10 SUTTON AVE - BUILDING INSPECTION (4) cF ob
7 �
The Commonwealth of Massachusetts RECEIVED RVICE
CITY OF
Board of Building Regulations an� t I�*001- SE SALEM
Massachusetts State Building Cod�)�r``�7$$0 CMR 1*Oki � RevisedSALE*r?0!!
Building Permit Application To Construct, Repair, lmgv gOr Ber olishh ao
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Dat,c Appl'
Building Official(Print Name) Si Lure date
SECTION 1: SITE INFORMATION
1.1 Property AddrM 1.2 Assessors Map & Parcel Numbers
L la Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
s Zoning District Proposed Use Lot Area(sq ft) Frontage(11)
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 Fl�ood 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:
1,h yC1 � '.. C�O {"C cd.2 tM fM.'d�U t.el -7 d
Name(Print) City,State,ZIP to SLA an dw 97s- T - 7a77
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) el Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify:
Brief Des ription of Proposed Work'-: / -�• / tl q. ( ) 7
It 3Iy c - W o0 d. 4 e
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Costs:
Item Labor and Materials) Official Use Only
I. Building $ J G0' 1. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical g ❑ Standard City/Town Application Fee
❑Total Project Cost (Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List: � '-
5. Mechanical (Fire $
Suppression) Total All Fees: $
Check No. Check Amount: Cash Amount:
6. Total Project Cost: $ 31 ❑Paid in Full ElOutstanding Balance Due:
M�t�c� izls
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License (CSL) b C,
License Number Expiration Date -
Name of CSL Holder
List CSL Type(see below) U
No. and Street Type Description
U Unrestricted(Buildings up to 35.000 cu. ft.)
Ctry/Town, State,ZIP �I R Restricted 1&2 Family Dwelling
M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
� n � 10/ l�0 9 /o'2-C�
A o}- '�2tr /t �_l �K G • HIC Registration Number Expiration Date
HIC Company Name or FIIC Registrant Name
No. a 0 a
nd Street Email address
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 .......... V 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 If/1 y i S 10✓2
to aacctt on my behalf, in all mattrers rela'tiive to work authorized by this building pet it application. Y
Print Owner's Name(Electronic Signature) Date
SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION
By e1mring my name below, 1 hereby attest under the pains and penalties of perjury that all of the information
coot ' d this a lication is true and accurate to the best of my knowledge and understanding,
r� l a-3 -IV
Print Owner's or AuthorizedAgent's 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.eov/oca Information on the Construction Supervisor License can be found at ww�v.niass.eov/dos
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'
AWre
51pli1BeA A & A SERVICES, INC.
AiRVICES 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
Buyeris)Name Date of Contrac
�' zd /
Buyers)Street Address,City,State and Zip Code
l0 5y ✓e - �X 7�1
Daytime Telep
phhone Number Evening Telephone Number Mobile Telephone Number E-Mail Address
O
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 A PROVEM ENT AGREEMENT,of which this Specification
Sheet is a part.
ROOFING SPECIFICATIO la2 I--t4
rip Roof of# AJ I layers of shingles
t Install 6'of ice and water shield at base of roof where 4' Install 15.1h felt paper to roof.
possible. Install 18-24"of ice and water shield in valleys. IF
1' Flash chimney as needed(no repointing included). I $ nstalLVperimeter drip edge to rakes and fascia areas.
t Install vent pipe boots and seal as needed. f Flash valleys as needed
t Install rollout type ridge vent. Tanks/plywood replacement
_ ifneeded there will be an extra charge of$
per hour for labor plus the cost of materials.
Om"Wir/Disposal Included: t Other:
Location:
Install new roof: Manufactureryr Style/type
Included in this proposal are thorough cleanup, building permit, and company/manufacturer warranties.
RUBBER ROOFING SPECIFICATION
T Strip Roof Not Strip Roof
t Install 112"High Density Fiberboard to existing roof using $ 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
fiberboard.s seam tape.
$ Flash up sidewall as needed.
Included in this proposal are thorough cleanup, building permit, and company/manufacturer warranties.
