318 HIGHLAND AVENUE - BUILDING JACKET •
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CITY OF SALEM, MASSACHUSETTS
airw y BOARD OF HEALTH
98 WASHINGTON STREET,3RD FLOOR Public Health
SALEM,MA 01970 Prevent.Promote.Protect.
TEL. (978) 741-1800
KIMBERLEY DRISCOLL health Q.salcm.cotn DAVID GREENBAUM,RS
MAYOR HEALTH AGENT
September 27, 2019
Daniel Twiss
318 Highland Avenue
Salem, MA 01970
Re: 318 Highland Avenue
Salem, MA 01970
Dear Sir or Madam:
At the request of the Salem Police Department I visited your property located at 318
Highland Avenue, Salem, MA on Friday, September 27, 2019. At that time I observed
several conditions that would be deemed to materially impair health and safety of the
occupants.
These include:
• There are no working smoke detectors or carbon monoxide detectors in the
building.
• The house is cluttered with a large quantity of combustible items.
• The doors and windows do not open and close freely or completely.
• There is a high volume of biohazard materials including an enormous number of
hypodermic needles throughout the dwelling.
• There is trash and debris littering the house as well as the entire property
• There are loose unsecure electric wires hanging throughout the dwelling.
• The ceiling throughout the main floor is removed creating a fire hazard in the
house.
Additionally, the building inspector has revoked the occupancy as an unsafe structure
and ordered the water and electric service to the house be terminated.
Based upon these observations and in accordance with Massachusetts General
Law, Chapter 111, Sections 127A and 127 B and 105 CMR: 410.000: Chapter II,
State Sanitary Code, Minimum Standards of Fitness for Human Habitation 105
CMR 410.831, the Board of Health determines that the danger to the life or health
of occupants is so immediate, condemnation is ordered immediately to the entire
dwelling and the hearing requirements of 105 CMR 410.831B and C are waived.
All occupants of the dwelling are ordered to vacate the dwelling immediately. If
any person refuses to leave the dwelling they may be forcibly removed by the
Board of Health or by local police authorities on the request of the Board of
Health.
No dwelling or portion thereof, which has been condemned and placarded as unfit for
human habitation, shall again be used for human habitation until written approval is
secured from, and the Board of Health removes such placard. No person shall deface
or remove the placard, except the Board of Health shall remove it whenever the defect
or defects upon which the condemnation and placard action was based have been
eliminated.
Should you be aggrieved by this Order, you have the right to request a hearing before
the Board of Health. A request for such a hearing must be received in writing in this
office of the Board of Health within seven (7) days of receipt of this Order. At said
hearing, you will be given the 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.
Sinc, ely,
/J
bavi G nbau
Health Agent
Cc: Sgt.Harry Rocheville,Salem Police Department
Salem Fire Department
Building Commissioner
Victoria Caldwell,Assistant City Solicitor
318 Highland Ave. -
CITY OF SALEM, MASSACHUSETTS
BUILDING DEPARTMENT
120 WASHINGTON STREET, 3""FLOOR
'Boy TEL. (978) 745-9595
FAX(978) 740-9846
KIMBERLEY DRISCOLL
MAYOR THOMAS ST.PIERRE
DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER
May 15, 2009
Daniel Twiss
318 Highland Ave
Salem, Ma. 01970
Mr.Twiss,
Yesterday,I was asked to join Health hrspector,David Greenbaum,on an inspection of your property. An
individual living in the home,showed us the main floor.The bathroom has been disassembled and only
partially reassambled.Electrical and Plumbing violations were obvious as well as the fact no building
permits have been pulled for the work. The bedroom doors have all been damaged. More importantly
there were no smoke detectors or carbon monoxide detectors on this floor. In the basement another unit
was discovered. At this point we asked Fire Inspector Holleran to join us.This Department has no records
of any permits and or zoning relief to construct this unit.
The home has been"condemned"by the Health Department and at this time I am removing the
Certificate of Occupancy until such time as all issues are addressed.
The Building Code violations are: 780 CMR sections 5110.1 through 5120.4 :5313 as well as violations
of the Mass State Electrical and Plumbing Codes.
Also there are two zoning violations of City of Salem. A second unit has been created in the basement and
you are renting rooms to individuals in a single family residence.
You directed not to occupy this home until a Certificate of Occupancy has been obtained from this
Department. You are further instructed to remove the illegal unit in the basement and to hire licensed
Electricians and Plumbers to remove the plumbing and wiring.
