13 BEACON STREET - BUILDIING JACKET 13 BEACON STREET
a
0013 BEACON STREET "`'' 270-2000
his#:' 6016 COMMONWEALTH OF MASSACHUSETTS
Map: 36
Block: CITY OF SALEM
Lot: 0345 •
Permit: Building \
Category: 434 Residential:additi BUILDING PERMIT
Permit# . 270-2000 '
Project# JS-2001-0535 ,, }
Est.Cost: $30,000.00 r
' a
Fee: $185.00 . PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Angelo C.Meimeteas General Contractor-Salem#2078
Lot Size(sq.ft.): 2075 , Owner: FULTON JOHN R
Zoning: R2 - r `
- .
Applicant: Angelo C --Ieas
Units _. —
ts Gained: -�-. __.._mn�� _: :..s..,,.,.
Units Lost: AT. 0013 BEACON STREET k*
ISSUED ON: 31-Oct-2000 EXPIRES ON: 30-Apr-2001
TO PERFORM THE FOLLOWING WORK.
Remodel &alterations.F.R.D.
,At Plprmit to n0ccupv
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of
Wiring D.P.W. Inspector of Buildings
Underground- Service:/�s...y a� Meter: Footings:
Rough:,;j(I/� v t House# Foundation:
/ Cr g C"/CS
Final: hal: Rough Frame: �
Fireplace/Chimney:
Gas Fire De tme t Board of Health �o
��/ � � � Insulation:
Rough Oil: l �
Final: /5
Finai: L'tG $mci:e: G/`
Treasury: I �/0/
THIS PERMIT MAY BE REVOKED BY THE CITY OF SALEM UPON VIOLATION OF ANY OF
ITS RULES AND REGULATIONS. b
Signature:
R Fee Type: Receipt No: Date Paid: Check No: Amount: .
BUILDING REC-2001-000662 25-Oct-00 ' 1287 $185.00
A.
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GeoTaIS®1998 Des Lauriers&Associates,Inc. s
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YSpVE AO
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CITY OF SALEM
s _ .- UIL,DT E MIL' -
OP-2001-0083 Building Permit No.: 270-2000
Commonwealth of Massachusetts
City of Salem
BUILDING,ELECTRICAL&MECHANICAL PERMITS DEPARTMENT
This is to Certify that the RESIDENCE located at
Dwelling Type
0013 BEACON STREET in the CITY OF SALEM
Xticiess Town/City Name
IS HEREBY GRANTED A PERMANENT
CERTIFICATE OF OCCUPANCY
Remodel &Alterations
This permit is granted in conformity with the Statutes and ordinances relating thereto,and
expires unless sooner suspended or revoked.
Expiration Date
. -------`------------------------------- - ------ - ---------------------
Issued On:Wed Jun 27,2001 y'--
GeoTMS®2001 Des Lauriers Municipal Solutions,Inc. _----------- --_-- ---- --- ----_--_-_------------------ ---
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3 Tito of #alem, massar4usetts
' Public Propertg Bepartment
Nuilbing Department
(One *nlem (4reen
508-745-9595 Ext. 380
Leo E. Tremblay
Director of Public Property
Inspector of Building February 10, 1997
Zoning Enforcement Officer
John Fulton
13 Beacon Street
Salem, Mass. 01970
RE: 13 Beacon Street
Dear Mr. Fulton:
Due to a complaint received through the Neighborhood Improvement
Committee hot line, I conducted an inspection of the above mentioned property
and found the following violations:
1. Overgrowth of grass and weeds in rear yard present a fire hazard and
must be removed and area cleaned up.
2. Front and rear stairs and rails need major repairs to conform to State
Building Codes.
3. Exterior siding needs major repairs and maintenance.
4. Gutters must be cleaned of debris and maintained.
Please notify this department within fifteen ( 15) days upon receipt of
this letter, to inform us as to what course of action you will take to rectify
these violations. Failure to do so will result in legal action being taken
against you.
Thank you in advance for your anticipated cooperation in this matter.
Sincerely,
r
Leo E. Tremblay
Inspector of Buildings
LET: scm
cc: Jane Guy
Councillor Flynn, Ward 2
� :w<-.
1 z.., Y jii>
3 �P Gifu of jttlem, massac4usetts
IluBlir i1rupertq i9epnrtment
Guilbing Department
(One #alem Green
508-745-9595 Ext. 380
Leo E. Tremblay
Director of Public Property
Inspector of Building
Zoning Enforcement Officer
June 17 , 1997
John Fulton
677 Kearsarge Way
Portsmouth, N.H. 03801
RE : 13 Beacon St . , Salem
Dear Mr . Fulton:
Per your request, please find enclosed all the
correspondence pertaining to the property located at 13
Beacon Street that you failed to receive .
This office is looking forward to working with you to
remove all violations on this piece of property, and to
see that property .is properly maintained.
As for the arrest warrant , at the Salem District
Court you will need to appeal in person at the Salem
District Court and ask for a default removal of the
charges .
If this office can be of any further assistance ,
please do not hesitate to call .
Sincerely ,
Leo E . Tremblay
Inspector of BuiYinggs
LET: scm
cc: Jane Guy
Councillor Flynn , Ward 2
APPLICATIONADULT NUMBER — Trial Court of Massachusetts
FO.A COMPLAINT _ JUVENILE Distract Court Department
ARREST 'C HEARING _ SUMMONS I �,=WARRANT I COURT DIVISION ro���
cow
ne within names Comolamant reaueSIS that a com Dlalnt Issue against the within I
amea aelenaanl Cnaramg saga defendant with the olfense(s) hStea oelpw. ,.L1� 86 Wss1>Iinglfon S11Nt
DATE OF APPLICATION I LATE OF OFFENSE I -LACE OF OFFENSE }� V SON -11M_G19T0
3/29/95 2/95 13 Beacon Street ' I-
NAME OF COMPLAINANT NO. I OFFENSE W.L. Ch.a
City of Salem Building Department
ADDRESS AND ZIP CODE OF COMPLAINANT Massachusetts State Secti
One Salem Green Building Code 104.1
Salem, Hass. 01970
z.
NAME.ADDRESS AND ZIP CODE OF DEFENDANT -
John Fulton
2'
13 Beacon Street
Salem, Mass. 01970 4.
COURT USE A hearing upon this complaint application DATE OF HEARING r TIME OF HEARING,, I COURT
ONLY—+ will be held at the above court address on �y./� /T AT /L `/ i �--
CASE PARTICULARS = SPECIFIC
NAME OF VICTIM DESCRIPTION OF PROPERTY VALUE OR PROPERTY TYPE OF CONTROLLED
NO. Owner aof ProoenY. Goode stolen.what Over or unser SUBSTANCE OR wEAP01
person ssaulleO.etc.
Oestrovea.etc. $250. Marijuana.qun.etc.
7
2
J
a
OTHER REMARKS: Failure to respond to correspondence from building department
x CA . (�
SIGNATURE OF COMPLAIN
DEFENDANT IDENTIFICATION INFORMATION — Complete data below if known./
DATE OF BIR 7H PLACE OF BIRTH SOCIAL SECURITY NUMBER SEx RAGE HEIGHT WEIGHT S H.
