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22A HARRISON RD - BUILDING INSPECTION Jr, The Commonwealth of Massachusetts 1, o Board of Building Regulations and Standards CITY OF t'(4 Massachusetts State Building Code, 780 CMR SALEM dMar 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 Applie . L Building Official(Print Name) Signature i Dale _ SECTION 1: SITE INFORMATI N _ .1 Property Address: 1.2 Assessors 1 ap& Pal/5'eP64,umbers Llla Is this an accepted street?yes _ no ._ Map Nwnber - —Parcel Number J 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq R) Frontage(11) 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 OWNERSIIIP' 2.1 wner'of Record, _04A- o (170 ------- Name(Print) City,Statc,ZIP o.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) arl Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Spccity: Brief Description of Proposed Work: SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials I. Building $ � D , (p 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: $ _ 6. Total Project Cost: $ Check No.____Check Amount: Cash Amount: ❑�(,� g'� Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 0 57-7 3 3 rt SC G-t�Y2 License Number Expiration Date Name of CS Holder 11,5 No/ - Lis[CSL Type(see below) li{ No.and Street �t t'� Type Description !q 7d U Unrestricted(Buildings u to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling Cityfrown,State,ZIP M Masonry RC Roofing Covering WS Window and Siding p SF Solid Fuel Burning Appliances I -7q(-6q a-y I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) &-I-A-�un v, I"LL S Inc . 1016209 Co l HIC Registration Number Expiration Dale HIC Company Name or HIC Registrant Name 11�, I�lo✓ 'N� S4 No. nd Street Email address l e.v� `1 Ib 97� ?4�-�`fa(7 Ci /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 .......... C'f No...........❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize Cikr 2-0 r to act on my behalf, in all matters relative to work authorized by this building ermit application. See a{-1 C I--e_d C6 K'Ho c 1901 �3 Print Owner's Name(Electronic Signature) Date SECTION 7b: OWNERI 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 Authorized Agent's Name(Electronic Signature) Dale 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 under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.¢ov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dos 2. When substantial work is planned,provide the information below: 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" /�,� /� Cp "�`'%' A & A SERVICES, INC. A&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 ROOFING SPECIFICATION SHEET Buyer(s)Name Date of Contract f'v1U2r4Tt6fTLI,I F Buyer(s)Street Address,City,State and Zip Code - 7-4 4/SOAJ .4D r91 &)t1 vhi9 01970 Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address 97S-8zS--9138 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 part. ROOFING SPECIFICATION Strip Roof of# 1i layers of shingles $ nstall fAlwFice and water shield a4.6ski eef roof where nstall 15.b felt paper to roof. , pPp��pesilals le stall 1R Onn of:AR And vv;tAr .,, �_ J t VriFlash chimney as-Mes9ecl.(no repointing included). `Y� If Install 6"perimeter drip edge to rakes and fascia areas nstall vent pipe boots and seal as needed. lash valleys as needed Install rollout type ridge vent. t lanks/plywood replacement under 32 SO FT included, more is needed there will be an extra charge of$W per hour for labor plus the cost of materials. Dumps t isposal Included: $Other: CO-Lar I Wb l7 lNtrir(, Location: /L Install new roof: Manufacturer Cen_7q//J 7ZW-0 3O yr Stylekype�cyar%LZ'Tu7L/¢L Included in this proposal are thorough cleanup,building permit,and company/manufacturer warranties. RUBBER ROOFING SPECIFICATION Strip Roof Not Strip Roof nstall 1/2"High Density Fiberboard to existing roof using Flash obstacles as needed. screws and plates. 