9 WARREN ST - BUILDING INSPECTION (3) The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY 'I i
Massachusetts State Building Code. 780 CNIR S1t't `
j� G.ti.cd . .-' 11
Building permit Application To Construct. Repair, Renovate Or Demolish a
One-or Two-Family Dwelling
This Section For Officia se Only
Building Permit Number: Date pplied: __ _
_-
Budding,Official (Prins Nauwl r Signature
SEC]'ION I SI I V INFORM:`.I '_P.
1.1 rope rtv Address:�J.., 1.2 tsscswrs RA,: sz P:^re l Nu inners
l.la Is this an accepted street?yes no_._- P rc 1 Namocr
L14 1,4 i1nnertvU rcn:mns:
I !
Zonmr District Proposed Use Lot Arc.t(sq IT) Frautage(lit -
1.5 Building Setbacks(ft)
Front Yard -- --- Side Yard., Rear
Required Provided Required Provided_ �_ Requited 1 ,•
_fit{.__—
1.6 Water Supply: (M on:.G.I.c.40,§54) 1.7 Flood Zone Informati 11.8 Sewage Disposal SN+
Zone: Outside Flood Zone"
Public❑ Private❑ Municipal ❑ Chi site 7 s:d, iicln ...
Check if yes❑_____— .._.... __.e
SECTION.2: PROPERTV''OWNERSHIP1 -
2.1 Owner'of Record:
— v4 via M o—l°I"t O .
Name(Print)
No and Street Icicphone I cad
-
SECTION 3: UF,SCRIP'1'fON OF PROPOSED WORK'(check all that
_ appSy)
New Construction ❑ Existing Building❑ Owner Occupied ❑ R aepaep a (s) .� TAlteranc.n sl >� Ic
i
Demolition ❑ Accessory Bldg.ElNtan cr Other ❑ Specify
Bnef Description of Proposed Wm k': -A (1 ..lX
SECTION 4: ESTIMATED CO.`+STRUCTION COSTS
Estimated Cost.'
Ite t tJ- t net i Use Only
(Labor and AAatci ill s t _ _ _
I. Buildm - $ 3 q -- I-. b uldin Peimil Fce a __ naicate L: a f(Ic t,.;
EJ Standard City/Town rAI-pncati n Fee
2. Electrical -_ _-_ S--- ----� ' ....❑ olal Project Cost �t i 6)x udtq�ucr_
3.
Plumbing I Other ees: $nV
/
i. Mechanical (I-IVAC $ (. st .:.• ._ L3�Q-J-_ .. F2
Sum ncssion) $ Total All Fees:
-.- _..
. -- - (,�, l-t lNo _Chet' m 1ount Cl_ 1
6. ota rojecosh
Total P - t C $ 3 53_1 ' Paiti
L ( _ �❑ in 1 ull ❑ Outstaudin 6 h.iicc i tu
SECTION 5: CONSTRUCTION SERVICES _J
5.11� Construction SupervisorLicense(CSL) ��---1
License Number Expiration Date
Name of CSL Holder t
1 I f No✓4� S4-,
List CSL Type(see below) U
No.and Street Type Description -
C M Q U Unrestricted Buildin s u to 35,000 cu. ft?
0 < 1 R Restricted 1&2 Family Dwellin
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
�} rt SF Solid Fuel Burning App:ianccs
1 Insulation _
'telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
1t.r R- _tC Registration _ FX�n'�
NI �� �l'LC� HIC Registration Number Exprratiori'(,are'i
HI �Co ip n,Nan e or FIIC Registrant Name
N and Street Email address
City/Town,State,ZIP 'felc hone
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 pi m
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 *t}
1,as Owner of the subject property,hereby authorize_��r __{}-0r��
to act on my behalf, in all matters relative to work authorized by this building permit application.
i
i
Print Owner's Name(Electronic Signature) Dste '
t
SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION
By entering my name below, I hereby attest under the pains and penalties of perjury that all of the informaiion -
coOnehis ap nation is true and accurate to the best of my knowledge and.understand ing.
i
_ t � - as-_► 3_
Print Owner`s or Authmiz d Agent's Name(Electronic Signature) Datc
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 n
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.&o "dps
2. When substantial work is planned,provide the information below: !
Total floor area s ft. (including garage,finished basement/attics,decks or porch
( q� ) (� gg g porch) - I
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__-__________
i
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
11/16/06 THU 17:04 FAX 617 393 2415 MEDFORD BUILDING DEPT. zoos .
a The Comirtonweallh of Massachuseds
- peparintent oflinnditslrialAccidents i
Office of-In ves6galions
s � 600 Washingdoer Street
b( Boston,MA 02111
ca www.nrass:goi,/die
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electnici�us/P mbers
Applicant Information Please Print I egibly
Name(Busincss/Organization/Individual):����1
Address: /ti NO✓"�
City/State/Zip: a(Gryl In 6 0600 Phone 4.
