81 OCEAN AVENUE - BUILDING INSPECTION 81 OCEAN AVENUE
r
t.UILUING OPEPT
DANVEIL4/SALEM ARF d4 )TA �'D RErnFn&ToM BC"t r o 0
90 Highland venu®, S ', 01970 }
Ruth S. Tafferteller 7> 9.11p� g3e�5blF�j
Area Director CITY OF 5+(J-H, Nhss. F7+daQfle dk EPd,I.IASS.
Gary M. Moore
Assoc, Area Director
Date: September 18, 1980
emorandun To: Nancy Haaard, Director
Poplar Street (East)
From; Gary M. Moore, A.A.D.
Danvers/Salem Area Office
3
Subject- Inspection,of 81 Ocean Avenue_
On Tuesday, September 16, 1980, I accompanied Salem Building Inspector,
Dan Mansur and Fire Marshall, Lt. David Goggin on an initial 424 Certi-
ficate of Occupancy inspection of the first and second floor apartments.
The reports of their findings will be forwarded to you as soon as they
are received by me, likely in 7-10 days. In the meantime, I would like
to share rry impressions and my interpretation of their findings, so that
we may get a head start on corrective actions.
Exterior - A marginal building, with questionable siding and
condition of porches; but acceptable. Porches and
back-yard must be cleared of debris and cleaned up,
as to present no health or fire safety problems.
Note - Do not keep any articles in hallways that in any
way hinder egress. �+
Interior - 1st and 2nd floors.
Layout or rooms,ie bedrooms that exit into kitchen,
demands one smoke detector in each bedroom. In ad-
dition, a smoke detector insist be located at the foot
of the basement stairs, and on the first and third
levels of the front and rear hallways. All eleven
smoke detectors moist be electric (not battery) and
interconnected, so that when one goes off, all go
off. There must be also a manual pull station, so
that the system and the residents evacuation time
can be tested. One pull station is all that is ne-
cessary`to cover the two units, so long as both apart-
i meet units are interconnected.
The front and rear stairways and halls must be painted
with a paint with a smoke and fire rate of spread rat-
ing of less than 450. (Most paints are rated and ap-
pears on the can label) . There are also clear,
colorless applications that does the same job without
j - - changing any of the "aesthetics". It's up to you and
the landlord as to color or clear paint this hallway.
SFRVING; DANVE,RSy MARBIEh:sAD, ACEDur.�I4N, PFS?301DY, SALEM
_ 2
The front hall must be painted all the way up to
the third floor, due to its openness, while the
rear needs only to the second floor.
The basement needs to be cleared of trash and in-
flamables. The furnaces appear OK, except that
one has an indiscernible name - Lt. Goggin can't
be sure its an approved unit, while the Texaco
burner has about 8" of exposed wire at the burner,
which needs to be oonduited. Also, two of the oil
tanks need filters at the beginning of the tubing,
running from the tank to the burner.
The only other notes of correction are: provide a
bracket for the fire extinguishers, so they won't
be tipped over (only one required for each apart-
ment) , cover the old stove pipe flue opening with
sheet rock on the second floor kitchen, and make
the second floor living roam door exit to the hall
operational. '(Rug appears to be in the way, bottom
of door may need to be cut down) .
Overall, the inspection went very well. Occupancy of the first floor,
of course, remains "on our own" without a certificate of occupancy. I
assured both men that second floor occupancy would be contingent upon
their return inspection and issuance of a temporary (90 day) certificate.
We should begin our efforts to met 424 code as soon as possible. I am
guestimating that it will cost about $1,200 to achieve conformance. I
reronirend that the Landlord attend to the oil burner,, tanks and clean-
up citations, while NFI and DKi attack the rest. You might consider
asking the landlord for some assistance with painting the halls, since
this benefits the entire building and investrrept.
Lt. Goggin accepted my idea to. save expense by interconnecting the eleven
smoke units and one pull station with surface mounted conduit, the kind
that is color coordinated, or could be painted to match ceiling wall, etc.
