BAKERS ISLAND - BUILDING INSPECTION (9) Y
f4. iN�fSi'�BE f Lf kN�I SPMOVED BY T44E
1hISl EC7tI8 ';I OR D'1;•.P TRENG GRANTED
CITY OF!SLEM-
No. 'O l—2c7 t�� � '� Date 7
Is Property Located In Location of (��� ��
the Historic District? Yes_No_ Building
Is Property Located in X
the Conservation Area? Yes_No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof Install Siding, Construct Deck, Shed, Pool,
Repair/Replace, Other: 2e��es �ucl m W s
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 E D rt N S'f I t.E S
Address & Phone � NUT-[&R R_a. N- r?FADI^/� 9-78
01A oI a y
Architect's Name N(3m i_ o w u E 2
Address & Phone
Mechanics Name 14 o n e o w�j E rt
Address & Phone L 1 PP
What Is the purpose of building? V r-1 MC-.R COT T A G G O N Ak it
Material of building? W 01 r>' If a dwoW �
offing,for how many families?
\1 N E
Will building conform to law? Es Asbestos? No
Estimated cost_&6_"'3 ' — City License• N A State License M /
A' S2s Boas Improveant 14
Lie. it
�620 Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
VL.
MAIL PERMIT TO: Eawlhl H SriL95 a3�NUT �E2 N0ReAb Nr—
MA c) 186�
- r
IF
No. f 01 - 2-00 Lj
APPLICATION FOR c
PERMIT TO
Re,nF
LOCAT
PERMIT GRANTED .
19 H
APPFCOV -D . s
IN PEQ-TOR BUILDINGS ^
ca r OF, SALEM,- MASSACHUSETTS
' PUBLIC PROPERTY DEPARTMENT
®' 120 WASHINGTON STREET, 3RD FLOOR
It 70 t SALEM, MA 01970
TEL. (978)745-9595 EXT. 380
�O FAX (978) 740-9846 .
STANLEY J. USOVICZ, JR.
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
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
disposal facility,as defined by MGL c III,S150A.
The debris will be disposed of at: 9 CO 6Z o vs�J ! ``
Location of Facility
(03
Signature of Permit Applicant Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
E pw(/j 47 S'1 l LE-S
Name of Permit Applicant
Firm Name,if any
a n/ N oaT(+7E01mc' M (D
Address, City & State
\NO(?-I' TO f3E �O JC_ 6N
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 cIII, S 150A, and the building permits or licenses are to
indicate the location of the facility.
CITY OF SALEM
BUILDING DEPARTMENT
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE 7 /u3
JOB LOCATION e 0, G R 'S -TS L A JJ7t LciT ( /J�
HOMEOWNER �S NV rre� i\ Nd<TiAEADWC. OI &Y-
ADDRESS
HOMEOWNER
TELEPHONE /
PRESENT MAILING ADDRESS ' ^,I VTT C GL I\� �l Cl Ali 1 I CA71 1 N p 01 A
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 hire who does not possess a
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 which there is,or is
intended to be,a one to 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 to all such work performed under the building permit.
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and
other applicable goes 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 h/she will comply with said procedures and
requirements.
HOMEOWNER'S SIGNATURE �C G utLvt
APPROVAL OF BUILDING INSPECTOR
See other side for state code
HOMEOWNER'S EXEMPTION
The code states that: "any homeowner performing work for which a buildinj erinit is required shall be
exempt from the provisions of this section (Section 109.1.1—licensing of Construction Supervisor);
Provided that is a homeowner engages a peisoti(s)for hire to do such work,,that such homeowner shall act
as supervisor."
Many homeowners who use this exemption are unaware 1haYthey are assuming the responsibilities of a
supervisor(see Appendix Q,Rules and Regulations for Licensing Construction Supervisors,Section
2.15).. This lack of awareness often results in serious problems,particularly when the homeowner hives
unlicensed persons. In this case your Board cannot proceed against the unlicensed person as it would with
licensed Supervisor. The homeowner acting as supervis6r is ultimately.responsible.
To ensure that the homeowner is fully aware of hVher respotsibilities,many communides require,as part
of the permit application,that the homeowner certify that he/she understands the responsibilities of a
supervisor. You may care to amend and adopt such a form/cerdfication for use in your community.
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