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96 BROADWAY - BUILDING JACKET 96 BROADWAY j, aQTY OF SALEM, MASSACHUSETTS INSPECTIONAL SERVICES DEPARTMENT THOMAS ST.PIERRE INSPECTIONAL SERVICES DIRECTOR /BUILDING C ON MISSIONER KIMB$RLEY DRISCOLL MAYOR 120 WASf-ANGT<)N STREET*SALEM,MASSAC130SET'IS 01970 TEL:978-745-9595♦ FA)c 978-740.9846 August 6,2014 F1 LEtJ YICI 14 Property Manager L/ I Cornell Realty Trust 100 Cummings Center 297-H Beverly,MA 01915 Re: 96 Broadway, Salem,MA, 01970 t Property Manager: The Building Department has been made aware that the sidewalk at 96 Broadway(along Canal Street) is impassable due to overgrown shrubs and vegetation. This situation creates an unsafe condition for pedestrians,and is in violation of City Ordinance. Sec. 38-9. Obstructions by shrubbery. No tenant, occupant, or owner having the care of any building or lot of land bordering on any street, lane, court, square,, or public place within the city shall allow any bushes, shrubbery, or any other form of plant growth to obstruct the safe passage of any pedestrian on any such street, lane, court, square, or public place. (Code 1973, ,¢26-9.1) Please have the sidewalk cleared of all obstructions within 21 days of receipt of this notice. Failure to resolve the issues cited above will be construed as non-compliance and may result in the issue of municipal tickets and fines as well as further enforcement actions. Thank-you, Harry Wagg , Assistant Building Inspector 978-619-5643 hwagg@salem.com CITY OF SALEM MONTH EAY P YEAR TIME CONTROL NO. poi 10;tbA I 0153 LOCATION ��O ktK k1tA NAME OF OFFENDER Q?1W-W-RMTftnusr ADDRESS I hereby acknowledge receipt ofthe foregoing citation/n X Date: [ ]Unable to obtain signature of offender X],Date Mailed I [ ]Posting Advertisements,Notices on City Property SCO 4-2 [ ]Illegal Signs [ ] Violation of State Building Code SCO 4-39 and 4-47 SCO 12-1 [ ]Removal of Unsightly Conditions,: P I Violation of BOCA Nat.Fire Prey.Code Q SOO 12-56 SCO 20-111 (D[ ]Keeping of Trailers,Comm.and Rec.Vehicles,etc. l D SCO 24-21.1 �/r []Removal of Snow/Ice from Sidewalks SCO 38-13 and 38-14 [1 SZO Zoning Ordinance 0 3ii-�I 0�5112uct1olJ/Shrz ut� Y }�)i0ther.0' ion: Signature of Enforcing Person Department Amount of Fine: [ ]Warning V]$25.00 [ ],$50.00 [ ]$100.00 [ ]$200.00 [ ]$300.00 [ ]Other You have the following alternatives in this matter within 21 days of the date of this notice: I ] choose to pay the fine within 21 days of the date of this notice. Enclose a check or money order payable to the City of Salem and return it in this envelope or by delivering in hand to the City Clerk's Office,City Hall,93 Washington Street,Salem, MA 01970.If delivering in hand,please note the hours of City Hall operation;Monday through Wednesday from 8:00 a.m.to 4:00 p.m.,Thursday from 8:00 a.m.to 7:00 p.m.and Friday from 8:00 a.m.to 12:00 p.m. [ I choose to contest this matter within 21 days of the date of this notice and request in writing a noncriminal hearing. Enclose a copy of this citation and mail H to the Clerk Magistrate,Salem District Court,65 Washington Street,Salem,MA 01970.The Court will schedule a hearing. FAILURE TO OBEY THIS NOTICE WITHIN 21 DAYS OF THE DATE OF THIS NOTICE WILL RESULT IN THE CITY OF SALEM APPLYING FOR THE ISSUANCE OF A CRIMINAL COMPLAINT AGAINSTYOUAND THE DENIAL OR REVOCATION OF ANY CITY OF SALEM PERMITS OR LICENSES YOU APPLY FOR OR THAT YOU HAVE BEEN GRANTED, INCLUDING BUILDING PERMITS. City of Salem,City Clerk's Office,93 Washington Street,Salem,MA 01970 (978)745-9595,ea.5610. SEE OTHER SIDE FOR FURTHER INSTRUCTIONS ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEALr Sidewalk Obstruction 96 Broadway 7/30/14 Site visit. Sidewalk obstructed. 8/6/14 Sent letter Requesting action. 