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0009 SALT WALL LN - BPA-07-603 ' DATE:_ i/9/o7 s Cirp Df a�AYPTTi, aaLUPft W 07 PLANS MUST BE FILED AND APPROVED BY THE INSPECTOR PRIOR TO A PERMIT BEING GRANTED Location of Building q 1+ O I ( _O n e Building Permit Application For: '(Circle whichever applies) Roof,Reroof, Install Sidin ct Deck, Shed,Pool Addition, Alteration, parfiteplsce ou,-tdation Only, Wrecking Other. PLEASE FILL OUT LEGIBLY & COMPLETELY TO AVOID DELAYS IN PROCESSING To the Inspector of Buildings: The undersigned hereby applies for a permit to build according to the following specifications: Owners NameLLLO ..y3M4 �)�hri Contractor. A �A Servlr-t5le nS bl' Sheet q ,,A�� City ' Street-11 t�r,r,4h s�. City Ism State Phone tffl) 711N-'?53a State KA Phone- (a7s)79 t + . Architect: CityofSalemLicit I�iDS Street City State Lic b HIP# I DI r009 State Phone ( ) _ Homeowners Exempt Form__m_Zno Structure: (please circle) Ingle Family, Multi Family# Other Estimated Cost of job S 3bc? D , Qo Will building confirmp law? yes no Asbestos?__yes__no Description of work to be done: ---- Tv�Sl �all -Cii)r (H� 11lnQ1 ronlnrnvyiar4 OInriDlclS A&A SERVICES, INC. Draw im o Mail Permit to: SALEM,MA 01970 Signature of Applicati ,SIGNED UNDER THE PENALTY OF PERJURY 5 CONSTRUCTION TO BE COMPLETED WITHIN SIX(6)MONTHS OF PERMIT ISSUED DATE Department use only: Permit# Zoning Map2ot Permit fee S „ COMMENTS: :i I .. e it ' PYo-iYxTj'� . t .., _.. _. F • J1�'I L �. . ,. sit, 12 .`1'�4myv1C��1 t ���� + f d; LL, uj 2 n � `O as The Commonwealth of Massachusetts Department of Industrial Accidents W Office oflnvestigations 600 Washington Street Boston, MA 02I11 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le blv Name(BusinesstOrganization/Individual):_ Q ��_ r•V���I �' C " Address: I I ri �l o r+h metre e+ City/State/Zip:-, M r:l 01970 Phone #: / T7$ 'N 1 ^pH a J E A re °u an employer?Check the appropriate box: I am a employer with� 4. ❑ i am a general contractor and 1 Tyeof projecb(required);employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction❑ 1 am a sole proprietor or partner- listed on the attached sheet. t 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. 9. Building addition p ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical 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 12,0 Roofrepairs insurance required.]t employees. [No workers' _ comp. insurance required.] 13.f Other_jn/ � " *Any applicant that checks box#I must also fill out the section below showing their workers'compensation polity information. - t I lomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such: lContmetors that check this box must attached an additional sheet showing the name of the sub-eontructom and their workers'comp,policy information lam an employer that is providing workers'compensation insurance for my employees,'.Below is the polley and Job site Information. —i� Insurance Company Name: t he__ T[^oVe It r Policy#or Self-ins.Lic.#:_ -( Q C 34 X I a ti in nn Expiration Date: q �' 1 O'7 Job Site Address:_`I JQI'f( City/State/Zip:,�i /jeto, "19 OtG"70 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration daQe). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties and a fate teof a fine up to$1,500.00 and/or one-year.imprisonment,as well as civil penalties in the form of STOP WORK ORDER of tip to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to Investigations of the DIA for insurance coverage verification. the Office a I do hereby certif nd r the pains and penalties of periury that the information provided above is true and correct Si mature Date Phone#: 918) 7L� — D H a/ OJJicial use only. Do not write in this area,to be completed by city or town official. City or Town: 'PermitiLicense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the . receiver or trustee of an individual,pirtnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152, §25C(6)also states that"every state or local licensingagency g enc y shall withhold the Issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the Insurance coverage