47 LINDEN ST - BUILDING INSPECTIONf
iM.�IN61MISt�E fit 1111 M1D APPROVED BY 1W
ems Atop rDAPROW UING GRANTED
CITY OF_SALEM
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BIRLD" Pgnw APPLICATION FOR:
Pernik w:
(Circle whiohaver apply) Roof. Rsroof. Instal Skft1 CorNOW DOCK
(LStmy, Pool.
RmpaidRepaa. 0dw, /H TQ. Q� (Q bVC Tl7N Z y u P eS
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS W PROCESUA
TO THE INSPECTOR OF BUWNGS:
The mdersipned heraby applies for a permit to build aacwft to to follomm*
specidicalions
Curors Name cr"m oAaay—
Address A Photo �� OA km 54.
Nohked's Name A)1 4
Address 6 Phone . o 1A f 1
Mechanics Name 6uw ne ekV. ,
Address& Photo 133S• 44.39
YMIII b Ma gapon of tMIYOYIp? I�eS�c�eH�io�
mdmw a tlullulrp4 wool -tee,m a- M a omm",for how many wmmn?0__
MIN Witt W mm to low? 16e s AebmW? V n known.
End Cod S, oda cky Uorw# N A Of Uo 0 AJ A
0 14C. f I ;� )*. %��
Signature of Applicant
Sli'i = MWR THE PENALTY
OF P1111111LIHIM
D ESCR1PTtON OF WORK TO BE DONE
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MAIL PERMIT
No.
APPLICATION FOR
// PEW I TO
cS/N�'S � s�/6ae.sJ G✓�/taCowf
LOCATION
PE thlff GRANTED
OF BU05W—
CITY OF SALEM, MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET. 3RO FLOOR
SALEM. MASSACHUSETTS 01970
STANLEY J. USOvICZ, JR. TELEPHONE: 978-745-9695 EXT. 380
MAYOR FAX: 978-740-9846
HOMEOWNER LICENSE EXEMPTION
Please Print
Date lz o, Ot
Job Location 4e}
Home Owner Address. de-7-
Home Owner Telephone 9 ss. a�a •��14
Present Mailing Address—
The current exemption of"Homeowner"was.extended to include owner-occupied
dwellings Of two Units or less and to allow such homeown9NO engage an individual for
hire who does not possess a license,provided that the Owner acts as supervisor.
DEFINITION OF HOMEOWNER.:.
Persons)who owns a parcel-of lard 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 sructtres. A person who constructs more.
than one home in a two year period shall not be considered a homeowner. Such
"homeownee,shall submit to the Building Official,on a form acceptable to the Building
OfficiP��l, that he/she be responsible for all such work 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 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 E7�TIOH
The Code states that: "Any Homeowner performing work for which a Building permit is
wired shall be exempt from the provisions of this section(Section 109.1.1 —Licensing
of Construction Supervisors): engages a Persona)for hire to
provided that a Homeowner
do such work, and that such Homeowner shall act as Supervisor.
any Homeowners who use this n tioi,are unaware that they are assuming the
race
Ajpendix Q Rules and Regulations for Licensing
responsibilities of a Supervisor(see Ap "in serious
Construction Supe visor$,Section 2.15). This hick awareness eons results
problems.Particularly when the Homeowner hires unlicensed persons. In this case your
Board cannot proceed against unlicensed won it would with a licensed
Supervisor. The Homeowner acting supervisoris ultimat��1y responsible.
Homeowner is full aware of his/her r bilities,many
y that
To ensure that the Homeo Application, the Homeowner certify
communities regain, as a part ib the Permit uPe On the last page of this issue is a
he/she understands the responsibilities of s Supervisor•
form currently used b'Several towns. You may can to amend and adopt such a
form/certification for use in your community
R� GI�IyaoS
CITY OF SALEMt MASSACHUSETTS
j PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RO FLOOR
SALEM, MASSACHUSETTS 01970
STANLEY J. USOVICZ, JR. TELEPHONE: 978-745-9595 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:
(Location of Facility)
Signature of Applicant
/2.L/O/f US-
Date