55 TREMONT ST - BUILDING INSPECTION (5) 0 Q-/ 1 --7g
The Commonwealth of Massachusetts
�n Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code,780 CMR SALEM
Revised Mar 2011
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date Applied: 0 1 — — l
A
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 PrrooPerty 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(ft)
1.5 Building Setbacks(it)
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 ifyes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner' f Record.
Name(Print) City,State,ZIP
!ii � e w�O—Y — ` J T- 7'1 S 39 (D 9
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ 1 Alteration(s) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg.❑ 1 Number of Units Other ❑ Specify:
Brief Description of Proposed Work':
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1.Building $ 0 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:$
' 11 Check No. Check Amount: Cash Amount:
`�
6.Total Project Cost: $ S� Q ❑Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
"r c `Ln License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
1 ( � No i -(� Si
No.and Street Type Description
1;6, IK.y, U Unrestricted(Buildings up to 35,000 cu.ft.
1 I R Restricted 1&2 Family Dwelling
Cityffown,State,ZIP M Mason
ry
RC Roofing Coveting
WS Window and Siding
q'�1p SF Solid Fuel Burning Appliances
Insulation
Telephone Email address D Demolition
5.2(�RRegist/e�red Home Improvement Contractor(HIC)
HIC Registration Number Expiration Date
MCC ompany Name or HIC Registrant Name
I I S Nc✓f h S+
No d Street Email address
ago 91?7fi 6y24
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 Issu ce of the building permit.
Signed Affidavit Attached? Yes .......... 12f 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 20f-r-4
to act on my behalf,in all matters relative to work authorized by this building permif application.
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By ente 'ng in name below,I hereby attest under the pains and penalties of perjury that all of the information
contaigerf inihis application is true and accurate to the best of my knowledge and understanding.
U// I - ?--,q -1I
Print Owner's or Aut rized 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.,o Information on the Construction Supervisor License can be found at www.mass.eov/dys
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"
,ram.
3 The Commonwealth of Massachusetts
DepartntetttrrflntlustriatAecitlents
office of Investigations
} � ` 600 Washington Street, Th Floor
� Boston, Mass. 02111
Workers' Compensation Insurance Affidavit: Building/Plumbing/Electrical Contractors
Applicant information: / Please PRINT leeibly
name:
address:
city 50t 12 state: M,A Zip: 01770 phone# 97F-71/i—zWcq
work site location(full address):
❑ 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
[✓f 1 am an employer providing workers' compensation for my employees working on this job.
company name: A- -f- fT�(� 1
address: I i 5" tV0 ✓ t ctn S4--
city: n p `L /
SO. �--�et t�, .�-/4 ( phone#; r—�( 70{— 77t IIy—O t;-V
insurance co. 1 f-�__ ( ✓a y e I -e �r- tS policy#
❑ I 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:
city: phone#:
insurance co. policy#
company name:
address:
cih" phone#:
insurance co. policy#
Attach additional sheet if necessary
Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of it fine up to S1,500.00 and/or
one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 it day against me. I understand that a
copy ofthis statement may be forwarded to the ffice of Investigations of the DIA for coverage verification.
if do herehy certify utu th pains marl p nalties of perjury that the information provided above is true find correct.
SwriaLL11 t �7 Date
Print name ✓ S-><a L 0 l O✓-,Lq Phone#
official use only do not write in this area to be completed by city or town official
city or town: permit/license# ❑Building Department
❑Licensing Board
❑check if immediate response is required []Selectmen's Office
❑ticalth Department
contact person: phone 0; ❑Other
(revised Sept.20(a)
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AAA
/ /1Si�102 A & A SERVICES, INC.
AAA SERVICES 115 NORTH STREET,SALEM,MA 01970
1 is 101 kyl 111111111 NITA 11MY91TATelephone:(978)741-0424 Fax:(978)-741-2012
Contractor Registration No. 101609
Federal EIN:04-3090162 Construction Supervisor No.CS057733
ROOFING SPECIFICATION SHEET
Buyerts)Name Data of Contract
Allfre
Buyegs)Street Address,City,State and Zip Code
Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address
78 7LIs 3
The Buyers)listed above hereby jointly and severally agree to purchase the goods andlor services listed below,in accorpence 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# layers of shingles
t Install 6'of ice and water shield at base of roof where IF Install 15.b felt paper to roof.
possible. Install 18-24"of ice and water shield in valleys.
t Flash chimney as needed(no repoinling included). 9 Install 6"perimeter drip edge to rakes and fascia areas.
$ Install vent pipe boots and seat as needed. 9 Flash valleys as needed
III Install rollout type ridge vent. I' Planks/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.
it Dumpster/Disposal Included: f Other:
Location:
Install new roof: Manufacturer yr Style/type
Included in this proposal are thorough cleanup, building permit,and company/manufacturer warranties.
