1 ISLAND AVE - BUILDING INSPECTION (5) -PL-*NS1dt#ST13EfiLE� APPROVED BY T44E
1US,PJXTL>R PWR TD.A.PERMIT BEING GRANTED
a
CITY OF SALEM
Date
a3 ��.trr' kI
Is Property Located in Location of
the Historic District? Yes No Building
Is Property Located in
the Conservation Area? Yes_No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) R09L Reroof, Install Siding, onstruct Deck hed, Pool,
Repair/Replac , Other: !/Ih
PLEASE FILL OUT LEGIBLY& COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the following
specifications: A
Owners Name ��1Af`� U 12t, 5
Address & Phone l TSLAv b (1tJ► 13) 1`f`f — S $Z
Architect's Name
Address & Phone j )
Mechanics Name
Address & Phone / // 1
j )
What is the purpose of building? LFye,G�n n r�
Material of building? Wou - If a dwelling, for how many families?
Will building co onn to law? t LL Asbestos?,/r/
Estimated coJ-J City License# N P State License #
Bose Improvement
Lie.
Stgnat re o Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE /
p
r,�'� �.-t- Q'r�/jf it moi/ -pst7 hoc✓ 0 /q/
MAIL PERMIT TO: IYII�IR�I �y�N S
NoD-C �
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
;APROV�D
PECTOR lgr BUILDINGS
v�� ■ yr .rwval� mwaiw%.nvapiB is
RALIC PMOFCM DVAR URM
(20 MMPI awftM !fll/i�ti>�AO ILoom
SMAW MA Of
T4(WM746-NN RM.300
PAs (CM 74616C
STMUM� X AL
VON
DWOM DT DORM AMDAVtt
1Y�moml�ea�vim pio�rldeer o[�1Q. P.1'�IMEW*a a a eotlidm
a[1latla�>�r _i eidot t�s.oo.�oodo.,ati�►
ami br sdti�l�slt iW b•s*e./dti a pe ap leoen/.eliAw.M�
co�.uoa atFret�tq►
otlsde Apr&r Doo
FMLY oompbb to bOow*febrromm
XAASS PSS CL&U L»
Nai AppNoW
FfisNama`itaq►
1 Z A�1Y� �uC . 1if�t�7G�Yh MI�
AAdm%CIV A Sho
IU about sWaft m9wo dkd dr wb to 66 MUMIM rmMdM mhA at air
ahmda dbulft or*odd be d4W is 11 P"fy6&40W slot WUN&"d
ddit as aAWly&tat ca$I^m/m.bml ftp.m;d or&iow=tr
i>Sar dW ba"oto Adft.►.
CITY OF SALEMO MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
4D SALEM, MASSACHUSETTS 01970
STANLEY J. USOVICZ, JR. TELEPHONE: 978-745-9593 EXT. 38o
MAYOR FAX: 978-740-9846
HOMEOWNER LICENSE EXEMPTION
Please Print.
Date 9 - 1$ -o S
Job Location 1 251�N A J Ewu 1 r�
Home Owner Address
Home Owner Telephone
Present Mailing Address I .S Sl.Awa n Pw n6yts.
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-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 proceduresandrequirements.
HOMEOWNERS SIGNATURE'
APPROVAL OF BUILDING INSPECTOR D
See other side for state code
r
HOMEOWNERS EREh1 11—
The Code states that: "Any Homeowner performing work for which a Building Permit is
required shall be exempt from the proviLicensing
sions of this section(Section 109.1.1 —engages's persons) for hire to
of Construction Supervisors):provided that a Homeowner
do such work,and that such Homeowner
shall act as Supervisor.
the
Many Homeowners who use this gzemption are;Rules acid Regulaaware that they tions foassr Licensing
responsibilities of a Supervisor(see Appendix Q;
Construction Supervisors, Section 2:15). This lack'of awareness often results in serious
problems,Particularly when the Homeowner hien i it would with a licensedersons. In ase your
Board cannot proceed against the unlicensed
is ultimately responsible.
Supervisor. The Homeowner acting *;
To ensure that the Homeowner is fully aware of hi hon,that the responsibilities,
omeowner certify that
communities require, as a part of the Permit App
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
z
R� b Sol yoo s