B-19-774 - 0042 BROAD STREET - Building Permit kI: SECI
The Commonwealth of Massachusett'`µt Department of Public SafetyMassachusetts State Building Code(780 Civ1R)Building Permit Application for any Building other than aOne-or Two-Fame 3�ty��i�izig �: 4€�(This Section For Official U.seOnly)
ermit Number: Date Applied: Building Official:
ION 1:LOCATION(Please indicate Block#and Lot#for locations for which a street address is not available)
(3o,& S-`41,:(.0 Qkl Q M O W7 0
No.and Street
City/Town Zip Code Name of Building(if applicable)
SECTION 2:PROPOSED.WORK
Edition of&Lk State Code used If New Construction check here❑or check all that apply I inthe two rows below
Existing Building❑ Repair❑ AiterationX Addition❑ Demolition ❑ (Please fill out and submit Appendix 1)
Change of Use ❑ Change of Occupancy 0 Other ❑ S e '
P �y-.
Are building plans and/or construction documents being supplied as part of this permit application' Yes ❑ No X
Is an Independent Structural Engineering Peer Review required?
Brief Description of Proposed Work: /3 S :&L"r �!� Yes ❑ No
i�t�nrn rlwd [Li Ad rnn)C o
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDMON,OR
CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CIvIR 34) ❑
Existing Use Group(s):
Proposed Use Group(s):
SECTION 4:BUILDING:HEI-HT AND,AREA
Existing Proposed
No.of Floors/Stories(include basement levels) &Area Per Floor(sq'ft.)
Total Area(scl.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❑ B: Business ❑
F: Facto F-1❑ F2❑ E: Educational ❑
H: High Hazard H-1❑ H-2❑ H-3 ❑ H-4❑
I: Institutional I-1❑ I-2❑ I-3❑ I-4 0 M: Mercantile❑ R: Residential H-�0
al R-1❑ R-2❑ R-3❑ R-4 0
S: Storage S i❑ S-2❑ U: Utility❑ Special Use❑and please describe below:
Special Use:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA ❑ [B ❑ �ILIA� 103II�[3
QIA 0 IIIB ❑ IV ❑ VA ❑ VB ❑
SECTION 7:SITEJNFORIMATION(refer to 780:C- 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 D
Private❑' or indentify Zone: or on site system❑ required❑or trench or specify:
permit is enclosed❑
Railroad right-of-way: Hazards to Air Navigation: ivrA 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:
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner + S��W �� p1q�
C�Y� n1 A ''Vo_ ��1 v�- brow :l Zip
Name(Print).
No.and Street City/Town
Property Owner Contact Information:
+ e-mail address
Title Telephone No. (business) Telephone No. (cell)
If applicable,the property owner hereby authorizes
Street Address City/Town State Zip
Name
to act on the ro er owner's behalf,in all matters relative to work authorized b this building permit application.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2)
Construction Control then check here and ski Section 10
building is less than 35,000 cu.ft.of enclosed spa.c-e and/or not under .1
10.1 Registered Professional Responsible for Cotruction ConiroT /01
(C�^O O
hriS ZarZt� 611t_7q(- 042-4 6 l
Tele hone No. Registration Number j�5 20
e-mail address o lQ 1
Name(Registrant) r,P0.� Q���Q �(�.
5 �0-r S'r - c� State Zip Discipline Expiration Date
Street Address City/Town
r
neral Contractor
� Servtees: �
ny Name CS__ 4C5�'2)'?j
License No. and Type if Applicable
aof Person Responsible for Construction
5 t�hn mw" �( d
�5 �S�(1-lrl S State Zip
City,/Towne
Street Address
--74 L Q 49,4 e-mail address
Tele hone No.(business) Telephone No. cell) -
SECTION 11:WORKERS`COv[PEi`1SATIbN Pi ISURANCE AFFIDr\VlT(M.G.L.c.152.§25C16))
A Workers'Compensation Insurance Atfidavit from the MA Department of Industrial i.ccidents must be completed and
submitted with this application. Failure to provide this affidavit will result in the denial a-the issuance of the building permit.
Is a si ed Affidavit submitted with this application?
Yes No �
SECTION 12:CONSTRUCTION COSTS AND PEIiN1IT FEE .
