35 WINTHROP ST - BUILDING INSPECTION (2) f1�Ils Y�MBYMWI -,-
CITY OF SA4 EM V
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DSIO PERMIT APPIdCATION im
. Psrmit Ia:
(CYols whM wwr apply) �a Sp, ^�°t W*, hM
PLEASE PM.L OUT UMMY a COMPLETELY TO AVOW OELAYS IN Puoowlnr
TO THE INSPECTOR OF BUWNOB:
hrsby sppla. for a Pwft to build sacoi ft to tlw IoNswirO
Ownses Name I(ELL
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Address a Phaw sm �:,� .M a c)i
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Address A Pla I I
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ssm is w.PNPM it of
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v�evrwq onnbns a hwt �p S s.e.nerr
1p UNY THI
oEscroPTTON OF VIM TO u DPWOF PERJURY
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CITY OF SALEM - ✓
BUILDING DEPARTtvSM
HOMEOWNER LICENSE EMAP1IOld
Pkasc Rat
lOBLOCATION S wr °'���"� ST 5(3�ti4v On Car
AOMEOWtIIR c.vF�Y�litiUS' S� S,a. ,. »v�dl Cli �1 k�3
ADD"
HOMEOWM to f � 5-3 6 r 1/ —4-
,EMPHoW ��stv� �tn,t oz>IF
PRESENT MAII.Il?G ADDAESS.,SL tL 71tLF--"..
The cnncaa csempdm of'homeowucfC was c.ncndcd w i xludc Owper occapted dwc?Up aCTWO
bite who does snot power a
Units or less WA to SHOW such hotncowmws to rngase sm imdividoal. .
license,.prvaa dw.11bt.owe"ad as supervhw.
mrmnoN OP meowtOL A, hkh
Person(s)who owns s p two
n land c which dmd or d�dwd mucmua accessory to sums mc>actundlat
inlended to he •one to two farniiy dwcffing ava car od shall tot be considered
farm suuc=vL A person who cons mw more than oa<home in s kd&L Pe*i
O1Ticisl.ost a form sezeptabk to Ae
a hodiug O r. Such`homevw ccf mbk w am such work paWnued m�det d� i Wes'
Buildir�OlTicisl.that lrJshc be rrspv .
The undersiped"hov=wrxr"asstancs tesponn'biGty for compliance with the Stan Banding Cods ud
other appEcabk soa by-hmm,rvks sad ugandoM
TM wxkniped"hou=wnct"ac n cs that hdshc tmdast m&the City of Sakm BaildmL Depuu=K.
minimum kzpcnion prvc cducs and rc^ytmemtcw and tlat hldx wO comply with said proeedwa w d
HOMEOWNHR': SiGHA
APPROVAL OF BUILDING INSPECTOR
Sec other sde for S=code
HOMEOWNER'S EXEMPTION
The code State that: 'any homeowner performing wank for which a building permit is mpir d span be
exempt from the ptv+isions of ibis section (Section 709.1.1-19ecosing of Conmruction Supervisotla;
Provided that is a bamecroma engages a person(a)for hme to do.such work,lba such bomsews er china"
as NpWIiQ�
Matq bonwownas who use this exemption we tmaware tbst tiny an a56tuning the reSp'OMMOM aft
supervisor (sec Appendix Q,Rules and Regulstioos for Liceosiog Construction Supervisors,Se cdim
.2.24 This lack of swa=mss often rcrults in serious problems,pudcuhmly when the homeowner bbss
urJk=sed person In Ibis case yew Board earnest proceed agaaat the mtllecmsed pertlan a it would win
licensed Strpcnisor. 71Pe boom"-Der acting as supervisor is ultimates rnEousibIL
To curet that the homeowner is fully aware of Wha responsibilities,many cummunides regoK.as pa
of the permii application,that the homeowner certify that he/she tmdcsnrtds tdre respot s%llides eta
supcnism. You may cart to amend and adopt sueb a fonalccrtificad on far use in your
PUBLIC PROPERTY DEPARTMENT
` 120 WASHINGTON STRM. !RO FLOOR '
SAI N,MA O t 970
TEL- (970)74"e98 Err.360
FAX (978) 740-9946
STANL.EY J. USOVICZ, JIL
MAYOR
DWOSAL OF DEBRIS AFFIDAVIT
In accordance with the provisiOw of MGL c 40,S34.1 acbwwiedge that as a con ifim
of Bmlding Permit 0 .all debris resulting fiom&a suction
govemed by this Building Permit shall be disposed of in a Fgwly licensed soH&w=m
disposal facility.as defined by M($,c BL S150/A.
The debris wM be disposed of at
Location ofFacr7it)►
R1/7/ 0 y
Sj Pert APPb� Dame
FULLY complete the following informations
(PLEASE PR?r CLEAnY)
Name ofPemkAppNew
Firm Name,if any.
Address,Crty&State
The above statute mequm that debris fivm the demolition,min ovadM rehab or otba
alteration of bu1fldmg or structure be disposed in a properly-Iimwd solid-waste disposal
facility as defined by MGL d%S150A, and the b(Wding permits or licenses we to
indicate the location of the facility.