10 CLEVELAND ST - BUILDING INSPECTION . � �� .
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JdSP.�CIL18 Pt�IDA 7D.A.PFAd�17' R�wG GRANTED
CITY OF SALEM
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�g p�� �� � I.xation of
the Hlatodc Olstrict7 Yes No `/ Bulldin8 -�
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BUILDWG PERMR APPUCATION FOR: '
Permit to:
(Circle whichever apply) Roo eroo Install Siding, Conetruct Dedc, Shed, Pool,
RepaidReplace. Other:
PLEASE FlLL 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: -
�,C�t � I '
Owners Name � . ,"� pS C'7 f,INC� i
Address & Phone Y ��../y� �3��
ArchRect's Name /}� L
AddressB� Phone ��, �� �ti � (l�1 � /_����
Mechanics Name '
Address &,Phone � �
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S' atur Appli
S UNDER THE PENALTY
OF PERJURY ,
OESC PTION OF WORK TO BE NE
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MNL PERMIT TO:
No.
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
/oJd-1 o 7.0
AP OVOD
INSPECTORF OF BUILDINGS
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CITY OF SALEM9 MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
�- 120 WASHINGTON STREET, 3RD FLOOR
SALEM, MASSACHUSETTS 01970
STANLEY J. USOVIC2, JR. TELEPHONE: 978-743-9393 EXT. 380
MAYOR FAX: 978-740-9848
HOMEOWNER LICENSE EXEMPTION
Please Print
Date to I
Job Location
Home Owner Address
Home Owner Telephone —
Present Mailing Address_ . /n /7,
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 iicts as supervisor.
.
pervisor.
DEFINITION OF HOMEOWNER - "
Person(s) who owns a parcel of land on which he/she resides or intends to redde, on.
which there is, oris intended to be, a one or two family dwelling, attached or detached
structures accessory to such use and/or farmstructures. A person who constructs mon
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 City of Salem
Building Department minimum inspectip ro I requirem is and that he/she
will comply with said procedures and r me
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING INSPECTOR
See other side for state code
HOMEOWNERS EXEMPTION
The Code states that: "Any Homeowner performing work for which a Building Permit is
sons of this section (Section 109.1.1— Licensing
required shall be exempt from the Prov'
of Construction Supervisors): Provided that a Homeowner engages a person(s) for hire to
do such work, and that such Homeowner shall act as Supervisor.
Marry Homeowners who use this exemption are, unaware that they ares,ming the
responsibilities of a Supervisor (see Appendix Q, Rules and Regulations for Licensing
Construction SupervIsorsp Section 2.15). This lack of awareness resserious
problems, Particularly when the Homeowner hires as it� d with a licensed
Board cannot proceed against the unlicensed p responsible'
Supervisor. The Homeowner acting as supervisor is ultimat IY
3.>
nsibilities, many
To ensure that the Homeowner is fully aware of hist t$iat the Homeowner certify that
communities require, as a Part of the permit Application.
On the page of this issue is a
he/she understands the responsibilities of a Supemay ca t such a
form currently used by several towns. You may care to amend and adopt
form/certification for use in your community.
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