13 ROSLYN ST - BUILDING INSPECTION 1 .
CK VS
The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code, 780 CMR MEMO SALEM
INSPECTIONAL &EfWMU2011
Building Permit Application To Construct, Repair,Renovate Or Demolish a
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date Applied:
Building Official(Print Name) S gnat
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
I3 kOSt� 'n Sf.
Ma
l.la Is this an accepted street.9 yes no P 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 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 Rec *
MI k-z 9 ,.,f#; „ Sa l�wr Mist- v 1770
Name(Print) City,State,ZIP
s lyn 5-{- Ce l7- %vS 2-39ie
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK''(check all that apply)
New Construction❑ Fixisting Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ Alteration(s) ❑ 1 Addition ❑
Demolition ❑ 1 Accessory Bldg.❑ Number of Units I Other ❑ Specify:
Brief Description of Proposed Work': 2
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1. Building $ g' i 1. Building Permit Fee:$ Indicate how fee is determined:
❑Standard City/Town Application Fee
2.Electrical $ ❑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: $ S
�y 0, ❑Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) S-� 33 5- a-�
Ck Y i j Z o ry License Number Expiration Date
Name of CSL Holder
I/ J Nov,tk Sl List CSL Type(see below) Q
No.and Street Type Description
Le-✓y, m .�t 0 1 9 -7 0 U Unrestricted(Buildings u to 35,000 cu.ft.
rf" I R Restricted 1&2 Family Dwelling
City own,State,ZIP M Masonry
RC Roofing Covering
W S Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Tele hone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
r,(�--5 � l (� 9 �
A- Registration
�Y�/�r� 5 �VvC HIC Registrr ation Number Expp iration Date
HIC
i o�pary Name or HiC Registrant Name
fUnril S-
No d Street Email address
.
�t ll.[ y, IMF{-- p 1 CI -7 0
City/Town,State ZIP 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..
I,as Owner of the subject property,hereby authorize C�-.✓ �-S 2 0 -
to act on my behalf, in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER' OR AUTHORIZED AGENT DECLARATION
By enterin my ntme below, I hereby attest under the pains and penalties of perjury that all of the information
contain t thi pplic 'on is true and accurate to the best of my knowledge and understanding.
Print wn r s or Auth rized ent's Name(Electronic Signature) Date
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 can be found at
www.mass. og v/oca Information on the Construction Supervisor License can be found at www.mass.eov/dps
2. When substantial work is planned,provide the information below:
Total floor 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"
Phone: 978-741-0424
Fax 9 - -2012AVD wwwa-aservices.com
® • • 115 North Street
Salem. MA 01970
March 18, 2014 Page 1 of 1
PROPOSAL FOR WORK TO BE DONE FOR
Mike Griffin
at
13 Roslyn Street
Salem, MA 01970
DECKS
REBUILD TWO (2) REAR DECKS (12'wide x 6' deep)
1 . Demo and dispose of two (2) rear,decks and roof system.
2. Dig out three (3) footings, 4' deep; and install 12" Sonotubes and fill with
concrete.
3. Frame 1st and 2nd floor decks'ustng 2'X'8" pressure treated for floor joists and
4" X 6" pressure treated support posts;`
4. Install 5/4" X 6" pressure treated decking for 1st and 2ndfloor decks.
5. Install new 2" X 4" pressure treated hand rails and 2 X 2";pressure treated
balusters to 1st and 2"d floor decks .
6. Install pressure treated lattice around base of deck
- A `i:.:
7. Trim out lattice with 1 '.X 8' pre"ssure,t�eated trim boards.
VINYL SIDING
ON BACK SIDE OF HOME ONLY, INCLUDING TRIM ON UPPER DORMER
1 . Cover all exposed sheathing with Tyvek House Wrap.
2. Build out areas where wood shingles are missing with 3/8" Dow Insulation
Panels
r ,
3. Cover body of home with 3/W-10 WInsulation Panels.
4. Install aluminum bug guard at lbase,of home.
5. Remove and dispose of existing aluminum trim coverage from windows and
dbor"s
6. , Install new aluminum deluxe trim coverage to windows and doors. Color: white.
7: Wrap fascia boards with alumi'66m.trim. Color: white.
8. . Cover all soffits with CertainTeed Center Vent Soffit. Color: white. //
9. Install CertainTeed Monogram.Vinyl Siding to back of house. Color:-fir'/,n��
10.All permits and cleanup included.
11.No painting is included.
12.Any dditional work is billed at;.$88-per man hour plus supplies.
CZ:initials Date MG initials Date
/� �/< o A & A SERVICES, INC.
