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121 WEBB ST - BUILDING INSPECTION (4) i The Commonwealth of Massachusetts t Board of Building Regulations and Standards Nit CIP Massachusetts State Building Code. 780 CMR. 7 ' edition I tit: Building Permit Application To Construct Repair. Renovate Or Demolish a Krriwd./mur,rn ! Once- or Ttr -Fondle Dtr �Ilin,q 1. 'rr(rS Thi ec(ion or Off 'ial Use Only Building Permit Nut er. D- e Applied: Sienalure: I r V I d Z 0!r B d ig onmiissioned Inspe or of B i IV Date _y SECT I: SITE INFORMATION 1.1 Property Address: 1.2 :assessors Map & Parcel Numbers I.la Is this an accepted street? yes no__ Map Number Parcel N'uwhei -- i 1.3 'Zoning information: 1.4 Property Dimensions: "toning District Proposed Use Lot Area(sq f ) Frontage(it) 15 Building Setbacks (ft) ! Front Yard Side Yards Rear Yard ! Required Provided Required Provided Reyui red Provi dcd 1.6 Water Supply: (M.G.L c. 40. §54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone? Public ❑ Private❑ Check if yes❑ Municipal ❑ On site Disposal syste in ❑ SECTION 2: PROPERTY OWNERSHIP[ 2.1 Ownertof ecord: Name(Print) Address for Service: 979 - Signature Telephone SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction ❑ Existing Building ❑ Owner-Occupied ❑ 1 Repairsls) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ I Accessory Bldg. I] Number of Units__ Other ❑ Specity: Brief Description of Proposed Work'': SECTION 4: ESTIMATED CONSTRUCTION COSTS item Estimated Costs: Official Use Only (Labor and Materials) _ I. Building $ 1. Building Permit Fee: $ Indicate how fee is de(ennined: ❑ Standard City/Town Application Fee - 2. Electrical S ❑Total Project Cost (Item 6) x multipli�er�^ .x 3. Plumbing $ ?. Other Fees: 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire Suppression) Total All Fees: S Check No. Check Amount: Cash Amount:_ o Total Project Cost: 5 Z-f 0c) ❑ Paid in Full ❑ Outstanding Balance Due:___ I SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor (CSL) License Numher lispiraiion Daly Name of CSL- Holder List CSI_Type (see beluwl _ . T ' e Descriition Wdns. C Unrrsuirlcd lu to 3S.lI00( I'1 R Resrictcd 18_'C F:uni h- Des elling Signature M Ma-sonry Only RC Residential Routine Cos erne Telephone t1'S Residental \L'mdow .md Sidnig SF Residemial Solid Fuel Burning :\ >>h:mec Ina,JLun-u f D Rasidcnnal Demolition 5.2 Registered Home Improvement Contractor 0110 HIC Company Name or HIC Registrant Name Registration Number Address Expiration Date Signature Telephone SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152. § 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure n, provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached'? Yes .......... ❑ No ........... ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT i 1, t,O ��)L C�O S 's;> as Owner of the subject property hereby authorize_ __ to act on my behalf. in all matters relative to work authorized by this building permit application. $I nIllure� Date _- . SECTION 7b: OWNER` OR AUTHORIZED AGENT DECLARATION 1 _ , as Owner or Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and behalf. Print Name i Signature of Owner or Authorized Agent - Date (Signed under the 2ains and penalties of edu ) NOTES: I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contr:acur (nut registered in the Home Improvement Contractor(HIC) Program), will not have access to the arbitration program or guaranty fund under M.G.L. c. I42A. Other important information on the HIC Program and Construction Supervisor Licensing (CSL)can be found in 730 C'MR Regulations 110.R6 and 110.R5. respectively. _'. When substantial work is planned, provide the information below: Total floors area(Sq. Ft.) (including garage, finished basement/attics, decks or poncho Gross living area (Sq. Ft.) Habitable room count _ Number of fireplaces Number of bedrooms -_ Number of bathrooms Number of halt/baths 'rype of heating system Number of decks/ porches j Type of cooling system Enclosed Open -- 3. "Total Project Square Footage" may be substituted for "Total Project Cost" 4 ` r Warm Traditions Stove Sho e p.