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11 MASON STREET - BUILDING JACKET __ // ��s � �ST��7� _, ;�I vu.tYE�r1 CITY OF SALEM BUILDING DEPARTMENT 1241 JUN -b All: 15 120 Washington Street, 3d Floor, Salem, MA 0 70 ABANDONED AND FORCLOSED PROPERTIES REGISTRATION FORM PROPERTY INFORMATION Address: 111 MASON ST. SALEM,MA 01970 Parcel ID# 16-0363-0 Square Footage of Building: 1084 SQFT Number of Stories: 2 Sprinkler System: YesOperational yes/no) Pipe System: Yes_No �/ (Opeal yes/no) Fire Detection System: es N � Operational yes/no) OWNER(S)"OF RECORD (attach additional sheets if necessary) Owner: SETERUS, INC Address: 14523 SW MILLIKAN WAY SUITE 200 BEAVERTON, OR 97005 Tel. No.: 877-272-2149 E-mail: REGISTRATIONS@SVCLNK.COM CONTACT PERSON/REGISTERED PROPERTY MANAGER TBD-PROPERTY IS IN PRE-FORECLOSURE/COLLECTIONS AND NOT BANK OWNED AT THIS TIME, Name: PLEASE ACCEPT OUR 24HR CONTACT INFO.A CONTRACTOR IS IN THE AREA. Primary Address (No P.O. Box) Business Tel. #: 877-272-2149 Non-Business Tel. #: 877-272-2149 E-Mail Address: REGISTRATIONS@SVCLNK.COM Emergency Telephone# - 24hr/day 877-272-2149 IS THE PROPERTY LISTED FOR SALE?Yes_No❑✓ If yes, Real Estate Agency Address: Tel. No. VACANT BUILDING PLAN: Please check which applies. 1. The building is to be demolished. 2. 7The building is to remain vacant. SEE ATTACHED 3. _The building is to be returned to appropriate occu cy or use. SIGNATURE OF OWNER(S)/OWNERS AGENT: DATE: r I REGISTRATION FEE $300 Cash/Money Order/Cert. Bank Check r r Date: May 23, 2017 City of Salem Building Department 120 Washington Street, 3rd Floor Salem, MA 01970 RE: 111 Mason St. Salem, MA 01970 Seterus is the servicer of record on the above referenced property. We have recently found this property to be vacant and have taken steps to secure the dwelling. The property will remain vacant until such time that the homeowner takes possession or until foreclosure and the subsequent sale of the property. Regular property inspections will be done to ensure the property is secured and the grounds maintained. If you have any questions regarding this information, please contact ServiceLink Field Services, toll free at 877-272-2149, or e-mail REGISTRATIONSL@SVCLNK.com. Sincerely, Property Registration, Preservation and Inspection Seterus SERVICELIN I A9;<tii4[R KGu bUf May 23, 2017 City of Salem Building Department 120 Washington Street, 3`d Floor Salem,MA 01970 To Whom It May Concern: Enclosed please find a property registration form for 111 Mason St. Salem,MA 01970 ServiceLink Field Services, LLC ("ServiceLink") is a national property preservation company and is authorized to act on behalf of the mortgagee to maintain and preserve the condition of this property. As part of our role in preserving the property,please find enclosed the Abandoned and Foreclosed Properties Registration Form. Please send all correspondence regarding the maintenance of property to the following address and ServiceLink will act on behalf of the mortgagee to resolve any issues. Seterus c/o ServiceLink Field Services, LLC 10385 Westmoor Dr., Ste. 100 Westminster, CO 80021 registrations@svcink.com ServiceLink's 24 hour contact number for this property is 1-877-272-2149. Please contact me if additional information is required. Sincerely, Jason Bartels Asset Registration Technician Office: 720.566.8316 Fax: 303-439-3893 Jason.Bartels@svclnk.com Enclosure ServiceLink Field Services,LLC• 10385 Westmoor Drive,Suite 100•Westminster, CO 80021 a ,> ,. �.,,�.. ........ ..... 