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41 FORRESTER ST - BUILDING INSPECTION +WMlltli W VR,rWW APMOVED GY US CITY OF SALEM xoww n, M Mrodo OYMot9in Yo Ne X t0� of :w Ai ? Yt_No� WJ LSDWQ PENT APPLICATION POD Pamk to: Oft W W aw an*) Ro a. Ir aWI Skft ConWW DsoK Shed, PoA R�p�idFUproa, ,har. PLEASE PLL L OUr LJfMLY A COWLEMY TO AVOW DM AYS N PVAXXNr TO THE QrBPBCTTDR OF fff!lLDM&- '. huaby appl u for a pwmk to bukd aooad ft io dw.foNospurdsom wirp i Addraaa 6 Phona 4 I Fo= r f (T9) 74K--3173 AM*A ft Nana Addma A Phorr t 1 MWmin Name Ad*m d Phona 51 Fe(knnas •. �y„A t l;l-i1 59 2-3a$ C� , wK�.a■p.po,.a a+�+o+ 2��,r�A dwdrq,a hoNr w,np ir11aM1 \\`/, w•�q ov+ow b Y.rr `fine A.ews.' �5�}��r—��,w�� v Q� ate, �av� (k r,.tia. i �.J �INO/1171Et PE�ML7Y• of PWURV oeecnPnoN OF w�oaa To 8E DONE MAIL PEMI y► � I�� f- c s SONI01 9 d0 !! OJAdMddV �� oZ 03IN O1NVN3d NOILV= . Ol 1/wi3d UOd NOLLvan& r i CITY OF SALEM9 MASSACHUSETTS PUBLIC PROPERTY DEPARTMENT 120 WASHINGTON STREET, 3RD FLOOR SALEM, MASSACHUSETTS 01970 STANLEY J. USOVICZ, JR. TELEPHONE: 978-745-9595 EXT. 380 MAYOR FAX: 978-740-9846 HOMEOWNER LICENSE EXEMPTION Please Print. Date �1-1 Job Location_ 411 r Home Owner Address Qa�l/3�.In S Home Owner Telephone to , MA Present Mailing Address r'MiftEj MA_ n12174ft 1 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 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 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 procedures and require nts. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING INSPECTOR See other side for state code HOMEOWNERS EXEMPTION er performing work for which a Building Permit is The Code states that: "Any Homeown required shall be exempt from ho provisions that Homeowner engages a person(s) for hire to of Construction Supervisors);p do such work, and that such Homeowner shall act as Supervisor. Many Homeowners who use this exemption are unaware that they are assuming he responsibilities of a Supervisor(see Appendix Q,Rules and Regulations for Licensing Construction Supervisors, Section 2.15). This lack of awareness often results in serious problems,Particularly when the Homeowner hires unlicensed persons. In this case your Board cannot proceed against he unlicensed person as it would with a licensed Supervisor. The Homeowner acting as supervisor is ultimately responsible. ties, many To ensure that the Homeowner is fully aware of his/herApplication, he Homeowner certify that communities require, as a part of he Permit Appli 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. RjW GIsoIZaol CITY OP SALZR% MASSACMUSEWS PUNUC PIIOPtilrtlf 09FAM[NT i9l law In 120 VAmmi -arn SMOR,aao Pta" SMAO'NA OI9" (!7q 7464a 9W.aw FAR (8741 74040 l STANUCT A UM IC& J L WAYM DMPOM O!DOU=AMAVR b Aooal&a wA&(bo plovia m atmm a 4q a4 I ubnwfadso(sat n a ammm ots. mft pwmk r .as dabdo n w ft&a do oaedooe =acting pr.mad by dti Fhtait i!a>!be dtpo�d din a ptoparbr>iedM alii.�uta di�peod�r duAead by 1Q.a>R!!1!!#A Lmm"@(Fm tigr otPetmit AppBeaet Dah FULLY oamptah dw hbwfq khmmdm OUAU PRW CL LULV) Outs F Ca.r�D :zf N�atPremit Apptlaet Fiu)(ame`if mW 1l torft, Sick( n. MA Addtt City s 3hlo 1b oboes 040 rd"m tint debm Am tbt damohdM rmovad^rAA or odw taltata m otbal ft or OucNn be diVmW in a p mpair-iicaUW sol W"m diap w Ad*ar&fiW by 11M GA 315ft and ftbudftPonnits of 5--into im(c+to do b a"of fbt&a*.