RUBBER ROOFING SPECIFICATION C � oN�
9 trip Roof $ Not Strip Roof 'D j S'pO SEoI h i t Uob re j.a{Fcl c�k>c s uAsf-p
Install 112" to existing roof using } Flash obstacles as needed.
screws and plates. 1p. /I-C�vA+u,.f.�. .7-/vyLlffifip7�4 ,j,
aall .060 membrane EPDM (Black) rubber roofing to Install 3x3 aluminum drip edge to perimeterp roof with
insy)9tf)snb rd w P vim• -Guredcover^fq w�+6/ od
t Flash up sidewall as needed. y/q(/ �Yikt C/ Sr�f•M•ti1i� c� S /h.
Included in this proposal are thorough cleanup, building permit,and company/manufacturer warranties.
s 4( L.4p c4u -Iffif se ,k yp,- -r-C�6 ip)1y
SPECIAL INSTRUCTIONS:
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17��rculY2��).Qr•�!/+ < rend t� A�'1 eJ['Ifi4 C/n;4rt�
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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 Buyers)and the contractor.Buyerts)hereby acknowledge that Buyers)
hes read this Specification Sheet, J
Contractor Initials: _ L_ Date: / a /1�4- Buyer's Initials: Date:
W �5 zafv
30 .
/� c V / ) A & A SERVICES, INC.
A&A J�Y yW 115 NORTH STREET, SALEM, MA 01970
• -• Tclephone:(978) 741-0424 Fax: (978) 741-2012
Contractor Registration No. 101609
Construction Supervisor No.CS057733
Federal EIN: 04-3090162
CUSTOM REMODELING AND IMPROVEMENT AGREEMENT
Bu e s a
Date of Con Cott
pCIGPH7d �.
Bu ors Street Address, City State and Zi Code
OIV70
Da lens Tele hone Number E`omingl Telephone Number Mobile Tele hone Number E-Mail Address
The Buyers)listed above hereby jointly and severally agree to purchase the goods and/or services listed on the accompanying specification sheets,in accordance
Wild 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 pos itled at Buyers address listed above.A&A Services,Inc.("Contractor"),hereby agrees to install or cause to be installed
the products or services listed in this Agreement at the Buyerls)address wilder above.This Agreement represents a cash sale of goods and services.The Buyerls)
agree to pay in Cash the Cost of the goods and services purchased as described herein,regardless of timing or approval of any financing Buyerls)may seek for their
purchase.
Purchase Pric P At/ Drltr Est Ste ing_Date:
Down Paymen. St.Comgletiod'Dale:
E ash
Amount Due on Stan of Job' �'G 6�T?.�7— 'T � j Check
p�,�� _
Amount Due an_of Completion: JJ��' '�/`—D,- Ell Credit Card No.
Amount Due on_of Completion: Expiration Date:
Balance Due on Upon Completion:' Sao 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(11)request that they be contacted via their telephone numbers car 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.
A&A Services tic. Buyerls)
ey. —nature Signature
Signature
Emit Name
Print Name
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 flghf.
ARBITRATION:Tha mntraGorandthe therms r hereby mvluallyagree In eGvmcethatin the event othereany has a disposewnmming this wmaingotherpaMrimy Submit suchdlspreatoe
M"I adutrenm eelm vTich hasbeeationa es',Me Sedrateryos Ne Eaddamoe OffiversDommerAffersar,Business Higuladansand the atheist shall esmquiresiowbdtlosum
a dearmon as pmved in M.GL c.142A. p
cnnlmrmrimd,>s M-n,lsnl-2( b
mar Din, y
NOTICE OF CgNCE LLATON NOT"' F ELLATN]N
DOM of Trap..- V--Ydh may Barrel this interval sell any penalty or Date of Thompson � i �'po may Cenral uis uansacoon,vitnout erry penalty or
otheaerialuMinthese tl yshomthe above date.IfyouwnuLanypmceMbadeder rehearse.adman Mree tables days homthe above date,IfymcamceL ampmpeMtratl din.
