The URL can be used to link to this page

274 DERBY STREET - BUILDING JACKET �— 274 DERBY STREET UPC 10333 No.153L-3 HASTINGS, NN CITY OF SALEM, MASSACHUSE-ITS F cif BUILDING DEPARTMENT `��.,'�-��• 120 W:vs[rlNcruN SnRLE*r, 3 fj-uuis TEL. (978) 745-9595 FAX (978) 740-9846 KIMBERLEY DRISCOLL MAYOR THOALJ,S ST.PIERRE DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER April 2 , 2007 The New England Pirate Musuem 274 Derby Street Salem Ma. 01970 Re: 274 Derby Street Dear Owner Your attention is hereby directed to the provisions of Section 12-56 of the Code of Ordinances, City of Salem, Massachusetts on file in the office of the City Clerk in City Hall. Pursuant to the provisions of said sections, you are herby notified that a certain unsightly condition exists on premises specifically described as graffiti which injures neighboring property and the public health, safety and welfare. You are therefore notified at once and in any event within 30 days from the date of this notice, to remove said unsightly condition from the property and hereafter to keep the said property free there from. In the event you fail to complete such work within the time hereinabove mentioned, the undersigned shall cause the same to be removed and you will be responsible from the cost of removal of the condition from the property. S i n c Ply, J 4�.' ��O Thomas St. Pierre Building Commissioner Zoning Enforcement Officer cc. Jason Silva, Mayors Office ENSOL July 11, 2002 Bnvironmenta(Sotutions for Business Mayor Stanley J. Usovicz,Jr. City of Salem 93 Washington Street Salem,MA 01970 Re: AMENDMENT AND RATIFCATION NOTICE OF ACTIVITY AND USE LIMITATION 274 Derby Street Salem,MA 01970 Release Tracking Number#3-11479 Dear Mayor Usoviczi The purpose of this letter is to inform the City of Salem's Chief Municipal Officer pursuant to the Massachusetts Contingency Plan (MCP), 310 CMR 40.1403(3)(d),that on 11 July 2002, an Amendment and Ratification Activity and Use Limitation as defined in the MCP, 310 CMR 40.1073, was recorded with the Essex County South Registry of Deeds for 274 Derby Street in Salem. Copies of the public notice to be published in the Salem Evening News and a certified copy of the Amendment and Ratification AUL are attached. Please address your questions concerning the attached to the undersigned at 978-670-0755. Sincerely, ENS ra Thomas P. Army Executive Vice President cc: City of Salem Building Code and Zoning Departments City of Salem Board of Health MA DEP, Bureau of Waste Site Cleanup,Northeast Region Office,Wilmington, MA 100 Treble Cove Road, Billerica,MA 01862 (978)670-0755 FAX: (978)670-0767 AMENDMENT AND RATIFICATION NOTICE OF ACTIVITY AND USE LIMITATION 274 Derby Street Salem,MA RELEASE TRACKING NUMBER: 3-11479 Pursuant to the Massachusetts Contingency Plan (3 10 CMR 40.1073), an AMENDMENT AND RATIFICATION NOTICE OF ACTIVITY AND USE LIMITATION on the above disposal site has been recorded and/or registered with the Essex County South Registry of Deeds on 11 July 2002. The AMENDMENT AND RATIFICATION NOTICE OF ACTIVITY AND USE LIMITATION will limit the following site activities and uses on the above property: Activities and Uses which are likely to involve the removal or disturbance of pavement or disturbance of urban fill located immediately beneath the pavement without prior development of a Soil Management Plan and a Health and Safety Plan; Relocation of urban fill from beneath the pavement on the property unless an LS15 renders an Opinion which states that such relocation is consistent with maintaining a condition of No Significant Risk; and Activities and Uses which may cause physical or chemical deterioration of the pavement. Any person interested in obtaining additional information or reviewing the AMENDMENT AND RATIFICATION NOTICE OF ACTIVITY AND USE LIMITATION and the disposal site file may contact New England Pirate Museum,Inc., 274 Derby Street, Salem,MA 01970;telephone 978-741-2800. 1 - IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII 2002071100418 RAW Pg,247 07/11/2002 13:59:00 OTHER Pg 1/9 AMENDMENT AND RATIFICATION OF NOTICE OF ACTIVITY AND USE LIMITATION (for amending and ratifying a Notice of Activity and Use Limitation recorded on or before October 29, 1999) WITNESSETH: v This Amendment and Ratification of Notice of Activity and Use Limitation V) ("Amendment and Ratification") is made as of this 11`h day of July, 2002, by New England Pirate Museum, Inc. at 274 Derby Street, Salem, MA, together with its successors and assigns v (collectively "Owner"). >4 En WITNESSETH: WHEREAS, Owner is the owner in fee simple of certain parcels of land located in Salem, Essex County, Massachusetts('Property"), pursuant to a deed recorded with the Essex South County Registry of Deeds in Book 12723, Page 46; WHEREAS, the Property comprises a disposal site, or part of a disposal site, as the result aof a release of oil and/or hazardous material ("the Disposal Site"). Response actions have been o selected for the Disposal Site in accordance with M.G.L. c.21E ("Chapter 21E") and the Massachusetts Contingency Plan, 310 CMR 40.0000 ("the MCP"). Said response actions are ° based upon (a) the restriction of human access toandcontact with oil and/or hazardous material . in soil and/or groundwater, and/or (b) the restriction of certain activities occurring in, on, v through, over or under the Property or a portion thereof. The Department of Environmental i" Protection has identified the Disposal Site as Release Tracking Number 3-11479; co WHEREAS, on August 30, 1994, Mrs. Rose Sullaway filed a Notice of Activity and Use Limitation with the Essex South County Registry of Deeds in Book 12723, Page 472 imposing an activity and use limitation on the Property ("the Original AUL"). The Property affected by the Original AUL and this Amendment and Ratification is hereinafter referred to as "the AUL Area." The AUL describes activities and uses that are permitted within the AUL Area, and defines obligations and conditions that must be maintained within the AUL Area. The AUL also describes uses and activities which, if carried out within the AUL Area, could result in Significant Risk to health, safety, public welfare or the environment due to potential exposure to residual contamination. WHEREAS, the following amendments to the Original AUL are necessary to ensure that j a condition of No Significant Risk is maintained at the Disposal Site. w M NOW, THEREFORE, Owner hereby amends the Original AUL as follows: AUL Opinion The basis of the Original AUL, as amended herein, is an Activity and Use Limitation Opinion ("AUL Opinion"), prepared by a Licensed Site Professional and attached hereto as 2002071100418 Bk;18927 Pg,248 07/11/2002 13:59:00 OTHER P9 2/9 Exhibit B. Said AUL Opinion replaces and supercedes any AUL Opinion contained or referenced in the Original AUL. Site Activities and Uses The following descriptions of Permitted Activities and Uses, Activities and Uses Inconsistent with the AUL Opinion, and Obligations and Conditions replace and supersede those contained in the Original AUL. 1. Permitted Activities and Uses. A condition of No Significant Risk to health, safety, public welfare or the environment exists for any foreseeable period of time so long as any of the following activities and uses occur within the AUL Area: (i) Commercial and industrial uses of the property and activities consistent therewith which do not involve the disturbance of urban fill; (ii) Excavation associated with emergency or short term (3 months or less) underground utility and/or construction work,provided it is conducted in accordance with a Soil Management Plan and a Health and Safety Plan in accordance with the Obligations (i) and (ii) below; and involves repair and/or replacement of the pavement with a comparable barrier immediately . following the completion of the project; (iii) Activities and uses which are not identified in this Opinion as being inconsistent with maintaining a condition of No Significant Risk; and, (iv) Such other activities and uses which, in the opinion of an LSP, shall present no greater risk of harm to health, safety, public welfare, or the environment than the activities and uses set forth in this paragraph. 2. Activities and Uses Inconsistent with the AUL Opinion. The following activities and uses, if implemented within the AUL Area, may result in a Significant Risk of harm to health, safety, public welfare or the environment: (i) Activities and Uses which are likely to involve the removal or disturbance of pavement or disturbance of urban fill located immediately beneath the pavement without prior development of a Soil Management Plan and a Health and Safety Plan in accordance with Obligations (i) and (ii) of this Notice; (ii) Relocation of urban fill from beneath the pavement on the property unless an LSP renders an Opinion which states that such relocation is consistent with maintaining a condition of No Significant Risk; and (iii) Activities and Uses which may cause physical or chemical deterioration of the pavement. 