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121 BRIDGE STREET - SEE 4 PLEASANT ST ALSO - BUILDING JACKET \ 12P BRIDGE STREET s ��,,,�,�yF � 1 ,�� ' " ��_ A � � . T. � � � NOTICE OF CITY ORDINANCE SALEM CITY OF SALEM CITY ORDINANCE Citation: 1941 �COND AqQ to � Date: 01/30/2015 :] Location: 121 BRIDGE STREET Badge Number: �' 'CIM[N�DO ,% Officer: HARRY WAGG, BUILDING DEPT Fine: 01/30/2015 $ 25 . 00 Violation: 05 REMOVAL OF SNOW/ICE FROM SIDEWALK (SCO 38-13 & 38-14) Payments : Other: $ -25 . 00 Docket : Verdict : TOTAL DUE: 05/27/2015 $ 0 .00 ABATEMENT,RECEIPT CITY OF SALEM MA-037-CO-2015-00-1941 CITY OF SALEM PARKING CLERK - 05/27/2015 sox z MI TOTAL DUE : 0 . 00 MILFORD,,MA 01757 (508)473-9660 ABATEMENT INFORMATION 05/27/2015 $25.00 SCHMIDT,PAMELA B DISMISSED IN COURT 121 BRIDGE STREET SALEM,MA 01970-0000 f153 DOCKET NUMBER 116 Trial Court of Massachusetts NO ' TICE OF NEXT EVENT District Court Department CASE NAME City of Salem v. Pamela Schmidt ATTORNEY(OR PRO SE PARTY)TO WHOM THIS COPY OF NOTICE IS ISSUED COURT NAME 8 ADDRESS City of Salem Salem District Court Bldg. Inspector 56 Federal Street 120 Washington Street Salem, MA 01970 Salem, MA 01970 NEXT COURT EVENT JUDGE OR MAGISTRATE(if already assigned) Magistrate Hearing 05(15/2015_a 1-1:_00,AM Clerk Magistrate Session No CELL. AAA COUNSEL FOR ALL PARTIES(OR PROSE PARTY) AAA ��®. E.D MUST APPEAR ON THE DATE&TIME SHOWN ABOVE 1 TO THE PARTIES TO THIS CASE: The nature, date and time of the next scheduled event concerning this case is indicated above. You are required to be present at this event. If you have good reason to request the Court to reschedule this event for another date, such request must be made by motion in accordance with the applicable court rule. Please note that the granting of a continuance is not automatic even when all the parties agree. Further Orders of the Court. DATEISSUED CLERK-MAGISTRATE March 27, 2015 Brian K Lawlor 014 www.mass.gov/courts Daterrime Printed 03-27-20151332:35 1 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION Two Center Plaza Boston, Massachusetts 02108-1904 (617) 723-3800, Ma Only(800) 392-6108, Fax (617) 557-5675 10/21/99 Form of Notice of Casualty Loss to Building Under Mass. Gen. Laws, Ch. 139, Sec.313 fUa�� SALEM BUILDING COMMISSIONER 2' SALEM CITY HALL ✓✓�r SALEM MA 01970 Re: Insured: PAMELA B. SCHMIDT Property Address: 121 B BRIDGE ST., SALEM, MA 01970 Policy Number: 0387240 Type Loss: Water Damage Date of Loss: 05/12/99 Claim Number: 175871 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. If any notice under Massachusetts General Laws, chapter 139, Section 3 B 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 Two Center Plaza Boston, Massachusetts 02108-1904 (617) 723-3800, Ma Only (800) 392-6108, Fax (617) 557-5675 04/08/99 Form of Notice of Casualty Loss to Building Under Mass. Gen. Laws, Ch. 139, Sec.313 ID SALEM BUILDING COMMISSIONER �� f S �Y' SALEM CITY HALL JL- SALEM MA 01970 60 5 J PAMELA B. SCHMIDT f� Re: Insured: Property Address: 121 B BRIDGE ST., SALEM, MA 01970 Policy Number: 0387240 ��- Type Loss: Water Damage Date of Loss: 03/15/99 Claim Number: 172382 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. If any notice under Massachusetts General Laws, chapter 139, Section 3 B 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 J -Sl� T ,�e5 CITY OF SALEM NEIGHBORHOOD IMPROVEMENT TASK FORCE Jurisdiction Hist. Comm. Yes ❑ NO 11 REFERRAL FORM Cons. Comm. Yes 0 No 11 SRA Yes ❑ No 11 Date: i Address: Complaint: y, 1)7 U- t- /4 J mac/ � r � Complainant: 16 the l c� Phone#: Z " �3 3 Address of Complainant: f 2/ /7t ; Jc,£ f� BUILDING INSPECTOR KEVIN HARVEY L'hecl� : _ /f) i/.U/v7'rn FIRE PREVENTION ELECTRICAL DEPARTMENT HEALTH DEPARTMENT CITY SOLICITOR ANIMAL CONTROL SALEM HOUSING AUTHORITY PLANNING DEPARTMENT / POLICE DEPARTMENT (,Heti v�;Yw C.7..i (46.4 / t' 10S �K/ ✓ eC4 1C/Ot'2`fJ TREASURER/COLLECTOR ASSESSOR f F DPW SHADE TREE DAN GEARY PLEASE CHECK THE ABOVE REFERENCED COMPLAINT AND RESPOND TO DAVE SHEP WITHIN ONE EEK. THANK YOU FOR YOUR ASSISTANCE. AC N: Q 92) SaRVata c-A Ewy 4335'�-N- �6llow eafagiaaaa,eaflfo¢nia 97302 �� • � ��.