0002 BROAD STREET - HISTORICAL - BLDG. JACKET . . �,,. , o
r��2 BROAD:_STREET
HISTORICAL .
CITY OF SALEM, MASSACHUSETTS
t, BUILDING DEPARTMENT
120 WASHINGTON STREET, 3'FLOOR
TEL:978-745-9595
FAx: 978-740-9846
KIMBERLEY DRISCOLL
MAYOR
THOMAS ST.PIERRE
DIRECTOR OF PUBLIC PROPERTIES/BUILDING COMMISSIONER
REQUIRED INSPECTION NOTICE
2 BROAD STREET
May 14, 2012
William Harlen Welsh
Cynthia Doyle-Wessh
2 Broad Street
Salem, Massachusetts 01970
Our office has received a complaint from the Salem Fire Prevention office regarding your property
located at 2 Broad Street.
The most concerning off these violations noted are the life safety, egress and unsafe conditions at the property, Failure
to maintain a required means of egress violates section 116.1 through 116.3 of the eighth edition of the Massachusetts
State Building Code with Mass amendments. Required Inspection must be conducted by our Department to assure
compliance with the State Building code and city ordinances. It is requested that all egress stairways and exit doors be
cleared immediately of any and all storage, debris and other items.
Under the provisions of 780 CMR, Section 104.6—Right of Entry, of the State Building Code, access to this property
must be granted for the purposes of this inspection. Please call this office immediately upon receipt of this letter, i this
property has rental units these tenants must be notified in advance of this inspection so that access to these spaces may
also be accomplished.
This Required Inspection shall be conducted by this office on Thursday,May 17, 2012 at 2:45 p.m.; failure to respond
to this notification will be construed as non-compliance, and as such an Administrative Search Warrant will be sought, so
as to allow the lawful inspection of this property. If you feel you are aggrieved by this order, your appeal is to the
Board of Buildings, Regulations and Standards in Boston.
If you have any further questions regarding this letter,please call this office at(978) 619-5648.
Respectfully,
Michael E. Lutrzykowski
Assistant Building Inspector
cc: file, Health Dept.,Fire Prevention,Jason Silva
f
6 Broad Street
JUL 19 4 09 P '83 Salem, KA 01970
18 July 1983
yy RECEIVED
The City o-, a SALEM,iP9A55.
The Board of Appeal, hr. James B. Hacker, Chairman
6ne Salem Green
Salem, h:assachusetts
Gentlemen:
Your attention is invited to the situation revolving around
creation of a new apartment at No. 2 Broad Street. No. 2 is
approximately one half of the building which lso includes
No. 4 Broad Street. From the beginning, this building has been
a two-family house, and it was so constructed. It is not two
separate buildings, although technical factors may lead to
designating it as such.
On the basis that the two sections of the house now have se-
parate owners, the Building Inspector has declared each sec-
tion a "house! and, therefore, each section may be divided in-
to two parts. Tn effect, "owner" is equated with "house." bn
this basis a permit to develop an apartment at No. 2 was granA
ted. It would follow that if one or each of the apartments
were to have two owners, division could occur again.
In any case f what has been a two-family house through the yeaha
stands now to become a three or four family house, or more.
Whatever legal or technical grounds may be cited to warrant
this subdivision, other factors are involved. In the first
place, since the character of the neighborhood would be al-
tered with the advent of an additional apartment, it would
have been considerate, if not mandatory, to acquaint the
abutters and neighbors of the proposed subdivision.
Aside from that point, there is the practical problem of park-
ing automobiles. There are fourteen cars owned by the resi-
dents of ti;e short block on the north side of Broad Street,
between Summer and Cambridge Streets. Seven of those cars
are connected with Nos. 2 and 4 Broad Street. Due to the
lack of off-street parking for them, all seven of those cars
must be parked on t e street. The result is that spaces whieh
other residents should reasonably expect to be available to
them, in front of their own houses, are taken by the residents
or renters of Nos. 2 and 4. This means that the other resi-
dents suffer the burden of a parking problem, which should
not be theirs at all.
PBW to Appeal Board, 7/18/83 2
T submit that the living of a number of persont in close
proximity calls for a code of ethics regardless of codified
law, and for the giving of considerationr.� o their neighborhood.
I submit, further, that such factors as parking must be taken
into consideration, in granting "expansion" permits. One mans@
legal right, even if there were such, should not be allowed to
p revail at his neighbor ' s expense or inconvenience. Tn this
case, owhers of single-family homes have rights, too, whether
recognized by existing ordinances and laws or not.
