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22 WILLOW AVE - BUILDING INSPECTION (6) �\ The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF SA EM Massachusetts State Building Code, 780 CMR Revised Mar 2011 Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: I Date Applied: Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1. �P1roperty Address: yy 1.2 Assessors Map& Parcel Numbers 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_Ownerotf�Recor n �,n •nri" Q(Q1 r1 f7 er 9�1��1` 0. Q, Vv'� I'L Name(Print) y/,�1.�� y�- i City,State,ZIP '7�7 r W11\0� I r C- Yf- 1 -7 (— JJ-7 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WOR-W(check all that apply) New Construction❑ FExisting Building Owner-Occupied Repairs(s) ❑ 1 Alteration(s) Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify: Brief Description of Plroposed WorkZ: I (0.ce f" UJ • ( �O�l cL �0�2 �Zr.+� �OOr SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials I. Building $ L4, ( 9 / 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) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees: $ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ U (P 39 , 13 Paid in Full ❑ Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) (,In C i S —Zt),r 2J License Number Expiration Date Name of CSL Holder List CSL Type(see below)I ' F NJ 0 ^0� l� No.and Street Type Description S �w\ ,^,� 1�. Q 1�� U Unrestricted(Buildings u to 35,000 cu.ft.) LN, rVl1'� R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Mason ry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 1 Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) �+ A-I .pr /�cp-5lv.c HIC- 1 ©I to09 HIC Co paI1Fo y Na e or HIC Registrant Name Registration Number Expiration Dale �( �' rh No.a d Street Email address n I F w, Mb+-- b 14-1 0 C?R-7`N 0Y 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 (,k✓i L S 0 e—Z)! to act on my behalf,in all matters relative to work authorized by this building permit application. ,<� co,.4, ac k lb-) ?- ) 3 Print Owner's Name(Electronic Signature) Date SECTION 7b: OWNEW 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 d i thi pplica ' n is true and accurate to the best of my knowledge and understanding. - )72 Print Owner's br Authorized gent's Name(Electronic Signature) Date NOTES: I. 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/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" r SPOSAL OF DEBRIS AFFMAMT In sco®rdance with the provisions of m� R L. c,40, Soc> 54, a condiilon 6- . Building P8mii$Number is that the dabeim resu ing from his work shall be disposed ofjn a pe®perly.licensed fa�liify as degas®d.by K 0. L c0 9 9, W. . Me debris will be®ispDsed at jgl9ga `ransf9F*S16!&ffon kwwd by HmthRids Carbr, i�nature V Peiml Applioanf Rafe r �— �I1PB �p�➢g 4O WaMS Of PermRAppEcanf . A A sc_Nec:eso lnoo HOKIh 9-teest. Salem. MA 01970 Address, city, sfafa, Zip Code i CITY OF S. .&M. NLL sSACHUSETTS BUILDING DEPARTN[m%T 120 WASHCVGTON STREET,3`c FLOOR TEL (978) 745-9595 FAX(978)740-9846 KI.NiBFRi RY DRISCOLL MAYOR THosw ST.PrEm DIRECTOR OF PUBLIC PROPERTY/BUILDING CO\L\MIONER Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Anolicant Information Please Print Legibly Name(Busim-&OrganizatioNlndividml): ✓ ✓1 s /YIC . Address:_ 1 L S ( o/-hn 5+. City/State/Zip: Q vv-\ )M L 0 1 R 7 0 Phone #: 27 R- 741 - O'l - -y Arq'you an employer-Check the appropriate box: Type of project(required): 1.E] 1 am a employer with 4. [] 1 am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet: 7. ❑Remodeling ship and have no employees These subcontractors have V. ❑Demolition working for me in any capacity. workers'comp.insurance. 9, (]Building addition (No workers'comp. insurance 5. (] We are a corporation and its 10.❑Electrical ears or additions required.) officers have exercised their 3.❑ 1 am a homeowner doing all work right of exemption per MGL I I.[]Plumbing repairs or additions myself.[No workers'comp, C. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' 13.E]Other comp. insurance required.] •Any applicant that checks box#1 must also fill out the section below showing their workM'compenmion policy infor"tioa. *I hvneownen who submit this affidavit indicating thcy are doing all work and then him outside contratrom must submit a new affidavit indicating such. :Contractors(hot check this box must attached an additional sheet showing the name of the sub-comreclom and their workem'comp.policy information. I am an anployer that is providing workers'compensation Insurance jar my employees. Below is the policy and Job site information. Insurance Company Name: [ C V0. e Qv,' S t Policy#or Self-ins. ��ILic.