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16 HARDY ST - BUILDING INSPECTION The Conunomceallh of N4assachusetts t\ Board of 131.1ilding Regulations and Stund:ilds \II'�It II'.\1.111 1(t�\ Massuchusctts State Building Code. 780 UNIR, 7 edition I',til( vT Building Permit Application To Construct Repair. Renovate Or Demolish :t Rr ns.,/ hnuwu, 011e- or Tno-Fu/nih Dtrrllin,g (1 — v� "This Section Far Official Use Only Building Permit Number: Date Applied: s "nal —`—t---- � I Building Con ni ssione / n,pcefor of 13" IJincs Date SECTION 1: SITE INFOR.-MATION LI Propertyn�A dress: 1.2 Assessors Map & Parcel Number's (� 1 Fit U Sf cSCL� Q Fn _------ I.Lt Is this an gree ed street? yes_ no_ Map Numher Parcel \'unifier 1.3 Zoning Information: 1.1 Property Dimensions: Zoning District Proposed Use Lot Arca(sq IU Fn>nwee ilii 1.5 Building Setbacks(ft) Front Yard Side Yards - Rear Yard Required Provided Required Provided Required Pne iJcd i 1.6 Water Supply: tM.G.L c. 40. §-)4) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone'! Municipal ❑ On site disposal s)sicm ❑ Public❑ Private❑ Check if yes[] SECTION 2: PROPERTY OWNERSHIPt 2.1 fi��`�r�r<�hd P���1 f7 Com_ 1 (P aocr) u �{�� _, ,5_ .r✓1 Nain-e(PPriyu) .Address for Service: g icnatur - Telephone i SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction ❑ Exis-ting Building❑ Owner-Occupied ❑ Repaus(s) ❑ Alteration(s) Addiiinn ❑ Demolition ❑ Accessory Bldg. ElNumber of Units_ Other ❑ Specily: Bn f Description of Pro used Work': 1 PO ,no �4�xt�nunq-- I — SECTION 4: ESTIMATED CONSTRUCTION COSTS Estimated Costs: Official USe Only hem (Labor and Materials) L Building $ UO I. Building Permit Fee: $_.Indicate hosa fee is drm eteined: ❑ Standard City/Town Application Fee - 2. Electrical $ ❑Total Project Cost' (Item 6) x multiplier i 3. Plumbing S 2. Other Fees: $ 4. \gerhanical iHA';1C) $ List: ------ 5. Mechanical (Fire S Total All Fees: Suppression) Check No. Check :Amount h. Total Project Cost: b Vc� 76 0 Paid in Full ❑ Outstanding 13:dance Due:--._ I SECTION 5: CONSTRUCTION SERVICES 5.1 LimnsteddConstructionStiperviso�r (CSL) C. ( i5 �r ,j -_/ — Ll,cn,e Number Iafj�Si rYaw�if/D:nc N'ann•at C'S L- I Older -- t / J ff� I_ul C'SL'I\pc ('cc hclum) Ts e Description - C I'nresincted i u t m 35.11110('u. Ft.; - R Restricted I.@'_ F:umis DANelline M:as.ntrs Chtlo RC Rcsidcnual Roulinc (berm, Trlei)h ,no R'S - Rc>id,nail \t m,-hm .md SiJine SF Re,ldenlial S.— , F.arl ISwnme Applianrc In,a.allaw;u D Resideinml Ucmnhunn 5.2 egis red If to Improvement Contractor 110 HIC Comp: y Name ur IIC R•,g stria N t - - Reelstrutiun N'umher or l AJdre F.xpap�d Date iSignature /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. Enlace 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 1 r as Owner of the subject property hereby authorize 1 to act on my behalf. in all matters relative ) rk :nthori ed by this building permit applirutiun. ` Sienature of Owner � Date c n— O- z {' SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLAR.A ION 1. Oki r 5 Q r ZLA . as Owner or Authorized Agent hereby declare that the statements and information on th regoing application are true and accurate, to the best of my knowledge and behalf. hlr 15 Pri tNt Signa ure'01 0wrieri"ol Authorized Agent Dale (Siened under the sins and penalties of er'u ') 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(HIC) Program), will not have access to.