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5 WINTER ISLAND RD - BUILDING INSPECTION ' 22�_ ► c4 (01 ICK ► szg3F-c> ►z 130 The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF Massachusetts State Building Code, 780 CMR S Revisedd Mar 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: Date Appli : Build ng official(Print Name) nat D e SECTION 1:SITE ORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers S W �.�e r is tcw cL�o�- 1.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(it) 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? Municipal ❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 wner'of Record: 110 u7 S AA--014'�v Name(Print) + f City,State,ZIP li f v42 �Sl0. J rd qq?--1j f'O)OU No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) Id Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work: S-►- L SA�Qr� C,-1 mqQ ViY\ 4 wv2.v, tC .e Lk)(n.8-ow S SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1.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) $ List: 5.Mechanical (Fire $ Su ression Total All Fees:$ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ 1.�S2.lsta-• ❑Paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) o 5--11 '3 .L B{-z—1 License Number Expiration Date Name of CSL Holder Lis[CSL Type(see below) 1 ) S Nn r, 'VN S k- No.and Street Type Description SU Unrestricted(Buildings up to 35,000 cu.ft. 0.UW A� /�.x 1`U't 0 1 R-1 0 R Restricted 1&2 Family Dwelling Cityrrown,State,ZIP M Masonry RC Roofing Covering WS Window and Siding p �7 SF Solid Fuel Burning Appliances p- ly'—oga-y I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) q 6 l Lo-o`9 IV\( , HIC RegistrationNumber Expiration Date HIC Q Y,Name or HIC Re Lant Name No. d Street T Y` �— 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 Issua cc of the building permit. Signed Affidavit Attached? Yes ..........ad No........... ❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIIE7S FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize CVq ri-1 L-0 r 2.� to act on my behalf, in all matters relative to work authorized by this building permit application. 4-e-e_. c o^4-r-0,-u4- q - 3--( ,3 Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contam this application is true and accurate to the best of my knowledge and understanding. Print Owner's or Authori d Agent'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.eov/oca Information on the Construction Supervisor License can be found at www.mass.eov/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" j CITY OF SM.EM, NLA SSACHUSETTS BUMDLNIG DEP ART%MNT + B• 130 WASHINGTON STREET,3'FLOOR °j TEL. (978) 745-9595 FAX(978)740-9W KI%tgFAT Fy DRTSCOLI T ,MAYOR HONLkS ST.PIERREi DIRECTOR OF PUBLIC PROPERTY/BL•ILDGVG COMMISSIONER Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information f� i Please Print Legibly Name (Bush siOrgtnizatioNlndividual): 1(�-t R- �Y-,/t _cs. 1 ✓k c Address: K td ,, S± City/State/Zip: SA�cm KA 0Ia1U ['hone:_ qjV 1Lfl —0\f3`j' Are o o'u an employer?Check the appropriate box: Type orproject(required): 1.Are a employer with 7 4. El am a general contractor and 1 6. El 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.t 7• L�J Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in an capacity. workers'comp.insurance. Y P h'• 9. ❑ Building addition [No workers comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL I L❑ 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' comp. insurance required.] 13.0 Other •Any applicml that cheeks box 91 most also rill out the section below stowing their workers'compensation policy information. Irom.:owrcrs who submit this altidavit indicating they am doing ail work and then hire outside cemmetore must submit a tmw altidavit indicating such. 'Conara.xors that check this box most attached an additional chest showing the name of the sub-contractions and their workem'comp,policy infomaation. l am an employer that is providing workers'compensatian insurance jar my employees. Below Is tire policy and jab she information. Insurance Company Name: 1 !My e �-2✓ .S Policy#or Self-ins.Lie.#: V Y14 p 3 K O 1 �[� _, 0.0,L--Expiration Date: 9 -1 3 —[ 3.._. Job Sire Address: . 