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Summ G PERWT APPLICATION IFOR:
Pernik to:
(Ckor whiotwwr apply) Roof. Rowl IMAM Sidklp, Construct Deck- Shed, Pool.
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PLEASE F%L OUT LEGIBLY A COMPLETELY TO AVOID DELAYS IN PROCESS"
TO THE INSPECTOR OF BUILDINGS:
The urrdersiprwd hereby applias for a permit to build accorclhp to Itw WWWMp
Owrw a Name J a IAVA m a VI4 K i
Address 3 Phone 5 /k o rd
Mriiteas Name
Address & Phew ( 1
Mechanics Name
Address & Phone j
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SSwim" of Applicant
SW= UNDER THE PENALTY
OF PwULARY
OESCR molkl OF WORT(TO BE DONE
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MAIL PERMIT TO: ��
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NO.
APPLICATION FOR
PERIIIT TO
LOCATION
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PERMIT GRANTED
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INSPECTOR(OF BULDINGS
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Salem Historical Commission
120 WASHINGaTON STREET,SALEM,MASSACHUSETTS 01970
(978)745-9595 EXT.311 FAX(978)740-0404
CERTIFICATE OF APPROPRIATENESS
It is hereby certified that the Salem Historical Commission has determined that the proposed:
❑ Construction ❑ Moving
❑ Reconstruction `l- Alteration
❑ Demolition ❑ painting
❑ Signage ❑ Other work
as described below will be appropriate to the preservation of said Historic District,as per the requirements set
forth in the Historic District's Act(M.G.L. Ch.40C)and the Salem Historic Districts Ordinance.
District: McIntire
Address of Property: 5 Monroe Street
Name of Record Owner: John Hermanski&Barbara Taylor
Description of Work Proposed:
Installation of pellet stove vent in location proposed andper specification provided conditional that vent be
painted the body color of the house and that during the off-season, when capped, that the sheet metal capping
be painted to match the body color of the house.
Dated: December 8. 2005 SAL JEM-HISTORICAL COMMISSION
-
The homeowner has the option not to commence the work (unless it relates to resolving an outstanding
violation). All work commenced must be completed within one year from this date unless otherwise indicated.
THIS IS NOT A BUILDING PERMIT. Please be sure to obtain the appropriate permits from the Inspector of
Buildings(or any other necessary permits or approvals)prior to commencing work.
CITY OF SALEM, MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET. 3RO FLOOR
SALEM. MASSACHUSETTS 01970
STANLEY J. USOVICZ, JR. TELEPHONE: 9711-743-9393 EXT. 380
MAYOR FAX: 978-740-984e
HOMEOWNER LICENSE EXEMMON
Please Print
Date 17-1
Job Location _ �, PVC b V% ro e— S4
Home Owner Address 4 m f
HOme Owner Tel 9 q
�>�—�Qs. ��1U Resent Mailing Addeees
The current exemption of"Homeownerewas.extended to include owner-occupied
dwellings of two Units or leas and to allow such homeowngstto engage an individual for
hire who does not possess a license,provided that the Owner''acts as supervisor.
DEFINITION OF HOMEOWNER.;
Pason(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,It one or two family dwelling, attached or detached
structures accessory to such use and/or fans 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
Peal, that he/she be responsible for all such 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 requiremen .
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING INSPECTOR ,
See other side for state code
]HOMEOWNERS QN
The Code states that. Any Homeowner performing work for which a Building Permit is
requiredshall be exempt from the provisions of this section(Section 109.1.1 — forbireto
of Construction Supervrsora). provided that a Homeowner engages a person )s
do such work, and that such Homeowner shall act as Supervisor.
lion are unaware that they are assuming the
Many Homeowners who use this exemption Rules and Regulations for Licensing
responsibilities of a Supervisor(see Appendix Q. often results in serious
Construction Supervisors.Section 2.1 S). This lack of awareness persons. In this case your
problems.Particularly when the Homeowner hires unlicensed
the unlicensed person as.it would with a licensed
Board cannot proceed against
sor is ul matgly responsible.
Supervisor. The Homeowner acting as supervisor
To ensure that the Homeowner is fully aware of his/her L 116 t rbi ome many
communities require, as a part of the Permit Application,dlat the Homeowner certify that
responsibilities of a Supervisor. On the last page of this issue is a
he/she understands the re eral can to amend and adopt such a
form currently used by several towns. You may
form/certification for I use in your community,
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