7 WILLOW AVE - BUILDING INSPECTION � 24 &_ -7 ��Z,
The Commonwealth of Massachusetts INSPECTIONAL S RVICES
I' Board of.BL ilding Regulations and Standards CITY OF
Massachusetts State Building Code, 780 Cbl S.`+�EM
R1015 MAY -l 4-i,41I. 201
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One- or Two-Family Dwelling
This Section For Official Use Only
''I^^r Building Permit Number: Date Applied:
U , / /
_. 4-z 0
Building OFficial(Print Name) Signature Date
(� SECTION 1: SITE INFORMATION
1.1 Property Address: e L2 Assessors Map& Parcel Numbers
'1 W
L la Is this an accepted street?yes_ no blap Number Parcel Number
1.3 Zoning Information: L4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq It) Frontage(ft)
1.5 Building,Setbacks(ft)
Front Yard Side Yards
Rear Yard
Required Provided Required Provided Required Provided
L6 Water Supply: (NLG.L c.40,§54) L7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: Out i
Public❑ Private❑ — Outside Flood Zone.
Chcck;ryes❑ Municipal❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Ownertof�tecord•
�e win Nlu rn z)r� zboro AA M703
Name(Print) City, State,ZIP
V 1�ta n✓cw�r. . 315-9-79'1370
No. and Street
Telephone P Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) Ef Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_ I Other ❑ Specify:
Brief Description of Proposed Work': fk ( {gyp ,w
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs:
(Labor and Materials) Official Use Only
I. Building $ 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. Mechanical (Fire $ --
Suppression) Total All Fees:$
Check No._Check Amount: Cash Amount:
6. Total Project Cost: $ 5 _3 ❑Paid in Full ❑ Outstanding Balance Due:
�IAXuD S(ICJ .C_
M V, bra
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
S(',I p GO / 1:- License Number Expiration Date
Name of CSL Holder '
//-- North Si List CSL Type(see below) U
No. and Street Type Description
0 / -76 U Unrestricted(Buildings u to 35.000 cu. ft.)
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP
M Masonry
RC Roofing Covering
WS Window and Siding
Gi .L SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
1 i',/I c.e- s C - LOf i00 q
HIC Compam Name or HICC Registrant Name HIC Registration Number Expirauon Date
IC C07 r0 f�-l2 JI
No nd Street
Email address
City/Town, State,ZIPS l z l 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 .......... C/ 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 y S -Z /2
to act on my behalf, in all matters relative to work authorized by this building pen it application.
( o �i���
Print Owner's Name(Electronic Signature) Date
SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION
Bye ring my name below, I hereby attest tinder the pains and penalties of perjury that all of the information
cont ' d this application is true and accurate to the best of my knowledge and understanding.
w r� - L/
Print Owner's or Authorized gent'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.gov/oca Information on the Construction Supervisor License can be found at www.mass.eov/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"
A^ w 1;3C0 Q A & A SERVICES, INC.
A&A SER V ICES 115 NORTH STREET, SALEM, MA 01970
III a•I IVA I=1015 Ira ff9JTJ1TJTdj1M Telephonc:(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 HE Name Date of Contract
yc myciFl Iy-zo-is
Bu er(s Street Atldress,Cat State and Zip Code p/JG/900Y!?Tr$
�6 *Ay✓Lc✓N"'[ D& 19,—r1,78&4,0 04,19 0Z703 7LQi�L,0w XIvLs N
KL?k/1yYQyN L(Nt
Da Imo Tele hone Number Evenin Telephone Number obde ere hone Number E-Mail Address
7f3- esz-9019 1 1978—$7`7— 1390 DW ol>��ly 6907_?'-N �.
The Buyer(s)listed above hereby jointly and severally agree to purchase the goods and/or services listed on the accompanying specification sheets,in accordaoaeL "i
frith the prices and tens 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.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 cast 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: $j Z. Est,Starting DateS-2V &-7
o Down Payment: Yam. Est.Completion Date'
0"t Cash
Amount Due on Start of Job: pQ�Check 1 _1
,RE Credit Card / l [y,
Amount ova on_cf Completion: Ng�j Y Icy 3,205-3 l<1Qi
Amount Due on of Completion: p Expiration Date: 0-2 —1
Balance Due on Upon Completion'. 3�921 3 4 e
GVC Code:
tyAlV Z WILL.W
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.Buyers)
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.Buyers)also(i)acknowledge that they were orally
Informed of their right to cancel this transaction;and hl)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 Ser ,Inc. Buyer(s)
By Signature p
Si at r
Print Name `u I`
V
Pit t Name
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 controvert Me honaowner hereby mNually agree in advance gat Inine event eiNerpany M1as a duMte cpnmming this contract rouree pond may subml such dater s b a
pm are
aryVatlon service vMlrli has been opposed by me Sacrosanct IM1e Exact Otter of Consumer Ptlatr and Business Represented]tax Diver paTy sM1all be reguiret to subnvl to suet;
mummor as proved in ii c.101A.
menib:con da eaxn mhula yam"- .
amr, Tale'.
