175 MARLBOROUGH ROAD - BUILDING INSPECTION 175 MARLBOROUGH ROAD
I
- 1
NOTICE OF CITY ORDINANCE CITY OF SALEM
SALEM CITY ORDINANCE
Citation: 2444 � :W r
Date:
02/03/2015 12 :00
10-0
Location: .
175 MARLBOROUGH ROAD
Badge Number:
Officer:
MICHAEL LUTRZYKOWSKI, BUILDING Fine:
02/03/2015 $ 75 . 00
Violation: 11
OTHER, CITATION
38-12 WINDROW
Payments :
Other:
$ -50 . 00
Docket :
Verdict :
TOTAL DUE:
04/07/2015 $ 25.00
Make checks payable to: CITY ORDINANCE
CITY OF SALEM MA-037-CO-2015-00-2444
• 04/07/2015
TOTAL DUE : 25 . 00
LEBLANC,DEBORAH J
175 MARLBOROUGH ROAD
SALEM,MA 01970-0000
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FIELD COPY
CITY OF SALEM BUILDING
SALEM. MASSACHUSETTS 01970 PERMIT
GATE
April 5, 93 MIT NO87-93
A� ApyFiE� .
APPLICANT Kevin McCrea •4p 52705 DRESS_ A r �.
pRyr�RE,�yy��S[��TAEFEf� ��T�(EN�O�.I�� ISTRCETI tCO ��§lCICC N!!1
LV DVASTE 1ArY1:N1.11J.1.1'[l] NUMBER OF
PERMIT TU (_I STORY DWELLING UNITS
T.PE Of IMPR
� ar
OpV..�E�MENT) NO. IPROROS[D
AT 14OCRTIONI 175 1' l rmig. ZONING
.M1O.1 ISTRE ETI I
DISTRICT
BETWE. AND
ICROS> STPEETI )CROSS SL Rff TI
SUBDIVISIONLOT
LOT BLOCK
BILE
BUILDING IS 70 BE FT. W,OE N, FT. LONG BY FT, IN NEIGNT AND SNALL CONFORM IN CONSTRUCTION
TO TYPE 1USE GROUP-BASEMENT
WALLS OR FOUNDAT ION
{r. me one call yinstall kitchen cabinets _
I T r P E I
REMARKS:
CALL FM PERMIT TD OCCUPY 745-9595
AREA OP5,200.00 PERMIT 41.00
VOLUME ESTIMATED [OST � - FEE S
do ue lc'lo unRE r[(T; _ - ---
OWNER _Sida Jerry Hass --
AnDRESi 115 rwq •, baieia.iva leo E. Tremblay
INSPECTOR OF BUILDINGS
INSPECTION RECORD
p.Te NoTS .ltooRrSS - a0411a UY! AND •SYSUKS IMS►[CTO•
- No. -� City of Salem Ward
� x
'�'ci,m+cuy
APPLICATION
FOR
PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION
IMPORTANT- flApplicant to completeX.
{, all items in sections:1, It, Ill, IV, and I
I. AT(LOCATION) ,� qS 0r 7` ZONDISTRICT
LOCATION (NO.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS ET)
LOT
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(If residential,enter number of new 12,0 One family 18 ❑ Amusement,recreational
(rousing units added,it any,in part D,13) 19 E] Chruch,other religious
13 ❑ Two or more family-Enter number
3 XAheration(See 2 above) of units ....................................................... 20 ❑ Industrial
21 ❑ Parking garage
4 ❑ Repair replacement 14 ❑ Transient hotel,motel,or dormitory-
Enter number of units ........................... 22 ❑ Service station,repair garage
5 E] Wrecking(It multifamily residential,enter number 23 E] Hospital,institutional
of units in building in Part D,13) 15 ❑ Garage
24 E] Office,bank,professional
6 ❑ Moving(relocation) 16 ❑ Carport 25 ❑ Public utility
7 ❑ Foundation only 17 ❑ O[her-Speciry 26 ❑ School,library,other educational
27 ❑ Stores,mercantile
B.OWNERSHIP 28 ❑ Tanks,towers
8 �L Private(individual,corporation,nonprofit
institution,etc.) 29 ❑ Other-Specify
9 ❑ Public(Federal,State,or local government
C.COST (Omit cents) Nmresidential-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 ......................................................... $ dOU at industrial plant.If use of existing building is being changed,enter proposed use.
To be installed but not included � /_
in the above cost 1�O . LSO
aElectrical........................................................................... p
b. Plumbing..........................................................................
c. Heating,air Conditioning............................................. r
d. Other(elevator.etc.).....................................................
11. TOTAL COST OF IMPROVEMENT $ S 00
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 fR Gas 40A Public or private company Will there be central air
31,®.Wootl frame 36 E] Oil 41 ❑ Private(septic tank,eta)
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)Q
No
43 ❑ Private(well,cistern)
J.DIMENSIONS
48. Number of stories M. DEMOLITION OF STRUCTURES:
............................
as. Total square feet of floor area. Has Approval from Historical Commission been received
all floors,based on exterior
dimensions ................................................ for any structure over fifty(50)years? Yes_ No_
50. Total land area,sq.It....................................................... Dig Safe Number
K.NUMBER OF OFF-STREET PARKING SPACES Pest Control:
51. Enclosed .1.....11....1.................
1 HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED?
sz. outdoorsYes N
L RESIDENTIAL BUILDINGS ONLY Water:
53. Enclosed............:._...._...._......................................._......, Electric:
Gas:
Full.........................'................ Sewer:
54. Number of
bathrooms DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED
Partial`----.---`--1111....-- BEFORE A PERMIT CAN BE ISSUED.
IV. COMPLETE THE FOLLOWING:
Historic District? Yes_ No-k (If yes,please enclose documentation from Hist. Com.)
Conservation Area? Yes_ NoJ-- (If yes, please enclose Order of Conditions)
Has Fire Prevention approved and stamped plans or applications? YeS4 No_
Is property located in the S.R.A.district? Yes_ NO--Y1.-
Comply with Zoning? Yes—X No (If no,enclose Board of Appeal decision)
Is lot grandfathered? Yes No_ (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# 05a-1 V5 Salem License#
Home Improvement Contractor# 110 9 1;-7 Homeowners Exempt form (if applicable) Yes_ No
CONSTRUCTION TO BE COMMENCED WITHIN SIX(6) MONTHS OF ISSUANCE OF BUILDING PERMIT
8 17 If an extension is necessary, please submit
CONSTRUCTION IS TO BE COMPLETED BY: 19 J 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.
Owner or
.c�a ect \ 5 RCIT o o RA 019-76 ll-5
Lessee <nke tM HA v 19 l 0 4a�g
2. �e�:.. cCce `1g Con ;oma 009
Cont2ctor `( P k Builder's ,jam �-)
o 0 ti/n License No. T+' a'-
��
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 a en nd we=to conform to all applicable laws of this jurisdiction.
Signature of applicantAddress �Q ./ i Application date
b ( d
� I r
DO NOT WRITE BELOW THIS LINE
VI. VALIDATION
Building C FOR DEPARTMENT USE ONLY
Permit number
Building Use Group
Permit issued y S 19�
Fire Grading
Building (�
Permit Fee $ Live Loading
Certificate of Occupancy $ Appd bOccupancy Load
rovey:
Drain Tile
Plan Review Fee $ �—
/ TIXE
NOTES AND Data - (For department use)
H
PERMIT TO BE MAILED TO: n
DATE MAILED: O 15?1A f
Construction to be started by: Completed by: /
t
E
VI ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
NOTES
SITE OR PLOT PLAN •For Applicant Use
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FINN �TE'S ANDNSP CTIOt,FD CO.',1 LETE OOM LI -- ------- — ---- --- --- �.
