Loading...
14 SHORE AVE - BUILDING INSPECTION a 1 � The Commonwealth of Massachusetts RECEIVE �n Board of Building Regulations and M Standarr4�SpECT10M S RVq EOF Massachusetts State Building Code, 780 C Revised Mar 2011 Building Permit Application To Construct, Repair, Renovate A1���li� Q ° One-or Two-Family Dwelling This Section For Official se Only Building Permit Number: Date A plied: Building Official(Print Name) Signature - Date r SECTION 1:SITE INFORMATION 1.1 Property Address• 1.2 Assessors Map&Parcel Numbers I� S'� n L l a 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 ❑ Checkifyes❑ SECTION 2: PROPERTY OWNERSHIP' 2hOwner'of Record: y�C�® wt5 ./ Gokn , 14 019 70 Name(Print) City,State,ZIP I� C&al--2 Aw gi ff 7 4 I- �-)LPLI No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work': IV 5 - SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1.Building $ 0 1. Building Permit Fee:$ Indicate how fee is determined: ❑Standard City/Town Application Fee 2.Electrical $ ❑Total Project Costa(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4.Mechanical (I VAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees:$ Check No. Check Amount: Cash Amount: 6. Total Project Cost: $ 13 1 V U 0 ❑Paid in Full ❑Outstanding Balance Due: Sc-a.�r A I� 1 SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) D 15--1 q 3 t License Number Expiration Date Name of CSL Holder 11 S wo/� cS+• List CSL Type(see below) No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft. R Restricted 1&2 Family Dwelling City/To",State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances O `�y I-0\{3-Y I insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) A+-A-c,e i-ce s I(� t (o q on D t HIC Registrationn Number Expiration Date HIC Company or Name HIC Registrant Name S� No. nd Street Email address o.l-e.w, fY11'1- 019q o q�g�Hl-o�t�-`� 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 1,as Owner of the subject property,hereby authorize thtrc S 2.0 rz:� to act on my behalf,in all matters relative to work authorized by this building permit application. �.. Cy✓. 4-r a L4- 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 contained in this plica on is t >e and accurate to the best of my knowledge and understanding. 1�- ( S- Iq Print Owner's or Aut tori4genes 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.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dVs 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" . l The Commonwealth of Massachusetts Department q/7ndustrinl Accidents office 01inuesti9ations c tht/ 600 Washington Street, T° Floor /j Boston, Mass. 02111 Workers' Compensation Insurance Affidavit: Building/Plumbing/Electrical Contractors Applicant information: Please PRINT leeibiv name: _G�,l'i,Sl.Q -zdrzv. address:C ��� �O✓ f 4t / [� i (/ r/ �/ city ' a �2 11�y state:/AMA (� zip: 019-70 phone# / / D "7TI—i 7V work site location(full address): L 1 ��re AVe /Ck-Lf—r . MA— el 1 '176 ❑ I am a homeowner performing all work myself. Prcjcct"fype: ❑New Construction ❑Remodel ❑ I am a sole proprietor and have no one working in any capacity. ❑ Building Addition I am an employer providing workers' compensationy for my employees working on this job. companv name. A '- 1q-4e a-V i,CS L f bA . address: ( ( gg.S !1/o ✓ 6 vh� S+' n p city: SG� ie (�i,� . /V 'rl phone#: —(�7tfL 7q7 �/ —O `t ;y insuranceco. T . '7—ra U-e l-e r '.S poliev# C); ' 3 &1 Oii d S ❑ I 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 policy# Company name address: city phone#: insurance co police# Attach additional sheet if necessary Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition ofcriminal penalties ofa fine tip to S1,500.00 and/or one years'imprisonment as well as civil penalties in the form of it S 1'011 WORK ORDER and a fine of$100.00 it day against me. I understand that a copy of this statement may be forwarded to the rice of Investigations of the DI:\for coverage verification. l rto hereby/certify un a th pains and p nalties oleperjury that the information provided above is true and correct Signaturcvr / �7 Dale ,_ Print name C,�(✓i S�Q r LOr--z / Phone# official use only do not write in this area to be completed by city or town official city or town: permit/license# [-]Building Department ❑Licensing Board - "I ❑check if immediate response is required ❑selectmen's Office ❑lle:dth Department contact person: phone#; ❑Other (revised Seri_2005) V R4 tl i A & A SERVICES, INC. A&A SERVICES 115 NORTH STREET,SALEM,MA 01970 • • ' • Telephone:(978)741-0424 