1 BOARDMAN STREET - BUILDING JACKET OEs &
74520 40% P4
MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston,Massachusetts 02108.1904
(617)723.3800 Me Only(800)392-6108.FAX(800)851.8424
2/23/2017
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: NICHOLAS BUTLER JR
Property Address: 1 BOARDMAN STREET UNIT 2-1, SALEM. MA 01970
Policy Number: 1183876
Type Loss: Mold caused by:Water Damage
Date of Loss: 02/02/2017
Claim Number: 412306
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,Chapter 143,section 6 to be applicable. If any
notice under Massachusetts General Laws,Chapter 139,Section 36 is appropriate,please direct it to the
attention of the writer and include a refer"ence to the captioned insured,location,policy number,date of loss
and claim or file number.
MPIUA Claims Division
CMA00021
5 CERTIFICATE ISSUER
I" CITY OF SALEMDATE _ne • ` 1 1X93
SALEM• MASSACHUSETTS 01970. BUILDING PERMIT
a4� CERTIFICATE OF OCCUPANCY
4illiam LawnsbyDAiE August U ) 93 335-53
APPLICANT Od._ Jam_`Lp ERMIT NO.
ADDRESS
IMO.I ISTq L[11 ICO41 R'S LICC M![�
PERMIT TO. Alt:erat ions (7 1 STORY Jwellinb NUMBER OF
11•P( OL IWROv(ML MII N0, IRR OROfLO Uf[I - DWELLING UNITS
AT ILOCATIONI I -boardmsn St • Malmo_ - ZONING .
(STREETI DISTRICT_
BETWEEN Forrester St .
' Irgo[S SIR AND
[tTl'
(CROS! ST RCLTI
SUBDIVISION LOT"' BLOCK - LOT
SIZE
BUILDING IS TO BE FT. WIDE P• FT. LONG 01 FT. IN KEIGAT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GPOUP BASEMENT WALLS OR FOUNDATION
'love kit Qilen/turn kitchen into Share "too"uaEjLci r plls{tib in} RLC O be moved
REMARKS:
V
RE
�[WfMWBBY[' 171111[x
r flc.SPULR[ [(LTI
a own
OWNER F�lll :.llll .+.Ste 118 by ss+mwrsR.(Idrlrerrrs.-rlrwrsvlbe{IveIlo.�ro�rseYl slelrswrspro
L 7: " 5977�ppqN,@REMISES
ADDRESS 5 Sat Q�1�g9�T 51 DEE3/'Ok LCSMOtT TbNS OF CERTIFICATE
x DEPARTMENTAL APPROVAL.FOR CERTIFICATE
of OCCUPANCY and COMPLIANCE
To filled in by each division indicated hereon
( 466 completion lof its final inspection.
BUILDINGS Permit No. 335-93
Approved by John J.: Uennings Date 10/ 13/93
Remarks
I
is
I �
PLUMBING Permit No.
Dennis ROss 10/6/93
Approved by Date
Remarks
i
i
ELECTRICAL Permit No.
Approved by Al Fal kowski Date 10/4/93
Remarks
FIre i
OTHER Permit No.
.,Approved by, L :t Hudson Date 9/ 10/93
Remarks
I
i
OTHER Permit No.
Approved by Date
Remarks
i
I
BUILDINta
PERMIT
JOB WEATHER CARD
GATE 19
PERMIT NO. ',��—'73
ADDRESS ISip EE it ICO4TR'3 LICENSEI
APPLICANT INo.I
NUMBER OF
DWELL TNG UNITS
(_I STORY
PERMIT TO 0. IPROPOSEO VSEI
ITf2 O! IMPR Ov[M[NTI DINING
DISTRICT
AT ILOCi 110N I9i REEiI
1 NO.1
AND ICp033 Si RECfI
BETWEEN IUOSa STREET)
OT
LOT BLOCK SIZE
SUBDIVISION
FT. IN HEIGHT ANO SHALL CONFORM IN CONSTRUCTION
BUILDING I$ TO BE FT, WIDE BY FT. LONG BY
BASEMENT WALLS OR FOUNDATION
TO TYPE � USE GROUP ITYPFI
REMARKS:
PERMIT
EE S
AREA OR ESTIMATED COST S
VOLUME ICISIL 50VRRf PECTI
BUILDING CEPT,
OWNER BY INSPECTOR OF BUILDINGS
ADDRESS
ALLEY 09 SIpEW ALH OR ANY PART TrIE9EOF, EITHER TEMPORARILY
BE AP
THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET.
