14 WARD ST - BUILDING INSPECTION -pWM*IWT9Ef*AW4AD APPROVED BY THE
tmgpz I'OB PBWR TDA.PERW RAING GRANTED
CITY OF_SALEM
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BUILDING PERMIT APPLICATION FOR:
Permk to:
(Ckcle whichever apply) Roof,_Roro�. Instal Siding, Constnx:t Dsok. Shsrl. Pool.
(--Rspai lWpW".OFW
PLEASE FILL OUT LEGIBLY i COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The underagiod hweby applies for a permd to build accorft to the WIlowhp
specificabow
Owner's Name L n K i n -C- M i n cy4 G .
Address & Phone 14-16 ward Sf-
Architect's Name -
Address & Phone
Mechanics Name
Address & Phone
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W of bA*V? ,fir -t/ a a wralrp,for how many amaw? 1
WE bAft conform to law? Ash$"?
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41LINDER THE PENALTY
OF PERJURY
DESCRIPTION OF WOPA TO BE DONE
MAIL PERMITTO:
5
1 I
No. zfLo
APPLICATION FOR
PERMIT TO
lz
LOCATION
PERMIT-GRANTED
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APPROVPD _
0R OF EPAILDINGS
CITY OF SALEM, MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
` 120 WASNIN6TON STREET, 3RO FLOOR
SALEM. MASSACNUSETTS 01970
STANLEY J. USOVICZ, JR. TELEPHONE: 978-745-9399 EXT. 380
MAVOR FAX: 978-740.9646
HOMEOWNER LICENSE EXEMPTION
Please Print.
Date // 2/ D S'
Job Location no
Home Owner Address
Home Owner
in�g T�elepone
h �� gGUI
Present Moil Addtga T.r1�n rf�( S i met 01470
The current exemption of"Homeowner"_was.extended to include owner-occupied
dwellings Of two Units or less and to allow such homed to engage an individual for
hire who does not posses a license,provided that the ow> 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 structured. A person who c m;ttucb 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"homeownee,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 mi
will com 1 with said �� inspection procedure and requirements and that he/sheP Y procedure and requirements.
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING INSPECTOR
See other side for state code
r .
13QMXO)VWMNE��0x
Code states that: "Any Homeowner performing work for which a Building Permit is
The sions of this section(Section 109.1.1 —Licensing
required shall be exempt from the provi
of Construction Supervisors);Provided that a Homeowner engages a person(s) for hue 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
Rules and Regulat►ons for Licensing
responsibilities of a Supervisor(see ApP�x Q often results in serious
Construction Supervisors.Section 2.15). This lack of awareness es this case your
problems,Particularly when the Homeowner bires unlicensed Persons*
Board cannot proceed against the unlicensed person as it would with a In
is ultimately responsible.
Supervisor. The Homeowner acting as supervisor
To ensure that the Homeowner is fully aware of his/her 'bilities,many
the Homeowner certify that
communities require, as a part of the Permit Application,rOn the last page of this issue is a
helshe understands the responsibilities of a Superviso • such a
form currently used by several towns. You may care to amend and adopt
form/certification for use in your community
R� Gl�plycos
CITY OF SALEM, MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
%IN6 SALEM, MASSACHUSETTS 01970
STANLEY J. USOVICZ, JR. TELEPHONE: 978-745-9595 EXT. 380
MAYOR FAX: 978-740-984 6
Salem Buildine Department
Debris Disposal Form
In accordance with the provisions of MGL c40 S 54, a condition of your
Building Permit is that the debris resulting from this work shall be disposed
of in a properly licensed solid waste disposal facility as defined by MGL
Chapter III, S 150 A.
The debris will be disposed of in:
I)() L+k Side- at,.L� (Location of Facility) 5Cc ler
Si na ure a A h `nt
PP
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Date