5 SUTTON AVE - BUILDING INSPECTION (2) The Commomv, rtt, efts
t
T =a is i Board of Building[2egutatioiltards i CITY OF
J Massachusetts State Building Code, 780 CMR SALEM
NR 1.
Building Permit Application To Construct, patr, Ren�wOr Demolish a
i One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date App ' d:
Building Official(Print Name) Signature Date
_ SECTION 1: SITE INFORMATION
1.1 P3pe Addregs: 11 Assessors Map& Parcel Numbers
JJ
1.1 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: (NLG.L c.40,§54) L7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone? Nlunicipal❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
�_p PO-WA?NC Gjl'AU6 S 1�a [PIM 44A Offl 0
Name(Print), City,Stag /
fi)nj 14 q7 �Q�!
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 Other ❑ Specity:
Brief Description of Proposed Wor -:
r
SECTION 4: ESTEMATED CONSTRUCTION COSTS
Item Estimated Costs:
Labor and Materials) Official Use Only
1. Building $ L4 1. Building Permit Fee:$ Indicate how fee is determined:
L6S.
Electrical $ ❑ Standard City/Town Application Fee
❑Total Project Cost' (Item 6)x multiplier x
Plumbing $ 2. Other Fees: $
Mechanical (FIVAC) $ List:
Mechanical (Fire $
ression) Total All Fees: $
3 Check No. Check Amount: Cash Amount:
Total Project Cost: $ ❑ Paid in Full ❑Outstanding Balance Due:
1t125 MAIL-eYj ,C,
SECTION 5: CONSTRUCTION SERVICES.'
5.1 nConstruction Supervisor License(CSL) -
( 20 Licensee 3-aS-7-7-1,3 Expiration Date 7�
NameofCSL '�{,,^ r'�y-7,\ T Description
N J7 , lv' ! /v U Unrestrictedto 35,000 Qi Ft
Ad Restricted 18c2 Famfly Dwdhng
M masoory Only
i RC Residential Rooflog Covain
p -7 -7 J r WS Reidential Wmdow nd Siding
SF Residential Solid Fuel Burning lianco
Telephone D Residential Demolition
51 Home Improvement Contractor Registration(HIC) /
Regislr-dtion Expiration Date t0 6
HIC Cry N e or FRC Re . t ame
S
A,ddms
Sipan=
7Y-7�11 - o Ufa
Telephone
SECTION 6: WORKER'S COMPENSATION INSURANCE AFFIDAVIT(M.G:L.c.Q52. §25C(6))
Worker's Compensation Insurance affidavit must be completed and submitted with this application.
Failure to provide an insurance affi vit may result in the denial of a building permit
Signed affidavit attached? Yes No Cl
SECTION 7a._'OWNER AUTHORIZATION TO BE'COMPLETED WHEN OWNER'S AGENT OR
-
CONTRACTOR APPLIES.FOR BUILDING PERMIT
I, Lf== r U 0 as Owner of the subject Property,
hereby authorize to act on my behalf in all matters relevant to work
authorized by this building permit-application.
t,SQe �(1V11i � . ttLC It k
Signature of Owner Date
SECTION 71i: I OWNER OR AUTHORIZED AGENT DECLARATION
I, 1�.�1{f(t{f(t Y' as Owner or Authorized Agent,hereby declare that the statements
and information foreWh3japplication are true qua acctaate,to the best of my know edge and belief.
Si ofownerorA orized� ent (Signed under the ams and r
l�r� ( � P � Penalties of Dare
SECTIONS:
DEBRIS DISPOSAL
All dumpsters of six(6)cubic yards or more are required to have a permit from the Marblehead Fire department call 781-639-3428.
In accordance with the provisions of 780 CMR and MGL c40,§54 a condition of issuance of this building permit is that debris
resulting from any work performed shall be disposed of in a roperly licensed soli waste disposal facility as defined by MGL c111,§
150a. 4zul de Aa - //N.C,
DEBRIS DISPOSAL LOCATION
SIGNATURE OF APPLICANT
•NOTE .
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 and Construction Supervisor Licensing(CSL)can be found in 780 CMR
Regulations.
z�
�� A �p nnr,��i++ A & A SERVICES, INC.