NOTICE OF CANCELLATION NOT LE OF CANCELLATION
Data of Interval t'/— 0—/�.You may mewl Ibis baneecoon..thwl any real w Data wTanea¢uo„ ^Z0-1 .Youmay cancel mh laneacumr.enthnut any penally ar
mugauon.Wmin three busmeas bays tram the above date.ll you cancel,any pmpeM traded in, obligation,Morin three tencreas days from the atone date.Nyouddncel.any proarmlraaet in.
any wymanls back by you under Me Contract or Sect,and any signal insnumert exewtetl any payrrenls nude by you under,,,cunuacr a,Sale and any negotiable inslnment executed
by you fall be names"Min 10 data Iollvsing recept by 0¢Seller of your uncelletion a.,. by you tell be seemed adore 10 days lateral receipt by the seller of your cancellation ratite,
and any-only interest adyng out of the transaction wall be cancelled 11 you cancel,you must and any servdry merest and,out of Me transaction wall be canre box,It yen cause.you must
make avelatle to the Seller at your residence,and substantially in as good danditim as wt,en make assemble to rod Seller at your residence,and substantially in as good condition as cans
ceiv¢4 any gaols toliveretto you under lbrs Lomrad or sale:or you may,;tyre wish merely concede,any gco]s telHeret to you under Nis Contract w Sale:orym nay,ityouvnsh wrryly
vein the insWtlbns of the Seller regarding Me Mum shipment o1 Me goods at the Saber's e�m the instruNcns N the sager regarding the Mum shipment of Ina gents at to Sent
expense and ask.II you do nuke Me goods available to the Seller and the Seller tices nd pid, expense and ask.II you do make Me goods available to Me seller and me S mr tices not part,
More up were 20 days of Me date of year Notice of Canaveral you may retain or severe of the them Up vahin 20 days 0 the data of your Notice of cancellation.you may ream or dlndeve of
gwdsltilhoutenyNMe.lop,tron.Ityoufa,IIDnakethegcodsavailablebtM1e Seller.crifyou the goods vaNON any NdMrodigation.Ilyw tail to rtake Ne goads availad¢lo th¢$ell¢r our
agree to Mum Me goods to the seller and hit to do so,men you remain liable for pertomance of you agree b return me goods to Ne Seller and fail 0 do so,then you rerraan liable for pedwtvnce
all personal under the Contract To cans¢I May transaction,null or deliver a fly and tlaletl of all obligations under the Camara,To cancel this transaction,mail or deliver a sand and tlaletl
copy of the wade puran notice or any other wren notice.or send a telegram,to ASA Services copy of 0e cancellation notice or any offer mean notice,or send a platform.to A rs Sciences,
115Norm Seeet Salem MA01970,NOTIATERTHANMIDNIGHTOF 115 count street Salem MA 01970.NOT ATER THAN MIDNIGHT OF Y—l_2—)-5--
e or,
I HEREBY CANCEL THIS TRANSACTION I HEREBY CANCEL THIS TRANSACTION
C......S,miture Dale: Consume,s Sgnatura Oate'
�p'@/ 9=19B A & A SERVICES, INC.
AAA SEE V ICES 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
KevIrJ rOvyr a o y- Z_ s—
Buyer(s)Street Address,City,State and Zip Code
J IN/LLoW /?V� S)91�1�✓ L 1�✓� a/�70
Duvniny ee.
Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address
97$-979- 1390
The Buyer(s)listed above hereby jointly and severally agree to purchase the goods and/or services listed below,in accordance with the prices and terms described on
this Specification sheet and the front and the reverse of the accompanying CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,of which this Specification
Sheet is a part.
ROOFING SPECIFICATION
Strip Roof of# layers of shingles
❑ Install ice and water shield at base of roof where ❑ Install 15.b felt paper to roof.
possible. Instal 4"of ice and water shield in valleys.
❑ Flash chimney as need o repointing included). ❑ Install 6"perimeter dri a to rakes and fascia areas.
❑ Install vent pipe boots and seal a eded. ❑ Flash,,,�ys as needed
❑ Install rollout type ridge vent. Planks/plywood replacement under 32 SO FT included,
'If more is needed there will be an extra charge of$
,>< our for labor plus the cost of materials.
O Dumpster/Disposal Include ❑Other:
Location:
Install new : Manufacturer yr Style/type
1 uded in this proposal are thorough cleanup,building permit,and company/manufacturer warranties.
K0)"1772-cl+40D ITT M/ RUBBER ROOFING SPECIFICATION
Strip Roof ❑ Not Strip Roof
Install 1/2"High Density Riles card to existing roof using Flash obstacles as needed.
screws and plates. f ry
,Install.060 membrane EPDM(Black)rubber roofing to IV Install 41aluminum drip edge to perimeter of roof with
fiberboards I seam tape.
Flash up sidewall as needed.
Included in this proposal are thorough cleanup,building permit,and company/manufacturer warranties.