This rrethod saves you from the very expensive method of wiring through walls,
floors and ceilings. Lt. Goggin suggested further, that each smoke unit have
its own horn, rather than separate horns, another potential cost saving idea.
Dan Mansur asked to be notified when the painting is being done, to be assured
it is the correct paint, and is being applied fully. This is also because he
has no method to otherwise be sure we painted the halls at all. You may also
want to consider volunteers to paint, if the landlord is not willing to help
with the effort, and contractor costs are prohibitive, I am willing to help
out as a start.
I was left with a very positive feeling. Lt. Goggin was especially helpful.
I trust that you are buoyed by this report. I have shared this information
verbally with Mary, Al Scott and Tom McLaughlin. I urged Mary to begin de-
veloping a fire escape plan, and to train and practice with the residents.
- 3 -
Mr. Mansur is particularly focused on this 424 re;,;rezent to test the
residents escape time. Let's be prepared. I also want to express ITY
sense of satisfaction you and your staff gave ire when I walked in with
Lt. Goggin and Mr. Mansur. The apartment was in great shape, and fire/
safety was at its optimum level, considering the resources at our dis-
posal.
Thank you, and please express m7' sentiments of appreciation to your staff
and the residents for a jcb of preparation well done. Please call me if
any of this is unclear. Iet's set October 1 as a target date, to have
both units ready for occupancy certificates.
i
PERIODIC OR SURVEY INSPECTION REPORT Q
C177 ( -a5 4-L,- la
la
INSPECTOR
Locations O �-
Responsible Parties---
1. Ownel/�le$ /'N L Telephone
Address l
2. Owner's Agent 1�--¢vti�, �0 lG /_—S Telephone
Address nCI Ww�7(.b
3. Tenant / ' / S Gy Telephone
Address
4. Contact Telephone
Address may.
Periodical SYPE OF INSPECTION Special
ZONING STATUS
Conforming Nom Conforming
Map District Use Use
BUILDING CODE STATUS
Before After Fire
Code Code Type Class Stories Limits
Legal Use or Occupancy
Actual Use or Occupancy
Fee Class Fee Invoice No. To No.
Notify No. Compliance Date Notice No.
Checked by Violations of
SUPERVISOR
I have made an inspection at the premises described above and hereby submit my report and
recommendations:
GENERAL OBSERVATIONS
Yard Sanitation Exits
Building Exterior Exit Signs
Accessory Buildings Fire Doors
Accessory Structures - Sprinkler System
Parking Facilities Storage Space
Loading Facilities Heating Apparatus
Fences Flammable Liquids
Interior Sanitation
Incinerators
Signs
Air Conditioning & Refrigeration
Elevators & Escalators
Electrical Wiring
Plumbing
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• PERIODIC OR SURVEY INSPECTION REPORT
F
Dote
INSPECTOR
Location
Responsible Parties-.--
1. Owner Telephone
Address
2. Owner's Agent Telephone
Address
3. Tenant Telephone
Address - -
4. Contact Telephone
Address
TYPE OF INSPECTION
Periodical Survey Special
ZONING STATUS .
Conforming Non-Conforming
Map District Use Use
BUILDING CODE STATUS
Before After - Fire
Code Code Type Class Stories Limits
Legal Use or Occupancy
Actual Use or Occupancy
Fee Class Fee Invoice No. To No.
Notify No. Compliance Date Notice No.
Checked by Violations of
SUPERVISOR
I-have made an inspection at the premises described above and hereby submit my report and
recommendations:
GENERAL OBSERVATIONS
MSonitotionation Exits
xterior Exit Signs
Buildings Fire Doors
Structures Sprinkler System
acilities Storage Space
acilities Heating Apparatus
Flammable Liquids
Interior Sanitation
Incinerators
Signs
Air Conditioning & Refrigeration
Elevators & Escalators
Electrical Wiring
Plumbing
k�, n ��/
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CERTIFICATE DATA
EXPIRES ISSUED CERTIFICATE NO. INSPECTOR
3/3/83 3/3/81 6-81 Budesky
• ORDERS •
ISSUED COMPLIED ISSUED COMPLIED
19 19 19 19
19 19 19 19
19 19 19 19
REMARKS Cnrriljnre - 1 hour rating
STREET & NUMBER 81 Ocean Ave. DATE 2/27/81
OTHER LICENSES OR PERMITS REQUIRED
Dept, of Mental Health, Commonwealth of Mass.
