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PUnUG PROPERTY DEPARTMENT
120 WASNINOTON a MWff,SRO FLOOR
' SALWA,MA 01 D70
TEL (970)74545" EXT.saw
FAX (076) 740-9 46
STAM AY J. U90VNZ, JR.
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
In umdaoce with the provisions of MGL c 40,SK I wkwwledp that as a camdidcm
of Bnildins Permit g .all debris nmdtmS from the comas wbvgy
Sovmed by this BuildiO8 Permit AaH be&goad of in a Popaly licensed SOH&waste
disposal S'ft.w dcfimW by M(L c jA SI3oA.
The deb&w1'11 be disposed of at Laps-�-f_ IDS I?SL4) Nl Cl
Ldcadam of Fadift
Sigoabue of e®it Applicant
FULLY complete the followioS infammadom;
(PLEASE PR r CLEARLY) \
Nn%-k�� w � (x �
Naa afre:�A��t
Fam Name,if my
Addmm,City k State
Mw above statute mqmrcs that debris from the demolitiM rwOvadon,mbab or other
alteration of bu&ft or a ucane be disposed in a properly-hewsed soH&waste disposd
facility ar defined by MGL cIM S 150A,sad the buikfmg pamits or licamr are to
iadieate the loesden of the facility.
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CTTY OF SALEM
BUnZING DEPARTMM
HOMEOWNER LICENSE E?MdMON
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Please Prime
DATE
JOB l ocAnaR1 /v Gt�wQP,� S l
• , }iOtriEOWI�A �0 �if�Gv.�.t..Pr S'
ADDRFS}i
NOMEOWN9t 97�7�/�J •
TEL PROW
PRESENT MAILING ADDRESS = ld
The cw.m9 ctearytmon of"homcow=C was cxtctdcd to bwlutk owuet-QCCupted dwslliop a[TWO
Units a less sad toshow such bomeowttas to ahgagc an ithdivmdud ios hive who dom am poser a. .
lmccnse,.provwtd tlumthq owner Oct as supotvsx
DEFIKMON OF HOMEOWNkR is
Person(s)wbo awns a psrul of land on which belshe resides or intends to tsaidq on wltkih isa�
into w to bc•a one to two farm y dwelling anadhed of dctadhed wucttaes �tmM to=ch'Ast aol be� w
farm svucumL A person who construes sort than tmc boom b �at�bk b rust
a bumcouildi g OQ. Suds t btJsht be pombsubno sU such work pafortned wmsu the bumldiog 1c
Building OlTicid,that hclshc be respothsh ,
The undenigned-homeow=r asstanes tcsWusiblft for wmplm=with the State Bandkg Code and
other applicabk lots by-laws,rules and tcguladous,
The tmdasigned-hoinwwn 'o atffirs Chad hdahc hudcstsrds the City of Sakan Bnildmg Depvv=K.
d7za aid
• mini.—inspction proczd hots arhd m=umm wW 11011Jshc will comPly v t mid PlO
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requirt� 2 1
HoNeOWNWS SIGNA
APPROVAL OF BUILDING INSPECTOR
See other sde for state Cade
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HOMEOWNER'S EXEMPTION
The code states that: 'any honuowrur performing wvA for which a building permit is re pbvd aball be
exempt from the pm+isioru of this section (Section 10p.Li-licensing of Coestruetim SuptrvisorQ
Provided that is a home %ma engages a person(s)for Wrt w do.such work,%bat such bomeowaer deer➢atx
as supernm..
Marry bomeownen who use this exemption arc imawart that they arc assturba the rrapo des aft
rvis rapcor (oft Appcodla Q,Rules and Regulations for lJctnsing Construetioo Supervisors,Saca am
.2.in This leek of ewarnnew often results in strions problems,particularly when the bomeowner blism
unlicensed perwm In ibis case your Board eamtot procccd apbm the unlit person as k wvold vi&
licensed Supcnisar. The bomeonver sling as supery sor is uidsmtcly resEom%k
To ensue that the homeowrcr is fully aware of W&U rcrp=nbi)itiM mmry oommmdda requite;as past
of the permit spplioBorq that the bomwwner certify that helshe undemunds the respossibilidu eta
super Abac. You may cart:to amend and adopt such a formlecnT=tim for toe in yom eeotmmnby.
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\ APPROVED
Loncre}� Founga� io Subject to approval by any othsr
authority h}57ky Si=L'-`3siC'L?GIl.
