12 CEDAR AVE - BUILDING INSPECTION (2) CITY OF &U EM
PUBLIC PROPERTY
DEPARTMENT
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MAYM
130 wAML%GTOq STW=♦SALEK.UMAOIL-SUM 01970
]E1:97a.73S-9S9S*FAX;978-740.9"
HOMEOWNER LICENSE EXEM"ION
Please Print
Date a 6 -0 7
Job Location
Home Owner Address
Home Owner Telephone 7 Y p
Present Mailing Address / � o c �f !S°-yl ao a/ _M '�
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 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 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 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 P
See other side for state code
CITY OF SALEM
PUBLIC PROPRERTY
Qs- DEPARTMENT
%IA10K I?C W.\91IVG:JN S:AEET ).iC I`y, fit.\ti.\f Il iLL'IN%91.
Tn:9M743-9595 •F%x:978.74G9846
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 C1411t section 111.3
Debris, and the provisions of vIGL c 40, S 54;
Building Permit # _ _ _ is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
111. S 150A.
The debris will be transported by:
(name of haular)
Hie debris will be disposed of in
(uamr of faclliry)
. __ iaddreiautfSciLlyl .
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7 . .
PUBLIC PROPERTY
DEPr1RT;\MNT
IG�e�n ev p,er v
NAYOt
'tom.MUMS"•FAX 978-740.98K
APPLICATION FOR TM REPAIR RENOVATION CONSTRUCTION
DEM LITION O CAAN O R
_ � R GE F USp O OCCLrp&M FOR ANY EXISTING
STRUC'TLR OR BUII Dtlrl(`
1.0 SITE INFORMATION
Location Name 0 hi Burning:
Property- -
Address: -
/ � cec/lgrcres-r
PnopartY le located In a:Conservation Area YIN ,U Q Hhtorlo OMW YM
7.0 OWNERSHIP INFORMATION
2.1 Owner of Land ` .
47
Name:
Address:
=A-V,-�Telephone.
3.000MPLETE THIS SECTION FOR WORK IN EXIMMIue BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use New
Demolition Existing
Approximate year of Area per floor (sf) Renovated
construction or renovation
of existing building New
Brief Description of Proposed Work:
/ lu S
-- . - -- Mail Permit to:
What is the current use of the Building? how many units9�--
Material of Building?�� if dwelling.
Asbestos? �
"it the Building Conform to Law?
r/ ��Architect's Name
Address and Phone
Mechanises NaMO
Address and Plane
Construction Supervisors Licensed eva�a C Registration S
Estimated Cost projsd S� Penrnit Fee Cabulatlon
permit Fee S 2� — Estimated Cost X$71S1000 Residential
Estimated Cost X S111S1000 Commercial------
- - An Additional $5.00 is added as an
Administrable Charge.
Make sure that all fields are properly and legibly written to avoid delays in processing.
The undersigned does hereby apply for a Building Permit to buildto the above stated
�/
specifications. Signed under penalty of perJury /��
Date
0
96
N
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