OCCUPATION
EMPLOYERISCHOOL MOTHER'S NAMEIMAIOENI FATHER'S NAME
i
c:.L1. Zai,
� ° �\ Cofttl�m, ttssttthusP�ts
aq 1'�J pniliir Vropp1Yi1 Oe�lIIrIIIIPIIt
s c� Buiiaing (Department
(Ont t�altm t6rtrn
500.745-9595 Est. 300
Leo E. Tremblay
Director of Public Property
Inspector of Building
Zoning Enforcement Officer February 2s. 1995
John Fulton
13 Beacon Street
Salem, Mass. 01970
?E: 13 Beacon Street
Dear Mr. Fulton:
This office has received complaints concerning the above mentioned
property. An inspection was conducted by this office on August 30, 1994
and the following violations must be attended to:
1. overgrowth of grass and weeds present a fire hazard and must
be removed.
2. Front and rear stairs and rails need major repairs to conform
to State Building Codes.
3. Gutters must be clean of debris and maintained.
4. The building is not being lived in, so it must be made safe
from entry.
Please contact this office upon receipt of this letter as to your course
of action on the above violations. Failure to do so will result in legal
action being taken against you.
Sincerely,
Leo E. Tremblay
Inspector of Buildings
LET: scm
cc: Dave Shea
Councillor Harvey, 'yard
;;��� =� �, �i�i3 i1? �FIlE2I1. �FI85EII�IIiSE�S
Ilultlic t1ropertg i9epartmcnt
iguilhing i3eparrment
(ane e�alem Wreen
5118-745-9595 Ext. 380
Leo E. Tremblay
Director of Public Property
inspector of Building
Zoning Enforcement Officer
August 31 , 1994
5 . L 55A—
John Fulton
13 Beacon Street
Salem. Mass. 0197
RE: 13 Beacon Street
Dear Mr. Fulton:
This office has received complaints concerning the above mentioned
property. An inspection was conducted by this office on August 30, 1994
and the following violations must be attended to.
1 . Overgrowth of grass and weeds present a fire hazard and must
be removed.
2. Front and rear stairs and rails need major repairs to conform
to State Building Codes.
3. Cutters must be clean of debris and maintained.
4 . The building is not being lived in, so it must be made safe
from entry.
Please contact this office upon receipt of this letter as to your
course of action on the above violations. °ailure to do so will result
in legal action being taken against you.
Sincerely,
Leo E. Tremblay
Inspector of Buildings
LET: scm
cc: Dave Shea
Councillor Harvey, '.'ard 2
CITY OF SALEM
NEIGIIBORHOOD IMPROVEMENT TASK FORCE
REFERRAL FORM
Date.-
Address:
ate:Address:
Compiaint: l ll�� n' Qa o w Phone rt
Comoiainant•.
DAVID SHEA, CHAIRMAN I I KEVIN HARVEY
BUILDING DING INSPECTOR I I Ft Ft'I'RTCAL DEPARTMENT
F E PREVENTION I I CITY SOLICITOR
ALTH DEPARTMENT I I SALEM HOUSING Auraosm
LICENSING I pnT rCE DFpARTMENT
PLANNING DEPARTMENT I I ASSESSOR
E a StIRFR1COLLECTOR
PLEASE CHECK THE ABOVE REFERENCED COMPLAINT AND RESPOND TO DAVE
SHEA WITHIN ONE \VEEK. HANK YOU FOR YOUR ASSISTANCE.
ACTION:
CITY OF SALU-1
NEIGHBORHOOD miPROVEIIIENT TASK FORCE
REFERRAL FORM
Dale: s
Address: >
Complaint: / 7 " l' ` n„c, ; r Phone
CLVIC',I alt. . �:� 417A1C TL, /` /1P � ` t/ G
Complainant:
DAVID SHEA CHAIRMAN KEVIN HARVEY
G Rtltr.DING INSPECTOR ELECTRICAL DEPARTMENT
PREVENTIONCITY SOLICITOR
�Al TH DEPARTMENT SALEM HOUSING AUTHORITY
LIC -NSIN G POLICE DEPARTMENT
Pt ANNING DEPARTMENT ASSESSOR
TREASURER/COLLECTOR
PLEASE CHECK THE ABOVE REFERENCED COMPLAINT AND RESPOND TO DAVI
SHEA WITHIN ONE WEEK. THANK YOU FOR YOUR ASSISTANCE.
v
ACTION �r'—�..,
i
i L:
Tito of Mussttr4usrtts
Public Propertg Department
iguilbing i9epariment
(*ne 6i lem cAreen
500.7.15-9595 Ext. 380
Leo E. Tremblay
Director of Public Property
Inspector of Building February 10, 1997
Zoning Enforcement Officer
John Fulton
13 Beacon Street
Salem, Mass. 01970
RE: 13 Beacon Street
Dear Mr. Fulton:
Due to a complaint received through the Neighborhood Improvement
Committee hot line, ' conducted an inspection of the above mentioned property
and found the following violations:
1. Overgrowth of grass and weeds in rear yard present a fire hazard and
must be removed and area cleaned up.
2. Front and rear stairs and rails need major repairs to conform to State
Building Codes .
3. Exterior siding needs major repairs and maintenance .
4 . Gutters must be cleaned of debris and maintained.
Please notify this department within fifteen i13 ) days upon receipt of
this letter, to inform us as to what course of action you will take to rectify
`hese violations. Failure to do so will result in legal action being taken
against you.
Thank you in advance for your anticipated cooperation in this matter.
Sincerely,
r
Leo E . Tremblav
Inspector of Buildings
LET: scm
cc: Jane Guy
Councillor Flvnn. ':ard
of �ttlem, fftssar4usetts
I na Vublic Prn}tertq Department
a „ Nuilaing Department
(Ont *sicm U4rrrn
500-745-9595 fid. 300
Leo E. Tremblay
Director of Public Property
Inspector of Building
Zoning Enforcement Officer
August 31, 1994
John Fulton
13 Beacon Street
Salem, Mass. 0197
RE: 13 Beacon Street
Dear Mr. Fulton:
This office has received complaints concerning the above mentioned
property. An inspection was conducted by this office on August 30, 1994
and the following violations must be attended to.
1 . Overgrowth of grass and weeds present a fire hazard and must
be removed.
2. Front and rear stairs and rails need major repairs to conform
to State Building Codes.
3. Gutters must be clean of debris and maintained.
4 . The building is not being lived in, so it must be made safe
from entry.
Please contact this office upon receipt of this letter as to your
course of action on the above violations. Failure to do so will result
in legal action being taken against you.
