B-19-775 - 0042 BROAD STREET - Building Permit i
r.
k.:SECTION
The Commonwealth of MassachusettsDepartment of Public Safety
Massachusetts State Building Code(780 CkiR) a ,Building Permit Application for any Building other than a One-or TwokFmi�ly w gi(This Section For Official Use Only) eermit Number: Date Applied: Building Official:
1:LOCATION(Please indicate Block#and Lot#for locations for which a street address is not available
No.and Street CityTown
/ Zip Code Name of Building(if applicable)
SECTION 2:PROPOSED WORK
Edition of lvbk State Code used If New Construction check here❑or check all that apply m the two rows PP Y below
Existing Building❑ Repair❑ Alteration Addition❑ Demon ❑ (Please fill out and submit Appendix 1)
Change of Use ❑ Change of Occupancy Other ❑ Sp':
:
Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No Is an Independent Structural.Engineering Peer Review required?
Brief Description of Proposed Work: 2/ g Yes ❑ No (�
T
y! _, S i l— d�`v��, l�cc PJt,lru' �l or s �—
Cl J
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
CHANGE IN USE OR OCCUPANCY
Check.here it an Existin a Building Investigation and Evaluation is enclosed(See 780 CIVIR 34) ❑
Existing Use Group(s): Proposed Use Group(s):
"SECTION 4c BLIILDING.H$IGHT AND AREA
Existing Proposed
No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.)
-
Total Area(sq.ft.)and Total Height
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A 4❑ A-.5❑ 8: Business ❑
F: Facto F-1❑ F2❑ E: Educational ❑
H: Hi( Hazard .H-1❑ 11-2❑ H-3 ❑ H-4❑ H-5 0 I: Institutional I-1❑ I-2❑ I-3❑ I-4❑ M: Mercantile❑
R: Residential R-1❑ 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)
LA IB ❑ HA ❑ IIB ❑ IIIA ❑ IIIB ❑ IV ❑ �VB
VA ❑
SECTION 7:SITE,INFORMATION(refer,to 780:GMR.111.0 for details gn each item)
Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal:
Public❑ Check if outside FIood Zone❑ Indicate municipal❑ A trench will not be Licensed Disposal Site❑
Private❑' or indentify Zone: or on site system❑ required❑or trench or specify:
permit is enclosed O
Railroad right-of-way: Hazard�tt.o Air Navi ation:g MA Historic Commission Review Process:
Not Applicable❑ Is Structure wi airport approach area? Is their review completed?
or Consent to Build enclosed❑ Y or No❑
Yes❑ No ❑
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code:
in Use Grkler 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 dLyn c s Q)g-1Q '
%sa.b e�f l� Le�`�S�eY ya b�rnac� S F 3 Zip
Name'(Pririt)`
No.and Street City/Town
Property Owner Contact Information:
Title Telephone No.(business) Telephone No. (cell)
e-mail address
If applicable,the property owner-hereby authorizes (4- '70
Chrl•S ZO"' I �5 Ci Town State Zip
b
uthorized _
Name Street Address ty
this building
to act on the property owner's behalf,in all matters relative to work a permit application.
SECTION 10:CONSTRUCTION CONTROL(Please till out Appendix 2)
building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here O and skip Section 10.1
10A Registered Professional Responsible for Cohstruction'ControT
E hris 7rne zu oot_7q(- o�
Tele hone No. Registration Numbe�'215 20
e-mail address o
Name(Registrant) ,,P QL0110 t
5 0-� —5 -- cC State Zip Discipline Expiration Date
11
Street Address City/Town
10.2 General Contractor
Rik Sery Ce5 tie.
Company Named _ ! CS 005
License No. and Type if Applicable
Name of Person Responsible for Construction s�(-
City/Town- State Zip
Street- Address
04'24 e-mail address
completed and
Tele hone No. usiness) Telephone No. cell)•
SECTION 11:WORKERS COMPENSATION INSURANCE AFF1126 T M.G.L.c.152.§25C(6))
A Workers'Compensation y ailure to provide this affid completed and
Affidavit m the avit Department
in the denial of the is uance o b he building permit.
submitted with this application.
Is a signed Affidavit submitted with this application? Yes' No
Cl
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Estimated Costs:(Labor.
Item and materials) Total Construction Cost(from Item 6)_$
3 1.Building Building Permit Fee=Total Construction Cost x (Insert here
$ appropriate municipal factor)_$
2.Electrical - .
3.Plumbing $ Note:Minimum fee=$ (contact municipality)
4.Mechanical (HVAC) $
5.Mechanical (Other) $ Enclose check payable to
6.Total Cost �- (contact municipality)and write check number here
'. $ � �0
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
ow'edge and understanding.
application is true and accurate to the best of g• aZg _1
4 I- 0 qa j
P�QC,
`S Title Telephone No.
ate
Please print and sign name 5awnn M
City/Town State Zip
Street Address
=Municipalector 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
grand replacement windows with,simulated divided lines for Unit 3,
Signed,
L.
`frustee Repr ative Printed/Signature Date
A� de A & A SERVICES; INC.
A�
Sim 19ffi 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 1WROVEMENT AGREEMENT
Buyer(s)Name Date of Contract
Buyer(s)Street Address,City,State and Zip Code
Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address
?�-7N�' 3SNlQ ��4361�(,E)n1s72'►�-��i �r
The Buyer(s)listed above herebyjointly 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 AM 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. A&A Services,Inc.("Contractor");hereby agrees to install or cause to be
installed the products or services listed in this Agreement at the Bilyer(s)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 timin or approval of any financing Buyer(s)
may seek for their purchase.$ f►�+C.l-v t�b7r � � � � OtSCai sf Q( Wb91�'dbr ti'dt`
Purchase Pricer 7i7 1001 Est.Starting Date:g- b-Z
Down PaymentA_7 00, Est.Completion Date:
[ ❑Cash
^ heck
Amount Due on Start of Job: : .700, ❑Credit Card ..
r
Amount Due on of Completion: ND,..
Amount Due on of Completion: Expiration Date:
Balance Due Upon Completion. 0Lf CVC Code:
It is agreed and understood by and between the parties that this Agreement,front anilf 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(1)acknowledge that they were orally Informed
of their right to cancel this transaction;and(II)request that they be contacted via their telephone numbers or email,as ed above,In the event
Contractor believes Buyer(s)would be interested in any additional quality.products or services of Contractor. DO NOT G TNIS CONTRACT IF IT
CONTAINS ANY BLANK SPACES.
A&A Services nc. Buyer(s)
By:
Signatu Signat e
Print Name 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.
ARBITRATION:The Contractor and the.Homeowner hereby mutually agree in advance that in the event either parry has a dispute concern mi tract, er parry may submit such dispute to
a private arbitration service which hus been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulatio m o arty shall be required to submit to such
arbitration as proved by M.G.L.c.142A. Gpn/r�/,
Contractor Initials: /p Buyer's Initials:
.Date: �� �1 / Data: `7
NODUF OF CANCELLATION - NOTICE OF GANGELLATION
Date of Transactionla- -I�_. You may cancel this transaction,without penalty or Date of Transactior� �. You may cancel this transaction,without penalty or
obligation,within three business days from the above date. tt 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. If you Cancel,you must make available to the Seller at your residence,and cancelled. If you cancel,you must make available to the Seiler 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,if 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.11 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 Seller 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 if you agree to return the goods to the If 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 telegram,to ABA S ices,115 North Street, tion notice or any other written notice,or send a telegr to rvices,115 North Street,
Salem,MA 01970,NOT LATER THAN MIDNIGHT OF(A-1 q—f T Salem,MA 01970,NOT LATER THAN MIDNIGHT O( a alai i�..