P&W SER Lig 115 NORTH STREET, SALEM, MA 01970
•- Telephone:(978)74I-0424 Fax: (978)741-2012
Contractor Registration No. 101609
Construction Supervisor No.CS057733
Federal EIN: 04-3090162
CUSTOM REMODELING AND IMPROVEMENT AGREEMENT
i BM
r s)Name Date of C
1/JCJ %
ontr 't
Buyers Sheet Atltlress,Ci ,State and L Code /,may �
t
Daytime Tele hone Number Evenin Tele hone Number Mobile Telephone Number E-Mail Address
C
The Buyers)listed above hereby jointly and severally agree to purchase the goods anchor services listed on the accompanying specification sheets,in accordance
win the prices and terms described on the front and the reverse of this agreement and any specification sheets(this"Agreement"),and Buyers)have requested
Nat such goods or services be installed or provided at Buyers address fisted above.A&A Services,Inc.('Contractor"),hereby agrees to install or Cause to be installed
Me products or services listed in this Agreement at the Buyers)address vmiften above.This Agreement represents a rash sale of goods and Stevens.The Buyer(s)
agree to pay in cash the cost of me goods and services purchased as described herein,regardless of timing or approval of any financing Buyers)may seek for their
purchhase.
-( Purchase Pf 3 11 Est.Starting Date:
IT
Down Paym Est.Completion Date:
C'9g v"1s"'Cash
Amount Due on Start of Job: y� W' Check
,, -7 9 Credit Card
Amount Due odri Completion: -/ No.
Amount Due on_of Completion ,+ Expiration Date'.
Balance Due on Upon Completio --l� L VC 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 gee parties,and there are no verbal understandings changing or modifying any of the terms of this Agreement.Buyers)
hereby acknowledge that Buyer(s)has read the front and the reverse of this agreement and has received a completed,signed and deed copy of this
Agreement,including the two abachad Notice of Cancellation forms,on the us%first wrigen above.Buyers)also(i)acknowledge that they were orally
informed of their right to cancel this transaction;and(II)request that they be contacted via their telephone numbers or email,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 THIS CONTRACT IF IT
CONTAINS ANY BLANK SPACES.
A&A Service Inc. Buyer(s)
By: Y.�. elf ��"'✓'vC}-'
Sign re Signa
%I RP-,\/Z's
Print Name p e
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.
ABBIT—ON:The-no..,and the Moeovrner hereby rwWally agree in advance that in Ire evaa,Moment.,hes a died.mnreming the contra,enter part,May scent curb the,.do a
private arGtration service wbtch has be an approvetl by to Seueelol N¢ExerufuxO -11 Consumer Jord Business Samoa—and the otherpany shall Be involve]to suenl to such
actuation as proved to So L c 14)A.
Contrs[ 1 I' 3 Yes tnitals
wm: ram:
)� rLj� TION TIL OF TIe a Tnsacupn ! � canceltscenters ,,.dtpm any penalty or Dale mTaseactiOn ay cancel Innsvanserlpn,veMnrt any penalty er
ouigalon chin Nree bu lessore tlate.Ifyeucanml,anypropeMuadedl¢ WllgationlNitresi ssd shoe theabove tlate Nyouany parrents made by vuntl Sale.and any negolael¢Insnunenl assured any payrrenk made by uno to Contract or Sale,and any regourseslnsWment ezxNed
by you will be m1umM in 10 days fdlovang local by Me Seller o1 your canculalon notice, try you yet�rewm or main 10 days 1dbvAng recapr by Me Swer of your cancellalon notice,
and any secudty'Itered adzng out of the transactor wall be Covered,If you cancel,you must and any seamy Interest ad9ng out of Me tramBNm rill on Cancelled.II you caret you moat
make available to Me Seller at your readence,and suManrally in as good wndidon as when make ewilaele to Me Seller at your residence,and subs cal in as geW condition as¢Ten
ell any grads delivered 0 you under tin Contratt or Sale;or for red,if you vAsR scri retvtl.anY'dl deltvxren to you under der Covered or Sale:or you May,it you wish,ounces
vnlh the tnsWcurre of the Seller regarding Me return shipment of Me goods at to Seller's ¢iM Me ireaddace,of Me Seller ,.Win,Me to..snipmed of In.g.a al the Sellers
