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119 HIGHLAND AVE - BPA 07-275 PUBLIC PROPERTY DEPARTNfEa�iT KIMSFALEY DRISCOLL MAYOR 120 WASHI.%GrM h'rREEr 1 may.MAssAoiLst-rrs 01970 TEL-978-745-9S9S 0 FAIL:9M740-9846 APPLICATION FOR THE REPAIR, RENOVATION, CONSTRUCTION, DEMOLITION, OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING STRUCTURE OR BUILDING 1.0 SITE INFORMATION Location Name: I19 //14f/1A.✓,9 Xvf- Building: W1,A,/C Property Address: /Iq 1/,,�,y1q fj) Iv Property is located in a; Conservation Area YIN IV Historic District YIN 41 _ 2.0 OWNERSHIP INFORMATION 2.1 Owner of Land e Name: Dgp-e Ai("4e4 Address: I19 1/I6r/I1Ai✓D AtI6 S41-6-7 IAA Telephone: 7-78 &.28 — 983v 3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY r;,ge�c�r Addition Existing Y©usc o2 Renovation ✓ Number of Stories Renovated Change in Use New rloctSE Demolition Existing F gA,?A4 C ,2�oo�(sF Approximate year of Area per floor (sf) Renovated construction or renovation of existing building New Brief Description of Proposed Work: YrAIP SHiNV'eCs OFF RoDF on/ yescSE - 4,¢e.04e t2c-axC Mail Permit to: What is the current use of the Building? Material of Building? If dwelling, how many units?— Will the Building Conform to Law? yE5 Asbestos? Architect's Name �'/A Address and Phone Mechanic's Name h Address and Phone Construction Supervisors License# HIC Registration# Estimated Cost of Project$ Permit Fee Calculation Permit Fee$ 3 Ou Estimated Cost X$7/$1000 Residential 9<22 Estimated Cost X$11/$1000 Commercial An Additional $5.00 is added as an Administrative charge. Make sure that all fields are properly and legibly written to avoid delays in processing. The undersigned does hereby apply for a Building Permit to build to the above stated specifications. Signed under penalty of perjury X /6 Date a 6 of N � w p a b � � a F 1 v , CITY OF SALEM r: PUBLIC PROPERTY DEPARTMENT KININELLbY E)RLW 1L � EM01970 �rAYOe 1�Wtital+Gr'��+S'CRE6�T*�x W.uSAW .S I7 L-97a•1•FAX:978.740-9a46 Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code,790 CMR section 111.5 Debris,and the provisions of MGL c 409 S 549 d is issued with the condition that the debris resulting from Building Permit this worst shall be disposed of in a propady licensed waste disposal facility as defined by MGL c 111.E 150A. The debris will be transported by: �P1A�✓ A ! T (name athauter) The debris will be disposed of in : (name of fx�Lty) a 7 rc K (fie of facility) siiplawre of parnik applicant due .Ichri+�l7Jue CITY OF SALEM PUBLIC PROPERTY DEPARTMENT KIMBERLEY DRISCOLL MAYOR 120 WASHINGTON STKIMT♦SALEM,MASSACHUSErIS 01970 TEL,978-745-9595 • FAx:978-740-9846 HOMEOWNER LICENSE EXEMPTION Please Print Date R� o6 Job Location 0 f/Il&dA1D dve Home Owner Address 119 ///G H CA.✓b </✓ff a/9a-v Home Owner Telephone (,^? y ) $z 8 - 9 g 3 0 Present Mailing Address „g //��/cares ,�i� Sacr + cvsV,o The current exemption of"Homeowners"was extended to include owner-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 acts 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 or 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 for all such work performed under the Building Permit. The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other applicable by-laws and regulations. The undersigned "homeowner" certifies that he/she understands the City of Salem Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE 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 provisions of this section(Section 109.1 —Licensing of Construction Supervisors); provided that a Homeowner engages a person(s) for hire to do such work, and the 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 of 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 a licensed Supervisor. The Homeowner acting as Supervisor is ultimately responsible. To ensure that the Homeowner is fully aware of his/her responsibilities, many communities require, as part of the Permit Application, that the Homeowner certify that he/she understands the Responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community.