� ,�� eek ,G� xs � .�� .� ism' � � �t ,9� ��• C64146 AO d � � /`� �m of �ttlem, Massar4usetts ' ' tlublic jlrapertg Department �e�� Nuilbing Department (One sialem (6reen 500-145-9595 Fxt. 300 Leo E. Tremblay Director of Public Property Inspector of Building Zoning Enforcement Officer February 2 , 1996 Barbara A. Erny 4335 N. Willow Glen Road Calabasa, California 91302 RE : 4 Pleasant Street Dear Ms . Erny: This office is in receipt of your letter dated January 26 , 1996 regarding the variance from the Board of Appeal at the above mentioned property. April 14 , 1996 is an acceptable date for your tenants to be moving out . Please notify this office when your apartment have been vacated. Thank you for your cooperation in this matter . Sincerely -� , Leo E . TremK Inspector of Buildings LET: scm cc: David Shea Tom Keough Councillor Flynn, Ward 2 �� c��' , ��s � y33 7 ,� � � PLANNTNG DEPARTMENT Aft, : • � • s /J�_i/ _ � I I � �� Sys'' ��3� vF j O Tito of 3ttlem, fttssar4usetts � q Publir DJrapertn i3epartment iguilbing Department (One t�alem lrireen 588-745-9595 Ext. 388 Leo E. Tremblay Director of Public Property Inspector of Building Zoning Enforcement Officer September 20, 1995 Barbara Erny Z•L 4335 North Willowgl^ e—n ~� Calabasas, California 91302 i RE: 121 Bridge Street\4 Pleasant Street Salem, Mass. 01970 Dear Ms. Erny: It has come to the attention of this office through the Neighborhood Improvement Committee hot line that you may be using the property located at the above mentioned location illegally. It has been alleged that there are more than (3) three unrelated persons occupying a one single family dwelling unit. If this is so, it is in violation of the City of Salem Zoning Ordinance, ,article II, Definition Section 2-1 general rules (Family) . Please contact this office upon receipt of this letter as to notify us of your intention in this matter. Failure to do so will result in legal action being taken against you. Thank you in advance for your cooperation in this matter. Sincerely, 'fie: Leo E. Tremblay i Inspector of Building I LET: scm cc: Dave Shea Councillor Harvey, Ward 2 i � Certified Mail P .921 991 834 i i r .- av (situ of �tticm' Aassar4uBctts Public Propertp Department iguilbing i9epartment (One dalem Green 508-745-9595 Ext. 3tltl Leo E. Tremblay Director of Public Property Inspector of Building Zoning Enforcement Officer September 20, 1995 Barbara Erny 4335 North Willowglen Calabasas, California 91302 RE: 121 Bridge Street\4 Pleasant Street Salem, Mass. 01970 Dear Ms. Erny: It has come to the attention of this office through the Neighborhood Improvement Committee hot line that you may be using the property located at the above mentioned location illegally. It has been alleged that there are more than (3) three unrelated persons occupying a one single family dwelling unit. If this is so, it is in violation of the City of Salem Zoning Ordinance, Article II, Definition Section 2-1 general rules (Family) . Please contact this office upon receipt of this letter as to notify us of your intention in this matter. Failure to do so will result in legal action being taken against you. Thank you in advance for your cooperation in this matter. Sincerely, Leo E. Tremblay Inspector of Building' LET: scm cc: Dave Shea Councillor Harvey, Ward 2 Certified Mail # P 921 991 834 1 - ARTICLE • P 921 991 834 UNE 1• Barbara Erny NUMBER e 4335 North Willowglen Calabasas, California 92302 t FOLD AT PERFORATION t -� WALZ INSERT IN STANDARD#10 WINDOW ENVELOPE. f , [E A T I T I E O M A I L S A 1ni i I PasTAc'E POSTMARK OR DATE of RETURN SHOW TO VMOM,DATE AND/ RESTRICTED RECEIPT / W ADDRESSOFDEWERY . DELIVERY SERVICE CERTIFIED FEE+RETURN RECEIPT WN �- TOTAL POSTAGE AND FEES - >N Z M0 EC RAGE PROVIDED- Wp SENT TO. NOT FOR INTERNATIONAL MAIL �WQ 0¢ `p K Barbara Erny `Po 4335 North Wi: lowgian,, Calabasas. California 92302 �o Fu F x 31 NV Vex lk. a A "� PS FORM 3800 i RECEIPT FOR CERTIFIED MAIL °' Po.EmVE �. - ----- ---------------------------------- --------- ------ ----- -- STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES(see front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address of the article,leaving the receipt attached,and present the article at a post office service window or hand it to your rural carrier(no extra charge). t. 