7/26/00 2002011100418 Bk;18921 Pg;249 0711112002 13:59:00 OTHER P9 3/9 3. Obligations and Conditions. The following obligations and/or conditions must be maintained within the AUL Area in order to maintain a condition of No Significant Risk: (i) A Soil Management Plan must be prepared by an LSP and implemented prior to the commencement of any activity that is likely to disturb the urban fill beneath the pavement. The Soil Management Plan should describe appropriate soil excavation, handling, storage, transport, and disposal procedures and include a description of engineering controls and air pollution procedures necessary to ensure that workers and receptors in the vicinity are not affected by fugitive dust or particulates. On-site workers must be informed of the requirements of the Soil Management Plan, and the plan must be available on-site throughout the course of the project; (ii) A Health and Safety Plan must be prepared by a Certified Industrial Hygienist or other qualified individual sufficiently trained in worker health and safety requirements and implemented prior to the commencement of any activity which involves the removal and/or disturbance of the pavement and/or is likely to disturb the urban fill, rendering it more accessible. The Plan should clearly describe the location of urban fill and specifically identify the types of personal protective equipment, monitoring devices, and engineering controls necessary to ensure that workers are not exposed to the constituents of urban fill through dermal contact, ingestion, and/or inhalation of particulate dusts. Workers who may come in contact with urban fill on the property must be informed of the presence of the contamination and all requirements of the Health and Safety Plan. The plan must be available on-site throughout the course of the project. (iii) The pavement on the property must be repaired and/or replaced with a comparable barrier to prevent future exposures to the underlying urban fill immediately following the completion of any activity which involves its removal and/or disturbance; (iv) The pavement on the property must be maintained to ensure that the urban fill remains inaccessible; and, (v) Annual inspections and associated record-keeping activities must be performed to confirm that the pavement is being properly maintained to prevent exposure to urban fill located beneath the paving and landscaping. Except as expressly amended herein, the Original AUL is hereby ratified and confirmed. Owner authorizes and consents to the recordation and/or registration of this Amendment, which shall be deemed to be effective as of the date the Original AUL was recorded and/or registered. 7/26/00 2002071100418 B08927 Pg zo 07/11/2002 13:69:00 OTHER P9 4/9 WITNESS the execution hereof under seal this day of July, 2002. 1 w England Pirate Museum, Inc. %1vIr. James Hurrell, Treasurer COMMONWEALTH OF MASSACHUSETTS Suffolk ss h,ly 9 2002 Then personally appeared the above-named James P. xurrell and acknowledged the foregoing instrument to be his free act and deed before me, Notary Public: S ott J. Mitchell My Commission Expires: Jan. 16, 20( The undersigned Waste Site Cleanup Professional certifies that, in his opinion, the terms of the Original AUL, as amended herein, are consistent with the AUL Opinion attached hereto as Exhibit B, and are appropriate to maintain a condition of No Significant Risk at the Disposal Site. �l �i zoo ms . 41��aT p@ Thomas P. Army TYG�fi P. ARGJT9 r 9 No.ut �� t T COMMONWEALTH OF MASSACHUSETTS ss ,L, 2002 Then personally appeared the above-named Thomas P. Army and acknowledged the foregoing instrument to be his free act and deed before me, Not ublic: My Commission Expires: �ctll /� .7avb'/ 7/26/00 1002071100418 Bk;18927 Pg;251 07/11/2002 13:59:00 OTHER Ps 5/9 Exhibit B Activity and .Use Limitation Opinion 274 Derby Street, Salem, MA DEP Release Tracking Number: 3-11479 In accordance with the requirements of§40.1074 of the Massachusetts Contingency Plan (MCP; 310 CMR 40), this Licensed Site Professional (LSP) Opinion has been prepared to support an Amendment and Ratification Notice of Activity and Use Limitation(AUL) concerning oil and hazardous material (OHM)release conditions at 274 Derby Street,in the City of Salem,Massachusetts. The AUL applies to the entire property. Background The 274 Derby Street property was developed with the existing structure since at least 1906, when it.was associated with the abutting Salem Hospital. From approximately 1911 to 1960,the 274 Derby Street property was occupied by automotive dealerships, service stations, and repair facilities. An auto parts store occupied the 274 Derby Street property from approximately 1960 to 1992, and the building was vacant until its current tenant,the New England Pirate Museum began its occupancy. The existing building has always occupied the majority of the property with a small area of land to the north and east. No record of underground storage tanks (USTs) exists for the 274 Derby Street property. The potential for USTs to remain on the property was evaluated using ground-penetrating radar(GPR)with test pit excavations, and no evidence of USTs was obtained. The entire property is covered either with the building footprint or bituminous pavement. The 274 Derby Street property is located in a commercial area of Salem,with municipal water supplied to the property and environs. ENSOL,Inc. performed an assessment of the 274 Derby Street property that included a GPR survey,excavation of two test pits,and advancement of 3 soil borings that were completed as groundwater monitoring wells. Four soil samples from each test pit were laboratory analyzed for petroleum hydrocarbons and polycyclic aromatic hydrocarbons (PAHs), and the two samples exhibiting the highest levels of hydrocarbons and PAHs were further analyzed for metals and polychlorinated biphenyls. Three soil samples exhibiting the greatest field screening evidence of contamination were laboratory analyzed for volatile organic compounds and petroleum hydrocarbons. Groundwater samples collected from the 3 wells were laboratory analyzed for petroleum and volatile organic compounds, and no evidence of contamination requiring action or notification was observed. The 274 Derby Street property,like much of the land along Derby Street in Salem, is filled. The testing program identified the types and concentrations of contaminants consistent with urban fill. Specifically, the fill is reported to contain PAHs,hydrocarbons,beryllium, and lead. The PAHs,beryllium and much of the material identified as hydrocarbons is likely related to coal or wood ash in the fill. Lead is commonly observed in soil in urban settings, and the hydrocarbons are either related to ash or incidental,historic petroleum spills. 2002071100418 Bk;18927 Pg;252 07/11/2002 13:69:00 OTHER Pe 6/9 Reason for Notice of Activity and Use Limitation Based on a Method 3 Risk Characterization,the site poses No Significant Risk for activities and uses consistent with its current commercial use and for industrial use. The urban fill is inaccessible by virtue of the existing building and the bituminous pavement on the property. No landscaping exists on the property. A risk of exposure was found to exist for a future construction worker exposed through direct contact with the fill material on the property. Further use of the 274 Derby Street property as a day care,residence, school or recreational area was not considered in the risk characterization;therefore,the Notice of Activity and Use Limitation prohibits those uses. The AUL also requires maintenance of the existing paving or landscaping, or construction of comparable surface coverings, and use of a Soil Management Plan to ensure proper handling of this fill in the event of excavation in the future. Permitted Uses and Activities. (i) Commercial and industrial uses of the property and activities consistent therewith which do not involve the disturbance of the urban fill; (ii) Excavation associated with emergency or short term(3 months or less) underground utility and/or construction work,provided it is conducted in accordance with a Soil Management Plan and a Health and Safety Plan in accordance with the Obligations (i) and(ii) of this Opinion; and involves repair and/or replacement of the pavement with a comparable barrier immediately following the completion of the project, (iii) Activities and uses which are not identified in this Opinion as being inconsistent with maintaining a condition of No Significant Risk; and, (iv) Such other activities and uses which,in the opinion of an LSP, shall present no greater risk of harm to health, safety,public welfare, or the environment than the activities and uses set forth in this paragraph. Activities and Uses Inconsistent with the AUL Opinion (i) Activities and Uses which are likely to involve the removal or disturbance of pavement or disturbance of urban fill located immediately beneath the pavement without prior development of a Soil Management Plan and a Health and Safety Plan in accordance with Obligations (i) and (ii) of this Notice; (ii) Relocation of urban fill from beneath the pavement on the property unless an LSP renders an Opinion which states that such relocation is consistent with maintaining a condition of No Significant Risk; and (iii) Activities and Uses which may cause physical or chemical deterioration of the pavement. Obligations and Conditions (i) A Soil Management Plan must be prepared by an LSP and implemented prior to the commencement of any activity that is likely to disturb the urban fill beneath the pavement. The Soil Management Plan should describe 2002011100418 Bk;18921 Pg;253 07/11/2002 13:59:00 OTHER P9 7/9 appropriate soil excavation,handling, storage,transport, and disposal procedures and include a description of engineering controls and air pollution procedures necessary.to ensure that workers and receptors in the vicinity are not affected by fugitive dust or particulates. On-site workers must be informed of the requirements of the Soil Management Plan, and the plan must be available on-site throughout the course of the project; (ri) A Health and Safety Plan must be prepared by a Certified Industrial Hygienist or other qualified individual sufficiently trained in worker health and safety requirements and implemented prior to the commencement of any activity which involves the removal and/or disturbance of the pavement and/or is likely to disturb the urban fill,rendering it more accessible. The Plan should clearly describe the location of urban fill and specifically identify the types of personal protective equipment,monitoring devices, and engineering controls necessary to ensure that workers are not exposed to the constituents of urban fill through dermal contact,ingestion, and/or inhalation of particulate dusts. Workers who may come in contact with urban fill on the 274 Derby Street property must be informed of the presence of the contamination and all requirements of the Health and Safety Plan. The plan must be available on-site throughout the course of the project. (iii) The pavement on the 274 Derby Street property must be repaired and/or replaced with a comparable barrier to prevent future exposures to the underlying urban fill immediately following the completion of any activity which involves its removal and/or disturbance; (iv) The pavement on the 274 Derby Street property must be maintained to ensure that the urban fill remains inaccessible; and, (v) Annual inspections and associated record-keeping activities must be performed to confirm that the pavement is being properly maintained to prevent ex surto urban fill located beneath the paving and landscaping. LSP: 11 I Thomas P. my,Licensed Site Prof ss" nal Date: July 9. 