SPECIAL INSTRUCTIONS:
o �� .Od7lrflTY,�cL� lfvG.ifYd -� �rorrl-l�wzT I-kp -�'C�wrn,os�er..c.✓I�
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LIs kesIt is agreed antl understood by antl betwahonShewith 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 Buyeris)and the Contractor. Buyeris)hereby acknowledge that Buyeris)
has read this Specification Sheet. r _
Contractor Initials: w Date: Buyer's Initials: 0((— Date: '
� 44 A & A SERVICES, INC." �
Aet;A$� CE$ 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
eu er s Name Date of Cent let Q ae1 a
Tf
Bu ers St drove Cit ate and Zip C reet Ad otle
SMO, AAA
Q�
Da ime Telephone Number (+� Evenin Tale hone Number Mobile Telephone Number E-Mail Address
J
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 antl the reverse of this agreement and any specification sheets(this'Agreement"),and Buyers)have requested
that such gootls or services be installed or provided at Buyer's address listed above.A8A Services,Inc.('Contractor"),hereby agrees to install or cause to be installed
the products 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 Buyer(s)may seek for their
purchase. /l
Purchase Price: / Est,Starting Dale: p�pi,.I
Down PaymenL_iL Est Completion Date: i�'—(_ r
Eh Cash
Amount Due on Start of Job: �)Check
4F Credit Card
Amount Due onof Completion: No
Amount Due on of Completion Expiration Date:
Balance Due on Upon Completion' I^�.7.LL 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 terms of this Agreement.Buyerls)
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 written above.Buyerls)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 Buyerls)would be interested in any additional quality products or services of Contractor.00 NOT SIGN THIS CONTRACT IF IT
CONTAINS ANY BLANK SPACES.
A&A Services,I _ Buyerls)
By:_ oll �ru t{c
Signature -
Signature ume/� Co _
Print Pnnt t Name / r�nt,44- ` o
( f
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.
ARenRATION:Top mmra ds r antl Ire rem ai nd,hereby mutually agree of advance that in tie evem either party has a dispute Conmming this mnbact,either pant may man,so&dispute to a
private aTazuon sa^ire wh,d,has bscn approved by Me Sersetaryol the Exemuve Olfire of Consumer AXalrs enC Business Regulations and the other pony shall be required to suboul to an&
aNromon as proved in M.G.L c 1I
crtmru Liars: e,:r=rr hr r
N OF CANC ON // O IC OrC N LATbM
pat¢M Tan58etion on may Cancel Ihis bensaction,vnlhoYl any penally or pate W Transaction .You may cancel Ihis 4ansaction,vnMout any penalty or
obligation.vAtNn Nree bus nods ays mom the above elate.ll you mnr¢I,any propenylredetl In obligation,xiNin three a nes tl Got M1om the above date.IfyW cancel,any propeMlrzdetl in.
any paym¢nls trade by you ands the Conl2ci or Sale,and enynepotiable insrcument exaWled any payments made byy uunderad COnpect or 5ale,end any negotiableineWmenlevemte0
by you MII he returned Main 10 days following receipt by Me Salter of your mnellation no,-. by you will be returned form 10 data folimeng receipt by the Seller of your cancellation notice,
and any modify interest adding out of the transaction will be parcelled.If you carol,you must and any aecunty There f ansin9 out of the oansallon MII be wnwlled.If you CM ,you must
make available to the Seller at your readends.and sub wnhalry in as good condition as wren make available be Me Seller at your resitlence,and subslanually in as good Wntli ion as xfien
reaeiveQ any goods delivered N you under this Contract or Sal:orom may,iflei Msh mmply received,any goNs delivered M you under as Comandor Sale',orycunay,ifyouvnsh,mrryly
MM Me insWc4ans of the Seller regarding the return shipment at Me goods an the Seller's with me insWNons of the Seller reptiong the rehire shipment of Me goods at the Seller'd
experney and risk.II you do make the goods moss ble to an.Sella,and the Seller do-nor pip expense and risk.If you do make the goods available W the Seller and me Seller days not pick
Memup MNin20daySof Medaleolyour NmiCeol Canmllabon yaumyrelinwdis% eollhe them up trip 20 days of the date of your Notes of CoopHledon,you may relin or dispose of
goods volartt any NMor obligation.If iiii it to make Me goods avagme be the Seller,or if you the goods without any former obligation.If you fail to oaks Me goods availade to the Send,a,a
agree to return the goods to the Seller and fail to do so,then you renain liable for pMormance of you agree to reNm fire goods l the Salter and fail to do do then You been liable for perfanance
all babsymms u noer Me Contract.To mnml Who larval mail or do-,a surd and dated Wall brothers under the Cover To cancel Mld transavlon,Yet ordeliwf a signed and dated
copy of Me wnmllation notice or any other written noum,or it a telegra w AB Services trey of the can brim notice or any o r wn0en notim,m send a telegram,berr��6F S999to
115 Nonn SVeeL Salem MA 019t0,NOT tgTER TXAN MIONIGFR OF (.r 115 North Street.Salem MA 01Wq NOT LATER THAN MIpNIGHT OF 1
I HEREBY CANCEL THIS TRANSACTION 1 I HEREBY CANCEL THIS TRANSACTION
Consumers Signature pate: Coneumer s slpnature pate:
The Commonwealth of Massach usetts
l' Department of Industriol Accidents
)� Office oflnifesG9atigns
F _ 600 A Washington Street, 7//' Floor
-Y Boston Mass. 02111
"- Workers' Compensation Insurance Affidavit: Building/Plumbing/Electrical Contractors
Applicant information: Please PRINT legibly
name: /�h r!( Pyk e 0- C)11Zl,
address/ [ I MOY ! N t 71 �E:e ��1
city 5a 12 Yvs state: f•,yt A /' Iziip: D 1917�t o phone# ?2` Sri-o y,y
work site location(full address)' ' l / e+l�✓\ - IV-P `:7a le iln M )4-Cl /et ()
❑ I am a homeowner performing all work myself. Project Type: ❑New Construction Remodel
❑ 1 am a sole proprietor and have no one working in any capacity. ❑ Building Addition
[f] 1 am an employer providing workers' compensationq for my employees working on this job.