1091*01131,'�, SERVICELINK NLS LLC p Line Invoice Mumber Amount OT46dont et /23/ 5 ".W 10 I 2000196718W1 6� C6519LOO28,44814SW12OT9 -96S , 7' $300.00 $0.00 $300.011 qj", j4 1 1 FOLD FOLD �Y Z "All oe t L I Tota! A `FOLD FOLD:r 'INKNUILUC k�6-01 RIVER-Slb, 1ACKS0NVMLETV32z 10900017310 V I '2 'tsnfhreC Him fir And'Zei��'45.61 P, ay to e,,,,='-Cj 0� TY:QF SALEM A'. S erb '��BWLOINdJAPAR "120 WASHINGTON STREET, 4�:-!v i,LUD FLOOR SALEM 1013'/04' "q. .14C, 0A kci li' 10900017 3 Ilia 1: 1211418221: 3 13 0 2 a 4 6 CITY OF SALEM >qIEDULE OFWnARTMENTAL PAYMENTS TO TREASURER �` / Department Name :/ ( Datej= � Department# Fisc Year 9/10 Form# J FROM WHOM ACCOUNT NUMBER&DESCRIPTION AMOUNT TOTAL AVIA P pC Oq 1� Total 9/10 Comprised of: Cash: b Checks: TOTAL DEPOSIT THE COMMONWEALTH OF MASSACHUSETTS,DEPARTMENT OF CORPORATIONS AND TAXATION,//BUREAU OF ACCOUNTS No. 200 To the Department Acer making the Payment: Receivef the sum of 1 Dollars, for the collections from_ ZZyj0 0, eQ61 to for collections as per schedule of this date,filed in my office. Treasurer Treasurer Ret,No:0 YRMUM �G _q D� 1cz ase ►vnn u Wt f'L7S C C3 f-14 T i T4 , • 0,4vL7 a l me u� S( CLQq{ C( 7 C9 4 o197 os--20.5 tl L . P N N 0 Commonwealth:of Massachusetts Essex Superiof Court, Department Trial Court 43 Appleton Street, Lawrence, MA 01840-1505 Tel,: 978=687-7463 ESSEX,SS Case No. ESCV 10-02490 Suchand Reddy Pingli, Plaintiff versus ) ORSETT/RES 6,LLC, Orsett Properties, Ltd., Old Republic ) National.Title Insurance Company, Luis.Rosero and Maria ) Lora-Rosero, Defendants ) MOTION TO VACATE JUDGMENT OF DISMISSAL 1. Plaintiff prays to the Court to vacate the JUDGMENT OF DISMISSAL. 2. Plaintiff intends to file the Returns of Service he received from the Counsel (Mark B. Ryan) along with the NOTICE OF WITHDRAWAL OF APPEARANCE OF COUNSEL. 3. Plaintiff is Plaintiff in a related Land Court (Suchard Reddy Pingli v. FNMA). Case No. 12 MISC 460427.-Plaintiff has been in contact with FNMA Counsel Sincerely.and Respectfully Submitted, Suchand Reddy Pingli, Self Represented Litigant 189-925 De Maisonneuve West, Montreal, Quebec, Canada Postal Code: H3A 0A5 Phone: 514-844-1452; Cell: 514-347-7464 Email: spingli@certainty.com RT cn '-EX t) 6r 12 .CtX 1 t�iLENK Page,l:of 1 CERTIFICATE OF SERVICE. The undersigned hereby certifies that a true copy of the Motion to Vacate Judgment of Dismissal dated April 6, 2012 was this day served upon all parties to this action by mailing same, via first class mail postage prepaid, to all parties or their respective Attorneys of record. Suchand Reddy Pingli, Plaintiff (gain urIInwettltil of. Massac4uuetts ESSEX, SS. SUPERIOR COURT DEPARTMENT OF ` HE TRIAL COURT CIVIL ACTION NO.: 10-2490 Suchand 11. Piugli; PLAINTIFF �. Orsett/ res G, Orsett Properties LTD, Old National Title Insurance Company, Louis Rosero and Maria Lora- Roscro, DEFENDANT . WITHDRAWAL OF APPEARANCE OF COUNSEL PL.F:ASE ENTER my Withdrawal of Appearance as Attorney on behall'of Plaintil1'. Suchand R. Pin,li in connection with the above-entitled ac-tion. Dated: �— Z I Z Respectfully submitted. \Mark 13. Ryan - Attorney for Plaintill' Assented to: Suchand R..Pingli Plaintiff Dated: Citp of *alem, 41a!9!5arbu!5ett5 r T Public Propertp �Beparttnent Nuilbing Mepartment One Oalem Oreen (978) 745-9595 (ext. 360 Peter Strout Director of Public Property Inspector of Buildings Zoning Enforcement Officer July 15, 1999 Alfonso Barcamonte 7 Stone Drive Peabody, Ma. 01960 RE: Unsafe Structure—Notice to Make Safe Dear Mr. Barcamonte: On Wednesday, July 14, 1999, I conducted an inspection of your property located at 11 Mason Street, following a complaint from the tenants and in accordance with the Massachusetts State Building Code 780 CMR 121.1 and 121.2 (unsafe structures). The inspection conducted confirmed that the rear porches and stairs are in a state of considerable, disrepair, damaged by