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11 DOW STREET - BUILDING JACKET P ii Dow 'sr:. " i �f 1 ,gOND1T�.�O CITY OF SALEM, MASSACHUSETTS PUBLIC PROPERTY DEPARTMENT 120 WASHINGTON STREET, 3RD FLOOR 27 SALEM, MASSACHUSETTS 01 970 TELEPHONE: 978-745-9595 EXT. 380 `�M�rrE ooh FAX: 978-740-9846 KIMBERLEY ORISCOLL MAYOR L March 25, 2013 C � To Whom it May Concern RE: 11 Dow Street According to our records, it has been determined that the property located at 1 l Dow Street is a legal grandfathered non-conforming five (5) family dwelling. This is to determine use only and in no way meant to confirm or deny whether said property is in compliance will all building, plumbing, gas, electrical, fire or health codes. Since ety, Thomas St. Pierre Zoning Enforcement Officer I RJS ROBERT J. SWAJIAN & ASSOCIATES, INC. INSURANCE ADJUSTERS 50 GROVE STREET SALEM.MA 01970 TELZPHONE(508)7"1.3811 FAX(508)741.3813 FORM OF NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASS. GEN. LAWS, CH. 1399 SEC. 3B TO: Building Commissioner or Board of Health or Inspector of Buildings Board of Selectman CITY (TOWN) HALL SAME addresses SALEM, MA 01970 i RE: INSURED: �_—LOU PROCOPIO PROPERTY ADDRESS: 11 DOW STREET POLICY NO: SBP 1449390 LOSS OF: 11 /8/91 FILE OR CLAIM NO• SEVERE FIRE - RJS-6118 Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1 ,000.00 or cause Mass. Gen. Laws, Chapter 143. Section 6 to be applicable. If any notice under Mass. Gen. Laws. Chapter 139, Section 3B is appropriate please direct it to the attention of the writer and include a reference to the captioned insured, location, policy nuanber, date of loss, and claim or fila number. ADJUSTERS TITLE: On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by first class mail . 11 /20/91 Robert J Swaji n, Adjuster o" 'ocr- Corneil Rd . 5452; 0 -4000 Danvers . MA (),1-9-223, 8 W- ( 508)') 7-2 X. 62170 Janu--r- 28 . 1992 RE : Building permit fc-�r 11 Dow -- tree-t . Salem . .11A To whom it may concern: When the contractor 1 :sired to repair -fire damage on the first floor at it Dow Street. Salem attempted to get a permit to perform the + work, he was advised that there is some confusion as to how many apartments are iocated at that address . r purchased the building in 1978 as a r," unit building . The building inspector indicates that this is a 3 unit building and the Assessors Office indicates that , according to his records , the building was listed as a 4 unit building in 1973 but they are currently taxing me on a 0 i_-,nit building. The buiLuing inspector nsvector. a(-.ivised me to get written st-atements from people who lived in the area who would confirm that the building was a 6 unit building prior to 1965 . 1 was able to find one neighbor who has lived in the area since 1960 and one who is familiar with the building, but has lived in the area since 1970 . Obviously there is a lot of confusion regarding the status of this building. I hope that this matter can be resolved quickly as there are tenants currently living in the other apartments who , thanks to your bureaucracy , are living under less than ideal conditions . I am confident that if someone of authority would simply take 15 minutes to inspect the building it would be evident that the construction of the apartments had to be done prior to 1965 (the plumbing and woodwork alone would indicate to anyone who had a modicum of building materials knowledge that these apartments had to be built prior to 1965 ) . Nevertheless , at this point I am only interested in rebuilding the damaged apartment and to bring it up to city codes . A quick resolution to this matter would be appreciated not only by myself but also the current tenants who are living there . I appreciate the fact that you must go through certain procedural matters but time is of the essence and I would appreciate an opportunity to discuss the matter with the appropriate city officials to resolve any issues on which we may differ. c 6 Si e Y, A " I rrlocokcof)"io CC: Craftman-Shipp, Inc . 11 Dow Street tenants ( 4) Hca CITY OF SALEM9 MASSACHUSETTS PUBLIC PROPERTY DEPARTMENT 120 WASHINGTON STREET, 3RD FLOOR SALEM, MAO 1970 � - TEL. (978) 745-9595 EXT. 380 FAX (978) 740-9846 STANLEY J. USOVICZ, JR. MAYOR December 3, 2002 COPY Wayne T. Hansen P.O. Box 8707 Salem, Ma. 01970 RE: 11 Dow Street Dear Owners: The basement apartment at 11 Dow Street is a grandfathered unit for the purpose of zoning. However, the State Building Code allows a dangerous egress to be called out at any time. The basement apartment needs a sheet rocked hallway to be constructed through the basement area to the rear stairway. Additionally, an egress window and window well needs to be constructed to establish an egress in the bedroom. A building permit will be required to update this work. Upon final inspection the apartment should be safe to rent. Sincerely, Thomas St. Pierre Acting Building Commissioner cc: Mayors Office Tom Phillbin Councillor Chuber Fire Prevention BOARD OFASSESSORS 93 WASHINGTON STREET,CITY HALL,SALEM,MASSACHUSETTS x,970 (508)745-9595 Ext.261 (508)744-5918 FAX �'cuvNs January 28 , 1992 To whom it may concern : The property located at 11 Dow Street (Assessors ' Parcel 134-0304 ) was found to be a four family house when listed in August 1973 as part of a city-wide revaluation program conducted at that time . Prior to 1973 , this office did not maintain any records on number of dwelling units in proper- ties in the city. It should be noted that the property card used at the time of listing was not signed by the owner ; rather the notation was made of "list owner" , indicating that the owner provid- ed the lister with the indicated information, including the number of units . However, certain notations on the card in- dicate that entry was gained at that time , namely informa- tion regarding special features in a second floor kitchen and the fact that no notation was made that the information was estimated, which was standard procedure when no entry had been gained . r y yours , L Peter M. Caron Chief Assessor Cit p of 6alem, Aaggacb gettg Public Property ;Department �3uilbing ?Department One balem Oreen 745-9595 (ext. 380 William H. Munroe Director of Public Property Inspector of Buildings j Zoning Enforcement Officer I January 23 , 1992 I Kevin Daly, Esq . City Solicitor City of Salem RE : 11 Dow Street ( R-3 ) Dear Mr. Daly: Will you kindly peruse the enclose data to determine the legal use of the above referenced property. Said property is located in an R-3 district ( Residential Multi-family District) . This is to determine use only and in no way is meant to confirm or deny whether said property is in compliance with all building, fire, electrical , plumbing or gas codes . Sincerely, �et�l�li�l �ll����eleLcC� Maurice M. Martineau Inspector of Buildings MMM:bms �l WIRD FIVE PRECINCT cls WARD FM PRZD=CNN No. Name of Person Listed Age Occupation I Ree. Last Year Nat'lty No.I Name of Nmea Listed Age Occupation Res. last Year Nat'Ity CONGRESS ST. R.Ennit ST. • h6, Caroms, Theresa B. At bas • 18 Jolet, Prances Teacher 1A Carnes, Alfred L5 Loa. via. 18 Beaueheaun, Ivatte Teacher • 18 Slowness, Maria Teacher DOW ST, 18 North, CLtre Teacher �, 16 Ayotto, DOLarm Teacher • U setkaskl, Tram 48 Plastica star. 11 Word St. • 19 PoGlarin, Alphonse L2 Shoe waw•. • U gotkownki, Carol• L4 Cleaner U Ward St. • 19 Pellerin, Claire 39 Ree. da. • 11 sotkasski, Peal • 19 Roy, Then" 52 Ree.win. • U Deschsys, Marguerite 61 At sae • 19 Roy, Maria H. 33 Bap•ria•. • U St. Joan,M. Irene 65 Bookkeeper • 19 Ray, Alice 32 CLsnar • U St. Jean, Annette 65 Clark • 19 Roy, M.Cecil, � ll Maguire, Aguas G. Clark • 19 les, Mary M. 23 Ca@hLr 38 Undue 9t. • •' U Hagnire,Madeline T. Clark • 19 Ise, Clara 60 At from 38 Gonion St. •`11 Psrismu, Aenu,d 67 Retired 32 Jackson St. • 19 Oaaketia, Ares 53 At 0as •.0 Parimau, Lam 67 At boas 32 Jackson St. • 19 Doucette, Herald A. 59 CmWst • IS-Lraque, Joseph F. 69 Saieemn • 19 Pelletier, Joseph R. 47 Harbor St. • 15 Lamqu•, Catharine 66 At bane • 19 Tardiff, With J. 47 Harbor St. • 15 Gsg000, Alm 63 Bank ecpl. • 19 Straw, Daniel • 15 Oagon, lea w anee u, • 21 Cloutier, Henry 53 M---4m at • 17 Labregm,Maurice 45 Mschlmst 32 Sala St. • 21 Cloutier,Mule A. 53 Sha war. • 17 Labraque, Amts 39 H.W. 32 Salm St. • 21 Fournier, Joseph J. 55 Lbarar • 17 McCarthy, Willies F. 55 Helium 21 Girard, Arthur 58 Maint.san • 17 McCarthy, era R. 51 At ham • 21 Girard, sralina 54 At ham • 43 Gagnon, Alfred A. Ll La. dor. • 21 Bedard, Ina 58 Hoop.win. 43 Gagnon, Lura 31 It uses • 21 Girard. Dolle • W Veaeki, genus 47 Pa utur • 21 Knight, Blanche 63 Waitress • 43 vemski, Elisabeth 37 H.W. • 25 Deseule, Tari" H. 78 ReUt•d • 51 Corvdu, Paul P. 39 Mechanic • 25 Daeuls, LGia 71 At Dam • 51 Corder, G,ariea 37 At ham • 25 Demul•, Blanche L2 At hos • 51 Cornier, Donald 32 Also. Aw. • 27 Demule, Albert 37 Meeh. spar. • 51 Cmeder, Irani• 29 Lab. skr. • 27 Demuia, Lim 35 It hoe • 53 Irwin, Ronald A. 26 Lab. "at. • 27 Gagnon, Albert 76 Retired • 53 &via, Lao P. 37 Fr. drlrar • 27 Ounce, Lads 76 At ham • 53 StsNCesles, Irtbasis• 66 At ham • 29 Cloutier, Alberts 26 H.W. • 57 Cameron, Arthur 56 Laborer • 29 Cloutier, "and 29 Shoe cutter • 57 Carron, Rose 58 At has • 29 Urifim, Andre J. 25 Tree surgeon • 57 Daly, IseGia 56 At has • 29 Darisea, Barbara 25 At has • 59 Riley, Joan P. 25 lea. w2. 30 Reruns, Adrian A. 57 Repa man 59 Riley, Glaris W. 24 At ham 30 Damm, J•sanie 50 At ham • 59 Charntte, Jomph 63 Janitor • )0 Bemns, Harass 21 Clerk • 59 Chaiette. Claunia 66 At ham • 32 leboauf, Lo 56 Elam rkr. • 32 lebasut, Gilberte 49 At ham HARBOR ST. • 32 Framr, George R. 47 Ls. ear. • 32 Trader, Cecil, L4 Waitress • 1 Lagos, Christos K. U Retired • 33 Rosiness, Luis 54 G. L skr. • 1 Larrabe•, Helen Cr.Bur.wkr. a 33 Robinson, Alb•rt1m 53 At tad 1 McIntosh, Alice Clark • 33 Robinson.Claudette 25 Clark • 1 Page, Irene Clark • 33 Thlbeult, Ower 69 Retired 1 Miley, Alice 44 Srperrisor • 33 Thim.1t, Elizabeth 68 At sae 1 man, Joseph 51 Janitor • 33 Gagn a, Hector J. 54 Machinist 1 Ouellette, Gerard 46 Clark • 33 Oagoao, Florence R. 52 H.W. • 1 Ouellette, Mule L. 76 At ham • 33 Gagnon, Gorge Z. 23 Elsctrlclan 1 Ouellette, Richard J. 35 Music teacher 33 Courcevarch•, Victor 74 R•Umd 1 Chandler, Anna 70 Dressmaker 33 Courtam,che, Adel. 68 At sae • 1 Martineau, Raymnd 39 Engineer • 33 Tsrnosnkl, &dLla 58 Ret. aur" 1 Marelroau, Auatte 39 Teacher • 33 Landry, Clarina 79 At ham 1 Goldstein, Mary At ham • 33 Ma,dsvills, Jam 24 H. W. 1 1 Goldstein, Annie Saleslady • 33 Nuwerille, Gorge J. 27 Techolclan 1 Poltras, Edeond 70 Retlred 34 Litwin, Edward 22 Machlalst Peabody • 1 Poltras, Marla A. 71 At has • 34 Stoard, Rem L. 42 Painter 1 Lagos, Sophie 58 At has • 34 Simard, Marl•L. 41 At boas 1 Lagos, Castes 32 Chenint • 34 Caron, Stanislas 53 Machinist • 1 Morin, Prod[L. 66 Retired 36 Man, Arthur 29 Munger 1 Morin, Lura 63 At boa 36 Dian, Audrey 29 At has • 1 Mahaay, Arthur 65 W. wkr. •361 Le8.1,Mabel 1 Mahoney' samb 61 At ham • 37 Bmlay, Wilfred 64 les.wkr. 1 Pelletier, Rita 26 Electron, wkr, 19 Forest Am. • 37 Beeley. Lillian 6l. Stitcher • 11 L'Italt•n, Robert 48 Tari driver 37 Man, Wilda 85 At Use • 11 L'ILalisn, 11133aa L4 It has a 37 Renville, Lads Charles L 54 52 Cashier 11 Provost, Lucille 23 At bonKul, al dr. • 11 Provost. Donald 26 orderer • 37 Marquis, Kul,R. 44 lase. w . • At • 11 Belanger, Bvalids 63 Retired • 38 NMIAlexander 48 Carpenter • 11 Voyerr Arthur J. 65 Retired • 38 NaLn, Josie At h 44 At sous • Daimler, Adolph D. 86 Retired • 38 Allain, , Ra Joseph 45 Shoe War. 117 Congress St. U • ll Plourde, Alice 41 41 Hasp. war. • 39 Beaulieu, LO Clerk _ • 15 Gunther, Robert H. 33 Cab. nfr. • 39 B"u11su, Annetta 45 At hon ' • 15 Daaracher, Ann V. 33 At ham • 39 Suellen, Ross M. 72 At ham 15 Harrison. W1111" 25 Ls. war. • 39 Novell, WIIU=P. 46 W.wkr. • 15 CeullLro, Aurcre 68 At ham 39 Ogosnde, Felix 34 Lest. Ww. 15 D'Orstlo, Val 46 Self am.la"d 39 Oquaado, Juanita 25 At sem 1 l.5 Means, leresto 07 Retired • 39 Whltcas, Dorothy • IS Sullivan, John J. 69 Retired • 39 Bahner, Lmrier 25 Shan rkr. • 15 Husiafa, Must 68 Retired • 39 Collin, Phillipe 22 Rspatman }t{ a ' 15 Rsimill•, Coned 78 Retired • 39 Collin, Carol 22 WatLrsm }�y • 15 L+bets,Max Retired 39 Arroyo, AcpLa 30 Last maker 1B Bull, Atlee 54 Teacher • 3 Arro7o, Priscilla 26 At ham 18 Bsrert. brialla 52 Teacher •3 Pallia. Tunas C. 25 mG • 18 Carols, fatia 49 Teacher 3 tallis, Patricia 21 • 18 Gages. {waw 47 Teacher •3 Belanger, Albert L 53 0. L woe. • 18 La�nilr, Jea®ett• 49 Tests" 3 Belanger, Lon 48 At bas i • 18 Tetreslt, Glaris 37 Teacher 3 Belanger,Richard Plastics mr. + LB Gnat, ma 60 Teacher •3 nahert7, Francis 40 Plaber Franklin • 18 Richard@, Alice 42 Teacher •3 Flaherty, Rath 31 At tons Tranklin • 18 Terris, June 28 Teacher 4O McGough, Am 36 H.W. 709 Corless St. • 18 Marette, Joahm 65 Principal 40 MCGagh, Joseph 38 Tr. driver 109 Congress St. IS Turgean, Kms 80 Teacher • 41 Decowtll, Donald 33 las.,dor. • 18 Cassrarn,Aures 67 Teacher • 41 D@aanlG,Myrna 30 At ham 18 Cote, Iaclenne 65 Teacher U Cross, Karam 25 At ham 18 Taalgeaot, Jaannatbe SS Teacher 41 Seldom, SL a Z) Shoe wtrn • 18 Want, Aurora 59 Teacher l.3 Belanger, Francis 22 Shan ski. 18 Bolavert, Lorette 60 Cook • 41 Iarepus, Jeannette 45 At boss 'l 16 Cassette, Cecil@ 53 Teacher • 41 Johsont Sonia 30 gGeatm.wn•. • 18 Bonin, Stas 53 Teacher 41 Johnson,Girard 22 7m. ski. 18 labells, Anita 53 Teacher • 41 Naama, 16111u B. 44 Maintsr .fir[ • IB St. Larent, LGllies 49 Teacher 41 Nadeau, Darls 40 At has , 41 film, Albert T. 64 Chesffeur 1B Beyer, Laarentla Teacher 1B 41 Tltas, Moans 56 At bas i 25 Ilarial.Marla Teacher k i Comments on the enclosed, Board of Asse«:ors letter iated 1 !28/92 . 