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BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof. Reroof. Install Siding, Construct Deck. Shed, Pool.
Repair/Replace. Other: S�o v e-
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS W PWCESSL40
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the following
specifications:
Owner's Name C� a r j e lr
Address a Phone a �a wy 07a ;�'J-7o
Architect's Name zj- W a r j asoh J rr
Address & Phone /'5 /!ci{ e r (77,5) 777 dT-d%7
Mechanics Name
Address & Phone L )
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Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPnON O WORK TO BE DOME
MAIL PERMIT TO:
No. �
APPLICATION FOR
PERMR TO
LOCATION
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PERMIT GRANTED
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INSPECTOR OF BUILDINGS
CITY OF SALEM, MASSACHUSETTS
` PUBLIC PROPERTY DEPARTMENT
L�
120 WASHINGTON STREET, 3RO FLOOR
SALEM. MASSACNUSETTS 01970
STANLEY J. U80V1C2, JR. TELEPHONE: 978-745-9593 EXT. 380
MAYOR FAX: 978-740-9846
HOMEOWNER LICENSE EXEMPTION
Please Print
Date o a2 o i
Job Location sfa/� /�,�✓ w�
Home Owner Address. (� �',/��ti r f, 7-, �Y
Home Owner Telephone 75'�/ 7
Present Mailing Addresa..
The current exemption of"Homeowners"was extended to include owner-occupied
dwellings of two Units or less and to allow such homed WuntO engage
possess a license Sag an sor.individual for
hire who does not
Po ,provided that the owriei'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 responsibilityfor compliance
ance with the
Building Code and other applicable by-laws and regulations. p State
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 % ,,a
See other side for state code
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I o M ZowNERs FEMAE
The Code states that: ,Any Homeowner performing work for which a Building Permit is
required�l be exempt from the provisions of this section(Section 109.1.1 —Licensing
of Construction Supervisors). provided that a Homeowner engages a person(s) for hire to
do such work, and that such Homeowner shall act as Supervisor.
Many Homeowners who use this exemptionar
e unaware that they are assuming the
responsibilities of a Supervisor(see Appendix Q.Rules and Regulations for Licensing
us
Construction Supervisors,Section 2.15). This lack of awareness often
result case you
problems,Particularly when the Homeowner h it p with ersons.a licensed
Board cannot proceed against the unlicensed P alven
Supervisor. The Homeowner acting as supervisor is ultimately responsible.
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To ensure that the Homeowner is fully aware of his/her responsibilities,many
communities require, as a part of the Permit Application,tlist the Homeowner certify that
he
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.
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