If you feel you are aggrieved by the Building Code matter, your Appeal is to the Board of
Buildings,Regulations and Standards in Boston. If you feel you are aggrieved by the Zoning
Interpretation,your Appeal is to the Salem Zoning Board of Appeals.Failure to comply with this order will
result in fines and a complaint being filed in Salem District Court.
Th
mos St.Pi e
Building D rector of Inspectional Services
Cc:file, Councilor Ryan,Jason Silva,David Greenbaum, Fire Inspector Holleran
MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
2 CENTER PLAZA
BOSTON, MASSACHUSETTS 02108-1904
800-392-6108 617-723-3800
DATE 10/02/98
Form of Notice of Casualty Loss to Building
Under Mass . Gen. Laws, Ch. 139, Sec . 3B
TO: SALEM BUILDING COMMISSIONER
SALEM CITY HALL
SALEM MA 01970
RE: Insured: MARY ADAMO
Property Address : 318 HIGHLAND AVE .
SALEM MA 01970
Policy Number: 20-2-397167-03
Type of Loss : WINDSTORM Date of Loss : 10/01/98
Claim Number: 20-2-0169190
Claim has been made involving loss, damage or destruction of the
above-captioned property, which may either exceed $1, 000 . 00 or cause
Massachusetts General Laws, Cha ter 143 , Section 6 to be applicable.
I any notice under Massac usetts Genera Laws, C apter 139, Section 3B
is appropriate, please direct it to the attention the and
include a reference to the captioned insured, location, policy number,
date of loss and claim or file number.
MPIUA Claims Division
MUA-CL-21
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lug Zi b _,l ift of Sairm, assar4usetts
v , '_; ✓
FILE-' Boar3 of CAtr}tettl
DECISION ON THE PETITION OF AMES J- ADAMO—(-PETITIONER) ;, MARY K.
ADAMO (OWNER) FOR VARIANCESL,AT 318 HIGHLAND AVE. (572).,-
A hearing on this petition was held June 6, 1989 with the following Board Memabers
present: James Fleming, Chairman; Messrs. , Febonio, Dore and LaBrecque. 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.
L
tioner is requesting Variances from density, setbacks, and use to allow
t to be divided and to cosntruct a single family dwelling at 318 Highland Ave.
locus is in a_B2_district-
Lhe Variances which 'nave been requested may be granted upon a finding of the
Board that:
a. ,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 in the same district;
b. literal enforcement of the provisions of the Zoning Ordinance would involve
substantial hardship, financial or otherwise to the petitioner;
c. 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 petition.
2. There is adequate parking on the site.
3. The intended use in in harmony with the existing neighborhood.
On the basis of the above findings of fact, and on the evidence presented, the
Board of Appeal concludes as follows:
1 . Special conditions exist which affect the subject property but not the
district generally;
2. Literal enforcement of the provisions of the Ordinance would work a substantial
hardship on the petitioner;
3. The relief reouested 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.
DECISION ON THE PETITION OF JAMES J. ADAMO (PETITIONER, iiARY K. ADAMO (OWNER)
FOR VARIANCES AT 318 HIGHLAND AVENUE, SALEM
page. two
Therefore, the Zoning Board of Appeal voted unanimously, =-O, to grant the relief
requested, subject to the following conditions:
11 CBoard
construction be done as_per the plans and dimensiens_submit.ted—to�the
of Appeal;_
2. All the requirements of the Salem Fire Department, relative to fire safety,
be adhered to by the petitioner;
3. Proper numbering of the new dwelling be obtained from the City of Salem
Assessors Office;
4. Petitioner obtain a Building Permit and Certificate of Occupancy.
GRANTED
ames M. Fleming, Esq. , Chai t9n
A COPY OF THIS DECISION HAS BEEN FILED WITH THE PLANNING BOARD AND THE CITY CLERK
Fopeal from th!s dersion, if any, shall be made purse,nt so Section 17 of
the Plass. General La.vs, Chanter 303. and shall h^ filed a.ithm 20 days
aster the date of filing of this decision in the oitice of the laity Clerl<.
Pursuant to isas. (,encrai Ls.vs. Ch - 4r)s. soctlmt !1, the Variance
or Permit pmraed here-n ':n(.li : take 1-ff= LIM a ccpy of the
(melon. )earin;, she cert ficotion of too City Clark that 20 dans have
elapsed and no apaeal nas been filed. or :Ian. d such aoocal has bcen
fYed, that It has been dismissed or denied i; recorded in the South Essex
Registry ct Deeds r.nd indexed under toe name or the owner of record or
is recorded and noted on the owner's Certificate of Title.
