The URL can be used to link to this page

43 PROCTOR ST UNIT 4 - BUILDING INSPECTION �( The Commonwealth of Massachusetts Department of Public Safety V4/ Massachusetts State Building Code(780 CMR) Qr- Building Permit Application for any Building other than a One-or Two-Family Dwelling (This Section For Official Use Only) Building Permit Number: Date Applied: Building Official: SECTION 1: LOCATION(Please indicate Block#and Lot#for locations for which a street address is not available) f+- 1M 01M No.and Street it /Town Zip Code Name of Building(if applicable) I (, '( LA SECTION 2:PROPOSED WORK Edition o State se If New Construction check here❑or check all that apply in the two rows below Existing Building❑ Repair❑ Alteration l Addition❑ Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify: ' Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ Nom Is an Independent Structural Engineering Peer Review required? Yes ❑ No Brief Description of Proposed Work: .�r G1L,2 •� P�l'i S hG P la r u o01�S - SECTIONS:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CNIR 34) ❑ Existing Use Group(s): Proposed Use Group(s): SECTION 4: BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) Total Area(sq.ft.) and Total Height(ft.) SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ F B: Business ❑ E: Educational ❑ F: Facto F-1 ❑ F2❑ H: High Hazard H-1 ❑ H-2❑ H-3 Cl H-4❑ H-5❑ I: Institutional 1-1 ❑ I-2❑ I-3❑ I-4❑ bL Mercantile❑ R: Residential R-113 R-2❑ R-3❑ R-4❑ S: Storage S-1 ❑ S-2❑ U: Utility❑ Special Use❑and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA IB El IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ 1 IV ❑ 1 VA 11 VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: Public❑ Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be Licensed Disposal Site❑ Private❑ or indentify Zone: or on site system❑ required 13 or trench or specify: permit is enclosed❑ Railroad right-of-way: T Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable❑ Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed❑ Yes❑ or No❑ Yes❑ No ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s): Type of Construction: Occupant Load per Floor: Does the building contain an Sprinkler System?: Special Stipulations: 1A(Atti� i0 C� .C_ oll (v SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner 'r IM 6G)N rjAL _,Q 10),-oc1pk S4- Sq�e rv� ©1 17© Name(Print) No. and Street City/Town Zip Property Owner Contact Information: Title - Telephone No. (business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes Name Street Address City/Town State Zip to act on the property owner's behalf,in all matters relative to work authorized by this building ern-it application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) (If building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here❑and skiE Section 10.1 10.1 Registered Professional Responsible for Construction Control Z ((+�y)y q �Lf�� r� n` lepho Q IPI/bl e-mail a�d_.td'reQgs Regis io?umber e� Street Address City/Town State Zip Discipline Expiratiob Date 10.2 General Contractor v t� Company Name pk ' 7 - ©✓ - R Name of Persoh Responsible for for C� License No. and Type if Applicable 1" S A I n rf )a-1�1 S reet Add ess City/Town State Zip Telephone No. (business) Telephone No. cell e-mail address SECTION 11:WORKERS'COYIPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6)) A Workers' Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of thissuance of the building permit. Is a signed Affidavit submitted with this application? Yes No ❑ SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)_$ 1. Building $ Building Permit Fee=Total Construction Cost x (Insert here 2.Electrical $ appropriate municipal factor)=$ 3.Plumbing - - $ 4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality) 5. Mechanical (Other) $ Enclose check payable to 6.Total Cost $ (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application t ue nd accurate to the best of my knowledge and understanding. Plea�print and si-h �Z� Title Telephone No. Date Street dresCity/Town Sta e Z-ipS /z Municipal Inspector to fill out this section upon application approval: - L^ 'vb `N Name Date ( `v V f3Q, . /�, /� �q�y��///��/■/�� A & A SERVICES, INC. ASA SER ICES 115 NORTH STREET, SALEM, iVIA 01970 M as Kill L71 I a I lyj I riitivi S IN 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 Bu e s Name Date of Contract / 7 .are Street Addr ss. Cil State and Zip Code 76 Daydron Tele hone Number Everm Tele in Number Mobile Tele It Number E-Mail Address The Buyer(s)listed above hereby jointly and severally agree to purchase the goods and/or services listed on the accompanying specification signets,in accordance with the prices and terms 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 stat Buyers address listed above.ASA Services,Inc.