Sincerely,
Leo E. Tremblay
Inspector of Buildings
LET: scm
cc: Dave Shea
Councillor Harvey, Ward 2
CITY OF SALEM
NEIGIIBORHOOD IMPROVEMENT TASK FORCE
REFERRAL FORM
Date: 24
Address: , n
Complaint: /IC�Q�/� o� ,D Phone Jl:
Complainant:
DAVID SHEA- CHAIRMAN KEVIN HARVEY
Rini DING INSPECTOR ELECTRICAL DEPARTMENT
FIRE PREVENTION CITY SOLICITOR
HEALTH DEPARTMENT SALEM HOUSING AUTHORPPY
LICENSING POLICE DEPARTMENT
PLANNING DEPARTMENT ASSESSOR
TREASURER/COLLECTOR
PLEASE CHECK THE ABOVE REFERENCED COMPLAINT AND RESPOND TO DAVE
SHEA WITHIN ONE WEEK. THANK YOU FOR YOUR ASSISTANCE.
ACTION:
Tito of #Ulem. massac4usetts
Ilublic Properttl 19epartment
?� Nuilbing Department
(Ont daltm (6rttn
508-745-9595 Ext. 380
Leo E. Tremblay
Director of Public Property
Inspector of Building
Zoning Enforcement Officer
June 17 , 1997
John Fulton
677 Kearsarge Way
Portsmouth, N.H. 03801
RE : 13 Beacon St . , Salem
Dear Mr . Fulton:
Per your request, please find enclosed all the
correspondence pertaining to the property located at 13
Beacon Street that you failed to receive .
This office is looking forward to working with you to
remove all violations on this piece of property, and to
see that property is properly maintained .
As for the arrest warrant , at the Salem District
Court you will need to appeal in person at the Salem
District Court and ask for a default removal of the
charges .
If this office can be of any further assistance ,
please do not hesitate to call .
Sincerely,
, Z�2
Leo E . Tremblay
Inspector of Bui ings
LET: scm
cc : Jane Guy
Councillor Flynn, Ward 2
APPLICATION -1 ADULT I NUMBER — Trial Court of Massachusetts
FOA CO APLAINT JUVENILE 1 t ` ; - District Court Department
ARREST SHEARING — SUMMONS I WARRANT COURT DIVISION �I�..r
ne within namea Comolalnant reaue SIS I.^ai d COm Dlalnt issue aq inst the within y� s� D.a.relt Vaw•
amea ❑etenaanl cnara ng said detenaant with the offensetSI -sten nalpw. ..U,j 65 Washuxyt"sum
DATE OF APPLICATION I -ATE OF OFFENSE I =LACE OF OFFENSE �1�;V 019M
3/29/95 2/95 j 13 Beacon Street \
NAME OF COMPLAINANT NO. I OFFENSE W.L. Ch. B
City of Salem Building Department
ADDRESS AND ZIP CODE OF COMPLAINANT Massachusetts State Secti
One Salem Green ( Building Code 104.1
Salem, Mass. 01970
2.
NAME.ADDRESS AND ZIP CODE OF DEFENDANT
John Milton
3.
13 Beacon Street
Salem, Mass. 01970
COURT USE A hearing upon this complaint application t DATE OF HEARING TIMEOFHEARING COUR
ONLY----.E will be held at the above court address on �// /r AT
CASE PARTICULARS = SPECIFIC
I NAME OF VICTIM DESCRIPTION OF PROPERTY VALUE OR PROPERTY TYPE OF CONTROLLED
NO. Owner of orocenv. Goods stolen.what Over or unaer SUBSTANCE OR WEAPO-
j person assaulted.etc. destrovea.etc. $250. Marijuana.gun.etc.
1
2
3
a
OTHER REMARKS: Failure to respond to correspondence from building department
X
' SIGNATURE OF COMPLAIN
DEFENDANT IDENTIFICATION INFORMATION — Complete data below If known
EDATE BIRTH PLACEOFBIRTH SOGIALSECURITY NUMBER SEX RAGE HEIGHT WEIGHT S H
ION
EMPLOYER/SCHOOL MOTHER'S NAME(MAIDEN) FATHER'S NAME
64��- •:�- -�' l
of *tt1Em. 4Eitts5arhUSjett5
Public Prnperm Uppartment
;Ruilbing Ocpartment
line ealem t5reen
500-745-9595 Et. 300
Leo E. Tremblay
Director of Public Property
Inspector of Building
Zoning Enforcement Officer February 23, 1995
John Fulton
13 Beacon Street
Salem, Mass. 01970
2E: 13 Beacon Street
Deac Mr. Fulton:
This office has received complaints concerning the above mentioned
property. An inspection was conducted by this office on August 30, 1994
and the following violations must be attended to:
1. Overgrowth of grass and weeds present a fire hazard and must
be removed.
2. Front and rear stairs and rails need major repairs to conform
to State Building Codes.
3. Gutters must be clean of debris and maintained.
4. The building is not being lived in, so it must be made safe
from entry.
Please contact this office upon receipt of this letter as to your course
of action on the above violations. Failure to do so will result in legal
action being taken against you.
Sincerely,
Leo E. Tremblay
Inspector of Buildings
LET: scm
cc: Dave Shea
Councillor Harvev, 'hard 2
11ultlir i1raping Erpartmtnt
Nuilbing i9partmtnt
(Ont *sltm ISrttn
508.745-9595 fin. 30D
Leo E. Tremblay
Director of Public Property
Inspector of Building
Zoning Enforcement Officer
August 31, 1994
55A—
John Fulton
13 Beacon Street
Salem. Mass. 0197
RE: 13 Beacon Street
Dear Mr. Fulton:
This office has received complaints concerning the above mentioned
property. An inspection was conducted by this office on August 30, 1994
and the following violations must be attended to.
1 . Overgrowth of grass and weeds present a fire hazard and must
be removed.
2. Front and rear stairs and rails need major repairs to conform
to State Building Codes.
3. Cutters must be clean of debris and maintained.
4 . The building is not being lived in, so it must be made safe
from entry.
Please contact this office upon receipt of this letter as to your
course of action on the above violations . Failure to do so will result
in legal action being taken against you.
Sincerely,
Leo E. Tremblav
Inspector of Buildings
LET: scm
cc: Dave Shea
Councillor Harvey, ' ard 2
CITY OF SALEM
NEIGIIBORHOOD VOPROVEMEN'T TASK FORCE
REFERRAL FORM
Date.-
Address:
ate:Address:
Compiaint:
Comniainant:
DAVM SHEA. CHAIRMAN I KEVIN HARVEY
AITII DING INSPECTOR I I Fi FCTRi AL DEPARTMaTr
FIRE PR_EVE=N I I CITY SOLICITOR
HEALTH DEPPARTMENT I I S w r EM HOUSING ALTTHOR=
i ICENSING I POT ICE DEPARTAZENT
PT-ANNING DEPARTMENT I I ASSESSOR
TREA SURFRIC'OLLECTOR
PLEASE CHECK THE ABOVE REFERENCED COMPLAINT AND RESPOND TO DAVE
SHEA WITHIN ONE 1VEEK. HANK YOU FOR YOUR ASSISTANCE.
ACTION:
CITY OF SALFAI
NEIGHBORHOOD BUPROVUIENT TASK FORCE
REFERRAL FOR11I
Date:
Address:
CompWnt: �i�� .<<°��� ^z� > r Picone N:
11 s.
.��� .� ��7YIL� n�.•, L.�r',' �b �/4//b1S 7ur /7Pr /it l'C
Complainant: �7"/F �C S �x �� ,�f'4'rg."
DAVID SHEACHAIRMAN KEVIN HARVEY
BUI DING INSPECTOR ELECTRICAL DEPARTMENT
VENTVENTION CITY SOLICITOR
11EALTH DEPARTMENT SALEM HOUSING AUTHOR=
LICENSING POLICE DEPARTMENT
PLANNING DEPARTMENT ASSESSOR
TREAS 1R_ER/COLLECTOR
PLEASE CIIECK THE ABOVE REFERENCED COMPLAINT AND RESPOND TO DAVI
SHEA WITHIN ONE WEEK. THANK YOU FOR YOUR ASSISTANCE.
ACTION: ®7'—c
-I '7 �+-��. ! �' .4._/✓ice
i
situ of tt1Pm. Aussar4u,srtts
I� '1F 1'o tlublir i1rupertq i3epartment
" iguilbing department
lone datem (5reen
500.7,13-9593 Ext. 300
Leo E. Tremblay
Director of Public Property
inspector of Building February 10, 1997
Zoning Enforcement Officer
John Fulton
13 Beacon Street
Salem, Mass. 01970
RE: 13 Beacon Street
Dear Mr. Fulton:
Due to a complaint received through the Neighborhood Improvement
Committee hot line, T conducted an inspection of the above mentioned property
and found the following violations:
1. Overgrowth of grass and weeds in rear yard present a fire hazard and
must be removed and area cleaned up.
2. Front and rear stairs and rails need major repairs to conform to State
Building Codes.
3. Exterior siding needs major repairs and maintenance .
4 . Gutters must be cleaned of debris and maintained.
Please notify this department within fifteen 11.3 ) days upon receipt of
this letter, to inform us as to what course of action you will take to rectify
these violations. Failure to do so will result in legal action being taken
against you.
Thank you in advance for your anticipated cooperation in this matter.
Sincerely,
Leo E. Tremblav
Inspector of Buildings
LET: scm
cc: Jane Guy
Councillor Flvnn. 'bard
(�i#g of i%fEm, massac4use##s
l r� Ilublir trapertg Department
Nuilbing Department
Ont *nitm (6reen
588.745-9595 $xt. 388
Leo E. Tremblay
Director of Public Property
Inspector of Building
Zoning Enforcement Officer
August 31, 1994 John Fulton
13 Beacon Street
Salem, Mass. 0197
RE: 13 Beacon Street
Dear Mr. Fulton:
This office has received complaints concerning the above mentioned
property. An inspection was conducted by this office on August 30, 1994
and the following violations must be attended to.
1 . Overgrowth of grass and weeds present a fire hazard and must
be removed.
2. Front and rear stairs and rails need major repairs to conform
to State Building Codes.
3. Gutters must be clean of debris and maintained.
4. The building is not being lived in, so it must be made safe
from entry.
Please contact this office upon receipt of this letter as to your
course of action on the above violations. Failure to do so will result
in legal action being taken against you.
Sincerely,
Leo E. Tremblay
Inspector of Buildings
LET: scm
cc: Dave Shea
Councillor Harvey, Ward 2
CITY OF SALEM
NEIGHBORHOOD IMPROVEMENT TASK FORCE
REFERRAL FORM
Date.
Address: �L/3 l /lGi2
Complaint: / 1!/ 66s/ �' Phone #:
Complainant:
DAVID SHEA. CHAIRMAN KEVIN HARVEY
BUI DING INSPECTOR ELECTRICAL DEPARTMENT
FIRE PREVENTION CITY SOLICITOR
HEALTH DEPARTMENT SALEM HOUSING AUTHORITY
LICENSING POLICE DEPARTMENT
Pr ANNING DEPARTMENT ASSESSOR
TREASURER/COLLECTOR
PLEASE CHECK THE ABOVE REFERENCED COMPLAINT AND RESPOND TO DAVE
SHEA WITHIN ONE WEEK. THANK YOU FOR YOUR ASSISTANCE.
ACTION:
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�, SENDER: I also wish to receive the II
I. . Complete items 1 and/or 2 for additional services. following services(for an extra fee):
I! . Complete items 3,and 4a 8 b. 9
• Print your name and address on the reverse of this form so that we can return this card _
m vas 1. [1 Addressee's Address _
• Attach this form to the front of the mailpiece,or on the back if space does not permit
• write"Return Receipt Requested"on the mailpiece below the article number. 2. EI Restricted Delivery
• The Return Receipt Fee will provide you the signature of the person delivered to and the Consult postmaster for fee.
tlate of deliver
13.Article Addressed to: � 4a.Article Number I
L1NE,• P 921 991 593
I � o
Jgllti kU1tQ11 4b.Service Type
1 I 13 Befacibn Street o
I r
±fig, 01970 CERTIFIED
m
7.Date of livery
m
m
Address's m
5.Signature-(Addressee) S.Addresseef°
(ONLY if requested and fee paid.)
I I
6.Signature—(Agent)
8 PS Form 3811,November 1990 DOMESTIC RETURN RECEIPT
y r:
CITY OF SALEM F,
BUILDING DEPARTMENT ' P 92Z 991 593 PM 3
CITY HALL ANNEX on �!
` ONE SALEM GREEN i
SALEM,'MASSACHUSETTS0197c ggA1�. ccp i � I
x
}:h-0t.ER
John Fulton
13 Beacon Street
l� -,per Salem, Mass. 01870 Vot e- q A
NAMN,
1St NOt�
2nd Nath
Roturn___,
61976-4te1 OS IIL, , IIIJ ,LIIIIII,I IIII III III III,I If 113 1111 I'll
(situ of tWem, +MUSSUc4uoetto
Public Pro#rerttl Department
wilding Department
(One ftem (Areen
588-745-9595 Ext. 388
Leo E. Tremblay
Director of Public Property
Inspector of Building
Zoning Enforcement Officer
August 31, 1994
John Fulton
13 Beacon Street
Salem, Mass. 0197
RE: 13 Beacon Street
Dear Mr. Fulton:
This office has received complaints concerning the above mentioned
property. An inspection was conducted by this office on August 30, 1994
and the following violations must be attended to.
1. Overgrowth of grass and weeds present a fire hazard and must
be removed.
2. Front and rear stairs and rails need major repairs to conform
to State Building Codes.
3. Gutters must be clean of debris and maintained.
4. The building is not being lived in, so it must be made safe
from entry.
Please contact this office upon receipt of this letter as to your
course of action on the above violations. Failure to do so will result
in legal action being taken against you.
