11 GARDNER STREET - BUILDING INSPECTION 11 Gardner St.
i
i2222 bT62 0000 OZhO 220E
CITY OF SALEM, MASSACHUSETTS
BUILDING INSPECTOR
120 WASHINGTON STREET, 3RD FLOOR
SALEM, MASSACHUSETTS 01970
I
®' 0VNICLAAMED 1? 2`1 fiT62 0000 0?-h0 2TOL.
Angela Decker
11Gaopoordne treet nit4 �)
Salem, assach setts 01970 1ST NOTICE I/"7,3
o��P %F 2ND NOTICLPLC 6
VIM. RETURN DEC a 2012
02 1R $ 05.750 LI ,
0006557030 NOV21 2012 `
MAILED FROM ZIPCODE 01970
i
UNITED STATES POSTAL SERVICE Firat-Class Mail
Postage 8 Fees Pald
USPS
Permit No.G-10
• Sender: Please
/print
tyyour
+name, address, and ZIP+4 in this box
SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION VE
■ Complete items 1,2,and 3.Also complete A. Signature
item 4 if Restricted Delivery is desired. ❑Agent
X
■ Print your name and address on the reverse ❑Addressee
so that we can return the card to you. B. Received by(Printed Name) C. Cate of Deliver,
N Attach this card to the back of the mailpiece,
or on the frontif space permits.
1. Article Addressed to: D. Is delivery address different from item 1? i7 Yes
If YES,enter delivery address below: ❑ No
3. Servicg Type
rb�-��"•"�-""��etl Mail ❑Express Mail
❑ Registered ❑Return Receipt for Merchandise
❑ Insured Mail ❑C.O.D.
4. Restricted Delivery?(Extra Fee) ❑yes
2. Article Number e7M>:/Fd6P
(Transfer from s e IJ
PS Form 3811,February 2004 Domestic Return Receipt 10259502-M-1540
CITY OF SALEM, MASSACHUSETTS
BUILDING DEPARTMENT
�s j�cT 120 WASHINGTON STREET, 3 FLOOR
9ecunns rd�
TEL: 978-745-9595
FAX: 978-740-9846
KIMBERLEY DRISCOLL
MAYOR
THOMAS STTIERRE
DIRECTOR OF PUBLIC PROPERTIES/BUILDING COMMISSIONER
REQUIRED INSPECTION NOTICE
11 Gardner Street
November 21, 2012
Angela Decker
11 Gardner Street- Unit 4
Salem, Massachusetts 01970
Ms. Decker,
The above referenced property has come to the attention of this department for the following reason(s):
A report has been made to this office that there is an illegal unit located in the shed at the rear of your property
constituting a second structure on your lot and creating an unsafe structur. For this reason an inspection must be
conducted by our office to assure compliance with the code and city ordinance.
The most concerning off these violations that has been received are the life safety and unsafe structure conditions at the
property for these reasons a Required Inspection must be conducted by our Department to assure compliance with the
State Building code and city ordinances.
Under the provisions of 780 CMR, Section 104.6—Right of Entry, of the State Building Code, access to this property
must be granted for the purposes of this inspection. Please call this office upon receipt of this letter, if this property has
rental units these tenants must be notified in advance of this inspection so that access to these spaces may also be
accomplished.
This Required Inspection shall be conducted by this office on Monday, November 26, 2012 at 15:00 am.; failure to
respond to this notification will be construed as non- compliance, with issuance of Municipal tickets and as such an
Administrative Search Warrant will be sought, so as to allow the lawful inspection of this property.
If you have any further questions regarding this letter,please call this office at(978) 619-5648.
Michael E. Lutrzykowski
Assistant Building Inspector
cc: file, Health Dept., Fire Prevention,Jason Silva
CITY OF SALEM, MASSACHUSETTS
BUILDING DEPARTMENT
120 WASHINGTON STREET, 31iD FLOOR
9h'C/MIHBW
'FEL:978-745-9595
FAx: 978-740-9846
KIMBERLEY DRISCOLL
MAYOR
THOMAS STTIERRE
DIRECTOR OF PUBLIC PROPERTIES/BUILDING COMMISSIONER
REQUIRED INSPECTION NOTICE
1 I Gardner Street
November 21, 2012
Angela Decker
11 Gardner Street- Unit 4
Salem, Massachusetts 01970
Ms. Decker,
The above referenced property has come to the attention of this department for the following reason(s):
A report has been made to this office that there is an illegal unit located in the shed at the rear of your property
constituting a second structure on your lot and creating an unsafe structure. For this reason an inspection must be
conducted by our office to assure compliance with the code and city ordinance.
The most concerning off these violations that has been received are the life safety and unsafe structure conditions at the
property for these reasons a Required Inspection must be conducted by our Department to assure compliance with the
State Building code and city ordinances.
Under the provisions of 780 CMR, Section 104.6—Right of Entry, of the State Building Code, access to this property
must be granted for the purposes of this inspection. Please call this office upon receipt of this letter, i this property has
rental units these tenants must be notified in advance of this inspection so that access to these spaces may also be
accomplished.
This Required Inspection shall be conducted by this office on Wednesday, November 21, 2012 at 5:15 p.m.; failure to
respond to this notification will be construed as non-compliance, with issuance of Municipal tickets and as such an
Administrative Search Warrant will be sought, so as to allow the lawful inspection of this property.
If you have any further questions regarding this letter,please call this office at(978) 619-5648.
Michael E. Lutrzykowski
Assistant Building Inspector
cc: file, Health Dept.,Fire Prevention, Jason Silva
a
CITY OF SALEM, MASSACHUSETTS
BUILDINGDEPARTMENT
120 WASHINGTON STREET, 3'DFLOOR
TEL: 978-745-9595
RtMaERLEY DRtSCOLL FAY: 978-740-9846
MAYOR
THOMAS ST.PIERRE
DIRECTOR OF PUBLIC PROPERTIES/BUILDING COMMISSIONER
REQUIRED INSPECTION NOTICE
11 Gardner Street
November 21,2012
Angela Decker
11 Gardner Street-Unit 4
Salem, Massachusetts 01970
Ms. Decker,
The above referenced property has come to the attention of this department for the following reason(s):
A report has been made to this office that there is an illegal unit located in the shed at the rear of your property
constituting a second structure on your lot and creating an unsafe structur. For this reason an inspection must be
conducted by our office to assure compliance with the code and city ordinance.
The most concerning off these violations that has been received are the life safety and unsafe structure conditions at the
property for these reasons a Required Inspection must be conducted by our Department to assure compliance with the
State Building code and city ordinances.
Under the provisions of 780 CMR, Section 104.6—Right ofEntry, of the State Building Code, access to this property
must be granted for the purposes of this inspection. Please call this office upon receipt of this letter, if this propertyhas
rental units these tenants must be notified in advance of this inspection so that access to these spaces may also be
accomplished.
This Required Inspection shall be conducted by this office on Monday,November 26, 2012 at 11:00 am.; failure to
respond to this notification will be construed as non- compliance, with issuance of Municipal tickets and as such an
Administrative Search Warrant will be sought, so as to allow the lawful inspection of this property.
If you have any further questions regarding this letter,please call this office at(978) 619-5648.
Michael E. Lutrzykowski f
Assistant Building Inspector
cc: file,Health Dept., Fire Prevention, Jason Silva
BUTTERWORTH & O'TOOLE, INC.
P.O. 80X 8294
SALEM, MA 01971-8294
ADJUSTERSIAPPRAISERS
FOR INSURANCE COMPANIES ONLY
TELEPHONE (978)741-5731 FAX (978)740-9109
April 03, 2001
FORM OF NOTICE OF CASUALTY LOSS TO BUILDING
UNDER MASS. GEN. LAWS, CH. 139, SEC. 3B
TO: Building Commissioner or Board of Health or
Inspector of Buildings Board of Selectmen
City/Town Hall City/Town Hall
ADDRESSES
Salem, MA 01970 Salem, MA 01970
RE: Insured: 11 Gardner Street Condo Association
Address : 11 Gardner Street
Salem, MA 01970
Policy No. : BP1-7-027-941
Loss of: 03/30/01
File or Claim No. : 14-0699
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, Ch. 139, Sec. 3B is appropriate, please direct it
to the attention of the writer and include a reference to the captioned
insured, location, policy number, date of loss and claim or file number.
If no reply is received from your office within ten days, we will
assume you have no liens of any type against this property and we will
recommend to the insuring company that this claim is paid.
Patrick Tobin
Adjuster
CERTIFICATE ISSUED
I rTi
< DATE October28. 1993 M
CITY OF SAIDA s , m-
'-
T s
SALEM MASSACHUSETTS 01970 a BUILDING PERMIT4.
4E v _ j CERTIFICATE'Of OCCUPANCY
r
i... ALL uat. 30s
;Philip 'Siirnham` ; DATE, $ ls„ 93 PE~qAt r77 No. 369-93"
APPLICANT_ f. :AOOR[55 _ er ea ,er St ',SaleOlaMR
Ta�� Iw01 '.-I6TRE[il .. I<O IRs CiG[xa[:. �'
Alterations j, � yye irin MON BER F 4
PERMIT TO I_.._l. STORY - - t DWELLING UNITS
v ("p, Pl'IURR0Y6M[Mll[ MO.— IPROPOftO
•�rlloo,noel IL.Gardnler Street 77, 618 S ;.� ' :.EON,INc
'.? iIMO.1 _A,E, I ISTREETI 3 .LISTA ICT
yet
eerNeEN Lafate $t.. .e Canar.st. 7' k
AND
1074056 STREET)" — - (CROSS STREt TIs
.. Y. -
SUBDIVISION BLOCK S101E
BUILDING IS 0 BE _FT. WIDE P �iT.LONG By ` FT' Iq NE@NT ANO-SAXLL CONFORM'14 CONSTRUCTION
TO TYPE �I JSE'GROUP�� _BASEMENT WAILS OR,FfOUNGAT10NT,.
SIEMARRS. Making current 3 family -.f'nta 4 familydi lling
AREA OR
VOLUME
' o elc aol.ert "it'.
