25 CLOVERDALE AVENUE - BUILDING JACKET No._ City of Salem wa.a
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APPLICATION'
� _. _ FOR _
PERMIT TO BUILD ADDITION, MAKE AL.TERATIONS OR NEW CONSTRUCTIOE�
IMPORT/INT-MPNeant to comPfeti alf/tems ln aectbns:y IR ll� N, and IX.
1. - �T P-ocanoro °?� 1p vu,-�,��-!._ ✓�i.j 4 a�r
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LOCATION
OF -- -- --
BEfWEEN -- �• MD
�'�u� ICR0983ft1��) . . � .. ,�10T �,
��V
" SUBDMSWN LOT �OCK SIZE
u. nr�nNo cosr oF suao�Na-a��r��rs�o.►�prere��a-o
0. TYPE 9F IMPROVEMENT D. PROPOSED USE-POR"DEMOIJTION"USE MOST RECENT USE -
� L����0 � . .. . . . 1�bropld�nW1
4 ❑ AdAltlon(q ieaidentle6 enbr numEer d new 12 Ons/amiY . 18.Q.A�n�Y.reaeetbnW .
Musinp unNa edded�il any�in Pert D� 13/ 19 ❑ CMrl4 oU�er ralipiaw
13 D Two a mae lemily-Enbi num0er � ❑ '� �.
3 ❑ Alteralion(3ee 2 ahorol - of unRs "'�._'__"_'_— i
< ❑ RePap�e0� 14 � henebnt�olel.mold a dormilorY' � 27 ❑ Parkin0 0�7s .
EMM iwmDer d unlfs _.__:.:._:.___. � ❑ ��1�'��1-
5 � Wreckin0(MmuMhmYy�es7dentle4enbrnum6x w . 23 � HoeO�.�tutlaW
af unifa in buildppin Part D.731 iS ❑�Garaps . . .
. Zs p arc�.e�w.�
e p ��+o a�ua,> >e ❑ c„oort, zs � we��mmr
7 ❑ Wu�datbn oNY 17 ❑ Dlhsr-Specby � 0� �hcd.Ii6ra,Y.olher eduCatiOrwl
. 27 Q Sbrs�,rro�pnW
B.OWNEfiBHIP � � 7���
a �PMata(IntlNiCual,corporstlw�.nonP�R 29 -OIPer-SpxN)'
inelihnbo.etc.l � ..
s Q Fuab(Federal,s�ate.«tocal govemment
C.COBT (Omd und) NonreaiexMl•Desuibq in demY w�ep0 ws d wilCirq�,a0.food P�oceeainp pent
' � maePins ahaP.�Y�0 e�ImP�.ebnbnlvY�Od.eeowderY�d��04
to. coel a impmv,menl ---._.____.-------- f aemchW aenoa;aerktng ge�epe r«departrnent atae.ramal oMce euNdtq.alics W+Wrw
at indmtrW denl.M uas d eaietin0 W+itl4i0 is Cekq ehenp�d.'�
To Ds'msta/led brt npt h�th.dg0 ..
in OM 86ove coe! ��� �j
,.. a Eleetrical..__".._..._...___.__...._._......_..__""_ ...
' .� ��� ,�p��/
b. Plumbng .._._..._.._.__.......____.._....__._"_____ ( �o�a�---�� 9 �`'v`�✓ �i_��� � �
c F1eaWi9.airwM'ilbn'vp.�________"_'___ /^ l / �'
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� 11�. TOTAI COST pF IMPROVEMENT � � /�/��IQ�; ` ., , . 1
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111. SELECTED CHARACTERISTICS OF BUILDING -For new buildings and add8ions, complete Parts E-L;demolitan,
com te on PaRs J 8 M, all others ski to IV )
E PRINGPAL TypE pF FppME F. PRNCpAL TYPE OF MEATp�fi RIEi, p. TYpE O SEWAOE DISPOSAL L TYPE OF MECNANICAL �
� � �Y(weM bearin9) 35 Q Ges 40 �Pudic a omets�Y WW uwrs w centrm e'r i
31 �Mbod hams 38 �Oi 61 Q Privete(eeWie hNc.ele.l ����/�1 p
32 Q �clu�s�d 37 O Ebctrkqy 44 �� �M �' � � .
. 33 Q Rainrorced mncrele 3e ❑ Coe� � H. TYPE OF WATER SUPPIY wr mse Cr an eNvvo/I
ao p on,e.-so��• sa ❑ on,e.-sa�a�. a2 Q�nem a c�.m�o�r � � � e, (�n�, �
a'i Q Pnvata lweu,cislun) . . . j
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+•o��"a � M, .DEMOLITION OF STRUCTURES: �
aa Nu�r�e«w so� .._.._............._.___.._....._..._..._ ::
as romi wwb reer a noo��r `/ Has APWoyal from Historical Commission been received �
a�nons,easea m e:iaror _ eZ� 7�� for 2IIY ShUCtUre over fiflY(`�)Y�? Yes_ No_ �
. . . ..__.__ . , �
aunancns�.-._._... -'—'-'-- -'- -' .
;, ; i
sn Tar mm are0.sa R--__..._._.._..- --- �- .f`�0 0 Dg$afe'Number ;
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ry , �
K Nu�n oF o�-srn�r v�svkces � Fest Contrd: �
st. Fncwsm _._.._._.------.._...__._....____._..._.. _ .
� "`` HpVE THE FOlLOWING UTiLITIES BEEN DISCO�NNECTEDT� �
s2owma.....---_..._..._..._._.._..._.._-------
�n�oExnw euanoxis ow�r VYa4er: . . , ,
uaao ;
Electric:'
sa �m°° -----=- -_-----
G.as'. ., . . „
F�r-------------- , , , o�- -.- sewer: I: �.
sa w,meeloi.
DOCUMENTATION POR THE ABOVE MUST BE ATfACHED
°�100"" e�_—__.�._.._�._.---I —_---BEFOREJI_PERMR CAN BE ISSUED.----
N. COMPI.ETE THE FOLLOWING: '
,.
Historic Districl't Yes_ No�Of yes,please enclose doCumentaUon irom Hfst Com.). _ _ .._� - _ _ • �•
., , _ .. .. � ., , _.. , ,. .., . _ �
Conservation Area4 ;.Yes_ No_ (N Y�:Please endose Order of Conddional.