2002 2002071100418 Bk;18927 P9;254 07/11/2002 13:59:00 OTHER Pe 8/9 asphalt-paved area of ,v New England a CL Pirate Museum (D < Derby Street Amendment and Ratification Exhibit A - Disposal Site Sketch Depicting N Notice of Activity and Use Limitation 274 Derby Street Areas of Paving and Landscaping To Be 1 Salem, MA Maintained Under the AUL n June 2002 Approximate Scale 1" = 15' 2002011100418 Bk;18921 P9:35 0711112002 13:59:00 OTHER Pe 919 Massachusetts Department of Environmental Protection gWSC-114S Bureau Of Waste Site Cleanup r ACTIVITY&USE LIMITATION (AUL) OPINION FORM Release Tracking Number 3❑- 11429 COMPLETE THIS FORM AND ATTACH AS AN EXHIBIT TO THE AUL DOCUMENT TO BE RECORDED AND/OR REGISTERED WITH THE REGISTRY OF DEEDS AND/OR LAND REGISTRATION OFFICE A. LOCATION OF DISPOSAL SITE AND PROPERTY SUBJECT TO AUL: - Disposal Site Name: Street: 274 Derby Street Location Aid: City/Town: Salem ZIP Code: 01970-3635 Address of property subject to AUL,if different than above. Street: City/Town: ZIP Code: B. THIS FORM IS BEING USED TO: ' Provide the LSP Opinion for an Amendment and Ratification of a Notice of Activi in a Notice of Audit Findings issued to: ty and Use Limitation,pursuant to instructions provided by DEP Name of Organization or person: New England Pirate Museum, Inc. Date issued: 10/16/2001 C. LSP OPINION: - I attest under the pains and penalties of perjury that I have personally examined and am familiar with this submittal,Including any and all documents accompanying this submittal. In my professional opinion and judgment based upon application of(I)the standard of care in 309 CMR 4.02(1),(Ii)the applicable provisions of 309 CMR 4.02(2)and(3),and(iii)the provisions of 309 CMR 4.03(5),to the best of my knowledge, information and belief. The Amendment and Ratification of the Activity and Use Limitation that is the subject of this submittal is being provided in accordance with instructions provided by the Department of Environmental Protection in a Notice of Audit Findings issued to:. Name of Organization or person: New England Pirate Museum, Inc. Date Issued: 10/16/2001 I am aware that significant penalties may result,including,but not limited to,possible fines and imprisonment,if I submit information which I know to be false,inaccurate or materially incomplete. Check here if the Response Action(s)on which this opinion is based,if any,am(were)subject to any order(s),permits)and/or approval(s) issued by DEP or EPA. If the box is checked,you MUST attach a statement identifying the applicable provisions thereof. LSP Name: Thomas P.Army 3050 °A M LSP#: Stamp: L�" (978) 670-0755 Telephone: Ext.: FAX: (978)670-0767t' LSP Signature: r ',pi t.%'. Date: 'Ah``'° fa `vy //'r ' 6, YOU YOU MUST COMPLETE ALL RELEVANT SECTIONS OF THIS FORM OR DEP MAY FIND THE DOCUMENT TO BE INCOMPLETE. Revised 4/2/2001 Page 1 of 1 -� COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION Metropolitan Boston—Northeast Regional Office JANE SWIFT - BOB DURAND Governor Secretary LAUREN A.LISS OCT 6 20Qi Commissioner Sullaway Revocable Living Trust Re: Salem—274 Derby St. 8831 N.W. 14" Street RTN 3-11479 Plantation, FL 33322 Response Action Outcome Attn: Rose Sullaway, Trustee Activity and Use Limitation Interim Deadline New England Pirate Museum,Inc. 274 Derby Street Salem, MA 01970 Attn: James Hurrell RAO SCREENING REVIEW AUL SUMMARY COMPLIANCE REVIEW AUL FIELD INSPECTION AUDIT FINDING Dear Ms. Sullaway and Mr. Hurrell: . On September 29, 1994, the Department of Environmental Protection(the Department)received a Class B-2 Response Action Outcome(RAO) Statement and Activity and Use Limitation (AUL)for the above-referenced site. On August 5, 1998,the Legislature enacted the`Brownfields Act"which called on the Department to conduct a targeted audit of all sites at which AULs have been implemented in order to ensure that these actions are meeting the requirements of Massachusetts' laws and regulations, including Massachusetts General Law chapter 21E and the Massachusetts Contingency Plan(MCP). The Department's audit of this site consisted of an RAO Screening Review, an AUL Summary Compliance Review, and an AUL Field Inspection to observe the condition of the area subject to the AUL. AUL FIELD INSPECTION AUDIT FINDING On August 12, 1999,the Department conducted an AUL Field Inspection at the location identified above to observe conditions related to an area subject to a Notice of Activity and Use Limitation. In particular, the AUL field inspection focused on activities and uses consistent with the terms and conditions of the AUL and whether obligations and conditions required to maintain a condition of No Significant Risk were being met. This information is available in alternate format by calling our ADA Coordinator at(617)574-6872. 205A Lowell St. wilmington,MA 01887 • Phone(978)661-7600 • Fax(978)661-7615 • TTD#(976)661-7679 Printed on Recycled Paper Salem,RTN 3-11479 2 As a result of the AUL Field Inspection,the Department has identified a violation of the requirements applicable to the AUL at the site that is outlined below along with corrective requirements. A copy of the AUL Field Screening Form is also enclosed. Violation of 310 CMR 40.1070(2): Failure of owners,holders of interest,RPs, PRPs, or Other Persons conducting response actions at a site to comply with the terms of an AUL (Class 1) The Notice of AUL recorded for the site requires the maintenance of pavement and landscaping in the area of the AUL to prevent access to underlying contaminated soil. The August 12, 1999 inspection observed that pavement in the area of the AUL was moderately cracked, with vegetative growth observed within the cracks. It is the responsibility of New England Pirate Museum, Inc., as the property owner at the time the AUL violation was observed,to implement the corrective action. In order to return to compliance with the MCP,within 60 days of the date of this Notice: 1. Submit a written description and photographic documentation to DEP that explains and verifies that the AUL area has been repaired and is in compliance with the maintenance requirements of the AUL. Your submittal must include a statement describing the condition of the entire AUL area and must, at a minimum, answer the following questions: a. Were any other paved or landscaped areas within the AUL in disrepair prior to or at the time of your receipt of this Notice? If yes,verify that such areas are now repaired and in compliance with the AUL; b. Has the use of the AUL area changed? If yes, describe such change(s)and the measures you have taken to ensure that such use(s) comply with the AUL; or 2. Provide a statement of activities and schedule for repair of the pavement in accordance with the requirement of the AUL that also addresses any additional areas of concern as identified in items La. & l.b. above. The deadline for submittal of your response to this Notice is an enforceable Interim Deadline issued pursuant to M.G.L. c. 21E, 310 CMR 40.0167 and 310 CMR 40.1140. If you fail to fully and properly respond by the Interim Deadline,you could be subject to legal action including criminal prosecution, court-imposed civil penalties,and/or civil administrative penalties assessed by DEP. RESPONSE ACTION OUTCOME (RAO) SCREENING REVIEW A screening review of the RAO was performed using a standard Department checklist. Examples of the Department's checklists are available on the Internet at http://www.state.ma.us/dep/bwsc/audits.htm. The Department is not directing you to undertake further response actions at this time. Please note, however,that the review conducted by the Salem,RTN 3-11479 3 1 Department was not a comprehensive audit, and the Department reserves the right to conduct a comprehensive audit of the RAO at any time in the future. It is possible that a future audit, if one occurs,may identify deficiencies and/or violations of applicable laws and regulations, and may require you to undertake further response actions at the site. AUL SUMMARY COMPLIANCE REVIEW Chapter 206 of the Acts of 1998 (The Brownfields Act)requires that the Department conduct an audit of all sites with AULs. In carrying out this mandate,the Department has established special procedures for reviewing AULs recorded on or before October 29, 1999, including the AUL submitted as part of the RAO for your site. Please note that these procedures do not apply to AULs recorded on or after October 30, 1999, and this Summary of AUL Compliance Review should not be relied upon to predict audit results for such AULs. Applying the procedures described above,the Department has identified errors in the AUL that require correction. Specifically: 1. The AUL does not contain the necessary owner signatures. The AUL incorrectly identifies Mrs. Rose Sullaway as the owner of the property at the time the AUL was recorded. Ruth Sullaway, as Trustee of the Sullaway Revocable Living Trust, conveyed the property to New England Pirate Museum, Inc. the day before the AUL was recorded. The AUL must identify New England Pirate Museum, Inc. as the owner of the property and must be signed by an authorized representative of the corporation. 