55 GALLOWS HILL RD - BUILDING INSPECTION ►N{�j OVED BY '4IE
,
T:LfB P19lCIR07 .P T I3EWG GRANTED
I
CITY OF SA"',
EM
No. �a Date Q ��
Ward
\^t p Zoning District
Is Property Located In Location of L R
the Historic District? Yes_No Building
Is Property Located in �(
the Cdnsarvation Area? Yes No (=
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Si ing, , onstruct Deck, Sh Pool,
Repair/Replace, Other: i�P
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:
Owner's Name
Address & Phone L12 71
Architect's Name
Address & Phone L
Mechanics Name 4
Address & Phone ( 1
What Is the purpose of building?
Material of building? ++ If a dwelling,for how many families?
Will building conform to law? d�� Asbestos? _Vol .
Estimated cost —city License # State cane #
Home improvement -� n0i J
//v1U Lie. /
gnature of pplicant
SIG1400 UN ER THE PENALTY
OF,PERJURY
DESCRIPTI0 O WORK TO BE DONE
l[:C'
l
MAIL PERMIT TO: �
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co CITY OF SALEM9 MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT -
o
120 WASHINGTON STREET, 3RD FLOOR
9 'slpa SALEM, MA O1 970
i� TEL. (978)745-9595 EXT. 380
FAX (978) 740-9846
STANLEY J. USOVICZ, JR. _
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the provisions of MGL c 40, S34, I aclmowledge that as a condition
of Building Permit 11 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, SI1II50A. Q �1
The debris will be disposed of at: l u c" o s
cation of Facility
Signature of 't Applicant Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
T6wr. S ) LaMIItI P_ V4
Name of Permit Applicant
Firm Name, if any
S (, /laws 9 U S4 ��e►�
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.
CITY OF SALEM
t. B=ING DEPARTMENT
HOMEOWNER LICENSE EXEMPTION
Please Prw
DATE
HOMEOWM
ADDRESS HOMEOWNER .2) L 6 — 2R/
TELEPHONE
PRESENT MAILING ADDRESS �2 n^
The current etcmption of"homeowncrC was emmuded to imludc or mr-occupkd dwitl1lap ofTWO
Units or less and to allow such homeowners to cngage an itdmdual for hire who does Tool Possess a
license,provided thaw the owner set as supervisor.
DEFTNITTON OF HOMEOWNER:
Person(s)who owns a parcel of land on which ht1she resides or intends to wide,on which these is,or b
intended to be,a one to two family dwelling attached or detached smrttves accessory to such use andh r
farm structures.A person who constrocu more than one hone in a two-year period sb211 ant be considered
a homeowner. Sufi`homeowtxf shall'subndt to the BuDdimg OffrckL tm a form acmptabk to tiro
vial that Wshe be nsible to all such work performed under the building Pm
Building Offs repo
The undersigned"bomeowner"assumes Tmponsibility for compliance with the State Bolding Code and
other applicable goes by-laws,rules and rcgulatiotts.
The undersigned"homeowner"certifies that hdshc understands the City of Salem Building Dcparoaart
minimum inspection procedures and=I ' ns and slat hl will ly said p ocedu ms and
HOMEOWNER'S SIGNATURE
APPROVAL OF BUILDING INSPECTOR
See other side for stair code
J
HOMEOWNER'S EXEMPTION
The code state that "any homeowner performing work for}vhich a building permit is required shall be
cscmpt from the prmisions of this section (ScZiou 109.1.1-13ceosiug of Construction Supervisors);
Provided that is a homeowner tugages a person (s)for hire to do.such work,that sueb bomeowaer Shan act
as supetwsar•". ,
Many bormowncn who use this exemption are i nawart that they arc assnraing the tespvns%Mties err a
supervisor (set Appeodis Q,Rults and Reguiarions for I.iQnsing COnatruetiOn Superrisors,Sectiat•
.1.24 This tack of awareness oflea results in serious problems,particuburly wbm the bomeowner bhu
uriliccnsed persons In this case your Board cannot proceed against the ttrilieensed person as it'%VM pith
licensed Supervisor. The bomeon•ocr acting as supervisor b oitimattly responsibb.
To ensure that the homeowner is fully aware of hVt=respoumbilitits,many eommwdtks nqui ;as putt
of the permit application.that the homeowner certify that hcJshc understands the responsibilities of a
cation for use in
You art to mend and adopt surch a fotrn�ccrttfi )atr 4•
supcnistn. may op