("Contractor),hereby agrees to install or Cause to be installed the products or services listed in this Agreement at the Buyers)address written above.This Agreement represents a cash sale of goods and services,The Buyer(s) agree to pay in cash the cost of the goods and services purchased as described herein,regardless of timing or approval of any financing Buyer(s)may seek for their purchase. LIPW Purchase Pricer Est.Starting Data rTYT Down Paymentasr Oi('..(�L'Cv/TY '-- Est.Completion Date' Ute. ash Amount Due on Start of Job: 1 Check Q'Credit Card Amount Due am of Completion: No. reL�e Amount Due on of Completiorr�C_ Expiration Date: �Jjj 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.Buyer(s) hereby acknowledge that auyinds)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(1)acknowledge that they were orally informed of their right to Cancel this transaction;and(it)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 Services, Buyer(s) _ By: Signature p Signature q�f Print Name SE344 �!!! �� ,2Y(i �7�� ' Print 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. ARBrtRAnoN:The mmraaror and the narneakep er hereby mutually agree in advance met in me event miner warn has a dispute.nmmmg the.nbeat,eimerparty may suburb such dispute to a pevate arGVation service uTich nes been ap rris etl wcm by He Sandpoint me Evi Created Consumer Afters and Business Regulations and me orhat party shall be recurred m submir rte such .b.a.n as proved in M.G.L c 1L2A, nt _ re .idol'. fryers t,7 raw nary'. N�jO�TICE OF CANCELLATION ��s�-n��,-{S�NNOO�OT CE OF CANCELLATION Date or nansacnon_�//y yell may mergers, this transaction vnmoul any penalty or Dere ortmnsetliane�� Yau may rancenbis oanaacnon.Armed any penalty or obligation.within mynah syn Sys he.Neabow tlare.11 you ranr¢L any prolsarNtaeeein, obnmr.r wimin., tlays from me above nate.if you cental.any pmperyoaeed in. any Payments mage ny you r oder Ina Carbon or Sale,and any membrane instrument execurad any payments made y you untler Iha ton.an Sale,and any negotiable Ingtmmers¢forward by you will be returned When 10 days following rateipt by me Seller N your mnmllanon weeks. by you vol be returnee wimin 10 days fNlaserg receipt by me Salle,of your rsneellanon notice. and any secuety interest adsing out of the transaction will be wnrellee.If you rooter you frust end any seventy antitrust...IIn,ow of the Imna...n All ba.,.died.If of cea.,.you must Wake avalable m the B&le,et your residenw,and subalannally in as gone cargern as wfia. rrvke available be the Seller at your resider¢,and subsmnnally in as prod condition as when yed.any goods ded"mantie to you under this dono-ap or Saler cryou may,ryou wren,mmyly reacreved,any g..a widened to you under Ma Contract a Sale;or you may,it you mah,comply .In In.instmcnons of we seller assuming the return shipment of he goods at the Sell.,a Am the lnsVurAons of the Salle,.,mein,me rewm shipment of the .its at the Sellars expense antl day.If you do—to Ina gootls a marcal,m as Seller antl the Seller does not perk expanse and oak.if you do make the goods available to we Seller and me Seller does nor pick mem up Awl 20 days of the sae of your Notice of Guaranty.you may ream o,earposead we mem up vnNre in 20 days of me dew of your Notof-0an.nanm,you may rearm or ounces of goods wimout any fuller Welgran.11 you fe 'rrukoo 0l. e the gtlava s llaGe to the Seller aril you the goods All any Witter afteatioo if you fan m rreke the goods available m me Seller.or if gree to ratum the goods to The Seller and dal to do so,then you remain liable far performance N you farce to return me goods to Me Seller and fail b do so,then you wmein liable for pe.omemor all obligautens untler the Charri To cancel this franction,mail or drover a signed and dated Wall ablganons under the Contras.TorencelahisbanseNon,mail wdenve,a signed