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10 HARDY ST - BUILDING INSPECTION The C'ommomce:dth of Massachusetts t 13oaid of 13utlding Regul:aionS wIJ Slandafd5 Massachusetts State Building Code. 780 CNIR. 7i1' edition VSIf Buildin-_ Permit Application To Construct. Repair. Renovate Or Demolish a R, i,„d law,,,, - - I One-nr Too-Family Dn'c1/1in•K _ �(J�( 'his Section For Otfic/al Use Only ,.(() Building Permit Number: Dat Applied: Siunature: '—:F-`�-- ------- Building C'onunis,iuncr/ Inspc or It13 ill ngs Dale S l F ON 1: SITE INFORMATION I.1 o — v Address' - 1.2 Assessors Map & Parcel Numbers �"� � Uni I fib ---- ZAL I.la Is this an accepted slieet7,yes_ nu_ Map Number P.ocel A'umhcr 1.3 Zoning Information: 1.4 Property Dimensions: Use Area(sy ttI Homage tit( Zoning District Propose) -- _ 1.5 Building Setbacks (ft) From Yard Side Yards Rear Yard ! Required Provided Required Provided Required Pro,Jcd I 1.6 Water Supply: (M.G.L c. 40, §54) 1.7 Flood Zone Information: - LS Sewage Disposal System: Zone: _ Outside Flood Zone' Municipals❑ On site Disposal sysicm ❑ Public ❑ Private❑ Check if yes❑ SECTION 2: PROPERTY OW ERS IPr 2 1 Ow ert t Record: I I IG n MSS n ' r I Name Pr nU . ddress for Service:. 1 q 8- 2-? 3 - (A9 � - Biel ature Telephone SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction ❑ Existing Building ❑ Owner-Occupied ❑ Repaus(s) ❑ Alteration(s) Addi(inn ❑ Demolition - ❑ Accessory Bldg. ❑ Number of Units_ I Other ❑ Specity: Brief Description of Proposed Work': --e V "O I --- SECTION A: ESTIMATED CONSTRUCTION COSTS Estimated Costs: Official Use Only - - Item - (Labor and Materials) _. L Building - $ I. Building Permit Fee: S Indicate how Ice is JciL!i nlned: ❑ Standard City/llnvn Application Fee I 2. Electrical 5 ❑Total Project Cush (Item 6) x multiplier x 3. Plumbing S 2. Other Fees: S 4. Mechanical (HVAC) $ I List — — I 5. Mechanical (Fire 5 Total All Fees: S Sup ressiun) " Check No. Check :\nwunt. (',I'll Am unt ---_- j b. Total Project Cost: 011 3 I �[', ❑ Paid in Full ❑ Outstanding Bal rwe Due-_ I SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor (CSL) 57-73 1 Lccnse Nunlher li>pnalion C:uc_ �u • afc's I ul cr — lJ List CSI. 1A-pc uac h6m t \JJr ro. 1� 1L c Dcsin tWtn I I L t itrC511trICd i u�lu ii.1100 CU V. R Rcsorcicd I.@2 Falllll\ Dt�elhne t) txp u'c \1 \laeirnn (fitly _� L4 I� ` 2u RC [2e>idinlial Roolinu Cote] n¢ 1'elepinme \1'S IL deuu.il \1 .m'HIL11M d Siding SF 12c,vdcmi:d .Snhd Fuel liunmm A th:mer li nl.il l.0 iu D Rcoideuu:d Demolition 5.2 Registere Ifonie Inprovenient Contractor (IIIC) Number Ill , milla ry . 'arne or f ICC Regis( ant Rrelslration al- r g9w -ILII-N2y Fs p 6 2(� 201a Irauun Date 5ienalnre 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. Fadure 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 OR CONTRACTOR APPLIES FOR BUILDING PERMIT • 1J, I, h ffinas Owner of the subject property hereby authorize M r I to act on my behalf, in :dl matters ,relative t wo authorized by this buil permit application. S Iwnat rc of Ot ter Date I n SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION I, l ih r I 7-6 / J � I Z w� . as Owner ur Authorized Agent hereby Jeckne that the statements and information on the fo going application:ue true and accurate, to the best of my knowledge and behalf. � at Pri �9 Si,1 atone f Owner r Authorized Agent Date J (Signed under the 2ains and penaltics