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BAKERS ISLAND - BUILDING INSPECTION (7) What w the current use of the 9uilding? ' Material of Suadirw? �O° If dwelling.how many units4 o we the euuauw conftm to T S Asb.stw? Amhit ds Name 1 - Address and Phone Medts Ws Name Address and Photo H�Regbtratlon Consb�Supervisors Lieans.0 Etknated coat �,/f+p1 boo Pw*Fee Cal uMm- sPennit Fes:�f�1-"`- Cat X=7Is1000 ResfdenNal EsWnaW Cost X 511/111000 C4nwnerde4- An Addit"$5.0O in added as an Adminmmfte dtarge. Make sure that alt fields are properly and Ieyibly written to avoid delays In processing. The undwsWad doge hereby apply for a Suiktktg PwMA to build to the above state sp�ation.. Signed under penalty of PedurY Date S 0 Imo, N O� s I s J CITY OF SALEM PUBLIC PROPRERTY DEPARTMENT 120 WAil R\6"CON S f REET♦SAL FM.StAS5ACM.-SL 1'C5 0191^, TFt:978-745-9595 •FAA:978.7+G9M Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5 Debris, and the provisions of MGL c 40, S 54; Building Permit # _ .- __ is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c 111.S 1.50A. The debris will be transported by: (tame of hauler) I'lne debris will be disposed of in OoDID - 6J '4 TtE- (name of facility) ln.i�,lY) +i :atu � of;xr - ricaat ---- i A, CITY OF SALEM PUBLIC PROPERTY DEPARTMENT KIMBERLEY DRISCOLL MAYOR 120 WASHINGTON STREET 1 SALEK%EAMAOilSE1TS 01970 T FL 978-74S-9S9S• FAX:978-740-9846 HOMEOWNER LICENSE EXEMPTION Please Print . Date 6 0 7 Job Location ��1�1� 2 S t S ` 14 o`) 1- © ( q© " d 12 S� Home Owner Address 70 _i- �q N 14 L o 6 N u R Home Owner Telephone 2 S'l 2 3 — 55 a 3 Present Mailing Address >-r P-t Z— . The current exemption of"Homeowners"was extended to include owner-occupied dwellings of two Units or less and to allow such homeowners to engage an individual for hue who,does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two 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 be responsible for all such work performed under the Building Permit. i The undersigned "homeowner"assumes responsibility for compliance with the State Building Code and other applicable by-laws and regulations. i The undersigned "homeowner"certifies that he/she understands the City of Salem Building Department minimum inspection procedures an requirements and that he/she will comply with said procedures and requiremen HOMEOWNERS SIGNATURE APPROVAL OF BUILDING INSPECTOR See other side for state code Homeowner's Exemption The Code states that: "Any Homeowner performing work for which a Building Permit is required shall be exempt from the provisions of this section(Section 109.1 —Licensing of Construction Supervisors),provided that a Homeowner engages a person(s) for hire to do such work,and the Homeowner shall act as Supervisor." Many Homeowners who use this exemption are unaware that they are assuming the responsibilities of a Supervisor(see Appendix Q,Rules and Regulations for Licensing of Construction Supervisors, Section 2.15). This lack of awareness often results in serious problems,particularly when the Homeowner hires unlicensed persons. In this case your Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The Homeowner acting as Supervisor is ultimately responsible. To ensure that the Homeowner is fully aware of his/her responsibilities,many communities require,as part of the Permit Application, that the Homeowner 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. r c GrrTUFs�'�,E,ti PUBLIC PROPERTY DEPARTINMNT Ii1.�FtaY ti..vw ~'`MOo 130 WwurwTnw'9n1ieT•swu�Nasuort:srr�s ot970 APPLICATION FOR THZ REPAIR.RENOYAjMN_ Cor4S gUCTI ON_. DEMOLMON OR 0AMS OF USE OR OCCUPANCY FOR ANY EJaRIN STRUCTURE OR BUILDING 1.0 SITE INFORMATION Location Nam« A K<<-Q S f S LA N Building: Pro"rty Address; LoiT' q� .- 01.�� Properly in loeeted in a;Conservation Arw YM HWAft t wict YIN 2.0 OWNERSHIP INFORMATION 2J owner of Land _ Name: Address: g-ro QvLL-ET H1l_4 Rp . sooT'�k \jtz c-r o6q $Z 3.0 COMPLETE THIS SECTION FOR WORK IN EYISIINt2 BUILDINGS ONLY Addition Existing Z Renovation x Number of Stories Renovated Change in Use New Demolition Existing 160 Approximate year of , Area per floor (sq Renovated construction or renovation of existing building New Sae[Description of Proposed Work: (sr, PL-lice- PoP c)4 Di-ck (P,) C— kepj-#tc,� PoiZC-(+ Mail Permit to: