123 MARLBOROUGH RD - BUILDING INSPECTION r�
` I
; aLo
.Ee,* ,APPROVED BY T44E
jbL*f#S*WST-9E fH.
.1N5pf TDB .PI$= TPA PEANUT BFING GRANTED
CITY OF SALEM
�i Date
No.
Location of I /
Is Property Located in Building
the Historic District? Yes_No
Is Properly Located in
the Conservation Area? Yes_No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed,UP0011
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: I nn
S4 Id, I URUAt1 I
Owners Name �
Address & Phone lad Mrk� �hrlRoSl (( lv ) �40'S1�1
Architect's Name
Address & Phone
Mechanics Name
Address & Phone f )
What is the purpose of building?
Material of building? d p "!�/ If a dwelling,for how many families?
"If building conform to law? X! � asbestos?
Estimated cost �o z9O City License 0 N A State License S
Boras improvement
f S na ure of Applicant
S GNED UNDER THE PENALTY
F PERJURY
DESCRIPTION OF WORK TO BE DONE
0
MAIL PERMIT TO: /r fl
No.
APPLICATION FOR
PERMIT TO
LOCATION
f ..
PERMIT GRANTED
APP &f l)
INSPECTOR OF BUILDINGS
i
CITY OF SALEMO MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
A
120 WASMINGTON STREET. 3RD FLOOR
SALEM. MA,SSACNUSETTS 01970
STANLEY J. UOOVICZ, JR. TELEPHONE: 978-74
wwroR 3-9696 EXT.. 380
FAX: 976-740.9846
HOMEOWNER LICENSE EXEMPTION
Please Print.
Date I 0 t
Job Location (23 Mfg. buc, ILO
Home Owner Address tL1 winulba,. L'
Home Owner Tel yd S/ / �
Present Mang
The current exemption of"Homeowners"was extended to include owner-occupied
dwellings Of two Units or leas and to allow such homeo to engage as individual for
hire who does not possess a license,Provided that the owl- as supavisor.
DEFINITION OF HOMEOWNER a
Person(s)who owns a paocel_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
Permial, 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 NAM 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 a
APPROVAL OF BUILDING IN P CTOR
See other side for state code
s
H011H:OWNERS ETON
performing work for which a Building Permit's
,u Code state�; `Any Homeowner on Section 109.1.1 —Licensing
of uired shall be exempt from the provisions that a Homeowner engages a peraon(s) for hire to
of such work,
a Supervisors);pro shall act as Supervisor.
do such work�that such Homeowner ing the
Many Homeowners who use this exemption are unaware that they Licensing
r(�Appendix Q,Rules and ReBulati in serious
responsibilities of a Sups Section
of awareness often results
Construction Supervisors.Sectron 2.15). �unlicensed persons. in this case your
problems.Particularly when the Homeowner as it would with s licensed
Board cannot Proceed against the unlicensed as supervisor
P� ul responsible.
Supervisor. The Homeowner acting as supemr y
To ensure that the Homeowner is fully aware of his/her r bHome many
art of the permit Application.=the Homeowner certify that
communities require. asap of this issue is a
On the last page
he/she understate the responsibilities of a Supervisor• such a
form currently used by several towns. You may care to amend and adopt
form/certification for use in your community,
R� �Isol yaps