and dews occur o1 the commitment nonce m any other andem nonce,ar sentl a tele A ropy of 11,cen,,Ihaka notice or any other Abner noted,or sentl a talegra services 115 Noah Street,Salem MA(insist.NOT[LATER TXAN MIDNIGHT OFrces 115 NOM Street,Salem MA 019]0.NOT LATER THAN MIDNIGHT OF 1 HEREBY CANCEL THIS TRANSACTION I HEREBY CANCEL THIS TRANSACTION Consumer's Spnawre DareConsumeis5igrre pate: i Ul � Pg )of �+ A & A SERVICES, INC. 115 NORTH STREET,SALEM,MA 01970 A&A SERVICES Telephone: (978)741-0424 fax:-(978)741-2012 MR•YU 0 ILYA W•• Contractor Registration No.101609 Federal EN: 04-3090162 Construction Supervisor No.CS057733 MISCELLANEOUS SPECIFICATION S IEET Buyer(S)Name Date of Contract r1eV) I 1 Y PR ? ib 6 Buyer(s)Street Address,City,State and Zip Code Ill Daytime Telephone/ Evening Telephone 'Mobile Telephone Number E-Mail Address 7 ( J The Buyers)listed above hereby totally and severly agree to purchase the goods and/or services listed below,in accordance with the prices and forms de- scribed on this specification sheet and the front and the reverse of the accompanying CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,of which the Specification sheet is a part. SPECIAL INSTRUCTIONS I�(Ilc�efactt� S �I1�1' or warK.araiS t � Fr®vl¢° yln.t4 1 .C. y 1 I py1 ( d, r .t Ch s�!-PDQ i r 0-1ad S z 1 N / "ko t� . 1s KPy>or� A Ii� 4aa-i n n,` U 9 /-, .. �, N�111 f Ei Y1 4 / Dors c b� PrP its 1 (—Ac:6r4 r2Lt r cc:W /rasz cat ex$eri o 9 i % IO DA\'K+- Yl4 €N ) .0 Pj Dal -✓f'I-.�r`nr !T`i Gr �.4M S3� drcrL Ar- r _ �s �69rP e�FE S� IA>2 A VV C�E} McrS rti •_R t�in 1a � f-fzavrl-sdb sn� Lam,�r 4-�-aY�t le s us,� to i�)i., n,ew �i�w�. �4fLal schz /VIc<,eI -t-Ne(,u w ►�'}�Su �D 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 parties,and there are no verbal understandings changingor modifying.and 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 bath the Buyer(s)and the Contractor. Buyers)hereby acknowledge that Buyer(s)has read the Specification Sheet. ConnSAector Initials: G—. Date: � ' Bu ers Initials: � — —7 � Y �L/ Date:�!— [>-j� i . ►?g zoo A' A & A SERVICES, INC. 115 NORTH STREET,SALEM,MA 01970 ASA SERVICES Telephone: (978)741-0424 fax: (978)741-2012 •-. Wkw Contractor Registration No.101609 Federal EIN: 04-3090162 Construction Supervisor No.CS057733 MISCELLANEOUS SPECIFICA110N SHEET 'Date of Contract Buyer(S)Name Buyer(-)Street Adtlress,City,State and Zip Cade *3 .,,c is G9 70 Daytime Telephone Evening Telephone Mobile Telephone Number E-Mail Address S 2 The Buyer(s)listed above hereby jointly and smarty agree to purchase the goods and/or services listed below,in accordance with the prices and terms de- scribed on this specification sheet and the front and the reverse of the accompanying CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,of which the Specification sheet is a part. SPECIAL INSTRUCTIONS Gl�>1ko SII Jof3 rn1,4ae FbriS�1 J4c��e-� w rn�xa)ass 1=7— r N C_ ScDP�e_ B bz 1 k)�a.ad SeSA" col, 1 r.QSg p j',Tf AI, act rvn� F fi er Q Ful (art rvLe_� vlteliof s L5, do en.42 0-xaecs01 _aA o 44( SRC n-,5- Wj! ) mG-X4zErNct- n f i Yi+- or MOt 2Y1 of ltN2r S U�k�JieJ A L4 J lnenX +O L20- F I 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 parties,and there are no verbal understandings changing or modifying and 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 bath the Buyers)and the Contractor. Buyers)hereby acknowledge that Buyer(s)has read the Specification Sheet. %// Contractor Initials: SL._- Date: tyy�-/Le Buyer's Initials: J� Date: / i ' CITY OF S,.UEM. NL-1SSACHUSETTS BI:iLDI[NG DEPAmmsT C}s�rN• 120 WASHLYGTON STREET, 3m FLOOR TFL 7 735-9595 Fux(978) 740-9846 iCIZiBERLEY DRISCOLL MAYOR THoh-w ST.Pmm DIRECTOR OF PUBLIC PROPERTY/BUI DLNG CONL%MIONER Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Annlicant Information Please Print Legibly Name (BusinessOrranizationilndividual):_Ay a Address: J i.� N 0,2ul S-1 ( � City/State/Zip: Phone#: { I I— / "D ya Are you an employer?Check the appropriate box: l.❑ 1 am a employer with 4. ❑ Type or project(required):1 am a general contractor and I T ❑New construction employees(full and/or part-time).' have hired the sub-contractors 6. 2_❑ 1 am a sole proprietor or partner_ listed on the attached sheet 7• ❑ Remodeling ship and have no employees These sub-contractors have S. ❑ Demolition working for me in any capacity. workers'comp.insurance, 9, Building addition [No workers'comp. insurance 5. El 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 11.