PERMANENTLY. ENCROACHMENTS LAMENTS ON PUBLIC PROPERTY. NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CO
EI
F PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT
DOES NOT RELEASE THE APPLICANT FROM THE CONDITION
► PROVED BY THE JURISDICTION. STREET LI ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAIN
FROM THE DEPARTMENT O
OF ANY APPLICABLE SUBDIVISION REST RICTION3. AND THIS pFpMITS ARE REO UI RED FOR
MINIMUM OF THREE
7CALLAPPROVEDARDEPT POSTED UNTBL FRINAL INSPECT I O ETINEO ON 9 HAS BEEN ELER TgAC AL ICP WM BINGABLE I AND
ANLL CORSTRVCTOONREMECHANICAL INSTALLATIONS.
TIL
I. FOU NOATIONS OR FADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE-NG SHALL NO
D. PRIOR TO COVERINONIALDNSPECB ONDAS BEEN MADEBE OCCUPIED UNMEMBEPSIREADY T' FINALIINCYCTION
POST THIS CARD SO IT IS VISIBLE FROM STREET APPROVALS
U
PLMBING INSPECTION APPROVALS
BUILDING INSPECTION APPROVALS I ��
2
GAS INSPECTION APPROVALS FIRE DEPT, INSPECTING
/APPROVALS
P ARD r F HEALTH 1
Coe ,
z
OTHER CITY ENGINEER z
INSPECTIONS INDICATED ON THIS
VOID IF CTRUCTION I
AN BE ARRANGED FOR BY TELEF
.,noir =uu_L NOT PROCEED UNTIL THE PERMIT MILL RECO eOHW TN MHSX MDN THS OFSDATE THE DR WRITTEN NOTIFICATION.
No. �.3 City of Salem Ward a
y4N.CM'n4-
V
fi
X
4culmc�
APPLICATION
FOR
PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION
IMPORTANT-Applicant to complete an items in sections:1, ll, 111, IV,and IX.
I.
AT(LOCATION) (JDA✓�✓Hdl� ?�r IJ/V/7 / ZONING '
LOCATION 004 (STREEn DISTRICT
OF BETWEEN 4- 1 rC�S,-� Y� � AND
BUILDING CR SSa REEn ICROSSSTREED
LOT
SUBDIVISION LOT BLOCK SIZE
II. TYPE AND COST OF BUILDING -All applicants complete Parts A -D
A. TYPE OF IMPROVEMENT D. PROPOSED USE-FOR"DEMOLITION"USE MOST RECENT USE
1 ❑ New building Residential Nonresidential
2 ❑ Addition(It residential,enter number of new 12 ❑ One family 18 ❑ Amusement,recreational
(rousing units added,it any,in part D,13) 19 E] Chruch,other religious
13 ® Two or morejy-Enter number
3 � Alteration(See 2 above) of units ...........&..trtvt!`,5....._..... . 20 ❑ Industrial OF
21 ❑ Parking garage
4 ❑ Repair replacement 14 ❑ Transient hotel,motel,or dormitory- 22 ❑ Service station,repair garage
Enter number of units ...........................
5 ❑ Wrecking(N multifamily residential,enter number 23 ❑ Hospital,institutional
of units in building in Part D, 13) 15 ❑ Garage ..
24 ❑ Office,bank,professional ,
6 ❑ Moving(relocation) 16 ❑ Carport 25 ❑ Public utility
7 ❑ Foundation only 26 ❑ School,library,other educational
17 ❑ Other-Specify 27 ❑ Stores,mercantile
B.OWNERSHIP
28 E] Tanks,towers
8 Private(individual,corporation,nonprofit
institution,etc.)
29 ❑ Other-Specify
9 ❑ Public(Federal,State,or local government
C.COST (Omit cents) Nonresidential-Describe in detail proposed use of buildings,e.g.,food processing plant,
/r�//L ^ machine shop,laundry building at hospital,elementary school,secondary school,college,
10. Cost of improvement ....................YX t/VV parochial school,parking garage for department store,rental office building,office building
""' 'r """ "" at industrial plant.If use of existing building is being changed,enter proposed use.
To be installed but not included
in the above cost
a. Electrical...........................................................................
b. Plumbing..........................................................................
c. Heating,air conditioning.............................................
d. Other(elevator,etc.).....................................................
11. TOTAL COST OF IMPROVEMENT s 3 Oaf
III. SELECTED CHARACTERISTICS OF BUILDING -For new buildings and additions, complete Parts E-L;demolition,
complete only Parts J& M, all others skip to IV
E. PRINCIPAL TYPE OF FRAME F. PRINCIPAL TYPE OF HEATING FUEL G. TYPE OF SEWAGE DISPOSAL I. TYPE OF MECHANICAL
30 Masonry(wall bearing) 35as 40 Public or private company Will there be central air
31 ❑ Wood frame 36 Oil
41 ❑ Private(septic tank,etc.) conditioning?