OWNER OF RECORD OF BUILDING Charles Hinchey
ADDRESS 355 Essex St. , Salem
CERTIFICATE ISSUED TO Northeastern Family Institute
ADDRESS 25 Cherry St. , Danvers, MA 01923
NAME OR ADDRESS IJAN IFEBIMARIAPRIMAYIJUN I JUL JAUG SEP JOCTINOVIDEC I USE - I YEAR
81 Ocean Ave. (Ocean Ave. Community (residence) I-2 81
81 Ocean Avenue (Ocean Ave. Community Residen4 I-2 81 ,
_ NAME OR ADDRESS I JANI FE MA APR MA JUNlJULl AUOSEH OCTI NOVIDECI YEAR
JRPOSE USED Community Residence
ROVIDE THE FOLLOWING INFORMATION AS APPLICABLE
OF STORIES 3 CLASS OF CONSTRUCTION Type 4 DATE ERECTED uk,
ERTIFIED CAPACITY: (BY STORY OR TYPE)
1st floor - 4
2nd floor - 4
UMBER OF ROOMS - HOSPITALS, SCHOOLS, HOTELS: (BY STORY OR TYPE)
UMBER OF DWELLING UNITS PER STORY
FORM SBCC-2�74 _•
4MERGENCY LIGHTING SYSTEM none
AEANS OF DETECTING AND EXTINGUISHING FIRE Smoke Detectors - ABC Fire Ext.
Pull station for lct & 2nd floors
OF ELEVATORS
OW HEATED Steam
OILER OR OTHER HEATING APPARATUS Boller
IOW LIGHTED Flectric HOW VENTILATED •Wn[l0&1C (Nato roll
'LACE OF ASSEMBLY: VES NO
PURPOSE USED
IN WHICH STORY
ITANDARD BOOTH INSTALLED LOCATION
IXED SEATING
OF AISLES AND WIDTH
'IRE RESISTANCE OF CURTAINS OR DRAPERIES
OF SANITARIES 1 LOCATION each floor
I OF GRADE FLOOR MEANS OF EGRESS DOORWAYS 2
I OF SEPARATE STAIRWAYS ACCESSIBLE PER STORY 2
A OF APPROVED INDEPENDENT EXITWAVS PER STORY 2
2 THE SALEM MASS `f
EVLNING NEWS SATURDAY, OCTOBER 2
1982
Or
3escape' as blase h�t� . Sale uilding
ByCARLJOHNSON One firefighter, Robert in thereand there was heavy . '.rushed to the scene to help lead
News Staff . Jellison of Ladder 2,received a damageto the wiring,ducts, and the groggy'•people 'from the
SALEM—Thirty-six persons, shoulder-arm injury and ,was floor joists.If that fire had gone three-story ' .dwelling which
including 21 emotionally ;:, taken.to Salem Hospital at the :unnoticed for another five or 10 housed 21' on t'he' first floor,
direction of Deputy Fire Chief minutes we would have had a according to Police Lt. William
disturbed adults who were Francis J.Bates. three alarmer." Herlihy. Eleven members of the
awaiting placement along the Kau Tan Nguyen family, living .
North Shore, were led to safety "He (Jellison).came over to i The fire was discovered by on the third floor; and Judith
from smoke permeated rooms - - me and said his and went dead, Patrolmen Kenneth Gibney, and - ,
at 81 Ocean Ave. at 3:25 a.m. and I sent him to the hospital," Patrolmen :Charles' Rehal Jr. F:111L
today by police and firefighters. Bates said. "It was heavy going and ; Murray Greenlaw Jr. (Continued on rage 2)
FIRE (Continued from Page 1), i=
tris emotionally disturbed persons,
: Carpenter and three young B who have an association with the
on the second floor'also had to be health and Education Services .
