12 GROVE ST - BUILDING INSPECTION 'l - 183Z `-e-- ' Z33 �{ Z
The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code, 780 CMR SALEM
Revised Mar 2011
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One- or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date Ap
// A-
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Zroperty Address: 1.2 Assessors Map& Parcel Numbers
-, _ l � GtroVg Sfi
L l a 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 ft) Frontage(In
I 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:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner of Record:
M `P ti n e I 'Z, Nl14 6 (9-7 O
Name(Print) City,State,ZIP
i a 5f ss, - - VWto
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s)-Wrl Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify:
Brief D/escriptionofProposed Work 2: (1t,S1--C l/ ((a ) 5, X V V/ replckc¢v��
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials)
I. Building $ 6 g S� i 1. Building Permit Fee: $ Indicate how fee is determined:
❑ Standard City/Town Application Fee
2. Electrical $
❑Total Project Cost (Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fees:$
Check No. Check Amount: Cash Amount:
6. Total Project Cost: $
S � �• 13Paid in Full ❑ Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License (CSL)
G_S l:z
LIA r, s 2 License Number Expiration Date
Name of CSL Holder r
List CSL Type(see below) U
No. and Street Type Description
l c(.-�� U Unrestricted(Buildings u to 35,000 cu. ft.)
tty/Town, State,ZIP rl R Restricted 1&2 FamilyDwellin
M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
10t (009 lQ-2-C� -
- E" 6�-"Szi��t C-�-S �/t G ' HIC Registration Number Exp n D�iratio ate
HIC Compay Name or HIC Registrant Name
!/ S m0 ✓1h. si-
No nd Street.dal Mgt C) C) G_Jg _Jq(_V,2-
Email address
City/Town, State,ZIP 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 .......... t31 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 Gt y r S 2 p f2
to act on my behalf, in all matters relative to work authorized by this building pe it application.
L0 V-J -o c�
Print Owner's Name(Electronic Signature) Date
SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION
By etMring my name below, I hereby attest under the pains and penalties of perjury that all of the information
coot ' d this application is true and accurate to the best of my knowledge and understanding.
Print Owner's or Authorized gent's Name(Electronic Signature) Date
NOTES:
1. 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 tinder 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/des
2. When substantial work is planned,provide the information below:
Total floor area(sq. ft.) (including garage, finished basemenUattics, decks or porch)
Gross living area(sq. R) 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'
PCL
A & A SERVICES, INC.
A&A S� 115 NORTH STREET, SALEM, MA 01970
Illigim '• 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 er s Name Date of Contract
MlCHWL- l.AwRENGB tM/cH✓�EL �fn,D� L // —/7—ly
Bu r s Street Atldmis ,Ci State and Zi Code
/Z 7QOvGr $T ri"" Mfg O1970
Da ime Telephone Number Evening Telephone Number Mobile Tale hone Number E-Mail Address
$57-22Z-y386 Mrs u9w¢c7lvca ae rdgfL,cwv)
The Buyer(s)listed above hereby jointly and severally agree to purchase the goods andha services listed on the accompanying specMcatlon sheets,in accordance
with the prices and terms described on the front and the reverse of Has agreement and any specification sheets Ithis'Agreement"),and Buyers)have requested
that such goods or services be installed or provided at Buyer's address listed above.ASA Services.Inc.("Contractor),hereby agrees to install or cause to be installed
the products or services listed in Mis Agreement at the Buyer(a)address written above.This Agreement represents a cash sale of goods and services.The Buyers)
agree to pay in cash the cost of the goods and services purchased as described herein,regardless of timing or approval of any financing Buyer(s)may seek for their
purchase.
S�SB Purchase Pricedr-
; r Est.Stading Date:IZ-/J I^ If
p
Down Payment: / /5 r Est Completion Date:I"zd /
Cash
Amount Due an Start of Job: ;{Check
Credit Card
Amount Due on of Completion: No
Amount Due on_of Completion: Expiration Date'
Balance Due on Upon Completion: 3qi CVC Code'
N is agreed and understood by and between the parties that Nis Agreement, front and back and any addendum, constitute the entire
understanding between the patties, and there are no verbal understandingschanging or modifying any of the terms of this Agreement.Buyers)
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 data Rest written above.Buyer(s)also(1)acknowledge that they were easily
informed of their right to cancel this bansaction;and(11)request that they be contacted via their telephone numbers cr email,as listed above,in the event
Contractor believes Buyer(s)would be interested in any addit oral quality products or services of Contractor. DO NOT SIGN THIS CONTRACT IF IT
CONTAINS ANY BLANK SPACES.