1 1 k) ttil� 'S�0.,& PU- City/State/Zip -tin A A-Q(q 70 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 S 1,500.00 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations or the DIA for insurance coverage verification. l do hereby c erfify a er to pa' s and penalties of perjury that the inform thin provided above is true and correcC Siena,— ,rry Date: --,3 3 Phone#: Ll (- Offc-fal use only. Do not write in this urea,to be completed by city or town otrial. _ City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.Cilyfrown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: DISPOSAL OF DEBRIS AFFID1 Yff •. h accordance wh ift provisions of M. Ga L c, 40, Sea, 54, a condition of Building Permit Number is that ffie da ria resulting from his Work aFiGil be disposed of in a pr®pariy.iicens®d facility as defined.by K G. L co i 9, Sao, 950a. The debris will 6d ®isp���� at Main i eans�e Sfttoon GROW bV HOFU 9ida COMM Ngnature of, Pe i , ®pii�aat Fate Flame of Permit Applicant . A &A Saryk-,as, Em% F,ff Rr ® 115 UNA &FgaL 8—aborna M-A 01970 + AGrztle A �p �� 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 Buyer(s)Name Date of Contract Buyer(s)Street Address,City,State and Zip Code Wi✓✓%P2. LSL4,9r%10 X,6 S4Vcir.-( 1114 01970 Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address 778-?ylf 0/c0 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 par. WINDOW REPLACEMENT t Remove and dispose of# existing wI dows. Install # y-- new .SN2lS w� windows:Oinyl t Wood (Ma facturer) _ Options: style Grid pattern Color Interior M4f/T Color Exterior lAdhTZE� Glass Type t6NJ/Lt,T_ Wrap exterior trim with aluminum: Style Color Rr t All windows will be installed according to the installation procedures in the portfolio. CCC3lly} Caulk all interior and exterior edges. t Insulate where possible around new units. Insulate window weight pockets if exist,and around new window units where possible. Included in this proposal are set up,clean up,Hepa vacuum and cleaning windows inside and out. Building permit included. BAY/BOWS/CASEMENT UNITS/ANY FULL CONSTRUCTION WINDOWS t Create new window opening by cutting through existing home and framing 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. If 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. OBay t Bow t Casement her w'mdow(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 t Remove and dispose of# existing storm window(s). t Install new storm windows# Manufacturer Style Color Option t Remove and dispose of# existing storm door(s). t Install new storm doors# Manufacturer Style Color Type: t Aluminum If Solid Core SPECIAL INSTRUCTIONS: ALo J-R: t AAIV 4vo/ 7nmW219-L- 0*2eelml-7" 7a 69­090Y AA / It is agreed and understood by and between the parties that this Specification Shom,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.Buyer(s)hereby acknowledge that Buyer(.) has read this Specification Sheet. Contractor Initials: IV-2 Date: p—�i�-/3 Buyer's Initials: G7 Date: A & A SERVICES, INC. A&A SERVICES 115 NORTH STREET, SALEM, MA 01970 EmPPILTAI • 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 Buyer(s) Name Date of.Contract MtAgv Lev 1 S-2- -13 Bu er s Street Address, City,State and ZipCode ruv n Da 'me Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address 8 7' q-D ©O vN/s1 t ovOeS@ T Nr�T The Buyerselistetl above hereby jointly and severally agree a purchase the goods antl/or services listed on the auom'Agreement"),and sheets,in accordance that the prices and terms be installed on the front and the reverse address this agreement antl any es,In cation sheen(this'eby agre s t antl Buyers)have eequested that suchgootls orservices be ins isArement tstar Buyer )addrelistetlabove.ve, Services.Inc.treprsents'a herebyagreeso in stall or cause to be installed the products or services listed in His Agreement at the Buyers)ed as dewdden above.This Agreement represents o cash sale n goads and services.The Buyers) agree to pay in Cash the cast of the goods and services purchased as described herein,regardless of liming or approval of any financing Buyer(s)may seek for their purchase. �}p purchase Price: /tarp 4r E .Stalling Date: — VV'0/5 Dow, Payment: � Est Completion Date: —IS— [])Cash Amount Due on Start of Job: Check 'Credit Card Amount Due on of Completion: No, Amount Due on of Completion: n Expiration Date: Balance Due on Upon Completio v 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.Buyer(s)also(1)acknowledge that they were orally informed of their right to Cancel this transaction;and(H)request that they be contacted via their telephone numbers or email,as listed above,In the event Contractor believes Buyer(s)would be interested in any additional quality products or services of Contactor. DO NOT SIGN THIS CONTRACT IF IT