19 CRESCENT DRIVE - BUILDING JACKET %
Dloomm
The Commonwealth of Massachuscll:7k
Town of
Board of Building Regulations and Stand
�. ?� .Iassachusems State Building Cute. 780 CNIR. dition Building DeptBuilding Permit Application To Construct. Repair. RenoOr Demolish aOne• tar Tnu•Fmru/M Onsflang
is Sects m or Offictd Use On
Building Permit Nu a RalS Applied:
Signature•. ye
Building Commissions nVector of Buildings Date
SECTION ).SITE INFORMATION
1.1 Property Address: I q "jrf z&n A 1.2 Assessors Map& Parcel Numbers
.SA +— MA
M Number Parcel Number
I.I a Is this an ace led street:'yes no Map
IJ Zoning Information: party Dimensions:
Zoning District Proposed Use La Arca(sq 0) Frontage(A)
1-9 Bulldinl Setbselts(R)
Front Yard Side Yards Rem Yard
Required Provided Required Provided Required Provided
16 Water Supply:(M.G.L c.40,154) 1.7 Flood Zoae Information: I.l Sewage Disposal System:
Zone: _ Outside Flood ZoneT Municipal O O t site disposal system O
Public O Private O Check if vesCl
SECTION 2: PROPERTY OWNERSHIP'
2.1 O er'ofRecord:1VV iq CR�5C� DAl%le 5.AJ
vim+
Ni IPrinq Address for Service:
�l/ ci -z % • 745 - 691 13
s Telepborw
SECTION J: DESCRIPTION OF PROPOSED WORK'(cheek ad that apply)
New Constnution O Fainting Building O Owner-Occupied D Repeirs(s) O Alterstion(s) G Addition O
Demolition O Accessory Bldg.O Number of Units_ Other O Specify!
Brief Description of Proposed Work': ��PArR ✓ *� /� -
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Costs: OMCI&I Use Only
Item Labor and Materials
1. Building f 1. Building Permit Fee: T Indicate how fee is determined:
O Standard City/Town Application Fee
2 Electrical f O Total Project Cost'(Item 6)x multiplier
Plumbing f 2. Other Fees: f % /c
4. .Mechanical (HVAC) f List: �(J
+ Mechanical (Fire S Total All Fees: f
Su resson
Check Vo. _Check Amount: Cash Amount:_
' h Total Project Cost f f>"®"m� O Paid in Full ❑Outstanding Balance Due
�-
i
r
SECTIONS: CONSTRUCTION SERVICES !
5.1 Licensed Consvuctlon Supervisor(CSL) CJ! 916 y J a2$/1 O%f
`%y,-?tag Q�r/O r> Li.ense Number Expiration Date!
NOW tit CSL Hylder Ltva CSL Type(xY heluwl V
. o' QoX ///i,01 rh/eheeA m19
Address RD
Desen ton/
[Residential
restricted u to 35.000 Cu. Fit
stricted Ik2 FamilyDreltin'
�taM/1Y'y(eo /7
Onlyf
"l idential Raofin Covenn'
Telephone ^ t�, tdennal Window and Sibm
J ✓ 1 tdenhal Sohd Fuel Bumm A hence Insulhhon
Demolition
5.2 Registered His Improvement Contractor(HIC)
e�75
HIC Company Name or HIC Reps Name trw Registration Number
S ' �vx vi✓RD S /�/
A />✓ 9 e, /e7e' Expiration Data
Signature Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e. ISL I ISC(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this andevit will result in the denial of the Issuance of the building permit.
Signed AffdavitAnached7 Yes.......... O No...........O
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, TV 1-1 /; 14 141 E -1 I-AP , as Owner of the subject property hereby
authorize JP A T 4 1 C V, O 5�Lo c9/7 to act on my behalf,in all matter
relalla to work authoriz by this building permit application.
A TAN -7
Si 'a o Ow Date
SECTION 7b:OWNERt OR AUTHORIZED AGENT DECLARATION
I, V L.I W H t `F N F A 0 as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and
behalf.
tr ( - W)i
P, A- J A N, 2 Z o I ✓
Sign of ner or A thorized gent Date
�St under the ams and naltia of r
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program), will Rg have access to the arbitration
program or guaranty fund under M.G.L. c. I42A. Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110,11116 and 110.R3,respectively.
