22 WILLOW AVE - BUILDING INSPECTION (4) r
�\ The Cunununwcalth of ,%1assachusc1[ts
Board of 131-lllding Regulations and St:ulda ds
Massachuse[ts State Building Code. 780 CME2. 7I' cdiuutl I 'Sli
+,
,, 1,1111hil
Building Permit Application To Consu•ucL Rrpair, Renocale Or Ihnullish a / _uu,\'
One- or Tun-fnrnih, Dwelling
This Section For Official Use Only
(7� J Building Permit Number: -Date Applied: -p----- _�
l
Building Cununlsel ner/ lspec r at Buildings Dale
SECTION 1: SITE IN TION
ljl�r1iperh' :\ddr•ss: 1.2.Assessors Nlap & Parcel Numbers 81Q70
Ma Number � Y:ucel NumM1rr— —
I.la Is this an accepted street? yes_ it().-- P
1.3 Zoning information: 1.4 Property Dimensions:
Lot Areas (U Frontage(lil
Zoning District Proposed Use y
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
I
Required Provided Re9 uired Provided Required Yrm ided
�
1.6 Water Supply: (M.G.L c.40. tl 54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone? h1unieipal ❑ On site disposal system ❑
Public❑ Private❑ Check if yes
SECTION2: PROPERTY OWNERSHIP'
2.1 Owner of R J)Ci i l�emat ') Cnka AA Q 1G70
Name (Print) 4ddr ss for Service:
SignLaturl - Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK' (cheek all that apply)
New Construction ❑ Existing Building ❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) Addition ❑
Demolition [3 Accessory Bldg. ❑ Number of Units_ Other ❑ Specily:
Brief Description of Proposed Work': k Y
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Costs: Official Use Only
Item (Labor and Materials)
I. Building Permit Fee: S Indicate how ann
tee is detrned:
Buildin_
❑ Standard City/Town :\pplication Fee
2. Electrical S ❑Total Project Cost' (Item 6) x multiplier e
i
3. Plumbing S '. Other Fees: $
4. Mechanical (HVAC) .S List
5. Mechanical (Fire S I Total All Fees: S
Su- ressinn))
po i Check No. Check Amount: Cash :\nnxuu:_•—.-- '
j b. Totai Project Cost: '� ') goof ❑ Paid In Full ❑ Outstanding Balance Due:---..
i
SECTION 5: CONSTRUCTION SF,RVICES
r"r��
trructiooii Supervisor (CSL) 152Z 4.2 _rj - /l /
Lironsc \'a ithhaF I:.xhi�ru—ion l)�,ilc�
4foof_nl CSI_'I'cpc Ixa hcloul
W r o- TV c Dtscri nnm
C Cniesuicied nt i In?5.000 Cu. Ft.i
5vrtyn `"j / f - R Restricted I Yt'_ Famil\ Dsttllin_
RC Residential lhndinc Crn time
Telephone \1'S Rnidnitial Window .ind SiJtne _
SI' Rr,Weiuiul Solid Fuel Bunting \i tltunrt imtall.iuuu
D Residential Uanndntun
5.� Re ter�d llome lm ro\ymenl or�tr, ctor (IIIC) �6/�O L)
tr
if ' unp;n N t e r 11C �i tr a N mt Regtstrauon Nmnher
t J�(0
Ad re.
V�! _xptrati m Date
S gnatwe 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.
Siened Affidavit Attached? Yes .......... ❑ No ........... ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN .
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I• Y I as Owner of the subject property hereby
authorize W to act on my behalf, in all maueis
relative t ork authori d y building ermit appli on.
ZOd
Sim tut ol'Ownei. Date
y J SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION
as Owner or Authorized Agent hereby declare
that the statements information on the ro going application are true and accurate, to the best of my knowledge and
behalf. ,
.. Print Nam
Signature of Owner or Au -torized Agent Date
(Siened under the pains and penalties of perjury)
NOTES:
I. An Owner who obtains a building permit to do his/her own work, or an owner who hires an unregistered contractor
(nut registered in the Home Improvement Contractor IHIC) Program), will not have access to.the arbitration
program or guaranty fund under M.G.L. c. t-t_'A. Other important information on the HIC Pru,_ram and
Construction Supervisor Licensing (CSL)can be found in 780 CMR Regulations I IO.R6 and I IO.R5. respectively
' When substantial work is planned, provide the information below-
Total floors area(Sq. Ft.) .(including garage, finished basemenUattics, decks ur-porchi
Gross living area(Sq. Ft.) Habitable room count _
N umber tit t'ireplaces Number of bedroom,
Number tit bathrooms Number of halt/hwhs
rope of healing system Numberot decks/ p,jrrhes ----_—__--
Type of cooling system Enclosed Open _-_-- -- --
i. "Total Project Square Footage' may be Substituted tot 'Total Project Cost-
J
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the provisions of M. G. L c. 40, Sec. 54, a condition of
Building Permit Number is that the debris resulting from this Wort,shall
be disposed of in a properly licensed facifity as defined.by M. G. L c. I i i, Sec."