(he at program or guaranty fund under M.G.L. e. 142A. Other important information on the HIC Program :nd Construction Supervisor Licensing (CSL) can be ti and in 780 CMR Rei•ulations 110.R6 and 110.R5, respectively. '. When substantial work is planned, provide the information below: Total flours area iSq. Ft.) (including garage, finished hasement/attics. Deeks or porchi Grass livine area I Sq. Ft.) Habitable room count Number of tireplaces - Number of hedraams Number of haihruoms NUIllbelof half/h;uh, fvpe of heating system Numher nt Decks/ parches. . Type of cumin" system_ Enclosed Open 3. "Total Project Square Footage" may be substituted for "Total Project Cost" _J CITY OF SALEM 3 PUBLIC PROPRERTY ray DEPARTMENT ,.V;t! I<I I t [,Kill x'11 \I.t,,'M 1'� \1's,1IISr, tiutst. \Ls,;.v 19 I'!..I:`)'X-"4;.959; # Norkers',Compensation Insurance Aftidarit: Builders/Contractors/Electricians/Plumbers A f ili ant Information Please Print Leflibly N;IIlh: lnuanr,; th_ant[au,nt lnJn:du,J.l: Ate A ddress: 1115 Nor+h Sire of q \ 1 I ('fly,Slate,Zip:� Mn [)I9�DPhone #: L 17� ) 2� I - ©j� 'l Are Fou an employer:' Check the appropriate box: Type of project (required): I I am a employer with nt 4. ❑ 1 aa general contractor and 1 6. New construction (� _�_ ❑ employees (full and/or part-time).• have hired the sub-contractors 7. ❑ Remodeling listed on the attached sheet. I '.❑ I :un a sole proprietor or partner- _ ship and have nu employees (hese sub-contractors have 8. ❑ Demolition working lir me in any capacity. workers' comp. Insurance. '9. ❑ Building addition (No workers' comp. insurance 5. ❑ We are a corporation and its lo.❑ Electrical repairs or additions required.] officers have exercised their right of exemption per N1GL 11.0 Plumbing repairs or additions i,❑ 1 am a homeowner doing all work b p p l_'.❑ Roof repairs myself. [No workers' comp. c. 152.employees. [ and or have no ./ insurance required.] t cmployesu. nc workers' 13.V ether--------------- comp. insurance required.] )�' •Any applicant[list checks box#1 must also till out the section below showing their workers'compensation policy information. ' If...neuwners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavil indicating such. C urac[ors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp. policy information. lain an employer that is providing workers'compensation insurance for my employees. Below is lite policy and job.site information. Insurance Company Name: �rV �re2 ��� Policy #or Self-ins. /Lic. #:II I D�4,,I10, ,J U 13 Expiration Date: f pR ( /� Job Site Address: I ll/ 1 1 ����1 U City/State/Zip: t 17 O Attach a copy of the workers' compen .tion 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 tSne up ar S I,ioo.W)and/or one-year imprisonment. os well its civil penalties to the firm of a STOP WORK ORDER and a fine of up to s2iO.Ut1 a duv against the violator. Be advised that a copy of this statement may be forwarded to the Office of Ins estigatinns of the DIA for insurance coxcrage verification. l Jo hereby certil•u u er he plains and penalties of perjury that the information pre)videdabove is [ride and correct. Date: — ,ii'tr.uure. 77 Uj/iciul use only. Do not write in this area, to he crmtpleted by city or Morn ofjiciaL ('it% or Fown: - ._-- .--.-- --- .---- PermiliLicense #_._.__. tssuim� Authority (circle one): I. liourd of Health 2. Building Department 3. Cih/town Clerk J. Electrical Inspector 5. Plumbing Inspector 6. Other -- Contact Person: —___---- -- _--- Phone Information and Instructions \LI>.achuseus (lencral Lamas chapter 13, requues-.111 cmplo%ers to pros de %corkers' compensation for their employ-ees. I'tII su.uu to this statute, all rnyrluree is dcfned .Is ".. cc en person in the sen ice of.mother under ane contract of hire. cep:cos or implied, oral or ccrinen.