25 WILLIAMS ST - BUILDING INSPECTION (2) r The Commonwealth of Massachusetts
INSPEC ZONAL OF
S
- �i � Board of Building Regulatiohs and Standard; CITY OF
41 ( Massachusetts State Building Code, 730 CMR SA M
Q� Building Permit Application To Construct, Repair, Renovate Or Demolis a
OOne- or Two-Family Dwelling
This Section For Official Use Only
I Building Permit Number: Date Applied:
�L�
Building Official(Print Name) Signature r ,(yate
1
SECTION 1: SITE INFORMATION
I Pr pr-erFty Address: s w— L2 .Assessors Map& Parcel Numbers
W-f 1�f 0.W15
L to 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(III
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?
Check ifyes❑ Municipal❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2 Ownerl of Re�cco,,{{d:n�(
I ck L�KN,--k r, &Z 1.e A, R#—(5 1t—) 6
Name(Print) City,State.ZIP
asw-� l(�0- �?- -7YY- 583�
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) O� Addition ❑
fiDremolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify:er De iption or Proposed WorV: I ri S�-0.11 S" 4i�a✓'-eS (JC90' I r 0i ° P
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs:
(Labor and Materials) Official Use Only
t. Building $ SD U 1. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical $ ❑ Standard City/Town Application Fee
❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) S List:
5. Nlechanical (Fire $
Suppression) Total All Fees: $
Check No. Check Amount: Cash Amount:
6. Total Project Cost: S (0 1 J 0 d ❑ Paid in Full ❑ Outstanding Balance Due:
} ILttt_c,D 2AC
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
/� G S-r-1(s G, —�_-��n_-LS
Lt _l:i"y S ?�,/ License Number Expiration Date
Name of CSL Holder
5— A16/-111 List CSL Type(see below)
No.and Street Type Description
M ✓L U Unrestricted(Buildings u to 3i,000 eu. ft.)
City/Town, State.ZIP �I R Restricted 1&2 Family Dwelling
M Masonry
RC Roofing Covering
WS Window and Siding
G SF Solid Fuel Burning Appliances
I Insulation
Tele hone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
A>Y S2t� iiCe iinC - IDI (o09 /� —,—D'e
HIC Compan�Name or HIC Registrant Name HIC Registration Number Expiration Dato
lL5 I1 0 �1h S-H
No. nd SCtreet
a eC vV", I'nn^^l iq--- D lc�rl G Email address
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 .......... 19/ 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 C 4 y i S 20✓2
to act on my behalf, in all matters relative to work authorized by this building perrn/it application.
C� (o gy�Nc,-E- t-a a-(5-
Print Owner's Name(Electronic Signature) Date
SECTION 7b: OWNERS OR AUTHORIZED AGENT DECLARATION
Bye ring my name below, I hereby attest under the pains and penalties of perjury that all of the information
con[ ' d this a yfiication is true and accurate to the best of my knowledge and understanding.
Print Owner's or Authorized gene's Name(Electronic Signature) Date
NOTES:
L 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.gov/oca Information on the Construction Supervisor License can be found at www.mass.eov/dat_s
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"
T� VZ,
�, A � T A & A SERVICES, INC.
A&A SERVICES 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
Buyer(s),^Name Date of Contract
MiClty / l31,
Buyers)Street Address,City,State and Zip Code
I ul I 'wus W- d, d(117C?
Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address
97Fs-7y - 6/7 783 �7`�
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. P(Yj gal Li/N,'(Cpr�-�rp
ROOFING SPECIFICATION PI VI (-Z>of kn{ef
Strip Roof of# At layers of shingles
Install 6'of ice and water shield at base of roof where O Install 15.b felt paper to roof. /730 S
pos ibld. l tall l8 of is and ter shieldjIDloife�sr w/LQ-f-Q. 0 I�+W/i�a�b¢i 'yt
❑ Flash chimney as needed(no repointing included). Install'perimeter drip edge to rakes and fascia areas.
nstall vent pipe boon and seal as needed. yL ❑ Flash valleys as needed
nstall rt>fkliiiWJNjCridge vent. -fa, r P�f �I'-f*'!!N ❑ Planks/plywood replacement under 32 SO FT included,
YbOf u5iN9 Shir10%VPif/�J 'If more is needed there will be an extra charge of$�
p� yff, ✓ per hour for labor plus the cost of materials. aN r;,&W
40WWRIVDisposal Included: Other f ce
Location: Fklik (25 llejW4 r--cmi--roof (u iclk I—, II pInstallew roof: Manufacturer J2�yr Style/type
d in this proposal are thorough cleanup,building permit,and company/manufacturer warranties.s n shiryffolill
wtRUBB ROOFLN SPECIE)CATION
❑Strip Roof ❑ Not Strip Roof At cV.4- 0,/
❑ Install 1/2"High Density Fiberboard to existing roof using ❑ Flash obstacles as needed.
screws and plates.