'when I went t4 ?i:, nrma tion ^ r i he assessors Office it was _lear that there was Some .:on cern as _o what might b ....:2?"2^.terized as the " 2utho.ritativeness" of the :.1 ,:,men+- which Mr . Caron used to base his judgement . Mr . Caron suggests that the person filling out the report had made a first-hand physical inspection of the building because there were some scribbled notes about the "special features in the second floor kitchen . " I question how a competent inspector could have gone through the whole building and not conclude that there were six units there . Again, it is evident even today , if only someone would take the time to .inspect the building, that there were 5 units ( .aaain based on the construction materials which are still in place) . I suspect that the information provided by the owner was less than complete to minimiZe the assessment of the property . The point I- want to make is there is enough bad record-keeping from all the city offices to warrant a face-to-face meeting with someone who can make decisions in the interest of the city , myself , the tenants and neighbors . Failing a quick and reasonable resolution to this matter, my only course of action is contribute to the decline of the Point neighborhood. My intent is to repair and upgrade the building and that is why I hired a reputable contractor to do the work according to city codes . But I am going to need your cooperation . r \� gig y gig c !! �� /!/S. )."„..IY�pp����••lM{{<y 11.o;'�]��uyylM,.l�..1.pleJ��!pp ��pp n !!...4.{!{�!{{.� ll.1l� ,�11 l ..lpp..yppJ � �!p!!p.!p !{.I,{...{ ylhilWill,is!l mj6111.MM M1ti� 5� " 19MA4 !< !, !,!AlKJ l< �l9l�m�1Y Q , 1V V�`O.ONN'ONNPV.Y`°NbN�F]��J'n�N-1N•]I~•.NNN1�V]II\]I.Nh.�]N�N]�I]N VIVn1m NNNNN�NI.1�NVaa�������N�n��1-���.'�•�I�vnn'.�.�•���1��`.�1'����nh>NY,1�N�.�Qi.'r}nn a .� •� Ni N � ; o n! `o Ia I o �4T s 4. A aT �a3 a u o i asa��� �� .R°•1°.inl°!°•1gin..f°.1100tjddodiAte`AS.1".!'`1! 2. R121p?)P?)APX?l".M�"2^�^^nR.^17RLtZ1���R��1nCfin � ��"��m>.yy� o nnn nnn nnnn Z L N YU A d } J l 1 •r o yy yG8 !lu_S�f n Oa ��UNy��_...MKp°..FO1 b.g°p`OJKNVllY6GGG\G] VKU'lxx•KJ..<JIlrrr---111 Y1 `OM. .!,.IAlJEfpy ,1 ._..1A(I1Y 3 31 Y s•� P�o!„}a,�B.1 C p°pa.ppI y�t p(y.I �! l . H.y�F mFg{M4 vSagy4ryym"t.. rWSbbY4!�4NN 37yy.-3 n18 FH.GGHyy{tO.]yH°�H H.fp..fp•GN8�Ir� pGG!I<M.� /]tmum V`O.Ob`D ..:I�t-�M1M1.V�n.�'I•'J .OJN1.~t�`OVI`OVJ"ND`ND`OV.�FF FJw�InNIN•.NVV.aNa�IILY J'1V4.0FV.O�b�NN�.•~]I.V]�3NC1.. O 1 9p C $ 9� 1° u`;0�9 � • a �$ � x o•; ' Y {o n; �� n (y o.�.4 � .S�a d6 lid �, t, 5� ° � �� �� y"� ♦ �� {{tlOG.� -�y 9y\[9 9S�■1 � �[{ �e ti -���•e!•{ {e��; a�,B .Y.I1.1.y.G.1,N1.N.1.y X41 vNt V V . C1 'Y�Yr L•�0 "LI U U�� Y.i�TL �f f) 01. .].1 � V A 4]m .i 1I p U O V (P(V lit 4p 6pp+f !.-I ry rl.iri.i ei ei'I.�r-1.-lri.riNr�-I.iN�l.i ti.i�r•�>UUUNIi]�V.Y.V.G„]�.PN rlri X1.1.4 r1 M.-IMr"IN.-I ri tel.-I.I..I�I.I�r'Ir1'i.-I�I pI.i.1.1.Y�I r���Nr"1'{.Y.-I ti�-I.i�e1 e1'I M.Y .414/4II�.y.-1.-1.-I.'i.'IM��.Y.-I II'1.'1 0• Z 1 ••t t•••M O M O 6 O i O O tr••O • •••t w• •••O•4 e ♦••••• O 1 w•. • O •!n• l••f•t••♦ •• • • •♦ ♦1 1♦♦♦• ♦ ♦ ♦ ♦♦♦♦♦ CITY OF SALEMe MASSACHUSETTS v6,�cono�r a '. �. BOARD OF HEALTH �°�. 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 '�'f'ge��M1N6 TEL. 978-74 1-1800 FAX 978-745-0343 STANLEY LISOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT July 23, 2002 Wayne Hanscom P.O. Box 8707 Salem, MA. 01970 Dear Mr. Hanscom: In accordance with Chapter III, Sections 127A and 1278 of the Massachusetts General Laws, 105 CMR 400.00; State Sanitary Code, Chapter 1: General Administrative Procedures and 105 CMR 410.00: State Sanitary Code, Chapter 11 Minimum Standards of Fitness for Human Habitation, an inspection was conducted of the property 11 Dow Street-#2L 1 occupied by Diane Defazio conducted by Jeff Vaughan, Senior Sanitarian on Monday,July 22, 2002 at 3:10 P.M.. Notice: If this rental unit is occupied by a child or children under the age of 6 years, it is the property owner's responsibility to notify tenants of lead related reports and tests, and to ensure that this unit complies fully with 105 CMR 460.000 : Regulations for Lead Poisoning Prevention and Control. For further information or to request an inspection, contact the Salem Health Department at 741-1800. You are hereby ORDERED to make a good-faith effort to correct the violations listed on the enclosed inspection report. Failure on your part to comply within the time specified on the enclosed inspection report will result in a complaint being sought against you in Salem District Court. Time for compliance begins with receipt of this Order. Should you be aggrieved by this Order, you have the right to request a hearing before the Board of Health. A request for said hearing must be received in writing in the office of the Board of Health within 7 days of receipt of this Order. At said hearing, you will be given an opportunity to be heard and to present witness and documentary evidence as to why this Order should be modified or withdrawn. You may be represented by an attorney. Please also be informed that you have the right to inspect and obtain copies of all relevant inspection or investigation reports, orders and other documentary information in the possession of this Board, and that any adverse party has the right to be present at the hearing. Please be advised that the conditions noted may enable the occupant(s)to use one or more of the statutory remedies available to them as outlined in the enclosed inspection report form. For the Board of Health: Reply to: Joanne Sc o Jeff Vaughan Health Agent Senior Sanitarian Certified Mail to Owner: 7001 1140 0000 6731 2797 Cc: Bldg. Insp., Electrical Inspector JS/sik c-h-violet CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 'i 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 s�� 4 TEL. 978-74 1-1800 4 FAX 978-745-0343 Page 1 of J STANLEY USOVICZ, JP JOANNE SCOTT, MPH, RS. CHO M 4YOR HEALTH AGENT State Sanitary Code, Chapter I): 105 CMR 410.000 Minimum Standards of Fitness for Human Habitation Occupant : Diane Defazio Phone: 978-740-8959 Address: 11 Dow Street Apt.# 2L Floor 2 Owner: Wayne Hanscom Address- P.O. Box 8707 Salem, MA. 01970 Inspection Date, July 22, 2002 Time: 3:10 PM Conducted By: Jeffrey Vaughan Accompanied By: tenant Anticipated Reinspection Date: Prior to re-rental. Specified Time Reg.#00..' Violation(s) Based on a tenant complaint an inspection was conducted in accordance with Article 11 of the State Sanitary Code 105 CMR,410.000. 7a Upon inspection the following were noted: e i'✓ w W /1¢�o loce o,q i AttT7 : . —ae 2Q c.0 iLo liti G one or more of the above violations may endanger or materially impair the health safety, and well being of the occupant(s) Code Enforcement Inspector Sr. Sanitarian Este es documento leqal importante. Puede que•afecte sus derechos. Puede adquirir una traduccion de esta forma sies necesario Ilamar al telefono 741-1800. Appendix II (14) Legal Remedies for Tenants of Residential Housing The following is a brief summary of some of the legal remedies tenants may use in order to get housing'code violations corrected : 1. Rent Withlioldine(Massachusetts General Laws, Chapter 239, section 8A): If Code Violations Are Not Being Corrected you may be entitled to hold back your rent payments. You can do this without being evicted if: You can prove that your dwelling unit or common areas contain code violations which are serious enough to endanger or materially impair your health of safety and that your landlord knew about the violations before you were behind in your rent. You did not cause the violations and they can be repaired while you continue to live in the building. You are prepared to-pay any portion of the rent into court if a judge orders you to pay it. ( 1=or this, it is best to put the rent money aside in a safe place) 2. Repair and Deduct(Massachusetts General Laws, Chapter III, section 127L): The law sometimes allows you to use your rent money to make the repairs yourself. If your local code enforcement agency certifies that there are code violations which may endanger or materially impair your health,safety,or well-being,and your landlord has received written notice of the violations,you may be able to use this remedy. If the owner fails to begin necessary repairs(or to enter into a written contract to have them made)within five days after the notice or to complete repairs within 14 days after notice,you can use up to four months rent in any year to make repairs. • , 3. _Retaliatory Rent Increases or Evictions Prohibited (Massachusetts General Laws,Chapter 186, section 18, and Chapter 239, Section 2A):The owner may not increase your rent or.evict you in retaliation for making a complaint to your local code enforcement agency_about code violations. If the owner raises your rent to try to evict within six months after you have made the complaint, he or she will have to show a good reason for the increase or eviction which is unrelated to your complaint. You may be able to sue the landlord for damages or if he or she tries this. 4. Rent Receivership (Massachusetts General Laws Chapter Il, section 127 C-H): The occupants and/or the Board of Health may petition the District or Superior Court to allow rent to be paid into court rather than to the owner. The court may then appoint a"receiver" who may spend as much of the rent money as is needed to correct the violation. The receiver is not subject to a spending limitation of four months'rent. 5. Breach of Warranty of Habitability: You may be entitled to sue your landlord to have all or some of your rent returned if your dwelling unit does not meet minimum standards of habitability. 6. Unfair& Deceptive Practices (Massachusetts General Laws, Chapter 93A) : Renting an apartment with code violations is a violation of the consumer protection act and regulations, for which you may sue an owner. The information presented above is only a summary of the law. Before you decide to withhold rent or take any other legal action, it is advisable that you consult an attorney. If you can not afford to consult an attorney; you should contact the nearest legal services office, which is [Neighborhood Legal Services 37 Friend Street Lynn, MA. 01902 (781)-599-7730 r CITY OF SALEM HEALTH DEPARTMENT Salem, Massachusetts 01970 Page a of q Date: 7/�, /o, Name: ��=Fizz, v Address: // Specified Time Reg.#410.. Violation(s) Gc.tir-i go az, rce i[o a /.v Arj c Nd C 7a 70 77 72ec `G/7c Com-STia � � ewe a�7 !• � cls '�....! �I✓9G L Nom+ `` -- COc� Ci.A/ .2AG` �" Z 1 CITY OF SALEM HEALTH DEPARTMENT Ji • ifs Salem, Massachusetts 01970 Page 3 of Date: /a Name: Address: Specified Time Reg.#410.. Violation(s) PIA'b,l �' •r�e ,1 STOD N e /q� .✓T '_ •af � w W /� PYA e i ' 02 is i j Td� G' Fe AN� C l Ca /uo. 77i2 � � , __w=,;. � _ y� —/ /N 7.H /� ,' 6 A�Sa �'C/.E�/G ..,G7Ts.✓ 7lG.�id I CITY OF SALEM HEALTH DEPARTMENT . a fla Salem, Massachusetts 01970 Page of Date: �/aa 10.z Name: Address: // /bo w ST--r_e=r Specified Time Reg.#410.. 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AGE OCCUPATION NO. NAME AGE OCCUPATION Res.1963 Nat'Ity N0. NAME Res.1963 Nat'Ity CONGRESS STREET - HARBOR STREET Eva 6 T ."