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31 FORRESTER ST - BUILDING INSPECTION (3) 1 �\ The Conurtomsealth of Massachusetts t Board of 13ullding Rcgul:tions wtd Standards Mt VIc ll'.\I.I'll L. IMIISUCIILISCUS State Building Code. 780 (';SIR. 7"' edition 1 l.hum,in Buildino Permit .-application To Construct. Repair. Renoc:ue Or Demolish a Rrruri (hie- orTnv-Famil. Duelling. --IfN `J -----1 This Section For Official Use Only �II ` - I M� Buildim_ Permit Number: Date Applied: d Srsnature: Building Con u",00er/ htspector of Buildings Date SECTION I: SITE INFORMATION I.1 Pro :address: 1.2 Assessors :Nap & Parcel Numbers I] �crty rroS+er �)fre& --- L Ia Is this an accepted sneet7 yes--,./— no hla_ P Number Pao:el Numher 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Isy tU Frontage fit) _ 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40. §54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone" Municipal❑ On Site disposal system ❑ Public❑ Private❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: 3 i -�YYP 51� rQe-� Name l rin ) Address For Service: Ems/ XAt � >>� Lg�s�-7�N - bc�tig�y � �S i unatu re Telephone SECTION 3: DESCRIPTION OF PROPOSED WORK"(cheek all that apply) New Construction ❑ Existing Building ❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) tV Addition ❑ Demolition ❑ Accessory.Bldg. ❑ Number of Units Other ❑ Sumly: Brief Description of Proposed Work': - Ty)c,+ a11 neP 0) re-placeme" ey11YU ODD(- if2 Ot7� t SECTION 4: ESTIMATED CONSTRUCTION COSTS Estimated Costs: Official Use Only Item (Labor and Materials) I. Building $ a2� 1 b 1. Building Permit Fee: $ Indicate how fee is determined: ❑ Standard City/Town Application Fee 2. Electrical ❑Total Project Cost (I em 6) x multiplier .x _ 3. Plumbing 3 2. Other Fees: $[ s_ 4. Mechanical (HVAC) 'S List: 5. Mechanical (Fire 5 --- Su cession) Total All Fees $ Check No. Check :\mount: j 0 Tatal Project Cast: $ - -_ ar-rl$ . C)C) ❑ Paid in Full ❑ Outstanding, 13:dance Due:.--- --- 1 SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) License \umhef I'..\pu:wnu Da(e Name of CSL- 11older I_ul C'SI.'I\pe (see hclua) I T\ C Descri it ion C L'nn c(nclrJ(u i w HIU Cu. Ft. R ResuMed 18e_ Fam(h Ds�e16n� Sid atl e \1 \Ltsonn Only RC Residential Roolind('o�armd Trlcplume \\'S RrsiJenual \\'mJu�� .wJ 1iJind SF 12cs(Jenti:d Solid F.rel 9unw(e \ i Haute 1(1,(.dlaw�n D RestJeuual Dcnmhu.m 5.� Regi'tered Ilome Improvement Contractor (HIC) I u too9 L A fV ILp. ..r f1r Reg(soatiun Number . liIC Company Na(ne or HIC R-g(slrant Name .— '_ :ae Sienewrc Telephone SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT I.G.L. c. 152. § 2506)) workers Compensation Insurance affidavit must be completed and submitted with this application. Future a( provide this affidavit will result in the denial of the Issuance of the building permit. -. Signed-Aftitlavi r'Attached?-"-- Yes "::... . -� Na -.....'_ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, r MOdQ r-e� as Owner of the subject property hereby authorize T er 7-r-)r Z� — to act on my behalf. in all matters relative to work authorized by this building permit application. 01F81 Date ' Signature of Owner` N SECTIO 7b: OWNER- OR AUTHORIZED AGENT DECLARATION as Owner or Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and behalf. i 1'Z pri - .:...-.� . ....__.__._-_•__.,.rj Date Siena- a 61 wrier or A orized .Agent . (Signed under(he pains and penalties of er'u ) NOTES: I. An Owner who obtains a building permit to do his/her own work or an imner who hires an unregistered contractor (nut registered in the Home Improvement Contractor (HIC) Program), will not have access to,the aibiu'aliun program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Prograun and Construction Supervisor Licensing (CSL) can be found in 780 NIR Re=ulations I IO.R6 and 110.R5, respectively. C s ..When substantial work is planned, provide the information below: Total flours area(Sq. Ft.) (including garage, finished basemen Uau(cs, decks or porch) I Gross living area (Sq. Ft.) Habitable room count -- ~umber of fireplaces Number ut bedrooms _ --- Number of bathrooms Number of halt/halhs —.--.— type of heating system Number of Jeckn/ pnrnccs ----------- - _ Enelused ._ Open t Type ocooling system. . - — - 3. "Total Project Square Footage- may be substituted for "Total Project Cost" j Ikk CITY OF SALEM PUBLIC PROPRERTY 00� �ellDEPARTMENT _. \Ltt� �K I_'" \Y'.t,l iiS�,r��>�Iltrfl • SU �L \t.t,,.�t l!t ,i- I :, .I')-: fP.l: ')-h-4;-9;95 F\S: 778--1-')840 Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers k > ilicant Information Please Print Le-ibly `;1Ilie t nu•Inr,s ()I_anvau,nt InJn 1J11aL1: A e A Seryt �es S�� W(]ress: J for+h Shr �t City,State;Zip: Phone 0: C T7S 7N i - ©)A Are you an employer:' Check the appropriate box: Type of project (required): I. I am a employer with 4. ❑ 1 am a general contractor and 1 6 New construction IJ ❑ employees(full and/or part-time).* have hiredthe sub-contractors ❑ RemoJeling '.❑ I :tin a sole proprietor or partner- listed on the attached sheet. 7. ship and have no employees These sub-contractors have 8. ❑ Demolition r, working—tnr_nte_m.UnX.capacity. workers' comp insurance. 9. ❑ Building addition -.�:_❑.We are a corporation and its - _ _ _ec,t ical s- _ -- `--. - - --,-]No workers' comp:-insurance--��-- - - 10.❑ Electrical repairs.ora.Jdmons - required.] ufiicers have exercised then -. l-right of exemption per N1GL t L❑ Plumbing repairs or additions t,❑ I ys a homeowner s' co all work c 5152 $1(4) and a have no 12.❑ Roof repairs myself. (No workers' comp. �( insurance required.] f employees. [No workers' 13.E l Other T)Dn1 S .comp. insurance required,] •,any,ipplicant ilea checks box#1 must also till out the section below showing their workers'compensation policy information. t I lumcuwners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. -(-ontracmrs that check this box must attached an additional sheet showing the name of the sub-cuniractors and their workers'comp.policy information. .1 am its employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information' Inutrance Company Name: /)��1,3/�7&`/�j ' Ex iration Dare: Policy # or Selt=ins..Lic. # —�_ p n �y,�e City/State/Zip:/State/Zi ..S� l em. Ml Qtg70 Job Site :\ddress:3t �7{�{rPStt°r 71t P�" ty P t :'Lttach a copy of the workers' compensation policy declaration page (showing.the policy number and expiration date). Failure to secure coverage as required under Section 25.4 of NIGL c. 152 can lead to the imposition of criminal penalties of a tine up to S 1.500.00 and/or one-year imprisonment, as well as civil penalties in the firm of a STOP WORK ORDER and a fine ,)Cup to S250.110 a Jay against the violator. Be advised that a copy of this statement may be limvarded to the Office of Irnctiti_atiuns of the DI:\ for insurance co%erage verification. - l do hereby ccrti/i tit e pep p his unr!petadtire uJ pe•rjur}'that are iujortuatinn provided above is true mrd correct. el:dt tire: r —f Phone lllliriu!ace only. Du not write in this area, to he iumplete•d by city or trr n•ta oJficiuL Perntiti License #_— .