BOARD OF APPEAL
AUG �.
lug 23 n 1 Itt of Salem, C assar4usetts V
FILE.' �Raar3 of �VFral
.,,T :. _ ....
DECISION ON THE PETITION OF JAMES J._ADAMO—( PETITIONER) , MARY K.
ADAMO (OWNER) FOR VARIANCES A18 HIGHLAND AVE' B=2)
A hearing on this petition was held June 6, 1989 with the following Board Memabers
present: James Fleming, Chairman; Messrs. , Febonio, Dore and LaBrecque. '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 is requesting Variances from density, setbacks, and use to allow
a lot to be divided and to cosntruct a single family dwelling at 318 Highland Ave.
The locus is in a B-2 district.
The Variances which have been requested may be granted upon a finding of the
Board that:
a.. 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 in the same district;
b. literal enforcement of the provisions of the Zoning Ordinance would involve
substantial hardship, financial or otherwise to the petitioner;
c. 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 petition.
2. There is adequate parking on the site.
3. The intended use in in harmony with the existing neighborhood.
On the basis of the above findings of fact, and on the evidence presented, the
Board of Appeal concludes as follows:
1 . Special conditions exist which affect the subject property but not the
district generally;
2. Literal enforcement of the provisions of the Ordinance would work a substantial
hardship on the petitioner;
3. The relief requested 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.
C/
c DECISION ON THE PETITION OF JAMES J. ADAMO ( PETITIONER, ;.ARY K. „DAMO (OWNER)
FOR VARIANCES AT 318 HIGHLAND AVENUE, SALEM
page. two
Therefore, the Zoning Board of Appeal voted unanimously, =-O, to grant the relief
requested, subject to the following conditions:
1 . All construction be done as per the plans and dimensions submitted to the
Board of Appeal;
2. All the requirements of the Salem Fire Department, relative to fire safety,
be adhered to by the petitioner;
3. Proper numbering of the new dwelling be obtained from the City of Salem
Assessors Office;
4 . Petitioner obtain a Building Permit and Certificate of Occupancy.
GRANTED
ames M. Fleming, Esq. , Chai n
A COPY OF THIS DECISION HAS BEEN FILED WITH THE PLANNING BOARD AND THE CITY CLERK
Aopeal from this decision. if any, shall be made purse.nt to Section 17 of
the floss. General Laws, Chanter 303. and shaft he Had r.ithm 20 days
alter the nate of Ninp of this decision in tire W7ice of the (Sty C:erk.
PerSLa...t to ida>s. Ce.^.^_rm Lo'.1G. Cli _. `;n8, Scrhon !1, thr varianre
or 5 e[i al Parma manta i hcie,n sn;i) take ffccf until a copy of the
r.+risia�. be;:r'r+ the cartfication of to^_ City Cl:-rk til�r 20 r!:rvs have
elapsed and no arpeal nas bean Plod, or :hat, if sash aoceal has baen
fled, that It las been dismissed or denied is recorded in file South Essex
Registry of Deeds and indexed under the name or the owner of record or
is recorded and noted on the owner's Certificate of Title.
BOARD OF APPEAL
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FORM - =ECISICN ZM tLERX.SALt.A M#SS.
Ms. Josephine Fusco
City Clerk
City Hall
Salem, MA 01970
Dear Ms. Fusco:
At a regularly scheduled meet;^- of `_}:e Salec. _1aaning Board held
on June 15, 1989 it was voted to endorse zoroval Under Sub-
division Control Law Not Reauired" on the following described plan:
1. Applicant:
Jim Adamo
318 Highland Avenue
Salem, MA 01970
2. Location and Description -
318 Highland Avenue Saiem,11A 01970
Deed of property records in Essex South District Registry.
Sincerely,
Walter Power III
Chairman
WP/sm
Ctg of tzlem, ffiassar4usetts
F 'Ih`ttII ntS �RIIMria
Cite,'fall
�4alrm,�9lassacf{usetta 0197U
NOTICE TO BE ATTACHED TO 0 d L
FORM"A" APPLICATIONS
See Form "A" applications for y m
complete instructions for filing. c a
All insertions shall be typewritten n m
or printed neatly in ink. 4-0
Date: lune 14. 1989
City Clerk
Salem, Massachusetts 01970
Dear Sir:
I hand you herewith two copies of Form A, an application submitted by me this day to the Plan.
ning Board of the City of Salem requesting a determination and an endorsement on a plan Sled with
said application that Planning Board approval under the Subdivision Control Rules and Regulations is
not required.
The land shown on the accompanying plan is located at ------318- Highland -Avenue- - -
- - - ------------------------------------------------------ in Ward ---------4 -
(insert street and street numbers here)
Signature of Owner .__=. _____ __ _ _ __ /
Street Address318 Highland Avenue - — —---— — - —
City/rown&State -SA lem,--MA---019ZD---------------------------------------------------
Telephone Number 592-4284----------------____
Ctu of *Iem, 4&ssar4usetts
vis P=
gag AMU
o4alem,'answc4usdb 01970
FORM A
APPLICATION FOR ENDORSEMENT
OF PLAN BELIEVED NOT TO REQUIRE
APPROVAL
In accordance with provisions of Section II-B, the
applicant must file, by delivery or registered mail, a
Notice with the City Clerk stating the date of sub-
mission for such determination. The notice shall be
attached to two copies of this Form A application.
The notice and both copies of the application must
be "date stamped" by the City Clerk and then one
copy of this Form A, with the Plan, filed with the
Planning Board by the applicant. All notices and
applications shall be typewritten or neatly printed
in ink.
Salem, Mass., ---_-•_June 14
To the Planning Board:
The undersigned, believing that the accompanying plan of his property in the City of Salem does not
constitute a subdivision within the meaning of the Subdivision Control Law because (See Sect. II-A and
_state specific reasons) ----Each of the lots shown on the accompanying plan has adequate
frontage on a public way pursuant to a Varlance'grante3 Uy Ehe Soaid oAppeal.
-------------------------------------------------------------- ---------—-------—---------- —-- —._
and herewith submits said plan for a determination and endorsement that Planning Board approval
under the Subdivision Control Law is not required.
1. Name of Owner -----Jim.Adam2-----------------------------—------—---------- — — ---
Address_..-318 Highland Avenue —
2. Name of Engineer or Surveyor ..._...john- ndove
Decoulos
A
Address____ --48
-r---St---r---e---et,,--- -P-----e --ab----
od-y-----, --MA---------0----196----0 --------------
______—___________---------------
__
-- --------------------------------------------------------------------------------
3. Deed of property records in _____—Essex__South ____ Registry
Book ------------------------------------- -- Page ------------------------------
4. Location and Description of Property: ---- - .._318 Highland Avenue, 3alem,MA
---------------------------------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------ -----------------------------------------------------------------------------------
-------------------------------------•------------------------------------------------------------------------------------------------------
5. All streets and abutting lot lines shall be shown_on the Plan tog#er with the names of the Owners
of the abutting lots. )
Signature of Owner-: `-- - - ------
Address---------------- - -- 9ghjqnAv_enuexSalemz----'-k---
--
TelephoneNumber -----------------------------------------------------------------------
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CITY OF SALEM, MASSACHUSETTS
BUILDING DEPARTMENT
ai"P" 120 WASHINGTON STREET,3RD FLOOR
'� TEL. (978) 745-9595
FAX(978) 740-9846
KIMBERLEY DRISCOLL
MAYOR THOMAS ST.PIERRE
DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER
October 3, 2019
Daniel Twiss
318 Highland Avenue
Salem Ma. 01970
Dear Mr. Twiss,
Salem Police executed an administrative search warrant at your property on Friday,September 27 2019. After
doing an Inspection of the home ,multiple Building Code,Fire, Electrical and Plumbing Code problems as well
as Multiple Sanitary code violations were apparent. It was also apparent that the single family home had been
changed into two units violating Salem Zoning. The second lower unit had been converted into a makeshift
party club which would be a place of assembly under the Building Code. The violations were serious enough to
cause the Health Department to condemn the property on Fitness and for me to remove the occupancy permit.
Because of the illicit uses ,Boarding House upstairs and nightclub on the lower unit, and the fact that an owner
was not present,the home was boarded up and utilities were cut.After repeated trespassing, I had a fence
erected across the driveway .
I have declared the home"dangerous and unsafe"per. Mass State Building Code 780 cmr section R 115.1
through R 116.3.
