37 BELLEVIEW AVE - BUILDING INSPECTION J
-VL11i mv6t-qE fK*g4 ID APPROVEf) BY T44E
ASPEC=PWR TD A.PEHW ABWO GRANTED
/o CITY OF SALEM
N0.22 \ fate 0 .
is Property Loyd in Location of
ate Historic 01014 7 Yes No SULIMns 7�yc�v �y-e./,g.,/�,.✓t:
Is Properly located in
the CwmwvaW Arm? Yes No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, R@roof, Install Siding, Construct Deck, Shed, Pool,
RepaidReplace, Other:
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS W PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the following
speafical ions:
Owner's Name -
Address A Phone
Architect's Name 6.14 r Oi fit;,Ctrs
Address & Phone ,9 7 yr- yy o Y
Mechanics Name
Address & Phone f 1
What le the POPoee of tNllldirg9 9otcc�
Ma"of bAft?�,-wsaNA 6i Do-� n a dwaYMp,for how many latnYiw4
WIN mriding cmonn to law?1�c AtY>ogoa? o
Ed=M casts a o a r City Ucwue• N P' SW Umm r
Base Iapioeerrnt O�
Lie. / Ld'�
Signature of Applicant
SKOW UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
a
MAIL PERMIT TO: ( PA P
y .
C
No. .'
APPLICATION FOR
PERM T TO
A
LOCATION
22
PERMIT GRANTED '
AP OVfD
INSPECTO OF BUILDINGS
• `p
CITY OF SALEM, MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT r-
a Q
120 VJ ASHINGTON STREET 3RD FLOOR
�C�M�Ng SALEM, MASSACHUSETTS 01970
STANLEY J. USOVICZ, JR. TELEPHONE: 978-745-9595 EXT. 380
MAYOR FAX: 978-740-9846
Salem Building Department
Debris Disposal Form
In accordance with the provisions of MGL c40 S 54, a condition of your
Building Permit is that the debris resulting from this work shall be disposed
of in a properly licensed solid waste disposal facility as defined by MGL
Chapter III, S 150 A.
The debris will be disposed of in:
S,'xt 1 (Location of Facility)
Signature of Applicant
izay <o<o6
Date
CITY OF SALEM, MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
SALEM, MASSACHUSETTS 01970 J'
' STANLEY J. USOVICZ, JR. TELEPHONE: 978-745-9595 EXT. 380
MAYOR FAX: 978-740-9846
HOMEOWNER LICENSE EXEMPTION
Please Print.
Date
Job Location _a 6e-4.,V,cz.) Fr✓
Home Owner Address z,7
Home Owner Telephone 9�2x_ gvy- 9 i
Present Mailing Address.
The current exemption of"Homeowners"was extended to include owner-occupied
dwellings of two Units or less and to allow such homeownetsato engage an individual for
hire who does not possess a license,provided that the owneC 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
than one home in a two yearconstructs
s such
more
"homeowner"shall submit to the Building Official,,on considered form acceptable to the Building
Official, that he/she be responsible for all such work performed under the Building
Permit.
The undersigned"homeowner"assumes responsibility for compliance with the State
Building Code and other applicable by-laws 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 and requirements.
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING INSPECTOR
See other side for state code
• , Y
H0ME0WNERS F.XE n0N
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 a Homeowner engages a person(s) for hire to
do such work, and 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 Append Q+Rules and Regulations for Licensing
Construction Supervisors, Section 2.15). This lack of awareness s000fen results you
problems,Particularly when the Homeowner h� it�unlicensed ��a licensed
Board cannot proceed against the unlicensed P nsible.
Supervisor. The Homeowner acting as supervisor is ultimat4ly respo
To ensure that the Homeowner is fully aware of his/her reties, �certify that
communities require+ as a p�of the Permit Application, a of this issue is a
he/she understands the responsibilities of a Supervisor. On the last page such a
form currently used by several towns. You may care to amend and adopt
form/certification for use in Your community.
Ro IsoIZao