21 WINTER ST - BUILDING INSPECTION "CITY-OF AL
' A PUBLIC PROPERTY
DEPARTMENT
KlmsoRLEY DRISCOIL
MAYOR 1?0 WASHINGTON STREET•SAlEK MASSAC3Hl;$EI-M 01970
TM-,978-745-9595♦FAx 97&740.9846
APPLICATION FOR THE REPAIR, RENOVATION, CONSTRUCTION.
DEMOLITION OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Name: Building:
Property Address:
Property is located in a; Conservation Area YIN Historic District Y/N 7z "C
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: Se �4/!!c�C / W 2f
Address:
Telephone:
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing
Renovation r/ Number of Stories Renovated /
Change in Use New
Demolition Existing 3&1J0
Approximate year of 7 Area per floor (so Renovated
construction or renovation
of existing building New
Brief Description of Proposed Work: f� �� !e�o%�``o�j
)7Cs�
Mail Permit to: �UL°
What is the current use of the Building? f PJr 1� w
Material of Building? 1/vd If dwelling, how many units?
Will the Building Conform to Law? Asbestos? 1170
Architect's Name
Address and Phone ( )
Mechanic's Name
Address and Phone
Construction Supervisors License# HIC Registration#
Estimated Cost of Project$ Odd Permit Fee Calculation
Permit Fee Estimated Cost X$71$1000 Residential
Estimated Cost X$11/$1000 Commercial
An Additional $5.00 is added as an
Administrative charge.
Make sure that all fields are properly and legibly written to avoid delays in processing.
The undersigned does hereby apply for a Building Permit to build to the above stated
specifications. Signed under penalty of pedury X; ,
Date
a � N
uNIN
N 00
N ICI
b
GL N y G
1
CITY OF SALEM
PUBLIC PROPERTY
DEPARTMENT
KIM BERLEY DRISCOLL
MAYOR I3D WASHINGTON STREET•SALEN,MASSACHUSEM 01970
TEL-978-745-9595• FAX:978.740-9M
HOMEOWNER LICENSE EXEMPTION
Please Print
Date Zo c
Job Location / t 11A 51-
Home Owner Address
Home Owner Telephone 9?
Present Mailing Address C( /b/y✓Gf o,1_ 1<f C Cep
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.
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 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"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 quirement .
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING INSPECTOR
See other side for state code
F
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 —Licensing of
Construction Supervisors);provided that a Homeowner engages a person(s) for hire to do
such work, and the 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 of
Section 2.15 . This lack of awareness
often results in serious
Construction Supervisors, S )
problems,particularly this case Y
when the Homeowner hires unlicensed persons. In
Board cannot proceed against the unlicensed person as it would with a licensed
Supervisor. The Homeowner acting as Supervisor is ultimately responsible.
To ensure that the Homeowner is fully aware of his/her responsibilities, many
communities require, as part of the Permit Application, that the Homeowner certify that
he/she understands the Responsibilities of a Supervisor. On the last page of this issue is a
form currently used by several towns. You may care to amend and adopt such a
our community.in
form/certification for use y
CrtY OF SALE►m
PUBLIC PROPERTY
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