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APPLICATION FoR
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LOCATION
PEFORT GRANTED
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CITY OF SALEM9, MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
SALEM. MASSACHUSETTS 01970
STANLEY J. USOviCZ, JR. TELEPHONE: 978-745-9899 EXT. 390
MAYOR FAX: 978-740-9846
HOMEOWNER LICENSE EXEMPTION
Please print
Date 1 I-710&
Job Location 341-C i- IvA (.92- Tr?E�a yr s�
Home Owner Addeest 46�- 7-R&40 yT 5r
Home Owner Telephone 7 a `�7 5 a181
Present Mailing Address 8 z T-(�c ruy•� sT—
The current exemption of"Homeowners"was.extended to include owner-occupied
dwellings of two URit:or less and to allow ndii
hire who does not such t the( to engage an individual for
possess a license,provided that the o as supervisor.
DEFINMON OF HOMEOWNER
Person(s)who owns a pmel.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
struchues 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 he that he/she understands the City of Salem
on procedures and requirements d
Building Department minimum inspecti
will comply with said procedures and requirements. an that he/s
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING
INSPECTOR
See other side for state code
mZOWNER —M—U" ON
The Code stasis that: "Any Homeowner Performing work for which a Building Permit is
re4�sW be exempt from the provisions of this section(Section 109.1.1 —Licensing
of Construction Suipetvison),provided that a Homeowner engages a Persons)for hne to
do such work, and that such Homeowner shall act as Supervisor.
Many Homeowners who use this exemption are unaware that they ate assuming the
t ,see Appendix Q Rules and Regulations far Licensing
tesponsibilitiea of a Supervise lack of awareness often results in serious
Construction Supervisors.Suction 2.15). This this case your
problems,Particularly when the Homeowner hires unlicensed
itc d�a licensed
Board cannot proceed against the unlicensed P�OII responsible
Supervisor. The Homeowner acting as supervisor is ultimately
To ensure that the Homeowner is fully aware of his/her bi one many
Gcationthe Homeowner certify that
communities require, as a Part of the Permit App On the last page of this issue is a
he/she understands the responsibilities of a Supervisor• - {such a
form currently used by several towns. You may care to amend and adopt
form/cettifieation for use in your community
R� �1301 goes'