8 SHORE AVE - BUILDING INSPECTION The Commonwealth of Massachusetts
'I ° Board of Building Regulations and Standards CITY OF
y Y ALEM
Massachusetts State Building Code, 780 CMR Revised Mar SdMar
mt Jn � I 20/1
N' Building Permit Application To Construct, Repair, Renovate Or Demolish a
!V One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date plied:
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1,,Vro erty Addres • 1.2 Assessors Map&Parcel Numbers
1.la Is this an accepted street?yes no Map 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 Record:
I(Xa.-l-dy�rL,- �alewt MA- o19'10
Name(Print) City,State,ZIP
8 Shore s `I7 -IYL/-`t /o
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units I Other ❑ Specify:
Brief Description of Proposed Work: ) ✓'✓l
re 0,Lp-V 2vc+ W I,ho S
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item
Estimated Costs:Labor and Materials Official Use Only
1.Building $ y 1. Building Permit Fee: $ Indicate how fee is determined:
❑Standard City/Town Application Fee
2.Electrical $ 3
❑Total Project Cost (item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (BVAC) $ List:
5.Mechanical (Fire
Suppression) $ Total All Fees: $
` Check No. Check Amount: Cash Amount:
'
6.Total Project Cost: $ `l 0 Paid in Full 0 Outstanding Balance Due:
' SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
r 3'2, 5� - 1-�
/1
l ,f'lrI S �rT�:�y License Number Expiration Date
Name of CSL Holder LA1 1�N 0,1"(� List CSL Type(see below)
No.and Street Type Description
_S0.�-M p/t �. O l q� U Unrestricted(Buildin s u to 35,000 cu.ft.
1 R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
I I-0� 1 Solid Fuel Burning Appliances
1 Insulation
Telephone Email address D Demolition
5.2/�Registered Home Improvement Contractor(HIC) , ()' LoO
f t +- �1(-k y--Vt U S V`C. - HIC Registration Number Expiration Date
Hit)Cyry NQ 7 g�I Ris[rant Name .
No, .e Email address0. - 1 - ° ►5-7`N- o`7 �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 e hY S
to act on my behalf,in all matters relative to work authorized by this building perrfiit application.
Print Owner's Name(Electronic Signature) Date
SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contame r this plication is true d accurate to the best of my knowledge and understanding.
Print vner's or Authorized A ar's Name(Electronic Signature) Date
NOTES:
I. 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.eov/oca Information on the Construction Supervisor License can be found at www.mass.gov/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 halfibaths
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"
CITY OF SALEM, IMASSACHUSETTS
BUMDING DEPARThEENT
• t p• 130 WASHINGTON STREET,3m FLOOR
TEL (978)745-9595
FAx(978) 740-98"
KISIBpRi FY DRISCOLL
T
�YOA dOhfAS ST.PIERRH
DIRECTOR OF PUBLIC PROPERTY/BCILDING CONDIISSIONFR
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Anplicant Information C Please Print Legibly
NailIC(Busi=vOrganiAzattiioNlndividml): �9� �X.rV {ce-5 I^C,
Address:.1 /V L S b✓' i-v St-
City/State/Zip: �a1 1� W44- CJ 9-1 b Phone 1/: 97 E -7VI "Q`ta-1
Are on an employer?Check the appropriate box: Type of project(required):
1.11 am a employer with-- 4. ❑ 1 am a general contractor and 1
6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
2-El 1 am a sole proprietor nr partner-
listed on the attached sheet.: 7- Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity, workers'comp.insurance. 9, ❑ Building addition
[No workers'comp. insurance 5. ❑ We are a corporation and its
required.]
officers have exercised their 10.0 Electrical repairs or additions
3.❑ 1 am a homeowner doing all work right of exemption per MGL I L❑ Plumbing repairs or additions
myself.(No workers'comp. c. 152,§1(4),and we have no 12-❑Roof repairs
insurance required.)t employees.[No workers' 13.❑Other
comp-insurance required.)
•Any applicant That checks box#1 most also MI out the senim below showing their worker'compensation policy infurmation.
t I fomeuwner who submit this affidavit indicating they am doing all work and then hire outside epnmWtor most submit a new affidavit indicating such.
-Contractors u nt cheek this box must attached an additional shoet showing the name of the sub-contractors and their workers'comp.policy information.
1 am an employer that is providing workers'compensadon insurancefor my employees. Below Is the policy and jab she
information
Insurance Company Name:—
Policy I-2� S
Policy#or Scif-ins..LLLiie.#:1 �_ A�� b 1 7 Expiration Date:
-7—
I/
�,3 �l`An� O `
Job Site Address: D ! ✓t-\O e AJ City/State/Zip: 40r , e r,^ y 1'4-1 ( 1 -7 6
Attach a copy of the workers'compensation policy declaration page(showing the policy number and erplmdon date).