- \n e mpGrrer is Jclined as "aft indis dual, panncrship, ,tssoclation. corporation or other legal entire'. or:my two or more ,,I the I'lregoIng engaged in ajoint enterprise, and including the legal represcntatices ofa deceased employer. or the I -ccicer or trustee of an individual. part11er01p, ai.socianon or other legal goofy, employ-1111, employees. Ilocveser the L'.c ncr of a dccelling house ha%Ing not more than three aparnncnts and cc ho resides therein, or the occupant of the dccclling house of:mother cvho employs persons to do maintenance. construction or repair Murk on Such dwelling house or on the grounds or building appurtcn:mt thereto'hall not because of inch employ stent be deemed to be an employee" \I(il_ chapter 152, §2SC(6) also States that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally. \1(iL chapter 152, §25C(7) States"Neither die conmmonwcalth nor any of its political subdivisions Shall enter into any contract fir the performance of public acork until acceptable ec idence of compliance with the insurance requirantenrs of this chapter have been presented to the contracting authority." .\pplicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractors) name(s), address(es) and phone numbers) 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 LCC or LLP dues have employees,a policy is required. Be advised that this affidavit may be 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 returned 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 he sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the aRidavit for you to till 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 permit/ icense applications in any given year, need only submit one affidavit indicating current polis information(if necessary) and under"Job Site�. policy ry) e 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 hone owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e, a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The ()ffice of Investigations would like to thank you in advance for your cooperation and should you have any questions, pleauc do not hesitate to give us a call. I lie Dcp:uvment's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Offlce of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 www.mass.gov/dia 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 work shall be disposed of in a properly licensed facility as defined.by M. G. L. c. 111, Sec. 150a. The debris will be disposed at: Salem Transfer Station owned by Northside Carting Signature of PermitApplicant Date Christopher Zorzy Name of Permit Applicant A &A Services, Inc. Firm Name 115 North Street, Salem AVIA 01970 Address, City, State, Zip Code i�l--' Nlassachusetts - Department of Public Safetc Board of Buildint Regulations and Standards Construction Supervisor License j License: CS 57733 Restricted to: 00 CHRISTOPHER ZORZY 115 NORTH ST SALEM, MA 01970 Expiration: 5/26/2011 m ('omiesimwr . ... I —_ _ Trkk: 14751. ..—.J . ..._. -_ �� .. Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 101609 Expiration: 6/26/2010 Tr: 267870 -:::-Type:_Private Corporation A&A SERVICES,iNG- • Christopher Zorzy. . 115 North Street >- y' Salem,MA 01970 '" Administrator Commonwealth of Massachusetts Division of Occupational Safety Laura M.Marlin,Commissioner g y Deleader-Contractor CHRISTOPHER ZORZY Eff. Date 04/01/09 Ank Exp. Date 04/08/10 s. DC000440 Member of C.O.N.E.S T. BO VIII IIIIII IIIIIIII VIII II IIII III II I II I II 2067ON-RENEW 'L A& A SERVICES, INC. 1 -SM°yJ�pICES 115 NORTH STREET,SALEM,MA 01970 - rjelmfflffvzff• Telephone:(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 Co tract Veboneh PreN�t'c V/ 1 k.� Buyers)Street Address,City,State and Zip Code Idll S+. i di q70 ,Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address: R7F 74 y_3 The Buyers)listed above hereby jointly and severally agree to purchase the goads and/or services listed on the accompanying specificatlon sheets,in accordance with the shoes and terms described on the front and Ne 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.