%Z&nua a 46 Carne eu, Therese B. Le Home a 18 LavvaalliGo Jeanette 4'.+ -'xacher-nun 4b Corneou, Alfred 411 Lea. Wkr- a 18 Tetrault, Gloria 32 Teacher-nun DOW STREET IB S`.Piorre. Maroollin 25 Teacher-nun Petersham Can. 18 Gens at, Emma 59 Teacher-nun Millbury 0 11 Deschamps, Marguerite 60 At Home 18 Letourneau, Hilda 48 Teacher-nun N.H. e ll St. Jean• M. Irene 64 Bookkeeper 18 Dueheaneau, Germaine 43 Principal Potersrhomga 0 11 Sc. Jean, Annette 65 Clerk 18 Brouillard, Rossi 44 e 11 Maguire, Agnes G. Clerk 18 Richards, Alice 44 Teacher Conn. 18 Turgeon, Yvonne 44 Teacher Southbridge o 11 Duff, Madeline T. Clerk 18 Terric, June 27 Teacher Southbridge 0 11 Duff, Beatrice 51 Inspector le Maher, Joan 26 Teacher Lowell a 15 Laroque, Joseph P.ne 68 Salesman 19 Douoetts, An., $2 Atr Nome 0 15 Leroque, Cather lane 67 AL Home a 15 Gagnon, Aimee 62 Bank Empl. 19 Novak, B Harold A. 58 Machinist achiChemist Saugus e 15 Gagnon, Anna 60 Shoe wkr. 19 Novak, Bemis 45 Housewife N.H. 17 Darr ish, Rita 39 Assembler 19 Novak, Ora 52 Housewife 0 17 Castonguay, Joseph A. 65 Shoo Mfg, • 19 Pellerin, Alphcneo 41 Shoe Yorker e 17 Caatonguey, Melvin 63 At Homo • 19 Pellerin, Claire 38 Elect-Ykr• 0 17 Ca,tonguay, Roger 45 Chemist a 19 Roy, Thsrssa 51 Eleet.Ykr. Castonguay, Shirley 41 17 Shoe Wkr. 0 19 Roy, Marie H. 32 Homp.�'• 0 17 McCarthy, William P. 54 Minn • 19 Roy, Alice 31 Cleaner 19 Marquis, Robert 39 Battery Comp. 0 17 McCarthy Eva R. 50 At Home • 19 Marquis, Jeanette At Home 17 Keough, Theodora 70 At Home 19 Howard, John a 43 Gagnon, Alfred A. 40 Lea. Wkr. 21 Olrard, Arthur 57 Maint. 47 Gagnon, La,,ra A. 31 At Home At Homa Vaneskl, Edward 46 Painter 46 Forrester • 21 Girard, Evallw 53 Hoa Win'. 43 Vaneskl, Elizabeth 36 Housewife 46 Forrester • 21 Bedard, Anna 62 Waitress 0 51 Cormier, Pail P. 38 Mechanic • 21 Knight, Blanche 2 Machinist e 51 Cormier, Genevieve 36 At Home • 21 Cloutier, Henry $ e 51 Cormier, Donald 31 Else. Wkr. 0 21 Cloutier, Marls A. 52 Shoo Yorker • 51 Cormier, Yvonne 28 Lab. Wkr. a 21 Fournier, Joseph J. 54 Laborer e $3 Erwin, Ronald A. 25 Lab. Ase't. • 2$ Demeule. 2aris H. 77 Retired a 53 Erwin, Leo P. 36 Truck Driver • 25 Desuule, Zslla 70 At Home • 53 Stanklewlcz, Avthemise 66 At Home a 25 Demoule, Blanche 41 At Home 0 57 Cameron, Arthur 55 Laborer • 27 Demeuls, Albert 36• 27 Demouls, Lina 34 At Home Maoh.Opsr. o $7 Cameron, floes 57 At Home • 27 Gamin, Albert 75 Retired • 57 Daly, Eme1La 5$ At Home a 27 Gagnon, Leda 76 At Rome • 59 Riley, John P. 24 Lea. Wkr. aa 29 Cloutier, Alberta 2$ Rousew ifs 42 Hazel • 59 Riley, Gloria W.Joseph 23 At Home 62 Janitor • 29 Cloutier, Raymond 28 Shoo Cutter 42 Hazel e 59 Charrette, Claudia 29 Darien, Andre, 24 Tres Surgeon • 59 Cherretce, Clde■ 6$ At Home • 29 Dorian, Barbara 24 At HOMO HARBOR STREET • 30 Berube, Adrian A. 56 Repair • 30 Berube, JOamils 49 At Homs e 1 Larrabee, Helen Credit Bureau • 30 Berubs, Norman 21 Clerk Wkr. • 1 McIntosh, Alice Clerk 100 Lafayette • 32 Labour, Leo Bleo8 At Homs e 1 Page, Irene Clerk 173 Lafayette • 32 Labour. 011bort• 46 Ua.Worker 1 Burke, Willi= Teacher Beverly • 32 Fraser, George R. Waitress 1 Burke, Dolle Bookkeeper Beverly • 32 Prager, Cecil* 43 1 Miley, Alice 43 Supervisor • 33 MandOT1110- Jen 23 Housewife 4 4 Woodside • 1 Dion, Joseph 50 Janitor • 37 MacutevillO, GsorgO J. 26 Maohlntainio la 266 Washington • 1 Ouellette, Marie L. 75 At Home • 33 Gagnon, Rector J. 53 ♦ 1 Ouellette, Gerard 45 Clerk • 33 Gagnon, Florence R. 51 Hou *wife 266 Washington • I Ouellette, Richard J. 34 Music Teacher • 33 Gagnon, George S. 22 Blsetrla len 266 Washington • 1 Chandler, Anna 69 Dressmaker • 33 Robinson, Luis 54 0.8. • 1 Martineau, Raymond 38 Engineer • 33 Robinson, A1DOl•L 1aO $2 At Rome, e 1 Martineau, Annette 36 Teacher • 33 Robinson, Claudette 25 Clerk • 1 Goldstein, Mary At Rome, 33 COurtaanoW,Vtotor 73 Retired e .1 Goldstein, Annie Saleslady 33 Co•Artmancho, Adele 6) Retired At 0 1 Pottrea. Edmond 70 Retired • 3) Landry. Sialine 7 68 Re8 Re Home e 1 Pottras, Marie A. 70 At Home • 33 Thlbault, Omer t tired • 1 Poltres, Ferdinand 31 Elea. Wkr. • 33 Thibault, Slissboth 67 At Homs a 1 Lagos, Cristos R. 73 Retired o 33 Thibault, Laurent L. 46 Pediatrician • 1 Lagos, Sophie $1 At Home 3} Parent, Aleide 68 Retired • 1 Lagos, Costs )j1 Chemist • 34 Caron, Stanialas $2 Machinist • 1 Morin, Prank L. 66 Retired a 34 Simard, Rene L. 1 Painter 1 Morin, Laura 62 At,Homs • 34 Simard, Marti L. 40 At Rome e 1 Mahoney, Arthur 64 Lea. Wkr. • 34 POttipas, Harold 25 Engineer )3 Kerber • 34 pettipao, Arlene 25 Housewife )3 Harbor • 1 Belanger Sarah 60 Re Home 6 4 11 Belanger, Eyelids 62 Retired 139 Ocean Avo. • 3 Dion, Arthur 28 AtnHome 4 Hazel • 11 Vo ser, Arthur J. 64 Retired Hazel 36 Dion, Audrey e 11 Provost, Donald 25 Tr. Driver 36 Armstrong, Robert 26 Veu1E Mtg. Essex • 11 Provost, Lucille 22 At Home 36 Armstrong, Betty 22 Housewlts Sass= • 11 Cormier, Adolph D. 85 Retired • 37 Bouley, Wilfred 63 Leatbor Wim. Stitcher • 11 Plourde, Alice., .41 Hoop. Wkr. • 37 Boulez Lillian 53 Funeral 1$ Lubets. Max Retired • 37 Banvll�O, Chanloo Z. $3 Cashier Director • 1$ Dsarochar, Robert N. 32 Cab. Mfg. • 37 B■uville, Lada 1 Cashier • 15 Desrocher, Ann& V.' 32 At Home 37 Dion,Marquis, Mario 4 At Beme . 0 15 Rainvtlle, Conrad 77 Retired • 37 iletio Marti e. 3 Retired O 15 Mustafa, Most' 68 Retired • 3 POlUtier, ]!>•llo. 6 Retired • 8 8owlan, Alexander 47 Carpenter r sspp • 15 Sullivan,, Aurone 68 Re Hou 3 At • 15 gull lean, John J. 68 Retired • 38 Burlap, 818aO 43 15 value, Joan • 39 Bquliw, Raymond 39 Alert )9 Beaulieu, Annette 44 At Hose 15 Dionne, Lorene 6 Retired • 39 Beaulieu,.Rose M. 45 Le Home 18 Turgaon, t—,Jom64 TeachPrincer-npalun a 39 Sowell, William P. tattier Worker 18 Turgeonr Emma 79 Teacher-nun 39 Whitcomb, Dorothy ♦ 18 Cauv■nt, Aurora 66 Teacher-nun Belanger Laurier 24 Shoo Yorker 18 Cots, Luconne 65 Teacher-nun )1 Belangor� Patricia 21 Shoo Worker 18 gousignant, Jeanette 57 Teacher-wan Lynn • Is ramie,Aarore 58Teacher-aum 39 SuoWr, Winston 21 Lather Worker 39 Collins, Phi111pP• 21 Repairman California 18 Botsvert, Loretto 59 Cook )q Coll ihs, Serol . . 21 Waitress Cdltornla f 1& B61sclair, Aurora 68' Reacher-nun Foal 18 Gossett*, Cootie 52 Toaoher-wan 39 Ch16as,-Pauline 26 Wsitresrt ion. b�bodd� • 1& Bonin, SemoImO 52 TOaoher-nun • j Belanger, Albert 8. 52 G.S. 18 Labelle, Anita 2 Tnohsr-nun 3 Belanger, Lura 47 At Rome a 18 St. Luront, Lillian $48 TosoWr-man - 3 Belanger, Kenneth 23 Maoh.Opr. 18 Buil, Alice 53 Teaohsr-nun 3 Bslsngor, Richard Plastid Wkr. I 18 Boisvert, Oebr1O11O 551 Teacher-nun - 39 Arro7•, Angelo 29 Last Maker • 18 Contois, Yvette p8 Toacher-mun 9 • Dentes a Voter a Denotes a Yo1or )/ 1 I Aga _ ell■aaa�'� Io Whom It May Concern: having lived in or around the Point Neighborhood inISalem, 'Massachusetts since 1 y D do hereby affirm that , as far as _ can remember , the property located at ii Dow Street , Salem , MA . County of Essex, has been used as a six (6 ) family dweiling since the above date . 7.@:natLtre : ,� 1Jate Name ( Print) : ��/-'r, T /.'E t4'�? , Address : n!157 Y�I t» ;1 City : Salem State : MA County : Essex Zip: 01970 .o Whom it May Concern : .i-eIY: :: having lived in or around the Point cieighbo.rhood in Sale Massachusetts since / % e do hereby affirm that , as far as I can remember , the property located at it Dow Street . Salem. MA , County of Essex, has been used as a six (6 ) family dwellina, since the above date . �• y I "ignature : _ Date : Name ( Print) : //�'��� /�% . � bt-e --o Address : ell L-1 .51-/ f' elL j.y 4-. i�7 ✓ ��i j 7� City : Salem State : MA County : Essex Zip: 01970 I WARD 5 PRECINCT I No. I Name Age i Occupollnn Res. 1971 I Not lty No. Name IAye Gccuyotion Ras. 1911 Nat'Ity 1 HARBOR ST. tante. DOW ST. ♦ 11 Cobb. JAm., 11. 26 � ,sl.�nnt rel IS ..^.e nx h.n aux. Ce n':.rC'64 Ttteher Canadian • 11 Cobb, Jecaveline C. ?7 Selesl,dv I • 18 Moreau, Merle a 70 TeaHoucher • ll Deschamps, M•reuerl[e 71 at nmm. • 18 Poirier, Anita A.�e M. 62 Teacher • II Kotkovki, Carel 15 at na-.e 19 SercLabeier. Anita A. 61 Cook • II Kotkovskl, Yvonne 56 A..,.Ier :9 9er<he r. Therese M. 57 Teacher ♦ and57 Clerk I L9 "*'h' ¢e, Rice 11 Raymond, 77 Teacher Gertrude a , Annette 74 Bkor. 1fl Monetce. Rite J. 71 Teacher ♦ 11 • It St.Jenn, An Irene 76 at hnma 18 Shertden, Nencv Y. 26 Teacher M. 13 Luerttn. Madeleine M. 24 Teacher -- • 15 Go non. Atme 70 Sank Clrrk � a. 56 RetLred • 15 Gagnon, Anna n8 Retire, 19 Bloi9 Blois. Anastasia ala M. 54 at her Roland • 15 L.rocq.e, Josech L. 76 nL home 1 ♦ 15 Laroc9 ue, Catherine N. 76 It name I 19 Pellerin, Alphonse ,0 Shoo Wkr. ;+ Pellenn. Claire D. 48 Shoe Wkr. l7 Cecelattl, DianeWilliam at 1'a. 64 Elect.Wkr. l7 Cecelotc 1, Diane at name 19 Ravi Thereon M. • 17 Rnu lay, Albert 70 Reti ro9 19 Pouc t , Anne E.lie 58 at home EO at home • 17 Healey, Blanche n. 64 at hnma i4 Dnueecte 17 Thertaulc, Email 16 °ricklevar ` ! DA.cette, Herold A. ES Retired i :9 3e u,l leu, 8avmond L. 17 Clerk 17 Therlsulc. JoycelyMaurice 24 Student ♦ 17 Isbroc tae, Maurice 57 At F.. Hen I 19 El11 lis. CharleneClerk • 17 Labrecque, Anita C. 47 ,r hmme I . 21 Cloutier nHenry E.1 MaehlnL¢ • 17 Labrecque, Delores ?4 Sec'. 65 Melat. Man Il Girard, Emile • 17 Labrec9ue, Victor 11 2I G rard, Evelin• 61 ac home 17 Labrecque, Leurelle 19 •^d•nr I :a at home • 47 Veneeki, Edward J. am It ne ?1 ,dud, Annie • 47 Gagnon, Alfred J. -F. !nether W,r. 1 tl :nianc, Blanche :1 at home 47 Gagnon, Laura ''• at none Dmeule, tells :9 at home 'tudent + Jmeule, Blanche 49 at home • 47 Gagnon. VEduare ? +_: n-c, Louts. J. 72 at home N.Y. • 47 Veneskl, Eduard -'S Pointe r. 43 Ven saki, Elhab stn '•5 it name I 27 see anus, Mlehael 20 Welder 21 c y: • 47 Veneeki, Patricia '1 8aev 2] Lo Ves0 ua•EMary J. 47 Retired • 51 Co smier. Donald .4 Lamp r4 r. I ?7 :hrdlff, • 51 Cone Ler, Yvonne AS at hmM e P•Ilrtler, Joseph R. .`0 ec • 53 Dube, Yvonne M. 74 at hnne I 21 MnrcLre... Neurite M. IB Mechanic lc • 53 Erwin. Leo P. 4' .lass k'kn I • 19 mirtineau, e. Cecllia L, 56 at home • 57 ErviRonald A. 71 tae. A.vr. 'laxer. :!amid J. 14 Student • n, 32 %seer, Caroline M. ?3 Teacher 57 Stenklevler. Lrthemise 74 It home i Adrian A. 57 Repairman • ., Het 1.cd '.,rube, 57 Gaston. Dorn i ,; 50 ec Aaeu e • 72 1„Ya eta i. Len J:- • 57 McNiff, Jeannette a. b0 •.c homI . -" .scabs, J • 57 Le Bhome lond, Yvnnn• a9 ac home Len 53 Glass sun • 57 Deschamps. Claire r. 7) ac nom. • 77 LOHA ref. Gilberts i6 et ho • 59 Averts, MArle r•d ac home 37 R,ntn,on, Louie W. 51 C.E. Wkr. 59 Stanley, Hinllred Look Ji Robinson, Albertine G. 50 at home 17 Robinson, Claudette 37 Bookkeeper HARBOR 511. 77 I;aRnon, Florence R. 58 at home 77 Land rv, Clarinda 35 at home 1 Tassinari, .ams 80 at home 37 Cormier, Ilsiee L. 51 It home • 1 Lo Roe, Stalls HD Retired 73 Lennard, Anna 79 at home 1 Spvropolous. Inannle JO Dent.Te:h Greek 77 Strom, Olaf D. 68 Retired 1 Spy ropoloun, Ca[nen ne 70 Stitcher Greek I : 73 Strom, Annette B. 67 at home • I Caron, Dellma 7n_ a[ none 77 Ouellette, to H. 50 Plumber • J7 Ouellette, Carolina 0. 48 at home 1 Tremblay, AnPellne M. Ad at home • 70 Retired 77 Ouellette, Theresa M. 21 Stewardess 1 Miley, Atlee L. • I Dion, !Aleph :8 Ro ap.Wk r. J4 Simard, Rene L. 57 Painter • m 34 Simard, Marie L. 57 at has I Ouellette, Gerard 52 Clerk . • )4 Slrre, Raymond Ll9 Student 1 Ouellette, Richard J. 42 4ue1c Teecner • E. • 1 Ouellette, Merle L. 87 at home • 34 Caron, Stanislas 62 inspector a 1 Martineau, Raymond W. =6 Elect. Engr• 34 Litwin, Edward W. 29 K.Chlntat • I Nattiest., Annette 1. 46 N.W. 74 Litwin. Dorothy R. 26 at home • t Goldstein, Mary ]fi at home J6 Lanett, Helen As Shetland l Goldstein, Ann 7.. at home 36 T•ainor. Mildred 42 at home IS Planar a t Mahoney. Sarah 68 ac home 7611 orillls. Coral. 31 at hoer Bsckac St. • 1 Pelletier, Rita M. 76 Else. Wkr. I • 37 Beeville. Emile C. L. 59 Fun. Dir. !ll���SSS"` • I McIntosh. Alice J. Clerk • 37 Beeville, Load* L. 56 at hoe 1 Genaac, Roger 57 Meat Cutter • 77 Tremblay, Yvette 64 at home 11 Dupleasia, Blanche 62 Hasp. Wkr. • 37 Girard. LudRer 69 Retired • 11 Cormier. Rather& b9 Retired 77 Smith. Rose 62 at home • 11 Voyer• Arthvr J. Retired 77 Fraser. Cao. H. 61 at home • it Plourde. Alice R. 41 Nurse 37 Fraser. Cecile 58 at home II Berton•, Donna 20 it home + 38 Howland. J. Alex 54 Carpenter 1JDa 6J at home • 38 Newland, Elsie C. 51 at home It Berry. It Bennett, Olive 59 Shoe me • 38 Revised, Ronald A. 21 Student Wer. Il6 Lafayette • ll Szymanski, Frank 5. 