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No.
APPLICATNM FOR
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114
PEFiIM GRANTED l
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CITY OF SALEM, MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
SALEM, MASSACHUSETTS 01970
STANLEY J. USOVICZ, JR. TELEPHONE: 978-748-9595 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:
/7£ m A (Location of Facility)
Signature of Applicant
Date
I�
CITY OF SALEM9 MASSACNUSETTS
PUBLIC PROPERTY DEPARTMENT
' 120 WASHINGTON STREET. 3RO FLOOR
SALEM. MASSACNUSETTS 01970
STANLEY J. USOVlc2. JR. TELEPHONE: 97a-748-9399 EXT. 360
MAYOR FAX: 978-740-9848
HOMEOWNER LICENSE EXEMPTION
Please Print
Date i a
Job Location XOSC/!w c�✓n Q
Home Owner Address S'9m P
Home Owner Telephone (9 78) 7S/� 9�/s
Present Mailing Addeeees-S'Ar,�
The current exemption of"Homeowners"was.extended to include owner-oecupied dwellings of two Units or less and to allow such homeown9to engages as individual for hire who does not possess a license,provided that the owner+'ects as supervisor.
DEFINITION OF HOMEOWNER 4a
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 structures. A person who constructs alone,
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 such work performed under the Building
Permit.
The undersigned"homeowner"assumes responsibility for compliance with the State
Building Code and other applicable by-laws and regulations.
The undersigned"homeowner"certifies Building Department minimum inspecti that he/she understands the City of Salem
on 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
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The Code states that: Any Homeowner Performing work for cc a Building Permit is
required shall be exempt from the provisions of this section(Section 109.1.1 —Licensing
of Construction gupeavisora);Provided that a Homeowner engages a person(s)for hue to
do such work and that such Homeowner shall act as Supervisor.
an unaware that they an assuming the
Many Homeowners who use this exemption 'Q Rules and Regulatrona for Licensing
responsibilities of a Supervisor(see A;Pe often results in serious
Construction Supervisors.Section 2.15). This lack of awareness sons. In this case your
problems,Particularly when the Homeowner hires unlicensed Per
Board cannot proceed against the unlicensed Person as it would with a licensed
acting as supervraor
ultimately responsible.
Supervisor. The Homeowner a
To ensure that the Homeowner is fully aware of his/her r 'bilitim many
art of the Permit Application, the Homeowner certify that
communities require. as a P on the last page of this issue is a
he/she understate the responsibilities of s Supervisor• such a
form currently used by several towns. You may care to amend and adopt
form/cerdfication for,use in your community'
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