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1 SYLVAN ST - BUILDING INSPECTION The Common tse;a[III of Massachusetts 1f r 13aarJ of 13 nlJing Regulations and StunJ:ar1, \11 NIt'I,I'.\I.I'I 1 blasSaChuSettS State Building Code. 780 UNIR, 7' edition til: f3uilJinC Permit Application To Construct, Repair. Renovate Or Demolish a /ii ruo''/.,/Imp,u o One- orTu'o-FumilrDuellin,q _frets r' ThFs Secti )n For Official Use Only Building Permit Number: phed; \.47 rA.0 Building Conunisnion•r/ Insperu I I i ua' ' `Datz 71ON I: SI'Z'E INFORMATION _-- LI Property Address: 1.2 Assessors Map & Parcel Numbers - L 1 a Is this an accepted strnobla eet? yes_ _ P Nunther Parcel Number 1.3 Zoning Information: 1.4' Property Dimensions: Zoning District Proposed Use Lot Area(sq 11) Frontage ili, 1.5 Building Setbacks(ft) Front Yard Side Yards - Rear Yard ! Required Provided Required Provided Required Pra%ided 1.6 Water Supply: (M G c. 40. §54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: — Outside Flood Zone'' ,Municipal ❑ On site disposal vstc;n ❑ Public❑ Private❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 caner'of Record: e /a TI°�nQ f �fYPef N e 1 Pri ) Address for Service: !29k 7W- oz/ 9 iinature Telephone SECTION 3: DESCRIPTION OF PROPOSED WORK-(ch c•k all that apply) New Construction ❑ Existing Building ❑ Owner-Occupied ❑ Repaus(s Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units_. Other ❑ Specily: Brief Description of Progused Work': "'roe, y itiN, SECTION d: ESTIMATED CONSTRUCTION COSTS Estimated Costs: Official Use Only Item (Labor and Materials) I. Building $ I. Building how fee Fee: 3 Indicate hof'ee is determined: ❑Standard City/Town ,\pplication Fee 2. Electrical $ ❑Total Project Cost' (Item 6) x multiplier x 3. Plumbing S 2. Other Fees: S J. Mechanical (HVAC) S List: 5. Mechanical (Fire `3 FoijiAll Fees: S_ Su. ressi,m) Check No. Check Amuum; h j b. Total Project Cost: /0 95 CID ❑ Paid to Full ❑ Outstanding Balance Uuz 7 t `I SECTION 5: C'ONSTRUC'TION SER 1'IC•F.S a 5.1 Licensed Construction Supervisor(CSL) '577 �l�ZG zQ // La•nse \'umber li%piramm )ale Name arc' '1 - 11 Ider I_u1 CSL'1'cpe('cc helawl WJr s. r I lv ¢ Desrri)lion L I L'nresirmcd nyi to 15.000 Cu. 1:1 R Restricted L@_' Fanull Des ollin_ 1 Slenature N1 Nlmonrs Only 2)lrf-7V/1-nya y RC ReEIJCI1lIalRUolilluCmcllll2 Telephone 11'S Rcsldenual Willai a .ma S1J111c SF Re,IJemial S01111 P'.Iel 1101111112•\r ihaucr In.i,ill.lw n,� D Re,IJentlal Demuhuun 5.2 gister•d 110 a Im ruvement -ontractor( ICI E� I? p /ne_._. /U/WO 9 -- Mc Cu any amc r IIC Ree strant Nall Regurauun Nunlhrr ` r 7�/�� _sprati( Date Signature Telephone SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152. § 2506)) Workers Compensation Insurance affidavit must be c p eted and submitted with this application. Fallurc nI pruride this affidavit will result in the denial of the Issuayfof 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 as Owner of the subject property hereby authorize //,S 2O1— to act on my behalf, in all mutters relai e ork authorized �� by thi b L g permit applica ion. -3 k/ Si nature ot'Owner Dale SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION ' [, ( ✓J�/. AZi �t7���� as Owner or Authorized Agent hereby declare that the statements and inflrrmation on the foregoing applic• _ n are true and accurate, to the best of my knowledge and behalf. S Print.Val Signature of 0wncr or A orized Agent Date (Sianed under the Dins and penalties of perjury) NOTES: I. An Owner who obtains a building permit to do his/her own work, or an owner who hires an unregistered contractor (nut registered in the Home Improvement Contractor(HIC) Program), will not haee 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 