2. The AUL does not adequately define what uses and activities are permitted at the site, what uses and activities are restricted, or what obligations and conditions must be maintained at the site. The AUL reads"landscaping and paved areas should be maintained to minimize human contact with soil-borne contaminants. The AUL does not adequately identify the location of the paved areas. To assist with compliance of the obligations of the AUL,the sketch plan must more specifically delineate the boundaries of the areas that must be covered by pavement to maintain a condition of No Significant Risk. The landscaped areas that must be maintained must also be delineated on the sketch plan. The language describing the obligation to maintain the pavement and landscaping must refer to an attached sketch plan for delineation of these areas (i.e. maintain the pavement and landscaping in the areas identified on the attached sketch plan). Additionally,the AUL must mandate that the obligations of the AUL be met. The obligations and conditions paragraph must use "shall' or"must"rather than"should". To correct these errors, an Amendment and Ratification of Notice of Activity and Use Limitation must be implemented within 180 days of the date of this Notice, using the enclosed form and instructions. The revised sketch plan may be attached as Exhibit C to the Amendment and Ratification Form. Please note that the AUL Opinion must be prepared and attached to the Amendment and Ratification Form using Form 114S. In addition, a legal notice regarding the original AUL and the AUL Amendment must be published in the local newspaper and a copy of the notice must be submitted to the Department. Alternatively, you may submit a new RAO Statement within 180 days of the date of this Notice, documenting the achievement of a Class A- Salem,RTN 3-11479 4 1 1, A-2, or B-1 RAO at the site(i.e. an RAO that does not rely on an AUL to maintain a level of No Significant Risk). This is an enforceable interim Deadline issued pursuant to M.G.L. c.21E, 310 CMR 40.0167 and 310 CMR 40.1140. If you do not meet this deadline you will be subject to enforcement action by the Department. Please note that this deadline relates 2nly to AUL corrections. Additional response actions required by this Notice of Audit Findings may be subject to shorter or longer deadlines. On August 29, 1994,Rose Sullaway,Trustee of the Sullaway Revocable Living Trust, sold the 274 Derby St. property to New England Pirate Museum, Inc. It is the responsibility of both the former and current property owners to correct the errors identified in the AUL. However, the current owner of the property must sign the corrected AUL (Amendment and Ratification). The Department has prepared forms and detailed instructions for implementing the required AUL corrections. Copies of the forms and instructions are attached, and are available on the Department's AUL Audit Project web page, httv://www.state.ma.us./det)/bwsc/files/audits/ aulfix.htm. This web page will be updated periodically to address any commonly asked questions that arise as a result of AUL audits. The Department is also offering several training workshops in the next few months. The Department recommends that you(and/or the Licensed Site Professional (LSP)/attorney preparing your AUL corrections)attend one of these workshops if you have questions on how to proceed. The training schedule is also available on the Department's AUL Audit Project web page. To obtain a schedule and/or register for the workshops, contact Thomas Potter, DEP's Statewide Audit Coordinator at(617)292-5628. POST AUDIT COMPLETION STATEMENT REQUIRED When the AUL Violation and AUL Errors are corrected, you should submit to the Department (attention: BWSC Audit Section) a Post-Audit Completion Statement in accordance with 310 CMR 40.1170, a copy of which is attached. LICENSED SITE PROFESSIONAL A copy of this letter has been sent to Thomas Army, LSP#3050, the LSP-of-Record for the Disposal site. LIMITATIONS & RESERVATION OF RIGHTS Please note that the screening review conducted by the Department on the RAO was not a comprehensive audit, and the Department reserves the right to conduct a comprehensive audit of the RAO at any time in the future. It is possible that a future comprehensive audit, if one occurs, may identify deficiencies and/or violations of applicable laws and regulations,may require you to undertake further response actions at the site, and may invalidate the AUL. The screening review is not a representation by the Department that the RAO complies with M.G.L. c. 21E, 310 CMR 40.0000, or any other laws, regulations, or requirements. Salem,RTN 3-11479 5 The Department's findings were based upon the accuracy and certainty of the information reviewed during the audit. These findings do not: (1)preclude future audits of past, current, or future actions at the site; (2)apply to actions or other aspects of the site that were not reviewed in the audit; (3)in any way constitute a release from any liability,obligation,action or penalty under M.G.L. c. 21E, 310 CMR 40.0000,or any other laws,regulations, or requirements. The Department retains authority to take or arrange,or to require any Responsible Party or Potentially Responsible Party to perform any response action authorized by M.G.L. c. 21E,which the Department deems necessary to protect health, safety,public welfare,or the environment. Sincerely, Patricia M. Donahue Chief,Audit Section Bureau of Waste Site Cleanup Filename: Nlhowes/P:/Letters/scnnof3-11479 Scnoa&6_105_31_01] Enclosures: AUL Field Screening Form AUL Amendment and Ratification Form and Instructions AUL Opinion Form(BWSC 1145) Audit Follow-up Plan Transmittal Form&Post-Audit Completion Statement (BWSC-111) cc: Salem Chief Municipal Officer Salem Health Department Salem Zoning Code Enforcement Official Salem Building Inspector Thomas Army, LSP-of-Record(LSP#3050)ENSOL, Inc., 100 Treble Cove Rd., North Billerica, MA 01862 Thomas M.Potter,Audit Coordinator,DEP-Boston NERO/Data Entry: RAO/TSAUD AUDINS/NAFVIO 1 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL.PROTECTION Metropolitan Boston—Northeast Regional Office JANE SWIFT BOB DURAND Governor Secretary LAUREN A.LISS OCT 2901 Commissioner Sullaway Revocable Living Trust Re: Salem—274 Derby St. 8831 N.W. 140i Street RTN 3-11479 Plantation, FL 33322 Response Action Outcome Attn: Rose Sullaway, Trustee Activity and Use Limitation Interim Deadline New England Pirate Museum, Inc. 274 Derby Street Salem, MA 01970 Attn: James Hurrell RAO SCREENING REVIEW AUL SUMMARY COMPLIANCE REVIEW AUL FIELD INSPECTION AUDIT FINDING Dear Ms. Sullaway and Mr. Hurrell: On September 29, 1994,the Department of Environmental Protection(the Department) received a Class B-2 Response Action Outcome (RAO) Statement and Activity and Use Limitation (AUL) for the above-referenced site. On August 5, 1998,the Legislature enacted the`Brownfields Act"which called on the Department to conduct a targeted audit of all sites at which AULs have been implemented in order to ensure that these actions are meeting the requirements of Massachusetts' laws and regulations, including Massachusetts General Law chapter 21 E and the Massachusetts Contingency Plan(MCP). The Department's audit of this site consisted of an RAO Screening Review, an AUL Summary Compliance Review, and an AUL Field Inspection to observe the condition of the area subject to the AUL. AUL FIELD INSPECTION AUDIT FINDING On August 12, 1999,the Department conducted an AUL Field Inspection at the location identified above to observe conditions related to an area subject to a Notice of Activity and Use Limitation. In particular,the AUL field inspection focused on activities and uses consistent with the terms and conditions of the AUL and whether obligations and conditions required to maintain a condition of No Significant Risk were being met. This information is available in alternate format by calling our ADA Coordinator at(617)574-6872. 205A Lowell St Wilmington,MA 01887 a Phone(978)661-7600 • Fax(978)661-7615 • T ro#(978)661-7679 Pnnted on Recycled Paper Salem,RTN 3-11479 2 `' As a result of the AUL Field Inspection,the Department has identified a violation of the requirements applicable to the AUL at the site that is outlined below along with corrective requirements. A copy of the AUL Field Screening Form is also enclosed. Violation of 310 CMR 40.1070(2): Failure of owners,holders of interest,RPs, PRFs,or Other Persons conducting response actions at a site to comply with the terms of an AUL (Class I) The Notice of AUL recorded for the site requires the maintenance of pavement and landscaping in the area of the AUL to prevent access to underlying contaminated soil. The August 12, 1999 inspection observed that pavement in the area of the AUL was moderately cracked,with vegetative growth observed within the cracks. It is the responsibility of New England Pirate Museum, Inc., as the property owner at the time the AUL violation was observed,to implement the corrective action. In order to return to compliance with the MCP,within 60 days of the date of this Notice: 1. Submit a written description and photographic documentation to DEP that explains and verifies that the AUL area has been repaired and is in compliance with the maintenance requirements of the AUL. Your submittal must include a statement describing the condition of the entire AUL area and must, at a minimum, answer the following questions: a. Were any other paved or landscaped areas within the AUL in disrepair prior to or at the time of your receipt of this Notice? If yes,verify that such areas are now repaired and in compliance with the AUL; b. Has the use of the AUL area changed? If yes, describe such change(s) and the measures you have taken to ensure that such use(s) comply with the AUL; or 2. Provide a statement of activities and schedule for repair of the pavement in accordance with the requirement of the AUL that also addresses any additional areas of concern as identified in items La. & I.b. above. The deadline for submittal of your response to this Notice is an enforceable Interim Deadline issued pursuant to M.G.L.c. 21E, 310 CMR 40.0167 and 310 CMR 40.1140. If you fail to fully and properly respond by the hlterim Deadline,you could be subject to legal action including criminal prosecution,court-imposed civil penalties,and/or civil administrative penalties assessed by DEP. RESPONSE ACTION OUTCOME (RAO) SCREENING REVIEW A screening review of the RAO was performed using a standard Department checklist. Examples of the Department's checklists are available on the Internet at htti)://www.state.ma.us/dep/bwsc/audits.htm. The Department is not directing you to undertake further response actions at this time. Please note,however,that the review conducted by the Salem,RTN 3-11479 3 r Department was not a comprehensive audit, and the Department reserves the right to conduct a comprehensive audit of the RAO at any time in the future. It is possible that a future audit, if one occurs,may identify deficiencies and/or violations of applicable laws and regulations,and may require you to undertake further response actions at the site. AUL SUMMARY COMPLIANCE REVIEW Chapter 206 of the Acts of 1998 (The Brownfields Act)requires that the Department conduct an audit of all sites with AULs. In carrying out this mandate,the Department has established special procedures for reviewing AULs recorded on or before October 29, 1999, including the AUL submitted as part of the RAO for your site. Please note that these procedures do not apply to AULs recorded on or after October 30, 1999, and this Summary of AUL Compliance Review should not be relied upon to predict audit results for such AULs. Applying the procedures described above,the Department has identified errors in the AUL that require correction. Specifically: 1. The AUL does not contain the necessary owner signatures. The AUL incorrectly identifies Mrs. Rose Sullaway as the owner of the property at the time the AUL was recorded. Ruth Sullaway, as Trustee of the Sullaway Revocable Living Trust, conveyed the property to New England Pirate Museum, Inc. the day before the AUL was recorded. The AUL must identify New England Pirate Museum, Inc. as the owner of the property and must be signed by an authorized representative of the corporation. 2. The AUL does not adequately define what uses and activities are permitted at the site, what uses and activities are restricted, or what obligations and conditions must be maintained at the site. The AUL reads "landscaping and paved areas should be maintained to minimize human contact with soil-borne contaminants." The AUL does not adequately identify the location of the paved areas. To assist with compliance of the obligations of the AUL, the sketch plan must more specifically delineate the boundaries of the areas that must be covered by pavement to maintain a condition of No Significant Risk. The landscaped areas that must be maintained must also be delineated on the sketch plan. The language describing the obligation to maintain the pavement and landscaping must refer to an attached sketch plan for delineation of these areas(i.e. maintain the pavement and landscaping in the areas identified on the attached sketch plan). Additionally, the AUL must mandate that the obligations of the AUL be met. The obligations and conditions paragraph must use "shall'or"must"rather than"should". To correct these errors, an Amendment and Ratification of Notice of Activity and Use Limitation must be implemented within 180 days of the date of this Notice, using the enclosed form and instructions. The revised sketch plan may be attached as Exhibit C to the Amendment and Ratification Form. Please note that the AUL Opinion must be prepared and attached to the Amendment and Ratification Form using Form 114S. In addition, a legal notice regarding the original AUL and the AUL Amendment must be published in the local newspaper and a copy of the notice must be submitted to the Department. Alternatively, you may submit a new RAO Statement within 180 days of the date of this Notice, documenting the achievement of a Class A- Salem,RTN 3-11479 4 1 1,A-2, or B-1 RAO at the site (i.e. an RAO that does not rely on an AUL to maintain a level of No Significant Risk). This is an enforceable interim Deadline issued pursuant to M.G.L. c.21E, 310 CMR 40.0167 and 310 CMR 40.1140. If you do not meet this deadline you will be subject to enforcement action by the Department. Please note that this deadline relates only to AUL corrections. Additional response actions required by this Notice of Audit Findings may be subject to shorter or longer deadlines. On August 29, 1994,Rose Sullaway, Trustee of the Sullaway Revocable Living Trust, sold the 274 Derby St. property to New England Pirate Museum, Inc. It is the responsibility of both the former and current property owners to correct the errors identified in the AUL. However,the current owner of the property must sign the corrected AUL (Amendment and Ratification). The Department has prepared forms and detailed instructions for implementing the required AUL corrections. Copies of the forms and instructions are attached, and are available on the Department's AUL Audit Project web page,http://www.state.ma.us./del)/bwsc/files/audits/ aulfix.htm. This web page will be updated periodically to address any commonly asked questions that arise as a result of AUL audits. The Department is also offering several training workshops in the next few months. The Department recommends that you(and/or the Licensed Site Professional (LSP)/attorney preparing your AUL corrections)attend one of these workshops if you have questions on how to proceed. The training schedule is also available on the Department's AUL Audit Project web page. To obtain a schedule and/or register for the workshops, contact Thomas Potter, DEP's Statewide Audit Coordinator at(617) 292-5628. POST AUDIT COMPLETION STATEMENT REQUIRED When the AUL Violation and AUL Errors are corrected, you should submit to the Department (attention: BWSC Audit Section)a Post-Audit Completion Statement in accordance with 310 CMR 40.1170, a copy of which is attached. LICENSED SITE PROFESSIONAL A copy of this letter has been sent to Thomas Army, LSP# 3050,the LSP-of-Record for the Disposal site. LIMITATIONS & RESERVATION OF RIGHTS Please note that the screening review conducted by the Department on the RAO was not a comprehensive audit, and the Department reserves the right to conduct a comprehensive audit of the RAO at any time in the future. It is possible that a future comprehensive audit, if one occurs, may identify deficiencies and/or violations of applicable laws and regulations,may require you to undertake further response actions at the site, and may invalidate the AUL. The screening review is not a representation by the Department that the RAO complies with M.G.L. c. 21E, 310 CMR 40.0000, or any other laws,regulations, or requirements. Salem,RTN 3-11479 5 1 The Department's findings were based upon the accuracy and certainty of the information reviewed during the audit. These findings do not: (1)preclude future audits of past, current, or future actions at the site; (2)apply to actions or other aspects of the site that were not reviewed in the audit; (3)in any way constitute a release from any liability,obligation, action or penalty under M.G.L. c. 21E, 310 CMR 40.0000, or any other laws,regulations,or requirements. The Department retains authority to take or arrange,or to require any Responsible Party or Potentially Responsible Party to perform any response action authorized by M.G.L. c. 21E,which the . . Department deems necessary to protect health, safety,public welfare,or the environment. Sincerely, Patricia M. Donahue Chief,Audit Section Bureau of Waste Site Cleanup Filename: Nlhowes/P:/Letters/scnnof3-11479 Scnoafv6105_31_01] Enclosures: AUL Field Screening Form AUL Amendment and Ratification Form and Instructions AUL Opinion Form(BWSC 1145) Audit Follow-up Plan Transmittal Form&Post-Audit Completion Statement (BWSC-111) cc: Salem Chief Municipal Officer Salem Health Department Salem Zoning Code Enforcement Official Salem Building Inspector Thomas Army, LSP-of-Record(LSP#3050)ENSOL,Inc., 100 Treble Cove Rd., North Billerica, MA 01862 Thomas M. Potter,Audit Coordinator,DEP-Boston NERO/Data Entry: RAO/TSAUD AUDINS/NAFVIO Business Certificate Citp of 6aiem, fflaggarbugettg DATE FILED f� Type: ❑ New Expiration DateD b Renewal, no change Number Renewal with change In conformity with the provisions of Chapter one hundred and ten, Section five of the Massachusetts General Laws, as amended the undersigned hereby declare(s) that a business is conducted under the title of61 : at. type of business 24�5�'UN? -F l F • by the following named person(s): (Include corporate name and title if corporate officer) Full Name Residence ��iv C��/��i��R�e��G Si tures -- - ---- �- � � � ----------------------------------------------------- -----zi ----------------------------------------------------- onl he above named person(s) personally appeared before me and made an oath that the foregoing statement is true. ----------------------------------------------------- ----------------------------------------------------- CITY CLERK Notary Public (seal) Date Commission Expires Identification Presented State Tax I.D. # S.S. # -3� (if available) In accordance with the provision of Chapter 337 of the Acts of 1985 and Chapter 110, Section 5,of Mass. General Laws, business certificates shall be in effect for four (4) years from the date of issue and shall be renewed each four years thereafter. A statement under oath must be filed with the town clerk upon discontinuing, retiring, or withdrawing from such business or partnership. Copies of such certificates shall be available at the address at which such business is conducted and shall be fumished on request during regular business hours to any person who has purchased goods or services from such business. Violations are subject to a fine of not more than three hundred dollars ($300.00) for each month dur-ina which No.JS "S`r City of Salem Ward / '�ceaxl�s' APPLICATION FOR PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION IMPORTANT (-Applicant to complete all items in IX AT sections:1, It, ill, IV, and I I. AT(LOCATION) �z �i=/��iY e�/ . ZONING DISTRICT LOCATION MUR70� OF BETWEEN s cAND caoss BUILDING JCROW ines LO EE11 SUBDIVISION LOT BLOCK SIZE II. TYPE AND COST OF BUILDING -All applicants complete Parts A -D A. TYPE OF IMPROVEMENT D. PROPOSED USE-FOR"DEMOLITION"USE MOST RECENT USE 1 C] Now building ReeWengal al 2 ❑ Addition(d residential,enter number of new 12 ❑ One family 18 musement,recreational (rousing units added,N any,in part D,13) 19 Chinch,other religious p�.,/ 13 ❑ Two or more family-Enter number 20 ❑ Industrial 3 IYI Akeretlon(See 2 above) of units.................._................._.._. 11``'''�� ........ 21 ❑ Parking garage 4 ❑ Repair replacement 14 ❑ Transient hotel,motel,or dormitory- Enter number of units ........................... 22 ❑ Service elastin,repair garage 5 ❑ Wrecking(d mulfilamily residential,amen number 23 ❑ Hospital,institutional of units in building in Part D.13) 15 ❑ Garage 24 ❑ Office,bank,Professional 6 ❑ Moving(relocation) 16 ❑ Carport 25 ❑ Public utility 26 [:] School,library,other educational 7 Foundation only 17 ❑ Other-Specify 27 ❑ Stores,mercantile B.O�W�,N('ERSHIP 28 ❑ Tanks,towers 6 W Private(individual,corporation,nonprofit 29 ❑ Ocher-Specify /"' institution,etc.) 9 ❑ Public(Fedeml,State,or local government C.COST (Omit cents) Nonresidential-Describe in detail proposed use of buildings,e.g.,food processing plant, machine shop,laundry building at hospital,elementary school,secondary school,college, �-` parochial school,parking garage for department store,rental office building,office building 10. Cost of improvement .......................................__....... at industrial Plant.If use of existing building is being changed enter proposed use. To be installed but not included /' in the above cost ,.._ �/�f/ S T (/ f� (>-e(L/ a. Electrical...................................................._._.... _.___... b. Plumbing......................................._....._.________ c. Heating,air conditioning.............................. d. Other(elevator.etc.)..........................._...._... ____._. — go/� 11. TOTAL COST OF IMPROVEMENT $ III. SELECTED CHARACTERISTICS OF BUILDING -For new buildings and additions,complete Parts E-L;demolition, complete only Parts J&M,all others skip to IV E. PRI rr�N��---C��IPAL TYPE OF FRAME F. PRINCIPAL TYPE OF HEATING FUEL G. TYPE OF SEWAGE DISPOSAL 1. TYPE OF MECHANICAL 30Z Masonry(wall bearing) 35,aGas 400Public or Private company Will there be central air 31 Wood frame 36 ❑ Oil 41 ❑ Private(septic tank,etc.) conditioning? 32 ❑ Structural steel 37 Electricity 44/gyes 45 ❑ No 33 ❑ Reinforced concrete 38 ❑ Coal H. TYPE OF WATER SUPPLY Will tt""hhe"''re by an elevator? ,.. 34 ❑ Other-Specify 39 ❑ Other-Specify 42,k Public or private company 46 E] Yes 47/.N No 43 ❑ Private(well,cistern) / J.DIMENSIONS - ae. Number of stones .................. M. DEMOLITION OF STRUCTURES: as. Taal square feet floor area, all floors,based o f extexterior Has Approval from Historical Commission been received amensions ........................ for any structure over fifty(50)years? Yes_ No_ 50. Taal land area,sq.It......................_....._........................ Dig Safe Number K.NUMBER OF OFF-STREET PARKING SPACES Pest Control: 51. Enclosed........................_.................................................. 52. outdoors.............. .................. HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED? Yes No L RESIDENTIAL BUILDINGS ONLY Water: 53. Enclosed ........................ Electric: Gas: 54. Number of Full........................................... Sewer: bathrooms DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED Partial"""................ BEFORE A PERMIT CAN BE ISSUED. IV. COMPLETE THE FOLLOWING: Historic District? Yes_ No-,K- (If yes, please enclose documentation from Hist Com.) Conservation Area? Yes_ No-A (If yes, please enclose Order of Conditions) Has Fire Prevention approved and stamped plans or applications? YeS-X No_ Is property located in the S.R.A.district? Yesl No_ Comply with Zoning? Yes-4 No_ (If no,enclose Board of Appeal decision) Is lot grandfathered? Yes_ No-�-- (If yes,submit documentation/if no,submit Board of Appeal decision) If new construction, has the proper Routing Slip been enclosed? Yes_ No_ AA&dw/ Is Architectural Access Board approval required? Yes— No (If yes, submit documentation) Massachusetts State Contractor License# OJCAI Salem License # Home Improvement Contractor# Homeowners Exempt form (if applicable) Yes_ No_ CONSTRUCTION TO BE COMMENCED WITHIN SIX (6)MONTHS OF ISSUANCE OF BUILDING PERMIT CONSTRUCTION IS TO BE COMPLETED BY: If an extension is necessary,please submit 10"611in writing to the Inspector of Buildings. V. IDENTIFICATION • To be completed by all applicants Name Mailing address-Number,street,city,and state ZIP Code Tel.No. 1. rtiPj F 14AVII 130 o Owner or ,. �A �A, ;7 Lessee rtal �r /6wG/� /= uSEv ) XfOfG J' . AE/* 1,,,54ss 7 z z. Comractor Builder's License No. 3. ArchKeCl or Engineer a / ass or gid I hereby certify that the proposed work is authorized by the owner of record and that I have been authorized by the owner to make this application as his authorized agent and we agree to conform to all applicable laws of this jurisdiction. Si not a of appli t Address App'cation date 411 DO NOT WRITE BELOW THIS LINE VI. VALIDATION Building /'�%�.�C�/ FOR DEPARTMENT USE ONLY Permit number ✓ !� T Buildingh / ��''((// Use Group Permit issued Ica Z6 19 7 Fire G ading Building Permit Fee $ 30 Live Loading Certificate of Occupancy $ Approved by: Occupancy Load Drain Tile $ Plan Review Fee $ 12 TITVE NOTES AND Data• (For department use) ti� a l SSL e,OPI u> �'� �� / 9 9�F cam✓ .�,,�� PERMIT TO BE MAILED TO: DATE MAILED: Construction to be started by: Completed by: VI ZONING PLAN EXAMINERS NOTES DISTRICT USE FRONT YARD SIDE YARD SIDE YARD REAR YARD NOTES SITE OR PLOT PLAN•For Applicant Use O N StjLeet MENT INSPE pPSPE j ONES S 11"NevK v4Sa2em, Ma a 01 970 MADE CTIONN MUSTRBEN 1N EPj � �/ (508) 745-7777 AHEADAT ST ONE W, MP .............. PHEP�-- FIRE DEPARTMENT CERTIFICATE OF APPROVAL FOR BUILDING PERMIT In acco,dance w4th the prow( .sZon,6 vs the Maazach"etts State Suttdtn_ and the Salem Fvice Code, appZi.eati.on des hereby made 4or a.pp•tovat os p. and the .s.%uance v4 a een,tt4 .caste v4 approval son a buZ d.ing pe'un-Lt b. SaZem F,•-te Depa2tment. (Re4_. Section 113. 3, Ma-6-A.. State Bldg. Coda) .f* Job Location: 9�0rOF�TT,� Owne•%/Occupant: L G� TCF 2�G OC EZ'ac.tt caZ Contractor: C% �. " 0 F.l ze Suppn.e s-Lton CuntAacto�c: \ S•gnatu,ze o4 Appt;cant: Phone #: _ �c Add ze.sa C.ty o•z AppZi.cant: 426) Town: AppnvvaC date: Z ?/e Ce ._t 6;.cate o4 approvaZ i.s hereby granted, on approved ptar�, or -submZ or- p•zoject detatt t,, by the SaZem Fine Department. AZC pian-s ane appy v£ _Zy bur i.denti.4tca,t,i.vn o4 type and Zoeati.on os 4•i to protection dev. and equipment. AZE ptans are 6ubject to approval v4 any vthet authcvL havZrna jwctisd.i.ctton. Upon compZet-ion, the appZ•i.cant or •in_,sta t2,t(a) •tequ.e.st an Znnpecti•on and/or test o4 the 4•4ne protection dev<ce-s and equ. .pment. ( ** FOR ADDITIONAL REQUIREMENTS, SEE REVERSE SIDE ** r� New evn.stLueti.on. Proputy Zocat•ion has no eompZ-.ance wi-th. the prow-4_Lten: Chapter 148, Section 26 C/E, M. G. L. , retatl.,e to the tnhta.,?a ttLon v4 approved ¢iice aeac Lm devi.eec. The_vwne Y titin prope,, y ins %equilted to obtain compZia.nce as a condition os obta indng a Bu•i Cdtng PeAm Property Zocati.on Z4 tin cvmpfia.nce with the prvvi ort-s Chapter 748 . Section 26 C/E, M. G. L. _ c_Z,Lati.on date: 3d L - F:e i!:_. und_2 7 , 500 Sq. Ft. - Uvv� � 900 q. Ft. 0 YR ! i, KU. W 3 W I FIRE DEPARTMENT CERTIFICATE OF APPROVAL FOR BUILDING PERMIT o f o `L =) F- ! In compliance with the provision of Section 113.5 of the Massachusetts z c State Building Code, and under guidelines agreed upon by the Salem Bldg. 'M Ozz _LuJ Inspector and the Salem Fire Chief, the applicant for a building permit F- - F- shall obtain the Certificate of Approval (see reverse side) and stamped OZ y W 0 plan approval from the Salem Fire Prevention Bureau. a n ,4 .7 ¢ Said application and approval is required before a, building permit may be ¢ i issued. The Massachusetts State Building Code requires compliance z W : approval of the Salem Fire Department, with reference to provisions of LL Co Articles 4 and 12 of the Building Code, the Salem Fire Code, Massachusetts Ow C General Laws, and 527 Code of Massachusetts Regulations. z < W Z L The applicant shall submit this application with three (3) sets of plans, O F drawn in sufficient clarity, to obtain stamped approval of the Salem Fire Z 0 < Department. This applies for all new construction, substantial o 'u' alterations, change of use and/or occupancy, and any other approvals ¢ z required by the Massachusetts General Laws, and the Salem Fire Code. Exception: Plans will not be required for structural work when the proposed work to be performed under the building permit will not, in the opinion of the Building Inspector, require a plan to show the nature and character of the work to be performed. Notice: Plans are normally required for fire suppression systems, fire alarm systems, tank installations, and Fire Code requirements. a ; z a Under the provisions of Article 22 of the Massachusetts State Building m v Code, certain proposed projects may not require submission of plans or v -" '' Z complete compliance with new construction requirements. In these � n z P P q - cases, provisions of Article 22, Appendix T, and Tables applicable m Z 3 shall apply. This section shall not, however, supersede the N provisions outlined in the Salem Fire Prevention Regulations, Chapter O 148, MGL, or 527 Code of Massachusetts Regulations. All permits for Z -{ � fire code use and/or occupancy shall apply for the entire structure; rn W '_ fire alarm and/or smoke detector installation shall apply to the m v entire structure based upon current requirements as per Laws and/or m ' Codes, but the existing structure may comply with regulations applicable for existing structures. Notice: Sub-contractors may also be required to file individual applications for a Fire Department Certificate of approval for the area of their work. Such sub-contractors shall file an Application to Install with the Fire prevention Bureau prior to commencing any work for those areas applicable. Form 81\ ( 10/90) APPOINTMENT FOR FINAL INSPECTION MUST BE MADE AT LEAST ONE WEEK AHEAD..--_ -----------.. _-- CITY OF SALEM BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please Print DATE JOB LOCATION �` �� J��/f��y 57- Number Str*et address Section of Town "HOMEOWNER ,2 7,� Y�IY dri/ Name Home phone Work phone PRESENT MAILING ADDRESS DSLL 047 �7�/D� �7own tate Zip Code The current exemption of "homeowners" was extended to include owner-occupied dwellings of six units or less and to allow such homeowners to engage an in- dividual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section 109.1 . 