3 LEMON STREET CT - BUILDING INSPECTION (4) r'
IKAW MU T-EWE flLfG--Af 0 APPROVED BY T*IE
INSPEXTOR ,PRMIR TO A PERMIT BEING GRANTED
CITY OF SALEM
NO.�` `,;�'� ..� aii,T�\ Date
u�
�n
)� Ward
�°ncrmrveo°�� Zoning District
Is Property Located in Location of
the Historic District? Yes_No_ Building 3 �w�h S7 t!asL
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:
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
Address & Phone 3 59y _0
Architect's Name
Address & Phone ( )
Mechanics Name
Address & Phone
What is the purpose of building?
Material of building? li/ If a dwelling, for how many families? Z
WIII building conform to law? r/�_� Asbestos?
Estimated cost T 2 15 co City License # State License #
Home Improvement '
Lic. 1 ✓��
Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE'' \ f
MAIL PERMIT TO:
No. —6\
APPLICATION FOR
PERMIT TO
��Jj
LOCATION
3 Zoe"Q, / Cbti� f
PERMIT GRANTED
l �y 19
AP RDVFD
INSPEC R tV�.O.T[D—IRG.
cn y OF SALEM
B=ING DEPARTMENT
HOMEOWrNER UCENSE E?MOM0N
• ill
Pkase Pft
JOBLOCATION
HOMEOWlI 3 ono S
ADDIRX4
HOMEOp'1>a `17 c� Sri 4't7 L-I 0p
TELEPkom
pREs»MA11.It?G ADDRESS .
The nmert.exemi don of"ham tow'am"was...ded to include owoa•.O=Pkd.dwtm6v otTWO
Umi»a]as and to allow such bomeownas w 04W sn individuflfor bise wLo does sat posses d
L«mepruvidcd tbm the ow§w set Os w"rvisw"
DEFRIUT"OF HOMEOWNER
Person(s)who owns a pw=l of lad on wbicb bchhe resides a irucmds to reside,op wbieb is
j,,1C7Acd to be,a one to two tamdly dwell'mt sttadwd a dctadted ttrucum od shot mot be aonsldesd
farm sovcwCL A persat wbo constructs mac than are home in��on !aeon s al lM b to 11Ya
a bameawmet. Such"homcowaer shsII submdtaU tht Building:ufi work pctonaed ttndet ths:hoding ire
Building OS�cisl,do bcJshe be uspousb
.The undmigned-bouma ne ammms t Wnsibility for=MPRarrx sriilt the State Building Code ad
w
other appgcabk goes by-laws,rules and regolatiomt
The tvdasigned"homeowrrd =dyes that ltc/she undersu+tdt the Ciq of Salem Bnilding Deparrtwat
minimum inspatiom F=dares ad mquiremcros and that Nshc wW comply with SaW po=dom ad
rcquirtar�
HOMEOVVNFR'S SIGNATURE
APPROVAL OF B=ING INSPECTOR ,W
See otba side for sett code
• q;
HOMEOWNER'S EXEMPTION
The cods state tlmc 'am hcmeowncr performinj work for which s building permit is requb d shan tit
cwrmpt from the prv+isions of this scrdou (Scenes 2tlyl.2-L•ccnsing of Construction SoperAmme
Pravided that is a horneowma engages i person(a)for hire to do.such wvrlt,that such bomeowaa aitas tan
s nryovisa�' •
mwV homeowners wbo use this exemption are Gmware that they arc assm bg the TeVOMMUN.erg
suparism(ace Appcodh Q,7tolcs and Ittgulationa for 73ecosiog Coostruetion Supervisors,Seedw
.2.24 This lack of awareness often uralu in scrions problems.pardeubA r when the hOMWWaabbn
In this untliccrtsed persons case your Board cannot s the mtliamed a i;wtsuld
Proceed gsisut pa�on vj&
licensed Stnpmi%F. 71i;botncow ber acting as supervisor is nWaoate�r n�oatsibll.
To cum that the homeowner is fatly aware of hNser mspomsibilhks,=wT emmwd"regolr%as pal
of the permii applicedoq that the borneowrter certify that hchhe tmdaswsft the rssponsibllhia sta
super�iwL You may can to wacod and adopt sud a fornVou tiftcation for use in yarn coummuft.
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 9RD FLOOR '
SALEM,MA O 1970
TEL (978)74"595 EXT. 360 °
FAX (976) 740.9646
STANLEY J. USOVKZ, JR.
MAYOR
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I I�
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the provisions of MGM c 40,S34,I aelmowledge that as a condition
of Building Permit# all debris resulting from the construction activity
governed by this Building Permit shaft be disposed of in a properly licensed sOH&Waste
disposal facility,as defined by MGL c III,S 150A
The debris WM be disposed of st: ko r7q5."4P 6- n
Location of Facility
Srgnature of Permit Applicant Dam
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
Name of Permit Applicant
Firm Name, if any
Address,City&State
u �
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 cIII, S 150A, and the building permits or licenses am to
indicate the location of the facility.
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