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23 FRANCIS RD - BUILDING INSPECTION (6) .�35 uc 32�� The Commonwealth of Massachusetts Wt 1itS Gfift1XI' itA F� Board of Building Regulations and Standards Tk!OF Massachusetts State Building Code, 780 CMR SALEM .101h JUN 13 eVa541ar 2011 t— Building Permit Application To Construct, Repair, Renovate O'r,Demolish a One- or Two-Family Dwelling This Section For Official Use Only Building Permit Number: Date A lied: t� Building Official(Print Name) Signature Dat SECTION 1: SITE INFORMATION 1.1 Propeµ�Address: 1.2 Assessors Map& Parcel Numbers �13 1 i24Qcts ea SQ kw, I.la Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq f) Frontage(It) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L a 40, §54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal ❑ On site disposal system ❑ Check if ves❑ SECTION 2: PROPERTY OWNERSHIP[ 2.1 Owner'of Recor C�19t (s- flow S -sAM. 04 �� 70 Name(Print) City, State,ZIP f Q? -Fe AA)eis K g�C=1/03— 136(a No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK (check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) 01 Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work'-: c s R <Atv -b Go SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials L Building $ -�0 1. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical $ ❑ Standard City/Town Application Fee 7 ❑Total Project Costs (Item 6)x multiplier x / 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (ITVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees: $ Check No. Check Amount: Cash Amount: 6. Total Project Cost: $ ❑ Paid in Full ❑ Outstanding Balance Due: MflL�-�-T-,3 G e 1 l� SECTION 5: CONSTRUCTION SERVICES 5.1 Construc'tio�jSupervisor'License(CSL) S 7 f / License Number Expirati n Dat r Namelof•CS�E E $j(ll, tilli� List CSL Type(see below) No. and St eet �( Type Description Q (1 �O U Unrestricted(Buildings u to 35.000 cu. ft.) _! R Restricted I&2 Family Dwellin City/Town t te, ZLF M Masonry RC Rooting Covering WS Window and Siding ^ ' // SF Solid Fuel Burning Appliances g1— %l I y� I Insulation Telephone Email address D Demolition 5.2 Regt�`tered Home Improvement Contractor(HIC) /0 C cF 04 a)U t�� C Regis(trration Number (EOs iratio Date H�C�Crany N QeK`'�I�l�^Rer nt Name No. d treet A V, �Q Email address l�rl , Vh� 61 170 7J-� f �2 Cit /Town,, St� Telephone SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152. § 25C(6)) Workers Compensation Insurance affidavit must be comp[ 'and submitted with this application. Failure to provide this affidavit will result in the denial of the [ssuance o e building permit. Signed Affidavit Attached? Yes .......... 4Z No....._.... ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owner of the subject property,hereby authorize' � 0 ('��,([. U (AC eS to act on my behalf, in all matters relative to work authorized by this building permit application. At Cr eD )eCS (1, b4_ Print Owner's Name(Electronic Signature) D to SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION 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. Print Owner's or Auth rized Agent's Name(Electron Signature) Dar NOTES: L An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC) Program), will not have access to the arbitration program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.eov/dps 2. When substantial work is planned, provide the information elow: Total floor area(sq. ft.) (including garage, finished basement/attics, decks or porch) Gross living area(sq. ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" '✓ _...iW, A & A SERVICES, INC. A81: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 ENTRY DOOR SPECIFICATION SHEET Buyers)Name Date of Contract Buyers)Street Address,City,State and Zip Code z3 FtL11—vC/ s R0 Stem r-ig 0i970 Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address 978- y2-3- i30& 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 fccompanying CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,of which this Specification Sheet is a part. / t'S)D F- I S 7- ENTRY DOOR Remove and dispose of# existing entry door units. I$'Install new entry doors# _ Manufacturer N2i, F /series_ V117\1rej✓"M-0 Location C S 1 0 E7_ 15 7- q i Type: O Steel ❑Fiberglass wV titling Patio Door ❑French Hinged Patio Door Model# Sidelight(s)# Sidelight(s)type/model# OPTIONS: C c Le-vi- ' Iry 4 , 7c-/{�H-/ 7r- ❑ Adjustable threshold for door. ❑ Grids for patio doors: Style: Prefinished ❑yes ❑no color: interior_ exterior_ ❑ Expand or shrink the size of the opening Details Cover exterior trim with aluminum coil stock: Style/-UVL- W A-0 74� Color r ✓c�f5 Hardware: -AQLocksot ❑Deadbolt VFootbolt ❑Mail Slat ❑Peepsite Detail 3/244-S S Replace interior trim a.:,�o-'-a. Details /.trS i nA31�/ 2 z r Replace exterior trim ae-needed Details //vS mil- NL-zk.