Are you an employer?Check the appropriate box: Type of project(required):
1.1 re3 1 ant a.employer with `� 4. ❑ I am a general contractor and 1 6. ❑ ew construction
employees full and/or part-time).* have hired the sub contractors
( p ; 7. [ Remodeling
2.❑ I am a sole proprietor or partner- listed on the attached sheet
ship and have no employees These sub-contractors have S. ❑Demolition
working for mein any capacity, workers'comp.insurance. 9. ❑Building addition
[No workers'oomp.insurance S. ❑ We are a corporation and its 10❑Electrical repairs or additions
ntquired.] officers have exercised their
3.El 1 am a homeowner doing all work right of exemption per MGL I I-❑Plumbing repairs or addinons .
myself.[No workers'comp. c. 752,§1(4),and we have no 12.❑Roof repairs
insurance required.]t employees- [No workers' 13 ❑ Other
n comp.insurance required.]
'Any applicant that ehe&s box 91 must also fill out the section below showing their worker'compensation policy information.
t Homcownets who submit this affidavit indicating they am doing all work and thrn him outside watActor must submit anew affidavit indicating sueh.
TC.mmc on flat cheek this box must atrebed an additional sheet sho Wing the name oflhe sub.runbr ton and their workers'comp.policy ihfomatian.
f am an employer that is providing workers-'cotnperualion insomftee for tnJ,employees: Below is the p0cy and job sUe i
i
injotrnadaa [
Insurance Compatry Nan7e: 1—r0.yd f-e✓S q —
Policy#or Self-ins.Lie.#: � -4 �K b-�1 5E Expiration Date: /'/ 3 ' 3 G
Job Site Address: I l ) 0-cc?.h SA-- Chy/Statc/Zip:�Le e 1v- [1/ A-0 117 0
At'[ach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Pailure 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 u err e p and penalties ofperjary that the lttfortrra lon provide_d above h trine and cat•rect
i
i ature, �y Date
Phone#•
FO:tMhcr
only. Do nor terim in.this area,w be comptded 6J,city or team Wiciat
n• PermitUccuse#
hority(circle one):
Health Z-Building department 3-City/Towa Clerk 4.Electrical Inspector S-Plumbing Iaspeetar
son- Phone#:
DISPOSAL OF-DEBRIS AFFIDAVIT ..
In accordance Mth the provisions of M. G, L. o, 40, Sao, 54, a condit1on of
Building Permit Number (� ik 6a debris resulting from this Work sIicll
be d8spsed ®!.1n pP®peP(�.(ECm��®� �((1r�� ��gu9®�.�}�F�9e�, �o �0 9 9, ®oo
The debris %pill be disposed at: UeM
Mmad NoFff- ide cam"n
Signature of, Pe�1 ®pIlcant
KP-ms of Pe r1t A�p11cant .
A &A Sgui-990 Inc.
Firm NG9
g Mth 9freaL Beira. A 01970
L
td, F, 6;F
-\ THE COMMONWEALTH OF MASSACHUSETTS
- •EXECUTIVE 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
LICENSE: DC000440 EXPIRES: Saturday,June 07,2014
IN ACCORDANCE WITH M.G.L. CH. 111, § 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.
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 § 19713(b)(2)AND 454 CMR 22.03.
HEATHER E.ROWE,DIRECTOR
e !pa•��r7�conuoea�of.CJ��¢Jdaclrue.(l`i
We Massachusetts -Department of Public Safety
Office of Consumer Affairs&Busiftess Regulation Board of Building Regulations and Standards
OME IMPROVEMENT CONTRACTOR Construction Super,isor
egistratfon 101609 Type License: CS-057733
xpirdtion: 6I26/2014. Private Corporatie
CIMSTOPHER ZORZY�ry o
A&A SERVICES
115 NORTH ST i�`lill0'►}/r _
Salem MA 01970- t
Christopher Zorzy
I ..