❑ Install.060 membrane EPDM(Black)rubber roofing to ❑ 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.
i5Lh!?_-60n+-vil J>WV ny ih of
SPECIAL INSTRUCTIONS: p
• lQP�1'Ldb�//'MIN I( sku1;42 r-lAsl,;nU kits and Zl s/wlrghl`s�
nfi
rA¢rK s-,dewA-y F7.r•A c, SaA4 1Qj'Vj c05ad(
6,LCgu1kerp d ash y pyyve(s ah�J2 {{ hnvl rmF nclude�( .
EL�Ll�rnmf 'ofl1-S oo ACUC,11
HSci S PNta -n C
G �{
B �/ hn�/fLL �(�y���y,f�Aii
It is agraetl aAdQ+to L 4µ} t2 tl understootl by antl between tM1e padies the hs Specification SM1ee,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. Buyers)hereby acknowledge that Buyeds)
has read this Specification Sheet.
x e "DContractor Initials: ��- Date: Bayer's Initials:
ate: / �J
�1 ,
A I
., /� �+��p`, 4 A & A SERVICES, INC.
ABcA�7G«Y y �7 115 NORTH STREET, SALEM, MA 01970
onto] •• 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 f Date of Cc Pact
C l L
Bu er s) Street Address.Ci ,State antl 2i Code
G(7 S 0177
Oa date Tele hone Number Evenin Tele hone Number Mobile Tele hone Number E-Mail Address
7MD 6/ 77 ;c("cle aAac
The Buyers)listed above hereby jointly and severally agree to purchase the goods and/or services listed on the accompanying specification sheets,in accomance �
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 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 euyer(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 Buyers)may seek for their
purchase.
Purchase one III, '/I/Z([,q./�14� r 7("Y'k.J� Est.Sterling Data
Do Payme I an- W1N(J'emu �,Yl r/ Est.Completion DalDom
Aid
Amount Due on Start of Job: / ,D,¢i Check
V_ / 1 /_ (� No Credit Card
Amour[Due on Completion' V I cfLOIAATre L No.
Amount Due on_of Completion' Expiration Date:
Balance Due on Upon Completio . OO CVC Code'
It is agreed and understood by and between the partles 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.Buyer(s)
hereby acknowledge that Buyers)has read the(rant and the reverse of this agreement and has received a completed,signed and dated copy of this
Agreement,including fine We attached Notice of Cancellation forms,on the date fiat written above.Buyer(s)also(I)acknowledge that they were orally
Informed of their right to cancel this transaction;and(id)request that they be contacted via their telephone numbers or email,as listed above,in the event
Contractor believes Buyers)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 SeryiQes,IL BuyeR
g ire
Si nature BUJ/
Print Name x Narpe y '
Print
Signature
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.
Me1TRAD ON:The dentacmr and Me homesteader hereby merely agreeIn advance that in the event either party bad a dispute demands has rmtraaethereaM tray submit such customs to a
private amio-ation service added nos been apprmetl by Me sevataryal me be..olfireal eonaamer nrca aavnre/ss�Rg,gmaliara antl me other parry shoo be regairetl to submiuo darn
arbwaticn as asked In M.G L=1a1q. (� //�f/�(
Chat BU"s Im(Iy�/L//Y�/M
Con,: / Dr,
NOTICE Of CMCELLATKIN J NOTICE OF CANCELLATION
Date of Transaction Wool
may morel the transaction,uiNON any penalty or Do of Transco fg .Ym may ranee/this separation,WNON any Penalty or
promise rtitMn thaeeb ool hem Me abke Eab.It you ran®I.any pmreMltatied in ob49ation vANin Ur puce tlayx hoar Ne ebova tlele.IlycacanceLanypmprrydroady,
any revives aside by you under In.Carbon or Sale, no any n,rkdreimtrvn'ent executed any peyrrents made by yes under Me Comand a,Sak.and any negotiable instrument emended
by you tell be madded yearn 10 days island,moral by Me Seller M your canrellason moss by you..be resumed Mean 10 days Mlouirg reui,by Me Belles of y a,comadeve,comae,
and any security interest Booing out ad the hansacdon vall be demand,it wo cande,You anda and any year imGe4 adding out of Me for amLon Hu be canerearm If you conce.year chat