In this particular case, it is understood that corrective action
can be taken without undue hardship t- those persons involved,
if it is taken before 1 September 1983•
Your attention to and consideration of this subject will be
appreciated. I speak with and for members of my neighborhood.
Prescott B. Wintersteen
Copies to: Building Inspector
City Solicitor
Tahernarle Ell urrh
Unit2b (94=4 of (94rist
7 .. -.` (ldvngxegtttivnttl)
's Wuslliugfuct ttna .7` eberal J�lreets
': ., I . tt(ent, l�ussttel[usetfs 01970
TELEPHONE: 744-3164
June 30, 1983
Mayor Jean A. Levesque
City Hall
Salem, Mass. 01970
Dear Mayor Levesque:
Thank you for meeting with the Reverends Bourgeois,
Crowson, LaPointe, Miller, and myself on Tuesday, June
21st. We are most appreciative of your cooperation and
I feel that our meeting was a productive one. I'm sorry
that I had to duck out when you were one the phone
before our meeting ended. However, I understand that
most of our work was finished by then.
Please let me know what you are able to find out
concerning our possible use of space in the East
Library, the CETA quarters, or any other options you
might uncover after your conversations with Messrs.
Macintosh and Smedile. We need to finalize concrete
plans for the Self Help Center by the end of the summer,
so time is short! I look forward to hearing from you at
your earliest convenience.
Sin ely,
Re John T. Pe
GRACE CHURCH IN SALEM
June 15, 1983
Mayor Jean Levesque
City Hall
Salm, MA 01970
Dear Mayor Levesque:
Here is a copy of the materials which we submitted to the Salem Planning
Department in support of our "Self-Help Center" which we spoke to you
about on May 9th. We are looking forward to talking with you further on
June 21st at our 9 o'clock meeting. I thought you would like to see this
to be updated on our plans.
We received a favorable response from the Planning Department, although
I don't know how much of our request will be honored. We have had
enthusiastic response from volunteers and others already.
Thank you for your consideration and your support.
Sincerely,
The Rev. Steven F. Crowson, President
Salem Clergy Association
SFC:NW
Encs.
385 ESSEX STREET SALEM, MASSACHUSETTS 01970 (617) 744-2796
GRACE CHURCH IN SALEM
May 26, 1983 r:
i
SALEM SELF-H1MP CENTER
IV;;
This is a request fran the Salem Clergy Association to°lthe Planning DepartmenttJ
for $5,000 to fund thesition of }k
po part-time coordinator for the Salem Self-Help 6
Center for the year October, 1983 - October, 1984.
s ,
a^,
-
Detail:.. In response to a growing carmunity awareness of ,the problems confronting °.
poor, hungry and haneless people in our area, the Clergy Association of Salah
formed a special ad hoc ccnmittee to initially investigate.and then propose the
creation of new resources to meet these needs. At thellast regular meeting of
the Clergy Association, the ad hoc committee was authorized by unanimous vote f.
- to form the organizing ooemiittee to manage the Salem Self-Help Center and to
initiate a grant request for the funding and financiallresources needed. t
Our plan is to locate the Center in a building convenient to the downtown area
}
' for servicing the Point and the Bridge Street caimunities. The building or ,.
facility will be used in the following wa
Y e
It will be space for a clothing swap activity;
it will be space for furniture and household goods recycling; �
it will have a cook-it-yourself kitchen for preparation of food by
people living in roans with no kitchens; S � ;
it will have a book room, a coffee and refreshment center, bathroom,
hopefully a shower, and will house the part-time 000rdinator office and
various volunteer personnel who will assist in the program.
Surplus food and donated food from restaurants and supermarkets will be solicited
for redistribution to the poor in this Center. The persons caning for help will
be encouraged to take part in the operation of the Center of a self-help basis.
The Center thus would be a drop-in resource for socializing, as well as locating 7"'1
resources and other needed services.
While the hospitality function is very important, the focus will be•on need
determination, advocacy, resource matching, resource development, and coordinating M +
assistance fran various churches and other helping organizations. This switch-
boarding
boarding function will help the Center as a focal point for help to a very
385 ESSEX STREET SAIEMj MASSACHUSETTS 01970 1(617) 740-2798 4
,
difficult and transient population to serve. The furniture recycling mentioned
above would be both asking for furniture donations and meeting 'requests for } i
furniture for persons just establishing permanent low-cost housing. Furniture .'a
r
storage would be off-site, probably at the Wesley Methodist Church.
