15 POND ST - BUILDING INSPECTION &d CITY OF SALEM
PUBLIC PROPERTY
zap-,
DEPARTMENT
KIM BERLEY DRiSCOLL
MAYOR
14 WASMNGTON STREET♦SALEK MASSACHUSEM 01970
TE L 978-745-9595 •FAX:978-740-9M
HOMEOWNER LICENSE EXEMPTION
Please Print
Date
Job Location } C
Home Owner Address_MCA
1-0
Home Owner Telephoned
Present Mailing Address
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.
DEFINITION OF HOMEOWNER
Person(s) who owns a parcel of land
which there is, or is intended to be, a one or two famil1edwellin sides or intends to reside, h
Y attach
structures accessory attached or detached
ccessory 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.
I
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 G
APPROVAL OF BUILDING INSPECTO
See other side for state code
Homeowner's Exemption
The Code states that: "Any Homeowner performing work for which a Building Permit is
required shall be exempt from the provisions of this section(Section 109.1 —Licensing of
Construction Supervisors);provided that a Homeowner engages a person(s) for hire to do
such work,and the Homeowner shall act as Supervisor."
Many Homeowners who use this exemption are unaware that they are assuming the
responsibilities of a Supervisor(see Appendix Q,Rules and Regulations for Licensing of
Construction Supervisors, Section 2.15). This lack of awareness often results in serious
problems,particularly when the Homeowner hires unlicensed persons. in thrs.case your
Board cannot proceed against the unlicensed person as it would with a licensed
Supervisor. The Homeowner acting as Supervisor is ultimately responsible.
To ensure that the Homeowner is fully aware of his/her responsibilities,many
communities require, as part of the Permit Application, that the Homeowner certify that .
he/she understands the Responsibilities of a Supervisor. On the last page of this issue is a
form currently used by several towns. You may care to amend and adopt such a
form/certification for use in your community.
L
Lately, mold has been in the news.Mold is a type of fungus. It occurs naturally in the environment, and it is
necessary for the natural decomposition of plant and other organic material. It spreads by means of microscopic
spores borne in the wind, and is found every where life can be supported. Building construction is not, and cannot
be, designed to exclude mold spores. If the growing conditions are right, mold can grow in your building. Most
property owners are familiar with mold growth In the form of bread mold, and mold that may grow on bathroom
tile. It can also grow on heating, ventilation and air conditioning systems, plumbing systems, walls, support beams
and other components of a building.
In order to grow, mold requires a food source.This might be supplied by items found in the building, such as
fabric, carpet or even wallpaper, or by building materials, such as drywall, wood and insulation to name a few. Also,
mold growth requires a temperate climate. The best growth occurs at temperatures between 40 F and 100 F. Finally,
mold growth requires moisture. Moisture is the only mold growth factor that can be controlled in a building. By
minimizing moisture, a property owner can reduce or eliminate mold growth.
Moisture in the building can have many causes.Spills, leaks, overflows, condensation, and high humidity are
common sources of building moisture. Good housekeeping and home maintenance practices are essential in the
effort to prevent or eliminate mold growth. If moisture is allowed to remain on the growth medium,mold can develop
within 24 to 48 hours.
Consequences of Mold.All mold is not necessarily harmful, but certain species of mold have been shown to have
adverse health effects in susceptible persons. The most common effects are allergic reactions,including skin irritation,
watery eyes, runny nose, coughing, sneezing, congestion, sore throat and headache. Individuals with suppressed
immune systems may risk infections. Some experts contend that symptoms can be more serious. However,
experts disagree about the level of mold exposure that Q may cause health problems, and about the exact nature
and extent of health problems that may be caused by mold.
