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81 CONGRESS STREET - BUILDING JACKET 5 rSu p e Ac i be Overdm&Ta4fddem 90%Larger Label Area III SMEAR KEEPING YOU ORGANIZED MD.lom yaarrarn- "NOMUM GET ORGHDIM AT SMEAD COM WLfmuocmw wstoST. �ticonolra.�o CITY OF SALEM, MASSACHUSETTS PUBLIC PROPERTY DEPARTMENT n .c 120 WASHINGTON STREET, 3RD FLOOR 4' SALEM, MASSACHUSETTS 01970 TELEPHONE: 978-745-9595 EXT. 380 INE otoFAX: 978-740-9846 KIMBERLEY DRISCOLL MAYOR September 24, 2012 Elizabeth Rennard City Solicitor 93 Washington Street Salem, Ma. 01970 RE: 8l Congress Street Dear Beth, I am requesting a lien to be placed on the property located at 81 Congress Street. Enclosed is the copy of the bill from Baystate Builders and Remodeling for $250.00 for the work done to the property. Thank you for your cooperation in this matter. Sincey,�fY/, Thomas St. Pierre Director oflnspectional Services Raystatc Building& 12anrxlcling Inc. I(lVoiC@ ? po box 725 -- _ 1 Salem, NIA 01970 Date Invoice:'# 'i 091211'x012 x4253 I�LGG11� (978)741-1700 ,. ,r - tommy abaysLrtebmlding.com Dua Date" 09/21/2012 Bill fo:�, City of Salem Massachusetts 93 Washington St Salem,MA 01970 Activity", — — - Amount 250.()0 •Job location 31 congress st 0.00 Board Lip 2 doors Install 2 hasps and 2 locks u � Lf) t� M h� ,`Ica Q• \V .. CL:t— � �n r y9od t3y: r C l Total 5250.00; Wo Build" SOLID"Customerst �.- � � LJ; Q , �� /D 6 �f ��¢.1r2� �ai o/97d • SENDER: Complete items 1 'and 2 when a� 'T7 Ser res are desired, and complete items 3 and 4. -i'� Put your address in the"RETURN TO" Space on tpe•r.vse side:Failure to do this will prevent this card from being returned to you.The return receipt fee ill rdGide you the name of theerson delivered to and the date of deliver . Far additional tees the ollowing services are available. Cons postmaster or ees an c eck oxles) or additional service(s) requested. t-U c 1. Show to whom delivered, date, and addressees address. 2. ❑ Restricted Delivery (Extra charge) Pl\ (Extra charge) 3. Article Addressed to: 4. Article Number Mr. Joseph ze�a�r, .Ji. �Q. ?0x 106 7 Type of Service: 019,96 ❑ Registered �r�4y� ❑ Insured SA/er2�1, /yI9• )aCenified M-11 COD ❑ Express Mail ❑ Return Receipt for Merchandise r' Always obtain signature of addressee fe- /'/, or agent and DATE DELIVERED. 5. Signature — dressee 8. Addressee's Address (ONLY if X requested and fee paid) 6. Sig tura- Agent 7. Date of Deliver OR a PS Form 3811, Apr. 1989 •U.S.G.P.G.1989-238-815 DOMESTIC RETURN RECEIPT 5ti J UNITED STATES POSTAL SERVIC PIA j OFFICIAL BUSINESS a i o C 111 lit SENDER INSTRUCTIONS 1 t 0 Print your name,address and ZIP Code �y�. J in the space below. Air- I • Complete items 1.2,3,and 4 on the U.S.MAIL reverse. �() • Attach to front of article if space permits, otherwise affix to back of article. PENALTY FOR PRIVATE • Endorse article "Return Receipt USE, $300 Requested"adjacent to number. RETURN Print Sender's name, address, and ZIP Code in the space below. TO //�� 7Vi I (�arriS� ( ,A/ 01?e la/air) Gee P 268 691 701 RECEIPT FOR CERTIFIED MAIL NO INSURANCE COVERAGE PROVIDED NOT FOR INTERNATIONAL MAIL (See Reverse) o e h 2e or )o JIB. e and b. 064 aS a and ZI o e Postage S 2- Certified Fee Special Delivery Fee Restricted Delivery Fee Return Receipt showing to whom and Date Delivered N m Return Receipt showingwhom, Date,and Address of Delivery d a TOTAL Postage and Fees S mPostmark or Date M E 0 LL N a STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES.(see hem) 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached and present the article at a post office service window or hand it to your rural carder. (no extra charge) i 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the return address of the article,date,detach and retain the receipt,and mall the article. i 3. If you want a return receipt,write the certified mail number and your name and address on a return recelpt card,Form 3811,and attach It to the front of the article by means of the gummed ends it space per- mics.Otherwise,affoc to back of article. Endorse front of article RETURN RECEIPT REQUESTED � adjacent to the number. 