2. When substantial work is planned, provide the information below:
Total noon area(Sy. Ft.) !including garage, finished basement/anics.decks or porch)
Gross living area(Sq. Ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half.Daths
Type of heating system Number of deckv porches
Tspeofcooltng system Enclosed ._Open
1 ' Total Project Square Footage"may he.uhsmuicd for-Total Project Cost-
-t CITY OF S.U.ENI, AASSACHUSETTS
% BuLDLNG DEnim(ENT
12o WASHINGTON STREET. )'w FLOOR.
T L (978) 745.9595
F.Vt(978) 740.984
KI\BERL.EY DRISCOLL Iltohw ST.PMUZ
MAYOR
DIRECrOROF Pt.euC PROPERTY/gcILDLUG coaanssloNER
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electrlclans/Plumben
Applicant Infarmation Please PHntLegibly
V21Te (Husirtea Organtratiorvltmbvtduaf): dJ'GOO_'b />91,%/ %/1VG .L.L G.
Address: Po 13 oX Ili i
City/Statc/Zip: M AA 01-4H• 4,0 MA shone m. 97 V /1Y e, /e a 7
Are you as employer!Cheek the appropriate bear Type of project(require*.
1.❑ 1 am a employer with 4. ❑ 1 am a general contractor and
employs=(full and/or pan-time).• have hired the gob-contractors 6. ❑New construction
2.❑ 1 am a sole proprietor or partner. listed on the anached shell t 7. Q Remodeling
*hip and have no employees Thee sub-contractors have ti. Q Demolition
working for me in any capacity. workers'comp.insuraoea 9. Q Building addition
(No workers'comp. insurance S. ❑ We ate a corpontiee and its
nquired.) of cane have exercised tick 10.Q Electrical repairs or additions
).❑ 1 am a homeowner doing all work right of exemption per MGL 11.Q Plumbing repairs or additions
myself.(No workers'comp. c. 152.41(4).and we have no 12.(SRoof repairs
insurance required.)► cunploytsa.No writers' 13.0 Other
comp. insurance required.]
•Any appacast Ihw chacea boa el mop a4a ne aw the sanws boloo sbowiag th*wwkwe'cpnpnar4a pods ilfimlldla
'I hwwawnns who mbw l dais aAldwie indicating They aw doing all wait ase thaw him aatridr tanuacrww man Miss&a Ike of dsva indicrins suck
:C.mailam thou chat this ban mud anachod as sddaiwwl char showing On In ne ar em an4ynLmmwo and'hub tttwho 'camp.putiry imramma".
I ate am employer that Is paviding wo►kers'comroensaden/mSnremea f*r my esNPit►ytes. SNoar h INePN/q awdJ*&SUN
inyormadam.
Insurance Company Name: N9 !t o V4[ UNJ c'Y ,j-/oP� %NSu�,pty�Q Co
Policy 4 or Self•ins. Lie. p: 713 t7 7 �L Expiration Date:
Job Site Address. /c? 0/11✓t; S~4,tA m/1 City/Stawzip. of<f 7a
.%nacb a copy or The workers'compensation policy doelaraflon pop(showing the popes number mad aspiration date)6
Failure to secure coverage as required under Section 23A of MGL a 152 can lead to the imposition of criminal penalties ofa
fine up to S I.500.00 and/or one-year imprisonment,as well an civil penalties in the form of a STOP WORK ORDER and a Ray
of up to S350.00 a day against the violator. lie adviavl[hats copy of this statement may be forwarded to the Office of
Invcaugatiuna nl'the MA for insurance covaraga verification.