Fax:(978)741-2012 Contractor Registration No. 101609 Federal EN:04-3090162 Construction Supervisor No.CS057733 ROOFING SPECIFICATION SHEET Buyer(s1 Name Date of Con act 4 IL-1- Buyer(s)Street Address,City,State and Ip Code 147 5,6l'0- 4v�? diA e'-', IM4, ©y -a Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address The Sevens)listed above hereby jointly and severally agree to purchase the goods and/or services listed below,in accordance with the Inced 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. ROOFING SPECIFICATION trip Roof of# layers of shingles t Install 6'of ice and water shield at base of roof where t Install 15.b felt paper to roof. possible. Install 18-24"of ice and water shield in valleys. t las chimn (no repointing included).X 2— t stall perimeter drip edge to rakes and fascia area . k Imo. $ stall vent pipe boolitand seal 2Rpol Flash valleys as needed If Install rollout type ridge vent. t Janks/plywood replacement under 32 SO FT included e "elm' (' "If more is needed there will be an extra charge of$ S� -041 If olle emo Pooh Ql�f per hour for labor plus the cost of materials. umpster/Disposal Included: ��� ke�) t Other: Location: Wivim4q -,for, Install new roof: Manufacturer (—'eII ' 3 yr Styleype 14AJA/[n-ILL. chided in this proposal are thorough cleanup,building permit,and companylmanufacturerworranties. RUBBER ROOFING SPECIFICATION t Strip Roof t Not Strip Roof If Install 112"High Density Fiberboard to existing roof using t Flash obstacles as needed, screws and plates. t Install.060 membrane EPDM (Black)rubber roofing to. t Install 3x3 aluminum drip edge to perimeter of roof with fiberboards seam tape. t Flash up sidewall as needed. Included in this proposal are thorough cleanup,building permit,and company/manufacturer warranties. }uftf;z� aw {�sfgf�sF,o-f�e� sk ny(es pi-n . c4p n SPECIAL INSTRUCTIONS: _ -_r 9 W Q v l� iwT r� 5 3�-Tf�O�cr� 1�.cldtiilLff(J It Zfupr21r (AItis unde I'e by andbetween the parties that this Specifica[lon Sheet,along witM1 CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,constitutes the entire understanding between the parties,an there are no verbal untlerstentlings changing or motliying any of the terms. TNs contract may not be changed or its terms modified or varied In any way unless s..b changes are in wrigng antl signetl by bofi the Buyer(s)antl the Comrectar. Buyer(s)herebIt..knowledge that Be,,(.) has read this Spaeth.."..Sbeel. r Contractor initials: L Date: U O / / Buyer's]rtitials: Date: 6 ,, /� �p�/ /7 A & A SERVICES, INC. A&A SER \I�� 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 CUSTOM REMODELING AND IMPROVEMENT AGREEMENT Bu ors N e Date M Co act n1S g Bu e s Street Adtlress, Ci ,State and 4 Code for too Da ime Tele hone Number venin Tee hone Number Mobile Telephone Number E-Mail Addresss, The Buyers)listed some hereby jointly and severally agree to purchase the goods and/or services listed on the accompanying specib lien sheets,in accordance with the prices and terms described on the front and the reverse of this agreement and any specification sheets(this'Agreement') and Buyer(s)have requested that such goods or services be installed or provided at point's address listed above.ASA Services,Inc.('Contractor),hereby agrees to install or cause to be installed the produces or o erates 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 descdbed herein,regardless of timing or approval of any financing Buyerls)may seek for their purchase. Purchase Foriceg1'�� IxY�I Est,Starting Data _ Down Paymel�t: 433 /(7 L!gip/ Est.Completion Date: T Of 9n Amount Due on Start of J. Credit Card Amount Due on—of Completion: INo. Amount Due on_of Completion:��j{ audJoev+- Expiration Data 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 forms of this Agreement.Buyers) hereby acknowledge that Buyerls)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 wdtten above.Buyerts)also(i)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 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 Se"ic ,Inc. Buyer(s) By: - S< _1L Signature Signature G X p Print Name ,4 ;vCti Print Name Signature Print Name You,the Buyerls), 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'.IDe contractor and Ne homeowner hereby nutually agree in advance that m me even)eitherpaM his a dspute mnmming this mneaff.eilHerpaM May subml such dispute to a private artipation a mwi iG has teen appeovM by the 5ecetaryol Ne Executive Olhceol Con /dIgdm rid address Regulaeorm and