15 WEBB ST - BUILDING INSPECTION 1u - 13g3
The Commonwealth of Massachusetts RECEIVE 0
° Board of Building Regulations and StandardINSPECTIONAL ERAWM
Massachusetts State Building Code,780 CMR Revised Mar 2011
Building Permit Application To Construct, Repair,Renovate dlbellAishq A % 04
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date A lied:
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1rPro AdrJresj,r 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(R)
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 Rec rd:
Name(Print) City,State,ZIP
JSw �bb 9-7a= -7V/-1?-11
o.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ Alteration(s) [&� Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units I Other ❑ Specify:
Brief Description of Proposed Work': 11,
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 trultiplier 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: $ ul C Q ❑Paid in Full ❑Outstanding Balance Due:
l
SECTION 5: CONSTRUCTION SERVICES
5.1/Construction Supervisor License(CSL)
(: 1A rt ? -Zo r?-X License Number Expiration Date
Name of CSL Holder
115 No l-th 5f List CSL Type(see below) b
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.
City/fown,State,ZIP R Restricted 1&2 FamilyDwelling
M Masonry
RC Roofing Covering
WS Window and Siding
Q SF Solid Fuel Burning Appliances
1 7 g- 7 441-6 V?-Y I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
4 A— Seryi-u Inc- CB l (�a9 (a-�
HIC Company Nam gg or HIC Registrant Name HIC Registration Number Expiratioonnate Date
of
No. d Str4reet Email address
foVY' M11- 614? 0
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 / h YZS L—,o/2l
to act on my behalf,in all matters relative to work authorized by this building permit application.
Co r-,A,--A( 'I-- 8 - 1 S- )`t
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
containedAi"lplicatic,n is true ccurate to the best of my knowledge and understanding.
1 g` !5- /y
1Pi'int Owner's or AuthorizedAgent'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.aov/dpss
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"
sae YJ 10F2--
A.
^ � ® o-l" A & A SERVICES, INC.
�df!'�►SEi2V6CES 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
Squirts)Name Date of Contract
- I-0 V7al
Buyerts)Street Address,City,State and Zip Code '
Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address
�179
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.
ROOFING SPECIFICATION
Strip Root of# _ layers of shingles i 7 6g
$ Install 6'of ice and water shield at base of roof where It Install 15.b felt paper to roof.
possible. Install 18-24"of ice and water shield in valleys. wA
t Flash chimney as needed(no repointing included). � I tall Be perimeter drip edge to rakes and fascia areas.
f Install vent pipe boots and seal as needed. t Flash valleys as needed
t Install rollout type ridge vent 19 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.
r/Disposal Included: $'Other:
ocation:
Install new roof: Manufacturer (fZ6.4 i n t4P'd yr Style/type x`r W/n c rle
Included in this proposal are thorough cleanup,building permit,and company/manufacturer warranties.
RUBBER ROOFING SPECIFICATION
t Strip Roof Not Strip Roof
Y 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.
$' Flash up sidewall as needed.
Included in this proposal are thorough cleanup, building permit, and company/manufacturer warranties.
SP CIAL INSTRUCTIONS: All
¢ ✓_ 6v C iW C.CYlll.
o ' S14 t/STde
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 Buyerts)and the Contractor. Bayonet hereby acknowledge that Buyerts)
has read this Specification Sheet. /�,u
Contractor Initials: Date: —Flo
/SLl /_ Buyer's Initials: Date:
\4 D zafz
30_
S" A & A SERVICES, INC.
A&A SERVICES 115 NORTH STREET, SALEM, MA 01970
•ITA 11:2 ILYA 1:11.101TUI IVA I 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
Bur at Name
y— Data of Con act
J�1/�Z ,A 1,"c
Bu ers) Sbeet Address.Cit,Slate and Zi C tle
�S a
Da ime Tele honrye Number Evenin Telephone Number Mobile Telephone Number E-Mail Address
O
The Buyers)listed above hereby jointly and severally agree to purchase the gootls and/or services listetl on the accompanying specification sheets,in accordance
arth the prices and terms described on the heel and the reverse of this agreement and any specification sheets(this'Agreement'),and Buyers)have requested
that such goods of Services be installed or provided at Buyer's 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 Buyers)address written above.This Agreement represents a cash sale of goods 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 Buyers)may seek for their
purchase. {�//'
Purchase Price' T (!' RO�A( /; Est.starting Date: yl,
Down Payment
�j}(f��y�,��j'�(/ n Est.Completion let..
Amount Due on Start of dob:
Credit Card
Amount Due on_of Completion: No.
Amount Due On_of Completion: Expiration Date:
Balance Due on Upon Completion' 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(III 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 produces or services of Contractor. DO NOT SIGN THIS CONTRACT IF IT
CONTAINS ANY BLANK SPACES.
A&A Se"ic s,Inc. Buyer(s)
Signature
/ 4-
Print N L�r ins
Print Nam
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 farm for an explanation of this right.
