26 GROVE ST - BUILDING INSPECTION iaL*fP5*rdST-BEfiL{�:ii1D 'APPROVE0 By T*IE
' ,PFWR TPrA PEBMIT 13EWG GRANTED
` CITY OF SALEM
No. # �.t o s +, Date 10 o
Ward
Zoning District
Is Property Located In Location of
the Historic District? Yes_No_ 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: Lek,o
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
Architect's Name
Address & Phone ( )
Mechanics Name
Address & Phone ( )
What Is the purpose of building?
Material of building? Con If a dwelling, for how many families?
WIII building conform to law? Asbestos?
Estimated cost o�'T City License# State License #
Home Improvement /
0" —Lic. i l '
Signature of'Appifbant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO:
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CITY OF SALEM
B=ING DEPARTMENT
HOMEOWNER LICENSE E?MMMON
Please Prbd
DATE
%—
JOB LOCATION
HOMEOWNER
ADDRESS c�j
HOMEOWNER
TELEPHONE
PRESENT MAILING ADDRESS
The ewrerd exemption of"homeowners"was a ncnded to include mroer-occupied dwdGop oSTWO
Units or less and to allow such homeowners to cnp&c an Individual for bite who does TO possm a
license,provided that ft.owner act as supervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to Tc ,on to such use Of i r
intended to be,s one to two family dwelling,attached or d atss
etached smlctmtss sory
farm structures.A person who constructs mort than one home in a two-ycat period sball not be considered
a bomcowner. Such"homcovarX shall'subrnit to the Building Official,on a form ac ccptabit to ffie
Building Official,that bc/shc be responsible to all such work performed trades the building peradi.
The undersigned"horncow ncr"asswncs respon-n'bility for wmpliw=with the State Building Code and
other applicable goes by-laws,rules and rcgu.12602L
The undmiptd'houtcowna"certifies that hdshc undcstands the City of Salem Building Departsu tl.
rrdrn mum inspation pros uics and rcquuenitnts and that hlshe will comply with said procedures and
requircarmA .
HOMEOWNER'S SIGNATURE
APPROVAL OF BUILDING INSPECTOR
Sec otbeT side for state code
r
HOMEOWNER'S EXEMPTION
The code states that.' "any homeowner performing work for svhich a building permit is required 3110 ht
c. empt from the provisions of this section (Section 109.1.1-liausius,of Construction Supervisors);
provided that is a homco A ner engages s person (s)for hue to do,such work that suet homeowner shall act
as supervuar."
Many bonncowners who use this exemption are unaware that they arc asswling the Teswnsibiliti s ofa
supervisor (sec Appcodia Q,Rules and Rcgulatious for Licensing Construction Supervisors,Sectisn
2.15} This lack of awareness often results in serious problems,particularly when the homeowner ithu
unlicensed persons In this case your Board cannot proceed against the tmdieensed paean su h would with
licensed Suprn-isor. The bomeov,tscr&cling as supervisor h uWwately responsib{6
To ensure that the homeowner is fully aware of T:A=respom''bilhies,marry eommunitires require;as pat
of the permit application,that the homeowner certify that heishe undcrstards the responsibilida eta
supcn'isor. You may cart to amend anid adopt such a form/Ocnific ition for use in your commMMiAr.
&a CITY OF SALEM9 MASSACHUSETTS
PUBLIO�PROPERTY DEPARTMENT
ri 120 WASHINGTON STREET, 3RD FLOOR
SALEM, MA O1 970
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 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, S 150A.
The debris will be disposed of at: gym/ {( h.`Gl 6c/-
Location of Facility
Signature of Perms Applicant 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.