18 PLEASANT ST - BUILDING INSPECTION CITY-OFSAL
PUBLIC PROPERTY
`• CK _ 7 5 DEPARTMENT r�
KPQF]UEY De1SCOLL
MAYOR 130 WASHINOLON b.MFET•SAta K MASSACHl:St-M 01970
TEI-,978-745-959S 0 FAx 978-730-9s"
APPLICATION FOR THE REPAIR, RENOVATION, CONSTRUCTION,
DEMOLITION OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING��
STRUCTURE OR BUILDING
1A SITE INFORMATION
77,
Location Name: Building: sc _.
Property Address:
Property is located in a:Conservation Area YIN Historic District Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land _
Name: k3 c=r n
Address:
Telephone: z — t
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use New
Demolition Existing
Approximate year of Area per floor (sf) Renovated
construction or renovation
of existing building New
&ief Description of Proposed Work:
K4
Mail Permit to:
What is the current use of the Building?
Material of Building? t✓ko o c/ If dwelling. how many units?
Will the Building Conform to Law? y� S Asbestos?
Architect's Name
Address and Phone
Mechanic's Name
Address and Phone
Construction Supervisors License# HIC Registration#
Estimated Cost of Project$ So `::' Permit Fee Calculation
Permit Fee$ Estimated Cost X$7/$1000 Residential
Estimated Cost X$11/$1000 Commercial
An Additional $5.00 is added as an
Administrative charge.
Make sure that all fields are properly and legibly written to avoid delays in processing.
The undersigned does hereby apply for a Building Permit to build to the above stated
2
specifications. Signed under penalty of perjury "
Date
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CITY OF SALEM
PUBLIC PROPERTY
DEPARTMENT
KI\OSERLEY DRISCGII.
MAYOR 120 WASHINGTON STREET♦SAI EM MASSACHUSET S 01970
TEL 978-74S-9595 0 FAx:978-740-9846
HOMEOWNER LICENSE EXEMPTION
Please Print
Date
Job Location
Home Owner Address S e �—
Home Owner Telephone 1 4
Present Mailing Address r� s
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 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 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 procedures and requirements.
HOMEOWNERS SIGNA
APPROVAL OF BUILD INSPECTOR
See other side for state code
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 —Licensing of
Construction Supervisors);provided that a Homeowner engages a person(s) for hire to do
such work, and the 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 of
Construction Supervisors, Section 2.15). This lack of awareness often results in serious
problems,particularly when the Homeowner hires unlicensed persons. In this case your
Board cannot proceed against the unlicensed person as it would with a licensed
Supervisor. The Homeowner acting as Supervisor is ultimately responsible.
To ensure that the Homeowner is fully aware of his/her responsibilities,many
communities require, as part of the Permit Application, that 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.
CITY OF SALEm
' PUBLIC PROPERTY
DEPARTMENT
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Coustructiom Debris Disposal Affidavit
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