4. If you want delivery restricted to the addressee,or to an authorized agent of the addressee,endorse RESTRICTED DELIVERY on the from of the article. 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. 6. Save this recelpfand presentit if you make idqulry. *U.S.G.P.o.1989-234.555 v d 1 ax 6 epIMMA tl� PECEIYED CITY OF SALEM HEALTH DEPARTMENT Ury OF Sall Fra, BOARD OF HEALTH Salem, Massachusetts 01970 ROBERT E. BLENKHORN May 5, 1986 9 NORTH STREET HEALTH AGENT - �- (617) 741-1800 Joseph Zelano P.O. Box 1064 Salem, Ma 01970 Dear Sir/D@ffWL In accordance with Chapter 111, Sections 127A and 127B, of the Massachusetts General Laws, 105 CMR 400.000: State Sanitary Code, Chapter 1: General Administrative Procedures and 105 CMR 410.000: State Sanitary Code, Chapter , II: Minimum Standards of Fitn_ess„for�Human_Habitation, an inspection was made of your, property at 81181 Congress St. � Salem, Massachusetts,- occupied by Common areas_ `—. - This inspection was conducted by V. Moustakis Salem Health Department, on 5/5/86 at 2:45 p.m. , The following violations still exist from FEBRUARY 24, 1986: The following action must be taken within 5 days from receipt of this order: (5 days from 2/24/86) Provide smoke detectors in front and back hallways of this 4 (or more) apartment structure Contact Fire Dept. (10 days from 2/24/86) Post name, address & phone number of owner in front interior lst floor hallway -. sign not less than 20 square inches'An size (30 days from 2/24/86) Provide Emergency lighting for common areas - Contact Bldg. Inspector Page 1 � \ SALEM HEALTH DEPARTMENT Page �of _2.. � 4 North Street Tenant(s)Salem, MA 01970 Common Areas_ "-� Prooerty in Salem at 81=815 Congress St. To: , Joseph. 2elano ONE OR MORE OF THE ABOVE VIOLATIONS MAY ENDANGER OR MATERIALLY IMPAIR THE HEALTH, SAFETY AND WELL-BEING OF THE OCCUPANTS. Failure on your part to comply within the specified time will result in a complaint being sought against you in Salem District Court. Should you be aggrieved by this Order, you have the right to request a hearing before the Board of Health. A request for said hearing must be received in writing in the office of the Board of Health within seven (7) days of receipt of this Order. At said hearing, you will be given an opportunity to be heard and to present witness and documentary evidence as to why this Order should be modified or withdrawn. You may be represented-by an attorney. Please also be informed that you have the right to inspect and obtain copies of all relevant inspection or investigation reports, orders and other documentary information in the possession of this Board, and that any adverse party has the right to be present at the hearing. Please be advised that the conditions noted may enable the occupant(s) to use one or more of the statutory remedies available to them as outlined in the enclosed inspection report form. FOR THE BOARD OF HEALTH ROBERT E.-BLENKHORN, C.H.O. Health Agent Certified Mail # P 328-419-263 enc. Inspection Report cc: Tenant Bldg. Inspector _ Electrical Inspector P1uM0119 b Gas InspectorF' Fire Dept. _ City Councillor Este es u ocumento legal importante• Puede que afecte sus derechos. a CITY OF SALEM PUBLIC PROPERTY DEPARTMENT KINWRLEY DRISCOII MAYOR 120 WASHINGTON$1itEE'T SALEM,MASSACHUSETTS 01970 TFL:978-745-9595 ♦ FA-x:978-740-9846 VIOLATION NOTICE PROPERTY LOCATION 81 CONGRESS STREET August 9, 2006 FILE COPY John Gorman P.O. Box 2159 Wakefield, MA 01880 Dear Mr. Gorman: The above listed property has been found to be in violation of the following State Codes and/or City Ordinances: 780 CMR, State Building Code, Section 103. This section governs the requirement that all systems in a structure be maintained in good working order. Whereas, the Soffit at the rear of this structure is open to the weather, it 4 is neither sanitary nor safe, and needs to be repaired The railing on most of the porches are in need of inspection and repair. I am also ordering an inspection based on Section 115 of the State Building Code so as to evaluate the general condition of this