97 LEACH ST - BUILDING INSPECTION (2) M
?.
j, N
-BE{. AfPROVEfl BY 'CIE
M
�I$p Tp}3 ,PF111pR TPA PERMIT BFUNG GRANTED T
CITY OF SALEM
No. / Date
Is Property Located in Location of
the Historic District? Yas No_ Building 9yak_
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: PAW T-, FIR si Fcro/z
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:
Ownees Name
Address & Phone LC�} cK <f- ON
Architect's NameT
Address & Phone / L
Mechanics Name
Address & Phone Z�aJ c q, f nst
What Is the Purpose of building? E4t�� n o7L
Materiel of building?
If a dwelling, for how many families? Z
Nil building cordoomt to law? / Asbestos?
Estimated cost Sr70, city License# N A State License #
Horace bwroveient
JAC' EhKature of Applicant
GNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE {
r
MAIL PERMIT TO:
No.
APPLICATION FOR
PERMIT TO
LOCATION.
PERMIT GRANTED
20r'X2
APP D
P ,.TOR OF B DINGS
t
• T
CITY' OF `3ALEM, MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON $TRIER, 3RO FLOOR
$ALIEN, MASSACNUS[TTS 01970
OTAMLLV J. USOVICZ, JR. TIELIE►NONIE: 970-745-959S EXT. 3a0
MAYOR FAX: 970-740-9844
Salem BAdlna Deoafte...
D_sbrh PLE0081 Form
In accordance with the provisions of MGL c40 S 54, a condition of your
Building Permit is that the debris resulting from this work shall be disposed
of in a properly licensed solid waste disposal
po al facility as def
ined b
Chapter III. S 150 A. Y MGL
The debris will be disposed of in:
(Location of Facility)
4aatum�re of Ap .cant
3 - ( 3 -uS
Date
CITY OF SALE11019 MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINOTON STREET. 31k0 FLOOR
SALEM. MASSACHUSCWS 01970
STANLET J. USOVICZ, JR. TELEPHONE: 976-745-9595 EXT. 360
MAYOR FAX: 976-740-9046
HOMEOWNER LICENSE EXEMPTION
Place Primt.
Dace
Job Location q 7 L f,?e-4 ST
Home Ownar Address oe Lear/ C' .. I
Home Owner TelephW I? s r
Present Mailing Address
c!n v t eaempam of"Hemwwnae wan,atmdal to inchidedwe owner occupied
tangs of taro,Unitt or h=and to allow such to mown % individual for
hire who does not possess a license,Provided that the owrre� as supervisor.
DEFINITION OF HOMEOWNER
Person(s):who Owru a pave/of land on whichWhichof he/she reside or intends to raider on
u. . intended to be,a one of two family dw
structure accessory to sac-use and/or farm sUraftft A suing or detached
than one home m a two year period shall not be considered homeownerm more
"lmmeownet"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
will comply with said procedures uiremmb requirements and
that he/she
.
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING INSPECTOR Q
See other side for state code
ON
HOINEOWNE1t3 EXEM� "
"MY HOmep°m�P
fmming work for which a Building Permit is
The Code states that: o
inquired shall be exempt from the PrO�OOi of thin mention(Section 109.1.1 —Licensing
PetsOn
a ( )a for hire to
of Construction Supavlsm)+PrOvadad that a Homaowna engages
do such work.and that such Homeowner shall act as Supervisor.
on are unaware that they are asmuming the
Many Homeowners who use this ex dix Q,Rules and Regulation for LicOM9
miles of a Superv�Or,(�0 m serious
�o�• • Section 2.11). This lack of awareness often results
Conatctxt►On SupeOm the Homeowner hired unlicaaeed Persons. In this case your
�1� P��'when &0 u��� as it would withal licensed
• Pin respond
Supervisor, The Homeowner acting son M -- l,
To ensure that the Homoowaer is fiilly swan of bia/har r o the Hties,many
that tiys omeownm cafify that
communities require. as,a part of the Permit APPlicati the feat page of this issue is a
lWahe understa O teeponp}bilitia of s Supwimor. on
used by se!erel towns. You may cars to,mead and adopt such a
form ctificlY
formlcatificstioa for use in yom- " unity.