26 SCENIC AVE - BUILDING INSPECTION fL111+6��EfIt�ND �ovr�8V ZiIE
JOISP�I06 POW TPA.P.URF AFM GRANT=
CITY OF_SALEM
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UWaINO PERMIT APPMCATION POR:
Pemlit t0:
(Ckola whiotwm apply) Rsroof. Ira" Skft COIW ud DOCK Shed, Pool.
PLEASE IrILL WT I E-0 MY i COMPLETELY TO AVOID DELAYS W PROMSSINQ
TO THE INSPECTOR OF NMI NM'
The ur4wsgrwd hereby spplias for a pamlk to build a0wmft to the folwMV
OwWs Name l' mac_ A-r�roU c=2-
Addrass& Phew ac- c�
Aratrkods Nanw
Address & Phons j 1
Meshsnics Name ,
Address A Ph"
V"Ia.r pupoM al buYdUlp7
uanar a buYdYp7 c.,, ,;�o .L r.dw.iww,to how rrNny grr�IM.4��'�cs=
wo kmam=ft n to hm? Mba"?
tylYmlW am rxro CAI Uoorw N A am umm•
SiprWun of Appiaant
SO= LINDER THE PENALTY
OF PINUM
DESCRWTION OF WOW TO BE DONE
MAIL PERMIT TO: D✓�
No.
APPLICATION FOR
PEIMtT TO
LOCATION
PERMIT GRANTED
20
IHS5PECVOA OF Bl8
CITY OF SALEM, MASSACHUSETTS
' PUBLIC PROPERTY DEPARTMENT
120 WASNINOTON STREET, 3RO FLOOR
SALEM, MASSACHUSETTS 01970
STANLEY J. UEOVICZ, JR. TELEPHONE: 978-748-9599 EXT. 380
MAYOR FAX: 978-740.9846
HOMEOWNER LICENSE EXEMPTION
Please Print.
Job Location
Home Owner Addrm c,
Home Owner Tel
Present Mailing Addr= aG
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 a license, -
possess cease,provided that the o
. _ ts as supervisor.
DEFINITION OF HOMEOWNER.
Person(s).who owns a paocel.of Landon which heJshe 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 shucques. A person who conatitucts
thaw one home in a two year period shall not be considered a homeowner Such more
"homeowner"shall submit to the Building Official,on a form acceptable to the Building
Official, that helshe 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 heJshe understands the City of Salem
Building Department minimum inspection procedures and requirements and that heJshe
will comply with said procedures and requirements.
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING INSPECTOR
See other side for state code
i
HOMEOWNERS EXMTIOP1
Codes that: "Any Homeowner performing work for which a Building Permit is
rThe equired shall 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.
May Homeowners who use this exemption an unaware that they am assuming the
Q.Rules and Regalationa for Licensing
responsibilities of a Supervisor( Appendix m serious
Construction Supervisors.Section 2.15). This lack of nlawareness often results
problems,Particularly when the Homeowner pins unlicensed Persons. is this case your
Board cannot proceed against the unlicensed Personas it would with a licensed
Supervisor, The Homeowner acting is ul responsible.
To ensure that the Homeowner is fully aware of his/her re bilities,many
communities require, as a part of the Permit Application- the Homeown er certify that
A
responsibilities of a Suporvisor• On the last Par of this issue is a
he/she under the respo by several
ne tower. You may care to amend and adopt such a
form currently
f0r�certification for,use in your community.
R� �I�IyaoS
CITY OF SALEM, MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASH I NGTON STREET, 3RD FLOOR
SALEM, MASSACHUSETTS 01970
STANLEY J. USOVICZ, JR. TELEPHONE: 978-745-9595 EXT. 380
MAYOR FAX: 978-740-9846
Salem Buildin¢ 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:
O o rM n 5 r-C-� (Location of Facility) �?C.
Signature of Applicant
Date