I Jo hereby cert nder that pains and penalder of perjury chat that information p rovidr�d/above is true and a arreeL
��•• t C Imo! 3��r' 1
Phone,/• �.p- `IfF:o - J r✓ v
O/J&•iaf we mdyt Dona write im this areal rat be.arnpietd by s'ity or tows o/Jls•ia(
City or ruavn: Pcrmit/I.Iccnse e
i Issuinr.\ulhurily Icircle one): �
1. Iloard of IlrullA 2. Building Department 1. Cityfrown Clerk J. Eleclrical Intpeclor S. Plumbing Inspector
6. thher
Utnfact Person: _ ._ _.. Phone e•
Massachusetts - Department of Public S:ifetN
Board of Building Regulations and Standards
Constr6ctic Supervisor License
License: CS 91643 r
Restricted to: 00
a
PATRICK M OSGOOD
PO BOX 1111
MARBLEHEAD. MA 01945
-/.sy::f- Expiration: 5/2812011
urr Tr#: 17594
Restricted to: 00
00- Unrestricted
1G-1 2 Family Homes
Failure to possess a current edition of the
Massachusetts State Building Code
is cause for revocation of this license. -
Referto: WWW.Mass.Gov/DPS
M ✓/te '(Oomvm0'/wM2GG/L a�✓/�Lamac�tude�a
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR
Registration: 134220
Expiration: 1 0/1212 01 1 Tr# 289730
Type:' '. Individual 1
OSGOOD PAINTING SERVICES
PATRICK OSGOOD
44 FOX RUN RD. g-�---
TOPSFIELD, MA 01983. Undersecretary
n^
DATE(MWDOTWYY)
ACORDTA CERTIFICATE OF LIABILITY INSURANCE 01 19 2010
PRODUCER (g78) 745^6464 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Rose Insurance HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
66 Raring Avenue
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P.O, Box 958
Salem MA 01970- INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A.One BeaaOn
Osgood Painting LLC INSURERB:National Union Fire Ins
P.O. Box 1111 INsuReRc
INSU ER O
Marblehead MA 01945- INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. SUED OR MAY PER A
REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MA
V BE ISSUED OR MAY PERYAIN,
THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, POLICY BFFECTIVE POLICY EXPIRATION
INSR % O'L TYPE OF INSURANCE POLICY NUMBER DATE MMIDDPfY DATE MMIDDM- LIMITS
LTR IN 1,000,000
A GENERAL LIABILITY 2V15153 05/26/2009 05/26/2010 EACH OCCURRENCE a
pAMAGE TO RENY'EO 9
X COMMERCIAL GENERAL LIABILITY PREMISES Ea adcunencY�
CLAIMS MADE ❑OCCUR MFD E- P A Ono amn 0
PERSONAI.a AOV INJURY 9 1,000 r O00
GENERAL AOGREOATE 4 2,000
r OOO
GEN'L AGGREGATE LIMIT APPLIES PER:
PRO CT3-CO /OP AG A 2,000,000
POLICY J T LOG / / / / IRONING
AUTOMOBILE WABIUW / / COMBINED SINGLE.LIMIT E
(Ee ecdldenl)
ANY AUTO
ALL OWNED AUTOS BODILY INJURY 9
(Per perem)
SCHEDULED AUTOS
/ / / / BODILY INJURY
HIRED AUTOS (Pm ACCMent) �
NON-OWNED AUTOS
/ / / / PROPERTY OAMAOF C
(Par ecclddnU
GAR AGE LIASII.RT AUTO ONLY-FA ACCIDENT P
ANY AUTO / / OTHER THAN EA ACC $
AUTO ONLY: AGO B
EXCESSA)MBRELLA LIABILITY / / / / EACHD RRENC., 9
OCCUR ❑ CLAIMS MADE AOORF;ATE P
B
DEDUCTIBLE
RETENTION
g WORKERS COMPENSATION AND 007137742 09/18/2009 09/18/2010 xljffi,,T
'�°{,�j
EMPLOYERS'LIABILITY E.L EACH ACCIDENT a 100,000
ANY PROPRIETOR(PARTNERIEXECUTIVE 10O,000
OFFICERIMEMBER EXCLUDEDT / / / / E,L DISEASE-EA EMPI.OYEEp
If ya.,deecrlbe ender E.L.DISEASE-POLICY LIMB I 8 500,000
SPECIAL PROVISIONS bald+.