As you can see, this concept tries to draw together canmmity resources into a
compatible and non-redundant client-oriented fashion. The meager resources of 9>
churches and other volunteer organizations need to makefcertain that their financial ya'
and material assistance is given to the most needy and distribUed on an equitable ;
i
basis. The Clergy Association through its organizing caltnittee will take full ;.
responsibility for developing a core of volunteers and managers for the various .X.
functions outlined above including developing donors and funding sources for thef,'
ongoing program. war'
In 'recent conversations with Mayor Levesque he suggested the Moose, the Rotarians,
the Chamber of Corrtnerce and others as possible sources Of financial assistance to
our effort. Mayor Leve r
yo has agreed to help us locate a facility; hopefully in ,
4 - t
the next couple of months. Since this Center would be an entry point, to many
services in the oaminity, proper and detailed coordination is necessary with nis
other helping agencies, and where none exist developing strategies to create :
sufficient resources to meet our local needs. s l-
TWO needs cane immediately to mind. The first is a soup kitchen operating R.
seven days a week to feed homeless transient people and `malnourished people
stuck away in. rooming houses. Crombie Street ChurchYand the+ St:,-Vincent de Paul y'
Society of the Ronan Catholic co6manity, in addition to 'the Salvation Army and
the North Shore Catholic Charities, are all beginning to build a soup kitchen
meal'service. However, at presentthere is only one free meal per week in Salem: i. z
The other need is for a temporary and permanent low-cost? shelter. Again, Crombie
Street Church,who furnishes the one meal per week, also 'is considering the
establishment of a temporary shelter at their site. We will do everything possible
to facilitate the conversion of their space for approved teorary `shelter use
t
and will continue to work with the Mayor and .other concerned groups to build
the supply of permanent low-cost housing alternatives. Mayor Levesque mentioned
t s
Section 8 funding still available but, considering the insufficient number of
L
Pv�.
rvA ry
r
a
low-cost units in Salem, this need will probably best ,tbe addressed on a regional
° level: f
Volunteers for the Self-help Center are already caning forward in response to
parish letters and announcements of the program. We have a RAP counsellor, a
registered nurse and several other people desiring tojdonate service to the
Center. A sample parish letter is attached to this funding request. We strongly
urge your approval of this grant request for the $5,090 salary for the part-time
coordinator. We know of no alternative process to meet this critical need at
this time. We need;your help and your i:nvolvemnt and guidance in serving these
unfortunate and needy people of our area.
Respectfully sdmitted, '
The Rev. Steven F. Crowson
President, "Salem Clergy Association
Aii Hoc committee Chairman
Rector, Grace Church in Salem
SFC:MBG s
x,
Att.
}
4
2
3 -
4
Play 30, 1983
Second Year Funding
This program will operate in the second year with approximately the same support
services budget and program budget, but will seek salary and rent support from the
social concerns commissions of the following church hierachies: The United Church
of Christ Congregational Community-Outreach Fund, The Episcopal Church Urban Grant
Pool, The United Methodist Social Ministry Program, St. ,Vincent d'Paul Society of
the Roman Catholic parishes, in addition to The North Shore Community Action Program
and other sources of public funding. Hopefully from the combination of sources,
this long-term project can be sustained.
7
our plan is to increasingly use volunteer and self-help labor so that more and
i
more of the financial resources would be directly made to the program budget.
While we are not basing the proposal on the use of city-owned or donated facility
use, we are working with the Mayor and others seeking low or no cost space.
P
Supplementary Statement
It is our desire and plan to serve the needs of the poor from all areas of Salem,
and especially the Point, Bridge Street and Boston Street areas. Any program
specifically tailored to meet the needs of the poor we believe will draw people
in need from all areas of the city. We understand youridesire that the target
areas be primary beneficiaries of your funding. However, we have by design tried
to include transients and street people who gather in the center city who either
have no place to live or are from other areas. If thisproject is successful
long-term, it could spawn similar projects in your target communities.
4
3
I
i
f
Attachment I to the Salem Clergy Associationr s Grant Proposal to The City
of Salem Planning Department for Salem Self Help Center for 1983-1984.
PROGRAM EXPENSE* FUNDING LURCE
A. Food Cash contributions from sponsoring
churches and synagogues and indiv.
B.. Clothes Public donation
C. Furniture Public donation'
D. Travel Aid Cash contributions from sponsor churches
and synagogues and indiv.
