The undemped-bomeo�vn d"assm=tsspormbility rot compliatcc with the Stan Bu�t>jag Code trod
otha applimblc Ica by-hers,rules and regulations.
The wAmigncd"homtow fAr"t dim s that hdshc=A atands the City of Salem Btdk6ag Dcpsraoat.
minimum inVp on pmcrdwes and tcqui==nts and that Nshc WiD comply with said ptocedtnes wd
Ttqdrcncm �o
HOMEOWNER'S SIGNATUREf[�
APPROVAL OF B=ING IN���FSPE`C'OR_ "
See other sde for stow code
l 4 �
HOMEOWNER'S EXEMPTION
The code suits that 'arry homeowner pufonrdng work for which a bulidbtg permit is stall be
exempt from the p ovisions of ibis section (Section IOP.1.1-Uccnsing of Construetim Sept rrboss)
Provided that is a homeowner engages a pcnm W for hire to do.such wort,tbat such homeowner am nix
as supervisalr"
Marry bmneowners who use this txcmpdon an iunwart that they are ass>usting the tespo iks of e
supervisor(set Appeodis Q,Ruks and Regulations for Licensing Construction Suptrrbos%Ses$N
.2.24 Ibis lsck of awareness cflcn results m scriout pmbkms,pardcabAy wbm the homeosraer lane
uniicsased perwm In Ibis ease your Board=tnot proceed sphm Ow wXcrosed per n a k wtattld WI&
licensed Supmisa. The 6omeonver suing as supervbor k uhianat*tsspM511.0 .
To ensure that the homeowner is fully aware of hither respon_n'bil ties.=wW eAmmtnddu tayr3re;ss past
of the pennil appliodM that the horneowntr certify that Waite understands the responsibilldes ofs
sopersism. You may rare to amend and adopt such a form/ctttifieatiexr for use in your
PUBLIC PROPERTY DEPARTMENT
120 WAfHINOTON STREaT, 300 FLOOR
SAI m,MA 01 B70
TEL. (9711)74"595 EXT.360
FAX (970) 740-9646
STANLEY J. USOVICZ, JR.
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the provisions of M(3L c 40,S34,I aclmowledge that as a condition
of Building Permit 0 .all debris resulting fi m the won activity
govemed by this Building Pemut shall be disposed of in a pmopaly licensed soH&wam
disposal facility,as defined by M(3I,c ID.S1S0A.
Thedebris wiII bedisposed of at: /\ �l`?C-��f�-,� -'
Lacadon of Facility
igustlas Permit APplicid Date
FULLY complete the following mfonaawm:
(PLEASE PRINT CLEARLY)
,c), ,2 �
Name ofPc mitApplicant
Firm Name6 if any
Address,City dt State
The above statute requires that debris tom the demolition, renovation,rrhab or other
alteration of bm7ding or structum be disposed in a properly-licensed soli&waate disposal
facility as defined by MG.ca S I50A, and the building permits or license:am to
indicate the location of the 6cility.