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CITY OF SALEMt MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RO FLOOR
SALEM, MASSACHUSETTS 01970
STANLEY J. USOVICZ, JR. TELEPHONE: 978-745-9595 EXT. 380
MAYOR FAX: 978-740-9846
Salem Buildin¢ Department
Debris Disposal Form
In accordance with the provisions of MGL c40 S 54 a condition
n of our
. . y
Building Permit is that the debris resulting from this work shall be disposed
of in a properly licensed solid waste disposal facility as defined by MGL
Chapter III, S 150 A.
The debris wyyil''l be disposed of in:
d (Location of Facility)
S'g re of Applicant
z 19 -zap S
Date
CITY OF SALEM9 MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RO FLOOR
SALEM. MASSACHUSETTS 01970
STANLEY J. USOVICZ, JR. TELEPHONE: 976-746-9696 EXT. 360
MAYOR FAX: 976-740-9646
H O MEOWNER LIC
ENSE EXEMPTION
Please Print
Date Z - -0�
Job Location J ( wry t
Home Owner Address
Home Owner Tel y /� 2
Present Mailing Address= �,,,c
The current exemption of"Homeowners"was.extended to include owner red
dwellings of two Units or less and to allow such homeo to engage an individual for
hire who does not possess a license,provided that the o as Supervisor.
DIWINITION OF HOMEOWNER: a
Peraon(s)who owns a parcel.of land on which heJshe re des 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 conspvets 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 g
permit.
such work performed under the Building
g
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 i tion Procedures and
will comply with said procedures rMuirements. requirements and that he/she
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING CTOR
See other side for state code
r
The Code states that: Any Homeowner performing work for which a Building Permit is
..
from the provisions of this section(Section 109.1.1 —Licensing
wired shall be exempt Pro'
that a Homeowner engages a person(s)for hue to
of Constriction Supervisors);pro
do such work,and that such Homeowner shall act as Supervisor.
don are unaware that they are asau r the
Many Homeowners who use this exemption Q,Rules and Regulattons for I.iceosung
responsibilities of a Supervisor 1 Appendix o�results in serious
Construction Supervisors.Section 2.' This lack of awareness persons. In this case Your
problems.Particularly when omeowner
gm unlicensed person as itbnu w�ould�a licensed
Board cannot proceed against m ,responsible.
Supemsor. :The Homeowner acting as supeMsnr is +i
To ensure that the Homeowner is fully aware of his/her resPOnsibilitiea,many
communities require, as a part of the Permit Application, the Homeownerthia issue is a
he/she understands the responsibilities of a Supervisor. On the last page
form currently used by Feral towns. You may care to amend and adopt such a
form/certification for use in your community.
R� �IZplyoas