I HEREBY CANCEL THIS TRANSACTION I HEREBY CANCEL THIS TRANSACTION
Consumer's Signature Date: Consumer's Signature Date:
+ AG.dAl—
e .
SI-1 A & A SERVICES, INC.
115//����,, pp ® �1Since1982
RTH
/� &A SERVICES Telephone:(8)74�1-042�4 Fax:978M741-20012
•M I a I LK I WE MITI
Contractor Registration No. 101609
Federal EIN:04-3090162 Construction Supervisor No.CS057733
WINDOWS AND STORM PRODUCT SPECIFICATION SHEET
Buyer(s)Name Date of Contract
-S-46EL bows�� 1c,,—l7—i 9
Buyer(s)Street Address,City,State and Zip Code
L( 7- 3/z oA U S T *3 Sf&ty1 /1111 o!9 7o
Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address
979-7vS-3Sy(o
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-REPLACEMENT
® Remove and dispose of# 9� � existin windows.
® Install # new f7/`tTL✓i�tj�{^n/�JIB$7-11 windows: t Vinyl &Wood14L vat,C$-AC)
(Manufacturer) l0
Options: Style D Grid pattern ` A
Color Interior P1 W Color Exterior ALvm, GLrA-p w 4 ITr Glass Type Darts LO-Ar fi (�nwr
#Wrap exterior trim with aluminum: Style Color j fr-1 40-S
All windows will be installed according to the installation procedures in the portfolio.
Caulk all interior and exterior edges.
® 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.
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.
® Note: Painting and staining not included.
N 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 t Solid Core
SPECIAL INSTRUCTIONS: RE-IQ STq V,- ��I s�'''�1 Ira TenA04— f; -S-1 r,5 S r
en-, AyJo .F<k e,TV T-1L
r= I8 r 67(o . pa t clr 5-ou
r
It is agreed and understood by and between the parties that this Specification Sheet,along with CUSTOM REMODELING AND IMPRO EMENT AGREEMENT,constitutes
the entire understanding between the parties,and there are no verbal understandings changing or modifying any of the term This ontract may not be changed or its
terms modified or varied in anyway unless such changes are in writing and signed by both the Buyer(s)and the Contractor. u r hereby acknowledge that Buyer(s)
has read this Specification Sheet.
Contractor Initials:_ Date: to- i-I-19 Buyer's Initials: ' Date:J k �� '�
The Commonweakh of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
w►vw,mrassgov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers
Applicant Information ! Please Print Legibly
Name(Business/Organization/Individual): Q"/�� scry�CZ_S /h C
Address: j (S No
City/State/Zip: � G 1.2�.� Phone#:
Are you an employer?Check the-appropri b-,/ ateok: Type of project(required):
1.Eh I am a employer with 9 _ 4. E I am a general contractor and I
employees(full and/or part-time).• have hired the sub-contractors 6• t0�New construction
2.❑I am a sole proprietor or partner- listed on the attached sheet.f 7. u Remodeling
ship and have no employees These sub-contractors have. 8. -1 Demolition
working ,for me in any capacity. workers'comp.insurance. 9, Building addition
(No workers'comp,insurance 5• ❑We are a corporation and its
II required.] officers have exercised their 10. Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL l l.❑Plumbing repairs or additions
myself.(No workers'comp. c.152,§1(4),and we have no 12.0 Roof repairs
insurance required.]t employees.[No workers'
comp.insurance required.] 13.❑Other
*A-y applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outsidecontractms must submit anew affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the sub-contreators and their workers'comp:policy information.
I am an employer that is providing workers'compensation insurance for my employees. Below is
information. the policy and job site
Insurance Company Name:
Policy#or Self-ins.Lic�:L#: t�P�3g ( � Expiration Date: -(
Job Site Address: geta S I'1.pr QJA1d
City/State/Zip:. &
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$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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
1 do hereby certify r e pains and penalties of perjury that the information provided above is true and correct
i mature: Date: (.