A&A SER�/IC S 115 NORTH STREET, SALEM, MA 01970
• ••• Telephone:fill 741-0424 Fax: (978) 741-2012
Contractor Registration No. 101609
Construction Supervisor No.CS057733
Federal EIN: 04-3090162
CUSTOM REMODELING AND IMPROVEMENT AGREEMENT
Bu s Name
' Date Of Contract
G 7-,�
Bu rs Street Address, Cit,State and Zip
Cotle
J3 OIC170
Da 'me Telephone Number Evenin Tele hone Number Mobile Tele hone Number E-Mail Atldress
61Z
The Buyerls)listed above hereby jointly and severally agree to purchase the goods and/or services listed on the accompanying speclhCagon Sheets,in accordance
with the prices and terms described on the front and the reverse of this agreement and any specification sheers(this"Agreement"),and Buyers)have requested
that such goods or services be installed or provided at Buyers address listed above.A&A Services,Inc.('Contractor'),hereby agrees to install or cause to be installed
the pmtlucts or services listed in this Agreement at the Buyerls)address written above.This Agreement represents a Cash sale of goods and services.The Buyerls)
agree to pay in cash the cost of the goods and services purchased as described herein,regardless of timing or approval of any financing Buyerls)may seek for their
purchase.
Purchase In c! ^$ 7 e0
Est.Starting Dater
Down Payment: '.'i Est Completion Date: M•++T/
t
Cash `
Amount Due on Start of Job:. v r Check
/� p,� �) j Credit Card
Amount Due on of Completion: No.
Amount Due on_of Completion: o Expiration Date'.
Balance Due on Upon Completion 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.Buyerls)
hereby acknowledge that Buyer(&)has read the front and the reverse of this agreement and has received a completed,signed and&led copy of this
Agreement,including the two attached Notice of Cancellation forms,on the pate first written above.Buyerls)also(1)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
Contraeir believes Buyerls)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 rv'ces,Inc. BID er( 1
By: ✓1�
Signature
•/ Signature
�Orz/
Print Na Print Name 4
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 wnlraoir and the Mrrenrmer hereby mumally Agree In advant¢that In Me event Altar pal has a Eispule mnreming this dentract.ei rdepaM my submit sutli tlispme to e
giver, reverse service whiU has been appeal by the sea¢taryal Me Fractures ORide of eansurrer Affairs and Business Reproplynsend Ne othe,party shall be Insured to submit tosuch '
a tera en as proved in M Gl c.142A.
pronmm']mini J: 144 - is,:
NOTICE Inirulr__
Dare:,/-2`'-/({ Doer -�u-Ier
NOTICE OF CANCELLATroN NOTICE OF CANCELLATIck
Dm¢d nansacYon�'?�/N vpt mar caarel mi5 hansacYon.without enY peaallY or Dal¢ed Tremaorm .You may dahoar PHY banana.,.vas had any Penalty or
Wligation,within three business pays M1om the above pale.llyoucended.re reparyheded in, obligation,admin three business days*am the grove pate.lfymnncelanypeopendmiumtlin,
any payments made by you under Me Confined or sale,and any negobads instrument enewted any pandame Made by You under be ea ct or Sato,and any negoaade server evervided
by you well be retumed wMan 10 days mlloveng Panama Iry He Serve of ywr container retire, by you Ann be returned earth 19 data falpeirg overe l be seller or P art
your meraaaonnovae.
and any eewdly Interest aariat out i me 4ad,and or swill be micelles If you wort,yas must and any adapted
t Interest anteing out rerae rm,and substantially en11 be pncelled II youf9n l you oust
mske awany gand o the Seller at your under uns and substantially in er goodmy,f you as as mhen make nd.any g to the Seller et your restl,mile antl ndaaleIn as my f you duration acvmdy
rhed.anygootls delivered the Said,
regarding Me
tradestiva:t either my, avasemver a cewed areseis dot and 1.yen he
tli6eontran wsala',or of In. ,if xism comply
sir survey
a NUGims of re Seller mega roi y Ne return sMpmmt of Me Poodle at re eeller s sir re instructions of the baker Meg goods
s re ream beborer
Natural al the goods el es Seller's
them up and isle,ff you,do make of Boobs available to is Seller aptly brain aeller does not lab themevense
up antl a 20II you f t make re yours otion A r me seller end the Seller oces not prof
rem upwlren2ntl berlhadateol Your No6ca of Cancellation,avirebletoe aesryse of the themupxiref Pm days olre Carolyom Noficeol Cakethe o¢yourua Maytetrome subs,i of
agMsenteWt any turretobitgation Wthe Saint and fall0 Make then you remertlerthe&earromifytu the awdleeroN Wum the
tdheellon.r andnailla Make the youaavailablerreeel nm
agree lcour, us,goodscete,1aMf1ard prverev. ivre to l.— faM pedoM no sped you agree bonsuder grn]amrhe does you ordeliera signed
wlrednd dated
all y of the mnnler rn noted or
earan pemit,or nail artlNlvna to A& Nevada mpydrall iibebnllabonn Cceoral.TooAncell transacineralordelivere I A&Aantl dated
mpy of the cancellation MA 0 or any either TER T notice,O send a 1`e r m r A8A Services, copy N the treat aeon notice or any OT L xnlfen notice,m sentl a eel¢p[ Io ABAJee ice
115 North slreeL Salem MAm WB,NOT LATER THAN MIDNIGHT OFJ-:,-/Y 115 NodM1 Street ealem MA 01970,NOT LATER THAN MIDNIGHT OF•Ja—JE'- 5� s
nsM•
I HEREBY CANCEL THIS TRANSACTION I HEREBY CANCEL THIS TRANSACTION rnret
GnsmrerY Stgna are Dale' Conwmers Stgnamre DHe:
�ESPOSALOF'DEBRilSAFFiDYAMT ..
ftiBding Pennit Number is that the debris PesuI$fng 6P@rn this WD,k shall
be disposed ofin a pP®pePly.IfcdnsQd fk fl$y as dafhad.by M 0, L o0 9I90 �e�o
e debris will be®Isposad at. Aaiama I PMRSTOe
owned by Mor SWO CaFM
SignatUrs Of Pa,Mi fdsan$
Date 7
Che!RbMee Z®"
Rome ®MNT;g P6fcan$ .