Has Fire Prevention approved and stamped plans or applicatio�s9 Yea_�No—
Is P���Y�ted in the S.RA:'disficCt Yes_ No�
Comply with ZoningT'' Yes= No_ If no,enclose Board of Appeal decision)
Is lot grandfathered? Yea`— No— pf yes.submit documentatlonld�o.submit 8oard of Appeal decision)
If new constructlon,has tfie proper Fiouting Slip been enclosed't Yea_✓ No_
Is Architectural Access Board approvat required? Yes_ No_ (If yes,submk documentation)
MassachuseMs State Contracta License# Salem License#
Home Improvement Contractor# Homeowners Exempt form (if applicable) Yes_ No_
CONSTRUCTION TO BE COMMENGED WITHIN SIX(6)MONTHS OF ISSUANCE OF BUILDING PERMIT
/ /3/ o � If an extension is necessary.P�ease submR .:..
CONSTFiUCT10N IS TO BE COMPLETED BY:'- � in writing to the Inspecta of Bwldinga
V. IDENTIFlCATION- To be completed by all applicants
�„s n�amny amreae-N�meer.s�rex cav,ana sras LP CoW TeL Na
i. a✓o...rP.w rvt ��er �3 6wI"'vt Ue. ,��C ✓Q ���7l� � 7
�« M «d'la��ff .hl� 7'tS�o2.Y2
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&ddels
�^��� . . � Liceros Ilo. .
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acnnea«
Enones
I hereby certily that the proposed work is autharized by the owner of record and that I have been authorized bY the owner to make ihis application
as his authorized eM and we ree to cadam to all kaWe taws of this iurisdiction.
SignaWre of lipnt Address Application date
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DO NOT WRITE BELOW THIS LINE
VI. VALIDATION
B�ilding --� FOR DEPARTMEM USE ONLY
P�ermft numbet ��
/� use Grouo
BUild1� W,�— � � 19 Fra Gradkq
�8(rtll�ISSUBd C�
Building � ���;� �e��
P�armit Fee $
occuvancr wad
C6f11flCa�8 Of�CCUp2fICy $ . APP��bY- /f�
$ /� \
Drain Tile � /1
Plan Review Fee $ / !� w�1� (-xz •'A��
. - � - � - TiTLE
-- � -� �— ------- _-.�--------- --- �------ ------------ -------
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IdOTES AND Data• (Fa department use) ���2
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PERMIT 70 BE MAILED TO:
DATE MAfLED: v_�
ConsUuction to be started by. Completed by. �
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� ,a�� ,� �Yo�sNOE,���E�<<S�a��o��TM,sP��a.TME �' ��. °� � s� � el �" ,�, � NOTICE OF INTENT APPLICATION
Q ror�i or�or v aEam�o uaaoveueHr'm coua� rew mca/srn� /�, ��o w4: � �i
a��a ccoEs u o srEcnan��us nuo ne rr [ * co w¢ouacucrvs � . Mn�� cuma�i3a�
on �a cnan. ns aaar or �yE conm c�. w co smucna, * s wc
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PGHF N�CONSiRUf.i IMPROVFMQJS N C fAE E MI P VEHM!
- SS E� Y ME 51PIE AN� PIE 10 AL iONN/MUNIdPkltt. � WERA S UN�L4111R9EL1 BUFIEO�"
�, E°" , =„o„��,s,���,o„<< N ,„.s.��,„„ � � _ -- °°°°EF - Salem, Massaclhusetts
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iu�v �=w+s = " emr aaxmnc*rs s pi o� u snansa c rax wewc fnosary
H !� ca+mo�oircc s u u N c000 wc xc aHn noN.
U - ,ga,mca wa;i ro uEuuN ws s��oa eor�. ��r vr,u s*earsro AJ °�� oerzaoannna re es s . ec w� c�c o os+r e� Iand Ownt t's: Dai-� .❑ a[id MiChelle Ambler
W si„u a,�oR rn��i, mery nn�uervoucn*(on rvcw)xonc[or w.cx�Mu (:IiAPlil(' SCAL}: p�qN Es . " . „ t3 -yn�m n.fn�e, �ai«a�, x�n o�s90
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a. �,,, , F�:„�;�;;�s�RM , „� q,� .n-,oR r,�„_,� , � � HAYBALE EROSION CONTROL (LIMIT OF WORK� _� �, .A ��,,;�
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CITY OF SALEM
ROUTING SLIP
NEW CONSTRUCTION �
CERTIFICATE OF OCCUPANCY
LOCATION: �� C-��'`t ��� Q��- DATE \Z��� � v �
APPLICANT: ` \��'`�� �-�
ASSFSSORS L � '
FRANKKUI.IK � < 1�"���5 DATE: Z �— 6�
(93 Washington Strcet) -
CITY CLERK
CHERYL LAPOINTE � � DATE: o2'I-O
(93 Washington Street)
PUBLICE SERVICFS �
BRUCE THIBODEAU DATE: � n
(l20 Washington Street)4 oor C'p���� � il
W wC
wA�x �� �j� � ��9� ,-n
DO'CCIE THIBODEAU r � DA��_«� /
(120 Washington Street)4'"Floor
CROSS CONNECT SUPERVISO � � �
BRIAN TffiBODEAU ��� DATE: I Cl�
(5 Jefferson Avenue)
:'LAIVNING �� P��w� �w.c �y.4ta,.�
A1'E� � �S�eaM �..4wt
�� (l20 Washington Street)3rd F7 '
as.-�^=�5�4' � � s����,�-
; �_�NSERVATiiDN COMMISSION '-- � y 6 ��
/ DATF_: �
V �11G Washington Street)3n° o0
ELECTRICAL -
JOHN GIARDI DA'fE:_s��O 7
(48 Lafayettc Str
FIRE PREVE ION '
ERIN GRIFFIN s ' DATE: ( Z Uk,i
(29 Fort Avenue) � � . y�. .`/ Sec,+e%
�f�,�..��] �.fn a.�c� Ve.r��itd GvnncC���'r
HEALTH no SGp��t¢17yK-�-�s�_Y-�--br �
JOANNE SCOTT 7 b DATE: 7'aS�
(120 Washington Sveet�
BUILDING
THOMAS ST. PIERRE DA"1'E:
(l20 Washingron Sveet) 3`d Floor
Massachusetts Depaetment�of Environmentat Protection
Bureau of Resource Protection -Wetlands DEP File Number:
� VNPA Form 5 — Order of Conditions 64-�3�
� Massachusetts Wetlands Protection Act M.G.L. c. 131 40
\/
, §
''�( A. General Information IIIIIIII�II�IIII��II�IIIII�II�I���II��I�III�II
Important: Salem 2006121400289 Bk;26383 Pg;501
Whenfilling Ffom: �.ConservationCommission �z/ta/zmme 13:14:00 OTHER P9 1/13
out forms on
the computer, z.This issuance is for(check one): a. � Order of Conditions b. ❑ Amended Order of Conditions
use only the
tab key to 3. To: Applicant: �
move your
cursor-do not Darren and Michelle Ambler
use the retum a.First Name b.Last Name c.Company
key. 13 Pyburn Avenue
"V� d.Mailing Address
`� Salem MA 01970
_ e.City/Town _ f.State g.Zip Code
� a. Property Owner (if different from applicant):
a. First Name b.Last Name c.Company
d.Mailing Address
e.Citylfown . f.State g.Zip Code
s. Project Location:
25 Cloverdale Avenue _ Salem
a.StreetAddress � b. City(fown
Map 9 Parcel 280
c.Assessors Map/Plat Number d. ParceVLot Number .
