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45 BROAD STREET - BUILDING JACKET l�6'��dcs�-�j' 'cam CITY OF SALEM DEPARTMENT OF PLANNING AND COMMUNITY DEVELOPMENT STANLEY J.USOVICZ,JR. MAYOR - 120 WASHINGTON STREET•SALEM,MASSACHUSETTS 01970 JOSEPH P.WALSH,JR. TEL 978-745-9595•FAX:978-740-0404 DIRECTOR - December 17, 2003 Mr. John Adelman 45 Broad Street, Unit#1 Salem, MA 01970 Dear Mr. Adelman: For the last several months we in the City of Salem's Department of Planning and Community Development, which oversees our community's housing development and rehabilitation efforts, have been working with you, first to provide you a First-Time Homebuyer Loan to assist in the purchase of your condominium in Salem, and more recently to provide you a loan to make improvements to your unit through the city's Housing Rehabilitation Loan Program. Both of these programs, as you know, help provide opportunities for low- and moderate-income residents of Salem to own their own home, and to address code violations and lead paint hazards in their homes. Beginning in late September, near the end of the rehabilitation project,you have raised several issues with my staff and others,presenting a series of questions and concerns regarding various aspects of both the work in your home in particular, and the city's rehabilitation program in general. This Department has been working since then to answer those questions and address those concerns. Throughout the fall, we have been in frequent contact with you(or through your attorney, as you later requested)to respond to your concerns as they arose, to provide you updates—in person, by phone, and in writing both by letter and email—on our efforts to resolve your concerns. And since mid-October,when you made a formal complaint to HUD New England Regional Office, we have also shared these responses to you with them, as required by federal regulation. Although there have been a series of emails and letters sent to you by the City throughout this process, addressing specific concerns as you've raised them, in light of the large number of issues you have raised over the course of the last three months, this correspondence is an attempt to provide you with a single, comprehensive response to your questions, as well a summary of the resolution of each of your concerns to date. Since you have copied a number of individuals on emails and letters outlining your concerns during the course of our work with you on this project, please note that I am also sharing a copy of this comprehensive report with as many of those individuals as I am aware of, as a courtesy to each of them,to offer an update on what we have done over the last three months to address your concerns. 1 This letter then will provide a brief summary of the background of the project, the concerns you have raised, and our responses in our effort to resolve them. Background and Scope of the Proiect The City of Salem's Housing Rehabilitation Loan Program provides Salem homeowners who meet federal income eligibility requirements a deferred-payment loan to finance the work needed to eliminate code violations and lead paint hazards in their homes. As a deferred payment loan, these loans are forgiven entirely if the homeowner remains in this home for a period of 15 years. You applied for, and received, financial assistance to make improvements to your housing condominium unit through this program. In May 2003,you entered into a Deferred Loan Agreement to participate in this program in order. to undertake various improvements to your condominium located at 45 Broad Street, Unit 1. These included: • supplying and installing five replacement windows, • installation of a new hot water heater, • installation of a new heating system • installation of a storm door, • removing and replacing all existing fixtures in the bathroom, • removing and replacing failing walls in the living room, • de-leading the interior woodwork, • repairing and replacing the kitchen faucet and sprayer, • repairing and replacing holes in the hardwood flooring. After receiving bids from contractors, you selected K.A. Johnson Builders to perform the work and entered into an Owner/Contractor Agreement for Rehabilitation with them to perform the nine (9) item scope of work described within the Work Write-up dated March 10, 2003 (copy enclosed). The total project costs were $30,675. The rehabilitation work commenced on June 23, 2003. Once all lead abatement and code compliance work was undertaken,you were granted first a temporary Certificate of Occupancy issued on October 10, followed by a final Certificate of Occupancy, which was issued on October 27. Also in October, in response to the concerns regarding the rehabilitation work you raised,. officials from the City, including staff of DPCD and representatives of each of the inspectional offices, met with you and your attorney, at your home, to inspect both your unit and the common areas of the condominium as well. At this meeting on October 14, progress on work items which were part of the original Work Write-Up/Contract were reviewed, as well as all other code- related items, and any additional items you wished to raise. At that meeting, we worked together to develop a final work"punch list" of all work items you wanted to see completed (Copy enclosed), including: 2 • bleed air out of the boiler, • correct over painting on door frame and door and clean paint off floor where necessary, • replace five windows with code compliant windows and caulk, • repair/replace ground fault outlet by kitchen sink, • adjust vanity door, • adjust,tub stopper, • adjust door strike in bathroom and hallway, • adjust storm door strike, • clean grout in bathroom floor, • ground plug at North wall in living room and • replace radiator covers to original position. The results of these efforts, including the schedule for work to complete the project, were communicated to you in writing, with a copy to HUD's New England Regional Office and others, in mid-October, 2003. Following several additional weeks of work by the City and the Contractor to address the items raised at that inspection,this week the Final Inspection Report was filed (copy enclosed), marking the completion of the work to be performed under the Rehabilitation Contract. Issues and Concerns Now that he work scope items have been completed and the final inspection report filed, we wanted to also communicate with you on the resolution of all other concerns you have had during the course of the project. In order to have the clarity needed to completely address the large number of items you raised, I find it helpful to consider each of your concerns as falling within one of four broad categories: 1. Issues/concerns relating to work that was performed within the scope of the Work Write Up/Contract for rehabilitation 2. Issues/concerns you have raised that are outside the scope of the Work Write Up/Contract 3. Issues regarding lead abatement in common areas of your condominium 4. Your Request for Relocation and Other Expenses A brief summary of the resolution of each category of concerns is below. In order to provide greater detail on each, following this letter are four separate memoranda to you, each addressing one of those categories in detail, outlining your specific concerns, and a description of how that concern has been addressed. 