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3 PATRIOT LN - BUILDING INSPECTION The Commonwealth of 1Vlassac u`se t tv Department of Public S'7'7��fp ty O ' Massachusetts State Building CodH'( G R l A 9: 01- Building Permit Application for any Building other than a One=or Two-Family Dwelling (� (This Section For Official Use Only) 1 Building Permit Number: Date Applied: Building Official: - l SECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which a street address is not available) / ;vES vim S alf yyk W0190 No.and Street City/Town Zip Code Name of Building(if applicable) SECTION 2:PROPOSED WORK ` Edition of MA State Code used If New Construction check here❑or check all that apply in the two rows below Existing Building❑ Repair❑ Alteration Addition❑ 1 Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No 0 Is an Independent Structural Engineering Peer Review required? Yes ❑ No [11 Brief Description of Proposed Work: SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑ Existing Use Group(s): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) Total Area(sq.ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ 1 B: Business ❑ E: Educational ❑ F: Facto F-1 ❑ F2❑ H: Hi h Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑ I: Institutional I-1 ❑ I-2❑ I-3 ❑ I-4❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3 ❑ R4❑ S: Storage S-1❑ S-2❑ U: Utility❑ Special Use❑and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA ❑ IB ❑ IIA ❑ IIB O IIIA ❑ IIIB ❑ IV ❑ 1 VA ❑ VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) Debris Removal:i Permit:Water Supply: Flood Zone Information: Sewage Disposal: TrenchLicensed Disposal Site❑ Public❑ Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be P Private❑ or indentify Zone: or on site system El permit ❑or trench or specify: permit is enclosed ❑ Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable❑ Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed❑ Yes❑ or No❑ Yes❑ No ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s): Type of Construction: Occupant Load per Floor: Does the building contain an Sprinkler System?: Special Stipulations: c6 `t SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner e Ae `(c ­' 3 R 4sle .S lei OR-70 Name(P int) I No.and Street City/Town Zip Property Owner Contact Information: Title Telephone No. (business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes 1,k /I /1 Name Street Address City/Town State Zip to act on the property owner's behalf,in all matters relative to work authorized by this building permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) If building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here O and skip Section 10.1 10.1 Registered Professional Responsible for Construction Control r t_a4 idler nz- �k_ 7�f-7OYa'� Name Re strant>. ITele h e o. e-mail addr ss Re str tion Numbe Street Address City/Town State Zip Discipline Ex irati n Date 10.2 General Contractor 'n J 6 Sreo;c� s Conmpany Name �^ ,q �t (Th r'. �eOLY r- 2_6 aZ� l3 s ^ o � Name of Person Iaesponsible for Constructiln License No. and Type if Applicable I1� tl 6w S4 Sa6e-�._ l� d Street Address City/Town State Zip Tele hone No. business Telephone No. cell e-mail address SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6)) A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents 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. Is a signed Affidavit submitted with this application? Yes❑ No ❑ SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE. Item Estimated Costs: (Labor and Materials) Total Construction Cost(from Item 6) _$ 1.Building $ Building Permit Fee=Total Construe Cost x (Insert here 2.Electrical $ appropriate munici actor $ 3.Plumbing $ 4b 4.Mechanical (HVAC) $ Note:Minimum fee62� (co act municipality) 5.Mechanical (Other) $ Enclose check payable 6.Total Cost $ 3 (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By enterin y name below iI hereby attest under the pains and penalties of perjury that all of the information contained in this applicatis tr a an ace ate to the best of my knowledge and understanding. Please print and si 1 me Title Telephone No. f Wate Street A s -1n'Y I Ci T n /! St e Zip ^ Municipal Inspector to fill out this section upon application approval: J"�"� �Z.