Failure to secure coverage as required under Section 25A of MGL a 132 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 statement may be forwarded to the Office of
Investigations ol'Ihc DIA for insurance coverage verification.
1 do hereby cerij ider the p Ins and penaider ojperjury that the information provided above( /
is truea t and correc
Phone#:
Ojjicial use only. Do sot write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1. Board of Itealth 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
i CITY OF S<uxm. iNLksSACHUSETTS
BUILDING DEPARTNtENT
• 130 WASHNGTON STREET,3" FLOOR
TEL (978) 745-9595
FA-X(978) 740-9846
1CIJfgFRLEY DRISCOLL
MAYORTHOMAS ST.PIERRs
DIRECTOR OF PUBLIC PROPERTY/BUILDING CONL%USSIONER
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5
Debris, and the provisions of MGL c 40, S 54;
Building Permit# is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
111, S 150A.
The debris will be transported by:
fq-fi Pr'��r,./ �S �Y�
(name of hauler)
The d�ebris will be disp(o�sed of in
"
(name of facility)
w.0sf_()—tf—V—k ,5��� /wt� ° 17-7
(address of facility
i
;signature ofper it applicant i
Jcbrisall'�,c
�1se A l& A SEJL69'ICEV`q INC. .
A S V'C 115 NORTH STREET,SALEM,MA 01970
offifflMECO�@ ® e Telephone: (978)741-0424 Fax: (978)741-2012
Contractor Registration No. 101609
Federal EIN:04-3090162 - Construction Supervisor No.CS057733
CUSTOM REMODELING AND IMPROVEMENT AGREEMENT
Date of Contract
Buyers)Name
K 8nt;�
Buyers)street Address,icily,State and Zip Code
Sbor�1 Anil WRQer SAIeiiai 444, ON C�
Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Adtlress:
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 this agreement and any specification sheetsf(this Aa ears rite), n oBcacse)to be ins have
thatproducts
rvsuch
goods or services be installed or Provided at Buyer's address listed above.A&A Seices,Inc.('Contractor), y 9
or services listed in this Agreement at the Buyers)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.
Purchase Price: Est.Starting Date: �6
Down Payment: 2r— Est.Completion Date:
❑Cash
Amount Due on start •of don: ❑Check
��I ((Gnri.•�'h�r� �� ❑Credit
Amount due on_of Completion: No. r T 93+/
' (� • pr
04 ^`j` —
Amount Due on_of Completion: Expiration Date:�
LL{ rBalance Due on Upon Completion: irlirr-0) C Code
It is agreed and understood by and between-the parties that this Agreement,front an 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.
Buyers)hereby acknowledge that Buyers)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. Buyer(s)also
(1)acknowledge that they were orally informed of their right to cancel this transaction;and(if)request that they be contacted via their
telephone numbers or e-mail,as listed above,in the event Contractor believes Buyer(s)would be Interested in any additional quality
products or services of Contractor. DO NOT SIGN TIBS CONTRACT IP IT CONTAINS ANY B SP Es. r
A&A Services, 'IC. Buyers) •.I
kI
(`1
BY Signature
Signatul �� , Il
Print Name Print Name
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 thefollowing Notice of Cancellation form for an explanation of this right.
ARBITRATION:Ts commands and Me homeowner hereby mutually agree In advance that In the eventelNer party has a dispute commands,this concep ,either rand may submit such dispute b
a private arbltratlon service whiN M1as Eeen approved by Pe Secretary o11N 6eMive OMica of Consumer AHelrs and Business Regulators and the other parry shall he comical to submit W
such icameton as proved m M G.L.c.1421
andpa=mrivid.ls ,G evy,r.md.lr: c
D.ta: DN,: 7
NOTICE ny CANCELLATION
Cate of Transaction s n .yw may cancel fhb tratisadlon,xitlbN arty peT
ab of TransatllonVYou maY canwl tM1is Vensaction,willwut any
Penalty or
obllgafion,wiNlnthree u daY%M1om theaWve Am Il you canwl.ary pmpeM trllgallon,wiNln Nre tlaysfrom the above tlate.Il youcancel,ary property tradedldanypaymeMsmade youuMerthe Contactorswe,mdvrynel'ptiabledss menley Pura bmade y You under the Compact or Bela,andany balanc .Instrment exewtetlby you will M retumN within 10daysthinkingreceipt by the seller of your corrella ted you All be exempt Alan 10 days following receiptby the Seller si your cancellation noticeantl any security Interest among out W the pkecticn wll be mulled.if you cancel,yndarrysewrlrylnterestadsingwomeuensecpon will be cancelled 1l you cancel,you must
