3 WARNER ST - BUILDING INSPECTION T� lTLr/'1iTTTO VLV D1 111G
L ,LNSPFXTQ-R ,PRIOR TD iA.PERMT BFJNG GRANTED
�7, �� a
rGITY OF SALEM
No. � .� p�w Date ✓12
63
�V, - h l if s Ward
\�e�ymneo 'fi` ,z Zoning District
Is Property Located in Location of
the Historic District? Yes_No_ Building ( ,(,)Q 0 ly,�
Is Property Located in
the Conservation Area? Yes No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Sidin onstruct Dec Shed, Pool,
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 E R G I S SLj L t 7 M iNk) I
Address & Phone 3 vy-h- EP- sr ( 979) 31 7 4 2 v 6
Architect's Name
Address & Phone ( )
Mechanics Name
Address & Phone ( )
What Is the purpose of building?
Material of building? If a dwelling, for how many families?
Will building conform to law? Asbestos?
Estimated cost o sv, - City License # State License #
Home Improvement v
(_ Lie. I n Gre of licant
SriSI ED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
C-MW ci LSWt ?_ FL" i 'nC- C- K _
MAIL PERMIT TO: (itJa i2 v,,Q- -
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CITY OF SALEM
BUILDING DEPARTMENT
xOMEOWNER LICENSE EXROTION
Plow Prw
DATE DCT 20, � 003
Ins LocAnoN 3R N E;z ��
HOMEOWNER Ej,� S i 5t}i ear L9 / T O
ADDRESS
HOMEOWNER I X 7 1 `I I/ ZD 6
TELEPHONE
PRESENT MAf1 ING ADDRESS 7i •xN Pr P- fZ
The nmvA.c.%cmption of"homeowners"was emended to include owoeroceupied dwdUnp of TWO
Units or less and to allow such homeowners to enpage an individual for biro who does ant posses a
liccnsc,.provided that the owner act as supervisor.
DEF1NMON OF HOMEOWNER
Posen(s)who owns a pw=l of land on which hdshc resides or intends to reside,on which there i;or b
intended w be,a one to two family dwelling,amachcd or dctachcd structues accesso y to such rise tnrdlat
farm structures.A person who contras more than one home in a twaycar period sbaU not be considered
a homeowner. Such"homemATei shall'subriut to Ox Bulding Olfrctal,on a form seccptabk aD tha
Building Offrcial,that he/she be ruponsrbie to all such work performed miler the building P=mk
The undenigncd"homeowner"assumes responsvability for compliance with the State Building Code trod
other applicable goes by-laws,rules and tegulatim&
The undcrsipmd"homeowner" certifies that hclshe understands the City of Salem Building Depar=vm.
minimum insp on procedures and requirements and that Mile will comply w Ah said proced=m and
requircmalL
HOMEOWNER'S SIGNATURE
APPROVAL OF BLM DING INSPECTOR �— r
Sec other side for state code
f
HOMEOWNER'S EXEMPTION
The code states that: "M homeowner performing work for which a building permit is mquved shall be
exempt from the prmisions of this section (Section 109.1.1-19censing of Construction Supervisors);
Provided that is a homeowner engages such a person (s)for hue to do. work,that such homeowner shall ad
as superwsar."
Many homeowners who use this exemption are unaware that they are anmming the responsibilities a[a '
(nee Appendix Q,Rules and Regu)atioos for Vcxvsing Construction Supervisors,SecOM
NP Oi
2.15} This lade of awareness oftenresults in serious problems,particularly when the homeownerbim
urilieensed persons. In this case your Board cannot proceed against the unlicensed person as It'would witL
licensed Supen'isor. The bome"Mcr suing as supervisor 1s ultimately responsible.
To ensure that the homeowner is fully aware of hiTher responr_n'biiities,marry eonummitiia mquire,'as part
of the permit 2pplimdor4 that the homeowner ecnify that hrlshe mukrsrands the responsibilities of a
supenisor. You may care to amend and adopt such a form/mrdfieatioa for use in)vW eommum -
.�o CITY OF SALEM9 MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
SALEM, MA 01970
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 Permit shall be disposed of in a properly licensed solid-waste
disposal facility, as defined by MGL c III, S 150A.
The debris will be disposed of at:
Location of Facility
1
a ature o ermit Applicant Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
Name of Permit Applicant
Firm Name, if any
3 ,u A 9t,&U E tz -b;
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 cHI, S 150A, and the building permits or licenses are to
indicate the location of the facility.