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21 EMERTON STREET - BUILDING JACKET 11 SuperTab. OWSIN&TW INUM 90%LargerLabelArea • • /// SME:AD KEEPING YOU ORGANIZED Mo.In" rrrer•OM as&kUaA GET ORGANIZEDAT SMEAD.COM �nccra®ooxiert imposMONIXUR 7Certifythat er: B-15-174 Permit Number: B-15-174 Commonwealth of Massachusetts City of Salem tify that the ..................................................................Two Family Building.......................................................... located at Building Type ....................................21 EMERTON STREET in the ..................................................................................................................... Ciry o Salem Address ........................................_.. ...... ................................................................... TowNCity Name IS HEREBY GRANTED A PERMANENT CERTIFICATE OF OCCUPANCY 21 EMERTON STREET UNIT 1 NICK ALLERADEIYORKSHIRE REALTY TRUST This Permit is granted in conformity with the Statutes and Ordinances relating thereto, and expires Nat Applicable unless sooner suspended or revoked. Expiration Date Issued On: Thursday, December 17, 2015 Certificate Number: B-15-174 Permit Number: B-15-174 Commonwealth of Massachusetts City of Salem This is to Certify that the ..................................................................Two Family. Building.......................................................... located at Building Type ......................................................................�I..EMERTON STREET Ci o Salem ............................................................................................................................... in the ...........................................t3.... ................................................................. Address Town/City Name IS HEREBY GRANTED A PERMANENT CERTIFICATE OF OCCUPANCY 21 EMERTON STREET UNIT 2 NICK ALLERADEIYORKSHIRE REALTY TRUST This Permit is granted in conformity with the Statutes and Ordinances relating thereto, and expires Not Applicable Date able .EPi unless sooner suspended or revoked. ration Issued On: Thursday, December 17, 2015 f -',COMMOMWOalth cif'Ma6sitchu w 6 setts GIN. S-6.lern of 1144 120Wa�fifngtOb�i, 3tdFWrZi[em.-M�0,197,10.(6761746� i,Z 4V �,4�c 9 fd 't kqturl�cirdto,sw .47 Mw 2 ?F 4�L ng, off IF ComfIfta i3f, M Andy SA Permit Ndf B41 5, :Aij Q �Pr 17.IZ a MWAI U: 405bl.u -Mf I T 0 'BU I I *l",W.V 0454.�, -V f,,,-�TE R p L C44, DAYS'18 S U E DDei,.R� r f• ' ..rg` qr f"x)Ltd 4,. 1q, 4, VA XORKSHI!rEAL.V-1rKUST AALERtJD NICHOLAS �pi j,�, -TR` 'i IFTMI ot 11V it vp"4 L ARM—,-f, REHAB —UMBING,& REPLACE,, IV %.f�QWING TODAYS' tW q aTF-P-MEN.J WLAHW, v I N 4, Rr 0 12 INA'4-i�, C C -dintractor LieeniieWv,�c�1,04 4� f Vx 3113/2010 All 02, e a, T his POrmit,stWOU doY`wnp W" .'R now 91 Yr cl ur CA nt one or more eXlensiors.not3o exceed sixvma aifterlssuahc*The MAI gyms z wr -W 7 work Wn,dnd,the appmyw constrmw 41peTmIL hat,teen,gi 17�, All tfu": "W tbn anemponva ConS any rOSSh8flbejMW N4 000arrtdv�,Wth the �Nvs Z,t This"PWM* -Shall.lbe-ft—p'la,odyn a,jc)aOc;hcjej�yjVi�I if ortoadafidshall 1bemadiritalned WO lKbrcorri0lstk'Zfc ;uw*;san or thp."redwi "el v' V ,4,t m Tfie� altff(%tAi of Orcc 91pahLyr*1 h&be Issuvditrifliol ti�the BUHOV�'anb Fjr.j Of0pa A., 6, xe, 71,�ll -11-1, ,�j -��u -". &�,,l 1 -�r�l P p V, Ml�il - ­­� -!?�' - , . . 41Q � % , I -L .. I 1� I., . , 4 A1104, q�� Al ---T fu 7f Obdup ON W.. .... A A 0 v -ill *,A ony Arleftfyea�aallablla ' t er s, + k Alt Permit Calls are the rb o4*v.of' p W. 'A 4% Communwealth of . ssac rase s City of Salem P� 1,:J .Nasn�n�n St,'srd FOOr`e�em,t,1i�O�u70 r�78�7d5•B s63 r5ea1 Retum card 10 9uitding Division for Certificate of Occupancy Structure CITY OF SALEM BUILDING PERMIT J% -� PERMIT TO BE POSTED IN THE WINDOW INSPECTION RECORD aretiefq �mdiitian 3i. INSPECTION: BY DATE -- r��.art'.tNon � -- - -. Plumbing/Gas Rotugh,30% Q1 t Electrical ` ;5eracs l :Fina+ Fire Department fPteJlrw}arr rit 1 + ywalth Department r; 4 ° 'POO I a _ �.... . STREET PERMIT p ._ cftp of I*ale li�: s Office of �nopector of jpuQDiugg zoo Arnussron is 64(yioen lo'./ ! /G� /7.' . 'l/�I r.�y<7z/✓ms s to occuf,Y`° - -1�(.,dA_ r Purpos . 4 infronl o es°Afate Com/ .e e-q •. 1 7PId - _ i ofsidea�'aUi, � ofsheet. � � � � J � ~� /-�is perMis f,. iledlo 1414. l204 r ,su ;?&/./o'le __.. Prooi ons of16e ounces ands!Whiles in re/alion!o C51reels andt6e �7nspeclion # and conslruclion of`Z�uirdlnys in!lie ci y of&a .. i f 1 Disc/w ol.�6(ic cSrruiarf rE �-3 9mrp¢clor ol'.2fui//mya� t ., i �a STREET PERMIT Citp of *aiem Office of 3nopector of Aluilbingg Gie-Vali Af r- pL�. 3 2015 ermission is Siere6y yioen to ..S E-V � 1._I 1'�k �k A g— to occupy for 2 y��rp� l (�1 ^^t V (y7 S i- Y� purposes in fron�lof%eslal¢ 1 tAt'���7DN tea/ ! ��G� of syf'r�emo� of slreel. .r7Sis permil is lmiler/lo P'l 1 20 / 5' , su6'ecllo ISe prooisions of lSe ordinances andslalales in re/alion to cslreels andlSie gnspeclion and Gonslruclion of-Tuildinys in 16e CiJ(of cSalem. / 'IJirec/w ol.'Ai6/ic c$¢rwber 9neped r of..Z3ui(Jinye c$i9nalure of`,App(roan! .. CsivcN G mcg x� 03/12/2015 00:33 9787940822 PAGE 01/03 STREET PERMIT BOND COHN WEALTH(W MASSACHUSETTS Bond No. Iofig"I9 KNOW ALL MEN BY THESE PRESENTS,That we, Steven Mahar as Principal,and the Trgxelera Casual fy nA ,rely,Ogmpyny of ApUtrlca a corporation duly organized under the laws of the State of CT and having a usual place of business in MA as Surety, are held and firmly bound onto the Town of alem as Obligee,in the full and just sum of One