structure and it's use and occupancy. To this end you will need to notify your tenants and call this office to setup this appointment. This inspection will be performed by a combined inspection team including Fire, Health, and Building Inspectors. Said violations must begin to be corrected, repaired, and/or brought into compliance within 2 days of your receipt of this notice. Failure to do so may result in further actions being brought against you, up to and including the filing of complaints at District Court. If you have any questions regarding this letter, please contact the Building Inspectors Office at(978) 745-9595, extension 386. Sincerely, CP4 eph E. Barber , Jr. Assistant Building Inspector CC: file, Mayor's Office, Councilor Corchado, Fire Prevention, Health Dept. a CITY OF SALEM PUBLIC PROPERTY DEPARTMENT KIMBFIR 6Y DRISCOLL MAYOR 120 WASIi1NGCON SKELT* SALEM,MAS$ACIIUS8PC5 0'1970 TEL978-745-9595 ♦ FAX:978-740-9846 VIOLATION NOTICE PROPERTY LOCATION 81 Congress Street ),47 Mr. John D Gorman AV- t, �JG�^' 81 Congress Street V Salem, Ma.01970 March 24, 2008 Dear Mr. Gorman The above listed property has been found to be in violation of the following State Codes and/or City Ordinances: Section 103 780 CMR (State Building Code) for failure to maintain your roof in a safe condition. Said violations must begin to be corrected, repaired, and/or brought into compliance within 7 days of your receipt of this notice. Failure to do so may result in further actions being brought against you, up to and including the filing of complaints at District Court. If you have any questions regarding this letter, please contact the Building Inspectors Office at (978) 745-9595, extension 5643. Sincerely, Thomas McGrath Assistant Building Inspector/ Local Inspector CC: file, Mayor's Office, Fire Prevention, Health Dept., CITY OF SALEM m . ro; PUBLIC PROPERTY DEPARTMENT KIMNERI..EY DRISCOLL MAYOR 120 WASHINGTON$'IRHGI * SALEM,DWSACHUSEITS 01970 Tr-.:978-745-9595 ♦ FAX:978-740-9846 VIOLATION NOTICE PROPERTY LOCATION 81 CONGRESS STREET August 9, 2006 John Gorman P.O. Box 2159 Wakefield, MA 01880 Dear Mr. Gorman: The above listed property has been found to be in violation of the following State Codes an City Ordinances: �''-'- 780 eMR'State Building Code, Section 103. This section governs the requirement that all systems in a structure be maintained in good working order. Whereas, the Soffit at the rear of this structure is open to the weather, it is neither sanitary nor safe, and needs to be repaired The railing on most of the porches are in need of inspection and repair. I am also ordering an inspection based on Section 115 of the State Building Code so as to evaluate the general condition of this structure and it's use and occupancy. To this end you will need to notify your tenants and call this office to set up this appointment This inspection will be performed by a combined inspection team including Fire, Health, and Building Inspectors. Said violations must begin to be corrected, repaired, and/or brought into compliance within 2 days of your receipt of this notice. Failure to do so may result in further actions being brought against you, up to and including the filing of complaints at District Court. If you have any questions regarding this letter, please contact the Building Inspectors Office at(978) 745-9595, extension 386. Sincerely, e h E.BarbeaJr: P Assistant Building'Inspector CC: file, Mayor's Office, Councilor Corchado, Fire Prevention, Health Dept. Citp of balem, agacjugett� Public Property Department � gw Nuilbing Department One *alem Oreen 745-9595 CXt. 380 William H. Munroe Director of Public Property Inspector of Buildings Zoning Enforcement Officer September 27, 1990 Mr. Joseph Zelano, Jr. P.O. Box 1064 Salem, MA. 01970 REQ: 81 Congress Street, Salem, MA. Dear Mr. Zelano: Due to complaints received at this office, a site visit was made at the above referenced property. Upon inspection, it was noted that the front parch floor boards are weak and deteriorating. This is a violation of the Massachusetts State Building Code, Section 