HomeMy WebLinkAboutMiscellaneous - Royal Crest Drive-Bldg. 36-Apt 30
c�
F-
n
K
(D
In
fi
W
i��
4
V
U
C
N
C
O
.j
O
U)
N
Q
.0
C
?
.j
m
J
0
LO
N
O
N
CD
9
Ot HORTH I L„
o '•• y�
_ • o
•' %
Town of North Andover
HEALTH DEPARTMENT
yACH
I�
CHECK #: DAT
LOCATION:
H/O NAME:
CONTRACTOR NAME:
Type of Permit or License: (Check box)
❑ Animal $
❑ Body Art Establishment $
❑ Body Art Practitioner $
❑ Dumpster $
❑ Food Service - Type: $
❑ Funeral Directors $
❑ Massage Establishment $
❑ Massage Practice $
❑ Offal (Septic) Hauler $
❑ Recreational Camp $
❑ Sun tanning $
❑ Swimming Pool $
❑ Tobacco $
❑ Trash/Solid Waste Hauler $
❑ Well Construction $
SEPTIC Systems:
❑ Septic - Soil Testing $
❑ Septic - Design Approval $
❑ Septic Disposal Works Construction (DWC) $
❑ Septic Disposal Works Installers (DWI) $
❑ Title 5 Inspector $
❑ Title 5 Report $
Other (Indicate 4 $jy—,11
(0) 1
Health Agen Initials
White - Applicant Yellow - Health Pink - Treasurer
ti
d - `
TOWN OF NORTH ANDOVER
NORTH ANDOVER, MASSACHUSETTS 01845
Ss�ecaus�
Permit Number /,::P, 75 ?-
Date
Date Issued 71d/1,qt
Expiration Date
Jackie's Law - Permit Application
Pursuant to G.L. c. 82A §1 and 520 CMR 7.00 et seq.(as amended)
THIS PERMIT MUST BE FULLY COMPLETED PRIOR TO CONSIDERATION
Name of Applicant
Phone Cell
} W SEE Fye u 1 t-i)i K30
Street Address
(q-76)took�11
t �f3 r-ta-esr�-et-c.L
City/Town MA
ZIP
r sc-�� �"4
via -74.
Name of Excavator (if different from applicant)
Phone Cell
Street Address '5A41-4 E
City/Town
MA
ZIP
Name of Owner(s) of Property
Phone Cell
A tmcz-�, I -omit A-it:-ov Ec- i LLC
Street Address
50 V-CgP L CO -CES -1— 3 3
City/Town
MA
ZIP
"ott U AµbOvG�
"A
01fA5
I
Permit Fee Received No Yes
Other Contact
Description, location and purpose of proposed trench:
Please describe the exact location of the proposed trench and its purpose (include a description of what is (or is intended) to
be laid in proposed trench (eg; pipes/cable lines etc..) Please use reverse side if additional space is needed.
rou �jbATtas V�A-T�iZ�2aaFit-�y �e.c1-�t�q��=
Insurance Certificate d#:
LA4jtA ` Civt ,• I i�>z°�. t.iL-�fz� e'aa-vi F—EsTo WE
to L carr�r-SkanC_\and. Aje-t ((T78) 835 - 01 02
Name and Contact Information of Insurer: jL4Ar_b0W 4-L
P4C-7l0WF_ IUSU'P_ &Xl E
i o 4 "44" 'er t?.0. 80X 428 Md9TH- A-NDUve2, WA olz4S -, carets cwLbs
Policy Expiration Date: ID 14
Dig Safe #:
2>1 4 - 2,70 - 93
Name of Competent Person (as defined by 520 CMR 7.02):
Massachusetts Hoisting License #
4 I ZolS
R -V - o339g3
License Grade:
Expiration Date:
BY SIGNING THIS FORM, THE APPLICANT, OWNER, AND EXCAVATOR ALL ACKNOWLEDGE
AND CERTIFY THAT THEY ARE FAMILIAR WITH, OR, BEFORE COMMENCEMENT OF THE
WORK, WILL BECOME FAMILIAR WITH, ALL LAWS AND REGULATIONS APPLICABLE TO
WORK PROPOSED, INCLUDING OSHA REGULATIONS, G.L. c. 82A, 520 CMR 7.00 et seq., AND ANY
APPLICABLE MUNICIPAL ORDINANCES, BY-LAWS AND REGULATIONS AND THEY COVENANT
AND AGREE THAT ALL WORK DONE UNDER THE PERMIT ISSUED FOR SUCH WORK WILL
COMPLY THEREWITH IN ALL RESPECTS AND WITH THE CONDITIONS SET FORTH BELOW.
