11 CHURCH ST - BUILDING INSPECTION (32) 1
c�—
The Commonwealth of Massachusetts
Department of Public Safety lUlb AUG -3. A 0 50
I5 Massachusetts State Building Code(780 CMR)
Building Permit Application for any Building other than a One-or Two-Family Dwelling
(This Section For Official Use Only)
t
t� 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)
l rrh,�f S�lervj 6 [0/20
No.and Street City/Town Zip Code Name of Building(if applicable)
(-- SECTION 2:PROPOSED WORK
Edition of MA State Code used If New Construction check here❑or check all that apply in the two rows below
Existing Building❑ Repair❑ Alteration Addition❑ 1 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 ❑ No q//
Is an Independent Structural Engineering Peer Review required? Yes ❑ No K+�
Brief Description of Proposed Work
r 1� 1Cou1
SECTION 3: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 CMR 34) ❑
Existing Use Group(s): I 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❑ 1 B: Business ❑ E: Educational ❑
F: Facto F-1 ❑ F2❑ H: High Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5 ❑
I: Institutional I-1 ❑ I-2❑ 1-3❑ 1-4❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R4❑ -
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 ❑ IIA ❑ IIB ❑ IIIA ❑ 111B ❑ I IV ❑ 1 VA ❑ 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 ❑ or trench or specify:
permit is enclosed❑
Railroad right-of-way: Hazards to Air Navigation: NIA 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:
R t'-tL-� SIB
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address,of Property Owner
at ]l �nseS !��11 f�cQ Mn 1aC �
Name�(Print) No. and Street City/Town Zip
Property Owner Contact Information:
Title Telephone No. (business) Telephone No. (cell) e-mail address
If apnplicabl the roperty 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 permit 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 skip Section 10.1
(10.1 Registered Professional Responsible for Construction Control ,q
Na 1 Tele ho e No. e-mail address Reis anion Number
It Ak a"
Street Address City/Town State Zip Discipline Exp atio Date
10.2 General Contractor
4e-fA .SE216 )IY� c
om any Name
0 Y"I'�n LPY- 7 MIEL 2A � C�_�7 3S
Name of Persc nqResponsible for Cons�tr,ction License No. and Type if Applicable
1� �oea sSi-_ wi to 9'7D
Street A�+d�-dresss� cCity/Town State Zip
Telephone No. (business) Telephone No. (cell) e-mail address
SECTION 11:WORKERS'COYIPENSAIION 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 the issuance 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)_$__r a. T
1. Building $ Building Permit Fee=Total Construction Cost x (Insert here
2. Electrical $ appropriate municipal factor)_$ ��1
3. Plumbing $ ���lll
4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality)
5.Mechanical (Other) $ Enclose check payable able 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 is true and accurate to the best of my knowledge and understanding.
r` r P✓ J7deAt 17e_. 7` - 7-1 !i6
-
Please pr t si na r` V Title Telephone No. Date
Street Addyess Ci To n St at Zip .-7
Municipal Inspector to fill out this section upon application approval:
Name Date
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)
/ I CArLh +A
No. and Street City /Town Zip Name of Building(if applicable)
For the above described property the following action was taken:
Water Shut Off? Yes ❑ No EY�/ Provider notified and Release obtained? Yes ❑ No ❑
Gas Shut Off? Yes ❑ No Gd"/ Provider notified and Release obtained? Yes ❑ No ❑
Electricity Shut Off? Yes ❑ No LV Provider notified and Release obtained? Yes ❑ No ❑
Yes.❑ No [jy Provider notified and Release obtained? Yes ❑ No ❑
Other (if applicable)
Yes ❑ No Provider notified and Release obtained? Yes ❑ No ❑
Other (if applicable)
1'30_;
'j'o tir A & A SERVICES, INC.
A&A SERVICES I IS NORTH S'IREL I. SALEAL NIA 01970
n f -Iclephonc:(o7$) 741-04>_4 Fas: (97M 741-7011
Contractor Registration No. 101609
Construction Supervisor No.CS057733
Federal EIN. 04-3090162
CUSTOM REMODELING AND INIPROVEMENT ACREF NIENT
Bu ohs) Name Date of Contract
�EID r 51PiET )SO Ll"7-0N 6, -30- l .
