95 JACKSON ST - BUILDING INSPECTION S Will ST�BE iilfg�i�Jfl APPROVED 8Y T*IE
JUS,PECT03 PIWR TD.A PERMIT BEING GRANTED
CITY OF SALEM
No.�.J/ 'D F.t ,�� � Date—; 2.2L LOOT
T.
Is Property Located In Location of
the Historic District? Yes No Building �S— Ta cKs o l.! rr
Is Property Located in
the Conservation Area? Yes No
BUILDING PERMIT APPLICATION FOR:
Permit to: �—
(Circle whichever apply) Roof, Reroof, stWa all-Siding, Construct Deck, Shed, Pool,
Repair/Re I , Other:
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:
Owner's Name u s s� ni rye +4qq>�
Address & Phone 14 c ka orJ
Architect's Name
Address & Phone ( )
Mechanics Name
Address & Phone ( )
What is the purpose of building? a
Material of building? W D OC& If a dwelling, for how many families? ) W 0
Will building conform to law? U -S Asbestos? yU
Estimated cost City License# N A State License #
�( \ Home Improvemeut v y�
Lic. i A:��I�/,�a..._�
Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
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MAIL PERMIT TO:
No.
APPLICATION FOR
PERMIT TOO
LOCATION
PERMIT GRANTED
AP OV�D
INSPECTOK OF BUILDINGS
CITY OF SAL AN, MASGACHUOL-rr*
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CITY OF SALEM, MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
4D SALEM, MASSACHUSETTS 01970
STANLEY J. USOVIC2, jot. TELEPHONE: 978-745-9595 EXT. 380
MAYOR FAX: 978-740-9846
HOMEOWNER LICENSE EXEMPTION
Please Print.
Date V
Job Location__
Home Owner Address
Home Owner Telephone
Present Mailing Address,,,. . ...
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
possess a licens
hire who does not e,provided that the ownet`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 procedures and requir ents.
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING INSPECTOR
See other side for state code
HOMEOWNERS� 11—ION
The Code states that: "Any Homeowner Performing work for which a Building Permit is
required shall be exempt from the provisions of this section(Section 109.1.1 —Licensing
of Construction Supervisors); provided that a Homeowner engages a person(s) for hire to
do such work, and that such Homeowner shall act as Supervisor.
g the
Many Homeowners who use this exemptionAppendix Q R and Regulations for Licensing
responsibilities of a Supervisor(see
Construction Supervisors+ Section meo This lack unlicensed awareness s nos resul in t �your
problems,Particularly when the Homeowner p rsonas it oould with a licensed
Board cannot proceed against the unlicensed p responsible.
Supervisor. The Homeowner acting as supervisor is ultimatFly �Po
r
To ensure that the Homeowner is fully aware of his/her
the Homeowner certify that
communities require, as a P�of the Permit Application, a w this issue is a
he/she understands the responsibilities of a Supervisor. On the last page
such a
form currently used by several towns. You may care to amend and adopt
form/certification for use in your community.
� GIsoIZooS
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