t'aund in 750 CMR Regulations 110.R6 and 110 R5. respectively. When substantial work is planned, provide the information below: Total floors area(Sq. Ft.) (includinizgarage, finished basemendattics, decks or porch) I - I Gross living area ISq. Fe.) Habitable room count _ Number or fireplaces Number of hedroom, Number of bathrooms Number or hall/hath, fvpe of heating systern Number of decks/p�lrches Type of cooling SySlem - Lnclo,ed Opcn --_-- -- -- 3. "Total Project Square Footage" may be Substituted for "Folal Project Coat" CITY OF SALEM PUBLIC PROPRERTY DEPARTMENT >..4�It!:1I1 ICK lel � II >• 11.1 ,iK SII1F1'I . 511f\I, %L\sU, III F I :+.I'I-: Yl1:9-8-'4;.959? a Fss: 7-B--a:-'1841 Workers' Compensation Insurance Afftdaiit: Builders/Coit true tors/Electricians/Plum bers _Applicant Information Please Print Le4ibly � V:IIl1C I[3u.nn•s t irg;lnlcanon hlJn IJuu1.1: A A \ddnss: IL5 f�t�)+h 5 if+ \ City,State,Zip: -SA1MJ, MP DIq-10 Phone 4: `17S) 2� I - OJJ ie \ou an employer"Check the appropriate box: Type of project (required): 1.5,/I atm a employer with _ 4. ED I atm a general contractor and 1 6. E] New construction employees(full and/or part-tithe).• have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7• ❑ Remodeling .hip and have no employees ncose.sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. q, ❑ 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 I.❑ PI u repairs of additions myself.(No workers'comp, c. 152, §1(4),and we have no 12. Roof repairs insurance required.] t employees. [No workers' 13.0 Other comp. insurance required.] •Any applicant that checks box#1 must also till out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and thin hire outside contractors must submit anew affidavit indicating such. :Contractors that check this box mailattached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I um on employer that is providing workers'compensation insurance for my employee.. Below is the policy and job site information. Insurance Company Naime: Policy p or Self-ins. Lic. (r /mob Expiration Date:/ Job Site Address: T,L_a � /L)T/�.L� City/State/Zip: Srw.l1–/7 P19 /97p A ttach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of NIGL c. 152 can lead to the imposition of criminal penalties of a ine up to 51.500.1)(1 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to)250.00 a Jay against the violator. Be advised that a copy of this statement may be f'orw arded to the Office of III\estieations of the D[A fur insurance coserage verification. 1 da hereby certij Vint •r dvpuif..and penalties aj'perjury that the information provided above is true and correc-e J U \ICn.lf llfe: Daft: Phonee. 91) B - 1- b Official use only. Do not write ut this area, to be contirleted by city or rown officiaL . City or I'gwn: . —.—_----------_--.--- PerrnitilAcense f—.--.---.---- Issuing .Authority (circle one): 1. Board of Health 2. Buildim; Department 3. Cif.wrown Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other _ Al Y Information and Instructions Ll...I:lmscus(lelie raI L.:nvs Chapter I" requnes all enipIo%ers to pro%ide aorkcrs' compensaIit)n fiir their emplo)ees. I'uu:au.uu m this.ta(ule,.in eniploree is defined as".. elen person it, the scr%lie of anoilier Under anY contract of hire, I,I oss or implied.ural or a riven." An eanplgrer is defined as "an indii dual,pinnership•association,corporation or other legal emity. or any two or more ,,(the 111n•glmig enea_sed in a Joint enterprise,and including [lie legal representati%es of a deveased employer.or the icccit er or tnutec of an individual,partnership,association or other le_L'al elitliv,vinploy nig employees. I IoN'c%er the n•.e ner of a dwelling house haw mg not inure thin