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OWN,, ERi,'AUTHORIZi►TION T,O HE COMPLE�ED WHEN �{�` . �r��� i!
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A gj24 as OwnerorAuthonzedA entherebyde�larc
thatKhe slntements and informanon on the foregoth applirnuon nre truue and hccureteF to tjic best of my knowledge and
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CITY OF SALEM
PUBLIC PROPRERTY
DEPAR"IA/IENT
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construction Debris Disposal Affidavit
(rcquited for all demolition and renovation work)
In accordance itli the sixth edition of the State Building Code, 780 CMR section 1 1 1.5
Debris, and the provisions of MGL c 40, S 54;
Building Permit t is issued with the condition that the debris resulting front
this work shall he disposed of in a pruperly licensed waste disposal facility as defined by MGL c
I 11, S 150A.
The debris will be transported by:
manic of hauler)
he debris will be disposed of in
t tome ul (uciliry)
�addre.. u r I]n l i ry l
a iaml of pc,mit .gtpheant
,late
CITY OF SALE.M
PUBLIC PROPERTY
DEPARTMENT
MAWN 130 wASM*Gl'CN SIXENT•SN EM MASSACKLSEM 01970
TEL 97670S-9S9S 0 FAx 978-740.9946
HOMEOWNER LICENSE EXE.MMON
Please Print
Date 9 ��7 ®a�
Job Location L 13E2 C.l.
Home Owner Address F
Home Owner Telephone
Present Mailing Address glom 2 _
The current exemption of"Homeowners"was extended to include owner-occupied
dwellings of two Units or less and to allow such homeowners to engage an individual for
hire who,does not possess a license,provided that the owner acts as supervisor.
DEFINMON OF HOMEOWNER
Person(s) who owns a parcel of land on which he/she resides or intends to resider, on
which there is, or is intended to be, a one or two family dwellin& 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 requirements.
HOMEOWNERS SIGNATURE
a—�?,
APPROVAL OF BUILDING INSPE
See other side for state code