the elements, structural supports damaged and in danger of collapse. You are hereby ordered to immediately make the structure secure and shall employ sufficient labor speedily to make it safe and have the porches and stairs rebuilt. You have until 12:00 noon of the day following the receipt of this notice to make secure all exterior entrances and to make the structure secure and to apply for a building permit. Failure to comply with thie requirements of this order immediately will result in legal action being taken against you. Please contact this office immediately upon receipt of this letter. Sincerely, � � Kevin G. Goggin Assistant Building Inspector cc: Fire Prevention Health Department Housing Authority Councillor Hayes,Ward 5 - -- Enright Lead Inspection 10 St. Luke's Rd. #1 Allston, MA 02134-3101 781-316-6826 LETTER OF FULL INITIAL LEAD INSPECTION COMPLIANCE DATE: 1/6/11 Suchand Pingli 26 Burroughs St. Danvers,MA 01923 Dear Mr. Pingli This letter is to certify that I inspected your property located at 11 ih Mason St. , apartment no. 1 , and relevant common areas, in the City or Town of Salem , for dangerous levels of lead according to 105 CMR 460.730 of the Regulations for Lead Poisoning Prevention and Control, and determined that there were no violations of the Lead Law, Massachusetts General Laws, Chapter 111, section 197. The inspection was conducted on 1/5/11 . �I also certify that I observed no evidence that unauthorized deleading activities may have occurred in this unit or in its associated common areas. Please be advised that Massachusetts law requires that only certain residential surfaces be free of lead paint. Thus, this letter does not mean that your property contains no lead paint. The premises or dwelling unit and relevant common areas shall remain in compliance only as long as there continues to be no peeling, chipping,or flaking lead paint or other accessible materials and as long as coverings forming an effective barrier over such paint and materials remain in place. The law grants you a 30-day maintenance period to repair deteriorated lead paint or detached coverings over such paint, and to clean up, during which time this Letter remains valid. The initial inspection report indicates which surfaces, if any, contain a dangerous level of lead, as well as those surfaces, if any,that were covered upon initial inspection. Sincerely, John t Inspector VR-3652 DPH License Number Should you have any questions about this letter,call the Department of Public Health at I-800-532-9571. Enright Lead Inspection 10 St. Luke's Rd.#1 Allston, MA 02134-3101 781-316-6826 LETTER OF FULL INITIAL LEAD INSPECTION COMPLIANCE DATE: 1/6/11 Suchand Pinxli 26 Burroughs St. Danvers MA 01923 Dear Mr. Pingli This letter is to certify that I inspected your property located at 11 1/2Mason St. apartment no. 2 , and relevant common areas, in the City or Town of Salem , for dangerous levels of lead according to 105 CMR 460.730 of the Regulations for Lead Poisoning Prevention and Control, and determined that there were no violations of the Lead Law, Massachusetts General Laws, Chapter 111, section 197. The inspection was conducted on 115/11 . �I also certify that I observed no evidence that unauthorized deleading activities may have occurred in this unit or in its associated common areas. Please be advised that Massachusetts law requires that only certain residential surfaces be free of lead paint. Thus, this letter does not mean that your property contains no lead paint. The premises or dwelling unit and relevant common areas shall remain in compliance only as long as there continues to be no peeling, chipping, or flaking lead paint or other accessible