24 MAPLE ST - BUILDING INSPECTION . t
I�SIMST- EfIL£ APPROVED By T44E
.IA pfXTDB PFI fl TP A PE MIT BfjNG GRANTED
CITY OF SALEM
Date
3 z3-d
No.
Location of / J
Is Property Located in Yea_No✓ Building
the Historic District?
✓ S JpGb�-
Is Property Located in Yeses No
the Conservation Area?
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) R of Reroof, Install Sidin , C�o�tstruct Deck, a Y d�° e
Repair/ eplace, Other. 1� Cc�ltl /99n�
�-
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 ci building? t y,� �/
v. �"�
Malarial
Address & Phone
Architect's Name
Address & Phone
Mechanics Name
Address & Phone ►mac 0
Whet is the purpose of building?
It a dwelling, for how many families?
will building t orm to law?
Asbesto4Signaturet
�� / City License x N A Estlmated cosome Improvement
Lie. ant
HE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
xLe
r001� rya
MAIL PERMIT TO:
No.
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
APP OVfD
INSPECTO OF.BUILDINGS
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: 978-740-9848
HOMEOWNER LICENSE EXEMPTION
Please Print.
Dde
Job Location Z
Home Owner Address. L G L
Home Owner Telephone L — 0/
Present Mailing Add ='1
G ;
The current exemption of"Homeowners"was extended to include o
dwellings of two Units or less and to allow canes-occupied
hire who does not such honmowng,s W engage an individual for
possess a license,provided that the ownge cts as supervisor.
DEFINITION OF HOMEOWNER 4r
Person(s)who owns a parcel.of land on which he/she resides or�t to resida
on
structures accessory
which there is,or r intended to be,a one or two family dwelling, attached or detached
to such use and/or farm structt =. 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 fort 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
Y Building Code and other applicable by-laws and regulations.
The undersigned"homeowner"certifies that he/she
Building � �� the City a Salem
g Department minimum inspection p d requirements and that he/she
will comply with said procedures and req
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING INSPECTOR - �
See other side for state code
L_
f
ow I
HOMEOWNERg�(p'pION
for which a Building Permit is
The Code states that. „Any Homeowner Performing work
ensing
aired shall be exempt from the provisions of this section(Section a 109.1.1 f hire to
Supervisors):provided that a Homeowner engages Pemo
of Constnucti shall alit as Supervisor.
do such work, and that such Homeowner
ft
Many Homeowners who use this exemption are unaware that they are assuming
Q,Rules and Regulation for Licensing
responstaibilities of a Supervisor(see Appendix lack of awareness often results in serious
Construction Supervisors.Section eo This persons. In this case your
problems,Particularly when the Homeowner hires unlicensed
the unlicensed person as it would with a licensed
Board carnet proceed against
Supervisor. The Homeowner acting ad sups03 responsible.
To ensure that the Homeowner is fully aware of his/her re��ilities.many _
communities require. as a part of the permit Application, the Homeownera issue ithat
abilities of a Supervisor. On the last page
of helshe understands die d towns. you may care to amend and adopt such a
form currently r community.
form/certification for use in y .ou
CITY OF SALEM9 MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASNINGTON STREET. 3RO FLOOR
SALEM. MASSACNUSETTS 01970
STAHLEY J. USOytCZ, JR. TELEPHONE: 978-745-9593 EXT. 380
MAYOR FAx: 978-740.9848
Salem BUlldlna Denatrtmm�A
Debris DigmW 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
Chapter III, S 150 A. be disposed
of in a properly licensed solid waste disposal facility as defined by MGL
The`debris will be disposed of in:
U� r(Location of Facility
Signature 'f p 'cant
Date