236 JEFFERSON AVE - BUILDING INSPECTION (2) C�
� � f
�f gwiiSTeEfIUE� A?PROVED BY T44E
„epTpl ,PFWR T. PERMIT B.EWG GRANTED
CITY OF SALEM
i CoN
Date �,", �'— a-c�o,b
No.2E] �.
Is Property Located In Location of ��rr
the Historic District? Yes_No ✓ Building a 3Cn
Is Property Located In
the Conservation Area? Yes_No 1�
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
Repair/Replace, Other: }jti I 6AIn
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 -o k vN ryl a h A S
Address & Phone a 3i* Te Ftrs v-n -Avg (Lill) W 3e - ,S3`I'+
Architect's Name
Address & Phone
Mechanics Name 4
Address & Phone
What is the purpose of building? I by 5 2..
Material of building? If a dwelling,for how many families? bYt 2,
Will building conform to law? Asbestos?
Estimated cost L04�aa City License # N A State License #
Home Improvement
Lic. /
S' ature of Applicant
SI NED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WONIC TO BE DONE
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pegra�,f- {w- fLAvVn64tn5
f'VA4 SRNs J70 I0k5-ef* Flmo,r
MAIL PERMIT TO: 3(P J e-�'(�-Sc vx Ave- S�"�^ , I A A 0 t 9''1b
No.2 &
APPLICATION FOR
PERMIT TO
0-7
LOCATION �^
rx9d 3 P men
b
PERMIT GRANTED
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APP OVFD
INSPECTOR F UILDINGS
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CITY OF SAL-:kM, MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET. 3RO FLOOR
SALEM. MASSACHUSETTS 01970
STANLEY J. USOVICZ, JR. TELEPHONE: 978-745-9595 EXT. 380
MAYOR FAX: 978-740-9846
HOMEOWNER LICENSE EXEMPTION
Please Print.
Date 3 - -1 - aeoto
Job Location o�3 b -eKe-csovI, Ave- _-.J �� ai�l� o
HomeOwnWAddressI I f TeFfcrsov> 4�e e� �. n�>} G 4Zo
Home Owner Telephone Li I 't S 39- S3�{
Present Mailing Address 8 3(P It- se , .0
The current exemption of"Homeowners -was extended to include owner-occupied
dwellings of two Units or less and to allow such homeo to engage an individual for
hire who does not possess a license,provided that the ow 1 1: as supervisor.
DEFINITION OF HOMEOWNER -a
Person(s)who owns a parcel
.of lard on which he/she resides or intends to reside,on
which there is,or is intmied 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 m 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.
Sohn Mab%S
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING INS ECTOR 1/41
See other side for state code
nomMOWNF.RS SON
The Code states that: "Any Homeowner performing work for which a Building Permit is
aired shall be exempt from the provisions of this section(Section 109.1.1 —Licensing
Supervisors):provided that a Homeowner engages a person(s) for hire to
of Construction
do such work.and that such Homeowner shall act as Surpervisor.
Many Homeowners who use this exemption are unaware that they are assuming the
Q Rules and Regulations for Licensing
responsibilities of a Supervisor(see APP� often results m serious
Construction Supervisors.Section 2.1 This leek n awareness as In this case your
problems.Particularly when the Homeowner hires unlicensed Persons.
Board cannot proceed the unlicensed P�OII as it would with a licensed
gupervisor. The Homeowner acting as supemsar Is u"responsible.
To ensure that the Homeowner is fully aware of his/her re albil our many
communities require. as a part of the Permit Application. n t e l Homeowners ism that
the responsibilities of a Supervisor• On the host Page of this issue is a
horse understands by several towns. You may care to amend and adopt such a
form currently
form/CertiScation for use in your community.
��fp� yaos
R
-1i
CITY OF SALEMj MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET. 3RD FLOOR
SALEM. MASSACHUSETYS 01970
sTANLEY J. UEOvIC=, JR. TELEPHONE: 978-745-959S EXT. 380
MAYOR FAX: 979-740.9846
Salem Building DeoartMenj
_Debris DISROW F3EM
In accordance with the provisions of MGL c40 S 54, a condition of your
Building Perni t 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:
to M�J s-f.
C a""b 7 S C MA —(Location of Facility)
Si ature of Applicant
3- -7 -ae066
Date