7 WILLOW AVE - BUILDING INSPECTION (2) $y Tb G< z�5`t Z
The Commonwealth of Massachusetts 5FE rl0tyQ1 cFpvl� S
Board of Building Regulations and Standards CI
I\ Massachusetts State Building Code, 780 CNIR 10jS (fQ�eC SALE ` 1t�
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Two-Family Dwelling
1 ^ This Section For Official Use Only
U 1 Building Permit Number: Date A lied:
Building Official(Print Name) Signature
/
SECTION 1: SITE INFORMATION
Ll Property Address: 1.2 Assessors Map& Parcel Numbers
'7 /,Ur Ilo�.r f�vt
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?
Check if yes[] Municipal❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.��1"Owner o Record
L4CViY1 �c fo�cf I I zloo�o_ AA 69--W3
Name(Print) J City,State,ZIP
TS( Fain&W'Dr 9IIF- sa - U933
No.and Street f Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) POTAddition ❑
Demolition ❑ Accessory Bldg. El Number of Units_ I Other ❑ Specify:
Brief Description of Proposed Work'-: / fl ,S e LA0LrPf ru-bLLA rpo �i'na 9
reoo ,� SO-Sci- 0t .f- s�o ( /
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs:
(Labor and Materials) Official Use Only
1. Building $ 6Op 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 S 2. Other Fees: $
4. Mechanical (FIVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fees:$
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ t Q Q(� ❑Paid in Full ❑ Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
S .w rr S2.,! License Number Expiration Date
Name of CSL Holder
J5- /1/0 f-I-h 51 List CSL Type(see below)—LA-
No. and Street Type Description
-7 U Unrestricted(Buildings up to 35.000 cu. ft.)
MR Restricted 1&2 Family Dwelling
City/Town, State,ZIP
MasonRooting CoverinWindow and SidinSolid Fuel Burning Appliances
Insulation
Tele hone Email address Demolition
5.2 Registered Home Improvement Contractor(HIC)
�d '�✓ i �S /AC- IDf (o09 -1z 2C "1
HIC Registration Number Expiration Date
HIC , an�Name or HIC Registrant Name
/Z S n o ✓tomS H
No. nd Street
�a LL t't/\ MA O l`l'l C) 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
I, as Owner of the subject property,hereby authorize ["��y 7 S 2p12
to act on my behalf, in all matters relative to work authorized by this building per it application.
GZ a_ (o r. aC 5-- 3 0- 1 S
Print Owner's Name(Electronic Signature) Date
SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION
Bye ring my name below, I hereby attest under the pains and penalties of perjury that all of the information
cont d this a lication is true and accurate to the best of my knowledge and understanding
r�95-30
Print Owner's or Authorized gene'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.sov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dos
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"
Y zznn
��,� //�� �+��pp /1rcr A & A SERVICES, INC.
A&A SERV CES 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
BLynch) Name Date of Contract
kP_VJ Ail MLI f�
Bu er(s) Street Address, City,Slate and Zip Code
�x(Q �/f-�2cvgvJ D2 /97TLeC54�fL0 M0402703 v - t. Af4a 70
�CEvh H Do Mina C-
a me Tele hone Number Evenin Tele hone Number Mobile Tehon le e Number E-Mail Address
978-85Z-889 97H-979-139O Fb Do7vl/k,cr ifo7nsar
The Buyers)listed above hereby jointly and severally agree to purchase the goods anchor services listed on the accompanying specifcation sheets,in accordance
Will 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 Buyers 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 Buyer(s)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 Boyers)may seek for their
purchase. /r
Purchase Fin Est Starting Date:6_7Z &-
Dawn Paymen Z OQQ• Est Completion Date: 6-26-y
- a Cash
Amount Due on Start of Job: E:Check V
Credit Card
Amount Due On of Completion: No.54(0(033000&g2)$
Amount Due on_of Completion: O Expiration Date0?--)
Balance Due on Upon Completion- //000' CVC Code 's lr,�po
a U ii usi Fli/G
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!eons of this Agreement.Buyerfs)
hereby acknowledge that Buyerfs)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.Buyerts)also(i)acknowledge that they were orally
informed of their right to cancel this transaction;and fill request that they be contacted via their telephone numbers or email,as listed above,in the event
Contractor believes Buyers)would bs interested in any additional quality products or services of Contractor. 00 NOT SIGN THIS CONTRACT IF IT
CONTAINS ANY BLANK SPACES.
A&A priestiee ,Inc. Buyer(s)ey: k
Signature�
Ga-�/f� ti Si datiburl �///
Print Name Pr 'e ' ' I
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.
ARBITRATION:The mmector aria the homeovmer hereby mutually agree in advance that in the event either dairy has a game ennceming this contract either parry nay sumo sum dispute to a
prate achom Vor wrote whlM has been approved by Yoe Sevetary of the Etecutive Office of Con Affairs and Business Regulations and the other party shall be required to sooner r to such
obscaeon as proved In M.G.L c 142A. V." _
Cnmmnn,ieir , 9uyye Itle
Durr s-in L�ra-y,T Dotc,S+
NOTICE of CANCELLATION NOTICE OF CANCELLAT ON
Data of Thomson-S"12'15,You may copse, ,is voneaamu,whom any penally or Data ofTransversef/)-r�You may cants,this removal vnhout any penalty or
obiigadon.wmm three busineesaays from me above cote.uyervi any proprn,freaed in, deduced,whin three dulness days from the above date.Ifyducenteranypmpenytradedin,
any payments made by you under The cooed or Sale,and any calmer.icawma,neeecutee any payments mane by You under me Comeau or Sale.and any deposit lnoumema.ecmee
by you evil ce returned Main to days rdlowng receipt by he setter of your cencenauon notice, by you vell he formed vathm 19 days fdmwng recsw by the Seller of your cancellation nonce,
Add any eetudty cohered arising out of me assured cog be conodled if you co col,you must and any re curry imsreat advng out of the radial will be cancelled.if you cancel You must
make ava0abta to me Seller aI Yburesadimand,,and submado"in as good rendition as when make available to the Seller at your readderade.and substantially in as good monde n as ended
reervervard,any goods delivered to you under this Contract or Sale',or you may.it you over,comply ovareved.any goods delivered to You under this Contract or sale',or you msy,if you cosh,comply
moth the assured—of the Seller regaling the return shipment of the goods at the Seller i Ath the Instructions of the Seller regarding me relum shipment of the goods at the Sellers
expense and risk,If you do make the goods available to the Soler and the Seller does nor pick ey,ense and risk.If yen do make the goods maitable to the seller and the Seller uses not piU
them up sihin 29 days ollhe date of Notice of Chastiser,you nay reran or dispose of the them up men 20 days of the data of your Notice of cancinal you may hater or dispose of
goods without any further otheaaon,if you al to make the goods available to the Sear.or if you He gootls whom any Inch.,odigstun.I you fail to—its the g.o available se me Salle,,or i1
agree toodum me gods Athe sugar and fail to do so.men you rennin liable for perfomance of you agree to return the 9oMs to as Seller and fail to do so,men you domain Maus far pedwmenw
all stationary under me CoMad,To cancel this recession,mail or deliver a signed and disk Ball diagrams under me Contma,To mantel this transaction,mail or deliver a signed and .it
copy of me conchnation nu de or any other carmen notice or said a tolegem to A�a'AlSemce, copy of me mnM[labm notice or any other an den notice,or send a telegram* to gall setv_s.
115himu Street Salemiviti,NOT LATER THAN MIDNIGHT OF 115 1� 115 North Street Salem MA019Te,NOT LATER THAN MIDNIGHT OF3-L�-
hi m.,m
I HEREBY CANCEL THIS TMNSACTION I HEREBY CANCEL THIS TRANSACTION
Cmsuner'a Signature Data Consumer r s Signature Date'.
A 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
Buyers)Name Date of Contract
Buyers)Street Address,City,State and Zip Code
8(a 2wA'11 D/C- M711-9_&&YL0 MIT 02703 i s
7 w/ L�-z . Pr✓d sr�u n nraa or
E✓fN fjoW.)"1 C
Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address
�784S2-99" 9 78 479—/3 9 0 twmZu lAfhjs@f�L
The Buyers)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 pad.