___ ------------- Iscuim; kuthnrit}' (circle one): "-- .. _. . .. . 1. Board of Ilealth 2. Building Department 3. Cih/fawn Clerk 4. Electrical Inspector 5. Plunlhing Inspector 6. 01her Information and Instructions >las.aChusens <4cneral l-aws Chapter I require, all eniplo%crs to pi ide workers' Compensation for their eniploy-ees. I'�.usuant to this aatute, .ut engtloree is defined Is ".. c%en person in the sera ice of anoilier under anv Contract ofltire, C\p:css or implied, oral or wnrtan. ' An :nt1dol er is defined as "aft indii ideal, parinCrship, .tssoCtation. Corporation or other ICgal entity. or :uiy nvo or niore ,.I the fnrcgomg cnga_ed in a joint cniciprise, and uICluding the legal rcpresetuati%es of a deceased cmployer. or the reCci�cr or trustee of an indi%-tdual, partnCnhip. association or other legal entity, employ in., employ-ees. Ilowe%er the "A n C r of a dwelling house hac ing not more than three apartments and who icsides therein, or file occupant of the dwClline house of another who euiploys persons to do maintenance, Construction or repair work on such dwelling house or on the _rounds or building appurtanant thereto shall not because of sueh employ nwnl be deemed to be an ennployer.' - \IGL. Chapter I i?, �N 25CI6) 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 rctluired." Additionally, NIGL chapter-152, �2 C(7) states "Neither the coinnionwealth nor:my of its political subdivisions shall inter into any contract for the performance of public cork until acceptable ei idence of compliance with the insurance requirenicnts of this chapter have been presented to the Contracting authority." - Applicants [)lease till out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary_supply_sub- —o9t-r--a-c--Lor(j) n;tme(s),�ddress(� ).and phone-nuriber(s) along with theircertificate(s) of- _-•—.-------- -------- insurance. .Limited Liability Companies ILLC-)"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 may be 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 their 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 permit/license applications in any given year,'need only submit one affidavit indicating current policy inforniation (if necessary) and under"Job Site Address" the applicant should write "all locations in (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 tilled out each ycar. 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 burn leaves etc.)said person is NOT required to complete this affidavit. Me I)(lice of Investigations would like to thank you in-advance for your Cooperation and should you have any questions, p1ca.0 do not hesitate to give us a Call. Ilie Depaitnient's address, telephone and lax 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 Fax # 617-727-7749 Re',axed 5-'b-t)i www.lnass.gov/ilia 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, Seca 150a. The debris will be disposed at: Salem Transfer Station owned by Northside Cartina Signature of Permit 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 ✓� ��d� r�yp✓l�r�or.� Board of Building Regulations and Standards Construction Supervisor License License: CS 57733 Bifthdate _:5/26/1958 ' fxplmtlon �126/2009 Tr# 13739 ,I I , Restriction DOS, II CHRISTOPHER 70RZY 115 NORTH ST _ SALEM, MA 01970' � Commissioner I ._... ,. . __.--_. ._._ .._ �...� ___ ., ._ ✓fie -�omrnonusaal�l .