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19 TANGLEWOOD LN - BUILDING INSPECTION The Commonwealth of Massachusetts Board of Building Regulations and Standards OFSALEM CITY Massachusetts State Building Code, 780 CMR, 76' edition RevvisedTanuary Building Permit Application To Construct, Repair, Renovate O etmolish a 1, 2008 One-or Two-F aly welling U This Secf n For Official Use Only Building Permit Number: D to A plied: Signature: 0 lk".0 Building Commissioner/Inspector of Bu di gs Date SECTI 1: SITE INFORMATION 1.1 ro erty Address: 1.2 Assessors Map&Parcel Numbers ly 1.1 a Is this a 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 ❑ Check if yes❑ .SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner of Record- /�� t- � `A71 Name(Print) {j A dress for ice: te 2>e�ysy� Signature Telephone SECTION 3:DESCRIPTION OF PROPOSED WORKz(check all that apply) New Construction❑ Ex sting Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units I Other ❑ Specify: Bri Descripfon of Proposed Work: — J?eO SECTION 4:ESTIMATED CONSTRUCTION COSTS Estimated Costs: Item (Labor and Materials) Official Use Only 1.Building $ 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑ 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 $ Total All Fees: $ Suppression) Check No. Check Amount: Cash Amount: 6. Total Project Cost: $ a y'� 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) n- ZLicense Number Ex iration ate Name fCSL- old- " r List CSL Type(see below) '" Type Description A U Unrestricted(up to 35,000 Cu.Ft. R Restricted 1&2 Family Dwelling tux i M Mason Only RC Residential Roofing Covering Telephone WS Residential Window and Siding SF Residential Solid Fuel Burning Appliance Installation D Residential Demolition 5 Re stered Home Improvement Contractor(I3IC) HIC Compan Name or C R strant N e _(' Registration Number J�� cation Mte Signature Telephone. - - SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152. g 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 Issuan 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, �// /)iT ,f,t/ p as Owner of the subject property hereby authorize Ci to act on my behalf,in all matters relative to work authorized by this building permit app: ation. Signature of Own ' AED ate n y / SECTION 7b: OWNE�W O UTHORIGR Al DECLARATION I, ( �/ l 2 7 as Owner or Authorized Agent hereby declare that the statements and�information on the foregoing plication are true and accurate,to the best of my knowledge and behal Print Nam Signature of Owner or Authorized Agent Date (Signed under the pains and l2malties of er'u 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 and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.R6 and 110.115,respectively. 2. When substantial work is planned,provide the information below: Total floors 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 halfibaths 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" :A",• The Commonwealth of Massachusetts µ Department oflndustrialAccidents -Wd i= Office of Investigations 600 Washington Street 1 Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): oca o Q ) inV Address: I ' b. N100S-If - City/State/Zip: MO 6 19 0 Phone #: 9 Are yAu an employer?Check the appropriate box: Type of project(required): 4. ❑ I am a general contractor and I 1.[0 I am a employer with 6. ❑New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have.workers' 9. ❑Building addition [No workers' comp. insurance comp. insurance? required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required.] Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. [Contractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have. employees. If the subcontractors have employees,they must provide their workers'comp.policy number. I ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. I I I Insurance Company Name: Q Ir1y��� i/J� Policy#or Self-ins. Lic. #: 7�y} 11 11 �1�/�y Expiration Date: �l C� Job Site Address: /4 Fes`1 Lp C�� '( / � l City/State/Zip /) tJ 1 / l 0 Attach a copy of the workers'-c pensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 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 day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify der a pains and penalties ofperjury that the information provided above is true and correct. Si nature: (�G Date: Phone#: 10 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: i Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(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 who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence 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-contractor(s)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 of the affidavit for you to fill 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 Office 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. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 4-24-07 www.mass.gov/dia DISOPSAL OF DEBRIS AFFIDAVIT 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 is osed of in a property licensed facility as defined by M.G.L.c. shall bed Y P p P Y 111, Sec. 150a. The debris will be disposed at: Salem Transfer Stat ion Owned by Northside Carting C�2/ '4� Signature of Ffermit Applicant 7 Date —T Christopher Zorzy Name of Permit Applicant A&A Services, Inc. Firm Name 115 North Street, Salem, MA 01970 Address, City, State, Zip Code Control No: 5 1 9 3 THE COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF LABOR i e DIVISIOIN OF OCCUPATIONAL SAFETY .. .19'STANmoRD STREET,BOSTON MAsSACHUsETTs 02114 DELEADER CONTRACTOR LICENSE A &A SERVICES, INC. 115 NORTH STREET SALEM MA 01970 LICENSE: DC000440 EXPIRES: Wednesday, April 11, 2012 IN ACCORDANCE WITH M.G.L. CH. 11 1, § 19713(b)AND 454 CMR 22.03,THIS LICENSE IS ISSUED BY THE DEPARTMENT OF LABOR,DIVISION OF OCCUPATIONAL SAFETY TO THE CONTRACTOR ABOVE FOR THE PURPOSE OF ENTERING INTO OR ENGAGING IN DELEADING WORK. 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. 11 I § 19713(b)(2)AND 454 CMR 22.03. HEATHER E. OWE,ACTING COMNESSIONER e Printed on Recr ycled Paper .. .:✓ --- ----- �� ". :Massachusetts - Department of Public S:d'ch airver Affaea ' Office of Consumer Affairs&B sincss Regnla4on Board of Building Reguln[ions ;uul Stand:urtls HOME IMPROVEMENT CONTRACTOR "" Construction Supervisor License Registration 101609 Type: License: CS 57733 Expiration 6/26)2012 Private Corporation SERVICES, iNC - CHRISTOPHER ZORZY ~ � 115 NORTH ST Christopher Zoay SALEM, MA 01970 115 North Street _ g� moo_ Salem,MA•01970 Undersecretary Expiration: 526/2013 ('anon issioner Tr#: 15935 i NOV-05-2010 16: 19 Sunrise Windows AA P.02 an v I INguard ® ® ® e o ® e A view that works Vanguard Windows are tested and certified to National Fenestration Rating Council (NFRC) standards. These are the numbers ENERGY STARe' uses to determine how fenestration products comply with their standards, and to categorize the products for the appropriate climate zone(s). Window Glass ", ,_Factor SHGC I Type Package ! , VG Plus 0.28 0.28 Double VG 12 0.28 0.21 C""® Hung VG'Ar 0.22 0.22 VG Plus 0.29 0.28 Slider VG 12 0.28 0.21 VG'Ar 0.22 0.22 VG Plus 0.28 0.28 Tilt-In Slider VG 12 0.28 0.21 ® Northern VG'Ar 0.22 0.22 ❑ North,Central VG Plus 0.28 0.30 (' :xrt+e••g Picture VG 12 027 0.22 ; ❑ South/Central w VG'Ar 0,21 0.22 �_,.[^;._ 1'. VG Plus 0.26 0.24 •-f .-; - Southern Casement VG 12 0.25 0.18 i.„- _ •„ Alternative VG'Ar 0.21 0.19 Coterie Allowed VG Plus 0.26 ^0.24 Awning VG 12 0.26 0.18 W VG'Ar 0.21 0.19 VG Plus 0.26 0.28 Casement VG 12 0.25 0.21 Picture r' VG'Ar 0.20 1 0.22 VG Plus 0.30 0.27 _. Sliding Door VG 12 0.29 0.20 " VG3Ar N/A NIAr N/A www.vanguardwindows.com This data Is accurate es of February 26,2009.Due to ongoing product changes,updated test results,or new industry standards ar requirements,this data may change over time.Ratings are for sizes specified by NPRC for testing and certi(Icatian.Ratings may vary depending on use or tempered glass,different grid or decorative glass options,glass for high altitudes,coastal applications,etc. i t•,•' rRAi.. e:. �r t °-tS ni - be�dwj.;c' 1.