E. Financial Assistance Discretionary Funds, Outreach from
sponsoring churches and synagogues
F. Temporary Shelter Contributions from local business
community
G. Advocacy: S.S. , Courts, Etc. Volunteer Personnel
H. Hospitality Supplies Contributions from local business
community
I. Donated Foods Restaurants and grocer contributions
*Combined value of in-kind services and financial contributions should exceed
$10,000 to be raised by Salem Clergy Association's Salem Self HelD Committee
from all sources.
SUPPORT SERVICES EXPENSE
A. Part-time coordinator of the project: $5;000
Planning,'Department Grant
e
B. Facility Rental- $?_„500 Sponsoriig Churches and Synagogues
C. Office Equipment & Supplies: $1,000
Donations from volunteers and private
_ individuals
D. Telephone &Utilities: $1,500 Local Business Community
E. Kitchen & Bathroom remodeling &
additions as required: $1,500 Donated contractor labor & donations
of equipment from volunteer organizations
F. Travel &incidental expenses
for volunteers: $500 Local service organizations
G. Truck & other cartage expense: $500
Contributa ions from Local Business Community
H. Liability Insurance: $500 Sponsoring Churches and Synagopes
Edwitormial
WCVBTV BOSTON,CHANNEL
Editorial Department
5 TV Place,Needham Br.Boston,MA 02192
(617)449-0400
Helping the Homeless
Title: Reference No.
PresentedB� . James Coppersmith , Vice President & General Manager 68
Broadcast: May 25 : 6 : 57 AM; 12 :28 PM; 6 :55 PM; 3 :40 AM
May 28 : 6 :58- PM; 3 :50 AM 1983
Tragically , thousands of persons in Massachusetts are homeless .
Some have been released from state mental institutions . Others
are the unemployed , and poor families who can no longer afford
a place to live . Solving the problem was one of Governor
Dukakis ' election priorities . Now his priority should be to.
resolve his differences with the legislature over a proposed
bill to help the homeless .
Legislative proponents and the Governor say they agree on the
basics : providing new shelters for those who have none . The
bill would also try to prevent homelessness by raising benefits
in some human services programs . It would strike an absurd
requirement in the General Relief program that makes homeless
persons ineligible for aid because they don ' t have an address .
What the Governor and legislature disagree on is how to provide
hospital care to General Relief recipients . The problem needs
solving . But the Governor and legislature shouldn 't sacrifice
the new shelters for the homeless to the more complex albeit
important question of medical care .
Just because the piercing cold of winter is behind us , we
shouldn ' t think it 's a picnic to live in the streets . The
Governor and the legislature should stop dragging their feet
on meeting the most fundamental need of those who are without
a roof over their heads .
WCVB-TV,Channel 5,presents editorials in the public interest on issues of concern to our community.Responsible opposing views are regularly broadcast.All comments from our
viewing audience,and all requests for ime to reply to editorials,should be directed to the Editorial Department,WCVB-TV 5T Place,Needham,Massachusetts 02192,
Telephone(617)449-0400.
Channel swishes to make clearthat all requests for time to reply to editorials are considered equally,from individual viewers as well as from spokesmen for government,business
and other organized groups. -
0tv of aIEm, I�z�StIL1�1tSQ#
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�� �LTtI.3TTt� �P�SiIxfY:tE2tf
Richard T. .";McIntosh
One Salem;Green
745-Dz13
June 22, 1983
Rev. Prescott B. Wintersteen
6`Broad Street
Salem, Massachusetts 01970
RE: R-2 Zoned District
2 Broad Street
a/k/a Lot #573 Assessors Map #25
containing 1 ,916 square feet
Dear Reverend Wintersteen:
Thank you for your letter of June 17, 1983 relating to the
above referenced property.
The allowed use for the property is two family dwelling.
I have issued a building permit to allow for creation,of an
apartment on the third floor.
Very truly yours,
Richard T. McIntosh
Zoning Enforcement Officer
RTM:bms
cc: Richard Stafford, City Solicitor
James Hacker, Chairman, Board of Appeal
REVEREND PRESCOTT B. WINTERSTEEN, D.D
SIX BROAD STREET 414 g:4§r���..
SALEM, MASSACHUSETTS 01870
17 June 19831
Mr. Richard T. McIntosh
Building Inspector, City of Salem v�'t.SJ AF :SAL;EAiAS,y�.