make avallableNihe seller e[ynur ravtlence,in suhstantiallyazgmdcoMNan as whenreake available to Ne Seller alyour rrsidence,Nabstantalany goods delivered W you under this Conbad cr Bate;or you may.d you wash,memory ny g.We delivered to you under this Conrad or sale;or you may it You wish,comply with the
Instrucfwrw of the Seller members,the raNm shipment of me gootls at the sellers expense and rearmenced of the Seller severance Me pace shipment of the goads at the Sellers axperau m
Milk. If You do make the gouda scrollable W the Seller antl the Seller does not pick them up risk. It you do make the goods evatable to Me Seller and Me Seller does not pick them up
Arm 20 data of the MWof Your redee of Cancellation,you may retain or rupees,of Me goods All So tlays M Me data of Notiw of Cancellation,you may,ream or depose al Me ds
wWaulanytudMrobligaton.ll you t'I to make Me goods available W We Seller or ll you agree without any furnme.elgation.Il you fall to make thagoWsavaibbleWNe Selle[or it ynu agree
W Tatum the goods W Me Seller said tat to do so.Men you remold hable fix performance of ell W romen Me gootls to Me Seller and fall b tlo so,then yw remelt nine for Parameters Ofall
obrgetons under Me LontracL To compel Mis thadeeres.mail M deliver a sbned and dated copy, scientists under Me contend.To Tercel Mb transaction.mall a do liver a all and bald copy
in on.[touch rotor or any other Armen notice or send a telegram,a A6A Bq5^^''Ices 1/IJ,t5 of fee-,card,-notice or any other wrltlen notice,or sand a bl ome'"Uis W Air
,M Se 11
North Stmet.Se assadm m,sees 01970,NOT LATER THAN MIONIGHr OF'7Z[J.. North Street Sale Mas.& el910,NOT IATER THAN MIDNIGHT OF eG
(Date)
D e)
I HEREBY CANCEL THIS TRANSACTION. Consumer's spent Cale THEREBY CANCEL THIS TRANSACTION. Consumer's signaNre Data \
+
SERVICES, INC.
A SERVICES 115 NORTH STREET,SALEM,MA 01970
11111811155111 . ® 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
Buyer(s)Name Date of Contract
at yer(s)Street Address,City,State and Zip Code Tf at-eAve 3 !/
e44
Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address
The Buyers)listed above hereby jointly and severally agree to purchase the grind.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.
WINDOW REPLACEMENY
9 Remove and dispose of# existing windows.
Install # Lv UP,, new 61wi rt St.-p� V�,/A4oi d _ windows:�inyl T Wood
(Manufacturer?
Options: Style � b b tO Ryuy0 Grid pattern S1SC ow-r(,�r' E ��flCIS�'TW2Q,fJ I F¢�' ems'
Color Interior 1A)(-k A E!— Color Exterior tA)1, Glass Type 1�C
T Wrap exterior trim with aluminum: Style Color
T All windows will be installed according to the installation procedures in the portfolio.
T so
lk all interior and exterior edges.
isolate where possible around new units.
T Insulate window weight pockets if exist,and around new window units where possible.
Included in this proposal are set up,clean up,Hepa vacuum and cleaning windows inside and out.
T 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.
T Remove and dispose of existing unil(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.
T 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.
T Bay T Bow *Casement T Other window(s)to include new interior style trim and new exterior style trim and head
flashing as needed.
T 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
T Remove and dispose of# existing storm door(s).
T Install new storm doors# Manufacturer
Style Color Type: T Aluminum T Solid Core
SPECIAL INSTRUCTIONS: i I
stEn/I/ ` �l7ifjonfLe
�� std�
�L fc� Le' + Sed wi acuS
wIr
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 parties,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 Buyers)and the contractor.Buyeds)hereby acknowledge that Buyers)
has read this specification Sheet.
�7 / Y
Contractor Initials: S G Date: [ �> Buyer's Initials: Date's
1:
f
AGrade
Above
Sime $2 Phone: 978-741-0424
Fax: . 978-741-2012
A&A SERVICES www.a-aseNices.com
., , 115 North Street
Salem, MA 01970
July 17, 200
City of Salem
Building Dept.
120 Washington Street
Salem; MA 01970
To Whom It May Concern:'
Enclosed please find the permit application for Kathy Bruin, 8 Shore Avenue,
Salem, MA to replace windows. .
I have enclosed a check fo'r $33 based on your fee schedule of$7 per $1,000.Oii
plus a $5 administrative fee. The total for the job was $4,288.00.
r
Please send the completed permit to A & A Services, [he. at 115 North;Street,
Salem, MA 01970. 1
r
If you have any questions; please contact me,at(978) 741''042.4.
Thank you
for your assistance. I
Sincerely,
Barbara Zorzy �,/� �'
Office Manager
r
/ �, 1