24 SAINT PETER STREET - BUILDING INSPECTION (2) �i3- 14 (0
C. l< ( -T lzge RECEIV
�Nf The Commonwealth of Massachusetts SERVICE
Department of Public Safety NAP
!
Massachusetts State Building Code(780 CMR) 1010'NAP ' 1 A
Building Permit Application for any Building other than a One-or Two-Family Dwelling 28
(This Section For Official Use Only)
Building Permit Number: Date Applied: Building Official:.
SECTION 1:LOCATION(Please indic a Block#and Lot#for locations for which a street address not available)
D-11 40- e 19-70 Sf-.
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❑ 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 C9'
Is an Independent Structural Engineering Peer Review required? Yet ❑ No A-/
Brief Description of Proposed Work:_I n,S-f-CI. /l /�(nwi' \/r
U-) vS an�1 "-,.j Jir<4I I'anlrac. ✓�� + aic+t re nd t
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) O
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 ❑ A4❑ A-5❑ 1 B: Business ❑ E: Educational ❑
F: Facto F-1❑ F2❑ H: High Hazard H-1❑ H-2❑ H-3 ❑ H-4❑ H-5❑
I: Institutional 1-1❑ 1-2❑ 1-3❑ 14❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R-4❑
S: Storage Sl❑ S-2❑ U: Utility❑ Special Use❑and please describe below:
Special Use:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA ❑ IB ❑ IIA13 IIBO IIIA ❑ IIIB ❑ IV 17 1 VAD VB17
SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item)
Debris Removal:
Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Licensed Disposal Site❑
Public❑ Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be p
Private❑ or indentify Zone: or on site system❑ required❑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:
II,Xt ✓� 3 � 18 �13
,
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner
pefer' S EOE5CO o_,CC Lkrcl� d4S�. P�Ck 'SS4- - le- MR 019-70
Name(Print) o.and Street City/Town Zip
Property Owner Contact Information:
�✓uce nTr. 6Ja✓den`�7_$ N5 a91 SSf�i
Title Telephone No.(business) Telephone No. (cell) e-mail address
If applicable,the property owner hereby authorizes
�+ 11"�P �✓—c1 S'Inc. rl�lorlT t- ljwle Iti1✓I' 01970
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)
f 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
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor
J t7 Le- A c
Company Name
Gtn�,s 20 rZ.i C- 5 0 S-7 -7 3 -3 " �(ei r-e s h - �egl
Name of Person Respon�4le for Construction License No. and Type if Applicable
50.E-2_+M — B fe17a
Street Address City/Town State Zip
1-79 I - 0$3
Telephone No. business Telephone No. cell e-mail address
SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT M.G.L.c.152.§ 25C 6
A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and
submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit.
Is a signed Affidavit submitted with this application? Yes O No ❑
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor '
and Materials) Total Construction Cost(from Item 6)_$
1.Building $ 3 c
Building Permit Fee=Total Construction Cost x (Insert here _
2.Electrical $ appropriate municipal factor)
3.Plumbing $
4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact (municipality)
5.Mechanical Other $ Enclose check payable to CI OTC (:�CJL vv .
6.Total Cost 1 $ "3 (contact municipality)and write check number here
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information contained in this
application is true and accurate to est of m knowledge and understanding.
Ctiris2ur2.1 � A& `legM- UYLy
Please print an (sign l ame's Title Telephone No. Date_,y.
It
�c 1,0�Sr— inA-- n l 9-7 a
Street Address City/Town State Zip
Municipal Inspector to fill out this section upon application approval:
Name Date
i CITY OF S�UZAI, 1N'LjiSS.XCHUS=S
BL'B-DINIG DEPARTmENiT
\ � 120 WASHINGTON STREET,Sao FLOOR
TEL (978)745-9595
FAx(978) 740-9846
KINfBFRr EY DRISCOLL
MAYOR THoltus ST.PIERRB
DIRECTOR OF PUBLIC PROPERTY/BUILDLsIG co%m ISSIONER
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information / Please Print Leeibly
Name(BusincssiOrganizatiotvin(lividwi): 1 ✓ .5 fvl
Address: 41-\
City/State/Zip: ,�c�k.t_v,, NLA-019'l b Phone#: G 7 7 -7 Y/ - n`f 3 y
Are you'an employer?Check the appropriate Tte b
�,� ype of project(required):
I.Ly"1 am a employer with 4• Q I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2.0 I am a sole proprietor or partner. listed on the attached sheet 7. ❑Remodeling
ship and have no employees These sub-contractors have S. ❑Demolition
working for me in any capacity, workers'comp.insurance. 9. 0 Building addition
[No workers'comp, insurance 5. 0 We are a corporation and its 10.❑Electrical repairs or additions
required.] officers have exercised their
3.0 I am a homeowner doing all work right of exemption per MGL I LEI Plumbing repairs or additions
myself.[No workers'comp. C. 152,§I(4),and we have no 12.0 Roof repairs
insurance required.]t employees. [No workers' 13.0Other
comp. insurance required.]
