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71 WEBB ST - BUILDING INSPECTION (4) ba5 a a5 Pa The Commonwealth of MassachusetfsVED ® Department of Public Safety,SPEC-i jo4AL SER`410ES Massachusetts State Building Code(780 CMR) Building Permit Application for any Building other than a -o vjca Faji�i1JOD%Felling (This Section For Official Use Only) Building Permit Number: Date Applied: Building Official: SECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which a street address is not available) 'lI [>J'�-bb S-f Scalewn e5t970 No.and Streetn� City/Town Zip Code Name of Building(if applicable) SECTION 2:PROPOSED WORK Edition of MA State Code used If New Construction check here❑ or check all that apply in the two rows below Existing Building❑ Repair❑ Alteration E( I Addition❑ 1 Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ Change of Occupancy ❑ 1 Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No ❑ Is an Independent Structural Engineering Peer Review required? Yes ❑ No ❑ Brief Description of Proposed Work: 5 9- L460 SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑ Existing Use Group(s): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) Total Area(sq.ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ B: Business ❑ E: Educational ❑ F: Facto F-1 ❑ F2❑ H: Hi gh Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑ I: Institutional I-1❑ 1-2❑ I-3❑ I4❑ M. Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R-4❑ S: Storage S-1❑ S-2❑ U: Utility❑ Special Use❑ and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ 1 IV ❑ 1 VA ❑ VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) Trench Permit: Debris Removal: Water Supply: Flood Zone Information: Sewage Disposal: Licensed Disposal Site❑ Public❑ Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be P Private❑ or indentify Zone: or on site system❑ required❑ or trench or specify: permit is enclosed❑ Railroad right-of-way: Hazards to Air Navigation: MA historic Commission Review Process: Not Applicable❑ Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed❑ Yes❑ or No❑ Yes❑ No ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s): Type of Construction: Occupant Load per Floor: Does the building contain an Sprinkler System?: Special Stipulations: aC SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner ✓ n Z (AJ�� Sf_ ztzvn 7:r -7oName(Print) No.and Street City/Town ipProperty Owner Contact Information: (o-4o ���r e.� Za3 2l�0c et1 I�ver✓aor ! Co Title Telephone No.(business) Telephone No. (cell) e-mail address') If applicable,the property owner hereby authorizes Inr S or2� 1 /Z IVo,- Ge r-. �� G 19-70 Name Street Address City/Town State Zip to act on the property owner's behalf,in all matters relative to work authorized by this building permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) If building is less than 35,000 cu.ft of enclosed space and/or not under Construction Control then check here O and skip Section 10.1 10.1 Registered Professional Responsible for Construction Control Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor Company Name Name of Person Responsible for Construction License No. and Type if Applicable l Street Address City/Town State Zip ��7N -G147t3i - Telephone No. business Telephone No. cell e-mail address SECTION 11:WORICFRS'CObIPENSATION INSURANCE AFFIDAVIT M.G.L,c.152.