22 MEMORIAL DR - BUILDING INSPECTION TLA11VVT-9E VED BY TWE
MPZC=PRIOR TDA.PEH1jIT BEING GRANTED
CITY OF_SALEM
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BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Corte" Deck. Shed, Pool,
Repair/Replace. Other:
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS W PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the following
specifications:
Owner's Name o s K wG
Address & Phone
Architect's Name
Address & Phone ( )
Mechanics Name �G
Address & Phone
Whd Is tfw purpose of bWWrg? S'
Mslarisl of buYdW toes a a.dwarrg,for how mmy Inman?
Ww b:WN corrwm to law? —4>5Aabasbs? �(d
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re of Appli
UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
A� e uy SYSC l�L 3-L l7 e i,u �1�� 4z
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MAIL PERMIT TO: �G t2�Ul Tr- � 307�. ,)U�Pu,l. /1/ g70'03G7
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No. 7
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
7.b
AP VD
INSPECTOPI OF BUILDINGS
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CITY OF SALEM, MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET. 3RO FLOOR
SALEM. MASSACNUSETTS 01970
STANLLY J. usOVICZ, JR. TELEPHONE: 978-745-9595 EXT. 380
MAYOR FAx: 978_740-9846
HOMEOWNER LICENSE EXEMPTION
Please Print.
Date .
Job Locations ti�Q
Home Owner Address
Home Owner Telephone
Present Mailing Address P4 /Sn 3p 7 • r y Gy/� �i /crnb a3b7
The current exemption of"Homeowners"was extended to include owner-occupied
dwellings of two Units or less and to allow such homeowneto 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 then 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 that he/she understands the City of Salem
Building Department minimum inspection procedures and requirements and that he/she
will comply with said procedur requirements.
HOMEOWNERS SIGNAM74
APPROVAL OF BUILDING INSPECTOR
See other side for state code
r � a
HOMEOWNERS EXEMPTION
The Code states that: .Any Homeowner Performing work for which a Building Permit is
required shall be prompt from the provisions of this section(Section 109.1.1 —Licensing
of Construction 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 and egulationss fo rLig the
censing
`responsibilities of a Supervisor(see Appendix Q,
Construction Supervisors,Section 2.15). This lack of awareness ryeseriousase
problems,Particularly when the Homeowner im as iunlicensed
wo�irld with a licensed
Board cannot proceed against the unlicensed p a liven
Supervisor. The Homeowner acting as supervisor is ultimately respo
To ensure that the Homeowner is fully aware of his/her responsibilities,many
communities require+ as a part of the Permit Application,tfiat the Homeowner certify that
he/she understands the responsibilities of a Supervisor. on the last page of this issue is a
form currently used by several towns. You may care to amend and adopt such a
form/certification for use in your community.
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