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21-23 CLEVELAND ROAD - BUILDING JACKET I Gr=4�53 The Commonwealth of Massachusetts OBoard of Building Regulations and Standards CITY q Massachusetts State Building Code, 780 CMR SALEW Revised Mall `-,t Building Permit Application To Construct, Repair, Renovate Or Demolish a —+ ( One or Two Family Dwelling e This Section For Official Use Only + tsl " k k a �- . . .r - � Bmtding.Permit Number..: , = =.um, ., i ,t Date plied: =..ate sFn�;.., n ,.�, +=at' . .._.dam _ _•• c�;g,,. � fi Building Official(Print Name) + _a :• Signaturetrrs e'J SECTION I-SITE INFORMATION x,�.r�,„_ '�= x;ar? "� a, , 'fl 1.1 Property q�ddress: / 1.2 Assessors Map& Parcel Numbers L .I/ �_3 L'/Pvelanc� & 4 L 1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq it) Frontage(11) _ 1.5 Building Setbacks(11) 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? Municipal❑ On site disposal system ❑ Check if yes❑ --SECTION 2:1 PROPERTY,OWNERSHIP'1', 2.1 Owner�9,IRecord: _ PN /legcf2 srJti Name(Print) City,State,ZIP No.and Street `telephone Email Address 1 SECTION 3: DESCRIPTION OF PROPOSED WORK(check all that apply),q,s, ;i, 11.,,, b, New Construction ❑ Existing Building Owner-Occupied ❑ 1 Repairs(s) ❑ I Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bid . ❑ Number of Units Other ❑ Specify: Brief Description of Proposed Workz: G �' ',P*SECTION 4:ESTIMATEb CONSTRUCTION COSTS mr%aW Estimated Costs: i ?' ,� ! P t u Item t Official Use Onlyg ? „ Labor and Materials) .. .._�.. �. 1. Building $ (�. �(��_, l Building Permit Fee $js Indicate how fee is determined ❑Standard City/Town Application Fee Dau ' ; �'h's 2, Electrical $ s �e e"slaTrr a ❑Total Project Cost„(Item x multiplier ixi as J. Plumbing $ 2 Other Fees: $'k Lfll 4. Mechanical (HVAC) $ List _ r P 5. Mechanical (Fire Su ression) $ TotatAll'Fees $ `'4'"' _ :_ 'v ' i ��p Check No s Check Amount " ... Cash Amo nt �r E 6. tat Project Cost: $ _ ❑ paid in Full ❑�Outstandmg Balance Due. )ink I rn17-�'t �m Vv 6 -C . k; SECTIONS:CONSTRUCTION SERVICES;.. .. ,. .. 5.1 Construction Supervisor License(CSL) License Number Expiration Date Name of CSI.Holder List CSL Type(see below) _ No.and St feet 0Type VISION a� Descrrpnon0 a O U Unrestricted(Buildings u to 35,000 cu.ft.) P. r R Restricted 1&2 Famil Dwelling Gty/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding // �p /� p SF Solid Fuel Burning Appliances 9�$-/SO bc&6-c.-ar ig t/a,lLG.0 Sf,,4•v I Insulation Telephone Email addres�� D Demolition 5.2 Registered Ho improvement Contractor(HIC) p IlJ9 / Y L `IQf �r� /!n( HIC Registration Number Expiration ate IC om ny Name or HIC R istrant Name dd iAPrt �.✓ /Q C{tns -je- ✓atte ,aL:uc N{� an reed d e t�l��el f'j rt�— 91 A 0/e55- rvo3-0ci9 5i5 k Email add City/Town, State,ZIP Tele hone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M G LS c 152 § 25C(6))AfiP „ 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 of the building permit. Signed Affidavit Attached? Yes .......... No...........❑ y SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN n' Gl,tl�a OWNER'S AGENT OR CONTRACTORAPPLIESIFOR BUILDING PER 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 t SECTION 7b:OWNER' AUTHORIZED AGENTDECLARATION By entering my name below,I hereby 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 and understanding. Print Owner's or Authorized Agent's Name(Electronic Signature) Date .._-. � H�P •::v .. .. 3�iflt.# ',? _ _. ...:iA ..... .. . NOTES a._...' i&7j!cp.a}rl"'m!na.,.,,,,,.a"`: ...a :��_;:�...._�.3(f'?Ite..' I. 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 HIC Program can be found at win .mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.eov/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 half/baths 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" ZI � �f 3 Lye�l�c%L" �� .