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27 SURREY RD - BUILDING INSPECTION • V 1 fw1p �E+�lr� Af1MOUEp er ZiiE PIER TO A.MW ARM GRANTED CITY OF SALEM v� can wod- m�oiwa b1 OYMo14� Yo�No� Lrtiw of ESL cr,"QZ. animsma w Pf* b toowd In rw GW=rAroe AwN . YN,_ND bL- Pormk b: WJLD M PEIMNT APPLICAIM FM (Chb whiall W apply) ppgl._=row-81d' CW4VW OSok. Sh4 Pook PLEAD PILL WT L EMLY A COWLrMY TO Av=DELAVS N PpOXXO� TO THE Q'IBPG TOR OF flJWNW '. nd hW* taft for a Mmk b build a000rd�+q b the foft&" 0~8 Name Address A Phan» f�icC2am AMhb t'a Nona Address it Phone — Msohenks Nam. Address A Phone wu bNOW mdm to r.rr t�gdom Dom M f,U1 air o, d 1� Lin. r SWO116 of Aaph=t INM UIID TIT TY' OMCMIMN OP WORK TO U DONE of PfuwRr MAIL PEFUT a APPLICATION FOR PERIETTO AV LOCATION PEREQT GRANTED 30iz t� INBPEC'TOR OF IBLK.DWM CITY OP SALtM9 MASSACMUSKIrTs i PtJ@uC PRopeaw DVARTMa mT 120MAIAMIM M M ARIIAR. aa'oFUMn SA—M,NA alt 070 TEL(070)749-911 11 tn.340 Is RAZ (1176) 7404MMO sTAML6V A Y MOVIC& JIL MAM D1940 L OF DBBiRi=AlmAVlf TO Aoaadm riff 68 POvidM a(]IM a 41%M I admorlWp ag 0 a cosdi = aHdmb f Poo N .21 dabda raEft i m So cambiwdm ac*4W pad by this>Ih remit Aft be d ""offs a pr =%F H=Md aOlid-VIOR awl"5d o r dwk"by Ida a iQ S!!" 7%debdA wM be dt%wW afat tA .LACNIM.,�aeiltgr M of Pmadt Applf Dow FULLY eaq*to du fbilorlog mhmW= (PIFAM PRW C LLUMV) XMI OfPiemit Apylfad ------------- Firs Namar if mW AddmW City•$ 6 �=119- mo 7110 AWMI 99M requ a 1119 ddm ftm (ba dasolit M rAapva"116 r"of OdW &azdw of bwl&j a At ucftw ba diapoaad W A plrlperfy.lx=W 5011d-raata d qWW fia*ai&&W by MM caL S15ft and ft builduppanWtA a jic..my t4 i CITY OF SALEMt MASSACHUSETTS PUBLIC PROPERTY DEPARTMENT 4D 120 WASHINGTON STREET, 3RD FLOOR SALEM, MASSACHUSETTS 01970 STANLEY J. USOVICZ, JR. TELEPHONE: 978-745-9595 EXT. 380 MAYOR FAX: 978-740-9846 HOMEOWNER LICENSE EXEMPTION Please Print Date $-t"1--zo 5- Job Location 2 S�Jcrvs, Home Owner Address �.- Home Owner Tel hone � �.$� '7V4 -4�42 � Present Mailing Address_�� s ��. , col 1 w. MA r�l°L'lb 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 "{ structures accessory to such use and/or f which there is, or is intended to be, a one or two family dwelling, attached or detached arm 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. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING INSPECTOR See other side for state code o HOMEOWNERS EXEMPTION The Code states that: "Any Homeowner performing work for which a Building Permit is og.1.1 —Licensing required shall be exempt from the provisions of this section(Section a 1person(s) for hire to r Construction Supervisors);provided that a Homeowner engages do such work, and that such Homeowner shall act as Supervisor. e this exemption are unaware that they are assuming the ers who use in Many Homeowners Rules and Regulations for Licensing responsibilities dix ,R see A en Q Cojstutio of a Supervisor( pp lack of awareness often results in serious Construction Supervisors, Section 2.15). This 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 a part of the Permit Application,that the Homeowner certify that responsibilities You maazcaze to amend and adopt suchisor. On the last page of assue is a he/she understands the form currently used by several towns. y form/certification for use in your community. K� �13o I yoo S