Boverls) Street Address City.Stale and Zip Code aJLY3 ad7olzG'S S
jPvlose'3 Hl" A wig c/I $i erL 14,q 019 it � + nc.rJNST 707
Dt time Tnae hone Number Evening Telephone Number Mobile TaI hone
178 3/y-Number E Mall Atldress
8`I70 Rrfor�4oyn/7-0/1/
c
The the pliyalisted above hereby jointly and severally agree to purchase the goodsen a and
a services listed on the accompanying rit-).And Bl sheets,in accordance
tram the good and terms be inbBtl On the front and the reverse aaddr of this agreement and any es,Inc,ca'Co sheets-).hereby agrees
e s t antl 11 or ca)have reyuesled
That such gaols Or mica list be Installed or reem nt.1 IN Buyntuaddrese listed above.ARA Services,In ('Contractor'a hereby agrees to install or cause to be installed
the products m services listed in this Agreement al Iho Buyegs)address described
Enbove.This Agreement timing
Of
a cash axle of goods and services.The Buyers)
agree to pay in cash the cost of the goods and selvlces purchased as describes herein,regardlos of liming br approval of any financing Buyer(s)may seek for their
purchase YY Yn�
Purchase Price:. I2 Slur --� Est Starting Date
Y280
}}�9
Duval PaYmenlj2�. I Est.Completion Dale: V as-I
Cash
Amount Duo on Stan of Job: Q Check.
El Credit Card
Amount Due on_ol Completion 1C No,
Amount Due on_Of Completion: FFtt Expiration Date:
! Balance Due on Upon Completion' �'� o' r
CVC Code
— I
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.Buyerlsl
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 file dale first written above.Buyer(s)also(r)acknowledge that they parr orally
informed of their right to cancel this Vansactlow and(II)request that they be...,acted via their telephone numbers or email,as listed above,in the event
Contractor believes Buyerls)would be Interested In any addition,)quality products or services of Contractor. DO NOT SIGN THIS CONTRACT IF IT
CONTAINS ANY BLAN�K SSPACES.
6c AA ServiL C3"� � 131rvcr(s) _.
By_Sign_"._—
ature " "- _- ----- - -----
SignaturereJ
Print Name Print ame
Signature
Print Name
You.the Buyer(s), may cancel this transaction at any time prior to midnight of the third business day after the dale of this
transaction, See the following Notice of Cancellation form for an explanation of this right.
ARBITRATION'The cmamcev Rntl gIe nmmowner he,.,avnuater ap,m v,aevanco that lu he eve ame pang na[a dewm cmceminp run call—Laimar poor nor sacml slain oners.la a
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amrenrlaoon as nmam in'a cuzA.
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NOTIC E OF CANCELLATION NOTICE OF CANCELLATION
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ml ryyl9'he reputation poor
pooror.To WYd Iesn nadv ntlY msal aagnM arq nRM nI mIidlgalmn.a rinper Ina C.nven,ioca11cN Ihii vanSazwrr,mail Or UM:v@raslpneJantl 91eU
mpy'd Ina ampor amW mind,
anyOT ar Totten aps FAC IGH a I, n AA$grvlcaf, pay d Ina cauthapp an our or any elver vnlbn no4w,oe xM a ase, dP e.1t05
11$NMM1$VarX.Salem NA mtlTU,NOT LATER MAN MIDNIGXT OF 115 Mr.Seem,Sanem W W970,NOT LITER TNAN MIDNIGIR OF7-2
�/r��
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I HEREBY CANCEL THIS TRANSACTION I HEREBY CANCEL THIS TRANSACTION
Comamers Si __Do.__ Gmsnlmra ogna m,.
yn. °at A & A SERVICES, INC.
SERVIY���� 115 NORTH STREET,SALENI, NIA 01970
CES Telephone(478) 741-0424 Fax: (978) 741-2012
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Contractor Registration No. 101609
Federal EIN:04-3090162 Construction Supervisor No. CS057733
WF%tTl WS AND ST0RD4 PRODUCT SPEC[F[CATION SF[EET
Buyerlsl Name Date Of Contract
REID + TAIxj0T Go1-{ N -r-ar,)
Buyegsi Street Address.City,State and Zip Code "4,;/4002 Cr 5
I I MoSES Hi�L- R� M 9Nc F+eS i n rtitw o19vy ti cr /a sr
i -,a�tvt-r n�rn �r97C1
Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address
I 97g-3/y-gt/7t0
The Buyer(s)listed above hereby jointly and severally agror.d purchase the goods andior services listed below,in a¢pmance.vith the prices and lards described on
this Specificaton sheet and the(rent and the reverse of the accompanying CUSTOM REMODELING AMID IMPROVEMENT AGREEMENT,of which this Specification
Sheet is a pan.
�^ WINDOW REPLACEMENT
r T/ Remove and dispose of 0 CJ existing window
t Install w new t: t CC5 S/ C�
✓' windows:�t Jinyl t Wood
(Manufacturer)
Options: Style D k _ Grid pattern I I
Color Interior yy�A t TL Color Exterior to," -' s- T� Glass Type QQy'�r nOL)GLtT(�9 P�V
IV 4Wrap exterior trim with aluminum: Style Color_ L<N`r'G /♦•24c'+J
t All windows will be installed according to the installation procedures in the portfolio. �r}5
T Caulk all interior and exterior edges.
0. 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 unigs)in its entirely.
Note:Electric and plumbing may exist in wail 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 root 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.
CNote: Painting and staining not included.
e 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 tnstail new storm doors# Manufacturer
Style Color Type: t Aluminum i Solid Core
SPECIAL INSTRUCTIONS:
— 7n S �/4 LL- Ci x,) PVG &k%� ;CYL_. &WV e-�17— .s'7-211" 7-V /7 Si Jc
w/,vroc>x/S ,
in r 1 Ue4a LA r r c 0.s Qc. le4k,, Yn ekq ta,-yl
11 is agreed and understood by and between the parties that this SpeCiflcation Shawl, ran,with CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,constitutes I 'the entire undersl.rdin,between the parties,end there are no vorbal und.ndrndings changing or modifying any of me terms. This contract may not be Changed or its
lama modified or varied in any way unless such changes are In writing end signed by both the auyegsr and the Contractor. Bu/yed&)hereby acknowledge that Buyerlsl
has read this Specification Sheet. _ —"eL �� �f'��l/O✓/
Contractor Initials: �r'e.� Date: 30 ^ {Buyer's Initials:
The Commonweaith Of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,ALA 01111
www,mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Ariplicant Information
Please Print Le ibly
Name(Businessforganization/Individual): �� 1� CAS IN C
Address:-- .! �s (G
City/State/Zip:_ C-�'—b y, ri1 I�( {y'L Phone#:9-1 `7 fr�
Are you an employer?Check the appropriate boa:
1.Erl am a employer with_ 4. ❑ 1 am a7edcontractor and 1 Type of project(required):
employees(full and/or part-time)." have hub-contractors 6 ❑New construction2.❑ I am a sole proprietor or partner- listed ached sheet. t 7. QRemodeling
ship and have no employees These actors have g. ❑Demolition
working for me in any capacity. worke insurance.[No workers'com insurance 5. 9. ❑Building addition
p ❑ Wz arration and itsrequired] officerercised their IQ❑Electrical repairs or additions
3.❑ 1 ant a homeowner doing all work right of exemption per MGL I I.❑Plumbing repairs or additions
myself.[No workers'comp. c. 152, §1(4),and we have no
insurance required.] r employees. 12.❑ Roof repairs
[No workers'
comp.insurance required.] 13.❑Other
Any aPPlicant that checks box At most also fill out the section below thawing their workers'compensation policy information.
t Homeowneth who submit this ntiuidavit indicating they am doing all work and then hire outside contractors..at submit a new affidavit indicanng such.
'Contractors that check this box must attached an additional sheet showing the name ofthe sub-contractors and their workers'comp.policy information.
