Loading...
22 CHASE STREET - BUILDING JACKET I'lie C'U,tt1I1011%veallh ur blassachuseus Board orBuilding Regulations and Standards CI IN OF tr ;, Slassachuselts State Building Code. 780 C'NIR ti'-,•' /l p nerd.I Grr'rl// Building Permit Applicalion TO Construct, Repair. Renovate Or Demolish a One-or run•Arndll•Un ellou, This Section For 011ricial Lie Onl Duilding Permit Number. Date Appl' Iludding 011icial print N;une) Signature Da SECTION I: SITE INFORMATION 1.1 Property AJJyej ^i IZ Assessurs Islap& Parcel Numbers 1.la Is this an acce ted street? a no Map Numher Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Ilropusc ,(lac Lot Arco(sq 11) Fro llage(it) 1.5 Building Setbacks(R) Front Yurd Side Yurds Rear Yard Required Proviticd Required Provided Required Provided 1.6 Water Supply:( .40.§Sq) 1.7 Flood Zone Informations 1.3 Sewage Disposal System: Ibblic❑ Private❑ Zone: _ Outside Flood Zone? Check ifcs❑ Municipal❑ On site disposals)stem ❑ SECTION7: PROPERTY OWNERSHIP' 2.1 Ownert of Re r N;une(P^rim) n IV,ZIP — U.and Strcct ° elephona Email Address SECTION J: DESCRIPTION OF PROPOSED WORKS(check a at apply) New Construction❑ Existing Building❑ Owner•Occupied ❑ Repoirsls Alterations) ❑ Addition ❑ Demolition ❑ accessory Bldg.❑ Number of IIntts_ Other ❑ Speeily: Brier Description of Proposed Work': SECTION J: ESTIMATE ONSTRCICTION COSTS Item Estimated Costs: Ofllclal Use Only((.abur:md.Materials) y I. Building S I. Building permit Fee: S Indicate how f'ee is determined: '. t:'learical S ❑Standard City.Toan Application Fee I'lumhing S ❑Total Project Cost'I Item 6)s multiplier J, \Icch.mic.d ill\ \('1 S List: S \Icchanic.il f hry — -- —•_ . . �u,ucssiunl S neat .\Il Fces: S _ n I'ntal lsr„jectCost: S C11"k Va. _...__('heck :\nunun: _ _l',uh \nunmt: "— ❑ n,id in Full 71 ilua". ling 11,I1.mce Due: St.'("HON S: ('ONS'I-It""HON SFR%'I('FS S.I 'onstructioo Su lervisur License({'SLI © 1 dZ 1't lira an I); ' N,uucul'C<Llhddu �! Ilst('`I. I)puhuul'elolll.__.__ — � I`tx Uescriptiun No an, .Str C ' U 141rcitrieteJ IOuilJin i li l0 1S,1111U eu. Il.l Ii ttnlrielad IRl I.unil Dwellin Masonry Cil)ifot,n,Stara LlP —._— KC Ktxdin l'uwrin µ'S Window,wd Sidin SF SOW fuel Ifurning\\pplimtces �� I Insulation Iln;u1 aJJrea U Deautliliun Talc bona HIC) !,2 Registered Ilume Itn wovem it C I IIC I(¢giardiun umber lip rues I all 1 al I a Name � Limail JJJross No. wit Ci own, State z P fete ION INSURANCE AFFIDAVIT(M.G.L.e. I53.1 23C(6)) SECTION 6:WORKERS'COMPENSAT completed and submitted with this application. Failure to provide Workers Compensation Insurance affidavit must be this affidavit will result in the denial of the lssuanceX4iebuilding permit. Signed AMdavit Attached? Yes .......... No• O SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owner of the subject property,hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. Data Print Uwnur's Nmle IElecwnie Signumro) SECTION 7b:OWNER OR pUTtIORIZED AGENT DECLARATION By entering my name below. I hereby attes ridera pains and enallles of perjury that all ut'the information con in this tin is true and a •urate I the I y kno ledge and understanding. f G I DJ ' Prim Uwnur'i or.\ulhurircJ,\�ent'i Nuaw haectm is Rign;uur VOTES: I. .\n Owner who obtains a building permit to do his her own work,or an owner who hires an unregistered eunuactur i nut registered in the Hmne Improvenxnt Contractor(HIC) Program),will nu have access to the arbitration program or guaranty 14u, wider M.G.L.c. I l?.4. Other important information on the HIC Program can be found at \t\t\t ,IM,, „ .