34 FORRESTER ST - BUILDING INSPECTION EI'�OF�Xt 1 J
"' ' PUBLIC PROPERTY
�" �`�" ' DEPAR'TNIENT
KO�lERLEY DRISCOLL
. �1.�roa 1�w.wnnicmN a'�-r�S��;,u,.,s,cx�st,�s o1970
1�i 97&745-9595�FnY:978-7i0-9&16
APPLICATION FOR TAE REPAIR RENOVATION. CONSTRUCTION.
DEMOLITION. OR CAANGE OF USE OR OCCUPANCY. FOR ANY EXISTING
STRUCTURE OR BUILDING
. 1.0 SITE INFORMATION
Location Name: 3 �/ arv�s �. S �. Building:
Property Rddress: 3'-� Fo ry-�s-�cr S .
S la �•
PropeAy ia bcated in a; Conservatlon Area Y/N�_Historic Distrid Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: C.'ra�� � L ✓
Address: 3�-/ �a+'r{S�Gt S .
S a �,ei.v� 1A/L�
Telephone: �t 7 �- g��/ - a�(Q lo
3.0 COMPLETE THIS SECTION FOR WORK IN FYIST�N� BUILOINGS ONLY
Addition Existing
Renovation X Number ot Stories Renovated
Change in Use � New �
OemoliGon Existing
Approximate year of Area per floor (s� Renovated
construction o renov w ��"] (�
of existing buildi �D S'U New
a.�Pf Description of Proposed Work: �
B,`��1 �— �i�,r��c- c��t 7-0 � ��'T, s�., K� T1'�'3
K r�c� — ��y� ��� G,�,���--s, s,:� � �
6,� ,� �� �- �,���
Upo,�,r-0� A�L e�cc?n-rc- , /a�v"' �
/ /
S�}'h a K���"'v`°.c.- �/rs, ) ,��Pf7 T
-- _ _
— _ -- --
---- - -Mail Permit to: ---� '��'res � ��w, �,�jJo� o2q 70
,
What is the current use ot the Buiiding? /"�S��G�"� L
Material of Building7 1-� "�'t �ML If dwelling, how many units7 .3 '
Will the Building Conform to Law? Asbest°$?
ArchitecYs Name
Address and Phone
Mechanic's Name �d���K � W�'� �"� �L' G. � d6 �'188�
� s�.�--sr hz•,,,,,�� �/�1'A. ci�o�
Address arxf Phone 7� ��' ,
Construction Supervisors License# HIC Registratlon#
Estimated Cost o�f,,P,�rojesct�3 �� ��tl Pertnit Fee Cak:ulalion
Permit Fee 5 1—"— Estimated Cost X S71S7000 Residential
! �'D•�a EsUmated Cost X$11/51000 Commercial
M Additional 55.00 is added as an
AdminiatraUve charge.
Make sure that all fields are properly and legiby written to avoid delays in processing.
The undersigned does hereby appiy for a Building Pertnit to build to the above state
specifications. Signed under penatly of perjury
X '
Date �� � a6
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1
CITY OF SALEM
'�� � � PUBLIC PROPERTY
;;
. DEPARTMENT
KIM1�SERI.EY DRI$(:OLL
MAYOR �?�WASHINGTON S'lRE6'T�SALEM�MASSACHIiSEI'IS O���O
r���s-��s-n�s • rnx:��eaao-�aaa
HOMEOWNER LICENSE EXEMPTION
Please Print
Date �' /� d L
Job Location �S `f Fn'rs�e� S7�., �q �y.�v� �{/� o�
HomeOwnerAddress 3y F».r�s�,. s . �,,, to,,,,, tA/1 �
P���'�
Home Owner Telephone 7 - — f,
Present Mailing Address 3 y F�„cs r S � Soi� a,;,� ,� (�l`h�l�
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 pazcel 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 fazm structures. A person who constructs more
than one home in a two yeaz 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-faws and regalatsuns. '
The undersigned"homeowner"certifies that he/she understands the City of Sa�iem
Building Department minimum inspection procedures and requirements and that he/she
will comply with said procedures and requireme
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING INSPECTOR
See other side for state code
,
�
Homeowner's Exemption
The Code states that: "Any Homeowner perfomung 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 aze unawaze that they aze assuming the
responsibilities of a Supervisor(see Appendix Q,Rules and Regulations for Licensing of
Construction Supervisors, Secrion 2.15). This lack of awazeness often results in serious
problems,particulazly when the Homeowner hires unlicensed persons. In this case your
Board cannot proceed against the unlicensed person as it would with a licensed
Supervisor. The Homeowner acring as Supervisor is ulrimately responsible.
To ensure that the Homeowner is fully awaze of his/her responsibiliries, many
communiries 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 caze to amend and adopt such a
fornilcertification for use in your community.
' .
CrrY OF S��t
� • PUBLIC PROPER'TY
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(requ�rad tos alt eaool�ioa.oe Knovatiaa w�alc)
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