64 Leather Wkr. • JB Hovland, Ane Marla 20 Student II Anketell+ Annie 79 Retired 78 Allain, Joseph 52 Yard Wkr. 11 Brown• Helen 52 at haeo I • 39 Sao Pedro, Hotel 24 M.Y. - a 15 Anderson, George x. 40 Barbar 79 Seo Pedm. Carlos 26 Pointer 1 , 15 Belisle, George A. 26 Painter 39 Meneim. Jose 69 Shoe Wkr. 15 Coss, John M. 22 Cook Brockton 79 Maneiro, Blanca SO Stitthar L.0 , 15 Schrader, Hotel 49 Store Clerk 79 Maeelm• Jose, Jr. 25 Student • 15 Lubeta, Max i6 Retired 79 Falsest. Marta 27 ar hase 15 Ellis. Thera • 39 Beenmtall, Roger 0. 50 at bar 15 Ellis. Rages 77 Leadrlast. a 79 Beausoleil, Rita J. 49 ".rose' Aida a 15 Mercier, Albert L. 49 P.O. Wkr. • 3911 Hloa, Lillian P. 42 Pottery Wkr. IS SC.LAurent. Lillian L. 55 Secretary 7911 Nims, Rmhuld 19 Student a 18 Sanchaerle, Grace F. 50 Principal 7911 Girard, Gerald S. 21 Student ., • 18 Je441, Marie R. 52 Teacher 3911 alma, Bruce D. 19 Student • L8 Leblanc. Anita L. 51 Teacher 3911 Castle. Richard T. 19 Student i • 18 P.Lchords. Alice Y. 49 CCD Coordinator 3911 Sallee, Charles, 21 Student - 18 Therrien, Denise E. 55 Teacher 40 Maws John T. 34 Shoe Wkr. IS Noreand• Lorraine L. 44 Teacher 40 Haves, Judith M. 26 Shoot Wks. a I8 Prud'homaq Irene A. 41 Teacher 40 Arroyo. Justine 59 Leacher WkT- - - 18 Tacresult, Lucille G. 40 Principal 40 Arroyo, Christine 23 at has, IB Pleea, Lucille P. 39 Teacher • 40 Oquendoe Pall. 41 Leather WkT. • 18 Martineau, Irene M. 34 Teacher a 40 Oquendo, Juanita 72 at has, IS Lapointe. Elizabeth A. 72 Superior • 41 Whitney, Kenneth A. 19 at has l8 Lavigne, Marie Z. 74 Housekeeper Cana. • 41 Whitney, Kevin R. 19 student IB Jacob, Jeannette M. 69 Music Teacher • 41 Whitney, Jam P. 41 at her • l8 Gamest, Catharine E. 66 Teacher 41 Wesley, Philip 51 Bot.Wkr. v • IS Renaud, Jeanne M. 72 Secretary 41 Wesley, Bessie 30 at has, • 18 Baelnat, Lucille L. 70 gutter 41 Weaver, Perry 25 Mason -Denotes a Vater WARD 5 PRECINCT 1 No. Name Age Occupation Res. 1970 Nat'Ny Na. Name Age Occupation` Res. 1970 Nat'Ity 18 Lavalm. Eva C. ve..+. Teacher N' DOW ST 18 Guertin, Madeleine '2J' Teacher 18 Lavigne. Marie `72 ikpr. Canadian ♦ 11 Cobb, James M. 25 pual.Concr. 51 Bay View Ave. 18 Genesi, Catherine E. 66 Teacher • 11 Cobb, Jacqueline C. 26 Saleslady 70 Bay View Ave. • 18 Ally, Marie Antoine cte 655 Seemecresa • ll Deschamps, Marguerite 70 At home 18 Moreau, Marie-Ange G. 68 ikpr. * ll Kockweki. Carol 74 At home 18 Cosaacts, Cecile C. 59 Teacher Canadian • 11 Kotkweki, Yvonne 55 Assembler • 18 L'Ho®e, Yvonne 60 Teacher + 11 Raymond, Gertrude 56 Clark 18 LaBelle, Anita A. 60 Cook + ll St. Jean, Annette 73 Bkpr. • l8 Morin, Claire 52 Prancer + it St. Jean, M. Irene 75 At home • 18 SenchegMaririn. Greer 49 Principal • 15 Gagnon, Aire 69 Bank clerk 18 LeBlanjoyalc, Marne R. 51 Teacher • 15 Gagnon. Anna 67 Retired • 18 LeBlanc. Anlca 50 Teacher + 15 Laneque. Joseph L. 75 At home 18 Marshes Rolan, Dorothy E. 52 Teacher Laconia. N. N. 19 Blals, Roland 55 At ired home • IS Lerocque. Catherine M. 75 At Rome • 19 Blots. Anastasia M. 57 At home • 17 Bewley, Albert 69 Retired 49 Shoe vkr. • 17 Rowley. Blanche D. 63 At home • 19 Pellerin, Claire D 19 Pellerin, Coni. D. 47 Shoe vkr. 17 Theriault, Eftail 25 At home Canada Canadian 19 Roy, Theresa M. 63 Electron. vkr. 17 Tharisul t, Gueslyhe 23 loam rkr. Canada Canadian • 19 Roy, M. Cecile 57 At home • 17 Labneque. Maurice 52 G. E. rkr. • 19 Doucette, Anne E. 59 At home • 17 Labrecque, Anita C. 46 At home l7 Labncque, Delona 23 Secy. 19 Doucette, Herold A. 64 Chem. aper. + l9 Beaulieu. Reymond L. 46 Clerk 17 trbnwegue, Vteter 20 Custodian • 21 Cloutier. Henry 60 Machinist 17 Labisequ•. Laura ata 17 Student 21 Cloutier, Marie Anna 67 At home • 47 Gagnon, Alfred J. 47 Lea. rkr. 21 Girard. Emile 64 Melnc. men 47 Gagnon, Laura 38 At home • 21 Girard, EvelLna 60 At home 43 Gagmen, Vanessa 17 Student 21 Bedard, Annie 69 Hoop. rkr. • 47 Veneski, Edward 54 Painter • 21 Knight, Blanche 70 At home a 43 Veneskl, Elisabeth L. 44 At hone 21 Fou rater, Joseph J. 60 Laborer 43 Vaneski, Patricia 18 Secy. • 51 Come, Halon A. 50 Else. -kr. 25 Demeuls, BlancZelis 76 At home • 51 Cormier. Donald 47 Lamp .wkr • 25 Demeula, • 51 Cormier, Yvne 64 At home • 27 Demeule, Albert J. 45 Mach. -per. hove 48 a w • Edith Re h J. 66 tired 19 Harbor St. ReSI Cherbomeau. Cora 74 At home • 27 Dameule, 41 home • 53 Dube. Yvonne M. 75 At home 29 Terdiff, EEdit7 • 57 Erwin, Leo P. 41 Glass rkr. • 29 Pelletier, Joseph R. fig Retired 19 Harbor St. • 53 EMn, Ronald A. 72 Lab. east. 29 Martineau, Maurice M. 36 Mechanic • 57 Scankiericm, Arthemise 73 At hams • 29 Martineau, M. Cecilia L. 35 At home • 57 Gagnon. Dora 74 Retired 29 Gagnon, Karim E. 52 At home • 57 McNiff. Jeannette B. 67 At home 248 Washington St. 29 Gagmen. Diana M. 28 At home • 57 Le Blond, Yvonne 68 An home 35 Perkins Se. • 32 Be rube. Adrian A. 62 Repot*man f 57 Ceoehamps, Claire M. 74 At home 35 Perkin St. • 72 Berube, Jeanne 59 At home I • 59 Ayecta, Marie 67 At hams 72 LeBoeuf. Leo 62 Elec. vkr. 59 Stanley, Winifred Cook 72 Bartow. LeBoeuf, MorinGilbe 55 At Game 32 Be rcona. Hecto 27 Foam vkr. 27 Salem St. e HARBOR ST. 32 Barton*. Donna 19 Fac. rkr. 27 Salem Sc. 33 Robinson. Louie W. 62 G. E. vkr. 1 Garen, 71 At home Robinson.• 73 Albertine C. 59 At home • ~� • t Trembleyy,, Angeline M. 67 At home 33 Robinson, Claudette 72 Bkp r. ♦ 1 Miley. Alice L. 69 Retired 33 Gagnon, Florence R. 57 At home • I Dion, Joseph 57 Hoop. rkr. • 37 Landry, Clarinda 84 At home I Ouellette. Ganes 51 Clerk • 33 Cormier, Helen L. 50 At home • I Ouellette, Richard J. 41 Music teacher 73 Leonard, An" 78 At home • l Ouellette, Marie L. 82 At home • 33 Steam, Olaf D. 66 C. E. vkr. • l Martineau, Raymond W. 45 Else. angr. • 37 Scram, Annette B. 62 At home • 1 Martineau, Annette T. 45 Teacher • 33 Ouellette, George H. 49 Plumber 75 At home • 37 Ouellette. Carolina 0. 47 At home • I Goldstein. Mary 34 Simard. Rama L. 56 Painter om • I Goldstein, Anne 73 At he • 1 PoitMana, Marie A. 79 At home 34 Simard. Marie L. Sfi At home • I honey. Sarah 67 At home • 74 Simard. Raymond E. 18 Student • I Palletlar, Rau M. IS Elec. rkr. • 74 Cann, Stanislas 6I Inspector • l Pelle. Sophia 64 At hose • 34 Litwin, Edward V. 28 Machinist • l Logw.McIntoS hieAliJ. Clerk • 34 Litwin, Dorothy 25 At home • 1 Larval Katherine J. 80 At holes • 77 Beeville. Emile C. E. 58 Fun. dl r. r • I Larrabse. Eleanor M. 40 I.R.S. vkr. • 77 Beeville, Leede E. 55 At home I assail Roger 52 Meatcutter • 37 Tremblay, Yvette 63 At home 19 Ward St. • 11 Duplessia, Blanche SS Hoop. vkr. • 37 Girard, Ludger 68 Retired 19 Ward St. • 11 Cormier, Barbara 68 Retired • 38 Newland, J. Alex 57 Carpenter • It Voyles, Arthur J. 71 Retired • 38 Norland. Elsie G. 50 At home • 11 Plourde, Alice R. 60 Rural, 38 Norland, Ronald 20 Student 11 Anketell, Annie 78 Retied 38 Newland, Am Marie 19 Student 11 Brows, Raton 51 At blame • 38 Gagnon, Joseph L.. Sr. 51 Machinist ll Aubut. Emilie 65 At hoes Caron. • 38 Gagnon, Virginia M. 48 At home �" • 11 Corriveau, Plonme M. 64 Retired 24 Hae,thone Blvd. 38 Gagnon, Paul 17 Student it Baker, Sandra J. 19 Pee. rkr. Middleton 39 Memel Jose 68 Shoe vkr. 11 Trudem, Donald 53 G. E. rkr. 39 Manetro, Blanca 57 Stitcher 11 teudsau, Blanche At how 39 Remain, Jose, Jr. 24 Student • 15 Anderson, George N. 79 Barber 79 Palsmne. Joseph 26 Machinist IS Schrader. Hamel 48 Ston clerk 39 Falcons, Marie 26 At home ,fi • 15 Mustafa, Marc 76 Retied • 79 Beausoleil, Roger 0. 49 At hems '�"7�'`R • 15 Lubsts. Ma< 73 Retire • 39 Beausoleil, Etta J. 48 Nurses' aide 13 Ellis, Thomas Retired 39 Oidew, Ghyslalne 46 At home Tip 13 Harrison. Theme C. 2e Machinist 12 Mason St. • 79% Nina, Lillian P. 41 Fac_vkr. 13 Vile", Roger 36 Lead.Wt Beverly 394 Hioe, Ronald 18 Student _ • 15 Mamier, Albert L. 48' P. 0. who. 60 Uach St. 39k George, Corinne M. 25 At home 17 Levesque, Mary A. 19 At how Peabody • 794 Collin, Phillippe R. 28 Auto vkr. _ 11 4vesqua, Mlchasl 19 Pec. rkr. Peabody 40 Means, John T. 33 Shoe vkr. • 18 Moreau, Marta-Ange 68 Hkpr. 40 Hrees, Judith M. '25 Shoe vkr. • 18 Richards, Alice Y. 48 Par. co-or. 40 Arroyo, Justine 38 Loa. vkr. If 18 gamiest, Lucille L. 69 Burger Patershu 40 Arroyo, Christina 22 At home t 18 Tecnault, Lucille C. 39 Principal Petersham • 40 Oquando, Palle 40 Lea. vkr. - l8 Bergeron. Doris E. 41 Tauber Patenhm • 40 Oquendo, Juanita 71 At home 18 Deaths"". Germaine C. 63 Teacher Petsnhm Canadian • 41 Williams, Else== 29 H. W. 17 Turner St. LB Pinetce, Evangelism L. 47 Teacher Petenhme 41 Whitney, Jean P. 41 At home kr. Beverly 18 Martineau, lane M. 37 Teacher 41 Wesley, Philip 70 Bot. v ' • 18 Renaud. Marguerite 71 Aset. grin. 41 Wesley, Bessie 29 At home Beverly ♦ 18 Harvey. Theresa SO Tauher 41 Weaver. Perry 24 Mason 4 School 9t. i r • le Normae. Lorraine L. 43 Teacher 41 Weaver, Judith A. 23 At home 4.Schwl St. • l8 Pnd'ho®e, tram 40 Teacher 41 Williams, Robert 40 Clerk 11 Turner St. • 18 Richard, F6rTl 37 Teacher 41 Williams, Eleanor 29 At home 11 Tuner St. • 18 Sim meau, Marie 58 Teacher • 414 LeBlond, Lorraine 30 At home *Denotes a Voter �� I' 11 ,�o • R��b �F<�PF4l� tN o `rf rHoL�.III�i��iaQ,.i a .7��6�={$y�J1.Iy]g �r..��. ..lir.��H��1n�9�1�o lila••Fa'y.2 i'`{�Y� yr._.. a y�1 �h1�� tl�fj{ $jy��� rdt 2 �q•� 2 g32yp Q1j2 Vl ud H�,Ia LM1q e] '9<:] 4) < K�:`3=11G«:�•iRy<:°:<6Rp<t::,IK(�KV�fI •Hr'19MfI Y_^MM O < :91 !1 pJY9 L•IYY YJ OJYY LY Y2,7"�!, tC4 ss{.[.,f•E,•VG<1)N L<UKK V C VNCCV:.aF a<K« UU UU (L<r<1 <N �� U�l.•iri,p TUU I[�•II•-mil l<� <p�FF••�•gi 1N� ��p,:al l� O F nbpp ,,pp 11yyy��I N.�\r]L nNNnl f, pY,O•N V,Q.y V\4 �I O'(\bb�IO FFff,, ,..t�.7 N_` F_]F V\N '-1 f.,e,NFL-1'4-I,�aOfI O.Y�•OnO�•a V„e pf'nO Ny NNmI^RN Na1n NJ`/•K',.'�rnNtVnN NN N r/ •O`V`DRm,TY.��I J`:1nN`J ,bV NN !J \4\'NV.V\eb t-�J�f^\t-M1nn NNN.'l�� Jnv.V\N V,V, •,u.FNN N Q p J is _ o. o? -•• _ .Hg <., I �iu8 c ,9 -'.S le•' Ii.1�t1 'j3c d' d 'l:vi d of Tit Of��ay �. 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H 5.: ;id ..at ��'C-.' b'� •.��•�l ���` ��7 m a OF 'J� � nc5 � PyJ 'yIf J�hrsati6 a.H�°j°a,y5�ya�F t�� �ga� ap " � �� �6� b� � ?uP 9 �pd9 a �:1` � �dC6a 6°4e9 �]$b6��R. aTfa:...BH78FS$ Nd :.Ca� Z Y H N N 3.::W 4 U V f I] .-1,y �1 ,..1.y�1,.1�1`.(\ V,y� I-t-FFM1FM1 �I•'�.� 1 Inn1`I L"C.4. r1�I,I•-1_1.1.INN,I�IN•Ir1.I rINNNN.IN�'�INNriNN�1.i�I,-(�rfri rl �r'1�r'I�rl ri Nri'1•I pl r'I„'1 '1,-I�r'i:1'1 ri Nrl r'Ir'1V.lr-I,I.I.I.I.IN.+...1��}__CC[,C.V.,I.V,CI 1�,..,.,,, � 1: Nn•:••�:::l:.:l.l...l.a�:s` li z a a•aaa aa•naaoaaa aaaoa sa_ao•caor.os aoo ;.on:.�.... .,_..,.:: a:>a ..•. ;oa .. aa000ca t c • � ao ooe Ir Gl< 18toL Rt'WIVI 1 -7 � INSPEMONAL SERVICES p The Commonwealth of Massachusetts 11�4 SEP Z. 5 3 Board of Building Regulations and Standards SALEM Massachusetts State Building Code,780 CMR Revised Mar 20! Building Permit Application To Construct,Repair,Renovate Or Demolish a One-or Two-Family Dwelling This Section For¢fficial Use Only Building Permit Number: Date Applied: jai.>/i Building Official Print Name Si g ( ) gnature Date SECTION 1:SITE INFORMATION 1.1,PropertyM s:P,-.Ir 1.2 Assessors Map&Parcel Numbers —.].to Is this an accepted street?yes x no Map Number Parcel Number 1.3 Zoning Information: '1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sgft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Check if yes0 Municipal❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' (WDR Salewla Name(Print) City,State,ZIP I IJL 1 �2_102 6 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction Existing Building El Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units_ I Other ❑ Specify: Brief Description of Proposed Work': S-FCu p O yta-�DV }alG SoIGLr SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: (Labor and Materials Official Use Only 1.Building $ ]. Building Permit Fee:$ Indicate how fee is determined: $ ❑Standard City/Town Application Fee 2.Electrical ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Su ression) Total All Fees: $ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ S 0 Paid in Full 0 Outstanding Balance Due: i SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 3l,me,5 License Number Exp ation ate Name of CSL Holder List CSL Type(see below) U No.and Street — Type Description Sa u� LLS A I O I(] O I U Unrestricted(Buildings u to 35,000 cu.ft.) �"l _t W R Restricted 1&2 Family Dwelling City/Toum,State ZIP M Masonry l/ RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances VIULV �p�p.l. I Insulation Telephone Email address Corn D Demolition 5.2 Registered Home Improvement Contractor(HIC) I-1 0�48 t V 1 1�I 1 Solo r 1 J�Vel(�p� �"LC— HIC Registration Number E HIC Com any Narm:8 HIC Registrant Name_- g prza on Date {�3 P N J. . 