15Ba.
The debris will be disposed at Salem 'transfer Statlon
owned by Northside Carting
Signature of PahnitApplinnt
Date
christooher zll
Name of Permit Appi cant .
A &A Services Inc.
Firm Name
115 Forth Street Salem. MA 01970
Address, City, State, Zip Code
CITY OF SALEM
PUBLIC PROPRERTY
`j DEPARTMENT
,. rnl:n\ net++t , ll
\IA Rt 12:%%*A,lliN1,l0N51KI'114SAIi \I,
I'l.l: ♦ F\\: 7 $•'J:•'15Jn
Workers' Compensation Insurance :lfftdal'it: Builders/Contractors/Electricians/Plumbers
Anlrlicant Information �^+ / Please Print Leeibly
Name I lhi,inc,s I ir_anttaIlon IltdI%Idua l.I: A L- A
:address: 115 nlnr+h fit°
City,State,'Zip: �I ffn I-hq of g-7a Phone R: ( `l7S) 7q1 - QH 2,,H
Are,/you au employer:'Check the appropriate box: FE] Remodeling
(required):
I.IJ I am a employer with ; ❑ I atn a general contractor and tstruction
employees(full andior part-time).* have hired the sub-contractors
'Q I :nn a sole proprietor or partner-
listed on the attached sheet. ingship and have no employees rhesesub-contractors have nworking for mein any capacity. workers' comp. insurance. addition
No workers' cum insurance 5. ❑ We are a corporation and its -
r P• 10.❑ Electrical repairs or additions
rryuired.J officers have exercised their
3. 1 am a homeowner doing all work right of exemption per MGL 1 1.❑ Plumbing repairs or additions {
myself. [No workers'comp. c. 152, §I(4), and we have no 12.❑ Roof rc air
insurance required-] t employees. [No workers' I Other
comp. insurance required.]
'Any applicant that checks box#I must also till out the section below showing their workers'compensation policy information.
t I lumcuwners who submit this affidavit indicating they are doing all work and than hire ourside contractors must submit a new affidavit indicating such
:Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp. policy information.
h urn an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information. �r /
htsurance Company Name:
Policy#or Self-ins. Lic. #:' t- \r 11 Mpp c `(t(3 ��yy �/'yy Expiration Date:
Job site Address: 22- WI, )\� ANe , )ajM�r { OkQ7UCity/State/Zip:
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
line up to S 1500.00 andlor one-year imprisonment,as well as civil penalties in the firm of a STOP WORK ORDER and a fine
of llp ro S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Imesti_ations of the DIA for insurance co\erage Verification.
I do hereby certify r ler to pains and pena/tiec ufperjury that the information provided above is
Prue and c•orrec•L
-wimiure: 4 ,11
I
Phn»c = Ll I l2
Official use wily. Do not write in this area. to be completed by city or town ojjic•iaz
City or i'aw n: - ------,-----_----- PerrnitiLiccnse #_
Itsuinq .luthorih. (circle one):
1. Board of Health 2. Building Department 3. Citpiruwn Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
I
Information and Instructions
\Lrs..ichuscus Cencral L:nvs chapter 132 regmres all cniploters to prof ide uorkcrs' compensation for their employees.
I'!usu.uu to this,%mute. ait en,ploree is defined as'•.. o%ery person in the sen ice of .Inulher Under any contract of hire,
cspress or iutpIicd, oral or ttriveit.•'
.\n einlilorer is defined as -an indi%:dual• partncrship,.issoctatiun. corporation or other la al entity. or any two or inure
,tithe fiurgoing enga red in ajuint enterprise, and including the legal representatites ofa deceased employer. or the
:cccit er or trustee of an individual, partncrship,association or other legal entity,cinpluy ing employees. l lowe%er the
n•a ner of a dwelling house ha%mg nut more than three apartments and aho resides therein, or the occupant of the
Ja clling house of another who employs persons to do maintenance,construction or repair tt ork on such dwelling house
or un the grounds or building appurtenant thereto shall not because of such employ nient be deemed tu-he-an-employee"
\It iL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the.issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant s%ho has not produced acceptable evidence of compliance with the insurance coverage required."
dditionally, NIGL chapter 152, $2:C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the pertonnance of'public atork until acceptable et idence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
.Applicants
Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary,supply sub-contractor(s) name(s),address(es)and phone number(s)along with their certificates) of
insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial
:Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be retumed to the city or town that the application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill.in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permiblicense applications in any given year, need only submit one affidavit indicating current
policy intorrnation (if necessary) and under"Job Site Address"the applicant should write"all locations in (city or
town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
i.c, a dug license or permit to burn leases etc.)said person is NOT required to complete this affidavit..