Estirnated.Cbsts:(Labor
Item and Materials) Total Construction Cost(from Item 6)_$
1.Buildin $ Y, ���� Building Permit Fee=Total Construction Cost x (Insert here
o. appropriate municipal-factor)_
2.Electrical $
3.Plumbing $ contact municipality)
Note:Minimum fee=$
4.Mechanical (HVAC)
5.Mechanical (Other) $ Enclose check payable to
6.Total Cost $ 06 W_ �— (contact municipality)and write check number here
SECTIO 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
to the best of ow edge and
application is true and accura
te understanding.
P�Qs�ds� aZB• _���_ o
h `S Title Telephone No. ate
Please print and sign name Sake�Y� m1 0
State Zip
City/Town
Street Address
�v p
Municipal Inspector to fill out this section upon application approval: Name Date
42 Broad Street Condominium Trust July 3,2019
42 Broad Street
Salem;,MA 01970
To Whom It May Concern,
The trustees of 42 Broad Street Condominium Trust approve the installation of Harvey Majesty
brand replacement windows with simulated divided lines for Unit 6.
Signed, �
7714�b
Trustpe Repr ative Printed/Signature Date
�}+ AMove
A & A SERVICES,INC.
sl—1982 115 NORTH STREET,SALEM,MA 01970
A&A SERVICES 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 Contract
nti-I-H (A sP/1-Nc9 J
Buyer(s)Street Address,City,State and Zip Code
em. V 019-70
Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address
170 1 R0y C'ft N (A5QAtQ �W141L_I
The Buyer(s)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 BOd the reverse of this Agreement and any specification sheets(this"Agreement"),and Buyer(s)have requested
that such goods or services be installed or provided at Buyer's address listed above. ABA Services,Inc.("Contractor"),hereby agrees to install or cause to be
installed the products or services listed in this Agreement at the Buyer(s)address written above.This Agreement represents a cash sate 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.f tur It-(II p��w(�Qt/�,yf���p�p �y5( � (S_ ,�t of dY�
Purchase Price: 8 7O T6Es�t.StartingDate: ' ( 8 10
Down Payment: Q r Est.Completion Date:
0 Cash
❑Check
Amount Due on Start of Job: ;Credit.Card,,
Amount Due on of Completion: No. 0 - 3 Zi I
Amount Due on of Completion: 83 Expiration Date: L�0—Z3
Balance Due Upon Completion: �7 t CVC Code: 3 q '
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 acknowl-
edge that Buyer(s)has read the front and reverse of this Agreement and has received a completed,-signed and dated copy of this Agreement,in-
cluding 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 jibs transaction;and(II)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 Contractor. DO HOT SIGN THIS CONTRACT IF IT
CONTAINS ANY BLANK SPACES.
A&A Services Inc. Buyer(s)
By: k
Signature Sign ure
[3v2c� iV
Print Name 0 4
Print glame U
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.
ARBITRATION:The Contractor anti the Homeowner hereby mutually agree in advance that in the event either party has a dispute concerning this contract,either party may submit such dispute to
a private arbitration service which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulations and the other party shall be required to submit to such
arbitration as proved by M.G.L c.142A.
Contractor InNalsL:/.. C�� Buyer's Initials: p -
Date: ro
!!__ NOTICE OF CANCELLATION / NOTICE OF CANCELLATION -
Data of Transaction it !? You may cancel this transaction,without penalty or Date of Transaction Y!Y/7. You may cancel this transaction,without penalty or
obligation,within three business days from the above date. If you cancel,any property obligation,within three business days from.the above date. If you cancel,any property
traded in,any payments made by you under the Contract or Sale,and any negotiable traded in,any payments made by you under the Contract or Sale,and any negotiable
instrument executed by you will be returned within 10 days following receipt by the Seller instrument executed by you will be returned within 10 days following receipt by the Seller
of your cancellation notice,and any security interest arising out of the transaction will be of your cancellation notice,and any security interest arising out of the transaction will be
cancelled. It you cancel,you must make available to the Seller at your residence,and cancelled. If you cancel,you must make available to the Seller at your residence,and
substantially in as good condition as when received,any goods delivered to you under this substantially in as good condition as when received,any goods delivered to you under this
Contract or Sale;or you may,it you wish,comply with the instructions of the Seller regarding Contract or sale;or you may,if you wish,comply with the instructions of the Seller regarding
the return shipment of the goods at the Seller's expense and risk..If you do make the goods the return shipment of the goods at the Seller's expense and risk.If you do make the goods
available to the Seller and the Selkrr does not pick them up within 20 days of the date of your available to the Seller and the Seller does not pick them up within 20 days of the date of your
Notice of Cancellation,you may retain or dispose of the goods without any further obligation. Notice of Cancellation,you may retain or dispose of the goods without any further obligation.