Phone#: `4 r
Offcial use only. Do not write in this area,-to.be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2:Building Department 3.City/Town Clerk 4.Electrical Insp75.Phu-m—bin.Inspector
6.Other
Contact Person: Phone#•
Phone: 978-741-0424
ase2:z „ Fax: 978-741-2012
ces.comA&A ,SERVr 115 North Street Salem,MA 01970
DISPOSAL OF DEBRIS AFFIDAVIT'
In accordance with the provisions of M.G.L.c.40, Sec. 54, a condition of Building
Permit�Number is that the debris resulting from this work shall be
disposed of in a property-licensed facility as defined by M.G.L.c. 111, Sec. 150a.
x The debris will be disposed at: Waste Management 877-515-2845
c/o Melrose Transfer Station
740 Broadway
r, Melrose, MA 02176
or
Waste Management, Dumpster Service
at
115 North Street
Salem, MA 01970
Signature of rmit Applicant
Christopher Zorzy, President
Name of Permit Applicant
-7
Date
tenmc81e NO: AU-144bZk
-� THE COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF LABOR ANI)WORKFORCE DEVELOPMENT
f~ t
DEPARTMENT ON LABOR STANDARDS '
19 STANIFURI)STREET,$OSTON,MASSACHllSETTS 02114
1
LEAD-SAFE RENOVATION CONTRACTOR LICENSE
' A &A SERVICES;INC.
115 NORTH STREET
SALEM MA 01970
LICENSE: LR002749 EXPIRES: Thursday,August 20,2020
I IN ACCORDANCE WITH M.G.L.C. 111,§ 1978(b)AND 454 CMR 22.04,THIS LICENSE IS ISSUED BY
THE DEPARTMENT OF LABOR STANDARDS TO THE CONTRACTOR ABOVE FOR THE PURPOSE OF
ENGAGING IN LEAD-SAFE RENOVATION.
i �
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. I I I.
§ 197B(b)(2)AND 454 CMR 22.04 WHEN ENGAGED IN LEAD-SAFE RENOVATION ANDIOR
MODERATE-RISK DELEADING WORK.LEAD SAFE RENOVATION CONTRACTORS MAY NOT
j PERFORM MODERATE RISK.DELEADING WORK UNLESS THEY EMPLOY A Sl1PERVISOR,WHO llAS
` TAKEN THE RFQUISITE TRAINING AS REQUIRED BY 454 CMR 22.00,TO OVERSEE THE,WORK.
1
••,-_ 020
WILLIAM D.MCKINNEY,DIRE I
l�r Commonwealth of Massachusetts
Ynnsr,verx,,.errfj� r��{ „ �,rAfralrs f usb sirs RpiNwon Division of Professional Liaensure
OfllM*f CDR=n
HOME IMPROVEMENT COKfRACTOR € I Board of Building Regulations and Standards
TYPE:Cavoratian
P Cons�riS visor
1016W t>GJ2512020 1.
e48uq SERVICES.INC j
CS-057733 y� ires.:05J26/2021
s.
CHRIStOPFIt�I!'
115 NORTH S(f
1:.HRISTOPHER ZORZY i SALEM MA / C
115 NORTH STREET ` Cart
' la 8
SALEM,MA 01970 - �UIS 330
Undemwfetiq
Commissioner
i
Salem Historical Commission
98 WASHINGTON STREET, SAL.EM.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 �_,,� ;✓
❑ iignage ❑ 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: 42 BibA Street:[lnit,l
Name of Record Owner:, Isabel Leinster
Description of Approval of Work:
Replace existing windows in unit with new Harvey Majesty aluminum clad SDL windows to match existing
811 configuration with thefollowing 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
document compliance with this Certificate.
Dated: July 18. 2019 SALEM HISTORICAL COMMISSION
By: a+ _ _
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.
Lk
•�..� � • is } - 1 � t� { 1 _
It _
- 1 /
jr
s
T
N � 2