45 LIBERTY - BUILDING INSPECTION fL111NSiMWT-BEfl!L—E MND APPROVED BY 774E
JdSP.EG=PH10R TD.A.PARIfT BEING GRANTED
�y 7 CITY OF_SALEM
No= y'�J�j 'W \� Date
s:
� J
Is Property Located in Location of I
the Historic Dlstrid? Yes_ il No_ Buding (�
Is Property Located in
the Conservation Aroa? Yes No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
Repair/Replace, 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:
Owners Name
Address & Phone f6`�if3� zrf� f{ /� &Igl 711V- o!S$
Architect's Name
Address & Phone 1
Mechanics Name -
Address & Phone L
What is the purpose of butiding?
Meerut of bWk irtp? If a dwaling,for how many families?
Will buildrg conforrn to law? Asbestos?
Estimated cost E City License♦ N rA State License e
Bowe improveaent
Signature of A00licant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
c
MAIL PERMIT TO:
F
No. � O
APPLICATION FOR
PERMIT TO
LOCATION
Ao
PERMIT GRANTED
s�
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AP OV�D
INSPECTOR OF BUILDINGS
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CITY OF SALEM, MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
� SALEM, MASSACHUSETTS 01970
STANLEY J. USOVICZ, JR. TELEPHONE: 978-743-9393 EXT. 380
MAYOR FAX: 978-740-9846
HOMEOWNER LICENSE EXEMPTION
Please Print
Date /a— V- o3
Job Location H,S^.c.i,r3 e►�tT ,S�ie� .4 v4` S
Home Owns Address
�R�,Bn MA
Home Owner Telephone 97 4 _ _7yy
Present Mailing Address . S d.a
The current exemption of"HomeowneW.,,was e t xterided to include owner-occupied
dwellings of two Units,or less and to allow such homeownelsto 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 them 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 SIGNATUREIV
APPROVAL OF BUILDING INSPECTOR
See other side for state code
pO NERS EXEEI�TION
The Code states that: "Any Homeowner Performing work for which a Building Permit is
Licensing
required shall be exempt from the provisions of this section(S tio a 109.1s, for hire to
of Construction Supervisors).provided that a Homeowner visengagesPESO
do such work, and that such Homeowner shall act as Supervisor. , , ,,
Many Homeowners who use this exemption are unaware that they me
ona�formLigceDSmB
responsibilities of a Supervisor(see Append Q,Mules ands
Construction Supervisors, Section 2.15). This lack of awareness o resulersons. In t s case you
problems,Particularly when the Homeowner hires unlicensed
as it would with a licensed
Board cannot proceed against the unlicensed p is ultim ly responsible.
Supervisor. The Homeowner acting as supervisor �`u-
ibilities,many
To ensure that the.Homeowner is fully aware of his/her e,Homeowner certify that
communities requre, as a p�of the Permit upeApp Page of this issue is a
he/she understands the responsibilities of Supervisor- aand adopt such a
form currently used by several towns. you may
care to amend
form/certification for use in your community,
fo blso tooS