47 HATHORNE ST - BUILDING INSPECTION t ,
?taSMiiST-BE ff L-ES-Afffil APPROVED BY T44E
.W5.PEXTOR ,PRWR TO A PERMIT BEING GRANTED
CITY OF SALEM
No yD
V ate
i0) Ward
Zoning District
Is Property Located in Location of t
the Historic District? Yes_h L Building r7 f fG7Jr�[ �T'
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,
epair/Replac,: Other: K,lrkb z _ t ,ty�h
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 9T_ /ll WAR ( M ) -741 -KOLD
Architect's Name
Address & Phone ( )
Mechanics Name
Address & Phone ( )
What is the purpose of building? II
Material of building? I p)' If a dwelling, for how many families?
Will building conform to law? Asbestos? Vw
Estimated cost �0�,i City License# State Lice e #
Home Improvement
Lic. i
S gnature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE I J
MAIL PERMIT TO:
No.w��\
APPLICATION FOR
PERMIT TO
LOCATION
-�
1' �7S/k�.Me
PERMIT GRANTED
APPFV D /
INSPECTOR OF f3U WINGS
,W PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 9RD FLOOR
SALEM,MA O1970
TEL (978)745-9595 EXT.360
FAX (976) 740-9646
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# , 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 MGLc`III A, pS150
.
The debris sposed of at t Y �% � S i U
Location of Facility
Signature of Permit 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.
1 •
• Cff OF SALEM
BUIIDING DEPARTMM
HOMEOWNER UCENSE rmyoT10N
Pkase PM
DAZE �
JOB LOCAZ7CD1 i� `� �U 1QiU Q
ADORES}
-HomEo*vNa �1'?k 741 Dlvz�
rmj3uom
PRESENT MAB-II?0 ADDRESS ��n^"-��' .
Wo
ma amas.exemptiom°f`f1O"KO"OOa�was emadcd m fi+ , owoe bix V pkd es I" p o=6
Units a less and is anew such bomoswam to�a m individtol for h w�does aot P t
L�,.ymvided gm*t.owset set as m"rvbw.
DEFT CnW(W HOWC)WML m taidq gt+rlddt there k,a 4
Pcnon(s)wm owes a pared of land oa which helshe tssides a iruends to mclb tut=dPW
intsrded to be,a one to two family dwclft&sasdr:d a dctadod suucnma s1yU aot ix eomsldeaad
farm struema.A perwn who constructs awls than cm home in a two-yesa Faiod
a homeowaa. Such`twm v,mef sha�'sobadt w the BuRdimg Offbd4 on a foam seupta%k b*4
Bw'ldimg Official.
that he/she be tcspomstbk to an md►work pQformed torlec °�'
Zhe tmderSrgrxd`homeowmrx"assurnex tesptnslbll79 fOT tzmphtmtz gtth IM State Bml>dktg Code ttd
othv appgcabk goes by-hms,►uks ad regulation
The tmdosip d'hoc�awne"arzi5a that helshe im�derstards the coity of
minimmt inspcniom Fo=dmes wad req/' t Wshe will eamm
requittsrcals.
HOI,gOWNWS SIGNATURE
APPROVAL Of BVMDING II�SP :CTOR
Sa other side for state code
HOMEOWNER'S EXEMPTION
The code states ll= 'WV hm=wmr performing work for whieb a bading permkl is mp.bW Ad be
c..umpt ircm the pro+iskoas of thb scCdon (Sa-tioo 309.1.1-k.3aosko9 of Coonructios Supervksori);
Provided 1Lac is a homeowner engages a per:on(s)foe Lire to do.:uch work.that ncb bmeownct Ad tea
Mark bomeownea who use this exemption are iumwac lbat they an Lamming the Tevomibuts.Ica
svperriwr(see Appcodh Q,Rules and Regulatloos for lictosleg Coostruetbrs Snpeavbon,SaAft
.2.24 Tbis bck ofewwams oftrnnsuhs in scriom probkms,pardcnkaV wbm the Wmwwswbisa
unikansed persarn In tills case your Bostd arm proceed aping the mXcmsed p wq=a it would wib
liacaud Supenisor. The bomtonver acting as supervisor is ohisoaseb twaEwoSPOL
To eusum tha the horatowmct is fu11y aware of UPI=nsponnblBda,map comtomds a uqdm.sus paw
of the pmal applicadvA that the homeowner cenify that h"K wu astands the tespons%ald"aft
sgwvbw. You may are to amend and adopt sueb a fotmk nVx:ad a fog tree in your ammudq.
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