14 RICE ST - BUILDING INSPECTION �4.1kNS{g1iSfi 9E f&E y1APMOVED BY T+IE
.LNSPZCJ.DB ,PFWR TD A_PERMIT BANG GRANTED
CITY OF SALEM /
Date
No. — "G v
s:
Location of \��( \,
Is Property Located in Building \\\ �
the Historic District? Yes_No l
Is Property Located in
the Conservation Area? Yes,No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install iding, onstruct Deck, Shed, Pool,
Repair/Replace, Other:
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:
Owners Name �I �'
Address & Phone � R �e S� 071)
Architect's Name
( 1 —
Address & Phone
Mechanics Name
( 1 —
Address & Phone
What is the purpose of building?
n a dwelling, for how many families?
Material of building?
WIII bulWing conform to law?
Asbestos?
C E�s�ated cod
7� — City License« N A state License #
Bane Imptove.ant KfiZgn=tureram• Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
i
MAIL PERMIT TO: 1 '
.1.
No. —
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
3f 30. �b� ZCy
A 0V D
N PEC 4 R OF BUILDINGS
CITY OF .SALEM, MASSACHUSETTS
J PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RO FLOOR
SALEM, MASSACHUSETTS 01970
STA14LRY J. USOVICZ, JR. TELEPHONE; 978-745-9395 EXT. 380
MAYOR FAX; 978-740-9846
HOMEOWNER LICENSE EXEMPTION
Please Print.
Date
Job Location /I/ R;ces�
Home Owner Addlees 1L?�P s F Sa lz wr
Home Mailing
Tel
Present:
Add�ras %7� �17s o351
The current exemption of"Homeowners"was extended to dude Owner-occupied
dwellings of two Unit$or less and to allow engage
n individual
him who does not such ho�leowngsito engage an individual for
possess a license.Provided that the owneti>cta as supervisor.
DEFINITION OF HOMEOWNER .. 4a
Person(s)who ovens a parcel of lard oe which he/she resides or intends to reside,on
which there uti or is intended to be,a one or two family dwelling,attached of detached
structures accessory to such use and/or farm structures. A person who constructs morn 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
Phi t, that he/she be responsible for all such work 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 inspection procedures and requirements and that he/she
will comply with said procedures and requirements.
HOMEOWNERS SIGNATURE(�S�s/iti�/�,,
APPROVAL OF BUILDING INSPECTOR
See other side for state code
eolt�owrl>E>�s�°N
The Code states that: "Any Homeowner performing work for wbich a Building Permit is
shall be exempt from the provisions of this section(Section 109.1.1 -Licensing
requiredided that a Homeowner engages a person(s)for bin to
of Construction Superviso srs);prov,Homeowner shall act as Supervisor'
do such work, and that such
Many Homeowners who use this exemption are unaware that they t assuminS the
g�
r(see Appendix Q,Rules and Regulations for
responsibilities of a Supervise
Constriction Supervisors.Section 2.15). This lack of unlicensed
dpe s ns results serious
problems.Particularly when the Homeowner hires unlicensed perso
unlicensed person as it would with a licensed
Board cannot proceed against
responsible.
Supervisor. The Homeowner acting as sup�nsor is ultime +
To ensure that the Homeowner is fully aware of his/her 11&the Hem.many
communities require, as a part of the Permit Application,tist the Homeowner eo of thia ispaue is a
responsibilities of a Superviaor. on the last page
he/she understands
towns. You may care to amend and adopt such a
form currently- r community.
form/certification for use in you
Row &I SO I SOV s
CITY OF SALEM, MASSACHUSETTS
• ♦ PUBLIC PROPERTY DEPARTMENT
120 WASMINGTOM STREET. 3RO FLOOR
SALEM. MASSACMUSETTS 01970
STAMLEV J. USOVICZ, JR. TELEPHONE: 978-745_9593 EXT. 380
MAYOR FAR: 978-740-9846
Salem Bnildina Dena_rtMent
' Debris DisnOsal 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:
-A )#' (Location of Facility) � e.m
r
ignature of Applicant
3I?-
Date