32 ❑ Structural steel 37 ❑ Electricity 44 ❑ Yes 45 ❑ No
33 Reinforced concrete 38 Coal H. TYPE OF WATER SUPPLY
❑ ❑ Will there by an elevatoR
34 ❑ Other-Specify 39 ❑ Other-Specify 42 ® Public or private company 46 ❑ Yes 47 ❑ No
43 ❑ Private(well,cistern)
J.DIMENSIONS M. DEMOLITION OF STRUCTURES:
48. Number of stories ..............................
49. Total square feet of floor area Approval r
all floors,based on exterior oval from Historical Commission been received
dimensions .-........................................ for any structure over fifty(50)years? Yes_ No
50. Total land area,sq.ft.. Dig Safe Number
K.NUMBER OF OFF-STREET PARKING SPACES Pest Control:
51. Enclosed.............................................................................
HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED?
52, Outdoors
Yes No
L RESIDENTIAL BUILDINGS ONLY Water:
53. Enclosed............................................................................. Electric:
Gas:
54. Number of Full................................... Sewer:
bathrooms DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED
Partial...................................... BEFORE A PERMIT CAN BE ISSUED.
IV. COMPLETE THE FOLLOWING:
Historic District? Yes_ NOV (If rt" please enclose documentation from Hist. Com.)
Conservation Area? Yes_ No (If yes, please enclose Order of Conditions)
Has Fire Prevention approved and stamped plans or applications? Yes_ No k Y S s el - VXA 0(<(F
�c Q
Is property located in the S.R.A. district? Yes_ No
Comply with Zoning? Yes_ No (If no nclose Board of Appeal decision)
Is lot grandfathered? Yes_ No (If yes,submit documentation/if no,submit Board of Appeal decision)
If new construction, has the proper Routing Slip been enclosed? Yes_
Is Architectural Access Board approval required? Yes_ No (If yes,submit documentation)
Massachusetts State Contractor License# Salem License#
Home Improvement Contractor# Homeowners Exempt form (if applicable) Yes No
CONSTRUCTION TO BE COMMENCED WITHIN SIX(6) MONTHS OF ISSUANCE OF BUILDING PERMIT
If an extension is necessary, please submit
CONSTRUCTION IS TO BE COMPLETED BY: in writing to the Inspector of Buildings.
V. IDENTIFICATION - To be completed by all applicants
Name Mailing address-Number,street,city,and state ZIP Code Tel.No.
IN/ i4/YI WAfhv 6oar N6gAl 41gl # ,A e a
Owner or
Leaaea D �a Cnnaur �y
2.
Contractor
Builder's
License No.
3.
Architect or
Engineer
I hereby certify that the proposed work is uthorized by the owner of record and that I have been authorized by the owner to make this application
as his authorized agent and we agree to conform to all applicable laws of this jurisdiction.
Sig tura f appl' �nt� Addr�� (/� gApplication date
DO NOT WRITE BELOW THIS LINE
VI. VALIDATION
Building 2� ^� FOR DEPARTMENT USE ONLY
Permit number �J J
Buildingl use Group
Permit issued 1 19 93
Building I /��/'�J� � /� �' ,A1I '- Fire Grading
Permit Fee $ � . �6— .U,-�f�Or ^l Live Loading
Certificate of Occupancy $ Approved by: Occupancy Load
Drain Tile $ ^�
Plan Review Fee $
ITL
NOTES AND Data-(For department use)
ary 6 v2 ,&I /LODm o
e4/ arm /LODE? ec ., cot T e
ca �iax� , dlnk& a •e Ndllej I-Z) Al�ax 4yASD . Ale-ul
C 0 e i idG a ix-efor �a�e
PERMIT TO BE MAILED TO: W///19kM GaWA+iA //tomrdryAtl qtr Sa, � �aIS, 0/97D
DATE MAILED:
Construction to be started by: Completed by:
VI ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
NOTES
SITE OR PLOT PLAN -For Applicant Use
O N
AYPLOVEB �/llf 43
Subject to approval by any otber
=t c ty having jurisdiction-
Cr,.". ci SALEM, MASS.