#: D"[ 3 Pk R 1 Expiration Date:-a-/I __ �ln ' Job Site Address: d w I 1�0 vJ Q . City/State/Zip: SJ dy yt�Y�fl—d 19 7 5 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 fine up to S1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator. He advised that a copy of this statement may be forwarded to the Office of Investigations or the DIA for insurance coverage verification. I do hereby cert jy n r the sins and pen ties of perJnry that the information provided above is true and correct. ( . Ir � / / Date: Phone199' 1 --o Official use only. Do not write in this area,to be completed by city or town ofjiciaL City or Town' PermivlJcense# Issuing Authority(circle one): 1. Board of Ilealth 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: _ Phone#: + nc a = e1Be2 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 Bavaria)Name Date of Contract Tit -I- M4W&I QeYL4Ak /o i7-13 Buyers)Street Address,City,State and Zip Code 2"L wa Loi 1 vt Sr42 ts^ 1 / t 01�70 Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address 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 part. y WINDOW REPLACEMENT t Remove and dispose of# 1 existing windows. ,J EdSH't/Tl A[iS 1 Install # 7 new 3/ �N�4 �.An windows:3Vinyl It Wood ,SU q(>YC.�m-G✓ and facturer) �1 (/E35T�gc- Opt10nS: Style 3 Grid pattern II// /UOlg- pp���� rL Color Interior Color Exterior W/7 y T� rift-6 Glass Type DM)6LO LOW-F �Fr Wrap exterior trim with aluminum: Style Color5�1 DI All windows will be installed according to the installation procedures in the portfolio. Caulk all interior and exterior edges. t Insulate where possible around new units. i Insulate window weight pockets if exist,and around new window units where possible. Included in this proposal are set up,clean up,Rape vacuum and cleaning windows inside and out. i Building permit included. - BAY/BOWS/CASEMENT UNITS/ANY FULL CONSTRUCTION WINDOWS t Create new window opening by cutting through existing home and training 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. a t 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. t Bay t Bow t Casement t Other window(s)to include new interior style trim and new exterior style trim and head flashing as needed. It Note. Painting and staining not included. STORM PRODUCTS t Remove and dispose of# existing storm window(s). t Install new storm windows# Manufacturer Style Color Option Remove and dispose of# existing storm Cootie). Install new storm doors# Manufacturer �0Vg-7 Style wl/F Color IAJY14>- Type: IrAluminum aSoidCare SPECIAL INSTRUCTIONS: .3 if ` /AiST�tLL A/F W Y Qvrfr�'7bn /Loyn+p /'-tc.LO/N S /9Y2auni 3/20 FZaWL S4-j 01nJz7 It is agreed and understood by and between the parries 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 connect may not be changed or Its terms modified or varied in any way unless such changes are in writing and signed by both the Buyens)and the contractor. Buyens)hereby acknowledge that Buyerls) ' has read this Specification Sheet. Contractor Initials: J Date:p f-7 3 Buyer's Initials: Date: /� c' �p / A & A SERVICES, INC. A&A SER 1 S 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 Date of Contract Bu r s Name Bu r s Steel Address,Cit ,Slate and Zip Code Dalterne Telephone Number EveningTelephone Number Mobile Telephone Number E-Mail Address -2Y C/7X 771- 7 fuW,Ibtwn4p lwK lC(� LUS The Buyerse and teams hereby jointly and rout any agree to purchase the goodsen snorer services listed on the accompanying specification sheets,ire requested that the prices and terms described on the front and the reverse of this agreement and any specification sheets'hie"Agreement"),and Buyers)have requested that such goods or services be installedre meat at—atthe Buyer's)address above.ABA Services,Ina('Contractor'a hereby agrees to install or rouse to be installed the products or services listed in this Agreement at the Buyers)adtlress written heave.This Agreement represents cash sale goods and services.The Buyers) agree to pay in cash the cost of the gootls and services purchased as described herein,regardless of liming or approval of any financing Buyers)may seek for their purchase. , Purchase Price eAP Est.Starting Date://—J7 Dorm Payment I TQa Est.Completion Date: ll-3d'- 3 }r�T.Cash Amount Due on Star)of