amerce and risk.If you tla make Me goods available IS Me Seller and the Seller does not pid, expense and risk.II you do make Me gao]s avaJade to to Seller and Me Seller dead nor pick
More up veal 00 dap of Me date of your Need of Cancellation you Cray retain or dispose of the Marc up'mMa Po days of Me data of your Notice ofCancellation.you tray recall or dispose of
Moved wtur any further obligaion.If you Mil to Mks the goods avaRable to Me Soar.or it you the goods wfNout any NMer Gatherred If you fail b Make Me go'ls available M the Seller Or If
agree t return Me gelds to to Seller add fail to do so,then you remain lAss for peeomence of You agrre to return the goods to Mc Seller and tail In do so,then you r¢mgan liable forperlormanw
all obligatiws under the Contract To cancel Me reaccoory red ad do.eI a s'gned an do red of all c8ltgodons under to Contraq.To cancel Mls thesaNen,mailwdelverang If dda d
copy of the canrellatoa room or any other nidten ndaw,or send a tele, ao BAS rvires, epYOl Mecenrellatim noEce or any otTh7 Mnnoleeo; dTa.a l,,rhuoon ASeM�
115Nonh Sheet Salem WoMbe NOT LATER THAN MIDNIGHT OF �� 115 NOM 5oeet Salem Moctri NOT IATERTXAN MIDNIGHTOF
1
I HEREBY CANCELTHIS TRANSACTION I HEREBY CANCEL THIS TRANSACTION
Cmeumr'a SignaNre Data. Consumers Signarure Dare:
V V�j tod-N A a, L O I
//��,�, //�� `rp _ia; A & A SERVICES, INC. C/1
A&A SERVICES 115 NORTH STREET,SALEM,MA 01970
• • Telephone:(978)741-0424 Fax: (978)741-2012
Contractor Registration No. 101609
Federal EIN:04-3090162 Construction Supervisor No.CS057733
ROOFING SPECIFICATION SHEET
Buyers)Name j Date of Coutr t
to rrA we— C
se
Buyers)Street Atltlress,City,State and Zip Code
Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address
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 pad.
ROOFING SPECIFICATION .d : 17-0r)I-
-
trip Roof of# layers of shingles 17f O M4
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 Flash chimney as needed(no repointing included). stallg'pert eter,dri edge to rnrinamilifascia Steps. O 9r,
t Install vent pipe boots and seal as needed. t Flash valleys as needed LIP
t Install rollout type ridge vent. t lanks/plywood replacement underincluded
"If more is needed there will be an extra charge of$
WA
t isposal Included: t Other:
I h l f 4 ,h-tf {ant
Install new roof: Manufacturer �L LJ-L'q�Y�. Style/typeb :14k
Included in this proposal are thorough cleanup,building permit, and company/manufacturer warranties. .�
RUBBER ROOFING SPECIFICATION
t Strip Roof t Not Strip Roof
t Install 1/2"High Density Fiberboard to existing roof using t Flash obstacles as needed.
screws and plates.
t Install.060 membrane EPDM(Black)rubber roofing to It 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.
SP IAL INSTRUCTIONS:
• Je�AA -
- --4-4-)
CnCA Clip l-M o (D 0
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 understendIngs changing or modifying any of the terms.The 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.Buyer(s)hereby acknowledge that Buyers)
has read this Specification sheet.
Contractor Initials: Date: -_ �/I`'' Buyer's Initials: Date: I a016
CITY OF &UEM, ANSSACHUSETTS
BU11DINK;DEPART W.NT
F 120 WASHINGTON STREET, Sao FLOOR TEL (978) 745-9595
FAX(978) 740-9846
KIitBERLEY DRISCOLL
MAYOR THoNus ST.PMR.RE
DIRECTOR OF PuBuc PROPERTY/Bl'nmNG CONLIQSSIONER
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information J� / ^� Please Print Le ibl
Name(Business;Orrytnizationflndividual):. }-t yt- Y,>{Q t Le S
s
Address: II NAg1j, &�—
City/State/Zip: Phone !#: �! — q
Are you an employer?Check the appropriate box:
Type of project(required):
LEI I am a employer with 4. E] 1 am a general contractor and 1
employees(full and/or part-time).' have hired the sub-contractors 6. 0 New construction
2.❑ I am a sole proprietor or partner. listed on the attached sheet. 2 7. ❑Remodeling
ship and have no emplayees These sub-contractors have 8. Demolition
working for me in any capacity, workers'comp. insurance.