Latitude and Longitude, if known (note:
elecVonic filers wifi click for GIS focator): e. �ataude f. Long@ude
s. Property recorded at the Registry of Deeds for(attach additional information if more than one parcel):
Essex
a.County b.Cert�cate(A registered land)
20337 243
c.Book ' d. Page
z Dates: August 31, 2006 SeptOmber 28, 2006 October 2, 2006
a. Date Notice of intent Filed b. Date Public Hearing Ciosed c.Date of Issuance
e. Final Approved Plans and Other pocuments (attach additional plan or document references as ,
needed):
Site Plan Plan to Accompany a Notice of Intent at#25 Cipverdale Avenue Salem, MA
a. Plan Title
Scott lan Patrowicz Scott lan Patrowicz
b.Prepared By c.Signed and Stamped by
September 28, 2006 1" = 10'
d.Final Revision Date e. Scale
f.Additional Plan or pocument Tdle g. Date
wpafortn5.dx• rev.Yt/0.5 Page 1 oF 9
�
�
Massachusetts Department'of Environmental Protection oEP Fiie Number. II
� Bureau of Resource Protection -Wetlands I
1IVPA 9Forrr9 5 - Order of Conditions 64-431
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 ,
B. Findings III
�. Findings pursuant to the Massachusetts Wetlands Protection Act: li
Following the review of the above-referenced Notice of Intent and based on the information provided '
in this application and presented at the public hearing, this Commission finds that the areas in which
work is proposed is significant to the folfowing interests of the Wetiands Protection Act. Check all that
applY:
a. � Public Water Supply b. ❑ Land Containing Shellfish c. � Preventio� of Poliution I
d. � Private Water Supply e. ❑ Fisheries f. � Protection of Wildlife �i
Habitat
y. � Groundwater Suppiy n. � Storm Damage Prevention i. � Flood Conhol
2. This Commission hereby finds the project, as proposed, is: (check one of the following boxes) I
Approved subject to: I
a. � the foliowing conditions which are necessary in accordance with the performance standards set
forth in the wetlands regulations. This Commissfon orders that ail work shall be performed in
aceordance with the Notice of intent referenced above, the following General Conditions, and any
other special conditions attached to this Ordec To the extent that the following conditions modify or
differ from the plans, specifications, or other proposals submitted with the Notice of Intent, these
conditions shall control.
Denied berause:
b. 0 tfie proposed work cannot be conditioned to meet the pertorma�ce standards set forth in the
wetland regulations. Therefore, work on this project may not go forward unless and until a new Notice
of Intent is submitted which provides measures which are adequate to protect these interests, and a
final Order of Conditions is issued. A description of the performa�ce standards which the
proposed work cannot meet is attached to this Order.
c. � the informafion submitted by the applicant is not sufficient to describe the site, the work, or the
effect of the work on the i�terests identified in the Wetlands Protection Act. Therefore, work on this
project may not go forward unless and until a revised Notice of Intent is submitted which provides
su�cient information and includes measures which are adequate to protect the AcYs interests, and a
final Order of Conditions is issued. A description of the specific infortnation which is lacking and
wMy it is neeessary is attached to th7s Order as per 310 CMR 10.05(6)(c).
Inland Resource Area Impacts: Check all that appiy below. (For Approvals Only)
s. � Buffer Zone Impacts: Shortest distance between limit of project disturbance and 15
wetland boundary (if available) a.iinearfeec
Resource Area Proposed Permitted Proposed Permitted
Afteration Alteration Replacement Replacement
4. ❑ Bank a.linearfeet b. linearfeet c.linearfeet d.linearfeet ,
5. ❑ Bordering Vegetated
Wetland a.square feet b.square feet c.square Teet d.square feet
6. ❑ Land Under Waterbodies a.square feet b.square feet c.square feet d.square feet
and Waterways
� e.cu.yd dredged f.cu.yd dredged
wpafortnS.Goc• rev.3!7/OS Page 2 of 9
Massachusetts Department'of Environmental Protection DEP Fiie Number:
� Bureau of Resource Protection - Wetlands
VUPa4 Form 5 — Order of Conditions 64-431
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
B. Findings (cont.)
Resource Area Proposed Permitted Proposed Permitted
Alteration Alteration Replacement Replacement
7. ❑ Bordering Land
� SubjeCt to Flooding a.square feet b.square feet c.square feet d.square feet
CubIC F00t FIOOd StOf2ge e.cubic feet f.cubic feet g.cubic feet h.cubic feet
s. ❑ Isolated Land Subject
to Flooding a.square feet b.square feet
. Cubic FOet F�ood Storege c.cubic feet d.cubic feet e.cubic feet f.cubic feet
a � Riverfront area a.Eotal sq.feet b.total sq.feet
Sq ft within 100 ft c.square feet d.square feet e.square feet f.square feet
Sq ft beiween 100-200 ft 9—square feet h.square feet i.square feet j.square feet
Coastal Resource Area Impacts: Check ali that apply below. (For Approvals Only)
�o. 0 Designated PoR Areas indicate size under Land Under the Ocean, below
��. ❑ Land Under the Ocean a.square feet b.square feet
c.cu.yd dredged d.cu.yd dredged
�z. ❑ Barrier Beaches indicate size under Coastal Beaches andlor Coastal Dunes below
13. ❑ Coastal Beaches a.square feet b.square feet c.dy nourishmt. d.dy nourishmt.
14. ❑ Coastai Dunes a.square feet b.square feet c.Gy nourishmt. d.Gy nourishmt
15. ❑ COaStal BaRks a. linearfeet b. linearfeet
�s. ❑ Rocky Intertidai Shores a.square feet b.square feet
17. ❑ Sait Marshes a.square feet b.square feet c.square feet d.square feet
1a. ❑ Land Under Sait Ponds a.square teet b.square teet
c.cu.yd dredged d.cu.yd dredged
19. ❑ Land Containing
Sh011fiSh a.square feet b.square feet c.square feet d.square feet
w: ❑ Fish Runs Indicafe size under Coastal Banks, iniand Bank, La�d Under the
Ocean, andlor inland Land Under Waterbodies and Waterways,
above
a.cu.yd dredged b.cu.yd dredged
zi. ❑, Land Subjectto Coastal
Storm Flowage a.square feet b.square feet
wpafortn5.tloc- ray.&1N5 Paee3oF9
Massachusetts DepartmenYoff Environmental Protection
� Bureau of Resource Protection -Wetiands DEP Fiie Number:
WPA Forr�n 5 - Order o# Conditions 64-431
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
C. Generai Gonditions Under Massachusetts Wetlands Protection Act
(only applicable to approved projects)
1. Failure to comply with all conditions stated herein, and with all related statutes and other regulatory
measures, shail be deemed cause to revoke or modify this Order.
