23 LEMON ST - BUILDING INSPECTION (4) �L11IMB A VE(D BY IRM
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CITY OF SALEM
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B '011MUM PERMIT APPLICATION FOR: '
PsmLk tm
(CIroN whlohwrr apply) , In" Skflnp, COnWW.DUK Shad, Post,
Olher:
PLEASE FILL OUT LEOWLY A COMPLETELY TO AVOID DELAYS W PROONO
TO THE INSPECTOR OF BUILDINGS;
The urdersipecl Why apples, for a psmik to btdld acoofft to the We.... rq
Owner's Name A*77 ep 4ri4,5r r
Address d Phone a_:s A47-wee o7- (TV 1 2y5- o x�3.
Awhkeot's Name
Address d Phone ( 1
MsaMnka Nano
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w o t on pqs it twmgt e o� �� owes
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OF PERJURY
DESCn-Frn m OP 1MORK TO BE DQNE
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MAIL PERMIT TO•
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PUBLIC PROPERTY DEPARTMENT
120 WkswN6TON STREaT, 3RD FLOOR
r SALa1r,MA 01 B70
TEL (978)743 595 EX'r.360
FAX (976) 740-9646
STANLEY J. USOVICZ, JR.
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the provisions of MGL c 40,S34,I aclmowledge that sa a cm&d u
of Bm7ding Permit S .all debris resulting from the constn>ctin aarvyy
governed by, this Building Permit shall be disposed of in a properly licensed solid-waste
disposal hd ty,as defined by M(3L c 1n SIX&
The debris will be disposed of at: atis2
Locaham of Facility
Sl>iatme o ermit Applicant Date
FULLY complete the following M&MNtM
(PLEASE PRINT CLEARLY)
Name ofPermit Applicant
-
Firm Name,if any
Address,City&State
The above statute requires that debris from the demolition, renovation.rehab or other
alteration of building or Strucnm be disposed in a properly-licensed solid-waste disposal
faality as defined by MQ,ca S 150A,and the building permits or license Rye to
indicate the location of the hcility.
CTPY OF SALEM
BUnZING DEPARTMM
HOMEOWNER UCENSE EKEMPTION
Pkm Prittt
DATE r-y�-.s y
JOBLOCATION
ADDRESS
H0ME0 ?m r79-
7�S
T LFPHONE
p�SEN'T MAII.AIG ADDRESS •��
The anent escmption of'homcow nets"was crnc>ded to include owoeroceapkd dwcmiv o[T9W0
Units a ka and to allow such homeown=to c 4ap an indiridud tot him who does pas�ess t not
Hctnsr..prwidcd than the owmei set ss supervhor.
DEFINITION OiF HOI&OW"Me on.vbkh tlwe h,a h
Penom(s)wbo owns s penal of land on which Wshe asides a buends tc*aide. o n* ttse srdkt
intended to K s one to two UnMy dwcllimg,smached a dctadKd smuctma mud sry t W be eurWWW
farm svucwm A pcnsam wbo connruas mmte than one home in s two-y on dorm, stxD W b to ma
a homeowner. such`homeopnd shaD submtit to the Bmlding OffieiaL,w da the building pa=L
Building Offuial,that brJOK be responstbk to all suit work pcfatned
The undcrsiptd'homcowtwr"Em macs rcTmbility for comPlitma whht a State Bundiq Code wd
otha appliiablc gas by-laws,rates smd tcgulatiaoi
The tmdersip d'homeowner"¢rube that he/she undvmw&the City of sakrn BuIldiq Dqw= t.
minimum k spc'tiom pmcrdum and rcgvircmcros and that INshe will comely with said p=dwu sud
requires. / �
HONSEOwNER'S SIGNATURE
APPROVAL OF BUILDING INSPECTOR
sm otber side fa sm is code
f �
HOMEOWNER'S EXEMPTION
The code states that: "any homeowner performinS work for which a building perntit is requb sbaD be
exempt from the provisions of ibis section (Section 10*.11-lSecosing of Conatruetioo SuptrvSsos*
Provided tbat is a honteowmm engages a person(s)for bire to do.such wont~that such bomeowm da so
as supervisoe .
Mary borneownen who use this exemption arc unaware that thry are assuming the teapoms%m q p f
supervisor (set Appcndh Qr Rules and Rcgolstions for licensing Construetlon SupuVIS01%Seeliaa
.2.13} This lack of awamicss often usttlu in serious pmbkmL%patieularly when tht k men =bin
undkc wed persons In this case you Board canm proccad asabm the mOccused prince u Illwttdd�
licensed Supcnisar. 7be bom "ver acing as supervisor is nldmate�rtsEonslbix,
To assure thm the hon mowntr is fully aware of IA4=mspouriblNes,rtmny eammmddes re IaM as paths
of the pcnait applieadvA that the homeowner certify that heJShe u dastartds the tuponsibmdes eta
supervisor. You may cart to amend and adopt suite a fonniccrdfica w for we in yom eoummu ft