}edfrom their apartment, and , Danvers .,�State the cellar to
Police is shift':commander mayhaveg
Herlihy said the first arriving sleep on a mattress and may
tactical patrol officers spotted have left a lighted cigarette on
heavy smoke and went inside toco le it �r,; . caned
kick doors open and help p P, , He'sid the budding is 0
0 STtiey made a'pood-'stop and by Chr�lstppher and j Cdgtgg ,±
no resident was m7ured," Bates ,p Hinc`l Ps a of Salero
said. He called for,,an extra bµsinessasNickle8ealtyTrulu-
ti "There will be an
piece of equipment at B 24 and vestigahon into this one,believe
u - recall was sounded at 4 38 He
u w y
•I .J"fi�fi4J4.Y" �,1.{:, tf• .,�1f .. .I 1( r.r'�. t "+�16M+,M`� e,
'said he `' Ieels one,, of the FA it"Lt.Herli Y sai
FORM secc-5-71i
W
a CITY/3'fXJP]-OF SALEM
In accordance with the Massachusetts State Building Code, Section Z08. Z5, this
Qty SyOb _
CERTIFICATE OF INSPECTION
is issued to . . . . . . . . . . . . . . . . . . . . . . . . NORTHEASTERN FAMILY INSTITUTE . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Trrtifl that I have inspected the. . . . . COMMUNITY RESIDENCEOCEAN AVENUE COMMUNITY RESIDENCE.
. . . . . . . .known as. .
located at. . . . . . 81 OCEAN AVENUE . . . . in the. . . CITY of SALEM
ESS. . . . . . . . . .Commonwealth o Massachusetts. The means o egress are sufficient or the following
County of. . . . . . . . . . f f 9 ff f f 9
number of persons:
BY STORY
Story Capacity Story Capacity Story Capacity Story Capacity
first floor four second floor four
BY PLACE OF ASSEMBLY OR STRUCTURE
Place of Assembly Place of Assembly
or Structure Capacity Location . . or Structure Capacity Location
6-81 3/3/81 3/3/83 _
Certificate Number Date Certificate Issued Date Certificate Expires ing Offici Z
The building official shall be notified within (ZO) days of any changes in the above information.
PERIODIC INSPECTION INFORMATION SHEET
Instructions: This information sheet is not an inspection checklist. Each time
a permanent.file card is typed for a new building or a new card for an old build-
ing, this information sheet can be prepared by the building inspector as a work
sheet from which the file card can be typed. The items of information on this
sheet are identical to the items on the file card. if all the information on this
sheet cannot be entered on the file card, this sheet should be filled out and
not discarded.
Street and Number ve-.
Name of Premises
Other Licenses or Permits Re fired f
55 •
Owner of Record of Building
Address
Certificate to be Issued to'
Address p
Use Group Classification _ Purpose Lsed J
Public 'or Private J �°�.,
Number of Stories ' Class of Construction,/vf„ U D e Erected
Certified Capacity (By Story or Type) �`�—
Id
o _ FLaOY.
Number of Rooms - Hospitals, Schools, Hotels (By Story or Type)
Number of Dwelling Units Per Story
Emergency Lighting System
Means of Detecting and Extinguishing Fire g
v � Y'i•h U/ cJ'`
Fire Alarm System 6h = h Y �(n op` .5 .