One Salem Green
Salem, MA 01970
Dear Mr. McIntosh,
I should like to bring a certain matter to your attention, regarding
2 Broad Street, Salem, Massachusetts.
As an abutter to the house which carries the addresses 2 and 4
Broad Street, I have observed the evidence of work being performed
at No. 2, which, I understand, is in connection with creating a
new apartment, an additional unit, at No. 2. The records of your
department show that you issued a permit for this conversion.
It occurs to me that the granting of this permission to convert
a one-family unit into a two-family unit may not be within the
letter and/or the spirit of the law. Such a conversion would be
inappropriate to the neighborhood and might well set an unfortunate
precedent. It may be noted, in addition, that the present prospect
is that a number of families may soon be added to the immediate
neighborhood, with the development of Nos. I and 3 Broad Street.
This area is already congested, traffic is heavy, the intersection
with Summer Street is dangerous, and the parking of present resi-
dents' vehicles, let alone any additional ones, is practically impossible,
within the block.
I respectfully request that you look into this situation and advise
me whether or not a permit has been issued which would enable the
conversion of a single-family unit into a two-family unit at No. 2
Broad Street. By copy of this letter I am inviting the attention of the
Board of Appeal to an action which may be a serious infraction of the
City of Salem's use and occupancy code. A partial list of neighbors
who support this request is indicated by the signatures below.
I thank you for giving this subject your immediate attention and
advising me of its present status.
Sincerely,
cc: Mr. James B. Hacker, Chairman
Board of Appeals
wl �ti rte. C . S rL A f3 S r7
�h
� ' ��`" �� �u111it �xulrzx2� �2�ttxtiuent
of "ialera'
Richard T. McIntosh
One Salem Green
745-021.3
May 1.7 , 1983
TO WHOM TT MAX CONCERN
RE: 2-BroacT Street-,
a; R--2. -Z.one District
The zoning for the above referenced property is
R-2 which allows for two family dwellings . 2 Broad
Street, further being identified as Lot #573 on Assessors
Map 42.5 and containing 1 , 916 square feet may be used as
a. two family dwelling unit.
Very truly yours ,
Richard T. McIntosh
Zoning Enforcement Officer
RTM:bms
Cc: Councillor Stephen Lovely
file
F1 R,.3 g` 3�
9 °S PH 183
?,IEC IAA k SS
Salem Historical Comn�� ery Nass.
CITY HALL. SALEM. MASS. 01970
March 2, 1983 _
William Rolke
2 Broad Street
Salem, Massachusetts 01970 _
Tsar Mr. Rolke:
As you know, your property at 2 Broad Street is located in the
McIntire Historic District. This means that the recent installation
of an electrical conduit on the facade of the building without
Commission review is a violation of the Salem Historic District Ordinance.
At its meeting of February 2, 1983, The Salem Historical Commission
voted unanimously to order removal of the conduit with no other such
electrical service visible from the street to be installed without
Commission approval. If removal is not accomplished within 30 days,
the matter will be referred to the City's legal department for
enforcement under Massachusetts General Laws Chapter 40C.
Your matter will be greatly. appreciated.
�Yours truly V U
�dacob 5. Wolfson
Chairman
JSWI ebra
cc John Condon, City Flectrician; Richard MacIntosh, Building Inspector
w C�pptN of �$SWenl' � Iassuchuse#ts
.,GaK 'r NUGO +iiep0$nunteaLyusrters .
James roman RECEIVEDt8t�11'
fngette ,,street
- CITY OF SALEM,MA
Chief �M 4%1. Q197D
744-1235
DATES August 9, 1982
Building Inspector
City of Salem, Mass.
One Salem Green
Salem, Ma. 01970
Sirs
As a result of an inspection or other notification to this
office, it appears that substantial alterations or new construction
is underway at the following; location, and this office has not
been provided with the plans for stamped approval prior to
starting the work.
Address 2 Broad Street, Salem, Ma.
Names William Rolke
Building Permit # 310
Under provisions of Article 1, Section 113. 5 *of the Mass. State
Budding Code , it appears that plans should have been submitted
to the Salem Fire Prevention Bureau, prior .to issuance .of; a
Building Permit.
This applies to the following itemss
Requires smoke detectors in entire structure, per Chapter 148,
Section 26C or 26E.
Please be advised that sufficient plans shall be submitted to this "
office, for the required stamped approval.
Respectfuy submit ed,
Capt. David J.: G gin
Salem Fire Marshal
cos William Rolke
2 Broad St, Salem, Ma.
Form #128
puhlir Vropertg Pepttrtment
epartrcertt
Richard T. McIntosh
One Salem Green
745-D213
Jean A. Levesque May 27, 1982
Mayor of Salem
Salem City Hall
Re. 2 Broad Street
Dear Mayor:
Regarding the above referenced property please be advised that this
department has no projected use for a parcel of land measuring 2. '0 x 29. '"93—
located in front of the above dwelling and would support its being desig-
nated as surplus property.