FLRE P;tFiMMON BUREAU
BY At X l!-w�
ptAt4 ARE APPROVED SOLELY FOR IDENTVICATION OF
TYPE AND LOCATION OF FIRE PROTECTION DEVICES"' .-
ALL FIR€ PROTECTION DEVICES ARE SUBJECT TO A'
FINALTILSTANOI I;SPCCTION,FORCOMPLETEOOMPI"';
ANCE 44TI1 Tf I E FIRE CODE
ame�memem masemw`®®®®®m_®eatmm ®g®m® fes®
Cly! -®
kithher, I 1-40
00
APP'D.� S 5�
Emma bedrorlm SIT SALEM
E
11 •] i 7Fgd 111" DEPT,
THESE DRA, I:'NGS TO BE
mommmummom 0 KEPT AY 2-1�LDING
INSP TQZI O
BUILDINGS
011
0 0
■
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■ I
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0
0
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ote:This drawing is an artistic Dwg no.
nterpretation of the general
ppearence of the floor plan.it Is
of meant to be an exact rendition.
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Design: owls 83 r Deg rw.
UI dimerrslom S elm deslgnadons This Io an original design and must Seale:1/2'= P Date : WA
;Wen are sublectto wrifi lon on not be released or copied unless
'+b oft and adjwbnerd to Ie fob applicable lee hes been paid or fob
andidom order plawd. Designer
Salem F.vice. Department-
Ft,%e P�ceventLon Swceau
48 La4ayette Street
SaZem, Ma 01970
(508) 745-7777
FFFIRE DEPARTMENT CERTIFICATE OF APPROVAL FOR BUILDING PERMIT
In accordance wZth the pnov.w-ion, o6 the Ma,64achu,6ett-6 State SuLtdtny Code
and the SaZem F-rice. Code, appltca .Ion 4,6 hereby made 4o-,L app-covaZ o4 pZans
and the 464uance o4 a cert-44dcate o4 appAovaZ jot a butZdtng penunit by the
Salem Fvice Department. (Re4. Section 113. 3, Mase. State Bldg. Code)
Job Location: � /
Owners/Occupant:
EZect,ttca.Z Cont-cacton:
F4,%e Suppne.6.64on Conttacton:
S.Lgnatwce 04 //�� �/ '
ApplLcant: f� l GB71�1/h�wUy Phone x:
Addne.6a o4 A C.i ty on.
AppZ,icant: ��OA�f�yjtliti Town: Sa/ey/
AppnovaZ date:
Ce tt4,Lcate o4 appAova2 .4E:6 hereby granted, on appxoved ptan6 we 6ubm-i tta.Z.
o4 project deta,i 2.6, by the Satem F.ice Department. AZZ pZan.6 ane approved
4oZeZy 4or. tdent444cation o4 type and tocatLon o4 4.1, a pnotectLon devtce4
and equipment. AZZ plana a+ce 4ubjeet to appnovaZ o4 any other. authon,i ty
ha.vtn.9 juAt4d.ictLon. Upon eompZetton, the appZ.Lea.nt on Zn,6ta.ZZen(4) 4ha t
,teque 6t an to apec t i,on and/o-c teat o4 the 4.4-ce pn.otect Lon devtce4 and
equtpment. ( ** FOR ADDITIONAL REQUIREMENTS, SEE REVERSE SIDE ** )
New co"tnuetLon.
Pzoperty ZoeatLon ha4 no eompZ.i.ance with the pnovt-64on,6 o4
Chaptea 148, Section 26 C/E, M.G. L. ; retative to the
.LrwtaZa tLon o4 approved 4uce aZavn devil ce4. The owne% o4
t z4,6 property 44 r.equtAed to obtain complLance a4 a
condtt.Zon o4 obtatntng a Bu.LZd ing Penm.i t.
__. .. . _._� ---P&operty Zocati.on .i.6 to compliance w.fth" the provii tons J6
Chapter 148, Section 26 C/E, M.G. L.
{
ExpZAat,Lon date: 011193 Al
*p-3 q Stgnatume o4 Fixe 064.LciaZ
Fee due: under. 7 , 500 Sq. Ft. - (is10:
7 , 500 Sq. Ft. on Zarge,. - 000
Foam #81 (Rev. 10/90 )
FIRE DEPARTMENT CERTIFICATE OF APPROVAL FOR BUILDING PERMIT
In compliance with the provision of Section 113.5 of the Massachusetts
State Building Code, and under guidelines agreed upon by the Salem Bldg.
Inspector and the Salem Fire Chief, the applicant for a building permit
shall obtain the Certificate of Approval (see reverse side) and stamped
plan approval from the Salem Fire Prevention Bureau.
Said application and approval is required before a building permit may be
issued. The Massachusetts State Building Code requires compliance
approval of the Salem Fire Department, with reference to provisions of
Articles 4 and 12 of the Building Code, the• Salem Fire Code, Massachusetts
General Laws, and 527 Code of Massachusetta Regulations.
