21 LEMON ST - BUILDING INSPECTION 4i 1&ffiT-E fiLf� A?4AROYE0 BY T*IE
&SPECT,DI ,PRWR TD,A..PERMIT BEING GRANTED
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CITY OF SALEM
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No. I N8= OOV :��` '� °�. Date
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NB
Is Property Located In Location of / \n/
the Historic District? Yes_No_ Building 21z�m yj
Is Property Located in
the Conservation Area? Yes No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Constir It D ck, Shed,p 7l P ol,
Re aidRe la��, Other: Ge or rw
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PLEASE FILL OUT LEGIBLY & COMPLETELY TO AVOWS DE YS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the following
specifications: L Dw P� o M G CaL�1JtJ
Owner's Name Az/0 j/,,z6
Address & Phone
Architect's Name �—
Address & Phone ((1►►1 ` ( 1
Mechanics Name ()7s �/�/4&111 4
Address & Phone
What is the purpose of building?
Material of building? O `7 If a dwelling, for how many families?
Will building crw(?
to law? Asbestos? /1/y
V�NrnEstimated cos &.4< City License p N A State Li ns d
Home Improvement
$20- Lic. 1
ignature of App cant
CtG' t t°I`` SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
OAC uJr �u
S'
ote
MAIL PERMIT TO: ZI&2&L
No. I q IS - z_0 c� q
APPLICATION FOR
PERMIT TO
,QQ? t�.r�_ dG2S2atC1
LOCATION
PERMIT GRANTED
APPROVFD ff�
INSPECTOR OF BUILDINGS
CITY OF SALEM
BUILDING DEPARTMENT
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE
JOB LOCATI o2pf/�1 Gl
HOMEOWNER .2/ h ay
ADDRESS
HOMEOWNERS �77/z5-- 7PP2
TELEPHONE , /
PRESENT MAiLfNG ADDREss e5&�i V,,,J L a ;1 y �-
The cement 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 act 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 to 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 Wshe be responsible to all such work performed under the building permit.
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and
other applicable goes by-laws,rules and regulations.
The undersigned"homeowner"certifies that he/she understands the City of Salem Building Depanment
minimum inspection procedures and requirem an t b/she will comply with said procedures and
requirements.
HOMEOWNER'S SIGNATURE
APPROVAL OF BUILDING INSPECTORl� L
See other side for state code
,f
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 109.1.1—Licensing of Construction Supervisors);
Provided that is a homeowner engages a person(s)for hire to do such work,that such 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 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
licensed Supervisor. The homeowner acting as supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of hi/her responsibilities,marry communities require,as part
of the permit application,that the homeowner certify that he/she understands the responsibilities of a
supervisor. You may care to amend and adopt such a form/certification for use in your community.
�oxn Q 77— OF SALEM,- MASSACHUSETTS
3 PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
1, SALEM,MA 01970
'3r TEL. (978)745-9595 EXT. 380
�Grm� FAX (978) 740-9846 .
STANLEY J. USOVICZ, JR. -
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the provisions of MGL c 40,S34,I aclmowledge 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,S150/A.
The debris will be disposed of at: '.�?_ ( -
Location of Facility
l�3
Permi Applicant Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
Name of Permit Appli t
Firm Name,if any
cat I MtL -�2-' Y
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 by MGL cII1, S 150A, and the building permits or licenses are to
indicate the location of the facility.