FA w
OWNER Philip Burnham re'nowlswwsw.swlo-rT14.w���riIo,,e..Yi jb7c/Ipsp,epp,,'ppR�j�o��EEew,pp,,o��ttlr1FlseNse'nsw.oe'n
li :orreater SC• a em, Sa SCEAi CVERSC SIBOERafAF{BiIW PREMISES
ApOq ESS 710N5 )F.CERTIFICATE.
DEPARTMENTAL APPROVAL FOR.CERTIFICATE
++ = of OCCUPANCY and COMPLIANCE
B k To be filled in by each division indicated hereon
^e;rI
t�upo6; completion of,.its final inspection.
;n BUILDINGS j Permit No. 369-93
Approved by John J:I Jpinnin is Date 10/27/93 I
Ramarks
Lu
F ; j s
GING ' ; � Permi!t No. i I
!
j Approved by Dennis Rn c '' ' Date _10/6%93 I
C Remarks 1 !
F �A
ELECTRICAL ' Permit No. a%< : + I
I !
{ Approved by 1A 11 Falkbwski ' i I pate "10/5%93 ltx 'h4
r Remarks '
OTHE - Fire,. Permit No. + 3r
s T,t
I
"Appfoved by1td. H�d�ori Date `'10/6%93 me,<ad
n , , z
I
Re"risi
i
-{..1
� I �� p •. 1 S � � � 4r
T , ' Permit No.
ri
a pproved byDate
r
=LL BUILDING
PERMIT
JOB WEATHER CARD
A brat 'G3
AT19 PERMIT NO
�EE � .
APPLICANT Alli. ZurA�tAm ADDRESS ! t sorceBLwr. St- Salem.[ na
- Dwell IND.) (STREET) (CONTR•!'LICENSE'
0 ,Al sursL S.QlIs 1i1g NUMBER OF DWELLING UNITS 4.
PERMIT TO 1_I STORY
ITY/f 0I 'uIROv[MLxTI No. (PROPOSED VSFI ,
61 Gardner St.raet wArd ZONING
AT (LOCATION( DISTRICT
1x0.1 ISTREf TI
LaCa7Lar,ia b[.
BETWEEN
ICPOIi SiRL[TI AND $nAi (CROS! ST PEf TI
LOT
SUBDIVISION LOT BLOCK SIZE
BUILDING IS TO BE FT, WIDE By FT. LONG BY FT, IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNOnTION
IlY/EI
REMARKS: :A6EA:{g eurrBnc 3 tsmily tutu 8 iaanily da=sLLin&
AREA OR ESTIMATED for Permit to', GOccup�J
pp iS ILVC; PERMIT ��.I%G
VOLUME ESTIMATED COST
C'131 L/SO VLR[ IfETI r-, i �I
Philip Sulahas ` �' ' y
OWNER BUILAtOUIFE0%, Juna4L%%0
ADDRESS +i vOr Y®Btet fir/ Seissi! l8a6N BY
INSPECTOR OF BUILDINGS
THIS PERMIT CONVEYS NO RIGHT TO, OCCUPYANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. E?'HER TEMPORARILY OR -
PERMANENTLY. ENCROACHMENTS ONI.PLLB LIC PROPERTY. NOT SPECIFICALLY PERMITTED UNDER T00 HE BUILDING CODE. MUST BE AP-
PROVED BY THE JURISDICTION.. STREET.OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED
FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM TNECONDITIONS -
OF ANY APPLICABLE SUBDIVISION RESTRICTIONS,
MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB PND THIS WHERE APPLICABLE SEPARATE.
INSPECTIONS PEQUIREO FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PFRMi TS ARE REOUIRED FOR
All CORS TR UC TION wOR N: ELECTRICAL. PLUMBING AND
I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY 15 RE- MECHANICAL INSTALLATIONS.
Z. PRIOR TO COVERING 5T R UC TUBAL QUIREO,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL
ME ME ADY TO LATML FINAL INSPECTION HAS BEEN MADE.
3. FINAL INSPECTION BEFORE
OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET
BUILO(NG INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS /(RELECTRICAL INSPECTION APPROVALS
/
P7ARO !'P HEALTH GAS INSPECTION APPROVALS FIRE DE/P/�/T., INSPECTING APPROVALS
OTHER CITY ENGINEER 2 J. // Z
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- - - - -
No. City of Salem ward
3�9 -
!i
A
4CUUNC�
APPLICATION
FOR
PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION
IMPORTANT-Applicant to complete all itemsX.
