115 MASON STREET - BUILDING INSPECTION 115 MASON STREET
a
MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston,Massachusetts 02108-1904
(617)723.3800 Ma Only(800)392-6108.FAX(8001851.8424
4/1/2015
Form of Notice of Casualty Loss to Building
Under Mass.Gen. Laws,Ch.139,Sec.313
SALEM BUILDING COMMISSIONER
SALEM CITY HALL
SALEM MA 01970
Re: Insured: KATHY ANN PAN EK
Property Address: 115 MASON ST,SALEM. MA 01970
Policy Number: 1234958
Type Loss: Ice Dams
Date of Loss: 02/13/2015
Claim Number: 336376
Claim has been made involving loss,damage or destruction of the above captioned property,which may either
exceed$1000.00 or cause Massachusetts General Laws,Chanter 143.section 6 to be applicable. If any
notice under Massachusetts General Laws,Chapter 139,Section 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.
MPIUA Claims Division
CMA00021
MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
2 CENTER PLAZA
BOSTON, MASSACHUSETTS 02108-1904
800-392-6108 617-723-3800
DATE 05/18/98
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: MARIANO C. CARROCA &
ANNA J. CARROCA
Property Address : 115 MASON STREET
SALEM MA 01970
Policy Number: 20-2-315333-08
Type of Loss : FIRE Date of Loss : 05/13/98
Claim Number: 20-2-0166025
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, Chapter 143 , Section 6 to be applicable .
I any notice under Massac usetts General Laws Cion oia ter 139, Section 3B
is appropriate, please direct it to the attent 'lie writer an
include a reference to the captioned insured, location, policy number,
date of loss and claim or file number.
MPIUA Claims Division
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MUA-CL-21
• - �coeo� ��r 0 d
CITY OF SALEM HEALTH DEPARTMENT
BOARD OF HEALTH
Salem, Massachusetts 01970
ROBERT E. BLENKHORN 9 NORTH STREET
HEALTH AGENT
(617) 741-1800
March 15, 1989 c)
O C7 r
Mario Carroca
115 Mason Street Apt. #1
--
Salem, MA 01970 rn<
�m r a
C3_
Dear Sir/Dear Madam: n
y �
In accordance with Chapter 111, Sections 127A and 127B, of the Massacti'usettav
General Laws, 105 CMR 400.000: State Sanitary Code, Chapter 1: General
Administrative Procedures and 105 CMR 410.000: State Sanitary Code, Chapter
II: Minimum Standards of Fitness for Human Habitation, an inspection was
made of your property at 115 Mason Street Apt. #2 Salem, Massachusetts,
occupied by Michael Noll This inspection was
conducted by V. Moustakis/Tenant Salem Health Department, on
3/14/89 @ 2:30 p.m .
Based upon said inspection, you are hereby ordered to take the following
action within 24 hours of receipt of this order:
No hot water - owner must provide facilities in good working order
capable of providing hot water of temperatures no lower than 110°F
nor more than 130°F.
Repair Electrical Outlet unit hanging outside of wall in Kitchen.
Repair electrical outlet unit (in use) hanging on outside of wall
in Study in accordance with mandates of Electrical Code.
Repair exposed wires in ceiling light fixture in Front Sitting Room
according to Electrical Code.
Only one electrical outlet - each room with exception of Kitchen must
have either (2) separate, working electrical wall outlets or overhead
light and one wall outlet - in working order at all times.
Repair electrical outlet unit hanging from wall in Sun Room.
The second means of egress (Back Hallway) leads down stairway di— r+ ect�ly"�
Fthru owner's apartment,._-This second means of egress must=go-d-irectly.
�to outside therefore-is not a legal-means-of-egress---Notify-Building
Inspector immediafely;:_
Page 1
SALEM HEALTH DEPARTMENT March 15, 1989 Page 2 of 4
9 North Street
Salem, MA 01970 Tenant(s) Michael Noll
Property in Salem at
To: Mario Carroca 115 Mason St. , Apt. 2
115 Mason Street Apt 111
Salem, MA 01970
VIOLATIONS (continued)
Based upon said inspection, you are hereby ordered to take the following
action within 24 hours of receipt of this order.
There are no smoke detectors in this apartment as mandated by Fire Code
creating serious potential fire hazards especially where there is no
2nd means of egress. Contact Fire Department immediately for info regarding
quantity and type and location of these detectors that must be installed
immediately.
Install smoke/fire detectors in both Front and Back Hallways which is mandated.
Install smoke detector at bottom of Cellar stairway as mandated.
Tenant complaint of leaking oil tank at time of inspection, material
resembling speedy-dri small pellets was on floor around burner and
tank and in some areas the floor moisture had seeped through. Am requesting
that Fire Department investigate possible oil spill owner must contact
this department as well. Department of Environmental Quality Engineering
must be notified and if oil must be removed by by licensed person and
disposed of at approved site.
Employ the services of recognized professional oil service firm to first
investigate and evaluate this matter and have them forward copy of their
findings/reports to this department immediately
Owner must provide heating system in safe good operating condition at
all times.
Rubbish out Tuesday for Municipal pickup which is Thursday. Rubbish cannot
be put out earlier than 6:00 p.m. the night before collection day nor later than
7:00 a.m. day of collection - Owner must make separate arrangements to have
appliance picked up municipality no longer picks up appliances.
Based upon said inspection, you are herby ordered to take the following
action within 3 days of receipt of this order:
Secure light cover Study (Front)
Replace ceiling light protective cover in Study.
Replace ceiling fixture protective cover in Daughter's Room.
Ikeplace^missing door_which_sep_arats_apar__tment_from�Fron__ t� Hallway:
`J
®4br4 SALEM HEALTH DEPARTMENT March 15, 1989 Page 3 of 4
9 North Street
� Salem, MA 01970 Tenant(s) Michael Noll
C
Property in Salem at
115 Mason Street Ani
To: Mario Carioca
115 Mason Street App 111
Salem, MA 01970
VIOLATIONS (continued)
Based upon said inspection, you are hereby ordered to take the following
action within 5 days of receipt of this order:
Replace missing locks on Kitchen windows.
Repair Kitchen window so it stays up freely at any level.
Repair Bathroom window so it will line up when locked and replace lock.
Bugs noted on wall and on floor - Provide services of licensed exterminator
with a copy of service invoice to this department.
Replace missing sashcords in Living Room windows so they stay open freely.
Repair/replace 3 operating locks and sashcords on on Study windows.
Install locks on Front Sitting Room windows.
Install locks on Daughter's Room windows.
Repair windows in Sun Room so they fit properly.
Install locks on Sun Room windows.
' Three (3) existing doors from apartment leading to 2nd floor landing of
front hallway minus operating locks that must be provided.
Clean and organize miscellaneous items and7,debris-creating_ser-ious-,fire_and.
safety hazards , n-cellar.
Based upon said inspection, you are hereby ordered to take the following
action within 10 days of receipt of this order:
Repair inoperable burner on the Kitchen stove.
Repair and scrape peeling and flaking and buckling Bathroom ceiling.
Replace Bathroom flooring with one piece non-absorbant, non-corrosive,
waterproof material.
Scrape and patch flaking ceiling in Living Room.
Replace broken window pane in Daughter's Room.
Investigae and repair Small Storage Room ceiling/walls - evidence of a leak.
SALEM HEALTH OEFARTMENT March 15, 1989 Page 4 of 4
9 North Street
Salem, MA 01970 Tenant(s) Michael Noll
Property in Salem at
To: Mario Carroca 115 Mason St. , Apt. #2
115 Mason Street Apt. 111 _
Salem, MA 01970
Based upon said inspection, you are hereby ordered to take the following
action within 15 days of receipt of this order:
Patch and/or replace Sun Room Linoleum.
Based upon said inspection, you are hereby ordered to take the following
action within 20 days of receipt of this order:
Replace Kitchen wood flooring with a non-absorbant, water proof, non-corrosive
material.
�' -
NOTE: Because-of=these-numerous-and-serious-violations;unlimmediate
mmediate
efforts are made by owner to .immediately begin correction, a compl�nt
(will be sought in Salem District Court shortly_. L-�-
�y
ONE OR MORE OF THE ABOVE VIOLATIONS MAY ENDANGER OR MATERIALLY IMPAIR THE HEALTH,
SAFETY AND WELL-BEING OF THE OCCUPANTS.