uaand (S1,000.00 )Dollars,lawful money of the United States,well and truly to be paid and for the payment of which wejointly and severally bind ourselves,our heirs, executors,administrators,successors and assigns,jointly and severally,firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH THAT WHEREAS,the above named Obligee has issued,or is about to issue,or may$om time to time hereafter issue to the said Principal a certain license or permit or certain licenses or permits for the use of streets and public ways of the said Obligee. NOW, THEREFORE, if the said principal shall faithfully observe and keep each end all of the agreements, stipulations, conditions, specifications and provisions by the said Principal to be kept and performed, contained in said licenses and/or permits issued to the sold Principal and in each and every extension of same,according to the full extent and spirit of said license and/or permits, and the ordinances of the said Obligee now relating, or that may relate thereto and shall lndemnify and save harmless the said Obligee from all liabilities, loss and expense whatsoever which the said Obligee may incur and suffer arising out of the issuance of such licensees and/or permits and all extensions of the same,and shall make no default therein,then this obligation shall be null and void;otherwise it shall be and remain in full force and effect. IN WITNESS WHEREOF,we hereunto set our hands and seals this 11 day of March in the year sols Steven Mahar �1 H �unlntr alewn mahar(Mar 12.2015) Travelers Casually sed Surety Company of America By, Mall ■ mdy Lawler,Attomeyin-Fact 5-2179(8166) 03/12/2015 00:33 9787940822 PAGE 02/03 :a mghemomWdlonR TRAVELERS J~ POWER OF ATTORNEY Farmington Casualty Company St.Paul Mercury insurance,Comps Fidelity and Guaranty Insurance Company St.Paul Casualty and Surely C'Company Fidelity and Guaranty lmunmce Underwrhan,I SL Paul Fire and Marine Imemrce Company Traveien Carisft and SusetyCompany IfAmerice w y United States FldaOty and Guaranty Company S!.veal Guardian Insurance Company Surety Bond No. 106239619 Prindpal: Steven Mahar e Brawitar Terrace MFTHUEN,MA 01tµ6 Obligee. Townef Salem 120 WaaMngton Straat SALEM,MA019y0 KNOW ALL MEN BY THESE PRESENTS:That Farmington Casualty Company,SL pawl Fire and Manna Insurance Company,St Paul Guardian Insurance Company, Sc Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Traveling casualty and Surety Company of America,and United States Fidelity and Guaranty Company,are corporations dulyorganized under the laws of the State of Connecticor, that Fidelity and Guaranty Insurance Company is a corporation duly organized under the laws of the State of Iowa,and that Fidelity and Guaranty Insurance Underwriters,Inc Is a corporation duly organized under the laws of the State of Wisconsin(herein eoliectivaly called the"Companies"),and that the Companies do hereby make,constitute and appoint MaryTnWy Lawler,of the Cltyef Methuen,State of MA,their true and lawful Att may(a)9n-Fact,to sign,execute,seal and acknowledge the surety bond referenced above. IN WITNESS WHEREOF,the Companies have caused this instrument to be signed and their corporate seals to be hereto affixed,this 10th day of Septerrtbm, 2012. Farmington Casualty Company St Paul Mercury Insurance Company Fidelity and Guaranty Insurance Company Travelers Casualty and Surety Company Fidelity and Guaranty Insurance Underwriters,Inc. Travelers Casualty and Sumtycompery of America St.Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company St.Paul Guardian Insurance Company a 1 1tor a T077 1�t �rE aeAL � +aM State of Connecticut City of Hartford is. By' Robert I- ey, en r ce res Unit— On ratOn this the 10th day of September,2012,before me personally appeared NOW L.Raney,who acknowledged himself to be the Senior Vie President of Farmington Casualty Company,Fidelity and Guaranty Insurance Company,Fidelity and Guaranty Insurance Underwriters,Inc.St Paul Fire and Marine Insurance Company,St Paul Guardian Insurance Company,St Paul Mercury Insurance Company,Travelers Casualty and Surety Company, Travelms Cesuahy rety and Su CompanyofAmenia,and United States Fidelity and Guaranty Company,and that he,as such,being authorised so to do, executed thefvregtInstrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer, In Wltnas,Whereof,I hereunto set my hand and Official seal. My Commission expires the 30th day of Jam,2016. • D ore ry t 03/12/2015 00:33 9787940822 PAGE 03/03 maha2onernwlbnk This Power of Attorney Is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Farmington Casualty Company,Fidelity and Guaranty Insurance Company,Fidelity and Guaranty Insurance 1lndenedtemInc,.St.Paul Fire and Marine Inaprante Company,SL Paul Cam Guardian Insurance Company,St.Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers Casualty and Suretyy M America, "Com end United States Fldelltyand Guaranty Company,which resolutions are now In full force and effect reading as follows: RESOLVED,that the Chairman,the President,any Vice Chairman,any Executive Vice President,any Senior Vice President any Vicar President any Second Vice President the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary may appoint Attorneys-In-Fact and Agents to act for and on behalf of the Company and may give such appointee such authority as his or bar certificate of authority may prescribe to sign with the Company's name and seat with the Company's seat bonds,recognlxances,contracts of Indemnity,and other writings obligatory in the nature of a bond,meognizenca,ormndltlenal undertaking,and anyefsold officers or the Board of Directors at any time may remove any such appointee and revoke the power given him or her,and It Is FURTHER RESOLVED,that the Chairman,the President any Vice Chairman, any Executive Vice President any 5e1110r Vice President or any Vice President may delegate all or any part of the foregoing authority to one or more officers or empkyees of this COmparry,prOylded that each such delegation Is In writing and a copy thereof Is Ned In the officedithe Seeretar,and It Is o FURTHER RESOLVED,that any bond,recognizance,contract of Indemnity,or writing obligatory In the nature of a bond,recognimnoe,or conditional undertaking shall be valid and binding upon the Company when(a)signed by the President any Vice Chel"ain,any Executive Vice President any Senior Vice President or any vice President any Second Ace President the Treasurer,any Assistant Treasurer,the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary Or Assistant Secretary,,or(b)duly executed(under seal,If required)by one or more Attorneys-in-Fact and Agents pursuant to the power prescribed In his or her cent lcate or their certificates Of authority car by one or more Company officers pursuant to a written delegation of authortty;and It Is FURTHER RESOLVED,that the signature of each of the following officers;President,any Executive Vice President any 5enlor Vice President any Ace President any Assistant Vice President any Secretary,any Assistant Secretary,and the seal Of the Company may beaffixed by facsimile tc any Power of Attorney or to any certificate relating thereto appointing Resident Vice presidents,Resident Assistant Secretaries or Attorneysdn-Fact for purposes only Of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof,and any such Power of Attorney or certificate bearing such facskmlle signature Or facsimile seal shall be valid and binding upon the Company and any such power$0 executed and certified by such facsimile signature and facsimile seal shall be valid and binding On the Company In the future with respect to any bond or understanding t0 which R is attached. 1,Kevin E,Hughes,the undersigned,Assistant Secretary,of Farmington Casualty Company,Fidelity and Guaranty fnwmce Company,Fidelity and Guaranty Inwrance Underwriters,Inc,St Paul Fire and Marine Insurance Company,St Paul Guardian Insurance Company,St.Paul Mercury Insurance Company,Travelers Casualty and Surety Comparry,Travelers Casualty and Surety Company of Americn,and United States Fldellty and Guaranty Company do herebycerdfy that the above and foregoing is a true and correct copy of the Power Of Attorneyexecuted by said Companies, which is In full force and effect and has not been revoked, IN TESTIMONYWHEREOP,I have hereunto set my hand and affixed the seals of saw Companies this 12 day of March,2015. �� e154- Kevll E.Hughes,Assistant Secretary ,sacs /YT) ff IoaA aaaae s �. `/i,�w-w• 1fa51 rw J O tq'�s Tovefifytheauthent(eityofthlsPowerofaetorney,eegf•800-421.398oazcatfdesusatwww,tmwitisbendtom, Masara/erto the AaOrnepin-Factnumber,010 abovaysoarad lndlvldwh and the details of the boOdta which the powez7s dtteched. QTY OF SALEM, MASSACHUSETTS BUILDING DEPARTMENT 120 WASHNGTONSTREET,31 mom \ � TEL. (978)745-9595 FAX(978)740-9846 KI aERLEYDRISCOLL MAYOR THOMAS ST.PIERRE DIRECTOR OF PUBLIC PROPERTYIBUILDING COMMISSIONER December 4, 2014 To Whom it May Concern RE: 21 Emerton Street Salem, Ma. 01970 According to our records, it has been determined that the property located at 21 Emerton Street is a legal grandfathered two (2) 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. Sincerely, Jr114.0 Thomas St. Pierre Zoning Enforcement Officer CITY OF SALEM, MASSACHUSETTS BUILDING DEPARTMENT 120 WASHINGTON STREET,3"D FLOOR TEL. (978) 745-9595 FAX(978) 740-9846 KIMBERLEY DRISCOLL MAYOR THomAS STRERRE DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER February 19, 2014 Janice Barker 565 Santa Ray Ave Oakland Ca. 94610 Re: 21 Emmerton Street Dear Ms. Barker, I am writing to you regarding the above property. You have been identified as the closet relative of the two ,t owners of this building. I,m not sure when you last saw the building, but the condition of it is not very good. The exterior porches are all failing and due to the porches and open soffits(allowing animals into the building) the property has been condemned on fitness. You should also know that the building is three tax quarters in arrears to the City. At the one year point, the City begins the tax taking process. If you could respond and let us know if you have any plans to take care of this property, it would be appreciated. Thomas St.Pierre Building Commissioner/Director of Inspectional Services CITY OF SALEM, MASSACHUSETTS rn � BUILDING DEPARTMENT 120 WASHINGTON STREET,3"°FLOOR � } TEL. (978) 745-9595 FAx(978) 740-9846 KIMBERLEY DRISOOLL MAYOR THomAS STTIERRE DIRE CTOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER February 11, 2014 Patricia Leszczynski 69 School Street Salem Ma. 01970 re:21 Emmerton Street Dear Ms Leszczynski, I have spoken with you previously about the property at 21 Emmerton. Can you update me if anything is happening regarding the disposition of the home. Also, if possible a list of the folks that are heirs. We need to do something with property. The abutters are concerned about the condition from a Pubic safety perspective as well as the general condition. Any assistance would be appreciated. Thom�s-St.Pierre Building Commissioner/Director of hispectional Services CITY OF SALEM, MASSACHUSETTS PUBLIC PROPERTY DEPARTMENT 120 WASHINGTON STREET, 3RD FLOOR SALEM, MASSACHUSETTS 01 970 ap' TELEPHONE: 978-745-9595 EXT. 380 FAX: 978-740-9846 KIMBERLEY DRISCOLL MAYOR September 10, 2013 Elizabeth Rennard City Solicitor 93 Washington Street Salem, Ma. 01970 RE: 21 Emerton Street Dear Beth, 1 am requesting a lien to be placed on the property located at 21 Emerton Street. Enclosed is the copy of the bill from Baystate Building & Remodeling for the emergency work done to the property. Thank you for your cooperation in this matter. Sincerely, 26?t,'✓ � Thomas St. P rre z Director of Inspectional Services �• , �F Baystate Building& Remodeling Inc. RI t Po box 725 >� Salem, MA 01970InV01Ce x r (978)741-1700 08/22/20!3 4335 tommy@baystatebuilding.com littp://www.baystatebuilding.com Ti.Te[ms �?