13 VICTORY RD - BUILDING INSPECTION (2) $ry �
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IMJSTeE fib °I PPROVED By T+IE
Il PEGTAJ3 AIDR ID",A PEf"T BEING GRANTED
CITY OF SALEM
No.
Date
Is Property Located in Location of nn /n�
the Historic District? Yes—No Building 13 urr,{or� ICCG
Is Property Located in
the conservation Area? Yes_No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Dec Sh ool,
Repair/Replace, 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 l(u Lie r F SMJ' J n `
Address & Phone 13 ,Cod f S��ewo �91s� 7`fS a3s`I
1.
�� Architect's Name A/ame aced
l °
(� Address & Phone 1
a`.
a Mechanics Name /✓o/uv o3ed
Address & Phone L
What Is the purpose of building? S+0 1CSC
Material of building? W 0 o CSC If a dwelling,for how many families?
Will building conform to laka,? yes Asbestos?
I , Ysh`
Estimated
cost 700 IkY City License S N A State License #
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Home Improveaent
Lie. i ih(i �I
Signature of Applic
SIGNED UNDER THE PENJI!IP
OF PERJURY 11,1{�? i
DESCRIPTION OF WORK TO BE DONE iI
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MAIL PERMIT TO: �� L1 fG ��/ 2ecGt Su/tr, '/'/4 ail
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APPLICATION FOR
PERMIT/TO
LOCATION
PERMIT GRANTED
APP, VfD
INSPECTOR OF BUILDINGS
t _
CITY OF SAUX
B=ING DEPARTMENT
B02v1EOWNER LICENSE Lxaa nw
Please Prftti
DATE "'I 22 6 ` '
JOB'LOCAT70N 13 V rG CU s �{ 1l oG fX i �c f t�^ -4
- , HOMEOWNtR I � �tG �vr`( 1C,ticeS' .r Selt.�+ �q•
ADDRM
HOMEOWNf3l
TELEPHONE n //++��
PRESENT MAILINNGADDRESSa�t� tMu Vl5
The narcffi exemption of`bomeownwC was ccended to include o+Totr-oc qb0 polied sp d'[vlO
Uniu or Iva and to allow such homeowners to engage sn individual Sor hirt I
liecax .provided that the owsti sd ss supervawr;.
DEFINITION OF HONSOWN88:
PcTson(s)who awns a pa=l of land on which Wax resides or intends to*wide,on wldeh�l ark
intended 10 be,a one to Two fanny dwelling,anached or dctadotd strucnacs od ssM t mat be se andemd
ff
farm steams.A person who constructs most Than one home in aatt'�on a g�s a ma t b W one
a homeowner. Such`hcmeowter" shop mbmot to*a BuBding tmda the building peTto*
Building Official,that Wshc be Ttspom-blt to ell sash work pafonued
mobil' for coin lLm=with The State BuDdmg Code Ed
"assurrtTs n p
The undvsigncd`homcownct T� Try
Qd=applicable goes by-laws,ruts and Ttgublium
The undasigncd'homeawr=" c crd5cs that hWdshc and the City of Salem BwVmgDepe>v=A.
minimum inspction procedures and rcq ' ��with said P
requutareas.
HOMEOWNER'S SIGNATURE
APPROVAL OF BUILDING INSPECTOR 4'y '
Sec other side for state code
HOWONVNER'S EXEMPTION
The code states that "any homeowner performing work for NA a building permit is requirod sball be
exempt from the provisions of this section (Section 3 9.11-1Scenskg of Construction Supervisor7);
Provided tbaz is a homeowner engages s person (s)for hire w do.such work,that such homeowm than ad
as superyisw.
Many bomcowrtas wbo use this=mption arc unaware that try arc assuzni ng the tesponsibUltin a[a -
superrj5w (sex Appcod'u Q,Roks and Regulations for l icnsiog Coosiruetion SupervUem Seetiaa
.2.1E). This lack of awareness often resuiu in serious problems,particularly when the homeowner hint
wZcrnsed asitw
unlicensed persom In this ease your Board carrot proceed against the person wld widl
licensed Supervisor. The b*MtM'oer sdinY as anpernsor b oWwaidy,risponsibit
To ensure that the homeowner is fully aware of hirer respon_nbil ties,toasty communities regime;as pmt
of the permit appliodoq that the homeowner certify that Wshe understands the responsibilities da
supervisor. You may care to amend and adopt sucb a formlocrdfication for rase in your eODwaswV,
i
CITY OF SALEM9 MASSACHUSETTS
S
PUBLIC PROPERTY DEPARTMENT
P
120 WASHINGTON STREET, 3RD FLOOR
�'• 'taa SALEM, MA 01970
.yqq� TEL. (978)745-9595 EXT. 380
FAX (978) 740-9846
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 Pen-nit shall be disposed of in a properly licensed solid-waste
disposal facility, as defined by MGL c III, S 150A. n c�
The debris will be disposed of at: �WCWrsca14 I?a It,
Location of Facility
L G�Gy'0 0'�8 0
Signature of Permit pplicant 15ate
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
R06e4 SMIf(n 3 2
Name of Permit Applicant
Firm Name, if any
OICT01-' a0 ( (Scjrm I IL ol'm
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.