• Z E31a- s-K r'rf-C1 C> C�4z(n/(� r� ❑ Install oak strip at floor as needed. Caulk interior and exterior edges. Insulate around new door unit where possible. >10 Painting is not included. Details Included in this proposal are set up and clean up. - STORM DOOR - - ❑ Remove and dispose of# existing storm door(s). ❑ Install new storm doors# Manufacturer /series Style Color Type: ❑Aluminum ❑Solid Core ❑ Location: ❑ Hardware style Color SPECIAL INSTRUCTIONS: /<r� I L_ Pat _ w rP2cGS— 5,170. 1.7 20 / It is agreed and understood by and between the parties that this Specification Sheet,along with the CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,constE tutes 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 its terms modified or varied In any way unless such changes are In writing and signed by both the Buyer s)and the Contractor. euyer(s)hereby acknowledge that Buyers)has read this Specification Sheet. // Contractor Initials: !T4 7 Date:b- -�� Buyer's Initials: X e•At? Dater' 6>k /� AAA /� A & A SERVICES, INC. AAA S CES 115 NORTH STREET, SALEM, MA 01970 • '• Telephone:(978) 741-0424 Fax: (978) 741-2012 Contractor Registration No. 101609 Construction Supervisor No.CS057733 Federal EIN: 04-3090162 CUSTOM REMODELING AND IMPROVEMENT AGREEMENT Bu rs Name pa of Contract ' t Td�4r/ Dye Date on pYt, to - on —((c go, Street Atltlress, Cit State and Zip Code z rrfr rc,os Rif S mr-7 01970 Drandgme Telephone Number Everagarg Telephone Number Mobile Tele hone Number E-Mail Address N r The Buyerls)listed above hereby jointly and severally agree to purchase the goods and/or a services listed on the accompanying ent').and B sheets,in requested with the prices and terms be installed on the front and the reverse DI this agreement and any specification sheets(this"Agreement').and Buyer(s)have requested that such goods orservices be in stalletlreementet the Buyer's)dress addrelistedabove.ve. Services,Inc ('represnts.hereby agrees to Install or cause to be installed the a to pay or services listed in this Agreement at the Buyerls)ed as devariden above.This Agreement represents o cash sale ngoods and services.The Buyer(s) agree to pay in cesM1 the cost of the goods and services purchased as tlescribed herein,regardless of timing or approval of any financing Buyerls)may seek for their purchase. Purchase Price: Est,Starting Date'7�� 7— w Down Payment: 205-0f Est.Completion Date: 7 0 Cash Amount Due on Stan of Job' J97Check Credit Card Amount Due onof Completion: No. Amount Due on of Completion: p Expiration Date'. Balance Due on Upon Completion: �/0 /ss�- 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.Buyerls) hereby acknowledge that Guyette)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.Buyerts)also(I)acknowledge that they were orally informed of their right to cancel this transaction;and(it)request that they be contacted via theirtelephone numbers or email,as listed above,in the event Contractor believes Guyette)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 Se es In/�c+.j�� Buyer(s) /^/ By:— �' K Ci�-y-�C 1—G-4J'z.r-.Z_. Signature Signature ED &V" Signature Cry P��e s Print Name Print Name Signature Print Name You,the Buyerls), 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. ARBnRATION:The wmradorand the nomeormer newly,annually agree in advance that the eve either Perry has a capuw moral this confused either party may whom such dispute to a More ardlrauonserww Anion has been assumed by the seweatt r the Execmrve call of eonsurwr Affairs and answers Regulations and the other parry shall be repaired to submit to such arbhwhon as proved in s:.G.c e.:au. e on Lantmrinr lmnm.;� colu mmah Parr: (—( —/La Dam NOTICE OF CANCELLATION �N�OTDCE OF CANCELLATION Date of TmnsectiM(Q 6_!G.You may cancel Nis bansactian,vnPout any panalry or Date of TransaNanfO—(Q=L 1P' may cancel Nis transaction,without any cenalry or obligation,within three business days Tram Ne above Paw. II you wnwl,any propetly Patled in, obligation,main Free business deyx hum the above date.It you cancel,any p opoMtrabeb in, any payments made by you under the Contact or Sale,and any,egovabla insbumenr e+ tad any payments made by you under the Contract or Sale,and any negorada pronounced borrowed you An be rearmed Mean 10 days formuing recul by He Seller W your canceraton notice, by you will ne reWmed within 10 days felowing receipt by the Seller of your sweatiness notice, and any security interest arising out of the label will be cancelled.If You cancel,you must and any sacunry cal arising how of the transaction Ado be Gnwllad.If you wnwl.you must make evailade to the Seller at your residers,and sob onoally in as good