�.Due`Date ,�s- "�, Due on receipt 08/22/2013 City of Salem Massachusetts 93 Washington St Salem, MA 01970 +e i3`s'f,:!. '.°tr k� fv5°Xf1tY1011ftt' •JOB LOCATION. 21 EMERTON ST "" " t"" t` • BOARD UP I I WINDOWS • INSTALL I LOCK AND HASP 550.00 50.00 N z r-J � w -1 ri c� n 00 _ I O rJ B.: We Build "SOLID "Customers! ia v Total ry p $600,OQ We Build'•SOLID"Customers! ���o�tiur�A CITY OF SALEM, MASSACHUSETTS - 3 BUILDING DEPARTMENT s 120 WASHINGTON STREET,3"D FLOOR TEL. (978) 7=45-9595 (978) 740-9846 Frvc KINIBERLEY DRISCOLL MAYOR THOMAS STTIERRE DIRECTOR OF PUBLIC PROPERTY/BUILDING COMIISSIONER Ann C. Lescynski/Caimi Lescynski Or current residents 21 Emerton Street Salem Ma. 01970 re :unsafe condition Dear Owner/Occupant, This Department has received and confirmed complaints regarding the exterior of your property. The rear porches are particularly unsafe and the front porch is also not in good condition. Under the authority of the Mass State Building Code 780 CMR section 116 ,I am declaring your building unsafe. You are directed to contact this office upon receipt of this letter to discuss your plan to repair these items. Failure to respond will result in daily municipal tickets and further enforcement actions. If you feel you are aggrieved by this order, Your appeal is the Board of Buildings, Regulations and Standards in Boston Thomas S Terre 14,—x,.. Z� vL_"J Building Commissioner/Director of Inspectional Services CITY OF SALEM, MASSACHUSETTS BUILDING DEPARTMENT 120 WASHINGTON STREET,3RD FLOOR 'ItL. (978) 745-9595 FAX(978) 740-9846 KIMBERLEY DRISCOLL MAYOR THomAs STTIERRE DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER Ann C. Lescynski/Taimi Lescynski Or current residents 21 Emerton Street Salem Ma. 01970 re :unsafe condition Dear Owner/Occupant, This Department has received and confirmed complaints regarding the exterior of your property. The rear porches are particularly unsafe and the front porch is also not in good condition. Under the authority of the Mass State Building Code 780 CMR section 116 ,I am declaring your building unsafe. You are directed to contact this office upon receipt of this letter to discuss your plan to repair these items. Failure to respond will result in daily municipal tickets and further enforcement actions. If you feel you are aggrieved by this order, your appeal is the Board of Buildings, Regulations and Standards in Boston ThomTZ c I---� Building Commissioner/Director of hispectional Services 3' i LETTERS OF AUTHORITY FOR Docket No. Commonwealth of Massachusetts ES14PO874EA The Trial Court PERSONAL REPRESENTATIVE Probate and Family Court Estate of: Essex Probate and Family Court 36 Federal Street Anna C Leszczynska Salem, MA 01970 Also known as: Ann C Leszczynski (978)744-1020 Date of Death: 01/04/2010 To: Roy F Gen lineau,Jr. 19 Goldsmith Ave Beverly, MA 01915 You have been appointed and qualified as Personal Representative in E] Supervised 0 Unsupervised administration of this estate on May 23, 2014 taste) These letters are proof of your authority to act pursuant to G.L. c. 1908, except for the following restrictions if any: n The Personal Representative was appointed before March 31, 2012 as Executor or Administrator of the estate. III' (Do Not Write Below This Line-For Court Use Only) ■ CERTIFICATION ♦ . I certify that it appears by the records of this Court that said appointment remains in full force and effect. IN TESTIMONY WHEREOF I have hereunto set my hand and affixed the seal of said Court. Q� � __ Date May 27,2014 V ,, Pamela A Casey O'Brien,Register of Probate ti DECREE Dock No. ComnwnwThee rtfa Cone sachusetts rt PUBLIC ADMINISTRATION Probate and Family Court Department YPO FSJ In the Estate of- eit G (/,7, -c esietyn � Late of: eMMMI, Peabad Attire ro o!c an Grn, Ladi'f Six /YKra Essex Division on: 3 36 Federal Street (`ate) Salem, MA 01970 the Honorable 14177y presided. 978-7441065 All persons interested ❑having assented having:been notified in accordance with the law and no objections were made; ❑objections were made which were later wdhdrawn or stricken; ❑objections were made and a hearing was held; IT IS DECREED that and Roy F.Gelineau,Jr. Df 49 Federal Street Salem,MA 01970 and and be appointed Public Administrator first giving bond ® with ❑ without sureties for the due performance of said trust Data J a 3//� T v r—r�(�M✓�t1� `�`�-. aL i I&OF Tit PROBATE AND FAMLY COURT CJP 9d(3131/12) TurboLaw-(g00)51a-8M-ag.1. c LETTERS OF AUTHORITY FOR Docket No. Commonwealth of Massachusetts ES14PO876EA The Trial Court PERSONAL REPRESENTATIVE Probate and Family Court Estate of: Essex Probate and Family Court Miriam Leszczynski 36 Federal Street Salem, MA 01970 Also known as: Miriam T Leszczynski,Taimi Mariam Lesczynski (978)744-1020 Date of Death: 02/0311996 i To: Roy F Gatineau,Jr. 19 Goldsmith Ave Beverly,MA 