00 \A J . _w\ LSotcLr a V tv r. No.and Street Email address C-DYte1 PYDVO UT '64(0o4 -1$13053O1QS City/Town,State,ZIP Tel- hone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes..........A No...........❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize V i y 1✓it Su l ar to act on my behalf,in allmatt/errs relative to work authorized by this building permit application. P-m ner's Name?Electronic Signature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in th' Prized on is true and accurate to the best of my knowledge and understanding. V t � - a-a -r Print O s r Agent's Name(Electronic Signature) Date NOTES: I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.eov/oca Information on the Construction Supervisor License can be found at www.mass.cov/dos 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" rr 4931 North 300 West,Provo,UT 84604 ([mployer Identification No,: 80-0756438 /, V�V���. solar E-Mil (877)404 vivi Pan:(R01)765-575R Massachusetts HIC License No.: 170848 4 '� E.w visupport@vivin[snlar cote www vivintsalarcom AR No.: # RESIDENTIAL POWER PURCHASE AGREEMENT This RESIDENTIAL POWER PURCHASE AGREEMENT(this"Agreement")is entered into by and between VIVINT SOLAR DEVELOPER.Li a Delaware limited liability Company("We","Ue"."Oui'1 and[ e undersigned Cusl nal("You Your"),as ofthe Transitional Date set forth below. Full Name('�. NI c,.. '" x Full Name.T au,ran _ Customer(s): .o. , ye, ON. ��Y1�.l`Z, �IJc-I CvI r n y0— ov. toss, _. Tel No.:-191 512- (d,Zl-- L Mail: c*5s Ile L. A✓', Property _ Street Address: L t—DpLO S+-- Address_._ City,County,State,Zip: SQ jeyvl Yh (��770_ r` L�/ se arlc ES X. DESI(:,'N %MI INS I LLA I'I(1N. %N'e.v ill d""-r,malall.'C"ill"Id malnmin a...In pholotoden.,[a;m on l',mr l'vnperl,,vhidi t.ill include:ill sulnr p.In...nl.else V..m:mo..mJ nlher tamp,�paln Izollean d}.Ihc'tq.n•.n"I.tin tin ilia'Je,a ihal in thr uannmr Pucka xnJ ih.11,rk Order that U'; .all pit sI'l. e,1 III "ala .Nil inaullonnn I'lli SMen,will he .t.Il,J by On' tl ln'I I , 1 ,_ rid n0.nh„ t T.. At uh \ t r n onI Ilion. NA• ,,It t l d .i n it u.11 and anneal ilt S I ui m u:n,nal n'l Ira ill JI l l l III I : ui ,.npl,Iu all ruluucJ it ln,m .IA,�(I'll 1 Iota all I',Iul, "'tin Cow n. am p,mdl. II nlu m dacl,u. S.,luu Ihal awn)"In n„I, Y,n aor,e tluu NA'z n.0"I'l1i11 V1.111 elznnud snag;hlw,n Gate 1 our Acctrle ulibly Ilhc..f olill'l teal N'.m dlall pm[Ide L.auh erpicn of Yom I Jilin bull.It,AVc mnv rat.,�ilnhl. requ,,l, UIll"Ih:m rho nee,ati0u lee de.erihoA ill Scewat I it.R'c sill desi,-o mid ill t ill ill Ss,lel.. it,, ,I,11n B. ACTIVATION. You agree to pay Us a one-time activation fez in the art:auul of S (fj _ \\c u ill Inl.rcnnnccl dui Nman w ilh�hc I ad-in Id cause the System to generate energyy measured m kilowatt hours ("hWh'I uhe"Lnr{qr hwallutn.n ,d Ihr Sy.min uanerally ulka gym; Jul and i,, anticipated to begin and be substitution ly complete between two(2)and six m,a c.A-hcread,'1 C. OWNERSHIP OF SYSTEM. We shall own the System as Our sell,personal property You will have no property interest in the Scalar. D. OPERATIONS AND MAINTENANCE. We will operate and ma ntim the System(i)at Our sole cost and expense;(ill in good condition;and(ill)in material compliance with all applicable laws and permits and the Utility's requirements. E. INSURANCE. We carry commercial general liability insurance.workers compensation insurance.and propertyy insurance on the System For more information concerning Our insurance,and to obtain a copy of Our certificate of insurance,please visit: www�vrvmtsolatcom/insumnce. 2.TERM,1'RICF.1 AVillI NTS,AND FINAN'C'JAI..DISCUOSFRE.s A. ENERGY PRICE. For all Energy produced by the System,You shall pa�Us So. •/LQ.j, _ r k1\I- a"Energy Price"),plus applicable taxes. The Energy Price shall increase each year by two and nine-tenths percent(2.9%). A o1 1;...I camnt tv S.stcm output,measured in kilowatt hours, .ill be A SOLAR ENERGY a in the DEVICE. Packet. THIS AGREEMENT IS FOR THE S�.LE OF ENERGY BY US 10 YOU AND NOT FOR THE SALE OF B. TERM. This Agreement shall be effective as of the Transaction Date and continue until the twentieth(20n)anniversary of the In-Service Date(the "Timm The"/a-.Service Date"shall be the first day after all of the following have been achieved ill the System has been installed and is cavablz of generating Energy,(it)all permits necessary to operate the System have been obtained,(in)the System has been Interconnected with the Utility,anJ(iv)all inspections and certificates required under applicable law or by the Utility have been completed or received. C. PAYMENTS. Beginningg w'th the first month following the In-Service Date and throughout the Term,We will send You an invoice reflecting the charges for Energy pr iced by the System in the previous month. You shall make monthly yaymenZ U Us by aulnmatie payyment deduction from Your designated checking account or credit card. It is Your responsibility to ensure that there are adequate funds or adequate credit Ilmv. There is no financingg charge associated with this Agreement. For all payments more than ten(10)days past due,We may impose a late charge equal to"Twenty-Five Dollars(S25) and interest at an annual rate often percent F /1.plus applicible taxes. If You continue to fail in make any payment within ten(10)days after We give You written notice,then We may exercise all remedies available to Us pursuant to Section 13(b). 0. PENE'AAL Allh,c 1,, 11h. farm You m:neW,l mail onnnn:c.vuh thn:\erccu.all,nl:I,oar-u.-yea Lml,.liil arts ine.a l¢.v A2rciIIl;nl muh U. Ind II lIli A r t�u Iiftlt 1a tl S,'I n at lleutl A [I, Lou,'It)- t l hi, A u,muuuh,• / r / (qui, 1 1,11 11,1111dti. Ar nuu"Id flu a it.,S,,nu c .ad.n ou.n You 1' moill aced lr limit. l_,m.aiuug t. nmal r I -lin:o) Intl dtt,la ,,,,ll1aInd nI h, TcmG If 1ou Jun Im Parch a, Opt,n the t'onbu,r 01"i.u. Ahe' i'M be dui thet.utru T;ll lx du .ahl:of ill' lawn,ba"d .n al.. inJytuduu apn .I m ta f.Iuhni "-11I t. h t. 'I1 - rIII in fh all r 1 t( Ill h, pn,i&,lt n Y, tit 11 tin n .rid" if h I'ot, If N4 'i, 1l,ul l a:lit m,f If, OvII,c Olna.1 Li ,IS Ot Lill all t ful , and all olhar n nnnuuY then ,.wmennd ollundh rt lr.W,w dl lr.nder Wnr.hq tdlcSy,I ato lou at ih,end wilt, t awn n't A,l,.Whr 1. klsi.. IC)ou chill In have die „tern mnu,,el We ill«nmva III Set n Ginn 1 11in I'n puce wuhiu mull,(all IL I,, II r the d th Tenn IF YOF DO No I'Not IF) ITS OF Vol it ELECTION 101 \N'(1I FIN SENDINC A 'A It FI EN \IllI('I; O its. II II!N III6 AL'RF:I \IISN'I v,ILL All 1'4 l kl it I'ICAI LN RENEW ON A YEAR-TO-YEAR BASIS UNTIL YOU NOTIFY US IN IN Itl'IING OF I Oi:R CLEF'"IION 141('n N('I(I. k I LEAST'SIX'T) ((,Ill DAYS PRIOR TOTHE END OF THE RENEWAL TERM. E. CREDIT CHECK. In connection with the execution of this Agreement and at any time dung-: -ma,You hereby authorize Us to it)obtain Your credit rating and report truth credit reporting a66renes;(it)to report Your payment performance and, his Agreement to credit reporting agencies; and ((in)disclose this marl other information to Our at Janos and actual or prospective leaden,financing partu investors,insurers,and acquirers. WE MAY HAVE PRESCREENED YOUR CREDIT. PRESCREENING OF CREDIT DOES NOT IMPACT YOUR CREDIT SCORE. YOU CAN CHOOSE TO STOP RECEIVING"PRESCREENED"OFFERS OF CREDIT FROM US AND OTHER COMPANIES BY CALLING TOLL-FREE (888) 567-8688. SEE PRESCREEN & OPT-OUT NOTICE(SECTION 29)BELOW FOR MORE INFORMATION ABOUT PRESCREENED OFFERS. 3.LIMITED WARRANTY A. LIMITED INSTALLA"LION WARRANTY. We provide a workmanship warranty that the System shall be free from material defects in design and workmanship under normal operatingconditirrns for the Term. We Ihrther warram that all rooftop penetrations We install shall be watertight as of the Aate of i stallauon. We do not provide any warranty to You with respect to any component ofthe System. Any manufacturer's Warranty is m addition to,not in lieu ol; this limited installation warranty. This warranty does not cover problems resulting from exposure to harmful materials and chemicals, fire, food, earthquake,or other acts of god,vandalism,alteration of system by anyone nol authorized by Us,or any other cause beyond Our control, i B. MANUFACTURERS'WARRANTIES. The System's solar modules'cam a minimum manufacturer's warranty of twenty(20)years as follows: (a)during the first ten(10)yyears of use,the modules'electrical output will not degrade by more(ban ten permem(l0%)from the(nginalfy rated outptit and (b)during the first twenty(20)years of use,the modules'electrical output will not degrade by more than twenty percent(20%)from the originally rated output The System's inverters carry a mmtmum manufactmer's warranty often(10)years against defects or component breakdowns. During the"form.We will enforce these warranties to the fullest extent possible. C. DISCLAIMER OF WARRANTY, EXCEPT AS SET FOR]H IN -THIS SECTION 3, WE MAKE NO OTII ER WARRANTY TO YOU OR ANY OTHER PERSON, WHETHER EXPRESS, IMPLIED OR STATUTORY, AS TO THE MERCHANTABILITY OR FITNESS FOR ANY PURPOSE OF THE EQUIPMENT. INSTALLATION, DESIGN, OPERATION, OR MAINTENANCE OF THE SYSTEM. THE PRODUCTION OR DELIVERY OF ENERGY, OR ANY OTHER ASSOCIATED SERVICE OR MATTER HEREUNDER, ALL OF WHICH WE HEREBY EXPRESSLY DISCLAIM, OUR LIABILITY FOR ANY BREACH OF ANY WARRANTY IS LIMITED TO REPAIRING 'THE SYSTEM OR YOUR PROPERTY TO THE EXTENT REQUIRED UNDER THIS AGREEMENT YOU ACKNOWLEDGE THAT WE ARE RELYING ON THIS SECTION 3,C. AS A CONDITION AND MATERIAL INDUCEMENT TO ENTER INTO THIS AGREEMENT. THERE ARE NO WARRANTIES WHICH EXTEND BEYOND THE DESCRIPTION OF THE FACE HEREOF. 4.REMOVAL OF THE SYSTEM You shall not make any Alterations(as defined in Section 9(c�)to the System. If You want to make repairs or im rovements m Your Property that require [he temporary removal of the Syystem or that mould mter�fere wI[lt its performance or opemtioq You mull glue L's'al Reast thirty(30)days'poor written notice (a"Customer-Requested Shutdown'q. You agree that any repair or improvement m Your 1'ropetty shall not materially alter YouIT rf where the System is installed. As compensation for Our removal,storage,and reinstallation of the System,You agree[o pay to Us a fee equal to Four Hundred and Ninety-Nine Dollars(5499)hefine We remove the System. You shall be required to pay the Shutdown Payment(as defined in Suu�� if Ili System is nut reinstalled within[Aihy(30)days of remuv¢!. In the event of tin emergency aRecol the System,You shall comact Us nmm�late Y If We are unable[o timely respond.You may(at Yourown expense)contmet with a licensed and qualified solar ms[aller m remove[tic System as necessary of make"pairs required by the emergency. You shall be responsible for any damage to be System that results from actions Taken by Your con/ratum 5.ARBITRATION OF DISPUTES Most customer concerns can be resolved quick)y and amicably by calling Our customer service department at (877) 404-4129. If Our customer service department is unable to resolve Your concern,You and We agree to resolve any DiSpDutc(as defined below))throng bindingQ arbitration or small claims court instead of courts of general l'urisdiction. BY SIGNING BELOW,VOU ACKNOWLEDGE AND AGREL- THAT(1)YOU ARE HEREBY WAIVING I III,RIGHT TO A TRIAL BY JURY;AND(II)YOU MAY BRING CLAIMS AGAINST US ONLY IN YOUR INDIVIDUAL CAPACITY,AND NOT AS A PLAINTIFF OR CLASS MEMBER IN ANY PURPORTED CLASS OR REPRESENTATIVE PROCEEDING. You and We agree to arbitrate all disputes, claims and controversies arising out of or relating to vowro n Y. solar 4931 North 300 West Structural Group Provo,UT84604 P: (801)234-7050 Scott E. Wyssling, PE Head of Structural Engineering Scott. sslin wy gL7a vivin tsolar.com September 10, 2014 Mr. Dan Rock, Project Manager Vivint Solar 24 Normac Road Woburn MA 01801 Re: Structural Engineering Services O'Brien Residence 11 Dow Street, Salem MA AR#3182929 5.00 kW System Dear Mr. Rock: Pursuant to your request, we have reviewed the following information regarding solar panel installation on the roof of the above referenced home: 1. Site Visit/Verification Form prepared by a Vivint Solar representative identifying specific site information including size and spacing of rafters for the existing roof structure. 