in sections:I, ll, Ill, IV,and I
I. AT(LOCATION) J el, 1�\Q J I} ZONING
r'$ DISTRICT
LOCATION " ) )
OF BETWEEN ( f AND
(CR SS STREET) (GROSSSTREET)
BUILDING LOT I 1 S9
SUBDIVISION LOT BLOCK SIZE
II. TYPE AND COST OF BUILDING -All applicants complete Parts A -D
A. TYPE OF IMPROVEMENT D. PROPOSED USE-FOR"DEMOLITION"USE MOST RECENT USE
1 ❑ New building Residential Nonresidential
2 ❑ Addition(It residential,enter number of new 12 ❑ One family 18 ❑ Amusement,recreational
housing units added,if any,in part D, 13) 19 ❑ Chruch,other religious
13 ® Two more family..Enter number
3 � Alteration(See 2 above) of units .......................................................LL 20 ❑ Industrial
4 ❑ Repair replacement 14 ❑ Transient hotel,motel,or dormitory- 21 ❑ Parking garage
Enter number of units ........................... 22 ❑ Service station,repair garage
5 ❑ Wrecking(n muttilamilyresidentiA enter number 23 ❑ Hospital,institutional
of units in building in Part D, 13) 15 ❑ Garage
24 E] Office,bank,professional
6 ❑ Moving(relocation) y 16 Carport 25 ❑ Public utility
7 ❑ Foundation only 26 ❑ School,library,other educational
17 ❑ Other-Specify 27 ❑ Stores,mercantile
EL OWNERSHIP 28 ❑ Tanks,towers
8 ® Private(individual,corporation,nonprofit
institution,eta)
29 ❑ Other-Specify
9 ❑ Public(Federal,State,or local government
C.COST (Omit cents) Nonresidential-Describe in detail proposed use of buildings,e.g.,food processing plant,
machine shop,laundry building at hospital,elementary school,secondary school,college,
parochial school,parking garage for department store,rental office building,office building
10. Cost of improvement ......................................................... $ at industrial plant.If use of existing building is being changed,enter proposed use.
To be installed but not included
in the above cost
a. Electrical...........................................................................
b. Plumbing..........................................................................
c. Heating,air conditioning.............................................
r
'.d. Other(elevator,etc.)..:...................................I..........
... -
11. TOTAL COST OF IMPROVEMENT $ 1
III. SELECTED CHARACTERISTICS OF BUILDING -For new buildings and additions, complete Parts E-L;demolition,
complete only Parts J&M, all others skip to IV
E. PRINCIPAL TYPE OF FRAME F. PRINCIPAL TYPE OF HEATING FUEL G. TYPE OF SEWAGE DISPOSAL 1. TYPE OF MECHANICAL
30 ❑ Masonry(wall bearing) 35 Gas 40 W Public or private company Will there be central air
31 Wood frame 36 ❑ Oil 41 ❑ Private(septic tank etc.) conditioning?
32 ❑ Structural steel 37 ❑ Electricity 44 ❑ Yes 45 ® No
33 Reinforced concrete 38 Coal H. TYPE OF WATER SUPPLY
❑ ❑ Will there by an elevator?
34 ❑ Other-Specify 39 ❑ Other-Specify 42 ® Public or private company 46 ❑ Yes 47 ® No
43 ❑ Private(well,cistem)
J.DIMENSIONS q
48. Number of stories ..........
M. DEMOLITION OF STRUCTURES:
..................I'. .....................
49. Total square feet of floor area, Has A
all floors,based on exterior ppr oval from Historical Commission been received
dimensions ...................................4,3.9-0........... for any structure over fifty(50)years? Yes_ No
50. Total land area,sq.ft...........�1.1 I...R...I............ Dig Safe Number
K.NUMBER OF OFF-STREET PARKING SPACES Pest Control:
51. Enclosed...................................-..................................
......
HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED?
52. Outdoors.................. .........` Yes No
L RESIDENTIAL BUILDINGS ONLY Water:
53. Enclosed......................:...................................................... Electric:
(� Gas:
54. Number of Full.......... ............................ Sewer:
bathrooms DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED
Partial ..."'.."' BEFORE A PERMIT CAN BE ISSUED.
IV. COMPLETE THE FOLLOWING:
Historic District? Yes_ No U (If yes, please enclose documentation from Hist. Com.)
Conservation Area? Yes_ Nov (If yes, please enclose Order of Conditions)
Has Fire Prevention approved and stamped plans or applications? Yes_ No_
Is property located in the S.R.A. district? Yes_ No
Comply with Zoning? Yes_ No_ (If no,enclose Board of Appeal decision)
Is lot grandfathered? Yes_ No Al (If yes,submit documentation/if no,submit Board of Appeal decision)
If new construction, has the proper Routing Slip been enclosed? Yes_ No�
Is Architectural Access Board approval required? Yes No (If yes, submit documentation)
Massachusetts State Contractor License # Salem License#
Home Improvement Contractor# Homeowners Exempt form (if applicable) Yes_ No_
CONSTRUCTION TO BE COMMENCED WITHIN SIX (6)MONTHS OF ISSUANCE OF BUILDING PERMIT
If an extension is necessary, please submit
CONSTRUCTION IS TO BE COMPLETED BY: in writing to the Inspector of Buildings.
V. IDENTIFICATION - To be completed by all applicants
Name Mailing address-Number,street,city,and state ZIP Code Tel.No.
O y 01rV 'IV4
Owner or
Lessee
2.
Contractor
Builder's
License No.
3.
Architect or
Engineer
I hereby certify that the proposed work is authorized by the owner of record and that I have been authorized by the owner to make this application
as his authorized agent and we agree to conform to all applicable laws of this jurisdiction.
Signa of aEpli Address Application date
DO NOT WRITE BELOW THIS LINE
VI. VALIDATION
Building T/J (Jy� FOR DEPARTMENT USE ONLY
Permit number c
Building Use Group
Permit issued 47 19
Fire Grading
Building /'
Permit Fee $ it. o ndL Live Loading
Certificate of Occupancy $ Approved by: occupancy Load
Drain Tile $
Plan Review Fee $ C-0-1
TITLE
NOTES AND Data-(For department use)
' tv4- T
(n,r 6 -(— G'
1 e o ; 1/.r �2C ' � vi � Fzccor
F C P.cS I Q. C
PERMIT TO BE MAILED TO:
DATE MAILED:
Construction to be started by: Completed by:
VI ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
NOTES
SITE OR PLOT PLAN •For Applicant Use
O N
:1TY
:+ 7UILDING DEPARTMENT
'OMEOWNER LICENSE EXEMPTION
'lease Print
DATE
UOB LOCATION �1 r-av�r�n on rj�
\ Number Street address Section or Town
"HOMEOWNER Pel ti, i,) b LA_ iscC
N meome pnone Work phone
PRESE,IT MAILING ADDRESS 11 1"orli-g_ . pa- qj
St,� r~. MQ Iq�lo
_ity/Town State gip Looe
-he current exemotion or "homeowners' was extenoeo to include owner-occuoiea
ideilinas or six units or less and to allow such homeowners zo engage an in-
diviouai for hire who does not possess a license. provided that the owner
acts as supervisor. ( State Building Code Section 109. 17
DEFINITION OF HOMEOWNER:
Person(s ) who owns a parcel of land on which he/she resides or intends to re-
side. on which there is , or is intended to be, a one to six family dwelling,
attached or detached structures accessory to such use and/or farm structures.
A person who constructs more than one home in a two-year period shall not be
considered a homeowner. Such "homeowner" shall submit to the Building Official ,
on a form acceptable to the Building Official , that he/she shall be responsible
for ail such work Derformed under the buildino Dermif ( Section 109. 1 . 1 )
he undersigned "homeowner" assumes responsibility for comoiiance nth the State
:uildina code and other applicable codes . :,y- laws . :-Dies and reauiaElons.
The undersigned "homeowner" certifies that he/she understands the City or Salem
Building Department minimum inspection procedures and requirements and that
he/she will comply with said procedures and requirements.
HOMEOWNER'S SIGNATURE P91Q�1_
APPROVAL OF BUILDING OFFICIALQA
NOTE: -hree family dwellings 35.000 cuoic feet. or larger. rill be required
to comply with State Building Code Section 127.0, Construction Control .
i
HOME Ol'1NER ' S EXEMPTION
-he Cede states that: " any Home Owner performing work for which a building
oermit s reauirea shall be exempt from the provisions of this section
(Section 109. 1 . 1 - Licensing of Construction Suoervisors ) ; provided that is
a Home Owner enaaaes a persons ) for hire to do such work , that sucn Home
Owner shall act as supervisor. "
Many Home Owners who use this exemption are unaware that they are assuming
the responsibilities of a supervisor (see Appendix Q, Rules and Regulations
for Licensing Construction Supervisors . Section 2. 15 ) . This lack of aware-
ness often results in serious problems. particularly when the Home Owner
hires unlicensed persons . in this case your Board cannot oroceea against
the unlicensed person as it would with licensed Supervisor. -he Home Owner
sctina as supervisor is ultimately responsible.
,3 ensure that the Home _,.mer fuily aware ^f his/her responsioi11ties .
:iany c:mmunities require. _,s part Of the permit application. that the Home
Owner ^artif"y that he/she understands the responsibilities of a supervisor.
On the last cage of this issue is a form currently used by several towns.
!ou may care to amend and adopt such a form/certification for use in your
community.
`c COMMONWEALM
TH OF ASSACHUSETTS
JEFAK�gNT OF INDUSTRIAL ACCIDENT'S
c ' 600 WASHINGTON STREET
�,• Sr
BOSTON, MASSACHUSETTS 02111
_ames. anode•
ss,one, WORKERS' COMPENSATION INSURANCE AFFIDAVIT
I.
(I Iccnsect oermInee)
with a principal place of business/residence at:
(CityistateiZip)
do herebv certify, under the pains and penalties of perjury, that:
] I am an employer providing the following workers' compensation coverage for my employees working on this
i0o.
Insurance Company Policy Number
[ J I am a sole proprietor and have no one working for me.
[ ] I am a sole proprietor, general contractor o home er (circle one) and have hired the contractors listed below
who have the following workers' compensation insurtn policies:
Name of Contractor Insurance Company/Policy Number
c, U t an
Name of Contactor Insurance Companv/Poliev Number
c - Alg
Name of Contractor Insurance Company/Policy Number
[J I am a homeowner performing all the work myself.
NOTE. Please be aware that while homeowners who employ persons to do maintenance.construction or repair work on a
dwelling of not more than three units in which the homeowner also resides or on the grounds appurtenant thereto ate oat generally
considered to be employers under the Workers' Compensation Act(GL G 152,sect. 1(5)), application by a homeowner for a license
or permit may evidence the legal sums of an employer under the WorkerCompensation Act.
i understand that a copy of this statement will be forwaraed to the Deparmsent of Industrial Accidents' Office of Insuranmfo,-coverage
�cnfieauon ana that failure to secure coverage as;required under Section 25A of MGL 152 can iead to the imposition of criminal oenalue
mnststsne of a fine of up to 51500.00 and/or imprisonment of up to one year aria civu penalties in rise form of a S[oo cork Order and a
fine of S 100.00 a day against me.
