90 MOFFATT RD - BUILDING INSPECTION io i7a L
ZS �3 8 S 04 350 7
The Commonwealth of'Massachusetts u e ly ;.1 ww.
Board of Building Regulations and Standart pilvf Al ' "`'CITY OF
Massachusetts State Building Code, 780 CMRtt��, npr�TT SAted ENIar LZ01/
Building Permit Application To Construct, Repair, Renova�OCfr EIAt 11 a
One-or Two-Family Dwelling
T This Section For Official Use Only
Building Permit Number: Date A lied:
Building Official(Print Name) - Signature Date
t - SECTION 1: SITE INFORNIATION
1.1 roperty Address L2 Assessors Nlap& Parcel Numbers
I i's
1.1a Is this an accepted street?yes_ no 1vlap Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard - Side Yards - Rear Yard
Required Provided Required Provided Requiredndisposaisystem
1.6 Water Supply: (NI.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Di
Zone: Outside Flood Zone?
Public❑ Private❑ - Check if yes❑ Municipal❑ O
SECTION 2: PROPERTY OWNERSHIP` q
2.l wnert of Record-
., J S O / D
(�J/p ` I al�r,�, Mfg 1 �
Name Printi I �l 1(7(y
( ) City, State ZIP
q Wln(�F?cF Road -7�1�1 3gy3
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK' (check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work'.
SECTION 4: ESTIMATED CONSTRUCTIOtN COSTS ,
Item Estimated Costs: Official Use Only
Labor and Materials)
1. Building $ 1. Building Permit Fee:$ 02 Indicate how fee is determined:
2. Electrical $
❑ Standard City/Town AK tcation Fee
❑Total Project Cost' (Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fees: $
Check No. Check Amount: Cash Amount:
6. Total Project Cost: $ a7 O r ❑ Paid in Full ❑Outstanding Balance Due:
I"FlI(.E�:V 1 0 t
SECTIONS CONSTRUCTION SERVICES.'
5.1 Corn�struction�'''�"""S��'��^u/per�lvisorLicense(CSL)
Ch r rr I R Zoe Zf L cease -[� ] Exp ation Date 7 1
Name off �' t{ I-�ig - A,� �y ,` T Description
�. U 1 1 /v( Q (7V U Urarstricmd to 35,000 Co.Ft.
Ad Restricted 1&2 Farafty Dwelling
nil M Masonry Only
/ RC Residential Roofs Coverin
FA �0 - -7 q J -O-t/ 1Y wS Residential Window and Siding
_/ 01 SF Residential Solid Fuel Burning fiance
Telephone D Residential Demolition
5.2 Home Improvement Contractor Registration(HIC) /
Registration�1 ()15 Expiration Date t0 6
HIC Corn�-yN a or HIC RegmgtName
r S
Addrtss
sigoatme
7k-7N! -'0 V
Telephone
SECTION 6:.;WORKER'S COMPENSATIONINSURANCE;AFFIDAVIT(M.G:L. c.152. §25C(6)) '
Worker's Compensation Insurance affidavit must be completed and submitted with this application.
Failure to provide an insurance off vit may result in the denial of a building permit.
Signed affidavit attached? Yea No 13
SECTION lac' OWNER AUTHORIZATION TO BE'COMPLETED WHEN OWNER'S AGENT OR '._,
CONTRACTOR APPLIES FOR BUILDING PERMTP
I, * r of lsoiC as Owner of the subject property,
hereby authorize -Ye k V l CPS to act on my behalf in all matters relevant to work
authorized by this building permit application.
Signature of Owner
..:. .. .., .c. ... _
SECTION 7b: . OWNER OR AUTHORIZED AGENT DECLARATION
I, r Z, Z as Owner or Authorized Agent,hereby declare that the statements
and information foreWi application are true ana accurate,to the best of my knowl ge d belief.
/ 6 /6
Signahae of Owner ar A orized ent (Sipped under the pains and penalties of perjury) Dam
SECTION 8: DEBRIS DISPOSAL" `
All dumpsters of six(6)cubic yards or more are re aired to have a permit from the Marblehead Fire department:call 781-639-3428.
In accordance with the provisions of 780 CMR and MGL c40,§54 a condition of issuance of this building permit is that debris
resulting from any work performed shall be disposed of in a roperly licensed soli¢waste disposal facility as defined by MGL clll,§
150a. �U L XV 11C {� Salem 1-1A 01970
DEBRIS DISPOSAL LOCATION
SIGNATURE OF APPLICANT
NOTE
An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor(not registered in
the Home Improvement Contractor(HIC)Program)will not have access to the arbitration program or guaranty fund under M.G.L.
c. 142A.Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 7s0 CMR
Regulations.
/�,, w ^3'0— A & A SERVICES, INC.
A&A$ CE$ 115 NORTH STREET, SALEM, MA 01970
• ''• Telephone:(978) 741-0424 Fax: (978) 741-2012
Contractor Registration No. 101609
Construction Supervisor No.CS057733
Federal EIN: 04-3090162
CUSTOM REMODELING AND IMPROVEMENT AGREEMENT
Bu err E Name Date of Contract
Bu rs Street Adtlress, Ci ,Stale and ZipCode
o F 7- rb
Daytime Telephone Number Evening Telephone Number Mobile Tele hone Number E-Mail Address
978-7NN-3943 Milli- N(:u1)2t:7W1i &i
The Buyers)listed above hereby jointly and severally agree to purchase the goods and/or services listed on the accompanying �9✓1�
pa tying spec IcauonVlal S Itf sheets, ta requested
once
with the prices and terms s be installed
on the front and the reverse address this agreement antl any specn cation sheets(this"Agreement'),antl Buyers)have requested
that such goods or services be in this tl re menthe t th Buyer' )addre listed above.above,
Services,Inc.t represents
a hereby agrees to install or Cause to be installed
fie products or services listed f this Agreement at the B purchased as described
above.This Agreement represents o cash sale n goods and services.The Buyers)
agree to pay in Cosh the cost of tt,e goods and services purchased as tlescdbetl herein,regardless of timing or approval of any financing Buyers)may seek for Meir
purchase.
Purchase'Pri Z7�9_ Est.Shading Date:
p W
Down Payment 930y Est.Completion Date: ' 7'i
o-1 ash
Amount Due on Start of Job: 'Check
3, to it Cartl
Amount Due on of Completion: No.
Amount Due on_of Completion' r Expiration Date:
Balance Due on Upon Completion CVC Code:
It is agreed and understood by and between the parties Net this Agreement,front and back and any addendum, constitute the entire
understanding between the parties,and there are no verbal understandings changing or modifying any of the terms of this Agreement.Buyers)
hereby acknowledge that Buyerts)has read the front and the reverse 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,Buyers)also(1)acknowledge that they were orelly
informed of their right to cancel this transaction;and fit)request that they be contacted via their telephone numbers or email,as listed above,in the event
Contractor believes Buyst would be interested in any additional quality products or services of Contractor.DO NOT SIGN THIS CONTRACT IF IT
CONTAINS ANY BLANK SPACES.
A&A Se ' e3e pc. Buyer(s)
By:Siena a el ell 6� i�/�^ -Ir.g
Signature
Li-4-4 L
Print Name - h'�Q-ten I1 Jt1� C )1 SC_•ipf
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 date of this
transaction. See the following Notice of Cancellation form for an explanation of this right.
ARBITRATION:The wnVacltt and the Iwrreamer hereby muNall .Imes in advance that in Ne event a her moor has a died .mmanymng this cgno-a6 eNhai eery,thirst such depute m a
private aNltretion loved ufikh has been approved by the Sevetaryol the Erewtire plficegl Combine Affairs and Business Hindi and the other pang shall be required to went to man
ardtraum as proven In M G L c.lase `A�
Conrro[,orini,Bls /.'•l Bu_Ys lniials.�2`t„MlAA,lLU)
j
NOTICE OF CANCELLATION NOTICE OF CANCELATON
Date g Tranacao lJ"3' 10.You may arrest this vansacum wmout any penalty or Date of Tmmn mn r/3—/& Yw may anal Hia tmnsacwn,MthoYl any penalty or
Cbligauor.whin tree business tlaysfromthe above deli.IfyouanaLany,mmorytadeim, Whigamn.Arun an,business days Martin above date 11youaocel,any propenytradid in.
any pleaded,.Code by you under trio Conmet sae,and any negoaagainsWmpnl exewred any commands made by you under me woman or sale,and any negotiable instrument reverted
by you ill ce mho ed Amin 10 days tollowog recas by the Seger of your ancellauon imam, by you vast be seemed within m Ways relining mul by the Seller of your earanauon noted,
and any secutly ntees arising out g to tansscgon All be cradled If yw ancel.you mast and any secudy interest arising am of me mansecam MII be pncelled II you dames,you must
Make moslabse to He aver at your evidence,and suntammily in as good end ten as Ann make Voltage to the seller at your redden,and subsmnaally in as gcN mntliaon as Area
i any games delivered to you mmer His Contras or sate)or you may,N yw AM.rival baboyed.an, sMs desWed to you whirr this Conran ar Me:or you may,if you Cosh damply
Am Me Instmcaons of the Seller regarding me return shipment 0 me goods at to Seller's will Me promoters of Me Seller regarding to return shipment of the goods at He Seller's
ery,nse and risk.If you do make the Hoods available to to SNler and the Seller tices net pi h expense and risk.If you do make me goods available to to Seller and He Seller does net lack
them up Comm 20 days onhe date m your Name,at cancelaen,you may retain or dispose m the them up whir20 days of the data g your Hours of Cameraman.you may retain or dispose of
goods wthom any Water ouigauon.If you far to make to goods assume to He Mier or n you thagoodswmoulanyfunherot igahon.IfyoufattomakerhegwdseveilabletiheSller,orit
agree ream me goods ro td saner and fan to do w.Hen rw remain uabre fo.pemmanea you agreamrammge goods mtheselleramfal tom eo,then you remainmoebrpenormance
all oni0atiors under the Carmel,To arcel this transaction,met or ddear a signed and dated mall oblyations underlie comreet roenel this bareanion,met ordeaer a signed and dated
ed or
tly
ay
115yNOMSomal,Salem MAO1WOnNOT LATER THAN MIDNIGHT OF4o-S_)_�,e5 115yNOM Small,SaIm MA01970nNOTLATER THAN MIDNIGHT OF rameg _ ,ces,
male, f/��V)mratCa�l.ri-
I HEREBY CANCEL THIS TRANSACTION I HEREBY CANCELTHMINFANSACTON
ConerameareSigrairre Dare Consumer a S,Melra Data
�+ �_�eea A & A SERVICES, INC.
115 01970
A&A SERVICES Telephone:: (8)74RTH �1--0 24�x(978)741-2012
Contractor Registration No. 101609
Federal EIN:04-3090162 Construction Supervisor No. CS057733
WINDOWS AND STORM PRODUCT SPECIFICATION SHEET
Buyers)Name Date of Contract
MARILyN 11MLS&A/
Buyers)Street Address,City,State and Zip Code
9b MOFF-47- RD .541L 1M r 4 a/97o
Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address
978-7yN -39Y3
The Buyers)listed above hereby jointly and severally agree to purchase the goods and/or services listed below,in accordance with the prices and terms described an
this Specification sheet and the front and the reverse of the accompanying CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,of which this Specification
Sheet is a pan.
WINDOW REPLACEMENT
Remove and dispose of# existing windows.
Install # new SVAAA:PST Zil77W41111iii windows:ginyl (Wood
(Mahufacmrer)
Options: st le Tul/J C1 Sc`M91V'i Grid pattern NEE
Color Interior L 12" *C*14 Color Exterior Wlq 1 7 ; Glass Type DcV d LLfP,Ad},TJC__LA�
MWrap exterior trim with aluminum: Style Color ' "`"Y 7••
q� All windows will be installed according to the installation procedures in the portfolio.
If Caulk all interior and exterior edges.
® Insulate where possible around new units.
Ot Insulate around new window units where possible.
f Included in this proposal are set up,clean up,Helps vacuum and cleaning windows inside and out.
f Building permit included.
BAY/BOWS/CASEMENT UNITS/ANY FULL CONSTRUCTION WINDOWS
t Create new window opening by cutting through existing home and framing in opening.
f Remove and dispose of existing units)in its entirety.
Note:Electric and plumbing may exist in wall and will require additional costs to customer if need to be dealt with.
If Install windows)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. 4$W"rii
If Bay t Bow IfCasement®Other window(s)to include new interior style trim and new exterior style trim and head
,�q flashing as needed,
V' Note: Painting and staining not included.
STORM PRODUCTS
t Remove and dispose of# existing storm window(s).
If Install new storm windows# Manufacturer
Style Color Option
If Remove and dispose of# existing storm door(s).
f Install new storm doors# Manufacturer
Style Color Type: t Aluminum t Solid Core
SPECIAL INSTRUCTIONS: lL finch = 3 &ql
D T= 30 . =
It is agreed and understood by and between the parties that this Specification Sheet,along with CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,constitutes
the entire understanding between the parties,and there are no verbal understandings changing or modifying any of theterms. This contract may not be changed or its
terms modified or varied in any way unless such changes are in writing and signed by both the Buyerts)and the Contractor. Butterfat hereby acknowledge that Buyens)
has read this Specification Sheet. �
Contractor Initials: q Date: 10--3 —A;! Buyer's Initials: )y Me u./ Date:/k jp 3
CITY OF S.M-E- ) N'LASSACHUSETTS
BL:u-DD;c DEP.•1RT%MNT
120 WASHLVGTON STREET, 31O FLOOR
T EL (978) 745-9595
FAx(978) 740-9846
KIJiBERiEY DR.ISCOLI.
MAYOR T 10.%LAs ST.PM&RE
DIRECTOR OF PUBLIC PROPERTY/BL'II-DLNG CO-%LN SIONER
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 C14IR section 111.5
Debris, and the provisions of MGL c 40, S 54;
Building Permit # is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
111, S 150A.
The debris will betransported by:
�VYI
(name of h er)
The debris will be disposed of in
h Ss— :1�0 Llity) �1�10✓� 6 I� �'V C1S�� t �
(name of facility)
emey�'
(address of facilit ) / I ' ^ I I �S— A)o r- E-��
M A
signature of permit applicant
to
debrisaff dm
CITY OF &U ENI, NDiSSACHUSETTS
BuILDIING DEPAR-rN[L iT
• ��eN• 120 WASHLNGTON STREET, 3so FLOOR
TEL (978) 745-9595
FAx(978) 740-9846
K'I\[BERLEY DRISCOI-I.
MAYOR THOMAs ST.1immix
DIRECTOR OF PUBLIC PROPERTY/BU DL\G COMMISSIONER
Workers' Compensation Insurance Affidavit: Builders/Contractors/El 1.ect11 ricians/Plumbers
Applicant Information Please Print Le ibi
Name (Business:Organization/Individual):.
L r
Address:
City/State/Zip: Phone !#: y��
Are you an employer?Check the appropriate box:
Type of project(required):
I.D I am a employer with 4. ❑ 1 am a general contractor and 1
employees(full and/or part-time).• have hired the sub-contractors 6. ❑New construction
2.0 1 am a sole proprietor or partner- listed on the attached sheet. : ?• D Remodeling
ship and have no employees These sub-contractors have 8. D Demolition
working for me in any capacity. workers'comp. insurance.
[No workers'comp. insurance 5. D We are a corporation and its 9' ❑ Building addition
required.] officers have exercised their 10.❑ Electrical repairs or additions
3.❑ 1 am a homeowner doing all work right of exemption per MGL I I.[]Plumbing repairs or additions
myself.[No workers'comp. c. 152,§I(4),and we have no 12,D Roo repairs
insurance required.)t employees. [No workers'
comp. insurance required.] 13.❑Other
Any appliram that checks box 41 most also fill out the seenim below showing;heir worker'compensation policy mrum atiom
r litmteowner who submit this affidavit indicating they are doing all work and thm him outside comsacmr must submit a new affidavit indicating such.
:Ccmrarmn that check this box must mtachat an addifiorul sheet showing dh name of the sub-contractors and their workers'comp.policy information.
l um an employer(hat is providing workers'compensation insurance for my employees. Below is the policy and Job site
information }—
Insurance Company Name:__ l 1 �.4 V e p K
Policy fF or Self-ins. Lic.
Expiration Date;�__`__�,���
Job Site Address:36 )VA � City/State/Zip: NJ A 0) �7 0
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 ZMGL c. 152 can lead to the imposition of criminal penalties of a
fine up to S1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of STOP WORK ORDER and a fine
of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
1 do hereby certify under d reeppJains and penalties ofperiury that the infarmadon provided above is rue ad correct.
'i gnat tree ��✓' s� /
Date: d (a p
Official use only. Do not write in this area,to be completed by city or town oJrciaL
City or Town' PermillLicense d
Issuing Authority (circle one):
1. Board of health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other _
Contact Person: _ Phone 4.
Massachusetts -Department of Public Safety
Board of Building Regulations and Standards
A&A SERVICES, INC
Christopher Zorzy `I_icense"CS-0'mi,
115 North Street
Salem, MA 01970 CHR[STOPHER T,O 715Z
ry
115 NORTH ST ` I A�
Salem MA 01970% rrya
i
SCn 1 Lu JUM-o5111 A
Expiration
=Office o(t,onsumerA((eira&[t;1IYIIII'SS Regulation Commissioner 05126 2o'`
HOME IMPROVEMENT CONTRACTOR
Registration 101609 Type'
Expiration 6/26I2018 Private Corporation
A&A SERVICES,INO
-_.
Christopher Zorzy
115 North Street --
Salem,MA 01970 (latlersecretary
„ s