ABANDON. & FORECLOSED PROP REGISTRATION JACKET CITY OF SALEM
BUILDING DEPARTMENT i
120 Washington Street, 3,d Floor,Salem, MA 01970 l'
ABANDONED AND FORECLOSED PROPERTIES REGISTRATION FORM
PROPERTY
bb INFORMATION �1
Address: _t� 5� � Parcel ID#_ acv ' 64H — C,
Square Footage of Building: uw�w Number of Stories: l-K�'Vk��
Sprinkler System:Yes No_(Operational yes/no) �11 S b���ke
_(Operational yes/no) c/
Pipe System:Yes_No } V .
Fire Detection System:Yes_No_(Operational yes/no) w'V\'Q-t/
OWNER(S) * OF RECORD (*attach additl nal sheets if necessary)
Owner: tL' Q77 �1V"O-
Address-_ \,4b �( ul) S�`P. Ali u1i► , �� 0 I `1 '?O
Telephone: UAVV\&"M E-mail: _ ok, Vk&1V�
CONTACT PERSON/REGISTERED PROPERTY MANAGER
Name: �u 1k 0 - (N L'LC c �
M UiiT
�v v�G21
Primary Address (No P.O. Box) �1 PL " S+ 1G A4' OA 1A 0 i a 76
r
Business Tel.#: - 3 '�6 - 14 Non-Business Tel. #: _SMAA,,P tis b—S i LU (S fe-(
E-Mail Address: V 'eU . i^ . 0V4
Emergency Telephone#- 24hr/day kO 0 3 1,- � 810
IS THE PROPERTY LISTED FOR SALE? Yes_ No_ i,�t �vl6ko
If yes, Real Estate Agency_
Address: Tel. No.
VACANT BUILDING PLAN: Please check which applies. f
1. The building is to be demolished. �J
2. The building is to remain vacant.
3. The building is to be returned to ap is occupancy or use.
SIGNATURE OF OWNER/OWNER'S AGENT:
DATE:
REGISTRATION FEE $300 Cash/Money Order/Cert. Bank Check '�� LC L
UUP