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CITY OF SALE149 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
Job Location G A /c r�, S i S L A ni n
Home Owrmr Address /`/,_�.�
Home Owner Telephone ") .Pi
Preeemt Malhrrg Address /�i ,ri�d�- R,�/e e T ti1.0 n �A � C 9 5!S
The current exemption of"Homeownere.was.extended to include owner-occupied
dwellings Of two Unite or less and to allow such homed to engage an individual for
hire who does not possess a license,provided that the o as supervisor.
DEFINITION OF HOMEOWNER ,p
Pwehirsohn(sho n a parcel-of land o which he/she resides or intcods to reside, on
there is,or is intended to be,It one or two family dwelling,attached or detached
structures accessory to such use and/or farm structures. A
than one home in a two year period shall not be consi Pam who constructs more
. Such
"homeownee'shall submit to the Building Official,On a form acceptable eto the Building
Official, that he/she be responsible for all such Permit work performed under the Building
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 inspection procedures and requirements and that he/she
will comply with said procedures and requirements.
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING INSPECTOR �y
See other side for state code
HOMEOWNERS EMEP"UON
The Code states that: Any Homeowner performing work for which a Building Permit it
..
required shall pt Mipt from the provisions of this section(Secti�o a 109.1n(1 s)—Licensing
or hire to
Of Construction Supervisors),provided that a Homeowner mSaB Pao
do such work, and that such Homeowner shall act as Supervisor.
Many Homeowners who use this exemption are unaware that they are assuming the
nape r(am Appendix Q Rules and Regulations for Licensing
nsibilitiea of a Supervise often r0sultd in serious
Construction Supervisors.gect<on 2.15). This lack of awareness this case your
problems.Particularly when the Homeowner hiresunlicensed
itc dp rs a lis. censed
this
Board cannot proceed againstthe unlicensed person as ultimagly responsible.
Supervisor. The Homeowner acting as supWAM a.
To ensure that the Homeowner is fully aware of his/her responsibilities.many
communities require, as a part of the Permit Application, at the Homeowners issue that
responsibilities of a Supervise'• On the last page of this issue is a
he/she understands the re veral can to amend and adopt such a
form currently used b3'86�'e�towns. You may
form/certification for use in your community,
�I;ol saes,
R
4 CITY OF SALEM, MASSACHUSETTS
• PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
SALEM, MASSACNUSETTS 01970
STANLEY J. USOVICZ, JR. TELEPHONE: 978-745-9595 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:
W �l i S /so-.ev 02 ,
h 4 if L a (Location of Facility /11 ,
14
Signa a of Applicant
Date