Very truly yours,
Richard T. McIntosh
Director of Public Property
cc - file
cc - Mr. and Mrs. William Rolke
cc - Morris Gordon Esquire
CK 030 ro
y� The Commonwealth of Massachusetts
t 'u?d Board of Building Regulations and Standards CITY OF
Massachusetts State Building CRt�380IIt SALEM .
�� r� Revised Mar 2011
Building Permit Application To Cons"WR�a�tp,(Renovg OMi4nolish a
One-or Two-Family Dwelling
This Section FJ4*fiA0t220A/_
Building Permit Number: - Date Applie (0 1-b
Building Official(Print Name) Signature Dat
, nt SECTION 1:SITE INFORMATION
U ' 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
?- 132A1� bt'
I.la Is this an accepted street?yes—bL no Map Number Parcel Number
t,(1 1.3 Zoning Information: 1.4 Property Dimensions:
^� Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Cbeck ifyes0
SECTION 2: PROPERTY OWNERSHIP'
2.1 Ownert of Record:
Y-WA SAU&A
Name(Print) City,State,ZIP
No.and Street Telephone Email Address
SECTION 3:DESCRIPTI4DN OF PROPOSED WORK=(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) Addition ❑
Demolition ❑ Accessory Bldg.Cl Number of Units Other ❑ Specify:
Brief Description of Proposed Work : PANED ON
CGo I'. Ln.p bI./
Q�TiE7c
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials - -
1.Building $ 0,dp 1. Building Permit Fee:$ Indicate how fee is determined:
❑Standard City/Town Application Fee
2.Electrical $ ❑TOW Project Costa:(Item 6)x multiplier x -.
3.Plumbing $ S'to, 2. Other Fecs: $ - �� / y\ —
4.Mechanical (HVAC) $ List: ( (J
5.Mechanical (Fire $ Total All Fees:$ -
Su ression -
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ ? 3t5�00.60 ❑Paid in Full ❑Outstanding Balance Due:
�l�S �t,P�t�►, s
kA 2S
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction yy&i �� A'SupervisorLiicense(CSL) cs- Or'l 1 �LO`413 q,u• I(d
� (Ak7AAN)i,tAd y License Number J Expiration Date t
Name of CSL Holder
t ' List CSL Type(see below)
'483 ry*N Type Description
No.
and Street '^,��t
CIV•DSot { t�IV- 0l7Liq U Unrestricted(Buildingsu to 35,000 cu.ft.
N R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
/ WS Window and Siding
SF Solid S7St�'36(•a2 2� I kHtXft Sl-a4.N I Insulation
Burning Appliances
4449
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 17?Zi M— !ll,`4.15�
�ZAaI YKAZ 1MNlAN HIC Registration Number Expiration Date
n�2 an py�N�`Nr lf�Registrant Name
t.{{+5 �/�iNt U YIYtTw/4Y��cT7d Ali-lam
No.I d W MA 017 Nq , y/ Email address
City/Town,State ZIP•t VD Telephone
IB
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(ALG.L.c,152.§ 25C(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 ..........K No...........❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,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.
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER' OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true andacc "'rat to the best of my knowledge and understanding.
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
xnwn ss. ov¢ /oca Information on the Construction Supervisor License can be found at www.masssov/dns
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
CITY OF SALEK MASSAaa)SETTS
r{ BLn DING DEPARTMENT
120 WASFIINGTONSTREET,3' R.00R
TBL.(978)745-9595
F
KIIv18ERLEYDRISOOLL FAX(978)740-9846
MAYOR THomAs ST.PIERRE
DIRECTOR OFPUBLICPROPERTYIBumDj%ODMMISSIONER
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR, Section 111.5 Debris,
and the provisions of MGL c40, 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 deposit facility as defined by MGL c 111, S 150A.