2. The Order does not grant any property rights or any exclusive privileges; it does not authorize any
injury to private property or invasion of private rights.
3. This Order does not relieve the permittee or any other person of the necessity of complying with all
other applica6le federal, state, or local statutes, ordinances, bylaws, or regulations.
4. The work authorized hereunder shall be completed within three years from the date of this Order
unless either of the following apply:
a. the work is a maintenance dredging project as provided for in the Act; or
b. the time for completion has been extended to a specified date more than three years, but less
than five years, from the date of issuance. If this Order is intended to be valid for more than three
years, the exfension date and the special circumstances warranting the extended time period are
set forth as a speciai condition in this Ordec
5. This Order may be extended by the issuing authority for one or more periods of up to three years each
upon application to the issuing authority at least 30 days prior to the expiration date of the Order. ;
6. Any fill used i� connection with this project shall be clean fill. Any fill shall contain no trash, refuse, !
rubbish, or debris, including tiut not fimited to lumber, bricks, plaster, wire, lath, paper, cardboard, I
pipe, tires, ashes, refrigerators, motor vehicles, or parts of any of the foregoing. I
7. This Order is not final until all administrative appeal periods from this Order have elapsed, or if such ��I
an appeal has been taken, until 811 proceedings before the Department have been completed.
8. No work shali be undertaken until the Order has become final and then has been recorded in the
Registry of Deeds or the Land Court for the district in which the land is located, within the chain of title
of the affected property. in the case of recorded land, the Final Order shail aiso be noted in the
Registry's Grantor Index under the name of the owner of the land upon which the proposed work is to
be done. In the case of the registered land, the Final Order shall also be noted on the Land CouR
Certificate of TiUe of the owner of the land upon which the proposed work is done. The recording
informatian shall be submitted to this Conservation Commission on the form at the end of this Order,
which form must be stamped by the Registry of Deeds, prior to the commencement of work.
9. A sign shall be displayed at the site not less then two square feet or more than three square feet in
size bearing the words,
"Massachusetts pepartment of Environmental Protection" [or, "MA DEP"]
"File Number 64-431 "
wparams.da• rev.ytros Peee a or s
Massachusetts DepartmenYoff Environmental Protection DEP File Number:
� Bureau of Resource Protection -Wetlands
V1IPA Form 5 - Order of Conditions 64-431
Massachusetts Wetiands Protection Act M.G.L. c. 131, §40
C. General Ganditions Under Massachusetts Wetlands Protection Act
10. Where the Department of Environmental Protection is requested to issue a Superseding Order, the
Conservation Commission shall he a party to all agency proceedings and hearings before DEP.
11. Upon completion of the work described herein, the applicant shall submit a Request for Certificate of
Compliance (WPA Form 8A)to the Conservation Commission.
12. The work shail conform to the plans and special conditions referenced in this order.
13. Any change to the plans identified in Condition #12 above shatl require the applicant to inquire of the
Conservation Commission in writing whether the change is signiflcant enough to require the filing of a
new Notice of Intent.
14. The Agent or members of the Conservation Commission and the Department of Environmental
Protection shall have the right to enter a�d inspect the area subject to this Order at reasonable hours
to evaluate compliance with the conditions stated in this Order, and may require the submittal of any
data deemed necessary by the Conservation Commission or Department for that evaluation.
15. This Order of Conditions shall apply to any successor in interest or successor in control of the
property subj�ct to this Order and to any contractor or other person performing work conditioned by
this Orde�.
16. Prior to the start of work, and if the project invoives work adjacent to a Bordering Vegetated Wetland,
the boundary of the wetiand in the vicinity of the proposed work area shail be marked by wooden
stakes or flagging. Once in place, the wetiand boundary markers shali be maintained until a Certificate
of Compliance has been issued by the Conservation Commission.
17. All sedimentation barriers shall 6e maintained in good repair until all disturbed areas have been fully
stabilized with vegetation or other means. At no time shall sediments be deposited in a wetland or
water body. During construction, the applicant or hislher designee shall inspect the erosion controls
on a daily basis and shaii remove accumulated sediments as needed. The applicant shall immediately
control any erosion problems that occur at the site and shali aiso immediately notify the Conservation
Commission, which reserves the right to require additional erosion and/or damage prevention controls
it may deem necessary. Sedimentation barriers shall serve as the limit of work unless another limit of
work line has been approved by this Order.
18. All work associated with this Order is required to comply with the Massachusetts Stormwater Policy
Standards.
Special Conditions:
If you need more -
spacefor
addHional
conditions,
seied box to
attach a text
document �
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Massachusetts Department of Environmental Protection
� Bureau of Resource Protection - Wetlands DEP Fiie Number:
UVPA Form 5 - Order of Conditions 64-431
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
D. Findings Under IUlunicipal Wetlands Bylaw or Ordinance
i. is a municipal wetlands bylaw or ordinance applicable? ❑ Yes � No
z. The hereby finds (check one that applies):
Conservation Commission
3. ❑ that the proposed work cannot be conditioned to meet the standards set forth in a municipai
ordinance or bylaw specifically:
a.Municipal Ordinance or Bylaw b.Citation
Therefore,work on this project may not go forward unless and untii a revised Notice of Intent is
submitted which provides measures which are adequate to meet these standards, and a final Order of
Conditiorts is issued.
a. ❑ that the following additional conditions are necessary to comply with a municipal ordinance or
tiylaw:
a. Municipal Ordinance or Byiaw b. Citation
The Commission orders that ail work shall be pertormed in accordance with the following conditions
and with the Notice of Intent referenced above. To the extent that the following conditions modify or
differ from the plans, specifications, or other proposals submitted with the Notice of Intent, the
conditions shail control.
if you need more c. The s ecial conditions relatin to munici al ordinance or b law are as follows:
space for p 9 P Y
additional � .
cond'Rions,
seled box to
attach a te#
document ❑
wpa(ortn5.tloc�rev.3H/OS Pa9e6a(9
Massachusetts Departmentof Environmental Protection
� Bureau of Resource Protection - Wetlands DEP File Number:
WPA Form 5 - Order of Conditions 64-431
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
E. Issuance
This Order is valid for three years, unless otherwise specified as a special (,�C�i��+� � ���o
condition pursuant to General Conditions#4, from the date of issuance. t.oace of iss�en'ce
Please indicate the number of inembers who wiil sign this form: four(4)
This Order must be signed by a majority of the Conservation Commission. z.Number of signers
The Order must be mailed by certified mail (return receipt requested) or hand delivered to the applicant. A
copy also must be mailed or hand delivered at the same time to the appropriate Department of
Environmental Protection Regional Office, if not filing electronicaily, and the property owner, if different
from applican
Signatures�l .
