21 VICTORY RD - BUILDING INSPECTION ,
13L-#lS-MOSTI�E fIL+D4r O AP41130VE0 By T44E
.IA ZC,T.DB PF311,1R Tp.A PERMIT .5FJNG GRANTED
CITY OF SALEM G /
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No Date
Is Property Located in Location of
the Historic District? Yes_No Build of I y rG 17)r 1
Is Property Located in
the Conservation Area? Yes_No 1
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
Repair/Replace, Other: Kn.sI\ V4uo-&� F
PLEASE FILL 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
specifications: /►
Owner's Name �3 �. ���» A JF �tsor\
Address & Phone ,"-I 'iIGhar/ R (q?k) F59 -0079
Architect's Name `
Address & Phone ( )
Mechanics Name
Address & Phone rr I F ( )
What is the purpose of building? me{case
oo S Y II T
Materfal of building? t,,trot)\ ce J If a dwelling,for how many families?
Will building conform to law? _V e 5 Asbestos? K o
Estimated cost p0 0 City License # N A State License #
(oS°' Rome Improvement /J— —
Lic. / zzt 1_
Signature of Xpplicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
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MAIL PERMITTO:
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APPLICATION FOR
PERMIT TO Nb
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PERMIT GRANTED
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CITY OF SALEM, MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
_ v
120 WASHINGTON STREET, 3RD FLOOR
SALEM, MASSACHUSETTS 01970
STANLEY J. USOVICZ, JR. - TELEPHONE: 978-745-9595 EXT. 380
MAYOR FAX: 978-740-9646
HOMEOWNER LICENSE EXEMPTION
Please Print
Date 9/± .o S I
Job Location 69 , v w�u r
Home Owner-Address j 1 ro. 9,
Home Owner Telephone 1 rV 007.
Present Mailing Address._,. : z , v„( a,
The current exemption of"Homeowners"-was.extended to include.owner-occupied
dwellings of two Units or less and to allow such homeown"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 requirements.
HOMEOWNERS SIGNATURES
APPROVAL OF BUILDING INSPECTOR
See other side for state code
I�
HOMEOWNERS EXUWUOR
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 109.1.1 —Licensing
of Construction Supervisors):provided that a Homeowner engages a person(s) 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 assuming the
responsibilities of a Supervisor(see Appendix Q.Rules and Regulations for Licensing
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 a part of the Permit Application,tlist the Homeownera issue is*that a
he/she understands the responsibilities of a Supervisor. on the last page of form currently used by several towns. You may care to amend and adopt such a
form/certification for use in your community.
R� G�3of yaoS
�41e1�v! l4 OIC7
36"X 80" 38' 16"X 32"
door Window
9'
16"X 32" window
5'
11' 3'
26'
closet
13'
16"X 32" window
6'
Stairs
3'
10' 28'