44 IRVING ST - BUILDING INSPECTION ° �4.91fP8 iST�E fiL APPROVED BY T44E
=PFCT0-R ,PFWR T-0.A.PEAMIT .B,E1NG GRANTED
CITY OF SALEM
Date ,
No. � tt
b(
\ .ti4 .
Is Property Located in Location of f
the Historic District? Yes_No Building
Is•Property Located in /
the Conservation Area? Yes_,No ✓
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Ro Reroof, tall Siding, Construct Deck, Shed, Pool,
Repair/Replace, Other:
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: n—
Owner's Name
Address & Phone CA-)1
Architect's Name
Address & Phone
Mechanics Name
Address & Phone f
What Is the purpose of building?
Material of building? If a dwelling, for how many families?
Will building conform to law? Asbestos?
Estimated cost City License #—EL—State License
Home Improvement
Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO:
a
No.
APPLICATION FOR
PERMIT TO
l�QDlac tom F
LOCATION
PERMIT GRANTED
AfPVFD
INSPECTQ OF BUILDINGS
r
CITY OF SALRiA, MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTO14 STREET. 3RO FLOOR
SALEM. MASSACNUBETTS 01970
STANLEY J. USOVICZ, JR. TELEPHONE: 97e-745-9598 EXT. 380
MATOR FAX: 978-740.9a4e
HOMEOWNER LIMSE EXEMPTION
Pleaw Pant.
Job Location 4� I
Home Owner Address
Home Own;IrT elephosbs -
Preaeot Mailing Addteaa�� �`f�/ ,i.C'�
The current exemption of"Hameownffe-was.extended to include owner-occupied
dwellings of two.Unita or lean and to allow such to
hire who does not possess a liceengage an individual for
ase,provided that the ownie as supervisor.
DEFINITION OF,H0WW' NEB '
Peraon(a),who Ow a psr d Of land on which he/she resides or intends to=4 on
which there is,or is intended to be.a one or two family dwelling, athw W or detached structures accessory to such use and/or farm st uchm A person who constructs more.
than one home in a two year period shag not be considered a homeowner. Such
"homeowner•'shall submit to the Building Official,on a form acceptable to the Building
Official,Permi that he/she be responsible for all such work performed under the Building
The undersigned"homeowner"assume responsibility f
Building ° ry or compliance with the State
g Code and other applicable by-laws andregnlahons.
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 '72ri.., �
See other side for state code
woMEOWNER9 MMDWW�noll
_ work for which a Building Permit is
"dam OWLAny Homeowner performing 109.1.1 —Licensing
The ffom the provisions of this section
re4�won exempt S ):provided that a Homeowner mgsges a PaWO(s)t�hire to
Of
���Homeowner shalt act as Supervisor.
are unaware that tbey are a�g the
Many Homeowner s who use thin exempti Qi Rules and Regulations on for Licensing
militia of a Sup ( 1A � msults in serious
Construction Su;aviw a• pawns. In this case your
problems.Particularly when the Homeowner lung unlicensed it would
Board canaot Prod apind the unlicensed p it would vin a hcenaed
a.supervisor ' ble.
SupcMwra .The HomeownerTo ensure aetmg f '
that the Homeowner is fully aware of hialhef respons<bilities,many
communities nqu M as a part of the Permit Applican^J&the Homeowner ceRi$'that
he/she the raponaibilttia of a Supervisor and adopt h last par of ss eras a
form c�arenttY used by several towns. you may care
for eceracsdon for, in your commurytY•
R� `I��taos
r
CITY OF SALBM, MASSACHUSKTTS
• • PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RO FLOOR
SALEM, MASSACHUSETTS 01970
9TANLEY J. USOViC=, JR. TELEPHONE: 970-743-9398 EXT. 3a0
MAYOR FAX: 979-740.9&44
B n
Debris
In accordance with the provisions of MGL c40 S 54, a condition of your
Building Permit is that the debris resulting from this work shall be disposed
of in a properly licensed solid waste disposal facility as defined by MGL
Chapter III, S 150 A.
The debris will be disposed of in:
'L (Location of Facility)
Signature of Applicant
Date