6ulgwnid•wag•LLS aaUd Ilol 999?o a 'uioou11
60C9199i06 pooh U00ullaM au0
wo2-6uigwnldwa6•mmm
60£8198•10h �D
V 6wgwnld•11139•L18"JA I101
's26ro43 Iano.µ ON
'RWaLsaMol+agoosuooMwa; -
UMoy It! JUM3 U1 aDlnras I000l t ,
buow ay,u0' n u0'aus u0
ygro s/wul 'nms I n�+l uwWW
i
z
W OO'pIO W Ueal0O11AUa'MMM r
:ale!p;je ino of o6 'soomosaj 1
�; plow 01 S�wl pue U011ew.i0lw ajow aof Jo
Iw19 epin6plow/splow/bepoftclawM Wf.dg4 :01 u
Nu!I eq1 mollof pus woo-6u!gwnldwe6•mmm
of oG -93!s qem ano Uo splow v
fnoge ajow lno pull use noA -p!oyasnoy
Joueelo 'safes a 01 Aem nog(uo Ilem eq p,noR
� �y ; "gip r * y` pue sdals e!dw!s xis eq1 mollo=l -asnoy jnoA
punoae plow ly6g nog(dlaq II!m lalgdwed s!ql
What can a property owner do?
The property owner can take positive steps to reduce or eliminate the
occurrence of mold growth in the building, minimizing any possible
problems that may be caused by mold. Some steps are shown below:
1 . Before bringing romptly clean up
items into the building, s, condensation and
check for signs of r sources of moisture.
mold. Potted plants oughly dry any wet
(roots and soil), faces or material.
furniture, furnish- Do not let water pool
ings or stored JL4
or stand in your
clothing and rbe ilace any material
bedding material, p y
as well as many other that cannot be thoroughly dried,
items, could already contain mold growth. such as drywall or insulation.
5. Inspect for leaks
2. Regular vacuuming and on a regular basis.
cleaning will help reduce Look for discoloration
solution and most J
mold levels. Mild bleach or wet spots. Repair any
the cleaners are leaks promptly. Inspect
effective in condensation pans
eliminating or refrigerators and air
preventing mold conditioners) for
growth. mold growth. Take notice of musty odors,
..:' and any visible signs of mold.
3. Keep the humidity
in the building 6. Should mold develop
low. Vent �� in a small area, thoroughly
clothes dryer i \ I clean the affected area with
to the out- ; o� a mild solution of bleach.
First, test to see if the
doors.Ventilate affected material or
i e o
kitchens and '� ® surface is color safe.
bathrooms by Porous materials, such
as fabric, upholstery or
opening the windows, Y '�'• . : carpet should be
by using exhaust fans, or discarded.
by running the air conditioning to remove Should mold develop in a large area,
excess moisture in the air, and to facilitate discuss with a professional.
evaporation of water from wet surfaces.
These steps can help you minimize mold growth, G E M
although no methods will prevent mold entirely.
Should mold growth be severe, call on the services Ong °°"�`°°"`nnm�
401.8675309
of a qualified professional cleaner. Tail free 1-877-Gem-Plumbing
One Wellington Road, Lincoln RI 02965
www.gemplumbin.q.com
C
When that professional service technician knocks on your door, many costs w D
have been incurred just to get him there, ready to do the job. x 3 a E
O T D L
o 0 W J D N L J
j L 22 NO O
�� _ C " O O O O O Nj T a m c 3 L
aa0-O.J`G K(n U N ZO
x 0 m 3 m 000000 00 ❑AT 00 o
Insurance-Trucks,Liability, e o m sAo m o .c c m D °1 t rn a 'o
Fire,Theft,Property,Worker's Specialized Training Periodic Lecture Truck Maintenance and Test Equipment m w ¢ J u c
P 9Dw w—
Courses&Refreshers Operation-Gas,Oil,Tires,etc. U T L N N c m` w
Compensation,Drug tests,etc. n t
w y o 0IY m uD Orq
N. N c C5 gD -E`= 'im3 m
c 5
,l3 N � 0 'o'-md 'oao m¢> c � ac
