18 LATHROP ST - BUILDING INSPECTION CITY OF SALEM
PUBLIC PROPERTY
DEPARTMENT
Ki NIBERLEY DRISCOLL
MAYOR 120 WASHINGTON STREET • SALEM,MASSACHUSETIS 01970
'IEL_978-745-9595 • FAX:978-740-9846
HOMEOWNER LICENSE EXEMPTION
Please
nPrii t
Date "17G
Job Location r
Home Owner Address Sf r
Home Owner Telephone W k} TV J— 2?-3.O-S- f
Present Mailing Address /�-t
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 pr ures ements and that he/she
will comply with said proced es and re ui ents.
HOMEOWNERS SIGNAT
APPROVAL OF BUILDING INSPECTOR
See other side for state code
Homeowner's 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(Section 109.1 —Licensing of
Construction Supervisors);provided that a Homeowner engages a person(s) for hire to do
such work, and the 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 of
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
Supervisor. The Homeowner acting as Supervisor is ultimately responsible.
To ensure that the Homeowner is fully aware of his/her responsibilities, many
communities require, as part of the Permit Application, that the Homeowner certify that
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.
PUBLIC PROPERTY
DEPARTM&NT
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130 W&UuNc,nm slrn" yuUM4.MAUACMSh a 01970
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APPLICATION FOR THE REPAIR, RENOVA•rrnN CONSTRUCTION
DEMOLITION. OR CHANGE OF USXOR OC XANCY FOR ANY EMSTIN
STRUCTURE OR BUILDINr
1.0 SITE INFOR TION
Location Name: 4awT-PF Angt
YU�S P,'n BUIk
Property Address:-1
Properly Is bested in a;Consanatbn Area YM; z Histaft District Y/N
2.0 OWNERSHIP INFORMATION
X Owner of Land
Name:
Address ( � a r a� 2`
Telephone: QI? 4 1 33Q�
3.000MPLETE THIS SECTION FOR WORK IN "1811W BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use New
Demolition Existing
Approximate year of Area per floor (sf) Renovated
construction or renovation
Of existing building New
add Description of Proposed Work:
-- --- ---Mall Permit t0• r»r �„� p. �' ` � __ m ��
What is the current use of the Building? it dwelUng.how man►units?
Material of Building? Asbestos?
yVa the Building Conform to Law?
Architects Name
Address and Phone
Mechanic's Name
Address and PtwM HIC Registration 0
Construction Supsrvaors uc°nse
Estimated.Coat of Prr d s Pew Fee Calculation
Estimated Cost X$7/$1000 Residential
Permit Fee Estirna Cott X s11/i1000 Commercial--— --
- An Additional$5.00 Is added as an
! Administrative charge.
Make sure that all flelds are properly and legibly written to avoid delays In processing.
Tits undersigned does hereby apply for a Building Permit to b to the vs s a
specifications. signed under Penalty of per)ury
Date aG 9
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