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MAIL PERMIT
no. '51
APPLICATION FOR
POW TO
LOCATION
PERIAT GRANTED
A 3/fl�Z 26
of OU LDOGs
0
CITY OF SALEM9 MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
SALEM, MASSACHUSETTS 01970
STANLEY J. USOVICZ, JR. TELEPHONE: 978-745-9595 EXT. 380
MAYOR FAX: 978-740-9846
Salem Building Department
Debris Disposal Form
In accordance with the provisions of MGL c40 S 54, a condition of your
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 will be disposed of in:
(Location of Facility)
Signature of Applicant
Date
t CITY OF SALEM, MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
SALEM, MASSACHUSETTS 01970
STANLET J. USOvICZ, JR. TELEPHONE: 978-745-9598 EXT. 380
MAYOR FAX: 978-740-9846
HOMEOWNER LICENSE EXEMPTION
Please Print.
Date //o%/
Job Location
Home Owner Address
Home Owner Teleph* Lf 3 , o-z- �<
Present Mailing Addreta .
The current exemption of"HomeowneW-was.extended to include owner-occupied
dwellings of two Units or leas and to allow such homed to engage au individual for
hire who doe not possess a license,provided that the our as supervisor.
DEFINITION OF HOMEOWNER c. 4'
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 dwelling,attached or detached
structures accessory to such use and/or farm sttticturva. A person who consttucts more
hall
than one home in a two year period s not be considered a homeowner, Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building
OfficiPeal, 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 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
iq
eol�owriERs °
The Code states that: "Any Homeowner performing
work for which a Building Permit is
inquired shall be exempt from the provisions of this section(Section 109.1.1 —Licensing
of Construction Supervisors);provided that a Homeow=engages a person(s) for hire to
do such work,and that such Homeowner shall act as Supervisor-
tion are unaware that they W.Mumwg the
„y Homeowners who use this m A Rules and Regulations for Ltceosntg
responsibilities of a Supervisor(see Appendix Q. often results m serious
Construction Supervisor.Section 21 - This lack of awareness
problems,Particularly when the Homeowner hires unlicensed persona. In this case your
Board cannot proceed against the unlicensed Amon it would with a licensed
Supervisor. The Homeowner acting as supervi sor is u1t responsible.
.1'
To ensure that the Homeowner is fully aware of his/her bilitiea,many
as a part of the permit Application, the Homeowner certify that
communities require. bilitiea of a Supervisor. on the last page of this issue is a
formhetsheunderstandsthe towns- You may care to amend and adopt such a
form currently community
forrdcertification for use in y , .our
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