121 WEBB ST - BUILDING INSPECTION (2)f
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a
f1 lY VfIED BY TW
AMNG GRANTED
CITY OF SALEM
olds 0
is Ropenly Loomed in Lmatun
• WIN OlddolT rites No
:• to OotwAn•t YsL_NoI/
BURDDKi PERMfT APPLICATION FOR:
Pamk tir
(Chb whlohwsr MW Roof, Rsroof, InW SWft Corns W,Dsok, Shod, Pool.
RspsklRsplsos, Oth�r:' _ /.vtTY9LL e�Lc 1 !4S
�IG��SS
PLEAISE FILL an U0KY A COMPLETELY TO AVOID DELA"IN PRWNWW
TO THE INSPECTOR OF BUILDING&
hw@W opow. for o "Mit to buM as w ft to ft fokswirp
Owners Nwe CAO, S
Address d Phone /a/ w Li3 k SST" QM
Ard*ocft Nano
Addnm & Phone ( 1
Modgnlos Nww -
Address 6 Phwa If 1 4
� Aria
wnd Y b p oposs it bllldYla/ {� :
maledd of buldig4 M s dwsiq,for how mnq Am~ t
VW bAft oo1d01111 b row9
• 1 \ N
lamed a". \a V CM LJoww r N A aMo LJoNw r k.
re of A~
SIGNID UNDER THE
OF PWUURY
DESCRIPTION OF WORK TO BE DQNE
IiNf�i MAIL PERMIT
P.
40
19
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afy Of SALBM
BUII.DING DEPARTMM
HOMEOWNER LICENSE EMAPTION
PkM Prig
JOBiAMOrf \a� �J ebb �� Sc� ems•_ w�
-10
.00
. HOMEOWNER
ADDRESS
5�
TELEPHM
014.710
PRESENT'MAII.IttG ADDRESS ��\ \��b v
The C=cg exemption of"hmrwawDcfs"was uuaded w irrclttde owner-ocwPied dnslGep dT�
Units or kss and to allow such homeowners toengage an indlviduaJ.
far hie•rho does scot poswt a
liecnse,.pfvndcd tbta the oxrser set ats supa'visot:
DEFIRMON OF HONMOWSMO
Person(s)who owns a pw=l of land on which btJghc resides of iruw&w TCSWC'on whldt Isswq to ach we m
wa
blcrtdtd w be,a one to two UnMy dwelling,anadttd or dttadwd smtcttves Od sba)1 aul he oen ndAw
cmd
farm smtcm A person who coruUuM mots than oat home it a two-y POW
a "home %me shall•submit to the BuBding OfficbI,on s form s=qubk to*6
hoatwwner. Sttdt
Building Oftdal,that brJsht be rtsponst'bk to such work pafortfted nfsdef the bet ldiag po wit.Tat undtasigned"bomeotmsf"rsstmtes Tapons'bift lot wmp1W=with the Stan Building Cods:wd
other applieabk goes by-lews,ntks and Tegulsdam
The wxkrsigned =tMcs that hdsht undws wds tht City of Salem Budding Deparoa of,
minimum irtsptction pfoczd wa and regtmsmcnu and that Wshe will comply*nth said p+ �
.
Tt4
HoNeowt OS SIGNATURE
APPROVAL OF BUILDING INSPECTOR
\ See other sde for watt code
HOMEOWNER'S EXEMPTION
The code states that.• `any houuowner performing work for which a building permit is required strop be
exempt from the provisions of this section (Section lOP.LI-L•ccosiog of Conaruetioo Supervisors);
Provided that is a homeowner engages a person W for his to do.such work that such homwwsa snap ad
as srpa•v oce
Mary borneownets who use this cxsmpdm are i r a that they an amming the>espo pq of a
supervisor(am Appeodh Q,Ruks and Regulations for Liecnsing Coostruetbn Super sum Saa:d.n
.2.24 This lack of swareness often results in serious problems,partieohwfiy when the horoeowaa bbe
unlicensed pe ms. In this case your Board cannot proceed against the unlicensed person S t wtittld Witt
licensed Svpcnisa. The homeow•acr acting as supervl+or is oldsnst*tea�woslWe,
To ensure that the homeowner is fully aware of hM=responsibilities,marry cxrmn=dda regdre;as Vase
of the permi4 application,that the homeowner ecnnfy that Won underskaads the msponsibilddes ofa
supervisor. You may care to amend and adopt suite a fornilesrtificatitxs for use in yaw eoamuadq
PUBLIC PROPERTY DEPARTMENT
• 120 WASNINWM STIIEaT, 3RD FLOOR '
i SALEM,MA O1 S70
TEL (276)7454595 EXT.360
FAX (S76) 740-9846
STANLEY J. USOVICE, JIL
MAYOR
DISPOSAL OF DEB=AFFIDAVIT
In accordance with the provisions of M(Z c 40,SA I aclmowledge that as a condition
of Building Permit# .all debris resulting from the e:aw&L ;em wdft
governed by this Building Permit shaft be disposed of m a p apaly licensed solid-waste
disposal facility,as defined by MC$,c Iq S150A.
The debris wig be disposed of at: �\--NZo 1
Location ofFaCr'Itt'y
Si of Pcm Applicant Dam
FULLY complete the following Mfo :
(PLEASE PRWr CLEARLY)
V �tsY1Q �R . C c—DS 5
Name of bimit AppHeat
Firm Name,if my
VA\ webs �A �0,-l0
Address,City at State
the above statute mp ms that debris from the demolition,renovation,rehab or otma
alteration of bmldmg or smicdue be disposed m a properly-licensed solid-waste disposal
facility as defined by MCs'I,cIII, S I50A,and the building permits or liceosa we to
indicate the bcsb n of tme facility.