�` �
-- — l --- � _
,� —_�
i ' �� l'� `
s
Notary Acknowledgeme t
Commonwealth of Massachusetts County of Essex
2g September 2006
Ofl thlS paY �f Month Year
Before me, the undersigned Notary Public, K. Cornacchio, D. Pabich, M. Blier, K. Glidden
personaily appeared Name of Document Signer
proved to me through satisfactory evidence of identification, which was/were
personally known
Description of evidence of identification
to be the person whose name is signed on the preceding or attached document, and acknowledged to
me that he/she signed it voluntarily for its stated purpose.
As member of Salem Conservafio� Commission
citylTown
¢,�, CAREY R DUQUES
��'�p�� �pp "�utary Pub6C
�� �7y ��COMMONWEALTH OF ANS�QRI�TB ,, /
UMy Commission E�irle � ., /� " !Y
nuqust +6.2013 Signature Notary Publi
Care Du ues
Printed Narne of Notary Public
Place notary seal and/or any stamp above August 16 2013
My Commission Expires(Date)
This Order is issued to the appficant as foilows:
❑ by hand delivery on � by certified mail, retum receipt requested, on
OG bE✓�? -Yc�
Date Date
wpafortnS.Gac• ray.3A/05 - Pa9a 7 of 9
L _ _ —
Massachusetts Departmen� of Environmental Protection
� Bureau of Resource Protection - Wetlands DEP File Number:
' WPA Form 5 - Order of Conditions 64-431
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
F. Appeals
The appiicant, the owner, any person aggrieved by this Order, any owner of land abutting the land subject
to this Order, or any ten residents of the city or town in which such land is Iocated, are hereby notified of
their right to request the appropriate DEP Regional Office to issue a Superseding Order of Conditions.
The request must be made by certified mail or hand delivery to the Department, with the appropriate filing
fee and a compleked Request of Departmental Action Fee Transmittal Form, as provided in 310 CMR
10.03(7)within ten business days from the date of issuance of this Order. A copy of the request shall at
the same time be sent by certified mail or hand delivery to the Conservation Commission and to the
applicant, if he/she is not the appellant. Any appellants seeking to appeal the DepartmenYs Superseding
Order associated with this appeal wili be required to demonstrate prior participation in the review of this project.
Previous participation in the permit proceeding means the submission of written information to the
Conservation Commission prior to the close of the public hearing, requesting a Superseding Order or
Determination, or providing written information to the Department prior to issuance of a Superseding Order
or Determination.
The request shall state clearly and conciseiy the objections to the Order which is being appealed and how
the Order does not contribute to the protection of the interests identified in the Massachusetts Wetlands
Protection Act, (M.G.L. c. 131, §40) and is inconsistent with the wetlands regulations (310 CMR 10.00).
To the extent that the Order is based on a municipai ordinance or bylaw, and not on the Massachusetfs
Wetlands Protec6on Act or regulations, the Department has no appellate jurisdiction.
Section G, Recording Information is availabie on the following page.
wpafortn5.7oc• rev.3HN5 . PageBo(9 �
Massachusetts Departmerat of Environmental Protection DEP File Number:
� Bureau of Resource Protection - Wetlands
' WPA Form 5 - Order of Conditions 64-431
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
G. Recording Information
This Order of Conditions must be recorded in the Registry of Deeds or the Land Court for the district in
which the land is located, within the chain of title of the affected property. In the case of recorded land, the
Final Order shall also be noted in the Registry's Grantor Index under the name of the owner of the land
subject to the Order. In the case of registered land, this Order shall also be noted on the Land Court
Certificate of Title of the owner of the land subject to the Order of Conditions. The recording information
on Page 7 of this form shall be submitted to the Conservation Commission listed below.
Salem
Conseivation Commission
Oetach on dotted line, have stamped by the Regisfry of Deeds and submit to the Conservation Commission.
-------------------------------------------------------------------------------------------------------•------------
To:
Salem
Conservation Commission
Please be advised that the Order of Conditions for the Project at:
25 Cloverdale Avenue 64-431
ProjeIX location DEP File Number
Has been recorded at the Registry of Deeds of:
County Book Page
for:
Property Owner
and has been noted in the chain of title of the affected property in:
��� �3 � �
Book Page
In accordance with the Order of Conditions issued on:
ia� i�l �C.�
Date
If recorded land, the instrument number identifying this transac8on is:
__�
InSVument Number
If registered land, the document number identifying this transaction is:
Document Number
Signatwe of Applicant
wpefam5.doc• rev.&il05 PaBa 9 of 9
�""'"� � • Attachment to Order of Condirions # 64-431
g�_=-_ti
���t��r: Page 1of 5
�,n`:�S
SALEM CONSERVATION COMMISSION
DEP FILE #64-431
25 Cloverdale Avenue
City of Salem, Massachusetts
ADDITIONAL FINDINGS
Based on the Estimated Habitats or Rare Wildlife and Certified Vemal Pools Map (June l, 2003) from Natural
Heritage & Endangered Species Program (NIIESP) of the Massachusetts Division of Fisheries and Wildlife, it has
been determined that this project dces not occur near any habitat of state-listed rare wildlife species nor contains any
vemal pools.
This Order is issued under the Massachusetts Wedands Protecrion Act,M.G.L.Chapter 131, Section 40 and the City
of Salem Wetlands Protection Ordinance, Salem Code Chapter 34, Secrion 34-1 —34-13.
This Order permits the construction of a singl�family house, associated utilities, driveway, and minor
improvements to the eartlten slope along the northern portion of the properiy. The improvements include the
removal of soIl from the location of the proposed single-family home, which will be distributed, per the approved
plan, near the e�sting boulder wall in the northwestem portion of the property. The existing earthen slope and
boulder wall will be re-graded per the approved plan. Additional improvements include the approved planting areas
labeled on the approved plan. The Commission has included addirional condirions which include the installation of
hay bales and si$ fence in the azeas noted on the approved plan as well as along the southem side of the e�sting
boulder wall which e�ctends to the eastern side of the pmperty adjacent to Rockmere Sh�eet.
