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12 CONANT ST - BUILDING PERMIT APP (002) �I t T-BEfiLf� AWIROVEO BY T*IE ,WPBCT -R ,PF,ili571R TD A PERMIT BEING GRANTED CITY OF SALEM ,NO, 11 No. J I!,— Z U O r a.`� Date �qfC/hIN6 D�JC- Is Property Located in Location of n the Historic District? Yes_No-S):� Building 66/wn7� �r Is Property Located in \ / the Conservation Area? Yes_No T BUILDING PERMIT APPLICATION FOR: Permit to: �� (Circle whichever apply) Roof, Reroof, Install Siding, t�C—ar�s� ruct Deck, Shed, Pool, Repair/Replace, 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: 1 Owner's Name �j ' LOp,, F Address & Phone a cdN,�vT S'f, Architect's Name Address & Phone Mechanics Name d L Z/r8lt! 6`/V1U/2�M I Address & Phone cd/lLi n)VI f What is the purpose of building? Material of building? //O� 77 WO 6 If a dwelling, for how mangy,families? Will building conform too law? Asbestos? 0 v y Estimated cost o '�� City License a N/k State Li ense # Home Improvement Lic. i Signature of Applic p37� Gl�— SIGNED UNDER THE PENALTY OF PERJURY DESCRIPTION OF WORK TO BE DONE L© b IZ P a- E�v— o2_ s ` F1 S71-/ E) LA-A.)n ��v MAIL PERMIT TO: No. �Jlo—Zc�o APPLICATION FOR PERMIT TO LOCATION PERMIT GRANTED "Z , / S 19 03 APP VED INSPECTOR O BUILDINGS 4 CITY OF SALEM BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please PriPrintDATE 6 a 0 _ IOE LOCATION 12-7- HOMEOWNER / � Cp J . L5—� ADDRESS /' HOMEOWNER `'/ q �/ L( TELEPHONE PRESENT MAILING ADDRESS The aurcnt exemption of"homeowners"was extended to include owner-occupied dwelGcps 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 hdshe resides or intends to reside,on which there is,or is intended to be,a one to two family dwelling,attached or detached structures sc=sory to such use and/or farm swcnaes.A person who constructs more than one home in a two-year period sball not be considered a homeowner. Such"homeowner" shall submit to the Building Official,on a form acceptable to the Building Official,that helshe be responsible to all such work performed under the building perwk The undersigned"homeowner"asstmmes responsibility for compliance with the State Building Code tmd other applicable goes by-laws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the City of Salem Building Departramt minimum inspection procedures and requirements and that hlshe will co ly with said proced»sa ttad requircmids. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING INSPECTOR See other side for state code J . 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—Uccosing of Construction Supervisors); provided that is a homeowner engages a person(s)for hire to do such work,that such homeowner shall act as supavrsor." Many homeowners who use this exemption are iuraware that they are assuming the fespotsrbilitia Ora sups viwr(see Appendix Q,Rules and Regulations for Vocosing Construction Supervisor!,Section .2.14 This lack of awareness often results in serious problems,particularly when the homeowner Lints unlicensed persons. In this case your Board cannot proceed against the unlicensed person as it would with licensed Supenisor. The homeowner acting as supervisor is ultimately.respon$IW To ensure that the homeownner is frilly aware of hL%a responsibilities,marry communities reoluuim as part of the permit application,that the homeowner certify that hdshe understands the responsibilities of a supervisor. You may care to amend and adopt such a form/ccnificatiat for use in your community. A0 i - � ---' �oxar OF SALEM. MASSACHUSETTS PUBLIC PROPERTY DEPARTMENT 2 120 WASHINGTON STREET, 3RD FLOOR - - a SALEM, MA 01970 TEL. (978)745-9595 ExT. 380 - �Grma FAX (978) 740-9846 STANLEY J. LISOVICZ, 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 / )O)�/ S//� at Location The debris will be disposed of a 0 — Location of Facility Signature of Permit ppli Date FULLY complete the following information. (PLEASE PRINT CLEARLY) � Name of Permit 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.