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do nut hesitate to give us a call.
the Dcparrdnent's address, telephone and fax number.
The Commonwealth of Massachusetts
Department of Industrial Accidents
OfMce of Investigations
600 Washington Street
Boston, MA 02111
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
Itet i:ed :-2c>•us - Fax # 617-727-7749 - -
www.mass.gov/dia
Massachusetts- Department of Public Safet%. ;I
Board of Buildint;Regulations and, Staodikrtlti,--
Construction Supervisor Licensee
License: CS 57733
r
i Restricted to: 00
CHRISTOPHER ZORZY ;
115 NORTH ST
SALEM, MA 01970 f
Expiration:.5/26/2011
('ununisiuncr Trm: 14751
✓fee �iammwau�vaCC{e a�. aaoaclvlaella
�\ Board of Building Regulations and Standa ds -.
HOME IMPROVEMENT CONTRACTOrt.
I 1 .
Registration*, 101609
Expiration' -6/26/2010 Tr# 267870
lug
I _ Type Pri Late Corporation
` A&S SERVICES, INC`
Christopher Zorzy -
I I �o North Street
Salem;MA 01970 Administrato
Commonwealth of Massachusetts
Division of Occupational Safety
Laura M.Marlin,Commissioner ®
Deleader-Contractor I��y
CHRISTOPHER ZORZY
Eff.Date 04/14/10
Exp. Date 04/13/11
DC000440
Member of C.0 N.E.S.T.
BO
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,,,, //�� �'p`/��fC� A &i A SERVICES, INC.
A6 A SGR tl ICES 115 NORTH STREET,SALEM,MA 01970
iTITAILlibleivivilm4lumummEEMTelephone:(978)741-0424 Fax:(978)741-2012
Contractor Registration No. 101609
Federal EIN:04-3090162 Construction Supervisor No. CS057733
CUSTOM REMODELING AND IMPROVEMENT AGREEMENT
Buyer(s)Name Date of Contract
fly, ^l ®e"rvrlaKos I <5-- z5--/0
Buyerls)Street Address,City,State and Zip Code ,'ter q(f/
ZZ WiLLeovut Av-r Si4L li /F70
Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address:
7vh
76-77?
The Buyers)listed above hereby jointly and severally agree to purchase the goods and/or 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 Buyerls)have requested that such
goods or services be installed or provided at Buyer's address listed Whose. A&A 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 Buyerls)agree to pay in
cash the cost of the goods and services put sed as described herein,regardless of timing or approval of any financing Buyerls)may seek for their purchase.
iCIi = # ''Z fle ca
Purchase Price:(� ,.,flD Est.Starting Date: �/-� ]—
Down Payment:# &l Est.Completion Date: 7—7
❑Cash
Amount Due on Start of Job: O Check
❑Credit Card
Amount due on of Completion: No.
Amount Due on of Completion: Expiration Date:
Balance Due on Upon Completion: I ZOO, 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 this Agreement.
Buyers)hereby acknowledge that Buyerls)has react the front and the reverse of this Agreement and has received a completed,signed
and dared copy of this Agreement,including the two attached Notice of Cancellation forms,on the date first written above. Buyer(s)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 e-mail,as listed above, in the event Contractor believes Buyer(s)would be interested in any additional quality
products or services of Contractor. DO NOT SIGN THIS CONTRACT IF IT CONTAINS ANY BLANK SPACES. /j////
By: Services,Inc. yer(
1 u LzXt
gy �J1 wfi
Signature t UP �� xSign�i N - :J& 5rn i-69
�T<ui�
Print Name Print Name
Signature
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.
