23 MOFFATT RD - BUILDING INSPECTION -P�I ll6i'9E f11E� APPROVED BY T+IE
JdSPFC1W PPWR TD.A.PERMIT BEING GRANTED
CITY OF_SALEM
Date A 3�0
Is Property Located in Location of `` � yt au(/Via Historic District? Yes No✓ Building d 3 u((e
Is Property Located in
tits Conservation Area? Yes No_
BUILDING PERMIT APPUCA71ON FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
Repair/Replace. Other: alvu F1,Oo,C 4-G R E Ss
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:
Ge-op-66 /Ir
Owner's Name GacG ', lvxo�"Opo Uk o S
a 3 m
Address & Phone f:q��M� MR, (97F-) 15�s-7a 78
Architect's Name
Address & Phone j 1
Mechanics Name
Address & Phone
What Is the purpose of building? /-�O m E
Material of balding? No o iy u a dweling,for how many families? -7�a O
WIN balding cordorm to law? YE S Asbestos? V
Estimated cost o City License Er N A State License e
Home Raptove..1 . 6.
Llc. 4
Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
00A)al Jr-r 5TOIk6U,4`f 1U 56-CCIVO Fl,002,
MAIL PERMIT TO: 0?3 J—T ll�
No.
APPLICATION FOR
PERMIT TO
lP1�y4,'IcQ n�n� S�ri� .
LOCATION
C;23
PERMIT GRANTED
AP AA VfD '
eta
INSPECTOR OF BUILDINGS
4
CITY OF SALEM, MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
14D SALEM, MASSACHUSETTS 01970
STANLEY J. USOVIC2, JR. TELEPHONE: 978-745-9595 EXT. 380
MAYOR FAx: 978-740.9648
HOMEOWNER LICENSE EXEMPTION
Please Print.
Date /D_ - / a7 005
Job Location
Home Owner Address g
Home Owner Telephone
Present Mailing Address v.. _ ..
The current exemption of"Homeowners".was extended to include owner-occupied
dwellings of two Units or less and to allow such homeownerp 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 t 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
"homeowner"shall submit toffi
the Building Oc'aI on aall not be form acceptable to a homeowner. S the uilding
Official, that he/she be responsible for all such t. work performed under the Building
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 procedures and requirements.
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING INSPECTOR
See other side for state code
I
HOMEOWNERS E7� TI0N
e Code states : "Any Homeowner performing work for which a Building Permit is
exempt from the provisions of this section(Section 109.1.1 —Licensing
required shall
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 that they are assummg'
::.
responsibilities of a Supervisor(see Appendix Q,Ames and Regulations for Licensing
lts in serious
Construction Supervisors, Section 2.15). This lack of awareness oft this seer your
Homeowner hires unlicensed persons.
problems,Particularly when the Homeo it would with a licensed
Board cannot proceed against the unlicensed person
Supervisor. The Homeowner acting as supervisor is ultimatgly responsible.
To ensure that the Homeowner is fully aware of his/he r �e H meowner certify sibilities,many that
communities require, as a pert of the Permit APP a e of this issue is a
helshe understands the responsibilities of a Supervisor. Oa the last P g t such a
form currently used by several towns-
form/certification for use in your community
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