15 HIGHLAND ST - BUILDING INSPECTION I
v
44"S IMST-eE fflz—E D APPROVED BY T44E
LNSP XTDR PRJDR TP A PERMIT BEING GRANTED
CITY OF SALEM
Date
Ward
��cimNsoo/� 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, n/Replac
nstall Siding, Construct Deck, Shed, Pool,
Rep, iOther: j±ac--/ Ire
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 : (Lcd+ I J Gj
Address & Phone ll`► ed— ( / 7f
Architec 3tne /
Address & Phone ( )
ec "am`
Address & Phone
What is the purpose of building?
Material of building? _I k-)Oc cl If a dwelling, for how many families?
Will building conform to
flaw? Asbestos?
Estlmated cost t/ - City License # e can e
Bome Improvement
Lic. 1
nature of Appii
IGNED UNDE HE PENALTY
OF PERJU
DESCRIPTION OF WORK TO BE DONE
L,k] l q oq—;C :;k \�w
o YC� ers DY
MAIL PERMIT TO: l t o41 e `I.-g
I-
t.
t
No.
APPLICATION FOR
nn PERMIT TO
�.�rc6i m� �e�lSx G✓i� O�an ��r�
LOCATION —�
PERMIT GRANTED
19
A"OVFD
INSPECTOri OF BUILDINGS
i
• J
s
1
-, Cr Y OF SALEM
BURD1NG DEPARTMENT
HclaowlER LICENSE EpvI M014
P)CM pm
DATE U v
JOB1 oCATION I �l I G�n I�1 l/1 I'
NOkiE0a11�R .
ADDRESS
HOWOW) d
9t 5 �
TELEPHOW
PRESENT MAILING ADDRESS r fh
The pQtatl cscmptitm of`homcowpcTs"was cxunded to include q,.ar.oecupied dwellhop ccTWO
Units a kss and to allow such bmrwowncsa to cow an irrdivtdttd for lore who doe not posses a
liccme,.pmvWcd t>m>be owaat ad as supervisor.
DEFIKITION OF HOMEOWtWL' oa Which tlwe is,a b
PcTsm(s)wbo owns a pcacl of knd on which lulshc resides a imcnds to tcside. 10 tat me aadks
intended w be,a one to Two fa*rdly dwclHM anachod a dctad cd wuctkvu �sSM �be tx Mderad
farm svucwmL A perwn who constructs awre than one home at a two-? Pen
Such lwmt0v'=f shall subn*to the Budding OfftaaL o°a fom se>xpttbk Iota
s bvtneowna. MAOthebuildmgPaM L
Bttildiag Official.That hTlshc be resportstbk to all such work perimTaed .
.Tbc tmdcniptd-bomcowncr"assumes caponsibi ty for compliera the stets Building Code and
otha appBesblc goes by-lawk rates and relulatiomL
The tmdasigrnd"homecwna"=ffm that hdsht a ndaswds the City of Salem Bu ldtitg Departsoal
minimtrm inspa mt pr°�ura and mcitmcrncrrts and that 1JsM wilt comply with said
P and
requkcmcmL
HOMEOWNER'S SIGMA
APPROVAL OF BIaDING INSPECTOR
Sec otba sde for stets code
y
HOMEOWNER'S EXEMPTION
The code state that• 'arty homeowner performing work for which a building pennithmpbw:ball be
mmpt from the ptmisions of this section (Section 11*aa-Uccosing of Counrnetloo SuptTvisors)
Provided that is h Lomeovmer engages a person(s)for hrme to do.such work,that mach homeoaaa shaA ad
as � •
Many boneownen who use this exemption are unaware that they are assttmmg the Tespevosibmdes are
supervisor (a"Appcodh Q,Aulu and Regulations for Licensing Coostr wedion Supervisors,Ssediw
2.14 This lack of awareness often testths in scriom problems,pardculart wbbm the hortreowaa idrea
urtlimtsod pcn m. In this case your Board cum pmcccd agsirat the unliieeased person a h would va
licensed Svpcni%F. 711t homeowvtr acting as supervisor fa ohitmste�tss�wosible,
To ensure that the homeowner is fully aware of hi/ha responslbilities.many a on m ndtlu nqdM.as pal
of the pmri4 application,that the homeowm r certify that b"m tmdcmunds the rssponsibilldes eta
Supcnism- You may care to amcud and adopt sueh a foraJccnif=1 im for rm in your coutwadq,
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREAM, 3ND FLoon
j SAL[M,MA 01570
TEL (278)7464596 EXT.380
/� FAX (B76) 740-8646
STANLIK' J. USOVM:Z, JR.
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
In axordance with the pro isiow Of MGL c 40,S34,I acknowledge that as a conditicn
of Balding Permit S 1 .all debris resulting firm the conauuction wdvity
governed by this Building Permit sW be disposed of in a properly licensed solid-wsM
disposal facility,as deffnad by MUL c EL S150(A.� }
The debris be disposed of at
Location of Facility
Signal ue emik ApPHOW9 I Dde
FULLY comPldte the following M&MISUM
ro. (PLEASE PRINT CLEARLY)
QA*e.r V r tUr(-ail
Name of Permit Applicant
Firm Name,if any
Address,City&State
The above statute requires that debris from the demolition, movation,rehab or other
alteration of building or atr ichue be disposed in a properly-licensed solid-waste disposal
facility as defined by MGI,cIff, S 150A,and the building permits or Hoe =are to
indicate the location of the facility.