169 FEDERAL ST - BUILDING INSPECTION Ho F
What is the current use of the Building? H dwelling.how many ands?
Material of Building? �✓ov D
Will the Building Conform to Law?
y£ 5 Asbestos?
ArchdocCs Name t
Address and Phone
Mechanic's Name
Address and Phone HIC Registration#
Construction Supervisors License 0
Estimated Coat of $ 060 permit Fee C Cost
Xtlon
Permit Fes i
Estimated
'_``�l.V\ Estimated Cost $7/51000 Residential
Estimated Cost X$11/51000 CanmerctaF--
- An Additional $5.00 is added as an
Administrative charge.
Make sure that all fields are property and legibly written to avoid delays in processing.
The undersigned does hereby apply for a Building
�Permit to build to the above stated
specifications. Signed under penalty of pedurY /�
Date S 7 n
Oy
V
'O r,
PUBLIC PROPERTY
DEPART&IEIVT ��
\11LGN CV 01
NAYOI E�)
130 WASMNGWW SrWM
lu"4 WASUCMl:5tl1S 01970
ML•978-745.9S93•FAX 97L74&M6
APPLICATION FOR THE REPAIR RENOVATION CONSTRUCTION
DEMOLITION. OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION T.
Location Name: Building:
-- ..
Property Addresx-_j(i,,j
Property is located in a;Conservation Area Y/N Historic Dletrld N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: JASoN CiMt2ETE
Address: 167 Fr-DFI?)4L s`T 5ALEr,q
Teleplxxle:
3.0 COMPLETE THIS SECTION FOR WORK IN MUSIWp BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use New
Demolition Existing
Approximate year of Area per floor(sO Renovated
construction or renovation
of existing building New
Bdef Description of Proposed Work:
REPLACE 2-r)oF
Mail Permit to: 161"9 F-E.Mg L 5"7- &E04 Mi9
-\ CITY OF SALEM
; j PUBLIC PROPRERTY
q45W DEPARTMENT
MA101, 120 W:\SInNGiON St'R[Er Snt-t+t.MAS nCFUS13T[s 0197G
Tm.a 978-745-9595 ♦ FAX:978-74ir9846
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5
Debris, and the provisions of MGL 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 hauler)
The debris will be disposed of in
(name f facility)
(address of facility)
signatwe of permit applicant
(late
�7�- �9�- ova � . . . .
::f':
CITY OF SALEM
PUBLIC PROPERTY
DEPARTMENT
KISWERIEY DRISCOLL
MAYOR
120 WASMNGTON s r&EEr•sALEK MnssncHusErrs 01970
TFi 978-745-9595♦FAX:978-740-9846
HOMEOWNER LICENSE EXEMPTION
Please Print
Date S o
Job Location l 6 9 F F n /2 A Z. S >
Home Owner Address— l d 9 1--E LLIZ A7 S;
Home Owner Telephone 9 7'? 7 y S- L 9,p I/
Present Mailing Address /61 FED F R A I ST
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.
i
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
r �
r
Homeowner's Exemuhon
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 —Licensing of
Construction Supervisors),provided that a Homeowner engages a person(s) for hire to do
such work, and the Homeowner shall act as Supe
rvisor."sor,,
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 of
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 a licensed
Supervisor. The Homeowner acting as Supervisor is ultimately responsible.
To ensure that the Homeowner is fully aware of his/her responsibilities,many
the Homeowner certify that
'ties require, as art of the Permit Application, that fY
communities eq P , , ,
he/she understands the Responsibilities of a Supervisor. On the last page of this issue is a
form currently used by several towns. You may care to amend and adopt such a
form/certification for use in your community.
CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
120WAitiiNC,ioNSTBLET • SALFM.MASSAC n. Lugo[,)^,
TEt:978-74 9595 •1'.4X:978-740-9846
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5
Debris, and the provisions of MGL 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:
72209 514 CO .
—_-- (narne of hauler)
1'hc debris will be disposed of in
(name of facility)
(address of facility)
X
r.aturc of penr�it appiieant
S 7 0
d to
y
Salem Historical Commission
120 WASHINGTON STREET,SALEM, MASSACHUSETTS 01970
(978)745-9595 EXT.311 FAX(978)740-0404
CERTIFICATE OF NON-APPLICABILITY
It is hereby certified that the Salem Historical Commission has determined that the proposed:
Construction ❑ Moving
Reconstruction ❑ Alteration
❑ Demolition ❑ Painting
❑ Signage ❑ Other Work
as described below does not involve an exterior architectural feature or involves a feature covered by the
exemptions or limitations set forth in the Historic District's Act(M.G.L. Ch. 40C) and the Salem Historic
Districts Ordinance.
District: McIntire
Address of Property: 169 Federal Street
Name of Record Owner: Jason Charette
Description of Work Proposed:
Replacement of roof to replicate existing(black or charcoal gray, 3-tab). No changes in color, material, design
or outward appearance. Non-applicable due to being in kind maintenance/replacement.
Dated: May 9, 2007 SALEM HI TO C OMMISSION
By:
The homeowner has the option not to commence the work (unless it relates to resolving an outstanding
violation). All work commenced must be completed within one year from this date unless otherwise indicated.
THIS IS NOT A BUILDING PERMIT. Please be sure to obtain the appropriate permits from the Inspector of
Buildings (or any other necessary permits or approvals) prior to commencing work.
O
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subject to 9ppnoval by y other
then
ty "g2uz'a s ,jora.
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FL!. FIRE PROTECTION DH:".CEO,l.'.'= P,C'yJe.7i"10 A
! ':.'.L'i!_6T ARO IMPECTION,FOR COfdFLE-IT CCbA.'U- '
A? VIM!THE FIR;CODE. I
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DANIrLS STREET
SALEM, MA . 0070
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