If you fail to make the goods available to the Seller,or it you agree to return the goods to the it you fail to make the goods available to the Seller,or it you agree to return the goods to the
Seller and fail to do so,then you remain liable for performance of all obligations under the Seller and fail to do so,then you remain liable for performance of all obligations under the
Contract.To cancel this transaction,mail or deliver a signed and dated copy of the cancella- Contract.To cancel this transaction,mail or deliver a signed and dated copy of the cancella-
tion notice or any other written notice,or send a telegra to A Seg�(ices,115 North Street, tion notice or any other written notice,or send a telegra to &A Se Ices,115 North Street,
Salem,MA 01970,NOT LATER THAN MIDNIGHT OF S Salem,MA 01970,NOT LATER THAN MIDNIGHT OF e 4
(Date) !! (Date)
I HEREBY CANCEL THIS TRANSACTION I HEREBY CANCEL THIS TRANSACTION
Consumer's Signature Date: Consumer's Signature Date:
+ AG2de
ncVe A & A SERVICES, INC.
M 1982
MA SERVICES Telephone::(9 8)74�1-042�4 Fax:978M741 20012
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
K Z- �12c9►�O S'>- �lt? S�1 L t�r�r M�9- dt 57�
Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address
,gt—(o32;la o7 �yI�}f+A SP�'V�1wu41L.
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 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.
WINDOW WELACEMENT
Remove and dispose of# existing indows.
Install # new windows: t Vinyl (DWOo L vwl,CL#143
( a ufacturer)
Options: Style Grid pattern 7 ! .5D L_
Color Interior_. Bkozlr m Color Exterior AL17ayt,QA D Glass Type �tW
Wrap exterior trim with aluminum: Style Color
11 All windows will be installed according to the installation procedures in the portfolio.
tfi Caulk all interior and exterior edges.
fInsulate where possible around new units.
tl 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.
f Building permit included.
BAY/BOWS/CASEMENT UNITS/ANY FULL CONSTRUCTION-WINDOWS
4 Create new window opening by cutting through existing home and framing in opening.
tt 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.
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.
Bay t Bow t Casement 9 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
t Remove and dispose Of# existing storm window(s).
* 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: 4 Aluminum t Solid Core
SPECIAL INSTRUCTIONS:
RG MW: + kE—1 M MAIL— t S"1lNZr 110 DM4 Q*_ •TPLt y✓l e
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 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.Buyer(s)hereby acknowledge that Buyer(s)
has read this Specification Sheet.
Contractor Initials:_C :�) Dater Buyer's Initials: (tJ' Date:
,
The Commonwealth of Massachusetts
Department ofindustrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www.massgov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers
Apalicant Information , " / Please Print Lezibly
Name(Business!organization/rndividual): �YV l CZ— /h C
Address:_ ( (S�fG f{� S-{-•� p
City/State/Zip:_ cCr(,C-"� Phone#:��0-
Are you an employer?Chgckthe.appaopriate box-, .
Type of project(required):
1.91 am a employer with_�— 4:❑I am a general contractor and I
employees(full and/or part-time).* have hired the sub contractors 6' Q Ne`'''construction
2.❑I am a sole proprietor or partner- listed on the attached sheet 1 7• 21kemodeling
ship and have no employees These sub-contractors have 8. ❑De n lilion
working for me in any capacity. workers'comp.insurance.
o workers'comp. 9. ❑Building addition
� p.insurance 5. ❑We are a corporation and its
required.] officers have exercised their 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL I I.0 Plumbing repairs or additions
myself.[No workers'comp. c.152,§1(4),and we have no 12.E]Roof repairs
insurance required.]t employees.[No workers'
comp,insurance required.] 13.❑Other
'Any applicant that checks box 1r 1 must also fill out the section below showing their workers'comp
ensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such,
tcontractors that check this box must attached an additional sheet showing the name,of the subcontractots and their workers'comp,policy information.
I am an employer that Is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:1-rU V(�-1-R
Policy#or Self-ins.Lic.#: 0R7g3 K9 Expiration Date: -t --
Job Site Address: 4 a City/State/Zip:: 1 0 Q 9'70
Attaich s 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$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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Inve;;tigations of the DIA for insurance coverage verification.