� a CITY OF SALEM PUBLIC PROPERTY DEPARTMENT KINMERLEY DRISGOLL MAYOR 120 WASHINGTON STREET♦ SALEM,MASSACHUSETTS 01970 TEL:978-745-9595 ♦FAx:978-740-9846 Notice of Unsafe Condition 21-23 Cleveland Road January 6, 2015 Kenneth P. Henderson 35 Fort Pond Road Acton, Massachusetts 01720 RE: 21-23 Cleveland Road—Roof Maintenance Dear Property Owner Our office received a complaint regarding your property located at 21-23 Cleveland Road of pieces of roof shingles from your roof that dislodged from the roof of your building onto the sidewalk and neighbors property. Upon a visual inspection of your building on January 5, 2015 it was noted that roof shingles were missing from your roof and noted on the adjoining properties roof plane. The roof appears in need of repair as it poses a risk to Public Safety below and your properties maintenance. You are hereby ordered to contact this immediately upon receipt of this letter and to begin to rectify these conditions within 7 days of receipt of this notice. Failure to do so may result in further actions being brought against you, up to and including the issuance of Municipal tickets or filing of criminal complaints at District Court. You have the right to appeal this order to the State Board of Building Regulations at One Ashburton Place, Boston, Ma. If you have any questions regarding this letter, please contact the Building Inspectors Office at (978) 619-5648. Respectfully, Michael E. Lutrzykowski Assistant Building Inspector Cc: file `loll 1:. . .., ' •,'^ 0125 6562 T000 OSOE Kik? 'F-SI-E v ••� y U.S.POSTAGE>>PITNEY BOWES w CITY OF SALEM S ` �'�j BUILDING INSPECTOR �� p 120 Washington Street 3'd floor = ZIP 01970 $ �06.4oO Salem,MA 01970 ! 02 IVY. 0001392928 JAN. O6. 2015 , M ��. o�p`'� c ✓moi Kenneth P Henderson a r }} 35 Fort Pond Road <-..' 1st NOTICE 2nd None Acton, Massact RETRRNER� k �r.. j RETURN TO SENDER { fi - 117Y A5LC 10 1- UK WAttU I � 'BCt 81970352303 *1921-00611-06-43 { -�%��'�+��• '�- illil�illlll,ILII�IIII,l�„I,I,ILilllli,llll„1.1.„�I,LI�J, J \ �. ��E _'! i j., ,+ � _.�� :..._: 'ti �..t __. } � �,. -. `� r' %� r �1� i j _� �" _ _� � k, COMPLETE !rtON ONDELIVERY1 M Complete items 1,2,and 3.Also complete A. Signa item 4 if Restricted Delivery is desired. E3 Agent 11 Print your name and address on the reverse X ❑Addressee so that we can return the card to you. B. Received by46nted Name) ate of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from Item 17 E3Yes 1. Article Addressed to: If YES,enter delivery address below: ❑NoI%/9/pTo%o41-d,3 C ioozdc-�'d TV 3. Service Type ❑Certified Mail® ❑Priority Mail Express"" ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑Collect on Delivery 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article'Number (Triclef l fromservlce labeQ Ijo PS Form 3811,July 2013 Domestic Return Recelpt UNITED STATES POSTAL J+ERCfICE- First-Class Mail Postage&Fees Paid ` s"l +. USPS 11 Permit No.G-10 • Sender: Please print your name, address, and ZIP+4®in this box• City Of Salem Building Department 120 Washington Street Salem, MA 01970 gn,Ililu,ph,Iil16Pi,Ili,I,q,„�u'IIhI,,�,II,I1i„il,li, ° CITY OF SALEM ��,. , ''1 PUBLIC PROPERTY � �_ "' DEPARTMENT �9eG�aK' KIMBERLEY DRISOOLL MAYOR 120 WASHINGTON STREET♦ SALEM,MASSACHUSETTS 01970 TEL:978-745-9595 ♦FAx 978-740-9846 Notice of Unsafe Condition 21-23 Cleveland Road January 6, 2015 Kenneth P. Henderson 35 Fort Pond Road Acton, Massachusetts 01720 RE: 21-23 Cleveland Road—Roof Maintenance Dear Property Owner Our office received a complaint regarding your property located at 21-23 Cleveland Road of pieces of roof shingles from your roof that dislodged from the roof of your building onto the sidewalk and neighbors property. Upon a visual inspection of your building on January 5, 2015 it was noted that roof shingles were missing from your roof and noted on the adjoining properties roof plane. The roof appears in need of repair as it poses a risk to Public Safety below and your properties maintenance. You are hereby ordered to contact this immediately upon receipt of this letter and to begin to rectify these conditions within 7 days of receipt of this notice. Failure to do so may result in further actions being brought against you, up to and including the issuance of Municipal tickets or filing of criminal complaints at District Court. You have the right to appeal this order to the State Board of Building Regulations at One Ashburton Place, Boston, Ma. If you have any questions regarding this letter,please contact the Building Inspectors Office at (978) 619-5648. Respectfully, Michael E. Lutrzykowski . Assistant Building Inspector Cc: file C®p