9/2/14 Sent Municipal Ticket # 0952 QTY OF SALEM, MASSACHUSETTS BUILDING DEPARTMENT ` 120 WASHINGTON STREET,3" FLOOR �rn TEL. (978) 745-9595 FAX(978) 740-9846 KIMBERLEY DRISCOLL MAYOR T�IOMAS ST.PIERRE DIRECTOR OF PUBLIC PROPERTY/BUILDING CONMSSIONER December 15, 2011 Cornell Realty Trust 1000 Cummings Center 207-H Beverly Ma 01915 R.E 96 Broadway Dear Owner, Yesterday, I was asked to inspect the basement area of your rental property at 96 Broadway.I was called there by the Health Department due to the non-functioning heat. There are two locked doors located on either side of the gas furnace as well as make-shift bathroom. .The two locked doors were previously identified by the Salem Police as two bedrooms. There are no permits for the construction of these two bedrooms, nor would they meet building code for ceiling height ,egress etc.You are directed to cease occupying these basement bedrooms immediately. You are further directed to secure building ,plumbing and electrical permits to remove the two bedrooms and bathroom. Addittionally, Information given to us by the Police and tenants identified six individuals living in the home. This is a violation of Salem Zoning and constitutes running an unlicensed rooming house. (M.G.L 140 section 22)You are further directed to reduce the occupants to no more than three unrelated persons.The names of the three occupants to be provide to this office. Failure to comply with these orders will result in further enforcement activities up to and including an application for criminal complaint. If you feel you are aggrieved by the Building Code order, your appeal is to the Board of Buildings,Regulations and Standards in Boston .If you have any questions, contact me directly. Thomr'�41 Pierre Building Commissioner/Director of Inspectional Services Note:This letter was sent to Mr. Camire on November 3,2011 CITY OF SALEM, MASSACHUSETTS BUILDING DEPARTMENT 120 WASHINGTON STREET,3m FLOOR TEL. (978) 745-9595 FAx(978) 740-9846 KIMBERLEY DRISCOLL MAYOR THOMAS ST.PIERRE DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER December 15, 2011 Cornell Realty Trust 1000 Cummings Center Beverly Ma. 01915 Re 96 Broadway Dear Owner, This Department has received a report from the Salem Police Department regarding your property. The complaint is that six or more unrelated individuals reside at the property. You Are directed to contact this office upon receipt of this notice to arrange for a required inspection .(.780 CMR section 115 Inspections). Failure to arrange for this Inspection will result in Municipal Code tickets and further enforcement activities. Thomas St Pierre rAK u�,o Building Commissioner irector of Inspectional Services Please Note, this letter was originally sent to Mr. Camire on October 10,2010 CITY OF SALEM, MASSACHUSEM 1( BUILDING DEPARTMENT a' t 120 WASHINGTON STREET,3�FLOOR TEL. (978)745-9595 FAX(978) 740-9846 KIMBERLEY DRISCOLL MAYOR THOMAS ST.PIERRE DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER October 10,2011 John Camire 53 Lawrence street Salem Ma. 01970 Re 96 Broadway Dear Owner, This Department has received a report from the Salem police Department regarding your property. The complaint is that six or more unrelated individuals reside at the property. You Are directed to contact this office upon receipt of this notice to arrange for a required inspection .(.780 CMR section 115 Inspections). Failure to arrange for this Inspection will result in Municipal Code tickets and further enforcement activities. Thomas St.Pien-e G � K Building Commissioner/Director of Inspectional Services REGISTERED OR CERTIFIED, RETURN RECEIPT REQUESTED. 1 i, n J�tt ropert� '•�j'J R S �nT��YTn� �P�IFIx�mPnt It<r6TEoir�` ,Lltinirl T. (D'P rirn, Jn, �npt. 1. 29-71 �7onm 7, (fiitg ?dal[ Mr. Henry G. Boucher, 11 Fairfield Street , q Salem, Massachusetts Dear Sir: Re-96 Broadway. Would you please call my office or come in to see me about your plans for complying with the recommendations made in my letter to you, dated January 5+h, with regard to the condition of the foundation of your building at 96 Broadway, and the general condition of the structure . I would appreciate hearing from you on this matter before it be- comes necessary to turn it over to the City Solicitor. It is impossi- ble for me to delay such action after Tuesday, February 2, 1971 . Very truly yours, DJOB: cc Alx�_Z'Av� Inspec r of Building" i ,y f 'T,s�,nvr.o�'�9 �TTTI�ITTT� �EI,ibTX�TITE.tT� . Amid J. OI 'Prion, Tr., Supt. 1• 5.71 �;7nnm 7, CULT �InII Mr. Henry G. Boucher 11 Fairfield Street Salemq Massachusetts Dear Sir: We have called your attention to the condition of a structure which you moved sometime ago to a location on Brae 4way. You have failed to follow recommendations made to you in a letter from this office dated March 23, with regard to installing a foundation and making this dwelling habitable by the first of May, . 1970. Copies of the applicable regulaticna of the City Building Code were forwarded to you advising you of the pen- alties involved for failure to secure or remove this building. You are hereby ordered to take immediate steps to install the founda- tion and repair this structure, or I shall be forced to comply with the provisions of the Building Code. Very truly yours, DJOB:cc CYO Z?Agfg&� OA Inspec or of Buildings • " i MAILED REGISTERED OR CERTIFIED MAIL, RETURN RECEIPT REQUESTED. "T of �CCE11T; �ISSFIL IT$P## °�{�'� f � �ublic �ru�rer#g �epttx�men# -hunt rr"�bnvFns°� iXI.W P -. ,panel J. (®'�Bricn, 29r.,,Supt. 1.1$.71 poom 7, Qitp pull Mr. Henry G. Boucher, 11 Fairfield Street, Salem, Massachusetts ' Dear Mr. Boucher; Re-Condition of your property at 96' Broadway. A copy of a letter sent to Mayor Samuel E. Zoll with regard to the condition of a dwelling owned by you at 96 Broadway is enclosed. This office has notified you repeatedly in writing and verbally, to remedy existing conditions referred to in this letter, and* you have neglected to follow these recommendations. It is now necessary £or me to inform you that if within TENDpyS of receipt of this letter this building does not meet the requirements of the City Building Code, we shall have no alternative but to enforce Sections 8, 99 10, and 11 of the Code, relating to penalties for viola- tions. Copies of these sections have been sent to you. You are hereby ORDERED to make this house secure and close up the foundation by adding extra block, The Building Code calls for ten inch fouMtdation and all you. have is eight inch block. Very truly yours, DJOBsco , Encl. 1 to Inspe of Buildings •' Salem, Mass., 01970 January 120 1971 City Hall Salem; Mass. Attention: Mr. Mayor Samuel Zoll: Dear Sirt We are abutters to the property owned by Mr. Boucher, who was allowed to move an old delapidated, (now nearly completely destroyed by vandals ) house, which was originally located on Forest Avenue, land which was acquired by Salem State College. ➢ispits our protest and that of all our neighbors (signed petition by this group of people - protesting the moving of such a house - to this property on Broadway. } Please check records on this; Mr. Boucher wanted a variance to the build- Ing code, to put this (huge) TWO family house on a lot barely large enough for a one farmly` douse. He was not given the variance, but, was allowed to move this monstrousity on the property, providing he housed ONE family* (Nothing has been done to it since.) Please find a little time in your busy schedule to come and inspect this (very dangerous) - (fire hazard) etc. , piece of property. We have time and time again called the Building. Inspector and complained of this unsafe structure. (The windows were boarded and so were t eoors lrs floor onlyi ) notice the condition of the foundation - not half finished* gaRing holes, certainly not meeting the standard building codes of our Children have been able to get in anyway; only last Sunday a group of boys littered our yard with over fifty ceiling tiles. Mr, Mayor before some child is killed or mained please* do something to rid our part of the city of this very dangerous condition, one fire has already been set. We have spoken to our lawyer; he suggested we contact the State Inspector, if., no action is being taken by our local authority. We cannot understand how such a situation can go unchecked for such a lenghtly time. Your kind attention to this matter is greatly appreciated, We hope to hear from you shortly, Very_.tr yours, eorgeeaureg A� 216 Canal St. Salem,Mass. cc : Building Inspector PLEASE FURNISH SERVICE(S) INDICATED BY CHECKED BLOCK(S). REQUIRED FEE(S) PAID. ❑ Show to whom, date and address Deliver ONLY where delivered ❑ to addressee RECEIPT Received the numbered article described below. REGISTERED NO. tllGVNAIOR NAME OF ADDRESSEE(Must always befilled in) CERTIFIED//N0. V131- /- d" 1 E OFADDRESSEE'S AGENT,IF ANY INSURED NO. DATE IVEREOELIVERED(only if regrre.rted) 058-10-718!8-11 847-188 aro POST OFFICE DEPARTMENT OFFICIAL BUSINESS 1 n �/ J PENALTY FOR PRIVATE USE TO AVOID 0 PAYMENT OF POSTAGE,SSR POSTMARK OF DELIVERING OFFICE Print your name and address below. If you want to m restrict delivery, or to have the address of delivery RETURN a shown on this recetpq check blocks) r to b side. Moisten gummed ends and attach this card to back of TO article. C4 4 D July 22, 1999 Mr. Peter Strout Director of Public Properties One Salem Green Salem,MA 01970 e Dear MSL The residents at 99 Broadway and 991/2 Broadway share a common sidewalk. There has been a missing section of downspout on the building at 99 Broadway for some time. And while this small section of downspout may seem to be inconsequential to most of us, this small section is of considerable concern to the resident of 991/2 Broadway. During last winter an ice build-up on this common sidewalk of two to three inches prohibited the resident at 99112 from using this shared sidewalk. This ice was a result of the missing section of downspout on the building at 99 Broadway. The resident of 991/2 Broadway is an 80 year old widow wishing to remain independent and live on her own. As you can see, this seemingly inconsequential matter is of considerable importance to a long time senior resident of our community. Would you please inspect and direct the current owner of 99 Broadway to correct this hazardous situation. Thank you for your attention to this matter. Sincerely, f Bill Kelle� Councillor for Ward 5 1 Praper#V Ptpadmen# ''cam=� r.`` �LiT�tm� �e�Jtlr�lneYt� ,Annie! 1J. M'Prien, Jr., 45upt. Porn 7, (Mig Pill Mr. Henry G. Boucher, 11 Fairfield Street, Salem, Massachusetts Dear Mr. Boucher; Re-Condition of your property at 96 Broadway. A copy of a letter sent to Mayor Samuel E. Zoll with regard to the condition of a dwelling owned by you at 96 Broadway is enclosed. This office has notified you repeatedly in writing and verbally, to remedy existing conditions referred to in this letter, and' you have neglected to follow these recommendations. It is now necessary for me to inform you that if within TE® of receipt .of this letter this building does not meet the requirements of the City Building Code, we shall have no alternative but to enforce Sections 8, 99 10, and 11 of the Code, relating to penalties for viola- tions. Copies of these sections have been sent to you. You are hereby ORDERED to make this house secure and close up the foundation by adding extra block. The Building Code calls for ten inch foundation and all you. have is eight inch block. Very truly' yours, DJOBscc , Encl. 1 t Inspe ) o Buildings I. Titv 1�f ��alera, t L rot )AA-c 11 vertu 3)e artment in ,,ovember 24, 1970 3:�twin 7, TRL7 Rill Mr.Henry Boucher 11 Fairfield Street Salem, Massachusetts Dear Sir: Dwelling on Pacific Street I sent you a letter dated March 23,1970 in regards to the condition of your dwelling on Pacific Street. (f We are still receiving complaints daily from property owners in, bothlareas, concerned for the value of their own Property and eventual devaluation of same because of the appearance of this building. # ff Please make immediate emergency repairs to this dwelling n in the nature of boarding up and securing the building to eliminate this serious hazard and nuisance in the neighborhood.fl & If these remedial. operations are not taken care of iTrimed.--', ate- ly, you leave me no alternative but to comply with Section 9 of the Building Code and Sections 8,10, and 11, a copy of which I sent you in the previous letter.' 'Very truly yours, May 15, 1972 Mr, Henry Boucher 11 Fairfield Street Salem, MA 01970 Dear Sirs Complaints have been received by this department in regard to your truck with a snow plow which has been parked on Broadway for the better part of a year. Same rubbish is noted in the truck body. We would appreciate your cooperation in moving the truck. Very truly yours$, Reply tot FOR THE BOARD OF HEALTH" JCHN J. ,TOOMEY, D.S.C. Colin E. Cameron, R.S. Health agent Senior Sanitarian f Certified Mail N7868li1 P (\i11T oflem, ttSbMC1I�xP## ,Pauid lj_ (Vprirn, Tr., 'Snpt. MARCH 23, 1970 . pnnm 7,.CIitU Mall Mr. Henry Boucher, 11 Fairfi.eld Street , Salem, Massachusetts ......may Dear Sir: Re-Broadway, Dwelling on Pacific Street On many occasions I have called your attention to the conditions of these two structures , complaints received in this department with regard to children playing in and around them, and advised you that they. should be boarded up and secured against entx'ance by any persons unauth- orized by you. We are receiving complaints daily from property owners in both areas, concerned for the value of their own property and eventual de- valuation of same because of the appearance of these buildings. We are enclosing copies of applicable sections from the City of Salem Building Code for your study. With regard to the building on Broadway, you shall have a founda- tion installed under this structure by the sixth of April , and the dwel- ling shall be made habitable by the first of May, 1970. Please make immediate emergency repairs to this fire damaged struc- ture on Pacific Street in the nature of boarding up and securing the building to eliminate this serious hazard and nuisance in the neighbor- hood. This structure also, 'shall be made habitable by the first of May, 1970. If these remedial operations are not taken care of exactly as or- dered, you leave me no alternative but to comply with Section 9 of the Building Code , a copy of which and Sections 8, 10, and 11 , are enclosed as mentioned above . Very truly yours, DJOB: cc '�.r�h i \. i'• �1�`i ' A }� Copy to: Health Dept. Inspector •o:f \Buildirigs Fire Dept. i y `°w C tv of '�$ttlem, ttsstttl��zse##s ,: :0 ��zblic �ru�er#g �e�ttr#men# A � g9� �lI[�llt$ �e�JFIX�1t1PY[� �uniel - "�xien, �r-, odnV}- 1.28-71 Roam Z, @life Pull Albert R. Pitcoff, Esq. , City Solicitor, 70 Washington Street, Salem, Massachusetts Dear Mr. Pitcoff: We are enclosing a copy of a letter sent to Mr. Henry G. Boucher on January 5, 1971 with regard to the condition of a structure owned by him located at 96- Broadway. Since writing this letter, we have heard nothing from Mr. Boucher, and at this time request your counsel as to what action may be taken to insure proper handling of this situation. Very truly yours, DJ OB:c c �` Encl. 1 Insp c or of Buildix) s BUILDING WRECKERS - ALLSTATE, NEPTUNE, ALLIED ALL THE SAME? We have a check for $400.60 from Neptune covering a permit for demolition at 113 North Street ; he also a permit for demolition has one for 70 Ward Street; does the check for $400.00 cover both jobs? Mr. Cameron was in about the contract for the demolition at 96 Broadway; the proposal is on the forms of the "Allstate Building Wrecking, Inc . , " but Gifford Russell assured him the Gatchells had nothing to do with it; did you know they are operating this out of a trailer parked on Franklin Street?? s � (fitU of �$Mlem, r4Vassztr4usp.tts Paurh of 19CAkth 31. inplan, + 1.11., (Lttnirmnn °� 5 lrnttil sdtrer! 1M-Airciu @lountie,�l. K- 3o11n X Zvameg, P.,S.@I. 1zird Aeslth cZ+grnt April 21, 1972 Allstate Building Wrecking, Inc. Franklin Street Salem, 1vIA 01970 Gentlemen; you are hereby authorized to raze the condemned structure at Lot No. 96 on Broadway in Salem, which is described on attached deed (Book 5826 and page 25). Upon completion of the razing of the structure and filling in the cellar hole (including compacting), submit your invoice to the Board of Health. In the interest of expediting the razing of this dangerous property, we have taken steps to exterminate this property for rodents. Very truly yours, Reply to: FOR THE BOARD OF HEALTH John J. Toomey, D. S. C. Colin E. Cameron, R. S. Health Agent Senior Sanitarian f Hand delivered CC; Building Inspector Encl. (1) Copy of quitclaim deed - Book 5826 page 25 S,15826 PG025 henry G. Boucher and Shirley J. Boucher, husband and w'fo, Sal k'In -ing 4r wnaffied, for Consideration paid, :anU ko Robert D. Bowes of 59 Federal Street Salem,, s id Essex County with 6)e land in said Salem, with the buildings thereon, bounded and described as follows: Bel-inning at the Southwesterly corner thereof and then running �'ORTill-'RLY on Broadway, fifty (50) feet; thence turning and running EASTERLY by land now or formerly of Tidewater Leather Company, one in;ndred (100) feet; thence turning and runninj,, . SOUTHERLY 'by Lot No. 97 on pian of Lmd hereinafter referred to, fifty (50) feet; and thon turning and running X%'ESTI,'RLY by Lot No. 94 on said plan, one hundred (100) feet t 1 0 the point of bc.-inniug. Containing five thousand (5,000) squire feet and being Lot No. DG on plan or ;m)rt4on of the Estate of James F. Almy, Salem, December, 1927, T. A. Appleton, C.E. rocorded with Essex &)uth District Registry of Deeds, Plan Book 54, Plan 93. For of title see deed to us from Omer R. Talbot et al, Trustees of Broadway Realty Trust, dated May 1, 1969 and recorded in said Registry, Book SLOG, Page 703. Consideration for this deed Is nominaL 111iturma..Q.Ur..hands and seals this......A00.....--day of .....Noyenlhe'...............1y. .......... .................... ...... ....... llpnTy. Uucho'r ............... ......... ?_.{..:v...:....:........................................ Shirley J: 'Boucher .................... .............................................................. ......... Essex, SL November 30, 19 71 71C,' personally appeared the above named Henry G. Boucher and Shirley J. Boucher I and acknowledged the foregoing instrument to be their cc act and :!"Cl' 1'cEQzc me I• e RONAN a HARRINGTON ATTORNEYS AT LAW FIFTY-NINE FEDERAL STREET JAMES T.RONAN", SALEM, MASSACHUSETTS 01970 JOHN T.RONAN _ MICHAEL J.HARRINGTON 617 744-0350 JACOB S.SEGAt ROBERTO. BOWES GEORGE W.ATKINS,41 November 22, 1971 Board of Health 5 Broad Street Salem, Massachusetts 01970 Attention: Colin E. Cameron, R. S. , Senior Sanitarian Dear Sir: This will acknowledge receipt of your certified mail letter dated November 17, 1971, concerning property of Henry and. Shirley Boucher located on Broadway. As you know, this office represents Mr. and Mrs. Boucher with respect to this matter. In accordance with the last paragraph of your letter, petition is hereby made for a hearing on the matter, Very truly yours, 4)ert . B��ca���i� wsd r r. (fit" ofttlem, Cttssttcl�usetts s q Poura of 'Menith ^n 31. 'iFiaplun, 1 .38., QIfluirman S �IrouA Street Jahn 1- Toomeg, P.,SX. Marcia T ut e,cR-�- 1 p . �- � a �eelfh Agent S November 17, 1971 Mr. Henry Boucher and Mrs. Shirley Boucher 11 Fairfield Street Salem, MA 01970 Dear .Sir and Madam: The condition of your property on Broadway (site of fire on November 15, 1971) is such that it endangers the health, —_ well being, comfort and safety, of the general public. This structure is ORDERED condemned and is ordered to be razed within (7) seven days and not later than November 26, 1971, under the authority of Article One of the Sanitary Code of the Commonwealth. After compliance you are advised of your right to a hearing before the Board of Health by filing a written petition in the office of the Board of Health within seven (7) days after receipt of this order. Very truly yours, Reply to: FOR THE BOARD OF HEALTH JOHN J. TOOMEY, D.S.C. Colin E. Cameron, R.S. Health Agent Senior Sanitarian f CC: Attorney Robert D. Bowes, Fifty Nine Federal Street, Salem, Mass. Inspector of Buildings, City Hall, Salem, Mass. Certified Mail #787381 - :a , r OL The Commonwealth of Massachusetts Department of Public Safety ¢ F Massachusetts State Building Code(780 CMR) Building Permit Application for any Building other than a One-or Two-Family Dwelling •(This SectionFol;Official Use,Only)� �, Building Permit Number Date•Appled Bwlduig Official SECTION I:LOCATION(Please indicate Block'#and Loth#for locations for"whiclia street address:is-notavailable)" q6 f�t�ac�wg� S� Salf� �j197c> No.and Street City/Town Zip Code Name of Building(if applicable) 'SECTIONIPROPOSEIJWORKIf Edition of MA State Code used_ If New Construction check here❑ or check all that apply in the two rows below Existing Building Repair❑ 1 Alteration E!r Addition❑ Demolition (Please fill out and submit Appendix 1) Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No Is an Independent Structural Engineerin Peer Review re9q�,wired? n Yes ❑ No ®� Brief Description of Proposed" ITP�^'1uL2 UVit,er,%W\ 'Y<iz�✓",s bgJpr-.ee\ SECTION.3:COMPLETE:THIS SECTION�IF EXISTING BUILDING;UNDERGOING RENOVATIONS ADDITION,OR:` CHANGE IN USE OR OCCUPANCY " Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑ Existing Use Group(s): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREAa Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) Total Area(sq.ft.)and Total Height(ft.) SECTION 5:USE'GROUP'(Check as a plica@le) ` A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A4❑ A-5❑ B: Business ❑ E: Educational ❑ F: Facto F-1 ❑ F2❑ I H: High Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑ I: Institutional I-1 ❑ 1-2❑ I-3❑ I-4❑ _- Mercantile❑ R: Residential R-113 R-2❑ R-3❑ R-4❑ S: Storage S-1 ❑ S-2❑ U: Utility❑ Special Use❑and please describe below: Special Use: SECTION 6:CONSTRUCTION-TYPE(Check,as applicable) . IA ❑ IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ IV ❑ VA ❑ VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CM_R 111.0 for details on each item)' '< Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: Public❑ Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be Licensed Deposal Site❑ required❑or trench or specify: Private❑ or indentify Zone: or on site system❑ permit is enclosed❑ Railroad right-of-way: Hazards to Air Navigation: NIA Historic Conunission Rev ierw Pax:ess: Not Applicable❑ Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed❑ Yes ❑ or No❑ Yes❑ No ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY ' Edition of COcle: Ur e Group(s):. Type of Construction: Occupant Load per Floor: Does the building contain an'Sprinkler System?: Special Stipulations: C r y -a wi SECTION 9: PROPERTY OWNER'AU_THORIZA 'ION Name and Address of Property Owner Name(Print) No.and Street City/Town Zip Property Owner Contact Information: Title Telephone No. (business) Telephone No. (cell) e-mail address If applicable, the property owner hereby authorizes Name Street Address City/Town State Zip to act on the property owner's behalf,in all matters relative to work authorized by this building permit application. ' SECTION 10 CONSTRUCTION CONTROL(Please fill out Appendix 2)? tf buiIdl'n ts""less than 35,000 cit.ft.of enclosed s ace`and/br dot undei Construetion,Conhbl then check here`O`and ski'Section 10.1) ' 10.1 Re 'stared Professional Responsible for Conshnction Control:-_ Name(Registrant) -Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 10.2 General.Contractor'« Company Name Name of Person Responsible for Construction License No. and Type if Applicable Street Address City/Town State Zip Telephone No. business Telephone No. cell e-mail address SECTION 11::4VORKERS'.lOMPENSATIONINSURANCE'AFFIDAVIT M.G.L.c.152 :-25C 6 ' A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Is a signed Affidavit submitted with this application? Yes❑ No O SECTIONL11 CONSTRUCTION"COSTS;AND PERMIT FEE, ` Item Estimated Costs: (Labor and Materials) Total Construction Cost(from Item 6)_$ 1. Building $ Building Permit Fee=Total Construction Cost x (Insert here 2. Electrical $ - appropriate municipal factor)=$ 3.Plumbing $ 4. Mechanical (FfVAC) $ Note:Minimum fee=$ (contact municipality) 5. Mechanical Other $ Enclose check payable to 6.Total Cost $ (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT, By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information contained in tlus application is true and accurate to the best of my knowledge and understanding. Please print and sign name Title Telephone No. Date Street Address City/Town St at Zip Municipal Inspector to fill out this section upon application approvah ame - - Date SAN-16-2013 12:30P FROM: 9789220277 70:19787443188 P.3 r_ v SECTION 3 PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner /fie}h Correa\ q6 Qp�cCQ Name(Print) No.and Street City/Town Zip Property Owner Contact Information: Title Telephone No.(business) Telephone No. (cell) a-mall address If applicable,the property owner hereby authorizes Name Street Address City/Town State Zip to act on the timperty owners behalf,in all matters relative to work authorized by this building permit application. $ECTION Ilk CONSTRUCTION CONTROL(please fill out Appendix 2) If building-is less than is oan eu ft.of enclosed s-ece and or not under Construction Control than check here 0 and skipSection 10.1 10.1 Registered Professional Res onsible Tot Consfrti¢tlon C.onirol - 5o ,r\ G9w\,K -17KAO 517q N�{rte(Registrant) T ephone No. e-mail address Registration Number V (4wIYy, S}. rev r1y\ CA170 Street Address City/Town State Zip Discipline Expiration Date 102 General Contractor J JL GPv�P/�\ CohhYgC�1RG Company Name �hr Cq.MvPE" Name of Person Responsible for Construction License No. and Type if Applicable 0a. �, Sa4r- i"7fi CACt70 Street Address City/Town State Zip wB S ,;.l eG1re.(1w\ CorAe,,0,�� Telephone No.jbusiness) Tele hone No4 tell e-mail address SECTIO 11:WOR 7NSURAN .AFFIDAVIT G.L.c.1s2. 25C A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the y'�suance of the building permit. Is a signed Affidavit submitted with this application? Yes H- No O 6ECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)=$ 1.Building $ Building Permit Fee-Total Construction Cost x_(Insert here 2.Electrical $ appropriate municipal factor)-$ 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality) 5.Mechanical Other $ Enclose check payable to 6.Total Cost $ a-�0 contact municipali )and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below,I hereby a st under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the st of my knowledge and understanding. Please print and sign name Title Telephone No. Date Street Address City/T State Zip Muhietpat lnspector-to fin out this sev"on upon application approvals - - - -- Name Date Crrx of S:u.F_2%15 ALSSACHUSE'rrs BUILDING DEPART\(ENT I20 WASHINGTON STREET, 3ao FLOOR TEL (978) 745-9595 FmX(978) 740.9846 Kl.N fB RT RY DRISCOII T MAYOR �loetAs Sr.PmxRf3 DIRECTOROF PUBLIC PROPERTY/aumDLNGco-a ssictNER Workers' Compensation insurance Affidavit: Builders!Contractors/Electricians/Piumbers Anolicant information Please Print Leeibtx Ninne(Busincss.OrganiratioNlndividual): 3 , \ GP^P!S\ COv,)rgC�N �G Address: G a I c —rl'.1 ca; Ji , , SO City/State/Zip: 7G Phone k: Are vius an employer?Check the appropriate bolt Type of project(required): 1. I am a employer with 4, 0 1 am a general contractor and 1 6. ❑New construction employees(fill and/or part-time).• have hired the sub-contractors 2.0 1 airs a solo proprietor or partner- listed on the attached sheet.t 7• ❑Remodeling ship and have no employees These subcontractors have V. 0 Demolition workingfor me in an capacity. workers'camp.insurance. Y9. ❑Building addition (No workers'comp, insurance 5. ❑ We are a corporation and its required.) officer have exercised their 10.0 Electrical repairs or additions 3.0 1 am a homeowner doing all work right of exemption per MGL i I.0 Plumbing repairs or additions myself.(No workers'comp. C. 152,}1(4),and we have no 12.0 Roof repair insurance required.)t employees.(No workers' comp.insurance required.] 13'0 Other •Any applicant tlua ctoslia box II moat also till uut thv section below showing thoir workers'mmpa icalon policy information. 'I L»nvowntnss who submit this atBdavta indicating they am doing all work and thin him outride contrac xis mists submit a now aMdavit indimiing tuck �Cvntracton thus chuck Ibis box most attached an atWitiussl ahmi showing the name of the ndscontnc cn,and thcit workon'comp,policy infomunon, l um un employer that it providing workers'compensation insurance for my employees: Below/s t/te poliey and fob site inforination. '/{J T 1r /��l �/7 C /�/� (/,�, fnsurdnce Company Ntarie: ' `ufQ -i-h J. ` 7k— • 41 -C 4,6 Policy N or Scl6its. Lic.N: Expiration Onto: Job Sifts Address: - City/S12trJZiP. - - Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failuro to secure coverage as required under Suction23A of,%,IGL c. 152 can lead to the imposition of criminal penalties of a tine up to S1,500.00 and/or one-year imprisonment.as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator. Ile advised that a copy of this statement may be rurwardud to the Office of Investigations uftho DIA fur insurance coverage verification. l do hereby certify ander die punts uud pen ultles of perjury t/rut the hrfammlon provided above is true uud correct Si�tnnmre: �'� ��, aC) Phunc N: 9 7S---S�- 9 17ft t OJjirful use asfy. Do not,write in this urea,to be conspleted by city at town allIC14t I cityor'rown: PermI0.Icense Issuing Aulhorily(circle one): I. Ifoard of licallh 2. Building Department I.Citytrown Clerk 4. Electrical luspector 5. Plumbing inspector 6.0thcir _.. Contactl'ersom -._ . ----- ._. Phone It: t } CITY OF SALEM, NLXSSACHUSETTS i l BUILD= DEPARTIMENT 3 lr- 120WASHLNGTON STREET, 3° FLOOR T EL (978) 745-9595 FAx(978) 740-9846 KI\QiERLF-Y DRISCOLL NYOR THo.%w ST.PIERRB DIRECTOR OF PUBLIC PROPERTY/SUILDLNG CO\LNIISSIONER 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 c 40, S 54; Building Permit 9 is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c 111, S 150A. The debris will be transported by: Jc h1� 0ePA (name of hauler) The debris will be disposed of in : --- (name of facility) _ -- --(address of facility) signature of permit applicant O date Icbn::Wf J.x