The applicant shall submit this application with- three (3) sets of plans,
drawn in sufficient clarity, to obtain stamped approval of the Salem Fire
Department. This applies for all new construction, substantial
alterations, change of use and/or occupancy, and any other approvals
required by the Massachusetts General Laws, and the Salem Fire Code.
Exception: Plans will not be required for structural work when the
proposed work to be performed ander. the building permit will
not, in the opinion of the Building' Inspector, require a
plan to show the nature and character of the work to be
performed.
Notice: Plans are normally required for- fire suppression systems,
fire alarm systems, tank installations, and Fire Code
requirements.
Under the provisions of Article 22 of the Massachusetts State Building
Code, certain proposed projects may not. require submission of plans or
complete compliance with new construction requirements. In these
cases, provisions of Article 22, Appendix T, and Tables applicable
shall apply. This section shall not, however, supersede the
provisions outlined in the Salem Fire Prevention Regulations, Chapter
148, MGL, or 527 Code of Massachusetts Regulations. A1l. permits for
fire code use and/or occupancy shall apply for the entire structure;
fire alarm and/or smoke detector installation shall. apply to the
entire structure based upon current requirements as per Laws and/or
Codes, but the existing structure may comply- with regulations
applicable for existing structures.
Notice: Sub-contractors may also be required to file individual
applications for a Fire Department Certificate of Approval
for the area of their work. Such sub-contractors shall file
an Application to Install with the Fire prevention Bureau
Prior to commencing any work for those areas applicable.
( Form 81X (10/90)
CITY OF SALEM
3UILDING DEPARTMENT
;OMEOWNER LICENSE EXEMPTION
Please Print
DATE g/Z/93
JOB LOCATION J 6e� rs�/looi/t/ Sfi UY//7� / S^�e{yi �Oiy//y/pir/
Number Street address Section or Town
"HOMEOWNER lol /eiN/Sli-y (–no 426kv2ineSS4C_
Name Home phone Work pnone
PRESENT MAILING ADDRESS
S0�/2 in i?'I i /x/970
City/Town State p Coae
-lie current exemption or "homeowners" was extended to include owner-occupied
dwellings of six units or less dna to allow such homeowners Co engage an in-
dividual for hire who does not possess a license, provided that the owner
acts as supervisor. ( State Building Code Section 109. 1 . 1 )
DEFINITION OF HOMEOWNER:
Person(s ) who owns a parcel of land on which he/she resides or intends to re-
side, on which there is, or is intended to be, a one to six family dwelling,
attached or detached structures accessory to such use and/or farm structures.
A person who constructs more than one home in a two-year period shall not be
considered a homeowner. Such "homeowner" shall submit to the Building Official ,
on a form acceptable to the Building Official . that he/she shall be responsible
for all such work performed under the building permit. Section 109. 1 . 1 )
-he unaersioned "homeowner" assumes responsibility for compiiance �•:ith the State
Luilding code and other applicable codes , by- laws, rules and reauiations.
The undersigned "homeowner" certifies that he/she understands the City or Salem
Building Department minimum inspection procedures and requirements and that
he/she will comply with said procedures and requirements.
HOMEOWNER 'S SIGNATURE "t—m �jjtij2td�jJ„/
APPROVAL OF BUILDING OFFICIAL
NOTE: Three family dwellings 35.000 cubic feet, or larger, ,,ill be required
to comply with State Building Code Section 127.0. Construction Control .
HOME OWNER ' S 7_7EMPTION
The Code states that: "Any Home Owner performing work for which a building
permit s required shall be exempt from the provisions of this section
(Section 109. 1 . 1 - Licensing of Construction Supervisors) ; provided that is
a Home Owner engages a person(s) for hire to do such work, that such Home
Owner shall act as suoervisor. "
Many Home Owners who use this exemption are unaware that they are assuming
the responsibilities of a supervisor (see Appendix Q, Rules and Regulations
for Licensina Construction Supervisors, Section 2. 15) . This lack of aware-
ness often results in serious problems, particularly when the Home Owner
hires unlicensed persons . in this case your Board cannot proceed aaainst
the uniicensed person as it would with licensed Supervisor. The Home Owner
actina as supervisor is ultimately responsible.
-o ensure that the Home O:ner is fully aware of his/her responsibilities .
many communities require. as part of the permit application, that the Home
Owner certify that he/she understands the responsibilities of a supervisor.
On the last page of this issue 'is a form currently used by several towns.
You may care to amend and adopt such a form/certification for use in your
community.