104. (maintenance) . Please contact this office within seven (7) days upon receipt of this letter and apply for the proper permit so we may rectify the situation. Siincely, David J. Harris Assistant Building Inspector DJH/jmh c.c. Board Of Health Ward Councillor City Solicitor Pile Prevention vg�00NU1T� �s9�c CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970- JOANNE SCOTT, MPH, RS,CHOth HEALTH AGENT 120 Washington Street —4 Floor Tel: (978)-741-1800 Fax (978)-745-0343 July 30, 2001 Yoleny Ynoa P.O. Box 8712 Salem, MA 01970 Dear Mr. Ynoa: In accordance with Chapter III, Sections 127A and 1278 of the Massachusetts General Laws, 105 CMR 400.00; State Sanitary Code, Chapter I: General Administrative Procedures and 105 CMR 410.00: State Sanitary Code, Chapter 11 Minimum Standards of Fitness for Human Habitation, an inspection was conducted of the property 83 Congress Street#2 occupied by Sandra Cesar conducted Jeffrey Vaughan, Senior Sanitarian on Friday, July 27, 2001 at 10:30 A.M.. Notice: If this rental unit is occupied by a child or children under the age of 6 years, it is the property owner's responsibility to notify tenants of lead related reports and tests, and to ensure that this unit complies fully with 105 CMR 460.000 : Regulations for Lead Poisoning Prevention and Control. For further information or to request an inspection, contact the Salem Health Department at 741-1800. You are hereby ORDERED to make a good-faith effort to correct the violations listed on the enclosed inspection report. Failure on your part to comply within the time specified on the enclosed inspection report will result in a complaint being sought against you in Salem District Court. Time for compliance begins with receipt of this Order. Should you be aggrieved by this Order, you have the right to request a hearing before the Board of Health. A request for said hearing must be received in writing in the office of the Board of Health within 7 days of receipt of this Order. At said hearing, you will be given an opportunity to be heard and to present witness and documentary evidence as to why this Order should be modified or withdrawn. You may be represented by an attorney. Please also be informed that you have the right to inspect and obtain copies of all relevant inspection or investigation reports, orders and other documentary information in the possession of this Board, and that any adverse party has the right to be present at the hearing. Please be advised that the conditions noted may enable the occupant(s) to use one or more of the statutory remedies available to them as outlined in the enclosed inspection report form. For the Board of Health: Reply to: Vd=nneSctt Jeffrey Vaughan Health Agent Senior Sanitarian cc: Councillor Scott LaCava ,Tenant, & Building Inspector Certified Mail#7099 3400 0008 9438 6662& Regular 1s`. Class Postage JS/sik c-h-violet CITY OF SALEM HEALTH DEPARTMENT rf� Salem, Massachusetts 01970 Page 1 of a State Sanitary Code, Chapter II: 105 CMR 410.000 Minimum Standards of Fitness for Human Habitation Occupant : Sandra Cesar Phone: 978-745-8779 Address: 83 Congress Street Apt.# 2 Floor 2 Owner: Yoleny Ynoa Address: P.O. Box 8712 Salem, MA. 01970 Inspection Date: July 27, 2001 Time: 10:30 AM Conducted By: Jeffrey Vaughan Accompanied By: tenant Anticipated Reinspection Date: days from receipt. Specified Time Reg.#410.. Violation(s) Based on a tenant complaint an inspection was conducted in accordance with Article II of the State Sanitary Code 105 CMR,410.000. Upon inspection the following were noted: U ec /%/+-.f C N 27 _{, JvV I•v TQiC U U N IV g2��gi 7a, A, S2 iG A One or more of the above violations may endanger or materially impair the health safety, and well being of the occupant(s) Code Enforcement Inspector � �r Sr. Sanitarian Este es documento legal importante. Puede que afecte sus derechos. Puede adquirir una traduccion de esta forma sies necesario Ilamar al telefono 741-1800. Appendix 11 (14) Legal Remedies for Tenants of Residential Housing The following is a brief summary of some of the legal remedies tenants may use.in order to