� Thank you for your recent stove order. Please be advised that you, as the .homeowner, are responsible for obtaining a building-permit for the installation of the stove. We are enclosing information that is necessary to obtain a building permit and our insurance agent will also be sending you a certificate of insurance. Once you have received the certificate you should apply for a.building permit. If you,have any questions, please call us at 978-777-5562. V-acxC i 144 Pine Street, P.O. Box 2081 Danvers, MA 01923 978-777-5562 WARM TRADITIONS STOVE SHOPPE A Division of AQUA TERRA PROPERTYMANAGEMENT, INC. Gmtractorc License # 032756 Edward A. Ferguson, Jr. 13".Ab&f"-01V .Vs l ' . . vrl Construction Supervisor License License: CS 32756 Birthdate: 10/15/1954 Expiration: 1 0/1 512 0 0 9 Tr# 5454 Restriction: 00 EDWARDA FERGUSON 15 PICKERING ST DANVERS, MA 01923 Commissioner Home Lwromment Contractm License # 134399 Aqua Terra Property Management, Inc. Edward Ferguson ,,yyam� 7//se 1°oo�srmsan<oeal!/r o�./G✓/noea�iu4efla 2-\ Board of Building Regulations and Standards HOME MPNTCONTRACTOR Registration: 134 134399 lug Expiration:. 11/13/2009 Tr# 260392 .Type: Private Corporation AQUA TERRA PROPERTY.MANAGEMENT,INC. EDWARD FERGUSON 144 PINE ST. ....� DANVERS,MA 01923 Administrator 144 Pine Street, P. O. Box 2081 Danvers, MA 01923 978-777-5562 1-800-286-5662 The Commonwealth ofMassaehusetds Depanwnr of Industrial Accidents Office of lmveftatlorrs UIV I 600 Washinslan&root Boston,MA 02M www.massgot✓dla a. Workers' Compeasetlon Josurance AflMdavftt Builders/Contractors/Electriciana/PlUZnbers Aopl)caot Inl2imation r1east Priat EelziDiv Pi;$ 0. Te(rd roppntt� i tna prnefl InC9 . i;aulc (8usnrsfK?pulivaonMdlvidueq: L�6Pr vYlift) �T0.di ,S Ylrtx>°� Address; ► `iY `P ne S ee+- `P• O. &A Ciry/State/Zip:_:LM ' 4, 4 019 6_ Phone#: G78• n7> 'SS(vc3- f An you so employer' CAock the appropriate bus; Type of project (nqulrod); 1..T1 am t esnpb.yer with __.9 Q. ❑ 1 am a general contractor and 1 60 employees (tall and/or pan•gmc) hevebtred the sub•coatricsore Ncw construtAoa 11 2.z] 1 am a tole proprietor or parmer• listed on tbeatrached sheets 7. [] Remodeling ship and be%a no employees These wlvcontraaort have g r] DerooWon working for me in any capacity. MAINS'COMP. insurance 9. ❑ Building addition (No workcn' comp. insurance 5. ❑ We we i eorporsdon aid its required.) OMCM have exercised then I G:Q Electrical reptirs or additions .1.L_ I am s homeowner doing all work right of exempdorl per`OL I L0 Plumbing tepsis or addiuow myself Nc workers' comp. c• 152, 11(e),and we have no 12.[] Roof repsin inswance re.luired.)t employees. (No workers' 13 4 Other comp. insurancercquiretij -'ncy epplie.m D►t 6"."fox al"we Woo Ail out Ito eeo➢oat lwlow tbowiat trek wooaan'vaopoadae potioy:nfarrnmi t Hvi w""who a1 IMI aria rfRdavil inaiatlne they on do p err work and lhoo MN wide conviom onus eatanit a Mel 4t5davit adis sting"L. �i onevc�o�-that'hcat No Sw bvm mrched N ddlemul.chest Worhis he norm One outrtgnvociars Opt thro avoten'w n[krt rna•pdin� .citation Ism an cmpleyer(hat d providinr workrrr'aoTpensorian insurance fo►nly employees Below it that polity and job she informariat% lasloaoce Company NtnW.' J r\e 1r)5oraryo-, LU• Of`4 \z 'S'Itit t, Cf— �PP Polity a or$elf•uts.Lie. N WG f©�`J )a D� Exptradon Date: '/ f�- glob Siu Address,_ � (A 1�() S l Y�1� ""CiryiStatCa* �� l ►�©I C] /[ / Attach a copy of the worths'comptioswon polley declarurlob page(showing the policy number and capitation date((!tt OF Ills Failure to serxue coverage n tequired under Secdoo 25A of MCL c. 152 can lead to the iraposi6oa ofcHminalpeualtics of a rme up to S1,500.00 mWorone•year imprisoomen% at well es civil peoaldea is the form ofa STOP WORK ORDER sad a fine orup to $250.00 a day ipiusi the violsior. Be advised that a copy ortbis staleraeni may be 7orwarded to the Office of invespgsliass orthe DIA forvssurimca coverage verification. 