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le OWNaPMW IWFORYATION
1/ Owner of Low
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Address ) 12- ffGA q 0 S-Vn e�t-
591e(Y\ (Y)0., bj � 70
Telephone' -7 qb�
SACOMPI:KTt TNIst >lECTION FOR WORK IN
���NO>t ONLY
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Number Of SWISS Renovated
Change In UN
New
0emaition
APProximate year of Existkj
Consbuctlon of renovatlon Area per AOOr(30 Renovated
of aids"buitdl<p
New
gad 0escription Of Proposed Work:
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Mad Permit to: Q Cn UQs3cx�r-L� -
�17 mo� LLn sf S4e�, ✓r1� c�i9�l�
CITY OF SAT-RM
PUBLIC PROPERTY
DEPARTMENT
K{lW��evwvv L
MAYOR
13O WMMNGTON SMEET•SMEK M. AW A00.-SEM 01970
TM 978-735-9S95*FAX;978-740.984
HOMEOWNER LICENSE EXEMPTION
Please Print
Date
Job Location l I a 1-n a/�
Home Owner Address 112 on �} .:. �Fn er F
Home Owner Telephone
Present Mailing Address—11 2- m c n ,n S S 141 e r (y A-
The current exemption of"Homeowners"was extended to include owner-occupied
dwellings of two Unite 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"assumm 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 :Z,,,
See other side for state code