SPECIAL INSTRUCTIONS:
_R9mai t !Za-<Ar,rP73y1_ 6"K1977n1{ 41- VwlfnrvM S1KJrrt,
,VCFT11rL r�2tG[� _ (or3�a�.
/�
Jr))S/HVAi� P2 l/iF4 57_ 8�
- 2Sb
It Is agreed and understood by and between the parties that this Specification Shei along with CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,constltulas
me entire understanding between the parties,and there are no verbal understandings changing or modifying any of the terms. This contrast 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 Buyers)
has mad this Specification Sheet.
✓l ly"1 Zl�'l . X/`•ram
' Contractor Initials:�� Date: y� Buyer's initials. -F/_ 1—. Date:10
The Commonwealth of Massachusetts
a ` t k DepartnrenloflmlustrialAccidents
Office ofinuesffgafions
600 Washington Street, 7`° Floor
= -a Boston, Mass. 02111
Workers' Compensation Insurance Affidavit: Building/Plumbing/Electrical Contractors
Applicant iinnformatiocn_:]..�, Please PRINT legibly
name: in>'l
address:: L l o rlyt iS" Y_et04/city 12 f"s state l 6 lip: 0/9-0 phone# Q i�-_7r71"r27(37
work site location(full address): 7 zIltoai yt, ScLkry, qA 01
p710
❑ I am a homeowner performing all work Project Type: ❑New Construction emodel
❑ 1 am a sole proprietor and have no one working in any capacity. ❑ Building Addition
[6 1 am an employ/e�r providing workers' compensation for my employees working on this job.
comnanvna11me: /-� - fT �trVl��St
address: 1 I pp.5- //Ci/O A v S 4—'
city: 5a i e (r'i'u . /rn trl phone#: —1�7t p/— 7n n7 f(}�/V
insurance co. ! ,-P_ 7rel V{� �'� �Y �.S polies,# 0,7 3 AA d f 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:
city: phone#:
insurance co. Police#
company name:
address:
city: phone#:
insurance co. police#
Attach additional sheet if necessary
Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition oferimin:d penalties of it tine tip 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 S100.00 a day against me. 1 understand that a
copy of this statement maybe forwarded to the ffice of Investigations of the DIA for coverage verification.
1 do hereby certify unt a llo pains and p names of perjury float the information provided above is true and correct.
i
signatur �7 Date fey , 9—1
Primname U,/�� / LOY Phone# 770 '7�f��
official use only do not write in this area to be completed by city or town official
city or town; permit/license t! ❑Building Department
❑Licensing Board
❑check if immediate response is required ❑Selectmen's Office
❑Health Department
contact person: phone#; —[]Other
(revised SeP�.20037
Certificate No: A043066
r
THE COMMONWEALTH OF MASSACHUSETT,
ffz—
WEEXECUTIVE OFFICE OF LABOR AND WORKFORCE DEVELOPMENT
— ��,
DEPARTMENT OF LABOR STANDARDS
I
19 STANIFORD STREET,BOSTON, MASSACHUSETTS 02114
DELEADER CONTRACTOR LICENSE
A &A SERVICES, INC.
115 NORTH STREET
SALEM MA 01970
I
I
LICENSE: DC000440 EXPIRES: Sunday,June 07,2015
IN ACCORDANCE WITH M.G.L. CH. 11 1, § 197B(b)AND 454 CMR 22.03, THIS LICENSE IS ISSUED BY
THE DEPARTMENT OF LABOR STANDARDS TO THE CONTRACTOR ABOVE FOR THE PURPOSE OF
ENTERING INTO OR ENGAGING IN DELEADING WORK.
THIS LICENSE IS VALID FOR A PERIOD OF ONE YEAR.
THIS LICENSE MUST BE MAINTAINED BY THE CONTRACTOR WHEN ENGAGED IN DELEADING
WORK IN ACCORDANCE WITH M.G.L. CH. 11 I § 197B(b)(2)AND 454 CMR 22.03.
(
HEATHER E. ROWE,DmCcTOR
bcardo 3ia1lJtng �JI a,:or, )IJ a[) d),,, _Office of Consumer Affairs&Business Regul,rnn
( mtrucnn Su lien nr __,—. `HOME IMPROVEMENT CONTRACTOR
'_icens=_ CS-057733 z— = Registration: 101609 TyIFe:
- Expiration: 6.26/2C16 Private C a,00ratic
CHRISTOPHER ZORZY
I l5 NORTH ST a,ryN A3A SERVICES, INC
Salem NtA 01970
11y'° Christopher Zorzy
115 North Street
Salem,MA 01970 -
05I2612015 Undersecreua
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O Phone: 978-741-0424
isxx- oix Fax: 978-741-2012
es.com
A&A ,SERVf d 115 North Street• ■ . Salem, MA 01970
May 4, 2015
City of Salem
Building Dept.
120 Washington Street
Salem, MA 01970
To Whom It May Concern:
Enclosed please find the permit applications 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.
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,
Ba=araZorzy
Office Manager