Job: LJ Check Cre ' Amount Due ono(Completion, No. Amount Due on_of Completion: Expiration Date Balance Due on Upon Completion p' 3o /�r 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 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 wally informed of their right to cancel this transaction;and(if)request that they be contacted via their telephone numbers or email,as listed above,in the event ConVactor 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 Serv'c se Inc. Buyer ) By: Signalture gna ureLf Si 1V Print Name � — Print Narhe 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 fallowing Notice of Cancellation form for an explanation of this right. ARBITRATION;TO.mandismiliumdNe M1omecwn M1 "andeddly agree in advanceNal in the event otherF"i and him h Iran.nine p M Y ubmisucM1 dspule lot pn mph r Moe wtr sh has 0.xn app ed by N S Woo N E n Olfice f C Aflaa,a o M ther,:M that be eta}ad m sudn'l le such arbitrationproved in MUG l 1C2A. y gri !o-e7-i3 p,r .. . NOTICE OF CANCELIATION NOTKEOFCANCELLATON Date OtTrandamengli3 Yoe may co eel mis trans hon,mthOUtanYWallyOr Dam of Transaction la-/7-O.Yoe may cancel this transhebon,wlnnml any partly or Wligation.whin Mme mainesa days tram Me am"data if you canrel any pmpert,varied in, obligation.MNin Mree buswss days room Me rtove dale.if yin cancel,any pmpeM trmed in, any wynenb made by you under Me Cwtwt or Sale,and any negoulde Thermal exewled any paymenm made by you under the Commit or Sale.and any negotiable lnshument ezewted by you art be rammed ufMin 10 days bussing mmpl by Me Seller M your ancellmon notice, by you art day returned M1M1in 10 days fameatfng receipt by Me Seller of your cancellation times. and any security interest arising out of the Vans Don will be enabled.It you cant you most and any security Interest arising rot of Me Momentum MII be cancelled.if yen cancel,you must make available W the Seller at your reader,and subsdnwl In as your condition as amen make available to to Seler at your reaidence,and subnansidly In as gw'tl condition as when e removed,anyl dsdelimmdbyouunder Mis Contractor Saleloryoumey,Il.w ,i .mrply moved,any goods infrared to you under Nis Contras mSale:oryou may,it on Wsh,empty ai u in.mortality oL the Sella,regarding Me return shipment of in.goods at the Sepses vAN Me inwmcdons of the Stlmr regWing the return shipment W the goods at Me Seller's de enact and risk.It YOU do make the goods available Io the Seller and Me Sella does nW I eryense and risk.If you do make the goods available to the Seller and Me Seller does not park tam up Whin 20 days W the date of Your Hearst ofeanmllatioo.you may retain ordieweeofine Hem up WMI 20 days W Me dam W yore Nodes of cabceuaueo.you may reui or dispose of goods uiNoul any rubber migration.If you tail to rose Me goods available be Me Seller w if you Me goods aiMout any fuller dogafpn.If you fail to make Me gads avatlade an the SNler,ora agme to return Me goads b ins Seller arm hit to do re,turn you remain liable for pedomanm of you agree 0 Wum the goods so Me Seller and fail Up do so,then You remain III farp ffo ne all obpmors under the Contras To cancel this Vanmoon mail or deliver a summed and Miami W all obligatiws under pre,Capper.TO cenrel thistrrneemoa mil or delier a signed and dated copy of Me reneellman node fir any in.,wrten route,o,and a trustful to Asa So des, aopv W me edoolma notice e,any oMe,amen nobs,or sera a teat AaA S hies 115NOnh Slreel,Salemlivi Q NOT IATERTHAN MIDNIGHTOF�3 - 115 Nam Street Salem He 01970.NOTIp1ERTHAN MIDNICHTOFr motor mamnl I HEREBY CANCEL THIS TRANSACTION I HEREBY CANCEL THIS TRANSACTION 'Cmsmmr'a Signature Date: Consumers Signature Data 30 � ' Phone: 978-741-0424 A&A S� S Fax: 9vices. om p www.a-aservices.com 115 North Street Salem,MA 01970 October 21, 2013 City of Salem Building Department 120 Washington Street Salem, MA 01970 To Whom It May Concern: Enclosed please find the permit-application for Tom & Mary Demakes at 22 Willow Avenue, Apt. 1, Salem, MA for vinyl window replacement and a storm door. f/ I have enclosed a check for$60 based on your fee sc� he'dule of$11.00 per $1,000.00 plus a $5 administrative fee. The total for the job w,a_s.$4,639.00. J Please send the 4pleted permit to A & A'Services, Inc.-at-115 North Street, Salem, MA 01970. If you have any questlons„�please contact me at,( ) 741-0424. i Thank you ffor your assistance. i Sincerely, Barbara Zorzy a Office Manager JV 1 IL i ` J 1