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23 FRANCIS RD - BUILDING INSPECTION (4) The Clnnmtincaealth of NlassachuSetts t Board of Building Rceulatiuns and Standards \Il'�It'II'.\I.I'I 1 assachusetts State Building Code. 7S11 CNMR. 7i1' edition I 'Sid /ii'ru r�l.liinwln Building Permit Application To Construct. Repair. Renovate Or Demolish a One- or Tu o-Fuinih• Dn elling This Section For Ottirial Use Only Date .A lied: F �— --- -� Building Permit Number: PP O Building Cununiss uner/ Inspector of Buildines SECTION I: SITE INFORMATION (-1 lP�o r[v :�ddr•.s:, pp 1.?.:\ssessurs Map & Parcel Numbers -- J Y�l(J�" t S d�nnj Ma Numher Farrel \'umbrr 1.I a Is this an accepted sheet'? yes_ no_ P 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sy (U Frnniage Ili) . Ls Building Setbacks (ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Prueidrd 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 sgsient ❑ Public ❑ Private ❑ Check if yes SECTION 2: PROPERTY OWNERSHIP' Owner[of Record Name(Print /L Address for Service: Signat� Telephone SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction ❑ Existing Building ❑ Owner-Occupied ❑ Repairsts) ❑ -Mheration(s) ❑ -i\dditinn ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Specify: Brief Description of Pr) 'ed Work"-,;. rl C� Al SECTION 4: ESTIMATED CONSTRUCTION COSTS Estimated Costs: Official Use Only llem (Labor and Materials) _ I. Buildim_ $3� �p 53 � 1. Building Permit Fee: $_ Indicate how Ice is determined: ❑ Standard City/Town Application Fee 2. Electrical S ❑Total Project Cost' (Item 6) x multiplier x 1. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: — 5. Mechanical (Fire S Total All Fees: S -- / / ( Check No. Check :\mount: Amount:_.- (a. rota) Project Cost: ❑ Paid In Full ❑ Outstanding Bakince Due:__ I SECTION 5: CONSTRucr1ON SERVICES 5.1 Licensed Construction Supervisor (CSL) 52,73�-) 2 � / fIS '7 License NumbeF li.�pii.u-u�u l).ue y Lot C'SL'1'%.pc (sea helou) \JJrc.. 1p c DCSc I'Iitioll L L'nrrsincied ni i m?5.000 Cu. Ft.i I R Restricted L@'_ Fainih Mkclline RC finu C'n\ermg Telephone WniJu" .mJ SiJinu SF Rcsidcntial tinted Fuel liurnuu \�,lnmce lu.t.ill,iw nt� D RniJeuual Dcuudwun 5bRe ter•dll�iefrin � ment4otitgjctor(IIIC) /6/ 0`f li 'nnp:n a] u r lic P gi� - u, N le Reutstration Number G 0 Address 4!JP-7C 1-6Lc2 P c �rati m Date Signature Telephone ' SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152. § 25C(6)) Workers Compensation Insurance affidavit 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. •Signed Affidavit Attached? Yes .......... ❑ No ........... ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN . OWNER'S AGENT ORaCONTRACTOR APPLIES FOR BUILDING PERMIT l as Owner of the subject property hereby authorize to act on my behalf. in all matters relative to work authorized y this building permit appli ion. . i nature ol'Owner Dme j� SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION I, 1,hn ka pr A-�T as Owner or Authorized Agent hereby declare that the statements and information on the fo going application are true and accurate, to the best of my knowledge and behalf. . q f./ ; n _ Print Name 7. .O Signature of Owneror Authorized AgenteC (Signed under the sins and enalues of er ti ) � ' P •` p ... .l�"•� .'�O NOTES: 1. An Owner who obtains a building permit to do his/her own work or an owner who hires an unregistered contraclur (nut registered in the Hume Improvement Contractor (HIC) Program), will not hate access to.the arbitration program or guaranty fund under M.G.L. c. 1-1'_A. Other important information on the HIC Program and Construction Supervisor Licensing (CSLI can be t'ound in 7S0 CMR Regulations I IO.R6 and 110.R5. respectively. ;. When substantial work is planned, provide the information below- 1 Total flours area(Sq. Ft.) .fincludinL garage, finished basement/attics, decks or porch) Gross living area (Sq. Ft.) Habitable room count _ heJrnnm..,Number of fireplaces Numberof - . Number of hathru� ms Nut b` n er of hilt/h:oh, � � rvpe of heating system Nwnber of decks/ p,,rches _-- Type of cooling system Enclosed Upon _--- —. -- 1. "Total Project Square Foortge" nary be substituted firr "Total Project Cast" � CITY OF SALEM PUBLIC PROPRERTY DEPARTMENT �.VJp!<i11 ILK lit �'II 11:\C.\il IINI,II iN lihI 1 4 S.11 I'Ll:')-8-';;-•1;•5 • F\x: 7-g.