Sincerely, /� ��/w//
Leo E. Tremblay
Inspector of Buildings
LET: scm
cc: Dave Shea
Councillor Harvey, Ward 2
Certified Mail # P 921 991 993
JUN-16-97 MON 16 : 11 000000000000 P. 02
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JUN-16-97 MON 16 : 11 000000000000 P. 03
TRY of #idem, Auoonousetto
Public Propertg department
fullbing IDeparttnent
(®nr 081em Queen
508-7454595 Ext. 390
Leo E. Tremblay
Director of Public Property
Inspector of Building
Zoning Enforcement Officer February 10, 1997
John Fulton
13 Beacon Street
Salem, Mass. 01970
RE: 13 Beacon Street
Dear Mr. Fulton:
Due to a complaint received through the Neighborhood Improvement
Committee hot line, I conducted an inspection of the above mentioned property
and found the following violations:
1. Overgrowth of grass and weeds in rear yard present a fire hazard and
must be removed and area cleaned up.
2. Front and rear stairs and rails need major repairs to conform to State
Building Codes.
3. Exterior siding needs major repairs and maintenance.
4. Gutters must be cleaned of debris and maintained.
Please notify this department within fifteen (15) days upon receipt of
this letter, to inform us as to what course of action you will take to rectify
these violations. Failure to do so will result in legal action being taken
against you.
Thank you in advance for your anticipated cooperation in this matter.
Sincerely,
Leo E. Tremblay
Inspector of Buildnos ,
LET: scm
cc: Jane Guy
Councillor Flynn, Ward 2
i
i
' - ARTICLE
r.
- P 931 991 593
UNE 1-
John Fulton, NUMBER .
13•Bea4on Street
Sa1Qm, Mass. 01.970
t FOLD AT PERFORATION WALZ r •
INSERT IN STANDARD#10 WINDOW ENVELOPE. E E R T I F I E D _
s 'z. M A I L S R '
CITY OF SALEM
NEIGIIBORHOOD IAIPROVEMENT TASK FORCE
lREFERRAL FORM
Date: /%5
Address: �� />T�• c CbL
Complaint: mr'i' /iou5r, Phone #:
CompWnant: .jc s'
DAVID SHEA. CHAIRMAN KEVIN HARVEY
BUILDING INSPECTOR ELECTRICAL DEPARTMENT
P VENTION CITY SOLICITOR
HEALTH DEPARTMENT SALEM HOUSING AUTHORITY
LICENSING POLICE DEPARTMENT
PLANNING DEPARTMENT ASSESSOR
TREASURERICOLLECTOR
f.
PLEASE CHECK THE ABOVE REFERENCED COMPLAINT AND RESPOND TO DAVE
SHEA WITHIN ONE WEEK. THANK YOU FOR YOUR ASSISTANCE.
ACTION: �'�^ �il.�—.��•- �t.v,--ems �1zo i
TItu of *Ulem' MUSSUc4uSPtts
Public Vropertg Mepartment
lRuilaing i3epartment
(Kane Balem (6rren
588-715-9595 Ext. 388
Leo E. Tremblay
Director of Public Property
Inspector of Building
Zoning Enforcement Officer February 10, 1997
John Fulton
13 Beacon Street
Salem, Mass. 01970
RE: 13 Beacon Street
Dear Mr. Fulton:
Due to a complaint received through the Neighborhood Improvement
Committee hot line, I conducted an inspection of the above mentioned property
and found the following violations:
1. Overgrowth of grass and weeds in rear yard present a fire hazard and
must be removed and area cleaned up.
2. Front and rear stairs and rails need major repairs to conform to State
Building Codes.
3. Exterior siding needs major repairs and maintenance.
4. Gutters must be cleaned of debris and maintained.
Please notify this department within fifteen ( 15) days upon receipt of
this letter, to inform us as to what course of action you will take to rectify
these violations. Failure to do so will result in legal action being taken
against you.
Thank you in advance for your anticipated cooperation in this matter.
Sincerely,
r
Leo E. Tremblay
Inspector of Buildings
LET: scm
cc: Jane Guy
Councillor Flynn, Ward 2
Ti#g of 1$ttlem, Masaar4uoeits
Public Propertg Department
aM" Nuilbing Department
tine 6alent Green
500-745-9595 $xt. 300
Leo E. Tremblay
Director of Public Property
Inspector of Building
Zoning Enforcement Officer
August 31, 1994
John Fulton
13 Beacon Street
Salem, Mass. 0197
RE: 13 Beacon Street
Dear Mr. Fulton:
This office has received complaints concerning the above mentioned
property. An inspection was conducted by this office on August 30, 1994
and the following violations must be attended to.
1. Overgrowth of grass and weeds present a fire hazard and must
be removed.
2. Front and rear stairs and rails need major repairs to conform
to State Building Codes.
3. Gutters must be clean of debris and maintained.
4. The building is not being lived in, so it must be made safe
from entry.
Please contact this office upon receipt of this letter as to your
course of action on the above violations. Failure to do so will result
in legal action being taken against you.
Sincerely,
Leo E. Tremblay
Inspector of Buildings
LET: scm
cc: Dave Shea
Councillor Harvey, Ward 2
CITY OF SALEM
NEIGHBORHOOD IMPROVEMENT TASK FORCE
REFERRAL FORM
Date.
Address: //l
Complaint: /'IY 66,j Phone #:
Complainant:
DAVID SHEA. CHAIRMAN KEVIN HARVEY
BUILDING INSPECTOR ELECTRICAL DEPARTMENT
FIRE PREVENTION CITY SOLICITOR
HEALTH DEPARTMENT SALEM HOUSING AUTHORITY
LICENSING POLICE DEPARTMENT
PLANNING DEPARTMENT ASSESSOR
TREASURER/COLLECTOR
PLEASE CHECK THE ABOVE REFERENCED COMPLAINT AND RESPOND TO DAVE
SHEA WITHIN ONE WEEK. THANK YOU FOR YOUR ASSISTANCE.
ACTION:
APPLICATION L] ADULT NUMBER
— Trial Court of Massachusetts
FW COMPLAINT JUVENILEI District Court Department
ARREST _x HEARING — SUMMONS _ WARRANT I COURT DIVISION
The Wllhid names complainant request that a COm Dlaint i55ue agI 5t the within S
named defendant. charging said defendant with the offenselsl listed b I w. 65 w
DATE OF APPLICATION DATE OF OFFENSE I PLACE OF OFFENSE somm hm 01870
3/29/95 2/95 13 Beacon Street
NAME OF COMPLAINANT NO OFFENSE .L. Ch. and Sec
City of Salem Building Department
AgpRESS AND ZIP CODE OF COMPLAINANT Massachusetts State Section
One Salem Green Building Code 104.1
Salem, Mass. 01970
2.
NAME,ADDRESS AND ZIP CODE OF DEFENDANT
John Fulton
13 Beacon Street 3.
Salem, Mass. 01970
a.
COURT USE I A hearing upon this complaint application DATEOFHFARING TIME OF HEARING COURT USE
ONLY—� will be held at the above court address on f� [%ti" 1 T AT %G. y S G'% --ONLY
CASE PARTICULARS = SPECIFIC
NAME OF VICTIM DESCRIPTION OF PROPERTY VALUE OR PROPERTY TYPE OF CONTROLLED
NO. Owner of property. Goods stolen.what Over or under SUBSTANCE OR WEAPON
person assaulted.etc. destroyed.etc. 8250. Marijuana.gun.etc.