?LA';"F.°E PRGt'ED SOLtLY FC.'.iC::".^.'i;';C=:i:iliJ OF
1 I` TYFE AND LOCiV—1 CN OF Fi-'F V,tal�7.13TM 054iCES.
.ALL FIRE: PROTECTION Drying ^... .CC,^»gCi'To A
r EST AND INSPECT-ION,FOR CO!+I FLUE CQMPU'
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\ "ire Department
48 Lafayette Street
Robert Sa�, Massachusetts01970-36 29 Fort Av
R. 95
Chief Tel 978-744-1235 Fire Prevention
978.744-69910 FaX 978-745-4646 g Bureau
978-745-7777
FIRE DEPARTMENT CERTIFICATE OF APPROVAL FOR A BUILDING PERMIT
IN ACCORDANCE WITH THE PROVISIONS OF THE IMASSACHUSETTS STATE BUILDING CODE
AND THE SALEM FIRE CODE, APPLICATION IS HEREBY MADE FOR THE APPROVAL OF. PLANS
AND THE ISSUANCE OF A CERTIFICATE OF APPROVAL FOR A BUILDING PERMIT BY TBE '
SALEH FIRE DEPARTMENT) ( Ref. Sectioa 1133 of the Mass. Bldg. Code)
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JOB LOCATION• to LawrellCj }-
OWNER/OCCUPANT: ►7nAr.UJ eC1 %��_ Y
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'! ,I ELECTRICAL CONTRACTOR:
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FIRE SOPPRBSSION CONTRACTOR:
SIGNATURE OF
*APPLICANT: Le1� PHONE ► m�j �p _
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ADDRESS OF t A =z r y r
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at � APPLICANTsj Y x CZTY OT `"
¢ :TOWN �r1
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s ®' APPROVAL DATE., x < 'y �Ze,1�0O�r"'k ,r R„. 'w: '�"� r R W✓., e t
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Certificate of approval hareb ar
x ar pP y granted, on approved plans or 'submittal of a '
project details, by, the SALEM FIRE DEPARTMENT. All`�plaua are approved's0lelys,^"
for ideotlficatioa of,type and location of fireAprotection devices and"e' quipments
All„plane are subject to approval of any other authority having jurisdiction.
Upon complation, the applies t 'or installar(s) shall request an inspection and/or*
test of. tha fiie 'protection devices and equipment. (ADDITTIONAL REQUIREMENTS,`
SEE REVERSE SIDE,A-**) ,h-. I Y'
NEW CONSTRUCTION.
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PROPERTY LOCATION ,HAS NO COMPLIANCE WITH THE PROVISIONS OF
CHAPTER 148, SECTION 26a"0/E, M.G.L., RELATIVE TO THE INSTALA
TION OF APPROVED FIRE AL.iRM DEVICES:" ,THE 'OWNER OF THIS PRO- '
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PERTY IS REQUIRED,TO OBTAIN COMPLIANCE:AS A CONDITION OF
OBTAINING 'A BUILDING- PERMIT.
n PROP1 RTr LOCATION IS IN tJ1IFLIA1CNE.;t;I1,H 171E PROVISION OF CH:\YT. ,F
148, SECTION 26 rF N.r,`'
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` In compliance with the provision of Section 113.5 of the Massachusetts
State Building Code, and under guidelines agreed upon by the Salem Bldg.
Inspector and the Salem Fire Chief, the applicant for a building permit
shall obtain the Certificate of Approval (see reverse side) and stamped
plan approval from the Salem Fire Prevention Bureau.
Said application and approval is required before a building permit may be
issued. The Massachusetts State Building Code requires compliance
approval of the Salem Fire Department, with reference to provisions of
Articles d and 12 of the Building Code, the Salem Fire Code, Massachusetts s
General Laws, and 527 Code of Massachusetts Regulations.
The applicant shall submit this application with three (3) sets of plans,
drawn in sufficient clarity, to obtain stamped approval of the,Salem Fire
Department. This applies for all new construction, substantial r .
Alterations, change of use and/or occupancy, and any other approvals.
required by the Massachusetts General Laws, and the Salem Fire Code.
Hxceptlon: Plana will not 1e required for structural work when the
proposed work to be performed under the building 'permit will
not, in the opinion of the Building Inspector, require a.
plan to show. the nature and character of the•work to be
performed. _
Notice: Plans are normally required for fire suppression systems,
fire alarm 'systems, tank installations, and Fire Code a
requirements. C
,
Under the provisions of article 22 of the Massachusetts State=Building
I " Code,S certain proposed projects may not require submisalon 'of;plans or
[ - complete compliance with new construction- requirements. In these
cases, provisions of Article 22,''Appendlx T, and Tables applicable
s shall apply. This section. shall not;. however, supersede the
"y provisions outlined in the Salem Fire Prevention Regulations, °Chapt.er `
118, MGL,`or 521,,Code of Massachusetts Regulations'. ;All permits for '
fire code use and/or occupancy shall apply, for the entire. structure;,..
fire alarm and/or smoke detector installation,'shall apply to the
entire structure based upon current requirements as per Lacs and/or s
s Codes, but the existing structure may comply with regulations
applicable for existing structures. }
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Notice: Sub-contractors may also be required to .file individual
applications for a Fire Department Certificate of .kpproval
for the area of their work. Such sub-contractors shall file
an Application to Install with the Fire prevention Bureau.
prior to commencing any work for those areas applicable.