6 HIBERNIA LN - BUILDING INSPECTION _ (� Ns I�IOIIn OhlMol7
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Yom it mm THE PENALTY
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DESCRIP" OF WOMK TO K DONE
MAIL PERMITS
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APPLICATION FOR
PIMIII TO
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LOCATION
PEF"T GRANTED l
OF eua.oOM
CITY OF .SALEM, MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET. 3RO FLOOR
SALEM. MASSACHUSETTS 01970
STANLEY J. USOvICZ, JR. TELEPHONE: 978-743-9E93 EXT. 380
MAYOR FAX: 97a-740.9848
HOMEOWNER LICENSE EXEMPTION
Please Print
Due ZlSld4�
Job Location /1: "E,( ^As*
Home Owner Address L d,de f
Home Owner Telephone
PrtaCnt�n$Ad�e9a(N.lyts.vi A s!ANE .:. Se/�.�, M.A t�
The current exemption of"Homeowners"._was extended to include o
dwellings of two Units or less and to allow such bomeo to engage an individual for
hire who does not possess a license,provided that the o " as supervisor.
DEFINITION OF HOMEOWNM r
Person(s)who owns a parcel of land on which he/she resildes 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 riot be considered a homeowner. Such
"homeownd'sball 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
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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 ��b
See other side for state code
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The Code states that: Any Homeowner performing work for which a Building Permit is
wed shall be exempt from the provisions of this section(Section 109.1.1 —Licensing
on Supervisors);provided that a Homeowner engages a peison(s) for hire to
of Constructs such Homeowner shall act as Supervisor.
do such work, and that
don'are unaware that they are assuming the _
Many Homeowners who use floss ve Appendix
Rules anus Regulations for Licensing
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responsibilities of a Supervisor(see APPE° Q'
Conammdon Supervisors:Section 2.15). This lack of awareness o this case your
Homeowner hires unlicensed perso
when the Hom
1 wh
ar
ro licensed
problems.Parts, Y �unlicensed pin�it would with a
Board cannot proceed against sor is ultimately responsible.
Supery W. The Homeowner a�►g supern
To ensure that the Homeowner is fully aware of his/her bilities,many
communities require, as a part of the Permit Application, the Homeowneracert►sue is a
responsibilitieshe of a Supervmor• On the and
page
form a and used bndS tby sevarel towns. you may can to amend and adopt such a
form currently
form/certification for use in your community.
so too S
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