r
The debris will be transported by:
CID AC/O
(name of hauler)
The debris will be disposed of in:
3a �fRca coi,I`A►��,�
(name of facility)
r c7 „�J (pUJZ� G I a U69S3,6e, ,Nl�
(address of facility)
Signature of applicant
Date
The Commonwealth of Massachusetts
! Department oflndustrialAecidents
I Congress Street,Suite 100
Boston,ALL 02114-2017
www.massgov/dia
Wworkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information �I � Please Print Le gib
Name(Basinass/Organization/Individual): ,hAP69 :. SrAM, me-,
Address: 14:83 /MIN) �
City/State/Zip: *0:/S6(J 4*01744 - ;' Phone#: y�-361 •OZq&
Are you an employer?Check the appropriate box: Type of project(required):
1.01 am a employer with employees(full and/orpan-time).' 7. New Construction
2.0 I am a.sole proprietor or partnership and have no employees working ferment g. 0 Remodeling
ay-capacity.[No workers'comp.insurance required]
3. t am a homeowner doingall work 9. ❑Demolition
myself.[No workers'comp.in required.]t
10 0 Building addition
4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions
proprietors with no employees.
yy..�� - 12.0 Plumbing repairs or additions
5.�►yl I am a general contractor and I have hired the subconfimctors listed on the attached sheet. ]3.❑Roof repairs
'��PPff Tbese sub-contractors have employees act have workers'comp.insuance=
6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other
152,§1(4),and we have no employees.(No workers'comp.insurance required.]
-Any applicant that checks box#1 most also fill out the section below showing then workers'cormpensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors most submit a new affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the mane of the subcontractors and state whether or not those entities have
employees. If the sub-contractors have employees,they most provide their workers'comp.polity,number.:. -
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site
information.
Insurance Company Name:
Policy#or Self-ins.Lie.M Expiration Date: -
Job Site Address: City/State/Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00
and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify u er t pains and penaties ofperjury that the information provided above is true and correct.
Signature' / Date: 6'ZL •lr
Phone#: Sd9'.341, OZQIo ----
Official use only. Do not write in this area,to be completed by city or town oKkial
City or Town: Permit/License#
Issuing Authority(circle one):.
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence,of compliance with the insurance coverage required."
Additionally,MGL chapter 152,§25C(7)states'Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(L LQ or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in_(city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dqg license or permit to bum leaves etc.)said person is NOT required to complete this affidavit.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston,MA 02114-2017.
Tel. #617-727-4900 ext. 7406 or 1-877-NIASSAFE
Fax#617-727-7749
Revised 02-23-15 www.mass.gov/dia
`=t
The Commonwealth of Massachusetts CITY OF
Board of Building Regulations and Standards SALEM
%VE Massachusetts State Building Code, 780 CMR Revised Mar 2011
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Two-Family Dwelling
This Section For Officipruse Only
Building Permit Number. Dat pplieds
S Dom,
Building Official(Print Name). Signature
SECTION 1:SITE INFORMATION' < m
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers Ln
m
f�0 0AC! rn
Ma Number Parcel Number
1.1 a Is this an accepted street?yes i/ no P
1.3 'Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq If) Frontage(If)
1.5 Building Setbacks(R)
Front Yard Side Yards Rear Yard
Require) Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Public Private❑ Check if es❑ P y
SECTION2: PROPERTY OWNERSHIP!'
2.1 Ownniert of Rwd: -6w/+ r4k
pOWk"( lr
N me(Print) City,State,ZIP!t o i3o4WL 8S -zLl- 4LIly A0AVq 10.AA( (2bAL .
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORW(check all that apply)
New Construction❑ 1 Existing Building Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑
Demolition ❑ 1 Accessory Bldg.❑ Number of Units_ I Other ❑ Specify:
Brief Description of Proposed Work': 1 Si /bW )
TTO
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials)
I. Building Permit Fee:$ Indicate how fee is determined:
I. Building S aJ pJa
❑Standard City/Town Application Fee
2. Electrical S 15 00 ❑Total Project Cosh(item 6)x multiplier x
3. Plumbing S ODU 2�QtherFees: S
4.Mcchanical (I-IVAC) S 1 , 000 List:
5. Mechanical (Fire S Total All Fees:S
Suppression)
Check No._Check Amount: Cash Amount:_
6.Total Project Cost: S d 0 ❑Paid in Full ❑Outstanding Balance Due:
cza1vE S�Z�
SECTION 5: CONSTRUCTION SERVICES t
5.1 Construction Supervisor License(CSL) Ji
—dq l 413 27 Z i
�t�?�r�� e Number Expiration Date
Nance of CSL Mulder (�
Lf �� T�)N ST L'fype(see below)No. and Stree[ e'. , Descriptionnnn Unnsuicted Duildin a to35,000cu. It./ I ' Restricted 1&2Famil Dwelling
City/Town,State,ZIP M Masonry
OL"� 1 , /a RC Rnolin Ccvc' n
"6 _1 WS SVindow and Sidin
SF Solid Fuel Burning Appliances
1 I Insulation
Telephone Email address I Demolition
5.2 Registered Home improvement Contractor(HIC) 1T7Z.Lic..
141 HIC Registration Number Expiration Date
MH C Cumpan Namo or fIIC Registrant Name
Ny,mid S ee` t n s()c3' zcl/„ Email address
CityiTown,State ZIP I Telephone fU
SECTION 6:WORKERS'.COMPENSATION INSURANCE AFFIDAVIT(M.G.L c.152.1 25C(6)),1
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the Is4uance of the building permit.