-, I hnformatiun on the Cunsiruetion Supervisor License can be found at tt+ +` I •n""" ,Ip` ?, \1 hen substantial work is planned,pruv ide the Informationill illg gg,b a finished basement attics.Jocks tit porch) Total Moor area I iy. ll.l - --- g 8 Habitable room count _ -. . , . Number titbcdnituns \anther of tircplaces .. .. —_ Number ol'hail baths . . . . Numhcrot'hathrvoms Numherol'decki, porellci I\Ile of hvalitlg i\Qelll 1.IIe IUieti _,Ill+ell h\1+Q,�1 idpinllJ' i\Uelil I { "1', ial 11roieet square 1'oot,we "'As be alb,tiltil tiv"I'\nal Project Cast" The Commonwealth of Massachusetts Board of Building Regulations and Standardsja CrrY OF Massachusetts State Building Code, 730 CMRSALEM ed Mar 20!1 Building Permit Application To Construct, Repair, Renovate Or Demo One-or Two-Family Dwelling This SectuifthrOfficial UseOnl Building Permit Numbei: Data Appli 'd{ Budding Official(Print Name) $ anaturaPata SECTION 1:SITE IN RiYG1TION. 1.1 Property AdtI (D 1.2 Assessors Map& Parcel Numbers 1.1 a Is this an acceptede street?yes no L hlap Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq it) Frontage(it) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.O.L c.40,§54)f 1.7 Flood Zone Information: 1.3 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone?Check if yesCl b[unicipet❑ On site disposal system ❑ SECTIONZ:; PROP.ERTB'OWNEi apt 7 777 2.1 OwnertoPRgcoyI / ^; e— �t Name(Print) �(�e City,Stat%ZIP �� L No.and Street �" - Tile hone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORIO*6beck ail at apply) New Construction ❑ Existing Building❑ Owner-Occupied ❑ I Repairs(s)eCIj Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units_ 2tr ❑ Specify: Brief Description of Proposed Work': SECTION 4: ESTUNLATED CONSTRUCTION COSTS- item Estimated Costs: Official Us Only... Labor and Materials I. Building ; 1. Building Permit Fee.S cate how fee is determined: �. Elcctriat! S ❑Standard.Cifytrown Application Fe&' ❑'rotal Pto,(ect Cost r(Item.6)x multiplier x J. Plumbing S 2, Other Fens: 3 t. Mechanical (IIVAQ S List: . ,Mechanical (Fire iiiE mcSsiun) _ } total All Fees:.S_ r t Clack No. _Check Auwunt: C•rSlt Autount n I'n ('n t:al Project it $ (] , --- -- f I aid in Pall Cl OutsCmdinq Ilalanct Uuo: SECTION 5: CONs'TRUCI•ION SERVICES 5.l Construction ' ervisor Liccuse(CSL) Lieenssa Number E.epi ati a D,to Name of CSL I folder List CSL Type(see below) S pype Description Unrestricted Buildin s u to 35,000 cu. tt. No. and Street U R Rcstrietcd 1&2 Faintly Dwelling CitylTown,State, ZIP iv! %lasonr RC Roofing Covering WS - Window and Sitting SF Solid Fuel Burning Appliances Insulation 'Nle hona Email addres9 D Demolition 5.2 Registered Home Imp oventent Con for(HIC) HIC Registration Number E. p' atio Uate I I i s in {I ' gislr nt Name O Email address No.and Ci /Town,State 'LIP Pale hone SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152. 1 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance qf4liebuildfrig'permit. Signed Affidavit Attached? Yes .......... No...........O' SECTION 7a: OWNER AUTHORIZATIONTO DE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner of the subject property,hereby authorize to act on my behalf, in all matters re lative to work authorized by this building permit application. Dnro Print Owner's N:une(Electronic Signature) SECTION 7h: OWNEW OR AUTHORIZED AGENT DECLARATION By entering my name below, I hereby attest rider the ains and penalties of perjury that all of the information contai tf e I in this a Izt n ' c rate to th b to' y knowledge and understanding. 14int , ear's or Authurind:\gant't Name( •lectru a iguatur�) NOTES: I. An Owner whu obtains a building permitjb do hisiher own work,or an owner who hires an unregistered contractor (nut registered in the Hume Improvement Contractor(HIC) Program),will nor have access to the;rbitratiun program or guaranty bold under M.O.L. c. I42A. Other important information on the HIC Program can be found at www nrts;.eov%oca Information on the Construction Supervisor license can be found at w,wv utass-,wv'dp_t 2. When substantial work is planned,provida the information below: —(including garage, tinished hascmcntfattics,decks or porch) Total flour area(;q. RJ tiros; liviay:Ica(sy. it.) )I bicuble n out count _ lund,er of tiraplace.q_._------_— Number of bedraums ----.