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PUBLIC PROPERTY DEPARTMENT
(jig 120 WASHINGTON aTRaaT, SRO FLOOR
SALKN.MA 01370
TEL. (978)743-9595 EXT.300
FAX (970) 740-9343
STANLEY J. U30VIC2, JIL
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
In accosdaoce with the pmviaiont of MM c 40,SA I acknowledge that as a eondidon
ofBm7din Permit S .all ddhris resdftq from the conwacbm gftvldy
Sovemed by this Building Permit shall be disposed of in a peropady lioestsad soyd-wUlc
disposal Aw tY.w deftoed by MC$,c EX SISO&
The debris wM be disposed of st /v o1QT?f S(Dr- eA-i T'!IV 6-
Locadost of FacrM'y
Sigoattne of Pamtit Applicant Dab
FULLY conWhft the following mfom>sbm
(PLBASB PRWP C LEARLY)
--Em-r (NIOoW Kl
Naas ofPatmkApplkaat
Fite Name,if any
I;L &Frroyo Ce-T �LtA MA-
Addtess.City dr State
The above statute requites that debris fzm the demolition,reaovxdM r"or other
alteration of budding or atruchn be disposed m a psopaly-leased so,"waste dispossi
finality as defined by MGL dM S130A,and the building permits or licemn ate to
indicate the location of the f dlity.
CITY OF SAlEM
BUIIDING DEPARTMENT
HOMEOWNER LICENSE EMaMON
Picric Ptld
_ 1��.,ocATloet �� G�ffo�� CST
• Holr�oWl (71IFIFOWk) .MKT
ADDURI
'Hol.�owtm� �17�' SQL S•745�5 F, r -► kl -`bb3--"7`�28
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PRESENT MAC-II?G ADDAE3E is GifFovcpC- •
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7ba C=cW c=mpdan of`bmneow'WC was exanded to bvlw&V"a w xuoptiedo es tees 0 so P o[ WO
Units or less and to,now melt bomeownaa to cWV an irdhidW tw bim VbQ popes
li=m pvviaed tms mt.owe wt as.vpervb.r.
DEF114M tOPHaMEOW?WL
Ptnom(s)wbc owns a Pw=l of lard on wbidt he/sh res e ide ofituends to tsside,on.rldefi *asRd
intaded to K a ant to two family dwclym&a=dwd atdcud' d sttucoves PA m nut>x eonsidAw
farm strucnaes.A person wbc constructs tame than one box in a r*V-Ycw P
OW sballk".
s bomtowna. such'bomeowmet" shalt subn*to the BuDding O$t i4 ORB form s=qtIbk to dta
Building Offie4 that bclsM be responsible to all smA work pofonaed mdu da building PWNIL
Ma undersigned'•bouma met"ssstmtes mponnbiliq tot r=Pliarta with t a Suit BaU tg Code sad
VLhw applicable goes by-law;toles and ugulaticaL
The und=ipcd'hov wwad'tzrf&a that hdsht tmdcmumods the Ctq of with Building .
minimum itvpecdQn pro=dures te4 t Nshe will eo>uply
nquirmtmt
HOMEOWNER'S Sl \
APPROVAL OF BLIIIDING INSPECTOR
Sec otbet side for state code
HOMEOWNER'S EXEN'JP'I'ION
The Cods states that 'W7 hoauowncr performing work for whicb a butdbV permit is to q&W Ad its
crcmp from the p vTisivw of Ibis section (Section 3091d-19ceosiog of Conatructioo Supervyore
Provided that is s homeowner engages s person(s)for hire w do.such work,tbst six&bomeowaa dM aat
Mara bomeowmetr wbo use this exemption we ue awmt that they are assttmiag an are
Supervisor(ow Appendbr Q.Auks and Regolatioss for Uccosiog Coossmcdoo SupervboM Ssedsal
.Z.]s} This mac of awareness often results in serious 'cv wbea
W�k�. the boSneowac
i� � hies
urJ;eensed in this case Board eanrwt s>x� >� proceed gascst lU mii«med prnpn as it•+o+t1d w16
licensed Supc+isac. The bomeowacr adimg as supervisor b uidsas**msrmsNAL
To ensure that the hameowner is fully swan of hvra resp=!mbilities,meaty oommmddes nq& ;sa pn1
of the pmW;sppli®don,that the iwmeowna artily that htWw mcdanm&the nspousibMet art
super vot YOU may Can to amcmd sad adop sus a brwlccnV=dm toe use is yom oammuft.