Signed Affidavit Attached? Yes .......... No...........❑
SECTION 7a,OWNER AUTHORIZATION.TO BE.COMPLETED.)VBEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize
t9 act on my behalf,in all matters relative to work authorized by this building permit application.
Print Uwncr's Name(Electronic Signature) Date
SECTION 7b:OWNE&t OR AUTHORIZED AGENT DECLARATION
By entering my 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.
y
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
NOTES:
I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will got have access to the arbitration
program or guaranty fund under NI.G.L.c. 1 d2A.Other important information on the HIC Program can be found at
wvvw.mass.eov'oea Information on the Construction Supervisor License can be.found at%vtvw.mass.eov/dns
2. When substantial work is planned,provide the information below:
Total floor area(sq. ft.) '� (including garage,finished basemendattics,decks or porch)
Gross living area(sq. ftJ Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
1. "I'otal Project Square Footage"may be substintled for"'rota) Project Cost"
QTY OF SALEM, MASSAaI mns
BUILDING DEPARTMENT
120 WAsmNGTON STREET,3'D FLOOR
TEL(978)745-9595
FAX(978)740-9846
KIlv18ERL1;YDRIS�LL
MAYOR THcmAS ST.PIERRE
DIRECTOR OF PUB11CFROFERT A IILDINGOJIv MSIONER
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR, Section 111.5 Debris,
and the provisions of MGL c40, S 54; Building Permit g is issued with the
condition that the debris resulting from this work shall be disposed of in a properly licensed
waste deposit facility as defined by MGL c 111, S 150A.
The debris will be transported by:
pjf 1NU6 INLJ
(name of hauler)
The debris will be disposed of in:
1KNSPt2
(name of facility)
sv a ix S�—
k{y)S0N ✓VI' - oL
(address of facility)
Signature of applicant
s, ls, l ')'-
Date
1 The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston,MA 02114-2017
www mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERAUTTING AUTHORITY.
Applicant Information Please Print Le ibl
Name (Busine/s (
ss//Orrganization/Individual): (f l NL
Address: ! J?:> /Yjq)N
City/state/Zip: ��uy�`] �✓ c7(� Phone#:
Are you an employer?Check the appropriate box: Type of project(required):
1. I am a employer with employees(full and/or part-time).' 7. ❑New construction
2. 1 am a sole proprietor or partnership and have no employees working for me in g. Remodeling
any capacity.[No workers'comp.insurance required.] -
3.❑1 am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. RDemolition
4.❑I am a homeowner and will be hiring contractors to conduct all work on my properly. I will 10 Building addition
ensure that all contractors either have workers'compensation insurance or are sole I I.❑Electrical repairs or additions
proprietors with no employees.
12.[]Plumbing repairs or additions
5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs
These sub-contractors have employees and have workers'comp.insurance.=
6.FJ We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other
152,§1(4),and we have no employees.[No workers'comp.insurance required.]
'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
=Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether m not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct.
Signature: Date'
Phone#:
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the pemut/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston, MA 02114-2017
Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE
Fax#617-727-7749
Revised 02-23-15 www.mass.gov/dia
L 5L
L
t
Massachusetts -Department of Public Safety
Board of Building Regulations and Standards
Construction Supervisor -
License: CS-049M
SN�-I r'I:S pf <
IAN B MAMA" KIN �
MAIN ST 7 P
Hudson MA 01749 wrjff
z
�• Expiration
Commissioner 09/2212016
F ,
tce of Consumer Affairs&BusinesTsORRe gulationMEIMPROVEMENTCONTACistraoon 77242
Oxer,
irabon * 8 Type:
II
, Individual
i IAN B. MAZMANIAr r
�l w. a
+' IAN 'MAZMANIAN j
+ 483 MAIN St,
HUDSON,MA 61749
1
f 'Ulu derseeretary ' p
qI i