Failure on your part to comply within the specified time will result in a complaint
being sought against you in Salem District Court.
Should you be aggrieved by this Order, you have the right to request a hearing before
the Board of Health. A request for said hearing must be received in writing in the
office of the Board of Health within seven (7) days of receipt-of this Order. At
said hearing, you will be given an 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.
Please be advised that the conditions noted may enable the occupant(s) to use one
or more of the statutory remedies available to them as outlined in the enclosed
inspection report form.
FOR TTHHH�EE BOARD QOf HEALTH REPLY TO
ROBERT E. BLENKHORN, C.H.O. V. MOUSTAKIS,
Health Agent SANITARIAN
Certified Mail 0 P-006-729-439
enc. Inspection Report
cc: Tenant2L x Bldg. Inspector = 1 Electrical Spector Plum6189 6 Gas Inspector
x Fire Dept. _ City Counci for
Este es on documento legal importante• Puede que afecte sus derechor..
'w
SENDER: Complete item, t, and 3.
£ Add your addrav in the "RETURN TO" space on
B � mere.
Y
m 1. The following service is requested (check one).
Show to whom and date delivered........-... 15('
® Show to whom, date,&address of delivery.. 350
iO � RESTRICTED DELIVERY.
a Show to whom and date delivered............. 651e
RESTRICTED DELIVERY.
Show to whom,date,andddress of delivery 850
x 2. ARTICLE ADDRESSED TO:
Mr. & Mrs. Mariano Corroca
i 115 Mason Street
Pit Salem, Mass. 01970
m 3. ARTICLE DESCRIPTION:
REGISTERED NO. CERTIFIED NO. INSURED NO.
Ir945282
y (Always obtaln signature at addrassaa or agent)
zI have received the article described above.
bn SIGNATURE ❑ Addressee ❑ Authorized agent
4 �
c 1.
/DATE OF DELIVERY ` Po MARK
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> J n
7 5. ADDRESS (Complete only it nrluasted) 4.�sy�^ e
6. UNABLE TO DELIVER BECAUSE ...CLERK'S
O INITIALS
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UNITED STATES POSTAL SERVICE
OFFICIAL BUSINESS
SENDER INSTRUCTIONS PENALTY FOR PRIVATE
Print your name,address,and ZIP Coda in the space helm. USE TO AVOID PAYMENT
OF POSTAGE, $300
Complete items 1, 2, and 3 on the reverse.
• Moisten gummed ends and attach to fmat of article Q&MAIL
if space permits. Otherwise affix to back of article.
• Endorse article "Return Receipt Requested" adja.
cent to number.
RETURN
TO
John B. Powers, Insp. of Building:
(Name of Bender)
'u
City Hall Annex, One Salcem Green
(Street or P.O. Box.)
k
Salem, Mass. 01970
(City, State, and ZIP Code)
•r
October 13, 1977
Mr. and Mrs. Mariann Carroca
115 Mason Street '
Salem, Massachusetts 01970
REt 115 Mason Street, Salem
Dear Mr, and Mrs. Carroca:
- Our inspection at the referenced address on this date shows that'-"",
you have four (4) kitchens and at least three (3) bathrooms on the
premises. Your home is located in an R-2 Zone "Residential Two (2)
Family" and as such you may have only two (2) dwelling units in the
building. In order for you to have more than the permitted units it
will be necessary for you to appear before the Board of Appeals
requesting a special permit for more than two (2) familifs.
However, this inspection reveals that the egress from the second
and third floors is not in comformance with the :Massachusetts State
Building Code (Section 2100. 10). This means that those floors
cannot be occupied until sflch time as the code requirements can be
met. It is necessary therefore that the third floor apartment be
immediately vacated. Failure to do so will be considered a violation
of the State Building Code (Section 122.0 with its attendant penalties.
If you have any questions regarding these matters please contact this
Office.
