37 LIBERTY HILL AVENUE - BUILDING INSPECTION (2) 4
No. City wa.a
� 'I City of Salem '6
A
'�ciwn.,a'd
APPLICATION
FOR
PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION
IMPORTANT-Applicant to complete all items in sections:1, it, III, IV, and IX-
nL
I, AT(LOCATION)
L11 1A�� L✓ N� L /W-i—
ZONING a
LOCATION " ' a REEnI
OF BETWEEN AND
(CR093 STREET) (CROSS STREET(
LOT
BUILDING
SUBDIVISION LOT_BLOCK SIZE
II. TYPE AND COST OF BUILDING •All applicants complete Parts A -D
A. TYPE OF IMPROVEMENT D. PROPOSED USE-FOR"DEMOLITION'USE MOST RECENT USE
1 ❑ New building Residential Nonresidential
16 Q Amusement recreational
2 F1Addition(If msidential,enter number of new 12 E3 One family
(rousing units added,it any,in part D,13) 19 Q Chinch,other religious
13 Q Two or more family-Enter number 20 Q Industrial
3 Q/Afferetion(See 2 above) of units .............................................._.
.... 21 Q Parking garage - - - -
4 ❑ Repair replacement 14 Q Transient hotel.motet or dormitory- 22 ❑ Service station,repair garage
Enter number of units ..............._.......... 23 ❑ Hospital,institutional
5 ❑ Wrecking(It mulMamily nesidential,enter number
of units in building in Pan D. 13) 15 [. , Garage 24 Q Office,bank,professional
6 ❑ Moving(relocation) 16 Cl Camo. 25 Q Public utility
26 ❑ School,library.other educational
7 Q Foundation only 17 ❑ Other-Specify 27 Q Stores.mercantile
B.OWNE HIP 28 ❑ Tanks.towers
8 Private(individual,corporation,nonprofit 29 ❑ Other Specify
institution.etc.)
9 Q Public(Federal,State,or local govemment
C.COST (omit cents) Nonresidential-Describe in detail proposed use of buildings,e.g.,food processing Plant
machine shop,laundry building at hospital,elementary school,secondary school college'
parochial school,parking garage for depanment store,rental office building,office building
10. Cost of improvement .............._......................................... $ (:;,2 000 r at industrial Plant.If use of existing building is being changed,enter Proposed use.
To be installed but not included
in the above cost
a. Electrical........................_.__...___---_....._._............... - ..
b. Plumbing..............................__..._-------.-----.....__...._._.
c. Heating,air conditioning....._._._................................
d. Other(elevator,etc.).......__.__._......__..._._._._.......
11. TOTAL COST OF IMPROVEMENT $ QOV
III. SELECTED CHARACTERISTICS OF BUILDING -For new buildings and additions, complete Parts E L;demolition,
complete only Parts J 8 M, all others skip to IV
E. PRINCIPAL TYPE OF FRAME F. PRINCIPAL TYPE OF HEATING FUEL G. TYPE OF SEWAGE DISPOSAL I. TYPE OF MECHANICAL
30 C] Masonry(wall bearing) 35 Q Gas 40 blro or private company Will there be central air
conditioning?
31 2 Wood trams, 36 Oil 41 E] Privets(septic tank etc.) 4n � Ves 45No
32 ❑ Stntctun d steel 37 Q Electricity
33 ❑ Reinforced concrete 38 ❑ Coal
H. TYPE ,, ATER SUPPLY Will there by an elevatoR
34 Q Other-Specify 39 Q Other-Specify 42 Public or Private company 46 ❑ Yes 47
43 Q Private tw811,di tem)
J.DIMENSIONS , M. DEMOLITION OF STRUCTURES: 9th
48. Number of stones .........................._...._..._._...._..._..
49. Total square feet of Boor area Has Approval from Historical Commission been received
a�based on e,nenm for any structure over fifty(50)years? Yes_ No_
so. Total land area sq.B..............................._.....--- Dig Safe Number
K.NUMBER OF OFF-STREET PARKING SPACES Pest Control:
51. Enclosed......................_.._........._..._....__..._._._.___..
HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED?
52. Outdoore.......__._....._.__..__...............__.._.._....-_.- I _ <:�---.. _ Yes No
L RESIDENTIAL BUILDINGS ONLY Water:
Electric: -
53. Enclosed....................._._._._..._..._........_......
_.._.. -
Gas:
Full....................._........_.__ Sewer:
54. Number of DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED
bathrooms
Pamal...........................__.. BEFORE A PERMIT CAN BE.ISSUED.
IV. COMPLETE THE FOLLOWING:
Historic District? Yes_ No�(If yes, please enclose documentation from Hist Com.)
