19 WILLOW AVE - BUILDING INSPECTION (3)r
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-P ilw iSteE fiL D'•APPROVED BY T*IE
WS,PECTDB PF31I.1R TP;A..P.ERMIT BFMG GRANTED
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CITY OF SALEM
No. fq�f -zOOy Date l 2-w
2
9`�MINE T .
Is Property Located in / Location of II
the Historic District? Yes_No_ Building \q W,\1) h&
Is Property Located in
the Conservation Area? Yes No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, 6 Pool,
Repair/Replace, Other:
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:
i
Owner's Name Tn i-niu AtJ 4;c� O✓t nn
Address & Phone LgU6 II go Af2, (97tr) 82S-176,"2
Architect's Name IVji="
Address & Phone )
Mechanics Name A)I tq
Address & Phone n ( )
What is the purpose of building? jZEst O�'Tkf3
Material of building? if a dwelling, for how many families?
Will building conform to law? Asbestos?
Estimated cost )gypo i City License # N A State u e #
Home Improvement
Lic. I
Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF W/OR11K TO BE DONE 11
lD k � TOofi cShPO. J��ked `b �e rhei�n. cf 4)atd bA�I1. ame
dDrl/L /.t Aj 6jb IM.M ALJS. Lr) Gn (( C(.l(i oc, t R G., k,4
}n �C ft-�64e) I home a)tieeS .
MAIL PERMIT TO: N OM tsOtN r )�2
POL-M0 V-> . t $ S'= j Peg
No. 19 y -200�
APPLICATION FOR
PERMIT TO p
Sd�
LOCATION
ZIT Cut r..
PERMIT GRANTED
19
APP OVD
INSPECTOR OF BUILDINGS
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CITY OF SALEM
BUII.DING DEPARTMENT
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE 7-063 A
JOB LOCATION 111 1�, (U� Ale
HOMEOWNER �� fn I i�1 Ght�
ADDRESS
HOMEOWNER
TELEPHONE
PRESENT MAILING ADDRESS RAI-(
The cmront 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 act as supervisor.
DEFINITION OF HOMEOW
NER:
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 to 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 to all such work performed under the building permit.
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and
other applicable goes by-laws,rules and regulations.
The undersigned"homeowner"certifies that he/she understands the City of Salem Building Department
minimum inspection procedures and requirements and that h/she will comply with said procedures and
requirements. �j�j
HOMEOWNER'S SIGNATURE _�S 2
APPROVAL OF BUILDING INSPECTOR
See other side for state code
3
HOMEOWNER'S EXEMPTION
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 is a homeowner engages a person(s)for hire to do such work,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
urbanised persons. In this case your Board cannot proceed against the unlicensed person as it would with
licensed Supervisor. The homeowner acting as supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of him responsibilities,many communities require,as part
of the permit application,that the homeowner certify that he/she understands the responsibilities of a
supervisor. You may care to amend and adopt such a fomJcertification for use in your community.