�% 1 glad Name Date y Appendix 1 For the demolition of structures the building permit applicant shall attest that utility and other service connections are properly addressed to ensure for public safety. Please fill in the information below and submit this appendix with the building permit application. The building permit applicant attests under the pains and penalties of perjury that the following is true and accurate. Property Location (Please indicate Block # and Lot # for locations for which a street address is not available) 3 &no C t No. and Street City /Town Zip Name of Building (if applicable) For the above described property the following action was taken: Water Shut Off? Yes ❑ No EZ Provider notified and Release obtained? Yes ❑ No ❑ Gas Shut Off? Yes ❑ No L9 Provider notified and Release obtained? Yes ❑ No ❑ Electricity Shut Off? Yes ❑ No l� Provider notified and Release obtained? Yes ❑ No ❑ Yes ❑ No � Provider notified and Release obtained? Yes ❑ No ❑ Other (if applicable) Yes ❑ No Provider notified and Release obtained? Yes ❑ No ❑ Other (if applicable) /� ���pp�/�//�rr A & A SERVICES, INC. A&A SBMCES 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 e s Name Date of Contract V C72 + 67LvHL,7oU9 6 0 51C Buys s Street Atltless, Git L.State and Zip Code P�i fo i s �a s�4�dv�t r� ®r970 Da Imo Tele hone Number Evening Telephone Number Mobile Telephone Number E-Mail Address 6l7-320 — 2oSlP The Buyegs)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'Agreemeni and Buyer(s)have requested that such goods or services be installed or provided at Buyer's address listed above.A&A Services,Inc.("Contractor"),hereby agrees to install or cause to be installed the products or services listed in this Agreement at the Buyer(s)address written above.This Agreement represents a Cash sale of goods and services,The Buyers) agree to pay in cash the Cost of the goods and services purchased as described herein,regardless of timing or approval of any financing Buyers)may seek for their purchase. bC Purchase Price: �39Est.Starting Date' '- i Down Payment: Est.Completion Date: 'Cash Amount Due on Stan of Job: © Check Credit Card Amount Due on of Completion: No. Amount Due on of Completion: Expiration Date: Balance Due on Upon Completion: R86, 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.Buyerfs) hereby acknowledge that Buyerfs)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.Buyerfs)also(I)acknowledge that they were orally Informed of their right to cancel this transaction;and(it)request that they be contacted via their telephone numbers or email,as listed above,In the event Contractor believes Buyerfs)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 Servic ,Inc. Buyer(s) /� _ By: Y j Signature J� nat Sigure Grn V 6oz`/-1i x VyEI K4-PA Goos � y Print Name Print Name x Signature Print Name You,the Buyerfs), 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. ARBRRATION:The wmraMr and the norreowner homey mutually agree N advance that In Me event rimer puny per.a do,.,.wnceming Ines—do,, are pany may su0mit such discuss to a prvab erblealion aemw for has been approved by me Seae w of the Employs Conce m Consumer affairs and Business Regodedus and the other party shall he returned to Submit Ie such sediment as proved in syc L cA 42A, � c�..,+�/l-, Y' V, ('antrennr ini,iplx�L ...It Iniruls: x Ever Crayr>C D6/oz�2o/6 NOTICE OF CANCELLATION / NOTICE OF CANCELLATION Date al Tremechon ��/i Y/.You may m Cal has transaction.HNoul any variety or Date of Tremacil 'Z-1 You may cancel this transaction,succor any penult,or obllgieon,wtlnen three business days tram the above date. Ifywcencel anyamisawadado, orchestra.vntnm three otherness days tram the above data.Ilyouwnw any PmpenynaaNrn any pw—dys made by you under me Comeau w Sale,and any nesoneble iismirent execumd any Premiums made by you under the Conrpad or Salo,and any asovade Instrument eaecNed IS you Wall be returnee aimed 10 days lWloxing receipt by me Seller of your cJneelleern routs, by yap MII be mantra d sour 10 days whoring temps by me Soler of your cancellation mars. and any secunry Interest anceng out of me implem nt vall Ee drncraded.If you candi you trust and any seamy Interest moung out of the vemactim tell he cancelled.If you canoed,you most make eac a s.to the Seller is your residence,and subdeneany in as good wnaetion as when make available to the Seller at your reeedence,and substantially on a5 good condition as vAen mceived.any goods dewared to you under this Contact or sale:or you may.If you Wean mrroly wt received,env appdz dmroeremt ytth thneer mid comae o<sale:Ipvou mat,ifydvsbeprmly win the instructions of Soler regaining the return shipment of be grads at the sedans wan the smoothen of seller regarerg the return Miami of the goods at the Soler s excenee no or 11 Ym do make the g-as aveeable m In.seder and the Soler does nor pick exposures and risk.0 you do make the goods available to the seller and me Seller does not pick them up yiun zo days&ina date of your Notice of Cancellation,you may retain or despma of me them up vemrn 20 days of the date of your Notice of Canwllson,you may retie on disclose goods vathem any former obl,dern.I1Y-taeuo make the goods available I.are Sore,on it you the gwas direct any lunMr ode9aeon n you to to make the goods available to the seller,ono :me to Were me goode to me Seller and Jail to do so.tyear,hen y rehear liable for podormance of you agree to return me goods In Me Seller and far to do so.then you mmern labor her perlumance all onagations under the Cmean,To wmN this transaction,mail or dahad a signed and dated of all abegaeoriS under the Conrad To cancel nis hansacbon.net or deleven a signed and dated 0py of oncelUem notice or any there vaned ne cce or seed se ter a In"A Service, copy of the cancellation mlece,on any man Carmen notice,or aeha a Iel n tom 9 A servims 115 Note,Sped Salem MA 01970.NOT LATER THAN MIDNIGHT OF V-Y-/lP 115 North Street,Salem MA 01970,NOT LATER THAN MIDNIGHT OF� Door, pram,, J HEREBY CANCEL THIS TRANSACTION 1 HEREBY CANCEL THIS TRANSACTION Omsurren's Signi Oata: Cansuner's Signature Dare: z9� A & A SERVICES, INC. A&A SERVICES 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 WINDOWS AND STORM PRODUCT SPECIFICATION SHEET Buyerls)Name - Date of Contract V/gZMy -i- ii&W* ll rwo_5Ky to - Z- I (o Buyerls)Street Address,City,State and Zip Code 3 PaT2/oTs -Ill -5_4 'M M0 0/770 Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address 17- 3 2-0-Zos(o A 2-a" li(geosk 9� The Buyerls)listed above hereby jointly and severally agree to purchase the goods andlor services listed below,in accordance with the prices and ter s tl=ibetl o"i this Specification sheet and the front and the reverse of the accompanying CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,of which this Specification Sheet is a part. WINDOW REPLACEMENT Q Remove and dispose of# J exist in windows. Install # new iI/ aZ exist J VK"y0 windows:�inyl t Wood ( anufacturer) Options: Style .SLI ojlye� Grid pattern IIIer-Yve— Color Interior W i Tfr Color Exterior (,LL/�/ 7?� Glass Type M16" I- RsV7s Wrap exterior trim with aluminum: Style Color © All windows will be installed according to the installation procedures in the portfolio. "I1 7 ® Caulk all interior and exterior edges. © Insulate where possible around new units. Insulate • n.�.......'nht f,Q;kat,_Lax;ui1,� around new window units where possible. f 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 t Create new window opening by cutting through existing home and framing in opening. If 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 soffit system. I Bay t Bow t Casement If Other windows)to include new interior style trim and new exterior style trim and head flashing as needed. Note: Painting and staining not included. STORM PRODUCTS t Remove and dispose of# existing storm window(s). t Install new storm windows# Manufacturer Style Color Option If Remove and dispose of# existing storm door(s). If Install new storm doors# Manufacturer Style Color Type: t Aluminum t Solid Core SPECIAL INSTRUCTIONS: DNS j7el.y,y� A/9-1'>✓ /vanj fix) P -oti//�, steps 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 patties,and there are no verbal understandings changing or modifying any of the terms. 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 Buyerls)and the Contractor. Buyers)hereby acknowledge that Buyer(s) has react this Specification Sheet. c Contractor Initials: 7 J Date:�'^Z �� Buyer's Initials: X V. k' Date:�C' D6 `�`wL_ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Prtnt Le tbly Name(Business/Organization/Individual): IR 'cery CAS /h C Address:— City/State/Zip:_ Sa L'L"2 M A-00 'Phone#: Ip-7t----7 Lf/-c Y j y Are you an employer?Check the appropriate boa: 1.�I am a employer with 4. F6ej roject(required): �_ ❑ 1 am a general contractor and I employees(full and/or part-time).' have hired the sub-contractorsconstruction2.❑ Iam a sole proprietor or partner- listed on the attached sheet.t deling ship and have no employees These sub-contractors have olition working for me in any capacity. workers'comp. insmance.(No workers'com .insurance 5. ding addition p ❑ We are a corporation and itsrequired.] officers have exercised their trical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repays insurance required.]r employees.[No workers' comp.insurance required.] 13.0 Other Any applicant that checks box#t must also fill out the section below showing their workers'compensation policy information. r Homeowners who submit this affidavit indicating they are doing all work and then hire outside comractms must submit a new affidavit indicating such. 'Contractors that check this box most attached an additional sheet showing the name of the subtcm mama and their workers'comp.polity information. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:rIra 1/ P—I-R f�S Policy#or Self-ins.Lic.#: `�-�3 K6 ( t� Expiration Date -(_� �—) Job Site Address: 'U'� t_d � L.Q` ^7B �-� CiTy/State/Zip:S� �4 ©1 r-Lf Attach a copy of the workers'compensation policy declaration page(showing the policy number and e£p//iration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fore of up to$250.00 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. l do hereby certify n er he pains and penalties of perjury that the informadan provided above ' true nd correct ato" / Date: f Phone#: Official use only. Donor write in this area,to be completed by ear or town official City or Town: Permit/License# 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#: k Massachusetts -Department of Public Safety A&A SERVICES, INC `a' Board of Building Regulations and Standards j Christopher Zorzy License: 115 North Street Lkcense: CS-057733 Salem, MA 01970 CMUS]FOP11ER7yORZX=. 115 NORTH ST - Salem MA 019707 SCA1 Ei 20M05/11 c-' Expiration J C�/eo Iprrnu/r n/no/r�� r�l�i��ckOrrn�,me/�, .4.+ � �����,17 i `12\ Office of Consumer Affairs&Business Regulation Commissioner 31 j dHOME IMPROVEMENT CONTRACTOR + Registration Z 101609 Type: y�r Expiration._,6 6/301.6 Private Corporation A&A SERVICES, INC�r ?; lf Christopher Zorzy 115 North Street Salem,MA 01970 Undersecretary 2q Phone: 978-741-0424 ir Fax: 978-741-2012 /L"1i PL1� .p(`\®/ e 115 North Street ® . Salem, MA 01970 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 property licensed facility as defined by M.G.L.c. 111, Sec. 150a. The debris will be disposed at: Waste Management 877-515-2845 c/o Melrose Transfer Station 740 Broadway Melrose, MA 02176 or Waste � p Management, Dum ster Service 9 at 115 North Street Salem, MA 01970 Signature of rmit Applicant Christopher Zorzy, President Name of Permit Applicant Date The Board requires that windows be replaced with an identical style to match (aesthetically) to the existing, although any brand is acceptable. I will inspect the railing damage today. Phil Sherman From: Valery K. [mailto:valerykaragodskyCabgmail.com] Sent: Sunday, May 08, 2016 7:46 AM To: Phil Sherman Subject: Replacement window Hello Mr. Sherman , I would like to replace window in my living room. Do we have any restriction about style or brand of the window ? I'd like to update you about after winter damage as well ( 3 Patriot Lane ) Attached photos. Thank you, Valery Karagodsky 2 Donna Nielsen From: Valery K. <valerykaragodsky@gmail.com> Sent: Friday, June 24, 2016 10:23 AM To: Donna Nielsen Subject: Fwd: Replacement window - 3 Patriot ---------- Forwarded message ---------- From: Phil Sherman <psherman(a,crowninshield.com> Date: Fri, Jun 24, 2016 at 10:14 AM Subject: RE: Replacement window - 3 Patriot To: "Valery K." <valerykara oQ dskv t+,gmail.com> The contractor should obtain a Building permit from the City of Salem. Phil Sherman From: Valery K. [mailto:valervkaragodskv(c)amail.com] Sent: Thursday, June 23, 2016 11:26 AM To: Phil Sherman Subject: Re: Replacement window - 3 Patriot Hello Mr. Sherman, Thank you for your response . But "A&A Services, INC" (115 North street , Salem, MA) requires Permit of the Association. May you prepare it for us ? They need or permit,or something like your answer,but signing. Thank you, Valery Karagodsky On Mon, May 9, 2016 at 9:51 AM, Phil Sherman <psherman cr,crowninshield.com> wrote: Ms. Karagodsky: 1 Donna Nielsen From: Valery K. <valerykaragodsky@gmail.com> Sent: Thursday, June 23, 2016 10:49 AM To: Donna Nielsen Subject: Fwd: Replacement window ---------- Forwarded message ---------- From: Valery K. <valerykaraeodsky(i�.email.com> Date: Thu, Jun 9, 2016 at 10:02 PM Subject: Replacement window To: Phil Sherman <pshermangcrowninshield.com> Hello Mr. Sherman. We are planning to replace a window. Do we need permit of the Hamlet Condominium ? Thanks, Valery Karagodsky i