I m
Signed this day of 19 q--- —
Licensee/Permiaee LicensoriPermirror
Citn of _`.�ttlem, :�ttssttthusetts
411C
Board of �upenl 32' 1 y
"S
DECISION ON THE TETITION_OF_PHILIP�BURNHAM
FOR VARIANCES ATyll GARDNER,STREET� - (R-2)
A hearing on this petition was held July 21, 1993 with the following Board
Members present: Francis X. Grealish Jr. , Chairman; George Ahmed, Stephen
Touchette and Stephen O'Grady. Notice of the hearing was sent to abutters
and others and notices of the hearing were properly published in the Salem
Evening News in accordance with Massachusetts General Laws Chapter 40A.
Petitioner, owner of the property, is requesting Variances from use to
allow a three family dwelling to be converted to a four family dwelling in
this R-2 district.
The Variance which has been requested may be granted upon a finding by this
Board that:
1. Special conditions and circumstances exist which especially affect the
land, building or structure involved and which are not generally affecting
other lands, buildings and structures involved.
2. Literal enforcement of the provisions of the Zoning Ordinance would
involve substantial hardship, financial or otherwise, to the petitioner.
3. Desirable relief may be granted without substantial detriment to the
public good and without nullifying or substantially derogating from the
intent of the district or the purpose of the Ordinance.
The Board of Appeal, after careful consideration of the evidence presented
at the hearing, and after viewing the plans, makes the following findings
of fact:
1. There was no opposition to the proposed request.
2. There were six (6) pieces of correspondence supporting the petitioners
request, two were direct abutters.
3. There are many multi-family dwellings in this area.
DECISION ON THE PETITION OF PHILIP BURNHAM -FOR VARIANCES AT
11 GARDNER STREET, SALEM
page two AUS V
On the basis of the above findings of fact, and on the evidence presented J'
at the hearing, the Board of Appeal concludes as follows:
1 . Special conditions exist which especially affect the subject property
but not the district in general.
2. Literal enforcement of the provisions of the Zoning Ordinance would
involve substantial hardship to the petitioner.
3. Desirable relief can be granted without substantial detriment to the
public good and without nullifying or substantially derogating from the
intent of the district or the purpose of the Ordinance.
Therefore, the Zoning Board of Appeal voted unanimously, 5-0, to grant the
variance requested, subject to the following conditions:
1. Petitioner shall comply with all city and state statutes, ordinances,
codes and regulations.
2. All construction shall be done as per the plans and dimensions
submitted.
3. Petitioner shall comply with all requirements of the Salem Fire
Department relative to smoke and fire safety.
4. Petitioner shall obtain a building permit from the City of Salem
Building Inspector.
5. A Certificate of Occupancy is to be obtained from the Inspector of
Buildings prior to occupying fourth unit.
VARIANCE GRANTED
July 21, 1993
Francis X. Grealish, Chairman
Board of Appeal
DECISION ON THE PETITION OF PHILIP BURNHAM. -
FOR VARIANCES AT 11 GARDNER STREET, SALEM
page three
A COPY OF THIS DECISION HAS BEEN FILED WITH THE PLANNING BOARD AND THE CITY
CLERK
Appeal from this decision, if any, shall be made pursuant to Section 17 of
the Massachusetts General Laws Chapter 40A, and shall be filed within 20
days after the date of filing of this decision in the office of the City
Clerk. Pursuant to Massachusetts General Laws Chapter 40A, Section 11, the
Variance or Special Permit granted herein shall not take effect until a
copy of the decision bearing the certification of the City Clerk that 20
days have elapsed and no appeal has been filed, or that, if such appeal has
been filed, that it has been dismissed or denied is recorded in the South
Essex Registry of Deeds and indexed under the name of the owner of record
or is recorded and noted on the owner's Certificate of Title.
Board of Appeal
(Cita of _&tlem; ussttcljusetts
Y ,s Board of Au}�enl � y 3
�ir� - 2'
DECISION ON THE PETITION OF PHILIP BURNHAM
FOR VARIANCES T 11 GARDNER STREET (R-2)
A hearing on this petition was held July 21, 1993 with the following Board
Members present: Francis X. Grealish Jr. , Chairman; George Ahmed, Stephen
Touchette and Stephen O'Grady. Notice of the hearing was sent to abutters
and others and notices of the hearing were properly published in the Salem
Evening News in accordance with Massachusetts General Laws Chapter 40A.
Petitioner, owner of the property, is requesting Variances from use to
allow a three family dwelling to be converted to a four family dwelling in
this R-2 district.
The Variance which has been requested may be granted upon a finding by this
Board that:
1. Special conditions and circumstances exist which especially affect the
land, building or structure involved and which are not generally affecting
other lands, buildings and structures involved.
2. Literal enforcement of the provisions of the Zoning Ordinance would
involve substantial hardship, financial or otherwise, to the petitioner.
3. Desirable relief may be granted without substantial detriment to the
public good and without nullifying or substantially derogating from the
intent of the district or the purpose of the Ordinance.