2. Design drawings of the proposed system including a site plan, roof plan and connection details for the solar panels. This information was prepared by the Design Group and will be utilized for approval and construction of the proposed system. 3. Photovoltaic Rooftop Solar System Permit Submittal identifying design parameters for the solar system. 4. Photographs of the interior and exterior of the roof system identifying existing structural members and their conditions. Based on the above information we have evaluated the structural capacity of the existing roof system to support the additional loads imposed by the solar panels and have the following comments related to our review and evaluation: Description of Residence: The existing residence is typical wood framing construction with the roof system consisting of 2 x 6 dimensional lumber at 16" on center. The attic space is unfinished and photos indicate that there was free access to visually inspect the size and condition of the roof rafters. All wood material utilized for the roof system is assumed to be Spruce-Pine-Fir#2 or better with standard construction components. Our review of the photos of the exterior roof does not indicate any signs of settlement or misalignment caused by overstressed underlying members. Stability Evaluation: A. Wind Uplift Loading 1. Refer to attached Ecolibrium Solar calculations sheet for ASCE/SEI7-10 Minimum Design Loads for Buildings and other Structures, wind speed of 100 mph based on Exposure Category"B" and 30 degree roof slopes on the dwelling areas. Ground snow load is 40 PSF for Exposure"B", Zone 2 per(ASCE/SEI7-10). 2. Total area subject to wind uplift is calculated for the Interior, Edge and Corner Zones of the dwelling. vivin '. Solar Page 2 of 2 B. Loading Criteria 10 PSF=Dead Load roofing/framing 40 PSF=Live Load(around snow load) 5 PSF=Dead Load solar oanels/mounting hardware Total Dead Load=15 PSF r The above values are within acceptable limits of recognized industry standards for similar structures. Analysis performed of the existing roof structure utilizing the above loading criteria indicates that the existing rafters will support the additional panel loading without damage, if installed correctly. C. Roof Structure Capacity 1. The photographs provided of the attic space and roof rafters show that the framing is in good condition with no visible signs of damage caused by prior overstressing. D. Solar Panel Anchorage 1. The solar panels shall be mounted in accordance with the most recent "Ecolibrium Solar Installation Manual', which can be found on the Ecolibrium Solar website (ecolibriumsolar.com). If during solar panel installation, the roof framing members appear unstable, deteriorated, structurally compromised or deflect non-uniformly, our office should be notified before proceeding with the installation. 2. Maximum allowable pullout per lag screw is 235 Ibs/inch of penetration as identified in the National Design Standards (NDS) of timber construction specifications for Hem-Fir (North Lumber) assumed. Based on our evaluation,the pullout value, utilizing a penetration depth of 2 Yi', is less than what is allowable per connection and therefore is adequate. Based on the variable factors for the existing roof framing and installation tolerances, using a thread depth of 2 Yz'with a minimum size of 5/16"lag screw per attachment point for panel anchor mounts should be adequate with a sufficient factor of safety. 3. Considering the roof slopes, the size, spacing, condition of roof, the panel supports shall be placed at and attached to no greater than every fourth roof rafter as panels are installed perpendicular across rafters and no greater than the panel length when installed parallel to the rafters (portrait). No panel supports spacing shall be greater than four(4) rafter spaces or 64"o/c,whichever is less. 4. Panel supports connections shall be staggered to distribute load to adjacent rafters. Based on the above evaluation, it is the opinion of this office that with appropriate panel anchors being utilized the roof system will adequately support the additional loading imposed by the solar panels. This evaluation is based on information supplied to us at the time of this report and current industry standards and practices. Should you have any questions regarding the above or if you require further information do not hesitate to contact me. ery truly yours, OF o 41/ O� E Cyr`. Y I y Scott E.WY ling, P Clw MA License No. 9oF EGISTEP` ESSIONN. vivi t. 5 C)i d r N -- ---- ------ ----- - c/) Q'3¢j �o°OEF �Ez !✓'m 0 I I � 'o� m PV SYSTEM SIZE: 5.00 kW DC I I JUNCTION BOX ATTACHED TO I I ARRAY USING ECO HARDWARE TO KEEP JUNCTION BOX OFF ROOF '^ I I BS OF PVC CONDUIT FROM JUNCTION BOX TO ELEC PANEL I I _ I I $ m � m o o < N d% I U 2 > U u f (20)Trina Solar TSM-250 PA05.18 MODULES WITH A En MOO TED ON THE FEAC MICRO-INVERTER w w i m MOUNTED ON THE BACK OF EACH MODULE Q 4 U 3 Z N a ? ? E o SHEET NAME: I II w Z -�J '- 0- PV INTERCONNECTION POINT, t d LOCKABLE DISCONNECT SWITCH, ANSI METER LOCATION, 8 UTILITY METER LOCATION — ��—�— ———�— —— SHEET 11 Dow St Salem MA 01970 NUMBER PV SYSTEM SITE PLAN 4 SCALE: 3/32"= V-0" d a o� y 0A m 0 Z C O y Cy 00 mtt b� mN oy NA b A.T 0 $ o iy B N T» of O 3 v S 2 m AN\\04 y < r (J m � w � ° m II � o M O a( O OA T O CI T C V My r D Z ,C= Di INSTALLERVIVINTSOLAR ` O'Brien Residence l MA01970 P\/ 20 ma ROOF ^yMALCLENSE.MAHEC1708484044129 "�"O�,j. ©l� � 11D.St V p PLAN DRAWNBY:MSM AR3182929 Last MMifieed 9l8/2014 u r UTILITY ACCOUNTNUMBER 6296947018 Oft The Commonwealth of MaF w Board of Building Reg �� CITY OF Massachusetts State Buildde, 78 ICES CoES SALEM Revised Mar 2011 Building Permit Application To ConstrO"i4 kerlmvt( rDemolish a One-or Two-Family Dwelling JJ SS This Section For Official Use Only Building Permit Number: Date Applied: a Building Official(Print Name) Signature Daze SECTION 1:SITE INFORMATION 1.1 Pro arty Address: 1.2 Assessors Map&Parcel Numbers 11 WSF .S64tevv, MA L l a Is this an accepted street?yes_ no Map Number Parcel Number 13 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(it) Front Yazd Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: MNwc 0,1591-y% a Ate IMrA bleb Name(Print) City,State,ZIP 11 po--) 4T 1 N S 10. &235 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORIe(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ 1 Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work : TO iAtR So„f..t y°1�co�j Lvtc..�,( e. aM,S V�sR-t�fl SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only abor and Materials 1.Building $ 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑ Standard City/Town Application Fee ❑Total Project Cost (Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees:$ Check No. Check Amount: Cash Amount: 6. Total Project Cost: $ N r'O 17 ❑Paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) . CS ��p11J S 11l 5 License Number Expiration Date Name of CSL Holder List CSL Type(see below) l..I q EAVr $� No.and Street Type Description ,n,� bl r1+�� U Unrestricted(Buildin s u to 35,000 cu.ft.) ��' ���"I i•1�' R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 7P1►?)-a 0370 Wo 1115'S63 6 e)WOO (41w_ I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) (� SS�y � le Q,� A-A, , V aA kl-��r.(ZAhu�t HIC Registration Number Expiratidn Date HIC Company Name or HIC R st t Name No.and Street Email address City/Town,State ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes .......... No...........❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize 4,eC1..d1 -t'"✓"� to act on my behalf,in all matters relative to work authorizeAy this building permit application. M1w� Print Owner's Name(Electronic Signature) Date SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. `�NN�S �l►\1lS uvJ �� aaq Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hives an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.eov/oca Information on the Construction Supervisor License can be found at www.mass.eov/dos 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project CosV' 840Z/LL/EO ruo�ssr._:,.�o;. OS 610 vm Apo9uad STEM S1NN80 £Z'BL.O7.'S� :asbaan '. 11t.I LA•1(Ilis O(�1 j.•nA jatla) � 'I S�.;CI�l1@j;i 7JL.S��OI;�It1�(Jp�U;^rlll?�i 16 Ploo- �. :Unrestricted=Buildings of any use group which i;,coatain less tan h 35,000 cubic fed[(991m')of enclosed space. Failure to possess a Current edition of the ptassacPeaetts State Building Code is cause for revocatlon of Mds lica4e: For DPSUCp�MpLg Ivfom%Uonvislt: w .Mass.Wv/DP5 . ACCW& CERTIFICATE OF LIABILITY INSURANCE 1/05/ 014 11/05/2014 THIS CERTIFICATE IS ISSUED AS A (MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the tans and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemen s. PRODUCER E: CT Lauranzano Insurance Agency PHONE (978) 927-8420 FAX .(9781 921-9162 107 Dodge Street L .LL@Lauranzano.Gom WSU 9)AFFORDING COVERAGE NAIC8 Beverly MA 01915- INsuRERAAtlantic Casualty Insurance Cc INSURED Bay State Weatherization 6 "euRERe:Pilgrim Insurance Construction LLC INSURERC: 13 Tremont Street INSURER o: INSURER E: Melrose MA 02176— INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTTRFt AWL SUM TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICY a"L LIMITS A GERERALtWaR1TY 1,143003849 3/31/2014 3/31/2015 EACH OCCURRENCE E 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES/ / / / E 100,000 CIKIMS-MADE ❑X OCCUR / / / / MED ExP we arson) E 5,000 PERSONAL S ADV INJURY E 1,000,000 GENERAL AGGREGATE E 2,000,000 GEN7 AGGREGATE LIMIT APPLIES PER: / / / / PRODUCTS-COMWOP AGO E 1,000,000 POLICY PRO- LOC / / NOWND E B AUTOMOBILE LUSILrtY 00001 18390 B 12 2010 8 12/2015 B8 .� SI L I 1,000.00 ANY AUTO / / / / BODILY INJURY(Per person) E ALL OWNED JAUHOS SCEDULED / / / / BODILY INJURY(PW aptl4en0 EAUTOS TOS-OWNED / / / J PROPERTY DAMAGE E I HIREDAUTOS / / / / E UMBRELLA UA8 I GCCUR / / / / EACH OCCURRENCE E EXCESS LUU) CLANS-NIADE / / / / AGGREGATE E DED RETENTION / / / / E WORKERS COMPENSATION I WCSTATU- OTH- AND EMPLOYERS'LmmLITY ANY PROPRIETORIPARTNEPIEXECUI YIN NIA EL.EACH ACCIDENT E- OFFICERIMEMBER EXCLUDED? / / / / IMarNMtM M NN) EL DISEASE-EA EMPLOYE E rye,,4e,asb,urMer / / / / E.L DISEASE-POLICY LIMIT E DESCRIPTION OF OPERATIONS below DESCMPMM OF OPERATIONS I LOCATIONSI VENICLES"Bch ACORD 101,A4etla al Remark,SCbemIM.Nmme,p,es IS mRWnb) Job location: 11 Dow Street, Salem, NA 01970 CERTIFICATE HOLDER CANCELLATION - Attn: Building Dept. SHOULD ANY IO THE ABOVE DESCRIBED N POLICIES WILL CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Salem AUTHOIUZED REPRESENTATIVE 120 Washington Street p/ Salem MA 01970- 6 ACORD 25(2010105) ®1988-2010 ACORD CORPORATICTIN. All rights reserved INS025(201005),01 The ACORD name and logo are registered marls of ACORD trice of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registrate, 7"A4g Type 10 Park Plaza-Suite 5170 s ExpPitlratlogJ/20q�; Supplement Ward Boston,MA 02116 BAY STATE WEATIFi RI N& g CONSTRUCTION DENNIS MILLS C 89 NEWBURY RD _ ROWLEY,MA 01969 .. _ Undersecretary Not valid without signature '� .. Weatherization Work Order Facility ID: 900090800 Work Order Date 10/21/14 Action Energy 47 Washington St., Gloucester, MA 01930 Auditor& Email: Barry Moir, bmoir@actioninc.org Project Name Obrien Dow Auditor Phorie(s): O.978-283-2131,C.978-879-6929 Address 11 Dow St,Salem Me 01970 Wx Contractor Bay State Weatherization& Owner/Sponsor M+K Obrien Contractor Phone: cell (617)548-7808 Primary Contact Mike O'Brien,owner,781-572-6235, 0 Other Contact Karin O'Brien, , #Bidgs,Apts&Area: 1 Bld(s),5 Units,4528 SFt. Lead and Contact Notes: Facility Notes: Construction Type(s) Wood Frame Balloon Siding is Aluminum grey over wood clapbd. Roof asph one way offti.afayette on st Parking only shingle, K+T remediation is done1l/3/14 need cert of Foundation Type inspection. Building is empty of insul except some fg in rear tstfl Kitchen Full Basement Unitoty. I Energy ConseMng Measures Energy ConservingMeasures Descriptor or Location I Unit I Est JActuall Unit Cost I Est Cost I Act Cost Wall Insulation Wall Construction Type(s) Section 1: Wall Type Sect 2: - Wood clapboard/shakes/shingles orHnyl dense pac, s ft $1.79 Single nailed asbestos/asphalt densepack) s It $2.21 Double nailed asbestos/aluminum densepack)ALUMINUM grey 1872 sf s ft $2.31 Drill rough plaster patch or finish wood pluo (ders ft $1.82 Vinyl over