(°Contracton,'hereby agrees to install or Cause to led installed the products r Services listed In this Agreement at the Buyer(.)address written above. This Agreement represents a cash sole of goods and services. The Buyers)agree to pay in cash the cost of Me goods and services purchased as described herein,regardless of timing or approval of any financing Buyers)may seek for their purchase. Purchase Price Est.Starting Date:_e �a Down Payment: �� � Est.Com lotion Date: Q In Amount Due on Start of JGb: heck ❑Credit Card Amount due on of Completion:�4: No. Amount Due on of Completion: Expiration Date: Balance Due on Upon Completion: 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 datedcopyof 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(l0 request that they be contacted via their telephone numbers or e-mail, 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 Services, Buyers) By: _�e'J-�ilu,r Signature/'2 Print Name yPrinI 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 fight. angnRATION:Tho con4attor and Ne tromedwarg hereby Ms."agree In advances that in Me eight either pend hes a dispute mnmming Nis contract,et r p may Submit Such Copula 0 a private guirsdon mumi a which has been epprovee"the Smretary of V,e Ifca IN Consumer AXvn and �fla'gulatens antl Me oNer paty shall Ee regulretl to submit b such arbi4ation as proved in foo.L d"HEI, �J^4 Cawazmini6al,'. 9.......tials: - oata: am Do Y ai/Iz%M ' Nor aF nAN l ar oN Nar or FESANrFyI_anol9 Date of ttmnrdbn roe mer mine,Ma 4arsawien,wonder any penalty m Data of Trom onion .you,may camel Ina tranaacbon,w room any penI or obligatlon,wNM=b ew eayafrom Me above date.If you fang,any pope,"ord ler, obligation,wmtm Mree business Bays form Me above date.it you mtml,my prcpem traded in. any payments made by you under the Contract or Sale,and any mgota is Instrument executed any payments made by you under to Corning Or sale,and any resulting instrument exemtM by you will be returned mumn 10 days tollomng receipt N Me Geller of your mnmllerion notice, by YOU will be reforms wi oin 10 days following Mobile by this,Seller IN your aatcellaYon hale., and any wound,interest arising out of Me f sal n will he commoul:If you deo 1,you must and airy Sammy Interact arising Me of the bm.a.will be bancelled. II you cancel,you must mound avawab in dee Selo,of Your reeidance,in substantially as gaol mndiidn m when rmeina, make aeallame to Me Seller at your residonce,M mbelanumy an good common as whenreceived, any goods benvoee ro you under this Construct or Sale:or you may,if you wish,dimply wide tM any golds delvered to You under tris borrow or sob:or you may.If you wish,comply with Me insbugions of Me Seller ugfusi g Me reNm shipment of to goods in the.ahem expense and insWctiena of Me Seller egarding the reNm shipment of Me goods at Me Sellers expend az risk If you do make Ne gotls magrbs in Me Gelkr and Me Seller does not pock them up me. If you do make Me go ice available t0 Pe Seller and!In.Sehe do-wt qck Mem up within 20 days of Me date of your Nahro of Commission,you may retain Or dioptre of Me goods amens 20 days of Me date of your Notice of Ca iib on,you may retain or discoed Of the 9uotls without arty further ablignmed.If you fall to make the goods available to be Seller or it you agree wiMmtanyfur robligaticn.Ilyoufaltomake Megmdsanilableb Ma Seller,orityouame to reNm Me goods to to Seller and tall 0 dl so,then you remain liable for pmlcrmame of all to rerun the goods to the Seller and fall to do as Men You mmun liable ler p Oo mance of all reigabons underem calling.To Mond ln'd 4adYctien,mal ordellver a signed and dated copy oblowbnsummethe Ormos,Ta cvael Mi9 Veruaalbn.mall oreeYvereagnae aN dalae copy of Me cancellalun min m ury other NOM Street,Salem,MasaMueadOand NOT LATER sTHAN a MIDNIGI,Tto OAFM North he ocanerollSalem,M aorcaM1nuy eo a 01970r NOT iLATER sTHAN a MIDNIGHT O IDNIGHTOF Services.115 posits (D.) I HEREBY OANCELTHISTRANSACTION. Consumer's Egnmm Dale I HEREBY CANCEL THIS TRANSACTION, Consumd,OSigh.r. Data A � Ssml= A & A SERVICES, INC. AAA CES 115 NORTH STREET,SALEM,MA 01970 wlllnp Telephone:(978)741-0424 Fax: (978)741-2012 Contractor Registration No. 101609 Federal EIN:04-3090162 Construction Supervisor No.CS057733 MISCELLANEOUS SPECIFICATION SHEET Buyer(s)Name Data of Contract Dura v) PreU+i�2 N �3 Buyer(s)Street Address,City,State and Zip Code 16 f-km S4- S .