Very truly yours,
JOHN B. POWERS
Superintendent of Public Property,
Inspector of Buildings
CC. Joseph Lubas, Health Department
JBP/mlr
Certified Mail #945282
October 12, 1977
Mr. .Joseph Lubas
Health Department
Dr. Robert Shaughnessy Hospital
Off Jefferson Avenue
Salem, Massachusetts 01970
Dear Joe,
This is to advise you that 115 Mason Street is located in an R-2
Zone and that two (2) family residences are a permitted use.
All apartments are required to have two (2) legal means of egress.
Very truly yours,
DANIEL F. MANSUR
Assietant Building Inspector
DFM/mlr
_ CCvs�-o
BUILDING DEPT
DR. ISRAEL KAkP AN-PUB IC HEALTH CENTER
OCT Z8 2 42 PH 177 j
BOARD OF�HEALTH; �1
RECEIVED a� Off'JeffecsoLAvenue
CITY OF SALEM,MASS. Salem;;Massachusetts 019,70 _
ri,—, yp yr WALTER F. SZCZERBINSKI,R.S.
ISRAEL.KAPLAN,M.D.
JOSEPH R.RICHARD _ - - HEALTH AGENT
J.ROBERT SHAUGHNESSY,M.D. - - ACTING (617)745-9000
ROBERT BLENKHORN
M.MARCIA COUNTIE,R.N. - - -
MILDRED C.MOULTON,R.N. -
EFFIE MAC DONALD - - -
Date October 26, 1977
Mariano C. and Ana J. Carroca
115 Mason Street
Salem, Massachusetts 01970
Dear Sir/Madam:
Levesque Apartment
During an inspection of your property .at 115 Mason.St., 3rd .floor, ,
in Salem, Massachusetts, on October 13, 1977 ; at 8:45 a.m. ,
the following violations have been noted:
The Board of Health has determined that the third floor apartment at 115 Mason
Street occupied by the Levesque family is unfit for human habitation and is a danger
to the life and/or health of the occupants and ORDERS that the apartment be condemned
and vacated within 30 days from receipt of this.notice for the following reasons:
1. Failure to provide sufficient number of acceptable
exits. Two are required.
2. Failure to provide heating facilities capable
of heating dwelling unit to minimum temperature
Enclosed is a copy of heating regulations
FOR THE BOARD OF HEALTH , Reply to
WALTER F. SZdERBINSKI,R.S. JOSEPH LUBAS
Acting Health Agent Sanitarian
'WFS/g
encls. Regulations 116 and 1112
cc: Luso American Credit Union, 21 Shamrock St. ,Peabody
Mr. and Mrs. Levesque, 115 Mason St. , Salem, 3rd Floor
Building Inspector
Certified Mail #
Return Receipt Requested
iii �, l
DR. ISRAEL KAPLAN PI,BL-IC HEALTH CENTER
,BOARD OF HEALTH
�� Off Tefferson.Qvenue Jsy
Salem,Massachusetts 019.70
ISRAEL.HM.D.
JOHN J. TOOMEY, D.P.M.
JOSEPH R..RICHARD ,HEALTH AGENT -
J.ROBERT SHAUGHNESSY,M.D. - October 26,1977 (617)745-9008
ROBERT BLENKHORN
M.MARCIA COUNTIE,R.N.
MILDRED C.MOULTON,R.N. -
EFFIE MAC DONALD
Luso American Credit Union
21 Shamrock Street
Peabody, Massachusetts 01960
Gentlemen;
As you are the mortagagee on property at 115 Mason Street, Salem, Massachusetts,
we are hereby notifying you that the third floor apartment at that address,
presently occupied by the Levesque family has been condemned by this department
and must be vacated within 30 days.
Enclosed is a copy of the letter sent to Mariano C. and Ana J. Carroca listing
the violations.
Very truly yours,
FOR THE BOARD OF HEALTH /
WALTER F. SZC INSKI,R.S. I
Acting Health Agent
WFS/g
Encl.
422244
Certified Mail It
Return Receipt requested.
COX
BUILDING DEPT
d
�•�, . Ne 29 9 37 AM '89
CITY OF SALEM HEALTH DEPARTMENT RECEIVED
BOARD OF HEALTH CITY OF SALEM,MASS.