•Any applicant[bat checks box#I must also fill out the section below showing their wosketi compensation policy intannatiom
1 hxneownen who submit this ahldavil indicating they arc doing all work and then hire m hude eoe reek s must submit a new,affidavit indicating nth.
-'Contmum that check this box must attached an additioned sheet showing the name of the sub• ntrxhim and their wurkm'comp.policy inlesmaton.
t am an employer that Is providing workers'compensation Insurance for my employees. Below is the policy and Jab site
information.
Insurance Company dame:_ --T—✓'cvv/2.1 Carr f
Policy 4 or Self-ins.Lie.#:_Q ?-4 3 M $1 L Expiration Date: 9—13 — 14
Job Site Address: I''-e..k t S City/State/Zip: Sex LC ✓vt /]'4-0 f 9 0
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
fine up to S1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to S250.00 a day against the violator. Be advised that a copy of this statenwnt may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify of Ins nd penalties ajperfay that the information provided above is true and correct.
St nature:7 ebate' /2
Phone#: q7 Sl l `/I
OJJlcid use only. Do not write in this area,to be completed by city or town of vial
City or Town: Permit/License#
Issuing Authority(circle one):
I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person- __ Phone#:
In acc®edancs with bra Provisions ®P mo G, L c. 40, Saco 54, a con ' ion of .
Building Permit Number is that the ddboa resulting from US Work shall
be disposed ®t:in a PrOParly licensed facility as dega9®d,by MA L �0 9 1 9, Sec.
Thd debris will be disposed at: Sa& m Transfer fttoon
owned by Nprft da Cap&
Mg�atars ®I Pests Pploaan,
Date
Chrisb- phs-PZo€zy
. I�a�a® �f Parx�iB�ppii�a�t .
A A A sa€vue®so laps
gsefa& Salem. MA 01970
Addpa,, , Cjti, Sfefgq Zip Coda
`3�53
/�, �{ SERVI./�ES A & A SERVICES, INC.
MQl/1 JGIlY 1\/�J 115 NORTH STREET, SALEM, MA 01970
III it• •-folvi a IV,I 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 (VA can�L
JeC�
guyerhip Name Date of ntracl
a .
Bu er s Street Atldress, Ci Beale and Zip Code I in
'Sack6k Af\A IX ' (g
Daltime Telephone Number Event Tele hone Number Mobile Tele hone Number E-Mail Address
s�6 N
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 Mrs agreement and any specification sheets(this"Agreement"),and Buyers)have requesletl
ghat such goods or services be installed or providetl al ai 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 weaten 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 pumhased as described herein,regardless of timing or approval of any financing Buyers)may seek for their
purchase. A� 11��
Purchase PIT T�l 1� Est.Starting Date:
Down Payme Est,Completion Date: �� E
Flo ( % pfcaan
-!12k''tflN7fo[cf� check
Amount Due on Start of Jab: yyyyyy,,,f
q. AI T• �,�f' t Credit Card
Amount Due on2of Completion: No
,r I/7 Amount Due on of Completion'JQ�� �T L1 U(�(�CN7 � ✓ / Expiration Date'
Balance Due on Upon Camplelion:! ���`� J ag 5ft CVC Code:
II 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(s)has react 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.Buyerls)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 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 Sery ,Inc. Buyer(s)
By: c�
Signature
Si not
Print Name /Ni G✓ � v��� A K)
Print Name ` 1r
Signature
Print Name
You,the Buyerls), may cancel this transaction at any time prior to midnight of the third business day after the dale of this
transaction. See the following Notice of Cancellation form for an explanation of this night.