get housing code violations corrected : 1. Rent Withholding(Massachusetts General Laws, Chapter 239, section&A): If Code Violations Are Not Being Corrected you may be entitled to hold back your rent payments. You can do this without being evicted if: You can prove that your dwelling unit or common areas contain code violations which are serious enough to endanger or materially impair your health of safety and that your landlord knew about the violations before you were behind in your rent. You did not cause the violations and they can be repaired while you continue to live in the building. You are prepared to pay any portion of the rent into court if a judge orders you to pay it. ( For this, it is best to put the rent money aside in a safe place) 2. Repair and Deduct(Massachusetts General Laws,Chapter III,section 127L): The law sometimes allows you to use your nent>money,to make the repairs yourself. If your local code enforcement agency certifies that there are cokviolations which may-endanger or materially impair your health,safety,or well-being, and your landlord has,received,written.notice of the violations,you may be able to use this remedy. If the owner fails to begin necessary repairs(or to enter into a written contract to have them made)within five days after the'notice onto complete repairs within 14 days after notice,you can use up to four months rent in any year to make iepairs. 3. Retaliaiory Rent Increases or Evictions Prohibited(Massachusetts General Laws,Chapter 186, section 18,and Chapter 239,Secfion 2A) The.owner may not increase your rent or evict you in retaliation for makinga-complaint to your local code enforcement agency about code violations_If the owner raises your rent to try to evict within six months after you have made the complaint,he or she will have to show a good reason for the increase or eviction which is unrelated to your complaint. You may be able to sue the landlor for damages or if he or she tries this. 4. Rent Receivership (Massachusetts General Laws Chapter U, section 127 C-H):The occupants and/or the Board of Health may petition the District or Superior Court to allow rent to be paid into court rather than to the owner.The court may then appoint a"receiver" who may spend as much of the rent money as is needcc to correct the violation_The receiver is not subject to a spending limitation of four months'rent. 5. Breach of Warranty of Habitability: You may be entitled to sue your landlord to have all or some of you rent returned if your dwelling unit does not meet minimum standards of habitability. 6. Unfair&Deceptive Practices(Massachusetts General Laws,Chapter 93A) : Renting an apartment with code violations is a violation of the consumer protection act and regulations, for which you may sue an owner. The information presented above is only a summary of the law. Before you decide to withhold rent or take an) other legal action, it is advisable that you consult an attorney. If you can not afford to consult an attorney, you should contact the nearest legal services office, which is Neighborhood Legal Services 37 Friend Street Lynn,MA. 01902 CITY OF SALEM HEALTH DEPARTMENT Salem, Massachusetts 01970 - Page _ .2 of ;2 Date: 2 f 2Ze, Name: Address: F 3 T- Specified Time Reg.#410.. Violation(s) / — LA => i.+Y f FC SGrQsI 22 .E' tv ' t Page of Date: Name: Address: Specified Time Reg.#410.. Violation(s) SALEM FIRE DEPARTMENT COMPLAINT FORM FIRE PREVENTION BUREAU Location of Complaint or Hazard %V� Complaint by ZAddress Nature of Complaint f P6 N7)f/I 1f� �0 U rti0/aw,cr o/V 9 -/9 —96 f Xox 7 6rPCl� �!?Gr n l�rf /5 fidr l ttl Received by Investigated by DATE...........................s a...t y Trn ESA.............. rnro Cs1 Action Taken < o� (n C? v� <p A Other Department Notified � w Form #58. (Rev.6/87) ; y • ��.CoxNiA"l0 BOARD OF APPEAL s as FEB 25 152 pi'y 'FE \u^epIHMB�FY ` £('Eli/ D CITY OF SALEM HEALTH DEPARTMENT CITY OF ALFA„ BOARD OF HEALTH Salem, Massachusetts 01970 ROBERT E. BLENKHORN 9 NORTH STREET HEALTH AGENT February 24, 1986 (6 17) 741-1800 y Joseph Zelano Box 1064 Salem, Mass. 01970 Dear