5+7 FLINT ST - BUILDING INSPECTION IdOSTBEffLfB-ANfl APPROVED BY T+IE
WPFXTDR ,PFWR TP A.PERMIT .B.EW G GRANTED
CITY OF SALEM
, 6� �j. �6710 -
No. "`� '� '�� Date
�gf�/MINV�v
Is Property Located In Location of c the Historic District? Yes� 7 u krST No Building J ft,
Is Property Located in
the Conservation Area? Yes_No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct eck, Shed, Pool,
Repair/Replace, Other: CLCL b o o r t is u �ePS
PLEASE FILL OUT LEGIBLY & COMPLETELY TO AVOID DELAYS IN PROCESSING
-�j L U L J aA 2 V- OL 0-v" C2.6� e
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the following
specifications:
Owner's Name
Address & Phone S / N T_ ST l t✓ ! (17 6 -7 �Lt.- z 7 760
Architect's Name to,
Address & Phone ✓) sQ
Mechanics Name 6;�f0 V_ e sarn 50 vi z
Address & Phone Tnu 'q09j�Ver(y Mr4 ( 5V 92,7 " 59 _T7
--R ' , ,J 'Oi )t
What Is the purpose of building? 1C t�r�0 i l tj cL (—= ! 1 J£) rv, 0.O P
Material of building? W 00 6:� If a dwelling, for how many families? -0
Will building conform to law? yam, S Asbestos? IV O
Estimated cost 361 5,00 City License # tJ /P State License #
Home Improvement
-� � c.
Signature oflApplicant
1 SIGNED UNDER THE PENALTY
0J 5 OF PERJURY
DESCRIPTION OF WORK TO BE DONE
�C__ o,_ , e �s�� a e
MAIL PERMIT TO:
No.,
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT,GRANTED
/ l/�7�n3 Lf
APPROVED
INSPECTOR OF BUILDINGS
tl.
CITY OF SALEM
B=ING DEPARTMENT
I30IvMOWNER LICENSE E)MMPTION
Please No
DATE 03 f
fOBLOCATION S + l—7
. HOMEOWNER 47bl �TUy C%C l
ADDRESS Q Q
HOMEOWNER
TELEPHONE
PRESENT MAILING ADDRESS S-�1� !f�T I (Z . A L,&M,( P t Q(?7 0
The amcra exemption of`bomcownmC was emended to include owntroceopied dwdlinp of TWO
Units or Icss and to albw such homeowners to engage an b&vidual for hire who does ant possm a
license,.Fmdcd that the owner act as saptrvisar.
DEF24MON OF HOMEOWNER:
Person(s)who owns a pawl of land on which hclshe resides or iruends to reside,on which there it,or is
intended to be,a ont to two family dwelling,saached or detached structures arzessory to such va andlot
farm st uctarcs.A person who constructs more than one home in a two-year period shall ant be considered
a bomcowma. Such"homcow•nef shall subndt to the Building Official,on a form acaptabk to the
Building Official,that lrrJshe be rtsponsiblt to all such work performed under the building permiL
.The undersigned`homeowner"assumes responsibility for compliance with the State Building Code and
other applicable goes by-laws,rules and rcgulatiaats.
The undersigned"homeowner"artifice that hdshe understands the City of Salina Building Deparuma
minimmn inspection procedures and requirements and that hlshc will comply with said procedraes and
mquircmefts. DI
HOMEOWNER'S SIGNATURE � �
APPROVAL OF BUlI.DING INSPECTOR
See other side for state code
f y
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 109.1.1-1ecensiog of Construction Supervisors);
Provided that is a homeowner engages a person(s)for hire to do such work,that such bov=waer tdtall arse
as saperMiw."
Manor homeowners who use this txen pdon are imawan that they arc assttrning the fesponsrbrLua der
nTcryisor(see Appcodis Q,Ruiw and Regulations for]Licensing Coustruetion Superviwrs,Seetiaa
2.14 This lack of awareness often tesuhs in serious problems,particularly when the bomi*wner bhu
rsons In this case our Board cannot proceed against the unlicensed person u it avuldd widt
unlicensed pc Y „_
licensed Supmiser. The boum"mcr acting as supervisor b 9Ww3telY mponAW
To ensure that the homeowner is frilly aware of hilt=responslbilities,marry eommunitites Maim as peat .
of the permit applicadon,that the homemvner certify that hdshe rmdmtands the responsibilities of a
supervisor. You may care to amend and adopt such a formic crtifrcation fur use in Ym commttrtk,
to . 71 OF SALEM,, M. ASSAcnuaci
PUBLIC. PRO?ERTY DEPARTMENT
A20 WASHINGTON STREET, 3RD FLOOR
y SALEM,MA01 970
TEL. (978)745-9595 EXT.380
�G FAX (978) 740-9846 .
;TANLEY J. USOVICZ, JR.
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the Provisions of MGL c 40,SK I acknowledge that as a condition
of Building Permit# all debris resulting from the constriction activity
governed by this Building Permit shall be disposed of in a properly licensed solid-waste
disposal facility,as defined by MGL c in,S150A. / r / �
+ I?9rO S;wa DG�
d ec n
The debris will be disposed of at: � 0(Th S, y 70
Location of Facmhty 1 j '/t I
�L-L 7 D s
Signature of P t Applicant
Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
Name of Permit Applicant
Firm Name,if any
sGrwi SI SA- L-EM, o / 9 -70
Address, City & State
The above statute requires that debris from the demolition,renovation,rehab or other
ed in a properly licensed solid-waste disposal
alteration of building or structure be dispos
and the building permits or licenses are to
facility as defined by MGL cIII, S 1 50A,
indicate the location of the facility.
Georgeworks BMW
George Sampson DATE ESTIMATE NO,
Box 409 a
Beverly,NIA 01915 1 9/13/2003 20
978-927-5977/Email
georgeworks@msn.com
NAME/ADDRESS
Ilse Pierce li
5 Flint St
Salem,Ma.01915 li
' I I
I
TERMS DUE DATE PROJECT
9/13/2003
DESCRIPTION OTY RATE I TOTAL I
Repair or replace existing gutters,or install new gutters.Price does 146 9.00 1 1,314.00
not include repairs to faeias or roof edges.Price includes
downspouts to ground level only.Price is per linear foot,includes
I
inside and outside corners.
Any repairs or new woodwork or hardware installed as needed. 1 900.00 900.00
Soffet repairs,remove had wood and replace,build out other areas
to make gutters effective. I
Any repairs or new woodwork or hardware installed as needed. 1 645.00 645.00
Repair clapboards above small porch roofs,inspect flashing and
I repair or counter flash as needed-
Any repairs or new woodwork or hardware installed as needed. 1 580.00 580.00
resurface porch roof sufaces with tar and gravel.Also repair drip
edges where needed.And replace crown molding where needed.
All prep work and application of finishes to custumer specifications. 1 180.00 180.00
Scrape and prime loose flaking paint all aroud house. j
5 5 �9 `AL yL e�L Q��zu�
(/
I I I I
i I
II
� I
TOTAL l
I $3 619.00
SIGNATURE