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i10NEp UNM THE PENALTY
OP P■RJIIIIY
OF WM TO U DONE
MAIL PERMIT TO,,,
No. "� o
APPLICATION FOR
PIMIII TO
oil I
LOCATION
PLANT GRANTED
' CITY OF SALEMO MASSACHUSETTS
06
�
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
06
SALEM. MASSACHUSETTS 01970
STANLEY J. USOVICZ, JR. TELEPHONE: 978-745-9595 EXT. 380
MAYOR FAX: 978-740-9846
Salem Buildin¢ 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:
I-Le (Location of Facility) d"g
Signature o Applicant
D C�
Date
CITY OF SALEM9 MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
J
120 WASHINGTON STREET. 3RO FLOOR
SALEM. MASSACHUSETTS 01970
STANLEY J. USOVICZ, JR. TELEPHONE: 978-748-9599 EXT. 380
MAYOR FAX: 978-740-9848
HOMEOWNER LICENSE EXEMPTION
Please Print
Date — 1,
Job Location 7 --2-7 4?-PC-EF
Home Owner Addrnme=n ALL 7
Home Owner Telephone 7 y
Present Mailing Ad1:11M
The current exemption of"Homeowners"was extended to
such homed include owner
dwellings Of two Unite or less and to allow -occupied
hire who does not possess a license,provided that the to engage an individual for
o as supervisor.
DEFINITION OF HOMEOWNER . J1
Peraon(s)who owns a paml_of land on which he/she resides or intends to regjde, on
which these is,or is intended to be,a One Or two family dwelling attached or detached
structures accessory to such use and/or farm shucttuq. 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 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
HOMEOWNERS F.XE�TIOH
that; "Any Homeowner performing work for which a Building Permit is
�Code
�be exempt from the provisi°ns of this won(Section 109.1.1 —Licensing
of Construction Supervisors);provided that a Homeowner engage$a persona) for hire to
shall act as Supervisor.
do such work.and that such Homeowner .
are unaware that they are assuming the
Many Homeowners who use this exemptionRules and Regulations for Licensing
responsibilities of a Supervisor(see Appendix Q. m serious
Construction Supervisors.Section 2.15). This lack of awareness o In&is case your
Problems.Particularly when the Homeowner hires unlicensed pas°
Board cannot proceed against the unlicensed person as it would with a In
Supervisor, The Homeowner acting as responsible.
x
To ensure that the Homeowner is fully aware of his/her re the Homecs,many
communities require. as a part of the permit Application. the Homeowner certify that
responsibilities of a Supervisor. On the last page of this issue is a
he/she and the es towns. You may can to amend and adopt such a
form currently r community
forrdceta5cation for use in y ,ou