Conservation Area? Yes_ No✓ (If yes,please enclose Order of Conditions)
Has Fire Prevention approved and stamped plans or applications? Yes_ No_
Is property located in the S.R.A.district? Yes_ No_
Comply with Zoning? Yes / No_ (If no,enclose Board of Appeal decision)
Is lot grandfathered? Yes✓ No_ (If yes,submit documentation/if no,submit Board of Appeal decision)
If new construction, has the proper Routing Slip been enclosed? Yes_ No_ N/
Is Architectural Access Board approval required? Yes/ /_ AJ//-,g-
Massachusetts
.
No_ (If yes,submit documentation) J �-
Massachusetts State Contractor License # J/ '//7 7 to Salem License#
Home Improvement Contractor# /�y79io Homeowners Exempt form(if applicable) Yes_ No
CONSTRUCTION TO BE COMMENCED WITHIN SIX(6)MONTHS OF ISSUANCE OF BUILDING PERMIT
� If an extension is necessary,please submit
CONSTRUCTION IS TO BE COMPLETED BY:
�J{/xf ,,� /)/d7�� in writing to the Inspector of Buildings.
V. IDENTIFICATION - To be completed by all applicants
Name Mailing address-Number,street,city,and state LP Code Tel.No.
7
Owner or
Lessee
2. P08;7a P08 �7 0 8
Contractor WA�✓zBG� ME kndeBuilder'sNo 11u79
License
3.
ArtTBact or
Enpnear
I hereby certify that the proposed work is authorized by the owner of record and that 1 have been authorized by the owner to make this application
as his authorized a ent and we agree to caftim to all applicable laws of this jurisdiction.
Signature of applicant Address r Arlie n da e
DO NOT WRITE BELOW THIS LINE
VI. VALIDATION
Building FOR DEPARTMENT USE ONLY
Permit number Use Group
Building 191_
Permit issued - Fire Grading
BuildingLive Loading
.Permit Fee $ Z 2 ' _
Occupancy Load
SCertificate of Occupancy $ Approved by:
Drain Tile $
'Plan Review Fee $
TRL
NOTES AND Data. (For department use)
1r�
IV
PERMIT TO BE MAILED TO: Z
DATE MAILED:
Construction to be started by: Completed by:
VI ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD
SIDE YARD
SIDE YARD
REAR YARD
NOTES
SITE OR PLOT PLAN •For Applicant Use
a
ON
-7 ,� ,_�.Jbvf/eteere�e�re
A",
_ .tom
V �I� -JV ✓ {�
tichi�t a. ❑ukakts vfT�Ti OO�IA�O6 A" vCJtlY"itaid,
COMMON, (fir.. all j - .J dam �.lb!
Keaara Tsut:umt LMOd.. . ,t&MMM"N+.. OtlOd
CUM=
tA171
Chutes J. JOLMM
.stator
'A EMO RAND UNI
I a. An Butlallat Ocearuaeanotatc ButWtai tnsxaors
FROM: CU= J. Din®.AJmmatramr
OA7E Oetooer J I. I71SR
SUWECT. MGL ria. 554. Added Rv r9M. 59 of the nen of 19"
he ataare.meauoact statute rcautre mat ucara resumes tram Inc ncmauaon. rcnow n NOW=
-r eater aater=twn oI a nurattae air straaure ne usoode t ut in a nroamn, nrcasar SUW �1111111101111
aaaty as adefwat av MGL .11. S11aA anu mat nutwme prnnm air dioceses are all lnNMMM4M 11011
,.I Inc taauty at Wallace Inc saw ucmis a all ale usttnsea. 'MIS RfiOUIR040MOOES NC
,APPLY TO NEW ('ONSTRUC.ON.
In urtrcr In sitautlty Inc profs am to nrrnwe atuturmlty. we are aaaamaat a calsl for i 1:t1R fta h
dies outer rcpra ucr atm use as it is seam Inc camattteu form rust be aammat w Inc otliea OWOf OPEN
,?cM= or o=ases: or rcmaaux it an vnur tctternc z.
n csc at mun=1=1.commer=L tnuustr=L ar multi-unit nnlsmy construction.Inc contraaaram01IM tat
:ale tlammW aUDmAirataaf 1t Inc time at Inc DtllWin[ 17crmit 2opuGtwn. In suca c==Iaasuols mcq
�d as At11daim an ae usm.
'he cammete law as cnmatnea to the Nnvemner rssue oI CODEWOR0 wmcn wild ale model :o WINE in it
sea awn weed ;; mu snoula have any uUQann. ntt=ae ICs us know.
CJDlktn
AFFMA ViT
As a result of the provtsions of MGL c 40. 554, t acknowledge that as a condition of Building Permit
Number all debris resulting from the construction activity governed by this
Building Permit shall be dtsoosed of to a oroperiv licensed solid waste dtsoosal facility, as defined by MGL
c 111. S 150A.
I oeritfv that i will notify the Building Official by
(hv0 months malnmuml of the location of the solid waste disposal faaiiry wnere the debns resulting from
the said construction activity shall be disoosed of, and i shall submit the appropriate form for attachment
to the Building Permit.