If you feel you are aggrieved by my actions related to the Building Code, your Appeal is to the Board of
Buildings ,regulations and Standards in Boston. If you wish to Appeal my Zoning Interpretation,Your Appeal
is to t e Salem Zoning Board of Appeal.
, 4AX
Thomas St.Pierre
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ELIZABETH M.RENNARD (,(47-i
1� ! � VICTORIA B.CALDWELL
CITY SOLICITOR ASSISTANT CITY SOLICITOR
93 WASHINGTON STREET 93 WASHINGTON STREET
SALEM,MA 01970 S
TEL:978.619.5633 M,MA 0
5634
FAX: 978.744.1279 T EL:978.619. 634
CITY OF SALEM FAX: 978.744.1279
EMAIL:BRENNARD@SALEM.COM KIMBERLEY L.DRISCOLL,MAYOR EMAIL:VCAI.DWEr L@SALEM.COM
LEGAL DEPARTMENT
93 WASHINGTON STREET
SALEM,MASSACHUSETTS 01970
December 13,2019
JP Morgan Chase Bank NA, a wholly owned subsidiary of
JP Morgan Chase& Co.
270 Park Avenue
New York,NY 10017
Re: 318 Highland Avenue,Salem,MA 01970
Dear Sir/Madam:
Enclosed please find an invoice from Action Emergency Management for$11,151.78 for services
required by the City of Salem to secure the above-referenced property and provide emergency services
following a police raid at the property.
As the mortgage holder and responsible party for the property, please remit payment to Action
Emergency Management with a copy to the City at the address above. Failure to do so will result in the
City paying the bill and recording a lien on the property.
Please feel free to contact me if you have any questions or need further information.
Sincerely,
cam ..,
Victoria B. Caldwell
Enclosure
cc: Thomas St. Pierre, Building Commissioner
Harmon Law Offices,PC, 150 California Street,Newton, MA 02458
CT Corporation System, 155 Federal Street,.Suite 700,Boston, MA 02110(Registered Agent)
,AGIIIIFIEN2/111044
Alial.111.111FAMISPONIMMIlli
231/2 Hour Board-Up and Restoration Service
Building Demolition & Gut Outs
(781) 286-3900 • Fax(781)286-3924
Toll Free: 1-800-BOARD-IT
1087 Broadway • Revere, MA 02151
Federal Tax ID#: 45-2848183
Service Date: 9/27/19 Incident No: FB 8484
Job Location: 318 Highland Ave Salem,MA Invoice Date: 10/2/2019
ACTION PERFORMED
On September 27,2019 Salem Police called Action to go to the address above and secure the
area, and trailer due to a raid, at the request of the Salem Inspectional Services Department
Action Emergency Services dispatched a crew of 41 E.S.U. Team Leader, and
3 E.S.0 Technicians and two trucks to board up windows, doors, and to secure the area.
Return Trip
On September 28,2019 the Salem Police called Action Emergency Management back to 318
Highland Ave, to install a temporary fence, to secure the area, and prevent people from
entering the area. Action sent a team of 4 men, 1 E.S.0 team Leader, and 3 E.S.U. Technicians
as well as 2 Emergency vehicles.
c1
Authorized Signature
Page 1 of 1
•
dial 11011 FM/NO
23 1l2 Hour Board-Up and Restoration Service
Building Demolition & Gut Outs
(781) 286-3900 • Fax(781) 286-3924
Toll Free: 1-800-BOARD-IT
1087 Broadway • Revere, MA 02151
Federal Tax ID#: 45-2848183
BILL TO JOB LOCATION INVOICE# FB 8484
318 Highland Ave Salem, MA INVOICE DATE: 10/2/2019
Service Date, Friday 27/09 3:30 PM
Day DD/MM Flme AM/PM
1 Window 1st floor left (B side) 38x41 Included
Thru Bolted 2 x 4 x 16
1 Window 1st floor left (B side) 22x51 Included
Thru Bolted 2 x 4 x 16
1 Window 1st floor left (B side) 22x51 Included
Thru Bolted 2 x 4 x 16
1 Window 1st floor left (B side) 48x50 Included
Thru Bolted 2 x 4 x 16
1 Window 2nd floor left (B side) 34x88 Included
Thru Bolted 2 x 4 x 16
1 Window 2nd floor left (B side) 74x39 Included
1 Window lower level rear(C side) 21x36 Included
1 Window lower level rear(C side) 21x36 Included
1 Window lower level rear(C side) 21x36 Included
1 Window lower level rear(C side) 21x36 Included
1 Window lower level rear(C side) 21x36 Included
Nails 3 4.00 $7.44 $29.76
Nails 2 2.00 $6.54 $13.08