required." . Additionally, MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." : i Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary, supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the cit y or town that the application for the permit or license is being requested,Pnot the D airmen 8Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'. compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permittlicense number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents :; t Office of Investigations " 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax# 617-727-7749 www.mass.gov/dia 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 b Northslde Cartin :i a Signature of Permit Applicant Date Christopher Zorzv Name of Permit Applicant A &A Services, Inc. Firm Name i, 115 North Street. Salem MA 01970 Address, City, State, Zip Code f Sr BOARD O�2(REOU " License: CONSTRUCTION SUPERVISOR Number,QS 057733 I BI �958 w r 'Sa q0! Tr,no: 12633 ' CHRI570PHER 115 NORTH ST SAL EM MA 019 70 c • � f ommlul i . . �.� :'T/�e worir.»ear�aerr�l� o�•f1•�a�urrelG Board of Building Rtgulstions and Studards HOME IMPROVEMENT CONTRACTOR Registration: 101809 Expiration: 8/28I2008 - Type: Private Corporation A&A SERVICES, INC Christopher Zorzy 115 North Street Salem,MA 01970 Deputy Administrator Commonwealth of Massachuset Division of Occupational Safefy Delemder-CBntractor {�,\��`�`j►J/�� CHRISTOPHER ZORZY . EH.Date 02/09I08 Data tYl/OBr07 DC0 0 ' - DC000440 himbod 00.RE.S.T. 7 BOSWRRENEW s' r P• Seabrooke . S NFRCCeMNed Solarileat Energy Product Directory Gain visible Light Condesation Star Product Type/Popular Glazing Options Number I U-value CoeHicent Transmission Resistence Approved Report# I Ex irationDate Double Huna GLW-DH-135 - - ETC-04-552-15675.0 12/182008 Clear IGU - 0.47 0.67 0.60 42.00 No All Grids <1' 0.47 0.51 0.53 4200 No All Grids 1' 0.47 0.45 0.47 42.00 No HFR Plus Low E Argon IGU 0.32 0.29 0.53 52.00 Yes All Grids <1' 0.32 0.26 0.47 52.00 Yes All Grids >7 - 0.32 0.23 0.42 52.00 Yes Mmuus Double Low E Argon IGU 0.31 0.27 0.47 53.00 Yes All Grids <7' 0.31 0.24 0.42 53.00 Yes All Grids >1' 0.31 0.22 0.37 53.00 Yes Mmuus 7.6(Triple Pane Double Low E Artion IGU 0.26 0.25 0.43 60.00 Yes All Grids <t' 0.27 -0.22 0.38 60.00 Yes All Grids W WA WA WA WA WA Slider GLWSL-135 ETC-04-552.15793.0 iml oo9 Clear IGU 0.46 0.56 0.59 42.00 No All Grids <1' 0.46 0.50 0.52 42.00 No All Grids >T 0.46 0.45 0.48 42.00 No Hi-R Plus Low E Argon IGU 0.30 0.28 0.52 55.00 Yes _ All Grids <t' 0.30 0.25 0.46 55.00 Yes All Grids >t 0.30 0.23 0.41 55.00 Yes Maxuus Double Low E Argon IGU 0.30 US 0.46 55.00 Yes All Grids <1' 0.30 0.24 0.41 55.00 Yes All Grids >l- 0.30 0.21 0.36 55.00 Yes Maxuus 7.6(Triple Pane Double Low E Argon IGU 0.25 0.24 0.42 60.00 Yes Ail Grids <1' 0.26 0.22 0.37 60.00 Yes All Grids >I- WA WA WA WA WA Picture GLW-PI-135 ETC-04-552-15755.0 12/112008 Clear IGU 0.46 0.66 0.69 43.00 No All Gdds <1' 0.46 0.59 0.62 43.00 No All Grids W 0.46 0.63 0.55 43.00 No Hi-R Plus Low E Argm IGU - 0.28 0.33 0.61 55.00 Yes All Grids <7' 0.28 0.30 0.55 55.00 Yes All Grids >T 0.28 0.27 0.49 55.00 Yes Maxuus Double Low E on IGU 0.27 0.31 0.54 56.00 Yes A0 Grids<T 0.27 0.26 0.49 56.00 Yes All Grids >7 0% 0.25 0.43 66.00 Yes Maxuus 7.6 TriplePane Double Low E IGU 0.191 0.28 1 0.49 65.00 Yes [.i Seabrooke Seabrooke RFAT' MMCCertlfied Solar Heat Energy Product Directory Gain Visible Light Condesation Star Product Type/Popular Glazing Options Number 1 U-value Coefficent Transmission Resistence Approved Report# Expiration Date All Grids GLW N 063 00001 00001 0.43 0.46 0.48 43.00 No HFR Plus Low E on IGU GLW N 063 00003 0.29 0.27 0.48 56.00 yes All Grids GLW N 063 00003 00001 0.29 0.24 0.42 56.00 Yes Maxuus 7.6(Triple Pane Double Low E AMon IGU GLW N 063 00006 0.23 0.23 1 0.38 63.00 Yes All Grids GLW N 063 000016 0.24 0.21 0.33 63.00 Yes n H 22per GLWN-005 Old design not labelin .Not Tested new design 01.33259.01 Not Labeli Clear IGU na Hi-R Plus Low E Argon IGU Special Shapes Gear IGU Hi-R Plus Low E Argon IGU Footnotes: Residential values single strength glass U-values w/o grIds total unit values DS or TS worst U-value w/grids Seabrooke