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FIELD COPY
CITY OF SALEM BUILDING �°
SALEM. MASSACHUSETTS 01970 PERMIT
1� VA UDATION
4COUNT:
DATE Sontamhar 14 19 91 PERMIT NO. 402-93
APPLICANT THomas O'Donnell ADDRESS 8 1/2 Adams Street _
' IN0.1 i51P[EfI IEONT+•S .rt(NS<I
'NUM
PERMIT TO RHOf �_) OF
STORY DWPllln� DWELLING UNITS 1
1111E 01 IMPROV[M[NTI NO. VPOPOS[D USE)
AT ILOCA110NI B 1/2 Adams St. Ward 5 ZONING
DISTRICT R�1
(X0.1 IS1RE[TI
BETWEEN AND
ICAOSa STREET) - (CROSS STR([TI
. LOT .
SUBDIVISION LOT BLOCK - SIZE
BUILDING IS.TO BE FT. WIDE B+ FT. LONG By FT. IN HEIGHT. AND SMALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION T
' IT.P❑
REMARKS: Reroof over I layer of roof shingle
PProve Date
IOIUME ESTIMATED COST $ 900.00. FEEMIT S 20.00
1 :C':SIC-SOUtNf F([ll
OWNER Thomas O'Doneell
A^DRESSB 1/2 Adams St._ Salem. ffiass. Le® E. Tremblay
INSPECTOR OF BUILDINGS
INSPECTION RECORD
DATE Noy[ p000n[ss - CNiTICISMS AND REMANKs IN$PECTow
• Plans must be tiled and approved by the Inspector before a permit will be granted.
No. y0 _ City of Salem Ward `
IS PROPERTY LOCATED IN THE / ;
HISTORIC DISTRICT? Yes_NO V a
IF SIDING, HAS ELECTRICAL II,�� '?cryF
PERMIT BEEN OBTAINED? Yes_N0{�`/.y Home Phone #_
��'' APPLICATION Bus. Phone # - eZ
FOR
PERMIT TO)®ROOF REROOF OR INSTALL SIDING
Salem,Mass.,
TO THE INSPECTOR OF BUILDINGS:
The undersigned herebv a plies for a permit to build cording to�r/�-e followin s ecific.atio^ns: n
Owner's name and addresp. �vt.pp__2. t�♦ irwr�.2__X J72 HYLA .�7— y�-�. _
Architect's name
q/d/
Mechanic's name and ad ress
Location of building,No. Z
What is the purpose of building?
Material of building? Asbestos? Xld
If a dwelling,for how many families^. _
Will the building confnnn to the requirements of the law?
Estimaied cost •7 0- " .ontractors Li No. �
Signature of applicant
REMARKS SIGNED UNDER THE
PENALTY OF PE JURY.
Ward
APPLICATION FOR
PERMIT TO ROOF
REROOF OR INSTALL SIDING
Location
PERMIT GRANTED
/
19/
c
Approved
t
Building /ns9 ctor /yam
CITY OF SALEM
BUILDING DEPARTMENT
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE /j
JOB LOC TIONL ��ny2 S/ ��.
Number /� Street address i Section of Town ?
"HOMEOWNER �IYrt ad 0l lax 1p 07111 / 21 7W-1ZJJ'
Name p� Home phone —`' Work phone
PRESENT MAILING ADDRESS a z �
City/Town State Zip Code
The current exemption of "homeowners" was extended to include owner-occupied
dwellings of six units or less and to allow such homeowners to engage an in-
dividual for hire who does not possess a license, provided that the owner
acts as supervisor. (State Building Code Section 109.1 .1
DEFINITION OF HOMEOWNER:
Person(s) who owns a parcel of land on which he/she resides or intends to re-
side, on which there is, or is intended to be, a one to six 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 shall be res onsible
for all such work performed under the building permit. Section 109.1 . 1
The undersigned "homeowner" assumes responsibility for compliance with the State
Building code and other applicable codes, 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
he/she will comply with said rocedures and requirements.
HOMEOWNER'S SIGNATURE
APPROVAL OF BUILDING OFFICIAL
NOTE: Three family dwellings 35,000 cubic feet, or larger, L/1be required
to comply with State Building Code Section 127.0, Construction Control .
HOME OWNER'S EXEMPTION
The Code states that: "Any Home Owner 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 Home Owner engages a person(s) for hire to do such work, that such Home
Owner shall act as supervisor. "
Many Home Owners 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 aware-
ness often results in serious problems, particularly when the Home Owner
hires unlicensed persons. In this case your Board cannot proceed against
the unlicensed person as it would with licensed Supervisor. The Home Owner
acting as supervisor is ultimately responsible.
To ensure that the Home Owner is fully aware of his/her responsibilities,
many communities require, as part of the permit application, that the Home
Owner 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 form/certification for use in your
community.
COMMONWEALTH OF MASSACHUSETTS
=k DEPARTMENT OF INDUSTRIAL ACCIDENT
S
_9Yj 600 WASHINGTON STREET
arses�, Ganoaen BOSTON, MASSACHUSETTS 02111
c^�ss,one WORKERS' COMPENSATION INSURANCE AFFIDAVIT
z 44V46�L PO
(licenseciperminee)
with a principal place
of business/residence at:
(City/State/Zip)
do hereby certify, under the pains and penalties of perjury, that:
[ ] I am an employer providing the following workers' compensation coverage for my employees working on this
job.
02"- q �7
Insurance Company Policy Number
[ � lama solc_proprictorcind have no one working for me.
I�am a soic proprietor, general contractor homcown circle one)and have hired the contractors listed below
who have the following workers' compensationn
insurance les:
Name of Contractor Insurance Company/Policy Number
Name of Contractor Insurance Company/Policy Number
Name of Contractor insurance Company/Policy Number
am a homeowner performing all the work myself.
NOTE: Please be aware that while homeowners who employ persons to do maintenance,construction or repair work on a
dwelling of not more than three units in which the homeowner also resides or on the grounds appurtenant thereto arc not generally
considered to be employers under the Workers'Compensation Act(GL C. 152,sect. 1(5)),application by a homeowner for a license
or permit may evidence the legal status of an employer under the Workers' Compensation Act.
1 understand that a copy of this statement will be forwarded to the Deparmicnt of Industrial Accidents' Office of Insurance for coverage
verification and that failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties
consisting of a fine of up to$1500.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a
fine of 5100.00 a day against me.
Signed this7�� ,p 42 day of / -2> 19 93
LicenseclPermittee Licensor/Permirror