115 North Street
Expiration
Undersecretary
Salem, MA 01970 5; 4 05/2612015
Commissioner
'wits li.ivancedTiraining
flak a' y 120 = io .. +�
lv y ai"! jCertainTeed4 i
W.
"''� •. - #20120426000840
Christopher Zorzy
Exp 4/26/2017
&A Services Inc 1 _
115 North St
[)61I CHRIS ZORL) Salem, MA 01970 i't,'� r tth -
Matth ew'J Gibson
.:. A & A'SERVICES, INC.
A&A SMICES 115 NORTH STREET,SALEM,MA 01970
:Telephone:(978)741-0424 Fax:(978)741-2012
Contractor Registration No. 101609
Federal EIN:04-3090162 y _. Construction Supervisor No.CS057733
- MISCELLANEOUS SPECIFICATION SHEET
L,
Buyer(s)Name - Date of Contract
G14�L t /�Ll 6/S. W1.7TYN6-
Buyer(s)Street Address,City;State and Zip Cade
6? JA11qn 2&*j sY- -5e1, VL z
Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address
8-7�f1-33q s- 978-Rl8-z373
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 sheet and the front and the reverse of the accompanying CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,of which this Specification
Sheet Is a part.
SPECIAL INSTRUCTIONS
,3h0 �iocryrt_. r$lG`/ 7il tpld'�
9Clo7�tot/ts` t Ofs s mjt 6k`9L6461-T oy 3n.9
iMs �2x))<-O tvilydw✓ 5,6 65-- /tiz� Cv/zeS ,
/(I � t Lt/r'�- 77�YL-5'!�c L�I� &&->y -
&"ff W (/�LV)d -Sk `f L H-F Aq? 2� 22
//US&iL- !UL'1tl 5�� Pn�' P�rIsla U-n /AV-7� rn/m &M/,UYJ
A/E3k1 Lt/t n/r0 ox1
9/✓ tm2
/NS✓L [vl arc r�cn �' 5 / 7 tga<Y D yut,s-J CIA.,eT
A-Alp GLt319rt1-`I/ 1lUGi-u0.7j'� , .
'` �t�-N�Lt! /NGL✓per
It is agreed and understood by and between the parties that this Specifwtlon Sheet,along with CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,constitutes
the entire understanding between the painter,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(a)and the Contractor. Buy (r)her yacbnowted that uyer(s)
has read this Specification Sheet. — k � 0113
Contractor Initials: � Date: ,?
� 13 Buyer's Initials: Date:
i
� pp E yg �1 0 A & A SERVICES, INC.
I�
A' &A S C 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'S -
Bu r s)'Namd Data of Contract
� L 4045"' U t 7 Z f-i3
eu rs) Street Address, Cit y,State and Li Code - •>• - '�
Da ice Telephone Number. Evenin Telephone Number Mobile Tele hone Number E-Mail Address
-7 l-3.3`t� -O6 -7313
The Buyer(:)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 an the front and the reverse of this agreement and any spedhoalien sheets(this'Agmement1r),and Buyers)have requested '
that Such goods or services be installed or provided at Buyer's address listed above.ABA Services,
Inc.('Contractor'),hereby agrees to install or cause to be installed ,
the products or services listed in this Agreement at the Buyer(:)address written above.This Agreement represents a cash sale of gootls 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. q p y
Purchase Price -�L/ I a ESL Staring Data:(v�ZY -1 `6 d
Down Payment#i� ESL Completion Data:
r�fjl'Cash
Amount Due on Start of Job: �I. Check
Credit Card 1
Amount Due on of Completion: No,
Amount Due on of Completion: Expiration Date:
Balance Due on Upon Completion S�' - 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 understanding.changing or modifying any of the terns 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 attached Notice of Cancellation forms,on the date first written above.Buyer(s)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 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 Ser ' es,Inc. Buyer(s)
Signa are SignaturV `
i / C 1 k CF3RL h7 .�xl�fitiv
Print Name Print Name
i
�S'Ignalure j
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 contracbrom the bomeoamer hereby nwWallyagrea in advance Pal in Me evens eiNerpaM has a distant wnceming NIs cormad,eararpaM1y may submit such dispute to a
Front a,bltratien Serviee whits Has been approval by Pe Secretary al Me Eaecuties Care of Lonsumerein and Bu9ness Renterec nsend Pe ether pare shall be required to submit b such
ammunme n as proved In WE L e142A.