§ 25C 6) A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the ' suance of the building permit. Is a signed Affidavit submitted with this application? Yes No ❑ SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)_$ 1.Building $ - p . Building Permit Fee=Total Construction Cost x (Insert here 2.Electrical $ appropriate municipal factor)_$ 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality) 5.Mechanical (Other) $ Enclose check payable to 6.Total Cost $ ?) C(p . / (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the bes f y knowledge and understanding. Cyr- p✓eSI'epnt �I�FS747_ © day Please print andsign nam - -� Title Telephone No. Date 17 -� un -ft^ SE- 5Q� uzvNe� A D t-I-R Street Address City/Town State Zip Municipal Inspector to fill out this section upon application approval: Name --- Name .. - - - .Date The Commortwealth of Massachusetts Department of Industrial Accidents Office 611nuesd0allons 600I'Vaslfitt r g on Street, T" Floor Boston, Mass. 02111 -- Workers' Compensation Insurance Affidavit: Building/Plumbing/Electrical Contractors Applicant informatioCn�:]..., Please.PRINT legibly name: _��C✓J nJ�/1 Lt p/lam LCy(Z . address/ ��J l VO✓ t 15�ir2 P�" [� / (/ ,/ city a I2 t"'s state: cMA c 1 _zip: 0//7y70 phoner#� / /'D\"7V1-eV work site location(full address): ik�io u� J Q�.X.J�-t- I r t� 6 I C) �C/ r ❑ 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 [1 I am an employer providing workers' compensation g for my employees working on thisjob. companv name: /",C,- /i- A -k trV I ��Ls C 15A t= . address' ( 1 ii5- Alo ✓-� S+- (] -7 p -7 [ ' / / city So i_Q /niit /r A- phone#: r-�( 7,?-�]t�n7 It -0L L insurance co. I h,_ 'r`Gl v✓e I-er- t.s nolicv# \J�L6 3 AA ?! S ❑ 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 nolicv# company name: address: city: phone#: _ insurance co nolicv# Attach additional sheet if necessary Failure to secure coverage as required under Section 25A of NIGI. 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or one years'imprisonment as well as civil penalties in the form of it STOP WORK ORDER and a fine of SI00.00 a day against me. I understand that a copy of this statement maybe forwarded to the fife of Investigations of the D(A for coverage verification. d do hereby /certij�un a th pains and p nalties of perjury that the information provided above is tr¢e and correct correcc SignaturN /- . Date ttF �1 , ( `] lr� Print name ✓i S�a ✓ -2 O✓:: Phone#_ fy 7 0 p`-7,t/1-0 official use only do not write in this area to be completed by city or town official city or lawn: permit/license# ❑Building Department ❑Licensing Board ;' ❑check if immediate response is required ❑Seleconen's Office ❑Health Department contact person: phone#; ❑Other v—,.d 5epi.2003) ^ w A & A SERVICES, INC. MA S 115 NORTH STREET, SALEM, MA 01970 • Telephone:(978) 741-0424 Fax: (978) 741-2012 Contractor Registration No. 101609 Construction Supervisor No.CS057733 Federal 1 04-3090162 MISCELLANEOUS SPECIFICATION SHEET Bu er s Name �n/ Data of Co tract w 'J S1 ecwoo 772-,./57 S z8—/S_ eu ers Street Atltlress. Ci State and ZipCode 71 ul�B� sr Sri r , rW a Da ime Tele hone Number Evenin Tele hone Number Mobile Telephone Number E-Mail Address /< li' 70Z 27 3 7'J-60 The Buyers)listed above hereby jointly and severally agree to purchase the goods andlor 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. NSu' FLF+sH,v� Rerldr12 SPECIAL INSTRUCTIONS k1Cla-7- s)oZr 3 /,& fj�t CALL Slf, vt�t eS �}av✓LS f7�av✓� U✓} �1 1� , /A)S—1)9-VL— 6yavy c,� ) 0 to- r w KI�lJs'L. SI-7 i ll%tlS bf S/O is;- hi F2o rvl A✓6, I- /1tiroG Q&32 yP FI"5- /ti S i7s v- !