of .erlur ') NOTES: I. An Owner who obtains a building permit to do his/her own work. or an owner who hires an unregistered contractor (nut registered in the Home Improvement Contractor (FIIC) Program), will not have access to_the ;ubitration program or guaranty fut}d under M.G.L. c. 112A. Other important information on the HIC Program and Construction Supervisor Licensing(CSL) can be found in 780 C NIR Regulations I IO.R6 and 1 10.10, respectively. '- When substantial work is planned, provide the information below: Total flours area(Sq. Ft.) l includme „aruge, finished hasemenUattics, Jerks or porch? f Gross livim., urea (Sq. Ft.) Habitable room count Number of fireplaces Number of hedroom.s -- —_--- Number of h.uhruums Number of halt/h:uhs --.-- fvpe of heating System Number of decks/ p,it hcs r Type tit Cooling s):stem Enclosed Upon -- 3. "To(al Project Square Footage' may be substituted lot Tolal-Prujeet Cost' 1 { i csa �- CITY OF SALEM PUBLIC PROPRERTY DEPARTMENT \L\.gig 12,",\1',NIli\,,frI\ti;Rhl'I \I - 11d: 9-8-74;.y;'i; F\x: Tg. i_'IS3n Workers' Compensation Insurance Afffd'a\it: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name I flu,un,; I h_ant[anon hWn IduaLl: A F A A,wfC5,:J1� rJnr+h 5f e+ City,StateZip: C-6 1.(fn MA 019-70 Phone #: �ASS) 7,H I - ©H 2)A F n an employer:'Check the •appropriate box: Type of project(required): am a employer with�� 4 ❑ I am a general contractor and 1 6 ❑ New construction mployees(full and/orpart-time).• have hired the sub-contractors 7. ❑ Remodeling am a sole proprietor or partner- listed on the attached sheet. ip and have'no employees rhesesub-contractors have 8. ❑ Demolitionorking for me in any capacity. workers' comp. insurance. q. ❑ Building addition No workers' cum insurance 5. ❑ We are a corporation and its l• P• 10.❑ Electrical repairs or additions required.) officers have exercised their 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, 51(4),and we have no 12.❑ Roof repairs ,{ insurance required.] f employees. [No workers' 13,4 Other w 1 n( oto comp. insurance required.] - - 'Any applicant that checks boa#1 must also lilt out the section below showing their workers'compensation policy information. 'I lumeuwners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $lonraclors that check this box must attached an additional sheet showing the name of the sub-cuntmctors and their workers'comp.policy information. l um an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. �r - Insurance Company Name: Policy #or Self ins. Lic. #: $ 13 Expiration Date: q� a� I I I Q n p, Job Site Address:� U qT L n I J G City/State/Zip:r J p nn m/ I lJ � `10 Attach a copy of the workers' compe sation 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 the up to S 1,500.00 and/or one-year imprisonment.as well:Is civil penalties in the firm of a STOP WORK ORDER and a fine Of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Insestiu,alions of the DIA for insurance co\erage l'er!flfalton. - l do hereby t:rrtif` under line puins and penalties of perjury that the information provided above is true and correct. Phone / 0 L4 1 ' 6 q � -/ 01 ieial u.se only. Do not write in this area, to be completed by city or town officiaL City or #—'----..--_—.