The Board of Appeal, after careful consideration of the evidence presented
at the hearing, and after viewing the plans, makes the following findings
of fact:
1. There was no opposition to the proposed request.
2. There were six (b) pieces of correspondence supporting the petitioners
request, two were direct abutters.
3. There are many multi-family dwellings in this area.
DECISION ON THE PETITION OF PHILIP BURNHAM -FOR VARIANCES AT
11 GARDNER STREET, SALEM
page two ��C 1/
On the basis of the above findings of fact, and on the evidence presented " JO
at the hearing, the Board of Appeal concludes as follows:
1. Special conditions exist which especially affect the subject property
but not the district in general.
2. Literal enforcement of the provisions of the Zoning Ordinance would
involve substantial hardship to the petitioner.
3. Desirable relief can be granted without substantial detriment to the
public good and without nullifying or substantially derogating from the
intent of the district or the purpose of the Ordinance.
Therefore, the Zoning Board of Appeal voted unanimously, 5-0, to grant the
variance requested, subject to the following conditions:
1. Petitioner shall comply with all city and state statutes, ordinances,
codes and regulations.
2. All construction shall be done as per the plans and dimensions
submitted.
3. Petitioner shall comply with all requirements of the Salem Fire
Department relative to smoke and fire safety.
4. Petitioner shall obtain a building permit from the City of Salem
Building Inspector.
5. A Certificate of Occupancy is to be obtained from the Inspector of
Buildings prior to occupying fourth unit.
VARIANCE GRANTED
July 21, 1993
L%
Francis X. Grealish, Chairman
Board of Appeal
DECISION ON THE PETITION OF PHILIP BURNHAM- -
FOR VARIANCES AT 11 GARDNER STREET, SALEM
page three
A COPY OF THIS DECISION HAS BEEN FILED WITH THE PLANNING BOARD AND THE CITY
CLERK
Appeal from this decision, if any, shall be made pursuant to Section 17 of
the Massachusetts General Laws Chapter 40A, and shall be filed within 20
days after the date of filing of this decision in the office of the City
Clerk. Pursuant to Massachusetts General Laws Chapter 40A, Section 11, the
Variance or Special Permit granted herein shall not take effect until a
copy of the decision bearing the certification of the City Clerk that 20
days have elapsed and no appeal has been filed, or that, if such appeal has
been filed, that it has been dismissed or denied is recorded in the South
Essex Registry of Deeds and indexed under the name of the owner of record
or is recorded and noted on the owner's Certificate of Title.
Board of Appeal
RECEIVED
Titg of �3al ra, f flusoac4Zsetts
J '80 MAY 29 A 9 :01
29oxrb of Apptttl
CITY CLERK'S OFFICE
SALEM; MASS.
MAY 21, 1980
"DECISION ON THE PETITION OF JAMES AHOLA REQUESTING A VARIANCE FOR 11 GARDNER STREET.
A hearing on this Petition was held on May 21, 1980, with the following
Board Members present: James H. .Boulger, Jr. , Chairman, Messrs. Hopper, Feeherry,
and Hacker and Associate Member Piemonte. Notices of the hearing were sent to
abutters and others and a notice of the hearing was published in the Salem Evening
News on May 7, 1980 and May 14, 1980 in accordance with Massachusetts General Laws,
Chapter 40A.
The Petitioner is requesting a variance for the property at 11 Gardner Street
(R-2 District) to construct an. addition to an existing three-family dwelling. A
variance is required because the proposed construction will increase the site
coverage to 38%. The Salem Zoning Ordinance allows 35% as a maximum site coverage
in an R-2 District.
The Board of Appeals, after consideration of the evidence presented at the
public hearing and after viewing the property makes the following findings of
fact:
1. The proposed construction will not adversely affect the neighborhood.
2. Many lots in the immediate area have greater lot coverage than that
provided for in the Petitioner's plan._
On the basisof the above findings of fact, and the evidence presented at
the public hearing, the Board of Appeals concludes as follows:
(1) . The proposed construction is consistent with other dwellings in the
neighborhood. Moreover, the site coverage problem presented by the
Petitioner exists because of a 5 car garage at the rear_of the property
which provides off-street parking.
(2) The conditions described above especially affect the area in question
but do not generally affect the zoning district in which the building
is located.
(3) The conditions described above which affect the land in question, but
not the zoning district generally cause a special hardship to the
petitioner.
(4) The desired variance may be granted without substantial detriment to the
public good.
Therefore the Board of Zoning Appeals unanimously voted in favor of granting ;.
the requested variance. A variance from maximum lot coverage requirements is
granted to the Petitioner on the following terms and conditions:
1. All work shall be in accordance with the plans on file with the BOArd.
PAGE TWO - DECISION - JAMES AHOLA - 11 GARDNER STREET G C F 11/ D
'80 MAY 29 A 9 :01
2. Site coverage shall not exceed 38%.
3. At no time in the future may the Petitio{rhYK}Sarii& to convert
N
this 3-family dwelling into a 4-family dwel�
GRANTED WITH CONDITIONS
- H1AIN
Anthony M. F herry
Acting Secretary
APPEAL FROM THIS DECISION, G APIY. SHALL BE MADE PURSUANT TO SECTION 17 OF THE MASS-
GENERAL LA'.VS. CHAPT_R SM, pMD SHALL BE FILED V1ITHSN 20 DAYS AFTER. THE DATE OF FILING .