1 do htnrby ire r the palropvant6waides of par that the lnfornation provided above Is true and torpor" $I[nanV[: yr v✓ e"��� '� ye� �Daa T"�� Official sane only. Do nor write to this arty,to be eomplarei by Of&OF WWR q,(ytcW Cliy or Town: _ Permh/Ucense N _ Iistlog Authority (drds 90e)t 1. 9osrd of Health 2. Ballding Department 3, Cityrfonv Cleric e. Electrics► Inspector 3.Plumbing Inspector 6 Other Coats#Ptrsow, Phone N: Q Department of Code Enforcement Debris Disposal Affidavit In accordance with the provisions of GL,c.40, sec. 564,It condition of permit N is that the debris resulting from ttas work shall be disposed of in a properly licensed solid waste disposal facility a;defined by 6L,c. 111, sec. 150A. The debris will,or has been disposed ofat: Location of Facility Location of action/jobsi a (Street Address) Signature of conttacto Date ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMMD/YYYY) Tu 07/29/2009 PRODUCER (978)887_4900 FAX (978)887-2404 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Edward. F. Sennott Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 16 South Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P. 0. Box 457 Topsfield, MA 01983 INSURERS AFFORDING COVERAGE NAIC# INSURED Aqua Terra Property Management, Inc. INSURERA: One Beacon insurance Co. 21970 OBA: Warm Traditions Stove Shoppe INSURERS: Employers Fire Insurance P 0 Box 2081 INSURERC: The Ins Co of the State of PA Danver, MA 01923 INSURER D: INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR D' TYPE OF INSURANCE POLICY NUMBER POLI EFF CTIVE LI Y EXPIRA N - LIMITS LTR NSR DATE MMMD DATE EXPIR IYY GENERAL LIABILITY 1U11863 04/14/2008 04/14/2009 EACH OCCURRENCE $ 1,000,00o X COMMERCIAL GENERAL LIABILITY DAMAGE rO RENTED PREMISES Ea urence $ SOO,OO CLAIMS MADE O OCCUR MED EXP(Any one person) $ 5,000 A PERSONAL BADVINJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,0040 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 POLICY PRO JECT LOC AUTOMOBILE LIABILITY IE64294 04/14/2008 04/14/2009 COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per Person) $ B S0010001 X HIREDAUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) S00,00 PROPERTY DAMAGE $ (Per accident) S00,00 GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR ❑ CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC69S120S 04/14/2008 04/14/2009 X TORYLIMITS ER EMPLOYERS'LIABNTY E.L.EACH ACCIDENT $ SQQ�QQ C ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYE 500,00 Des,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT 1 $ 500,00 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Mr Wayne Cross BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 121 Webb St OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Salem, MA 01970 AUTHORIZED REPRESENTATIVE Peter Sennott LA ACORD 25(2001108) CACORD CORPORATION 1988 SAFETY LABEL (FOUND ON BACK WALL IN HOPPER) Report Pic. A""Deb J9100010ir February,1297 1 OUADRAitRE 12W F/$__ Listed Sad Fuel(PNlct Type)Room Hooter Also Su tal Far Mobl-Nana auW aflor, This pellet-bur Nng eppi-cc has been taaW and listed for usa In manufactured Ilonnrs In,cosedrin with OM B14-ZWO U"vgh O1e4380& wmrrtock Hersey Manul'eftwed by vW AALADDIN R-06 AVAIWARMPRODUun 401" 'PREVENT HOUSE FIRES' CONNs, M10911/ _ Install and use only In secondaries,with Tested To: ULC$6 74A9 995 mar,ufaetureez Installa lm and orating ULC S827#193 Instructions.Contact local building or FOR USE WITH PELLEIRED WOOD FUEL fire officials about restrictions and ONLY. hapsetlan In your are& hput floating:BB HL tueWtour . WMWNO-FOR MOBILE HONES:Do