OTHER
DESCRIPTION OF OPERATIONSILOCATIONSAIEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
CERTIFICATE HOLDER CANCELLATION
(978) 740-9846 ( ) — SHOUW ANY OF THE ABOVE DESGmBED POLICIES BE CANCELLED BEFORE THE
Building Inspector EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
OSO DAYS WRITTEN NDTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT
City of Salem FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF AM KIND UPON THE
INSURER ITS AGENTS OR REPRESENTATIVES,
AUTHORIMO REPRESENTATIVE
ACORD 25(2001/08) W ACORD CORPORATION 198E
INS025(CICa).M
( �i •.f�,n4 ate%f' � �
I° CRESCENT DRIVE
_ -
:1
{
Titij of *alem, fitttssac4usetts
VuhUc Properttl Begnrtment
Guilding Department
(Ont Belem (Areen
50B-745-9595 ;Ext. 300
Leo E. Tremblay
Director of Public Property
Inspector of Building
Zoning Enforcement Officer December 8, 1994
Julie Whitehead
19 Crescent Drive
Salem, Mass. 01970
RE: 19=Cescent_Drive'::7
Dear Ms. Whitehead:
This ofice sent you a letter on October 20, 1994 concerning an illegal
apartment at the above mentioned property. (Letter enclosed) I have not
had any response from you since October 26, 1994.
Please call this office to update this situation. Failure to do so
will result in legal action being taken against you within the next (15)
fifteen days.
Sincerely,
G/�rtl'llC�' .
Leo E. Tremblay
Inspector of Buildi s
LET: scm
cc: Dave Shea
Councillor Ahmed, Ward 1
Certified Mail # 921 991 646
r
R
' (situ of �ttlem, fttssttr4usetts
Publir PrupertU Department
+iguilbing Department
(One 6alem (5reen
500-745-9595 Ext. 300
Leo E. Tremblay
Director of Public Property
Inspector of Building
Zoning Enforcement Officer October 20, 1994
Julie Whitehead
19 Crescent Drive
Salem, Mass. 01970
RE: 19 Crescent Drive
Dear Ms. Whitehead:
This office has received a complaint through the Neighborhood improvement
hot line alleging an illegal apartment at the above mentioned address. This
property is located in a (R-1) Residential Single Family dwelling district,
and only one dwelling unit is allowed. Special Permit through the City of
Salem Board of Appeals would have to be granted in order to have a second
dwelling unit on the premises.
Please contact this office upon receipt of this letter as to inform
us of your course of action. Failure to do so will result in legal action
being taken against you.
Thank you in advance for your anticipated cooperation in this matter.
Sincerely,
Leo E. Tremblay
Inspector of Buildings
LET: scm
cc: Dave Shea
Councillor Ahmed, Ward 1
Certified Mail # P 921 991 615
r
. 0
�mr1e>
CITY OF SALEM - MASSACHUSETTS
ROBERTA. LEDOUX Legal Department JOHN D. KEENAN
City Solicitor 93 Washington Street Assistant City Solicitor
508-741-2711 Salem, Massachusetts 01970 508-745-7710
February 25, 1997
Mr. Leo E. Tremblay
Building Inspector
City of Salem
One Salem Green
Salem, Massachusetts 01970
Dear Leo:
I did have a letter from Julie Whitehead, 19 Crescent Drive, Salem. The letter
does not solve the issue of it being in violation of zoning and I think it would probably
be the right time to take out a criminal complaint against her.
Very truly yours,
ROBERT A. LED X
City Solicitor
RAL/leh
File CS9470.47
December 9, 1994
Mr. Robert LeDoux
City Hall
Salem, MA 01970
Dear Mr. LeDoux,
I received a letter from Mr. Leo Tremblay stating that a
complaint was made through the Neighborhood Improvement hot line
about my residence.
own a split level single family home on Crescent Drive. I am a
single, working parent with a teen-age daughter. I am sharing my
house with another single parent with a seven year old son. This
arrangement has been a very supportive one for both of us. Neither
of us receives child support or alimony. By sharing expenses,
housework and child care, I am able to work a second job and my
roommate is able to attend college.
I spoke with Mr. Tremblay and he suggested that I contact you
for an interpertation of the law stating that four unrelated people
could not share a residence. In examining the relationships in this
house, I am unrelated to two (2) people: my roommate and her son.