A&A Se i s,Inc. Buyer(s) Q
By: X• Y V��
Signature
Signature
Print Name X MtC4h9Z Ztff`/l7 elL
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.
ARBITRATION.The contracWantl Me hornessa er hereby mutually agent in advance that in Me event sister pal has a discuss berthing this rnntrac,titer so,may submit sure Me,.ba
g n hats areidvive dace...has been eppavea by to Seaelaryae Me Easculite OKm of Consumeralters'a^nd-Business Regulatlws and to..or par daft ft ba adei ed c nude,as sudl
softhearted as proved In M.G.L c.102A, I,� YYY L
Comrs IFY Jmoriahms: aurcJ,lnilub oa /
th:_//—/'I—/N Date: x ,TIr^( 2111 y
HOMES OF CANCELLATHDIN NOTICE OF CANCELLATION
Data atTranss 'I /csm/ --r'/Y,You may-moth Nis transistor,valhoul any PonaM or Date of Tren9Bcdon ^1 You may tinsel this transaction,without any parsley er
141igetion,niNin laree turrets days M1om to a[ava date.Iryouranslenyprepar Vaasa in, wligason,wtjntreebuMi ssdeyshom Meawyeaale.llyouwncel,any propertraded in.
any peynenb made by you under Me contractor Sale,and any negosatio i tedummt eaeal� any werear s made by you under to contract or Stile,and any read able In eunem Associate you will se rem H sued t address,10 days ,recap,by to Seller of your cancellason thew
, by yen Ball ere stores Main le Move fullmvllg repipt by Me Seder of your cancedauon above,and any aewnry interey adding out of the transactor win be candled.It you pnul,ynu must am any sewmry imeres arising put of the Iremacden MII do Cancelletl,if you caned,you Must
Ireke avalmae to Me seller at your residents,and wbslansany in as good mndldnn as when ivke available to to Serer at your residence,and substanowly in Me good wndidon as when
ardered.any goosed daivated to you under this Covered or sale:or you near.'ifyou shah,deal red d,mygaadzaalieare toruumerthis Cantmaor Sa§,arrow mar.it yen avian,®teq
sIN ad losnaideft m ad seller rappers the return abandon v1 to goody at to edger a sold to transient m me Sager reca ring the mum shipment of to goods at the Senera
everse and disk.a out do make to goody available to the Seller and Me saner does not pia expense and not.If you der make the goods avadalae to Ire Son«am the Seller mda rat pia
Main up was 20data of data of your Noted ofcarsdadon,yen may rated or discuss of Me them ut
goedesnNowary wnherategaban.dyou 1en N max¢Me gaodsat-aimme to Ne saner n psWinze earsertodaleaI yourwou House ofCandescent,aln goosamaylelam or SdiscussIMat
w you the agree as see anyluMke to Me Salarlywfaillooaketn gwdsevyladebte 5elle[nce
agree loreNm de note Me Curproot to Me gravitated(I Metao do zo.laen you reor deliver larpedomanmof you agree bresu to Me Conduct.
To erase laiis deed,Man You or repair
alledif Meevredtttt".amI.ny cancelntis.read9on mail or tltlivera stance and daletl of all obligations under Me Lantrad.To coneN Mis transacdoo,mailer deliwrevgnM and dabtl
ropy al to canmNsan norm w any older wtidan nonce,or tend a lelegam 1 A8A SeIi's do of cane toe ellaeon period or any other vmllen noses,or send a Widened to ABA services,North Sveel,BSIem MA 01970.NOT LATER THAN MIDNIGNT OF fl5M.Saee,seem MA 01970,NOT tATERTHAN MIDNIGHT OF I,�-Ly
throw as
I HEREBY CANCEL THIS TRANSACTION I HEREBY CANCEL THIS TRANSACTION
Consumer a&,,A.. Dale: Consumers Signature Dale:
A & A SERVICES, INC.
