14 WILLIAMS ST - BUILDING INSPECTION (2) Td —I`l 'l3� -WIzS
--71 $110
The Commonwealth of Massachusetts 1NSP�&LION IV EO
Board of Building Regulations and Standards SERVICES
Massachusetts State Building Code, 780 CMR ReSALEM
'vi�(} �0lJ8
Building Permit Application To Construct,Repair,Renovate Or Demolish a [[ A 1: 20
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date Applied:
Building Official(Print Name) Sign tur Date
SECTION 1:SITE INFORMATION
1.1�1Property Address: r L 1.2 Assessors Map&Parcel Numbers
1 l (A�i, re S l'1
L la 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(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'
k, Owner'of Record:
Clorg ( ontoo-DonAlaaecu� c�c. gA-0(ct- z)
Name(Print) I City,State,ZIP
mUJ;)G cti.w.T 9 --#�L T(ni7- 671- D-Q. a �
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ 1 Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) tit Addition ❑
Demolition ❑ 1 Other ❑ Specify:
Brief Description of Proposed Workz: to ru kk) V i rv.l I re O(Q C.,
w;..dam .,., s mt- i 5 l i
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1.Building $ L� -1 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:$
Check No. Check Amount: Cash Amount:
6. Total Project Cost: $ lr 9 -7 ❑Paid in Full ❑Outstanding Balance Due:
L1��
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) .
6k S 2c r J License Number Expiration Date
Name of CSL Holder
r S NO/ S+ List CSL Type(see below) (�{
No.and Street Type Description
Sam iM M i9 p r 4 7 o U Unrestricted(Buildings up to 35,000 cu.ft.
R Restricted 1&2 Famil Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Coveting
WS Window and Siding
SF Solid Fuel Burning Appliances
,T a- I Insulation
Telephone Email address I D Demolition
5.21 Registered Home Improvement Contractor(HIC)
ITd- t"1-�tr'✓t [.�S bnc— HIC Registration Number Expiration Date
HIC ComRName or HIC Registrant Name
No d treet� Email address r�rA- (� cg7 o q�8-�Y�-oYay
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
1,as Owner of the subject property,hereby authorize i✓'lrl ` 0e-
to act
(on�my behalf, in all matters rre
pri elative to work authorized by this building pe it application.
nt 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
contai ed t application is true and accurate to the best of my knowledge and understanding.
I �
Print OwnVr'd or Auth zed 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.eov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps
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"
_ The Commonwealth of Massachusetts
�P z (�' Department of Industrial Accidents
Office 01inuestigatlons
} 1 600 Washington Street 7 h Floor
\ � fj g
Boston Mass. 02111
ast:5"
Workers' Compensation Insurance Affidavit: Building/Plumbing/Electrical Contractors
Applicant information: / Please PRINT legibly
in
name: _l.. `1'l:Sp-r � LC�IZu,
address l/J NO✓ r !1 �t�2Q�"t
city 6aI2 +r state M({L4 zip: 60 phone# 97�r /-oV9V
work site location(full address): W t��1 a.yv -i Jl �.V✓J I•t/T o 147d
❑ 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 employ/e�r providing workers' compensation(for my employees working on this job.
company name: A 't-" ,�. l Qa�rV-1 �2-St l 1 C
address: l i .S IVO � S 4t
pp
city 'So, tuft r//T•6TI (� phone#' /-�(�7t0//- 7�/n7y 7/(ry—Q'7 e-7
insurance co. ql 1 ;ra y Q I-e r- ' policy# V;lL-b .3 " l v 1 5— _
❑ 1 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:
city phone#:
insurance co policy#
Attach additional sheet if necessary
Failure to secure coverage as required under Section 25A of w1Gf. 152 can lead to the imposition oferiminal penalties of a fine up to S1,M0.00 and/or
one years' imprisonment as well as civil penalties in the form ofa STOP WORK ORDER and a fine of S100.00 a day against me. 1 understand that it
copy of this statement may be forwarded to the Tice of Investigations of the DIA for coverage verification.
/do hereby/certify uWell, pains and p putties of perjrry that the information provided above is true and correct. t f
Signature'✓ Date �-(0`—/1 �1 �(
Print name ✓i- C-{-00 / - OYZ. / Phone#
official use only qo act 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 ❑Selectmmt's Office
❑Health Department
contact person: phone#; ❑Other
�' (revised Sept 2001)
DISPOSAL OF DEBRIS AFFIDAVIT ..
is aGoordanon� ids bFa provisions of M. 40o Sso, 64o a condit6on V,
Building Permit:Humber is that td dabris resulting from this Wc),k shall
be disposed Df.in a properly.ficeras®d faciiii
950a.