Number of Elevators
How Heated
Boiler or Other Heating A paratus
How Lighted How Ventilated
Place of Assembly: Yes No Purpose Used
In Which Story
Standard Booth Installed Location
Fixed Seating
Number of Aisles and Width of Each
Fire Resistance of Curtains or Draperies
Number of Sanitaries Location Eatt oFif
Number of Grade Floor Meas of Egress Doorways
Number of Separate Stairways Accessible Per Story
Number of Approved Independent Exitways Per Story
Remarks: _ �/ JJp•�
Date Certificate Issued Date Certificate Expires I 73
Date Orders Iss Date Orders Complied
Inspector Date --P
FORM SBCC-1-74
COMMONWEALTH OF MASSACHUSETTS
CITY/TOWN OF
Ulf APPLICATION FOR CERTIFICATE OF INSPECTION
Date ) �.g (✓) Fee Required (Amount ) 5� _
( ) No Fee Required
In accordance with the provisions of the Massachusetts State Building
Code , Section 108 ,15 , I hereby apply for a Certificate of Inspection for
the below-named premises located at the following address :
Street and Number 16 Coctac� CL, re-
Name of Premises 0 __, Gm, rn. An„ S IC�Pr c �/f-d27Si
Purpose for Which Premises is Used Cimcev-�._. r h c , q C_Q_
License( s ) or Permit ( s ) Required for the Premises by Other Governmental
Agencies :
License or Permit Agency
Certificate to be Issued to
Addreas � 5 cS1on . r$ $ Y�9LOZAA , ST4aC�cnn 01c52�
Owner of Record of Building AA
Address 355 4iwS� Co_An
Name of Present Holder of Certificate
Name of Agent , if any
v l 111 i
SIGNATUREOF PERSON TO WHOM TITLE
CERTIFICATE IS ISSUED OR HIS
AUTHORIZED AGENT11�//$1
DATE
INSTRUCTIONS :
1 ) Make check payable to :
2 ) , Return this . application with your check to :
PLEASE NOTE :
1 ) Application form with accompanying fee must be submitted for each build-
ing or structure or part thereof to be certified .
2 ) Application and fee must be received before the certificate will be issued .
3 ) The building official shall be notified within ten ( 10 ) days of any change
in the above information.
CERTIFICATE # EXPIRATION DATE :
FORM SBCC-3-74
has U
29 91tiONORTHEASTERN Family Institute, Inc.
FE�f 1,4
ED SS¢non-profit organization to provide alternative Human Services
C1,�Y tJF SQ
January 27, 1981
Mr. Robert Gauthier
Director of Public Properties
1 Salem Green
Salem, MA 01970
RE: 81 Ocean Avenue
Dear Mr. Gauthier:
I would like to request a certificate of occupancy under
Section 424.7 of the Building Code, for the first and second
floors of 81 Ocean Avenue. The property was inspected on
January 26, 1981 by your office.
Each floor will:-.be occupied by four mental health
clients, and the programs will be supervised by our agency.
If you need any further information, please contact
me at 774-0774.
Sincerely,
V
Nancy
nccy 'HocJard
NR:gl
cc: Gary Moore
25 Cherry Street•Danvers,Massachusetts 01923.617-774-0774 Gregory Street•Middleton,Massachusetts 01949.617-774-5844
158S.Common Street•Lynn,Massachusetts 01902•617-599-7360 1005-7 Main Street•Brockton,Massachusetts 02401 •617-586-5159
142—144 E.Main Street•Gloucester,Massachusetts 01930•617-283-6594
SALEM FIRE PREVENTION BUREAU
48 LAFAYETTE STREET
SALEM, MASS
GROUP r_ARI; AhaD PLACEML':NT LTCENSING A:JD CONSULTATION
FIRE INSPEC'T'ION: M_�:IIOR".0
This is to certify that Group Care Residence (N. S. A?ental Health)
-----Name of Vaci.lity -
located at 81 Ocean Ave. Salem, I',Iass. 01S?70
Address ---
was inspected on Jan. 26, 1981 by Inspe_ctor Raymond T. Dans_reau_
—Date Name of Inspector.
Report of Inspection:
Fire Alarm Test conducted and accepted.
Occupancy inspection condected. and all conditions found satisfactory
at time of inspection,
1
i)_E.X71 I?,Y-rl'O Vt?(1
c c a Salem Bld . in.Sp. (�
Salem Health ,')e p t. _
QCCti art
811rn -.