w N m ULLOO¢Z Z u)W
❑0000❑ 00 100 ❑❑
A Iz
4ati D
o > > o
U J T w
Taxes,Income,Property, c x N �'
Business,Social Security, Yellow Page Advertising, Tools Warehouse Shop and o 0 o m m `c E
Trucks(ladders;etc.) a c _m c m 2 0 o y
Employment Compensation Radio,Television Office Rent r m o c U c 10 a D w O= m
m'o m yy m 5 ¢ v! $t o
OM m M.o m 3 0 $S Z m
N 'U N 200.2 0 N
Ila
k OIQIO ❑t]000❑ ❑❑ ❑❑ ❑❑
t�rJ C T " ` �• ] « J N R N m m m C N m U O
3333 it
« 0'2 c
rnc `o o wD w w¢ c o,w
Quality Control Stock of Replacement Parts Phone,Light,Heat Service Management Office Equipment m m c n > € J El N m E E ai
Administration. c Y 'y c o �t `- O ;n o
p 'm 00 uwivw¢Ud 3 ow c m
_❑� Iy rnE ma wan" 0 c Eo Z
!�'� d oQ oa do, o wOJ m 3 � c `w c
—rn w E E U
_a —
pEpyo �. a E D_ z: a .o
lit 0 3 0' a a u
Computerization Business Expense-Legal Employee Benefits Office Help Stationery,Office Supplies Q d 'v $ 3 ¢ O r
Counsel,Recruitment,etc. and Postage
I i
Don't judge service charges solely by the time the technician spends in your home or business. v r
When our professional service technician arrives at your door, the technician is actually making repairs on customer premises, s 'r
many costs have already been incurred just to get the technician traveling to keep service appointments, or participating in y..
and our service truck there, ready and able to complete the job. training programs to sharpen skills. j m a
Without years of training, it would not be possible fora The cost of doing business(overhead)must also be added to O W Q • .�, E
doctor to make a diagnosis and prescribe a remedy. Consider the technician's salary.These overhead costs can amount to • 0 7T C v ' :E 1-
for a moment that it isn't just his initial training, but an on going substantially more than the technician's salary. ' M = MLU CL jUi
variety of continuing study,and the expense of maintaining an Now comes profit.A 15%net profit on the selling price, III d • Q jP ii E S
adequately equipped staff and office. although seldom realized,would be ideal.Accordingly, if your .,^,s- OI • i EEg o ;
As a patient, you pay for his knowledge and skill plus a share service charge is$200.00 and we are efficient enough to earn ` p Q 8 z
of his business costs(overhead). Even if he spends only a few 15%of the$200.00,we earn 30 taxable dollars.We are sure C i o o I
minutes with you,his fee could range from$50.00 to$150.00 you'll agree that is not excessive for providing top quality �j V J d V rd„ V a ff ;
depending upon his degree of expertise. services on your premises. III H } £ V W 3
This analogy holds true in any service business.The charge All things considered,the cost to a service organization for its Z C
for providing service on your premises cannot be determined service technician's time on the job is the same whether he a a R 'g m E
solely by the.time it takes the technicians to make the repairs. works with tools'or not.A service call that results only in a - Z Ifl o a s
A qualified service organization's costs begin with the salary diagnosis and estimate for resolving the problem warrants a ',?. O o
u .
of the professional technician.This amount is the same whether service charge. ___________ ___________
I
I
I
i
� t ��A� Y TY
0 r t� ��A
2 m m M n r ri N Gem Plumbing, Heating, and Air Conditioning Guarantees
N
zCPU
z c m M y I our workmanship and the quality of all materials used.