[No workers'comp. insurance 5. ❑ We are a corporation and its 9' ❑Building addition
required.] officers have exercised their 10.❑ Electrical repairs or additions
3. 1 am a homeowner doing ail work right of exemption per MGL I LEI 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'
comp. insurance required.] 13.❑Other
•Any applicant that chtxtca box d I must alw fill out the section below showing their workers'wmpenwiun policy information.
-Cantm�
'licmeawrters who submit this affidavit indicating they are doing ail work and then hire outside conemctor I most submit a new affidavit indicating such.
ton that cheek this box must attached an a Mitional sheet showing ate name of the sub ntractors and their workers'wrap.policy information.
an employer that is providing workers'compensation it
information. rsuratrce jar my employees. Below is the policy and Jab site
i
Insurance Company Name: --}--_ IJ �A Q e i I�y-S• F�
Policy#or Self-!as. Lic.#:_ l / I n:3 Expiration Date:—/ --
job Site Address: �� t ((f p I1 p Ciry/State./Zip: Sq�P M A
Attach a copy of the workers'compensation policy declaration page(showtng the policy number a �j
P cY expiration
Failure to secure coverage as
. p oa date).
lead
o the imposition of criminal penalties
fine up to S 1.500.00 and/or one-year dimprisonment:as under Section 5well as civil penalties in the form of a STOP WORK ORDER and of 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
lavestigations of the DIA for insurance coverage verification.
I do hereby Certify under thepp/ains and penalties of perjury that the infarsnatlon provides/a ove i trae and correct.
Darr. /
Phon #: LIS—
OJrchd use only. Do not write in this urea,to he completed by city or town aJ Iciat
City or Town: Permit/License#
Issuing Aulhority(circle one):
L Board of Health 2.Building Department 3.Citylfawn Clerk 0. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
CITY OF S�U.E.N1, L UsSACHLSETTS
BuiLDNG DEPA.RTJIEINT
• 120 WASHNGTON STREET, Yo FLOOR
` TEL (978) 745-9595
FAx(978) 740-9846
KI.NiBERLF.Y DRISCOLL
MAYOR Tm%w ST.PtERRE
DIRECTOR OF PUBLIC PROPERTY/BUUMLNG CONL%=IONER
Construction Debris Affidavit
Disposal
p fidavit
(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
I11, S 150A.
The debris will be transported by:
(name of h er)
The debris will be disposed of in :
hnSe- 7rragc&-r ( lov1
(name of facility)
6ti�e rasp titil.� 0� i l I IS )0C)Y- h S+
(address of facilit
S", 10
� 4 ot � �ta
signature of permit applicant
/b
to
Jcbrisa0.ilce
S
Massachusetts Departn'ient of Public Safety
Board of Building Regulations and Standards
A&A SERVICES, INC
Christopher Zorzy License'OP1" se CS-0577 4,,333 l �R
115 North Street r
Salem, MA 01970 CHRISTOPHER 7,e11
115 NORTH ST ;
Salem lV1A 01970= A°.'�W",',,,,.
:I'.li I va i'IIM I I'./II
lil\
Expiration
.., „/,./ .,,;i/ / //,..,:I,,,l,.a,�i41 J� ��¢- 05/26/2017
Oflice of(oasunier Affairs& Rasiaess Regulation Connnissinner
�� �, ttyy 1II HOME IMPROVEMENT CONTRACTOR
( Registration. ,,.ipl Registration. ,,.101609 Type:
Expiration 6/26M18 Private Corporation
A&A SERVICES, INCI
Christopher 2orzy
115 North Street
Salem, MA 01970 undersecretary