materials and as long as coverings forming an effective barrier over such paint and materials remain in place. The law grants you a 30-day maintenance period to repair deteriorated lead paint or detached coverings over such paint, and to clean up, during which time this Letter remains valid. The initial inspection report indicates which surfaces, if any, contain a dangerous level of lead, as well as those surfaces, if any, that were covered upon initial inspection. Sincerel John ght, Inspector 1/R-3652 DPH License Number Should you have any questions about this letter,call the Department of Public Health at 1-800-532.9571. Enright Lead Inspection 10 St. Luke's Rd. #1 Allston, MA. 02134-3101 781-316-6826 LETTER OF FULL INITIAL LEAD INSPECTION COMPLIANCE Suchand Pingli 26 Burroughs St. Danvers,MA 01923 Dear Mr. Pingli This letter is to certify that I inspected your property located at 11 '% Mason St., Unit 3 , and relevant interior and exterior common areas, in the City/Town of Salem for dangerous levels of lead according to 105 CMR 460.730 of the Regulations for Lead Poisoning Prevention and Control,and determined that there were no violations of the Lead Law, Massachusetts General Laws,Chapter 111,section 197. The inspection was conducted on !Q/ 28 /13. ® I also certify that I observed no evidence or signs that unauthorized deleading activities may have occurred in this unit or in its associated common areas. Please be advised that Massachusetts law requires that only certain residential surfaces be free of lead paint. Thus, this letter does not mean that your property contains no lead paint. The residential premises or dwelling unit and relevant common areas shall remain in compliance with the requirements of the Lead Laws referenced above only as long as there continues to be no peeling, chipping or flaking lead paint or other accessible leaded material as long as coverings and/or encapsulants forming an effective barrier over such naint or other leaded materials remain in Place and as Ion as surfaces reversed to correct lead hazards remain reversed and securely in place The law grants you a 30-day maintenance period to repair deteriorated lead paint or detached coverings over such paint, and to clean up, during which time this Letter remains valid. The initial inspection report indicates which surfaces, if any, contain a dangerous level of lead, as well as those surfaces, if any,that were covered upon initial inspection. The CLPPP authorized serial number for this Letter of Full Initial Lead Inspection Compliance is 63753652102913-3. This number is tracked and unique to this address and unit. DO NOT LOSE THESE DOCUMENTS. If the documents are lost you will be required to have additional private inspector services that may cost you significant amounts of money. This Letter of Full Initial Lead Inspection Compliance is only for the address and unit number noted above. If you change the street address, unit/apartment number or any other identifying information pertaining to the residential premises referred to in this Letter of Full Initial Lead Inspection Compliance, this Compliance Letter may be considered null and void by the Department of Public Health and/or a municipal health office. Do not alter this document in any way. Altering this document is fraudulent and may endanger the health and safety of a child which may result in significant legal consequences. In addition to any potential civil liability which may arise as the result of the alteration of this Letter of Compliance, the Massachusetts Department of Public Health's Childhood Lead Poisoning Prevention program may seek criminal prosecution of any person who alters this