BAKERS ISLAND - BUILDING INSPECTION (8) IIWT-RE fIL*Gm D APPROVED BY T44E
.WSPFXTDR .PE, DR TD.A_PEAMITB,EWG GRANTED
CITY OF SALEM
No. Date 10-)85 42,
_
�d03
\ NE
Is Property Located in Location of pp�(zzz y Akotlr
the Historic District? Yes_No Building /J/r� Z1Sli¢/t/j
Is Property Located in �tl d PO/A/7- W 0!d
P Y /'p�.d7� D F lSLA,V�
the Conservation Area? Yes_No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof Rer nstall Siding, Construct Deck, Shed, Pool,
Repa ep ac1 Other: liU�sr A*G PaAY �
PLEASE FILL OUT LEGIBLY & COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the following
specifications:
Owner's Name ( I��C /J��SY
73�,Eo sBy S 7" _
Address & Phone FA/2F��z� er O6��s ��d3) �7y-o2SS
Architect's Name /1 d/t/E
Address & Phone S 1
Mechanics Name Itfe
Address & Phon ( 1
What is the purpose of buildin S 077
fqCYndA/
atena o u Iding? DOD � /Yl� f a dwelling, for how many families? ONc"
Nil building conform to law? Asbestos? k00Ne
7 Estimated cost 0/52y 2��City License# N A State License#
Home Improvement
Lie. ►
Signature f Applrcant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
M���y/PLAY POV J' kmrCu2��arlY axe�- 30�'a�r�r���Nre��aFrEar ;J�nl .742
T1� a/02RfE� /S (yrStk0 Z-A re�RfNdY P�4P -0R&ERddFOVZ-J6,Ch
R?6F,Cx7-,tFAJa1n4 ENVY Our 78 /40TOI AtiFXW,-eNM41Ny60s6.
�EPt/1�� IJ�STLt/ALLOF FA�1/LY/P�fiY PBB/7—!T /S SHAY TLJURk y dUY QdY
L A 7D lP&PZA C p<AT6- !a:/NJ�dG/ N/77( ifle/n/-5Mf1Nd;t-7k M�7 G!/iN tl
Mb.MdV� X¢ f�ezU Fz2�-r TV ;L/nVZ-- //P4U1ri PeRC4
t—/UeNEOF 'i'71/� GU/<,L 1111PIN�� cStJ dJ2 PROP.�X'T/ �DRbtr�s OR CeRsTL/N�' �dNr�
o� U�iGNPx�Rs-
MAIL PERMIT TO:_ 73 C, by St YLO°Bstretl
73 Crosby St
Fairfield CT 06432
No. 2
APPLICATION FOR
PERMIT TO
LOCATION:
PERMIT GRANTED
APPROVFD
INSPECTOR OF BUILDINGS
r
OF SALEM,- MASSACHUSETTS
RUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
@ a SALEM, MA O 1970
�'�m ✓. TEL. (978)745-9595 EXT. 380
FAX (978) 740-9846 . .
y„
STANLEY J. USOVICZ, JR. - So
MAYOR 6
d
DISPOSAL OF DEBRIS AFFIDAVIT S
In accordance with the provisions of MGL c 40, S34,I acknowledge 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
defined b MGL c S150A.disposal facility,as d y ID,
� AIDaJ )'X'!��2U3'PZu , earr.9c�
The debris will be disposed of at: 40 527RAPP OF ` APB� � �� r2Cu coD NF�CP1q��
Location of Facility ANY 0fi4,62 DE6X/O ';'.4i B� T�FKrN
.1F IPf (EZ)j OeAW 7ZI So��-) tUASTC 5/72�
Z�06�T ��'I•N lU,(%E E /(,N�S�1 il-LUASTf y�`/�S A/2c
/ / Z ;W-s 1h955�c+�USErr�
Srgi afore lflpen4tkpplicaCt Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
Name of Permit Applicant
Aid
Firm Name,if any
73 1' l2dTBY
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 cHI, S 150A, and the building permits or licenses are to
indicate the location of the facility.
• ; CITY OF SALEM
BUILDING DEPARTMENT
HOMEOWNER LICENSE E}MMPTION
Please Print
DATE
JOB LOCATION
73
HOMEOWNER O� So2�
ADDRESS r
HOMEOWNER
TELEPHONE S'T
PRESENT MAILING ADDRESS ���/PFiGZ J� Codes_ a G ga S"
The current exemption of"homeowners"was&.mended to include ew ner-acaupied dwellings of TWO
Units or less and to allow such homeowners to engage an individual for hire who does na possess It
license,provided that the owner act as supervisor.
DEFINITION OF HOMEOWNER:
Person(s)who owns a parcel of land on which he/she resides or intends to reside.on whichis
or Is
intended to be,a one to two family dwelling,attached or detached structures Rccessory to vxh ust
aodhr
farm structures. A person who constructs more than one home in a two-year period shall rat be considered
a homeowner. Such"homcomme shall submit to the Building Official,on It form acceptable to the
Building Official,that heJshe be responsible to all such work performed under the building permit.
The undersigned"homeowner"assmnes responsibility for compliance with the State Building Code tmd
other applicable goes by-laws,rides and regulations.
The undersigned'homeowner"certifies that helshe undwnands the City of Salem Building Depwtmwl.
minimum inspection procedures and mquiremems and that h/she will comply with said procedma and
required m
HOMEOWNER'S SIGNATURE
APPROVAL OF BUILDING INSPECTOR "!
See other aide for slate 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 ibis section (Section 1Q9.1.1—Licensing of Construction Supervisors);
Provided that is a horevi;:.zr e:.V-ges a pemon(s)for hire to do such work,that sueb homeowner daji act
as supansoa."
Many homeowners wbo use this exemption arc unaware that they are assuming the responsibilities of a
supervisor(see Appendix Q,Rules and Regulations for Licensing Construction Supervisors,Sectim
.2.14 Ibis lack of awareness often results in serious problems,particularly when the homeowner bum
unlicensed persons In this ease your Board cannot proceed against the'UX=ased person as itavuld with
licensed Supervisor. The bomconver acting as supervisor its ultimately responsible
To ensure that the homeowner is fully aware of M%cr responsibilities,many communities require,e,as part
of the permit application,that the homeowner certify that hc1she tmdeesumds the responsibilities of a
supervisor. You may care to amend and adopt such a fortn/ccnification for use in your community.