MOO > zi�
-1 w z Gas Furnace Heat Exchangers: 20 years
o0Z � o1'r1
�z O j i Parts & Labor: 12 months
0)
Q. a �r
N o o ° Air Conditioner Compressor & Coil: 5 years
o m m 5n5 Parts & Labor: 12 months
OD � In C3 r
z m Residential Electrical Material: 12 months
G) mH Labor: 12 months ,
H
Dr j Drain line repiping Material: 5 years
Labor: 12 months
Garbage Disposers Materials & Labor: 5 years (1/2 hp)
10 years (3/4 hp)
z Zz Residential Drain and Sewer Cleaning No warranty unless otherwise
=i mrno noted in writing on contract
m2KOM
ymmno Hydro -Jetting of Drain Lines Equipment& Labor: 30 days
N oDm Refrigerant Leak Repair No warranty unless otherwise
noted in writing on contract
Water Heaters - Residential
Gas Materials & Labor: 6 years or 10 years
Electric - tank type Tank only: 5 years
_q _ Parts & Labor: 12 months
�-o o CT7 Water line repiping with copper tubing Material: 5 years ✓
3 N o d „ _ ^ N Labor: 12 months
D ' W All Other Installations & Repairs Parts & Labor: 12 months
TT
CIO
D N S 1D =O CI
o m > Extended Warranties are available at additional cost. 475236
g a �d b g d o-. s ` Should mry defects in material or workmanship occur during the period of warranty,.we will
$a po N s N o 00 repair or replace (at our discretion), at no charge. Keep this warranty along with the
3 N ; = tii o p 3 _a` contract to warranty work performed. The warranty is fully transferable.
SSS o ems+D o ` (See Terms and Conditions on the back of the contract for details on all warranties.The warranty is valid provided
d w all items in the Terms and Conditions are fully adhered to.)
Your "Consumer bill � Do Gem Plumbers
Rights". . .
/ G � real I smell good?
of Rights„• • • the plumbing heafing cng draindeaning y y
an an eednc s nc water airauaM The do.And the are considerate, courteous&careful.
On she. On time.On the money.
Gem provides local service in eve RI town —
Gem Plumbing Way from Woonsocket to Westerly. No travel charges. Inside you'll find your
Toll Free 877•Gem•Plumbing easy to understand
Here's what we promise and or 401.867.5309 " Full 100%
www.gemplumbing.com
what you can expect when One Wellington Road, Lincoln, RI 02865 Satisfaction
you choose Gem Plumbing and Guarantee",
Heating for service:
f`' ' ' and your
"Consumer
1 . We'll make an appointment ` - Bill of Rights".
and be there when we say we ,�
will. "Gem Club" � Plus:
Enjoy Valet service with our
Gem Club. For pennies a day you The Top Ten
2. You'll get respect with kind, can protect your home from costly reasons
courteous service and appreciation and annoying plumbing problems. Ask to call
for choosing Gem. your service tech for more information
or call Gem at 867.5309 todayl Gem!
s .
3. Our Technician will clean up and
leave the site in better condition Top 10 Reasons to Call Gem Plumbing g-
than he found it. #10 100% Satisfaction Guaranteed
#9. Catchy phone number f
4. Our Technician will be
knowledgeable, pleasant, clean, #8. We really do smell good ,
neat and of the highest moral #7. One call does it all
character. #6. True 24 hour emergency service
r
r
#5. Straight forward pricing
5. You will be 1001/o fully satisfied #4. State of the art technology
with our work or we will do it #3. Family owned since 1949 logo
again, to your satisfaction, for y ! s � G E M
#2. Money-back Guarantee
d plumbing Ivanne aool®g drain droning
FREE, or we'll refund your money. an nn eMnt time.on
emoen query
#1. We're the best! Toll Frye 877.779•4434 On sue. On time.On the money.
Our simple , easy-to -understand 100% Satisfaction Guarantee :
If you are not 100% satisfied with our installation or service repair,
we will do the job again to your satisfaction for FREE!
You'll like Gem's Home Services.
Our mission is to provide every customer with the highest quality workmanship, to
ensure the fastest possible service 24/7, and to give you our "Straight Forward"
price: no nonsense, no hidden charges or hard sell.
Our services include • Plumbing • Heating - Cooling • Electrical • Drain Cleaning
Video Pipe Inspection • Septic • Indoor Air Quality
You can talk to a live Technician before he gets to your house!