document after it is originally issued. Sincerely, John M3652 10/ 29 /13 Inspector License# Daze Questions?Call the Department of Public Health at 1-800-532.9571. DO NOT LOSE THESE DOCUMENTS LOFIC-m01112 Pave l of I P 070 324 778 RECEIPT FOR CERTIFIED MAIL NO INSURANCE COVERAGE PROVIDED NOT FOR INTERNATIONAL MAIL (See Reverse) Sent to % I � L)CO�50 N_?inoNiE Slreel antl N a P.OStale and ZIP Code . Postage 5 Certified Fee Special Delivery Fee Restricted Delivery Fee Return Receipt showing to whom and Date Delivered N q Return Receipt showing to whom, Date.and Address of Delivery w j TOTAL Postage and Fees S Postmark or Date E `o LL N a STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES.(sea frond 1. 11 you want this receipt postmarked,stick the gummed stub to the rigm or the return address leaving the receipt attached and present the article at a post office service window or hand it to your rural carrier. (no extra charge) 2. If you de not want this receipt postmarked,stick the gummed stub to the right of the return address of the article,dale,detach and retain the receipt,and mail the article. 3. II you want a return receipt,write the certified mail number and your name and address on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space per- mits.Otherwise, affix to back of article. Endorse front of article RETURN RECEIPT REQUESTED adjacent to the number. 4. If you want delivery restricted to the addressee,or to an authorized agent of the addressee,endorse RESTRICTED DELIVERY on the front of the article. 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt. II return receipt is requested,check the applicable blacks in item 1 of Form 3811, 6. Save this receipt and present it if you make inquiry. ^U.S.G.P.0.1988-217-132 Cftp of *alem, jT1a5!6arbU2;ett2 / s�'401- Public Propertp Department Wtulbing -Department One$alem green _ (978) 745-9595 text. 380 Peter Strout a S Lii c LF Director of Public Property — / 3 e"P rJ t y Inspector of Buildings (\ Zoning Enforcement Officer July 15, 1999 Alfonso Barcamonte 7 Stone Drive Peabody, Ma. 01960 RE: Unsafe Structure—Notice to Make Safe Dear Mr. Barcamonte: On Wednesday, July 14, 1999, 1 conducted an inspection of your property located at 11 Mason Street, following a complaint from the tenants and in accordance with the Massachusetts State Building Code 780 CMR 121.1 and 121.2 (unsafe structures). The inspection conducted confirmed that the rear porches and stairs are in a state of considerable, disrepair, damaged by the elements, structural supports damaged and in danger of collapse. You are hereby ordered to immediately make the structure secure and shall employ sufficient labor speedily to make it safe and have the porches and stairs rebuilt. You have until 12:00 noon of the day following the receipt of this notice to make secure all exterior entrances and to make the structure secure and to apply for a building permit. Failure to comply with thie requirements of this order immediately will result in legal action being taken against you. Please contact this office immediately upon receipt of this letter. Sincerely, Kevin G. Goggin Assistant Building Inspector cc: Fire Prevention Health Department Housing Authority Councillor Hayes, Ward 5 -- cq , t Plans must be filed and approved by the Inspector before a permit will be granted. No. 'i` —f— City of Salem Ward_y� IS PROPERTY LOCATED IN THE / HISTORIC DISTRICT? Yes_N0 .......... s IF SIDING, HAS ELECTRICAL �� Home Phone #. 