8 BUFFUM ST - BPA-2004-394 ti
"--*NS MU T-9E fllL+-C�idJAPPROVED BY T44E
wojxT RWR T-O.A.PERMT.BFING GRANTED
VTY OF SALEM
Date
-V
cz.
Ward
Zoning District
Is Property Located In Location of Do
the Historic District? Yes—No v/ Building
Is Property Located in
the Conservation Area? Yes—No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roo Reroo , Install Siding, Construct Deck, Shed, Pool,
Repai*r/ epp ace, Other:
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/ -e_
Address & Phone
Architect's Name
Address & Phone
Mechanics Name
Address & Phone
What Is the purpose of building?
Material of building? If a dwelling, for how many families?
Will building conform to law? Asbestos?
Estimated cost A-15-0 City License# Stat nse
ig
Home Improvement 7 4eA p licant
C�- ig t e el Aoplicant T
SIjD UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
V�
MAIL PERMIT TO:
m 70 M � D a
all _5"Lpq-
"f',i. s e."a6 £ T(O. 4 �
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v CITY OF SALEM9 MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
u R
� $ 120 WASHINGTON STREET, 3RD FLOOR
SALEM, MA 01970
TEL. (978)745-9595 EXT. 380
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, S 150A.
The debris will be disposed of at: IBLA M .s
Location of Facility
Si a of Permit Applicant Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
Name of Pfermit Applicant
Firm Name, if any
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.
z
CITY OF SALEM
B=ING DEPARTMENT
HOMEOWNER LICENSE E)MWnON
Please PrW
DATE
JOB LOCATION✓ R r i t�PZA in
ADDRE4
HOMEOWNER/ 7 t- 21 S 11,16Y
TELEPHONE nn
PRESENT MAILING ADDRESS
The nment.cxcmpdon eo
of"homwners"was r-,nc dcd to include on•ocr.occup'w_d d"clli f of TWO
Units or less and to allow such homeowners to ctgage an individual for hive who does not Posner a
license,provided that the owo"act as supervisor.
DEF1141TION OF HOMEOWNER
Person(s)who awns a pa=l of land an which hdshc resides or intends to reside,on which there i; is
intended to be,a one to two farnily dwelling,attached or dcta6ed smrtmcs accessory 10 sueb use aadlar
farm structures.A person wbo constructs more than one home in a two-year period shall nol be considered
a homeowner. Such"homeowner shall'sibmit to the Binding Official,on a form aceep"k to tLe
Building Official,that hdshe be responsible to all such work performed under the building Punk
The undersigned"homeowner assumes respoTmbility for compliance with the State Building Code tmd
othu applicab►c goes by-laws,rules and regulatioffi
The undcrsipied"homeowner" certifies that hUshc undv=n&the City of Salem Building Deparuneal
minimum inspection procedures and nu- t Nshc 'I) comply with said proccdues and
rcquirz>Mris.
'S S1GNA
HOMEOWNER �y--� p
APPROVAL OF BUILDING INSPECTOR v
See other side for state code
HOMEOWNER'S EXEMPTION
The code state that "arry homeowner performing work for which a building percent is required shall be
cxcmpt from the pnnisious of this section (Section 199.1.1-liaosing of Construction 5uperrisors);
Prodded that is a homeowner engages a person (s)for hire to do.srcb work,that sueb bomeowaer d aD as,.
as srpervisa.� ,
Many bomcowncrs wbo use this exemption are i nawanc that they are asstunatg the?ssponnbMIks of a
stperyysor (sex Appcodix Qr Rules and Regularioos for Lkcnsing COnstruetion Superrisoes,Seetian
.2.14 This lark of awareness oflcn results in serious prvblcros,particularly wbm the bomeoscner Luau
unlicensed persons In ibis case your Board cannot proceed against the unliccuscd person as k.%-M d with
licensed Supmiwr. Tbc bomeo+,ver acfug as supervisor is ultimately responsibl6
To enstue that the homeowner is fully aware of I:A=mspoun'bilities,marry eommtmitla rcqui ;as part
of the permit applieetiort,that the homeowner cenify that hdshe understands the responsibiff cs;of a
supervisor. You may care to amend and adopt such a fonn/eertifieation for use iu your eommudp,
J