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44 BALCOMB ST - BPA-2001-61 REPAIR SHED ROOF fL QSiWI�iS "9EfIL{ Na4'jki PROVED BY T44E IJ FCTL 1►I ipR TD J� PF IT BEING GRANTED CITY OF SALEM —Zoo Date © 03 is Property Located In 90cation of the Historic District? Yes—No� V Building 's Q- 41TY) Is Property Located In the Conservation Area? Yes_No BUILDING PERMIT APPLICATION FOR: Permit to: (Circle whichever apply) Roro.of, Install Siding, Construct Deck, Shed, Pool, Repair Replace, Other: Z"hPA e0Q1F 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 MR RlNe 1e GA 61 fZ Address & Phone .04 . Q I com 2, SVj?PPA- It 1 Architect's Name �) ))pr Address & Phone N I IIR ( 1 Mechanics Name N I fl Address & Phone N �-q' f 1 What Is the purpose of building? Materiel of building? It a dwelling,for how many families? Will building conform to law? \ Asbestos? �1 ` ) Estimated cost oC6(� 00.� Clry License a N A Stet License S '\ V Home rover ant 'V Signature of Applicant SIGNED UNDER THE PENALTY OF PERJURY DESCRIPTION OF WORK TO BE DONE \\ l�(C)L >e I < T� 62,r�Nc F�c Sl �rg 3�o�ca MAIL PERMIT TO: No AF4 20 o Lf APPLICATION FOR G PERMIT TO LOC'AT PERMIT GAA14TED . ,9 APP a 0) INSPE T-R O 4LNS Y CITY OF SALEM BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please Print / DATE 7/1Q! Q 3 JOB LOCATION HOMEOWNER ADDRESS HOMEOWNER, 7 yf-/- y 110 TELEPHONE PRESENT MAILING ADDRESS The cement 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 inside,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 penmL 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. r HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING IN2SPECTOR 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 109.1.1—licensing of Construction Supervisors); Provided that is a homeowner engages a person(s)for hire to do such work,that such 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 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 licensed Supervisor. The homeowner acting as supervisor is ultimately responsible. To ensure that the homeowner is fully aware of hither responsibilities,many communities 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/certification for use in your community. e co T 1. . Y OF SALEM, MASSACHUSETTS 6 � PUBLIC PROPERTY DEPARTMENT 120 WASHINGTON STREET, 3RD FLOOR aV 70 SALEM, MA 01970 3 TEL. (978)745-9595 EXT. 380 ��Mnu 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: '0�T 1 elf' ty. Location of Facility ignature of Permit Applicant Date FULLY complete the following information: (PLEASE PRINT CLEARLY) - Name of Permit Applicant Firm Name,if any L/�/�'Sr�C cdNh S l 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 cIII, S 150A, and the building permits or licenses are to indicate the location of the facility.