Salem, Massachusetts 01970
ROBERT E. BLENKHORN 9 NORTH STREET
HEALTH AGENT
(617) 741-1800 March 28, 1989
Mario Carroca
115 Mason Street #1
Salem, MA 01970
Dear Sir/Dear Madam:
In accordance with Chapter 111, Sections 127A and 127B, of the Massachusetts
General Laws, 105 CMR 400.000: State Sanitary Code, Chapter 1:, General
Administrative Procedures and 105 CMR 410.000: .S`tate, Sanitary 'Code, Chapter
II: Minimum Standards of Fitness for Human Habitation, an inspection was
made of your property,a[115 Mason St. . Ant. 2— Salem, Massachusetts,
occupied by Michael Noll = This inspection was
conducted by V. Moustakis/Tenant Salem Health Department, on
3/23/89 @ 2:30 p.m
Based upon said reinspection, you are hereby ordered to take the following
action within 24 hours of receipt of this order:
Tenant complaint he pays for electricity used by owner. Owner shall pay
and provide electricity and gas used in each dwelling.unless provided in
rental agreement. Licensed electrician must be employed to investigate.
Stove out at)sidewalk creating Health and Safety hazard - City does
not pickup appliances - owner responsibility to remove and dispose of.
NOTE: By copy of .this report we request the assistance of Building Inspector;
Fire Prevention and Electrical Inspector who have already received
copies of 3/15/89 report.
Page 1
SALEM HEALTH DEPARTMENT March 28, 1989 Page 2 of 2
9 North Street
Salem, MA 01970 Tenant(s) Michael Noll
Property in Salem at
To: Mario Carroca 115 Mason Street 112
115 Mason Street 31
Salem MA 01970
ONE OR MORE.-OF THE ABOVE VIOLATIONS MAY ENDANGER OR MATERIALLY IMPAIR THE HEALTH,
SAFETY AND WELL-BEING OF THE OCCUPANTS.
Failure on-your part to comply within the specified time will result in a complaint
being sought against you in Salem District Court.
Should you be aggrieved 'by this Order, you have the right to request a hearing before
the Board of Health'. A request for said hearing must be received in writing in the
office of the Board,.of Health within seven (7) days of receipt of this Order. At
said hearing, you will be given an 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.
Please be advised that the conditions noted may enable the occupant(s) to use one
or more of the statutory remedies available to them as outlined in the enclosed
inspection report form.
FOR THE BOARD OF HEALTH reply to
ROBERT E. BLENKHORN, C.H.O. V. MOUSTAKIS,
Health Agent SANITARIAN
Certified Nail 9 P-006-729-460
enc. Inspection Report
cc: Tenant A x Bldg. Inspector B Electrical �t}spector Plum6*99 6 Gas Inspector
_X Fire Dept. _ City Councillor
Late es un documento legal importnnte• Puede que afecte sue derechos.
} ,SALEM HEALTH DEPARTMENT Page-1 of�_
4 9 North Street
r
Salem, MA 01970
STATE SANITARY CODE, CHAPTER II: 105 CMR 410.000
"MIINIMUM STANDARDS 'OF FITNESS FOR HUMAN HABITATION"
,// �y
OCCUPANT: �/ r 6 P Ala LL PHONE: /yS 7 2
ADDRESS: lelo,YeAl �f APT.�_FLOOR _
OWNER: `O/P/d l /.P .coca- ADDRESS:
INSPECTION DATE: 3- j�TIME: . O /3n
CONDUCTED BY: ACCOMPANIED BY: TFnn/�l
ANTICIPATED REINSPECTION DATE:
SPECIFIED REG. O
TIME1 .... VIOLATION
LL
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Ivr
Ow
07ZL
One or more of the above violations may endanger or materially
impair the health, safety and well-being of the occupant(s)
Signed and certified under the pains and penalties of perjury i
CODS ENFORCEHM MWECTOR
i
Este on un documento legal Importants. Puede qua &facts sue derechos.
Puede adquiriruna traduccion de seta forma.
