6 SYLVAN ST - BUILDING INSPECTION (2) /
The Commonwealth of Massachusetts INSPECT NA�Ij�FRICES
Board of Building Regulations and Standards
Massachusetts State Building Code,780 CMR SALEM
1111U AU Jeff Building Permit Application To Construct, Repair,Renovate Or Demo ish a
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date Appf d:
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
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(It)
1.5 Building Setbacks(11)
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 Owner'of�ecord:
I^�Ary ..�b�/t Gyi SR.fn y0.l 2m M A 0 -7 t/
Name(Print) City,State,ZIP
an No. d 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 ❑ Specify:
Brief Description of Proposed Work': tn T&II f29 14 qL5PL1CQ:L10
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
I.Building $ JC' I 1. Building Permit Fee:$ Indicate how fee is determined:
❑Standard City/Town Application Fee
2.Electrical $ ❑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: $ �� 0 0Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 051-1.33 r
G. AS License Number Expiration Date
Name ofL Holder
I l S 11f v
List CSL Type(see below)
�fh 5�-
No.and Street Type Description
O ( 9 7 d U Unrestricted(Buildings u to 35,000 cu.fl.
CitylFown,State,ZIP R Restricted 1&2 FamilyDwelling
M Masonry
RC Roofing Covering
WS Window and Siding
U SF Solid Fuel Burning Appliances
91 E bb-- I 1 0 v 2�.�f 1 Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
A--l-►t-�e r,ri a 5 � b I (o o `1 _a
HIC Registration Number Expirationtion Date
HIC(Con oar amp or MC egistrant Name
No.and SVeet Email address
�,aL vv." Mt9- 0 ( vlzs
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 Cl,Z I C. ZOl'z y
to act on my behalf,in all matters relative to work authorized by this building permit application.
�� co✓v4MCAsr 9- 1 ,5-- 19
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
cont ' ed' this application is true and accurate to the best of my knowledge and understanding.
Print Owner's o Authori Agent'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 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 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"
PCES
a, /� �+�p A & A SERVICES, INC.
A&A$� 115 NORTH STREET, SAEEM, 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
Bu e s Name
Date of Contract
YR �: ✓0R AI ✓® NS Eh/
eu r s Street Address, City.State and ZipCode
S t-vAiv s T cowl rYi o/97 D
Da ice Tel hone Number Evenin Tele hone Number Mobile Tele hone Number E-Mail Address
978_7W�- /y �R/3NJOXlN/tJ 7-
N L-T The Buyerls)listed above hereby jointly and severally agree to purchase the goods andlor Services listed on the accompanying specification sheets,m accordance
with the prices and terms described on the front and the reverse of this agreement and any specification sheets(this`Agreement'),and Buyerls)have requested
that such goods or services be installed or provided at Buyers address listed above.ASA Services,Inc.('Contractor'),hereby agrees to install or muse to be installed
the products or services listetl in Mis Agreement at the Buyerls)address warden above.This Agreement represents a Cash sale of goods and services.The Buyerls)
agree to pay in man the cost of Me goods and services purchased as described herein,regardless of timing or approval of any financing Buyerts)may seek for their
purchase. �/7
Purchase Price So!! Est.Starting Date r J -Z
Dovm Payment t07�
Est.Completion Date �2-7—/
Eli,Cash
Amount Due on Start of Job:—_ l Check
0 Amount Due on Credit Card_
of Completion: No.
Amount Due on_of Completion: Expiration Date'
Balance Due on Upon Completion 33 �r
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 Buyerts)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 dale first written above.Buyerls)also(I)acknowledge that they were orally
informed of their right to cancel this transaction;and(11)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.
:
---Se—<: - S)
By:
Signature L-D Signature _
f3v2C�� �\
Print Name �FrA14eC 1S UO�7IBVS Er)
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:The mmmoverand the homeowner hereby musuf ly agree in advanwthel in the event ether pang has a dispute cnnreming this comas,eimermn,may submit sum dopule to a
summer
as
axTi[h hasteen eppovetl py the seveleryolthe Exeative gM1ceWConsurpu sRegWatiormand Inarearpathshallberegwredlesubmit to such
good.
es poval in M G.L c t43A. ��jjT�,�,
Cnmtenrrirsinlr&[t' auycr'al
oars:rT-te.3/ -/Y Date.