-�:-'t8�n - Workers' Compensation Insurance Afftda�it: Builders/Contractors/Electricians/Plumbers applicant information Please Print Leuibiy N:lllle tnu,mass t 4'gamcanun Iudn!dualt: A L A City,Stale Zip: S011M 1-12 121170 Phone #: L `37SS ) 7,H I - D)J 2,)A Are cuu an employer:'Check the appropriate box: Type of project(required): I.dl am a employer with A5 4- ❑ I am a general contractor and I 6, ❑ tires construction employees(full andfor part-time).* have hired the sub-contractors '.❑ I am a sole proprietor or partner- listed on the attached sheet. 7• ❑ Remodeling ship and have no employees These.sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. q• ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.[ ot7icers have exercised their I0.❑ Electrical repairs or additions 3.❑ 1 am 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 12.❑ Roof repairs insurance required.] t employees. [No workers' 13.�Z'Other comp. insurance required.] •Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t I lumeowners who submit this affidavit indicating they are doing all work and then hire outside contractors most submit a new affidavit indicating such. :Contractors that check this box must attachedan additional sheet showing the name of the sub-contractors and their workers'comp. policy information. f mn 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. #: t- a�2 H 5 U 13 Expiration Date: g� J"b Site Address: OI J !rr T rp_s Lad 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 NIGL c. 152 can lead to the imposition of criminal penalties of a line up to S 1.500.00 andi'or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine ufup h) S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Im esti_atiuns of the DIA lur insurance cu\erage verification. J do hereby c•rrtijy,and,r the ins and penalties of perjury that the information provided above is true utid c•orrec•L Cien.nure: / nn Date: Official use attly. Do nut write in this area, to be completed by city or rown ojficiaC Gtv or 1'uw n: - -------.-_.—_-- -- PermitiLicense #—._—..--.—_-- lscaing Authority (circle tine): 1. Board of Health 2. Building Department 3. C'itc/Ttiswn Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other _ Information and Instructions �Li.,.icIitiscus (irneraI Lawvs chapter I52 requ;resall employers atpnnide workers' compensation for theiremplo)ees. P".n'su.uu nl this N(amte. .ul cliph; ree is dclined.as "_ ewen pcnon tit the scn ice of .mollier under any contract of lure. cylrces or iniplicd,oral or w rinen." An enrpinrer is dclined as "an individual, partnership. Issoclation,corporation or other legal entity, or: i1 two or inure ,it the foregoing engaged in a joint enterprise•and including the legal rcprescntatit os ul'a deceased employer.or the lcceiw cr or tru,lee of an individual,partnership,association or other ICCaI entity, crnplo)ing empio}ces. Ituwc%cr the ,,•.w ncr of a dwelling house hay mg not more than three apartments and w ho resides therein, or the occupant of the dww elling house ofanother who employs persons to do maintenance,construction or repair work on such dwelling house or 1 m the grounds or building appunenant ;hereto shall not because of such employ nient he deemed to-be-an-employer.= — — .%I(IL 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 or compliance with the insurance coverage required." Addiriunally, %IGL chapter 152,j25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the perfomtance of public+work until acceptable cw idence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out 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 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 pennit/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 information(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 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 burn leaves etc.)said person is NOT required to complete this affidavit.. 'File Uff ice of Investigations would like to thank you in advance for your cooperation and should you have any questions, pleasi do not hesitate to give us a call. nic Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Oltice of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Rc'.;scd :-'(a-05 Fax # 617-727-7749 www.inass.gov/dia 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, 150a. The debris will be disposed at Salem Transfar Station mined by Northside Carting Al Signature bf Pe Applicant 0 Date Christooher Zorzy Nam s of Permit Applicant . A &A Services Inc Firm Name 115 North Street, Saiem MA 01970 Andress, Crty, State, Zip Code iU ssachusetts Department of Public Sakti Board of Buildut �Regulations and 5[kn'&11 d5 -Construction Supervisor License - License: CS 57733 c Restricted to: 00 CHRISTOPHER ZORZY 115 NORTH ST _ SALEM, MA 01970 i Expiration:.5/26/2011 ('onunissimier Tr#: 14751 . .. �llse -Piammmweml!!c'a ✓l�aaaomlrsnelza - Board of Budding Regulations and Standa'ds Yi HOME IMPROVEMENT CONTRACTOR Registration:, 101609 Expiration: 6/26/2010 Tr# 267870 Type--_Pr!Vate Corporation A&A SERVICES,INC j ,Christopher Zorzy `11 i5-North Street )Salem;MA 01970 Admrmstrato Commonwealth of Massachusetts Division of Occupation{Safety Laura M.Marlin,Commissioner tr y Deleader-Contractor IpI�Im�U". CHRISTOPHER ZORZY Eff. Date 04/14/10 Exp. Date 04/13/11 . DC000440 Memberd C.O.N.ES.I. BO y� IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII III oil 1111 805 0 NEW + A6 rk ' A�,^ AA ` 9 �2 A & A SERVICES, INC. LA&A SERVICES 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 CUSTOM REMODELING AND IMPROVEMENT AGREEMENT Buyer(s)Name Date of Contract ep- _ T&-7 /w Paws 1 (1- Zo -1 Buyer(s)Street Address,City,State and Zip Code Z3 F-p,,4AJv_/S 2b S111-i ! Mn 0/970 Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address: 97q-7V/- /85 7&-yZ3—/30 The Buyer(s)listed above hereby jointly and severally agree to purchase the goads and/or services listed on the accompanying specification sheets,in accordance with the prices and terms described an the front and 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 Buyers)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 he e�'In,regardless of timing or approval of any financing Buyers)may seek for their purchase. Purchase Price 1053 Est.Starting Date: n Down Payment: /00r Est.Completion Date: /0 ❑Cash Amount Due on Start of Job: 9 },Check S r0 f ❑Credit Card Amount due onZ Completion: 00 No. Amount Due on of Completion: J Expiration Date: Balance Due on Upon Completion: 9353, CVC Code: 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 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 the date first written above. Buyer(s)also (i)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 a-mail,as listed above, In the event Contractor believes Buyer(s)would be interested in any additional quality products or services of Contractor. DO NOT SIGN THIS CONTRACT IF IT CONTAINS ANY BLANK SPACES. Al Services,Inc. //// Buyer(s) n ^ By, Signature 'Signat�6ylt i /Bit' ✓S Print Name Print e �— ^• f, )fc- 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 panel and Me hemeowner hereby mutually agree In advance Nat In Me event either path has a O&pute mnceming Mis contract,dither party may Submit such dispute to a private aNitralion service which has been approved by the Secretary M the Ca Wa Ord,of Consumer Afters an(I Busings$,Ijegulatlons aW the other paM shall be relfrincd M submit to Such a.made 8a proved In MGL.of si pp)/.S^y-� r� CL—y/✓t(��P Contractor-less bil Date'. r/_—�=I.11—�� see:— file, /(O NOTICE OF QAN(:FI I ATION NOT fF(IF(:ANfELLAT ON Dare of Transaction You may cancel this tmnsaaon,Wrthom any penally or Date al Tmnsardlon You may cancel this Mmsacudn,without any penally or obligation,within three business days from the above time.11 you cancel,any ampary traded in, IrMigatloq within NreS business days from Me above data It you cancel,any pmpeM traded in, any payments made by you under the Barnard or Sale,and!Say negotiable instmmant executed any payments made by you under the Contract or Sale,and any negotiable lnstmmem exeral by you elf be WUMW wiNm la days rollover,retells by the Seller of your wndellatlon nMl. by you will be mtumed within 10 days following receipt by the Seller of rout cencellatlon notm, and any secudry Inc.,..Scene act m the toreadec on Will be cencelled, it you cancel,you muss and any Security Interest arming out M the tansacton will be cancelled. If you cancel,you must make available to Me eeller as your awashae,in SubAentally as,md mrdired as when resNN, make available he the Seller at your resMenr,In substantially AS good wndican as when reroved, any goods delivered to you under this Contract or Sale:or you may,If you wish,comply with the any goods delivered M you under this Comracs or Sale:or you mag I you wish,comply with the tremendous of the Seller regrading me realm Shipment of Me go We at the Sellars eepanse end InsuuNons of Me Seller regarding the mum shipment of Me goods at the Sellers asperse and hill It you do make the goods available to Me Seller antl to Seller does nor pick them up dsk If you do make the goods mall to the Seller aW the Seller does root pick Mem up within 20 days of Me time of your Notice W Cncellaton,you may retain or massive of the