70 LEAVITT ST - BUILDING INSPECTION fL*N6�f1U6T�E fKA91011ND APPROVED BY T41E
AUPFCMB PRIOR W A PEBWT BEING GRANTED
CITY OF SALEM
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Permit to: E WIT
BUILDING P 'APPUCATION FOR:
(Circe Whichever apply) Roof, Reroof, Indall Siding, CMSMX:t Deck, Shed, Pool.
Repair/Replace. Other.
PLEASE FILL OUT LEMLY&COMPLETELY TO AVOID DELAYS MI PROCES MKy
TO THE INSPECTOR OF BUILDINGS: '•
The undersowd hereby applies for a permit to bola accorcl4ig.to the WAov*V
specifications:
Owners Name 1 1 A
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Address Phone7R 1 Zt1el-.
Architect's Name
Address d Phone f
Mechanics Name
Address A Phone I' t
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§bnabirs of Applicant
UNDER THE PENALTY,
DESCRIPTION OF NfM TO BE DONE of PERJURY
Q,4,172 perms
MAIL PERMIT TO:
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CITY OF SALEM9 MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
10 120 WASHINGTON STREET, 3RD FLOOR
SALEM, MASSACHUSETTS 01970
STANLEY J. USOVICZ, JR. TELEPHONE: 978-745-9595 EXT. 380
MAYOR FAX: 978-740-9846
HOMEOWNER LICENSE EXEMPTION
Please Print
Date ,.
Job Location
Home Owner A a
Home Owner Telephone 7 _
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
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 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 �Iztn2
See other side for state code
HOMEOWNERS EXEMPTION
The Any Homeowner Per
Code states that: " t°rtmng workfor which a Building Permit is
required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing hire °
of Construction Supervisors):Provided that a Homeowner engages a peison(s).
do such work, and.that such Homeowner shall act as Supervisor
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ass
Many Homeowners who use this exemption are unaware that they� fomr i iCg the ng
responsibilities of a Supervisor(see Appendix Q,Rule and Regulations in
Coristruction Supervisors. Section•2.15). This lack of awnreness��results s case your
problems,Particularly when the Homeowner ed hires 1 it would with a licensed
Board cannot proceed against the acting
as supervisor e personsor is ultimately responsible.
Supervisor. The Homeowner acting P `4,
To ensure that the Homeowner is fully aware of his nthe Homeowner certib'htles'many fy that
communities require, as a part of the Permit Application,
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
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