AI&A SERVICES TelepoOR(NORTH
24 Fa: 978M747 20012
Contractor Registration No. 101609
Federal EIN:04-3090162 Construction Supervisor No. GS057733
WINDOWS AND STORM PRODUCT SPECIFICATION SHEET
Buyers)Name Date of Contract
Ni/C�/9 E'L LAtvvrQ�7v�e�,+-/'�fyClfyrcZ �/,vO E'L i_ i/-/7-/y
Buyer(s)Street Address,City,State and Zip Code
/ Z Rcvts -9'7- S'FJZrlh" M9 0/570
Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address
8s7- Zz2-C13 S 6
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 reversed the accompanying CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,of which this Specification
Sheet is a part.
WINDOW REPLACEMENT
® Remove and dispose of# (0 existin windows.
/ �sstwt.;/AgG.S 2'"' s/"::Pik
O Install # cis new �.�i .�:� ?/��.n r windows:®Vinyl T Wood
.Z D k (Manufacturer)
Options: Style y 14oP,0&rZ— Grid pattern Nc771/67 ,✓�
Color Interior -LV//77 Color Exterior oIM 77s- Glass Type QaV�(e"o/�V�GOpV`�
Wrap exterior trim with aluminum: Style L— /J G/y!> Color w'
T All windows will be installed according to the installation procedures in the portfolio. 4aL ns S'I CT 4 L$S:S
Caulk all interior and exterior edges.
® Insulate where possible around new units.
Insulate window weight pockets if exist,and around new window units where possible.
f Included in this proposal are set up,clean up, Hepa vacuum and cleaning windows inside and out.
f Building permit included.
BAY/BOWS/CASEMENT UNITS/ANY FULL CONSTRUCTION WINDOWS
If Create new window opening by cutting through existing home and framing in opening.
T Remove and dispose of existing unit(s)in its entirety.
Note:Electric and plumbing may exist in wall and will require additional costs to customer if need to be dealt with.
f Install window(s)into opening(s).
Note: If Bay or Bow installation to include cable support system,new roof system(matching color as close as possible)
or tie into existing soffit system.
It Bay f Bow f Casement f Other window(s)to include new interior style trim and new exterior style trim and head
flashing as needed.
Note: Painting and staining not included.
STORM PRODUCTS
f Remove and dispose of# existing storm window(s).
f Install new storm windows# Manufacturer
Style Color Option
f Remove and dispose of# existing storm door(s).
t Install new storm doors# Manufacturer
Style Color Type: If Aluminum - If Solid Core
SPECIAL INSTRUCTIONS: /1VS7YhL Ales.%- //v7WM/`- *Vn E5lc7fr12/9K--
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It Is agreed and understood by and between the parties met 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 its
terms modified or varied in any way unless such changes are in writing and signed by both the Buyedi f and the Contractor. Buyers)hereby acknowledge that Buyers)
has read this Specification Sheet. tr�A
Contractor Initials: yVc-� Date: P—/7—/y Buyer's lnitialsk 'r`2 Date: I (l lei o�
The Commonwealth of Massachusetts
l a, Department of Industrial Accidents
tit " Ofl1C001invest1g860OS
600 Washington Street, 7 f Floor
Boston,Mass. 02111
E.r 5
Workers' Compensation Insurance Affidavit Building/Plumbing/Electrical Contractors
Applicant information: Please PRINT legibly
name: _CAr —1-0a t,- �Zo'rzf
address 1 t MO t' t N s-f/2{4
City '0 (-e m state MA zip: 01970 phone#
work site location(fill address) ✓B �'� S�r A( 'Q ivl M6 0072)
❑ I am a homeowner performing all work myself. Project Type: ❑ New Construction ❑Remodel
❑ 1 am a sole proprietor and have no one working in any capacity. ❑ Building Addition
I am an employer providing
�workers' compensationg for my employees working on thisjob.
