21 NORTHEND AVE - BUILDING INSPECTION (2) �- The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
r Massachusetts State Building Code, 780 CMR SALEM
Building Permit Application To Construct, Repair, Renovate Or Demolish a Revised Mar_7
011
One-or Two-Family Dwelling
This Section For fficia se Only
Building Permit Number: ate pplied:
i
Building Official(Print Name) ig r Date
SECTION l: SITE F MATION
1.1 Property Address:a( NU✓_tkZy1 - AV-e . 1. Assessors Map & Parcel Numbers
1.1 a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq It) Frontage In)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.L c. 40, §54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: Outside Flood Zone? Municipal ❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record: n�
M.�Y'.J k is 0 At-&A &r.e I t IcLVY tk L�l� t tK Ar O l q� O
Name(Print) City,State,ZIP
ad Na✓ Il I Rve. q_N__I 1S-- 0(�0 I3���11rso�C�ro,,�s�sf. 1
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction ❑ Existing Building Oa,- Owner-Occupied S" Repairs(s) ❑ Alteration(s) R" Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specily:
Brief Description of Proposed Work 2:�/1,5-/='CC__1�.� Vin'll��(QGeivt.L✓i'{f__�_/�
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials)
Building $ q 9 8 i 1. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical g ❑ Standard City/Town Application 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: $ i..� J_ g, 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL)
( 1A,- 1 5-` , 0 kv,(r -Z0 TZ V License Number Expiration Date
Name of CSL-Eo der List CSL Type(see below)
i'�1n f ct(
Type Description
AjP es U Unrestricted(up to 35,000 Cu.Ft.
v R Restricted 1&2 Family Dwelling
Si afore `[ M Masonry Only
RC Residential Roofing Coverin
Telephone WS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5.2 Registered Home Improvement Contractor(HIC) (Ca L l•,' 9
l nt-liCe2S iVtC.
HIC Com a ry Nam_e or HIC Regist ant Name Registration Number
Se
ddres qIG 7VL�i`aif. Expiration Date
Sigma re Telephone / 1
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
as Owner of the subject property hereby
authorize (nr" C^f"'n Q�l.-c" ~Z C �2v/ to act on my behalf,in all matters
relative to work authorized by this building permit application.
Signature of Owner Date
SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION
1 , 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 Name
Signature of Owner or Authorized Agent Date
(Signed under the pains and penalties of perjury
NOTES:
1. 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 780 CMR Regulations 110.R6 and 110.R5,respectively.
2. When substantial work is planned,provide the information below:
Total floors area(Sq.Ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(Sq.Ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
DISPOSAL OF DEBRIS AFFIDA T
In acDordanrS with the provisions of Ise, G. L. c. 40, Sao. 54, a cond Uon of
Building Permit Number is that the debris rasulfhg `<,'rom this woit shall
W. Nip aisp���� �k l� �P®�ePly f°s�d��®d facility as delta,i®�.by VA G. I=, oo 119, Sao.
90,@2.
The debris will be ®lspMed St Wain ` Vans'ge Sftfj0"
owed bV tNoFff-imido CRFUH
1gri k rg of Pa, l pplicarak
Date
NP-m9 of Permi$Applicaek .
A A SaFWoes. bcc
5r`dr NIG®
115HOLM geeayko Salerno MA 001976
address, City, Skate, Zip CDds
The Commonwealth of Massachusetts
�1 ` (7 Department of Industrial Accidents
office offnoestfgations
600 Washington Street, 7h Floor
Boston, Mass. 02111
_�..5;g..Workers' Compensation Insurance Affidavit: Building/Plumbing/Electrical Contractors
Applicant information: Please PRINT legibly
name: _C/i Y- 5- j1 k e r-
address: - i -el p [ / 0 y ' /
City �.P 1't" state: /ViiF1 : 49/ / 7 /0 phone "7Tf-oYaY
work site location(full address):
❑ I am a homeowner performing all work myself. Project Type: ❑New Construction ❑Remodel
❑ I am a sole proprietor and have no one working in any capacity. ❑ Building Addition
21 1 am an employer providing workers' compensation for my employees working on thisjob.
company name: /�C`- -Z- A- r�Q-,--v 1 (.l�s P �c
address: ( 1 3S t it C ✓ V ��11 S�1 ' (� �j �[ / /
city S a � le (MO M,TI phone#: -1�7l 0 - 7����7}} I -/6 Y 2-7
insurance co. �Q ra lJ-e 1-e r tS policv# ()a-td 3 ra l b 1 5
❑ I am a sole proprietor, general contractor,or homeowner(circle one) and have hired the contractors listed below who have
the following workers' compensation polices:
company name:
address:
City: phone#:
insurance co police,#
company name:
address:
City, phone#•
insurance co policy#
Attach additional sheet if necessary
Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of it fine up to S1,500.00 and/or
one years'imprisonment as well as civil penalties in the farm of STOP WORT(ORDER and a fine of$100.00 a day against me. 1 understand that a
copy of this statement may be forwarded to the ,Price of Investigations of the DIA for coverage verification.
Ida hereby/certify unde7ldippains,and p naities of perjury that the information provided above is true and correct.
Signahu'�/ ` _ �-7 Dale f��l [/G o -1 �- /
Print name 'ay
Q ✓ LO✓2a,/ Phone# 770 �771t�(l Tr "
official use only do not write in this area to be completed by city or town official
city or town: - permit/license#_[]Building Department
❑Licensing Board
❑check if immediate response is required ❑Selectmen's Office
❑Iiealth Department
contact person: phone#; ❑Other
(revised Sept.2003)
THE COMMONWEALTH OF MASSACHUSETTS
ExFCUTNE OFFICE OF LABOR AND WORKFORCE DEVELOPMENT
DEPARTMENT OF LABOR STANDARDS
19 STANIFORD STREET,BOSTON,MASSACHUSETTS 02114
DELEADER CONTRACTOR LICENSE
A &A SERVICES, INC.
115 NORTH STREET
SALEM MA 01970
LICENSE: DC000440 EXPIRES: Friday,May 10,2013
IN ACCORDANCE WITH M.G.L. CH. 111, § 197B(b)AND 454 CMR 22.03, THIS LICENSE IS ISSUED BY
THE DEPARTMENT OF LABOR STANDARDS TO THE CONTRACTOR ABOVE FOR THE PURPOSE OF
ENTERING INTO OR ENGAGING IN DELEADING WORK.
THIS LICENSE IS VALID FOR A PERIOD OF ONE YEAR.
THIS LICENSE MUST BE MAINTAINED BY THE CONTRACTOR WHEN ENGAGED IN DELEADING
WORK IN ACCORDANCE WITH M.G.L. CH. I I I § 197B(b)(2)AND 454 CMR 22.03.
HEATHER E.ROWE,DIRECTOR
*� liLissachusetts- Department of Public Safer
p� Vlze Consumer
Affairsl&Bui ifiess taau�uaell3
Office of Consumer Affairs&Busi ess Regulation Board Of Building Re'-1,1111t[ions :uul Shtnll:U'll\
OME IMPROVEMENT CONTRACTOR Construction Supervisor License .
19,stratron: 101609 Type:
IF
License: CS 57733
xpiration ,.612612014 Private Corporatio t
Y
A&A SERVICES INC ,, I
, CHRISTOPHER ZORZY ,
115 NORTH ST
Christopher Zorzy -
SALEM, MA 01970
115 North Street
Salem, MA 01970 -
Undersecretary
Expiration: 5/26/2013
- _ l'onnaissionrr Tr#: 15935
6UILDING_PERFORMANCE INSTITUTE..INC: . \ r
1.07 Hermes Road, Suite 1.10
Malta, NY 12020 Advanced Training
(871) 274-1274 jProgram
Fiber Cement Siding
Christopher Zorzy #201 204 260 00 940
ro
A&A Services Inc Exp 4/26/2017
j jKpi CHRISZORLY
115 North St
CA Salem, MA 01970
t'-�
1 - _ CANDIDATE ID= LANO '�x,
Matthew]Gibson
... .�_ ... . .a..= ♦ .. \S: p,I,�iniele.erl Mi IlnM1./nrL..I..............n�l Inr
NOV-05r-2010 1G: 19 Sunrise Windows AA P.02
vanguard W I N D O 41' 5 EMME
A view that works
Vanguard Windows are tested and certified to National Fenestration Rating Council (NFRC)
standards, These are the numbers ENERGY STAR® uses to determine how fenestration products comply
with their standards, and to categorize the products for the appropriate climate zone(s).
Window Glass U-Factor SHGC i
Type Package ®;
VG Plus 0.28 0.28
Double VG 12 0.28 0.21 I"
Hung
VG3Ar 0.22 0.22
VG plus 0.29 0.28
Slider VG 12 0.28 0.21
VG'Ar 0.22 0.22
VG Plus 0.28 0.28
Tilt-In Slider VG 12 0.28 0.21 FF ® Northorn
VG'Ar 0.22 0.22 ❑ NorthiCentrel
VG Plus 0.28 0.30 r'+^11••.,
Picture VG 12 0.27 0.22 ; _. ❑ Sculh/Central
.r ...
VG'Ar _0.21 0.22
VG Plus 0.26 0.24 1 ® Southern
Casement VG 12 0.25 0.18Alternative
VG'Ar 0.21 0.19 CntensAllowed
VG Plus 0.26 - ^0.24
Awning VG 12 0.26 0.18 W
_VG'Ar_ 0.21 o.19
VG Plus 0,26 0.28
Casement VG 12 0.25 0-21
Picture r` Y
_VG'Ar 0.20 0.22 _
VG Plus 0.30 0,27
Sliding Door VG 12
VG'Ar N/AL N/A I N/A
www.vanguardwindows.com
This data is accurate as of February 25,2oog.Due to ongoing product changes,updated test results,at new industry standards or requirements,this data may change over
time.Ratings are for sizes specified by NFRC for testing and eertifcation.Ratings may vary depending on use of tempered glass,different grid at decorative glass options,glass
for high altitudes,coastal applications,etc.
l
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TOTAL P.02
Ab.
Above
Since 1962 Phone: 978-741-0424
-2012
w w SER /ICES Fax: 9vices. om
//9� pQPJ/'�Y V\ ■p(-w/ ■V- V\ www.a-aservices.com
115 North Street
Salem, MA 01970
November 30, 2012
City of Salem
Building Dept.
120 Washington Street
Salem, MA 01970
To Whom It May Concern:
Enclosed please find the permit application for Barry Johnson at 21 Northend
Avenue, Salem, MA to replace windows.
/ 1
I have enclosed a check for $40 based on your fee schedule of$7 per $1000 plus a
$5 administrative fee. The total for the job was $4,698.00.
Please send the completed permit to A & A Services, Inc. at'115 North Street,
Salem, MA 01970.
If you have any questions, please contact me at (978);741-0424.
f
Thank you for your assistance.
Sincerely,
r
Barbara Zorzy
Office Manager
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