1 DEFINITION OF HOMEOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to re- side, on which there is, or is intended to be, a one to six family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official , on a form acceptable to the Building Official , that he/she shall be res onsible for all such work performed under the building permit. Section 109.1 .1 The undersigned "homeowner" assumes responsibility for compliance with the State Building code and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the City of Salem Building Department minimum j spection procedures and requirements and that he/she will comply with sad pr cedures an re ements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING FICIAL NOTE: Three family dwellings 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127.0, Construction Control . HOME OWNER'S EXEMPTION The Code states that: "Any Home Owner performing work for which a building permit is required shall be exempt from the provisions of this section (Section 109.1 .1 - Licensing of Construction Supervisors) ; provided that is a Home Owner engages a person(s) for hire to do such work, that such Home Owner shall act as supervisor." Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q, Rules and Regulations for Licensing Construction Supervisors, Section 2. 15) . This lack of aware- ness often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case your Board cannot proceed against the unlicensed person as it would with licensed Supervisor. The Home Owner acting as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/her responsibilities, many communities require, as part of the permit application, that the Home Owner certify that he/she understands the responsibilities of a supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. ,a ✓fie TDam�n�uuea,�t ��l��Gt� 'a Obi �(lIILLG A4- 1, .��al. �omaa o�,�uetdc:.o c�.erfmta4oRs a.>,d✓rawdaw�s» MichaelS. Dukakis .� . Cel. Amraw�.. Governor - a /Jet Kentaro Tsutsumt v ✓7aas 0210.0 Chairman (617) ;_+} Charles J. Dineraa Administrator MEMORANDUM TO: All Building DepartmentsiStatc Building Inspectors FROM: Charles J. Dingo. Administrator DATE. Octoncr 31. 1788 SUBJECT: MGT. coo, ti54. Added Rv r594, ti9 of the Act% of 1987 The above•mcntioncii statute requires that debris resulting tram the demolition. renovation. rehabilitation or nincr aitcration til a building or structure he disposcu of in a properiv licensed solid waNC disposal facility as defined by MGL e111. S150A and that huddine permits or licenses are to mmtate the location of the lactllty at which the said debris is to he disposed. THIS REOUIREMENT DOES NOT \PPLY TO NEW CONSTRUCTION. In order to simahfv the process and to provtdc undormtiv. we arc attacbme a copy rat a hlrm-whieb ion can either reproduce and use as it is since the completeu form will be attached to the otiico cupv of liuthlfvig- permits or licenses: or reproduce it on Your Icttencc7d. In case of municipal,commeretal.industrial,or multi-unit housing construction, the rnntracmr may viol know the dumpster subcontractor at the time of the budding permit application. In such cases. the atuebed COPY of an Affidavit can be usod. The complete law is canta nca in the November Issue of CODEWORD which will be mailed to van in the next two weeks. If you should have any question. please let us know. CJDlkm AFFIDAVIT As a result of the provisions of MGL c 40, S54, I acknowledge that as a condition of Building Permit Number all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. I certify that I will notify the Building Official by (Trvo months maximum) of the location of the solid waste disposal facility where the debris resulting from the said construction activity shall be disposed of, and I shall submit the appropriate form for attachment to the Building Permit. 1-2 Date Signature of Permit Applicant (Print or type the following information) Name of Permit Applicant Firm Name, if any Address In accordance with the provisions of MGL c 40, S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 111, S 150k The debris will he disposed of in: (LoFauon of Facility) / Ttl, Ena 471711w.u.y L �y✓1 . Signature of Pe it Applicant /Date ENSOL BnvironmentalSolutions for Business September 9, 1994 Mr. Leo Tremblay,Building Code and Zoning Officer City of Salem Building Department One Salem Green Salem, MA 01970 Subject: ACTIVITY AND USE LIMITATION Release,Tracking Number#3-11479 p74.Derb Street;..` Salem, MA (herein referred to as the Site) Dear Mr.Tremblay: The purpose of this letter is to inform the City of Salem Building Code and Zoning Departments pursuant to the Massachusetts Contingency Plan (MCP), 310 CMR 40.1403(3)(d), that on 30 August 1994;an Activity and Use Limitation as defined in the MCP, 310 CMR 40.1073, has been recorded with the Essex County South Registry of Deeds for 274 Derby Street in Salem. The purpose of the Activity and Use Limitation will limit the following site activities and uses on the above property: • soil excavation without appropriate OSHA training and a Health and Safety Plan; • removing building or pavement and exposing contaminated soils for prolonged periods to human contact; and, • residential or commercial use that would be likely to result in direct human contact with soil-borne contaminants. The property is currently owned by Mrs. Rose Sullaway, which is listed as the Potential Responsible Party by the Massachusetts Department of Environmental Protection, and the contact for the Site is Mr. Irving Shapiro,2 Milk Street Extension, Peabody,MA a the telephone number(508) 531-4399;ENSOL, Inc. serves as consultants. 100 Treble Cove Road,Suite#5 145 Crary Street,Suite#5 Billerica,MA 01862 Providence,RI 02903 (508)670-0755 FAX:(508)670-0767 (401)272-3850 FAX:(401)272-3851 ENSOL, Inc. If you have any questions or comments,please do not hesitate to contact me at(508)670- 0755. Sincerely, ENSOL, Inc. Scott R. Salisbury Environmental Analyst cc: City of Salem Mayors Office City of Salem Board of Health Ms. Larissa Drennan/MA DEP BWSC Mr. Irving Shapiro EVOL—BnvironmentalSolutions for Business r a CO.'^!ONi7FAI.TII OF w&SSAL-F{IISL11J - C- CITT V1 CITY OF SALEM "-'=`"• , APPLZCSIION FOR CEiIIFICATE OF INSPECTION O_ Date Fee Re?'tVir64 5 0 ( ) No Feer--A ,qu a — in accordance with the provisions of the Massachusetts State�Build'ing Code. Se 108. 15. i hereny appiy for a Certificate of Inspection for the below-gamed premise located ac the following address: �y y- Street 6 Number 4 Name of Premises ,04, xr Purpose for which Premises is u ed �7L.�EUIs� f / �f r) J,/ - License(s) or Permits) required for the premises by other Governmental Agencies: License or Permit Agency Certificate to be issued to: psl`U�rLusn Address: 7 Ji, .S7 .7.��r".�i ,o, 0f92eO Owner of Record of Building: / �+ G H C•, Address:. 22 'f ��/I°O�i .) � 56125-w O/i/,;� O. Name of Present Bolder of Certif'_cate: �`� �ryx�jpry� f�/I.B•/� /��t-Ll2 .ZHG Name of Agent. L` any. . - - S -ure of Person to wnam vertcf icate TIII_E /ice issued or hisiher authora.zed agent eL/4 46�— IN=UC=ONS: Day rime phone 17311-3rlJ0 1. Make check payable to: The City of Salem 2. Return this application with your check to: Iasnecror of Buildings. Ciry of Salem Building Department. One Sales Green. Salem. MA. 01970. PLEASE NOSE: I. Application form with required fee musc be submitted for each building or stracrm of part thereof to be certified. 2. Application 6 fee must be received before the certificate wiU be issued. J. The building official shall be notified within ten (10) days of any change in the above iriformation. CEMFICATE 1 7111 p' ZIFZ%ATION DATE: / / / 0 USe- f} -• 3 4-,�I - Yds ,,. e �-� � � i ��, r�� ,, 1 ��s - �� Pis� �� 5 �. r� PERIODIC INSPECTION REPORT This form is to be completed each time a Periodic Inspection is made. At the time a new Certificate of Inspection is issued, a notation indicating that the fee has been paid will be made to Application Form prior to the new Certificate of Inspection being issued. Any changes since the last inspection are to be added to the file card of the premises. Street 5 Number .e -- L Name of Premises Albi Ena Pi Znq -I Certificate to be issued to: N T— �G CJ VCS 7P X19 U�P U V}2 z)C Address a / �1 DQ ( b!d S I^ I /� Owner of Record of Building �V Q (tet � zn4 /W✓1 �� ' ��1 USe u lkl Address 5U Purpose for which premises are used '�rnySP�) M 't C9 f4 Changes since last Inspection (required on file card also) 1. /d 2. 3. 4. 5. Date Order Issued: Order Issued To: Address Date Violations ((Corrected: (� REMARKS: I Y Y., 514 vt no L I 11 v l -,4fkU p W�2 Vl il v1 U I have this day inspected the above premises, and the same conforms to the pertinent requirements of the Massachusetts State Building Code and the rules and regulations pursuant thereto. Date Building official Certificate # 0 J"1`6 Date Issued: Date Expires: Recommended Next Inspection: 'c�� r V b CITY/TOWN OF " P In accordance with the Massachusetts State Building Code, Section 108. 15, this CERTIFICATE OF INSPECTION is issued to w. . . 'oy.la,n. .01. . . . . . fi ra ff. . . . . f'Y v.m. . . . . . . . . . . . . . . . . . . . . . . . . . . . y &rhfg that ^^Ihave inspected the. . . . . . . .e(f Wl 1SC. & • • • • • • • • • • .known as. . . . . . . . . . . . . . . . . . . . . . . . . . . located at. . . . . . . . �. �- q . . .De r.�! V� . . . . ��: in the. . . . . . . . . . . . .of. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . County of. . . . . . . . . . . . . . . . . Commonwealth of Massachusetts. The means of egress are sufficient for the following number of persons: BY STORY Story Capacity Story Capacity Story Capacity Story Capacity BY PLACE OF ASSEMBLY OR STRUCTURE Place of Assembly Place of Assembly or Structure Capacity Location or Structure Capacity : Location -169 Certificate Number Date Certificate Issued Cate Certificate Expires Building Officp Z The building official shall be notified within (10) days of any changes in the above information. (�I�P (Z amutanwralt4 of tt Cl t Pi#� d , d CITY OF SALEM y` In accordance with the Massachusetts State Building Code, Section 108. 15, this GSM Sae v CERTIFICATE OF INSPECTION is issued {{ tom..{{ ss '- - ) C 7 F,-) 7 KYpaijil3 that I have inspected the premises known as '"'''rtl ---t' ? 12 I-r bii.l _. located atr`' in the city of Salem County of Essex Commonwealth of Massachusetts. The means of egress are sufficient for the following number of persons: BY STORY �' 7'•' r :w z,7 -'Y F.?7 t 'y' "J J .:>!%," 7, .A h f, Story Capacity St6ry Capacity Story CaPact y rS or Capacity ",7„ r G1-3 BY PLACE OF ASSEMBLY OR STRUCTURE Place of Assembly Place of Assembly or Structure Capacity Location or Structure Capacity Location XUAIA Certificate Number Date Certificate Issued Date Certificate Expires Itluilding Officin The building official shall be notified within (10) days of any changes in the above information. 