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APPLICATION FOR
p /PERIfr TO
LWATION
PEFOA GRANTED
APPAXWED
M2ECTCR OF MMM
CITY OF SALEM, MASSACHUSETTS
a PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET. 3RO FLOOR
SALEM. MASSACHUSETTS 01970
STANLEY J. USOVIC2, JR. TELEPHONE: 979-748-9597 EXT. 380
MAYOR FAX: 978-740-9848
HOMEOWNER LICENSE EXEMPTION
Please Print.
Datee L-112066
Job Location 2n-
Home Owner Address
Home Owner Telephone 9; f
Present Mailing Address. 1,8 v�kn'cY" si _ Sfk ,414
The current exemption of"Homeowners"._was extended to include ownw-occupied
dwellings Of two Units or less and to allow such homeo to engage an individual for
hire who does not possess a license,provided that the o as supervisor.
DEFINITION OF HOMEOWNER .
Person(s)who ovens a parcel.of land on which he/she resides or in
which there is,or is intended to tends a reside,con
h
' structures accessory� �a one or two family dwelling, attached or detached
ry such use and/or farm. structures.
than one home m a a person who constructs more
�� � two year period shall not be considered a homeowner.
homeowner' shall submit to the Building Official,on a form Such
Official, that he/she be responsible for all such work acceptable B the Building
Permit 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 p adores and u'
will comply with said procedures and �1 irements and that he/she
rots.
HOMEOWNERS SIGNATURE /
APPROVAL OF BUILDING INSPECTOR
See other side for state code
4
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 persons) for hire to
shall act as Supervisor.
do such work, and that such Homeowner
Many Homeowners who use this exemption are unaware that they an assuming the
r see Appendix Q.Rules and Regulations for Licensing
respond of a Supetviso ( ogen results in serious
Construction Supervisors,Section 2.15). This lack n awareness ns. In this case your
problems.Particularly when the Homeowner hires unlicensed Pecs°
unlicensed person as it would with a licensed
Bowan P H� acting as suPW4=is ultimat�responsible.
a
To ensure that the Homeowner is fully aware of his/her 'bilities,many
as a part of the Permit Application,
Homeowner certify that
communities understands
t, responsibilities of a Supervisor. On the last page of this issue is a
forme rre used by eeral towns. You may can to amend and adopt such a
form currently
form/certification for use in your community
Ro `I j0 l yao t
CITY OF SALEM, MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
SALEM. MASSACHUSETTS 01970
STANLEY J. USOVICZ, JR. TELEPHONE: 978-743-9593 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:
L- of Facility)
-- y (Location G'
Signature of Applicant
i�y /z oo�
Date