companv name: A ,1.". �iTQf.✓I'V-I
add Tess ( 15 A 4/O ✓ d d'"1 J�r �]
city' SO. Le (^-,, 1 1�,4- phone#: -l-2t F- 7���7] �/ -0 1 , ;L
insurance co 71 72a y-e I2 r- 'S poliev# C) l 3 AA Cy 15
❑ I am a sole proprietor, general contractor,m homeowner(circle one) and have hired the contractors listed below who have
the following workers' compensation polices:
company name'
address:
city- phone#:
insurance co policv#
company name:
address:
cite: #:
insurance co pnlicv#
Attach additional sheet if necessary
Failure to secure coverage as required under Section 25A of YIGL. 152 can lead to the imposition of criminal penalties pro fine up to SI,500.00 and/or
one years'imprisonment as well as civil penalties in the form oft,STOP WORK ORDER and it fine of S100.00 a day against me. 1 understand that it
copy of this statement may be forwarded to the Mice of Investigations of the DIA for coverage verification.
I do hereby certify unr, 5 th pains untt p natties of perjury that the information provided above is true and correct.
Signauu'/ Date
Print name ✓%CQ r OYZ. / Phone# 7 O 7 OY,
official use only do not write in this area to be completed by city or town official
city or town: permittlicense# ❑Building Department
❑Licensing Board
❑check if immediate response is required ❑Selectmen's Office
❑Health Department
contact person: phone#; ❑Other
(revised Sept 2001)
Control No: 33262
THE COMMONWEALTH OF MASSACHUSETTS
DEPARTMENT OF LABOR
DIVISION OF OCCUPATIONAL SAFETY
19 STANIFORD STREET, BOSTON, MASSACHUSETTS 021.14
LEAD-SAFE RENOVATION CONTRACTOR LICENSING WAIVER
A & A Services, Inc.
115 North Street
Salem, MA 01970
WAIVER: LW 000318 EXPIRES: February 12, 2615
IN ACCORDANCE WITH M.G.L. C. 111, § 197(B)(b)AND 454 CMR 22.03(3)(b),
THIS LEAD-SAFE RENOVATION CONTRACTOR LICENSING WAIVER IS
ISSUED BY THE DIV. OF OCCUPATIONAL SAFETY TO THE CONTRACTOR
ABOVE FOR THE PURPOSE OF PERFORMING LEAD-SAFE RENOVATION
WORK.
THIS LEAD-SAFE RENOVATION CONTRACTOR LICENSING WAIVER MUST
BE MAINTAINED BY THE CONTRACTOR IN ACCORDANCE WITH M.G.L. C.
111, § 19713(b) AND 454 CMR 22.04 WHEN PERFORMING LEAD-SAFE
RENOVATION WORK. /
HEATHER E. ROWE,ACTING COMMISSIONER
Massachusetts - Department of Public Safety
r
Board of Building Regulations and Standards Advanced Training
Program
Cnn.truction super,Nor
License CS-057733 Certainiteed
.
aFiber Cement Siding
CMUSTOPHER ZORZY
lls voRTH sT - Christopher Zorzy #20120426000840
Salem MA 010^97
j - A&A Services Inc Exp 4r262017
115 North St ..._,_
95 's -X iration. Salem, MA 01970
C ommiss,oner
05/26/2075 Matthew J Gibson
nwger enass.c„�,R
Administered by Data Works International,Inc.
_s Office of Cunsumer AfLrirs.W. Business Regulation
ew ..
-"*®�NOME IMPROVEMENT CONTRACTOR
Registration: 101609 Type:
- �Expiration: 6l26I2016 Private Corporatic
A&A SERVICES, INC
Christopher Zo2y
115 North Street
Salem, MA 01970 Undersecretary
with th,�75 ;al�f� 9i ff90 G, L a 40, Sam dA, a co hleuo ] of
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