ARBITMTION:The eonuatlmand the Mneowner hereby mu Wally agree in aderrou Net m irm¢rent Indistinctness asssl�adlisgggp le wnwming Nis wnirand,eilnerpany may mbour sum dingere to a
private an ianden urviw Mlitll M1as been eppovetl by Me Sco ward Ne Ettculive Or read Oo M u s Reg mnq antl am other paM ahall be required to subMl to surA
aNIVa4on as moorom n M G.L c IQ2 //P/
Colo. puny Ya ltherd,o.m:�y poi,.—
NOTICEa �� 1
''/may/, OF CANCELLATION higni OF CANCE L.TON
Dale W Treated. ,TYou may cancel this transfer,without any penally or Cate of Tranucuon�.You may wnwl into transaNw,—a-any penalty or
obligation,vnNin Nreen gggrrrtlays M1cm Pe abase date.Il you cans¢,any propeM traded in, ob,iSgmdym,xilhin three days ham Ne above date.llywrancel.anypapenylatlwin,
any reyments made by you under be Contract or Sale,and any negotiable Inmurrent.-.led any payments made by you under the Contractor Sale,and any nepeorrol emb enlexeculed
A
you will retumN vnlM1in 10 tlays Wlloufig teceipl by Pe Seger of your cancellation-tire, by you will be returned MiM1in 10 days fglwnng receipt by the Seller of your cancellation rmuce,
and any shanty Interest arising our of be Iransacgm upl be cancelled If you career,you must and any estudy interest arising out of are members ers MII Ire wnwned If you tenser your most
make readable to be Seller at your Assume and wbstoraally In as good wndNw as men make asaierso to the Seller at your more ce,and substantially in as good condition as when
served,any gwds delivered to you under this Contract or Sak'.or you may,ilyw vnsq aagly reforeved,any goods beirodd Wyou untler Nds Gamest or Sale:or you may,eyou vnsq comply
vmh the marruGiws of the Seller regarding the rerun shanenl of the goods at be Sellers -0 the Immediate pl the Seller regarding the return shipment of He gwds at He Seats
manse and risk.It you tla make the goods available to the Seller and the Sudan date he pick becomes and risk.If you do mom the goods evatum W He Seller and be Seller tices not pick
Nemup Mthin20da�ofNedmeofyourNobi WGncellauon,younayretadnd&¢pawofthe them OR In 20 days of thedate N your Thinco of Careegmeor yen may..in or disposed
,do in..,any comme mehmn.Il you faitra—he the 0aad1¢wiled¢to In suits,or a yea m areas MlNWlany Wrsherrddgation.IfywlaBW makethbgoodommilabla blhe Seller.Ord
a0ree m return he Roos As ma a.and ball or do se.men you.in liable I.mbgAanw of you agree to round be goods to be Seller and(all to do m,ban Wu remain liable for penormasee
all auditors under the Gonad.To cancel aietransachon,ereir or deliver a sgned and dated of all eadditlone under the Confused.To coned this rental nail or deliver a signed and datetl
may of be ranwllaries notice or any other some,notch.or s'ndatelegre ions, copy of the ran ile4on mdoe or any other vmtlen rolire,or send a lei edram, AS
Its Nonh Street Salem MA%9TO.NOT lATE0.THAN MIDNIGHT OF 115 North Sobet Salem MA 01 W0,NOT LATER THAN MIDNIGHT OF
I HEREBY CANCEL THIS TRANSACTION I HEREBY CANCEL THIS TRANSACTION
Consumers Sigmae, Dale'. Cwsmer s Signature Date:
wnA �0 A & A SERVICES, INC. C1C3
9
AAA SM 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
MISCELLANEOUS SPECIFICATION SHEET
Bu er s Name Date of Contract
sc� l hr a.
Bu ers Street Atltlress,Cit ,State and Zi Codeif
�tl St- - . 0(9?
Da ime Tele hone Number Evening Telephone Number Mobile Telephone Number E-Mail Address
-S 6Egli6d R
The Buyers)listed above hereby jointly and severally agree to purchase the goods and/or services listed below,in accordance with the prices and terms described on
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.
SPECIAL INSTRUCTIONS i
OP I W Mfl�✓t_
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reolacpnw�.l-i- windo� un;-[--, RS F�Ibcus .
ar � I_Ar��tntts-�•l�Q��[ci�ce windows w.u11F( oA/��scr �v.NP
hung14 OIL, 3 Lie ands oNtoo wtrdjx4 ?'Ovef-FSgrii Di6l
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� � S/✓�414Qc- units fio 2,o Nt alp #i•,nun windou:s wi I� OC� �Ayo�i
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It is agreed and understood by and between the parties that this Specification Sheet,alongwith CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,constitutes
the entire understanding beNveen the parties,and there are no verbal understandings Changing m 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 Buyers)and the Contractor.Buyers)hereby acknowledge that Buyers)
has read this Specification Sheet, ••�l J / (; )
Contractor Initials: J'-- Date: Buyer's Initials: iA.� -' Date:yLJ2/��7
�° A & A SERVICES, INC.
AsA S 115 NORTH STREET, SALEM, MA 01970
-- Telephone:(978) 741-0424 Fax: (978) 741-2012
Contractor Registration No. 101609
Construction Supervisor No.GS057733
Federal EIN: 04-3090162
MISCELLANEOUS SPECIFICATION SHEET
Bu ers me ( Data or Contact
es ;sc� CIu2 Z /5
Bu ers Street Atltl�re`ss, CII .State�lI and Zip Code
Da ime Tele hone Number , Eveninq Telephone Number Mobile Telephone Number E-Mail Address
The Buyers)listed above hereby jointly and severally agree to purchase the goods andlor services listed below,in accordance with the prices and terms described on
this Specification sheet and the front and the reverse or the accompanying CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,of which this Specification
Sheet is a part.
SPECIAL INSTRUCTIONS
o� N1m11 CA bct'ch
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It is agreed and understood by and between the parties that this Specification Sheet,alongwith CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,constitutes
the entire understanding between the parties,and there are no wit al 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 Buyer(s)and the Contractor.BuyegsJ hereby acknowledge that Buyers)
has read this Specification Sheet.
Contractor
Contractor Initials:� Date: Buyer's Initials: YL N/Y 1 Dater
A&A.SERVICES,INC: . . .1839.
City of Salem 3/7/2014
5000 • Cost of Goods Sold:5115 . Permits St. Peter's Window Permit 258.00
A&A Beverly Coop 63 St..Peter's Permit 258.00