1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: rct, tl
Policy#or Self-ins. Lic. PI C))--�-4-3
Expiration Date:JY
lob Site Address:hktc4,31- U7 (ten l� t d O`/,+ A
City/State/Zip:_ W ,I t`i O
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
tine 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 maybe forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
1 do hereby certify: n er ne pains and penalties of perjury that the information provided above is a and orrect
Sivnature: ��t '`p
Phone q Cl �� �{" It-. �/ -3—f
Date: �
Official use only. Do nor write in this area,to be completed by city or town offrciaL
City or Town:
Permit/License#
[ssuiog Authority(circle one):
1.Boer I of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
b.Other
Contact Person:
Phone#:
CITY OF S �LE.NI, -L-1SSACHUSETTS
BuII.DNc; DEPART%LENT
N • 130 WASHNGTOY STREET, 3' FLOOR
T�EL (978) 745-9595
FAX(978) 740-9846
KIJBERLEY DRISCOLL
MAYOR T Hoaus ST.PIERRE
DIRECTOR OF PUBLIC PROPERTY/BUIIDLVG CO%L\II5SIONER
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CNIR 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 be transported by:
(nanne of haulerl
The debris will be disposed of in
(name of facility) Q r `/��[�•!��MC(��� eeyc�
(address of facility I I I — /v ✓+1 ,-N S
'X
signature of permit applicant
tla e
dcbrivlyduc
F
Massachusetts -Department of Public Safety
A&A SERVICES, INC Board of Building Regulations and Standards
f,i,n6trii surwr-'. ,;r
Christopher Zorzy i
115 North Street License: CS-057733
Salem, MA 01970 CMUS.OPHER 7,eRML�
115 NORTH ST 5 1
Salem MA 01970% c �
SCA1 ii 20M-05I11
c^� Expiration
neurnrrrncn�l/.r�ryGln�wrrr/rr.ic�lG7 J.�i.+ OS126/2017
office of Consumer Affairs&Business Regulation Commissioner
HOME IMPROVEMENT CONTRACTOR
Registration 101609 Tye'
Expiration 6126/201,8 Private Corporation
A&A SERVICES, INCI
Christopher Zorzy 1 r.
115 North Street
Salem,MA 01970 Undersecretary
The Essex Condominium
Telephone: 978-532-4800 1 Far.978-532-6023
c/o Crowninshield Management Corp.
18 Crowninshield Street
Peabody, AM o196o
Reid& Vanessa Boynton
Unit 707, The Essex Condominium
11 Church St.
Salem, MA 01970
Dear Mr. & Mrs. Boynton,
The Essex Trustees have reviewed your request to replace six windows with white vinyl double-
hung Harvey Classic replacement windows with exterior white grids. The Trustees have given
their consent for you to proceed with your replacement, but with the following qualifications:
The Trustees are not in a position to assess the engineering details of your request nor can they be
assured that the final product will be in accord with the plans. Thus you the Owner retain the
responsibility for ensuring that the finished work does not"affect the appearance or structure of
the Condominium,or the integrity of its systems",that"all materials used and Work performed
shall comply with all OSHA, other federal, state, county, and municipal laws, rules, ordinances,
codes and regulations," and that the work is carried out by the contractor in the manner specified
by the Essex Condo Documents* (vis a vis hours, removal of refuse, noise, etc.).
Regarding replacement windows, please be aware that:
o Windows must be of a quality equal or greater to the original windows;
o Installation shall be done by a reputable contractor with a good work record and
references, and as required by State Building Code, the contractor must obtain a
building permit from the City of Salem. This ensures that the contractor is properly
licensed and insured;
o The appearance from the outside must be identical to that of the original windows,
specifically as to color(white), number and spacing of mullions(grids), and location
of mullions/grids on the outside of the outer pane(not between the panes);
o Screens must cover only the bottom half of the windows to match those throughout
the rest of the building;
o Flashing must be to Massachusetts code standards
Please contact the Management Company if you have additional questions.
Good luck with your project.
Signed: �o% /l,o/in Date: July 26, 2016
As managing agent for The Essex Condominium
*Exhibit C of the Certificate as to the Rules and Regulations, Book 23224, Pg. 241, South Essex
Registry of Deeds and Sections 5.2 and 5.15 of the Declaration of Trust, Book 101169, Pg. 84.
Both are available in the black bound copies of the Essex Condo Documents available from the
front office.