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CITY OF SM.EM
PUBLIC PROPERTY
DEPARTMENT
KJ1Wc� ,.1l ff�w-ty�
NAvoa 130wAs*NGroN9n zr•ltm— WwctwRseris01970
Tn.978•73S.959S 0 FAX 978-740.9"
HOMEOWNER LICENSE EXEMPTION
Please Print
Data 0(, -R-)G - 3401
Job Location ('�N�t 6 ��
Home Owner Address sNPW 11, ST
Home Owner Telephone
Present Mailing Address A 1Sa( C�svLf.S S�
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.
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 dwellin& 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 SIGNATURE
APPROVAL OF BUILDING INSPECTOR
See other side for state code
CITY OF SALEM
PUBLIC PROPRERTY
DEPAR'I"�IENT
I \\ .I,I IIN,�.I'♦11?�.�
Ill- ')'8 •4;');;J; • 1:\.C. 1;7.1 '4:'0.S 41.
Construction Debris Disposal Affidavit
(re(luired ti)r all demolition and renovation work)
In accordance \N ith the sixth edition of the State Building Code, 7S0 C'MR section 11 L5
Debris, and the provisions of NIGL c 40, S 54;
Building Permit it is issued with the condition that the debris resulting from
this work shall he disposed of in a pruperly licensed waste disposal facility as defined by MGL c
111, S 150A.
The debris will be transported by:
I name ut hauler)
I he debris will be disposed of in
(name ut laaluy)
saa"PSU_vr LA
IuJdres, u(IhcilitVl /J^
• �namrc of p.nnit applicant
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