01915 You have been appointed and qualified as Personal Representative in ❑ Supervised ❑ Unsupervised administration of this estate on May 23,2014 PaMeT These letters are proof of your authority to act pursuant to G.L.c. 1908,except for the following restrictions if any: i ❑ The Personal Representative was appointed before March 31,2012 as Executor or Administrator of the estate. (Do Not write Below This Line-for Court Use Only) ■ CERTIFICATION a I certify that it appears by the records of this Court that said appointment remains in full force and effect. IN TE8TIMONY WHEREOF I have hereunto set my hand and affixed the seal of said Court. (�' sw�►���r r' Date May 27,2014 y �, Pamela A Casey O'Brien, Register,of Probate MPC 751 (3/31112) DWcommonwealth of Maseachuseft DECREE The Trial Court PUBLIC ADMINISTRATION Prolate and Family court Department RIP In the Estate of: Miriam Leszczynski aka Miriam T.Leszczynski aim Taimi Mariam Lesczymld Late of Salem At the Essex Division on; 36 Federal Street I iddl�/��� Salem.MA 01970 the Honorable i4 I V presided. 978-7441065 All persons interested ❑having assented I having been notified in accordance with the law and IN no objections were nude; ❑objections were made which were later withdrawn or stricken; ❑objections were made and a hearing was held; R IS DECREED that and Roy F.Gatineau,Jr. 49 Federal Street Salem,MA 01970 and and be appointed Public Administrator first giving bond ® with ❑ without sureties for the due performance of said trust. Date �a�lty JU I OF THj PROBATE AND FAMILY COURT CJP 9d(3/31112) Tukbotaw-(8M 51"n6-ag.E 0002 EMERTON STREET LODGING HOUSE City of Salem Mass Housing (Health) - Inspection ( Rev. Jun 01,2010 ) Area To Inspect:: Item: Status: Nature of problem or correction: Hot Water(110' F- 130° F) Not Done Ok to Issue Certificate?: Sufficient quantity and pressure FAIL The hot water temperature measured at 150.8 degrees F.Owner to provide hot NO (410.190) water at a minimum temperature of 110 degrees F and not to exceed 130 degrees F. . Building Layout The Same?: No Kitchen Facilities Not Done Inspector: Stove and oven in good repair FAIL The kitchen stove is missing a knob. Repalce the knob. David Greenbaum (410.100(A)(2)) Date&Time Requested: Owners Installation & Maintenance Resp Not Done at Sinks, tubs/showers, toilets, heating FAIL All refrigerators and freezers in the kitchen are in need of a thorough cleaning Date of Inspection: equipment, gas pipes, water heating and defrosting. Tuesday, June 01, 2010 equipment, siove &ovens, electrical Reinspect By:: fixtures &wiring. The above equipment is maintained in good working order Certificate Number: (410.351(A)) Owners Responsibility to Maintain Struc Not Done Certificate Expires On: - Windows,floorS, doors, ceilings, roof in FAIL There is water damage on the ceiling of room 1-1. Investigate the source of the good condition (410.500) leak and repair. Repair and repaint the ceiling. Status: There are water stains and damage on the ceiling of room 1-2. Investigate the OPEN - source of the leak and repair. Repair and repaint the ceiling. Notes: There is a hanging electrical box in the ceiling of room l-2. Repaair and resecure Rooms 2-1, 2-2 and 2-4 had the electrical box. no violations. There is dhipping/pealing paint above the sink on the ceiling of room 1-2. Cc: Building Licensing Fire Scrape and repaint all chipping/peeling paint. ' Prevention There is water damage on the ceiling of room 2-3. Investigate the source of the leak and repair. Repair and repaint the ceiling. 120 Washington Street,4th FloorSALEM,MA'Phone:(978)741-1800'Fax:(978)745-0343 GwTMS®2010 Des Lauriers Municipal Solutio Page 1 of 2 N DI 7,1114 CITY OF SALEM, IVIASSACH USE,TTS BOARD OF APPEAL YNK W120W\SI[IN(;IONS MITI* 0 KIN113i:Ti.ry D[uscou. Ti:i.r:978-745-9595 # Fx:978-740-9346 NL\�,oR fm December 5, 2013 C=1 Decision nC-� I City of Salem Board of Appeals cn Petition of EMIL KRANER requesting a Special Permit under Section 3.3.2 Non o orm i>v Uses of the Salem Zoning Ordinance to allow the conversion of an existing Rooming H ti,,. to 5 sidential units, at the property located at 2 EMERTON STREET (112 Zoning District). (J) N"I r%3 A public hearing on the above Petition was opened on November 20, 2013 pursuant to M.G.L Ch. 40A, § 11. The hearing was closed on that date with the following Salem Board of Appeals members present: Ms. Curran (Chair), Mr. Duffy, Mr. Watkins, and Mr. Tsitsinos. The Petitioner seeks a Special Permit under Section 3.3.2 Noncoi�iitzving Uses of the Salem Zoning Ordinance. Statements of fact: I. In the petition date-stamped October 28, 2013, the Petitioner requested a Special Permit to change from one nonconforming use to ,mother, at the property located at 2 Emerton Street. 2. Mr. Emil I:,raner, the Petitioner, presented the petition for the property at 2 Emerton Street (IZ2 Zoning District). 3. 'rhe budding is currently in use as a rooming house, and is in poor condition. It has three double- occupancy rooms, four single-occupancy rooms, and one 2-bedroom apartment, for a total of 8 units. 4. The Petitioner proposes to convert the existing budding to four 1-bedroom living units and one two- bedroom living unit, for a total of 5 units. The Petitioner proposes to renovate the plumbing and electrical systems, as well as the interior and exterior finishes. 