18 LINCOLN RD - BUILDING INSPECTION }
IN--A -MttST-BEfILiE APPROVED BY T44E
.WSRECTDR ,PEAR T-O.A.PERMIT B,EWG GRANTED
CITY OF SALEM
No. 152--ZO0 Date 3 U 03
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Is Property Located in Location of
the Historic District? Yes_No X Building 18 bwcot w Po Ay
Is Property Located in
the Conservation Area? Yes_No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, he 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 JOLAYUB Gyq U7'd 1 Eft
Address & Phone 18 L 1 V6 Q1, W P-0 (178 ) �yv-�YS6
Architect's Name
Address & Phone ( )
Mechanics Name
Address & Phone ( )
What Is the purpose of building? 57bIZA -
Material of building? (Aj 00 f) If a dwelling, for how many families?
Will building conform to law? y F.5 Asbestos? U D
Estimated cost If 2.00 City License # N P' State License 0
2po Lome Improvement X
Lic. 1. Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO: Pblewie 6;Vt1r 1,fv- 1iivca6r4, /204d
E
No. 1s2-2o�y
APPLICATION FOR
PERMIT TO
LOCATION.
1 S L i N CA L-" Iz p ,
PERMIT GRANTED
APPROVED
INSPECTOR OF BUILDINGS
LOT 4G
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LOTS 47, 48 0 49 LOT 93
RRER° 7408 t S.F
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CITY OF SALEM
BUILDING DEPARTMENT
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE -31 Jul 03
JOB LOCATION lP LjjucoLw Qn ad
HOMEOWNER I L i wLdL w 0o A4
ADDRESS
HOMEOWNER
TELEPHONE
PRESENT MAILING ADDRESS L/ NLo( w r-p A
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 he/she 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,Hiles and regulations.
The undersigned"homeowner"certifies that he/she understands the City of Salem Building Department
minimum inspection procedures and requirements and that h/she will comply with said procedures and
requirements.
HOMEOWNER'S SIGNATURE
APPROVAL OF BUILDING INSPECTOR
See other side for state code
s_
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 bites
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 hUher responsibilities,many communities requim as part
of the permit application,that the homeowner certify that he/she understands the responsibilities of a
supervisor. You may tare to amend and adopt such a form/certification for use in your community.
4 �oeu OF SALEM,- MASSACHUSE77S
3 PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
2
� '• 90 SALEMr MA 01970
TEL. (978)745-9595 ExT. 380
�Grna FAX (976) 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
resulting from the construction activity
all debris res
of Building Pe
rmit# g
governed by this Building Permit shall be disposed of in a properly licensed solid-waste
disposal facility,as defined by MGL c III,S150A.
The debris will be disposed of at: kp rj ✓t 7 N- S 10 j C AV Ti n j
Location of Facility
17 9/ i. 6 .3
Signature of Permi Applicant at
FULLY complete the following information.
(PLEASE PRINT CLEARLY)
2c) L J4 w/J (I-r4 v Y 1'} IFS`
Name of Permit Applicant
Firm Name,if any
/y Llluco
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 cIII, S 150A, and the building permits Or licenses are to
indicate the location of the facility.