any payreants made by you under the Conrad or Sale,and any niparrale insbumentexecNetl any payment made by you under the command or sals,and any negodeble,,.W nserecuted
by you MII be murder nithin 10 days bllmnng receipt by Me seller of your Consultants strip, by you vnll be resumed tons 10 days fallovnng scalps by the Seller of yam mandilamen nano,
end any Moore Interest wising oN of the barea ded will be ranrxlled.If you Cancel,you mass and any se sing,interest areas out of Ma transaction vall be Combined If yw dorsal.You must
mile available He the Soler at Your rearmaddly and suhstareally in as good oandinon as when Take available to the Seller at your readents,and sulaga Bally in as goes wndinon as xTen
waved.any goods delivered b you under this Comas Or Sale:or you Tay,it You Yeah.amply remord,any 9oMs del Ivered to you under M¢Contract an Sale:oryou may.if You val comply
win the mainframer of Me Seller regarding the realm shiprrent of Me goods al the Solder's fam Me irrstructiom of the Mier loved ON the return shipment of the goods at the Seller's
expense and risk.If yen do hake the goads Season 10 To Seller and Me Seller does nor play expense and risk.If you do ranks she goods available to Me Seller and We Seller tices nor mr,
them up ari in 20 days of the data of your Nobs of Correlated.You may retain Or disease of Me them up anale 20 days M the date of your Name of Consliation,yW my Cerro or number of
goads Mthout any Immarrodeaton.If you kith make the goods assure to to Color,or it You the goods amour any NMm obngatbn.ll You tall to Take the goods avalalle to the Seller,m if
agree to retum We goods to Me Seller and fail to do he then you remain liable for pedormanBa of You agree to return the goods to the Sort and fail to do m,Men You remain liable lm persona e
a11 oNyabma under the Combed.To cenmudis tansamon,mail or deliver a signed and dated mmloldieabtnaundartba Camrm mandrel Mermaneaman,rnauordelieravgnedanddaled
day M the wndalland room or any other wMenntuce msendeteleeam,;AaA - mpy of me mnmllaam stem or any other Cadres norm.oemmanlega ABA 0;ces,
115 NOM 5veel,Salem MA 019]O,NOT LATER TXAN MIDNIGHT OF 115NONh Sheet Salem MA01P0,NOTLATER THAN MIDNIGHT OF
I HEREBY CANCEL THIS TMNSACTON I HEREBY CANCEL THIS TRANSACTION
Consumer's SigneWre Date: Cor uteri Signature Dan'
MSPOSA� OF DEBRIS AFFIDAMT
In accordance tivitth fhe provisions ®f M. Ge L. r. 40, Son, 549 a con ' ion,of
Building Permit Number f����®�e�ri� r���i'in frogs this Work shall
b�disposed ®fin a pr®pmrfy.fcensed faonify as defined.by fro Ga
M&debris will be dispensed Ito
roofs by ireonWds caoin
V
ignsfura ®f Pe i ppficard
wiiig OMNIMppiicanf .
A A Seruug®so Inn
FEE Gs
MQQ &EIRL Salerno MA 01970
Addreg.s, City, S td, Zip Coda
THE COMMONWEALTH OF MASSACHUSETTS
vnEXECUTIVE OFFICE OF LABOR AND WORKFORCE DEVELOPMENT
DEPARTMENT OF LABOR STANDARDS
19 STANIFORD STREET,BOSTON,MASSACHUSETTS 02114
DELEADER.CONTRACTOR LICENSE
A&A SERVICES; INC.
115 NORTH STREET ,
SALEM MA 01970 '
a.
LICENSE, DC000440 EXPIRES: Saturday,June 07;2.014
IN ACCORDANCE-WITH M.G.L..CH. 111, § 19713(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: ,
THIS LICENSE IS VALID FOR A PERIOD OF ONE YEAR.
i
THIS LICENSE MUST BE MAINTAINED BY THE CONTRACTOR WHEN ENGAGED IN DELEADING
WORK IN ACCORDANCE WITH M.G.L. CH, 111 § 19713(b)(2)AND 454 CMR 22.03.
HEATHER E,ROWE,DIRECTOR
e rpomunza�xuie a�ULAa�arhrraeCGf iM Massachusetts -Department of Public Safety
Office of Consumer Affairs&Busihess Regulation Lj Board of Building Regulations and Standards
OME IMPROVEMENT CONTRACTOR Construction Supers isor
egistration 101609 Type: License: CS-057733 _
xpiration fi[2Y2014, Private Corporalic.
E - -' - CMUSTOPHERZORZY' r% ---
A&ASERVICES INt,:+ 115 NORTHST m ti
Salem MA 01970�
Christopher Zorzy
115 North Street - g .=.-�<s_o '+ + , `
- c-� Expiration
Salem, MA 01970
Undersecretary - -Z-�+""' � �" 05/26/2015
Commissioner
i
'07li-rfne Po)6 .,ui` 1!7 Advanced Training
Program
(Sl/) <74-1274 (Z. CertainTee�d
#20120426000840
Christopher Zorzy Exp 4/26/2017
A&A Services Inc
115 North St
YT t�Y 3, CFI RTS ZOR2Y Salem, MA 01970
+ e —. Matthew JGibson
.r
Phone: 978-741-04 24
Fax: 978-741-2012
p&A SERV J ww.a-aservices.com
MATU-M9714 NA RZ M 115 North Street
Salem,MA 01970
January 29, 2014
City of Salem
Building Dept.
120 Washington Street
Salem, MA 01970
To Whom It May Concern:
Enclosed please find the permit application for Marc Bouchard, 55 Tremont
Street, Salem, MA.
I have enclosed a check for$40 based on your fee schedule of$7 per$1,000.00
plus a$5 administrative fee. The total for the j�b was $4,500.00'�
Please send the completed permit to A &A Services, Inc. at 115 North Street,
Salem, MA 01970. ��
If you have any questions,please contact me at (978) 741-0424.
Thank you for your assistance. L
Sincerely,
Barbara Zorzy LLL
Office Manager
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