O NOTICE r' NOTICE OF CANCELLATION
Dale of Tnn C!ermorn -/3-&_You may carrel His mysideNon,writer,any penalty Or Date of Tmosecdon s-/3a YYau may sanml We hourcher,vefoof any penes,or
obligation,wiles Nreepusinresdayshomineaboceded llyouancekerryprocehytradedln unreason,Agin three business days homtheaWvedate llywcenwl.-ypovitymade]in,
any payments made by you under We Contras or See.and any negotiable instrument executed any payments Trade by you under the Contras or Sale,and any reaction Instrument Ailby you All the mormed Alvin 10 days tdlpvnng mount by the Seller Oryour wncelionsnoti nce, by yuu will be retuned Artin 10 days tot c.,receipt by 1M Serer of your dares aYrn-tine,
and any security interest arising old of the random vull Im cencelkd.If you cancer you most and any security inteest their,oul of We 0aneallon will be cancelled.It you goal,you must
muse available b the Seller W your residence,and subsorderly in as good moral as wren rake available to me seller M your readenre,and subAantially In as Who readder as Aran
rved,anygc sdelrveredloyouundert*Contresor Sele:a-youmsy,lfy-wish.-,ply rewivetl,anyBoo]s ti�aref byw untlerN¢Conmau or5ale;or,orray,Nyouvem,pmply
AM the insW.—o1 the Sell-regeNin9 in.renor Woman,oI the Bonds et the Seller s with the instructign of the Sailer regarding the room shi orent of me goods at the Serer a
expense end risk II you do make Me goods available to Ne SNIar end the sailer does not pad expense and nek.H you do make the goods available b We Seller and Me Seller does not pick
Mein up within 20 days of Me dale of your Notic M Demotions,your my Oran or fiscal of We them up within 20 days of data of your Nrtitt M Cannellab-.you may train or MsposeW
goods w.Moro any Worst Obligation.N you fail to make the gases available b the Seller or it you the goods MMON any further odtgerin.if you fail to make the goods evadable b the Seller,or it
aprea brae..Me goofs to the Sister and fail to do do.Ian you mourn Bede br cedmmance of yuu agms to refum In. pre We SHlNand'.if to do sup then you remain liable lrr cedomance
el oblgeti-s under We German.To cancel Win ransallon,neat or all a signed and dated of all obligations under the Contras.To nnwl this generation,mail or tlellver a signed and tlatetl
copy of the correlation name or any older wntlen-tire,or send a telegraj0 t A&A Services, cpy of the canortudon notic or any other earth mad,,m send a Ielryr$m W A8A S;ry
115 Nemeses,Seem MA01B)q NOT IATERT.MIDNIGHT OF M_ n,.N fl5N.-SUNT-a-MA111911.NOT—STHM mad,,
}J-//O-/Yices,
room ''// mmet /
I HEREBY CANCEL THIS TRANSACTION I HEREBY CANCEL The TRANSACTION
Consumers Signaere Dee: consumer'a 5ignaNre Date'.
nc a
1i A & A SERVICES, INC.
AAA 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
Buyer(s)Name Date of Contract
f&f-Alk- 4- moo~ foy,,�-N.5 07IJ
5uyer(s)Street Address,City.State and Zip Code
& SyLVPw �'% SRLey"I Mq O/9,70
Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address
F79- 7Ys-IY?l
The Buyer(s)Iisteb above hereby jointly and severally agree to purchase the goods anchor 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 Roof of# //!i layers of shingles
nstall j:Illif ice and water shield 94 69se of roof where nstall 15.b felt paper to roof.
p ssible. Ipgts1l 10 2 4"sf igB and water In I�.n a I I Eye.
lash chimney as needed (no repointing included). IlIfInstall 8"perimeter drip edge to rakes and fascia areas.
Install vent pipe boots and seal as needed. Wflash valleys as needed
nstall#@4&*t type ridge vent. (DPlanks/plywood replacement under 32 SO FT included,
�N�FFEL SHLNy G>� Ve'>vT 'If more is needed there will be an extra charge of$R
per hour for labor plus the cost of materials.
® umpste Disposal Included: t Other: qAF 131SQ�ffNr�
Location: 02t"Bw;I-v "Alh/
Install new roof: Manufacturer q1 o yr Style/type
ncluded in this proposal are thorough cleanup, building permit, and company/manufacturer warranties.
RUBBER ROOFING SPECIFICATION
t Strip Roof t Not Strip Roof
4 Install 1/2"High Density Fiberboard to existing roof using E Flash obstacles as needed.
screws and plates.
F Install.060 membrane EPDM(Black)rubber roofing to t Install 3x3 aluminum drip edge to perimeter of roof with
fiberboard.s seam tape.
f Flash up sidewall as needed.
Included in this proposal are thorough cleanup,building permit,and company/manufacturer warranties.
SPECIAL INSTRUCTIONS:
It is agreed and understood by and behveen 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 Buyerts)and the Contractor. Buyer(s)hereby acknowledge that Buyers)
has read this Specification Sheet.
Contractor Initials Date: Buyer's Initials: Date:. (-3 10
i'
r THE COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF LABORAND WORKFORCL9 DEVELOPMENT j
DEPARTMENT OF LABOR STANDARDS
19 STANIFORD STREET. 1305"I'ON, �tASS.4CFIUSETI'S 02114
I
DELEADER CONTRACTOR LICENSE
I
A & A SERVICES, INC.
