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7 HAYWARD ST - BUILDING INSPECTION .. r IRIAMIAtlKIN#%dN #ND AVMOYEG er ae iLP=PAR TD A.PRd SMO GMWkD CITY OF SALEM wod,�� ,.J is Flom v L=Nmd mntiq olwla ft waft Ohdpl9'N y_�No_ I+rt� of M FIG"If Loafa01n PernLk to BULLMI PfBNEf APPLAUTION POI% (Chb whlofow apply) Roof. Rerod, IrwltM !:Mobv t RoPSWRBPW& OIIMr:-T^r �r e�' rti� 4 $IMd. Peel. PLEABE M L our L ROWLY a COMPLETELY TO AVOW DRAYS N PROfNNNG TO THE IN8P6CTQR OF BUILDING& '. The eoMn hom. W tPPING tr t POM to build WWRI p,b the,tbw*p OWWS Nnoae w7��tQL'� �v�✓•�vc�,/ A111h A Phone fr-24-► -7 -ir Auu►hft t Nerve Aditn A Phone f ► Meolw ics Nerve C c hrs 2 �� ✓ Aditm fL Phone r 114�� - o MflwL r b PvPoM etl eWdr�1 uww d a++pt w e awiq,for taw m"f v VOW"aoww b Lw1 A.ewe s EMd colt 'too LJoww• �� LloN1M• W ! / �� v SIp1e n of App M �IONfm L �TIN PINALTY' of PULRW offficnfPnoN OF wa�c To f�E,Dor� IrMl1. Pf38yNT T0; ��'�,2 G�Jl�tO i f gggmgo �oe2at S7 f S n 03IW4W 1WAl3d NOLLV= oL JA� F CITY OF SALEMv MASSACHUSETTS y 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 k � -�o r Job Location Home Owner Address Home Owner Telephone -7 7 y g—Ge6 Present Mailing Address -7 r).,, 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 act s 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 inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE c 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 required shall be exempt from the provisions of this section eng(Seages a tion 1 person(s)(s) for hire to of Construction Supervisors); provided that a Homeowner eng g P do such work, and that such Homeowner shall act as Supervisor. Many Homeowners who use this exemption are unaware that they are assuming the 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 the unlicensed person as it would with a licensed eowner acting as supervisor is ultimately responsible. Supervisor. The Horn To ensure that the Homeowner is fully aware of his/herresponsibilities,,t hatwner certify that ies require as a part of the Permit Application, umt q t page of this issue is a comet he/she understands the responsibilities of a Supervisor. On the asp g form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. R� I to I Zoo S CITY OR SALUNg MASSACHUSETTS PUmUC PIIOPUM DCPAWMCNT 120MMaNINamm SMEW.3a0►LOM mok, M MAOIMO TEL crn171Msss W.300 STANUM A U20VIC16 .JR DOPOM OF D»RS AFMAVf7 Is - - - q amCO wflb 16a p *Y mkm di"a 406 SK I ubowlWp did r a cmdWm ds11�Ihlsit r .s1 d16da��t ltas s.saerelledoa aedlrigr rm' d bb db gWlft Frfmll seat be dbpm d dim a Pi Gly logo" rod"willbedhooridie w%l( /' Loeadam dlaeiligr �-CA C-- S*WM dFarmil AppAcM Daft FULLY ooq*ft dw b5wft kh madom OMEASS PRW CLEARLY) Nasti a[l�lmit/IppEed Fh=Nam%ifuw Addm%CityA sum nw Abow SWAB requitaa fill ddm fi m dw dsmobdo%rmo slogs rehab of odor ahmdo ofbdVq or*wan be d>poead im a pmpafy6&s=W soo&wsw sr ds&W by M M cnX 31"A.and tea%ildf 1pngiti or&=so am to ir>dkatr d!m loados of dr�f'.