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the return address of the article,date,detach and retain the receipt,and mail the article. 3. If you want a return receipt,write the certified-mail number and your name and address on a return , receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space permits.Otherwise,affix to back of article.Endorse front of article RETURN RECEIPT REQUESTED adjacent to the number. 4. If you want delivery restricted to the addressee,or to an authorized agent of the addressee,endorse RESTRICTED DELIVERY on the front of the article. 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.If return receipt is requested,check the applicable blocks in item 1 of Form 3811. 6. Save this receipt and present it if you make inquiry. �� SENDER: • Complete items 1 and/or 2 for additional services. I also Wish to receive the • Complete items 3,and as s s following services(for an extra fee): • Print your name,and address on the reverse of this form so that we can return this card to yop, 1. ❑ Addressee's Address • Attach this forrq 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. ❑ Restricted Delivery • The Retverurn Consult postmaster for fee. Recgipt Fee will provide you the signature of the person delivered to and the data of deli 3.Article Addressed td: r i 4a.Article Number "r..b.tr.c Lr.t P 921 991 834 L 31$ .i�%.h 1.1,1 }t3 u e . 4b.Service Type )K.,CERTIFIED 7.Date I � 5.Signature (Addressee) 8.Addressee's Address (ONLY if requested and fee paid.) v 6.Signature—(Agent) PS Form 3811,November 1990 DOMESTIC RETURN RECEIPT i United States Postal Service �. + Official Business ,.-- .. /Qcc PENALTY FOR PRIVATE USE,$300 II III III III III III IIIIII III III IIIIIIIIIIIIIIIIIIIIIII INSPECTOR OF BUILDINGS ONE SALEM GREEN SALEM MA 01970-3724 �o Cfity of �ttlem, Mamiar4usetts Public Propertg Department Nuilbing Department (One dalem (5reen 508-745-9595 CO. 300 Leo E. Tremblay Director of Public Property Inspector of Building Zoning Enforcement Officer September 20, 1995 Barbara Erny 4335 North Willowglen Calabasas, California 92302 RE: 121 Bridge Street\4 Pleasant Street Salem, Mass. 01970 Dear Ms. Erny: It has come to the attention of this office through the Neighborhood Improvement Committee hot line that you may be using the property located at the above mentioned location illegally. It has been alleged that there are more than (3) three unrelated persons occupying a one single family dwelling unit. If this is so, it is in violation of the City of Salem Zoning Ordinance, Article TI, Definition Section 2-1 general rules (Family) . Please contact this office upon receipt of this letter as to notify us of your intention in this matter. Failure to do so will result in legal action being taken against you. Thank you in advance for your cooperation in this matter. Sincerely, Leo E. Tremblay Inspector of Building LET: scm cc: Dave Shea Councillor Harvey, Ward 2 Certified Mail # P 921 991 834 CITY OF SALEM NEIGHBORHOOD IMPROVEMENT 'CASK FORCE REFERRAL FORM Date: Address: Complaint: 2Z- 7`t� 2� -�. LL� ✓� �� Complainant: Phone#: Address of Complainant: DAVID SHEA. CHAIRMAN KEVIN HARVEY BUILDING INSPECTOR ELECTRICAL DEPARTMENT FIRE PREVENTION CITY SOLICITOR HEALTH DEPARTMENT SALEM HOUSING AUTHORITY ANIMAL CONTROL POLICE DEPARTMENT PLANNING DEPARTMENT ASSESSOR TREASURER/COLLECTOR DPW WARD COUNCILLOR DAN GEARY SHADE TREE PLEASE CHECK THE ABOVE REFERENCED COMPLAINT AND RESPOND