1
2
3
4
OTHER REMARKS: Failure to respond to correspondence from building department
x
SIGNATURE OF COMPLAIN
DEFENDANT IDENTIFICATION INFORMATION — Complete data below if known.(
DATEOF BIRTH PLACE OF BIRTH SOCIAL SECURITY NUMBER SEX RACE HEIGHT WEIGHT S HAIR
OCCUPATION EMPLOYERISCHOOL MOTHER'S NAME(MAIDEN) FATHER'S NAME
C%
3
Z
D
_2
N
O
a
v
t
DC-CR2(3188)
of !�Ptticm, fttssac4uset#s
Pultlie 11rapertu department
,q Builbing Department
(One Belem (&ran
508-745-9595 Ext. 389
Leo E. Tremblay
Director of Public Property
Inspector of Building
Zoning Enforcement Officer February 28, 1995
John Fulton
13 Beacon Street
Salem, Mass. 01970
RE: 13 Beacon Street
Dear Mr. Fulton:
This office has received complaints concerning the above mentioned
property. An inspection was conducted by this office on August 30, 1994
and the following violations must be attended to:
1. Overgrowth of grass and weeds present a fire hazard and must
be removed.
2. Front and rear stairs and rails need major repairs to conform
to State Building Codes.
3. Gutters must be clean of debris and maintained.
4. The building is not being lived in, so it must be made safe
from entry.
Please contact this office upon receipt of this letter as to your course
of action on the above violations. Failure to do so will result in legal
action being taken against you.
Sincerely,
Leo E. Tremblay
Inspector of Buildings
LET: scm
cc: Dave Shea
Councillor Harvey, Ward 2
�P TRU d tt1Pm, Massar4use#ts
I9ublic trnpertq Deportment
�Q*M Nuilbing liepurtment
(One t)atrm (breen
508-745-9595 Fxt. 300
Leo E. Tremblay
Director of Public Property
Inspector of Building
Zoning Enforcement Officer
August 31, 1994
John Fulton
13 Beacon Street
Salem, Mass. 0197
RE: 13 Beacon Street
Dear Mr. Fulton:
This office has received complaints concerning the above mentioned
property. An inspection was conducted by this office on August 30, 1994
and the following violations must be attended to.
1. Overgrowth of grass and weeds present a fire hazard and must
be removed.
2. Front and rear stairs and rails need major repairs to conform
to State Building Codes.
3. Gutters must be clean of debris and maintained.
4. The building is not being lived in, so it must be made safe
from entry.
Please contact this office upon receipt of this letter as to your
course of action on the above violations. Failure to do so will result
in legal action being taken against you.
Sincerely,
CS,v �
Leo E. Tremblay
Inspector of Buildings
LET: scm
cc: Dave Shea
Councillor Harvey, Ward 2
CITY OF SALEM
NEIGHBORHOOD IMPROVEMENT TASK FORCE
//��.,� REFERRAL FORM
Date: '�`( /'/te�r
Address: ,I I Lu i
Compiaint_ / I C�Q.y(GYist¢ Y l Td l�'�—p Phone �i:
Comniainant:
DAVID SHEA. CHAIRMAN I KEVIN HARVEY
BUILDING INSPECTOR FT FC"I'RTCAL DEPARTMENT
FIRE PREVENTION I CITY SOLICITOR
HEALTH DEPARTMENT SAL M HOUSING AUTHORITY
LICENSING I POLICE DEPARTMENT
PLANNING DEPARTMENT I ASSESSOR
LlTREASURER/COLLECTOR
PLEASE CHECK THE ABOVE REFERENCED COMPLAINT AND RESPOND TO DAVE
SHEA WITHIN ONE WEEK. THANK YOU FOR YOUR ASSISTANCE.
ACTION:
Tito of tWem, massac4usetts
Public Propertg Department
NuilDing Department
(One 6alem Green
508-745-9595 $xt. 300
Leo E. Tremblay
Director of Public Property
Inspector of Building
Zoning Enforcement Officer February 28, 1995
John Fulton
13 Beacon Street
Salem, Mass. 01970
RE: 13 Beacon Street
Dear Mr. Fulton:
This office has received complaints concerning the above mentioned
property. An inspection was conducted by this office on August 30, 1994
and the following violations must be attended to:
1. Overgrowth of grass and weeds present a fire hazard and must
be removed.
2. Front and rear stairs and rails need major repairs to conform
to State Building Codes.
3. Gutters must be clean of debris and maintained.
4. The building is not being lived in, so it must be made safe
from entry.
Please contact this office upon receipt of this letter as to your course
of action on the above violations. Failure to do so will result in legal
action being taken against you.
Sincerely,
C. lKliYY' /
Leo E. Tremblay �k
Inspector of Buildings
LET: scm
cc: Dave Shea
Councillor Harvey, Ward 2
�.' Yo
APPLICPTION ❑ ADULT NUMBER Trial Court of Massachusetts
FOR COM LAIRT ❑ JUVENILE District Court Department
❑ ARREST E� HEARING ❑ SUMMONS ❑ WARRANT COURT DIVISION
The within named complainant requests that a complaint issue against the within $11i:DlstNct Gou"
named defendant, charging said defendant with the offense(s) listed below. 65 vftwii✓'1000 sheet
DATE OF APPLICATION I DATE OF OFFENSE PLACE OF OFFENSE�1g�
3/29/95 2/95 13 Beacon Street
NAME OF COMPLAINANT
City of Salem Building Department NO. OFFENSE G.L. Ch. and Seo
AgpRESS AND ZIP CODE OF COMPLAINANT
One Salem Green 1 Massachusetts State Section
Building Code 104.1
Salem, Mass. 01970
2.
NAME,ADDRESS AND ZIP CODE OF DEFENDANT
John Fulton
13 Beacon Street 3.
Salem, Mass. 01970
4.
COURT USE A hearing upon this complaint applicationDATEOFHEARING TIMEOFHEARING COURT USE
ONLY-0. will be held at the above court address on AT �� �f S / -�" *—ONLY
CASE PARTICULARS —" # SPECIFIC
NAME OF VICTIM DESCRIPTION OF PROPERTY VALUE OR PROPERTY TYPE OF CONTROLLED
NO. Owner of property, Goods stolen,what Over or under SUBSTANCE OR WEAPON
person assaulted,etc. destroyed,etc. $250. Marijuana,gun,etc.