---- fsaring Authority (circle one): I. Board of Ilcalth 2. Building Department 3. Cih'irown Clerk 4. Electrical Inspector 5. Plumbing Inspector 6, Other _ Contact Person:----__ -- Phone #:-- Information and Instructions %lasetchuscns General Laws chapter I" regwres;dl cinplu\ers to pro\ide \torkcrs' compensation for their employees. I'tusu.uu n,this scuule. .ut rrupL't'ee is defined as -.. a\ery person III the ser\ice of.mwher under any contract of hire. c\press or implied, oral or t\rinen." \n errrptirrer is defined as "art indi\ du:rl, parmarship..rsxrcIation.corporation or other Icgal entity, or mit two or more of the fivcgoing engaged in a joint enterprise, and including the legal representati\es of a deceased employer,or the recen er or trustee of an individual, partnership, association or other legal entity, enploy ing employees. IIUw'e\er the nu ner of a dwelling house ha\mg nut more than three apartments and a ho resides therein, or the occupant of the ,It%tilling house of;mother who employs persons to do maintenance, construction or repair t\ork on such dwelling house or,III the _rounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." \IGL chapter 152, �s 25C(6)also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate 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, %IGL chapter 152, $25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the periunnance of public %\ork until acceptable e\idence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please till 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 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 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 tilled 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 tic.)said person is NOT required to complete this affidavit. The Office of fm cstigations 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. rile Department's address, telephone and Fax number: The Commonwealth of Massachusetts Department of Industrial Accidents OIIIce of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 www.mass.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, Sec. 150a. The debris will be disposed at Salem Transfer Station owned by Northside Carft Signature of Permit Applicant Date Christopher Zorzy Dame of Permit Applicant A &A Services Inc. Firm game 115 forth Street, Salem MBA 01970 Address, City, State, Zip Code vanguard NFRC Performance . W I ND O W S Specifications A vlew that works101 — — vanguard Our windows are tested and certified to National Fenestration Rating aWM Council(NFRC) standards. Product testing data can be viewed by going to NFRC's web site, www.nfrc.org, and entering the appropriate Certified Product Directory(CPD) number. Double Slider Tilt-In Standard Casement Awning Casement Sliding Hung Slider Picture Picture Door NFRC CPD No. SUW-K-1- SUW-K-2- SUW-K-6- SUW-K-7- SUW-K-4- SUW-K-B- SUW-K-3- SUW-K-5- 00083 00045 00047 00010 00036 00010 00038 00004 Clear Glass µrPM x _ NFRC CPD No. SUW-K-1- SUW-K-8- SUW-K-3- N/A 00086 00048 00050 00012 00040 00012 00040. Sun- Smart Glassram - �$" .. . , m.. .a. . , r3. .. . NFRC CPD No. SUWK-1- SUW K-2- SUW-K-6- SUW-K-7- SUW-K-4- SUWK-8- SUW-K-3 SUW-K-5 00085 00047 00049 00011 00039 00011 00039 00005 Ultra- UVss Glass NFRC CPD No. SUWK-1- SUW-K-2- SUW-K-6- SUW-K-7- SUWK 4 SUW-K-8- SUW-K-3- SUW-K-S 00088 00050 00045 00014 00042 00014 00042 00005 Kr90 Glass a n All performance values are for windows without grids in between the panes of glass. 