TO DAVE SHEA WITHIN ONE WEEK. THANK YOU FOR YOUR ASSISTANCE. ACTION: Lesley Management Group October 25 , 1994 Leo Tremblay Building Department One Salem Green Salem, MA 01970 Dear Mr . Tremblay : In reference to your letter of September 27 , 1994 regarding the number of unrelated people living at 4 Pleasant Street , please be advised that the reported problem has been resolved and that thereare now three students on the lease and living at this residence . Thank you for your attention to this matter and please contact Lesley Management Group if any other matters of concern arise . Sincerely yours , Mark W. Livermore Property Manager MWL/lls P.O. Box 946 • Marblehead, MA 01945 (617) 639-0534 4�, j !�° `��alRv �" T a" �° SENDER Complete items 1 and/or 2 for additional services. I also wish to receive the • complete items 3,and 4a,a la following services(for an extra fee): • Print your name and address on the reverse of this form so that we can return this card to you. 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. ❑ Restricted Delivery • The Return Receipt Fee will provide,you the signature of the person delivered to and the date of deliver . Consult postmaster for fee. 3.Article Addressed to: 4a.Article Number P 921 991 612 Ms. Si Earny 4b.Service Type 4335 N.Idtllclw Glen Cnlab-mvi, C3+: 95302 � CERTIFIED '7 Date of Del er 5.Sign e-t dresse ) _ B.Addressee's Address (ONLY if requested and fee paid.) 6.Signature—(Agent) PS Form 3811,November 1990 DOMESTIC RETURN RECEIPT United States Postal Service II I I II Official Business PENALTY FOR PRIVATE USE,$300 INSPECTOR OF BUILDINGS ONE SALEM GREEN SALEM MA 01970-3724 V, w 3 ` a Titg of tt1Em, 1Eitt ttrl�u Pt# Ilublic 11rnpertg Department Nuilbing Department (One f3atem Green 508-745-9595 $xt. 380 Leo E. Tremblay Director of Public Property Inspector of Building Zoning Enforcement Officer October 24, 1994 Ms. Barbara Earny 4335 N.Willow Glen Calabasas, Ca. 91302 RE: 121 Bridge St./ 4 Pleasant St. Salem, Mass. Dear Ms. Earny: This office sent you a letter on September 27, 1994 concerning the alleged illegal use of you condo (Letter enclosed) . We asked you to contact this office to inform us as to your course of action in this matter. We have failed to hear from you as of October 24, 1994. If I do not have contact from you either by mail or by telephone by November 15, 1994, I will file papers through the Salem District Courts in order to resolve these issues. Thank you in advance for your anticipated cooperation in this matter. Si 77ncerel �24n LGc Leo E. Tremblay Inspector of Buildings LET: scm cc: Dave Shea Councillor Harvey, Ward 2 Certified Mail li P921 991 612 4 . Tttu of 81em. Massac4usjetts ? i'¢ Publir frapertg Department Nuilbing Department (One ftlem Srren 508-745-9595 ;Ext. 380 Leo E. Tremblay Director of Public Property Inspector of Building Zoning Enforcement Officer September 27, 1994 Ms. Barbara Earny 4335 N. Willow Glen Calabasas, CA 91302 Re: 121 Bridge St./4 Pleasant St. Salem, MA Dear Ms. Earny, This office has received a complaint alleging. that there are more than three (3) unrelated people living in your condominium located at the above mentioned address. It is a violation of the City of Salem Zoning Ordinance to have more than three (3) unrelated people living in one unit. Please call this office upon receipt of this letter so we may attend to these alleged violations. Failure to do so will lead to legal action being taken against you. Thank you for your anticipated cooperation regarding this matter. Sincerely,,/, /. Leo E. Tremblay Director of Public Property c.c. David Shea Ward Councillor CITY OF SALEM NEIGHBORHOOD EAPROVEMENT TASK FORCE REFERRAL FORM Date. S y Address: Complaint: Tao / aw rte lg*-Jw,,2e-w e- Phone #: t!/o�7�s.✓ e� LrYI'i9/�.G+Ca[.S �Ly.�6rB A '✓ �Y. Ilea.)621tia C9 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 V PLEASE CHECK THE ABOVE REFERENCED COMPLAINT AND RESPOND TO DAVE SHEA WITHIN ONE WEEK. THANK YOU FOR YOUR ASSISTANCE. ACTION: o =L UP 2 11 1991 i ccpt ARTICLE • P 921 991 612 UNE i. ; NUMBER Ms. Barbara Carny 4335 N.Willow Glen Calabasas, CW 91302 t FOLD AT PERFORATION t Fir, r 1F WALZ INSERT IN STANDARD#10 WINDOW ENVELOPE. E E R T I f I E D M A l l f 0.TH (situ of *Ulem, Massac4usetts Public Propertq Department Nuilbing Department (One Belem Green 588-745-9595 >Ext. 300 Leo E. Tremblay Director of Public Property Inspector of Building Zoning Enforcement Officer September 27, 1994 Ms. Barbara Earny 4335 N. Willow Glen Calabasas, CA 91302 Re: gI21"Budge St./4 Pleasant St. Salem, MA Dear Ms. Earny, This office has received a complaint alleging that there are more than three (3) unrelated people living in your condominium located at the above mentioned address. It is a violation of the City of Salem Zoning Ordinance to have more than three (3) unrelated people living in one unit. Please call this office upon receipt of this letter so we may attend to these alleged violations. Failure to do so will lead to legal action being taken against you. Thank you for your anticipated cooperation regarding this matter. Sincerely, Leo E. Tremblay Director of Public Property C.C. David Shea Ward Councillor CITY OF SALEM NEIGHBORHOOD E14PROVEMENT TASK FORCE �+ REFERRAL FORM Date: // y c� n Address: T �<e/9�i¢ /Complaint: 7m— /!tel gfy5yyNr�1 �� Phone #: L.4u�� tP/I �/�N /N�/s✓ ��o/7/e.✓ e� G2� i��/oG�B��S�,`�.�brB �1�� 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: STP 2 11 1994 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION Two Center Plaza Boston, Massachusetts 02108-1904 (617) 723-3800, Ma Only (800) 392-6108, Fax (617) 557-5675 07/23/99 Form of Notice of Casualty Loss to Building Under Mass. Gen. Laws, Ch. 139, Sec.3B SALEM BUILDING COMMISSIONER SALEM CITY HALL SALEM MA 01970 Re: Ins-red: PAMELA B. SCHMIDT Property Address: 121 B BRIDGE ST., SALEM, MA 01970 Policy Number: 0387240 Type Loss: Water Damage Date of Loss: 05/05/99 Claim Number: 173876 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. If any notice under Massachusetts General Laws chapter 139, Section 3 B 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 — — The Commonwr:lth of MassaChusetls AI t\ Hoard of 11,111ding Regulations and Standaids \II I'll II' \I Il 1 \�\ i %1assaChusettS State Building Code. 7S'O('\1R. 7 edition SI Building Permit Application To ('onstruex. Repair. Reno%:ue Or Demolish a R, nrJ huu,,n i — (hir- r)r" Tu u-l•iuluh Dirrllin,t -- -a This Seen yr ,eclat the Only —1 Building Permit N nber: Dale \pplied: --1 Building Cuinmi..w el/ Inslxclur of Bull wgs Dale ' SECTION 1: SITE INFORMATION 1.1 Pr pore .Address: ,Z 12 .Assessors Slap & Parcel Numbers o _ t.la In this cut accepted street ' yes ll'tp Numh,:r 1.4 I 1 - Zoning District_—_ Proposed Use I Lot Area isy tit Flounce (li) I 1.5 Building Setbacks (ft) �------ - Frmi Yard Side Yards Rrar Y;uJ -- TI RryRequiredJ Provide) RcyurJ PruoiJeJ RaywreJ -1--- Pine iJ,J 1.6 Water Supply: (M.G.L c 10, §54) 1.7 Flood Zone Information: 11.8 Sewage Disposal System: Zune: Outside Fhx)d Zone'.' � Public E]� Private ❑.. — 1 4ALinicipal 8 On site Jisinrsal sysiem ❑ Check if yes❑ _- SECTION 2: PROPERTY OWNERSHIP' 2.1 Owners of Record-. I '' �•+/ _��dpt He d Yi ✓ .,lJd7�e C _ 1 -A2 41 a1 p 6 cJ f Name PrinU Address for Service: Signature ielephune —SECTION 3: DESCRIPTION OF PROPOSED WORK (checkk all that apply) r.v Cunsrrov(ion ❑ Exixtinl. Buildings Owner-Occupied ❑ Repairsls) ® I \iteraunnlsi L�C!pob t ,n _CAI Accessui� Bldg. ❑ I Number of Units c1. Other ❑ Spei sly _- Brief Description of Proposed 1V' irk': Lr�r,e ✓C E x id' i�� /�7A.Sa nIN.0 if yviQQ_.—__ l -�tyel P/�_�.fo eel r►r - �d�._/� .�. ..N6� �5'�'-f.... o�__s�'��o,:�s_.�s2-.Sd_P/q�fn�er.,_ i -- �_ —— - i SECTION d: ESTIMATED CONSTRUCTION COSTS li�m Estimated Costs: Official Use Only (Labor and Materials) _ I. Building S 1. Building Permit Fee:.