1-
2
3
4 '
OTHER REMARKS:
Failure to respond to correspondence from building department
SIGNATURE OF COMPLAI
DEFENDANT IDENTIFICATION INFORMATION — Complete data below if known.,
DATE OF BIRTH PLACE OF BIRTH SOCIAL SECURITY NUMBER SEX RACE HEIGHT WEIGHTEYES HAIR
OCCUPATION EMPLOYER/SCHOOL MOTHER'S NAME(MAIDEN) FATHER'S NAME
V
3
z
Z
zD
z
A�
A
DC-CR2(3/88)
.. i
TitU of *al m, Massar4usPtts
((1*teQD"M0#-
Publir Prnpertg i3epartment
Nuilbing Department
(One *stem (6reen
588-745-9595 Vxt. 300
Leo E. Tremblay
Director of Public Property
Inspector of Building
Zoning Enforcement Officer February 28, 1995
John Fulton
13 Beacon Street
Salem, Mass. 01970
RE: 13 Beacon Street
Dear Mr. Fulton:
This office has received complaints concerning the above mentioned
property. An inspection was conducted by this office on August 30, 1994
and the following violations must be attended to:
1. Overgrowth of grass and weeds present a fire hazard and must
be removed.
2. Front and rear stairs and rails need major repairs to conform
to State Building Codes.
3. Gutters must be clean of debris and maintained.
4. The building is not being lived in, so it must be made safe
from entry.
Please contact this office upon receipt of this letter as to your course
of action on the above violations. Failure to do so will result in legal
action being taken against you.
Sincerely,
�1
Leo E. Tremblay
Inspector of Buildings
LET: sem
cc: Dave Shea
Councillor Harvey, Ward 2
Tito 1f #Ullem, massac4usletts
Public Prnpertg Department
Sullbing Department
(One dntem (green
588-745-9595 Ext. 388
Leo E. Tremblay
Director of Public Property
Inspector of Building
Zoning Enforcement Officer
August 31, 1994
John Fulton
13 Beacon Street
Salem, Mass. 0197
RE: 13 Beacon Street
Dear Mr. Fulton:
This office has received complaints concerning the above mentioned
property. An inspection was conducted by this office on August 30, 1994
and the following violations must be attended to.
1 . Overgrowth of grass and weeds present a fire .hazard and must
be removed.
2. Front and rear stairs and rails need major repairs to conform
to State Building Codes.
3. Gutters must be clean of debris and maintained.
4. The building is not being lived in, so it must be made safe
from entry.
Please contact this office upon receipt of this letter as to your
course of action on the above violations. Failure to do so will result
in legal action being taken against you.
Sincerely,
Leo E. Tremblay
Inspector of Buildings
LET: scm
cc: Dave Shea
Councillor Harvey, Ward 2
CITY OF SALEM
NEIGHBORHOOD IMPROVEMENT TASK FORCE
^ REFERRAL FORM
Date:
Address:
Complaint: Phone #:
Complainant:
DAVID SHEA, CHAIRMAN KEVIN HARVEY
BUILDING INSPECTOR ELECTRICAL DEPARTMENT
FIRE PREVENTION CITY SOLICITOR
HEALTH DEPARTMENT SALEM HOUSING AUTHORITY
LICENSING POLICE DEPARTMENT
PLANNING DEPARTMENT ASSESSOR
TREASURERICOLLECTOR
PLEASE CHECK THE ABOVE REFERENCED COMPLAINT AND RESPOND TO DAVE
SHEA WITHIN ONE WEEK. THANK YOU FOR YOUR ASSISTANCE.
ACTION:
BUTTERWORTH & O'TOOLE, INC.
ADJUSTFRS/APPRAISERS
FOR INSURANCE COMPANIES ONLY
P.O.BOX 8294
SALEM,MA 01971-8294
TEL. (978)741-5731 -
FAX (978)740-9109
c Iaim sRbutterworthotoole.com
02/16/2016
FORM OF NOTICE OF CASUALTY LOSS TO BUILDING
UNDER MASS. GEN. LAWS, CH. 139, SEC. 3B
TO: Building Commissioner or Board of Health or
Inspector of Buildings Board of Selectmen
City/Town Hall City/Town Hall
ADDRESSES
Salem, MA 01970 Salem, MA 01970
RE : Insured: Kelly Cook
Address : 13 Beacon Street
Salem, MA 01970
Policy No. : 2480897
Loss of: 02/14/2016 Water / Burst Pipe
File or Claim No. : 066-0164
Claim has been made involving loss, damage or destruction of the above
captioned property, which may either exceed $1, 000 . 00 or cause Mass. Gen. Laws,
Chapter 143, Section 6 to be applicable. If any notice under Mass . Gen. Laws,
Ch. 139, Sec. 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.
If no reply is received from your office within ten days, we will assume
you have no liens of any type against this property and we will recommend to the
insuring company that this claim is paid.
Jack McKeon
Adjuster
r
Member of
National Association of Independent Insurance Adjusters
� The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY
Massachusetts Slate Building Code. 780 C'MR, 7"eJition OF SALEM
Revised Jornrrrry
Building Permit Application To Construct/Repair, Renovate Or Demolish a /• =/RAY
One-or Two-Family Dwelling
ly is Section or ORcial Use Only
�•--�
I Building Permit Number: Date Applied: iJ
n / Signature: .J
',1� Building misaioner/In f B ridings Date
`'JJI\ddd CTION 1:SITE INFORMATION
I.1 Property Address: 1.2 Assessors Map& Parcel Numbers
1
I.la Is this an accepted street°yes no Map Number Parcel Number
IJ Zoning Information: IA Property Dimensions:
Zoning District Proposed Use La Area(sq 11) Frontage(11)
1.5 Building Setbacks(R)
From Yard Side Yards Rear Yard
' Required Provided Requited Provided Required Provided
1.6 Water Supply:(M.G.t.c.40,§54) 1.7 Flood Zone lmfornsatlon: 1.8 Sewage Disposal System:
Zone: Outside Flood Zone?
Public❑ Private O — Check if es❑ Municipal❑ On site disposal system ❑
/p SECTION 2: PROPERTY OWNERSHIP'Qwn// `1Reeord: ,40,f e� I�PEfCPJ� c�I
N e(Print) dress lot Service:
signature clphone
SECTION J: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction O Existing Building❑ Owner-Occupied O Repairs(s) Alterations) ❑ Addition ❑
Demolition ❑ Accessory Bldg.O Number of Units— I Other ❑ Spteily:
Brief Desert ton of P posed o '•
1
>A
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: OHlelal Use Only
Labor and Materials
I. Building IS r (] I. Building Permit Fee:s Indicate how fee is determined:
2. Electrical S ❑Standard City/Town Application Fee
O Total Project Cost(Ilem 6)x multiplier x
J. Plumbing s 2. Other Fees: S
4. Mechanical (IIVAC) s List:
5. Mechanical (Fire s _
Suppression) Total All Fees: s
Check No. Check Amount: Cash Amount:
6. Total Protect Cos l: s 7r D ❑Paid in Full O Outstanding Balance Due:
.42i(/"taC
SECTION S: CONSTRUCTION SERVICES
ti
5.1 Licensed Construction Supervisor(CSL) � J r�2
Ile
/ a IfId M 4!4/ I.icense Naumerr I:
f'bNpiratiun
N:une ul' '1.•I IuIJe List C'SL type(see below)
r 06cription
Address, U llnrestricicd to 14(M Cu. FI.