ihrce:iparmunts and a ho resides therein•or the occupant of the duelling house of another who employs persons to do maintenance,construction or repair a ork on such dwelling house ar on the grounds or building appurte iant thereto shall not because of'sueh cnipiny neem he deemed rofie-an-employe. MGL chapter 15.2, �250(6)also states that"every state or local licensing agency 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 svho has not produced acceptable evidence of compliance with the insurance coYerage required." Addiriunally,MGL chapter 152, $-'5C(7)states**Neither the commonwealth nor any of its political subdivisions shall enter into any.contract for the performance of public cork until acceptable o idonce of compliance with the insurance requirements of this chapter have been presented to the contracting authority." 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 city or town that the application for the permit or license is being requested, not the Department 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 if the affidavit for you to till out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license 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 burn leaves etc.)said person is NOT required to complete this affidavit. The tlfticc 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. File Department's address, telephone and tax number: The Commonwealth of Massachusetts Department of Industrial Accidents Of ice of Investigations . 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE ltei t«d 5-'0.05 Fax # 617-727-7749 www.mass.gov/dia DISPOSAL OF DEBRIS AFF[DAvrr 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." t SQa. The debris will be disposed at: Salem Transfer Station owned by Northside Carcina Signature of PermitApplicant Date r Christopher torry Name of permit Applicant . A &A Services Inc. Firm Name 'I'f 5 Noccts Street. Salem. I&A 01970 Address, City, State, Zip Code — Massachusetts- Department of Public Safetc 9 Board of Building Regulation,and Standards Construction Supervisor License i License: CS 57733 Restricted to: 00 CHRISTOPHER ZORZY 115 NORTH ST SALEM, MA 01970 • clG_ !y/1jE Expiration: 526/2011 ` ('onunissiuner Tr#: 14751 I cz Board of Building Regulations and Standards — HOME IMPROVEMENT CONTRACTOR Registration: 101609 vpiratioie 6/262010 Tr* 267870 _Private Corporation A&A SERVICES, Christopher Zorry:, 44 115 North Street Salem,MA 01970 Commonwealth of Massachusetts Division of Occupational Safety Laura M.Martin,Commissioner kg Deleader-Contractor �t CHRISTOPHER ZORZY Eff.Date M01109 • ,. -_ Exp. Date 04x06110 . DC000440 Member of C.O.N.ES.T. J BO II Illlilll I III iiilli ir1111i II EOS70NRENEWy A & A SERVICES, INC. -t.J 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 CUSTOM REMODELING AND IMPROVEMENT AGREEMENT Buyers)Name Date of Contract Buyer(s)Street Address,City,State and Zip Code 1`17 Ti215_YMM51— .S14✓i M Mrd 01970 Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address: Q78- 7Yf; =jq 979- 7y0- y67_q R The Buyers)listed above hereby jointly and severally agree to purchase the goods anchor services listed on the accompanying specification sheets,in accordance with the prices and terms described on the front Bad the reverse of this agreement and any specification sheets(this'Agreemenr),and Buyer(s)have requested that such goads or services be installed or provided at Buyer's address listed above.A&A Services,Inc.