-___-- .--___-- Number Number of 1ml0ailis fy pc of he.uin,; ;y;icttt _--- -- --- F:nclo.;ed t tpcit i -- � l "f•v.ill'nq::t �yuircl� ,1.r,;e" iu.rql+e ;nh;titnt: It;+r " Ir.ill'rnj�.tl'ost'• .. - . The'Commonwealth of Massachusetts Department of Public Safety Msesaclmsctts State Building Code(780 CMR) Building Permit Application for any Building other than a One-or Two-Family Dwelling (This Section For Official Use Only) Building Permit Number: Date Applied: Building Official: SECTION 1: LOCATION(Please indicate Block#and Lot#for locations for which a street address is not available) as ckw sf saleM" 61170 No.and Street City/Town Zip COde Name of Building(if applicable) — SECTION 2:PROPOSED WORK Edition of NIA State Code used If New Construction check here❑or check all that apply in the two rows below Existing Building Vj Repair❑ Alteration X, Addition❑ Demolition ❑ (Please fill out and submit Appendix'I) Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No / Is an Independent Structural Engineerin Peer Review required?,� ^ �Yes ❑ No lrY Brief Description nolf^Proposed Work: � Ql'�'V(('4\ 0 ! -Q. l C' ) �- �� mil;<zz - F\ot-� W � �n>z �C--o t� l•�r r�ca Ift�(YYl comer COo CM nX (DA12 knedynC". Q2(CI rO N rCP SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CNIR 34) ❑ Existing Use Group(s): P,_A(�04jh,_f;,3_'r-,6 /k�mr Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq. ft.) Total Area(sq.ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A4❑ A-5❑ 1 B: Business ❑ E: Educational ❑ F: Facto F-1 ❑ F2❑ H: High Hazard H-1 ❑ H-2❑ H-3 ❑ H-d❑ H-5❑ L• Institutional l-1 ❑ 1-2❑ 1-3 El14 CIM: Mercantile❑ R. Residential R-10 R-2 R-3❑ R-4❑ S: Storage Sl ❑ S2❑ U: Utility❑ Special Use❑and please describe below: Special Use, SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA ❑ IB ❑ [IA ❑ IIB ❑ IIIA ❑ IIIB ❑ IV ❑ VA ❑ VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: Public Check if outside PIOoJ Zone❑ Indicate numicipnlx .4 trench Will not be Licensed Disposal Site reyuiredxfOr trench Or specify: Private❑ or indentify Zone or On site system ❑ 'permit is enclosed❑ Railroad right-of-way: hazards to Air Navigation: Ai.� I nr:r Not Applicable)( Is Structure within airport ap Broach area? Is their rcv,ew completed? , t Or Consent to Build Unclosed❑ Yes❑ Or:VO Yes❑ NO ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s):. 'INpe Of Construction: OCCUpmtt Load per hoar: DUOS the building Contain an Sprinkler St stem?: _Special Stipulations: _-_ SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner M"M as c6sp .s5k 5,e te"VI oty7o Name(Print) No.and Street City/Town Zip Property Owner Contact Information: c1—W ---WjV 3317 "-'goy- SS 1-7 t l acAmJ. Leg/47c ®iexce Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable, the property owner hereby authorizes Name Street Address City/Town State Zip to act on the property owner's behalf,in all matters relative to work authorized by this building permit application. - SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) If building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here O and skip Section 10.1 10.1 Registered Professional Responsible for Construction Control Nano(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor 96ROA F, IR" l l�S MG 147&No Company Name -75(.�,C -rL3RV1(3Jq, csL atG3q Name of Person Responsible for Construction License No. and Type if Ap licable 51 Oil Ue-1rN R Q-x0 au �av�u V� q3 Street Address City/Town State Zip lc�C6mCG,s+-� Telephone No.