Page 2 of 4
ofilliarAcnimit
231/2 Hour Board-Up and Restoration Service
Building Demolition & Gut Outs
(781) 286-3900 • Fax(781) 286-3924
Toll Free: 1-800-BOARD-IT
1087 Broadway • Revere, MA 02151
Federal Tax ID#: 45-2848183
BILL TO JOB LOCATION INVOICE# FB 8484
318 Highland Ave Salem, MA INVOICE DATE: 10/2/2019
Service Date>>> Friday 27/09 15:00 PM
Day 1 Time AM/PM
1 E.S.U. Team Leader 09/28/19 4.00 $142.50 $570.00
Deferred Rate
1 E.S.U.Techinician 09/28/19 4.00 $97.50 $390.00
Deferred Rate
1 E.S.U. Techinician 09/28/19 4.00 $97.50 $390.00
Deferred Rate
1 E.S.U. Techinician 09/28/19 4.00 $97.50 $390.00
Deferred Rate
H-9 09/28/19 4.00 $55.00 $220.00
E.S.U. Truck
T-10 09/28/19 4.00 $55.00 $220.00
E.S.U. Truck
Total $11,151.78
Page 4 of 4
t w
Th p ealth of Massachusetts
fi&is and Standards CITY OF
1 use�ttts State Building Code, 780 CMR SALEM
Revised Mar 2011
JBuilding Permit fJI or2 to(AneuiZ tepair,Renovate Or Demolish a
II11 e-or Two-Family Dwelling
This Section For Offici4lUse Only
Building Permit Number: Date pplied:
Building Official(Print Nam F) Signature
/ SECTION 1:SITE INFORMATION
1.1 rop Ad r a 1.2 Assessors Map&Parcel Numbers
t , 1M
1.1a Is this accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) 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 System1�0
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal sy
Check if yes❑
S�ECC{T'ION 2: PROPE(�RTY OWNERSHIP'�9/ p �/
Name(Print) City,State,ZIP
g 0 e _J 1e 978 � �� Tw1z o
No.and Street Telephone Email Address
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_ ther ❑ Specify:
Brief Description of Proposed Work':
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official U Only
Labor and Materials sen
y
1.Building $ 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Costa(hem 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 Co t: d�f ❑Paid in Full ❑Outstanding Balance Due:
S
SECTION 5: CONSTRUCTION SERVICES
rNme
onstruction Supervisor License(CSL)
License Number Expiration Date
f CSL HolderLis[CSL Type(see below)
. Street Type Description
U Unrestricted Buildin s u to 35,000 cu.ft.
City/Town,State,ZIP
R Restricted 1&2Famil Dwellin
M Maso
RC Roofin Coverin
WS Window and Sidin
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Expna[ion Date
HIC Company Name or HIC Registrant Name
No.and Street
Email address
Ci /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.
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
cont e in this appf do d accurate to the best of my knowledge and understanding.
Print Owner's or Authorized Agent's Name(Electronic Signature) Da
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.gov/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 parch)
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"
r
1M_"lS1MtSi'•9£f4l.E AffxROVED BY T44E
,LNS#;FCT,dB F*Wfl �D.A..PEEIhilT B,EiNG GRANTED
CITY OF SALEM
1 C—ZfSv s Date
No. —2
,yet ,� �.
n Oki
iA. / e
Is Property Located In / Location of
the Historic District? Yes_No V Building �rL L Gg
Is Property Located in
the Conservation Area? Yes_No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Sh , Pool,
Repair/Replace, Other:
PLEASE FILL OUT LEGIBLY & COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the following
specifications:
Owner's Name DIA t
I�fi
Address & Phone �(K Hin C'OVIC� 1� Wh 7W -d09D
Architect's Name
Address & Phone L 1
Mechanics Name 4
Address & Phone ( 1
What is the purpose of building?
Material of building? If a dwelling,for how many families?
Will building conform to law? Asbestos?
Estimated cost I� r City License 0 N o' State License 0
�j� Home Improvement /f/�
C; , Vv Lic. I �il
` Signature of Applicant
cv-to9v SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO:
II (
mt i
NO. '5q^2-00q
APPLICATION FOR
PERMIT TO
LOCATLON
PERMIT GRANTED
APPJWYf D
INSPECTOR OF BUILDINGS