GENERAL CONDITIONS
1. This Order of Conditions must be recorded in its entirety (all 5 pages) at the Essex County Registry of
Deeds or the Land Court for the district in which the land is located, after the expiration of the 10-day
appeal period and within 30 days of the issuance. A copy of the recording infarmation must be
submitted to the Salem Conservation Commission before any work approved in this Order
commences.
2. Approval of this applicatia�does not conatitute complianca with any law or regulation other than
M.G.L Chapter 131, Section 40, Wetlands Regulations 310 CMR ]0.00 and the City of Salem Wetlands
Protecfion Ordinance,Salem Code Chapter 34, Section 34-1—3413.
3. All work shall be perfortned in accordance with this Order of Conditions and approved site plan(s). No
alteration of wetland resource areas or associated buffer zones, other than that approved in this Order,
shall occur on this property without prior approval from the C:ommission.
4. Prior to any work commencing a sign shall be displayed showing DEP File#64-431, and not placed on
a living tree.
5. No work approved in this Order may commence until the ten(10)day appeal period has lapsed from the
date of the issuance of this Order.
6. With respect to this Order,the Commission designates the Conservation Agent as its agent with powers
to act on its behalf in administering and enforcing this Order.
�d";'""_�.� � Attachment to Order of Conditions #64-431
.—r �
:�v���s� Page 2of 5
'4..r,',�
7. The Commission or its Agent,officers,or employees shall have the right to enter and inspect the property at
any time for compliance with the condirions ofthis Order,the WeUands Protection Act MGL Chapter t31,
Section 40,the Wetlands Regulafions 310 CMR 10.00,and shail have the right to require any data or
documentation tBat it deems necessary for that evaluation.
8. The term "ApplicanY'as used in this Order of Conditions shall refer to the owner, any successor in
interest or successor in control of the property referenced in the Notice of inte�t, supporting documents
and this Order of Conditions. The Commission shall be notified in writing within 30 days of all
transfers of title of any portion of the property that takes place prior to issuance of the Certificate of
Compliance.
9. It is the responsibi(ity of the applicant to procure all other applicable federal, state and local permits and
approvals associated with this project. These permits may include but are not necessarily limited to the
following:
(1) Section 404 of the Federal Water Pollufion Control Act(P.L.92-500, 86 stat. 816),U.S.Army
Corps of Engineers.
(2) Water Quality Certification in accordance with the Federal Water Pollution Control under authority
of sec. 27(5)of Chapter 21 of the Massachusetts General Laws as codified in 314 CMR 9.00.
(3) Sewer Extension Permit from the DEP Division of Water Pollution Control under G.L. Ch. 21 A ss7
and 314 CMR 7.00. Any Board of Health permit for septic system design for any portion of the
septic system within ]00 feet of wetlands shall be submitted to the Commission prior to
constrection iniriation.
(4) Design Requirements for Construction in Floodplains under the State Building Code (780 CMR
744.).
10. If there aze conflicting conditions within this Order,the stricter condition(s) shall rule.
11. All work shall be pesformed so as to ensure that there will be no sedimentarion into wetlands and
surface waters during construction or after completion of the project.
12. The Commission or iYs Agent shall have the discretion to modify the erosion/siltation control methods
and boundary during construction if necessary.
13. The Commission reserves the right to impose additional conditions on portions of this project or this site
to mitigate any actuat br potenrial impacts resu(ting from the work herein permitted.
14. The work shall conform to the following attached plans and special conditions:
Fina1 Approved Plans
Site Plan to Accompany a Notice of Intent Application at#25 Cloverdale Avenue Sa1em, MA
(Titte)
September 28,2006
(Dated) ^
Scott Ian Patrowicz
(Signed and Slamped by)
City of Salem Conservation Commission
(On ftle with)
�
R�".","'f� � Attachment to Order of Conditions #64-431
.»,�f�= Page 3of 5
�-,:;�5
15. Any proposed changes in the approved pla�(s)or any deviation in construction from the approved
plan(s)shalI require the applicant to file a Notice of Project Change with the Commission. The Notice
shall be accompanied by a written inquiry prior to their implementation in the field, as to whether the
change(s)is substantial enough to require filing a new Notice of Intent or a request to correct or amend
this Order of Conditions. A copy of such request shall at the same time be sent to the Deparhnent of
Environmental Protection.
16. In wnjuncrion with the sale of this properry or any portion thereof before a Cedificate of Compliance has
been issued,the applicant or current landowner shall submit to the Commission a statement signed by the
buyer that he/she is awaze of an outstanding Order of Condifions on the propedy and has received a copy of
the Order of Conditions.
PRIOR TO CONSTRUCTION
17. Prior to the commencement of any activity on this site other than activities listed above,there
shall be a Pre-Construction Meeting beriveen the project supervisor,the contractor responsible for the
work, and a member of the Conservation Commission or its Administrator to ensure that the
requirements of the Order of Conditions are understood. The staked erosion control line shall be
adjusted, if necessary, during the pre-construction meeting. Please contact the Conservation Commission
Agent at(978)'745-9595 ext 31] at least forly-eight(48)hours prior to any activity to arsange for the
pre-construction meeting.
18. Prior to the pr�construction meeting and commencement of any acfiviTy on this site, sedimentation and
emsion control barriers shall be insfalled as shown on the approval plan(s)and detail drawings. The
Commission and/or its Administrator shall inspect and approve such installarion at the pre-construction
meeting.
19. No clearing of vegetation,including trees,or disturbance of soil shall occur prior to the pre-construction
meeting. Minimal disturbance of shrubs and herbaceous plants shall be allowed prior to the pre-
construction meeting if absolutely necessary in order to place erosion control stakes where required.
20. There sh�ll be 20 hay bales and wooden stakes under cover on the site Yo be used only for emergency
erosion control.
EROSION CON1'ROL
21. Appropriate erosion control devices shall be in place prior to the beginning of any phase of construction,
and shall be maintained during conshucrion in the wetland azeas and buffer zones. The erosion control
specifications provided in the Notice of Intent and the erosion conh-ol provision in the Order will be the
minimum standards for this project;the Commission may require additional measures.
22. All debris, fill and excavated material shall be stockpiled a location far enough away from the wetland
resot�rce areas to prevent sediment from entering wetland resource areas.
23. Erosion and sedimentation control devices shall be inspected after each storm event and repaired or
replaced as necessary. Any accumulated silt adjacent to the barriers shall be removed.
24. The area of constrvction shall remain in a stable condition at the close of each construction day.
25. Any de-watering of trenches or other excavation required during construcrion shall be conducted so as
to prevent siltafion of weUand resource azeas. All dischazge from de-watering activities shall be filtered
through hay bale sediment traps, silt filter bags or other means approved by the Commission or its
Administrator.
