190 LORING AVE - BUILDING INSPECTION -PWAS1d T-9EfKA94*A9 APPROVED BY T44E
jwtacTDB PP" TD A PE.13111
.fT ACING GRANTED
h� CITY OF SALEM
No. (J \ Date //- 3- o�
i"
is Property Located in Location of
do Historic District? Yea No sauding
Is Properly Located in
dre cawww won ABM? Yak No_
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) eroof. Install Siding. Deck. had. Pool.
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
motions:
Owners Name //G7 /Z/;� OZ t
Address & Phone (9a A,46- 2. Z
Architect's Name
Address & Phone j
Mechanics Name
Address & Phone ( 1
Whet Is it*pwpoes of aYbkp4 S/DSiN
M"M d blrlld4q? ///a tl a dwaft,for how many familin?
Will binding caMomt to law? yors Asbestos?
Esrrnated cost City LicenW 1 N A Stale Llow"
Lic.
Signature of Applicant
SKWED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WOR A TO BE DONE
MAIL PERMIT TO.
No.
APPLICATION FOR
PERM T TO
LOCATION
/90 La.e�n/c p-✓�
PEpp•//MIT GRANTED
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AP OVfD
OR OF BUILDINGS
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CITY OF SALEM, MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
SALEM, MASSACHUSETTS 01970
STANLEY J. USOVICZ, JR. TELEPHONE: 978-745-9595 EXT. 380
MAYOR FAX: 978-740-9846
Salem Building Department
Debris Disposal Form
In accordance with the provisions of MGL c40 S 54, a condition of your
Building Permit is that the debris resulting from this work shall be disposed
of in a properly licensed solid waste disposal facility as defined by MGL
Chapter III, S 150 A.
The debris will be disposed of in:
LD/Zz-'L!� Z4 UE (Location of Fac' ' —
Signature f Applicant
I - 3 - 0
Date
CITY OF SALEMO MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
40 SALEM, MASSACHUSETTS 01970
STANLEY J. USOVICZ, JR. TELEPHONE: 978-745-9595 EXT. 380
MAYOR FAX: 978-740-9846
HOMEOWNER LICEN
SE EXEMPTION
Please Print
Date
Job Location / Z
Home OwataAddeess. o
Home Owner Telephone
Present Mailing Address p UE
The current exemption of"Homeowners"was extended to include owner-occupied
dwellings of two Units or less and to allow such homeownr to engage an individual for
hire who does not possess a license,provided that the owner'acts 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 or 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 for all such work performed under the Building
Permit.
The undersigned"homeowner"assumes responsibility for compliance with the State
Building Code and other applicable by-laws and regulations.
The undersigned"homeowner"certifies t hdaho mrderyyan the City of Salem
Building Department minim ection procedures and require is and that he/she
will comply with said pr ures and req . ern
HOMEOWNERS SI
APPROVAL OF BUILDING INSPECTOR
See other side for state code
HOMEOWNERS 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
required
Supervisors). Provided that a Homeowner engages a person(s) for hire to
do such work, and 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 1 Mould v�dthed a licensed In this case Your
Board cannot proceed against the unlicensed p nsible.
Supervisor. The Homeowner acting as supervisor is ultimat9ly respo
3
To ensure that the Homeowner is fully aware of his/her r e Homeowner certify that
communities require, as a Part of the Permit App w this issue is a
he/she understands the responsibilities of a Supervisor. On the last page form currently used by several towns. You may care to amend and adopt such a
form/certification for use in your community.
R� GlsolyooS