�aaaaclm�etYa _ , ---- - Board of Building Regulations and Standards - - HOMEIMPROVEMENTCONTRACTOR ug Registration: 101609 Expiration: 6/26/2010 - Tr# 267870 °Type: Private Corporation A&A SERVICES,iNC -= Christopher Zortyy., 7 115 North Street Salem,MA 01970 -" Administrator Commonwealth of Massachusetts Division of Occupational Safety It Laura M.Martin,Commissioner Deleader-Contractor CHRISTOPHER ZORZY Eff.Date 0400 .� �' { - Exp.Date 04/08/8/09 9 DC000440 it Iemberof C.O.N.E.S.T. BO ���[IIIIIIIIIIIIIIIIII1111111111IN111IIIII111111111 BOSTON-RENEW �✓ � A & A SERVICES, INC. A&A . C 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.CS057733 - ENTRY DOOR SPECIFICATION SHEET Buyers)Name Date of Contract - Mqaq-/-7 -v8 Buyers)Street Address,City,State and Zip Code 3 / �b22EST�rt ST S'ot�t� Mr9 0/970 Daytime Telephone Number Evening Telephone Number Mobil.Telephone Number E-Mail Address 9'79-7y(I- i 978-9'n=35-117 The Buyers)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 W. ENTRY DOOR Remove and dispose of# existing entry door units. Install new entry doors# Manufacturer 721til Location Z it ;-� t Q•SJO(_r -/04pl Type: O Steel XmoothStar ❑Fiberclassic ❑ClassicCraft ❑Sliding Patio Door ❑French Hinged Patio Door Model#i�7o flfl Sidelights)#_42 Sidelight(s)type/model# /v� OPTIONS: - - Adjustable threshold for Therni Door ❑Grids for patio doors: Style: 6 A/I*Stain Kit: Supplied to owner Expand or shrink the size of the opening Details Cover exterior trim with aluminum coil stock: Style Color Hardware: >}iandelset Veadbolt ❑Footbolt ❑Mail Slot ❑Peepaite �f Install oak strip at floor as needed. Caulk interior nd exterior edges. Insulate around new door unit where possible. >f Painting is not included. Included in this proposal are set up and clean up. STORM DOOR ,,�Remove and dispose of# / existing storm door(s) g#% .,t Install new storm doors# Manufacturer 7 'V Style LL-L17E Color Type: O Aluminum X3olid Core I AvLocation: / PL ovr[ Irg SlD� �bt2 SPECIAL INSTRUCTIONS: ' /NSTJ3LL H/�t� !n/TL'1LtuYL ATnJ E�7Z�Ytto� T7trw1 iw7bn2easL 772l 7•D QF / ty[ L /0,l iZ b Is agreed and underatood by and between Me paNNe Nat the specification Sheet,all with Me CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,const, Wtes the ends understanding between the Padles,and them art no verbal understandings changing or madXying any of Me terms. ThIa eommd may not he changed or as term.modified or varied In any way unless such changes am In adding and signed by both Me Royal and Me Contractor. Buyar(s)hereby acknowledge that Buyer(.)has read this Specficatlon Sheet q p Contractor Initials:_� Date: / /7—�B Buyer's Initials:X-AVJIA— Date/;t�a �+ A & A SERVICES, INC. EMM 115 NORTH STREET,SALEM,MA 01970 MITI kit Fromw"Ill I I a%imirlym Telephone:(978)741-0424 For(978)741-2012 Contractor Registration No. 101609 Federal EIN:04-3090162 Construction Supervisor No.CS057733 _ CUSTOM REMODELING AND IMPROVEMENT AGREEMENT Buyers)Name Date of Chnoact M�Qy Maoo2C 9 -i7 -o8 Buyers)Street Address,City,State and Zip Code 3 ST SAI,ew1 Inq 0/970 Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail.Address: - 976-7yy-roroY9 976-97C/-35117 The Buyers)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 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 at Buyer's address listed above.ABA Services,Inc.("Conkadof),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 man sale of goods and services. The Buyers)agree to pay in cash the mat of the goods an services purchased as descritiml herein,regardless of timing or approval of any financing Buyer(s)may seek for their purchase. Purchase Price. 