CONTAINS ANY BLANK SPACES. A&A Service fill C. Buyer(s) �j � By: K /. Signature Signature G5 n Signet re Print Name Print Name Signature Print Name You,the coterie), 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. ARBRRATION:The ormearmr end Na homeowner bme,rmluallymnes m ativanre main the event either pant has a dro ule wnwming Has Secure.either pant may suborn(such Eispers ro a Prvare monsoon seMcs sonot has Seen approved by the Sevetaryof Ne Exeative OM®of Consurnarrooffews and Buvness RegW ashoend theotherparrshall be repWretl to subMt to suU aAitmtion as paves m M.G.L caa]A. - con n "Is: eayeJ:mauls: are mQ� ]�t NOTICE OF CANCELLATION NOTICE NOTICE OF CANCELlAT10N Date W Transaction 8"L —13.Yw may cant Mis tra Won.WaoW any penalty or Dale of Thimpo on O l y^r�/3.You may mast Its sanatory without any penalty or ebligatlon,vnNin Nrae Easiness tlays ham Me eMve tlele.0youcaeel,mypmpeMh'adedin. oblawar,vntho three business days Tom me above dale.if you Comes,any property MyRd in, a any Forma Made by you under the causes or sale,and any negaeade insEumenl exameed any payments mile by you under the Contrast or Sal.and any negobable lns0umenl emoltei by You sell be caused Wthin 10 days follo.Wng mentor by the Seller of your hencellation notice, by you aoI be raWmed enter 10 days fdlwmg Mpr by the Spear of your cancellation norms. and any seathty moves short out of me Y&teadion will be rameged.n you ances,you most antl any amounts imeresl she,our of the o-ansecOm sill CB restated.If you can t you—at make avellaae to the Seller at Your modence,and sure an ralry in as gmtl mndmon as xhen make availatee to the seller at your residents,and suEnantlaly In as good mndamn as Shen observed,any goods doubled to you under this Comsat or Sale;oryou my,ifyw sear,dermly haressaid,Cory gootls delivaretl to you under Nis Contractor Sale:oryou may,ilyou moo.mnsly vAth Me ihopmes ee of Me seller r ymding the harem trimmest of the gootls el the SHIm's sty the incomes.of the Seller remosen as me..shipment of the goods et has Seller's emense and dsk.It ym do make Ne goods a egabre he the stllx ant in.Seller tices not I. foreme and risk.If you do rake Me goods available to Me Seler and Me Seller does net piA Mem up wit io 20 days of Me data of your Nobel of comespeon,yw ray train or release of Me them up xithin 20 data of Me data of your Nooks of Cancellation,you ray retain or 4smser of goods sumps arty NMer foraton,If you but to make Me goods available to Me SHler or if you the goods Without any further cdigalion.If you fail to make Me goods asanible for Me Seller,or if agree to realm Me goods to Me Seller and fail to do be Men you remain liable for palmonares of you agree to velum me goods to the Sellerandred Wdo m,me you remvn[]able for performance all oulgatims under the Compol.Toeancel Mis hansacdon.mail or dower a signed and dated of all obligations under the Cormatl.To sanMl this formation.mail or deliver a mgatl and acted Copy of the ancesUdon mem w avy oin Canton noIca.cr eend a lelymm O PBA$eMtea, Copy of Me ancNladan nOdR or any alhp wAleo naO W.oh sentl a leley��^1 ABA S 115 North Sheet,Salem MA 0100,NOT LATER THAN MIDNIGHT OgK-�/—/3 115 Notts StmeL Salem MA 01970,NOT LATER THAN MIDNIGHT OF,�-3/=/ `ea lossam looter I HEREBY CANCELTHIS TRANSACTION I HEREBY CANCELTHIS TRANSACTION Consumes agrees, Date: Consumels9gnamre D. 4 _ THE COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF LABOR AND WORKFORCE DEVELOPMENT DEPARTMENT OF LABOR STANDARDS `.. 19 STAMFORD STREET,BOSTON,MASSACHUSETTS 02114 DELEADER CONTRACTOR LICENSE A&A SERVICES, INC. 115 NORTH STREET SALEM MA 01970 LICENSE: DC000440 EXPIRES: Saturday,June 07,2014 IN ACCORDANCE WITH M.G.L. CH. 111, § 197B(b)AND 454 CUR 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. 111 § 19713(b)(2)AND 454 CMR 22.03. HEATHER E.ROwE,DIRECTOR �� � t.ffl( Massachusetts - Department of Public Safety Oftice of Consumer Affairs @c Busihess Regulation Board of Building Regulations and Standards eOME IMPROVEMENT CONTRACTOR Construction Supervisor egistration 101609 Type: License: CS-057133 xpiration: fi[26/2014_ Private Corporatio A&ASER.VICES INC- 115 115 NORTH ST -` Salem NIA 019707 i Zorz Christopher P Y 115 North Street Expiration Salem, MA 01970 Undersecretary �-�^^ ���`�` � ` 0 5/2 612 01 5 ' commissioner I I ( av ;- - I r { Christopher Zorzy #20120426000840 A&A Services Inc Exp 4/26/2017 115 North St b 33 CHRIS Z ORL't Salem, MA01970 Pv}atthew JGibson h�i cmracMaopa,rs I