3 1. Work within the scope of the Salem Rehabilitation Loan Program Contract: The work write-up and Contract approved funding for the completion of nine(9)items. According to the Final Inspection Report, all items within the work scope are complete. A summary of the specific work items,your concerns with each, and the resolution to each is described in detail in the attached Memorandum#1. 2. Rehabilitation issues that are outside the scope of the Rehabilitation Loan Program Contract: In addition to the nine (9) items within the work scope,you have raised concerns about other issues that were beyond the scope of the work of your Rehabilitation Loan with the City of Salem. These items include building code concerns you had in common areas of the Condominium as well as work you privately contracted with K.A. Johnson to perform for you, such as installation of weather stripping to the front door. We have also tried to assist in the resolution of this issue as well. Department of Planning and Community Development(DPCD) staff have either directly acted to resolve the matter, coordinated resolution of the issue on your behalf. A summary of the specific issues you raised outside the scope of our work with you is . provided in attached Memorandum#2. 3. Lead abatement in common areas: , Lead abatement for the interior of your unit was completed as part of the original work scope. In addition, you raised some concerns regarding lead abatement in the common areas of your condominium as well,work which was not part of the original Work Write- Up/Contract. After a review of federal and state regulations, we have concluded that should a child under the age of six be in residence in your building,the common areas of your building would need to comply with lead paint regulations of the Commonwealth of Massachusetts. That is not the case in your building however. That being said, we have informed the condominium association that should they wish to apply for a loan from the City to address possible lead based paint hazards in the common area and exterior of the building, we will work with them to review the income eligibility of the residents of each unit to determine if they are eligible for assistance. A summary of the specific issues you raised regarding lead abatement in common areas is provided in attached Memorandum #3. 4 4. Relocation assistance and other expenses: You have made a request for relocation compensation(copy enclosed) in the amount of $16,702.42 for per diem meals and lodging and incidentals, an amount which you arrived at based on what you said were the Government Service Administration's"food and lodging per diem expenses to be paid in cash to Government Employees and Government Contractors". We have recently completed a review of the Federal regulations pertaining to housing rehabilitation through the HOME Program,the Uniform Relocation Assistance Act and Department of Public Health regulations pertaining to lead hazard reduction. First,we discovered that under none of these programs are relocation expenses calculated using the Federal Per Diem Travel Rates,the method you used in your request. More significantly,based on these applicable federal regulations of relocation expenses, we have determined that you are not eligible for mandatory relocation assistance. We were directed by HUD staff to review several relevant regulations and clarifications, including most directly a Policy Guidance Bulletin on the subject of Payment of Temporary Relocation Expenses, which informed us "Owner-occupants participating voluntarily [in an abatement or hazard reduction for a HUD-assisted project] are not entitled to reimbursement for temporary relocation expenses" [emphasis added]. However, this same Policy Guidance Bulletin suggests that jurisdictions using federal funds for these projects do have the discretion to offer Optional Relocation Assistance in certain circumstances. In light of your case, the City of Salem will be adopting a new policy for Optional Relocation Assistance, which among other things will provide for reimbursement of Temporary Relocation Expenses, based on calculation of actual expenses and the submission of original paid receipts for lodging. Typically a new policy would only be available to future applicants, however in consideration of the confusion regarding your eligibility and in light of the extraordinary circumstances of your situation, our new policy will include yours as an extraordinary situation, which will enable us to review a new request from you as the first under this new policy. Again, a detailed discussion of the analysis we used to determine your ineligibility for mandatory relocation expenses, as well as information regarding a new Optional Relocation Assistance Policy, is provided in attached Memorandum#4. I hope this summary, as well the more detailed memoranda attached, address the questions and concerns you have raised throughout this process. I know that the last few months have been a difficult time for you personally, and I can not imagine that the difficulties associated with resolving this rehabilitation project have made that 5 situation easier for you. I am sorry that this process has gone on as long as it has. But I am pleased that the tasks on yourWork Write-Up/Contract have been completed, and we look forward to working with you on your request for relocation assistance under our Optional Relocation Assistance policy. Sincerely, rhP. r. ent of Planning and Community Development sachusetts cc: Stanley J. Usovicz, Mayor, City of Salem Kevin J. Keogh, HUD Regional Office Director,New England Regional Office cc: Cover Only Senator Edward M. Kennedy Congressman John F. Tierney State Senator Frederick Berry Robert L. Paquin, HUD, Director Office of Community Planning and Development Diane J. Fournier, HUD, Webmaster Nancy Frank, HUD, Program Intem Edward Flynn, Secretary, Massachusetts Executive Office of Public Safety John McCarthy, State Building Inspector Dennis P. Flynn, Attorney at Law Laura A. DeToma, Councilor at Large Thomas H. Furey, Councilor at Large Kevin R. Harvey, Councilor at Large Arthur C. Sargeant, III, Councilor at Large Claudia Chuber, Ward One Councilor Regina R. Flynn, Ward Two Councilor Joan B. Lovely, Ward Three Councilor Leonard F. O'Leary, Ward Four Councilor Kimberly L. Driscoll, Ward Five Councilor Michael Bencal, Ward Six Councilor Joseph A. O'Keefe, Sr. Ward Seven Councilor Thomas Dowd,North Shore Lead Paint Testing Service John Keenan, City of Salem, City Solicitor Tom St. Pierre, City of Salem, Building Commissioner Robert Turner, City of Salem, Fire Chief Deborah Burkinshaw, City of Salem, City Clerk Joanne Scott, Health Agent, Salem Board of Health Jeffrey Vaughn, Health Inspector, Salem Board of Health John Giardi, City of Salem, City Electrician Thomas Philbin, City of Salem, Chief Administrative Aide 6 Lynne Montague, City of Salem, Executive Secretary to the Mayor Joan Pizzello, City of Salem Karl Johnson, K.A. Johnson Builders Paul Hunter, Department of Public Health Greg Tocco, Department of Public Health Sharon Cameron, Assistant Director BEHA/CLPPP Lori Balboni, Assistant Attorney, Office of the Attorney General, Commonwealth of Massachusetts Peter Copelas, Heritage Cooperative Bank Jackie Matula, Trustee, Arborside Condominium Association Rabbi Illana Rosansky Dr. Robert D. Fallon, Jr. M.D. Dr. Christian Fantim, D.C. cc: Via email Andrew Innes, Arron Home Inspection - - A Whently Williams Susan Wheeler Jim Higgs Keyspan (webmaster) Keith Bluestein Hannah Adelman Ruth Goldman Ellen Disco Kelleher Diane Cohen kpodone@hewitt.com hsobelman@attbi.com Okeefedavid@hotmail.com anjelkatt@netscape.net irisvg@maspirg.org Enc.