Mo dabris will be disposed at Uam
owned by i orftldo Carlo
ignatura 01 Pdami' ®plican
Data
A A SoMpap,
F� NOfth 96raat Salem MA 09970
V� py io tz
+ PGratl
se98P A & A SERVICES, INC.
AAA SERVICES 115 NORTH STREET,SALEM,MA 01970
��" 01illill Telephone:(978)741-0424 Fax:(978)741-2012
Contractor Registration No. 101609
Federal EIN:04-3090162 Construction Supervisor No. CS057733
WINDOWS AND STORM PRODUCT SPECIFICATION SHEET
Buyers)Name Date of Contract
Do 1 I'd Dan NAACAIA. �y !
Buyer(s)Street Atltlress,City,State and Zip Corte
H W\ iAAn g r +, 'j--y
Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address
0 . ;G- o_ ou bM
The Buyerls)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 wM1m this Specification
Sheet is a part.
WINDOW REPLACEMENT SASkist ffRc1/,SCr-wo
i Remove and dispose of# i 7 existing windows
l/ y2fiP5
CV Install # 17 new 5V�n/ri 5� r'A09ml windows:V nyl It Wood
16 D1y (Manufacturer)
Options: Style I .sl1 deR Grid pattern U t5 I A�l
Color Interior LU �e. Color Exterior (V� f LS—' Glass Type '95
t Wrap exterior trim with aluminum: Style Color A
J
All windows will be installed according to the installation procedures in the portfolio,
Caulk all interior and exterior edges.
Insulate where possible around new units.
//C—��IInsulate window weight pockets if exist,and around new window units where possible.
l..t_ancluded in this proposal are set up,clean up,Hepa vacuum and cleaning windows inside and out,
t, uilding permit included,
BAY/BOWS/CASEMENT UNITS/ANY FULL CONSTRUCTION WINDOWS l
t Create new window opening by cutting through existing home and framing in opening.
t Remove and dispose of existing 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.
♦ 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.
If Bay It Bow t Casement t Other windows)to include new interior style trim and new exterior style trim and head
flashing as needed.
t Note: Painting and staining not included.
STORM PRODUCTS
I 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
SPECIAL INSTRUCTIONS: II
���OV,, yoy�e'ria4 tii� Sta,PS nN 1All VlJl2iALl
7tC_e__ injs w `16 k X S ck
A e '( 7tsf`d� 3 d �,Q
SS
It is agreed and understood by and between fie 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 l
terms mortified or varied In any way unless such changes are In writing and signed by both the Buyerts)and the Consul Buyers)hereby acknowledge that Berens)
has read this Specification Sheet. ! �� !�
Contractor Initials:S L/ Date: �� I Buyer's Initials: Date:
jJ ZofZ
,gym= A & A SERVICES, INC.
A&A SLAY Ivor 115 NORTH STREET, SALEM, MA 01970
E in•ILYA 10 ILYA 1:1:1611TA a ff,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
Bu er s Name Date of Contract
d
Bu ens street Address,City,tage antl Zi Code
M S Z
Da ime Tele hone Nvmber Fieldng Telephone Number Mobile Tele hone Number E-Mail Address
i i DP6 A d � o n�,�-2�• '
The buyers)listed above hereby jointly and severally agree to purchase the goods antlior services listed on 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"Agreement),and Buyers)have requested
that such goods or services be installed or proadetl atat 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 Buyerls)address written above.This Agreement represents a cash sale of goods and services.The Buyers)
agree to pay in Cash the cast of the goods and services purchased as described herein,regardless of timing or approval of any financing Buyer(s)may seek for their
purchase. t / /22
Purchase Price: ��Np���pp��.��.��.rr�� ,aQ! t I Cy ( 6.J Est.stoning Dater
Down Paymemt:tT_ y' .Completion Date:�G
gu c hr.mro4i
L kJJW n 'u Bh
Amount Due on Stan of Job: ` '1� /"'"^- �C Check
// L /rip 6gUa' / ( Credit Card
Amount Due on /%ef Completion.T�C�1_ Ty' 1,,J _ V No
Amount Due on of Completion (ICC! �� ..-�L1N Expiration Data
Baance Due on Upon Completionn'.�1y� O.d 7 CVC Cotle:
IX
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 posed copy of this
Agreement Including the two attached Notice of Cancellation forms,on the data first wdhen above.Buyerls)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 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 Serv' s,Inc. Buyer(
By:
Si ature
Signal e
Print Name - hVIC_"L u
Print Named
Signaturen_ / /
bonat4
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 right.
