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167 FEDERAL ST - BUILDING INSPECTION r ry �I # 1131 \ O� DATE: 1 , $4o Cttp Df 'rsaafzra, a55arbm; tt5 PLANS MUST BE FILED AND APPROVED BY THE INSPECTOR PRIOR TO A PERMIT BEING GRANTED Location of Building_&7 fed e-rQ S�C 1 Building Permit Applicati r: (Circle whichever applies Roo eroof, Install Siding,Construct Deck, Shed,Pool Addition, Alteration, Repair/Replace, Foundation.Only, Wrecking Other. PLEASE FILL OUT LEGIBLY & COMPLETELY TO AVOID DELAYS IN PROCESSING To the Inspector of Buildings: The undersigned hereby applies for a permit to build according to the following specifications: Owners Name: bu Contractor: A e A Se-rvlu5' '(hnt> Z6 r-AtA street ((D7 FP/)P,YQ PEA City rLWy Street A 15 N n(4h 5I ' City—"� State Phone ( ) 4,�j'� . 1{ ( (o State M A Phone, 0 78) 77 1-_D�I A/ Architect: City of Salem Lic#— /••{Q5 Street City State Lic k5 Hlp k (D I to 09 State Phone ( ) Homeowners Exempt Form_yes ✓ no Structure: (please circl Single Famil • Multi Family# Other Estimated Cost of job S /a 9, UD Will building confirm to law?—z--ycs no Asbestos?lees_/no Description of work to be done: S�rl o a /l PX l,Sh/1 Gz /a L 1 P ✓� /�� �� �� s�rlf 9/a 5/2u�r D� -frh a5uear na 0 • A&A SERVICES, INC. Drawings Sy miffed:_yes no Mail Permit t0: 1 SALEM,MA 01970 Signature R Applicati ,SIGNED UNDER THE PENALTY OF PERJURY CONSTRUCTION TO BE COMPLETED WITHIN SIX (6)MONTHS OF PERMIT ISSUED DATE Department use only: Permit# Zoning Map/Lot Permit fee$ COMMMS: • I 1 APPLICATION FOR ' PFRMtIT f0 11 LOCATION A7 lei, e PE MIT GRANTED AP Ovp INSPECT OF BUILDINGS CEB=CATE OF OCCUPANCY . YES NO shot A & A SERVICES, INC. /p��, /,+�� 115 NORTH STREET,SALEM,MA 01970 Telephone:(978)741-0424 Fax:(978)741-2012 Contractor Registration No. 101609 Federal EIN:04-3090162 Construction Supervisor No.GS057733 ROOFING SPECIFICATION SHEET . Buyer(s)Name Date of Contract n 6oCJ4'v1 7 zl 07 Buyer(s)Street Address,City,State and Zip Code " to 7 'Feder i s 1.W coot_O 17a Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address " The Buyer(s)listed above hereby jointly and severally agree to purchase the goods anNor services listed below,In accordance with the prose and terms describetl 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. ROOFING SPECIFICATION .. Strip Roof of# AJ I layers of shingles Install 6'of ice and water shield at base of roof where UKnstall 15.b felt paper to roof. possible. Install 13-24"of ice and water shield in valleys. - Flash chimney as needed(no repointing included). 1se`jnstaII#perimeter drip edge to rakes and fascia areas. nstall vent pipe boots and seal as needed. ❑ Flash valleys as needed ❑ Install rollout type ridge vent. Planks/plywood replacement under 32 SO FT included, *If more is needed there will be an extra charge of$ per hour for labor plus the cost of materials.. ❑ Dumpste isposal cluded: Attic� j54-eY• ❑Other: •� Location: Install new roof: Manufacturer CAfi-RIN{ead- yr - Stylettype CAB O .Included in this proposal are thorough cleanup,building permit,and company/manufacturer warranties. RUBBER ROOFING SPECIFICATION ❑Strip Roof ❑ Not Strip Roof ❑ Install 1/2"High Density Fiberboard to existing roof using ❑ Flash obstacles as needed. screws and plates. O Install.060 membrane EPDM(Black)rubber roofing to ❑ Install 3x3 aluminum drip edge to perimeter of roof with fiberboard.s seam tape. ❑Flash up sidewall as needed. - Included in this proposal are thorough cleanup,building permit,and company/manufacturer warranties. SPECIAL INSTRUCTIONS: It Is agreed and understood by and between the parties Mat this Specification Sheet,along with CUSTOM REMODELING AND IMPROVEMENT AGREEMEW,,cuhetltutes Me entire understanding between Me handles,and Mere are no ventral understandings changing or modifying any of Me harms.This contract not,not be changed or he terms modified or varied In any way unless such changes are In writing and signed by both Me Buyerls)and Me Corrtmctor.Buyerls)hereby acknowledge Mat Buyar(e) " has read this specification sheet. Contractor Initials: SL . Date: _((],j[0 Buyer's Initials: Date: � 7 II I s A & A SERVICES, INC. 115 NORTH STREET,SALEM,MA 01970 RAVIIIIa. a Telephone:(978)741-0424 Fax:(978)741-2012 Contractor.Registration No. 101609 Federal EIN:04-3090162 Construction Supervisor No.GS057733 CUSTOM REMODELING AND IMPROVEMENT AGREEMENT Buyers)Name Date of Contract Avis 6ordavr a Buyer(s)Street Address,City,State end Lp Code - - 67 ceder L S� _ S )er1 01 Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address: ` w q7$ 2 16, The Buyers)lined above hereby jointly and severally agree to purchase the goods andlor Services listed on the accompanying specification sheets,in accordance with me prices prices and terms described on Me ham and the reverse of this agreement and Bay specification sheets(this'Agreem uir),and Buyerls)have requested Met such goods or services be installed or provided at Buyers address listed above.A&A Services,Ix.