17 LOVETT ST - BUILDING INSPECTION ,NVIF bEAJ0VJll(Y
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a itMST-BE fiLf�lfJ APPROVED BY T*IE
s "w LNS,p,X3.-,QI3 ,PF,tILaR TDrA_PERMT.BFJNG GRANTED
CITY OF SALEM
No. ' .td �`\ Date
Ward
Zoning District
Is Property Located in / Location of
the Historic District? Yes_No✓ Building
Is Property Located in
the Conservation Area? Yea_No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof Install Siding, Construct Deck, Shed, Pool,
Repair eplace, 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 "t"J
Address & Phone '1 t-K.f - o
Architect's Name vv\A'C�
Address & Phone Sr (g"g 3�
Mechanics Name
Address & Phone ( )
What Is the purpose of building?
Material of building? LL>mo,�L If a dwelling, for how many families?
WIII building conform to law? Asbestos?
Estimated cost Qd-C7D City License # State License #
Home Improvement
Lie. i
Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO:
i
f t
CITY OF SALEM
BUILDING DEPARTMENT
HOMEOWNER LICENSE E?MTION
Phase Prat
DATE tioI 1� 3
JOB LOCATION
HOMEOWNER t
ADDRESS
HOMEOWNER ' IC�cE -yogp
TELEPHONE
PRESENT MAILING ADDRESS
The eturent exemption of"homeowners"was emended to include owner-occupied dwellings of TWO
Units or less and to allow such homwwners to engage an individual foi bite who does not possess s
license,provided tltaa the owner act as supervisor.
DEFWCI70N OF HOMEOWNER:
Person(s)who owns a parcel of land on which he/she resides or intends to reside,ondch such rti err r is
intended to bc,a one to two family dwelling,anachcd or detached structures sc=ssm l
farm structures.A person who constructs mort than one home in a two-year period sball not be considered
a homeowner. Such"homcowrtei" shall submit to the BuDding Offtcisl,on a form aazptabie to*A
Building Official,that Wshe be responnble to all such work performed ruder the budding pemvl.
The tmdasigned"bomcowner"ammtes responnbility for compliance with the State Building Code mtd
other applicable goes by-laws,rules and regulations.
The undersigned'homeowrter" mrd5es that hdshe understands the City of Salem Building Dcparnromt.
minimum inTccuon procedures and rcgrnrcrnents and that h/she will comply with said proocdtaes sod
regttiremerrs
HONIEOWNER'S SIGNATURE
APPROVAL OF BUILDING INSPECTOR
See otba side for stam code
HOT7 O"ER'S EXEMPTION:
The code states that "any homeowner performing work for which.a building permit is required shall be
exempt from the prmisions of this section (Section 109.1.1-Liexosing of Construction Superviwr�;
Provided that is a homeowner engages a person(s)for hire to do.such work,that such bomeowaa shall act
as supervisor."
Many bomeowners wbo use this ca-empdon arc unaware that they are asstruing the;esponsr'bMtks Ora
supervisor (sex Appcudix Q,Rules and Regulations for Li¢nsioY COOstrUCtlnn Superviwrs,Seetba
.2.14 This lack of awareness often resuhs in serious problems,particularly when the homeowner hoes
unlicensed persoam In this case your Board cannot proceed against the unUcensed pmm. as it aould with
licensed Supcnisor. Mm bome"-Dtr acting as supervisor is ultimately renpousiblf.
To ensure that the homeowner is fully aware of Whet tmpoun'blbtie s,rrrany eomrawrlties TtTfirt;as VA
of the pennit application,that the homemrner ecrufy that hclshe mrdastands The re sponsibititia da
superisor. You may care to amend and adopt such a form/ccnification for ust in your eoarmttcQ.
o CITY OF SALEM9 MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
3 $ 120 WASAINGTOK STREET, 3RD FLOOR
SALEM, MA01970
.- ✓ TEL. (978)745-9595 EXT. 380
�p 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, S150A.
The debris will be disposed of at: I 1 �''�� `� S
Location of Facility
o.tmAx 1 X5
Signature of Permit Applicant Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY) l
Name of Permit Applicant
Firm Name, if any
1 '-15�-
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.