condition as wren make available to the Seller at you resident,,and substantally in as good condition as wren vad,any goods delivered to you unberNrs u ma Contract or Sale,or yoy.it you Aran,moral goods received any gs delivered novae under this Contract or Sale',or you may,H you wish comply Wrh Me watruders of the Seller regading the return shipment W the goads at Me Sellers wine the instructions of the Seller regarding the return shipment of the goods at the Sellers expense and risk.If you do make Me goods avagrate to Me Seller and the Seller tlws net Pay expense and ask.If you do make the golds evaiwble ro the Sellet and the Seller aces nor pick were up wihir 20 data of the data of your Notiw of Castellani you nay reain or disFase of the them up within 20 days of He dew Ol your Notice of Canwllation,you may retain or dismse of goods vnMout any further whatever If you fail to make the goods avaifabw to the Sollar,or if you begoMSWMoutenyuMerougharion.it you fail gainers the god-savailabfe W He Seller on agmetometumthegaWstothesellerand MilrodosaN,n mrwinllaolebrpedomance of you agree he return the goods to we Seller and b it[ado so.then you reaala liabfeNrpedamanw ell obligations under Me Contract,To cant Mis uanwNDn.mail or deliver a signed and dated of all obligations under life Confatt To cancel[his transaction,mail or calwor a signed and dead copy of the cancellation notiw or any oMer Arrive nearby out send a Idle rem,[a A 5�¢rvicea copy of the connotation notice or any other—form n notice, send a trial 115 North Share Salem MA 01970,NOT t Mff THAN MIDNIGHT OF + rp 115 North Street,Been MA 01 970.NOT LATER THAN MIONCHT OF 0s nee ran I HEREBY CANCEL THIS TRANSACTION I HEREBY CANCEL THIS TRANSACTION Consumer's Si,mmum Date: Consumers Signature Date'. Y2 0 Phone: 978-741-0424 ,982.,o12 Fax: 978-741-2012 iLi]l A SERVICE 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. The debris will be disposed at: Waste Management 877-515-2845 c/o Melrose Transfer Station 740 Broadway Melrose, MA 02176 or Waste Management, Dumpster Service at 115 North Street Salem, MA 01970 � U l V' Signature of Permit Applicant Christopher ZorzV, President Name of Permit Applicant 6 4, Date { Massachusetts - Department of Public Safety I Board of Building Regulations and Standards A&A SERVICES, INC Christopher Zorzy 115 North Street License: CS-0 733 a: ' n . Salem, MA 01970 C MSTOPHER7,oRU. Sal IYO 111A A Sal 9�� s em 01919 70� ' SCA 1 u 20M-05111 i D � \ \- Expiration i q%frz onR.iirnvincrrl/�-a�J�Inami�r��o�eL/7 J�.- 05/!6/2017 Office of Consumer Affairs&Business Regulation Commissioner HOME IMPROVEMENT CONTRACTOR Registration a,101609 Type' Expiration 6/261201.8 Private Corporation Y I ASA SERVICES. INC' t jist= - Christopher Zorzy $Ni - 115 North Street Salem,MA 01970 Undersecretary The Commonwealth of Massachusetts Department Of Industrial Accidents Office of investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): p r C Address:--1-t ""E{ 5 — -- City/State/Zip: �Cr lx Phone#2-78—­7 tf Are you an employer?Check the appropriate box: 1.Ly I am a employer with 4. Type of project(required): ❑ I am a general contractor and(- employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I earn a sole proprietor or partner- listed on the attached sheet t 7. [v7Re:Ming ship and have no to These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. [No workers'com insurance 5. 9. ❑Building addition P. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I 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 12. Roof repairs insurance required.]t employees.(No workers' ❑ comp,insurance required.] 13.0 Other •Any applicant that Checks box#t must also fill out the section mew showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside wntreetors must submit a new affidavit indicating such. 'Cmmraetma that cheek this box must attached-additional sheet showing me name of the sub<onra.wns and their workers'comp.policy irtformadon. /am an employer that is providing workers'compensation insurance jot my employees. Below is the policy and job site information. Insurance Company Name:�T_r U U 0--,-Y--5- Policy#or Self-ins,Lic.#: ra- '3D C Expiration Date: -( �—) Job Site Address: l __ C(�S /State/Zip:_Sa,.I�!'y I'1 4-- G Q I �- Attach a copy of the workers'compensation policy declaration page(sh City/State/Zip: CiTythe 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 ofa fine up to$1,500.00 and/or one 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 n er a pains and penalties of perjury that the i.farmadon provided abo a is a and comae[ Si ature: Date: Phone L(. d� Official 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/fown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: