10 LEVAL RD - BUILDING INSPECTION (5) MU TeE f4L-ED-AfJ0 APPROVED BY T*IE
.INSPECTOR PWJ3 TP.A.PEMT BEING GRANTED
CITY OF SALEM
/� :.;u
No. y�t:/.�j .` � `\ Date
\"ecrmNe o�"'
Is Property Located In ✓ Location of
the Historic District? Yes_No_ Building I C7 1-45VA-L O/Zp
Is Property Located in
the Conservation Area? Yes No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
f3 al Replace, Other: nrcf4c,
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 9f 0 bF�✓ S
Address & Phone
Architect's Name
Address & Phone ( )
Mechanics Name 4
Address & Phone ( )
What is the purpose of building? 10 6—
Material of building? tN a�n If a dwelling, for how many families? /
Will building conform to law? y Asbestos?
Estimated cost 'Qd City License t N ' State License #
Home Improveaent
�VV7 Lic. i �S
X Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
C)r)L>° OU 4eck
MAIL PERMIT TO:
�j
No.
APPLICATION FOR
PERMIT TO
�� ��Qi,�J —QEGKsu� YlLkr cS
LOCATION
/O
PERMIT GRANTED
AP �tOVfD
7�,"q
INSPECTOR OF BUILDINGS
CITY OF SALEMO, MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
SALEM, MASSACHUSETTS 01970
STANLEY J. UsOVIC2, in. TELEPHONE: 978-745-9595 EXT. 380
MAYOR FAX: 978-740-9846
HOMEOWNER LICENSE EXEMPTION
Please Print.
Date
Job Location / o L/_JAL 1?®
Home Owner Address . S/�p-R
Home Owner Telephone 9
Present Mailing Address , ,
The current exemption of"Homeowners",_was,extended to:include owner occupied
dwellings of two Units or less and to allow such homeownto engage an individual for
hire who does not possess a license, provided that the ownei'`acts as supervisor:
DEFINITION OF HOMEOWNER.,;, `a
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 requirements,
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING INSPECTOR
See other side for state code
HOMEOWNERS EXEMPTION
Code ; "Any Homeowner performing work for which a Building Permit is
The
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.
Many homeowners who use this exemption are unaware that they an atioassuming
ssumr iLicensing
the
responsibilities of a Supervisor(see Appendix Q,Rules and Regul
ns
Construction Supervisors, Section 2.15). This lack of awareness often results
s. In thiscase o
problems,Particularly when the Homeowner hires unlicensed it p with a licensed
a the unlicensed person t proceed against .
Board isnno p ultim 1 responsible.
Supervisor., The Homeowner acting as supervisor is ��
that the Homeowner is fully aware of his/her responsibilities,many that
To ensuret Application, ` the Homeowner certify communities require, as a part ns bilities of a Supervisor. On the last page of this issue is a
the
he/she understandsresponsibilities t such a
form currently used by several towns-
form/certification for use in your community.
R� �Izol yaos
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