Anibrad ION:Tha warear more Mmeownor hereby monellyogroom advance Thal In theevententerparryhas a deputecaneemim this WnPa[LeMRpan,narystitartslim dispute be
p arm mdm4on service erirhnas been aproved by the eeaetary W Ine haduti o OHiw of Gonsumer Affairs and Business assassinated dre oNa lady snail be required to submt I;such
fedtation as proved in M.G.L o142A.
Chun,M fiat, Serve,lei'l:
Dote pair: . ) 91. 7•t. (J-
��//////��NOTICE OF CANCELLATION —'g—f 1 NOTICE or CAXCELIAT ON
owe W Transaction ,(�uffir ♦ou may cancel Nis vansallon,without any penally w Oate of TrenseNon ou may cancel Nis nansacum,wlNoul any penalty or
Mligation,wilnin Mreed ysfrom the aMrx date.Il you rsnceL any pmceMtratled In obligation,Wlkn Nree days horn Me above pate.If you cart,any property traded in,
any summers made by you under the contact or sale.and any negobame instrument stopped any payments trade y der the Conbad or Sale.and any negutiade instrument erealed
for
ye,via bo awmed vitim 10 days rognvnng ra oupt Iry ode MIN of your va oud eunn nacre. by you art be named Mmm to den hadmang result by rile Sauer nl your undeve adon mace,
and any seventy mushom arising out of Me transaction will be cancel N.X you tenet.you roars and any securme idome di out of Me bansaNm xia he ran tiled.X you cancel,you must
doe available to he Seller at year reardence,and wbsmntory in as 9sb wndition as wren Treke aveilade to the Saph al roof reridenre,and substenaely in as good inn demon as when
carved,any goods delivered to you underthis Cmtradm Bale:orybe may,11 yin our comply ived,enygoWr tlellvered to youuMer Mis eontradw5ak;or you may,ilyou wish,memory
With the memorials of He Som regawing Me fawn Wiener,of ode gods at the Miss'a MP Me restradome of ode Seller members the rearm inerrant of Me amps at the Seller's
expense and risk.If you do make Me goods available to the Seller and be Soler days not pith mare ver and rush,If you do make the goods available to Me Seller and be Seller tices not pick
Memup main 20 days a the dale W your Notice ma of Cameraman you y retain or dispom of the mainup vain 20 pays of the data of your Ntice na o of confounder you y retain or diose sp N
goods vaob any further obligWion.It you had brake Me goods available to the Soler.or it you Me goods vithoW any Nippon obligadnn,Il you pal be make be g.a available to in.Soler,or,
agree to return ode goods to ode Soler am fail b do of Men you rearman liable for cedomrance of yen.1.ommor the gears A be seller antl torero do so,than ..,.—an add.a,performance
all odliganms under the Conbart To carrel Its transaction nu it or deliver a signed and bated of all imams under Me Champ.To cancel this dismadarl frail or deliver a signed and drum
copy of the candis adon noMa or any other widen notice,or send a selega T,p copy of the remainder notice or any oNtt when notice;,send o telagam.ty A Seyy
115 NoMBtreet,Salem MA 01970,NOT LATER THAN MIONIGHr Or e 115Nrub Sueet,Salem MA01970,NOT LATER THAN MIDNIGHT OF Sme)
nmw /;jf'',t
I HEREBY CANCEL THIS TRANSACTION I HEREBY CANCEL THIS TRANSACTION
Consumer r Signature Data: Cause.,,minimum Dafe:
1
Phone: 978-741-042 4
Fax: 978-741-2012
p&A SER www.a-aservices.com
ONIORTAIMILTA 115 North Street
Salem,MA 01970
January 10, 2013
City of Salem
Building Dept.
120 Washington Street
Salem, MA 01970
To Whom It May Concern:
Enclosed please find the permit,apppli ation for Debra Longo, 14 Williams Street,
#2, Salem, MA to replace windows.
I have enclosed a check tor$$110.00 based on your fee schedule of$7 per
$1,000.00 plus a$5 administrative fee. The total for the job�was$l4,473.00.
Please send the completed pe mr it to A &A Services, Inc. at"I 1.5-North Street,
Salem, MA 01970.
If you have any" questions,please contact me at (978) 741-0424.
Thank you for your
Sincerely,
Barbara Zorzy
Office Manager