not Install opp0ancs In a Il*o Ing mom An Electrical Rating: outside combustion air Pnlet most be I IS VAC,60 R4 Stan U Amps,Run 1.8 providsd The SVUCMal IneegrMy,of the Amps. mobil*home Boa.selling and wall muat Reuse power cord way from uWt be mNrdelned. Components Mquh*d for Meblls Hs,ma DANGER: Risk of alentrleal shock. Inlander:Partmi-os 0a 111-05M Disconnect fl power glass s only balers, servicing.Replan glow only witdealer. Seem Refer to mandseluren's Instructions and carb am available from your deals,!. local codes for precautions regvimd lse To start, set thermostat above room pasting ehbnney through a combustlNa temperature. The stove will Ilght well or ceiling. Inspect and cigen vent rim P system frequently In accord nee with automatically. To shut down, set manWaeturaYt htatnrctloret thenmoelet to below mom temperature. For ft rdw Instructions,raise to ewrnse's Do not Install a flue damper In the prgped, ethsual venting system o1 this unit.De _ not connect this urdt to a chimney sendng Keep viewln9 and ash removal doom another appSana. ilghtlyekaed dW11,901POWN"M Instep vent at clearances opeeffed by the Use a T or e'din arise type"L'of W vent manufacturer. seMng eve _ Mlnknum ci searn«s to Combustible Materials emus ramnru neaaraslcua us*a nonKembustibls floo mt. seers a• aR each aide unit and s under unit 2'19O mm to each dale of unit and B'/1SO mm In front of franc stairs,door. r+-Are clths,"6 DWORdar Installation Cuan rr A. B C D IforbanW Tore PdlttVeai IM/lmm 2WSomm WA 2WSBmm Vertical T Pam Vera t IN1 e7 mm WA 2 Yn//5 as 2 kV50 mm Vertical Reallodld-NOTE 1 6 11047 mm WA 2 bM m 2 WSO ma - Ved" Moblis Nome-NOT@ 2 6 W14Tmm WA SkMmm 2hWmas Imocai rSingle rM.OA Moves WA 3irmasa 2WSOmm Note 11 in teoiderdal Imu," elene,when ruing part 61111-038O(3'top vent), 24 gauge abple wan Due oonnecior maybe used. Note 2: In mobile home IrnsNlleuon whew us"put 0911-MOO(3'top Verdi. usa Uststl double wen Rue 0MAIMIAm.M outside Yr kit(part 0B11-0SSO a . 911-0570)must be used with mobge home h"WhIldm U.S.ENVIRONMENTAL PROTECTION AOEHCV This model is eamptt fropm EA cordilic mumcfer 40 CFR$0331 by deRMtlon [Wood Nicolas P .. Ddo of Manufacture 1 gas 1999 2000 Jan. Feb. Map. A J J A Sept.° " D ■ . ■ . . ` ■ ■ ■ ■ ■ ■ ■ . ■ . DO NOT REMOVE THIS LABEL Made In U.BJL Page 3 7EPA up to 14,620 . 8128-7/16 32-5-16 29-1/16 425 3,300 to 60,200/4 28-7116 22-15/16 258 7475 to 34,400 to 12,9001 4 40 28-1/2 31-5/8 27-5/8 349 up to 17,200 2.0 to 5.5 80 160 .9 2,350 to 47,300 25-7/16 27-3/4 , to 12,900 7.5 too 52 160 (211­518 wr 21-3/16 240 14 34,400 cast ron easel CLEARANCES Mt.Vernon AE e A Back Wall to Appliance......................1' ALCOVE INSTALLATION FLOOR e Side Wall to Appliance......................6' Min Alcove Side Wll...........43' PROTECTION Corner Installation: Min Alcove Side Wall.............6" C Wallto Appliance..............................2' Min Alcove width................ ' 1............2" With Top Vent Kit: Max Alcove Depth...............3636° I............2• a D Back Wall to Flue Pipe.......................V K...........6" E Side Wall to Cast Top ......................6' F Back Wall to Appliancee......................8' CORNER HEARTH PAD SIZE x Corner with Top Vent Kit: 38-3/4"w x 38-3/4'd Advanced Energy G Walls to Appliance............................3' Use a noncombustible floor protector,extending beneath A Back Wall to Appliance......................2" heater and to the front/sides/ Castile PP ALCOVE INSTALLATION rear as indicated.Measure B Side Wall to Cast To p:... . .......6" Min Alcove Hei ht...............43' e C Corner Install Walls to Applippliancence.......2" g front distance(K)from the With Vertical 3"-6"Adapter Kit Installed Min Alcove Side Wall.............6• surface of the glass door. Romp c D Back Wall to Flue Pipe.......................3' Min Alcove Wiidth................38' E Side Wall to Cast To 6, Max Alcove Depth...............36' Ep........................ F Back Wall to Appliance......................8- q1 11 e . G Corner Install Walls to Appliance.......2- CORNER HEARTH PAD SIZE IMPORTANT—READ Original Energy o H Corner Install Walls to Flue Pipe........3" 34-1/8'wx 34-1/8'd BEFORE YOU INSTALL[' Refer to the Owner/Installation Classic Bay �� ee��--�''\��I A Back Wall to Appliance......................2" ALCOVE INSTALLATION Manual for complete clearance 1200 //�\ ' B Side Wall to Appliance....Bonne.......6' Min Alcove Side Wall ...........44" requirements and specifications. B `'/�t I C Corner Install Walls to Appliance.......1" Min Alcove Side Wall.....40-1/2. The images and descriptions in With Vertical Adapter Kit Min Alcove width...............36" this brochure are provided to D Back Wall[o Flue Pipe.......................3' Max Alcove Depth...............36" assist you in product selection E Side Wall to Appliance......................6" only. F Back Wall to Appliance................7-112' e G Corner Install Walls to Appliance.......2' CORNER HEARTH PAD SIZE 'Heating capacity(in square feet)is a 40-5/8"wx40-5/8•d guideline only and may differ slightly due to climate,building construction and condition,amount and quality of Original Energy - Insulation,location of the heater,and air movement In the room.Based on maximum square feet of Energy Star Santa Fe j A Back Wall too Appliance......................2" ALCOVE INSTALLATION and equivalent, m,d insulated with ..'s inlhea B Side Wall to Cas[Tope......................6• Min VEIN Height TALLA-..............43' and framed insulatedfloors ceilings heating C Corner Install Walls to Appliance.......2• Min Alcove Side Wall.............6- one 1. With Vertical 3"-6"Adapter Kit Installed Min Alcove Width................38' 'See Owner's Manual for exceptions. D Back Wall to Flue Pipe.......................3- Max Alcove Depth...............36- ",Btu/Hour input calculated using �':.. E Side Wall to Cast Tope......................6' premium woad pellets at vary, Btu/lb. the F Back Wall to Appliance......................7' Btu output will vary,depending on the 10 G Corner Install Walls to Appliance.......2" CORNER HEARTH PAD SIZE brand of fuel used.For best results, Original Energy H Corner Install Walls to Flue Pipe........3' 38-7/8•w x 38-7/8"d consult your authorized Quadra-Fire dealer. rnf.-raj:t &FIgeofferseor limitedrehaserfortrantytimeo our pellet heatinge orlglnal purchaser lka ha Ity on a of the appliancedefect;in material and workmanship. See yourdi4`Flre dealerfordetalls. .� Warm Traditions Stove Shoppe QU//GRE1• /RE 144 Pine Street Danvers,MA 01923 Visit our Web site at www.quadrafire.com 978-777-5562 Quadra-Fire is a registered trademark of Hearth 13 Home Technologies.Product specifications and O J V pricing subject to change without notice. All Quadra-Fire pellet appliances shown are tested and listed with OMNI-Test Laboratories,Inc.,of Beaverton,Oregon to ASTM E1509,ULC 5627-00 and ULC/ORD-CI482 Room Heater Pellet Fuel Burning Type(UM)84-HUD.Suitable for use in mobile homes.These.products are covered by US Patents Nos.5000100 and 5582117 and other patents pending. Product specifications and pricing subject to change without notice. ODF-1014U-0508 CITY OF SALEM PUBLIC PROPERTY DEPARTMENT KJMOM" Nnroa MWAsumaroaSnsar•3AaK =mou970 TIM.9"L743.95"• Fns 97L7449" HOMEOWNER LICENSE+ EXEMPTION please priat Date 0'"/02 - O Job Location / ,9 1 (y) 7 SA L c_0-7 Home Owner Address C Home Owner Telephone - ? 41 e( S fo 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. DEFINMON OF HOMEOWNER Persons)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 dwellin&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"assume@ 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 k*e2�(=Z� Llt—� APPROVAL OF BUILDLNG [INSPECTOR side for state c See other ode