5 moo` CERTIFICATE ISSUED CITY OF SALEM i� DATE 5/10/95 SALEM, MASSACHUSETTS 01970 BUILDING PERMIT - '�4�DgNT CERTIFICATE OF OCCUPANCY DATE 12/6 19 94 PERMIT NO. 5U.,5-94 APPLICANT Jam(.-.L. nurrell ADDRESS 130 htCwdoin Sl_ ..OSC:�:.., Zvi' (X0.) ISTREFTI ICONTR'S LICENIEI OF PERMIT TO remodel (_I STORY hU3• DWELLLRING UNITS I1•11 OF IM PR OVFME xII -x0. - (PPOPOSEO USE) 274 .11eroy St. Ware . ZONING S-`. AT (LOCATION) DISTRICT (N0:) (STREEII BETWEEN_ AND ICROSS STREET) (CROSS STPEETI LOT SUBDIVISIONLOT BLOCK SIZE BUILDING IS TO BE FT, WIDE P., FT. LONG BY ''FT. IN NE?GxT'AND SNALL>CONFORM-IN CONSTRUCTION TO TYPE USE.GROUP BASEMENT WALLS OR FOUNDATION ... (TYPE( Remodel interior of building for museum b gift shop. REMARKS:. WWF AREA ON VOLUME ' C;:BIL SO U49 E.FE[TI JBmeG Hili"rE.11 o.'A+loi-rlve�nsrfloevlo�Is�loew benoaYlo e�(oe.Yloirl Arun srneme nWNER a TQQ�E�PO�S�TED ON PREMISES ADDRESS -howaoin St. bcstol" ire: SEELd&Ee 1$?O -4 CONDITIONS OF CERTIFICATE w DEPARTMENTAL APPROVAL FOR CERTIFICATE ! of OCCUPANCY and COMPLIANCE' To be filled in by each division indicated hereon upon completion of its final inspection. BUILDINGS Permit No. 585-94 Approved by LEO TREMBLAY Date s/l195 I I Remarks i i PLUMBING Permit No. Approved by JOHN LECLERC Date 5/5/95 Remarks i i I ELECTRICAL Permit No. t � Approved by PAUL TUTTLE Date 5/3/95 Remarks :r OTHER Fire Permit No. Approved by_N. LAPOINTE Date 5 10 95 Al! Remarks OTHER Permit No. Approved by Date Remarks .a I BUILDING PERMIT JOB WEATHER CARD DATE 19 PERMIT NO. APPLICANT ADDRESS IN0.1 ISTREETI ICONTR'S LICENSEI NUMBER OF PERMIT TO. I_) STORY DWELLING UNITS (TYPE 01 IMPROVEMENT( NO. (PROPOSED USE) ZONING AT (LOCATION) DISTRICT IND.) (STREET) BETWEEN AND (CROSS STREET) ICROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT, IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: �. ) ,,,,°J. l� �inne CaEI sur Pe; ��►� ,�; �,Ltpy, VREA OR p OLUME ESTIMATED COST $ FEE MIT S. _ I :CUBIC/SQUARE FEET) F OWNER BUILDING DEPT. ADDRESS BY THIS PERMIT CONVEYSNO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY P*RT THEREOF. EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY. NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP- PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINEO 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 APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REOUIRED FAR - CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR . ALL CONSTRUCTION WORK: ELECTRICAL, PLUMBING- AND 1. FOUNDATIONS 0. FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL OUIRED,SUCH BUILDING SHALLNOT BE OCCUPIED UNTIL MEMBERSIREADY TO LATH). FINAL INSPECTION HAS BEEN MADE. S. FINAL INSPELTION.BEFORE OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILD INSP TION APPROVALS zm UMBING E TION APPROVALS ELECTRICAL INSPECTION APPROVALS IN/�4111'44 ®r. 1 BO D F HEALTH GAS INSPECTION APPROVALS FI DEPT. INSP TING APPRO I OTHER CITY ENGINEER - 2 / Z /a WORK SHALL NOT PFKICEED UNTIL THE PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD INSPECTOR HAS APPROVED THE VARIOUS WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE CAN BE ARRANGED FOR BY TELEPHONE STAGES OF CONSTRUCTION. PERMIT IS ISSUED AS NOTED ABOVE. OR WRITTEN NOTIFICATION. i AND PIRATE M INC DERBY STREETASSACHUSETTS 01970 ONE: (508) 741-2800 L Eos€ 6��/-y/ s /771' st7'/.�/�/ (�Oh S �G�vG ✓��"' ✓ I (r� l � �. The Commonwealth Of Massachusetts ,y a Department of Public Safely ' F..r...l \la>.adnnvus 5t.ue 114,11 l;Code 1,90 C\IR)1Z,% nlh E.hti,m i ' - City of Salem 'Building Permit Application for any Buildin•• other than a I-or 2-Family Dwelling I Ill, Priori Fill QO'laal I Only) Ilia Liing I'gnmt Numlxr Da,tr ApphrJ: .,, Building Inspvctor I SECTION h LOCA 'ION (Please indicate Block a and Lot a for locations for which a street address is not•aviiL ble/ i\J(lq �79' ' ._-`�_---yJt/1 �.!/�' /9/�7 r��rt'rt'�S Aily�Y15✓1 j No,and Street C Its /Town Lip Cale .Name of Building(It opplt,, lel SECTION 2:PROPOSED WORK ' It New L"WIfrualon check here O or check all thal apply In the two rows below - E:trstingBmldingO-- Rrpatr .---Allrratiun-a - --AJditnmO -Drmolilitm-0"-(-1'lrasr-/ill-tiul-and-.ubmd-ApvrnJi+�1-)—__ ChangrofUse 01 ChangeolOccupincy ❑' •'. Other ❑ Specify: ;i-• "" Arr building plans and/or construction documents being supplied as part of this permit applicalion? Yes 0 No Js� Is an,Independent Structural Engineering Peer Review required2 Yes 0 No� Brief Description of Proposed Work: �J��#PC A ' SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION;ADDITION,OR CHANGE IN USE OR OCCUPANCY - Check here it an Exlst(n6 Building Evaluation is enclosed(5m 780 CMR 3402.0) 0 up(s):Existing UseGro Proposed Us Group(s): M Existing Hazard Index 780CMR 34: Proposed Hazard Index 780 CR 34: SECTION 4:BUILDING HEIGHT AND AREA _ Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(l ft.) Total'Area.(.sill:f1.)and Total Height(ft.) All- SECT70N 3:USE GROUP(Check as a licable) A: Assembl A-1 O A•2r 0 A•2nc O A•3 A4 O A-5 0 B: Business ❑ E: Educational ❑ F. Facto F-1 0 F2❑ 1 H: III Hazard H-1 O H-2❑ H-3 0 H-4 O H-5 0 I: Institutlonai I•I ❑ 1-2 0 I-•l O 1-4❑ 1 M: Merrantlle 0 R: Residential R-10 R-2❑ R-3❑ R-4 ❑ S: Storage S-1 ❑ S-2❑ U: Utility 0 Spectai Use O and lease descnble below: tipmal Use: , SECTION 6:CONSTRUCTION TYPE(Check as o licable) . IA 0 IB O IIA 0 (ISO IIIA 0 1118 ❑ I IVA VA O Va 0 SECTION 7:SITE INFORMATION(refer to 780 CMR I I I.0 for details on each iternf I . I Water Supply: Flood Zone Information: Sewage Disposal: rrench Permit: IJr bris Itemuval: ('buck J.nd.µly Fl;.dl Lnna 1i,dfb.1le munrnf,, \ lirni'h well not l Llia•n.cd Ui.p,•.,d`�,Ir`f� felt alc❑ nr m.la•nloa Lnnv. _ nnm.dr�c.trm ❑` r"Iu1rcJ Oor trench �r.t•ccrl,. f•rrmlt 1.vnchr.eal 0 I ItailroaJ nghbof-way; Hazards to Air Yavigalion: \I\ I h.L.n, l R., \, 1 \pt•Ip.rl•IvQ Lyru.11nv,.ahul.nip,nl el•lq,ud, r a `.. ,I. then n•,icl./ . .,nl•Irlr.l•\ cn.L -cJD �• . - Vr.❑••�r\nQ /L )v.❑ \•, Q �/4 CONTENT OF CERTIFICA fE OF OCCUPANCY "--� I .Iilp ql II. -J(' .___ L-,.(n••I,/9•I _ flfa.q\ in,�lfll,h,91 lla(l,fVrll l ••.qt i'cll i •., --..� 16 , ihr l•rulJu,q. .nLun.cal Apr u.Ilk- Hcnl• �I•.'i wl�Irpul,u...... ' . . _ It F SECTION 9: PROPERTY OWNER AUTHORIZATION \',ima.uid ,\.LIn•s ul I'n tl•arly Osyner Mpif�t//Z�-�� 3ez_gO,�ScJill, 91.¢._ \.Irate tl'rmtl N,,— td ?trcet Mils, 1,,,,n - Q�•/0� `:'i• firm,,•rt s lhs n yr Con tail l n l u r mouton 727 / 48toa &f title Telephone No. (busmesx) Telephone No. (cell) email.Lldn.� I(.I l•I•hi.tbly, the prttpvol,u%s nvr haretw authorizes ,•. .� c I11/� � \.tm� ?Ir vi AJdrrw Catsv Tosyn Mate Zip w•.act ran ltir +nt vrh' .%,ner's behalf, m all mauers rvlauye to work authorized by this fnuldln •permitapplicon,m: SECTION`I0:CONSTRUCTION CONTROL(Please fill out Appendix 2) (it I•uddm•is lass dun 15,laa,cu.It.of dnd.uasl+uie anJ/ar nu1 under Can.Iruatton Control Ihv.%,heck here D and 4, t\•.lent III II 10.1 Re istered Professional Responsible for Construction Control . J 7>�.� 97� ?vas ads , •ca.>7 _- -yl�e� a rp u e ��rrss O eKutra ion Nu brr Street Aaddrrreess�s/•/• City/Town (Slate. Lip Discipline Expiranun Date 102 General Contractor Company Name: • p ZSS 4.2G/•�" .. N. me of Perslm Res ms.ble for v cliu License No. and Type if Applicable "�Itti•� �= �fyl1W — Sheet Address R' � City/Town e� =e/(.dr Stale ip-d JVV;V Telephone No.(bustness) Telephone No. cell e-mail address SECTION 11:WO KE ANC FF1D V (M.G.L.c.152. 25C(6)) . A Workei 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? YetAK, No O SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(labor 'd Materials) Total Construction Cost(from hem 6) a f � 1. Building f • 17 Building Permit Fee-Total Construction Cost x _(Insert here 2. Electrical f appropriate municipal factor)=f 3. plumbing f Vote:Minimum fee f (contact municipality) 4. Mechanical (HVAC) f 5, Mechaniwl (Other) f Enclose check payable to 6. Total Cost f and write check number here t SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT Rv emeriti my name below, I herebv attest under the pains and penalties o(pequry that all of the Infurmaiwn a ,ntame, n this .Ipphcalwn 1.,true.lnd accurate to the beet of mY knowledgeand undvrslandmti. pi" . s a-ems.--- 78 YX wig' ��I� iI'L•.i.v pnnL.Ind •pn n.nna• / fitly frlrpht me \ iota• .. .brr 1pI Ira•. cit% . Gaan o Z, -- LOf All \lunicipal Illspectur to fill out this section upon application approval: \.line Il.i:a• 81 RAILROAD AVENUE ROWLEY, MA 01969 TEL 978-948-2005 FAx 978-948-7002 EMAIL JAQUITHARCHITECTS®MAC.COM DAVID F. JAQUITH , AIA 28 March 2011 Salem Building Department City Hall Annex 120 Washington Street, 3rd floor Salem, Ma. 01970 Re: Repair of roof truss Pirates Museum 274 Derby Street Salem, Massachusetts Dear Tom: I have reviewed the existing condition of a truss supporting end at the Pirates' Museum, 274 Derby Street, Salem, Massachusetts and propose that the truss end be repaired as it has been originally built. The condition that caused the rotted area will be repaired and roof/parapet repaired. I will coordinate with the contractor all the procedures necessary to put the truss back to it's original condition. If you have any questions, please give me a call. SOA in r y, i/ '� � �c�,y a I DAVID F. - Registered ct JAQUITH din Ne.2363 w +• !c Rowley, MA cc: Pirates' Museum =„„;'�w 4a ?Nor 0as' Enclosure: (Photographs) ai Jam . 1 '94 Yrs �I g rk .q 4 t ` �kii- _ , v � , r � A'_' t ' All OWN— Y k to y� '•5 V v b ,(' c. v s Jv\ spa y f a� 1 r •^k 3 �a Ate_ CITY OF SALEM, MASSACHUSETTS rrit BUILDING DEPARTMENT 9E"WASHINGTON STkEET,3-RD FLOOR TEL: 978-745-9595 KIMBERLEY DRISCOLL FAX: 978-740-9846 MAYOR THOMAS ST.PIERRE DIRECTOR OF PUBLIC PROPERTIES/BUILDING COMMISSIONER May 13, 2020 James Hurrell 14 Ocean BLVD North Hampton N.H. 03862 Mr. Hurrell This letter is to follow up on our conversation we had on the phone. As I made you aware a large portion of the brick facade collapsed at the building you own at 274 Derby St. in Salem Ma. I am requiring you to contact an Engineer to inspect the integrity of the entire brick façade to prevent any more collapses. Please send me an Engineers report upon completion. Also a plan For a repair of the collapsed portion of brick. Stephen Cummings Local Building Inspector (978)-619-5643