3 WARNER ST - BUILDING INSPECTION (2) -PL 1 S ''-DE f L{-P'Al llj A?PROVED BY T*IE
i IAdSi?ECJTP R TP 'pailli T 13,EWG GRANTED
I
CITY OF SLEM
N 25 03
f
N .y �' Date
o. � .�
r'•
Ward
Zoning District
Is Property Located In Location of _ _
the Historic District? Yes_No_ Building n�/{ S
Is.Property Located in
the Consenradon Area? Yes No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
Repair/Replace, Other: V 2 AjAz
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 T 6 (2 Mi4 N c
Address & Phone i (L NI i=A -//1 0 6
Architect's Name
Address & Phone ( )
Mechanics Name
Address & Phone n / ( l
What Is the purpose of building? 4C t h, I-e ,--a
Material o1 building? hlood If a dwelling, for how many families?
Will building conform to law? _T 5 Asbestos?
Estimated cos od90 City License # State License #
]come Improvement
Lic. 1
�
C� Signs re of Ap icant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF
//WORK TO BE DONE
ev' Tel
MAIL PERMIT TO: HO„.e o���
..........
.............
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CTIY OF SALEM
BUII DING DEPARTMM
HOMEOWNER LICENSE E)MWnON
Please Print
DATE
JOB LOCATION
ADDRESS
HOMEOWNER 7� �/ �/ �l
TELEMONE
PRESENT MAILING ADDRESS
The ehunvtt,etemption of"homeowners"was extended to include owncr.oc"Oed dwelvi f ofTWO
Units or less and to allow such homeowners to engage an individual for bile who does not posto<s a
license,provided that the owner act as supetviwr.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which it
intended w be,a one to two family dwelling,anached or detached suuc=a accessory 10
e andfor
farm structures.A pctson who constructs more than om home in a two-year period sball twt be cons dared
a bomcowver. Such"homtoNNTwf shall submit to the Building 015dal,on a form acceptable m 69
Building Off eW,that Wsix be tesponsiblt to all such work performed MAU lire building permit.
The undersigned"homeawna"asnum responsibility for compliance with the State BtuBdmg Code tmd
other applicable goes by-laws,Hiles and n gulaiiart.
The undersipcd"homeowner"eeriMes that hdshc understands the City of Salem Building Departmatt.
minimum inspection proccduua and requurcmcnts and that hlshe will comply with said proceduuts had
regniren=M
HOMEOWNER'S SIGNATURE
.APPROVAL OF BUILDING INSPECTOR 4-7
Sec otber side for state code
HOMEOWNERS EXEMPTION
The code states that "any homeowner performing work for uvhieh a building permit is requved shall be
exempt from the provisions orthis section (Section 1119.1.1-L'ccusiug of Construction Supervisors);
is a homeowner engages a rson s for hire to do.such work,that such bomeowaer shall am
' that ( )
as
Provided . person
rYp "-A w
M y bomeowners who use this exemption are iurawarc that they arc assurn ng the Tesponstbtliues d a
suprnisor(see Appcodis Q,Rules and Regulatious for Uceosing COnstruction Supervisors,Sectkm
2.24 This lack of awareness often results in serious problems,particolwly wbcn the homeowner bins
unlicensed persom. In this cam your Board cannot proceed agairat the UrWcensed person aS h would with
licensed Supevisor. The bOmON eDer scout as supetrnor i7 uhimately respousiblt:
To ensure that the homeowner is fully aware of hVt=respoasrbilrties,marg eorrtmmtities regime U FA
of the permit application,that the honeowrur certify that hclshe understands the responsibilities o(a
supervisor. You may care to amend and adopt suet a form/cerdlication for use in your eoatmunip.
OF SALEM,- MASSACHUSETTS
v�{off PUBLIC �RdPERTY DEPARTMENT
120.WASHINGTON STREET, 3RO FLOOR
:, qp SALEM, MA 01970
TEL. (978)745-9595 EXT. 380
FAx (978) 740-9B46 .
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
disposaffacility,as defined by MGL c III, S150A.
The debris will be disposed of at: ,�1✓
Location of Facility
-''
-, gnature of fenhit Applicant Dat
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
Name of Permit 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
indicate the location of the facility.