Dept., 04, Nlonf.al
:file
"',,'PB Form 4.1._ V "nv^
lo' �r� C1 C)
0 Av�
C44t-c-
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CITY ®F SALEM Fee Due $5.00
Cash
FIRE DEPARTME-NT - FIRE PREVENTION BUREAU
r. 48 Lafayette Si., Rec'd by
Salem, Massachusetts 01970
De-C 1 _19 0
(Ibte)
APPLICATION FOR APPROVAL OF PLANS: Fire Prot. Equip.
—` ""`- - - -"— ' &'F.P.Code Inst.
To: HEAD OF FIRE DEPARTMENT Fire Alarm System: V
Fire Extinguishing . —
System .:x..........:::
In accordance with Lhe provisions of the Massachuseets State Building Code and the
Salem Fire Code, application is hereby made for approval of plans for the install-
ation of Fire Protection devices.
LOCATION: oqk-ST !' .AL µl -r-VJIP�s-S
OWNER OR OCCUPANT_ C � L�P,aLz} .G —_ TCI -k `i fC) Lw
INSTALLER: — WAyu .AL,9,& , LICENSE u —
INSTALLERS ADDRESSj&Ald- �Q - — - TEL. 11elf_6000
Plant: are approved solely for identification of type and location of devices.
Installation subject to final inspection and filing of Ce_of Completion.
Uath approved:
��ync ure N'WIl Fant)
Date of expiration-__.-6.,1V-81_
;r CITY 5t3�i1� 1i Fee Paid $5.00
e;r
4!, ' ?
I(t Sp^r `) FIRE DEPARTMENT - FIRE PREVENTION BUREAU
Salem, Massaclw.,etts 0170
ora:ne.F:::y.
PERMIT TO INSTALL: Date De '15, 71!
Fire Extinguishing System _ Fire Protection Equipment
and Fire Prevention Code
Fire Alarm System X Required Installations.
Owners
Name C _ Nikal Raalt$ Co- .Rnlam -- —...-
o'
Installers
Name Wa e_ Alarm Co .-L-Fly a Shanahan)
.� -- ------ ---
Permit is hereby granted based on approved plans ; to install the system designated
_nbove_Al1 plans are approved solely for identification of type. and location of '
fire protection devices. Al plans are subiect to ammroval of -a;ny_other authoriLy
having jurisdiction and issuance of a phrmit by said authority. Upon completion, the
installer renuest te a est and fila Certificate of Completion or Insoer-tion~
i.0 CAT ION_ _y -✓� Ave - Sal am Ma _ —__--- -- -- ot;.
(Give llift,�'''�",ocofl<�n nhoet and m- or d.e dbo in such munnor ae to rov'.de nclm
syk ,liflc ton l _ >7 —
_. ulpnotur� gnmtinJ 8�..��/ '
This permit will expire.__11 1 _3_Hlem_F ire
1T1t1e)
Kw- ('12W PL'T1.Wr MUST BE CONSMCUOUSLY POSTED U110N '1211:: 11111fJISES.) 'CZJ
Form #81 (Rev. 7/78)
9.
a DEC 15 1980 -._. .. „
APPnoVFD r t9" t
a a Subject tO a
n a aeiharit pproval by any other $ W 4
rp n y havin, jIIH diction. n D �
CITY of 'S<1.LEPrT, A,C,9 S cap y
FIPL PREVFNTL�N n,UR rw
yl O By M (A
PLANS APPROVED S ELY
TYPE AND LOCATION OF FlRErOR I ICANON I
ALL FIRE PROTECTION p !ROTECTION DEVICES, `
FINAL TEST AND INSPECTIOHES 'RE SDRIECT TO q,
TViQ RNCE WITEU ,(rye IINE COOS, MR COMPLETE CDiRPLF1 J
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"DEC15'1980 ....„aAPPIMVED
JSItIAiCrt to npprovnl by nny other v (A AY
dtA having .7uI1 Miction. t rn rs. �;
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VENTION `UREA c k H T c^yCA '
Y
- O By PLANS M1 APPROVEO SOL r04 IDENCIZD ION Of 'f 12 ` fTI S�
(� 'a Ii AND LOCATION OF TIRE 7ROTECTION DEVICES,
v, ALL FIRE PROTEC11ON DEVIZES ARE SUBJECT TO A.