115 NORTH STREET
SALEM NIA 01970
LICENSE: DC000440 EXPIRES: Sunday,June 07,2015 I
IN ACCORDANCE WITH M.G.L. CH. 11 I, § 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
!
I
THIS LICENSE IS VALID FOR A PERIOD OF ONE YEAR.
THIS LICENSE MUST BE MAINTAINED BY THE CONTRACTOR WHEN ENGAGED IN DELEADING
WORK IN ACCORDANCE WITH M.G.L. CH. 111 § 197B(b)(2)AND 454 CMR 22.03.
I
I
i
I
HEATHER E. ROwE, DiREcToR
t / Massachusetts - Department of Public Satzty
Office of Consumer Affairs& Business Regulation n Board of Building Regulations and Standards
11'y i,HOME IMPROVEMENT CONTRACTOR Construawn Superrisnr
1\ iRegistration: 101609 Type:
Expiration: 6/26/2016 Private Corporatic! License: CS-057733 4 .
A&A SERVICES, INC CHRISTOPHER ZORZY - '
115 NORTH ST
Christopher Zorzy Salem NLa 019707
115 North Street
Salem, MA 01970 Undersecretary �,�� E;cpiration
Commissioner 05/26/2015
4, s;
yt
= >. 1 Christopher Zorzy a 20120426000840
r A&A Services Inc Exp 4/26/2017
115 North St
_
Salem. MA 01970
The Commonwealth of Massachusetts
��k r DepartmentofbidustrialAccidents
Office nflnuestigations
600 Washington Street, 71h Floor
\
''' Boston, Mass. 02111
3t_
Workers' Compensation Insurance Affidavit: Building/Plumbing/Electrical Contractors
Applicant information: Please PRINT legibly
name: _��t'J CIS/ py�r1.Q C✓1 7e-;/—z
address: �� /VO✓ ! N t 7/ --e o:i
city 1 e state: MA zip: 0//7-70 phone 4 7F-7 S//—D Vo v
work site location(full address): lSl- ��(ya-0- 5;t- sc�-(11 uvv 1 0"I'rl G (Q 2.0
❑ I am a homeowner performing all work myself. Project Type: ❑New Construction❑Remodel
❑ I am a sole proprietor and have no one working in any capacity. ❑ Building Addition
[� I am an employer providing workers'compensation'for my employees working on thisjob.
company name: A '- >'�I- 'S Q,s-y I-�.�5t f d'lG
address:�'( 1 gS 11I0 ✓ E zn J+- n p [
city: , i-ee-(1 �� M'- phone#: /-�I ?O - 7A'71 // -/6 y ZV
insurance co. I hX_. �fOI y e I re r- '5 nolicv# V;: q,? All to l 5- _
❑ 1 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:
tits' phone#:
insurance co. policy#
company name:
address:
city: phone#:
insurance co nolicv#
Attack additional sheet if necessary
Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of it fine up to S1,50600 and/or
one years'imprisonment as well as civil penalties in the form of it S'rop WORK ORDER and o fine of S100.00 it day against me. I understand that a
copy of this statement may be forwarded to the ffice of Investigations of the DLy for coverage verification.
l do hereby/certify unt a Ih pains mud p nalties of perjury that the information provided above is true and cor�reect.
Signaturty/ Date Ot t7an ! t�'
Print name Phone#
official use only do not write in this area to be completed by city or toe'n official
s city or torn: permit/license# ❑Building Department
(-]Licensing Board
❑check if immediate response is required ❑Selectmen's Office
❑Health Department
contact person: phoned; ❑Other
(rovkedscai.2001)
DISPOSAL OF DEBRISAITMAST
MWAS NL G. L. a, 40, Say, a Con-dido,n o,
is that US AM resulting from ttss Work Ski-li
do dabrls well fit@ glapos€d at yjar 9 mttswaa SyVan
�l
Ngnal a of Pmsms;
TRM®
A a A saNIOaso Inc,
Rm Pd ®
Addre s, �atv, State, zip code
30
Aw'J Phone: 978-741-0424
MA SE \VICES Fax: 978-741-2012
www.a-aservices.com
115 North Street
Salem,MA 01970
August 15, 2014
City of Salem
Building Dept.
120 Washington Street
Salem, MA 01970
To Whom It May Concern:
Enclosed please find the permibapp icalical Lion for Frank Johansen, 6 Sylvan Street,
Salem, MA to replace windows.
I have enclosed a check for$40.00 based on your fee schedule of$7 per
$1,000.00 plus a$5 administrative fee. The total for the job was $5,011.00.
Please send the colnpleted permit to A & A Servvices, Inc. at 115-North Street,
Salem, MA 01970.
If you have an question' s, please contact me at (978)I741-'0424.
V
Thank you,for your
Sincerely,
Barbara Zorzy
Office Manager