(16) Attachment 91 - Work within the scope of the Rehabilitation Loan Program Attachment#2 - Work outside the scope of the Rehabilitation Loan Program Attachment#3 - Relocation assistance and other expenses Attachment#4 - Lead abatement in common areas Work Write-Up dated March 10, 2003 October 14, 2003 City Inspection final work"Punch List" Final Inspection Report Optional Relocation Assistance Policy Letter dated 10/4/03 from John Adelman, Request for Relocation Assistance Letter dated 10/28/03 from International Floors Letter to Arborside Condo Association dated 10/16/03 from Thomas St. Pierre Letter to John Adelman dated 10/9/03 from the Department of Public Health Coastal Industries Non Prorated Limited Warranty dated 11/3/03 Letter dated 11/13/03 from Coastal Industries, Inc. Letter dated 12/15/03 from John Giardi, City Electrician Letter dated 6/27/03 from John Adelman to Jackie Matula 7 Page 1 of 3 r� Joe Walsh From: John Adelman [ohnadelman@yahoo.com] Sent: Sunday, October 26, 2003 9:21 AM To: whently; Tocco, Greg (DPH); Susan Wheeler; Stanley Usovicz, Jr.; Joseph Walsh; Joanne Scott; Hunter, Paul (DPH); Frederick Berry; Edward Flynn; Bob Paquin; Dennis Flynn Cc: Sargeatlarge74@aol.com; Ruth Goldman; Robert Turner; LennyOLeary@webtv.net; Ladetoma@aol.com; KLDRISC@aol.com; KevinHarvey@nextel.blackberry.net; Keith Bluestein; John Giardi; Hannah Adelman; H Sobelman; FMOKEEFEPE@aol.com; Dobrusin, Paul; Diane Cohen; David O'Keefe; CouncilorBencal@hotmail.com; c.chuber@comcast.net; Andrew Innes Subject: 45 Broad Street UPDATE NO OCCUPANCY YET!!!!!!!!!!!!!T!!!M!!!!! Dear Dennis Flynn: Please forward this e-mail to anyone I forgot. I'm still pretty upset about not having the quiet enjoyment of my home and I don't want to hurt anyone's feelings for omitting them. Additionally, I don't want the omission to be yet another excuse for additional delayed completion. Friday afternoon John McCarthy of the Commonwealth of Massachusetts, Department of Public Safety visited my home and made an inspection. He also left me with a complaint form which I need to complete six times and return with my signature. HUD requires the Administrators of their programs to protect the borrower from UNSCRUPULOUS Contractors. I would like to make sure the City refers to any and all agencies proper enforcement action for all violations. One entry found for unscrupulous. Main Entry: un•scru•pu•lous 4)) Pronunciation: - ' skru-py&-1&s Function: adjective Date: 1803 not scrupulous : UNPRINCIPLED un•scru•pu•lous•ly adverb - un•scru•pu•lous•ness noun He was happy to learn that I had not locked the contractor out, as is my right, as a homeowner and that the City has keys to my home to allow access to any and all who need to inspector repair problems. This allows the contractor to be given the opportunity to correct errors as they occur. McCarthy understands the confusion created by the uses of K.A. Johnson Builders and Windows by Wells and told me it was smart to avoid adding additional confusion with Bay State Window's Installation of Blinds. Having Bay State Install the Blinds and K.A. Johnson remove them as needed and return them to place allows for each supplier to blame the other for problems. 10/27/2003 Page 2 of 3 Mr. McCarthy reviewed the list from Mr. Andrew Innes, Aaron Home Inspection and knows that a number of items have been corrected. He examined the storm door and said that the problems of it not fitting properly were adjustments. He he said that I should be getting a "Certification and Warranty" from the Manufacturer of the Windows since the rating tags were removed. Please ask Stacey to get that from Johnson, Gilbert and Cole of Marblehead, the supplier, or Coastal Industries, the Manufacturer. He told me that the sashes of the windows should stay up when the window is opened. I told Mr. McCarthy that the Rep. from Coastal was going to call me and that I would be asking him to visit with tools to adjust the door and windows since they are still not correct. We visited the basement and I explained about the crimping of the exhaust hose from the bath room vent. He wrote the most notes about the exhaust hose as he did for anything. Mr. McCarthy also review the outside door jam, and the first floor and basement windows. He admitted his knowledge of"Lead Paint Abatement and Removal" was limited and he was not clear to me as to the enforcement of Illegal Lead removal. 1 told him I would speak with the Attorney General's Office about this. We discussed the windows low E issue and.I told him I learned that it was about a $100 - $150 chisel per window. I asked if the Commonwealth would be following up with Gilbert and Cole to see if he did this chisel with others. I explained that I had arranged for a $150K Cash Out loan for one of his customers who had thirty eight windows (38) replaced by Johnson. That would be a $3,800 to $5,700 chisel. That's a real expensive chisel. Generally, Mr. McCarthy referred to some of the workmanship on my home improvements as sloppy. Now, I guess I should ask again the Planning Department what they will do to make me Happy? I'm still out of my home, Monday will be day 127. How about some expense money? Stacey told me that the expenses of temporary living were a construction expense. Because I was preoccupied with my dad, I didn't press on this detail. Mark Lausier of M F Lausier and Sons Plumbing and Heating, the Master Plumber introduced to me by Mr. Johnson, told me l would be back in my home taking a bath, a week after he started. This promise was made and work was started in June 2003. Maybe Mr. Lausier should be made to pay me living expenses. Saturday, I had the opportunity to speak with several tile specialists. The discoloration of grout may occur due to uneven mixing of different batches of grout. I now see discoloration of grout between the tiles on the wall. This I am told is due to an improperly prepared surface and the beginning of MOLD. 10/27/2003 Page 3 of 3 The only guaranteed solution is ripping out the work, treating the surface F and putting the grout and tile back properly. I wonder how long this takes? Why should I be expected to trust the contractor who closed walls before the Building Inspector could look, cheated on de-leading and chiseled on the windows and didn't have the professionalism to properly adjust the windows and storm doors when he got caught? Respectfully and Homelessly Submitted, John Adelman IncrediMoi/- Email has finally evolved - Click Here 10/27/2003 e vg,¢o o G CITY OF SALEM, MASSACHUSETTS :} < � PUBLIC PROPERTY DEPARTMENT 9 � �✓' 120 WASHINGTON STREET,.3RD FLOOR SALEM, MASSACHUSETTS 01970 STANLEY J. USOVICZ, JR. TELEPHONE: 978-745-9595 EXT. 380 MAYOR FAX: 978-740-9846 October 16, 2003 Jackie Matula (aPy Arborside Condo Association 45 Broad Street Unit 2 Salem, Ma. 01970 RE: Common Area 45 Broad St. Mr. Matula: This week, I, along with Inspectors from Plumbing and Gas, Electrical and representatives from the Planning Department, conducted an inspection of Mr. Adleman's unit at 45 Broad Street. During the Inspection, some issues came up pertaining to the common areas and they were the following. Plumb/Gas 1. Flue pipe serving two hot water heaters is pitched the wrong way. Also a Plumbing and gas permit needs to be obtained for the same hot water heater An inspection will be required after the corrections are made. Electrical 2. The City Electrician taped up an open wire in the ceiling of the boiler room. A Licensed Electrician will need to permit and terminate the wire. Also, the light fixture in the back hall, first floor needs to be repaired or replaced. An Electrical Inspection will be required upon completion. Thank you in advance for your anticipated cooperation in this matter. If you have any questions, please contact me directly. Sincerely, Thomas St. Pierre Acting Building Commissioner cc: Tom Phillbin Joe Walsh Denise McClure Stacy Bernson Jane Guy John Giardi Dennis Ross Certificate No: 877-2003 Building Permit No.: 877-2003 Commonwealth of Massachusetts City of Salem Building Electrical Mechanical Permits This is to Certify that the RESIDENCE located at Dwelling Type i 0045 BROAD STREET in the CITY OF SALEM ....................- - - - - .-..--------------- Address Town/City Name IS HEREBY GRANTED A PERMANENT CERTIFICATE OF OCCUPANCY UNIT ONE I This permit is granted in conformity with the Statutes and ordinances relating thereto, and expires unless sooner suspended or revoked. Expiration Date Issued On: Mon Oct 27, 2003 - - - GeoTMS®2003 Des Lauriers Municipal Solutions,Inc. ------- -------- ------ --------- - ---------------- Certificate No: 877-2003 Building Permit No.: 877-2003 Commonwealth of Massachusetts City of Salem Building Electrical Mechanical Permits This is to Certify that the RESIDENCE located at Dwelling Type 0045 BROAD STREET in the CITY OF SALEM .....-...-.......... ..................._.._ .. _............................. ........................... Address Town/Cit Name IS HEREBY GRANTED A PERMANENT CERTIFICATE OF OCCUPANCY UNIT ONE This permit is granted in conformity with the Statutes and ordinances relating thereto, and expires unless sooner suspended or revoked. Expiration Date Issued On: Mon Oct 27,2003 - ------ ----------------------------------------- ---------------- GeoTMS®2003 Des Ladders Municipal Solutions,Inc. - — - -- -- --.-------------------------- ----- --------- Certificate No: 877-2003 Building Permit No.: 877-2003 Commonwealth of Massachusetts City of Salem Building Electrical Mechanical Permits This is to Certify that the RESIDENCE located at Dwelling Type 0045 BROAD STREET in the CITY OF SALEM Address TowniCity Name IS HEREBY GRANTED A PERMANENT CERTIFICATE OF OCCUPANCY UNIT ONE This permit is granted in conformity with the Statutes and ordinances relating thereto, and expires unless sooner suspended or revoked. Expiration Date Issued On: Mon Oct 27, 2003 - - -- - - -........ . - - GeoTMS®2003 Des Lauriers Municipal Solutions,Inc. -------—--------- ------------------------------------------------- I Certificate No: 877-2003 Building Permit No.: 877-2003 Commonwealth of Massachusetts City of Salem Building Electrical Mechanical Permits This is to Certify that the RESIDENCE located at ................... Dwelling Type 0045 BROAD STREET in the CITY OF SALEM Address Town/City Name IS HEREBY GRANTED A PERMANENT CERTIFICATE OF OCCUPANCY UNIT ONE This permit is granted in conformity with the Statutes and ordinances relating thereto, and expires unless sooner suspended or revoked. Expiration Date _-.._. ._.. ........... . Issued On: Mon Oct 27, 2003 ------------------------------------------__......--...... ---- Geoi 2003 Des Launers Municipal Solutions,Inc. ..._._..-.-.-_,_--_______-._________.._....___._...... ___------- The Commonwealth of Massachusetts oM 1z by Department of Public Health Board of Building Regulations and Standards One Ashburton Place, Room 1301 Boston, Massachusetts 02108-1618 Phone (617)727-7532 Fax (617) 227-1754 Mr. Mark Mooney Acting Chief of Inspections Department of Public Safety Room 1301 One Ashburton Place Boston, Massachusetts 02108-1618 October 28, 2003 RE: 45 Broad Street - Salem, Massachusetts Dear Sir, The following is a report of a meeting and inspection at the above referenced.address. The purpose of the meeting and inspection was to investigate allegations of building code violations at unit#1,45 Broad Street - Salem, Massachusetts. This is a 2-room unit in a 2 story 4 unit condominium building of 5-13 construction with brick veneer exterior, pre-code building. After talking with Mark Mooney, Tom Riley - BBRS and Tom St. Pierre of Salem Building Department I was able to contact the owner Mr. John Adelman and made an appointment to meet Friday October 24, 2003 between 2:15 - 2:30 p.m. at the site. I met with Mr. Adelman at the appointed time and we walked around the unit while he explained the alterations done by the contractor, K.A. Johnson Builders of 25 Reed Street - Marblehead, Massachusetts. The project was financed through a program administered by the City of Salem, Department of Planning and Community Development. The scope of work comprised of demolition of the bathroom and replace bathroom, replace windows, remove and replace interior wall covering in the living room, front and back storm doors, minor electrical work, replace hot water tank and boiler, and delead woodwork in the unit. According to the contract work was to commence on June 9, 2003 a building permit was issued June 23, 2003 by the City of Salem. Mr. Adelman was less than pleased with the progress of the work or the finished.product. He also advised me that a team of inspectors from the City of Salem visited the site Thursday October 23, 2003 and when they left most of the items were signed off. Mr. Adelman produced an inspection report from a private inspection service by the name of Andrew Innes dated October 7, 2003. Mr. Adelamn and I reviewed the list: 1. Boiler not firing - pilot light not lit- OK 2. Radiator covers reinstalled - done - OK 3. Hot water heater- vent flue sloped - adjusted - OK 4. Reinsulate hot water line - owner aware 5. Outer back door- covering used as lead encapsulement removed - interfered with door closing - owner aware 6. Paint on door casing - cleaned 7. Front storm door- needs adjustment 8. Seal seams at sill - done 9. Windows below residential U value 10. No ground fault at sink - ground fault in place - OK 11. Ground fault would not reset - owner says it resets 12. Wall plug -reversed or not grounded - owner says repaired 13. Living room closet door not square - adjusted 14. Wall paint on floor-cleaned 15. Vanity door will not shut - works - OK 16. Grout on bathroom floor varies In review the only code issue is that the new replacement windows are said to be a .49 U value code requirement is .44 U value. I have not seen any labels to prove or disprove this issue. Evidently Mr. Adelman has been in contact with the factory that