make available b the dater at your nordence,and substantially in as Mood mcold-as ar n make avelf to day Saner at your r denro,and substantially in as gmd condition as when
seared,any Phone repeated b you indications Cono-ah or Saba or you may.tlycu me,dki damr,ard.any goods delivered myou under they Conbatl a sap;or yes may.stand von.,Sealy
-p the astrodome ask,If of the Seller meaning nd realm sfie Sake n Me goods at and of pickier a Msh Me and ristio If of the said,reg oods Me dle Me Colt h Me goads at she et Pick
expense and ask.If you do make Ma gmds avallabb 0 Me Seller antl the Belles does rid pled expanse and risk you f e do Na yours available b Me Color and a Seller does di not pick
them upwith adyf to artmeroedation lived
Notice ofke Mel good you may renMe SoisMaxe of led them no vnMin lO tlays of Na dale of your Notice NCancelladon,you may realm or dispose of
gttAs wiNout anylurlherobligatron.Ilyou tail to peke Me goods available to the Seller orily0u thegwds duatioany/under Wine Sailhound Yallboekelhe putmmeibbleto NaeNler,aril
W,oria;ups Me gmm them Seder and lei/da tlharrov you remain table lorpedand evod youa9reetoreWm OegaMsbthe Selleracel this
you remalvera shred avmated
'{ ad;negations antler the Contmca.To Penad has Vanaec4on,amil or dal'rvera signed and deletl ;tell oblgetions under Ne Conbatl.TO Cancel Nis transaction.mail adeliverasigned and dead
may od Ne tlnwlladon no0w or any other untlen notiCB,ar repo adel-i s may at the ncella4w notice re any older unpen nodes.a zero a tela9ramffffAf000000 rrrr����A Servlms.
115 North Street Salem MA 01910.NOT LATER TIWJ MIDNIGHT OF 115NOMeVee{Salem MA01970.NOTIATER'Nord
MIDNIGHT OF
I HEREBY CANCEL TXIS TRANSACTION I HEREBY CANCELTHIS TRANSACTION 77
Conswrer's Signature Dale: Genemrefs Signature Data'
'\_1
The Commonwealth of Massachusetts
_...
�It _ Department of Industrial Accidents
Office oflnuesdgations
r I 600 Washington Street, 21h Floor
a\\ q Boston,Mass. 02111
Workers' Compensation Insurance Affidavit: Building/Plumbing/Electrical Contractors
Applicant information: f Please PRINT leeibly
name:address:
city �� �O✓ ! N t��i�-e P'�"
city JLN state: MA zip: 0/770 phone# 97g--7V1 Yay
work site location(full address)' a s 'W r O 1 X yvw& s-f- 5 MIT O 1 Cr 70
❑ 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' compensationQ for my employees working on this job.
company name: f",T,- t ����r:Q('a'V 1 LC7
address:`( i 5- (O✓O ✓ t y✓�t J 4i ' (� p -7 [ �5 f / �7
City: ('Q I ee (M-l', .erg/--'rt phone#: -t -7E- /n'7 1 -Q 'Y ;LV
insurance co. I ,.Y- f r0,y/e I-e i- t.S policy# p,- " 1 w l U
❑ 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. poliev#
company name:
address:
city: hone#:
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 a fine tip to S1,500.00 and/or
one years'imprisonment as well as civil penalties in the form of a STOP NVORK ORDER and a fine ofS100.00 a day against me. 1 understand thud a
copy of this statement may be forwarded to the lice of Investigations of the UTA for coverage verification.
I do berebi,cerlify tor a th pains",tip fatties of perjury that the information provided above isi true and correct.
Signahn'cNr / Date
Print name ✓% C � ✓ ZOY2.A Phone#
} r ,��uFs.,.a" iC :af�'.,.ee'.,., "��.r�;;..F•.',v�� -.,._ .,..:„ �, .<„_, .. . +. . .
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#; ❑Olher
(revised S,t.2003) _
=ycoi aPey?m16F1 's y pPoYGIOS Of M. G, L �a ��, Sn. e4, � ��?6Pu3Fl oi
Stiu91ng pcnn3 Number is ti`�l , 1� >5 3� sy}ullrng i f� ilk i�l
-FIY fey: deslned,by AA, Ga L
1503,
!old d7bs) vilgi y
9
5va -
RIMS
Aeu�� o
Elam
12 13 NOUh �'68� IM�,g Oi'Pvw ��1d�suao O�A� Fb(,gQ j
Address, 6ity stia, zip