1 WINTER ST - BUILDING INSPECTION V6A
fi_-APPS MtI T-OEfilfG-ANG A?PROVED BY T44E
11SPEGT R PWR TDA PERMIT B.EWG GRANTED
CITY OF SALEM
No. "� �\ Date
2.3
s.p
Is Property Located in Location of
the Historic District? Yes_No_ Building v V I J
Is Property Located in
the Conservation Area? Yes_No
BUILDING PERMIT APPLICATION FOR:
Permit to: �
(Circle whichever apply) �,00r•'Reroof, Install Siding, Construct Deck, Shed, 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:
Owner's Name a �z
Address & Phone I [Ali S� f x � � Q '&3
Architect's Name
Address & Phone ( )
Mechanics Name
Address & Phone n ( 1
What is the purpose of building? I hLmL
Material of building? ,(fr)(�xl11 If a dwelling,for how many families?
Will building conform to law? Y Asbestos?
Estimated cost 1 vl y City License a N p' State License a/
Hone Improvement C /�
I Lie. I
Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
12 a1 (L�
MAIL PERMIT TO: (.(N /l�(
' No '
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
APPROVFD
, b
INSPECTOIA OF BUILDINGS
CITY or SALSM6 MAsswCMustrrs
PuauC PROPW Y OWAMUMT
tm WbAw - I Oman, Sao Itoon
aksw w►oa3o
T8L ass»asaaw M.aas
►as (GM 7404MG
s•AWAV A�s. Jw.
DISPOSAL( !DIMS APM&VIT
Is a000adaaeo sift 69 p wAdma dMM a 44 3%1 aebawWp did r a comMaa
o[>la mbe ftmk• .i alfa mdit Sm 6m aaaodaa-im oedit
v by db saaft hma&A ba dhpud dia s pepaf r band aos&wmb
alapaad�r aee.tbyirclt.s�sib
Saab wmbea go"ato 1VW0(* Cwt;/009
Laealiaa dFaailiq►
C� - 23U 'S--
SWOOM dr mi<AppAnd Dow
FMY o mpift da hffipwhg ios mW=
GLEAM Paw CiaA>MY)
Naa.dramle Appbasl
AddmkaWAUW
FimiNaar`itagr
'ft AD"SUM dW dab&he dw demNiM ado% nbab of abt
altaWo dbo'>d(ot or mudw be aigo d is a prqu usuw JON&Maw dqmd
t9dit as ds&W br hM aA 31^and ft bW ft pamid or Scawa"ro
ind"do bgwm of&how.
CITY OF SALEM9 MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
SALEM, MASSACHUSETTS 01970
STANLEY J. U90VICZ, JR. TELEPHONE: 978-745-9595 EXT. 380
MAYOR FAX: 978-740-9846
HOMEOWNER LICENSE EXEMPTION
Please Print.
Date
Job Location �e
lr
Home Owner Address
Home Owner Telephone
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 ownei'acts as supervisor.
1 .
DEFINITION OF HOMEOWNER ''
Person(s)who owns a parcel of land on which he/she resides or intendsf 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
Official,on a form acceptable to th
"homeowner"shall submit to the Building Oe 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 SIGNATURE LL Ll
APPROVAL OF BUILDING INSPECTOR
See other side for state code
HOMEOWNERS EXIE MPTTION
The Code states that: "Any Homeowner performing work for which a Building Permit is
required shall be exempt from the provisions of this section(Seca 1 person(s) for hire to
of Construction Supervisors); provided that a Homeowner engagesP
do such work,and that such Homeowner shall act as Supervisor-
who Homeowners who use this exemption are unaware that they are as-summgthe,..
ppendix Q,Rules and Regulations for Licensing
responsibilities of a Supervisor(see A
Construction Supervisors, Section 2.15)• This lack unlicensed awazepe oftresults aser►y your
problems,Particularly when the Homeowner tuld with a licensed
Board cannot proceed against the unlicensed
p rson as is ultimately responsible.
Supervisor. The Homeowner actinga;a-
To ensure that the Homeowner
fully
Permit Appli tion,that the Homeowner issue is a
he/she enders certify that
communities require, as a part of the
lands the responsibilities of a Supervisor. On the last page of sa
form currently used by several towns. You may care to amend and adopt
form/certification for use in your community,
R
G 3p I zoo S
I