2 HOLLY ST - BUILDING INSPECTION ,1 STYE ftLf D APPROVED BY T44E
WSPfXTD,R ,PF R IP A..P.ERMT.B,EING GRANTED
CITY OF SALEM (
No. l Z<f>O Date 1 �'
e
Is Property Located in Location of /
the Historic District? Yes_No Building 14b f_c\T V
Is Property Located in
the Conservation Area? Yes_No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, R oof Install Siding, Construct Deck, Shed, Pool,
Repa Replace, Other: 3 out3 i Y naD�S
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 t4j A, �F�Q /eti .vr___.�__ �__ V
Address & Phone 4, 4-bi- ( 97 ) 74 -- b alb
Architect's Name
Address & Phone 1
Mechanics Name MfiIk N
Address & Phone 130 Q,4mnST kweR S f 97oo 1 77g-`3 Po
What Is the purpose of building?
Material of building? If a dwelling, for how many families? Z
Will building conform to law? Asbestos?
Estimated cost Cyr'°' City License # N A State Lic nse #42L60 l
LI
-7 q Home Improvement V B t
Lic. ► /0o6,g`y
�L�, -- nature of Applicant
SICKED UNDER. THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
!l1l SI a9� J<N ff e- OOA?S IN .6&N�r6 OArhka to
SrpRr�, pooRS
MAIL PERMIT TO: NLI:Zz, 0 ✓ 0p r=TIV G
tbv"
'jl a ovs r � +- Sol pV S�
'i
a
APPLICATION FOR
PERMIT TO
�o o rrj
LOCATION.
PERMIT GRANTED
L$
AOV�D
l/"�ctl�u�
INSPECTOR OF BUILDINGS
V
7
..L
CITY OF SALEM
BUILDING DEPARTMENT
HOMEOWNER LICENSE EXEMPTION
Please Prim
DATE 7 a
— 5`' O�2
JOB LOCATION j
HOMEOWNER a LL
ADDRESS
HOMEOWNER cl (Y Z 4
TELEPHONE
PRESENT MAILING ADDRESS -5 9 Aq
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 act 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 to 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 to all such work performed under the building permit
The undersigned"homeowner"asswnes responsibility for compliance with the State Building Code and
other applicable goes by-laws,rules and regulations.
The undersigned"homeowner'certifies that he/she understands the City of Salem Building Department
minimum inspection procedures and requirements and that h/she will comply with said procedures and
requirements.
HOMEOWNER'S SIGNATURE
APPROVAL OF BUILDING INSPECTOR
See other side for state code
r
HOMEOWNER'S EXEMPTION
The code states that: "any homeowner performing work for which a building permit is required shall be
exempt from the prrnisions of this section(Section 109.1.1—licensing of Construction Supervisors);
Provided that is a homeowner engages a person(s)for hire to do such work,that such 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 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
licensed Supervisor. The homeowner acting as supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of Myer responsibilities,many communities require,as part
of the permit application,that the homeowner certify that he/she understands the responsibilities of a
supervisor. You may care to amend and adopt such a forn✓certification for use in your community.
"'J OF 5ALEM. Ir1A==}+�-n`.'="' ` "
{off a PUBLIC PROPERTY DEPARTMENT
• • 120 WASHINGTON STREET, 3RO FLOOR
SALEM,MA O t 970
3 1y
TEL. (978)745-9595 EXT.380
Req FAX (978) 740-9846 .
STANLEY J. USOVICZ, JR'
MAYOR
DISPOSAL OF DEBRIS AFFIDAVa
In accordance with the provisions of MGL c 40,S34,I acknowledge t constr�� condition
of Building Permit# all debris resulting
disposed of in a properly licensed slid-waste
governed by this Building Permit shall be
disposal facility,as defined by MGL c III,S150A.
vUC5 72W,5 Fe2
The debris will be disposed of at: DLocation of Facility
gnamre Permit Applicant Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY
Name of Permit Applicant
Firm Name,if any
(gyp -,r CT pHn6veRS MM4,
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-licensedor licenses aree disposal
facility as defined by MGL cM, S 150A, and the building Permits
indicate the location of the facility.
ard of Building R;g aions and Standards
One Ashburton Place- Room 1301
Boston. Massachusetts 02108
ome Improvement Contractor Registration
Registration: 100654
Type: Individual
Expiration: 6/2212004
IRA G. MALKIN
ItIra Malkin
180 Dayton St
Danvers, MA 019
Update Address and return card.Mark reason for change
Address 011tenewal OEmplquato O i.ost Card
goar
�d of Buildin ulations
One Ashburton i a gg
.. rton Place, Ism 1301
Boston, Ma 02108-1618
License: CONSTRUCTI N SUPERyISOR LICENSE Birthdate: 07/31/1955
Number: CS 02001 1 Expires:_07/31/2005 Restricted To: 00
IRA G MALKIN "
180 DAYTON ST
DANVERS, MA 01923
Tr.no: 14077
Keep top for receipt and change of address notification.
Board of Reading Reiralafts i and Standards Lieese or rag6tratioa valid for iadividal use only
HOME BIIPROYBIIFM before tie eotpb:atha date. Ufeund retara to:
100 Registration: 100554 Board of BoNlog ons;and Standards
6r7?l2004 OneAsbb�a Nave Pin 1301
ExPhuUw Bodo%Ma 02108
Type: individual
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