ROOFING SPECIFICATION
Strip of# layers of shingles
❑ Install 6'of ice water shield at base of roof where O Install 15.b felt paper to ro
possible. Install 18-24" a and water shield in valleys.
O Flash chimney as needed(no toting included). ❑ Install " nmeter drip edge to rakes and fascia areas.
I] Install vent pipe boots and seal as neede Flash valleys as needed
0 Install rollout type ridge vent. Planks/plywood replacement under 32 SO FT included,
"If is needed there will be an extra charge of$
per hour bor plus the cost of materials.
❑ Dumpster/Disposal Ind ❑ Other:
Location:
Install new r Manufacturer yr Style/type
In ed in this proposal are thorough cleanup,building permit,and company/manufacturer warranties.
RUBBER ROOFING SPECIFICATION
Strip Roof ❑ Not Strip Roof //VS ZIMIL 2 // C6 X pL-i'/WCCD
Install 1/2"High DensityFiklerboard to existing roof using XFIash obstacles as needed. III S/01� u!✓1 t,r_
screws and plates. li;te 1-ex , (g -8 /woih�7,
stall.060 membrane EPDM(Black)rubber roofing to Install _ a'In luminum 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.
SACK KITzI f10ArT7avV
SPECIAL INSTRUCTIONS: Q[rvt,Lo✓fS 0 4 S P(7o-1 cjF &>ccS T/My Al-v„4 1,v n,t tFK S c)-Ar
r� �rn rmr� Grrt C/,9- tSor-/T S7wf./L NF3ly Fwsel✓ tSa1c„wrr�,�
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9),/772-1 f9l Sl /3rV-O Ci by),�- Elio 1)V6L ✓off
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v/SL13L),,� Ric EYE TR/rh 2cspia,2 rw/zrr�
�f3fi4yL `hrct�= Z (aoS, R-nv-eL 1'12te_�=k Y2j! .
DI.SGw.�TP2,�JJ699=OOpp: zr3(o9•�(`� q� p/SLo✓NJ�/GrCcT�=TH3�Z`�. '� _
h is"mod To ned.adersto r by a�beNveen lM1e pa[Iles tha �ii Spec tlo�S .,,along eu � ELING Tact.,VEM ,O Ndp o nslit
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 Buyer($)and the contractor. Buyers)hereby acknowledge that Buyers)
has read this Specification Sheet.
Contractor Initials: �,�{�
(/ � Date: 2 -/S Buyer's Initials: Date:#4�
The Commonwealth of Massachusetts
po IV
I Department of Industrial Accidents
F Office oflnoesU atlons
600 6Vnshuegion Street, 7/' Floor
`` Boston, Mass. 02//1
apt::.5.a :
Workers' Compensation Insurance Affidavit: Building/Plumbing/Electrical Contractors
AVDlicant information: Please PRINT leeibly
name: _ /� ✓i,> p�rrl..�C�1�C)lZ .
address:/ [ I NO✓( N t 7 I �2 Q� (fit�y —7 r/
citV JCn (2 ar state: Mi zip:
0070,�^ ,/phone#R / / D - / VIna(Ag
work site location(full address .l�frfle9rtue lGBo.�t.� '�J�t•C..��'` IY1 r'f 8)-1'�1C7'�
❑ 1 am a homeowner performing all work myself. Project Type: ❑New Construction ❑Remodel
❑ 1 am a sole proprietor and have no one working in any capacity. ❑ Building Addition
1� 1 am an employer providing workers' compensation for my employees working on thisjob. ..
comnanv name: /Y,,� 'l'. �A— J. z l'-V 1 �-S t �AA C
address:�'t 1 i.S !1/O �n� S"-- p -7`L �5 / �7
city: S a ( ee (M-S .�7/114- phone#: ram%�7t 0 -�]t�r7] �Q�/V '1 92V
insurance co. I t� c- f ,-a v e I-e r 15 policv# t ,-lLt.S L"/l O d _
❑ 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. police#
Attach additional sheet if necessary
Failure to secure coverage as required under Section 25A of NIGL 152 can lead to the imposition of criminal penalties of a fine up to SL500.00 and/or
one years'imprisonment as well as civil penalties in the form oft STOP WORK ORDER and a fine of5100.00 a day against me. 1 understood that a
copy of this statement maybe forwarded to the nice of Investigations of the DIA for coverage verification.