ini— barer:Date. misul,:
Date: — Date:
NOTICE Of CANCELLATION p NOTICE OF CANCELLATION
Dale of T.r_dbn7 2y 13.You may of INa connection,without any pcarry or Data of Transact ion7 1-3.Yancey as col this Iransactloq vmham any penalty or
oblryalion.Within three m th locame dayahoeabovadme-Ifywayeand nypmpedylear i0. moisture,awards three business days Inertly.
abe do,..ltyoucencel,anypmpenycadedin,
any paymxnls matle by you antler Ne Lontraca or BNe.end eny negotiable insWmenl¢mwaetl any payments made by You untie,the Contract or Sale,and any negotiable instrument executed
W you yell he returned vitrin 10 days fallowing recruits by Me Seller of your renandYon entice, by you will be retumad v5Nln 10 days follwmg receipt by me 5 J,a,of your wncellaVon no,-,
antl any semnly moment sitting out of Pe transaction mll be ancelletl,If you anal,you must and any secunry interest acting am of Me transaal of he once Q It you cancel.you must
neke available to in.
Seller at your measure.and subseanWlly in as good condition as Arm make available to the Seller at your residence and substantially in as good mndi0on as when
receleas any goods delivered to You under the Contract or Mew or you may,if you whir.comply arelved,any goods delvered to You under Nk conbaU or Sale;or you may,is you Vil comply
x4h the imcuctlwas of the Seller regarding Me return SNpment of Pe gootls at me color'a Mlh Pe instructions of Pe Seller regarding the return shipment of the goods as Me Seller§
evyeres and risk.If years do make the goads available to the Seller-and Pe Seller does not pink expense and&L If you do make Me gores available so the Sister and He Seller doe.not Fit so
them up within 20 days ofM.date of your Nobs of Caroodumon,you truly realm or dispose of the them up years 20 days of the data of your Noua of Cancellation,you trey resin or da,mae of
goods errhat any luMer uWgatior if you fail to make Me goods available to Ne due,or if you Pe goods where anyfuMer oblessam.If your fail to cake Pe goods comable to Me Seller or
agree to realm Megoods to she Seller and tail to do as then your remain Gable for performance of you agree b return the goods to aha Sets rend fall is do car.then You remain liable for performance
all oWhIs m.-it.,Me Curacao.To cancel this caneatlioq mail or deliver a signed antl rased of all obligations under Me contract.To compel this termadon,mall ordidwyer a slgred and its add i
eopy of Me mncellaMn notic or any other vrtiMn retie,or seed a let e rz to MA Services, copy of the ancelladon nofie ar any Omer weber notice,or seed a lety/ �so'�p S.-c",
115 North Street,Salem MA 01970.NOT IATFR THAN MIDNIGHT OF 115 of
SYeeL Salem MA 01970.NOT LATER THAN MIDNIO1fr OF rent
. n r tV ;re,e, 3
I HEREBY CANCEL THIS TRANSACTION I HEREBY CANCEL THIS TRANSACTION —1
Consumer'.Signa.. Date Cuaturr sBlgnalure Data 1
Grade
Abovee
Since 19l 2 Phone: 978-741-0424
Q_e �w` Fax: 978-741-2012
e
/' &A SER V 'CW w .a-aservices.com
• , 115 North Street
Salem, MA 01970
July 25, 2013
City of Salem
Building Dept.
120 Washington Street
Salem, MA 01970
To Whom It May Concern:
Enclosed please find the permit-application for Carl Wathne at 9 Warren Street,
Salem, MA to replace the roof. It
I have enclosed a check Z$33 based on your fee schedule of$7 per$1,000.00
plus a $5 administrative fee. The total for the job was $3,539.00.
Please send the completed permit to A & A Services, Inc. at 115 North Street,
Salem, MA 01970. f
r' r
If you have any questions, please contact me at (978) 741-0424.
f � J
Thank you for your assistance. i
f ,
Sincerely,
Barbara Zozy
Office Manager
r
i
f ,