3a- 0 78 PERMIT BEEN OBTAINED? Yes No APPLICATION Bus. Phone # 53 a -off 7 PERMIT TO ROO , REROOF R INSTALL SIDING Salem,Mass., TO THE INSPECTOR OF BUILDINGS: The undersigned herebv applies for a permit to build according to the following specifications: Owner's name and address gZ�Oit/t0 _ �AX!C-4 /d/V G�� Architect's name Mechanic's name and address _ tt� _ Pt.Cn... Location of building,No �� _ _ CAI S r What is the purpose of building? _ Material of building? Asbestos? If a dwelling,for how many families^. __ Will the building conform to the re uirements of the law? Estimated cost tractors Lic. No Signature of applicant S. REMARKS 51GNED UND R THE - - PENALTY OF PERJURY. No. �� / Ward APPLICATION FOR PERMIT TO ROOF REROOF OR INSTALL SIDING f Location I MIA� AIR 04, t 1 0 PERMIT'u/`� GRANTED 7 19 A rovWk I a V�&Idlfnspeclnspecl r� COMMONWEALTH OF MASSACHUSETTS 6 JEFAR:'hiEi�T OF INDUSTRIAL ACCIDENTS ^�'' 600 WASHINGTON STREET . anope' BOSTON. MASSACHUSETTS 02111 :aures ss.one• WORKERS' COMPENSATION INSURANCE AFFIDAVIT (I icensect ocrm[nea with a principal place of business/residence ar: D �3 (City/StameZip do hereby terrify, under the pains and penalties of perjury. that: ] I am an empiover providing the following workers compensation coverage for my employees working on this lob. Insurance Company Policy Number ( j 1 am a sole proprietor and have no one working for me. I am a sole proprietor. general contractor or homeowner (circle one) and have hired the contactors listed below who have the following workers' compensation insurance policies: Name or Contactor Insurance Company/Polies Number lame or ContractorInsurance CompanyiPolicv Number Name of Contractor Insumnee CompanyiPolicv Number Q I am a homeowner performing all the work myself. NOTE: Please be aware that while homeowner"who empioy persons to do maiatenwm-construction or repair Werk on ■ ra the grounds Appurtenant thereto are not dweilinqa_ of not more than three units in which the bomeowner ciao rendes or oaerally conndered to be empiovers under the Worker"' Compensation Aa(GL C. 152.sect. 1(5)).appiieatioo by a homeowner forr a livase or permit msy evtdeaee the iel l sums of an empiover under the Workers Compensation ACL i understana that a copy of this statement will be forwaraed to me Department of Industriai Acddena' Office of insurano:for coverage �cni¢auon and that uiiure to secure coverage ss repmred under Section 25A of MGL 152 cast iead to me imvasition of urn road penaltia contsun¢of a lure of up to 51500.00 ana'or imprisonment of iso to one year and civii Densities m me form of a stop Work Order and a rine of S 100.00 a days against me. 19 �-- Siened this �` Shy of — Licensees Permince licntsori Permiaor 04/07/1994 09 52 508-741-2009 SOUCY IMS AGCY I1,10 PAGE 01 _ S s TO/M7E7R- #n xP7'/J O ' ISSUE DATEIMMODm �9. �� yy6�A® CS S 6 07 94) i } PRODUCER THIS CERTiFICATFIS ISSUED AS A MATTER OF INFORMATION ONLY AND SOUCY INSURANCE AGENCY CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE 201 WASHINGTON STREET t POLICIES BELOW, P.O. BOX 4484 COMPANIES AFFORDING COVERAGE SALEM, MASSACHUSETTS t 01970 COMPANY A LETTEA .AETNA L & C COMPANY 8 INboa[D _� LETTER AETNA L & C ARTHUR S . BETTENCOURT 1 COMPAri" `r— MANUEL ESPINOLP. i LETTER 20 ESQUIRE DRIVE COMPANY PEABODY, M A ;ETT`P L-TTCR COVERAGES THIS "S TO CERTIFY THAT -W.. Pp_r':ES Y INSUPANCE USIED BELOW l*l D'eEN ISS= �O TI1E INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTN!THERL:OL TAN0IN•J ANY ARPMCNT :ER44 Oft MNDrT MOF ANY C4XTTRAC. OR OTHER DOCUMENT WfTH RESPECT TO WHICH THIS" CERTIFICATE FRAY RF. ISSUED OR !AA. P4RTAuX Tta WAWA-F AF;07l D' 9Y THE POLICIES DEtCRIBED HSF42IN IS SUWECT TO ALL THE TERMS• � EXCLUSIONS AND COND^TG',.t C� SUC• Pry V'ISt JFMTE EH^'JWN MAY HAVE E£FN RBUUCEO BY PAID CLAIMS. " 1RI TYPE OFiNYURAAGf POLICYNUMFEIII Pa L1Ci X:API!"JV�POLICY EXPIRATION' LIMITS OATliN MyJCII^ CATt�W;0/00", , GENERAL