1 do herehy/certify uor a th pains a nl p /allies of perjury that the information provided ahove is true and correct.
Signatures/ Date ��_ �✓4-J
Print name G 0Y2../ Phone# q7 O 7 Y� v T�"
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 irimmediate response is required ❑Selectmen's Office
[]Health Department
contact person: phone n; ❑Other
l revised Sep;.2003)
Cert icat=_No: A043066
r THE COMMONWEALTH OF NLASSACFIUSETTS
7 E\ECUTIVE OFFICE OF LABOR AND WORKFORCE DEVELOPMENT
=! DEPA.RTINIEINT OF LABOR STANDARDS
^' 19 SLANIFORD STREET, BOSTON, N/(ASSACHHSETTS 02114
DELEADER CONTRACTOR LICENSE
A & A SERVICES, INC.
115 NORTH STREET
SALEN( NIA 01970
LICENSE: DC000.440 EXPIRES: Sunday,June 07, 2015
N ACCORDANCE WITH NI.G.L. CH. I 11, § 197B(b) AND 454 CNIR 22.03, THIS LICENSE IS ISSUED BY
THE DEPARTMENT OF LABOR STANDARDS TO THE CONTRACTOR ABOVE FOR THE PURPOSE OF
ENTERING INTO OR ENGAGING N DELEADING WORK.
THIS LICENSE IS VALID FOR A PERIOD OF ONE YEAR.
THIS LICENSE MUST BE MAINTAINED BY THE CONTR I ACTOR bvHEN ENGAGED I DELEADING
WORK N ACCORDANCE WITH NLG.L. CH. I I I § 197B(b)(2) AND 454 CN1R 22.03.
HEATFIFP E. Ro% E, Dir-EcTCr.
i � IJ3id 1 .� 3
Office of Coneumer Affairs&Raluese Re,nl:�rp❑
HOME IMPROVEMENT CONTRACTOR
CS-057733 _ Registration: i91609 7 P
Expiration 5,'B;?S15
CHRISTOPHERZORZY -, Private; Doratic
115 NORTH ST - +1 .A3A SERVICES, INC
Salem ALA, 01970- 1I ,
,'.. Christopher Z,,Y
115 North Street
J�-• �„y�. ='o �' " , Salem, MA 01970 —�—�—_
-r,.; 05/26/2015 Undersecretin
https://elicense.chs.state.ma.us/eGov/Web/PaymentResuIt.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
D to a Submitted: Wednesday, May 06, 2015
Applicant Name: CHRISTOPHER ZORZY
iLicense Number: CS-057733
Agency: MADPS
Process: Renew License process
Payment Information
Authorization Code: 125004
Received Date: 5/6/2015 9:26:33 AM
Received Amount: $100.00
MAY O ffi 2015
of 1
5/6/2015 9:26 AD
O Phone: 978-741-0424
e Fax: 978-741-2012
A w p S E R O 115 Noah Street
�j+�►LtA"��1 \VI 115 North Street
• . . S Salem,MA 01970
May 30, 2015
City of Salem
Building Dept.
120 Washington Street
Salem, MA 01970
To Whom It May Concern:
Enclosed please find the permit application for Kevin Mugford, 7 Willow
Avenue, Salem, MA.
I have enclosed a check for$42.00 based on your fee schedule of$7.00
per $1,000.00. The job was $6,000.00.
Please send the completed permit to A & A Services, Inc. at 115 North
Street, Salem, MA 01970.
If you have any questions, please contact me at (978) 741-0424.
Thank you for your assistance.
Sincerely,
Barbara Zorzy d d
Office Manager