112 LINDEN ST - BUILDING INSPECTION EI` T-OFS-ALEx --
PUBLIC PROPERTY `
DEPARTMENT
KI.%MFJU-Sy 1)USCOLL
MAYon 120WASIONa"!-rR ♦SntEu MASSAC3/l I-M01970
TM-,978-74S-9595*FAX:976-740-9946
APPLICATION FOR THE REPAIR, RENOVATION CONSTRUCTION.
DEMOLITION OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING
STRUCTURE OR BUILDING
rProperty
ATION
! , Z Llndr{ Building:
:
ted in a;Conservation Area Y/N Historic District YIN
2.0 OWNERSHIP INFORMATION q w
2.1 Owner of Land M(cAc-e t Ka l 0 �u2U a N e 7 N
Name:
Address:
Telephone:
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING 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 New
of existing building
Brief Description of Proposed Work:
Mail Permit to:
What is the current use of the Building?
Material of Building? W�eA-,t V--e If dwelling. how many units?
Will the Building Conform to Law? Asbestos?
Archft—aV448Me
awe G� c�
Address and Phone 2 �� — � o "� /
Construction Supervisors License# HIC Registration#
Estimated Cost of ro $ Permit Fee Calculation
Permft Fee$ Estimated Cost X$7/$1000 Residential
Estimated Cost X$11/$1000 Commercial
An Additional$5.00 is added as an
Administrative charge.
Make sure that all fields are properly and legibly written to avoid delays in processing.
The undersigned does hereby apply for a Building Permit to build to th ve sta ed
specifications. Signed under penalty of perjury X
Date 2
of
N
O
41
gwg
I C 3
a
a
� C L O
i
u 0, V o u
O u 6
CITY OF SALEM
PUBLIC PROPERTY
DEPARTMENT
YJMHERIEY DMA:OLL
MAYOR
120 wASHINGTON STREEr•SAL E K MASSACHUSE1T5 01970
TEL,978-745-9S95♦ FAX:978-740-9846
HOMEOWNER LICENSE EXEMPTION
Please Print
Date C,
Job Location 12- L 1 nay"
Home Owner Address ZC'E 1V�(Sp
Home Owner Telephone G7 &
Present Mailing Address { P`n-'tl
i
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.
DEFDUION 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.
I
The undersigned "homeowner"certifies that he/she understands the City of Salem
Building Department minimum inspection procedures
will comply with said P P dares and requirements and that he/she
P Y aid rocedure
P s uirements.
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING INSPEC
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.
Crud OF SAtEm
PUBLIC PROPEM
DEPAITUE rr
CoasbvCdom DArk Dbpu d AfiM twit
48"yVd 632 AWN" s altd iaauwnlse- WNWO
to aoosedseelt ltt&dw dwh P11101111 a- i f D�eS Cad,,706 CIA soda IIIJ
ID"� Us brW�dtlt eolt�dalt d:at dr eerb n.�uLiy�
We shad e•disposed atbt a Dom►de0"vest dlgesd Addq a§dWwm by ilia.s
su.stS
TlwddwbwDb.WwWO adbP
GJ 60f
The dd i.win be disposed atilt:
(ns of�4►f
Lp&"
dw