27 UPHAM ST - BUILDING INSPECTION ,
ISL+rNe1AUSTIDE flLAWkwO APPROVED 8Y TW
JNBPECIDB PRIOR TO A.PEBWf BEING GRANTED
o CITY OF SALEM n
wane
Zaf*Q /�
M»WftMc Did"? YM Nolelg �tUmto
,/ Sla P/tij/
Qarawaon AM? Y41 No fL
Permit to:
BUILDING PERMIT APPLICATION FOR:
(Curds whbhem apply) Roof. Reroof. Install Siding, Cwmbv t Deck. Shed, Pool,
Repair/Replace. Other:
PLEASE RLL OUT LEGIBLY i COMPLETELY TO AVOID DELAYS W PROCEBWjQ
TO THE INSPECTOR OF BUILDINGS: 1.
The urrdereiprred hereby applies for a permit to build aocortLV to the bNowkp
speomoafts: �.
Owner's Name 2
Address A Phone 9 5 —
Archkeds Name
Address Q Phone ( )
Mechanics Name _
Address A Phone
IArMW a buldrg7 l P���ec �/� Na - ror now Nam anft9
We bA rig= a n to law' ��S ANfMbr4 //I
F.wnwNd aMt c3��py lkrrar r 8Mr t►oww r
t
SfprraWn of Appfic@Kt—
SNOW f;WR THE PO4ALTY'
DESCRIPTION OF WORK TO BE DONE OF PERJURY
MAIL PERMIT Tt7
L
APPLICATION FOR
PERMT TO
C�usn
LOCATION
PERMIT GRANTED
19
AP �D
/?"
INSPECTOR OF BUILDINGS
01
s CITY OF SALEM9 MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
SALEM, MASSACHUSETTS 01970
STANLEY J. USOVICZ, JR. TELEPHONE: 978-745-9595 EXT. 380
MAYOR FAX: 978-740.9848
HOMEOWNER LICENSE EXEMPTION
Please Print
Date
Job Location i� 7 ��//l�iy ST //110
Home Owner Address
Home Owner Telephone 1�7
Present Mailing Address ,
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 q irements.
HOMEOWNERS SIGNA
APPROVAL OF BUILDIN SPECTOR yw /�
See other side for state code
HOMEOWNERS EXEMPTION
The Code states that: "Any Homeowner performing work for which a Building Permit is
—Licensing
iequired shall be exempt from the provisions of this section CS a ection 109.1 �s) for hire to
of Construction Supervisors):provided that a Homeowner engagesPao
do such work, and that such Homeowner shall act as Supervisor-
x Many Homeowners who use this exemption
are unaware
Q Rules thatnd they am astions for ng th mg.
responsibilities of a Supervisor(see Appendix
Construction Supervisors, Section 2.15). This lack of awareness often results in serious
problems,Particularly when the Homeowner hrunlicensed it ld with a licensed
persons. In thi's case your
Board cannot proceed against the unlicensed person sor is ultimately responsible.
Supervisor. The Homeowner acting as supervi
To ensure that the Homeowner is fully aware of his/her responsibilities,wner certify that
communities require, as a part of the Permit Application,
of a Supervisor. On the last page of this issue is a
he/she understands the responsibilities
form currently used by several towns. You may care to amend and adopt such a
form/certification for use in your community.
K� I so I too S