name:
company nam 't- .��1 Q f V I �-S P A C
address I gSO fV0 ✓�n4 �l S+- (]�7 p `L + , �7
city' SQ. i-re-,�fi+��'. MA- phone#: -! 79- 7A 7 IQ'` Q d-�
insurance co I s-vX„ 7-;-c, ✓R '-e - '.S policy# 0,;t 3 &1 V 1 5
❑ I am a sole proprietor, general contractor,or homeowner(circle one) and have hired the contractors listed below who have
the following workers' compensation polices:
company name'
address:
city phone#:
insurance ca. policy#
company name:
address:
city phone#:
insurance co poliev#
Attach additional sheet if necessary
Failure to secure coverage as required under Section 25A of NIGt. 152 can lead to the imposition oferiminal penalties of a fine up to S1,500.00 and/or
one,years' imprisonment its well as civil penalties in the form ofa STOP WORK ORDER and it fine of$100.00 a day against me 1 understand that it
copy of this statement may be forwarded to the ice of Investigations of the DIA for coverage verification. _
I rto hereby certify uur 1h pains and p unites of perjury that the information provided above is true and correct.
Signal a Date
Print name ✓% To2 / Phone# 7 O -7 1 o 7�
official use only do not write in this area to be completed by city or town official
city or town: permit/license# ❑Building Department
❑Licensing Board
❑check if immediate response is required ❑Selecnnen's Office
❑Health Department
contact person: phone H; ❑Other
(revised Sept 2003)
O0 DEBRIS
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Control No: 33262
THE COMMONWEALTH OF MASSACHUSETTS
DEPARTMENT OF LABOR
DIVISION OF OCCUPATIONAL SAFETY
19 STANIFORD STREET, BOSTON,MASSACHUSETTS 02114
LEAD-SAFE RENOVATION CONTRACTOR LICENSING WAIVER
A & A Services, Inc.
115 North Street
Salem, MA 01970
WAIVER: LW 000318 EXPIRES: February 12, 2015
IN ACCORDANCE WITH M.G.L. C. 111, § 197(B)(b) AND,454 CMR 22.03(3)(b),
THIS LEAD-SAFE RENOVATION CONTRACTOR LICENSING WAIVER IS
ISSUED BY THE DIV. OF OCCUPATIONAL SAFETY TO THE CONTRACTOR
ABOVE FOR THE PURPOSE OF PERFORMING LEAD-SAFE RENOVATION
WORK.
THIS LEAD-SAFE RENOVATION CONTRACTOR LICENSING WAIVER MUST
BE MAINTAINED BY THE CONTRACTOR IN ACCORDANCE WITH M.G.L. C.
111, § 197B(b) AND 454 CMR 22.04 WHEN PERFORMING LEAD-SAFE
RENOVATION WORK.
HEATHER E. ROWE,ACTING COMMISSIONER
Massachusetts - Department of Public Safety17 f-
x:
Board of Building Regulations and Standard � Advanced Trainin'b
Construction Super,isj.;r P gram-
Ina
• . __ . ...
License: CS-057733
Pber Cement Siding
CHRISTOPIIER ZORZY
115 NORTH ST a _
Salem MA 01970 Christopher Zorzy n 20120426000640
- A&A Services Inc Exp 4262017
'� " 115 North St
Jam• � , ' " `� =xpiration. Salem, MA 01970
Commissioner
OS/26/2015 Matthew J Gibson r
rrawr camma�c .
Administered by Data Works International,Inc. +
Office of Consumer Affitirs& Business Regulation
ACME
OME IMPROVEMENT CONTRACTOR
m-:�-_Registration: 101609 Type: °
t. Z= Expiration: 6/26/2016 Private Corporatic
A&A SERVICES, INC
Christopher Zorzy
115 North Street
< _
Salem, MA 01970
Undersecretary '
Phone: 978-741-0424
AL7 A S� 30 www Fax: 9 -2012
J .a-aservices.vices.com
115 North Street
Salem, MA 01970
November 20, 2014
City of Salem
Building Dept.
120 Washington Street
Salem, MA 01970
To Whom It May Concern:
Enclosed please find the permit,appl tion for Michael Zindell, 12 Grove Street,
Salem, MA to replace basement windows. I /�
I have enclosed a check for$42.00 based on your fee sched�ule of$7.00 per
$1,000.00. The total for the jobfwas $5,858.00!
Please send the completed permit to A�& A Services, Inc. at 115.North Street,
Salem, MA 01970. 1-
If you have any questions, please contact me at (978) 741-0424.
Thank you f r yourr,assistance.
Sincerely, /
Barbara Z rzy
Office Manager