408 JEFFERSON AVE - BUILDING INSPECTION (3) • f
11.9l Mgffl STff f bf�,APPROVED BY T44E
WSPFXT -R PF,tdLIR T-0 A.PERMIT B,EWG GRANTED
CITY OF SALEM
"N
No.. 3— -2(7p t " , Date
�. mnem
Is Property Located in Location of
the Historic District? Yes_No Buildingf
Is Property Located in
the Conservation Area? Yes_No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roo Reroof, Install Siding, Construct Deck, Shed, Pool,
epair/ epla , 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:
Owner's Name �Pc�t, e- �lt►T�
Address & Phone q ?) --�G-KW(M a*-7V4 7(D&3
Architect's Name
Address & Phone 1
Mechanics Name
Address & Phone
What is the purpose of building?
n 1 l�h/I�TiJ�J l
Material of building?� ��\�cS��V( , If a dwelling, for how many families?
Will building conform to law?II _Asbestos?
Estimated cost W•O City License# N A State ' e as #
�h• 310oo CA,-- q 1� �rovement
Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO:
No. 230-Zoo�j
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
!!7f g %-3 10
AP VFD
INSPECTOWOF BUILDINGS
0408 JEFFERSON AVENUE 230-2004
cJS#: 8267 COMMONWEALTH OF MASSACHUSETTS
Map -T 31 s, CITY OF SALEM
Block:
Lot: 0090
Category: 434 Residential: additi
Permit 230.2004 BUILDING PERMIT
roject# JS-2004-0372
Est. Cost. $6,000.00
Fe�$41.00
Const. Class: , PERMISSION IS HEREBY GRANTED TO:
Use Group: ., Contractor: License:
Vol Size(sq. It): 6600: UNKNOWN
Zoning: RI - Owner:_ MCSHAY, PAUL
Units Gained: Applicant: MCSHAY, PAUL
Units Lost: AT 0408 JEFFERSON AVENUE
Dig Safe#:
ISSUED ON: 11-Sep-2003 AMENDED ON: EXPIRES ON: 01-Mar-2004
TO PERFORM THE FOLLOWING WORK:
230-2004 REMODEL KITCHEN. TJS
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Electric Gas Plumbing Buildin
Underground: Underground: Underground: Excavation:
Service: Meter: Footings:
Rough: Rough: Rough: Foundation:
Final: Final: Final: Rough Frame:
Fireplace/Chimney:
D.P.W. Fire Health
Insulation:
Meter: Oil:
Final:
House# Smoke:
Water: Alarm: Treasury:
Sewer: Sprinklers:
THIS PERMIT MAY BE REVOKED BY THE CITY OF SALEM UPON VIOLATION OF ANY OF ITS
RULES AND REGULATIONS.
Signature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
BUILDING REC-2004-000389 29-Aug-03 477 $41,00
GeoTMS®2003 Des Lauriers Municipal Solutions,Inc.
OF SALEM, MASSACHUSETT5
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
90 SALEM,MA 01970
TEL. (978)745-9595 EXT.380
far FAX (978) 740-9846 .
STANLEY J. USOVICZ, JR.
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the provisions of MGL c 40,S34,I aclmowledge that as a condition
of Building Permit# all debris resulting from the construction activity
governed by this Building Permit shall be disposed of in a properly licensed solid-waste
disposal facility, as defined by MGL c III,S150A.
The debris will be disposed of at: JrJ
Location of Fac 'ty
4igmnature of Permit Appli
Date�-
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
9PML
Name of Permit Applicant
Firm Name,if any
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-licensed solid-waste disposal
facility as defined by MGL cHI, S 150A, and the building permits or licenses are to
indicate the location of the facility.
i
CITY OF SALEM
BUILDING DEPARTMENT
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE O3
JOB LOCATION
HOMEOWNER
ADDRESS
HOMEOWNER
TELEPHONE
PRESENT MAILING ADDRESS tc)
The cement c\emption of"homeowners"was emended 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"assumes 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 req ' nts and that h/she will mply with said procedures and
requirements.
HOMEOWNER'S SIGNATURE
APPROVAL OF BUILDING INSPECTOR
See other side for state code
I
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 109.1.1—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 persoru 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 hither 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 form/certification for use in your community.