("Contraotod'j,hereby agrees to install or cause to be Installed Me product or services listed in this Agreement at the Buyer(s)address written above. This Agreement represents a cash sale of goods and services. The Buyerls)agree a pay In cash the cost of the goods Bad somities purchased as described herein,regardless of timing or approval of any financing Buyerls)may seek.for their purchase. hi iSC S si-e . Purchase P ace. .fdQ ')ZR - Est.Starting Date: Down Payment: 41n, Est.Completion Date: ❑Cash Amount Due on Stan of Job: ❑Check ❑Credit Cam Amount due on of Completion: No. Amount Due on of Completion: Expiration Date: Balance Due on Upon Completion: — tar+,( S COH ttJIN,Y1d CVC Code: r6d O DOA)OWL DI 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 Buyerls)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. Buyerls)also (1)acknowledge that they were orally informed of their right to cancel this transaction;and(it)request that they be contacted vie their telephone numbers or e-mail,as listed above,In the event Contractor believes Buyerls)would be Interested in any additional quality products or services of Contractor. DO NOT SIGN TITS CONTRACT IF IT CONTAINS ANY BLANK SPACES. A&A Services Inc. Buyer ) Signatte 1-3 Al LNd�I X natu Print Name Print Name Signature Prim Name You,the Buyer(s),may cancel this transaction at any time prior to midnight of the third business day after Me date of this transaction. See the following Notice of Cancellation form for an explanation of this right.. xMIT O.:Imnuerm.ram me romemeMe,MM,1 memmly W-In w--M.m memmm amw pent ve.dapum mncemlry Be.....or per,May beemn even eapvmm e plvem bromeem serv.wnlcn nec Caen egxwee ey Me eamemy,a me 6averve corks a consumer xi antl Bummer se rearm.eM Ne otlrer mix evid be na..be some to vekmbn be p,wtl In M,G.L c.14M. 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(pare) loom) I HEREBY CANCELTHIS TRMIS4CRON. Consumersegname Date I HEREBY CANCELTHIS TRANS4,7RON. ComumerSsaovem Dam 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 Pe it Applicant Date Christopher Zorzy Name of Permit Applicant A &A Services, Inc. Firm Name 115 North Street, Salem. MA 01970 Address, City, State, Zip Code The Commonwealth of Massachusetts I I Department of Industrial Accidents I i9 r.l Office of Investigations '`it� �i 1 � 600 Washington Street Boston, MA 02111 e to www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): A je r Vi a Address: 1 15 Q o r+h ,Sir(f e+ City/State/Zip:_6n_ p,yy` M la DI cr70 Phone #: ( 9-7`b) 211 —Q<l H Are ypu an employer?Check the appropriate box: Type of project(required): t. I am a employer with 4. ❑ I am a general contractor and 1 6. ❑ New construction employees(full and/or part-time).' have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. t 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their ME] Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself [No workers' comp. c. 152, §1(4),and we have no insurance required.] t employees. 12.❑ oofrepairs q ] [No workers' 13. Other XO� comp. insurance required.] `Any applicant that checks box 1 must also fill out the section below showing their workers'compensation policy information. t Ilomcowners 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 sub-contractors 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: Policy#or Self-ins.Lic. #: �/L', l�]�Q JX r o`Z h (p Expiration Date: I i3 q D 7 Job Site Address: /&7 ��/it C Q ! t� P e City/State/Zip' M Mg olenD Attach a copy of the workers' compensation policy declaration page(showing the policy number an 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. I do hereby certify unde3the pains and penalties ofperjury that the information provided above is true and correct. Signature: 4 Date b 710 I Phone#: F only. Do not write in this area,to be completed by city or town oJrciaL n: Permit/License# hority(circle one):Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector son: Phone#• Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees..However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a 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,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill an the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary, supply sub-contractor(s)name(s),address(es) and phone number(s)along with their certificate(s)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 LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe 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 thew self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill 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 pemuUlicense applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations to (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 home 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 bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia Board of Building Regulations and Standards Construction Supervisor License License: CS 57733 Bi_rftiilate::,5/26/1958 E� I 5?.6/2009 Tr# 13739 1ReS-if Crtion M T CHRISTOPHER 41�t 115 NORTH ST ��— SALEM, MA 01970 Commissioner Commonwealth of Massachusetts Division of Occupational Safety Robert J. Prezioso,Commissioner Deleader-Contractor CHRISTOPHER ZORZY Eff.Date 04/02107 - Exp.Date 04/01/08 "' DC000440 i - Nem6er o(C.O.N.E.S.T. 08 BO IIIIIIIIIIIIII�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII�II BOSTON-RENEW? i ✓�ee -!°iomvmaouoeai o��/l�o-oe¢r,/xuoedn Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration. 101609 Expiration•_ 6/26/2008 1 Private Cpryoration j, A&A SERVICES INCi . 1 Christopher Zorzy 115 North Street :•'Salem;MA 01970 Deputy Administrator.. I i R e 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 ❑ 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: McTntim Address of Propert Name of Record Owner: Ana Gordan Description of Work Proposed: Replacement of roof with Slate Gray, 3 tab asphalt shingles. Repair windows to replicate existing. No change in color, material, design or outward appearance. Replace double casement window in kitchen and single casement window n bathroom with Pella Architectural Series casement windows as shown in drawing and catalog cut. Soft vent portion of application continued to the meeting of August 1, 2007. Dated: July 19 2007 SALEM HISTORICAL COMMISSION By: The homeowner has the option not to commence the work (unless relates to resolving an outstan g 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.