= When you've got a problem, call GEM at 867-5309. When you call, you can talk to
a real person. . .a technician! No voice mail or answering machines ever. You'll talk
to a knowledgeable technician who understands your problems and can provide
`. you with the right answers right from the start.
a You get true 24 hour emergency
service. Gem Plumbing and Heating is a family
mp;/
owned business started in 1949 by
When you have an emergency, our dad, Larry Gemma Sr. We're proud
you can't wait until tomorrow! to be one of the largest service Call Gem any time day or night companies in New England. We thank
N. w I every day of the year. our dedicated technicians and staff
and, you, our customer for making
When something goes wrong, this possible.
4 we'll be there to fix it!
- r a Gem has more expertly �` � --
'` trained technicians and more
trucks on the road than any
other service company in G
EM
• �r
.-= New England! We'll be out lumbin8 heann malinH dean deann
end Dan a m, septic W"J."qualdy
there in practically no time! ran Free 877Gem•Plumbing •ake. ae Um.On the money.
CITY OP SALmi
PUBLIC PROPE M
DEPART Mirr
MAN* :�.► seMA�.tuo�lt a��tONa.
TftO 464506f afW4& W
Cogsmedor UArb DbpoW AMdmll
(mini��dreel�d:vs�vrto�road
Is wl&iN Ad 400��SdWlmGCWk 7M Cta UdW*tll!
D&kmddwpwWkM
$„�rwmit r s btiori w(l�du eoodae.�m.aeM.nruthiy�
�ria!iA.01»dlsDoui a�ht s peO.b Ko�o�.rw dlga�i �diQer by h110.A
tu.slJaA
r+.d.�l.••in�e�n�o�w�
The debt will be d1spoW ofhe:
Own
a NII) Mk
L1YvRw dpatul�liaat
Tony Franco
i
A&F CONSTRUCTION
ROOFING • SIDING
SALEM.MASSACHUSE rS•License#147601
978-578-6516
cue ceu
sii3i c.o;;see=sso9 (am)3` o �l@T!/IC@ Vro1' IF 4 ( 5 L b
T- 1East Greenwich Attleboro,MA -� �'• +
(40)"4-IM (5"M-035e JOB COMPLETED ❑ YES ❑ NO
b E Brit ewater,MA Haverhill,MA �G /
am;n d�anmg (Seri 697-3999 (978)TA-1300 � Of_� :Work Order#
plMm4m61 kenrorg I rnoTm; N(ewbbUrypOrt,MA - Hampton,NH TECH R AUTHORIZED BY:
Try dui -4442 (603)926-6648 - - .
On site.On time.On the money. -
(a22)GEAU MMi[E•(SM 436-KA4 DI TEL.N
One Wellington Road Lincoln,RI 02865 -
/� www.gemontlme.com, CLIENT P. .N O Y JV -
Bill To: a-'ak-49/j/ M -
�� DATE INSPECTION DONE ❑.
Billing Address:
G JOB NAME FREE INSPECTION DATE
City: State: Zip: V/ 7 �Q JOB LOCATION '
E-mail: DAT MPL ED - JOB N r . -Q
I hereby authorize a service charge of $ : rITUATION t7/SGtcr eG
x R " �
RMOMMENDATIONS's r 2S
WORK PERFORMED.
OTY TASK NUMBER TASK DESCRIPTION STRAIGHT-FORWARD PRICE
a 3 07
FURNACE/BOILER- MAKE/MODEL SERIAL NO. TOTAL
A■ .t. . .
