28 WEBB ST - BUILDING INSPECTION ti.
;MOVED 8Y 7iiE
IDR� I A1=INR GRANTED 7
a+ti
CITY OF SEM
No. ,.. Dees.
Location of
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6.2 � •�/ S S
BUILDING PERMIT APPLICATION FOR:
Pam k to:
(Chlo whichowr apply) ROL Raroof, Installr.S
apidho Construct Osck. SMd. Pool.
ephwe, Other �KPPf�i� P� Pl ti
PLEASE FILL OUT LEGIBLY A COMPLETELY TO AVOID DELAYS W PROCNM
TO THE INSPECTOR OF BUILDINGS:
The undermigrod hereby applies for a parmlt to build according to Mu bum"
Owner's Name
Address a Phrom,: L)S
Amhk*Ws Name
Address 3 Phons ( 1
Maohmics Name
Address & Pharra
whir Is se pupas it I g! .'.
a dwatrnp,W how many Waal
ww Olditil0 AN Inj 11 to W? �!
i."
Ea>rnwtad ad� D?J CS►Lk wm• N A craft Uo a► a.
laws I�ro�at ,
�ut rdc.
lllVV� Signature-of ^'.
SIGNF�D UNDER THE PrM •
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
1
. ,
4
MAIL PERMIT TO• r
NO.,
AppUCATION FOR
PPEERWT TO /
LOCATION
+�ERMIT GRANTED
APP
FD1 7v
`-
INSPECTOR O BUILDINGS
CITY OF SAUX
B=ING DEPAYTMENt
HOMEOWNER LICENSE EXEMPTION
Please Prat
DATE D
JOBLOCA ON a
moN EOwNm o2 P Wii 3 ST
ADDRESS
HOMEOwm
TELEPHONE
PRESENT W.ILW.G ADDRESS 5A>~I
The narcnt c+ampdon of`homeownat"was cxtendcd to include owocr occupied dwemiss otTwo
Units or ka and to a]low such honmow n=to engage an individual for)rice who does not poaaeaa i
h'anse,.provided tbal the owonr ad as aupervbor,
DEMUTION OF HOMEOWNER
Person(s)who owns a pm=l of land on which hclshc resides or but w reside,on which these It,or Is .
immnded to be,a one to two fanny dwelling•amadwd or dctachtd avu ram accessary to loch we andkr
farm suvcwm A person who constructs morn than one home in a two-year period sbA mot be considered
a hoummucr. Such`homeowlKf shalf subn*to the BuBdimg Of5ci4 on a form S=qubk to to
Building Official,that he/she be responsibk to all such work paformcd mda the but'lding P=*
The wtdcrsiptd`bomeowner"assanes resp0r�nbility for compliance with the State BuBdmg Code and
oil=applicable goes by-laws,Tula amd regmlaticaL
The undcsipicd`hotr certifies that hdshe umdemands the
wof Sam De pwv=K.
mnimm inaon p0ccdues ad rcquuemnu ad ht h/shcwillmP1Y pmoc&
Te9
HOMEOWNER'S SIGNATURE Al
APPROVAL OF B=ING INSPECTOR
Sec other side for start code
}
HOMEOWNER'S EXEMPTION
The code state that 'any bomeowner performing work for which a building permit is required sbal be
crcmpt from the provisions of ibis sccdon (Section]9�13-L'ccnsiog of Constrvctitm Superviwrs);
provided that is a Dom c%.ncr engages a person (s)for hcc to do,such work,that suet bomeowaer sha➢ad
as supervises.'
MM bmneowners who use this mmp6on arc ironware that they arc asswriing the TesponsAiMiks Ora
supervisor (see Appcodh Q,Rules and Regulatiooa for Licensing Construction Supervisom Sec*u
.2.14 This lack of awarcness often=Wu in serious problem,particubriy when the bomeowncrbb"
urjkcrssed penom in this case your Board cannot pruned against the mt cm-Sed penoa u b wmuld tf
licensed Supervisor. 7be boweowvcr seting as supervisor is nhimately roEoosibba.
To ensure that the homeowner is fully aware of his w rcpon-lbMies,many oommuaiBes regeme,as paint
of the permit appliodo0.that the homeowner certify that WShc tmderstarde the respkmsibiiities eta
supervisor. You may care to arncnd and adopt such a Immilc rtifxatien for fast in yoke eontmnnIQ.
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
-.. SALEM,MA O 1970
TEL (978)745-9595 EXT. 360
FAX (978) 740-9646
STANLEY J. USOVICZ. JR.
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the provisions of MGL c 40,S34,I aclmowledge 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,S150A.
The debris will be disposed of atRe�n1s Fr2 ST/�lio/� S u1E1 M�cc�7t �c�
Location of Facility
lgnature of Permit plicant Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
J24
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,S150A, and the building permits or licenses are to
indicate the location of the facility.