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92 MOFFATT RD - BUILDING INSPECTION Gk J3 33 y - ^> The Conunomce:dth of MassachusettS r t Board of 131.11Iding Rcgttlations :utd Standards \II Nl( 111AH I MaSS:µ htlSettS State Building Code. 780 (•MR. 7"' edition SI. +. Building Permit Application To Construct. Repair. Renox:ae Or Dcniolish a Kr rvsrJ tt%mu, One- or Tiro-F'mnijr Doi,elling, _—� This Section For Official Use Only Building Permit Numh r. Date Applied: _------ _� Signature: , Building Commissioner/ Inspector of Buddiugs Date SECTION 1: SITE INFORMATION 1. Property� reps: p 1.2 assessors M1lap & Parcel Numbers� �OCt_ I.la Is this an accepted street? yes_ no Map Number P:acel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq II) Frontage IIII _ 1.5 Building Setbacks(ft) From Yard Side Yards - Rear Yard Required Provided - Required Provided Required Prue ided 1.6 Water Supply: (M.G.L c. 40. §54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone'? ,yiunicipal ❑ On site disposal system ❑ Public CI Private❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP[ � Owner/tofRecord: / 'n/1 9 �7 MA 6jg70 0.v.jnrl�erie✓iCVf CC9t✓ve'-2t' 4'l 1• ldtC-U.� I'`tt �r. nn-, tlrl Name i Print) Address for Service: ��S gnatu r�r Teic phone j SECTION 3: DESCRIPTION OF PROPOSED WORK"(check all that apply) New Construction ❑ Existing Building ❑ Owner-Occupied ❑=Repairs(s) eration(s) 0 Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units_ y: _Brief Description of Proposed work-: 14 5111 o i SECTION 4: ESTIMATED CONSTRUCTION COSTS Estimated Costs: Official Use Only Item fl-abor and Materials) [2. Building $ tT Q 1. Building Permit Fee: S Indicate huu fee is determined: ❑ Standard City/Town Application Fee Electrical b ❑Total Project Cost} (Item 6) x multiplier x Plumbing S 2. Other Fees:Mechanical (HVAC) 5 List: i. Mechanical (Fire 5 Total :\II Fens: S- ---- Su ressionl Check No. Check :\mount: Cash Amount:_.__.. b. Total Project Cost: S J 9SbT.o ❑ Paid in Full ❑ Outstanding I3al:mre Due:-- V v� t SECTION 5: CONSTRUCTION SE.RVICF,S 5.�1 jL,ic�e�nsed Construction Supervisor(CSL) F-77� ��•q I.IJ-��2Ll�r. � 1 LIL'en,e NumheF lixpir;uuni 17:aa ;Name of CS L- 11 older ' � I_i+l C'S1,l'cpe (see halutcl Wdre• s Tv c Descri xion L ('nrestricied(up to 3;.000 Cu. Pt.. R Resumed Ir@'_ F--- '- Dtr rl l.ne 11 R ai&ntonrN Only JO RC evdenual Rur�line Cotcnn_ Telephone \l'S Itrsidrno,tl \Vinduo .ind Siduie SP Re+ideinial Sohd furl liunune \ rrhanrc In.t.ilLm�ni D Rr&[Iual Demolition 5 Regi'tered IIome Improvement Contractor (111C) I C)) o09 —_ HIC Company Name or I I C R•gist rant Name - Registration Number Addres r (�i817A I- 61 A-q Expiration Date Signature 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 ........... ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN . OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT eckAiJ pr �y-R-y�-2_x/+2.✓2 yvt -ei- , as Owner of the subject property hereby authorize Chrittopher 7= to act on my behalf. in all matters relative to work authorized by this building permit application. X 1�&2(y �i 0 / :'rSienutur _u_I Owners� � eDaieT SECTION 7b: OWN,EW OR AUTHORIZED AGENT DECLARATION /e I. ( I'11`_6f-00 1el- Z(-3CLLA as Owner or Authorized Agent herebIdeclaie that the statements and information on the foregoing application are true and accurate, to the best of my kno behalf. Ir Z Print Na Signature of Owner or Au[ razed Agent Date (Siened under the pairis and penalties of er'u ) - NOTES: I. 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 Plot 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 780 C'MR Re.gulations 110.R6 and I IO.RS. respectively. 2. When substantial work is planned, provide the information below: Total flours area (Sq. Ft.)- - [including garage, finished hasement/attics, decks or porch[ Gross living area iSq. Ft.) Habitable room count Number of tireplares Number of bedrooms ---_—_ Number of bathrooms Nirtnber of halt/hash, rvpe of heating system Number rat decks/ pouchcs ___-- "Type of cooling system Fnclo,eJ (Jpcn .-_-- -- _ 3. "Total Project Square Footage" may be substituted for "Total Project Cost" J 4t A & A SERVICES, INC. AAA CES 115 NORTH STREET,SALEM,MA 01970 IMMOTM Telephone:(978)741-0424 Fax: (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 _ Buyer(s)Street Address,City,State and Zip Code Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address - ►B (.3SI The Buyers)listed above hereby jointly and severally agree to purchase Me goods and/or services listed below,in accordance with the prices and terms describetl on this Specification sheet and the front and Me 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 # 0 new WK0 th KS—T W t`•tlh%l'' windows: ❑Vinyl p},Wood (Manufacturer) l Options: Style Dt °,1 _ Grid pattern Color Interior Lr 55 Color Exterior L A Glass Type b� � ❑ Wrap exterior trim with aluminum: Style - Color 0 All windows will be installed according to the installation procedures in the portfolio. ❑ Caulk all interior and exterior edges. A Insulate where possible around new units. 15 Insulate window weight pockets if exist,and around new window units where possible. - )d Included in this proposal are set up,clean up,Hepa vacuum and cleaning windows inside and out. ❑ Building permit included. BAY/BOWS/CASEMENT UNITS/ANY FULL CONSTRUCTION WINDOWS ❑ Create new window opening by cutting through existing home and framing in opening. ❑ Remove and dispose of existing 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. ❑ 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 so0it.system. O Bay ❑Bow ❑Casement ❑Other window(s)to include new interior style trim and new exterior style trim and head flashing as needed. - ❑ Note: Painting and staining not included. STORM PRODUCTS ❑ Remove and dispose of# existing storm window(s). ❑ Install new storm windows# Manufacturer s Style Color Option ❑ Remove and dispose of# existing storm door(s). ❑ Install new storm doors# - Manufacturer Style Color Type: ❑Aluminum ❑Solid Core SPECIAL INSTRUCTIONS: �ARoJtfJ Kim WWn� 6 sy. &9-TD5 amt sns�lac�( kl+�t Qr K Wy_t_ oas�tblt u'uQU4CC r1a-7w11 1.-\aIQO W It is agreed and understood by and between Me pares Met this Speclfical lon Sheet,along with CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,constitutes the entire understanding between Me penes,and Mere are no verhal understandings changing or modifying any of Me terms. This contrail may not be changed or he terms modified or varied in any way unless such changes ere in willing and signed by boM Me Buyers)and the Contractor. Buyer s)hereby Inumowledge Met Buyer(s) lies reed MI9 SpecMcation Shea t. ' Contractor Initials: Date: 1-13 Buyer's Initia,4ZA4 Date: �� w� i , Above S4m19ae A & A SERVICES, INC. _ ,S' M C 115 NORTH STREET,SALEM,MA 01970 • 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 Val UL, CnPn;Esc ►- ►3-09 Buyerts)Street Address,City,State and Zip Code SlDi'LiwIf weft 01910 Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address: The Buyers)listed above hereby jointly and severally agree to purchase the goods and/or services listed on the accompanying specification sheets;in accordance with - the prices and terms described on the front and the reverse of this agreement and any specification sheets(this"Agreement"),and Buyers)have requested that such goods or services be installed or provided at Buyer's address listed above. ASA Services,Ina('Contraetol^),hereby agrees to install or cause to be installed the products or services listed in this Agreement at the Buyers)address written above. This Agreement represents a cash sale of goods and services. The Buyerts)agree to pay in cash the cost of Me goods and services purchased as described herein,regardless of timing or approval of any financing Buyers)may seek for their purchase. Purchase Price: H) 1.�COl L 1rlic� Est.Starting Date: Down Payment: �aw y Est.Completion Date:C If —ay Amount Due on Start of Job: JbP,&Pl 'CID 3C Q P":9 �(_l ❑Check (�Y 0112 / �Dn O Credit Card Amount due on of Completion: �N No. Amount Due on_of Completion: Expiration Date: Balance Due on Upon Completion: 5�OD CVC Code: It is agreed and understood by and between the parties that 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 Buyers)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 (I)acknowledge that they were orally Informed of their right to cancel this transaction;and(11)request that they be contacted via their telephone numbers or a-mail, as listed above, in the event Contractor believes Buyers)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 Serv' esy,Jac. Bu er(s) By: ^C 7 /�-' 1 .Gi-.ram , - g Sig turel Si tine 1 rub 12NfiRD C-77'i�lia Y9y& 6,epila-. Print Name Print Name Signature Print Name j 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. ARBnRATION:The wMatlw ant the Ma..,hereby muwelry oath in entente mu an the w pw a vast..Our ty a- dispum-.-..a,Be.wn ther pant trea ei may sulmn suchute disp a " a Mr M amih a se,Mce whch has been approved by Me Seaemry of Me Executive OMts or Consumer Aaarrs and Business Regulations and he other parry all W required m suhms m wain arhitralkn as pmredlnMG.l c.laYA. 'RIP ., Cacoacrm iniral Bum',,lax 16 DUO, oast: NQTIQE OF CANCLUADQIx FI LATION Date o1 Tmnactlgn .YOU may carrel Mb UonaaNw,witurat any Ponaly or Date of Tmnse on P13 .You may rental Mls bansawbn,wltlmN any penalty or oblgation,withn three business days from Me above dab.It YOU moot any prawM traded in, obligation.within Mrea business days from Me above data If you cancel,any proper,traded in. any payments made you under me Conhect or Sale,and any na mo o Instrument execvbd any paymanta made by you under Me conuaw or Sale,ant any neptlable instrument eaecubd My you will M relumad within 10 days blowing receipt by the seller of your combeHadon hunts, by you will be rowm within 10 days folbwing obtain by Me Seller of your cexellamn muse. and any mcudy Interest arising end of the tins oon will be senwlled. 0 you cool you most and any sewny imerest arisiOg Out Of the trerwctbn will be nncelled 11 you cancel.You must make smanalf to Me Soler it pur bs]erwe,in wbstandaly as ynon condition as when mceands. makeavalabbmlheselardwommsaerice,In subsientblyugmd cwNitbn aawMn receire0. any goo]s defmretl to you unaertnis eomraet or Sale:w yw may,it you wish,ewnpy with Me any goods defweral to you under this Contract Or Sale;or you may,I you wish,comply with the InsWpbns of the seller"pal tits reNm shpment of me goods at Me Sellars expense and instrutl'rons of Me Sepal.9.i.9 the reNm shipment M the gads at Me Sellere..,a.and ask. If You do make the goods domable to Me Soler and Me Sol does me pi them up ask. If you do make Me goods available to the Soler and Me Seller Wee net pax them up womb 90 days of Me data of yas Nadia.Of carasnauon,you may main or dlspow of the goads Milan go days of the data of your Not of cancellation,you may reran waspow of Me good withoutanyfuMerobll9ation Il you leilbma'w me gaodaaveileble la Me Seller,or it you agree witlpulenybMermuld ice. If you Be to make the goads marebleto Me Sale,arty.agree to will Me goods is to Seller and Fall m do w,Men you reman liable for personnel of all to maim Me punts to Me Boller and tail m do w,Men YOU reman food far par r mr.nce of e0 obligations under the Contract To ranch BUM transaction,mail or deliver a signed and dabd ropy Oblga%ns under Me contract To coneal mis nameabn.mall or dower a signed and dated w%- o Me cenwllatms.1.or an,.,her wads.a.lw,or sent if adisma,to AM1�Sa 15 of Me ca,cellopn does,Or any other wsilten norms,Or wand a telegram,to AflA Sxv out 15 NOM Street,Seen,Mmwtlluaetla 0190.NOT LATER THAN MIDNIGHT OFI . Nor,Showt Selem,Messachumed.01970,NOT LATER THAN MIDNIGHT OF 1 1/0 . (Data) (Dam) I HEREBY CANCEL THIS TRANSACTION. Conwmtt's SxpwUdra Date I HEREBY CANCELTHSTRANSACTION. ConsummS Signature Data CITY OF SALEM 3,f�"s PUBLIC PROPRERTY tr k w DEPARTMENT \LU,�n I--'J \\'�,iil�t,f��tilahhi • ti.�liV, \l.�„�� 1!I •ii :, :lt^ . Workers' Compensation Insurance Af ida%it: Builders/Contractors/Electricians/Plumbers ,kit li ant Information Plr.+se Print LeeiblV ,N;1111C i Bu.ures t k_amiauun Indn;.foal I: A.!?, A 6erv] Ck5 s0c Address: 5 v r 1 h 5+y e—+ City,Scue.zip: 12—A JIM Phone #: Are you an employer? Check the appropriate box: "fype of project (required): 4. ❑ I am a general contractor and 1 6. 1.LJ 1 am a employer with�_ ❑ New construction employees (full and/or part-time).' have hired the sub-contractors 7. ❑ Remodeling _'.❑ I am a sole proprietor or partner- listed on the attached sheet. t These sub-contractors have iS. ❑ Demolition ship and have no emplovees working for me in any capacity. workers' comp. insurance. 9 ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10 ❑ Electrical repairs or additions required.[ officers have exercised their i rht of exemption per MGL 1 L❑ Plumbing repairs or additions },❑ r I am a homeowner doing all work 6 P P myself. [No workers' comp. C. 152, §1(4), and we have no 12.❑ Roof repairs insurance required.] 1 employees. [No workers' 13 [gother t comp. insurance required.] •:xoy applicant dw checks box#1 must also till out the section below showing their workers'compensation policy information. p t I lumeuwners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. •t-Ulltrnitn6 that cluck this box most attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. l uor all employer that is providing workers'coorpensadon insurance for xty employees. Below is the policy and job site infornrution. / Insurance Company Name: Tray e,Lcvim.,l pp 4• ExpirationDate: Policy # or Self=ins. Lic. #: '. Du��M�'J� U� e 9— Job Site Address: �� M � City/State/Zip: 5M. C v,AA y L70 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 MGL c. 152 can lead to the imposition of criminal penalties of a tine up to S l J00.00 and(or one-year imprisonment. as well as civil penalties in the firm of a STOP WORK ORDER and a fine ,)t up to S2i0.00 a Jay against the violator. Be advised that a copy Of this statement may be forwarded to the Office of ImQstivations of the DIA for insurance coverage verification. -------------- 1 do hereby' !,crtiftndee pains and 'nalties of perjury that the information provided above is true cord correct. Date ` J lh —UJ/icial use only. Do not write in this area. to be completed by city or town official City or Town: PermitiLicense #_..---__----..--------- Issuing .luthorily (circle one): I. Huard of Health 2. Building Department 3. Cit%,town Clerk J. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person:_—__—.-- .— Phone #:_— Information and Instructions \I.t<.,IC ht I>cns (iclei al 1,awS chapter i>' rcqu ncrall emplo%ci to pnn 1de %%orkers' compensation Ior their cot p loyees. I'tosu.uu to this .tattne. .m etnpluree is dctvted as ". c%ery person in the sen we of anther under any contract of[tire, cypress or irnplicJ. oral or �tI tten." An :nrphn'er is defined as "an indi%;dual. purtner, lip. .1,socution, corporation or other Ic,al entity. or any two or more of the forc,oing cm,a,ed in ajoint cnrcrpriSe, and includine the legal rcprcscntati�es of a deceased employer, or the tecci%cr or trustee of.tn individual, partnership, association or other legal cnnty, employ in,employees. I lowcxer the „.%ricr of a wciting house hat ing not ;note than three apartments and ti,ho resides therein, or the occupant of the duelling house of;mother who entplo%s persons to do maintenance. construction or repair work on Such dwelling house or on tile ,iounds or building appurtenant thereto Shall not because of such employment be deemed to be an employer." \Il iL chapter I52, �s 25C(6) also States that "every slate or local licensing agency shall withhold file issuance or renewal 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, 'tI(;L chapter 152, j25C(7) States "Neither the conmwmvealth nor any of its political Subdivisions shall cwcr into any contract tier the performance of public work until acceptable e%idence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." .\pplicants Please lilt out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members 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 this 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 be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of[lie affidavit for you to till out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit license applications in any given year, need only Submit one affidavit indicating current policy information (if necessary) and under"Job Site Address"the 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 applicant as proof that 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 (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The (Mice of Investigations would like to thank you in advance for your cooperation and should you have any questions, please Jo not hesitate to give us a call. the D) p:uvment'S address, telephone and fax 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 I(e%iSrd 5-'6-05 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, Sec. 150a. The debris will be disposed at: Salem Transfer Station owned by Northside Cartina - Signature of Pe it Applicant 13 7007 Date Christopher Zorzy Name of Permit Applicant A & A Services, Inc. Firm Name 115 North Street, Salem, MA 01970 Address, City, State, Zip Code j �f 0/ee �oommzaral!/c o��aaaac/%ereelYa Board of Building Regulations and Standards Construction Supervisor License License: CS 57733 Bithdate.::5/26/1958 a EXpvatfon :526/2009 Tr# 13739 IL Restnctfon 00 4 j CHRISTOPHER ZQRZ-Y� gv 115 NORTH ST j SALEM, MA 01970 Commissioner - ,per ✓lie YOoonmzanuie¢r!i�t �� \ Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 101609 Expiration: 6/26/2010 Tr# 267870 Type:- .Private Corporation A&A SERVICES, Christopher Zorzy�,;+, 115 North Street Salem,MA 01970 Administrator Commonwealth of Massachusetts Division of Occupational Safety Laura M.Marlin,Commissioner W Deleader-Contractor CHRISTOPHER ZORZY Eff. Date 04/09/08 Exp. Date O4/O8/09 ® � + u „s . DC000440 Nbmber of C 0.N.ES T. BO II IIIIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIIIIII BOSTON.RENEW