THE UNDERSIGNED OWNER AUTHORIZES THE APPLICANT TO APPLY FOR THE PERMIT AND
THE EXCAVATOR TO UNDERTAKE SUCH WORK ON THE PROPERTY OF THE OWNER, AND
ALSO, FOR THE DURATION OF CONSTRUCTION, AUTHORIZES PERSONS DULY APPOINTED BY
THE MUNICIPALITY TO ENTER UPON THE PROPERTY TO MONITOR AND INSPECT THE WORK
FOR CONFORMITY WITH THE CONDITIONS ATTACHED HERETO AND THE LAWS AND
REGULATIONS GOVERING SUCH WORK.
THE UNDERSIGNED APPLICANT, OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY
TO REIMBURSE THE MUNICIPALITY FOR ANY AND ALL COSTS AND EXPENSES INCURRED BY
THE MUNICIPALITY IN CONNECTION WITH THIS PERMIT AND THE WORK CONDUCTED
THEREUNDER, INCLUDING BUT NOT LIMITED TO ENFORCING THE REQUIREMENTS OF STATE
LAW AND CONDITIONS OF THIS PERMIT, INSPECTIONS MADE TO ASSURE COMPLIANCE
THEREWITH, AND MEASURES TAKEN BY THE MUNICIPALITY TO PROTECT THE PUBLIC
WHERE THE APPLICANT OWNER OR EXCAVATOR HAS FAILED TO COMPLY THEREWITH
INCLUDING POLICE DETAILS AND OTHER REMEDIAL MEASURES DEEMED NECESSARY BY
THE MUNICIPALITY.
THE UNDERSIGNED APPLICANT, OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY
TO DEFEND, INDEMNIFY, AND HOLD HARMLESS THE MUNICIPALITY AND ALL OF ITS AGENTS
AND EMPLOYEES FROM ANY AND ALL LIABILITY, CAUSES OR ACTION, COSTS, AND EXPENSES
RESULTING FROM OR ARISING OUT OF ANY INJURY, DEATH, LOSS, OR DAMAGE TO ANY
PERSON OR PROPERTY DURING THE WORK CONDUCTED UNDER THIS PERMIT.
APPLICANT SIGNATURE
DATE -71-7114
EXC VATOR SIGNATURE (IF DIFFERENT)
DATE
OWNER'S SIGNATURE (IF DIFFERENT)
DATE:
21Page
CONDITIONS AND REQUIREMENTS PURSUANT TO G.L.C.82A AND 520 CMR 7.00 et seq.
(as amended)
By signing the application, the applicant understands and agrees to comply with the following:
Vi.
No trench may be excavated unless the requirements of sections 40 through 40D of chapter 82, and any
accompanying regulations, have been met and this permit is invalid unless and until said requirements
have been complied with by the excavator applying for the permit including, but not limited to, the
establishment of a valid excavation number with the underground plant damage prevention system as
said system is defined in section 76D of chapter 164 (DIG SAFE);
Trenches may pose a significant health -and safety hazard. Pursuant to Section I of Chapter 82 of the
General Laws, an excavator shall not leave any open trench unattended without first making every
reasonable effort to eliminate any recognized safety hazard that may exist as a result of leaving said
open trench unattended. Excavators should consult regulations promulgated by the Department of
Public Safety in order to familiarize themselves with the recognized safety hazards associated with
excavations and open trenches and the procedures required or recommended by said department in
order to make every reasonable effort to eliminate said safety hazards which may include covering,
barricading or otherwise protecting open trenches from accidental entry.
Persons engaging in any in any trenching operation shall familiarize themselves with the federal safety
standards promulgated by the Occupational Safety and Health Administration on excavations: 29 CFR
1926.650 et.seq., entitled Subpart P `Excavations".
Excavators engaging in any trenching operation who utilize hoisting or other mechanical equipment
subject to chapter 146 shall only employ individuals licensed to operate said equipment by the
Department of Public Safety pursuant to said chapter and this permit must be presented to said licensed
operator before any excavation is commenced;
By applying for, accepting and signing this permit, the applicant hereby attests to the following: (1) that
they have read and understands the regulations promulgated by the Department of Public Safety with
regard to construction related excavations and trench safety; (2) that he has read and understands the
federal safety standards promulgated by the Occupational Safety and Health Administration on
excavations: 29 CMR 1926.650 et.seq., entitled Subpart P "Excavations" as well as any other
excavation requirements established by this municipality; and (3) that he is aware of and has, with
regard to the proposed trench excavation on private property or proposed excavation of a city or town
public way that forms the basis of the permit application, complied with the requirements of sections 40-
40D of chapter 82A.
This permit shall be posted in plain view on the site of the trench.
For additional information please visit the Department of Public Safety's website at www.mass_gov/dps
3 1 P a g e
FILE COMMENTS
Name: Mohamid Yakine
Comments:
Date:12-27-2004
On December 28, 2004 I spoke to Mark Johnson regarding Bldg 36 U. I faxed
over the Order Letter, then called and spoke to Terry confirming receipt.
Town of North Andover
Office of the Health Department aj
}
Community Development and Services Division
400 Osgood Street
q _ >`
%
North Andover, Massachusetts 01845 9sSgcHUSEt
Susan Sawyer (978) 688-9540 - Phone
Public Health Director (978) 688-9542 - Fax
NORTH ANDOVER BOARD OF HEALTH
ORDER LETTER
Issued under the provisions of the State Sanitary Code, Chapter II, Minimum Standards of
Fitness for Human Habitation, 105 CMR 410.000.
Date: December 27, 2004
To Owner of Record:
Royal Crest
Attn: Mark Johnson
50 Royal Crest Drive
North Andover, MA. 01845
Property Location:
Mohamid Yakine
Bldg. 36 Apt: 3
North Andover, MA. 01845
An authorized inspection was made of your property at the above referenced address
by North Andover Health Department personnel on December 20, 2004.
This inspection revealed violations of certain regulations of the State Sanitary Code,
Chapter II, as listed on the attached Violation Form. You are hereby ORDERED to correct
these violations within the time allotted on the enclosed form. Failure to comply within the
specified time period may result in further action by the North Andover Board of Health.
You have the right to request a hearing before the Board of Health if you feel this order
should be modified or withdrawn. A request for said hearing must be made in writing and
received by the Health Department within seven (7) days from the receipt of this order. At
said hearing you will be given an opportunity to be heard and to present witnesses and
documentary evidence as to why this order should be modified or withdrawn. All affected
parties will be informed of the date, time and place of the hearing and of their right to inspect
and copy all records concerning the matter to be heard. You may be represented by an
attorney. You have the right to inspect and obtain copies of all relevant records concerning the
matter to be heard.
Michele E. Grant
Public Health Inspector
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-95311 IIEALT11 688-9540 PLANNING 688-9535
Re: Property: 36 Royal Crest Ave: Apt. 3
From: North Andover Board of Health
Date: December 20, 2004
ORDER LETTER
An authorized inspection of Bldg. 36 Unit was performed by Board of Health staff on
December 20, 2004 at which violations of 105 CMR 410.000 Chapter II of the State Sanitary
Code, Minimum Standards of Fitness for Human Habitation were found. Failure to respond
within the allotted time period may result in a Board of Health finding that the dwelling is
unfit for human habitation.
All violations must be corrected within seven (7) days of receipt of this Order Letter or a
plan for completion must be approved by this office if a professional contractor must be
hired to do the work.
Violation
Regulatory
Reference
Re -
Inspection
➢ Master bedroom - ceiling with peeling
410.500
2/3/05
paint.
Observed old ceiling patch that the paint has
COMPLIED
separated away from the subsurface. Damage
likely due to improper preparation of the surface.
Owner must maintain ceilings in good condition
Owner must repair as needed.
➢ Mold on personal items
2/3/05
Mold has formed on clothing and shoes.
Observed 2 pair of shoes and suit pants. Also,
owner has
observed mold beginning to form around
moved
window casings from continue dampness due to
high humidity in the apartment.
The owner must maintain the premises free
from chronic dampness.
2/3/05
The management was contacted by the tenant
Has
about the mold issue. Management has
complied
delivered a dehumidifier unit that must be kept
running and emptied as often as needed by the
tenant.
A summary report must be submitted to the
Health Department within 30 days of this notice.
The tenant must clean and maintain areas
weekly with Bleach -based household cleaner to
Re: Property: 36 Royal Crest Ave. Apt. 3
From: North Andover Board of Health
Date: December 20, 2004
keep mold from forming. If the level of
humidity is not lower within one month by
these methods, an air quality expert may be
required to determine a long-term plan of action
for this unit.
Cc:
1. Mohamed Akine,Bldg 36, #3 MA 01887
2. AIMCO, 5550 LDJ Freeway, Mailbox 28, Dallas, TX 75240
Town of North Andover
Office of the Health Department
Community Development and Services Division
27 Charles Street
North Andover, Massachusetts 01845 "ssACHUs�`
Susan Y. Sawyer, REHS/RS
Public Health Director
DATE: January 3, 2005
TO OWNER OF RECORD
Royal Crest Estates
Attn: Mark Johnson, Manager
North Andover, MA 01845
50 Royal Crest Drive
North Andover, MA 01845
978.688.9540 - Phone
978.688.9542 - Fax
E -Mail: healthdepW-,townofnortha:ndover.com
Website: hgp:://www.townofnorthan.dover.com
Letter Of Compliance
PROPERTY LOCATION
36 Royal Crest Estates Apt: 3A
North Andover, MA. 01845
A Health Department ORDER LETTER dated November 2nd, 2004 was issued to you as owner
of record of the property listed above citing violations of the State Sanitary Code, 105 CMR
410.000, Minimum Standards of Fitness for Human Habitation. A re -inspection of the property
has found that all of the violations noted on the Order Letter have been corrected. The Health
Department would like to thank you for your cooperation.
/Zc rely,
.chele E. Gran
Public Health Inspector
Xc: File
AIMCO
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 IIEALTII 688-9540 PLANNING 688-9535
ill �n(�v fir,
V6Fs---"
January 4, 2005
Michele Grant
Public Health Inspector
Town of North Andover
Office of the Health Department
Community Development and Services Division
400 Osgood Street
North Andover, Massachusetts 01845
Dear Ms. Grant:
This response is directed to your letter dated December 27th, 2004 regarding 36 Royal Crest Avenue,
Apt 3 and the above mentioned visit to the property.
As requested, please note below the Action Plan for the apartment and the community.
36 Royal Crest Avenue, Apartment #3
1. Repair ceiling. Contractor is scheduled for January 4, 2005
2. Simulate living conditions and monitor humidity and temperature levels.
Please note, that the Resident has vacated the apartment. Also, please take into consideration that
there is no record of the Resident informing Management concerning the ceiling damage. .
Upon completion of the "turnover" of the apartment, Royal Crest Management will invite the Office of
Health Department to visit the apartment as many times as necessary to obtain certificate of
compliance.
We trust that the positive steps taken above will result in providing a solid foundation for the future and
look forward to completing the above action plan to all parties' mutual satisfaction.
Sincerely,
Mark T. Johnson
Community Manager, Royal Crest -North Andover
w
sn
P
s �co
co
jS O
n N li
};;v1s� i
11AIJI i
amu...... w.u.. ua
'�an��rti
m
m
m
O
O
O
ru
...�� ru
o m
C3
r-
00 0
w
N
s �w
4wa
>
b
�
zAW
o
oHA
oWz
rn
Hx�
�0
0
Ln
M r O
41
H
0 IM
H n
-- a
IA in
O rq
U in
l ° in rxl in
r4z qv
O r4
Hb, M
in o O
q
co PC
o Q EH
r mnz
a
m� NH
vvv V !rf i� W d>
O�xwa
HHHH904
'� Z OOk
k
N
{
iY
t
� O _D O cD n
Q D :0,v 0 Aa
a N _S M CDO fD �.
O O O y D •
CD CD 0
_
V O OO O O o-
O
-6. cc'
h
m @' m ID
\ �� CD0`s°am
2 °
3 -w� w •
�~ �OoIn ornD
3 O O (OD O
3 O N cD O •
1 P m a�]
I I ''
0 N N •
N r
r
w O x n D
❑ ❑ -'
ID
m fn
Z N CD
m o
N D NC < N
=� N
KN •
Cl (D a _O j 42 rp O.
(D I Q �
w CLa 0_
w
N N y
42 CD
000 w m v
l
O "0 CL •
C � r
J y y O w
37 N Q 3 � •
CD
m 0 cD
•o
o •J
CD ❑❑❑❑
Z D D 0
O y 2t0
a? (D
0 0
f/
co m Z
Town of North Andover
Office of the Health Department
Community Development and Services Division
400 Osgood Street
North Andover, Massachusetts 01845
Susan Sawyer (978) 688-9540 -Phone
(978) 688-9542 -Fax
Public Health Director
NORTH ANDOVER BOARD OF HEALTH
ORDER LETTER
Issued under the provisions of the State Sanitary Code, Chapter II, Minimum Standards of
Fitness for Human Habitation, 105 CMR 410.000.
Date: December 27, 2004
To Owner of Record:
Royal Crest
Attn: Mark Johnson
50 Royal Crest Drive
North Andover, MA. 01845
Property Location:
Mohamid Yakine
Bldg. 36 Apt: 3
North Andover, MA. 01845
. An authorized inspection was made of your property at the above referenced address
by North Andover Health Department personnel on December 20, 2004.
This inspection revealed violations of certain regulations of the State Sanitary Code,
Chapter II, as listed on the attached Violation Form. You are hereby ORDERED to correct
these violations within the time allotted on the enclosed form. Failure to comply within the
specified time period may result in further action by the North Andover Board of Health.
You have the right to request a hearing before the Board of Health if you feel this order
should be modified or withdrawn. A request for said hearing must be made in writing and
received by the Health Department within seven (7) days from the receipt of this order. At
said hearing you will be given an opportunity to be heard and to present witnesses and
documentary evidence as to why this order should be modified or withdrawn. All affected
parties will be informed of the date, time and place of the hearing and of their right to inspect
and copy all records concerning the matter to be heard. You may be represented by an
attorney. You have the right to inspect and obtain copies of all relevant records concerning the
matter to be heard.
Michele E. Grant
Public Health Inspector
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVA'T'ION 688-9530 IIEAL'rIT 688-9540 PLANNING 688-9535
I'll
Re: Property: 36 Royal Crest Ave. Apt. 3
From: North Andover Board of Health
Date: December 20, 2004
ORDER LETTER
An authorized inspection of Bldg. 36 Unit was performed by Board of Health staff on
December 20, 2004 at which violations of 105 CMR 410.000 Chapter II of the State Sanitary
Code, Minimum Standards of Fitness for Human Habitation were found. Failure to respond
within the allotted time period may result in a Board of Health finding that the dwelling is
unfit for human habitation.
All violations must be corrected within seven (7) days of receipt of this Order Letter or a
plan for completion must be approved by this office if a professional contractor must be
hired to do the work.
Violation
Regulatory
Reference
Re -
Inspection
➢ Master bedroom - ceiling with peeling
410.500
paint.
Observed old ceiling patch that the paint has
separated away from the subsurface. Damage likely
due to improper preparation of the surface.
Owner must maintain ceilings in good condition
Owner must repair as needed.
➢ Mold on personal items
Mold has formed on clothing and shoes. Observed
2 pair of shoes and suit pants. Also, observed mold
beginning to form around window casings from
continue dampness due to high humidity in the
apartment.
The owner must maintain the premises free from
chronic dampness.
The management was contacted by the tenant
about the mold issue. Management has delivered
a dehumidifier unit that must be kept running
and emptied as often as needed by the tenant.
A summary report must be submitted to the
Health Department within 30 days of this notice.
The tenant must clean and maintain areas weekly
with Bleach -based household cleaner to keep
mold from forming, If the level of humidity is not
Re: Property: 36 Royal Crest Ave. Apt. 3
From: North Andover Board of Health
Date: December 20, 2004
lower within one month by these methods, an air
quality expert may be required to determine a
long-term plan of action for this unit.
Cc:
1. Mohamed Akine,Bldg 36, #3 MA 01887
2. AIMCO, 5550 LDJ Freeway, Mailbox 28, Dallas, TX 75240
Town of North Andover
Office of the Health Department
Community Development and Services Division y
400 Osgood Street
North Andover, Massachusetts 01845 CNUS��
Susan Sawyer (978) 688-9540 - Phone
Public Health Director (978) 688-9542 - Fax
NORTH ANDOVER BOARD OF HEALTH
ORDER LETTER
Issued under the provisions of the State Sanitary Code, Chapter II, Minimum Standards of
Fitness for Human Habitation, 105 CMR 410.000.
Date: December 27, 2004
To Owner of Record:
Royal Crest
Attn: Mark Johnson
50 Royal Crest Drive
North Andover, MA. 01845
Property Location:
Mohamid Yakine
Bldg. 36 Apt: 3
North Andover, MA. 01845
An authorized inspection was made of your property at the above referenced address
by North Andover Health Department personnel on December 20, 2004.
This inspection revealed violations of certain regulations of the State Sanitary Code,
Chapter II, as listed on the attached Violation Form. You are hereby ORDERED to correct
these violations within the time allotted on the enclosed form. Failure to comply within the
specified time period may result in further action by the North Andover Board of Health.
You have the right to request a hearing before the Board of Health if you feel this order
should be modified or withdrawn. A request for said hearing must be made in writing and
received by the Health Department within seven (7) days from the receipt of this order. At
said hearing you will be given an opportunity to be heard and to present witnesses and
documentary evidence as to why this order should be modified or withdrawn. All affected
parties will be informed of the date, time and place of the hearing and of their right to inspect
and copy all records concerning the matter to be heard. You may be represented by an
attorney. You have the right to inspect and obtain copies of all relevant records concerning the
matter to be heard.
i
Michele E. Grant
Public Health Inspector
BOARD OF APPEALS 688-9541 BI-IILDING 688-9545 CONSERVA'T'ION 688-9530 HEAU11 688-9540 PLANNING 688-9535
Re: Property: 36 Royal Crest Ave. Apt. 3
From: North Andover Board of Health
Date: December 20, 2004
ORDER LETTER
An authorized inspection of Bldg. 36 Unit was performed by Board of Health staff on
December 20, 2004 at which violations of 105 CMR 410.000 Chapter II of the State Sanitary
Code, Minimum Standards of Fitness for Human Habitation were found. Failure to respond
within the allotted time period may result in a Board of Health finding that the dwelling is
unfit for human habitation.
All violations must be corrected within seven (7) days of receipt of this Order Letter or a
plan for completionmust be approved by this office if a professional contractor must be
4-!1 An rho Awnrl-
Violation
Regulatory
Reference
Re -
Inspection
➢ Master bedroom - ceiling with peeling
410.500
paint.
Observed old ceiling patch that the paint has
separated away from the subsurface. Damage likely
due to improper preparation of the surface.
Owner must maintain ceilings in good condition
Owner must repair as needed.
➢ Mold on personal items
Mold has formed on clothing and shoes. Observed
2 pair of shoes and suit pants. Also, observed mold
beginning to form around window casings from
continue dampness due to high humidity in the
apartment.
The owner must maintain the premises free from
chronic dampness.
The management was contacted by the tenant
about the mold issue. Management has delivered
a dehumidifier unit that must be kept running
and emptied as often as needed by the tenant.
A summary report must be submitted to the
Health Department within 30 days of this notice.
The tenant must clean and maintain areas weekly
with Bleach -based household cleaner to keep
mold from forming. If the level of humidity is not
Re: Property: 36 Royal Crest Ave. Apt. 3
From: North Andover Board of Health
Date: December 20. 2004
lower within one month by these methods, an air
quality expert may be required to determine a
long-term plan of action for this unit.
Cc:
1. Mohamed Akine,Bldg 36, #3 MA 01887
2. AIMCO, 5550 LDJ Freeway, Mailbox 28, Dallas, TX 75240
Postage
Certified Fee
$ �
(�
Postmark
ReturnReceipt Fee
i �,J
Here
(Endorsement Required)
Restricted Delivery Fee
(Endorsement Required)
Total Postage & Fees $
Name 1 se Print Clearly) (To b completed b mailer)
- ----�l__��---- -------- l����-------------------------------------
tree , t. No.; r PO Box o.
-� -�f---------------------------
City, Sta e IP+ 4
• MS,.
Certified Mail Provides:
■ A mailing receipt
e A unique identifier for your mailpiece
■ A signature upon delivery
■ A record of delivery kept by the Postal Service for two years
Important Reminders:
■ Certified Mail may ONLY be combined with First -Class Mail or Priority Mail.
o Certified Mail is not available for any class of international mail.
■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For
valuables, please consider Insured or Registered Mail.
■ For an additional fee, a Return Receipt may be requested to provide proof of
delivery. To obtain Return Receipt service, please complete and attach a Return
Receipt (PS Form 3811) to the article and add applicable postage to cover the
fee. Endorse mailpiece "Return Receipt Requested". To receive a fee waiver for
a duplicate return receipt, a USPS postmark on your Certified Mail receipt is
required.
s For an additional fee, delivery may be restricted to the addressee or
addressee's authorized agent. Advise the clerk or mark the mailpiece with the
endorsement "Restricted Delivery".
■ If a postmark on the Certified Mail receipt is desired, please present the arti-
cle at the post office for postmarking. If a postmark on the Certified Mail
receipt is not needed, detach and affix label with postage and mail.
IMPORTANT: Save this receipt and present it when making an inquiry.
PS Form 3800, July 1999 (Reverse) 102595-99-M-1938
M
—0
M
r9
Postage
ru
M
Certified Fee
C3
Return Receipt Fee
r.q
(Endorsement Required)
C3
Restricted Delivery Fee
C3
(Endorsement Required)
Postmark
Here
C3 Total Postage, & F.. $
ru
IU Nam Please Print early) (To be completed by mailer)
M Z
...............
54pt
t ,,-;Ap POB N
Ir tiiii%.
Er- 70 -
M ..— ---------------- ................. ........ ---- --
... ------------------------
Pity, S a, 4
Certified Mail Provides:
■ A mailing receipt
s A unique identifier for your mailpiece
■ A signature upon delivery
■ A record of delivery kept by the Postal Service for two years
Important Reminders:
■ Certified Mail may ONLY be combined with First -Class Mail or Priority Mail.
o Certified Mail is not available for any class of international mail.
■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For
valuables, please consider Insured or Registered Mail.
s For an additional fee, a Return Receipt may be requested to provide proof of
delivery. To obtain Return Receipt service, please complete and attach a Return
Receipt (PS Form 3811) to the article and add applicable postage to cover the
fee. Endorse mailpiece "Return Receipt Requested". To receive a fee waiver for
a duplicate return receipt, a USPS postmark on your Certified Mail receipt is
required.
le For an additional fee, delivery may be restricted to the addressee or
a(joressee's authorized agent. Advise the clerk or mark the mailpiece with the
endorsemenX "Restricted Delivery".
■ If a postmark on the Certified Mail receipt is desired, please present the arti-
cle at the post office for postmarking. If a postmark on the Certified Mail
receipt is not needed, detach and affix label with postage and mail.
IMPORTANT. Save this receipt asci present it when making an inquiry.
PS Form 3800, July 1999 (Reverse) 102595-99-M-1938
Town of North Andover
Office of the Health Department
Community Development and Services Division
400 Osgood Street
North Andover, Massachusetts 01845
Susan Sawyer (978) 688-9540 - Phone
Public Health Director (978) 688-9542 - Fax
NORTH ANDOVER BOARD OF HEALTH
ORDER LETTER
Issued under the provisions of the State Sanitary Code, Chapter II, Minimum Standards of
Fitness for Human Habitation, 105 CMR 410.000.
Date: December 27, 2004
To Owner of Record:
Royal Crest
Attn: Mark Johnson
50 Royal Crest Drive
North Andover, MA. 01845
Property Location:
Mohamid Yakine
Bldg. 36 Apt: 3
North Andover, MA. 01845
An authorized inspection was made of your property at the above referenced address
by North Andover Health Department personnel on December 20, 2004.
This inspection revealed violations of certain regulations of the State Sanitary Code,
Chapter II, as listed on the attached Violation Form. You are hereby ORDERED to correct
these violations within the time allotted on the enclosed form. Failure to comply within the
specified time period may result in further action by the North Andover Board of Health.
You have the right to request a hearing before the Board of Health if you feel this order
should be modified or withdrawn. A request for said hearing must be made in writing and
received by the Health Department within seven (7) days from the receipt of this order. At
said hearing you will be given an opportunity to be heard and to present witnesses and
documentary evidence as to why this order should be modified or withdrawn. All affected
parties will be informed of the date, time and place of the hearing and of their right to inspect
and copy all records concerning the matter to be heard. You may be represented by an
attorney. You have the right to inspect and obtain copies of all relevant records concerning the
matter to be heard.
Michele E. Grant
Public Health Inspector
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 IIEAL'r11688-9540 PLANNING 688-9535
i
Re: Property: 36 Royal Crest Ave. Apt. 3
From: North Andover Board of Health
Date: December 20, 2004
ORDER LETTER
An authorized inspection of Bldg. 36 Unit was performed by Board of Health staff on
December 20, 2004 at which violations of 105 CMR 410.000 Chapter II of the State Sanitary
Code, Minimum Standards of Fitness for Human Habitation were found. Failure to respond
within the allotted time period may result in a Board of Health finding that the dwelling is
unfit for human habitation.
All violations must be corrected within seven (7) days of receipt of this Order Letter or a
plan for completion must be approved by this office if a professional contractor must be
h;rPd to do the work.
Violation
Regulatory
Reference
Re -
Inspection
➢ Master bedroom - ceiling with peeling
410.500
paint.
Observed old ceiling patch that the paint has
separated away from the subsurface. Damage likely
due to improper preparation of the surface.
Owner must maintain ceilings in good condition
Owner must repair as needed.
➢ Mold on personal items
Mold has formed on clothing and shoes. Observed
2 pair of shoes and suit pants. Also, observed mold
beginning to form around window casings from
continue dampness due to high humidity in the
apartment.
The owner must maintain the premises free from
chronic dampness.
The management was contacted by the tenant
about the mold issue. Management has delivered
a dehumidifier unit that must be kept running
and emptied as often as needed by the tenant.
A summary report must be submitted to the
Health Department within 30 days of this notice.
The tenant must clean and maintain areas weekly
with Bleach -based household cleaner to keep
mold from forming. If the level of humidity is not
Re: Property: 36 Royal Crest Ave. Apt. 3
From: North Andover Board of Health
Date: December 20, 2004
lower within one month by these methods, an air
quality expert may be required to determine a
long-term plan of action for this unit.
Cc:
1. Mohamed Akine,Bldg 36, #3 MA 01887
2. AIMCO, 5550 LDJ Freeway, Mailbox 28, Dallas, TX 75240
Town of North Andover
Office of the Health Department
Community Development and Services Division
400 Osgood Street
North Andover, Massachusetts 01845
Susan Sawyer (978) 688-9540 - Phone
Public Healtlt Director (978) 688-9542 - Fax
NORTH ANDOVER BOARD OF HEALTH
ORDER LETTER
Issued under the provisions of the State Sanitary Code, Chapter II, Minimum Standards of
Fitness for Human Habitation, 105 CMR 410.000.
Date: December 27, 2004
To Owner of Record:
Royal Crest
Attn: Mark Johnson
50 Royal Crest Drive
North Andover, MA. 01845
Property Location:
Mohamid Yakine
Bldg. 36 Apt: 3
North Andover, MA. 01845
An authorized inspection was made of your property at the above referenced address
by North Andover Health Department personnel on December 20, 2004.
This inspection revealed violations of certain regulations of the State Sanitary Code,
Chapter Il, as listed on the attached Violation Form. You are hereby ORDERED to correct
these violations within the time allotted on the enclosed form. Failure to comply within the
specified time period may result in further action by the North Andover Board of Health.
You have the right to request a hearing before the Board of Health if you feel this order
should be modified or withdrawn. A request for said hearing must be made in writing and
received by the Health Department within seven (7) days from the receipt of this order. At
said hearing you will be given an opportunity to be heard and to present witnesses and
documentary evidence as to why this order should be modified or withdrawn. All affected
parties will be informed of the date, time and place of the hearing and of their right to inspect
and copy all records concerning the matter to be heard. You may be represented by an
attorney. You have the right to inspect and obtain copies of all relevant records concerning the
matter to be heard.
"i
Michele E. Grant
Public Health Inspector
BOARD OI APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
r
Re: Property: 36 Royal Crest Ave. Apt. 3
From: North Andover Board of Health
Date: December 20, 2004
ORDER LETTER
An authorized inspection of Bldg. 36 Unit was performed by Board of Health staff on
December 20, 2004 at which violations of 105 CMR 410.000 Chapter II of the State Sanitary
Code, Minimum Standards of Fitness for Human Habitation were found. Failure to respond
within the allotted time period may result in a Board of Health finding that the dwelling is
unfit for human habitation.
All violations must be corrected within seven (7) days of receipt of this Order Letter or a
plan for completion must be approved by this office if a professional contractor must be
hired to do the work.
Violation
Regulatory
Reference
Re -
Inspection
➢ Master bedroom - ceiling with peeling
410.500
paint.
Observed old ceiling patch that the paint has
separated away from the subsurface. Damage likely
due to improper preparation of the surface.
Owner must maintain ceilings in good condition
Owner must repair as needed.
➢ Mold on personal items
Mold has formed on clothing and shoes. Observed
2 pair of shoes and suit pants. Also, observed mold
beginning to form around window casings from
continue dampness due to high humidity in the
apartment.
The owner must maintain the premises free from
chronic dampness.
The management was contacted by the tenant
about the mold issue. Management has delivered
a dehumidifier unit that must be kept running
and emptied as often as needed by the tenant.
A summary report must be submitted to the
Health Department within 30 days of this notice.
The tenant must clean and maintain areas weekly
with Bleach -based household cleaner to keep
mold from forming. If the level of humidity is not
r
Re: Property: 36 Royal Crest Ave. Apt. 3
From: North Andover Board of Health
Date: December 20, 2004
lower within one month by these methods, an air
quality expert may be required to determine a
long-term plan of action for this unit.
Cc:
1. Mohamed Akine,Bldg 36, #3 MA 01887
2. AIMCO, 5550 LDJ Freeway, Mailbox 28, Dallas, TX 75240
TRANSMISSION VERIFICATION REPORT
TIME
12128/2004 13:07
NAME
HEALTH
FAX
9786888476
TEL
9786888476
SER.#
000B4J120960
DATE DIME
12128 12:30
FAX NO./NAME
819786829064
DURATION
00:00:29
PAGE(S)
03
RESULT
OK
MODE
STANDARD
ECM
NORTH ANDOVER HEALTH DEPARTMENT
.� 27 Charles Street • North Andover, MA 01845
Tel. 978 688-9540 • Fax: 978 688-9542
email: healthdept@townofnorthandover.com
Complaint Investigation/Inspection Report
S a"X r.001 -
Rev. 6/04
INSPECTOR
Y
Sawyer, Susan
Subject:
Start:
End:
Recurrence:
Yakine - /1%dlll J
brother Mohmed
bldg 36 , apt 3
Mon 12/20/2004 1:00 PM
Mon 12/20/2004 1:30 PM
(none)
y -7=I -qt L
� 7 -087-'