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ITI! OF S° 'LEM
No. O ( .p Date �? S
Ward
Zoning District
Is Property Located In Location of
the Historic District? Yes_No✓ Building-- 10 L
Is Property Located in
the.Conservation Area? Yes_No _
BUILDING PERMIT APPLICATIO FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed Pool,
Repair/Replace, Other: 00
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 pe 7-el� AZh
Address & Phone 1193 0 c eRh -4 v 617f 7 el
Architect's Name
Address & Phone L 1
Mechanics Name
Address & Phone 11 ( )
What is the purpose of building?
Material of building? la-Ti "mBPh If a dwailing, for how many families?
Will building conform to law? Asbestos? ovr —
Estimated coo. 000 City Licenser State License r
,1320 7 Bone Improvement &X_0_t�
Lic. if
Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
7'0 6- i-AV-e
MAIL PERMIT TO: 3 U e- e0.1 4 v w
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CITY OF SALEM
BUILDING DEPARTMENT
HOMEOWNER LICENSE EXEMPTION
Please Prim
DATE ���18103
JOB
HOMEOWNER 5 m 2
ADDRESS ! _
HOMEOWNER �—
TELEPHONE O
PRESENT MAILING ADDRESS J �s j 0 G Cq�l ':;t L i,n/
The nurew ammpdon of"homeowners"was extended to include owner-occupied dwellings of TWO
Uniu or less and to allow such homeowners to engage an individual for hire who does riot possess a
license,provided that the owner act as supervisor.
DEFINITION OF HOMEOWNER:
Person(s)who owns a parcel of land on which hdshe resides or intends to reside,on which there it,or is
intended to be,a one to two family dwelling,attached or detached structures;accessory to such use and/or
farm suvcnaes. A person who constructs more Ban one home in a two-year period shall not be considered
a homeowner. Such"homeosme shall submit to the Building Official,on a form acceptable to the
Building Official,that Wshe be responsible to all such work performed under the building permit
The undersigned"homeowner"amines responsibility for compliance with the State Building Code and
other applicable goes by-laws,rules and regulations.
The undersigned"homeowner"certifies that hdshe understands the City of Salem Building Dep uma
minimum inspection procedures and requirements and that hlshc will comply with said procedures aced
HOMEOWNER'S SIGNATURE
APPROVAL OF BUILDING INSPECTOR (xe
See other side for state code
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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 him to do such work,that such homeowner dMU a*
as r-p •isA•A • _
Many homeowners who use this exemption are unaware that they are assuming the fesponsibiUties of a
supervisor(see Appendix Q,Rules and Regulations for Licensing Construction Superviwn,Section
2.14 This lack of awareness often results in serious problem,particularly when the homeowner hi m
unlicensed persons In this case your Board cannot proceed against the unlicensed person as it vmudd with
licensed Supenisor. The homeowner acting as supervisor is ultimately.responsible.
To ensure that the homeowner is fully aware of hAer msponsrbllities,many communities requim,as part
of the permit application,that the homeowner certify that ht/she understands the responsibilities of a
supenvisor. You may cam to amend and adopt such a form/certification for use in your community.
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