A & A SoNjrgp, @pace
Fir
116 NOPtf'3 MORE Salem. MA 01970
AddPeas, cEv, tafd, Zip Code
��- The Commonwealth ofMassachusetts
o7 Departmetrt oflndustrial Accidents
t� Office offnuesGgations
t 600 Washington Street, 7`b Floor
``- V.
Bosto
n,
o. Mass. 02111 11
Workers' Compensation Insurance Affidavit: Building/Plumbing/Electrical Contractors
Applicant information: Please PRINT legibly
name: -l//ih`/%:J n�A er-
address:: (�J NO✓! 4t s7/ ;e-eyi [ (/ r/ ,l
City Ja I2 n/ state: MA C zip: D/970 phonne# / 7F--7Tf',o7r�
worksite location(full address): fZo5 (�,14 S-f- J �.�-C-✓h M � 0f / 7r'S
❑ I am a homeowner performing all work y elf. Project Type: ❑New Construction ❑Remodel
❑ 1 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.
/
comnanv name: /"/C�,l" A— 'S-'Q..IrV
address:city: Sol,
S phone#: 9:1 9— 7 [
L t �l
insuranceco. � 7--fxyRI-eY1S policv# (-),q 3AA ? pS
❑ 1 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. policv#
company name:
address:
city: phone#:
insurance co. policy#
Attack additional sheet if necessary
Failure to secure coverage as required under Section 25A of:MGL 152 can lead to the imposition oferiminal penalties ofa fine up to SL-500.00 and/or
one years'imprisonment as well as civil penalties in the form ofa STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a
copy of this statement maybe forwarded[o the lice of Investigations of the DIA for coverage verification.
l do hereby certify un a fly pains nnrl p nalo"of perjury that the information provider/above is true and correct.
Signaut Date
Printname Phone#
as
..: official use only do not write in this area to be completed by city or town official
city or town: _ permit/licenseq ❑Building Department
❑Licensing Board
❑check if immediate response is required ❑Selectmen's Off-ice
❑Health Department
conflict person: phone H; ❑Other
tre��s�a s�p,20031
. —11 } v` "M ',I- x q �p : «. ,F
THE COMMONWEALTH OF MASSA_CHUSETTS
.� ,EXECUTIVE OFFICE OF LABOR AND WORKFORCE DEVELOPMENT
�. DEPARTMENT OF LABOR STANDARDS
19 STANIFORD STREET,BOSTON,MASSACHUSETTS 02114
DELEADER'.CONTRACTOR LICENSE
A&A SERVICES,INC.
I I NORTH STREET}.:
SALEM MA 01970'
LICENSE DC000440. t. EXPIRES: Saturday,June 07;2014
IN ACCORDANCE WITH M.G.L..CH,111,}§I97B(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. 111 § 19713(b)(2)AND 454 CMR 22.03.
i
I
'HEATHER E.ROWE,DIRECTOR
U
p9 t,�(� Massachusetts -Department of Public Safety
e rpommernzmea�l�C oP/�ladaac�israelti 'Wf
Office of Consumer Affairs&Bali essRegulatien Board of Building Regulations and Standards
OME IMPROVEMENT CONTRACTOR Construction Supervisor
Type: t,
egis4ration 10,1609 yp License: CS-057733
xpiration 6126/2014 Private Corporatie
cMUSTOPHER ZORZY" r 9
A&A SERVICES, 115 NORTH ST =
it 1• - Salem NI[A 01970�
Christopher Zorzy �..`.n
115 North Street - - g="L`"�- ' 'i' i' '0+
Salem, MA 01970 - - � „ Expiration
Undersecretary Commissioner 0 512 6/2 01 5
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#20120426000W
Christopher Zorzy
Exp 4/262017
A&A Services Inc
115 North St
V_)�i [1iRrS ZUR2Y Salem, MA 01970
U Y Cn rio;-re IO to?-��3 � Matthew J Gi6son
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A&A SERVICES,INC. - 895
City of Salem / 4/29/2014
Cost of Goods Sold:Permits Griffin, Mike Vin Sid/Deck Permit 182.00
A&A Beverly Coop 63 Griffin Vin Sid/Deck Permit 182.00
A&A SERVICES,INC. - 1 896
City of Salem 4/29/2014
Cost of Goods Sold:Permits Griffin, Mike Vin Sid/Deck Permit 104.00
ty
3 i�oslN S Ti3 '���_ BZ(
A&A Beverly,Coop 63 Griffin Vin Sid/Deck Permit 104.00