Sir/Dear Madam: In accordance with Chapter 111, Sections 127A and 127B, of the Massachusetts General Laws, 105 CMR 400.000: State Sanitary Code, Chapter 1: General Administrative Procedures and 105 CMR 410.000: State Sanitary Code, Chapter II: Minimum Standards o-£_Fitness—for-Human.Habitation, an inspection,was made of your property at81-81} Congress Street � — Salem, Massachusetts, occupied by Common Area This inspection was conducted by V. Moustakis Salem Health Department, on 2/13/86 at 9:45 A.M . Based upon said inspection, you are hereby ordered to take the following action within 5 days of receipt of this order: /K There were no smoke detectors in hallways of this 4 apartment (or possibly more) structure - Contact Fire Prevention to quantity and type and location needed. Based upon said inspection, you are hereby ordered to take the following action within 10 days of receipt of this order: There must be a posting of owners Name, Address and Phone Number in the Front Halls. Based upon said inspection, you are hereby ordered to take the following action within 30 days of receipt of this order: ! If this is considered a 4 or more apartment structure, there is no emergency lighting which must be provided - Contact Building Inspector and Electrical Department. Page 1 SALEM HEALTH DEPARTMENT Page _2_of 2 c , 9 North Street February 24, 1986 Tenant(s) Common Area Salem, MA 01970 Property in Salem at 8.178.1.1 Congress Street To:Joseph Zelano ' ox 4-- Salem,em, ass. ONE OR MORE OF THE ABOVE VIOLATIONS MAY ENDANGER OR MATERIALLY IMPAIR THE HEALTH, SAFETY AND WELL-BEING OF THE OCCUPANTS. Failure on your-part to comply within the specified time will result in a complaint being sought against you in Salem District Court., Should you be aggrieved by this Order, you have the right to request a hearing before the Board of Health. A request for said hearing must be received in writing in the office of the Board of Health within seven (7) days of receipt of this Order. At said hearing, you will be given an opportunity to be heard and to present witness and documentary evidence as to why this Order should be modified or withdrawn. You may be represented by an attorney. Please also be informed that you have the right to inspect and obtain copies of all relevant inspection or investigation reports, orders and other documentary information in the possession of this Board, and that any adverse party has the right to be present at the hearing. Please be advised that the conditions noted may enable the occupant(s) to use one or more of the statutory remedies available to them as outlined in the enclosed inspection report form. FOR THE BOARD QOFF HEALTH ROBERT E. $LENKHORN, C.H.O. Health Agent Certified Mail # P-681-936-217 enc. Inspection Report cc: Tenant X Bldg. Inspector _ Electrical Inspector Plumbtng & Gas Inspector X Fire Dept. _ City Councillor Este es un documento legal importante• Puede que afecte sus derechos. e P T Leo �S C) , Q� �CjLi 5.;.TE Z[rr y CITY SALEM BUILDING SALEM, MASSACHUSETTS 01970 6" PERMIT ';A R..F"I 19 rib `i a:-...3 `-1`_i F, 1 i'� T ryry DATE 19 PERMIT NO. APPLICANT ADDRESS .4 L'a.h..l_. .I.Zh I 1 (N0.) (STREET) (CONTR'S LICENSE) EA11?TNG; it G ' '7--942.._10 744 CITY STATE ZIP CODE TEL.NO. ', TWO od wiori E F,MIi_l: NUMBEROF 4 PERMIT TO STORY— DWELLING UNITS (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) ZONING AT(LOCATION) 00181. COIy(iI"•;1';;L':i=� SS" RE-IET' DISTRICT (NO) (STREET) BETWEEN AND (GROSS STREET) (CROSS STREET) M'r'-\.I-' ,.i 1} .i. .. - LOT SUBDIVISION - LOT ''' BLOCK SIZE BUILDING ISTO BE FT.WIDE BV FT.LONG BY_ FT.IN HEIGHTAND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: ' '\15'fRl._ "a:. ; .W ' .:I: CA,i; rl4i'I'S �'Ivz� ;'i._, li�'C:'T'Yli^F: <; ,_Ir� it..,, i. .... �r-. AREA OR ,9 IC',1;71 PERMIT QQ VOLUME ESTIMATED COST FEE W (CUBIC/SQUARE FEET) OWNER i---1..)i 7 1 fl13A - . GT ,,;. -Y, .. _ BUILDING DEPT. C_ ADDRESS `17 -(-II'@iS iJ': aT .a 171_.El I IV'jhl BY L... . I THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF,EITHER TEMPORARILY OR PERMANENTLY,ENCROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION,STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL INSPECTIONS APPROVED PLANS MUST BE RETAINED ON JOB AND THIS CARD KEPT WHERE APPLICABLE SEPARATE REQUIRED FOR ALL CONSTRUCTION WORK: POSTED UNTIL FINAL INSPECTION HAS BEEN MADE. WHERE A PERMITS ARE REQUIRED FOR 1.FOUNDATIONS OR FOOTINGS. CERTIFICATE OF OCCUPANCY IS REOUVD,SUCH BUILDING SHALL ELECTRICAL,PLUMBING AND 2.PRIOR TO COVERING STRUCTURAL MECHANICAL INSTALLATIONS. MEMBERS(READY TO LATH). NOT BE OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. 