�"'�°��,� ' . Attachment to Oxdex of Condirions # 64-431
;n�ra Page4of 5
a:',,.:w�"s
26. Within thirry(30)days of completion of construction on any given portion of the project, all dismrbed
azeas in the completed portion of the site shall be permanently stabilized with rapidly growing
vegetative wver,using sufficient top soil to assure long-term stabilization of disturbed areas.
27. If soils are to be disturbed for longer that two(2)months,a temporary cover of rye or other grass should
be established to prevent erosion and sedimentation. If the season is not appropriate for plant growth,
exposed surface shall be stabilized by other appropriate erosion control measures, firmiy anchored,to
prevent soils from being washed by rain or flooding.
DURING CONSTRUCTION
28. A copy ofthis Order of Conditions and the plan(s)approved in this Order shall be available on site at all
times when work is in progress.
29. No alteration or acrivity shall occur beyond the limit of work as defined by the siltation barriers shown on
the approved plan(s).
30. All waste products,grubbed stumps,slash;constr�action materiais, etc.shall be deposited at least 100 feet
from weUand resource azeas and 200 feet from river.
31. Cement trucks shall not be washed out in any wetland resource or buffer zone area,nor into any drainage
system. Any deposit of cement or concrete products into a buffer zone or wet9and resource area shall be
immediately removed.
32. All exposed sub-soils shall be covered by a minimum ofthree(3)inches o£quality screened loam topsoil
prior to seeding and final stabilization.
33. Immediately following drainage structure installation all inlets shall be protected by silt fence,haybale
barriers and/or silt bags to filter silt from stormwater before it enters the drainage system.
34. There shall be no pumping of water from wetland resource azeas.
35. All equipment shall be inspected regulazly for Leaks. Any leaking hydraulic lines,cylinders or any other
components shall be fixed immediately.
36. During conslruction,all drainage shuctures shail be inspected regularly and cleaned as necessary.
37. The applicant is herhy notified that failure to comply with all requuements herein may result in the issuance
of enfoncement actions by the Conservation(_:ommission including,but not limited to, civil administrative
penalties under M.G.L Chapter 21A, secrion 16.
AF1'ER CONSTRUCTION
38. Upon completion of construction and final soil stabilizarion,the applicant shall submit the following to
the Conservarion Commission to request a Certificate of Compliance(COC):
(1) A Completed Request for a Certificate of Compliance form(WPA Form 8A or other form if
required by the Conservation Commission at the time of request).
(2) A letter from a Registered Professional Engineer certifying compliance of the property with this
Order of Conditions.
(3) An"As-Built"plan signed and stamped by a Registered Professional Engineer or Land Surveyor
showing post-conslrucrion conditions within all areas under the jurisdiction of the Massachusetts
Wetlands Protecrion Act. This plan shall include at a minimum:
L
pd"i°'^4 ' . Attachment to Order of Conditions # 64431
,�,''' r� Page 5of 5
> t
Y�'�pb'�
(a) All wetlaqd resource area boundazies with associated buffer zones and regulatory setback
azeas taken from the plan(s)approved in this Order of Conditions;
(b) L,ocations and elevations of all stormwater management conveyances,shvctures and best
management designs,including foundation drains,conslructed under this Order within any
wetland resource area or buffer wne;
(c) Distances from any structures constructed under this Order to wetland resource areas-
"structures"include,but are not limited to,all buildings, septic system components,wells,
utility lines,fences,retaining wa11s,and roads/driveways;
(d) A line delineating the limit of work-`�vork"includes any filling,excavating and/or
disturbance of soils or vegetation approved under this Order;
39. When issued,the Certificate of Compliance must be rewrded at the Essex County Registry of Deeds
and a copy of the recording submitted to the Salem Conservation Commission.
40. If the completed work differs from that in the original plans and conditions,the report must specify how
the work differs; at which time the applicant shall fust request a modification to the Order. Only upon
review and approval by the Commission,may the applicant request in writing a Certificate of
Compliance as described above.
41. Erosion control devices shall remain in place and properly functioning unril all exposed soils have been
stabilized with final vegetative cover and the Conservation Commission and/or its Administrator has
authorized their removal.
ADDITIONAL CONDTTIONS
42. Applicant shall install with stakes both hay bales and silt fence as erosion control measures and both hay
bales and silt fence shall also be installed along the south side of the e�cisting boulder wall extending to
the east up to the property line adjacent to Rockmere Street.
o �
°�v � CITY OF SALEM
�
��� CONSERVATION COMMISSION
October 2, 2006
Darren and Michelle Ambler
13 Pyburn Avenue
Salem, Massachusetts 01970 '
Re: Order of Conditions—DEP #64-431
25 Coverdale Avnue, Salem, Massachusetts
Dear Mr. and Mrs. Ambler:
Enclosed, please find the Order of Conditions for the above referenced project.
Following the 10-day appeal period (as of October 13, 2006), this document and the
attached Special Conditions must be recorded at the Essex County Registry of Deeds (36
Federal Street, Salem, MA). Once recorded, please return a copy of Page 9 of the Order,
which will indicate to the Commission that the document has been recorded.
As indicated in the Order, prior to any work commencing, this Order must be recorded, a
sign shall be displayed showing DEP File # 64-� within public view, erosion control
measures shall be installed, and contact me at l�as� 48 hours prior to any activity to
schedule a pre-construction meeting to review the Order with your hired contractor.
If you have any further questions, please feel free to contact me 978.745.9595 x 311.
Sincerely,
a � �,
��
Cazey D�ues �
Conservation Agent/ Staff Ylanner
Enclosures
I2O WASHINGTON STREET, S.ALEM, MASSACHUSETTS 01970 . Te�: 978.745.9595 Fnx: 978.740.0404 � WWW.SALEM.COM
i
. �
� COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PPOTECTION
ONE WINTER STREET, BOSTON, MA 02108 617-2.".2-5500
MITT ROMNEY STEPHEN R. PRITCHARD
Governor Secretary
KERRY HEALEY ROBERT W. GOLLEDGE,Jr.
Lieutenant Governor Commissioner
DEP File# 064-0431
RE: NOTIFICATION OF WETLANDS PROTECTION ACT FILE NLTMFsER SALEIvI
DATE: 9/18/2006 5:07 PM (city/town)
The Department of Environmental Protection has received a Notice of Intent filed in accordance with the
Wetlands Protection Act (M.G.L. c. 131, §40):
Applicant: Darren Ambler Owner:
,,, ,
Address: 13 Pyburn Avenue Address: ,
Salem,MA 01970
LOCUS: 25 Cloverdale Avenue
IF CHECKED, THE FOLLOWING ITEM(S)APPLY TO THIS NOTICE OF INTENT:
A.�X�This project has been assigned the following file# : 064-0431
Although a file#is reing issued,please note the following:
C.Q Other Regulatory Jurisdiction
L Q Application has been forwarded to Waterways Regulatory Program to deternune if a
Chapter 91 License is required.
