10 PURCHASE ST - BUILDING INSPECTION (2) .pL."W1 Wjr*EfV.f& f) *PPROVED eY im
W3 efa P4R TDA.PK8W BBWG GRANTED
CITY OF_SALEM
NO. DW
lmmat"u of
an", -m '. 01111W Y_,No 1aiLdlas �l� �rl S�
is Aop.ny LoWed In
Is Connwaaapn Am? Vat_No�
BWLDING PERMIT APPLICATION FOR:
Permit to:
(Ckole whichever apply) Roof, Rer00f, Install SWk4 Cauttuct Deck. Shed, Poo,
Rpsu/Replaa, Omen._
PLEASE Fill OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROCESS"
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permd to build according to the following
specifications: /1
Owner's Narno /Yi ��✓�`
Address & Phone Je Jk1Vr64,Q-2 5
Architect's Name
Address & Phone 1 I
Mechanics Name ,
Address & Phone
MaWW Of armrq? 1n/0D-V--> I a own&*,for how many fami"?
we Wift conform to law? AahaaWa?
Eaf o"oW )SOD My Liar=M N A Slam a
fro■. � � y
C
THE PENAL
OF PMUURY
D=R1F TWN OF WORK TO BE DONE
MAIL PERMIT TO: to Q�rcli�se � 5�� mH a,�,�
NO. ��
APPLICATION FOR
PEW
/T TO
LOCATION
PERMIT GRANTED
OVfD
Q
OR OF LDMIGS
" F
to /
CITY OF SALEM, MASSACHUSETTS
Q.
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
��NINB♦ SALEM, MASSACHUSETTS 01970
STANLEY J. USOVICZ, JR. TELEPHONE: 978-745-9595 EXT. 380
MAYOR FAX: 978-740-9846
Salem Building Department
Debris Disposal Form
In accordance with the provisions of MGL c40 S 54, a condition of your
Building Permit is that the debris resulting from this work shall be disposed
of in a properly licensed solid waste disposal facility as defined by MGL
Chapter III, S 150 A.
The debris will be disposed of in:
�rrrrSiL� (Location of Facility)
ASignLure o icant
/1 z; es---
Date
CITY OF SALEM, MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RO FLOOR
SALEM. MASSACHUSETTS 01970
STANLKY J. USOVICZ, JR. TELEPHONE: 978-745-9595 EXT. 380
MAYOR FAX: 978-740-9846
HOMEOWNER LICENSE EXEMPTION
Please Print.
Date zo d�
Job Location
Home Owner Address. tense
Home Owner Telephone '
Present Mailing Address
The current exemption of"Homeowners"was.extended to include owner-occupied
dwellings of two Units or less and to allow such homeo to engage an individual for
hire who does not possess a license,provided that the o is as supervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a Pawl-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 sttuchrres. 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 Ofbcial,on a form acceptable to the Building
Official, that he/she be responsible for all such work
Permit 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 i proved and requirements and that he/she
will comply with said procedures d r them n .
HOMEOWNERS SIGNA
APPROVAL OF BUILDING INSPECTOR
See other side for state code
HOMEOWNERS ELnx% oK
The Code states that: "Any Homeowner performing work for which a Building Permit is
shah be ac smpt from the provisions of this section(Section 109.1.1 —Licensing
required of Construction Supervisors),provided that a Homeowner engages a person(s)for him to
do such work,and that such Homeowner shall act as Supervisor.
exemption are unaware that they are assuming the
Many Homeowners who use this exemp ions for Licensing
rsponsibilities of a Supervisor(see Appendix Q,Rules and Regulatm serious
Construction Supervisors.Section 2.15). This leek n awareness s nS In�this case your
problems,Particularly when the Homeowner bins as It w�ould�a licensed
Board cannot proceed against the unlicensed p�OII responsible.
Supervisor. The Homeowner acting as supervisor is ultimatly4resp°
To ensure that the Homeowner is fully aware of his/her re o he Homeowner
many
communities requite, as a part of the Permit Application,
the omeowner cattily
that
A
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 can to amend and adopt such a
form/cerdfication for use in your community.
`I jO I Zoo S
R