3.FINAL INSPECTION BEFORE OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 1141 z o z Tt SlT: n c `� (1:'tion Is REED ° // ann��/t� sve k N! ase call " Cl Sri '"' 0 c Ext. 388 BOARD OF HEALTH CTION'A - FIRE DEPT.INSPEC ITING APPROVALS oe 0 8m OTHER CITY ENGINEER p - WORK SHALL NOT PROCEED UNTIL THE PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION WORKIS INSPECTIONS INDICATED ON THIS CARD INSPECTOR HAS APPROVED THE VARIOUS NOT STARTED WITHYV SIX MONTHS OF DATE THE PERMIT IS ISSUED CAN BE ARRANGED FOR BY TELEPHONE STAGES OF CONSTRUCTION. A$NOTED ABOVE OR WRITTEN NOTIFICATION. )Y 7 6 a1�N A \\ 01 l � rwTP CITY OF SALEM BUILDING DEPARTMENT w� CITY HALL ANNEX o FP4 ONE SALEM GREEN �y 19 JUL SALEM, MASSACHUSETTS 01970 ® /S96No w. a OU�OF Nor ss l °may° 0Pp Tq NoZfl SON my F SUFFGF pUFA�BOX - _(PE��OSU�HSTR ORpEFSS� R . - UPpATF CUST�FR SEq / k �� it {t!t tltit kit tt i it It 4t Ii ttS It ti y I 31 RECFIVEp (� The Commonwealth of Massac � I t SERVICES �} Department of Public Safetn V➢U Massachusetts State Budding Code(7&II A —8 A Building Permit Application for any Building other than a One-or Two-Family d S(ling - (This Section For ffi 'al Use Only):. . �(1 Building Permit Number: Date Applied: Budding Official: SECTION 1:LOCATION(Please indicate Block ff and Lot R for locations for which a street address is not available) No.and Street City/Town Zip Code Name of Building(If applicable) SECTION 2 PROPOSED WORK, Edition of MA State Code used_ - If New Construction check here❑or check all that apply in the two rows below Existing Building•' Repair Alteration ❑ 1 Addition❑ 1 Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ 1 Change of Occupancy Cl I Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ NA '— Is an Independent Structural Engineering Peer Reviev requve [ Yes ❑ No4r� Brief D cri tion of Proposed Work: !3/hi� 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 CMR 34) Existing Use Group(s): 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❑ B: Business ❑ E: Educational ❑ F: Facto F-1❑ F2❑ 1 H: Hi h Hazard H-1❑ H-2❑ H-3 ❑ H-4❑ H-5❑ I: Institutional 1-1 El 1-2❑ 1-3❑ 14❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R-4❑ S: Storage S-1 ❑ S-2❑ U: Utility❑ Special Use❑and please describe below: Special Use: 1. SECTION 6.CONSTRUCTION TYPE(Check as a plicable) IA ❑ IB ❑ HA ❑ IIB ❑ ILIA ❑ IIIB ❑ 1 IV ❑ 1 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 T Check if outside Flood Zone❑ Indicate municipally' A trench will not be Licensed Disposal Site❑ Private❑ or indentify Zone: or on site system❑ required❑or trench or specify:permit is enclosed❑ Railroad right-of- a Hazards to Air Navigation: �I�\I_I:st n.wnun{sm m It p, • I'r xe•s: Not Applicable Is Structure within airport ipp ach area? Is their review completed? or Consent to Budd enclosed❑ Yes❑ or No Yes❑ No ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Coale: Use Group(s): Type of Construction: Occupant Load per Floor: Does the building contain an Sprinkler System?: Special Stipulations: e R� SECTION9: PROPERTY OWNER AUTHORIZATION I Name and Address of Property Owner r ,.��Qnr�� Fr I.CQM��P S-r S's�ENi ol��Q Name(Print) No.and reet City/Town Zip Property Owner Contact Information: P0J1 Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby author' es /�� Nane Str—eet�ss City/Town State Zip to act on the property owners behalf,in all matters relative to work authorized by this building permit apelication. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) If budding is less than 35,000 cu.R:of enclosed space and/or not under Construction Control then check here O and s-ip Section 10.1 10.1 Registered Professional Responsible for Construction Control Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 10:2 General Con ctor - Comp.tn Name Name of Person Responsible for Construction License No. and Type if Applicable ' ®3 Street Address City/Town S Zip Telephone No. business Telephone No. cell e-mail address SECTION 11:tYOItKEPS'COMPENSA1[OtN INBURANCH AFF'IDAVI'f M.G.L.c.152.9 25C6 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 O SECTION 12:.CONSTRUCTION COSTS AND PERMITFEE Estimated Costs:(Labor Item m 6)_$ and Materials) Total Construction Cost(from Ite 1.Building $ 41V- Building Permit Fee=Total Construction Cost x_(Insert here 2.Electrical $ appropriate municipal factor)_$ 3. Plumbing $ Note:Minimum Fce=$ (contact municipality) 4.Mechanical (HVAC) $ � 5.Mechanical Other $ Enclose check payable to 6.Total Cost $ m�_ (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below,I hereby attest under the pains and penalties of perjury that an of the information contained in this application is true and accurate to the best of my knowledge and understanding. Pleasant an igttam 4 Title Telephone No Da e Street Add City/ own State Municipal Inspector to fill out this section upon application approval: / Date QTY OF SALEA MASSAaiUSEM BUILDING DEPARTMENT 120 WAsmNGTONSMET,370FLOOR TBL(978)745-9595 KIMBERLEYDRISCX)LL FAX(978)740-9846 MAYOR THomm ST.PIERRE DIRECTOR OF PUBucpROPERTY/Bua DING ODAwssIONER Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 CMR, Section 111.5 Debris, and the provisions of MGL c40, S 54; Building Permit# is with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste deposit facility as defined by MGL c 111, S 150A. The debris will be transported by: �l fk 7s V� (name of hauler) The debris will be disposed of in: (name of facility) (address of facility) ctSignature of applian /Z--- Date i 'L- �4 • • • • • • • _ WIC peluoD ,. •, ' ...•.. fie 4! . . am 1�! Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supenisor _ License: CS-087958 PAUL A GUE '' RYtA,� t, 113 DODGE POND Rt) LYMA 4 NH 03585 "�RV „ "' Expiration Commissioner 05/05/2015 Unrestricted -Buildings of any use group which contain less than 35,000 cubic feet(991m)of enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. for.DPS.Licensing.information visit. www.Mass.Gov/DPS '4 The Commonwealth of Massachusetts Department oflndustrialAccidents - 5 1 Congress Street, Suite 100 — Boston, MA 02114-2017 5 www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information nn Please Print Le ibl t Gz4i/l Name (Business/Organiza[ion/Individual); g� /'/ /0/.'/� T, ' /S Address: City/State/Zip: e�lfWhone#: Are you an employer?Check the appropriate box: Type of project(required): I,R]1 am a employer with 2 employees(full and/or part-time).• 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in $, ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t ]0 ❑Building addition 4.7 I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I I.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.�Roof repairs These sub-contractors have employees and have workers'comp.insurance.= N 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.4RI Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] .Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site Y information. Insurance Company Name: Jam/ Policy#or Self-ins. pLic.tY t�/ e ` ID�- rOl y7� '^ d O�y9Expiration Date: Job Site Address: 0 1 (U��frS City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I-do hereby cerd under the pains and dies ofper' that the information provided above is true nd correct. Siena>�;��G- -+�+-�� Date: �� Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their v self-insurance license number on the appropriate line. City or Town Officials t Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/hcense number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under`Job Site Address"the applicant should write"all locations in_(city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia