30 PRESCOTT ST - BUILDING INSPECTION 1'7
Citp DfaYPm, � aL�uPtt
PLANS MUST BE FILED AND APPROVED BY THE
INSPECTOR PRIOR TO A PERMIT BEING GRANTED
Location of Building Tr Snt>I-I- 51-r6e
Building Permit Application For:
'(Circle whichever applies) Roof, Reroof, Install Sid* ct Deck, Shed, Pool
Addition, Aiteration RepairMepia Foundation Only, Wrecking
Other-
PLEASE FILL OUT LEGIBLY & COMPLETELY TO AVOID DELAYS IN PROCESSING
ry ,
To the Inspector of Buildings:
The undersigned hereby applies for a permit to build according to the following specifications:
OwoersName:-DIGnne, :b ry-AhUe_ Contractor: ChriStnr�Qar 7,n
StreetQ PYP.SOI City Street 115 North Atraat Clly_ Salam
StateMPt Phone --7D31 State MA Phone(978) 741 -049.4
Architect: City of Salem Lic# 1405
Street City State Lic#0 5 7 7 3 3 HIP# 101609
State Phone ( ) Homeowners Exempt Form_yes ✓no
Structure: (please circle Ingle Family Multi Family# Other
Estimated Cost of job S 11 , I)A I . 00
Will building confirm to law? yes no
Asbestos? es ,,/'no
Description of work to be done:
=✓�SIC111 —PourlPov, �IW� ���1 f � r42-121616ovInort{ A)Iry) t �25
Drawings bmitte :_yes_z no Mail Permit to: I18 NORTH STREET
% RAr.F.M ATA-A�a79
X ,
Signature o Appli lion,SIGNED UNDER THE PENALTY OF PERJURY
CONSTRUCTION TO BE COMPLETED WITHIN SIX (6)MONTHS OF PERMIT ISSUED DATE
Department use only: Permit# Zoning Map/Lot
Permit fee$
CONHMS:
No. y
APPLICATION FOR
' PERW TO
LOCATION
PE MIT GRANTED
APP fD
INSPECTOP OI' BUILDINGS
CERTIFICATE OF OCCUPANCY
YES
NO +
r
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 No aide Cartina -
J) Al - . .
Signature of Penn Applicant
Date
Christopher Zorn►
Name of Permit Applicant
A &A Services, Inc.
Firm Name
115 North Street. Salem. MA 01970
Address, City, State, Zip Code
The Commonwealth of Massachusetts
• Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, Mass. 02111
Workers'Compensation Insurance Affidavit: Building/Plumbing/Electrical Contractots
name:
location:
city: state: zip: phone#•
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
I am an employer providing workers'compensation for my employees working on this job.
conivanytiame ASGY VICe S, TYI G.
address: 11955 fJ6M-) 5fY-ee-+
city: Sn I e_m phone#• 1974 V4 i -0-4 aH
insuranceco. fie- TfGtyeAGr-S policy#• wCG343 )091520
❑ I am a sole proprietor,general contractor,or homeowner(circle one) and have hired the contractors listed below who
have the following workers'compensation policies:
company name:
address:
city: phone#
insurance co. policy#•
company name•
address:
I
city: phone#•
insurance co._ policy#:
Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine aP to$1,500.00 and/or
one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a
copy of this statement forwarded to the Office of Investigations of the DIA for coverage verifications. _
!do hereby cerdjy a d t palms and enahtes ofperjury that the information provided above is true and correct
Signature Date
Print Name hone# (q'719) 7H 1 -0 H a N
official use only do not write in this area to be completed by city or town official
city or town: petmitjlicense# ❑ Building bipbrmrcnt
❑ check if immediate response is required Licensing—board required ❑ seleconen's oisce
❑ Health Department
contact person: phone M ❑ other
(revised Sept 2003) .
! BOARD OAF g p NeREGULgoT`IpN I -
License. CONSTRUCTION SUPERVISOR
Number C6 057733
Blr heats 05/26/1958
Expire$�OS/26/2{007 Tr.no: 12633
Restrlctetll
CHRISTOPHER ZORZY f 444
115 NORTH STD �,� —/
' SALEM, MA 01970 � � -
Commlealoner i
I' 07ie" omartornc awe o�✓l�ouw/u�Je�/d...
Board of Building Regulations and 5tandanls
HOME IMPROVEMENT CONTRACTOR -
Registration: 101609
Expiration: 6/26/2006
Type: Private Corporation
A&A SERVICES,INC
Christopher Zorzy
115 Nonh Street
Salem,MA 01970
AJministralur
Commonwealth of Massachusefts—�
Division of Occupational Safety
RabWJ Ra oso,Com..aos,
Deleader-Contractor
CHRISTOPHER ZORZY
EH.Dale 02/09%
Exp.Date 028607
DCO O ••,1
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8057ONRENEW
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n , - and filter 90%of : construction exterior heat m warm
i; ' Uvalue 010 4 + r
different choices. Depending :3 + , 1 vS s. t € UV radiation.that r weather {
t;..y 1vfu e r fl tf E causesfading li trs34
on various factors—like the -
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part of the country you live Energy Excellent•. Very Good: Three Very Good: Two Very Good: Excellent energy-efficiency
® Whole-Window glass panes and SolarControln'Plus Three panels of properties.Very good
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y 1 Whole-Wmdow ;lglass panes^indud inch PVBinterlayerjinch PVa.inter ;sound,lowers energy costs',.
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you'll Want t0 be sure you r "�' r - - !'two sheets of glass' Plus coating filtei `'duty:window ;,Beat security option and
PIPS v Center-of-Glass '� - w
�rtaglasssystemthat'Stuandapolyvmyl S 99%ofUVlight . construction very goodertergyeffidercy�
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and 9/16 urch." x i 4 homes in most climates
right for you. Gorell offers ' msulahng apace f .1° f
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value=0.29 insulating space. coating filters 75% glass and heavy- In cold weather it retains
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U-value
=0.25 s.25 g. ability to reflect exterior
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(l heat make it a strong
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Use the Chart to the right 10 'Climate Very,Good iGood Two glass Good-:Solar Good 'Double- ,Excellent value.AE- r -
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help select the right glass Masterm Uv aloe 0,30 '`,insulating space. coating filters 75% glass`and heavy-,'! effidency and improved
> ' of UV light that x `du wmdow 'home-comfort.its solar
CenterofGlass s , 3 ' g ty.
system for your home. causes fading s ' construction heat gain properties 1
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for
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Whole-window U-values shown above are based on a 5301
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•Ultraviolet light(UV)is one factor of minty that can fade
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the part of the spectrum that causes fading.
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