OF TMS DECISION IN THE OFFICE OF THE CITY CLERH. c - 1 -
PURSANF TO t"ASS. CE':ERAL t:i11S. CHARTER V3. S'CTION 11, THE V,!NAN,, Or^, ..P ZC!AL PERSHT
CRkt:FED HEREtii, iHALL Ia i -iAr.E EFFECT U.IFIL A COPY OF THE OEc;SfO'i, DEAR` S THE CERT- :
FICATIDri OF THF CITY CLEF.!; T'dAT 20 DA?S HAVE ELi7SEO AND t!0 AFRE",L N!S B`-['`i FILED,
OR THAT, IF SU;aI :N APPEAL fHAS CBEEA' III-Et-THAI IT HAS PEEN DLitt ISSED OR ME OF T - -RECORDED HI THE SOUTH ESS . R_;U""TRY CF DEEDS AND HIDERED Ut1CCP. THE hd'�E OF THE 0:'1NE8
OF RECORD OR IS RECORDED AND NOTED ON THE O:YNER'S CERTIFICATE OF TITLE. -
BOARD. OF APPEAL
A COPY OF THIS DECISION HAS BEEN FILED WITH THE PLANNING BOARD AND THE CITY CLERK.
n �,y Cts of �$tt[eni, nss�ztlju etta , a
"Eire 1lrpnrtmrnt 31r0iq!tartew 2l�
NOTICE OF FIRE CODE VIOLATIONRE''r1 11.1Ass-
Ct F Sh?. Pi
Owner, Occupant or Violator ,Tames Ahola
Location Of Violation 11-112 Gardner Street, Salem, Mass. 01970 ,• ': .
Date of Violation April 23, 1979Time: 10:00 A.M.
As a result of an inspection or an incident observed by an inspector
of the Salem Fire Department, the following violations of Mass, General'""'
Laws and/or Salem Fire Code were found to exist, as follows:
Operation of a business occupancy in a residential zone without permits, pr
__No permits for repair psrage, welding & cutting, auto body shop and flammable painting`
and storage of flamna.bles. Also keeping of unregistered cars and open electrical res
_ wiw.
Salem Fiiv Code Articles #l, #16, //17, 20 and 31.
Violation of _Mass. General Laws Chanter 1.48 Sections #5.#28(0).#21 and # 4
M. G. L. ; F. P. R. 0r Salem Fire Code < .
TYPE OF NOTICE:
1. va< ;
Warning Notice : 2. Court Action Notices X •
3. Violation Ordered to Cease Immediately: x
4. Violation to be Corrected within two Days of This No'ticre
5. Return Written Report of Corrective Action—to be Taken, Requested. wi
6. Contact Fire Prevention Bureau, for re-inspection, x
Notice :
A record of this violation has been planed in our files and may be a
basis for furthur actions, as the legal need arises.
Such furthur action shall be taken as the law requires, for failure
to comply, with any of the above requirements, within the stipulated
time. (References Mass. General Laws, Chapter 1481 Section 30. )
Method of Services Date : 4/23/79 Times 10.15 A.M. ':
Hand Delivery Del.. bys Recd by: g
Regular Mails '+
Certified Mail : Cert. # 916760 Receipt Regested Yes
Copy posted on premises: 10/23/79 Per Order of �t4 �,A =
By Act. Capt. Goggin Title Salem Fire Marshal '. s�'
Witnessed by Insp. Dansreau
cc: Building Inspector
Electrical Inspector. w
Health Dept. ( C4/�•'� 7 v
liel.l.r_ni.c Crodi.t Union
6 u'
Form #26B (Rev, 1/78 )
ori0'r 'T
VI_14LiJ11dGLri'T
CITY O �S'ALEM-HEAL T h'�A TMENT
BOARD " Tj. . 919 e
Dr. Is�"r el I i e enter ��P �g 9 �,1 tai 19
z
f U
O
ff� n
rsy lss- WICENED
al M as t ; .
�� ur CITY OF SAI.EP�':,
iSASS.
e
PHILIP H.SAINDON \�J,yg�IN ROBERT E. BLENKHORN
JOSEPH R. RICHARD
M.MARCIA COUNTIE,R.N. HEALTH AGENT
MILDRED C.MOULTON,R.N. (617)745-9000
EFFIE MACDONALD
ROBERT C.BONIN
Mr. Jack Powers
Building Inspector April 17, 1979
One Salem Green
Salem, Mass. 01970
Dear Sir:
As A result of a complaint received by our office on 11-112 Gardner St. ,
the following conditions were found in the backyard of this residence:
1. Five cars and a tractor being stored there.
2. Owner states automotive repair work is being done to vehicles
at this address.
3. Tires automotive spare parts also stored in back yard.
We refer this to your attention and input, and respectfully
request your findings in this matter.
Very truly yours, Reply to:
FOR THE BOARD OF HEALTH
Robert E. Blenkhorn Peter Grady
Health Agent Sanitarian
REB/cic
cc: Fire Prevention
Chair Person Public Health
Counciler-Jean M. Rochna
Owner