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DESCRIPTION OF WOW TO U DONE
MAILMMTTQ / 3/
No.
APPLICATION FOR
PE l TO
LOCATION
PERIAT GRANTED
JaudAot (l Zo
OF
CITY OF SALEM, MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RO FLOOR
SALEM, MASSACHUSETTS 01970
STANLEY J. UEOVICZ, JR. TELEPHONE: 978-745-9595 EXT. 380
MAYOR FAX: 978-740-9046
HOMEOWNER LICENSE EXEMPTION
Please print
Date — /q— �o
Job Location '
HOMO Owner Address
Home Owner Telephone
Present Mailing Addreea;,
The current exemption of"Homeowners"was
dwellings Of two Units or less and to allow extended to include ownea-occupied
hire who does not such home° : , to engage an individual for
Possess a license,provided that the o is as supervisor.
DEFINMON OF HOMEOWNER. a
Person(s)who owns apsrcelof lard 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 acceasory 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
Peal, that he/she be responsible for all such work performed under the Building
The undersigned"homeowner"assumes responsibility for compliance with the State
-laws and regulations.
Building Code and other applicable by
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
APPROVAL OF BUILDING INSPECTOR
See other side for state code
H MEOWNERSEXEMpnom
The
Code states tbat: "Any
Homeowner performing work for which a Building Permit is
shall be exempt from the provisions of this section(Section 109.1.1 -Licensing
required of Construction Supervisors);provided that a Homeowner engages a person(s) for hue to
do such work, and that such Homeowner shall act as Supervisor.
Manlion are unaware that they are assuming the
y Homeowners who use this exemption Q.Rules and Regulations for licensing
responsibilities of a Supervisor( Appendix
Constriction Supervisors,Section 2.15). This lack of awareness o rteaults n this case serious
problems.Particularly when the Homeowner hires unlicensed perso
unlicensed person as it would with a licensed
Board cannot proceed against is 1y responsible.
Supervisor. The Homeowner acting as�s" a-i
To ensure that the Homeowner is fully aware of his/her re Hom.many
communities require+ as a part of the Permit Application, thea Homeowner certify that
ibilities of a Supervisor• On the last Page of this issue is a
he/she and rstands the ti used h9 towns You may care to
form/certification for use in y , amend and adopt such a
form currently our community.
R� `I sp l tam t
CITY OF SALEMv MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RO FLOOR
SALEM, MASSACHUSETTS 01970
STANLEY J. USOVICZ, JR. TELEPHONE: 978-745-9598 EXT. 380
MAYOR FAX: 978-740-9846
Salem Building Department
Debris Disposal Form
In accordance with the provisions of MGL c40 S 54, a condition of your
Building Permit is that the debris resulting from this work shall be disposed
of in a properly licensed solid waste disposal facility as defined by MGL
Chapter III, S 150 A.
The debris will be disposed of in:
411'"0 _ /)U/Y1xDsT�" (Location of Facility
Signature of Applican
Date