She is also unrelated to two (2) people: myself and my daughter.
This is where the interpertations needs to be clarified. Are we 4
unrelated people or only 2 unrelated?
I would appreciate your help in this matter as I need to appraise
Mr. Tremblay of the situation for his records.
Sincerely,
tuliAnn hite ead
ent Drive
A 01970-1236
kome (sop 7�5-6973
work �4en+lei Sc,we� S
Otg of 19-ratem, fiRttssac4usetts
Public Propertg Department
Nudbing Department
(One *alem (6reen
508-745-9595 Ext. 300
Leo E. Tremblay
Director of Public Property
Inspector of Building
Zoning Enforcement Officer October 20, 1994
Julie Whitehead
19 Crescent Drive
Salem, Mass. 01970
RE: 19 Crescent Drive
Dear Ms. Whitehead:
This office has received a complaint through the Neighborhood Improvement
hot line alleging an illegal apartment at the above mentioned address. This
property is located in a (R-1) Residential Single Family dwelling district,
and only one dwelling unit is allowed. Special Permit through the City of
Salem Board of Appeals would have to be granted in order to have a second
dwelling unit on the premises.
Please contact this office upon receipt of this letter as to inform
us of your course of action. Failure to do so will result in legal action
being taken against you.
Thank you in advance for your anticipated cooperation in this matter.
Sincerely,
Leo E. Tremblay
Inspector of Buildings
LET: scm
cc: Dave Shea
Councillor Ahmed, Ward 1
Certified Mail ll P 921 991 615
��
' � r _ _
Joy to the world! The Lord is come:
Let earth receive her King;
Let every heart prepare Him room,
And heav'n and nature sing,
And heav n and nature sing,
And heav n, and heav n and nature sing.
We Wish You A Merry Christmas
NDEI if
•EComplete items 1 and/or 2 for additional services. I also wish to receive the II
• Complete Mems 3,and as a b. following services(for an extra fee): I
• Print your name and address on the reverse of this form so that we can return this card
to you. 1. ❑ Addressee's Address
• Attach this form to the front of the mailpiece,or on the back if space does not permit.
• Write'Return Receipt Requested'on the mailpiece below the article number. 2. El Restricted Delivery
• The Return Receipt Fee will provide ycu the signature�f per3 livered to and the
date of deliver . Consult postmaster for fee.
3.Article Addressed to4a.Article Number
�''�• ��A1 � P 921 991 646 �
Julle 'Whitehend Q� �� Q 4b.Service Type
iq Crescent D ive, n �� Q
Salem, MMS. 0197'
v � CERTIFIED
�*•�`' ""` 7.Date of Delivery
Z �
Y,,natlre
—(A B ssee) 8.Addressee's Address '
t t (ONLY if requested and fee paid.)
I
—(Agent)
11,November 1990 DOMESTIC RETURN RECEIPT
United States Postal Service
Official Business -w -
PENALTY FOR PRIVATE
USE,$300
Il��u�ulll�lulu��ll�null�l���lu��l�l���ln�ll
INSPECTOR OF BUILDINGS
ONE SALEM GREEN
SALEM MA 01970-3724
I
241 LYNNFIELD STREET
PEABODY, MASSACHUSETTS 01960
Tel. 531.3711
December 9, 1988
Julie Whitehead
1 Cherry Street
Salem, MA 01970
Job Location:11crescent Drive Salem
October 29, 1988 Excavator 8 hours @ $55.00 per hour $ 440.00
Operator 8 hours @ $30.00 per hour 240.00
10-W Dump 6 hours @ $42.00 per hour 252.00
$ 932.00
5% Sales Tax + 22.00
$ 954.00
e
Titg of *Ulem, fiittssac4usetts
Public Properttl Department
Nuilbing Department
(Pae !idem Green
500-745-9595 Vxt. 300
Leo E. Tremblay
Director of Public Property
Inspector of Building
Zoning Enforcement Officer December 8, 1994
Julie Whitehead
19 Crescent Drive
Salem, Mass. 01970
RE: 19 Crescent Drive
Dear Ms. Whitehead:
This ofice sent you a letter on October 20, 1994 concerning an illegal
apartment at the above mentioned property. (Letter enclosed) I have not
had any response from you since October 26, 1994.
