193 1-2 NORTH ST - BUILDING INSPECTION (2) 44:AM MU T-BE ffL-E l APPROVED BY T44E
W5..P XTD-R PRID13 TD.A..PERMIT BEING GRANTED
CITY OF SALEM
No. Date Gl �3
oz
\°�irrnne a�°
Is Property Located in Location of
the Historic District? Yes_No Building LIACD
Is Property Located in ,n
the Conservation Area? Yes_No X"
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed Pool,
Repair/Replace, 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 /lAl2EAl 2. PIO Z .p
Address & Phone 196 A/aeT/V ST 079) Zed - 3/07
Architect's Name S" .gp S /Z. S. R-
Address & Phone GSs AeTsl)zoaTS AUE (qw) Yq l-Fggl 9
Mechanics Name
Address & Phone )
What is the purpose of building? STOk9 AGE
Material of building? L If a dwelling, for how many families?
Will building conform to law? YCiJ Asbestos? A16
Estimated costllll1v4f City License # N A State License #
Z o� Home Improvement
Up�giA Lic. 1
Si nature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO: 193 �A AfbleT1l sT Sh&n MI-) 01976
No. 2-0 c�Lj
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
/g �D 2.0
APR FD
Du�
INSPECTOR OF BUILDINGS
"p
CITY OF SALEM
BUILDING DEPARTMENT
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE f b 3
JOB LOCATION / 9 3/a /1/D e Zff s 7-
HOMEOWNER 17 3�a Mae l� 5 r
ADDRESS
HOMEOWNER 7 7§ 7 21,0 31D 7
TELEPHONE /� p
PRESENT MAILING ADDRESS//a /l/6,e 7 T, S'A1 n� hL/ 8�17o
The current exemption of"homeowners"was extended to include owner-occupied dwellings of TWO
Units or less and to allow such homeowners to engage an individual for hire who does not possess a
license,provided that the owner act 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 to be,a one to 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 to all such work performed under the building permit.
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and
other applicable goes by-laws,ndes and regulations.
The undersigned"homeowner'certifies that he/she understands the City of Salem Building Department
minimum inspection procedures and requirements and that h/she will comply with said procedures and
requirements.
HOMEOWNER'S SIGNATURE
APPROVAL OF BUILDING INSPECTOR
See other side for state code
A
HOMEOWNER'S EXEMPTION
The code states that: "any homeowner performing work for which a building permit is required shall be
exempt from the provisions of this section(Section 109.1.1—Licensing of Construction Supervisors);
Provided that is a homeowner engages a person(s)for hire to do such work,that such homeowner shall act
as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a
supervisor(see Appendix Q,Rules and Regulations for Licensing Construction Supervisors,Section
2.15} This lack of awareness often results in serious problems,particularly when the homeowner biro
unlicensed persons. In this case your Board cannot proceed against the unlicensed person as it would with
licensed Supervisor. The homeowner acting as supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of hi/her responsibilities,marry communities require,as part
of the permit application that the homeowner certify that he/she understands the responsibilities of a
supervisor. You may care to amend and adopt such a form/certification for use in your community.