$ Indicate how Ice is Jeiennutrd ❑ Standard City/Town Application Fee '_. Electrical ❑ Total Project Cost' (Item 6) x multiplier x _ 1. Plumbing .S '. Other Fees: S 4. Mechanical (HVAC) $ List: __- 5. Mechanical (Fire Total :\Ii Fees: --- Su) ressiun) p 09 Check No. Check :\mount: <'.uh A11101,1111 -- _ 0 Fatal Project Cost' S 38a� ❑ Paid in Full ❑ Ou(aGmdint-, Balance Due: 7 33- Oo s SECTION 5: CONSTRUCTION SERVICES S.I Licensed Construction Supervisor (C'SL) /►` ��ty�/ �� /� _o20ld [-11CIn.c N'umher !`.,pir.wuu I).ne Nauta IIIZ'SI.- I1"Ider ,�[� / e(�� G a L/J 6n,''�"�c✓O R. ( q IB�M 6(! LioI('St. f,pe„a•hrlowl —�.F,yd AJ, /y1 R, Ty c Dr,cl'III Io❑ N Rr,uietrd L@_ f.lnuh D"elline � Sipialnre %I >I:monry Daly _9ylR—ye33o/ KC Rr,idcnual Roolinc nnn�_ (rlr Rune P AA$ Ke,id.uual All ndoa,_u;J — SP Re,idnw.tl .Solid Furl 8wniu D Re,idenlial Deniolwon 5.2 Registered Home Improvement Contractor(1110 — HIC Company Name or HIC Registrant Name Rep,trauom Nuwher Address Enpration Date ;timwrr -!'c'eprlome SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c, 152. § 25C(6)) Workers Compensation Insurance affidavit must be comple(ed and submitted with this applieauon. Failure u: provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes .......... ❑ No __...._. O SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owner of the subject property herebv authorize to act on my behalf, in all matters re!ative to wotk authorized by this building permit application. N swilature 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 are true and accurate, to the best of my knowledge and behalf. Print Name - -- -- Signature of Owner or Author zcd .Agcrt Date (Si med under the alas and penalties ill er u ) NOTES: 1. An Owner who obtains a building permit to du his/her own work. or an owner who hires all unreglstetcd contra'lor1 (nut registered in the Hume Improvement Contractor (HIC) Program). will not have acces, to Ine arbitration program or guaranty fund under M.G.L. c. 142A. Other important information on (he HIC Pr(,Lrtm and Construction Supervisor Licensing WSL)can be ti and in 780(.'N1R Regulations I M R6 and I I0.R5, re,pectncly ' When substantial work is planned, provide the information below: Total floors area(Sy. Ft.1 (including garage, finished haserne❑t/amcs. decks or porrhi Gross living area a Sq. Ft.) Habitable room count Number of fireplaces Numberofhedroum, Number of hathmoms Number of hilt/hash, ------------------ .... l-cpe of hearing system -_ Number otdeck,/ porche, F}pe of cooling sy,lem Opal i. ' Total Project Square Footage" tnay he ellbNotuted tor "Fo(al Project ('o,I" — � CITY OF SALEM Y `r' Aa; PUBLIC PROPRERTY DEPARTMENT '.I i ilc f_'Q I:IT • 7.\II\ . \l.\ii\( -II - I.I I. ')7Y-745-9595 1 l'\S: 'i 78 .74:9541, Construction Debris Disposal Affidavit (tvtlttired fix all demolition and renovation work) In accordance \N ith the sixth edition of the State Building Code, 780 CMR section 1 1 1.5 Debris, and the prop isions of!bIGL c 40, S 54; Building Permit # is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c l 11, S 150A. The debris will be transported by: �/ cs (name of I uler) I lie debris will be disposed of in (name of tacili ) �ald�ipsco`7yL (address otfacility) signature of permit applicant plate , t --- I'lie Commonwealth of Massachusetts Huard of Building Regulations and SI;mJards CI I'1'OF NLtssachusetts State Building Cude,'75O(AIR Building Permit AppliC;diun To C'unstnlct. Repair. Renovate Or Demolish a Or:e-fir ru'n-Fumllr Dtre/lilt This Section For OI eial Usc Orel Building Permit Number: ate Appl' lluilding 011iciul(Print N;une) Si Uatc SECTION 1: SITE INFORIIIATION 1.1 Property Addres t 1,2 Assessurs NIap di Porce I.la Is this an acre ted stria . 'es no 1 .