L4lfl.ITV .... �•— -GENERAL AGGREGATE j t 600, 00( Ar X COMMAP{pt GCM1ERA. ^'.rN 1J 7 G' I C /' C ��' F?'i.F:06�n^d. O 26/93 OS/2�/94.PFRODUcca-coA,P(oPAGG.,b 600, 00 CIAiMbY.A7[r; 11 ?egsCNue-A-D�V—INUR—µ�'s 300, 00 I ',OWNER&ACON'4ACICRJFPO' � EAONOCCURRENCE i 300 , 00( FIREOAMAGE(.AnY wt.IUSI E 300,10 eAPEs 5 O 0 AUTCMOSIIE[IASitlh - ' --, t t OON 01NED eINOLE b I fANV AJTO 1! LIMIT ITI_—'jlr ALi OWM1ED AUIC9 I �--^ f 'SODrLY1NJJAY b SCmlOuk%L A•,TOOlPn pwtoItX -r NIP FO AVTOS _ ^• OW�EDIu'D7 4 SOOTY NJORY s NON. (TC•ntgEMl) GARAGE I'AS.. '� f - - �`�^._ _'•4 X �PROPEATT DA IAAG'c' Ib IEYC-SU LIASILITY EACROCCURRENCE •b UMORELLAVOqM I A4r`R^E_GATE F DTMER THAs VGP S:...1.�JI:'d I WORK IR S CON PENIATN4 STATUTORYUMITO .4 AI AND C23y3a1348CFJy 101/ 11/931 }0111/94EACHACboyir is 10_0, 00 F.MPLOY2pe Lre DIVI'r ; O:q EAHE•POLIQY_L,M)T Is SOO OO DYSEASF'.CACN 6AHPLOYEEl310O OO 'OTnER OESCRIYPOH OF O?EAAT:ON!(LC('.\i.�NS,rbN.6L!!;lNC,AI dbY� • ' f CERTIFICATE HOLDER N F1,iATION - 1 • . .. SHOUt,O ANY OF THE ABOVE' DESCRIBED POUCIES BE CANCELLED EEFORE THE CITY OF SALEM E.IIT!F.AIKAN GATE THEREOF, -. HF ISSUINO COMPANY WILL ENDEAVOR TO BUILDING INSPECTOR MAP. 10 GAYS KR S�I��p((��Sb�E ONE SALEM GR EN LEFT, BUT FAl1.VRE TD . L S ^ I F 1 O LIGAIION OP SALEM, MA 1IA61'JTY OF ANY IGND UPON THE P ANY,ITS AOEPTTS 0 EPRESENTaTNE3. _ 01970 AUTNORIEEOAE NfATIYE PAUL K SOUCY 110d A6°7AD CO PORAYILVJ:t9l6:. `Plans must be tiled and approved by the Inspector before a permit will be granted. No. a9g -93 City of Salem Ward IS PROPERTY LOCATED IN THE ;+ HISTORIC DISTRICT? Yes No(,/ i IF SIDING, HAS ELECTRICAL PERMIT BEEN OBTAINED? Yes -/No Home Phone # ;3 7 Y 2- z 3 APPLICATION Bus. Phone # FOR PERMIT TO ROOF, REROOF O INSTALL SIDING Salem,Mass., TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit to build according to the following specificatiorys:, ^ /Z Owner's name and address _ O _ 3�.Aq a fit/GfG�� Architect's name Mechanic's name and address '/ o KS 4wd L1 7Q� Location of building,No. u/10 -r 4— What is the purpose of building? % ` _ Material of building? —UZO' O Asbestos? / If a dwelling,for how many families^ Will the building conform to the requirements of the law? Estimated cost SOU. p-a Co tors Lic.No. _ rL Signature of applicant REMARKS SIGNED UNDER THE PENALTY OF PERJURY. No(:2 Ward APPLICATION FOR PERMIT TO ROOF REROOF OR INSTALL SIDING Location / l 0.50 1A PERMIT GRANTED 19 Approv / O c B 7ding lnspe cr ,J% &Yptd'� /l-�� 5 City of Salem, Mass. g ELECTRICAL DEPARTMENT 44 Lafayette Street y4ap� PAUL M. TUTTLE ,CITY ELECTRICIAN To: INSPECTO IL NGS Salem, Mss. ------ ----------- Electrical Contractor (Signature of Applicant) �Gar.c 3 -�°........__------- ----_-------- --------- scocC ST has signified their intention of performing the required electrical work, viz: removing and later replacing all electrical wires, fixtures, receptacles, etc., own joutside of building located at: J!..�....✓- ------------------------------- --------- ----------Street in conjunction with a wall siding installation to be made by: Cy. .... ................... . ...._- ----Siding Contractor STv�/ens S-i �!yr ............................................................... ISSUED Bn� l This is a requirement, preliminary to the issuance of a permit for the sidewall installation by the Inspector of Buildings. . ORIGINAL-SID INSTALLEN PINK COPY-BLDG. IN INSP. YELLOW COPY-ELEC. FILE ` CITY OF SALEM 3UILDING DEPARTMENT . HOMEOWNER LICENSE EXEMPTION Please Print DATE Z�26/ 3 JOB LOCATION //%— ezw,;/ Number Street address Section Town C aB� "HOMEOWNERLFC^ISD 1-?19x(nIttOG1t7-6 53/- 033 o Name Home phone Work pnone PRESENT MAILING ADDRESS �/ S TO"'VE CIty/ lalwn hate LID Code -lie current exemption of ",homeowners" has extended to include owner-occupied dwellinas of six units or less ana to allow such homeowners to engage an in- dividual for hire who does not possess a license, provided that the owner acts as supervisor. ( State Building Code Section 109. 