❑ Plumbing repairs or additions myself.[No workers'comp. e. 152,§1(4),and we have no 12.❑ Roof repairs insurance required.)t employees. [No workers' COMP. insurance required.] 13.❑ Other 11 fAny applira d that checks box#1 most also fill out the sectiuo bclow showing their workers'compemadon policy iniurtnmion_ 1[omeuwners who submit this affidavit indicating they as doing all work and then hire outside contractors most submit a now affidavit indicting suck Cuntrm�:ten that cheek this box must attached an additional sheet showing the name of the aub conuaetors and their worker'comp,policy Information. I am an employer that it providing workers'compensation Insurance for my emplayees. Below!s the policy and job site information. D ) Insurance Company dame:_ Policy#ur SelF--ins. Lic. #: nnnn r/ I� )� ��k g Expiration Date: /�_/!�-t�� Q Job Site Address: PCcX Ist�`\ ( Ciry/Slmc/Zip_�_ "r"_'V_Q� ) ( -7 0 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 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify nt er the Party and penalties ojperjury that the iajormuNan provided aba is t ue and Si>na i correct: ire• Dntr. a Mn Phon - Ofrichd use only. Do not write in this area,to be completed by c4 or town offrciai City or Town: PermitfLicense# Issuing Authority (circle one): I. Board of Health 2.Building Department 3.Cityrrown Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: _ Phone#: CITY OF S.Ul.,M, NbSSACHLSETI'S BUILDING DEPAR IENT • R 130 WASHNGTON STREET, 3�FLOOR, TEL (978) 745-9595 FAx(978) 740-9W KI-,iBERLFY DRISCOLL MAYOR THo.Nw ST.PmRAE DIRECTOR OF PUBLIC PROPERTY/BUILDING CONMSSIONER Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5 Debris, and the provisions of MGL c 40, S 54; Building Permit# is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c 111, S 150A. The debris will "bee transported by: (name of haWer) The debris will be disposed of in : hnC� �rQas�r 0✓l (name of facility) 2- c. Vie raSP K140� �KwVAp^ Cl�vt`ce (address of facilit ) / I 1 S / 0S-�'- Sa leen MA signature of permit applicant ate JcbrisatLduc Pope & Proctor Condo Association 43 Proctor St. Salem,Mass.01970 August 13,2016 To Whom it may Concern. We,the undersigned members of Pope&Proctor Condo Association,do not have a problem with Marion Tina installing a new fiberglass half-moon glass at the top front door and a fiberglass back door,window with built-in shade. Loan Nyguen 17 Pope St.Salem,Ma Ashley Linear 19 Pope St.Salem, Ma Ron Desantis 41 Proctor St.Salem,Ma Any other questions,please let me know. Thank You, , Marion Tina 978-618-7041 Pope and Proctor Condo Association Appendix 1 For the demolition of structures the building permit applicant shall attest that utility and other service connections are properly addressed to ensure for public safety. Please fill in the information below and submit this appendix with the building permit application. The building permit applicant attests under the pains and penalties of perjury that the following is true and accurate. Property Location (Please indicate Block # and Lot # for locations for which a street address is not available) No. and Street City own Zip Name of Building (if applicable) For the above described property the following action was taken: Water Shut Off? Yes ❑ No Provider notified and Release obtained? Yes ❑ No ❑ Gas Shut Off? Yes ❑ No M Provider notified and Release obtained? Yes ❑ No ❑ Electricity Shut Off? Yes ❑ No Provider notified and Release obtained? Yes ❑ No ❑ Yes ❑ No Provider notified and Release obtained? Yes ❑ No ❑ Other (if applicable) ,_, / Yes ❑ No [V Provider notified and Release obtained? Yes ❑ No ❑ Other (if applicable) Massachusetts - Department of Public Safety A&A SERVICES, INC Board of Building Regulations and Standards ewer Christopher Zorzy License: 115 North Street CS-057733 Salem, MA 01970 CHRISTOPHER 7s101R 115 NORTH ST Salem MA 01970% SGA 1 {; 2010 05111 Expiration Office of Carsnmer Affairs&Ousiness Regulation Commissioner 05126/2017 I i4: HOME IMPROVEMENT CONTRACTOR Registration. 101609 Type' / Expiration 6!26/2018 Private Corporation A&A SERVICES,INCI 17 Christopher Zorzy - 115 North Street Salem,MA 01970 Iludersccretary