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60 PROCTOR ST - BUILDING INSPECTION ITY-OF-Vl L h' ' PUBLIC PROPERTY DEPARTNIENT KIMUFJLLEY DRISIXHl oo UU i MAYDI 120 WASHINGTON h MEET 1 ' Q S=s,�LWtncx�serts 01970 TEL'978-745-959S*FAx 97&740.98" APPLICATION FOR THE REPAIR. RENOVATION, CONSTRUCTION, DEMOLITION: OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING STRUCTURE OR BUILDING IIA SITE INFORMATION Location Name: 6�1Building: — -- Property Property is located in a; Conservation Area YIN Historic District YIN 2.0 OWNERSHIP INFORMATION 2.1 Owner of Land Name: Address: Telephone: 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 (so Renovated construction or renovation of existing building New Brief Description of Proposed Work: Mail Permit to: What is the current use of the Building? Material of Building? If dwelling, how many units? Will the Building Conform to Law? Asbestos? Architect's Name Address and Phone Mechanic's Name Address and Phone Construction Supervisors License# HIC Registration# Estimated Cost of Project$ Permit Fee Calculation Permit Fee$ - - Estimated Cost X$71$1000 Residential EsUmated 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 specifications. Signed under penalty of perjury X Date of N O \ L Ys W F 93 C� y o « D d a - O - r CITY OF SALEM PUBLIC PROPERTY DEPARTMENT KIMBERLEY DRISCOLL MAYOR 120 WASHINGTON STREET♦SALEM,MASSACHUSEI'IS 01970 TEL-978-745-9595♦ FAx:978-740-9946 HOMEOWNER LICENSE EXEMPTION Please Print Date 0—/(1/ TT Job Location �� U C° Home Owner Address Home Owner Telephone c-, Present Mailing Address 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 SIGNATURE & —� APPROVAL OF BUILDING 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. � PETTY"CASH oah FOR AMtUNT APPROVAL � A I J �YY RECEIVED BY i^.ury FORM�4109 I J i 746 -2� 11!&P164�t>!6i�E fL*q-#j*0 APPROVED BY T44E JFGTAA PRWR TDA.PE8IWT BEING GRANTED CITY OF SALEM is Pm ww Located in / Location of i 6 �/C 11 C f OG Me HiNwte owdw !�—/ kduiov la Is ftowy Locww In ft Conmer aMon AIM? NO WG PERMIT APPLICATION FOR P it o: (Cir ich r a IY Roof, Reroof, Install Siding, Constr t Pack. Shed, Pool, Repai eplace, Other: Cfid o✓i�-: PLEA t Ya4 COMPLETELY TO AVOID D PROCESSING TO THE O a UILDINGS: The i hgmtwv applies t a pe it to bu' rding to the following Owners e / ( !J Al O l�/1/ Address a one Architects Nam Address & Phone L 1 Mechanics Name ff C Agile C-� Address & Phone 3 (�a� Sf• �� UCheSf�� (y7y1 whM Is an gapesw of a,Ydrq? ��lM �Q �-- M.t«l.l a a,rdrq? �voo � ✓/fin.w+a�ww,»how many tanuGas? wN Ouk"=don to law? I<5 MCaaos? 4 � Wnwwa oast 5 00. " Cay Uconse s ►J o` emu um" e l S fag 779 ire Twtcrsowwat 4� LP C�P�c i'i`' + n Signature of Applicant SIGNED UNDER THE PENALTY DESCRIPTION OF WORK TO BE DONE OF PERJURY (oil .� MAIL PERMIT TO.. 1 7 No. ),I APPLICATION FOR f PERMIT TO ' LOCATION PERMIT GRANTED t ' 2.0 APf 9O- INSPECTOR OF BUILDINGS w CITY OF SALEM PUBLIC PROPERTY DEPARTMENT KINMERLEY DRISCOLL MAYOR 11-0 WASNINGTON STREET#$A1 FN .V(A,\SACHUSECIS 01970 TEL 978-745-9595 ♦ FAX:978-740-9846 HOMEOWNER LICENSE EXEMPTION Please Print Date /1//�- / 0 Job Location 6 , M 14 Home Owner Address Home Owner Telephone / 9 S' 9 as L4 ft Present Mailing Address S A,�-e- 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 regulaiiuns. 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 �L APPROVAL OF BUILDING INSPECTOR See other side for state code I 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.