14 LAURENT RD - BUILDING INSPECTION CITY OF ALE1
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PUBLIC PROPERTY
DEPARTMENT
KIMBFI I.EY DRISCOIL
MAYOR 120 WASHINGCON STREET JAiray MAiSAailStl'rs 01970 d
TEL 978-745-959S•FAx:978.740-9W -�Q
APPLICATION FOR THE REPAIR, RENOVATION, CONSTRUCTION.
DEMOLITION. OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Name: Building:
Property Address:
Property is located in a; Conservation Area Y/N _yyI Historic District Y/N_p 1_
210 OWNERSHIP INFORMATION
2.1 Owner of Land 1
Name: 6 �j [ tcre
Address:
2�h 1
Telephone: 7t/ �l — G SS
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use New
Demolition Existing
Approximate year of Area per floor (so Renovated
construction or renovation
of existing building New
Brief Description of Proposed Work:
5U,% ; ^ j �- VZ-',Oe)
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Mail Permit to: 1 �l �
T
What is the current use of the Building? 1Ap
Material of Building? U)eq-^�> if dwelling, how many units?
Will the Building Conform to Law? -e-3 Asbestos? dV 0
Archnect's Name
Address and Phone
Mechanic's Name
Address and Phone
Construction Supervisors License# HIC Registration#
Estimated Cost ofRrqjeet C oo°-6 Permit Fee Calculation
Permit Fee$ Estimated Cost X$7/311000 Residential
Estimated Cost X$11/$1000 Commercial
An Additional $5.00 is added as an
Administrative charge.
Make sure that all fields are properly and legibly written to avoid delays in processing.
The undersigned does hereby apply for a Building Per o bu'd t the ab ted
specifications. Signed under penalty of perjury
Date 2 7 D
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CITY OF SALEM
i r PUBLIC PROPERTY
DEPARTMENT
IOI.GW.R W DRmcom NGTON J'r&E r•SALEK\L%bSACH SM-M 01970
1+�p WA�W
�lAYoe 59S*FA>L 97a.7•W98d6
'It�J:978.7iS-9
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance
with the sixth edition of the State Building Code,780 CMR section 111.5
Debris,and the provisions of MGL c 40.8 34:
Building Permit p is issued with the condition that the debris resulting from
this work shall be dispos
ed of in a pmpe f1Y licensed waste disposal facility as defined by MGL c
111.s 150A.
The debris will be transported by: c Vol x
(nun of ltsular)
The debris will be disposed of in:
(name of facility)
(address of facility)
si Zoe
rmit applicant
data
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CITY OF SALEM
I. PUBLIC PROPERTY
DEPARTMENT
KIMBE.RLEY DRISCOLL
MAYOR 120 WASHINGTON STREE'1 SALEM,MASSACHUSErIS 01970
TEu 978-745-9595 • FAx:978-740-9846
HOMEOWNER LICENSE EXEMPTION
Please Print
Date 7 0 d
Job Location .Ci9✓/L �1 l
Home Owner Address .y✓�e.rT
Home Owner Telephone -7 8— —7 y rT /
Present Mailing Address ,i- �n
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 acts 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 or 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 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"certi t he/she underst s the City of Salem
Building Department minimum i pection roc dures an irements and that he/she
will comply with said procedur and re it ents.
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING INSPECTOR 1,FWc7
See other side for state code
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 —Licensing of
Construction Supervisors),provided that a Homeowner engages a person(s) for hire to do
such work, and the 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 of
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 a licensed
Supervisor. The Homeowner acting as Supervisor is ultimately responsible.
To ensure that the Homeowner is fully aware of his/her responsibilities, many
communities require, as part of the Permit Application, that the Homeowner certify that
he/she understands the Responsibilities of a Supervisor. On the last page of this issue is a
form currently used by several towns. You may care to amend and adopt such a
form/certification for use in your community.