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80 MOFFATT RD - BUILDING INSPECTION 0\ i , � 4 �\ The C'oi nnomvealth of Massachusetts I t)R l t Board of 131.1tlding Re_ttl:nions and Standards \II'Nll'II' \1] IY 1.: MIaSS:ICI1tISCUS State Building Code. 780 C'MR. 7"' edition I 'Sl: " r ",Y Building Permit Application To Construct, Repair. Renovate Or Demolish a lei„'d h ilh/, One- or Titu-Fumih, Dn e ing This Section For Official Use Only Building Permit Number: Date Applied: -------- _� o i Signal w"e: ----"-!-`—��-"-------- i &(i Wing Commissioned Insp cior of Buildings Date SECTION 1: SITE INFORMATION I. Property A ess: 1.2 Assessors Map & Parcel Numbers M �4T AMC / - Farrel Numher 1.Lt Is this an accepted street' yes ✓ no--- Map Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sy li) Frontage Ui) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard ! Reyui red Provided Rcyuired Provided Required Pro<idcd 1.6 Water Supply: (M.G.Lc. 40, §54) 1.7 Flood Zone Information: 1.8 Sewage Disposal-System: Zone: _ Outside Flood Zone?` Municipal-❑ On site disposal s)stcm ❑ Public❑ Private ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' �.1 Owner f Record: l/ 8D t 10 ffA it i2 CO(d Nmne i Prim) Address (or Service: �-� p (,n)-7tiA4 - �0g5 gSigna Telephone SECTION 3: DESCRIPTION OF PROPOSED WORK(cheek all that apply) struction ❑ ExistingBuilding ❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) Addition ❑ n ❑ Accessory Bldg. ❑ Number of Units Other ❑ SpecilY: cription of Proposed Work': tN - Ft Y/ttilll� c2p I?-A )IA)S — SECTION 4: ESTIMATED CONSTRUCTION COSTS Estimated Costs: Official Use Only Item (Labor and Materials) L Building $ W7 H 1. Building Permit Fee: S Indicate how fee is detornuned: ❑ Standard City/Town Application Fee 2. Electrical S ❑ Total Project Cost (Item 6) x multiplier x i 1. Plumbing S 2. Other Fees: S J. Mechanical (HV:1C) 5 List: — i. Mechanical (Fire 5 --- 'rotal All Fees: S SUppressioni Check No. Check :\mount: <':uh :\nnwnc___.__ j b. fulal Project Cost: 0Paid in Full ❑ OutaGmJine I3;J:uxe.Uuz:"_=_ ___ _ SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSI.) 55-77J33___ _/' hr' .1..,p f' U,ensc Numbet 1'.Nptraltan Date Nast mot C'SL- I lulder - Lul C•SI.Type )Nee Ts'pc Descri noon fd,, . L l'tit stnrtrJ n]11 In:i.lHlO Cu. P(.i I i R Restricted L@'_ F:umlN U lhn_ f S)gneut AA M Resident al R ls �� V y RC' Residential Routing l'a�rrutg TClephtute \\'S RcNid.•nital \\InJ00 Al d liJin_ __ SF Rrei& nial Sated Fuel Bunung \ th:mCe III'I.Illitiml j D Residential Dvmohu," 5A Rego tered Home Improvement Contractor (111C) 1Q'(poq eJf.E I(•JQ� Sf1 Reg)suatlon Numher -- 11IC Company. Naine or 11 C R•gtstmnt Name Addr•s (g7$)T7A11-bJ4A-q E.xptratit�ate Steno re _ Telephone SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L.c. 152. § 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached'? Yes ... ...... No - - "- -- �- - --� 0 SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN . OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I JQVY�S h h as Owner of the subject property hereby authorize n PV-) r zd(�ZA1 to act on my behalf. in all matters relative to work authorized by this building permit application. X -7 Signature of 'net If Date SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION I as Owner or Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and behalf. Print Nume� Signature of Owner or Authonzed.Agent Dote - (Signed under the euins andpenalties of er'u ) NOTES: I. An Owner who obtains a building permit to do his/her own work or Lin owner who hires an unregistercd contractor (not registered in the Home Improvement Contractor (HIC) Program), will not have access to the wbitr Lion program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program and Construction Supervisor Licensing (CSL)can be found in 7SO C NIR Regulations I IO.R6 and 110"119, respectively. '. When substantial work is planned, provide the Information below: Total floors area (Sq.Ft.i (including garage, finished hasement/a(ticN, decks or porch) I (;toss living area iSq. Ft.) Hahitable room N:ount 'Dumber of fireplaces Number of bedrooms -- Number of hathruoms Number of halt/h:uhs rope of healing System - Number nt deCkN/ pI,ichcN - "rypc of cooling syuem - GnCluNed 1. -Total Project Square Footage- may be Substituted foi To(al Project Cont­ I J CITY OF SALEM s� PUBLIC PROPRERTY DEPARTMENT 12 \\'\,l i��,,!,�� l:url ♦ 1sl tsl. \Ls.:sr V) I'1.1: 9-8-"lj-')SYi ♦ F,x: '/-J.-1�-'INin Workers' Compensation Insurance Af idasit: Builders/Contractors/Electricians/Plumbers Please Print Legibly A 1 thean[ Information A !2 A S2rvlU5 Svc N;II11C ;nu,inr,s l h�.m;tau,�n. InJ��:.Iu.J.IL \ddress: NOr+h City,St:lte/Zip: �nl eyyt I (l� DI��� Phone #: ( 17S) 7't-1I - ©j� Type of project(required): Are %no an employer:' Check the appropriate box: I.LJ I :un a employer with_6'7)2)C�' _ 4. ❑ 1 ain a general contractor and 1 6. 0 New construction employees(full :md/or part-time)." have hired the sub-contractors 7. Remodeling listed on the attached sheet. ?.❑ 1 :un a sole proprietor or partner- These sub-contractors have `J. ❑ Demolition ;hip and have no employees ,corking for me in any capacity. workers' comp. insurance. y, Building addition [No workers' comp. insurance 5 ElWe sure a corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their right of exemption per btGL 11.0 Plumbing repairs or additions i.❑ I am a homeowner doing all work b myself. [No workers' comp. c. 152, $I(4), and we have no 12.0 Roof repairs insurance required.] ' employees. [No workers 13 Other '1 DVS comp. insurance required.] •Any applicant that checks bun n 1 must also till out the section below showing their workers'compensation policy information. ' l lonn•uwmers whu submit;his affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Cdntrucmrs that check this box most attached an additional sheet showing the nameof the sub-contractors and their workers'comp. policy information. /ant an employer that is providing ovirkers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Nana: t vlr , < Policy 4 or Self-ins. Lic, At: VV I �, �D Expiration Date: ,. tj4 r Job Site Address. . (30 LA fn einn :1 City/State/Zip: 21C M�1 {7d Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of NIGL c. 152 can lead to the imposition of criminal,penalties of a tine up to S 1.500.00 and/or one-year imprisonment, as well as civil penalties in the firm of a STOP WORK ORDER and a fine ,tfup to S2i0.00 a day against the violator. He advised that a copy of this statement may be titrwarded to the Office of I II,c.�t lLL:Itlpns of the DL\ for insurance co,crtge cel Ificatinn. - T o hereby Leo"ti/ 'a ul r the ui rs and pc•nalie.s of perjury drat doe infiwinution providedubore i.s true and correct. Date:tt.uura: Phone - olliriul use un/p. Do not write is this area, to be completed by city or town Official Cin or lbw n: _ -- lssuing .\uthority (circle one): 1. Board of Health 2. Building Department 3. City'/fawn Clerk 4. Electrical Inspector Al. Plunbing Inspector 6. other ---- -- Contact 1'crson: ----—.---- ------- Phone _- Information and Instructions \La:.achusets General 1_aws chapter I5' rcyu I es A! cnIll I0�cl to pro%idc xs orkers' con hp ensation for their cniployces. I'ursuoau to this a:uute. un rmpfiq•ee is defined .is , cl,cr% person in the scn ice of another under any contract of hire. ,\prcas or implied, oral or hs risen." \n rmpG,-rer is defined as '%i i indi%idual. partnership, .a,sociation, corporation or other le,,al entity.-or :mti too or more of the fnrc oine engaged in ajoint enterprise, and including the legal representau%cs of a deceased employer. or tine rccci�cr or trustee of:m individual. partnership, ,association or other level entity, employ in_ employees. I lo%scNer the „o ner ota dwelling house has ine not shore than three apartments .and %%ho resides therein, or the occupant of the ,I�Iling house ofunother who emplo-is persons to do maintenance. con,trucoon or repair asork on such dwelling house „r „n the enwnds or building appurtenant (hereto Shall not because of such enplo)anent be deemed to he an employer." NL(iL, chapter 152, �s25C(6) also states that 'es-cry state or local licensing agency shall withhold the issuance or I enewal of a license or permit to operate a_business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, IlIGL chapter I52, �'SC(7) ;rates "Neither the conunomvealih nor any of its political subdivisions shall enter into inv contract fix the perfinmance of public %pork until :acceptable evidence of compliance with the insurance requirements of this chapter pace been presented to the contracting authority." Applicants Please till out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s).naine(s), address(es) and phone nuntber(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the mernbers or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that (his affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain'a workers' - compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. - City or Town Officials Please he sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit tax you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the pe=it/license number which will be used as a reference number. In addition, an applicant that must submit multiple perniadicense applications in any given year, need only submit one affidavit indicating current policy intonation (if necessary) and under"Job Site Address" tilt applicant should write "all locations in (city or town)." A copy of the affidavit.that has been officially stamped or marked by the city or town may be provided to the ;if as prooflhat a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture 0 c. a dog license or permit to burn leaves etc.)said person is NOT required to,complete this affidavit. Phe (Itfice of Invesigations would like to thank you in advmxe for your cooperation and should you hne any questions, - ple:ue do not hesitate to give us ❑ Call. fhe Dcpaninent's :address, telephonc .and fix number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations, 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Re,. «d 5-'0-0 Fax # 617-727-7749 www.mass.gov/dia DISPOSAL OF DEBRIS AFFIDAVIT In accordance with the provisions of M. G. L. c. 40, Sec. 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed facility as defined.by M. G. L. c. 111, Seca 150a. The debris will be disposed at: Salem Transfer Station owned by Northside Carting Signature of Pe it Applicant Sal ao 0 Date --r— Christopher Zorzy Name of Permit Applicant A & A Services, Inc. Firm Name 115 North Street, Salem, MA 01970 Address, City, State, Zip Code ' T� �� � �✓d!¢aa��uaer� 1 Board of Building Regulations and Standards ' �.: Construction Supervisor License , License: CS 57733 r B rthdate 5/26/1958 i 1 Expiration 512612009 - Tr# 13739 it Restriction OOI � �. CHRISTOPHER ZQRZYr� /_i, 115 NORTH ST SALEM,MA 01970 `"' Commissioner ,A �ze -�iomvmo�uaeald/z rr�✓NLa45¢clude�d Board of Building Regulations and Standards HOME IMPROVEMENT 10109 CONTRACTOR Registration: 101609 Expiration: 6/26/2010 Tr# 267870 Type: Private Corporation A&A SERVICES,INC Christopher Zorzy< i/,;;•� ' 115 North Street Salem,MA 01970 ...-y., Administrator Commonwealth of Massachusetts Division of Occupational Safety Laura M Marlin,Commissioner q� Deleader-Contractor CHRISTOPHER ZORZY Eff.Date 04/09/08 Date 04/OS/09 DC0 O < DC000440 Member of C.O.N_E.S.L 9 BO IIIIIII IIII IIIII IIIII IIII IIIII IIIII IIIII IIIII IIII IIII BOSTONRENEW. l ui rrFRc The Difference is Ckeorl. Vanguard Windows UltraCore frame-Triple-Glazed, FO"Rearg Ccund. Krypton90,Low-E ProductType:Verdcal Slider ENERGY PERFORMANCE RATINGS U-Factor(U.SJI-P) Solar Heat Gain Coefficient 0 . 18 0 . 22 FCondlensation DDITIONAL PERFORMANCE RATINGSsibleTransmittance Air Leakage(U.SJI-P) 0942 001 Resistance 70 Mamrtactorerstipulehs that these ratings cumfonn to appgcahle NFRC procedures for determining whole product performance.NFRC ratings are determined for a fund set of environmental conditions and a specific product size.Consult mamdaelumr's Itterature for other product performance information. www.nfrocrg - Actual test sample.03 air leakage. oa �wla� A & A SERVICES, INC. gook A g_A_SER"AC�' 115 NORTH STREET,SALEM,MA 01970 JOa/c�S�- .• '+ Telephone:(978)741-0424 Fax:(978)741-2012 _ Contractor Registration No:'101609 Federal EIN:04-30 901 62 Construction Supervisor No.CS057733 _ WINDOWS AND STORM PACT SPECIFICATION SjjEET Date of Contract - - Buyeds)Name - t - 7- - i Buyers)Street Address,City,Slate and To C Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-mail Address 1 Z The Buyer(s)listed above hereby jointy and severely agree to purchase me goods andlor services listed below,in accobance with the prices and terms described on Nis Specification sheet and the front and Me revebe of me accompanying CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,of which this Specification Sheet is a pan. WINDOW REPLACEMENT r mil, Remove and dispose of existing windows. A- Install # new n windows: rTY<nyl ❑Wood (Manufacturer) Options: style I^<isltPinda ° Grid pattern �.qa�t $JS� I t'�fn Color Interior Color Exterior L 1 1111'r4 Glass Type - CilL Wrap exterior trim with aluminum' Style / el'QnA Color r UK� ` -All windows will be installed according to the installation procedures in the portfolio. Of-Caulk all interior and exterior edges. 63-' Insulate where possible around new units. ,15—Insulate window weight pockets if exist,and around new window units where possible. IP Included in this proposal are set up,clean up,Hepa vacuum and cleaning windows inside and out. -F;k Building permit included. BAY/BOWS/CASEMENT UNITS/ANY FULL CONSTRUCTION WINDOWS OIL Create new window opening by cutting through existing home and framing in opening. Remove and dispose of existing I unit(s)in its entirety. Note:Electric and plumbing may exist in wall and will require additional costs to customer if need to be dealt with. 11, Install_�_ window(s)into opening(s). - _ Note. If Bay or Bow installation to include Cable support system,new roof system(matching color as close as possible) or tie into existing soffit system. ❑ Bay ❑Bow OLICasement ❑Other window(s)to include new interior style trim and new exterior style trim and head Flashing as needed. Qepla e,,uCl11— Note: Painting and staining not included. STORM PRODUCTS Remove and dispose of#__T__existing storm window(s). ❑ Install new storm windows# Manufacturer _ Style Color Option ❑ Remove and dispose of# existing storm debris). ❑ Install new storm doors# Manufacturer Style Color Type: ❑Aluminum O Solid Core SPECIAL INSTRUCTIONS: K Bch I (11ctc] t i 11 Ian Q IQC� ¢/)f QSy_MV/7f ,Pell "Ta<-,Q- t5tt4 I>N B+Qct� ,4s�9�w0/•.-�y—y�'�/ - a�' Ott I QpQIaC P er,.' t-t } - N is agreed and understood by and aldermen Me pardldm that this specification Sheet,along with CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,constants. the entre understanding eel bans modified or varied lnmetn way ur Me nless each changes are In witting.M..,rend them am no werleal andsgned Ey Doth Negoverns)or land Me fying any ontractor.atlyery leambyacknowledge Ne BBuper has reed this Bpmerication Sheet Contractor Initials: Date: Buyer's Initials: Date: T , 64, Uvl Shorts. A & A SERVICES, INC. MASENM 115 NORTH STREET,SALEM,MA 01970 a a Telephone: (978)741-0424 Fax: (978)741-2012 Contractor Registration No.101609 - Federal EIN:04-3090162 Construction Supervisor No.CS057733 CUSTOM REMODELING AND IMPROVEMENT AGREEMENT Buyers)Name Date of Contract - - + ` v Buyer(s)Street Address,City,State and Zip Code Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address: '7Y4- / Ki Ll :zmmN The Buyega)listed above hereby jointly and severally agree to puchase Me goods and/or services listed on the accompanying specification sheets,in accordance with Me prices and terms described on the front and Me reverse of this agreement and any specification sheets(this'Agreemenrl,and Buyers)have requested Met such goods or services be installed as provided at Buyer's address listed above.A&A Services,Inc. hereby agrees M install or cause M be installed Me products or services listed in this Agreement at the Buyers)address written above. This Agreement represents a cash sale of goods and services. The Buyer(s)agree to pay In cash the cost of the goods antl services purchased as described herein,regardless of timing or approval of any financing Buyer(s)may seek for their p�u�rc�haasee.. Purchase Price: t�-11r-4 Q.a 4f.A Sq/% Est Staring Date: e ����-����(�� Down Payment: t a7.00 1CPA — 1 $LJ Est.Completion Date:0 Cash JLzLU TD&iV-' 9`7 gi 'Check 44 6(p - Amount Due on Start of Job: —! . ❑Credit Cab (O Amount due on of Com)le[io ' :Expiration Dal e:on tira i O Amount Due on of Completion: 22 - Balance Due on Upon Completion: a V CvC Code: B Is agreed and understood by and between the parties that this Agreement,front abd back and any addendum,constitute the entire . understanding behawn the parties,and there are no verbal understandings changing or modifying any of the terms of this Agreement. Buyer(s)hereby acknowledge that Buyer(s)has read the front and the reveres of this Agreement and has received a completed,signed and dated copy of this Agreement,Including the two attached Notice of Cancellation forms,on the date first written above. Buyer(s)also (0 acknowledge that they were orally Informed of their right to cancel this transaction;and(II)request that they be contacted via their - telephone numbers or a-mall,as listed above, in the event Contractor believes Buyer(s)would be Interested! in any additional quality products or services of Contractor. DO NOT SIGN THIS CONTRACT U IT CONTAINS ANY BLANK SPACES. A&A Ser as, e. Buyer(s) Signature re Print Name Print Name Signature Print Name You,the Buyer(s),may cancel this transaction at any time prior to midnight of the third business day after the data of this transaction. 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