%fap Numhcr Purccl Number I.! Zoning Information: 1.4 Property Dimensions: /.uning District 11ropowd Uw Lot Area Uq 11) Frontage(11) 1.5 Building Setbacks(1111) From Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.I.c. 40.134) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: lhiblic❑ private❑ Zone: _ Outside Flood Z, Municipal O On site disposal s)stem ❑ Check if ycsC SECTION2. PROPERTY OWNERSHIP' 3.1 wner'of Record: 3rairnfltl Cxl�rnidk �41erv, m/� ISI970 Name(Print) City,State,ZIP l al F>rl'dc e Ad, 97Y'59B 7�337 No.mid Street - relepbone Email Address SECTION J: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction O Existing Building❑ Owner-Occupied ❑ Repairs(s) Alteratlon(s) ❑ 1 Addition ❑ Demolition ❑ Accessory 13ldg.0 Number of Units_ Other ❑ Spccily: Dricf Description of Proposed Work-: rl Vip ✓dgxv tuory- : h4 dory- SECTION J: ESTLMATED CONSTRUCTION COSTS hem Estimated Costs: Ofllclal Use Only i Labor and .\Lmerials) I. Building S ) -73o 1. Building Permit Fee: S Indicate how tee is determined: I _'. Glearical S i O Standard CityrTu,vn Application Fee ❑Tutal Project C ostt(hesn 6)x multiplier 1 I'hunhing S i ]. Other Fees: S - J, \Icch.mical III\ \('1 i List:.- Vrch.mic.tl 0 ory --------.-- \u pres;ionl S rotalAllFees: S_.-'----_ —'— '-' _ .. .. . ._ . . Check No. ('heck Amount: l'.lah \moms : n 1'nlrl project Cnvt: i Ji 73b ❑ P,lid in Full C3 Onisumding Bal.mcc Doc: SECHONS: ('l)NSl'R(i("f10NSERVI('F.S 5.1 C'onstructiml Supen ieor License(C'SI.I 9 q 17 a -- - .� 1�low Iicen,u Nunlhcr Ivpiraiou l>aIt Naneo(ILSLIloldv�rv ' II.tCSL1'%Fwlsecalusvl.__._ 'I)pt Ucicription No. and Seet tr GG U U (III (hlfcslriol d(Duildin's li it) 35.001)CIn. It _ U0. MA' 0 )gd6.__----- -- R Itc,trictcd IRSP.unil Deellin Cilvil'o++n. talc.Lll' %I .Mastro RC ltmwin Covcrin H'S Window.wJ Sidin SF Solid fuel Burning Appliances 1 Insulation l'elc holry tannin aJdreis U Danoliliun 5,2 Registered fiume Improvement Contractor(IIIC) lyE6$$ l0 1a r rr�a L,Ot,✓QS ��(11PS lip r\`�Cf S )IIC Registration Nwnher f?cpiruliun Uutc I IIC Con tin) Nana or I IIC'I(}•gistrw t Nano I� Qp^"��.�,,`� � B In( -�...,_ c ..� a laf6 Siou�{'1lb�A,GH /IIFl hil_'.Y1dM� Nu. and Su.e 0I77 k; ddrrrs• nr6V , M A- e17,A. 417-391-o 116 city own,State ZI Telephone SECTION tit WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c. I52. 1 23C(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 Affidavit Attached? Yes .......... No...........O SECTION 7a:OWNERAUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner of the subject property,hereby authorize gfcl ( hr, lent[to act on my behalf,in all mattersrr to work authorized b his building permit application. I ad 1'rinl Uwncr's Nwne(Elcclrunle Slgnuturc) SECTION 7b:OWNER' OR AUTHORIZED AGENT DECLARATION By entering Illy name below, I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. I'rinl U+1 ner's ur:\ullnmied A�enl'i Nunes IIJecln arse Slgnaluro) Dale Noyes: Owner who obtains a building pmnil to do his. own work.or an owner who hires an unregistered cuntrnctur Uwe registered in the Hume hnprovennent Contractor IHIC) Program).will nu have access to the arbitration program ur guarant) fund under>I.G.L.c. 142.4. Other impurtant int'urmation on the HIC Program can be liwnd at I Information on the Construction Supervisor License can be found at +I p„ In.1,; wok 'It', \\hen substantial Iwrk is planned,provide the information below: total flour area I sy. t1.1 . _—__.__I including yaroye, finished bascnlenl attics.J¢cks ur porch I Gross It%ing ,ilea I sy. 11.1 H:Ibitablt room count \till&cr of lircplaces .. ... _. _... .J— Number tit'hcdroulrts _ . . \unlher ofhathraumns \umber ul'hall halhi l I\pe of hc.lting i)urul \wnher o1 Jccki• p++rchcs f)J,vofcoollltg i)aenl I'ncln,iJ . .Open t l'fojed $,hlllfe tPUI.11a" tillly I+c suh,tiudcJ tiV"I',o,d Protect C+bl" RECEIVED The Commonwealth of Massachusetts 201pe�tf�t jn'APap'l 6afety Massachusetts$"tate$ut'�ding ode(780 CMR) Building Permit Application for any Building other than a One-or Two-Family Dwelling (This Section For Official Use Only) Building Permit Number: Date Applied: Building Official: SECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which a street address is not available) I o No.and Street City/Town