ARBITRATION:The mntaMr end the homeowner hereby mutually all in encountered In Me event¢tear pare M1as a dispute mnrernJJfig this mntred,either pare may submit such dispute to
e pdvate a ilalion service which has Men eppmved by the Sevrelaty of the Executive Office of Consumer Attain end Business na and the otM1er pare shall we required to submtl to
such emission a5 proved In M Gi alwM. X n^,rtrecwrivitials'.' -� Buyer's lvirials:
Deco:
' r Nl1TIf.F nG CPNfFII aTnN N/OTl- OAF AN F�eT ON
Date of trammNmi/ Z Y-10.You may carnal this transaction,vMM1out any Ponalty or Oats of Tmnsadion7 zy L V.You may cancel this tanaactioq wlthoN my,penalty or
obfgetlon,Wind three business does from the areas data.If you cancel,any pmcer,traded In, obligation,within three business days from the above date.If you cancel,any pmmem,traded in,
any payment made by you antl.,Me Confused or Sots and eery negotiable instrument executed any payments made by you under the contract or Sale,and any anotiabla lbrommenl executed
by you will M returned wlMin to data follmving receipt by the Seller of your cancellation notice, by you will M demand where 10 days to iessi ng receipt by Me Seller of your rancallation nombi
and Any sourly interest mining out W Me then aided will be cancelled. If You cancel.you must and any security interest adsirg oft Of the transaction MII be cancelled If you cancel,you must
make available to the Seller of your mufform,in substantially as grew compact as when brown, make available to the S.Il,at your counsel in emotional as good wMNOn we when informed,
any galls delivered b you under this Contract or Sale;or you may,II you war.comply who the Italy goods delivered to you under this Concert or Sale;or you may.If you wish.comply wan the
instructions of the Seller meaning the realm shipment of the goods at Me Sellers expense end instructions Of Me Seller regarding Me return ampmeM of the goods at the Sellers expense and
Nsk It you do make the goods available to IM1e Seller and Me Seller deas not pick them up riek. It You do make me goods available is Me Seller and Me Seller does toot pick Nem up
within an days of Me date of your Notice of Cancellatiw,you may relate or dbpcee Of the goods within M days of Be data of your Notice of Cancellation,you may retain Or planned of the goods
wiled any further obllgalbn. 9 you fail fir make the goods aveilabb to Me seller,or It you agree without Any fuller obligation.If you fail M make the goods available to the Seller,or if you eras
M m m Me goods to Me Salley and fail to d0 m,then you remain liable for performance of all to return Me goods to the Seller and fall to do so,Men You remein liable be perlmmaner of all
obllgafions under Me Contact To cancal this transaction,mail or deliver a signed antl dated copy obligetlons under Me Contract.To cancel this Monsanto mall a,deliver a signed end dated apply
of Me cancellation hWiw or any What written notice,or send a Western,to A&A Services,115 of Me commission erotica or any other added notice,or send a telegram,to ALI Services,115
Noon Street,Salem,decelerations 01970.NOT IATER THAN MIDNIGHT Ol 27 Noll Start,Salem,Mossadmisutls 01970,NOT LATER THAN MmNIGM OlI
(Dates lore)
I HEREBY CANCEL THIS TRANSACTION, Consumers Signature Date I HEREBY CANCEL THIS TRANSACTION. Consumer's Signatum Date
' 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
WINDOWS AND STORM PRODUCT SPECIFICATION SHEET
Buyers)Name Date of Contract
—rom 7 trm,4,f6T
Buyer(s)Street Address,City,State and Zip Code
22 WILL.OW Ave' SALeW / InA 0/0170
Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address
978-7vS &SR9 7"4
978-77) - zy
The Buyer(s)listed above hereby jointly and severally agree to purchase the goads 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.
7 WINDOW REPLACEMENT
XRemove and dispose of# J existing windows.
X Install # .3 new SflJV/LT.(&�_ PC7LE7U774&S windows.,Vvinyl ❑Wood
(Manufacturer) ,!
Options: Style �� Grid pattern AA11✓5"_
Color Interior LC/ i-71;' Color Exterior dUA T:�'__ Glass Type
04Wrap exterior trim with aluminum: Style Color
All windows will be installed according to the installation procedures in the portfolio.
y� Caulk all interior and exterior edges.
eX Insulate where possible around new units.
l�(1 Insulate window weight pockets if exist,and around new window units where possible.
Included in this proposal are set up,clean up,Hope vacuum and cleaning windows inside and out.
/Building permit included.
BAY/BOWS/CASEMENT UNITS/ANY FULL CONSTRUCTION WINDOWS
❑ Create new window opening by cutting through existing home and framing in opening.
❑ 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 openingis).
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.
❑ Bay ❑Bow ❑Casement ❑Other window(s)to include new interior style trim and new exterior style trim and head
flashing as needed.
�?Note: Painting and staining not included.
STORM PRODUCTS
❑ Remove and dispose of# existing storm window(s).
❑ Install new storm windows# Manufacturer
Style Color Option
❑ Remove and dispose of# existing storm door(s).
❑ Install new storm doors# Manufacturer
Style _ Color Type: ❑Aluminum Cl Solid(:ore
SPECIAL INSTRUCTIONS: &lf7W
ph/l,/noel ,
It Is agreed and understood by and between the parties that this Specification Sheet,along with CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,constitutes
the entire understanding between the"dies,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(S)and the Contractor. Buyers)hereby knowledge that Buyers)
has read this specification Sheeeet{.,tn
Contractor Initials: y Date: S- 7-�fQ Buyer's Initials J Date' ��,j