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RUOLIG PROPERTY DEPARTMENT
1Z0 WAsHINaroM VMKJWT, saDFLooR
SALLM,MA O1 t)70
TEL (978)745-MOO FMT.ato
FAX (979) 740-9646
STANLEY J. USOVWZ., JR.
MAYOR
DISPOSAL OF DEB=AFFIDAVIT
In=a dance with the provisions OfMGL c 4%SK I acbwwle*that as a condition
of Bm7dmg Pawk .all debris rwokb*Am the eogncdm wdft
®ovened by d&Bcdldmg Permit sha$be disposed of is a pnrady licemW solid-waste
disposal facilely,a.debaed by M(it.a 13L S150A.
Mw debris wM be diapered of st _&q" /raxg.,-p
Locmd=of FaUW
i PemritApp 'cart Doer
FULLY eample0e the f)nowms m mcat m
(PLEASE PRM C LEAMT)
NameofP Applicant
Firm Nnic.if say
S 'Rell,eVtP[, i a(gP ' (e) , I► lc
Addcem City k State
The above statute mquu=that debris ftm the demolition,=Overdo rehab or other
alteration of bm7d'mg or sMjcfte be disposed in it properly-hceaaed BOH&wsste disposal
fidW as de mW by MGL ca S150A, sad the building permits or&mm ace to
indiate the bud=of the facility.
CTYY OF SALEM
Bunmi NG DEPARTN1i M
HOMEOWNER LICENSE SON
Pkam Prime
DATE Z _Q c
IOBWCATIGN
• .� `fie(� e�i�ew Clu2 �� �k �'1/�.4 •
HOME0�1liFA
ADDRESS 2
TELEPHM
PMWrMAD-NGADDPMS
e�m csrmptioei of"bomeownar was eatcnded w include wroer-o=plcd dwcU6V dTm
Mw Uniu a less and w allow such hm mowlm w Cop an individual for bite wbo doa not posses a
lia�,.provided tbm the uwnei ael as supetviw►
DEFrN mON OF HOt gOWNFAt: an wbkh there Is,or is
PcTsm(s)who owns a poccl of land on which lu/shc naida or irate nds w reside, to nKb tae aadlet
inter to be,a one w two bIrMy dwelling,anadwd of de adKd strucwa od sba0 not be considered
farm roan cs.A Pcnast who construcu rreart than one home BuBding a lcbL on form ,
pubk to tiff
a bvuwogg Official.wna. S
Building thm brJshe beTtspombk aall such work pafonned each the building p=m L
The undesigned"bomcowner"m urna=ponnbift for complianoc sntb the State BnDding Code wd
otha applicable goes by-laws,roles and teguls6eatt
The nmdosiVjcd•hemeowna"codes that hdshe undcsmnds the City of Salem Ba&g Deparooet.
minimum inspection proeedwa and negtmemems and that hlsbe WM Wmp1y with=W.Pomdom ad
TtqubcmcgIL
HOMEOWNER'S SIGNATURE
ULf aY
APPROVAL Of B=ING INSPECTOR
See other sick for state code
a
HOMEOWNER'S EXEMPTION
The code states tbac 'any honvowncr performing,ovA for which a buDding permit is req*ed Ad he
cxemyl from the p uvisions ofibis scrdon (section 7opaa-lfccosiag or Comructloo Super wro
Provided that is a homeowner engages ii person(s)for Mm to do.sucb wort,that such botaeow m d all act
as sgaQ ii
Marry boascowners who use this exemption we tmawan that they are assysaing the rtapo ft des
Nperv+=* (see Appeodh Q,Rules and Regulatiow for Veeosiog CoostruNon SnperAms,See"
.2.23)6 This lack of awareness often xmIts in serious ptobbfc s pardcobvly wbeo the homeowner bbai
unlicensed person In tbiS east yom Board cannot prooced agaaat the vaccased pee as it would W16
licensed Supcnisa. The bomeowver acting as super isor b vidmalsib res�wosfhid,
To casure that the homeowner Is fully aware of hin==ponsiblHcS,ma"oomwm3tla reqube;aS poet
of the permit application,that the homeowner certify that he/she tmderstartds lbe rsspoastbilitks da
supenism. You may raft to amend and adopt such a foraWcunYwatias for use in year