`: �kuIS�10q{'rr!.• 1', r TOTAL P.02 w� Tn� =bga2 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 EIN:04-3090162 Construction Supervisor No.CS057733 CUSTOM REMODELING AND IMPROVEMENT AGREEMENT Buyers)Name Date of Contract AI k­­3L)- 3v,( Buyers)St eel Address,City,State and Zip Code fit, ^ fk nn Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address; 7%-7'- -- qif The Buyer(s)listed above hereby jointly and severally agree to purchase the goods and/or services listed an the accompanying specification sheets,in accordance with the prices and terms described on the front and the reverse of this agreement and any specification sheets(this"Agreeme l and Buyer(s)have requested that such goods 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 Buyer(s)agree to pay in cash the cost of the goods and services urchmed as describe tl hereinu regardless of timing or approval of any financing Buyerlsl may seek for their purchase. GANU OfU ."Le— 'N O� Purchase Price: 24e ii ff, Est.Starting Date. � a Dawn Payment: INlNrllF 'L� Est.Completion Date: .It 1st 7 Cash Amount Due on Start of Job: �'N C' "h^h � er¢ U ❑C Ir Card Amount due on of Completion: �. +Jc Pal w'ws�4✓- No. Amount Due on of Completion: E� Expiration Date: Balance Due on Upon Completion: / CVC Code: It is agreed and understood by and between the parties that this Agreement,front aB.d 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. Buyer(s)hereby acknowledge that Buyer(s)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 allached Notice of Cancellation forms,on the date first written above. Buyers)also (i)acknowledge that they were orally informed of their right to cancel this transaction;and(it)request that they be contacted via their telephone numbers or e-mail, 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 1F IT CONTAINS ANY BLANK SPACES. A&A Serv�In� /I Buyer(s) j Signatures Signatu e Jlwt Ld, 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:The wntracOr aM the homeowner hereby m uany agree in advance 1het he the seem either paM has a chance concemitg this wmmor,either party may submit such dispute A e p,iwre arbitration service wail M1as been approved by the Secretary M the Executive Order of Consumer Affairs and Business Regulations antl the other parry shall be required to submit b such arampron as proved In M G_c.1 upO Contmcror infra ate. Date'been flat D NOTCE CE CANCFI I ATO NOT CE OF CANCELLATON Date of Tobaccos .You may cancel this lchavinrioo wimad any penalty or Dare of Tramedlon .You may call Nis treneacrian,wlNour any penalty ie obligation.wiNln three business days from me above dens,if you cancel any propeM batled In. obligation,whin three business days tram the above dare. If you canwl.any property board in, any payments made by you maker Me Cartoon an Sale,and any negotiable Imtrvment executed any payments made by you under the Conrad or Sale,antl any negotiable Instrument executed by you will be retuned wihie 10 days(allowing rewipr by the Seller of your cancellation notice, by you will be returned within 10 days following receipt sty the Seller of your underion no,0, and any security inhered arising am of the transaction will be cancelled. 11 you cancel,you must am any soccomp,dramet arising out of the normactlpn will be Cancelled If you CBl you must make available To the Seller ar your residence,in sutrtantialll goodwMhps as when received, make awWal He the Call at your hardeners.in substantially as gmi mNifwn as ahad raceiel any goods delivered to you under this Conrad or Sale;or you may,it you whip comply with the any goods delivered to you under this Commor or Sale:or you may if you wism.comply with the instructions of Me Seller regarding Me return shipment of the goods at Me salters expanse am managrient of the Seller regarding the return shipment of Me goods at the Sellers expense and risk. If