3 IRVING ST - BUILDING INSPECTION (2) 41 +
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m-THE IN PECTOR OF BINLOM ;
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Oaaea Name -Da v �6 1
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Arch Wft Name 1neh.t
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BUILDING DEYART vOu
miaoWNER UCENSE EX00MON
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JOB IOCATION T►'V 1K V ft
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ADDRESS
HOMEOWm
TELEPHOW
PRESENT MAII.IING ADDRESS � T�V_Ko� �f[ -1
The etm t exemption of bowwawpes"was ettcrded to inslutk mroerxwPied dvrdlitop dTW 0
for hne who does not pawn a
Units a less and to slk+w such hormeowttera to en€age an intdividud. .
license,.*uvWcd that the awmai ad as wpervbx.
DEFINITION OF HOMEOWNER
Person(s)who owns s partzl of land on which bdstte resides of intends to reside+an w%k%ok k' .
intended to be,a one to two UnMY dwelling,anached of dctactcd scucmvcs acmx&Mm&we con ndesed
dftr
farm sweaurs A person who constructs more than om home is a two-? p�od ghat
a homeowner. Such home Tter shalt a&mh w the BuDdlmg Offe4 on a fbM saeptttbk ttt Art
Building OSteisl,that btJshe be respom'bk to all such work performed!under the building TR=
.The undersigned"bomcowncs"m m m rmponnbitity foe compliarh x la ith the Stan Building Code tmd
other appliable goes by-law,,nda snd tegulationt.
The tmdeniped"houKowncr"ccrti m that hdshe mhderatards the City of Saktn Bmildag DepamotK
=mwm inspection pmcedmea and rcq ' ma and that Mahe will comply with said p acc6ma and
rcqukcnmm
HOMEOWNER'S SIGNATURE
APPROVAL OF BUILDING INSPECTOR
Sec other side for sate code
HOMEOWNER'S EXEMPTION
The code state that• `any honeowner performing wodt for which a butnding permit is regtdred sball be
exempt from the prcNiewns orthis section (Section 30P.L2-liccosing or Constr uctioa Suptrvisoro
Provided that is a hornecoma engages&person(s)for Wm to do.such work that End homwwsm Ann sect
as ..
Man)bonwowncs who use this exemption arc unaware that t wy we assmning the respoissMdes aft
avpervisar (set Appeodic Q,Rules sod Regulations for Lictosing Cocstr uctbo Supervisors,SeC*m
.2.14 TLis lack of awareness oRtn reds in serious problems,peroeirbat when tht bcm6*wna bh"
unikensed pcmm in this cm your Board cannot pmc=d againm tht wgiaased peraoa as it vmwd wb3
licensed Supcnisor. The bomt"-Dtr swing as supervisor is whimat* IL
To mauve that the homeowrreT is fu11y aware of Mw responsibilities,marry eornmmtides regidr ;es past
of the pernil appl'tadoq that the homeowner certify that hchhc mdasmnds the responsibilities da
supcn ism. You may Cart to amcod and adopt slob a foradanifiadan for wt in your cmraoudq
PL101.1G PROPERTY DEPARTMENT
120 WASMIMOTON arMMff, SRO FLOOR
OALaM,MA O t 070
T[L (970)74"595 En.300
FAX (070) 7409046
STANLItY J. USIOVIM JIL
MAYOR
DISPOSAL OF DEBRIS APFIDAVlT
Is Accordance with the proviaiona of MGL c 40,04,I aclmowlo*that as a caod dm
of Bm'ldmg Permit S .aD debris resuldnS from the dam scbvgy
governed by this Bm'kl'mg Permit sW be disposed of in a propaiy licensed SOH waste
disposal sty,as defmW by MGL a EX S130A.
The debris wr71 be disposed of at: L�n.socatimaf F
ate' Salelw� M4
Sigmahis of ycaot Dab
MMY complete the following mfomawm
(PLEASE PRIM CLEARLY)
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Name ofPermit AppWous
Fnm Name,if any
3 s+, reel cmr 4a 47)ig4
Aftess.City A Stag
The above statute requires that debris from the demolition,movation,rebab or other
alteration of bur&ft or aonwrm be disposed in a properly-licensed so"waste disposal
facility AS defined by MGL CIM S130A,and the building permits or licema are to
indiate the location of the faa6ly.
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