5. '['here is no parking on the property, and the existing footprint of the budding does not leave adequate space for the creation of parking on-site. 0. Ward 2 Councilor Mike Sosnowski (17 Collins Street) speaks in opposition to the petition. Councilor Sosnowski stated that the parking need for the existing rooming house is only for the manager/owner, none of the other units have parking needs. The proposed Use at 5 residential units would require 5-10 cars. 7. Fd Beaupre of I I Boardman Street, Carolyn Barres of 9 Boardman Street, Kathleen Cullen of 25 Forrester Street, Ted Kobialka of 27 Forrester Street, Kristine Doll of 30 Forrester Street, Fd Keenan of 21 Forrester Street,Jan Costa of 17 Forrester Street, MqryAtuic Currin of 35 Forrester Street, and Christina Bash of 37 Forrester Street all speak in opposition of the Petition, due to the existing lack of street parking in the neighborhood. Ms. Dolt stated that at one point a fire truck was tillable to navigate through the neighborhood and down I:iiicrtori Street due to the narrow width of the street and the congestion of the parked cars. Elie Salem Board of :Appeals, after careftil considcration of the evidence I)ITSCEIrCd :It the I)LII)IiC hearing, and :ificr rlior(mgh review 4 rlic 11CH6011S, ilICILI(lilIg HIC Al)P1iCMion narrative and plans, and the llctitioncr's and I)LIbliC tC.Srilliom, 1n.lkcs Ille follm6lig findings 111:11 dIC j)J()j)(11Cd j)1(1jUC[ %\:tS IOLAild ((I be n ` City of Salem Board of Appeals December 5,2013 Project: 2 Emerton Street Page 2 of 2 tnore detrimental to the neighborhood than the existing nonconforming use and does not meet the provisions of the City of Salem Zoning Ordinance: Findings: 1. The proposed change in use will generate the need for more parking than the existing use. 2. The proposed change in use mould be substantially more detrimental than the existing nonconforming use to the neighborhood, due to the lack of on-site parking for residents. 3. The existing congested street parking conditions impede the access of emergency vehicles. The addition of five residential units requiring on-street parking accommodations mould pose a public safety hazard. On the basis of the above statements of facts and findings, the Salem Board of Appeals voted four (4) opposed (bis. Curran — Chair, Dir. Duffy, Mr. Watkins, and Mr. Tsitsinos against) and none (0) in favor, to approve the Special Permit to allow change from one nonconforming use to another. The petition is denied. 4WC6.0 ct'wev�_ /V",/I - Rebecca Curran, Chair Board of Appeals A COPY OF THIS DECISION FL\S BEEN FILED WITFI THE PLANNING BOARD AND THE CM'CLERK I ppeal vim Voir derision, f mry, ,hall be made pursuant to See ion 17 of die Ma sachnselts Gewral L.rrvf Cbapter 40A, aad iball be filer!ailbill 20 (lays of fling o)Ibis decision in the odice o/lbe GO Clerk. Pursuant to lbe Alassaduuetls General L mx Chapter 40A, Section 11, the I in*an,e or Spedal Permit granted herein.rball not lake eed rnrlil a,opy of the dea im bearing Me rertflkale op the City Clerk has Leen filed will) the E, ex Soulb Reguny ojDeeds. CITY OF SALEM, MASSACHUSETTS y BOARD OF HEALTH 120 WASHINGTON STREET,4""FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAx(978) 745-0343 MAYOR Dcxr:e.NBAUM@SAr.BM.COM DAVID Gm;i?NBAum ACTING HEALTH AGENT June 2, 2010 Step Four Realty Trust Philip J. Malonson, Trustee 6 Simmons Lane North Billerica, MA 01862 Dear Sir/Madam: In accordance with Chapter III, Sections 127A and 127B 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 at 2-4 Emerton Street(Lodging House) conducted by David Greenbaum, Acting Health Agent,Tuesday,June 1,2010 @ 9:00am. 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 Board of Health at 978-741-1800. 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 tc present witness and documentary evidence as to why this Order should be modified or withdrawn. An attorney may represent you. Please also be informed that you have the right to inspect and obtain copies of all relevant inspection in 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. Forhe Board o Health vid11 Gre nb m Acting Health Agent Sent certified mail—7007 1490 0002 3077 4274 Co111111 mceaith oriklassachusetts INSPECTIONAL SERVICES Sheet ;Metal Permit 1015 JAN 20 A ID 11 Date: Estimated lob Coat $ Iki(ia--- Permit hbc:S _ Plans Submitted: YES NO� Plans Recicwcd: YES -- NO � Business I.Itcrosc;1 &it� Applicant License k 1 Business intitnnation: Property Owner/job Location tntiumatium: Name: [Name. nV n Smeet: c`�I- street: eryo Cityrl'own: r/ City y � ffuwm:SdIld�l ©Lq7 Telephone: Chi Telephone: LI) - Photo I.D.D. rcquircd/Cupy of Photo LD. attached: YES V/NO ^ J-1 /M-1-anrestricted license y ""n Wiwi J-2 J M-2-restricted Indaeiii s 3-stories or less and commercial up to IO,Wo sq. ft.t 2-stories or less Residential: 1-2family Multi-Iamily_ Condu/'fOwnhouses __ Other Conttuercial: OI'tice— Retail industrial -- _ Educational Institutional) Other_ Square Footage: under 10.000 sq, Q. ✓ ,>ver 10,000 sq. 11.— Number(if Stories: Sheet tnetal work to he counpleted: New Work:_ / Rcnoradon:� IIVAC' ✓ NielaI Watershed Roofing� -- Kitchen Exhaust System Metal Chimney Vents Air Balancing_ Prm ide detailed description of work to be done' v —r_CU-hS e C>+ ♦ L l 2 6 INSURANCE COVERAGE: j I have a current liability insurance Policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yes No❑If you have checked Yes,indicate the 00 of coverage by checking the appropriate box below: " A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee rides not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws.and that my signature on this permit application WUM this requirement. Check One Only VIAL Owner ❑ Agent ❑ yr Signature of Owner or Owner's Agent ng this Plicilft"are true and By chocking this box0.I hereby certify that all of the details and InlarmaUon I hays submitted�It Floor n e Permit issued far Phts appis a ion wille accurate to the best of my knowledge and that all shoat metal work and Instailatldns M in compitance with all pertinent provision of the Massachusetts Bulidin9 Code and Chapter tt2 of the General Laws. Duct Inspection required prior to Insulation installation: YES__NO Proagi Insorctinns Comment Dee FLt�I tnenection onuten D:tr� i Type of License: i gy ❑Master [j blaster-Restricted i - .. Signature at Licensee (]joumoyperson•Reswcted License Number i hea> .. _.. ,.._.