Please call this office to update this situation. Failure to do so
will result in legal action being taken against you within the next (15)
fifteen days.
Sincerely,
Leo E. Tremblay
Inspector of Buildi s
LET: scm
cc: Dave Shea
Councillor Ahmed, Ward 1
Certified Mail li 921 991 646
r
Titu of %*tt1an, Massar4usrtts
Public Propertp i9epartment
iguilbing Bepartment
(One oaten Green
588-745-9595 Ext. 388
Leo E. Tremblay
Director of Public Property
Inspector of Building
Zoning Enforcement Officer October 20, 1994
Julie Whitehead
19 Crescent Drive
Salem, Mass. 01970
RE: 19 Crescent Drive
Dear Ms. Whitehead:
This office has received a complaint through the Neighborhood Improvement
hot line alleging an illegal apartment at the above mentioned address. This
property is located in a (R-1) Residential Single Family dwelling district,
and only one dwelling unit is allowed. Special Permit through the City of
Salem Board of Appeals would have to be granted in order to have a second
dwelling unit on the premises.
Please contact this office upon receipt of this letter as to inform
us of your course of action. Failure to do so will result in legal action
being taken against you.
Thank you in advance for your anticipated cooperation in this matter.
Sincerely, J
Leo E. Tremblay
Inspector of Buildings
LET: scm
cc: Dave Shea
Councillor Ahmed, Ward 1
Certified Mail # P 921 991 615
CITY OF SALEM
NEIGIMORHOOD IMPROVEMENT TASK FORCE
. REFERRAL FORM
Date: �y 11C) —, -7- 17V
Address:
Complaint: e �u —c `> `t Phone #:
Comptainant•.,��=c
DAVID SHEA. CHAIRMAN KEVIN HARVEY
�IBUILDING INSPECTOR I ELECTRICAL DEPARTMENT
EIRE PREVENTION I CITY SOLICITOR
HEALTH DEPARTMENT I SALEM HOUSING AUTHORITY
L
LICENSING I POLICE DEPARTMENT
Pi_ANNING DEPARTMENT I ASSESSOR
TREASURER/COLLECTOR
PLEASE CHECK THE ABOVE REFERENCED COMPLAINT AND RESPOND TO DAVE
SHEA WITHIN ONE WEEK. THANK YOU FOR YOUR ASSISTANCE.
ACTION:
:eNoeR` i r` I also wish to receive the
Complete items 1 And/or 2 for additional services, Yq.
• complete items s,and 4a s In, following services(for an extra fee):
• Print your name and address on the reverse of this form so that we can return this card
to you. 1. ❑ Addressee's Address
• Attach this form to the front of the mailpiece,or on the back if space does not perna"
• Write'Return Receipt Requested"on the mailpiece below the article number. 2. ❑ Restricted Delivery
• The Return Receipt Fee will provide you the signature of the person delivered to and tF@' Consult postmaster for fee.
date of delivery.
3.Article Addressed to: 4a.Article Number
P 921 991615
��LTdi !C3i ^1C1 4 e Type
19 Crescent Drive h %128,,93
SA3esVi, Mos. 019"10 ��y M � IFIED
r
l 1 .
Dat
.$,'gf Delivery
N � � �� w
5. g ss `"r`Os@@`'a Addr S
If questg d fee paid.)
6.SWignature—(Agent �t¢� 6
PS Form 3811,November 1990 Bt3M IC RETURN RECEIPT
United States Postal Service ,
Official Business
6�%
•�
1994
USE,$
Ill�n�nl�l�inlu�llluu�ll�lu�lu��l�lu�l�ull
INSPECTOR OF BUILDINGS
ONE SALEM GREEN
SALEM MA 01970-3724
ARTICLE
P 921 991615
UNE i. - '
NUMBER
JtydBlQ8be47;9dad � 1
1.9 Cresgdnt Drive L 11
Salem, Mass. 01910
g ,t.
- I
t FOLD AT PERFORATION t r WALZ
INSERT IN STANDARD#10 WINDOW ENVELOPE. [ERT If I ED
M A I [ E R nn C,IILIIII