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CITY OF SM -M
PUBLIC PROPERTY
DEPARTMENT
W� t30w&%a> GWW37fsir 9 SALMS AOACHUNM01970
Tr3.91.L7JS.959% 9 FAx 97$.740.9&M
HOMEOWNER LICENSE EXEIMPTION
Pies" "t
Date L ' a
Job Location h e f\ �ci-&r^ Iq 7 0
Home Owner Address 2 °�
Home Owner Telephone --I q —
present Mailing Address '-n '^"--e
The current exemption of"Homeowners"was extended to include owner-occupied
dwellings of two Units or leas and to allow such homeowners to engage an individual for
hire who.does not possess a license,provided that the owner act@ as supervisor.
DEFINMON OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside, on
which there is, or is intended to be, a one or two family dwelling, attached or detached
structures accessory to such use and/or farm structures. A person who constructs more
than one home in a two year period shall not be considered a homeowner. Such
"homeowner"shall submit to the Building Official,on a form acceptable to the Building
Official, that he/she be responsible for all such work performed under the Building
Permit.
The undersigned "homeowner"assumes responsibility for compliance with the State
Building Code and other applicable by-laws and regulations.
The undersigned "homeowner"certifies that he/she understands the City of Salem
Building Department minimum inspection procedures and requirements and that he/she
will comply with said procedures and Mquirements.
HOMEOWNERS SIGNATURE
,APPROVAL OF BUILDLNG (INSPECTOR
See other side for state code
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CITY OF SALEM
,l rt PUBLIC PROPRERTY
a '�,• DEP AR"I . IENT
.� '.1illlr � �\II \I, \L\ .\�
III 9'$-'4i X 'i-.Y.V: '64i.
Construction Debris Disposal Affidavit
(requited lirr all demolition and icnovation work)
In accordance ith the sixth edition of the Statc Building Code, 780 CRIR section 1 1 L5
Dcbi is, and the provisions of.'vIGL c 40, S 54;
Building Permit ! is issued with [lie condition that the debris resulting from
this work shall be disposed of in a pruperly licensed waste disposal Iacility as defined by MGL c
l 11, S 150A.
The debris \will he It by:
(name of hauler) V
The debris will be disposed of in
(uumr ul Iaeility)
I a�IJre,v u(Iarllity)
s
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