11 RAWLINS ST - BUILDING INSPECTION (2) f1-MSi WV-gEf D APPROVED BY T*E
JdSP�CIIOB PRIOR TDA.PE a f AEWti GRANTED
CITY OF_SALEM
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is PmpwtyLacmW in location of
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BLULDRia PERWT APPLICATION FOR:
Permit to:
(Circle whichever apply) Root. Reroof, Install SiCikg , Conetr O Deolr.�Pool,
Repa fleplaoe. Other
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS W PROCESSM
TO THE INSPECTOR OF WILDING&
The undersip W hereby applies for a permit to build acoordinp to the tolbwk V
specifications:
Owner's Name /24wy- al.tt.4.sr
Address & Phcne (sf ) y'7a - 7yf s7�
Architects Name
Address & Phone j 1
Mechanics Name
Address & Phone ( 1
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MO W of bulldYg? Fd6a a a dwsov.for how mmy taman?
we bA*v cwdom to law? Aj Mbwm? A)
EarimW coal O° CYy uoww o W/o. mw uo •
s Are
Sowurg of Applicant
SW= UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORT(TO BE DONE
sr dA cS/ P
MAIL PERMIT TO:4"wWr; sf 5y/x-n alb
r
1 1
S
No.
APPLICATION FOR
PEFOW TO
LOCATION
PERMIT GRANTED
A=
INSPECTOR BUILDINGS -
j
4'
CITY OF SALEM, MASSACHUSETTS
• PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RO FLOOR
SALEM, MASSACHUSETTS 01970
STANLEY J. USOVICZ, JR. TELEPHONE: 978-743-9599 EXT. 380
MAYOR FAX: 978-740-9846
HOMEOWNER LICENSE EXEMPTION
Please Print.
Date /01-
Job Location1/_2A��r,i
Home Owner Address. S/l Pre,
Home Owner Telephone Z 7E 7Vr P706
Present Mailing Address.e.. 'fi4v a,
The current exemption of"Homeowners"was.extended to include owner-occupied
dwellings of two Units or less and to allow such homeownep.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 v
See other side for state code
n 2•.V
HOMEOWNERS E"-WnON
The Code states that: ,Any Homeowner perfortning work for which a Building Permit is
required shall be exempt from the provisions of this section(Section 109.1.1$for hire to
of Construction SupervLicensing
isors).providedthat a Homeowner engagesa Peron( �
do such work,and 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 awned �ns In lts�e case
ious
Your
problems,Particularly when the Homeowner him�it unlicensed
with a licensed
Board cannot proceed against the unlicensed p alven
Supervisor. The Homeowner acting as supervisor is ultimatgly responsible.
To ensure that the Homeowner is fully aware of his/her responsibilities,many
communities require, as a 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.
4
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