2. Q Applicant is advised to forward a copy of the Notice of Intent to the Corps of Engineers
for review (call 1-800-362-4367 for information).
D. Q 401 Water Quality Certification
The project described in your Notice of Intent requires a 401 Water Quality Certification
from the Department of Environmental Protection and may require submittal of a 401 application
form. See below for further details:
1. Q Based upon the information submitted in and with your Notice of Intent a separate 401
Water Quality Certificatiou application form is not required. The Department has reviewed
the plans submitted by the applicant and finds that there is reasonable assurance that the project or
activity will be conducted in a manner that will not violate the Massachusetts Surface Water
Quality Standards, provided that:
a) the applicant receives and complies with a Final Order of Conditions from the local
conservation commission or the Department;
b) The Order of Conditions does not cause the loss of more than S,OOOsq.ft. of bordering
vegetated wetlands and land under water and/or the dredging of r_ru.e[han 100 cubic yards of
land under water;
This informaHon is available in alrernah format Call Donald M.Gomes,ADA Coordinator a1617-556-]057.TDD Service-1-800-29&2207.
DEP on the World Wide Web: http://www.mass.gov/dep
� Pnntetl on Recycled Papei
,�
c) any loss of vegetated wetlands has been mitigated with a minimum replication of I:1; and is
. not part of a subdivision; does not cause the ioss of any Wetlands designated as
d) The project is not exempt from the M.G.L. c. 131, §40-the Wetlands Protection Act;
Outstanding Resource Waters; and does not cause the loss of any salt marsh.
Therefore, provided tUat the above conditions are satisfied, the Final Order of Conditions will serve as the
Water Qua!ity Ceriification for this project. This does not relieve the applicant of the duty to comply with
any other statutes or reguiations.
2. Q Before the activity described in the Notice of Intent can commence, you must obtain a Water
Quality Certification form from this Regional Office. Please complete the enclosed 401 Water
Quality Certificafion applicarion form and file it with this Regional Office for review.
3. () Your project involves dredging of greater than 100 cubic yards of material or requires a
pernut fi-om the Feeleral Enerey Reeulatory Commission for work in "wate�of the
Commonwealth." Therefore, your proposed project is subject to 314 CMR 9.00 and requires a
Water Quality Certification. Please complete the eaclosed 401 Water Quality Certification
application form and file it with the Department of Environmental Protection, Waterways
Program, and One Winter Street,Boston, MA 02108. Contact the Division of Waterways
program at 617-292-5655 if you have and questions.
For more information please contact: Ms. JILL PROVENCAL @(978)694-3250 or at 978 694- ��
2224. II
Cc: I
Conservation Commission: 3alem Conservation Commission, City Hall 1 Salem Green I
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1NSULAiEO STAPLES RE�UIRED TO SUPPORT HLL WIRING e cel R.R.q2 BOX 683 31376HAMILTON 1 � �
1298 S�. FT. SMOKE DETECTORS REOUIREU EVERY 1200 SI7. FT. W/3I62� ADDITI�N
ALL SM�KE OETECTORS ARE TO BE INTERCONNECTEO AND ANY LOCATED L/VERPOOL, PA �70a5 ]S T S T OR Y
- WITHIN 20'-0' OF A 9aTH OR KITCHEN ARE TO BE PHOTO-ELECTRIC
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INSULATED STAPLES REOUIRED TO SUPPORT ALL WIRING 3 B
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UPC 10330
No. 153L � taas�
HASTINGS,MN
Certificate No: 206-08 Building Permit No.: 206-08
Commonwealth of Massachusetts
City of Salem
Building Electrical Mechanical Permits
This is to Certify that the RESIDENCE located at
Dwelling Type
002 CLOVERDALE AVENUE in the CITY OF SALEM
Address Town/City Name
IS HEREBY GRANTED A TEMPORARY CERTIFICATE OF
OCCUPANCY
25 CLOVERDALE AVE
I
This permit is granted in confri with the Statutes and ordinances relating thereto, and
expires _ unless sooner suspended or revoked.
Expiration Date
Issued On:Tue Dec 30, 2005 - - - - -- -
GeoTMS®2008 Des Lauriers Municipal Solutions,Inc. -- - - '- '-' - - --------- ..... ----- ---- ISI
r �
0025 CLOVERDALE AVENUE 206-08
GIS#: 663s — COMMONWEALTH OF MASSACHUSETTS
Map ----109 --
Block: CITY OF SALEM
Lot: 10280
Category: IOINew Single family;
Perntit 1206-08 - BUILDING PERMIT
Project# JS2008-000448
Est. Cost: 1$314,000.00
Fee Charged: $2,203.00 _
:Balance Due: $.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License: Expires
Use Group: _ 1 Edward Cavatora General Contractor-cs 088692
Lot Size(sq. ft.):117582.1228 -:,Owner: AMBLER MICHELLE
Zoning: RI
Units Gained: Applicant: AMBLER MICHELLE
- --'
Units Lost: AT. 0025 CLOVERDALE AVENUE
Dig Safe
ISSUED ON: 16-Aug-2007 AMENDED ON: EXPIRES ON: 19-Feb-2007
TO PERFORM THE FOLLOWING WORK:
CONSTRUCT NEW SINGLE FAMILY DWELLING
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Electric Ga Plumbing Building
Underground:y-.Z y-L' nderground: Underground: Excavation:
Service: Meter: �) ✓ Footings:
�t?'�F'U� �.ilk ���,YiS�y.2�•
Rough3/p.�e �„f ugh: Rough: l�`�I 1 Foundation:DK e. �- �
/�s!!si`7FJ.�.r�fi�sJ
Final: ^ al: Final: Rough Frame:
Fireplace/Chimney:
D.P.W. Fire / Health
Insulation:
Meter: Oil: N /
16
House q Smok Final: ' ! I Jb t7
-01
b
/L� Assessor Treasury: ` V
Water: Alarm:/_2
�[l /
Sewer: Sprinklers: ((( Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF SALEM UPOfT710LATION OF ANY OF ITS
RULES AND REGULATIONS. / "I Oki
Signature: -M,y—��
Fee Type: Receipt No: Date Paid: Check No: Amount:
Bhnd"m' —�x-+�•-�-.,•• .RF.C.2A4.8:0U1W2L.�,,.,,, 16-Aug-07 11561 52,203.00
An iRSPection IS F3 QIR n
4W f MMOtion of work, pie&"Asp
7459595 Ext 385
GcoTMSL9 2008 Des Lauriers Municipal Solutions,Inc.