070507 SSI5-V3 1 (� Massachusetts - Department of Public Safet} 1 Board oi'Buildin Re_•viatiuns and Standards Construction-Sup ervisor License License: CS 57733 Restricted to: 00 - CHRISTOPHER ZORZY 115 NORTH ST - - - - --SALEM,MA 01970 - - _- Expiration: 5/26/2011 i (bnnnk unwr Tr#: 14751 ' _ . .. . . ._ ..... .....�-__�......._ •,_ _ .. .. ommnaouoea✓.Fn ./l!�amaa�wres�r3 ' --- Board o ding Regrrlatlons and Standards ----. .. ..._......... .. .. ... ... . _.._..._ � - tBuii HOME IMPROVEMENT CON TRACTOR Registration: 101609 lug E.:Piratiom 6/25/2010 TrO 267870 S: T' e: Pdvote Corporation =� is •:..='. :. A&A SERVICES,IINC-n x Christopher ZoryiA �ug= 115 North Street Salem,MA 01970 -'- Administrator _ Commonwealth of Massachusetts Division of Occupational Safety 4. Laura M Marlin,Commissioner o Deleader-Contractor CHRISTOPHER ZORZY Eff.Date. 04 M/09 Exp.Date 04/08/10 . . 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I�,.,�pp A&A SERVICES, INC. W SERVM 115 NORTH STREET,SALEM,MA 01970 Telephone:(978)741-0424 Fax:(978)741-2012 Comeador Registration No.101" Federal EIN:04-3090162 Canstrupeon SUPOM.No.CSO5nW WINDOWS AND STORM PRODUCT SPECIFICATION 51WU &rryda Neme Oele of Cpdncl n 11PIS4!nA MAnn 7n Smatkunne,C' ,slm ed zp CMs �-iQy S4. S 3rd FL Dayffin.T.b N...r Ewnim Tebnpae Nw Monte TNe eNumler EMMabdnes Q1$—a73 3 c4rts}ca-w,_Iarin�msv. M TM euwdnl laceea,+o lwmb/IemM eiM eevwery-.sm.m lRRvwwweo,ae aiwtr®row.sRaelmw.mewwmnoe wmwpwn pow wmw aznlwe ' IF4 BpadlFaem•hw ana tlx M1OM mtl ew heaves d nm evap•mpa aV51eM RENOCEIINa NM1p W VMVEMQIn RGflEEMEM.'dMM Ph aps:lAulk 8lpelherye WINDOW REPLACEMENT y�^� ab alspdaedf 'kn Cd2 eMsgn�wintowa. e�nslall f i-41 C4a new_' EvW e VAnywtrd waWoxs: We ny4 ❑WOW (alaradanurerf Opsone:S)b j� 1>1�a�wVQ GM pane. N o q f-d.S CMor lMcdor la)l.:i'� CglOr Eaterbr Wlxi�GI.Type Jklifit .o jarepe ienw tmn wnn alwrdnum: SMe Won Ube Lr'�VlwlMovrs win be Imlened ecmtdNq to th InatallMbn ptaeaures In Na pomono. $,+ E f/�RUIle m Modor and.honor M,as. pf esQS N'/I .ram wbene possible erouM new uMls. T Inculata wbgvx weigh peWeb If Mun,eM,round new wrtlow unts etmm poeamb. d In his proposal are set up,dsn up,Hem wpoum amd deanI g wlndowp Insure ant our. A eanalrg vermnllldudad. ... BAY/BOWS/CASEMENT UNI ZANY FUU MMSTRUCDON WINWM . 0 Cmate n.v vdMow operang by rating through totaling home ant!haming In oFedng. 0 Remove and dapwe o1 etleang unit.)In he eMt.W.. We:Eleaufc and plumbing may exW In wag and Mn mcOuha odd'Nonal posts to evub suer 8 neod to be Beall with. O Mall_wagpw(e)"a cpenirg(e). Nab:It Say Or Box natallatbn 0Intel,pobte suppmt awtem,new mot syawn(mamng min s aloe,at poslble) or 9.aunt IOU,ml8t system. ❑ Bey Wane O Casement 000er wlmWow(s)M include new bbarbr style idm anal haw eMarbr styN ben ant Meal nadAng as needed. o Nam: Palatm and Wainin,rathclutlatl. STORM PRODUCTS O_ Remwe ant dispose oft eeiadrg slmm window(,). ❑ Installnwslmm wlndowe J Manuladuner Style_ Color Option O Remwe ant dlapme of f aMfing sbwm dome. O bstall new aba"doom J Manufacturer style_ COW Type: ❑Aluminum OSlid Con SPECIAL INSTRUCTIONS: 7Ax Cred.+ k�ifri4 to b�A, e b•pM•N mM•Iro,pr�e.u..nwpR4•pLLPA Bpaalllvlkn Blv(•rmp non Ca9iW Rd0aPlwa•M,aPRwEadl•fAEFYEM.mnIWY• wemY w..IwMw In.mn eul,...anwi Ite.auen.) rv.�LLu.e.Remaexm•a uwMO•epw 1,.0 hs.neae,we..nwenawe.,w�I®.Rnwwe•nw.Nepew Wrce Mo,mwwvwl•)aewhew.,...eWa•1�.ww..baa.era 4 M•wbeus 6p•tlMtlbn 6lvt ` v COenedur.dial.: SL DOW 4/ie�o - Buyers Nivals: ! `�\\ .DMe