�1 C?lg7G Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address+ j21r­ZV+ee 24 VAJ100 J1 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 term.described on this Specification sheet and the front and the reverse of the accompanying CUSTOMREMODELINGAND IMPROVEMENT AGREEMENT,of which this Specification Sheet is a pad. SPECIAL INSTRUCTIONS W i N too W �-Ns+Al lI A+;art 2(-Co e�r— P aQWC A'o sk"1111"! Rsiocic DjesWck Appciawwfx/),Vl Wofz (r= AIUblelIkAAa WiVIdowS wi+tYl SriAS AY13 /�L-scrZeIVS . pc�=Acocvirgs }:9 tom' e �cl� I So�Sn-C & 010e1,1nnj S»s nln Q RA( AAznlgeAAc .g11A J;,�F 0C 7-(^� - SP U a in+eGinr Af--e 45 qs Nz2decb Tp�crll,0t-e wed �'�ieS i F Px1sF;nq - r CuA BAck i yi+e r ior SJ66(1--4 S AS A;d�Aeei Rep��tc� ivl�er'�c�G lno�tds�gs ,a-s Ne�zdp�1. '° �uilu r`voi,9-mss oa�cx+e�io� mill aU �d-�IooG 1�.F+�'ldeo{'lLonti LtY\ lA- c2 F clsi,nc� Zx - r &Raic Tkra2- SiOS Lie Vlq 'ZX STOCK 62QJM0ve Arm re OLA As A��1 ec� `` . t C-A UL k x o+, S6 o` 1 Nr ��+2R'�� �C'(M /fS N-r2a-c�eQ o C_ip-A" urn 1nSl na �D,a 1),A C1AVc hY a w ��eX w nod �S p p A-�. 9 Ra.pVtc�-_ ex riot' +-1-IAA aN exkriar- 10SM1 ts AS Ne�ded>, �xSi�a e�eT rivl�� Zo't�1�� xstock-, It Is agreed and understood by and between Me partes Chet MIs Specification Sheet along with CUSTOM REMODELING AND IMPROVEMENTAGREEMENT,constitutes Ne entire understanding between the parties,and there are no verbal undersh ndings changing or modHying any of the terms.This conhael may not be changed or Its W..modifled or vaded In any way unless suchchanges are In analog and signed by both Me Buyer(s)and Me Conbaetor. Savona)hereby acknowledge Net Buyer(s) hes reed si this Speilcetien Sheet. C L��f L/1 JJ/, Contractor Initials: Date: -f �IT/ ��o`� Buyer's Initials: Date: 7 -LA-f� �m Salem .Historical Commission 120 WASHINGTON STREET, SALEM, MASSACHUSETTS 01970 (978) 745-9595 EXT. 311 FAX (978) 740-0404 CERTIFICATE OF APPROPRIATENESS It is hereby certified that the Salem Historical Commission has determined that the proposed: ❑ Construction ❑ Moving ❑ ReconstructionJ� Alteration ❑ Demolition ❑ Painting ❑ Signage ❑ Other work as described below will be appropriate to the preservation of said Historic District, as per the requirements set forth in the Historic District's Act (M.G.L. Ch. 40C) and the Salem Historic Districts Ordinance. District: Derby Street Address of Property 16 Hardy Street Name of Record Owner: Deborah Prentice Description of Work Proposed: Replace all ten windows with wood, 6 over 6, Marvin Ultimate Double Hung, simulated divided lite windows with bronze spacer and 7/8" mullions, painted to match existing window trim. Casing to match existing q x S, not brick mould casing). Application for gutters &downspouts continued to the meeting of October 1, 2008. Dated: September 18 2008 SEM HISTORICAL COMMISSION quu,/By. , j The homeowner has the option not to commence the work (unless it relates to resolving an outstandir violation). All work commenced must be completed within one year from this date unless otherwiseindicated. THIS IS NOT A BUILDING PERMIT. Please be sure to obtain the appropriate permits from the Inspector of Buildings (or any other necessary permits or approvals) prior to commencing work.