325 JEFFERSON AVE - BUILDING INSPECTION •3'
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PUSUC PROPERTY DEPARTMENT
120 WAzmjma7ou WMKZT, SRDF MfI
SALKN,MA 01 S70
TEL (279)745-D595 F=.380
FAX (978) 740•9846
STANLEY J. USOVI= JR.
MAYOR
DWOSAL OF DOW AFFIDAVIT
Ia aaoid@=with the ptovfsioas of M(li,c 40,S34,I wbwwledge that an a amffm
Of Btd]&M Permit 0 .A debris resu*g from the o msoucdm activity
ed pvem by WE BuSft Permit AM be disposed of in a Fopedy hceaaed sor&wnb
disposal hoSy,as defamed by M(li,a EX SISOA.
71e debris will be disposed of at nT r Vakn Sy,- t k4r 61c�
Locadm a ftfli y
Sisurm OfPermit A WHcaat Date
FULLY complde the foHown n&nnahm
(PLEASE PRW CLEARLY)
JH!A KK-t Cr btl\f �1�2
Name of Permit AMWw mt
Film Named ifamy
a15 J r.MV AtE 3 are oz
Addresb City&Sme
Mw above startafe regm m that debris fimD the daaolitioa,rmova lM rehab or Others•
Wtaatim of bmildiag or Mucum be disposed in a properly-Hemud soN&wsste disposal
facility as de mW by MM cnL Sl50A,ad the building pamits or licmw sm to
iaaHcate the location of the facility.
CTTY OF SALEM
BUIIDING DEPARTMENT
HOINMOWNFR LICENSE MMAPT1ON
Please Pahl
DATE J UYl e i coq KQ IJV E
JOBUXAT9GN
Hor�Owlux 3�� �� � fw�' •
ADM=
•HohgOWNl�t q��-��I-�Qo l • "
Tazmom
PAESEN!'MA11.II?G ADDl� �� AV6' _ •
The currcN cscmptiati af"bomeowacrs"was C=Ddcd to Snrlude owvcr o=pied dwcMmp dTM
Uniu a kss and w allow such bm=wms to=PF an individual fos bare srlto does s a posKs f
liauc,,paovWtd t M.ft owner set ss su""'W.
DEF•)Jd•1TON OF HOWOwme tm whldt there h a B
Person(s)who owns a pw=l of land an which beishe resides of Jatends to tcside, sb >o talch ttx ardlot
intended m be,a cm 10 two famfiy dwcMn&suached a detached Mucma osM t aot k st wAP ad
Wm stru om A pcnon who Constroas rt'ott than oae home in a two y Pe^
pgxSal,on a form sescpabk somas
a uildiq nu. Such"homeownd pom-bbk to au tveh work rdonned tmdtx the latilditq POIUL
Suildinb OS'cial.that lxJahc be tcspor's' .
The mdcnipxd"bomwwwr asstmtes tcsP=-''"bUk lot ComPlianoc whhthe Stan BUB&g Code wd
other appBtabic gas by-bv a,rota ttad tcgulauont
T ac mdvsigrd'hom wsttet"=d6cs that heft undcrsw'ds the City of sak in Buile n Depwtmol.
nlwmmn b;p=on pnxtdu=and regtdneatems and'h
at lVshc will Comply with said p weed to tud
HOMEOWNER'S SIGNATM l L
APPROVAL OF BUILDING WSPECTOR
See olba sick for state code
HOA7EOWNER'S EXEMPTION
Tht code states that.• 'any botruowrrcr performing wv'rlCfor whicb a building permit is requmd sbmA be
exempt from the pm+isiow of Ibis sccdon (Section ]I*.1.3-lictosiog of Construction Superrisort)
provided that b a homeawntT engages a pcnon(a)for hits to do.such work that such k=wwaer shall ma
�
Marty borneownes who use this exemption are imawan that they arc anwoing the tapo=%Dpq a fO
supervisot(net Appcodis Q,Rules and Regulations for l.letoaiog Coostruedon Supervisors,Seedm
.2.24 This lack of awareness often results in serious probkms,particularly when tbt hcm;nww=bbad
urJkmsed persons. In ibis case your Board ca=wt proceed agaatst the w0cemsed peaton n it WOM veldt
litxtued Supcnisor. Tbc beweonvtr acting as supcnis)r is whim**. r IEM IL
To ensure that the bomeowncr is fully aware of hvr=nzpombTl ties,ruany commmdda requite;urn
of the pmrii application,that the homeowner ccnify that hcVm urAkntands the responsibiNda oht
supcnis". You may care to amend and adopt sui b a fonalcurtYkatim fur use in yoty coamwdq