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aara. .,�la�raaa�as
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�tichaei S. Dukaic+s ,,
Govemor /301
Kentaro Tsutsumt
Gt�aorbw. K�aasaos � OY108
Chairman 6171
Charles J. Dine=
Administrator
MEMORANDUM
TO: Ail Building Dcpartmcntsr5tae Building inspectors
FROM: Charles J. Dineno. Administrator
DATE October 31. 1988
SUSIECT. MC.1. cd0 SSd Added flv r594, S9 of the Act] n( 1997
The
ire-mentioned
requires that debris
tatute
or other alteration ofsresulting
a buildi g Orr structure be disn
liftZILINDIS
posed of raev
properiv licensedsolid wit ebdiSPOW
(aaiur as definea by MGL all. 5150A and that budding permits or licenses are to indicate the Ioarron
of the faelity at which the said debns is to be disposed. THIS REOUIREMENT DOES NOT
APPLY TO NEW CONSTRUCTION.
In order to simpufv the process and to provide undormuv, we are attaching a copy of a form which
ichnu
can either reproduce and use as it u since the completed form W`111 be attached to rife office copy 6
permits or ifeeasesr or reproduce it on your letterhead.
In ase of municipal,commercial.Industrial.or multiunit housing construction.the contactor may not know
the dumm:cr subcontractor at the came of the building permit apphatt= In such aces. the attattiiod CCW
of an AMdavit as be used.
The complete law is concerned in the Novr embeissue of CODE:wORD which wiii be marled to we io tee
tied two vwrJ L If you should have any question, please let us know.
CM&M
,I
Cap of �afem, _Fa-qsarhugrtts
s., pubUc �3rnnrrtn Denarttnent
+,c sullaing Devartnlrnl
one jusum drrrn
735-9595 exl. 250
William H. Munroe
Director of Public Praperty
Inspector of Buildings
Zoning Enforcement, ufiiccr
In a=raanee vin Inc provtstan+ of MGL c 40. S 54, a mnanton of Budding Permit
Number u that Inc acbru resulting from this wart snail be
dubasm of In a properiv uccnscta solid wutrdupasl laaltry as defined by MGL c 111. S
150A
The acbru will be aauposra of in:
L Z Vw��OSCB 1 S�t'Vt C C�
(Location at Fxtury)
Signature at Permit Applicant
9�
Date
COMMONWEALTH OF MASSACHUSETTS
E DEPAI -17v1E VT OF INDUSTRIAL ACCIDENTS
_ 600 WASHINGTON STREET
fames. Camooei; BOSTON, MASSACHUSETTS 02111
-Cm. -ss,one, WORKERS' COMPENSATION INSURANCE AFFIDAVIT
E� //, c c7 en
(licensee/permirme)
with a principal place of business/residence at:
o- w� p OW„ )Apr W- W9
(City/scam/Zip)
do hereby 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
job. 1 t�
\,f)c rr' ,4VPr JS(/c'(ill re
Insurance Company Policy Number
( J I am a sole proprietor and have no one working for me.
[ J 1 am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below
who have the following workers' compensation insurance policies:
Name of Contractor Insurance Company/Policy Number
Name of Contractor Insurance Company/Policy Number
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 iban three units in which the homeowner also resides or on the grounds appurtenant thereto are not generally
considered to be employers under the Workers' Compensation Act(GL C. 152,sect. 1(5)),application by a homeowner for a license
or permit m:y evid--mace�ihe legal--m as of an employer under:he Workers' Compensation ACL
I understand that a copy of this statement will be forwarded to the Department of Industrial Accidents'Office of Insurance for coverage
verification and thsmfw1ure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties
consisting of a fine of up to 51500.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a
fine of$100.00 a day against mer. {,
Signed th' 1 day of ' 19 9-3
Licensee/Perraim m Licensor/Permirror