("Contranci f hereby agrees to install or cause to lie installed the products or services listed in this Agreement at the Buyerts)address wriaen above.This Agreement represents a cash sale of goods and services. The Buyers)agree to pay in cash th cost of the goods antl services purchasetl as described herein,regardless of timing or approval of any financing Buyer(s)may seek for their purchase. Purchase Price: �Lo bPT'I Gln] Est.Starting Date: Down Payment: SHGO. Pp:-31wdil"l { ACIVf—t,N 334C', Est Completion Dater T /� 874L-S ash Amount Due an Stan of Job: Paz, 35-3• ❑Check // (� ' Amount due on of Completion: C$rv>tnel;l�yy� -Ts'� &oil J O Credit Card Amount Due on of Completion: ki C yi Expiration Date: Balance Due on Upon Completion:7tY r J 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 Buyers)hereby acknowledge that Buyer(s)has mad 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. Buyers)also (1)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 a-mall,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 Services,Inc. Buyer SY SignatureM nip" ignature �V C7 •—y >c,IZI CYJ.g f1D SJL,✓Ea7 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 the following Notice of Cancellation form for an explanation of this right. ARBITRATION.T wntamorand Nehomenwna,h...by mMudy agree in developer Nat m Ma Arend other party has a dispute mtcemim Mismno-em,biller ped,may summit such opera to a &a.athuaem mMce which has beer determined!W the secreary d the Exeaagre once of Colswmeranalre em eueleefs Regulators aro the aper parry shall the remained M swmd to such promotion res proved In M.G.L.ol41A. ` Jpz Cmrmcrar mmaI Buyai Wvals: o.e�.�=LO wt<: NOTIQFnFQANCFNeTInN NOTI. OF CANCEL l ATIO Date d Tr wm,bm3-2-(0 You may cancel Nis bang .wllrod aro e m Care elTmmallon L1�10 .Ym may ampel Nis bamsaatm,wmmd any penury v odgadmn,oft,three business days from the move doteIf youFoot,am pmed,traded in. oblgaedn.wiMM mree wanes Gays from Ne amus ems.nyou enwl.env pmmMvmed th, any payments mem by you urger Me common m sale,Ara any nmaade instrument dxmded any paymenes made q you under the confirm or sale and any notorious Nawmam awcmm In,you will be returned within to days IGlmdng receipt by the Smtsr of spur emardwon rotice, or you will be rmumm wMln do days ralpMne resseno by the seller d your established node, am my amunty Imerest were oN m Itre trensallon will be eanxlled.It rot emcm,spm mum and any factory Interest enslrg but of Ne importer will be uncalled. II you Front you mu d make avaioad or tore Seller at your doNnrq,In scabrously has grol wMltpn es Open rtteMd, make ava0ebb b Ne Spur at your prepared,in wMLnfally as gwM condition as when mehed, any goods delivered to you under Me comas at Sale;or you may.IT you wW,wmpy with Ne myduds movements to you under the comment or sale or you may,it you Amo.wmplywM the InSWdions of the Smlertparding Ne rmum sname.of for ponds of Ne Sellers expense antl inaWNAre of Ne Seller regWltp the retum shipment N Ne gams At Me Sellers expense and risk. It you do make Ne goods avalable to to Seller for Me Seller doee net pick 1Mm up risk. 9 You do make ben bonds available to iM Seller vtl the Selor beaked rot am them up _ within 20 days of the date of your Notice of Contended,you may nown or discuss of Ne goods within W days M Me data of your Notke d CmMllestion,you may main or dlsooee N Me gcros without any tumor obligation.tl you fall M make Me fords avmlabb to Me Skilled,or if you A9me MlMxdaMMMer WliBafion.Itspulailwmaoe gwdsevailmkMMe BelHaorilymagne to return Na pads to NA Sure,antl tar to d0 so.than yxi nama'vt liable non Podpmarde d all to return the goods to Me Seller and had to do st,Man you Tamen it"for pedOmaree of as - obligationsunderlMconeecLToweep¢l this maruesion.mall or eloor a signed am dated spy o1 ,01mor Merthe CwNad To carrel Nisbansampn:mdladeliveresgnedarM dalxl deity of the moderated nodro or any added woMen Noiu,or send a lelegram,to AM SeMue.115 of IM consisted mule or my dor miter rotiu,or sem