Loading...
12 SAVOY RD - BUILDING INSPECTION (2) CITY OF SALEM PUBLIC PROPERTY DEPARTMENT YIMBERLBY DRMCOLL MAYOR 120 WASHINGTON S REer•SA cu MASSAaiuSEM 01970 7Ei-978-745-9595 • FAx:978.740-9W HOMEOWNER LICENSE EXEMPTION Please Print Date 03L6.507 Job Location I a S .4 V 0 V R A Home Owner Address f R g ,q y y R �, Home Owner Telephone 1� q q 9 . 7 4-q. 'r Present Mailing Address 1 a 5 R ve y R a F A-tIr— M A'14 ® /9 9Q 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. 1 C N S � es - ©3oaa4- HOMEOWNERS SIGNATURE ' 6XPIR6P �i a; og 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 Application, that the Homeowner certify that f the Permit A n, 'ties wire, as art o PP communities ran P of this issue is a Responsibilities of a Supervisor. On the last page he/she understands the Respo P You may taro-to amend and adopt such a currently used b se veral Y forth curr y Y form/certification for use in your community. EI`I OF E -- ` PUBLIC PROPERTY 'S' DEPARTMENT KI?WFJIIEY DRISCOLL MAYOR 1?0 WASHINGTON STREET♦SALLY MASSACNl;atITS 01970 TE:9'.&74S-9S9S* FAx:978-740-98" APPLICATION FOR THE REPAIR, RENOVATION, CONSTRUCTION. DEMOLITION OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING STRUCTURE OR BUILDING 1.0 SITE INFORMATION 1? 1; ['L ltC l "T W O C RA Ktr_0 Q f-ItST6✓; Cr-iyAt S Location Name: I a S A V o I? R L7 . Building: tZe S f=nfTA 2 ti a�vs Property Address: I�L S A VoY R 'D property is located in a;Conservation Area YIN Historic District YIN 2.0 OWNERSHIP INFORMATION ,po nr l+LC� 4- MA R Y M 1 L El A-uD 2.1 Owner of Land PoNA-L-D -t- HAkY M IG W-A vD Name: D o N A-I^0 -1- 1`t ►L i 6M Address: I S A V C GZ d Telephone: f • 01 78 • 74-4 - •`79 8 8 3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY Addition NO Existing 3 Renovation Y t-fS Number of Stories Renovated a Change in Use f j 6 New Demolition X5• Existing 1 3 'X 14' Approximate year of Area per floor On Renovated I S ' x 14 construction or renovation " of existing building New SAM G"�HA NG E Brief Description of Proposed Work: L, t vI Nr. RA t C-P Cf�_, IJ-ING PP.IkT - / NSTALI- tVt= R., -P-Ry w,aI.c_ Gj:/ L-/Iva ? XIA/r ev1lA_,, 1-401, d1N69 SCe- oND FL, ©arz $ Rr-AloUr, Pr, �sr�rz �� �h' 1�iNG F R � C � witH il� v wh-l. , IU w r RlTft -E- Lois !(v . - Mail Permit to: What is the current use of the Building? I? NTAL ' Material of Building? W d O A If dwelling, how many units? O N 1= Will the Building Conform to Law? Y F—:z S Asbestos? N O Architect's Name 'P R I V&rC- 'p L 4 N $Y O W rJ C— IZ Address and Phone 125HVbV RD.,,SAL6M Mh ( ( ) T 7 8 r) ¢4-, 74$ $ Mechanic's Name L.) B D 5 S f E K rz CO N S T 2 0 c r/d 1t1l, 1 131 C K f, R To IV $ Address and Phone C t t l•7 S ( 5-8 1 a 3 31 — 1. 617. 599. N M A • O /904- Construction Supervisors License# C S r7 3 A 74 6 HIC Registration# 10 4 3 / 7 Estimated Cost of Project$ 7I�Lcy 0• Permit Fee Calculation Permit Fee$ (o1 Estimated Cost X$7/$1000 Residential Estimated Cost X$11/$1000 Commercial [,,4 [3 ,ZASsFug An Additional $5.00 is added as an Administrative charge. Make sure that all fields are property and legibly written to avoid delays in processing. The undersigned does hereby apply for a Building Permit to build to the above stated ,r specifications. Signed under penalty of perjury X ���/�/Gk�%'1 �✓ Date xc °o •�' �� � . a o 3 o u 06_-- ---