2�78r dl/771,i/ �GAIL = $212Za Est.Stoning Date: Onwn Paymenrf, .97�r S f C e 57VIr2i4 IOL./Z'19 Est.Completion Data: O Cash Amount Due on Stan of Job: O Check 'Credit CaM �,SCaVo f L Amount due on of Completion: No.(oLel/29 PiQ y4D 3 ow� ' - Amount Due an of Completion: Expiration Date: Balance Due on Upon.Completion:v ii� r Critic Code: 07 Z 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 Buyers)hereby acknowledge that Buyers)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. Buyer(a)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 e-mail,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,Inc � ��{ Buyer s()_ Signature 85- Signature ` m.4di - 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. A w ITRrmaN:Tn sweedanoyer Mrs abed ax.nnowd by y summer, of In Emoti na Loin ute a ant either party nee one —er meontemy mb Meoffe suer,ne,y mew aupmn o numeow ro w bM.ale aawrom nerww wnin roe been appro+.e W N.sdetey.f Me Ee.anye Cone a con..mer snare bond some.:,Reg,dmmna era via Omar Pan,'eltau n rawme b bobmu to , boon amino...a paved In M.c.L.o'.. . X pro dn l, _� hoe:'.he I, CJ� Q ryOIt FOF eTON Q ���/N�OTCE OF rANf pan on Trenee er .You may®M'el ma v ...any barely m Cate M Thrombn 9-rn-o8.You may cancel min-entered w rboul any penaally be ouieron,whin None heirs Who M1Wn the whorls Nis.if yW caned,any nobody traded in, oboarene-trylntre6Mwnessay,lrono,,mo tlete.",re Centel,ary PrgRry.a le , any baymwnew made by you order Me C-ow.or Saw and any ne0or irmtNTem eweddotl Bey payments made by you under me common be See.and any readable Merriment execute] - by You yell be owned won 10 days telexing made heMe Earlier d Your concoubson ounce, by you will be reWrne]ynew 10 days farmers recent by Me Seller of yma anmlMlNn notive and tiny—.a Interest eriof.vaof the trat.n will be barrobi If you[a ...U must add any ssariy,intoned-any.1.I Me townwayn whi.webbed If you can 1,you mum moonorlan'e en Me Bear L your raWemem somebody as Keel wMNs as when nodded move owned b the Senor A Your manatew m sumwnYdly as gatl mndiLbn es Mod someM. my hands delivered to you under the OomRm or Bei or you may,it you wish,compy we two any Moves demand to you under mu contract or ode:or you may.It ym endr.comply win Me InsWntldc of the Bear member,Me under shown of me cause at me sesed ow ,ense and M5Wc4ons at the Seller boding the TWn Semen to Me g0.tls at me Sellers expense and risk. II your be an Me gWtls avdurs.b me Seller and Me Beni tlwe not 0.loam up risk r ye,do make the pone awrood s N Me Sayer aN the Sella ticq Me pkk Mom up embin M days of Me date of your Wood of Cancellation,you may wood or turbine of ma Mads within A Jaye d to dada d your room on Caedlanon.You may W n or dietyse of me good witlgdayh.mwoMlgatbn.Il you ldlto make rip 0.nsavailablebtne$elbr,q.ypY agree without arty NMm You When.If you to b make the goods available b Me SoW or it you wgree to m me Monts to the Salter and low w do sp men you remein Innis for whormace at ell M room Me exce to Me Bela,ad to to d,m,Man you remdn are for penormanca of ell obiganns under me common.To commit Me thess,,ion mail or deliver a dined and bated mby orthamns under me Indeed.To eadM Me UenseCllon.real or dower a varied and dead may , of Me cancalusion de ibe or ary soer wdryM adkq or sent a telegram,t.AM.Mmis,its or Me c mbeho sn of or any.aer woolen More.or uM a telegram,b A swybw0.its R.Street,Sdsn,Masseehueetls m alic NOT LATER mid.MIONIGIR OF — He.StreetBeam.useseehYseM1 01 mr,NOT IATER THAN MIDNIOXT OF (Oats (Cash I HEREBY CANCELTIISTRANSACTION. Coneumusagnwtm Dab HEREBYCMICELTHISTRANSeCTION. C.nsumery5f,mmlde Ode L