13 LAUREL ST - BUILDING INSPECTION (2) -el— ,p
e4llSTif fHiED--AfJD APPROVED BY T44E
W5PECTDA ,PFXIR Tp A PERMT.BfJNG GRANTED
Y CITY OF SALEM
V 0 T A
No. > �Ctr .L �`\ Date f0 l7
Ward
\°ttrrsNeo�'D} Zoning District
Is Property Located in Location of /� /
the Historic District? Yes_No /K Building
Is Property Located in
the Conservation Area? Yes No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed Pool,
Repair/Replace, Other: ` 'H
oj-7'1t� T f�G
GZAITi kcd"-n-
l/Y
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 & in, If' jCjfri�y/�ffjf f
Address & Phone f 3 Lf�ieF ST (QA-6) 7 wS= 9 - 6
Architect's Name
Address & Phone ( )
Mechanics Name
Address & Phone n ( )
What is the purpose of building?
Material of building? If a dwelling, for how many families?
Will building conform to law? ��f Asbestos?
Estimated cost 3 QOd City License # State License #
Home Improvement
Lic. l
Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO: jet,, .e Ot-✓, -e r
No.
APPLICATION FOR
PERMIT TO
LOCATION / �}
"3 C/r 4 re 1 ✓� r
PERMIT GRANTED
///� � ,s
APP V�D
INSPECTOR BUILDI S
CTfY OF SALEM
BUnZING DEPAKTMM
IiOMEOWNEIL LICENSE MMOM01N
Pkase prig
DATE 21'
.1OBLOCATIONmomEowm
ADDRFS� � G
'HOMEOWM
T>z.EPxol�
PRESENTMA�II'?GADDRESE � 3 '
Tbc charoa cxc>ap�oa of homeowvcrs"was exmnded to irrctadc q v r gceapkd dwal6v of Tm
Units a ka andUccnw m allow such borowwrmts to an indhidu!1 fat hilt w�doer thol posaettt a
,.y wWtd tiz a the owner act as superrkw -
DEFAIITION OF HOA�OWNk7l
Pcnon(s)who owns a parcel of land on which Wabe resides or hurnds to tesidt;.on wtddh k
inrcr,dad w Ec,a one to Two family dwcllint sascrod of dctaded str»cw"Occ a w MA We unft
not be tansidaed
farm strucum A pesam who COT=cts mart than one home in a twat' reed
Such`h m v§mr' shalt s»brrat to the BuDding official.oa a farm seccptabk to*A
a •net. bk u all such work pafmmed mdar the boudba pout
Buildinild%g S Offhcial.OW hrJshe be responsh .
The undmighmd"bouxow•rxr"asaharas mponnbilily tot comylitmoc with tf►t State Ba tj Code 99
wha applicabk Sacs by-lava.roles and teS Aslic t
ccrtifies that hthhe tudassands The Ciq of Sakta Buik Depvaad.
The tmdcnigrcd'on pr cc4u" wm wiilh raid Fmk mad
. minimum insp�tion proccdmta and rcquv7dftt7
HO1v1E0W?aVS SIGNATURE
G
APPROVAL OF B=ING INSPECTOR
Sec otber side for stau code
HOMEOWNER'S EXEMPTION
The Code states that 'arty homeowmr performing wmk fvr wWcb a buDdb4 permit is regnLed sba8 be
c.� mpl from the ptommos s of this sccdon (Sectloa 7e91d—IJecosiog of Conaructloo Supt rvirore;
Provided that is a borrteowita ertgaga a persao(s)for Aire to do.such that sveb Domeowyer t3raD tslx
as sapavisae
Mara bonwowtten who use this exemption are ivawarc that they are asamaiag the TCpomidffida era
sttpervbm(sa Appcodir Q,Ruks and Replarions for Vatosiog Coostruedoa Supervisors,SWAM
.2.24 Ws lack of awwwms of-m resolu in scriour problems,particoWV when the Ummwaer Lbws
unliccrne. pemm In this Case yaw Board cannot proceed agaatst the w9kcased petloa as 1t would wid
lianred Supervisor. The Domeontxr aafng as wperv4or Is oldosteb ra�oosihN.
To ettstne that the homeowner is fully aware of hyber respoan'bMties,many cmwnmdda Tcqdm.as pan
of the permil applkadvA that the homeowner certify that WahC uukn nds the responsibnMes era
supcnisoe. YOU may care to amend and adopt a»ib a form/ecnifte dm ibr un in yewr cwg=dq,
PUBLIC PROPERTY DEPARTMENT
120 WASNINGTON STREET, 3RD FLOOR
SALEM.MA O1970
TEL. (976)745-9595 EXT.360
FAX (976) 740-9646
STANLEY J. USOVICZ, JR.
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the provisions of MGL c 40,S34,I acknowledge 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,S 150A
The debris will be disposed of at
Location of Facility
Signature of Permit Applicant Vale
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
L ov tI i C �yr Tffi�
Name of Permit Applicant
Firm Name,if any
r 3
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 b MGL c11I, S150A, and the building permits or licenses are to
� y
indicate the location of the facility.
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