ARBITRATION.The contractor and the homeowner hereby radically agree in cos to that In the event eirrerm,has ablsq:to mnremmg InisconoacLalher mr,:a,under ad.dispute ma
privateed astrnunitewhir has been approved by the Seuetary Ol we Eeewtive OPoLe WConwmar 9ness Regulations and 1M olM1er paM shall be r¢0uiretl to suhrrtil to such
arbitretlmespmved ire ye hash.
Data'un nrinit er,yris lnirialx:
amt moos
NOTICE OF CANCELLATION NOTICE OF CANCELLATION
Odle of Tansaction .VOu may cancel Ilvs Vensedion,withoN any panaltY or oats of T2nsaction ou Ivy cancel Nis transaction,witM1oul any penalty or
Mliga4on,svilDin lM1re since days hem llle aWve data 1l you cancel,any surgery broad in, obligason.vdthlnthree us ss e'ys M1ommseseul Ilyouoncel,anYPmMbytradadin,
any paments made.by got
der the Contract or Sale,and any Royal'mmumerl executed any payments made by you undo the Cmtad or Sale,and any negotiable InslNment¢coulee
by you will be returned varin 10 days talent receipt by the seller M your cancellation notice, by you will be returned vnthln 10 days farday,g rereipt by the Seiler a your cancellation notice,
and any seonly Internet dosing out of the lansacllon sail be wncelkd II you cancel.You most and any seadly Interest ansing out of See Vansackon will he n¢I,cancelled.If You call you mull
rvke available as the Seller at your residenm and subaborgally In as over wndii on as when make available to the Seller at year resident .and persona lly in as good Condition as wren
er any gootls delivered to You under Has Contract or Sale',or you my,if you dish mnply ceivetl,any goMs delivarea to you urvJerthis Conlrscl ar 5a@;oryou may,llywwish,ewrylY
ach the instru bions oI the Seller agenda the return Shamir of the gootls at the Bellers with the inslmcheas of the Seser regarding the return shipment of the goads at the Seller's
egame and risk.If you do rvke the .its available as Ed Sellet and the Seller does not ever exoonee end risk.II you do make the golds available to the Seller and No super does not pick
them up endid 20 days onhe date ofyour Nohta amaneenanon,youmaybetamordepdseofine them up wilMn 20 days of the date 0l
Your Notice of ca a the g you lla retain or d leree of
goods doithwt any NMer obligation X you felu0 do
opathen you eveimaaaue Selkc wNe an the goods to return
fanner oNi"alk.Ifywlado do so hen awes avadablamthe Sornmene
all aborted Merth goods mmact To Askiand tomw.Pan,mid or inhume mrpedanddated yorebarre under
9wdsbme Todrrnala fail men yar renew liable mred and dated
all rmieatirna ender the cono-act.To cancel lnla o-anaammn.mail or deliver signed and rated clad nmigatinns utwenne cnmam.Tnrancel Inis bansacmn,mad of ami.era signed aria dated
As of the circulated entire,or any other carmen L.m una a tmegra to A brands. copy onhe cancellation notice or any oth he noir or send a blrg A
115 Norh 56aeL Salem MA 019]O,NOT LATERTHAN MinNIGHT OF 115 NOM SbreL SalemMA019]O.NOTLATERTXANMmNIGNTOF-
In 1
I HEREBY CANCEL THIS TRANSACTION [HEREBY CANCEL THIS TRANSACTION
Cmsurrer'a Signature Cate: Consumer's Signature Cate:
r , The Common weafth of Massach usetts
L (6 Departnient of Industrial Aceidetets
y l Office oflnuestigadens
r E 600 Washington Street, T" Floor
Boston,Mass. 01111
Workers' Compensation Insurance Affidavit: Building/Plumbing/Electrical Contractors
Applicant information: Please PRINT legibly
name: `
address: //J wo ay Cl! i�-N r Jeel
`
city JGt I e � � state: MA zip: 019-7D phone#
✓
work site location(full address): /J W e-b 6 '5+ �Ct�m f�l n Q 1 q�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 this job.
compan name: 4 '/t"- A--a 0-V-i BLS r C to C
address:C� / g5" 11IO ✓�nE v✓�1 S 4-. (] p -1�[ �5+ / �7 � /
city: r>�l. i-ref li^i�P, .-7I-L-TI ( phone#: -(�71 O - /�^7 // —`V `Y ;L c
insurance co. I I-.X._ ( ✓a v e I -e r- �5 police# d,- Iq� A l b d 5-
❑ 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:
cite: phone#:
insurance co. policy#
company name:
address:
city phone#:
insurance cm policy#
Attach additional sheet if necessary
Failure to secure coverage as required under Section 25A of\IGL 152 can lead to the imposition of criminal penalties ofa fine up to SL500.00 and/or
one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of SI00.00 a day against me. I understand that a
ropy of this statement may be forwarded to the (lice of Investigations of the UL\for coverage verification.
t do hereby certify fill fit pains ntnl p nalties of perjury that the information provided above is true and correct.
Signatwe 1 - �7 Date rJ
Print nam // k/t C� ✓/_�0 l LOY2. / Phone# !7
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
.. ❑health Department
contact person: phone tt; ❑Otter
(rwisedsepi.Zoal)