asbestos densepack) scift $2.31 Test drill 4 sides K+T creeds work flat rate 1 $60.00 $60.00 $2.50 ContractDhAuditor K&T Knob&Tube Wiring Findings and location Door Measures Weatherstrip w/(klon orequal white ea 6 $45.50 $273.00 Fixed Sweep ea 6 $15.75 94.50 Automatic Sweep ea $23.00 i7_r. r1i inhuron nr i_mov nr nrn iiv�luN nn rinnr rnlhr+aHin o0 9 4:ri nn @1 n9 on R-U wuUtwl OIJ VI 1-111"VI C ulvpICl I4 VII UVVI 1G01141 TOLLIO Cp 1 L 1 .pu I.VV Q IVL.VV Repair/ I Door ea $52.00 Window Measures Weatherstrip Window/Schle al or equivalent persid $6.00 Glass Replacement to 64 ul ea $44.00 Top Sash Lock as $9.50 Miscellaneous Insulation Dlstrlbudon pe - Secondary type - Duct insulation R-5 sq ft $3.10 Domestic water pipe wrap In ft $2.63 dronic pipe insulation to 1"copper pipe R-5 In ft $3.41 Hydronic pipe insulation 1.25'- 1.5'copper pipe In ft $3.68 Steam i e insulation to 1.5"-2"iron pipe R-5 . In ft $6.35 Steam i e insulation 3" iron pipe R-5 In ft $7.61 Water Conserving Measures Spa 2000 showerhead orequivalent ea $30.00 Aerator 0.5 GPM bathroom ea $15.00 Aerator 2.0 GPM kitchen swivel/dualspray ea $21.00 Auditor Notes-Page 1 Heating Energy Service _ National Grid Gas Heat Attic Insulation R-38 unrestricted-settled cellulose main flat sq ft 1095 $1.47 $1,609.65 R-30 unrestricted-settled cellulose sq ft $1.37 R-18-20 unrestricted-settled cellulose sq ft $1.29 R-18-20 unrestricted-settled cellulose sq ft $1.29 R-10-12 unrestricted-settled cellulose sq ft $1.21 R-30 restricted-slopes/floored fill w/cellulose slopes+front att fir s ft 558 $1.48 $825.84 R-18-20 restricted-slopes/floored fill w/cellulo s ft $1.42 R-10-12 restricted-slopes/floored fill w/celluloc s ft $1.30 Thermodome or fv1lagnetic pull down stairway bi ea $180.00 Kneewalls R-12 cellulose behind permeable mi front attic end flr sq ft 226 $1.73 $390.98 Attic Ventilation Rectangular gable vend ea $92.00 Roof vent 135 1 sq ftNFV large ea $95.00 Rectangular soffit vent ea $27.00 Pro pa Vent k In. O.C. Rafter Spacing ea $4.00 Miscellaneous Measures Weatherstrip Q-Ion orequal)&R-30 attic hatc ea $33.50 Blower door set-up with pre&post tests ea $45.00 Attic/basement sealing with two-part foam Mc,see penetrations notes man/hr 6 $75.00 $450.00 Attic/basement sealing with two-part foam Bsmt;see perimeter Loc note man/hr 4 $75.00 $300.00 Seal ducts with mastic or butyl backed toe hr $65.00 Cut/finish attic-kneewall access ea $105.00 Vent kit/bath fan ea $89.00 Clothes dryer vent including Exhaust Duct ea $89.00 Labor only charge man/hr $60.00 Basement Insulation Garage ceiling cavity filled s ft $2.10 Sill two-part foam w/unfaced fiberglass batt In ft $2.20 Perimeter Wrap R-5 reinforced foil or vinyl face sq ft $1.91 Perimeter 2"T-max orequivalent foam board sq ft $2.50 6 ml poly on ground scift $0." Air Sealing Descriptions Hours Bulk head door treatments Other door or window repair Block aZZulate window at Other Program Repair Penetrations Penetration Codes(Electrical/Plumbing): CV=chimneyNent pipe,EP=Electrical penetrations ,PP=Plumbing penetrations, Hours Location(s)Description: wP=wall plates,RL=Recessed lights,EB=Electrical boxes,For D= Fans orducts EP CH PP By Pass or Perimeter By-Pass Codes:FKT=underkneewall, CNV= ceilinglwall intersection,Sint=soffit interior,Cnt0=cantilever overhang,BSL= Hours Location(s)Descdption: Bsmt SIII. PP EP CH BSL Auditor Notes-Page 2 Air Sealing Costs Estimated $1,219.50 Actual $ Facility Notes: Siding is Aluminum grey over wood clapbd. Roof asph shingle, K+T remediation is done1l/3/14 need cart of inspection. Building is empty of insul except some fg in rear 1st fl Kitchen Completion Date: $4,105.97 1< Estimated Total Costs $0.00 jAct Total A4C"R CERTIFICATE lvsnol OF LIABILITY INSURANCE 4 ��. a THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DO ES N OT AF FIRMATIVELY O R N EGATIVELY AM END, E XTEND O R AL TER T HE C OVERAGE AF FORDED B Y T HE P OLICIES BELOW. THIS CERTIFICATE OF I NSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NONE: Berkley Assigned Risk Services Lauranzano Insurance Agency 107 Dodge St ac.No.Exl 800 634-4589 Alc.No.: 866 215-8118 AODEss: Polic rvices berkle k.com Beverly,MA 01915 INSURERS AFFORDING COVERAGE NMCS INSURERA INSURED Bay State Weatherization and Construction LLC INSURER B: INSURER C: 720 Governors Hwy INSURER a NSUER E. South Windsor CT 06074 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD MMIDDIYYYY MwDDIYYYV GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED $ COMMERCIAL GENERAL LIABILITY PREMISES Ea oxurrence CLAIMS-MADE1:1 OCCUR 0 MED EXP An onePerson) $ PERSONAL$ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS—COMPIOP AGG $ PRO- $ POLICY El JECT El LOC AUTOMOBILE LIABILITY Ea accMenl $ ANY AUTO BODILY INJURY Per arson $ ALL OWNED SCHEDULED AUTOS $ 1 AUTOSEl BODILY INJURY Per accident) NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS El AUTOS Peracddein $ UMBRELLA LIAB OCCUREl EACH OCCURRENCE $ EXCESS LIAR CLAIMS1MADE AGGREGATE $ DOE. LJ RETENTION$ $ WORKERS COMPENSATION WC STATU- µ AND EMPLOYERS'LIABILITY YIN TORY LIMITS ER ANY PROPRIETORIPATNEW A FFICEJMEM ER EXCLUDED E%ECUTIVE NIA WC-20-2D'DD4736-01 5/14/2014 5/14/2015 EL EACH ACCIDENT $ SDDDgD.OD (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500000.00 K yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500000.00 El DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(Almelt ACORD 101,"dibonal Remarim Sdmdule,IF more space is requited) Election Category Election Status Name All Entities/Insureds: Other Exclude Mark Goodhue Bay State Weatherization and Construction LLC CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of Salem Attn:Building Dept EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 120 Washington Street ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Salem MA 01970 4f The Commonwealth of MassachAMM NAL SERVICES Department of Public Safety Massachusetts State Building Code(780 CMR) 1 4 JVN _ �.g Building Permit Application for any Building other than a One-or wo- amy i el (This Section For Official Use Only) Building Permit Number: Date Applied: Building Official: SECTION 1:L\\O�� c CATION(Please indicate Block#and Lot#for locations for which a street address is not available) No.and Street City/Town Zip Code Name of Building(if applicable) SECTION 2•PROPOSED WORK Edition of MA State Code used If New Construction check here❑or check all that apply in the two rows below Existing Building❑ Repair❑ Alteration ❑ Addition❑ Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No ❑ Is an Independent Structural Engineering Peer Review required? Yes ❑ No ❑ Brief Description of Proposed Work: S-1 Y :, ,� C.`�{tT SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑ Existing Use Group(s): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) Total Area(sq.ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A4❑ A-5❑ 1 B: Business ❑ E: Educational ❑ F. Facto F-1❑ F2❑ H: HI Hazard H-1❑ H-2❑ H-3 ❑ H-4❑ H-5❑ L• Institutional 1-1❑ I-2❑ I-3❑ I11❑ M. Mercantile❑ R: Residential R-1❑ R-2❑ R-3❑ R4❑ S: Storage Sl❑ S-2❑ U: Utility❑ Special Use❑and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA IB ❑ HA ❑ HB ❑ IIIA ❑ IIIB ❑ IV ❑ 1 VA VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) Water Supply: Flood Zone Information Sewage Disposal: Trench Permit: Debris Removal: Public❑ Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be Licensed Disposal Site❑ Private❑ or indentify Zone: or on site system❑ required❑or trench or specify: pennit is enclosed❑ Railroad right-of-way: I Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable❑ Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed❑ Yes❑ or No❑ Yes❑ No ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s): Type of Construction: Occupant Load per Floor: Does the building contain an Sprinkler System?: Special Stipulations: SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner Name(Print) No.and Street City/Town Zip Property Owner Contact Information: Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes Name Street Address City/Town State Zip to act on the property owner's behalf,in all matters relative to work authorized by this building permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) If building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here 0 and skip Section 10.1 10.1 Registered Professional Responsible for Construction Control Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor Company Name �i �\ � ':i CSL LS- \03S5n Name of Person Responsible for Construction License No. and Type if Applicable 4,J� Street Address City/Town ' State Zip Telephone No.(business) Telephone No. cell e-mail address SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT .G.L.c.15Z§25C 6 A Workers Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Is a signed Affidavit submitted with this application? Yes❑ No ❑ SECTION 12 CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)_$ 1.Building $ J O Building Permit Fee=Total Construction Cost x_(Insert here 2.Electrical $ appropriate municipal factor)_$ 3.Plumbing $ 4.Mechanical WAC) $ Note:Minimum fee=$ (contact municipality) 5.Mechanical Other $ Enclose check payable to 6.Total Cost 1 $ (contact municipality)and write check number here SECTION 13.SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my kno edge and understanding. Please print angn na ,,,., �J \ Title d si Telephone No. Date Street Address City/Town State Zip / Municipal Inspector to fill out this section upon application approval: 11 Name Date CITY OF S.ULEM, iNJASSACHUSETTS • BI:ILDLNG DEPAR mENT 120 WASHINGTON STREET,Sao FLOOR p°f T EL (978)745-9595 FAX(978)740-9846 KIN BERLF-Y DRISCOLL MAYOR T Hobo ST.PIERRH DIRECTOR OF PUBLIC PROPERTY/Buu.DING CO%masSIONER Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricia"Plumbers Analicant Information Please Print Leeibly NaMC(Busim-ssiOrganizatioNlndividual): Address: `�)"3 City/State/Zip: r� 1� t.` Phone #: Are you an employer?Cheek the appropriate box: Type of project(required): 1.�s I am a employer with 0 6' 4. ❑ 1 am a general contractor and 1 El New construction employees(full and/or part-time).• have hired the subcontractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.: ?• ❑Remodeling ship and have no employees These sub-contractors have S. ❑Demolition working for me in any capacity. workers'comp.insurance. 9, ❑Building addition [No workers'comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 1 I.❑Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' MCI Other comp.insurance required.] ;Any applicant that checks brae al must also rill out the section below showing their worker'compensation policy inrotmadon. t I Inmeownen who submit this afndavit indicating they are doing oil work and then hire outside contractors trust submit a new affidavit indicating suck :Contmton that cheek this box must anached an additional about showing the name of ate subcontractors and their workers'comp.policy infannadon. !am an employer that Is providing workers'cornpenmdon Insurance for my employees, Below Is the policy and job tme information. . Insurance Company Policy#or Self ias.Lie. Expiration Date: ` — Job Site Address: W c City/State/Zip: &- �,, ,)NC\e Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S 1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of it STOP WORK ORDER and a fine of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of investigations of the DIA for insurance coverage verification !do hereby cerr jy under thepains andpenallies of perjury that the irrformatlon provided above/Is true and coma . ' l re; / _ /pA�/vti Date' 6 /3/ Phone t1: Ojjcial use only. Donor write in this area,to be completed by city or Iowa ojjlciaL City or Town: Permit/ldccuse# Issuing Authority(circle one): I.Board of Ilealth 2.Building Department 3.CitylTown Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person• Phone#: i CITY OF S�U.&%l 2NLksS.ACHUSET7S BUILDINGDEPARTNE ENT WN 130 WASHINGTON STREET, 3i0 FLOOR TEL (978) 745-9595 FAX(978) 740-9846 KI%.IBERLEY DRISCOLL MAYOR THows ST.Pmm DIRECTOR OF PUBLIC PROPERTY/BU LDING CO%06USSIONER Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5 Debris, and the provisions of MGL c 40, S 54; Building Permit# is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c 111, S 150A. The debris will be transported by: (name of hauler) The debris will be disposed of in : C ,,,..