golds within 2s days of the date of your Roger of Cancellation,you may retain or distance of Me goods "has any funkier Mel'galmd.If you fail to make the gcWS avatable to Me Seller,or if you agree without any further obligation.If you fail to make the,cods available he the Seller or I you agree So return the goods to Me Seller and fail to ded AS.then you remain liable for performance M all b reNm the goods to Me Seller add fall to do ao,then you remain liable far perormance of all obligasgnsundertheCompecs.Tocancelthis trartwclbn,mal ordeliver a signed and dated ropy obligathem under the Contmm.To cancel this transaction,mail or deliver a signed add dated copy of she dmhmIateon nords or amy other wdtere dike,ar send a elegram rvs-116 of Me cancellatio nice m any dMer writr nMitt,traded a telegram M A8A Services 115 NegoStreet Slem Massachre.01970,NOTIATERTHAN MIDNIG,TOF V�03 North Sheet,Salem.Massachusets 01970,NOT LITER THAN MIDNIGHT OF t/ L 3—ire (Date) camem I HEREBY CANCEL THIS TRANSACTION. Conwmer a agree— 0. 1 HEREBY CANCEL THIS TRANSACTION. Consumer's S.'emme D. J A & A SERVICES, INC. A, M SERVICES 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 VINYL SIDING SPECIFICATION SHEET Buyers)Name - Date of Contract CAr41(3 -h T&A-Al PIN✓&-V-S el-20 -/0 Buyers)Street Address,City,State and Zip Code Z3 fi/�r�i"c/ s l2D Sx}L 1171; 01970 Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address 9a8-9�!l- i8sy 9a8-/iz3 -13a � The Buyers)listed above hereby jointly and severally agree to purchase the goods antl/er 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. VINYL SIDING m/Remove and dispose of existing L4.l6CV S!P/Nt r Z t-R4 -( siding. Note: INSWZln ?M [n31r ffnvs�GVli/� Remove and dispose of old gutters. ❑,'remove and dispose of aluminum gutters. P3'Install new.032 gaugegjuminum seamless gutters and down spouts as follows: - ❑ Open Gutter W fhe Glgter Shutter Color: Coer body of home with 3/8 inch thick Dow High Performance Insulating Board. , 2er all trim with aluminum coil stock including the following: Color: rInstall trim deluxe window trim ❑ upper porch trim oards do trim ❑ Other: oards rake boards ffitPanelsStyle:/NVI S/(/6W7_ Color: C44" yl siding to body of home as follows: /�',{'anufacturer: 1}LS7D/.r y`1 9L�Style:L r/ rColor: SI�r7'/G H Replace existing+Y dbR attic louver vents with vinyl vents. Cover porch ceilings with CertainTeed beaded porch panels. Zemove and re-install existing shutters. f'tall# b pair of Girardin new vinyl shutters. bNi✓v7+- `/"'�y" ff rner Post style: S1YA (zoel/L6 Color: S&/Yi Ir7 r 6aan debris from grounds on a daily basis;clean grounds thoroughly at completion. H' Incl ed in this proposal are the following items: /ZB ding and Electrical Permits - y29ic Electrical work including removal and remounting of fixtures electric service,and wires. W'Basic siding accessories including light,outlet,spigot blocks,dryer vents,and exhaust vents. SPECIAL INSTRUCTIONS: r IIV J77VVL- 3 r f�cLr3 rit3ryTS 1 7D So��/T 0 1/vS7_*Gt- /V674_J 1)C F_Ve_1q /da),_9_0 • /L AV gorn-W M100D 0A/ leg-&a- ,S A & A Services, Inc. provides a five-year labor warranty on vinyl siding installation to include any re-installation of any vinyl siding, gutters, and aluminum coverage work due to any faulty workmanship. This warranty does not cover any Acts of God including ice dams,lightning strikes,falling trees,damage from vandalism,or improper use. 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 as terms modified or varied in any way unless such changes are in writing and signed by both the Buyer(.)and the contractor. Buyer(s)hereby acknowledge that Buyer(.) has read this Specification Shceet•M Zyi-� Contractor Initials: lob Date: N�U-I0 Buyer's Initials: klXV/-' Date: �D A&ade Above Since 1982 A&A SERVICta MT1051#0 WAG If WN 115 NORTH STREET SALEM, MA 01970 PHONE: (978) 741-0424 FAX: (978) 741-2012 DATE: 6 In TO: Ko y l n FAX q � a - -7uLlly 03 l 1 FROM: d o /m(a, JI Q Vf QS NUMBER OF PAGES TO FOLLOW: . _ REGARDING: 1 I Q so (-Aa e kcfl ) Ca 1 Wm ,�-E N- E opnwef •S exod -Sue-rt. w A o I Coo ff- " q% - esf wort Sfr `f i*s , �, 20 - :ZoZO 1�?Utl:k.S Jul flu 05/13/2010 10:38 FAX 13787412012 A&ASERVICES 001 7RESULT TX REPORT1158 18787443311 ST. TIME 05/13 10 : 35 TIME USE 00' 43 PAGES SENT 1 OK AGrade Above Since1982 A&.4 SERV���� ' A 115 NORTH STREET SALEM, MA 01970 -PHONE: (978) 741-0424 FAX: (978) 741-2012 DATE: TO: KA V I FAX#: q..((�1 U FROM: UQ m* PJ Sto OS NUMBER OF PAGES TO FOLLOW: REGARDING: QI nnSO El D(11 S (Sri 1 o H I ,i A o 14-lr-)