I do hereby certify n r e pains and penalties ofperjury that the information provided above istrue and correct
Signature: Date: 7 p _
Phone#: Lf
FF,.
rieial use only. Do not write in this area,to be completed by city or torten o�icia[
y or Town:. Permit/License#
uing Authority(circle one):
Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
�J10-
1982Phone: 978-741-0424
Fax: 978-741-2012
A&A. SERVICE9
115 No th Street
115 North Street
® Salem,MA 01970
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the provisions of M.G.L.c.40, Sec. 54, a condition of Building
Permig Number is that the debris resulting from this work shall be
disposed of in a property licensed facility as defined by MAL.c.. 111, Sec. 150a.
The debris will be disposed at: ' Waste Management 877-515-2845
c/o Melrose Transfer Station
740 Broadway
Melrose, MA 02176
or
Waste Management, Dumpster Service
at
115 North Street
Salem, MA 01970
Signature of rmit Applicant
Christopher Zorzy: President
Name of Permit Applicant
� (� l�
Date
o
Fc Genmca1e N0: AU44bZb
a•, i
k THE COMMONWEALTH OF MASSACNIISETTS
EXFCIITIVE OFFICF OF LABOR AND WORKFORCE•DEVELOPMENT
DEPARTMENT OF LABOR STANAARDS
jd•' 19 STANIFORD S?REET,BOSTON.MASSACHUSETTS 02114 !
LEAD-SAFE RENOVATION CONTRACTOR LICENSE
A &A SERVICES,INC.
115 NORTH STREET
SALEM MA 01970
LICENSE: LR002749 EXPIRES: Thursday,August 20,2020
IN ACCORDANCE WITH M.G.L.C. 1 11,§ 1978(b)AND 454 CMR 22.04,TH1S`LICENSE IS ISSUED BY
THE DEPARTMENT OF LABOR STANDARDS TO THE CONTRACTOR ABOVE FOR THE PURPOSE OF
ENGAGING 1N LEAD-SAFE RENOVATION.'
THIS LICENSE IS VALID FOR A PERIOD OF FIVE(5)YEARS.
THIS LICENSE MUST BE MAINTAINED BY THE CONTRACTOR IN ACCORDANCE WITH M.G.L.C. 11 I.
§ 197B(b)(2)AND 454 CMR 22.04 WHEN ENGAGED IN LEAD-SAFE RENOVATION AND/OR
MODERATE-RISK DELEADING WORK.LEAD SAFE RENOVATION CONTRACTORS MAY NOT
j PERFORM MODERATE RISK DELEADING WORK UNLESS THEY EMPLOY A SUPERVISOR,WHO HAS
TAKEN THE REQUISITE TRAINING AS REQUIRED BY 454 CMR 22.00,TO OVERSEE THE,WORK.
WILLIAM D. &INNEY,D1R
�y'k,.Ycam�xarwc�'�J�ouai+�ir�(�s Commonwealth of Massachusetts
Orlke of con umer-Af*s i»w pitrws'p b1kM Div of Professional Licensure
HOME IIAPAOVEMENT CONTRACTOR Board of Building Regulations and Standards
TYPE'Carooramon Cons r, r�lt @�t visor
E> r
101609 Y ; Tres.A5126/2021
ABA SERVICES,INC j CS-057733
CHRISTOPHIQIS t
11ti NORTH Sf C
L;HRlSTOPHER ZOHZY i SALEM MA
15 NORTH r �C
S&EM,MA 070� O ~ 17�a
Untielsectetary l5�,73
Commissioner
i
4
� 1
,,
r Salem Historical Commission
98 WASHINGTON STREET, SALEM,MASSACHUSETTS 01970
(978)619-5685
CERTIFICATE OF APPROPRIATENESS
It is hereby certified that the Salem Historical Commission has determined that the proposed:
✓ Construction ❑ Moving
❑ Reconstruction ❑ 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: McIntire District
'Address of Property 4.2 Bread StreefUmt.b-
` Name of Record Owner;__Cynthia Spanjz:_
Description of Approval of Work:
Replace existing windows in unit with new Harvey Majesty aluminum clad SDL windows to match existing
811 configuration with the following conditions:
■ Exterior of windows to be brush painted in white to match existing trim color;
■ All trim at brick molding to be preserved intact;
■ Any gaps at muntins to be filled and painted,-
• Windows to be installed per details shown on attached drawing detail.
This approval is based on the age,materials and location of the subject building.
Upon completion of work,please notify Historical Commission staff as final sign-off is required to
documeiit compliance with this Certificate.
Dated:._ July 1 S,2019 SALEM HISTORICAL COMMISSION
The homeowner has the option not to commence the work(unless it relates to resolving an outstanding
violation;). All work commenced must be completed within one year from this date unless otherwise
indicated.
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.
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