FINAL TEST AND INSPECTION, ItOR COMPLETE COMPIE (CpJ 'D
O a$. ANCE WITH, (HE FIRE CUDE.
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DEC 1. 5 1980 ,
APPROVER
A Subjoct to Approvni by any other v ,T ` D {I
�^� nclhority having jurisdiction. . k� j
�'N, �} CITY (.)r11C SALEM, MASS. ?
� ? r� a Mtjyg 41i V
I
MILE PREVENTI N 3UREAU
CA m
.. By
PLANS E APPROVED ELY FOR FICATION of
p. TYPE NO LOCATION OF ORE ? TC 1IOR DEVICES,
^+� ALL FIRE PROTECTION DEVICES ARE SUBJECT TO A.
I?. FINAL TEST AND INSPECTION, FOR COMPLETE COMPO-
RACE WIT" INS FIRE CODE
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NORTHEASTERN FAMIf WSTITUTE, Inc.
a non-profit organization to provide alternative Human Services
OCT i 1i i9Q Ai198kj
MY OFuSALtJ ADMINISTRATIVE OFFICES:
25 Cherry Street
Danvers,MA 01923
517-774-0774
September 21; . 1984
Building Inspector
City of Salem
City Hall Annex
One Salem Green
Salem, MA 01970
To Whom This May Concern:
Northeastern Family Institute has not occupied the
premises at 81 Ocean Avenue since 11/1/81.-
Sincerely
Frieda Miller
Assistant Director
FM:gwl
COMMONWEALTH OF MASSACHUSETTS
t'- clmYl.� ���-.oF 6 atl������
� ALEM
APPLICATION FORINSPECTION:
Date CITY OF a PR h AS L3
Fee Required (Amount fya_D
( } No Fee Required
In accordance with the provisions of the Massachusetts State Building
Code , Section 108 ,15 , I hereby apply for a Certificate of Inspection for
the below-named premises located at the following address:
Street and Number
Name of Premises
Purpose for Which Premises is Used
License( s ) or Permit(s ) Required for t e Premises by Other Governmental
Agencies :
License or Permit Agency
Certificate to be Issued to
Address
's ---
Owner 6f-Record of Building
Address
Name of Present Holder of Certificate
Name of Agent , if any
SIGNATURE OF PERSON TO WHOM TITLE
CERTIFICATE IS ISSUED OR HIS
AUTHORIZED .AGENT + `
DATE
INSTRUCTIONS :
1) Make check payable to : CITY OF SALEM
2) Return this application with your check/ to: Richard T. McIntosh
Building Department, 1 Salem Green, Salem,Ma +—
PLEASE NOTE :
1 ) Application form with accompanying fee must be submitted for each- build-
ing
achbuild-ing or structure or part thereof to be certified_
2 ) Application and fee must be received before the certificate will be issi
3 ) T^e building official shall be notified within ten (10) days of any cba:
in the above information,
CERTIFICATE # E{PIRATIOK DATE:
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2NDOFFICER
For Inspection of Group Care Residence (Regulated by 'Dept, of: Mental Health)
Per Sections 424 .0 and 438.0 of Mass , State Building Code;
SALEM FIRE PREVENTION . BUREAU
48 LAFAYETTE STREET
SALEM; ,MASS. '
GRbUPCARE AND PLACE643IT.LICEiSING. ATD_CONSULTATION
. - . FIRE INSPECTIONS REPORT. _
This is to certify that Health & Education Services Inc .
Name of Facility-`
(2nd floor)
located at 81 Ocean Ave .Salem Mass 01970
Address
was inspected on 09-11-82 by : Raymond T ' Dansreau
Date Naemof Inspector
Report of Inspection:
Conditions satisfactory at time of. inspection..
Approved: iy .
Disapproved`.
cc-, Salem Bldg. Insp.
Salem Health Dept.
Occupant ' t
Fire Chief
,.. k, of ental
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Bow 100, } rt;,otne , Ma. Ol'>=r j
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Ciq,,Y,OF,SALE