11 FRANCIS RD - BUILDING INSPECTION r
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-PLA1461AOST-OE fiLf� APPROVED BY T44E
=P,ECT1DA PfflQR TA.A.PE8MT.BFjNo GRANTED
CITY OF SALEM tt
No. 7 S J 2 o o ��`� " ���\ Date
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°�7PIIN6
Is Property Located In Location of
the Historic District? Yes_� Building'
Is Property Located in
the Conservation Area? Yes_No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct 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: n
Owners Name YM �a�� Q-0 V\V\a C—
Address & Phone \I Fi",rx'r\ C l S K
Architect's Name
Address & Phone )
Mechanics Name 4
Address & Phone ( 1
What Is the purpose of building? arts r c�;_
Material of building? If a dwelling,for how many families? _
Will building conform to law? Asbestos?
Estimated cost City License# N A State License #
0o Home Improvement
�`Zo �cKZSS Lic. !
Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WRkWBE dbk
Cuwsh /gply �Pc � j
2-4 1 K-OutyD noov
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MAIL PERMIT TO:4sS ya- 94J&C 9 �K
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No. 17 J -Z-001
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APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
2.0
APPROV D
INSPECTOR OF BUILDINGS
PIP .
MORTGAGE INSPECTION
BAY STATE SURVEYING ASSOCIATES INC. JOB #
100 CUMMINGS CENTER, SUITE#316J, BEVERLY,MA., 01915
sAL EM NOTES:
LOCATION :...................:...M�..... ..................... t)This is a mortgage inspection survey and not an
Instrument survey,therefore this plot plan is for
SCALE : 1" = 30 DATE :.......Q..5..�. �......... mortgage inspection purposes only.It is NOT to
be used to establish boundaries or for the construction
t3K' ) �� of any type of Improvements.
REFERENCE : .. :. .............. 21 This survey is based on survey marks of others.
.'r 1sii x....T ^�Na..........••••• 3)Bushes,shrubs,fences and tree Imes do not
..................................................... necessarily indicate property lines.
6RF_i4T NA2� rlM,40C4,4 ✓��41 Whenever an offset Is T+-or less,an Instrument
TO:. survey is recommended to determine property
The location of the building(s)as shown,either Imes,and any possible encroachments.
complied with the local zoning setbacks at the time of 5)Offsets shown are approximate,and are tote
construction or is exempt from violation enforcement action used only for the determination of zoning,Not to
under Mass.G.L.Title VII Chapter 40A Section 7 be used to establish property Imes.
6)In my professional opinion the building(s)are not
located in the special good hazard zone,as
defined by N.U.D.MAP# Z50/oZ 7-
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SUiwEY OR'S SEAL IS NOT
EMBOSSED.THE PLAN IS A COPY
THAT SHOULD BE ASSUMED TO
CONTAIN UNAUTHORIZED ALTERATIONS.
THE CERTIFICATION CONTAINED ON
THIS DOCUMENT SHALL NOT APPLY
TO COPIES.
OF 5ALEM. irtA55a�.nv.
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
SALEM,MA O 1970
TEL. (978)745-9595 EXT.380
�q FAX (978) 740-9846 .
5TANLEY 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
shall be disposed of in a properly licensed solid-waste
governed by this Building Permit
disposal facility,as defined by MGL cIII,S150A.
The debris will be disposed of at
Location of Facility
Signature4op—ami—tAppticlnt Date
FULLY complete the following information.
(PLEASE PRINT CLEARLY)
Name of Permit Applicant
Firm Name,if any
Address, City & State
above statute requires that debris from the demolition,renovation,rehab or other
The -waste disposal
alteration of building or structure be disposed in aproperly-licensed solid sp
facility as defined by MGL cIII,S 150A, and the building permits or licenses are to
indicate the location of the facility.
I
CITY OF SALEM
BUILDING DEPARTMENT
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE O /3
JOB LOCATION
HOMEOWNER l� ��•'11 C-1S /G( '�_
ADDRESS !/
HOMEOWNER (q
TELEPHONE
PRESENT MAILING ADDRESS //
The current exemption of"homeowners"was emended to include owuer-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 act 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 to 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 to all such work performed under the building permit.
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and
other applicable goes by-laws,rules and regulations.
The undersigned"homeowner"certifies that he/she understands the City of Salem Building Department
minimum ion' Procedures and requirements and that h/she will comply with said procedures and
�u
requirements.
HOMEOWNER'S SIGNA
APPROVAL OF BUILDING INSPECTOR
See other side for state code
HOMEOWNER'S EXEMPTION
The code states that: "any homeowner performing work for which a building permit is required shall be
exempt from the prmisions of this section(Section 109.1.1—licensing of Construction Supervisors);
Provided that is a homeowner engages a person(s)for hire to do such work,that such homeowner shall act
as supervisor."
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 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
licensed Supenisor. The homeowner acting as supervisor is ultimately responsible.
To ensue that the homeowner is fully aware of hi/her responsibilities,many communities regture,as part
of the permit application,that the homeowner certify that he/she understands the responsibilities of a
supervisor. You may care to amend and adopt such a form/certification for use in your community.