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CITY OF SALEM
:f PUBLIC PROPERTY
DEPARTMENT
KIMBERLF_Y DRISCOLL
MAYOR 120 WASHINGCON STREET♦SALEM,MASSACHUSEM. 01970
TEL:978-745-9595 ♦ FAX:978-740-9846
HOMEOWNER LICENSE EXEMPTION
Please Print �p
Date
Job Location s GI�/, n,-Q -
Home Owner Address S2YK-P
Home Owner Telephone 7A —7yS�- S-S- Y-'
Present Mailing Address 5,ayr-2
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 requir ents.
HOMEOWNERS SIGNATURE Q
APPROVAL OF BUILDING INSPECTOR L G
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
communities require, as 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.
CITY OF SALEM
PUBLIC PROPERTY
DEPARTMENT
KIMBERL.EY DRISCOLL
MAYOR
IZO WASHING]ON S'LREE"C*$ALEM,MAssAcrlusetTs 01970
TEL 978-745-9595 ♦ FAx:978-740-9846
Construction Debris Disposal Affidavit
(required for.all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5
Debris, and c
and the provisions of MGL 40, S 54;
Building Permit# ___ is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
111, S 150A.
The debris will be transported by:
(name of hauler)
The debris will be dis�posse�d,of in
na=-
(name of facility)
(address of facility)
signature of permit applicant
date
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Salem Historical Commission
120 WASHINGTON STREET,SALEM, MASSACHUSETTS 01970
(978)745-9595 EXT.311 FAX(978)740-0404
CERTIFICATE OF APPROPRIATENESS
It is hereby certified that the Salem Historical Commission has determined that the proposed:
Construction ❑ Moving
Reconstruction ❑ Alteration
❑ Demolition ❑ Painting
❑ Signage ❑ Other work
as described below will be appropriate to the preservation of said Historic District, as per the
requirements set forth in the Historic District's Act(M.G.L. Ch. 40C) and the Salem Historic Districts
Ordinance.
District: McIntire
Address of Property: 59 Summer Street
Name of Record Owner: Susan Sillars
Description of Work Proposed:
Construction of deck and pergola screen at rear of house as has already been constructed.
Dated: June 9, 2006 SALEM HISTORICAL COMMISSIO
By: 9jzw� ��f�/
The homeowner has the option not to commence the work (unless it relates to resolving an outstanding
violation). All work commenced must be completed within one year from this date unless otherwise
indicated.
THIS IS NOT A BUILDING PERMIT. Please be sure to obtain the appropriate permits from the
Inspector of Buildings (or any other necessary permits or approvals) prior to commencing work.