makes the windows and has an agreement to replace the sashes. Mr. Adelman feels that a complaint against the contractor is in order. I left a complaint form and the letter of explanation with him. I have not talked to the contractor, as of yet, I will contact you after I have spoken to them. The deleading work is alleged to have been started by an unqualified person and finished by a licensed person, see attached letter. If you have any questions please contact me at (617) 561-3458. Attachments 2 / fo n J. McCa� State Building Inspector 1lACNMc ti! Da John C 'C + -----Original Message-- From: Andrew Innes f ✓� Date: Tuesday, October 07, 2003 23:39:38 To: j Subject: In lma tion 45 road Subject: Inspection 45 Broad Apt 1 Aaron Home Inspection October 7, 2003 1 Summary Report Broad Street Apt. 1 S Salem, Ma This inspection and report is limited to the items below. Reference is also made to my inspection of 5/23/01. Heating: John Adelam 979-744*W 1.Boiler is not firing on. Pum responds to the thermostat but nothing else 45 Broad #1 9 P P g NIA R1970�3147 does. Have boiler turned on or repaired as needed. The boiler should then inspected and approved by Keyspan. They should check flame, venting, any leaking, circulation, pressure and temperature and any other items as needed. Pressure gauge was high today 381lbs. 2.Radiator covers in apartment should be reinstalled. v Hot water heater: v 3.Vent flue slopes down. It should slope up. v 4.Reinsulate hot water line. Outer back door: 5. Metal lead protection casing has been removed@ Inner Back door: / 6. Paint has been spread over door casing trim in hall. Clean up required. Front Storm Door: 7. Not fit to frame and weatherstripping A �✓S�yl i Living room Windows 10/8/2003 A7- -"lwc ✓ ; of 8. Seal seams at sills Windows general: - ---� 9. Not clean and are below residential U factor Electric: 10.No ground fault plug at kitchen sink. v 11.Bath ground fault plug would not reset and should not be tied to fan and light. 12.Living room plug on wall toward street appears to be reversed and or not grounded or weakly grounded. !_� " 13.Living room closet door not square to frame. 14.Wall paint dripped on floors. 15.Bath vanity door will not shut. // 16.Bath floor grout varies in color. CONDO ASSOCIATION ISSUES: 17.Gas smell in basement. Have gas company check for leaks. 18.Mold on boiler walls. 19.Scorching on 3rd floor boiler. Have Keyspan check. 201oose hot wire hanging from boiler room ceiling. Andrew S. Innes High-speed Internet access as low as $29.95/month (depending on the local service providers in your area). Click here. hftps://broadband.msn.com 10/8/2003 10-24-03: 9o42AMp :617 248 0813 4 17i 19 ` at 14 03 0e:45a John ndelman _ 000-000-0000 P- 2 A`TYAC/✓MG- I The Commonwealth of Massachusetts Executive Office of Health and Human Services Department of Public Health _ Bureau of Environmental Health Assessment Childhood Lead Poisoning Prevention Program 56 Roland Street, Suite 100 MRT ROMNEY Boston, MA 02129-1235 mhANOR KERRY HEALEY UEVe+ GOYtRnAR RONALD PRESTON SEU2IMY CHRISTINE C FERGUSON CO Ssi m - October 9, 2003 Mr.John Adelman 45 Broad St.#1 Salem,Massachusetts 01970 Dear Mr. Adelman: I have reviewed the paperwork associated with the lead removal activities at your home at 45 Broad St, C.Salem. The Childhood Lead Poisoning Prevention Program(CLPPP) is unable to authorize the issuance of any compliance documentation for this unit for two reasons: I. deleading activities were performed by persons not authorized to perform such work 2. common areas associated with the dwelling unit were not deleaded. However, based upon the reinspection report prepared by Inspector Tom Dowd on 9/24/03 and 9/30/03, the passing set of dust samples collected on 9/30/03,and the documentation that a full clean up of the unit interior was conducted by a licensed deleader(Randy Wel Is,DC00007),CLPPP is able to deem this unit fit forreoccupancy. _ Please note that this letter does not certify that the unit is in compliance with the state Lead Law.In order for this unit to be eligible for a Letter of Unauthorized Deleading,any common area violations must be corrected by authorized persons and documented by a licensed lead inspector. Please refer to the Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000, for more information about deleading requirements and for information on penalties associated with unauthorized deleading.The regulations may be viewed on our website at www.statc.ma.uS1dPh/clpp or you may obtain a.copy by calling 800-532-9571. Please contact me at 617-284-8400 if you have any questions. Sincerely, Sharon Cameron Assistant Director BEHA/CLPPP Cc:Stacey Slack' John Adelman` - 45 Broad Street4l Salem, MA 01970 Friday,June 27, 2003 ' Jackie Matula,Trustee V vv� y Arborside Condo Association 45 Broad Street#3 Salem,MA 01970 Dear Jackie: Please accept my apologies again for any dismption or discomfort concerning the renovations to my residence. I have learned of problems of which I was not aware. Karl Johnson,the contractor,is a personal friend,and so is his wife. The end result of the work he does is excellent,I have seen it at his home and the homes of other customers. Construction is dirty,messy,noisy,and necessary if you want to live nicely in an old building. Each time I have learned of a problem,I have been directly involved When I learned of a problem which was a"HEALTH or SAFETY ISSUE"I stayed on the telephone and returned to 45 Broad Street,#1, Salem,MA,leaving my temporary residence,until the immediate threat to"Health and Safety"was abated and I spoke with the Licensed Tradesman who promised to do a site visit and complete the correction the SAME EVENING. The General Contractor doing my work is Insured should there be any property damage or personal injury, which goes beyond his assets. I have a condo policy,which I would use should there be any claims against me for property damage or personal injury. Additionally,the old appliances in the basement are noisy and in the past I have not complained but been disturbed. I ask that you and the other owners are formally informed by the"Association"that they should check the noise level of their appliances and either repair or replace them if they are noisy. Please ask W. latch to have his tenant ask her guests to use the doorbell rather than the horn. She has her sister's little dog from time to time,but the bark of that dog is quiet and not too bothersome. Please ask Sue O'Leary to insist that her meal delivery person's stop ringing my bell and knocking on my door. Also,Jackie,I ask also that you speak with the Condo Association Insurance Company about coverage for the disruption a unit owners'"Quite Enjoyment". This would be considered a Personal Injury as the result of either negligent acts of the Association. Please call me on my cell phone at 978-219-9449 where I will answer or have voice mail concerning the tentatively scheduled Association meeting on Sunday. rrnest egards� � a /f i John Adelman `— 1pddmlmw4n#Ni04No APPADVGD By we P1f,>nA TO A`.f SIEW ARM ORANTkD CITY OF SALEM No, Ward Zu"D"m in.► o in ra NO Bch of g / volUbm 4S old isPWNYL*CftdIrk / ' )4 1—F ® b OawNMVM AM? . rn NO Permk t0: BULOM POW APPLICATION PM (CMole wlNpwm apply) Roof• PA a ShMd. P001, PLEASE ML ONT UMMY i COOPiAMY TO AVM DSLAVB N PPA) 10 M THE INSPECTOR OF BUWNf3B: Do urdwsowd herby sp An for a parmk to build aooad ft to ft.toNowkq Ow ws Name W !�C r/� 7. �-�1 C E Adanes a Phone ` - aQao-j s i J�(T 1 c Amhk@Ws NwW Addmu A Phone ( ) MeohaMm Name Addmu A Phone ( 1 wlwr M ar p.pa.w twasnorr Mdmd a' -64 t N a dwernp,for how m*q lmedft9 w•4d*q=dam b low? EelaredWd �lo6 CegUo oq6 R' r • BY3Y `! aim awwwaiwat J uc* ' ftlft na of AXIM4 SENSE)IM1N1 THE PENALTY' OP POi1 M OESCI PTION OF WORK TO of DONE MAIL PERMIT Trx I ywx; ,f ow .4'r ay�a t •wr�.�.,. . .yam. ...a :�.y.. r ^'- '�%'•�. A PUBLIC PROPERTY � l DEPART NIEINT Ki?MFA EY DRISCOLL MAYOR 120 WASHINGTON STREET 1"' v,MANtnatt;st�-rs 01970 IF1:978-715-959S•FAM 97&740-9U6 APPLICATION FOR THE REPAIR, RENOVATION, CONSTRUCTION. DEMOLITION. OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING STRUCTURE OR BUILDING 1 A SITE INFORMATION Location Name: Building: _ — Property-Address Sq" Property is located in a; Conservation Area Y& Historic District Y 2.0 OWNERSHIP INFORMATION 2.1 Owner of Land Name: McKie yyl,QTJ _ Address: `lS 8,� 0 Srr atO /'Loa2 S .�l Telephone: 9 Y r{ V W 3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY Addition Existing 3 Renovation Number of Stories Renovated Change in Use New Demolition Existing Approximate year of Area per floor (sf) Renovated construction or renovation of existing building New Brief Description of Proposed Work: [ 2y� 447W I,?j er- l /✓d am �r� h�i62S I�A'T�� ?oi(er^rS'rN IBC. Mail Permit to: 7r}cK, A1,17-tA4 �/S 2D/� 5 f Sa �,� •+o/� or57o What is the current use of the Building? C j C' ° Material of Building?661 c'K If dwelling, how many units? Will the Building Conform to Law? Asbestos? Architect's Name Address and Phone Mechanic's Name MCL d-nd T Address and Phone � 4&s"QLr 8� Construction supervisors License# &Uq 4 ct HIC Registration# Estimated Cost of Prrect$1�Lo— Permit Fee Calculation Permit Fee$1S.dJ—�s t d Estimated Cost X$71$1000 Residential Estimated Cost X$11/$1000-Commercial An Additional $5.00 is added as an Administrative charge. Make sure that all fields are properly and legibly written to avoid delays In processing. The undersigned does hereby apply for a Building �Permit ,to build to the above stated specifications. Signed under penalty of perjury Date UN 0 96 0 1 ~ y a q � Y F <O C G - - o- - _ — --- - - -- -- - -- CITY OF SALEM PUBLIC PROPRERTY DEPARTMENT aUatErr.att DRMC= MAYOR uo Wwvmacrmsr& T a sAm 4 Nwmalus m01970 TIL•M745-959S a FAX 9711-740.9846 Workers' Compensation Insurance Affidavit: Builders/Contractorsmectrlcianw?iumbera Annlicant Information please 1Mwe r ezility Name(Busi doajy Address: City/State/Zip: Phone Ara you an employer?Cheek the appropriate boss Type of project(required): 1.0 1 am a employer with 4. 0 1 am a general Contractor and I 0 employees(&a andler part-dme).• have hired the subcontractors 6 New construction 2jo 1 am a sole proprietor or partner. listed on the attached sheet.t 7. ®Remodeling ship and have no employes These sub ContrsCtas have 8. fit]Demolition working for me in any capacity. workers'comp.Wourance. 9. 0 Budding addition (No workers'comp.insurance !. 0 We am a corporation and its required.) offices have exercised their 10.0 Electrical repair at additions 3.0 1 am a homeowner doing all work right of exemption per MOL 11.99 Plumbing repair or additions myself.[No workers'comp. C. 132,j 1(4),and we have no insurance requuad]t employes.[No workers' 12•0 Roof repairs �p insurance ) 13.0 Other ;Any w4"s dui cheeks box et mac arm M out the"silos bdow dmvie4 desk wwtae Ham$mw wile mbak lob dliderk mdk+tlns airy we doing s9 wadi end toes him ouglds em Waso tees efEdtvY tComnn that check this box must st NAW sa eddidood shoot dawiog the acme of tors mbsaeeecsae and rostra warkae•camp !true as employer that ie pro tddirj workers cowpeaaodoa lnseruwc4foi my Potter Whrousnon. employees. Below 4 rail pole!and job AV lajorwatlar - - Insurance Company Name: Policy 0 or Self-ins.Lie.N Expiration Date: Job Site Address:_` S�� S( Rr, City/Statelzir-1 +46111 LI&W LE10 Attack a copy of the workan'compensation policy declaration page(showing the policy number and expiradon dab). Failure to secure coverage as required under Section 23A of MGL a 152 can lead to rho fine up to 51,300.00 aCNar oneof tj imprisonment,as well as civil penalties in the form of fa STOP WOtion CRK ORDE11 and a t5ae riminal panel es of of up to 3250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Offlcs of Investigations of the DIA for insurance coverage verification. Ida hereby ceraiJj a der the pairs an nojper/ary tier the Jnjormadom provided above 4r true and correct Si�attere: /l � r\CC// `/l �fi F&lisother eu onlJ► Do toe wrlM 1n this area,to be coApkW 67 clq or rows of)lirld Town: PermItAl.1cease M Authority(circle one): d of Health 2.Building Department 3.Cityfrown Clerk 4. Electrical Inspector S.Plumbing Inspector Contact Person: Phone p• Information and Instructions tts General Laws chapter 152 requites all employers to provide workers'compensation for their emp Ycm massachusepursuant to dtia statue,an eup/oYn is defined as"...every person in the service of another undo any connect of htr%. ... express or implied.ad or written." aSSociaaen,eorporstion or other legal entity.or any two a more of he foregoing n defied am an joint eatapr+8.��n$the�representatives of a deceased emP�Yer,a the of the focegtru t engaged amoc attoz at other legal cetuy,employing employee• However the receiver a trustee g o individual.of moc ht a and who resides therein.or the occupant of tbo ownw of s dwelling bear hairmt Olt mote°tons toms maintenanspareagemce, or wall on ssoh d hanna dwelling horse o[another who�PmYa Pam m do not f such angelcuou be deemed to be an employer." or on the grounds a budding appurtenant toerem shall not because of web employment "eV state err 10ta1 bleerodat agency fhag withhold the Wfl`°Ce w MGL chapter 152,4 r permit min states that cry V the eemm0awalth for any a business a to mpo set buildings the insurance coverage required" ree0wal of a tleeeaa or P to°acceptableduced svldeaa of eomptlaaet e Additionally,d ly, bore not chapter 152.125C('n AMC$"Neither the commonwealth roc any of its Political ance with the an shall Ate 'MGL of public work until acceptable evidence of compliance with the insiraaee rate into any f this for the bier to the contracting authority." requireaiente of this chapter Applicants ,Pcnsadm affidavit completely.by checidnt toe boxes that apply myo ur situation and,if Please fill out the workers' co necessary,supply a tib•conuactnr(s)name(s).address(ea)and PMne number(')along with t��PmY�e)Of than the Limited Liability Companies(LLC)or Limited Liability partnerships(l.l.P) i�r`on`' m carry enders'coon maurance. If an LLC or LLP does have members or partners,are not required advised ghee this affidavit may he submitted m the Department of industrial Accidents a policy is nqmcovers Abe be ann to alga and date the afsdavIL The affidavit should Accidents for confirmation of insurance application for the permit or license is being requested.not the Department of be returned m the city er men that the app to obtain a workers' Industrial Acoidene. Should you hive any qua" rent the law or if