R Restricted IA2 F—it 11-111n
Signalure� M M ()nI
( �Q RC Residential Rain C'overin
cleplk r WS Residential Window and Sidin
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
3.2 R dtsn Home It pforemeet Contractor(HIC) /0_7�—) 6`-7
I IIC Co 4 y Nan err fll 'RGegist ) e —I Registration Nu ber
Address ���1 E pi one
Signatu 'fc ephne
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. ISL 125C(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 Affidevit Attached? Yes ..........0 No...........0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1 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.
Si ore of Owner Date
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
1 ,as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application we true and accurate,to the best of my knowledge and
behalf.
Print Name
�lr�N ��yZ �'e
Signatum o caner or Aut ized Agent [late
Si under the ins and penalties of 'u
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who him an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will rW have access to the arbitration
program or guaranty fund under M.G.L.c. I42A.Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 790 CMR Regulations I I O.R6 and I IO.R3,respectively.
When subnliai work is planned,provide the information below:
Tidal floors area slaISq. Ft.) (including garage,finished basement/attics.decks or porch)
Gross living area(Sq.Ft.) Habitable room count
Number Orr
f fireplaces Number of bedrooms
LT3
umber of bathrooms Number of half/baths
pe of heating system Number of decks/porches
pe of cooling system Enclosed Open
-Total Project Square Footage"maybe substituted for"Total Project Cost"
I'lie C'ununonsveallh ul'bl:usnchusc0s
Cl Board u(BuilJing Regulations and Standards 'I'1' OF
+ Massachusetts State Building Code, 730 C'(NR \L1:•\I
(' Revrwd 1/dr'rll l
.....
13tiilJiog Permit Nppiication 'ro Construct. Repair, Renovate Or Demolish a
one-or rwo-hunu(I pn'elOn.V
Phis Section Fur Olfci 1-Use OnI
Building Permit Number: D Applied: _
Building 0111cial(Print Mwnc) Signature Duce
SECTION I:SITE INFORMATION
I.I Pro y 53: � ST 1.2 Assessors Map Ss urcel Number —
I.la Is this an accepted street?yes no Nlnp Number I'urccl Number
1.3 Zoning Inrormutlon: 1,4 Properly Dimensions:
/oning District I'ropo%J Use Lot Arco(sq It) Frontage(II)
1.5 Building Setbacks(R)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.I.C. Jo.§54) 1.7 Flood Zone Information: I.g Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Lone? Municipal O On site disposals)stem ❑
Check if ros❑
SECTION1: PROPERTY OWNERSHIP'
2.1 gitrrol'Recort C 11��1j1 o lljo
1`E1A4' LpC�� v� f' Li/) . 1 `r3C 1
N;wrc Print) C' '.51at— ems_
I Re-A colt/ ST 8SI
No and Street relephune Email Address
SECTION J: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) A Alteratlo O Addition ❑
Demolition ❑ Accessory Bldg.❑ N mber or Units Ot S Icily:
�ryefpes rtplionof Proposed \Vark': `. ifn2 J Ca�✓1 1!
L�/G✓ . — / �P ic}�
SECT ON a; ESTLNATED CONSTRUCTION COSTS
bent Estimated Costs: Official Use Only
Il.,tbur and .\I;urrialsl
I. Building S 4f a()O I. Building Permit Fee: S Indicate how fee is determined:
_'. Electrical S ❑Standard City Tos+n Application Fee
❑Total Project C'ui ' eat x multiplier _ _ s
1 Plumbing S ?. Other Fees: S_� 1, \lecli.mic.il iIIC 1(') ) Lisle__
�u,we�iionl rotal .\IlFees: S____
r abo ( hacl. \'u. ( heck ;\mount l'.ish \natant
o Total 1 rnjcct Cost: ) `7 r ❑P,iid in Full 0 Ouutanding Bal.tnce Due:
SE('PIONS: CONS I'MICTION.NERVI('F:S
5.1 Consiructiot Supe isur License(C SI•) �`1 a i �_ l'q 1 Z
--- - — -- -- —/u� pip �1 _. .....____ Icense Nunlhcr isspir hol 1);to
\',unc ol'01. I loldcr
((/J�� — Iis[01. I\pe(seuhelu,tl __IG
">.._.V-Y- - - -- --,-- 'I)p,. Micripdon
No. .InJ Street
— --- I 1 h'Irlcl d I I IludJin�i li l0 1S,UU11 cu. IL1
_ (JJ—� It Nearicl.J IRS P.Imil D,tdlin
L'itsi I'uan.Suue.LII' .N \I:Isun
NC Roulin On-in
...—. AS N'indow,uld.SiJin
SF Solid Fuel Ilumin \ Iallcei
N' PP
1 Insulation
l'cic hone I mail aldres. D Demolition
3 Register d lume Impruve el t Contra `-0r(HIC) �3620 f 2 'Z i 1 Z
((/ - T IIIC Regislrn"li un Wr I.gt'rat un Dale
I Ill'.Emtrp I enlc u 1 lie i r- it c
Ny. ;ut 5 •,j�e „AA /ny� Kjb7! �.i l:muila Jnia
CI own. Sale,ZIP b 1 �1rel)c(ohlunee
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 153. 1 33C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this atlldavit will result in the denial of the Iss of the building permit.
Signed AMdavit Attached? Yes .......... No...........C
SECTION 7s:OWNERAkUTHORIZATION TO BE CONIPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES-FOR BUILDING P RAIIT
1, as Owner of the subject property,hereby authorize L ( (
to act on my behalf,in all tatters relative to work authorized by this building permit applicr tion.
LL I A 12--,
I'rinl ,ester's Nwn (Electronic.Signature) Dula
SECTION 7b:OWNER1 OR AUTHORIZED AGENT DECLARATION
By entering my name below, I hereby attest under the pains and penalties of perjury that all of the informatiun
contained in this application is true and accurate to the best of my knowledge and understanding.
l
Prim O,mtei i or:\uthorireJ.\gent'+Nnnle Ilfl¢clrunic Sign;uura) Data
.NOTES:
I. .\n Osvner who obtains a building permit to do his-her own work,or an owner who hires an unregistered cumraclur
I nut registered in the Hume Improvement Cunirnetor(HIC) Program),will rru have access to the arbitntiun
program ur guaranty lund under M.G.L. c. 1 J'A. Other impurtanl information on the HIC Program can be Inu Id at
,I,,,s n .l+. . , , •, I Inronnatiun an the Cunstruction Supersisor License can be found at ,,,,,, Ill Ip,
2. N hen substantial lwrk is planned, provide the infurntadon below:
R,ta1 flour area I sy. 11.1 - ____„_1 including garage. finished basement anics, decks or porch)
Urois living area l s+ 11.1 - )Iabilahle ruom count
\unlbcroflirel,lacei _ _-.. .___ \umherofhcdruuuu
\unther„t'hathroomi . . _ . . \lunberol hall,hathi . .
I\pc olhe.tting s)item \umher ol'decks, porches
I�pc'da'nling s\acln I'nclovcJ Opal
t "l oLII 1'fUiCe( Square l',h,l•Ige"111;1\ he NIhiIII111CJ lof 1oLIl 'rP)ecl(,bl"