45 LINDEN ST - BUILDING INSPECTION f
�y, t iat9klfS9tnllSi$C f111{#'1Nfly A?PfIOVED BY T4FE
#�^ , ; • Sp DIB PFUDR TD,A.PEBMIT.B,EWG GRANTED
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CITY OF SA°LEM
No. / J �` �� Date AO D
Ward J
\Fcrmnea'� , Zoning District
Is Property Located in Location of
the Historic District? Yes_No r/ Building 4(5
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 C k U G- 2:�-/P /q u 1-4X
Address & Phone AI 6' CkD ER (9 70 7 1--/,5' -Q J4 71
Architect's Name
Address & Phone ( )
Mechanics Name E)
Address & Phone
What is the purpose of building?
Material of building? L-L)C)m �k If a dwelling, for how many families?
Will building conform to law? 4r-5 Asbestos?
Estimated cost /5'6 Q 0 N City License N State License p
Rome Improvement
Signaturb of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
tir i of c1�= (Rf—�1 4-CC /3 i4c►C sTrszr
MAIL PERMIT TO: 17L-q- L-r N D E—N S
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o CITY OF SALEM9 MASSACHUSETTS
' PUBLIC P03PERTY DEPARTMENT
3 120 WASHINGTON STREET, 3RD FLOOR
lam SALEM, MA 01 970
TEL. (978)745-9595 EXT. 380
FAX (978) 740-9846
STANLEY J. USOVICZ, JR.
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the provisions of MGL c 40, S34, I acknowledge 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, OA. l
The debris will be disposed of at: I
L cation of Facility
ign�ure of Permit Applic Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
14-- IR) d U L
Name of Permit 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 structure be disposed in a properly-licensed solid-waste disposal
facility as defined by MGL cIII, S150A, and the building permits or licenses are to
indicate the location of the facility.
CITY OF SALEM
BUILDING DEPARTMENT
HOMEOWNER LICENSE EXEMPTION
Please Prb9
DATE. c 33
JOB1 OCAnoN �F 5 Li cv P��i S fi
HOMEOWNERS` t N D
ADDRESS
HOMEOWNER 9 `7 7 of ,r —D 471
TELEPHONE (/ s
PRESENT MAILING ADDRESS 14 S h l R D Q—L
The emrcrd exemption of"homeowners"was cvtlAed to include orrncroccapied dwcllinv efTWO
Units a less and to allow such homers to rngage an individual for bite who does To posseta a
lieense,.pro`ided that the owm act as supervisor.
DEF241nON OF HOMEOWNER:
Pcrzon(s)who owns a patscl of land on which he/she resides or intends to reside,on w1dch thm h i.orsnd is
intended to be,a one to two family dwelling,anached or detached strucnaea aeQssor) to
farm sv ==.A person who constructs more than one home in a rwo-year period shall not be twnsidcmd
a homeowner. Such"homcow7xf shall'submh to tht Building Offrcisl,Ord a form aec ci?"k 10 tha
Building Official,that hclshe be responstble to all such work performed tinder the building permk
The tmderaigned"homeowner"asswnes resportnbility for compliance with the State Bundling Code and
other applicable goes by-laws,Tula and tcgulaticM
The undersigned"homeow=r certifies chat hdshc understands the City of Salem Building Depa mmst.
minimum inspection procedures and rcg6 mcrtts and that hlshc will comply with said ptocedums and
rcquirtsM++c
HOMEOWNER'S SIGNA
APPROVAL OF BUILDING INSPECTOR
Sec other side for state code
r
HOMEOWNER'S EXEMPTION
The code states that "any homeowner performing work for which a building permit is requited shall be
cxcmpt from the pravisiow of this section (Section 11.1.1-liaosing of COnstl7retl0n Supervisors);
Provided that is a homeowner engages a person (s)for hire to do.such work,that sueb bomeoww shall act
as SIIpUY1Sa.
Many bomcowncts wbo use this catmpdon are unaware that they an awrarinng the fesponstbilities of a
supervisor(see Appcodix Q, Rules and]ZtVIationsfor Licensing COnsirnetion Supervisors,SectiM
.2.14 This lack of swmness often resuhs in serious problems,particularly when the homeowncr buts
unlicensed pem s. In ibis rase your Board cannot proceed against the unlicensed person as It'%VWd with
licensed Supcnisor. Tire bomeorver acing as supervfwr is Ultimately mpooslbk.
To ensure that the homeowner is fully aware of Unver renpoun'bilities,marry eommuufti ies rtqube;as part
of the permit application,that the homeowner certify that he/she understands the resportsibi6ties at
supervisor. You may rare to amend and adopt such a formloenification for use in yav cmm um ft-