a tore don,b AW Brooks,115 Nath Stroll,Belem,MassactuaM14 01970,NOT LITER THAN MIDNIGHT OF North Sheet,Sslem,MusachmeW at970,NOT LATER THAN MIDNIGHT OF (Odle) Joel.) I HEREBY CANCEL THIS TRANSACTION. (gnwmon BgnaNre Cate I HEREBY CANCEL THIS TRANSACTION. Cmandefs5gnatme Data (�'� A & A SERVICES, INC. SER[1 0ICES 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 Buyer(s)Name Date of Contract QICd Buyer(s)Street Address,City,State and Zip Code S,gLeyvl M4 o 197D Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address 97g-7Yd— 0 z 19 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 part. ROOFING SPECIFICATION Strip RoofZpipeboots i layers of shingles I nstall 6ater shield at base of roof where 10, Install 15.b felt paper to roof. possible. of ice and water shield in valleys. lash cedeel no repointing included). �t Install 6"perimeter drip edge to rakes and fascia areas. nstall vand seal as needed. CZ lash valleys as needed wl ip Install rollout type ridge vent, tanks/plywood replacement under 32 SO FT included, 'If more is needed there will be an extra charge of$ per hour for labor plus the cost of materials. Du psi /Disposal Included: Other: Cj"Lo,2 !. S7P1/L X//,//7g— Loc : Install new roof: Manufacturer 0(dYL'T7?w7b-W 30 yr Stylettype 3 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 t Install 3x3 aluminum drip edge to perimeter of roof with fiberboard.s seam tape. - t Flash up sidewall as needed. Included in this proposal are thorough cleanup,building permit,and company/manufacturer warranties. SPECIAL INSTRUCTIONS: >Hs-/79-1i- Com) Auraj y;,vLIL qi1sur uNc) vow 7-,l Cv-cmerx�w�ro f It is agreed and understood by and between the"Mee that this Specification Sl eel,along with CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,eonstbutes the entire understanding between the parties,and there are no verbal understandings changing or modifying any of the terms. This scathed may not be changed or Its terms modified or varied in any way unless such changes are In writing and signed by both the Buyer($)and the Connector.Buyer(s)hereby acknowledge that Buyer($) has mad this Specification Sheat. '7 Contractor Initials: _ Date: 7 � 'O Buyer's Initials:x n s D-I: 3h o ma Greta �lao A & A SERVICES, INC. A&ASBMCES 115 NORTH STREET,SALEM,MA 01970 �• B Telephone:(978)741-0424 Fax:(978)741-2012 Contractor Registration No. 101609 Federal EIN:04-3090162 Construction Supervisor No.CS057733 MISCELLANEOUS SPECIFICATION SHEET Buyers)Name Date of Contract Flex SILvoo- 3-Z - /o Buyers)Street Address,City,State and Zip Code` Daytime Telephon"Number Evening Telephone Number Mobile Telephone Number E-Mail Address 9�8-7ti1-0211 The Buyer(s)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 sheel and the hom and the reverse of the accompanying CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,of which this Specification Sheet is a part. SPECIAL INSTRUCTIONS 1 /x-777 C /N.(LL/9 T/OYV e 11JS77¢LL spm, ,�7 o1�rn w /w7-I'1t­-i`t- 7040 P T of w✓�S , �Lcvy -!N /S yr C[3Lc v�osa� /ivs�L�aZc�l wrrylf &Y+.-*A5— r /N t 7YI�G L L y y X F3 r/TTLO27YL nn ff1L�oVN"_iJ r filet �t 7-b &4-Ck- 0-- �/ G/-i It Is agreed and understood by and between no pelves Net this Specification Sheet,along with CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,conelilutes the entire understanding between the partles,and there are no verbal understandings changing or modifying any of the terms.Thle contract may not be changed or Its terms modified or varied In any way,unless such changes am In writing and signed by bath the Buyerls)and Me Contractor.Barone)hereby acknowledge that Buyer(s) has reed this Speciflostlan Short. Contractor Initials: 16 / Date: 7—2 —'0 Buyer's Initials:XRs Dater/