two u party shall be required to suMtlt m ation er iarderes pbovvor in ed G L C.142A A DILI auy pie"" Dee De Man ANC m oti OF CANCELLATION Date of Tranvcdon You may cancel Nis Inso w witroul any penalty or Dale of Tranaaction .Youmay cancel this hansac4on,wiltroW any penally or obligagon,wlNm Nree si as den 11.the above deal ll you-.Los any gas,, abed in, obllgagon,wimm Nree usi�ss a.'ifom Ne aNve dale.Ilyouwnml.anypmcerry Vaded in, any pDrients do of yo reset Ne Contractor Selg and any negatableinstru nteaewted anypaymanlsnadeb you under the Contract or Sale,and any negotiable instrument eaeated W you vall be returred yo 10 days Russians raboal by Me Seller of your cancellation mtiu, by you WWII be doomed uitiie 10 days ldlosi ng rewia by the Seller of your cancellation notice. and any seventy interest Dal out of Me bansaction will be cancelled,11 you rancef you must and any sewtily interest arising out of the happ Non will be cenea led.If year cancel,you must brake available W the Seller at your beivdence,and subsbnsally In as good wnscon as when nuke available to the Seller at your raidcast and substantially in as good wndieon as wren Ived any goods delivered for you unclerth're Conbed or Sale:an your my,if you with,shmay ceived,any geMsdelivebetl to you under Nis eonintlwyak:or you may,ilyou vnsq rmply Ath In.insimcgws W Me Sella avaNbrg the velum ahiprrenl of Me goods al Ne Sellers yo the imuudions of the Selo begardng the return spepnerl of the shot al the Saffer's .,an-and risk.If your do brake be goods available to the SHler and the Seller does not qd erye—and risk.It you do make Me goods available W Me Seller and Me Seller does rot pick them up wtNin 20 days of the data of ybur Notice of Cancellation,you may rekin or surged of the them up vnNin 20 days of the date of your Notice of Canfroadon.into may retain or dispose of goose verhoe any further obligabon.If you Jail to crake the goods available w Me Serer,or X you the goods WOoul any further burger-if your fail to rake the goods available to the Seller.or if agree b return Me goods to the SHla and rail to do so,then yw remain Made for perMmance of you agree to return the gsds to the Calla and fail to do 60,then you certain liable to,pa/omance all oblgabms under the Comad.To sane¢I this annual mail or deliver a signed and dated of all obligations under the contmd To ourcel this dansal nail or deliver a signed and dated mpyonnetreet.Solon MA01orany OmerLTER Tcarte,or sendatele�/ a r'Nr o1 me tanaelkdon notice ob any other wnicenrogm.msaneat¢I¢grabtyA tee. I15 NOM abeel.Salem MA 019]O,NOT LATER THAN MIDNIGHT OF 115 Nunn Sireel,Salem MA 019]O,NOT tATER THAN MIpNIGNT OF�d/9Y%/// r I HEREBY CANCEL THIS TRANSACTION 1 HEREBY CANCELTMB TMNagCTION consuls Signature notes Consubrers Signature Dale: I _ ?r THE COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OI'LABOR AND WORKFORCE DEVELOPNIEN'T --� DEPARTMENT OF LABOR STANDARDS 19 STANIFORD STREET, BOSTON, MASSACEIUSETTS 02114 DELEADER CONTRACTOR LICENSE A & A SERVICES, INC. 115 NORTH STREET I SALEM NIA 01970 i I LICENSE: DC000440 EXPIRES: Sunday,June 07,2015 I IN ACCORDANCE WITH N.G.L. CH. I 11, § 197B(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. I I THIS LICENSE IS VALID FOR A PERIOD OF ONE YEAR. I I, THIS LICENSE MUST BE MAINTAINED BY THE CONTRACTOR WHEN ENGAGED IN DELEADING WORK IN ACCORDANCE WITH M.G.L. CH. I I I § 197B(b)(2)AND 454 CMR 22.03. I HEATEIER E. ROWE, DIRECTOR ...... ��'�� ' f®f Massachusetts - Department of public Safety Oftiee of Consumer Affairs& Business Regulation — -, L-' Board of Building Regulations and Standards . ,(HOME IMPROVEMENT CONTRACTOR Cnmruchon Supcn'surIRe istration- 101609 Type: Expiration: 6/26/2016 Private Corporatic! License: CS-057733 3'._, ABA SERVICES, INC CHRISTOPHER 2ORZYI, ., 115 NORTH ST Christopher Zorzy Salem MA 01970 115 North Street Salem, MA 01970 -Undersecretary `.1.�- fj ,. Expiration j Commissioner 0512612015 vIONS xI Christopher Zorzy 920120426000840 A&A Services Inc Exp 4/26/2017 rr 77 115 North St Bpi _ I 'J, * '-_ ..,j,. Salem, MA 01970 ':;+ OF-DEBRIS Arr DANA` �a!kh the provisI01s§1 K C, L, 40, 8,3% 54, a condl=.n 61 Building Permit Mumber IS $ha �d db1a� 6�dalU 610 �air sjo; Snc9l be d;S��a9d ®fln a pzopArI fMna�� �lil�f�� ��a�d�.���A, �, �, oa ' a ¢63d dd e';s 'Atii(be dss,p3Ded @$o ���,� Ow19d by N5ff�wd=_g CRIMe lQ Fmsm® Of Permit Aopiicam . A A A , Inc T17r rm TQ�� s �a �g . g C '�ib kG�'e 6t'm�' 2`fi1H��G5o dd A 01970 Addmq, 06,ty, S$gsa, Zip Code