Due Signature of Permit Appliant
(Print or tvpe the following information)
,9c��En � vnl�J
Name of Permit Appittant
Firm Name. if any
Address
In acaaraance with the provisions of MGL c 40. S 54. a condition of Buildine Permit
Number is that the debris resulttne from this worK shall be
disposed of in a property hcettsea solid waste disposal facility as defined by MGL c 111. S
150A
Ile debris will be disposed of in:
(Ibmuon of Facility)
Signature of Permit aopumnt
Date
CITY OF SALEM
BUILDING DEPARTMENT
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE /7 9
JOB LOCATION `17 L/ TY /-//L6 lqUAlli,?7V -
Number Street address Section of Town
"HOMEOWNER i�LGRED 'DONA/ 7��— A- 4
Name Home phone Work phone
PRESENT MAILING ADDRESS SA MF
City/Town State Zip Code
The current exemption of "homeowners" was extended to include owner-occupied
dwellings of six units or less and to allow such homeowners to engage an in-
dividual for hire who does not possess a license, rovided that the owner
acts as supervisor. (State Building Code Section 109.1 . 1
DEFINITION OF HOMEOWNER:
Person(s) who owns a parcel of land on which he/she resides or intends to re-
side, on which there is, or is intended to be, a one to six family dwelling,
attached or detached structures accessory to such use and/or farm structures.
A person who constructs more than one home in a two-year period shall not be
considered a homeowner. Such "homeowner" shall submit to the Building Official,
on a form acceptable to the Building Official , that he/she shall be res ons
for all such work performed under the building permit. Section lOg. .
The undersigned "homeowner" assumes responsibility for compliance with the State
Building code and other applicable codes, by-laws, rules and regulations.
The undersigned "homeowner" certifies that he/she understands the City of Salem
Building Department minimum inspection procedures and requirements and that
he/she will comply with said procedures aAd requ e nts. — —
HOMEOWNER'S SIGNATURE
APPROVAL OF BUILDING OFFICIAL
'TOTE: Three family dwellings 35.000 cubic feet. or larcer. :rill be required
to comply with State Building Code Section 127.0. Construction Control .
HOME OWNER ' S EXEMPTION
The Code states that: "Any Home Owner performing work for which a building
permit is required shall be exempt from the provisions of this section
(Section 109.1 .1 - Licensing of Construction Supervisors) ; provided that is - — -
a Home Owner engages a person(s) for hire to do such work, that such Home
Owner shall act as supervisor. "
Many Home Owners who use this exemption are unaware that they are assuming
the responsibilities of a supervisor (see Appendix Q, Rules and Regulations--
for Licensing Construction Supervisors, Section 2.15). This lack of aware
ness often results in serious problems, particularly when the Home Owner
hires unlicensed persons. In this case your Board cannot proceed against !4
the unlicensed person as it would with licensed Supervisor. The Home Owner ^
acting as supervisor is ultimately responsible.
To ensure that the Home Owner is fully aware of his/her responsibilities,
many communities require, as part of the permit application, that the Home
Owner certify that he/she understands the responsibilities of a supervisor.
On the last page of this issue is a form currently used by several towns.
You may care to amend and adopt such a form/certification for use in your
community.
l'/�ass SF 27/D/J
N u,, A -bo;zmeR5
i be
.zx8 Rrd� �l'z 2x4 ►�,f�4R
/Z� crl>x sll�r#Al�
R5pAnlf sk'r'5le5
s014i,o'1 8'carv. a16p ed9c
x8 F"CuR
zx4 CD16P Tie Ix�e 5ofA'f
Ix3 st
ljplwa 11
✓hy! S�d��Q
1y �Z„ CDk SlrWf�v
- - (o` InSU14T10V)
2.Y S4ud
S;„yk isle Sync
AeS,a(ence
Nom, AeRs
to be
1�
zr8 R.die d�z
CDx s s #A- +
R5PMO 5{ ingle5
�ifi5t' Ja //i' 9"Tsvla��7 g"(a Iv. 1716?ej2c
xs Fascu+
.2X& Co16RTie
wa 11
c-Dx
G` Znsvlq��an
Zr6 sfvd
5:.,91e 2-r4e 5-&
l7dnn /t�e5!�ehee
le en,,
_Cizoss ior�
Ntw A
i robeCp
ra.
le
aXe �i die d rz
6fG4R
RsphAO 15W-51f5
�xiS J //.' �f"Tsv(a7�ia7 Irewlit. ")a;?Mge
)Y,5 F45ciR
2X4 Co16PTie Ix/e Saf�'4
Ix3 si r
✓q/
y,," CDx
G` Znsu(afian
zY4 sfud
l2e51a�ehee
� -
0(//,
cSq leen, r-2�ss.