you do make the goods available to the Seller and the Seller dws net pick them up risk. If you do make the goods eveleable ro Inc Seller ead me Seller does not pick Nero up within 20 days of the date of your Nonce of Cancellation,you may return or dlsoove of Ne goods wi In 20 days of the data Of your Nnllce of Cancellation,you may retain or dispose of me guests wirhoutanyfuMerobllgatbn. Ilyw tall to make tM1e gOMS availeblerorhe Sellep or if you agree without any further obligation, Ilyou fail to make the goods available tote Seller.or if you agree ro mium the gootls to the Seller and fail to do so,then you remain liable far performance of all to return the galls to the Seller antl fail A do w,that you remain lishle for performance of all obligations under me Contratl.To cancel this theca ioq mail or deliver a signed and dated spur obllgatlomundeiNa Centred.To cancel this Vanmctlon,mall or deliver signed and dared copy of the cancellation norm or any Other written notice,or sand a 1al gram,to ABA Smvrces.115 of Me cancellation notice or any most writlen nonce,or send a telegram,to AeA Serdices.115 NOM Street,Saem,Masse UWts 01970,NOT LATER THAN MIDNIGHT OF North Sheet.Salem,Massachusetts 01970,NOT LATER THAN MIDNIGHT OF (Date) (mate) I HEREBY CANCEL THIS TRANSACTION. Consumer s Signature Dare I HEREBY CANCEL THIS TRANSACTION. Consumer's Signature Data • C + FGatl /��n�'p `/ /7��° A & A SERVICES, INC. P�Q•.l'1��i`�i"E�Y DIES 115 NORTH STREET,SALEM,MA 01970 irellyj 10 1 IVAN a 41191MMUMM Telephone:(978)741-0424 Fax:(978)741-2012 Contractor Registration No. 101609 Federal Ell 04-3090162 Construction Supervisor No.CS057733 WINDOWS AND STORM PRODUCT SPECIFICATION SHEET Buyers)Name Date of Contract Buyer(s)Street Address,City,State and Zip Cade t6y,�WDol Lm& O ?� 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 pan. 'T WINDOW REPLACEMENT p t Remove and ispose of# 7 �exis/ling winc�pws. C/iihe ���7� ^Y r�,� t Install #7 new Iqt//N7 )'4rl?�i N!?l ,It9dows: Vin t Wood I (Manufacturer) Options: Style I ✓3� ' ij , / —p ry �1 C��L C>'w Grid pattern Color Color Interior Color Exterior 4VVIi-v— Glay$'s Type I Wrap exterior trim with aluminum: Style - y--e- Color UDU tz It All windows will be installed according to the installation procedures in the portfolio. t Caulk all interior and exterior edges. t Insulate where possible around new units. t Insulate window weight pockets if exist,and around new window units where possible. t Included in this proposal are set up,clean up,Reps vacuum and cleaning windows inside and out. t Building permit included. BAY/BOWS/CASEMENT UNITS/ANY FULL CONSTRUCTION WINDOWS If Create new window opening by cutting through existing home and framing in opening. t Remove and dispose of existing 1 unit(s)in its entirety. Note:Electric and plumbing may exist in wall and will require additional costs to customer if need to be dealt with. t Install window(s)into opening(s). Note: If Bay or Bow installation to include cable support system,new roof system(matching color as close as possible) or tie into existing.soffit system. t Bay t Bow t Casement�t Other window(s)to include new interior style trim and new exterior style trim and head flashing as nee e t Note: Painting and staining not included. STORM PRODUCTS t Remove and dispose of# existing storm window(s). t Install new storm windows# Manufacturer Style Color Option t Remove and dispose of# existing storm door(s). t Install new storm doors# Manufacturer Style Color Type: t Aluminum t Solid Core ((�prQ,+��7(1�I1 %� 'Ult�'9 bJJGE�at �nY�t•1�^/rfGi/G W.N�p.✓ J1!I��) Ivt&3S'fr+¢.,yten.r SPECIAL INSTRUCTIO S: Tr.is, J( ;"IriYx1.t 0" Ara Vhneyn�� (;1t'r rvyiwr. ,-�,�� r�iy�I !`2tlM sue_ 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 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 Buyer(s)and the Contractor.Buyers)hereby acknowledge that Buyers) has read this Specification Sheet. Contractor Initials: ,//, __ Date: f4yIl Buyer's Initials: Datek__-�j -