— f-1._._..- Check at .._�r •u�ss:,yr�:{.:�'rt!t ' i tusPuttm 3igiWturo at Permit APProvol , i - The Commonwealth of Massaclp 10RXL SERVICES W Department of Public Safety Massachusetts State Building Code(780CMR �S u'� �� L. 59 Building Permit Application for any Building other than a One a y eNrng .(This Section For Official Use Only) .J� Building Permit Number: Date Applied: / Building Official: SECTION 1:LOCATION(Please indicate Block X and Lot#for locations for which a street address is not available) Er,� . ,lOr>_ Salem 0/970 No.and Street City/Town Zip Code Name of Building(if applicable) SECTION 1 PROPOSED WORK I Edition of MA State Code used_ If New Construction check here❑or check all that apply in the two rows below Existing Building❑ Repair$ Alteration ❑ 1 Addition❑ 1 Demolition ❑ (Please fill out and submit Appendix l) Change of Use ❑ Change of Occupancy ❑ 1 Other ❑ Specify: Are building plans and/or construction documents being supplied os part of this permit application? Yes ❑ No N Is an Independent Structural Engineerin Peer Review«quired? Yes ❑ No N Brief Description of Proposed Work:. ' (e& t40" 0�� .L✓A/� LB✓Q(7✓l.5 9 ka 4 L P _AD ,4i O/9✓.4 Co G' 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.) t/ 900 - Lf 9OU Total Area(sq.ft.)and Total Height(ft.) ,� 7� 30' 2.700 30 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❑ II: High Hazard H-1❑ H-2❑ H-3 ❑ H-4❑ H-5❑ 1: Institutional I-1 ❑ 1-2❑ 1-3❑ 1-4❑ M: Mercantile❑ . R: Residential R-1❑ R-2❑ R-3❑ R4 Cl S: Storage S-1 ❑ S-2❑ U: Utility❑ Special Use❑and please describe below: Special Use: - SECTION 6:CONSTRUCTION TYPE(Check as a Iicable)[A Cl IB ❑ HA ❑ IIB ❑ IIIA ❑ IIIB ❑ 1 IV ❑ 1 VA VIE ❑ 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 18 Check if outside Flood Zone❑ Indicate municipal® A trench will not be Licensed Disposal Site 1$ Private❑ or indentify Zone: or on site system required 0or trench or specify:❑ permit is enclosed❑ Railroad right-of-way: Ilazards to Air Navigation: %I\t Iki ,i, C .... ti n I r�iro-I r;rsa; Not Applicable H Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed❑ 1 Yes❑ or No IF I Yes❑ No Cl SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s):_ type of Constriction:_ Occupant Load per I Does Elie building contain an Sprinkler Systenn?: _ Special Stipulations: �%fkVL L4 f' SECTION 9: PROPERTY OWNER AUTHORIZATION Nffmuv,and e dues II roperty Owner / �t ei4 6,r �� �N.ern 5� Sif IePK Naive(Print) J,. No.and Street City/Town Zip Property Owner Contact Information: lllz l .4//?:gd% iyi 31E-?& 'ritle Telephone No.(business) Telephone No. (cell) a-mail address If applicable,the property owner hereby authorizes �fl-e✓e h /'�s �iaT 5' Qret..�-r-f-er Fer _.+�f<-1?rdvvi � or8�1�f 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 a pplication, 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❑and skip Section 10.1 10.1 RegisteredProfessional Responsible for Construction Control S?W,gen Z4- 9?44r 977-�- %,4-T 0 A7 4rc A:5 h,-a ffmy, Nam`�rj.�(Registrant) Telephone No. a-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor My/igr 6m4r /c- kavi Company Name S4evev% ./411,qr CSL CS- /OV97A /J/CO /6 `Y/ 6 j Name of Person Responsible for Construction License No. and Type if Applicable 4 �re✓s er -Erg vrb yy Street Address City/Town State Zip 91-F -Foy ac/SD Fey. Aq so .�4�C6.�s�'rd,4,0,A IF 1¢/106 . c 6 KA Telephone No. business Telephone No. cell e-mail address SECTION 11:WC)RKF:IZS'COMB'FN5A I JON INSURANCE AFFIDAVrr M.G.L.c.152.§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 0 No ❑ SECTION 12•CONSTRUCTION COSTS AND PERMIT FEE Estimated Costs: (Labor Item and Materials) Total Construction Cost(from Item 6)_$/��• sod 1. Building $ Ov Building Permit Fee=Total Construction Cost x_(Insert here 2.Electrical $,f® 00 appropriate municipal factor)_$ 3. Plumbing $ 90 00v d. Mechanical (HVAC) $ 167 06V Note:Minimum fee=$ ntact run I p11 t ) 5. Mechanical Other $ 3y 6 Enclose check payable to 6.Total Cost $ /a kSoo (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 knowledge and understanding. Sa3 /vs Pleaue p cat and sign name / _ Title Telephone No. Date Street Address City/Town State Zip Municipal Inspector to fill out this section upon application approval: LJ 40-*411A. Name Date Soo - � U — Rr �C> vo The Commonwealth of Massachusetts INSPECTI NAL SER UlfBoard of Building Regulations and Standards CITY OF t1 Massachusetts State Building Code, 780 CMR zoo ON -R iSXi Zfl Building Permit Application To Construct, Repair,Renovate Or Demolish a One- or Two-Family Dwelling This Section For Offl ' 1 Use Only rY�--- Building Permit Number: D e Applied: �J�J Building Official(Print Name) Signature V *Dae IN SECTION 1: SITE INFORMATION '--' 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers at Crv)e 4., Skoz-- Salem MA 3t'i—h��9 — O 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1'3 Zoning Information: 1.4 Property Dimensions: �'ZI V,Z Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(it) 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: Zone: Outside Flood Zone? Public Private❑ Check ifyes❑ Munprh g'On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP 2.1 Owner of Record: SaAeVA Mvk 0I St i:o Name(Print City,State,ZIP 2A meek 6175)voi33 C�nyt4S QYPooruia rl No.and Street Telephone EmailYdd�ies�� SECTION 3:DESCRIPTION OF PROPOSED WORK' (check all that apply) New Construction ❑ Existing Building ❑ Owner-Occupied ❑ Repairs(s) Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units - Other ❑ Specify: Brief Description of Proposed Work 2: 2.t) n v a r t S SECTIO 4:E [MATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1.Building $ 2.2, 000 1. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical $ o� ❑ Standard City/Town Application Fee 10 00 ❑Total Project Cost' (Item 6)x multiplier x 3. Plumbing $ t— 000 2. Other Fees: $ 4. Mechanical (HVAC) $ l O DODa o List: 5.Mechanical (Fire $ Suppression) Total All Fees: $ 6. Total Project Cost: $ _ Check No. Check Amount: Cash Amount: 'S D OC) ❑Paid in Full ❑ Outstanding Balance Due: M►"I1_E:u 1zk (-I SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) S License Number Expiration Date Name of CSL Holder AList CSL Type(see below) �P� SNP �k No.and Street Type Description r-J� U Unrestricted(Buildings up to 35,000 cu.ft. "0✓�C���11 (�27j�� R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone - Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) �,,,, k S . l Ot t ) HIC R`g.6 at o(n Ira 15 Registration Number E ptrat on Date HIC Company Name or HIC Registrant Name / W N &I C 5Uw CA ICt ✓3 Lam'. Ca VY\cg.<t ✓)� No.and Street Email address V-- 30t 5U"d-Qyq-4Vs Cit own, 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 ..........x No ...........❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT , 1,as Owner of the subject p perry,hereby authorize C G Y ' vv, 0A1 Wl lost b alf, ' r afters relative to work authorized by this building permit application. M I r,tibJ Gre IZ- 5 1y r t Ow is Name(EI ronic Signature) Date —� CTION 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 this application is true and accurate to the best of my knowledge and understanding. I - S - I wner's or A orized Agent's Na (Ele r me Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will 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.gov/dps 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.) 1'1 DO Habitable room count Number of fireplaces O Number of bedrooms le Number of bathrooms Number of half/baths 1 Type of heating system aa r ce Number of decks/porches 2 Type of cooling system e e v,1v-a( A./ Enclosed Open 3. "Total Project Square Footage"maybe substituted for"Total Project Cost" The Commonwealth of Massachusetts b1°s Board of Building Regulations and Standards CITY OF Massachusetts State Building Code,780 CMR SALEM 'Zia Revised Mar 2011�LE� Building Permit Application To Construct,Repair,Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: Date AppCed: Building Official(Print Name) Signature DAe SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers .. 66 m N l.l a Is this an accepted street?yes no Map Number Parcel Number a ry 1.3 Zoning Information: 1.4 Property Dimensions: nM. Z r'r1 Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) W fart 1.5 Building Setbacks(ft) bo r CD Front Yard Side Yards Rear Yard 99 Required Provided Required Provided Required Provid4 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' 2.1'0"err g sec d: �,�':c✓1 71t�)lit Q �7r4yAf y1/v'5 'r >.Ac�zh, 'M� C5 /9 7° City,State,ZIP /� � b -Y(^fsG1N/A of� ,N�ft7orsr �7,q-7q1-L©U Z Eby( 4P_C r ✓Lay' tiN2. ( i>/'J No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK''(check all that apply) New Construction IV Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units I Other ❑ Specify: Brief Description of Proposed Work': fISU/L 0 D JrL U D S ' -10L Z T Frtf .6 S 2�7e- N6- %f6U � pjCA -o SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials • 1.Building $ NZ), 1. 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 (IIVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees:$ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ y5n• rlv ❑paid in Full - ❑Outstanding Balance Due: C�o tf- W , yr (o/Z1 SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) Aur-lo I e /// 1 ;Z;l �4. Z, W ii,#a License Number Expiration Date Name of CSL Holder / I I List CSL Type(see below) Street No.and Seet � �V 'JV �V Type Description U Unrestricted(Buildings up to 35,000 cu.ft S�tL /Ps eoml¢. eI/%'7 R Restricted 1&2 FamilyDwelling City/town,Stale,Zip M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) ��rp# R C Af7'K,Y /ter a' HIC Registration Number. x ration Dale HIC Co�-� any�`or�HIC4R,e�gi�strant Name b�.�C�15j��YV 'dlU 1sJc�g�( @Af(2A/7�2',/Q�C�Aie/LFLdi2 No.and Stre t Email addre �tr/ SCOT! � niyo-� 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 to act on my behalf,in all matters relative to work authorized by this building permit application. i1,ln '7 Gk-LIn/,4-4, hSi"'4 -rlVL4id/( 4y Print Owner'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 this application is true and accurate to the best of my knowledge and understanding. 171-90adq �FlWL 9cG I Ahoy) M h,�y 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 hires an unregistered contractor (not registered in the Home Improvement Contractor(IUC)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. og v/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 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"maybe substituted for"Total Project Cost"