�i vM r v� T2H-shl ✓ v✓{�e7t Nl �c� . /NS779VIL AI W r aF -P2fm6To r(.7o6Y2- s-fi5LII 7-o A clG h,;-Y" 2'� /N3 -rSrf'LL /-72,y1.yf a,v vr✓( 601-L- C 4 P f f �, f3oTYrf � S(017- 24 -,r 2 rvrz vs . �Pie L `f 6`1 o wnr9� 'a 61 7-D UJVn->v M oy"f, 3537 , Odd ®GAG On/N,7�Q /L l c1�' 32 [Sr W 070 , /.S"T PL OVW- lG) 7 1HKYV w rn(r->rI �!Vtn J✓G'— r !J .t�az7F b� ()� L-2w�s i7N� 1rlW t1 L �u„�ClL(�l�"vrs% Gilt ti,nuKJ - 7NS7)5`,VL �/ ) /v8tiy Svn�2� ��SHrvi7ra [_ V)ivkfL w t�✓�','GoLo,Z Lij-�14 1 T-9- , r'1't/L S- F—-t/P &W^O G Gt,' -V/0 /Iviet'il D tF-b 67-79-7 L- PIL bc2r = 93. Q 15560yN -r I7Z-Gb'= i 77sS <�- T077-L il)6Y'tI73-) >- =4 1-730, It Is agreed and understood by and between the parties that this Specification Sheet,along with CUSTOM REMODELING D 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 Name modified or vaned in any way unless such changes are in writing and signed by both the Buyerls)and the Contractor.Buyer(s) hereby acknowledge that Buyers) has read this Specification Ended. [�7,/ '1 Contractor Initials: '' J Date: ` Buyer's Initials: ')C Date: A� � �p�n =c A & A SERVICES, INC. /1&A SER IC S 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 Bu r s Name Date of Contract L /d S'T eCysk e VS - 2-8 IT - Bu ers Street Atltlress,Cit.State and Zip Code 7 /iL'L�3Q ST .Si?Z�tr✓�t !'9Il' (7L-`?70 Da 'me Tele hone Number Evenin Tele hone Number Mobile Telephone Number E-Mail Address 1t4y702-273-7,..0 1 1 KV5rkki-rJ-&',i d z— mg, ,Ca The Buyerls)listed above hereby jointly and severally agree to purchase the ante. goods a .services listed on the accompanying specification sheets,in accordance with Me prices and terms described on the front and the reverse of this agreement and any specification sheets(this'Agreement'),and Buyegs)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 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 purchased as described herein,regardless of timing or approval of any financing Buyerls)may seek for their purchase. p/1 �/ Purchase Price: 3 1 IV'F Shc1�/Nd4,��i�/FL A''.(�/N/1 Est Starting Dater-Z� -y Down Payment: 133o r iC L-) rrY/�' -Z IS Est.Completion Date' 7-/S'� �� - °,Cash Amount Due on Strait of Job: K/n14rn C111-J `Check 1,t:lN Oln1/ IS i FL aunrx- a Credit Card Amount Due on of Completion: No. _ 00 Amount Due on of Completion: 77Sr Expiration Date' Balance Due on Upon Completion: ZIoCOOF 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 Nis 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.Buyegs)also(i)acknowledge that they were orally informed of their right to cancel this transaction;and(if)request that they be contacted via their telephone numbers or email,as listed above,In the event Cantractor believes Buyerls)would be Interested in any addigonal quality products or services of Contractor, DO NOT SIGN THIS CONTRACT IF IT CONTAINS ANY BLANK SPACES. A&A Sery s, D. Buyer(s) By' X _ V — � Signature U'✓ BU2[I.�� Signature \, Print Name Print Name S(ig)nat�ure Itn1aQY-{- CK r.*G 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. ARBTRATON:To,mnNatlw ane Nub Iwme—a,nereaby..,,,ago-in aovance gal er the subs en Hoer peat nubs a dbwle cormmtnn"is wno-ad.eimerp¢nY rreY sulmil sufA Oispwe lo. 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And envsemeryt the Sarising out peeInce.an ooallabrancsllstl.nyoomnml,ad moss amen available ytmeaesarising rut elaerps.andawiner ay in as.nYourzncd,yours treks avatuue g s delivered!seller at roar unbridle antl act onSale, to ae Imoe cordf you rn ea arm make avaaame to Ne wir at your msieeace,ane act or Sale. N ou gonemy.aYou vide ac omen woe.anywan Baker regarding ratan er salet 01 roae goods awise.meerlr atra.andgoods corneredoeloymrgardigtteoneea or Sde:a,you marroa ash.Sol., o..mla ag Ne tnelrew.If a do seller regaining g.return a sSelle age goats at es of pi a ag rse Instrawona or do Salle,regarding gt return a,Sets, e s a Nt grade at es ut pick thenreve uand ask.II you eo makega goods Hereby, a Co to Nea.yo and t he Seller blame, nutpick the.experse up and n Se If you tloean make Ne1bhous of loge$honerantl to$oiler does but pick Nemu pwiNN200ny urso1 fire data opeoplol Your Noam of Canbegoodse vableu may to iirwmsmual yoireu themupagin]O a.anysolge eeteol,If you oil Cake her Youularm tin to e Bear or agmetgoods oleou thegn ItO igaa'on.Il You lailWdoso to cake chunpu maele to fireSeller artlyou t uagr Wmtu enylurrstothea(on.Iand lIll to TakeNa goals availage to me$Hler,wl anree to velum tnegoce s toga Sel kv ane ll this Oonc NenyJuramatn Bade larpedand rated you agrhala realmgrlie Caole.1.caanbtailbeosa N¢n pa redecar a signed acted an under are Lmo-aor any other vocis tranm.r.or or eHlvere signed and Doan of the cnceraern coude or my ran ial snif"umens,on.mail heaivsrasinnee and acted mpy p1.aM adst,Shaun notice m any Other written AN or-no a LLJegrg� A8A SeMwe, copy OI the ranctllenon notice or any oger wnXen naaas,or sane a he y Agp Se 115 North$Iree1.581em M4019]e.NOT IATER THAN MmNIGM OF S-lA_t� 115 NmN$IreeL$slam kN nl9]9.NOT L9TER THAN MIDNIGHT OF _ ( mer., I HEREBY CANCEL THIS TRANSACTION 1 HEREBY CANCEL THIS TRANSACTION Consumer's S,opike. Date: Cmemeniiabrna re Dale' Certlncat=_ MD A043065 THE CONIAIONV� EALTH OF IAIASSACHLISETTS -_ ESECUTI`,-F OFFICE OF L,00,AND V,0PKFORCE DE\ELOP.IE\T 1 DEPA.RTIMEi\T OF LABOR ST.kNDARDS 19 S"Fk\;IFORD STREET, BOS fnN, N'IASSACHUSETTS 02 114 DELEADER CONTRACTOR LICENSE \ c2 ,A SERVICES, INC, 115 NORTH STREET SALENi NIA 01970 LICENSE: DC000440 EXPIRES: Sund.ly,June 07, 2015 IN ACCORDANCE WITH NLG.L. CH I 11, § 197B(b) AND 454 CIMR_'3.03, THIS LICENSE IS ISSUED BY THE DEPART,"ILENT OF LABOR STA.PfD.ARDS TO THE CONTRACTOR.ABOVE FOP,THE PURPOSE OF ENTERING INTO OR ENGAGNG N DELEADING WORK. THIS LICENSE IS VALID FOR A PERIOD OF ONE YEAR. THIS LICENSE P.IICST BE NIAINITAI�IED BY THE CON;TIZACTOR SA'HEN ENGAGED N DELEADING `,VORK lid ACCORDANCE WITH NI.G.L. CH. I I I § 197B(b)(2) AND 454 CNIR 22.03. HEATHER E. ROVVE, DlriEc�nG- HOME IMPROVEMENT CONTRACTOR CS-057733 _ 'RagistraUon JId09 spirehon' 6:'_6 2Ct6 ria?: E CfMSTOPHER ZORZY Y' 5oranc 115 NORTH ST .A-'A SERVICES, ImC Salem LNL4 01970- it " •. Christopher Zom_y 115 'Iorlh Striat Salem. MA 01970 — ;r-r•; ; - 05/26/2015 Undencer¢a11 ' https://elicetise.chs.state.ma.us/eGovilYeb/PavmeaLResult.aspx?answ. Application Submitted Your application has been submitted and all fees have been applied to your credit card. Please print this page as your proof of submission and receipt of payment. Application Information !Date Submitted: --- b'Jedresday, Play 06, 2015 --- -- pplicant Name: CHRISTOPHER ZORZY :License Number: CS-057733 !Agency: MADPS Process: Renew License process Payment Information Authorization Code: 12C04 Received Date: 5/E/2015 9:26:33 AM Received Amount a1)0.00 a MA'Y 0 6 2015 Oft il� y��hJ11S 'i1�I S17 S 'o•p ?��.311=,'-=9 l ..... . ... _ .. !u 7 'n-JIIJ��I M ai�'sa�> 5'y�s,� i�3alalr ='i'Sts u�;_ 1�•r vil�l �6jT , - y3� S�iyii Yl 3J10 S�yY b' Ii��j �C rij �J _ I Data - buy �8� +ail la raeS, C6I S as r IR r�'F�F��