A/C MAKE/MODEL SERIAL NO, WATER HEATER MAKE/MODEL SERIAL NO. -
PAYMENT OF THIS INVOICE/CONTRACT DUE UPON COMPLETION OF WORK
I authorize Gem Plumbing and HeafHq C.m ,,Inc.to begin work.The Imdomlgned,states they are an oramn/authbrzed repreeentatirre W Me premleeeal which the violed mentioned above is to tie done.I hereby so Module you to
Barde
en Me wore as as stated in the above named.and m d to use such labor and materials as you death advalaeble.Paymd s is de des ban Mal is rendered, COD.A monthlyice sery charge of 1 3r4%will be added Ore day following the
due doe.I agree to pay ademeys re s M tie amount of TO%of the gross toed but rot less Man$350 am court costs in the amend of legal action.If or,check does not clear.I will bra liable for a penalty in Me amount of 3 times Me amount
of the c eck,in no case more than$1p)0 and In no case less than$200,plus the face value of the check and court casts in accord man R.I.G.L.5-42-3.If the clm*does clear,there win W a$50 W fee for each time ins union,was
returned.I have mad thisoptimal FRONT'S BACK and agree to be bound by all of the terms ema mil herein. - -
A 35%re miclung tee MA apply On all Spatial color Items.
ao, t�
t hereby authorize you to proceed cold the alcove work at the up front price of$ x,�-�--,-,� RR 0 SIGNATURE
TECH QUALITY STANDARDS INSPECTED WORK O APPEARANCE O CLEAN-UP O ATTITUDE O COURTEOUS O
I TESTED WATER PRESSURE To BE: I do hereby state that the above work has been installed in a workmanlike mall leak free and to the appy ble building codes.
STREET HOUSE
Las.l LBS/ OL—L—
Sd.IN So.IN �/-3 !, x L IYs.( ��u'�idwkw S",.
ACCEPTANCE OF WORK PERFORMED I rind Me mh ce the materiels rendered and inataned in connection win the above mentioned,to have been competed in a satisfactory manner I agree that Me
amount sell from,on his contact M Me spare labeled-TOTAL-to W Me total and complete up here price/minimum charge f agree to pay reasonable atdme/s fees and court costs In the event of legal action.A monthly service
charge of 1 314%wig boadde l after 10 days I aiemmMedge Oet I have read and relearned a legible cop/of this commis and have read Me Notice b Ovmer and statement required on contract.
Payment type:pu��sh O Vie ❑ M/C ❑ AMEX O Discover ❑ Check M Lic.No. State
LAST 4 LOTUS OF OARD NUMBER EXP DATE AUTHORIZATION WOE OUTHORIZED SIGNATURE
PUBLIC PROPERTY
DEPART�IET ,
ISIAIMEY DRISCOLL
MAYOR 120 WASHIN=N STREET•SALLW X%%SACHLS6TIS 01970
't41978-745-959S•FAR:978-740.9846
APPLICATION FOR THE REPAIR, RENOVATION, CONSTRUCTION,
DEMOLITION OR CHANGE OF USE OR OCCUPANCY_, FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Name' I.0-gilding:
Property Address: T, � Qi '
a
Property is ted in a;Conservation Area Y N' Historic District Y�L u I
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name:
Address:
Telephone: �-7
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use New
Demolition Existing
Approximate year of Area per floor (sf) Renovated
construction or renovation
of existing building New
Brief Description of Proposed Work:
Mail Permit to:
What is the current use of the Building? 1--i V , viG and o
Material of Building? �n If dwelling, how many units? Ci—
Will the Building Conform to Law? Asbestos? S
Architect's Name (=� e OV a l)n i
Address and Phone 1 S And 75 �t�—(� 7 y y 49 30
Mechanic's Name
Address and Phone J
Construction Supervisors License# I bl- RDn HIC Registration#AseC".�E
Estimated Cost of P ject$ Oj Permit Fee Calculation
Permit Fee$q� 920. �a Estimated Cost X$7/$1000 Residential
Estimated Cost X$11/$1000 Commercial
An Additional $5.00 is added as an
Administrative charge.
Make sure that all fields are properly and legibly written to avoid delays in processing.
The undersigned does hereby apply for a Building Permit to build to the above stated
specifications. Signed under penalty of pefjury ,�v-Orl o—V LI f
Date
I
_ I
0
`o u
w
4 u 4 4