1 SUMMIT AVE - BUILDING INSPECTION . �
�L�N6i�11i6��EfiL{-��MND APPROYED 8Y 7+IE
JdSPFCIt18 PRIDR 7D.A.PEFI6�IT&�1NG GRANTED
CITY OF SALEM
No.��� ;"` �' � o� 10 /e/ �.S
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Is Property Loeatod in lacation of �' �ny
the Hiataic Dlsl�idT Yes No� 8+�i]din8 (.��hM'`\' ' �
;� Carmarwtlqn AAa? Yas No�
BUILDiNG PERMIT APPUCATION FOR:
Permit ta
(Circle whichever apply) Roof, Reroof, Instell Siding, Construct D�Shed� Poo�.
Repsu/Replac�. Other.�lov�'�/urc
PLEASE FlLL 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
spec'rfications: -
Gwner's IVame r� � � /'��t ``�
I
Address & Phonel-�Summ�T�/e �/� � ( �'Z� �4�f�'l/3 "�,
Arc�itect's Name ���
Address 8� Phone `.351�t���� 197�s 1��°r 3Z
Mechanics Name '
Address & Phone � �
Whet Is the purpose or building9
M�txiel of bullding? u/ooG� 118 dweYing,lor how mer►y temiNes? �
YWY b�rWinq coMorm to law9_„ As�os7
EsWneted cosl Soo a Cm a �y���K N p' Sfa1a UoYnea N
���L, Bo�a Lprovarnt ��cG � 'v"'` ' —
�� � � Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
OESCRIPTION OF WORK TO BE DONE
c���,� ���' ,r�,��t � t�v�oo� �
MAII PERMIT TO:
No.361a
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
APPA&f D
(r 41,,n4
INSPECTOR OF BUILDINGS
I
t
STANLEY J. USOVICZ, JR.
MAYOR
Please Print,
Date /O / / z-1-
Job
Job Location/
Home Owner
CITY OF SALEM, MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
SALEM, MASSACHUSETTS 01970
TELEPHONE: 978-745-9393 EXT. 380
FAX: 978-740-9848
HOMEOWNER LICENSE EXEMP'T'ION
Home Owner Telephol
Present Mailing Addre_
/2-�;
-----------------
The current exemption of "Homeowners" was extended.to. include owner -occupied
dwellings of two. Units.or less and to allow such homeowner, to engage an individual for
hire who does not possess a license, provided that the owner'ects as supervisor.
DEFINITION OF HOMEOWNER-:, a
Person(s) who owns a parcel. of land on which he/she resides or intends toreside, on
which there is, oris 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 mon
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
POffiiccial, 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 1,
APPROVAL OF BUILDING INSPECTOR
See other side for state code
99MEOWNEIt3 EXEMPTION
The Code states that: "Any Homeowner performing work for which a Building Permit is
wired shall be exempt from the provisions of this section (Section 109. person(s)
1 )Licensing
of Construction Supervisors); provided that a Homeowner engages a persons) for hire to
do such work, and that such Homeowner shall act as Supervisor.
Many Homeowners who use this exemption are unaware that they are asswning the
responsibilities of a Supervisor (see Append Q. Rules and Regulations for Licensing
fO
Construction Superv-1 results in serious
isors, Section 2.15). This lack of awareness os ase your
problems, Particularly when the Homeowner hires as itw ed th a licensed
Board cannot proceed against the unlicensed person nsible.
Supervisor. The Homeowner acting as supervisor is ultimately respo
To ensure that the Homeowner is fully aware of his/her responsibilities, many
communities require, as a part of the Permit Application, tliat 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/cei tificadon for use in your community.
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