1 . 1 ) 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 all such work performed under the building permit. ( Section 109. 1 . 1 ) The unaersioned "homeowner' .assumes responsibility for comDiiance :rith the State wilding code and other applicable codes . by- iaws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the City of Salem Building Department minimum inspection procedures and requirements and that he/she will comply with said 4cedures a requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OF ICIAL ,VOTE: Three family dwellings 35. 000 cubic feet, or larger, . ill be required to comply with State Building Code Section 127.0, Construction Control . HOME OWNER' S EXEMPTION The Code states that: "Any Home Owner performing work for which a building permit is required shall be exempt from the provisions of this section (Section 109. 1 . 1 - Licensing of Construction Supervisors ) ; provided that is a Home Owner engages a person(s ) for hire to do such work, that such 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 proceed against the unlicensed person as it would with licensed Supervisor. The Home Owner actino as supervisor is ultimately responsible. -o ensure that the Home Owner i- fully aware of his/her responsibilities. many communities reouire. as part of the permit application, that the Home Owner �:ertifv that he/she understands the responsibilities of a supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. COMMONWEALTH OF MASSACHUSETTS cE DEFAR MF2Tr OF INDUSTRIAL ACCIDENTS • ,,� 600 WASHINGTON STREET ;aures� Gamooen BOSTON, MASSACHUSETTS 02111 , . T ss ore WORKERS' COMPENSATION,INSURANCE AFFIDAVIT rdGFeIVSO e�AM0AlTF - (I icenseci permnee) with a principal place of business/residence at: ( iry/StateiZip) 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. Insurance Company Policy Number [ ] I am a sole proprietor and have no one working for me. • [ ] I am a sole proprietor, general contractor rhomeowner ircle one) and have hired the contractors listed below who have the following workers' compensation insurance policies: �l� 4L,0 �dNST Name of Contractor Insurance Company/Policy Number Name of Contractor Insurance Company/Policy Number Name of Contractor Insurance Company/Policy Number ' 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 are not generally considered to be employers under the Workers' Compenution Act(GL C. 152.sect. 1(5)), application by a homeowner for a license or permit may evidence the legal status of an employer under the Workers' Compensation Act. 1 understand that a copy of this statement will be forwarded to the Department of Industrial Accidents' Office of Insurance for coverage Verification and that failure 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 $1500.00 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 me. Signed this �/� 4 day of 19 9 3 LicenseeiPermirtec Licensor/Permirtor April 2901982 A F F A D A V I T To: The building Inspector City of Salem City Hall Salem, Massachusetts e I, Helen Santos do hereby certify that my property located at 113§ Mason Street, Salem, Massachusetts,-was rented to and occupied by Mr. & Mrs. Ralph.Jeremy until June 1980. Helen Santos Hillside Avenue Middleton, Massachusetts 9, / 9 4.4 JAMES MANITAKOS,Nc!!4 'Public My Commission Eitpires. Feb.5, 1983 5 - - - --Sa ,v, -- — -- Ov- X-`-� A.------------ �'�:------- - ---- � 1 T 4, - - - ------ ---