APPENDIX 11 (1 4) 'F
.Legal Remedies For Tenants of
Hesidenilul Eluusing'
Tilt FOI.LOWING IS A BRIEF SUMMARY OESONIF. OF TTIF. LEGAL FkMEI)IFS TF.NANTS•MAY USE IN ORDER TO GE'f
IIOUSINC CODE VIOLATIONS CORHECTED:
I. Rent Withholding(General Laws Chapter.)9 Section dA)
If C'ode'Violations Are Nrt( Berns-Corrected you may be entitled to hold back your rent payments. You can do this without bong
evicted if. `
A. You can prove that your dwellint•unit or cornmun areas contain code violations which are senuus enough to endanger or maters
ally impair your health or safety and that your landlord knew about the violations before you were behind tat your run.
B. You did not cause the violations and they caobc repaired while you continue to live in the building. -
C. You are prepared to pay any'jidrtfon iif the rent into court if a judge orders you to pay it.(Fnr,this it is best to put the rent money
aside in a safe place.) - -
2. -Repair and Deduct(6etieral Laws Chapter.I t l Section 127L);: -' -•_The taw sometimes allows you to use your rent money to make the repairs yourself. If your local code enforcement agency certifies that
there are code violations which endanger-or materially impair your health,.safety or walibef
•' ng anC your.landlord has.received written notice*.
-of.lne violatioets,you may,be able to use this remedy. If the purger fits lo,begin necessary repairs(m to enter imn a ocit."li tact to nave s :
themmade)within five days after notice dr.to complete repairs within 14 days after notice you can use ul,to four montlis ieiii in any year to
.._:_:make the repairs.
3. Retaliatory Rett tetcrearesor Evictions Prohibited(Oeeeetglla«a Chapter 186,Srxsion 18 and Chapter 239 Section 2A).
The CYtner may nol idcrease.yoor•tint or evict you:tn retldialiola for makings complaint to your local code enforcement agency about
``codevfolatioan:/f-rheownetnisei-ji+oi,?etteotvr{esio encaariilninsiaaoonehsafter yduhagemadethe eompWnLheorsk.wi(.haiEto^s1tQw_..... . . --
;a good reason for the in" ase or eYict)on whieh'G Anrelated to dour complaint.You may be able to sue the landleed.for damages if he or she
_neslhK
�.. .
d. i.T 'Rem
Receivershj6c" L V.C4*peI(f:4ectioes IVCH) :,.
.. ... • .0 ..
1 he aoSupspta angorthe board of health may Petition:the Disuia or Superior Courtto allow rent w ba paid into coon ratherthan to
the otmer.Q)le i�wtn may then appoint i"eFetiVet"'plod tyayspetrdu much oft he tem money suit needed to correct the violation.Noce re.- `
eeiver is cot subject to it spending limitation of four tnonthe.runt.;:
_> S. Breach of Warranty of Habitability.
You maybe entitle)to sue your landlord to have all or snme of your rent returned if your dwelling unit does atm meet minimum stand.
. ands of habitability.
6. Unfair and Deceptive Practices(General laws Chapter 97A).
Renting an apartTent with code violations is a violation of the consumer protection act and regulations for which you may sue an
Owner. -
THE INFORMATION PRESENTED ABOVE IS ONLY A SUMMARY OF THE LAW. BEFORE YOU DECIDE TO WITHHOLD
YOUR AENT OR TAKE ANY OTHER LEGAL ACTION.IT LS ADV LSABLE THAT YOU CONSULT AN AT rORNEY.IF YOU CAN-
NOT AFFORD TO CONSULT AN ATTORNEY.YOU SHOULD CONTALT Til E NEAREST LEGAL SERVICES OFFICE W RICH IS:
,,y. - (NAM ' :t.:., ..•... ..oa �..: ...:� :fTELEFHON@N MBER)
FOIIaLJI H089SA WARR(N.JK. NOV,1979
. _ q ny-^.ip :.]C., 5�•nt♦1739..•;•....y'•'+-"' • ' • ^1r ^
Page 'Z of .-
' . SALEM HEALTH DEPARTMENT DATE:_
9 North Street
Salem, MA 01970
NAME: A11 X0e—/-. /VO/L- ADDRESS: �IS�/LIQ Olt/ S�
SPECIFIED REG. #
TIME 410. . . . VIOLATION
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