24 FORRESTER - BUILDING INSPECTION .pL-*"6* T-qE fIL£94mq APPROVED BY T4IE
ASpZ=W p@= TDA.f?F.AIFW1NC GRANTED
CITY OF_SALEM
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BUILDWG PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding. Construct Deck. Shed Pool
RepaidReplace. Other: r e Vic(C- tvuxl er n 12 P ;J
PLEASE FILL OUT LEGIBLY i COMPLETELY TO AVOID DELAYS W PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the following
_ specifications-
Owner's Narne 4,�/M NQU A ✓ -
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Address & Phone 8 L) fbr ,��- r 1 I Lj
Architect's Name �rrA l7 i l/1 A,4n i c�hon
Address & Phone ` I lac , Z(-?Sn Lc t� L 1
Mechanics Name
Address & Phone L
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OF PERJURY
DESCRIPTION OF WORK TO BE DONE
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CITY OF SALEM, MASSACHUSETTS
y PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
SALEM, MASSACHUSETTS 01970
STANLEY J. USOVICZ, JR. TELEPHONE: 978-745-9595 EXT. 380
MAYOR FAA: 978-740-9846
HOMEOWNER LICENSE EXEMPTION
Please Print.
Date' Q�- C)S
Job Location �� �( X r 1c �
Home Owner Address
Home Owner Telephone 1 ? y 1 j , ,S(o u( o
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 ownefacts 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 insp!Ctionprocedures and requirements and that he/she
will comply with said proved and requirem e/J
HOMEOWNERS SIGNA c�C�✓' —
APPROVAL OF BUILDING INSPECTOR % qv-4w
See other side for state code
t
HOMEOWNERS,EX MPTION
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 a 109.1 (
—Licensing
of Construction Supervisors):Provided that a Homeowner engages a persons) for hire to
do such work, and that such Homeowner shall act as Supervisor.
the
Many Homeowners who use this exemption
a Q Rules and Rere unaware thatgulations for r Licensin8
responsibilities of a Supervisor(see Appendix
Construction Supervisors, Section 2.15). This lack of awareness so � s serious
problems,Particularly when the Homeowner hires n 10t� 1ed d with a licensed
Board cannot proceed against the unlicensed supervisor is ultimately responsible.
Supervisor. The Homeowner acting Derv►
To ensure that the Homeowner is fully aware of his/her responsibties' many Application,that the Homeowner certify that
communities require, as a part of the Permit
he/she understands the responsibilities of a Supervisor. On the last page of this issue is a
towns. You may care to amend and adopt such a
form currently used by several
form/certification for use in your community.
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