(business) Telephone No. ceB e-mail address SECTION 11: M)1,KP.KS (k)%11'1NS:\I ION IVURAN(T Al F11)'1V1[ M.G.L.c.152. 2SC 6 A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Is a signed Affidavit submitted with this application? Yes❑ No ❑ SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)_$ 1. Building $ 606 Building Permit Fee=Total Construction Cost x (Insert here 2. Electrical $ 11 appropriate municipal factor)_$ 3. Plumbing $ 4. Mechanical (HVAC) $ Note: Minimum fee=$ (contact municipality) 5. Mechanical Other $ Enclose check payable to 6.Total Cost 1 $ 6 ?Ga m(contact unicipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below, I herebv attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge rid understanding. / h ( Ge8Gs.c 0` 1�76,- 8Y- 33l7 Please girt and sign name Title Telephone o. Date Azin Street Address City/Town Stale ip Municipal Inspector to fill out this section upon application approval: Name Date � 7 f7 c 0� The Commonwealth of Massachusetts Wjlar CEUED CITY OF Board of Building Regulations and Standan:103" !j� ,: ' ��EM Massachusetts State Building Code, 780 CMR Revised Mar 2011 Building Permit Application To Construct,Repair, Renovate2WlJQ"oti& aA lQ. 3 U One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: Date Applied: I Building Official(Print Name) Signature Date - - SECTION 1: SITE INFORMATION Ca1.1 FPrope dr s: 1.2 Assessors Map&Parcel Numbers 1.1 a Is this an accepted street?yes_ no Map Number Parcel Number 13 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M-G-L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Check if yes❑ Municipal ❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP[ 2.1 Owner of Re or Name(Print) City,State,ZIP - ar C !`pIl -i� No.and Street elep one Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) Alterations) ❑ 1 Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units_ I Other ❑ Sp ik. Brief Description of Proposed Work': r SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: (Labor and Mat'44erials Official Use Only 1. Building $ gj2f 1. Building Permit Fee:$ indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees:$ Check No. Check Amount: Cash Amount: 6. Total Project Cost: $ ❑Paid-in Full ❑Outstanding Balance Due: toll?- I n t L-Cp 1U SZOY•rZ l . SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) Lwla6 License umber Ex ti Daie Name of CSL Holder - - See List CSL Type(see below) (`1 d No.an t - Type ° Description - U Unrestricted(Buildingss cft.� f R Restricted l&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding pr� SF Solid Fuel Burning Appliances y p I 1 Insulation Telephone Email address D Demolition 5.2 Registered ome Iut oveme_Contractor(HIC) IIIRegistration Number Exp' n tiDate n e 's t Name d r Email address Ci /Town,State,ZIP Telephone SECTION 6:WORKERS' COMPENSATION INSURANCE AFFIDAVrr(M.G.L.c.152.§,25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance the building permit Signed Affidavit Attached? Yes .......... No...........❑ SECTION 7ai OWNER AUTHORIZATION TO BE COMPLETED'WREN OWNER'S AGENT OR CONTRACTOR APPLIESFORBUILDING PERMIT I,as Owner of the subject property,hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER' OR AUTHORIZED AGENT DECLARATION By entering name below,I hereby attest under the pains and penalties of perjury that all of the information contained' Y'saplic 'on i hue and accurate to the best of my knowledge and understanding. Print Owner'sjbr Nuthdrized Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the RIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq. ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of halfibaths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage,may be substituted for"Total Project Cost" rTab® Wers 90%Larger Label Area /// I SMEA® KEEPING YOU ORGANIZED Na 10901 pwWow Eke Erebus► GET ORGANIZED AT SMEAD.COM URREMMCQWW �oxvostmHsu�n Certificate No: 847-11 Building Permit No.: 847-11 Commonwealth of Massachusetts 1City of Salem ® Building Electrical Mechanical Permits 0 This is to Certify that the RESIDENCE located at Dwelling Type 22 CHASE STREET in the CITY OF SALEM ------------------------------ ---------------- ------------------------------ry---------------------------------- Address Town/Ci Name IS HEREBY GRANTED A PERMANENT CERTIFICATE OF OCCUPANCY OCCUPANCY PERMIT FOR(22 CHASE STREET) This permit is granted in conformity with the Statutes and ordinances relating thereto, and expires unless sooner suspended or revoked. Expiration Date ----_________------- �' ----------- - Issued On: Mon Sep 12, 2011 ------------ ------------------------ - -44--Az - -- - -- -- GeoTMS®2011 Des Lauriers Municipal Solutions,Inc. ------------------------------------------------------------------------------- 22 CHASE STREET `, 847-11 GIs x. 7405 — COMMONWEALTH OF MASSACHUSETTS Neap 34 t CITY OF SALEM Block w Lot ��, 0462 Category:''7"" ` RENOVATIONS°!�1`' Pei mt#xt, n 847.11K al, BUILDING PERMIT Project JS-2011001402 .. U Est. Costi $16,70000 Fee Char edi, $192.00 g RMV a, v PERMISSION IS HEREBY GRANTED TO: Const. Class: ' 1i Contractor: License: Expires Use Group: - `�0 Semper F Builders/Jeff Turner Lot Size(sq.ft.): 5185.818 ' Zoning: R2 Owner: Mike LeBlanc . �Applicant: Sem e-F Rui,dersdeff Turner jiJnus�ameu: r PP P r Units LostAT: 22 CHASE STREET Dig Safe#:.. �) ISSUED ON: 01-Jun-2011 AMENDED ON: EXPIRES ON. 01-Oct-2011 TO PERFORM THE FOLLOWING WORK: ELECTRICAL UPDATE, GUT OUT FIRST FLOOR APT FOR THE KITCHEN LIVING ROOM,DINING ROOM AND ONE BEDROOM,AND REPLACE ENTRANCE DOOR jbh POST THIS CARD SO IT IS VISIBLE FROM THE STREET Electric Gas Plumbing Building Underground: Underground:. Underground: Excavation: Service: Meter: Footings: Rough:c.,ryz Y-1114 1j14 Rough: Rough: Foundation: /t Final: // Final: Final: Rough Frame:fix—, I ellI 1t 1,v" Fireplace/Chimney: l 1 D.P.W. Fire Health OKIKAi 0117 Insulation: I Meter: Oil: Final: n House# Smoke: Water: Alarm: Assessor Treasury: ((( Sewer: Sprinklers: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF SALEM UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. � rN Signature: � F�AfiTAuT rnmmr:p ng rnNTRAt't:fffWWJ9T Date Paid: Check No: Amount: BEAMMAE FOR PERIODIC INSPECTKI3(1S21DLF4)9Ii-)47 01-Jun-I1 572 $192.00 CHAPTER 11CONSTRUCTFIOR LIST OF REQUIRED INSPECTIONS.ON.SEE CURRENT BUILDING CODE Call r o ®ccury CALL 970-619-0641 TO SCHEDULE AN INSPECTION GeoTMSm 2011 Des Lauriers Municipal Solutions,Inc. �,CONDIT YSCYE AO CITY OF SALEM BUILDING PERMIT a3a 06i�1 Michael Winston & Associates, LLC Innovative Risk Specialists POB 287 Salem,NH 03079 Tel: 603-494-2366 - Fax: 888-306-8106 - E-mail: michaelwinston@comcast.net May 7,2020 Building Commissioner/Building Inspector Board of Selectman/Board of Health 93 Washington Street Salem, MA 01970 RE: Michael LeBlanc POB 541 East Wareham, MA 02538 Type of Loss: Water Date of Loss: May 4, 2020 Policy: DP00012296 Claim number: DL000353 Our File#: MW20-081 Location of Loss: 22 Chase Street, Salem, MA 01970 MAY 13 FH :b2 MAY To whom it may concern: The above-captioned claim has been made involving damages or destruction of property which may exceed $1,000.00 or cause Massachusetts General Laws, Chapter 143,Section 6 to be applicable. If any notice under Massachusetts General Laws, Chapter 139B is appropriate, please direct it to the attention of the undersigned and include a reference to the captioned insured, location, policy number, date of loss,cause of loss and claim or file number. On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above via first class mail. Sincerely, Michael Winston Adjuster