you era required at the number listed below. Self-insured companies enter their compensation Policy.plane call the Department bilge. Sep{ l cmn number on theBPPMCIM city or Towa.Ofndad legibly. The Department has provided a space at the bottom please be Sure that the affidavit is complete eve and printed f�Y• has to contact you regarding the applicant. of the affidavit for you to fill out in the event the Office of Investigations Please be sure to fill in the permiMense number which will be used a.nerd only reference number. I addition,an applicant that must submit multiple permitJireens0 applications in any give year, only submit one a affidavit iadicatint current policy information(if necessary)and under"Job Site Addm e"the applicant should write"all locations in_—JcitY w or marked by the city er town may be provided m the town)."A copy of the affidavit that has been officially stamped permits or liceoaes A now afudrvit most be filled out each applicant as proof that a valid affidavit it to file for alicense P�not related to any business or commercial venture year.Where °home owner or burn l is obtaining to complete this affidavit (i.e. a dot license nt permit m balm lava etc.)said person is NOT required you have any questions, and should y •Coe Office of Investigations would like to thank you is advance for your cooperation please do not hesitate to give us a call. 'The Department's address-telephone and fax number. The Commonwalth of M&SSWhUSetts Mpattment of Indust[W Accidents O®a of favadVMens 600 Was111119 n Street Bogto4 MA 02111 Tel. #617-7274900 text 406 of 1-877-MASSAFE Fax#617-727-7749 Revised 5-26-05 www•mawpv/dia GT1Y OF SALEM PUBLIC PROPERLY DEPAXrMENr TIL nsa+s sets.PA*97 .74&*W Coasbvedos Debris DkWat AM&vtt (c�etaei sw ad aad ass�vsdas wad !a mwdm wide des d&@ sires Huddles CWk 7W CM2 ssadm III.! C"d die p wAstati dUM s 406 254 gumks tMeedi it bliss/vft do s uMw dW dss I I I mmldiy Aos thk watt absn bo dispo"dbl a propm�►fsassse wws dtgaat a�ngr ss ds�sd by t►�cs.s tlt.�tJM TThs debris will be humpood by: 1 �s4Gl i' Wr db� Ths debris win bo disp n"d in: (ammo ac had" •S�)PqPy Psco7'r AA s4 � u cmda�+ati d� lip"m alp"*mppliaat lots C) 'f L�116�A116T�E fILi1141019 AfMvEo By Tw AWZCIj1B P8= TO A:PEBNIT REM GRANTED CITY OF SALEM No. �V1V Q-- ff wand zar.o owns the dalc OYtnct?„ Yea No ioeatioa o[ W -- .� am�a,ssms 4« t32ag�Q S'T Is Aopub Locshd„ :. tha CarwnMlon Arse? Yet__No_ Permit to: BUILDING PERMIT APPLICATION FOR: (Circle whichever apply) Roof, Install Siding. QW81rW Dsdr, Shed, Pod, Other:lY1QL� v C!{ee T/( e�/C PLEASE FILL OUT LEGIBLY A COMPLETELY TO AVOID DELAYS IN PROCESSWO TO THE INSPECTOR OF BUILDINGS: ' The undwsipnsd hereby applies for a permit to build aocord4ip.to the.foibwkV speoifloaftu: pp Owners Name �'�`8a 2g t3 e O-A as &96'C Address A Phone Architect's Name L1� Address A Phone Mechanics Name �)i C4 A-P4 ! . L.A.C K Address A Phone f Cosa UST A oy- Wpm 99 y— 909 e vzs n /I Whet Is fr pzpm of bWldln�l e<Qs L '��✓�n MMsrw of talldkrp?Lgr CV M a dwalkq,for how mmy amwa? WE b Aft cart..to kw? Asb«as? d/ Fslnrsad oat -!�y o�cjjja"#0�37yq wmm Llosrrsa• 9 asp. Ifpro�t G Lie. 1.a4�— tV Suture of Applicant SgNED UNDER THE PENALTY OF PERJURY DE8CRIPTION OF WORK.TO BE DONE ` yr.. 6Lt 1 Ur tu ` }}�� V 7 � MAIL PERMIT TO: i .t. ��1� - 05 Nd. APPLICATION FOR PERMT TO �(�G�y1c� . ��teel �v� l� � �astxn'774— Sa,l,er LOCATION PERMIT GRANTED 19 w: , APPPOVPD INSPECTOR OF BUILDINGS . f CITY OF SALEM9 MASSACHUSETTS PUBLIC PROPERTY DEPARTMENT 120 WASHINGTON STREET, 3RD FLOOR SALEM, MA 01 970 TEL. (978)745-9595 ExT. 380 FAx (976) 740-9846 STANLEY J. USOVICZ, JR. MAYOR DISPOSAL OF DEBRIS AFFIDAVIT In accordance with the provisions of MGL c 40, S34, I acknowledge that as a condition of Building Permit# ,all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid-waste disposal facility, as defined by MGL c R S 150A. The debris will be disposed of at:-�9L 14V1X t/36211& /�j Location of Facility Signature of Permit Applicant Date FULLY complete the following information: (PLEASE PRINT CLEARLY) W rCL14 61", T l-4 GV Name of Permit Applicant Firm Name,if any 4BSP(JJ-7- 19 UQ-- 01WV2'U oly-�2 Address, City& State The above statute requires that debris from the demolition,renovation, rehab or other alteration of building or stricture be disposed in a properly-licensed solid-waste disposal facility as defined by MGL ca S 150A, and the building permits or licenses are to indicate the location of the facility. Arborside Condo Association 45 Broad Street Salem, MA 01970 City of Salem Building Inspector Washington Street Salem, MA 01970 To Whom it may concern, j William T. Lach, mason contractor, has the permission of the Arborside Condominium Association to remove and replace a small section of basement drywall that has some mold on it. Thank you. Sincerely, c,A�c� Jacquelyn Matula The Commonwealth of Massachusetts Department of Industrial Accidents office 611HI sBgatleas 600 Washington Street, Ira Floor Boston,Mass. 02111 ` Workers' Compensation Insurance Affidavit: Building/Plumbin lectrical Contractors �� _a* Please PRIlYT leeibty ' A hcant information• / name �r /�t�lftit `L��-14 address: - t/��9-k�1 S/Q L� tr ��9 cit Odd JU4L/S state: Vo a! zip' �(y2 2 / phone# 912r�—2,941 '- Y6 2F work site location(full address)� 7 )3�204D S� �� ant 4' 7/ I am a homeowner performing all work myself. Project Type: ❑New Construction®Remodel ❑ I am a sole proprietor and have no one working in any capacity. ❑Building Addition ❑ I am an employer providing workers compensation for my employees working on this job 3 coin an name: Aw � > • ^ -�� . . address: ' ' '" �` ` r .xy -iN, UIN "a 'qaa:` ,r-tom city: � c`4} t 'fSi'af 'f`+F4mi'it k'hi insurance co.zwka� ..-... ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: ,- .. ,., .. lew ce F coin an name: - address: City: tuDh00¢# ''� Sa 4. {a st3=:"°s.�e.a 3 6", r4 ,�xr� '„; `vint �a.`,-,y' ✓t�' t insurance co. ,. .,. v,. r €+..,r„ '�•`'�'"�,n.;'"y,�a"'3a€�6wk^' t `�a. .,�.: <t�IN 7 companyy name: - a address. A- A ,•,3�. � ��rm city: phone# ' -^`'6y` insurance co.. is#r.%*^dW �.;r` wf _.,""",�, s..4 ,�....,.. 1t„s .. . . , .- . .. Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Once of Investigations of the DIA for coverage verification. I do hereby certif=�=- es of perjury that the information provided above is true an correct. Signature n /- Date Print name Z1/ ///r' 6 (arc 4 4 50q Crh 0" ',,,None# F2111)3) only do not write in this area to be completed by city or town official : permit/license# ❑Building Department []Licensing Board immediate response is required ❑Selectmen's Office ❑Health Department son: phone#; ❑Otherm1 Dow Co11N1Y�e0aANO Yak, OLUSI M0 PMW APPLICATION FOR: Permit w (Ckdo W*Awm apply) ROL Roof. kwtaY SWft CCn@vW Deck. Shad• Pool. pepNypspym, Ogwr, a/o.J PLEASE FILL OUR LEOSLY A COMPLETELY TO AVOW DELAYS IN PROCBAiMIa TO THE INSPECTOR OF IN III NOS: The underoosci to eby applies for a pormk to bold aowd% to Ow foMowkp Owners Name r L&iR T 1✓9 f`f Address a Phmw !�;- /°p si y hL i /�OQ— (9) OA� ave(zs � Aral OW& Name Address It Phorw r!�li Za L , MKft:ics Nam i� G4 c ff Addrgs a Phone 5AwIZ as f4& dam- f , war:.sr p.pow ar odmw kzs �IXelJ7-i ,qC. UAJO-S r//✓.IT rrrar d WNW '6/L�K s a awaatq,for sow army kyaaw4 YMII&Aw oorrorra b awl 9 Alo EdWAW M4°��' mu w• N A Ntla uJ M�3 ao�a 7aTeo�t . , X Soulwo of Apoimd Som LMMOER THE PENALTY DESCiIIFFION OF WON TO SE DONE OP P■It,NJRY neP_D4) f'457.-2,t Wei a-S AWIO ire- 11 W4�-S 779 k 7-4l fly MAIL PERMIT TO: 5 1124---o oL o L)e L� J}l/� /�t�ei25 {�!✓� D�9 Z3 j i APPLICATION FOR PMIII TO ✓/ 7d/" ��ib� Olf'4r7a �� LOCATION S Uro4Gl �1a�B PERMIT GRANTED CITY OF SALEM, MASSACHUSETTS PUBLIC PROPERTY DEPARTMENT 120 WASHINGTON STREET, 3RD FLOOR SALEM. MASSACHUSETTS 01970 STANLEY J. LISOVICZ, JR. TELEPHONE: 978-745-9595 EXT. 380 MAYOR FAX: 978-740.9846 Salem Buildin¢ Department I Debris Disposal Form In accordance with the provisions of MGL c40 S 54, a condition of your Building Permit is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL Chapter 11I, S 150 A. rThe debris will be disposed of in: " I 41 Tc y (Location of Facility) W Signature of Applicant Al6,r- Date /Ire a,ummvmrcwN. ..,/ ........^_._------ Deportment of IMUW'd Accident kvO,Q9ae of Inve�ations 600 WasUnglon Street Boston,MA 02111 WWWAsasafo✓1L Workers'Compensation Insurance AWavit: BuBdeNContr#ctors/El Pleas Print &Z fl A Intortna$ Please Print I-e'nib>� Name Uc I �✓t c l/1��,J Addt'as: cry/StatdZia Eta�duts a 9z.2 Phaae : 9 2 A 72 c( y��q F ployer!Cheek tkrapproprh to bo= Type cf proled(ngdrea): ploye with 4. ❑ I am a peaail conacmr and I 6. 0 New construction (1L8and/orpart-time * Lave hued me 7 6A ✓le pioprietoa tilted so dte atra aimhed aban Qg,,�7 �Cts/Laveibempktytxs TLtxe a►b.eontraaon Lave S. ❑ Damolitiafor tde in Pl capacuy w orkw comp•bs mace, 9. ❑Boikliog addition (N g tfor comp itimraad 3. � We area corporation add is 10.(] Electrical npaim or addition of&m Lave c wmiaed their . (� rWA of exemption per MGL or additions addition 3.t Y myaetE [No tvortera comp aatk o: 1s2,41(4�and we MGL to 12.0 Roof repaus� iasnrat►a ralni<ad]t avloyed' N workow 3. other & �4 LC f2 i/1 comp.imurmcerequired.] < c •AnYaPP> thataheebLootalmo do>mods*WWWbdowmovingarofrvotitets' WNWWh9modw . t Hmoeovoa vita atmdt ebb dndavit adicaft dry an doba an walk md*0 ids vyt♦id,oommNemn rent aloft&ww affidavit baficatina amh tCaotnAota thtt,cbaek No ban rent attae6ad ao addibmd moat moviq aw nm of rite atbeanha ad main wooers'cony.pth'Leo• !art a aePbya that is provldJnd tnarAvn'eoatpsasaloa iaswrrect for my eMPloym dsJotr itr tkePoflq aut/ob afar` Innuancc Company Now. Policy#or Self-im.Lie.# Expiration Data Job Site Address: 6� 64 S 7— City/State2ip: Attack a copy of the worken'.eompandon policy declaration pti#e(stowing the lanky number and expiration date} Fats me b seenre coverage at req* d under Section 25A of MGL c. 152 can Ind to the imposition of criminal penalties of a fine W b$1,500.00 attd/ot one yar imprieomaect.as well as civl pmahim in the foam of a STOP WORK ORDER and a tine of up to$250.W a day apaimit the violator. Be advised that a copy of thin statement May be forwarded m the t>e&0 of Investigation of the DIA for Worsoce coverage verification. !do heresy een* thepabrs of�wy rAtat the Wp=&*x ProvllrJ is and ams re Q/Qaaa1[G �!/ / c v i Date: /_7 O,&W uw at* !JI sat ardN Gr tAfr aYt,a►bt c�MMIYIt PA'iclaL City or Town lermlt/[Jaase/ Issuing Antherily(drde 0w)- 1.Board of Health L Building Department 3.Ckylfown Clerk 4.Electrical Impcetor 5.Plambia`Impertor 6.other Contact Perwm Phan#' Massachusetts General Laws chapter 152 requires afi employers in provide worlm, compensation for their employee. Pursuant to this sumt% an am pka is defined as"...every person in the service of another under any contract of hire,' ezpress or implied,oral or writIC L' An mpfeyar is defined as"m individual,pameship,association,corps or odher legal eoft or any two or mtxe of the foregoing eagard:is a joist ens 01%and.iocla ft the legal natives of a deceased employer,or db receiver air.tmsie, of an isdiv4A partnership,association or oiler legal entity.cupbymg employee, lbwwetr then owner of a dweltiog house hsvint not mtm than throe and who resides there*or the occupant of tbs dwd&g home of a odw who employs petsom to do makkansc a eomwctin or repair wart on sub dwelling bone or on the grounds or budding apportenant dhads d uM rut became of sash empbymet be deemed to be an employer." MGL chapter 152,12SIX6)*0 Inns that"every date or toed tieeadsg apusq dwA wkhbdd the lase see or resewal of a Recant or permit to operate a badness or to construct bWkftp In the tommooweakb for any RWHU E wbo ban not prodsad meats hle evidence dtompllua wNb the insaranoe toveragt rtgnind." Additionally,M%dwsar 152,12M sates"Neimer she commonweshk net any of ilr political subdivisions alWl enter into my contract fir the perkumma of public welt um it acceptable evidence of oompHmce wilt the issuance requiremma of dui chapser have been presented is the eonuactieg soilai ty." Plese fifi out dos workers'compensation affidavit completely,by elect log the bozo that apply b your situation and,if accemy,supply sa6-aonVsapr(s)name(sj addreaKes)and Phone Aber(s)along with their cestificate(s)of imminc . Limited L abi ty Conopanie.=or Limited Liability Parmanhya(LIY)with no employee other than due members or partners,are not required to carry workers'compensation immmce. If an=err I-I.P does have employees,a policy is required. Be advised dst this affidavit may be subs td to due Department of Iadustiial Accidents for cenfirmadon of immmc a coverage. Man be rare to tip and date the AWavk. The affidavit thoald be retuned to the city or town that the application for the permit or license is being requested,tut the bepartment of Industrial Accidents.. Should you have any questionsregardleg the law or ifyou are required w obtain a workers' companimo penny,please call"Depiamntat at the owrhber listed below. Self-insured companies should eater then selfinsmattaIieemtn n3beroadie.ap;16,elme: City or Tows Oflicisli Please be sure dial the affidavit is complete and printed legibly. The Depuhaent has.pmvided s space at the bottom of the affidavit for you to M out in the went the Office of Investigations has to contact you regarding the applicant Please be sure to till in the pemm/Ikeme m nber which wM be used as a reference number. In addition,an applicant that mot submit multiple perm blicense applications in my given year,need only submit one affidavit indicating anent policy inf07IDmOn(if necessary)and under"lob Site Address"the applicant should write"all locations in (city or town}"A copy ofthe aBd svit that has been odki&W stamped or.madW by the,city or town may,be provided to des applicas as proof that s valid affidavit is on fle fa Arturo permit or license. Anew at8davit mast be fMcd out each year.Where a bone owner or cititoen is obailiting s liceoee or permit not related to say business or commercial vem ere (ice.a dog Heenan or pea nk to bsin kava ere.)tsid peon u NOT regihW ie completed*afiMmit " The Office oflmesdgatiom would like to shack you in advance fir your cooperation and should you have any quesdox% ple4se do mthainte'Wgivense all. The Departments address,telephone and ter:mmbeh The Commonweabli of Massachusetts Depatmlettt of Industrial Accidents Olken d InvesdPdons 600 Wa mStan stied BOMM6 MA 02111 TeL # 617-7274900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 5-26-05 www.mass.gov/dia