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JNSPZCTDB PP" TD A.PEAOIIIIT RENO GRANTED
CITY OF SALEM
No. D Date T-30'7005'
Is Property Located in Location of
the Historic District? Yes No_lx__ Building Sc,lem
Is Property Located In
Me conservation Area? Yak No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
Repair/Replace, Other: 600y' Stove az+d hAf-r-
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
specffications: /I
Owner's Name elligl-S LUCK-S
Address & Phone 22L 6✓/LL//9-r -5 5T (WF) 7yy'lo0/e
Architect's Name ghi
Address & Phone N1/1 ( 1
Mechanics Name 1111A
Address & Phone 111A L 1
What is the purpose of building? ft's/0ey7-/AL
Material of building? 4/o io 1113&37a's If a dwelling, for how many families? aZ
Will building conform to law? Asbestos?
Estimated cost city License a N P' State L'cense #
Bame Improvement
Lie. #
Signature 6f Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
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MAIL PERMIT TO: 22L (HILL/f/r? 5D --4gLE/7'I� Aj%�d/9?j6
No. 322 L�Co
APPLICATION FOR
PERMIT TO
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LOCATION
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PERMIT GRANTED
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APPROVED
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ECTOR OF BUILDINGS
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CITY OF SALEM9, MASSACHUSETTS
i
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET. 3RO FLOOR
SALEM. MASSACHUSETTS 01970
STANLEY J. UEOVICZ, JR. TELEPHONE: 978-74E-9393 EXT. 380
MAYOR FAX: 978-740-9843
HOMEOWNER LICENSE EXEMPTION
Please Print.
Date 051:/00 2CYI�
Job Location�I G,i/C�i�/nS ST
Home Owner Address 2ZL ip �� O/97c1
L✓iLL1fCiY11 �
Home Owner Telephone L7± 7,V,1—6Q18'
Present Mailing Addnes. C✓i�u/trn5 sT s19C�ytf /Ylfl �/97+
The current exemption of"Homeowners",,was extended to include owner-occupied
dwellings of two Units or less and to allow such homeownep to engage an individual for
hire who does not possess a license,provided that the owner acts as supervisor.
DEFINITION OF HOMEOWNER, . 7a
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 dwelling, attached or detached
structures accessory to such use and/or farm structures. A
than one home in a two year person who.constructs more
. 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 perform
Permit. ed under the Building
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 r utrements.
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING INSPECTOR
See other side for state code
I
HOMEOWNERS EXEMPTION
The Code states that: "Any Homeowner performing work for which a Building Permit is
provisions of this section(Section 109.1.1 —Licensing
required shall be exempt from the
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.
g the
Many Homeowners who use this exemption are unaware that they are ppendix Q Rules and Regulations fo Lice�►g
responsibilities of a Supervisor(see A results
Construction Supervisors. Section 2.15). This lack of awacenessed �often In this case Y
problems.Particularly when the Homeowner
�c�� hires personas itCew uld with a licensed
Board cannot proceed against sor is ultimatgly responsible.
Supervisor. The Homeowner acting as supervisor ?I
ibilitiM many
To ensure that the Homeowner is fully aware of his/her diat e Homeowner certify that
communities require, as a Part of the Permit Application,sor. On the last page of this issue is a
he/she understands the responsibilities of a Supervi
You may care to amend and adopt such a
form currently used by several towns.
form/certification for use in Your community