� (name of facility) '(address of facility) signature of permit applicant date JcbrisaliJic ` v■ evre ■ avveeae� vv■ 17 % Foster Street Salem, MA 01970 (979) 745-7313 PROPOSAL April 29,2014 SUBMITTED TO: Mike O'Brien 11 Dow Street Salem, Ms. 01970 We hereby submit specifications and estimates for: To remove all existing slate and asphalt roof shingles from complete main roof. To install ice and water shield covering all lower roof edges, up both valleys and under all flashing points prior to re-roofing. To install asphalt saturated felt paper covering all roof boarding prior to re-roofing. To install all new metal drip edge along all roof edges, both horizontal and vertical. To install architectural (GAF or Certainteed High Definition 30 year) roof shingles covering complete roof as mentioned above. To install up to 50 linear feet of roof boarding if necessary. To install new roof flanges on roof vent pipes. To counter flash and/or reseal the chimney flashing as necessary. If lead flashing is too damaged on the chimney we will grind it out and re-lead at an additional cost of$350.00. To clean up and remove all roofing debris from job site. We propose hereby to furnish material and labor—complete in accordance with above specifications,for the sum of Fifteen Thousand --------------------__-_---------____-------Dollars ($15,000.00) Payment to be made as follows; One third to start balance upon completion All material is guaranteed to be specified. All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from above specifications Involving extra costs will be executed only upon written orders,and will become an extra charge over the estimate. All agreements contingent upon strikes,accidents or delays beyond our control. Owner to carry fire,tornado and other necessary insurance. Our workers are fully covered by workman's Compensation Insurance. Acceptance of Proposal—You are au orizedtodn.t pifect ied.' Authorized Signature: Signature: T Date of Acceptance: S J Pu The Commonwealth of Massachusetts Department of Public Safety 'i' ,� � ,\lassachu>alls State Building Code(7811 C\IR) Building Permit Application for any Building other than a One-or,rwo-Famil elfin (this Section For Official Use Only) Building 1'ermit Nun)ber _ Dale Applied: __-_ Building Official: 7avaii'lable) SECTION 1:LOCAPION(Please indicate Block N and Lot N furlocations fur which astreet addreNo.and Street City /rown /ip Code Name of Buildin SECTION 2:PROPOSED WORK Edition of.MA Stale Code used _ If New Construction check here❑or check all that apply in Ili•Iwo rows below ' Existing Building ❑ Repair :\Itemlion ❑ 1 Addition❑ Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this pens t application? Yes ❑ No ❑--__ Is in Independent Structural Engineering Peer ev))e}*'rcyuirc _ Yes ❑ No ❑ Brief Description of Proposed 11'urk:-_-- fKubl1o�L �er� _ SECTION 3:COMPLETE Tlfls SECTION IF EXISTING BUILDING UNDERGOING RENOVA"rION,a\DmTION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CNIR 14) ❑ Existing Use Gruup(S): Proposed Use Group(s): -_— SECTION 4: BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq. ft.) Total .Area(sq. ft.)and Total Height(ft.) /G r SECTION 5:USE GROUP(Check as applicable) A: Assembly A-I ❑ A-2❑ Nightclub ❑ A-3 ❑ A4❑ A-i❑ 1 B: Business ❑ E: Educational ❑ F: Facto F-1 ❑ F2❑ FI: Ili h hazard H-1 ClH-2❑ H-3 ❑ 11-4❑ 11-5❑ 1: Institutional I-1 ❑ 1-2❑ 1.1❑ 14❑ 1\I: Mercantile❑ R:. Residential R-10 It 2❑ R-1❑ R4 ❑ S: Storage S-t ❑ S-2❑ � - U: Utility❑ Special Use❑and please describe below: Special Use SECrION 6:CONS'I'RUCTION'IWE(Check as applicable) IA ❑ . Ill ❑ 1IA ❑.. 1111 ❑ IIIA ❑ . IIIB ❑ IV ❑ VA ❑ \'ll ❑ SEC FION 7:SI"IT INFORMATION(refer to 780 C NIR 111.8 for details on each item) Water Supply: Flood"Zany Information: Sewage Disposal: Trench Permit Debris Removal: - A Irenth will not be Licensed Disposal Site Cl Public❑ Check if outside Road zone❑ Indicate municipal ❑ I'm ole❑ or iudvntify Tune: _---- or on site system❑ rryuired❑or Irenth or specify: permil is enclosed ❑ Railroad right-of-way: [Wards to Air Navigation: �i '• . ,n , .. .. ... , .Not:Applicable❑ Is Strm cur•within rid app math area' Is their rn•v irw tomplovd' or Loment to Build vntlowd ❑ 1 vs❑ or.No❑ Sos❑ No ❑ SECTION 8:CONTENT OF CFR HHCA'I'F OF OCCUPANCY I`ditwo ul Cade. L'sv Group(,): I\'pv.d Con>truchon: " _ lkcupant I.oad por I loon Uor, the building:ontain•m 4prinlder i.d y11Pui.11iolls: _ - SECT I0N 9: 1'ROI'EITI'Y OWNliit AU'I'IIOIIIZA'I'ION Nam utd Address ul 1'r, pony Owner -- No.and Street City/Town -- Zip -- Property Owner Contact Information: I"ille telephone No. (business) Telephone No. (cell) a-mail address -- If applicable, the properly owner hereby authorizes - -- Name Street Address City/Town State Zip — lu act on the property owner's behalf, in all matters relative to work authorized by this building, ,omit a„lication. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) 1f building is less than.15,UU1 cu.ft.of enclosed s wce and or not under Constriction Control then check here O and skit,Section 10.1 10.1 Ile istered Professional Responsible for Construction Control Nance(Registrant) Telephone No. o-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor Company Name NA%tersonesponsible for Construction License No. and Type if Applicable Strcet Address City/Town State Zip Tcic,hone No. business Telephone No. ce I c-mail address - SECTION II:mgtili ,( (INW1V. AI'(ON I af0aVI1 M.G.L.c.152.1 25C6 A Workers'Compensation Insurance Affidavit from the NIA Department of Industrial Accidents must be completed and submitted with this application, Failure to provide this affid wit will result in the denial of the issuance of the building permit. Is a signed Affidavit submitted with this a lication? Yes❑ No ❑ SECTION 12 CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor ��G• and Materials) Total Construction Cost(from Item 6)=S O 1. Building S Building Permit Fee=Total Construction Cost x_(Insert here '_. Electrical- S appropriate municipal factor) =S {. plumbing S t=5 t oe: Minimum fee _('Inact nmu , ) J. .Mcx'h,mical (HV:\C) S Note: 3. .\Icrhaniral Other y _ Enclose dieck payable to G. a. rotal Cost S (contact ntunicipalih'),mil write check nun nor SECTION I3:SIGNATURE OF BUILDING PERMIT APPLICANT lie emerin+; nr. n,ume below, I hereby attest a I, t pai and penalties of perjury that all of the infonn,ttion contained in this at, , c Lion is true and accura/thw , ty n dge and understanding. a� O I lone print,In, sign 11,111 Ile Irh hunt No Date Strrr't Address Citni town State /ip Municipal Inspector to fill out this section upon application approval; L__ --_—. _Nance Pow--- IM9assachusetts- Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License License. CS 9'1942 MICHAEL L MERCURIO 127 OAK ST WAKEFIELD, MA 01880 _ Expiration: 1/4/2013- ('onunissi.mer Tr#: 9263 Office of �E=cAftirs&Bdsiae"sss Vgu ahoa License or registration valid for indiyidul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration149839 Type: Office of Consumer Affairs and Business Regulation Expiration 2/1312 0 1 4 DBA 10 Park Plaza-Suite 5170 c �s 7 Boston;MA 02116 TMUR10 CONSTRUCTION— . r. MICHAEL _ .j iLL✓� ////ff � 127 OAK WAKEFIELD, MA 01880 w Undersecretary Not valid without signature CITY OF S-VUNIa J%ws:ICHUSETTS BUILDING DEPAWDILF—NT �t') 120 1'(/.\SNLVGTON STREET, 3iO FLOOK A�p7Kat.:,�. , . ` • T"EL (978) 745-953 5 Ruse.(973) 7.10.9844 �1�tf3EAlEY DRiSCOLL �L�YOA Titosw ST.PiuAz DIRECTOR OF PUBLIC PROPERTY/BUR.DF%'G CO\LMISSIONER Workers' Compensation Insurance Affidavit: Uuilderi/Contractorv/Electrlci•rns/Plumbers li illeant Information Please Print Legibly V;I111C Illueiiu�•e�Ur�7mralion,lndividu.d):_ 1/l/�O/GS �G:at-S/�" CityiStntclzip:s� odS . Dlfy yD(shone N: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ 1 am a employer with 4. ❑ I am a general contractor and I 6. ❑Now construction umploycex(full and/or part-time).• have hired the sub-contractors 2.0 1 am is sole proprietor or partner. listed on the attached.hh9cL t 7. (] Remodeling .hip and have no employees These subcontractors have V. ❑Demolition working for me in any capacity, workers'camp,insurance, 9, C1 building additson [No workers'.camp.insurance 3. ❑ We are a corporation and its requircJ.] ofRcers have axrraised their l0.❑ Electrical repairs or additions 3.❑ 1 ran a homeowner doing all work right of exemption per MGL I I.❑Plumbing repairs or additions myself.(No workers'Gump, c. 132,11(4),and we have no 12.❑Roof repair insurance required.)t umpluyees.(No workers' l3.❑Other comp. insurancercquired.) •.vny appAl dW chvdu bot el muss Alta all out the W litre below showing their waken'compensation pulky inaamo ion, 'I A.nauwn v who whmir this A1110avis indiwlns they ae doing all worts Ind then hiro uunids cantnesas au/l mhmh arm 3171davit indicting tech. t',�mtxWn that uhvsk this box mud ranched An.Wailluna.hss.hewing Iho mmro of the rubeunlesckxs And Ihair workaro'comp,policy InWmnava. l one an eutpluyer thug Is pruvldlnx workers cunrpensmlun Insuruneejar my empluyeeA Below Is the polky and fob sits, I n,ururee Company Nmne: �Iig�s/ cL1Of_ • Policy 4 or Sclf-itu. Lis d: /, .cezl 7 Expiration Date: �'i lob Sita Addruss: Cityistatr/Zip: ��2 - Attach acopy of the workers'coinpensatloo policy declaration page(showing the polity numbar and 4xplratloa data). Fllluru to vecure cuverage as required under Section 21A of\fGL c. 152 can lead to the imposition of criminal penalties of a rive up to il,500.d0 ond/ur one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a line of up to 5230.00 I day ]yallist die violator. Ile]dvi.(ed that.!copy of this nialemcrit may lW larwarded to III,Gltico If Iavc,lig�Iiuns ai the 01A Ibr insurance coverage veriliciliun. /du hereby rrrnjy r rdn du pain un penaltlrr ajperjury that the htjurnwdou pruvidrJ above its rue and correct UI/idol rue ouly, Oa nor write in this area, robe completed by city or town nf/lciaf City nr l"wV,I: I„uin;• tilhurily (eirclo unc): 1. Iiu•ud sal Ilcahh S. ILlihllm;I)c(cutment 1. Cilylfntvn Clerk J, Electrical ht,peclur i, 1'Innlhint! f lipectur G. Ihlive --- --- ._. To: Page 1 of 2 2012-05-08 13:30:58(GMT) Lauranzano Insurance Agency From.Larry Lauranzano AC-Ql CERTIFICATE OF LIABILITY INSURANCE DATE 0112012 os/o1/zolz PRODUCER (978) 927-8420 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Lauranzano Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 107 Dodge Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Beverly MA 01915- INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A:Penn America Insurance Co _ Rodrigo Guimaraes INSURER B:Travelers Guimaraes Construction INSURER C 21 Balcomb Street INSURER D: Salem MA 01970- INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, 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. INSR ADD'L TYPE OF INSURANCE POLICYNUMBER POLICY MMIDDTIVE POLICY EXPIRATION LTR NSRD ( " DATE(MMIDDM') LIMITS A X GENERAL LIABILITY PA06905937 03/09/2012 03/09/2013 EACH OCCURRENCE $ 1,000,000 D 41dAGE X COMMERCIAL GENERAL LIABILITY P TO RENTED AEMISESEe 1T,,'ence $' 100,000 CLAIMS MADE FXIOCCUR / / / / MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMPIOP AGO $ 2,000,000 7X POLICYPEa Loc AUTOMOBILE LIABILITY / / / / COMBINED SINGLE LIMIT $, ANY AUTO (Ea accident) ALL OWNED AUTOS / / / / BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS / / / / BODILY INJURY NON-OWNED AUTOS (Perecciaen[) $ PROPERTYDAMAGE (Per ecddenl) $ GARAGE LIABILITY AUTO ONLY EAACCIDENT $ ANYAUTO / / / / OTHER THAN EA ACC $ AUTO ONLY: AGO t EXCESSIUMBRELLALIABILM / / / / EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ WC WORKERS COMPENSATION AND / / / / TORY LIMITS OER EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNER)EXECUTIVE EL.EACH ACCIDENT Is OFFICEGMEMSER EXCLUDED? / / E.L.DISEASE-EA EMPLOYEE'6 I yes.describe undw SPECIAL PROVISIONS below EL.DISEASE-POLICYLIMIT '$ OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES(EXCLUSIONS ADDED BY ENDORSEMENT(SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION (978) 745-9595 5641 (978) 740-9846 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 20 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT City of Salem FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE Public Properties Department INSURER,ITS AGENTS OR REPRESENTATIVES. 120 Washington Street AUTHORIZED REPRESENTATIVE Salem MA 01970- ._- A(�CORD 25(2001/08) ©ACORD CORPORATION 1988 INS025(0108).05 ELECTRONIC LASER FORMS,INC-(800)327-0596 Pagel J2 I