Zip Code Name of Building(if applicable) SECTION 2:PROPOSED WORK Edition of MA State Code used If New Construction check here❑or check all that apply in the two rows below Alteration ❑ Addition❑ Demolition ❑ (Please fill out and submit Appendix 1) Existing Building 0 Repai4 Change of Use ❑ 1 Change of Occupancy ❑ Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No ❑ Is an Independent Structural Engineering Peer Review required? Yes ❑ No ❑ Brief Description of Proposed ork: I ICY I IV Vr,It Trait 1 1 (0 SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑ Existing Use Group(s): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) Total Area(sq.ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ 1 B: Business ❑ E: Educational ❑ F: Facto F-1 ❑ F2❑ 1 H: High Hazard H-1❑ H-2❑ H-3 ❑ H-4❑ H-5❑ I: Institutional I-1 ❑ I-2❑ I-3❑ 14❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R-4❑ O S: Storage S-1 ❑ S-2❑ U: Utility❑ Special Use❑and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ 1 IV ❑ 1 VA ❑ VB ❑ (� SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) J' Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: Public❑ Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be Licensed Disposal Site❑ Private❑ or indentify Zone: or on site system❑ required❑ or trench or specify:permit is enclosed ❑ Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process: INot Applicable❑ Is Structure within airport approach area? Is their review completed? 1.— or Consent to Build enclosed❑ Yes❑ or No❑ Yes❑ No ❑ ` SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s): Type of Construction: Occupant Load per Floor: Does the building contain an Sprinkler System?: Special Stipulations: CV1 fa l L--C'17 • SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner �?L mAlu 5LkmA+ lal iery\ 6IT76 Name(Print) No.and Street J City/Town Zip Property Owner Contact Informatio Ofvnt�r � �9° 9 Title Telephone No. (business) Telephone No. (cell) e-mail address IfaP.�licable,the proper owner hereby authorizes ' I'SrC�Gr� a�br1P /3(0 ✓n'Gf�eQ �— g(77 Name Street Address City/Town State Zip to act on the property owner's behalf,in all matters relative to work authorized by this building permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) If building is less than 35,000 cu, ft.of enclosed space and/or not under Construction Control then check here E3 and skip Section 10.1 10.1 Re 'stered Professional Res onsible for Construction Control (,owed 4me C.Oh4k S G9- 9- e9`fb riehard' [�nna/us e FGY Name(Registrant) Tele hon No. e-mail address egistration Number Stre Address City/Town State Zip Discipline xpira 'on Date 10.2Gyenne�eral Contractor Ylll/ �S7i!!�•tAq—z L-at='ea Company Name Name of Person kesponsible for Construction Micense No. and Type if Applicable 1 51 a 97a Street Address City/Town State Zip Telephone No. business Telephone No. cell e-mail address SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT .G.L.c.152.§ 25C 6 A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents 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. Is a signed Affidavit submitted with this application? Yes❑ No 13 SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs: (Labor and Materials) Total Construction Cost(from Item 6)_$ 1.Building $ 2 _ Building Permit Fee=Total Construction Cost x (Insert here 2.Electrical $ g / appropriate municipal factor)_$ 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality) 5.Mechanical Other $ / Enclose check payable to 6.Total Cost $ 3 �� (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below,I hereby attest under the pains and berialties of perjury that all of the information contained in this • application is true and accurate to the bet my owl g standing. o i 62(-_3s y-o4 4 � Please print and sign na _Title Telephone No. ate ?n.f / �X`-`��JI6�CQC V�,h� OLO- 0177 Street Address City/Town State Zip [Municipal Inspector to fill out this section upon application approval: Name Date