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9 WALL ST - BUILDING INSPECTION f1.�RISiIAifSfi�EfH.f AppRovEo BY 744E p TpR ,pFWR To A PEMT BEING GRANTED CITY OF SALEM ,3* Date 7 No. Location of Is Property Located In Yes_,No_ ]3ni ldin8 the Historic District?Is Property Located in the Conservation Area? Yes No BUILDING PERMIT APPLICATION FOR: Permit to: (Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Poo. Repair/Replace, Other: &COMPLETELY TO AVOID DELAYS IN PROCESSING PLEASE FILL OUT LEGIBLY TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit to build according to the following specifications: Owners Name 's Address & Phone �� / OQ � (�/7 )S 90 �9/a •7 Architect's Name ( 1 — Address & Phone Mechanics Name 1 — Address & Phone What Is the purpose of building? If a dwelling, for how many families? Materiel of building? �.— will building conform to law? Asbestos? Estimated co city License# N ra state, x �� floe. ImplovesenC (�XJ\ lgnature of Applicant SIGNED UNDER THE PENALTY OF PERJURY DESCRIPTION OF(�WORK TO BE DONE MAIL PERMIT TO: APPLICATION FOR PERMIT TO LOCATION PERMIT GRANTED L$ APP VID INSPECTOR F BUILDINGS rr a CITY OR SALEM9 MASSACHUSETTS PUBLIC PROPERTY DEPARTMENT 120 WASHINGTON STREET, 3RO FLOOR SALEM. MASSACNUSETTS 01970 l//) a7AML8T:J:1JEOVICZ, JR. TELEPHONE: 978-743-9598 EXT. 380 MAYOR FAX: 978-7409846 i HOMEOWNER UMSE EXEMPTION Please Print. Date o3 Job Location S Home Owner Ad&M- . Home OwnerTelaphAWP 47s 741/-/G 0 Z Present Mailing Address__ 9 /11 a[ f c me curnt ra CwVdw of"Homeowner" s ex watended to inchI&owner-occupied lli dweThngs of two.Uai*or less and to allow such hire who does not to engage an individual for Possess a license,provided that the owria ar . DEFIIVITION OP,HOMEOW�IEB Person($);wtio owm a partceLof land on which IWWN resides or intends to reakK on which there i4 oe is intended to bed a one or twomily fa dwell&att@dW or detached structures accessory to such use and/or farm stnuc ft A person who constructs more dm one home in a two year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official,on a form acceptable to the Building Official, that he/she be responsible for all such work performed under the Building The undersigned"homeowner"aulmlea responsibility for compliance with the State Building Code and other applicable by-laws and regulations. The undersigned"homeowner"certifies that he/she understands the City of Salem Building Department minimum inspection procedures and requirements and that he/she will comply with said Procedures and requirements. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING INS ECTOR See other side for state code A t 90MEOWNM EI�h'�TiON work for which a Building Permit is The Code state+that. "Any Homeowner of rMwed shall be exempt ftm the pro person(s) visions of this section(Section 1 — to of Conatrucdon Supa�ots)'provded that a Homeowner enter a °mD°(s) do such work.and that such Homeowner shall act ss Supervisor. Mmy Homeowners wbo use this exemption are unaware that they are assuming the nee Q.Rules and Ow for Licensing relponsilati of a Supervisor( Appendix Section 2:1�. This lack of awareness oR�raatlts�serious Construction S' 180m' Homeowner biros unlicensed persons. In this case your problems►Particularly when the Homeo &g it would with.a licensed Booardv Homeowner ffi.sod.Person uWnvj e. as supervisor u To ensure that the Homeowner is hilly aware of his/her bilities.many • as a part of the Permit ppplicationthe Homeowner certify that communities req> bilitiee of a Supervisor: On am last Page of this issue is a helsbe under amend and adopt such a form currently used by several towns. You may care to formlce dScadon forum in your community R� ��Isaos CITY OR SALEMII MASSACHUSETTS • • PUBLIC PROPERTY DEPARTMENT 120 WASHINGTON STREET. 3R0 FLOOR SALEM. MASSACHUSETTS 01970 STANLEY J. USOYICZ, JR. TELEPHONE: 97a-743-9395 EXT, 380 MAYOR FAX: 979-740.9646 Salem Building Depm t eft Debris DisnosW Form In accordance with the provisions of MGL c40 S 54, a condition of your Building Permit is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL Chapter III, S 150 A. The debris will be disposed of in: alerA JTft ns-(2er (Location of Facili ty)�-�1e� rn� gnature of Applicant o. �� r � Date CITY OF SALEM9 MASSACHUSETTS PUBLIC PROPERTY DEPARTMENT 120 WASHINGTON STREET. 3RD FLOOR 0. ' " SALEM. MASSACNUSaTTS 01970 STANtET J. USOVIC=, JR. TELEPHONE: 978-745-9399 EXT. 380 MAYOR FAX: 978-740-9846 HOMEOWNER LICENSE E,XEMPTTON Please Print. Date 3 of� (o Job Location _ / c J of Slrep�4— HOme Owner Address. Home OwnerTelephasle "1 -S Prepent Mailing Addroea, The cwm=t exemption of"Homeowners^wal.eutw"to iuclude owner-occupied dwellings of two Umb or less and to allow,such ho>peo to engage an individual for hire who dos not possess a license,provided that the ow ne as;supervisor. DEFIIVITION OF,HOMEOWNER . y' Persons)who ow, =a paocel.Of land on which he/she resides or intends to rea*on which there is,or is intended to bed,a one or two family dwelling, attached or detached structures accessory to such use and/or fans*11cturee, A person who conepvets more than one home in a two year period shall not be considered a homeowner Such "homeowner"shall submit to the Building Official,on a form acceptable to the Building Official, thit he/she be responsible for all such work performed under the Building g The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable by-laws and regulations. The undersigned"homeowner"certifies that he/she understands the City of Salem Building Departm nt minimum inspection procedures and requirements and that he/she will comply with said proved uiremenb HOMEOWNERS SIGNA APPROVAL OF BUILDING INSPECTOR See other side for state code • 01t1 13o11�oWNE1eeS EX1R+M>:TI work for which a Building?emit is The Code states Hutt "a►Y Homeowner Section 109.1.1 —Licensing inquired"be exempt from the provisions of this wtka ( a s)far hire to of Construction Supevraots)+Provided that a l ad as supervisor. engage Peso do such work,and that such Homeowner shall act re Supervisor. see Rules and Regalatrons Umsmg they as assuming the Many Homeowners who use this exemption bilitiaa of a Sups moo( 2.1 h►ck of awareness often results in serious Construction Supevi when the Homeowner hind unlicensed persons. in this case your problems.ParOculaclYtheunlideiaed pas on as it would with a licensed Board w p��acting as avpe"sor i4 uldm&T** le. supamTo ensure that the Homeowner is fully aware of hisim abilitieso many of the Permit Application-the Homeowner certify that communities req heal lbivties of a Supervisor. On the heat page of this issue is a he/she undeats wed by,several towns You may care to amend and adopt such a form cutrentLY forwcerdficatio>t.for use in your community. Ito 4 sa f sod r