3 x t v Install.060 membrane EPDM(Black)rubber roofing to nstall gft9 aluminum drip edge to perimeter of roof with ffiib�erboard.s seam tape. Rc Flash up sidewall as needed. ncluded in this proposal are thorough cleanup, building permit,and company/manufacturer warranties. /6 `7/e SPECIAL INSTRUCTIONS: ° JC�v�LGI/Lr-r- P[SPYJSt� 07= �(S7uC, B�br1 v�'YL HA/N> l�cw ov , %6*U S 719-Li_ /V ee y U 3 Z Ct rlvc, �Vfi;nv C7 c-Z7iti2 S'tt S 7" GAJ / LE1G eZ t e-3C-- /s � live-z-vo ea lU e 3 x y 601,V v tyov rS' f G�6�ws It is agreed and understood by and between the parties that this Speciacetion Shell,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 Buyers)and the Contractor. Buyer(a)hereby acknowledge that Buyer(s) has read this Specification Sheet Contractor Initials: V ✓ Date: 2—2 1— )3 Buyer's Initials: K' Date:x 3 z t t3 Added . A & A SERVICES, INC. A&A SERVICES 115 NORTH STREET,SALEM,MA 01970 plitilksle b 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 iMvn r 47--il LIKA Buyers)Street Address,City,State and Zip Gods 2A I�gRR)5�7�1 20 SH-�e� �� or97D Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address: 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 intellect 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 Buyer(s)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 orapproval of any financing Buyers)may seek for their purchase. Purchase Pric �SO Toe/u'�YL.`-�8� te-i�`3 Est.Starting Da1 y-/S Down Paymelcoo. ��/���/ Est.Completion Date: /{'IS-� ,^ _, (•/ 9��� Cash Amount Due on Stan of Job: t'�p pGT1"V' Q01�7-'Y1— f'1 G� >CiGlficyck O Credit Card li Amount due on of Completion: No. Amount Due on of Completion: / Expiration Date: - Balance Due on Upon Completion 4 CVC Code: III 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 react 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 fit)request that they be contacted via their telephone numbers or e-mail,as listed above, in the event Contractor believes Buyer(s)would be interested in any additional quality products or services of Co b ctor. DO NOT SIGN THIS CONTRACT IF IT CONTAINS ANY BLANK SPACES. A&A Services,Inc. �/ Xyel 7� BY I Signature Signature t�oL3Un-CAE X /Vi lei L.lsc�-{-- li Print Name riot Name Signature x 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 Tee Contractor and the homeowner hereby Wrily agree In advance that In me event ellher party has a dispute exncemingthis contraq elver party may Submit Such disputeto e private erdi elan rvi sece whichve led been crowd by are Secmtmy of in live Office s of Consumer Affair d Business negulations and tire other party snail be required to submit to such arbitration as proved In M.aL CA 42A. � � AQ.f.. Ccabubr Wlhtr. Buyrrieritlntss Data 9 OTCE nF EtANCE IATON NnT[E OF CANCELLATION Date of Transaction 4 Z I'13.You may Cancel Coro transectlon,without any penalty or Date of Tmaseceon 2.21-13 .You may Cancel this rcarlsacupn.wlmout any penally er obligaaoawiNlnmreebuslnessdayefmm Oo above date lfyoa cancel,any propem traded in, obligation.xrm:n three bltsineaccid from Naebovacese.lfyoucancel,mypropenyvededin, any payments made by you under the contract or Sale,and any negoredle instrument executed any payments made by You under Me Compact or Sale,"any negotiable momentum exuded by you will be return M whin 10 days bllowing receipt by the Seller of Your Cancellation notice. by You will be rearmed within 10 days follwing receipt by the Seller M Your cance11e0on nor do and any security Interest come out of Me transaction will be cancelled II you Cancel.You must and any Security Interest arising orb of are mainsatlbn will be parcelled If you carrel,You must Make available bare Seller at your residelw,In sub M4aly as good CoMltion an also,racerveQ hake ovaleNe to to deliver Your resMarao,In substarltiely asgeW condition was when received, any goods delivered b you under Nis Content or Sale;or you may,if you wish,comply who the any goods dowered to you under this Comma or Sale;or you may,N you wish,Crimpy with the instructions of Me Seller regarbing the rearm shipment of Me goods at the Sellers expense and Instructions N the Seller regarding are rearm shipment of the goods at the Sellers expense and risk II you do melee the goods available to the Seller and Me Seller does not pick them up use. It you do make Me goods available b the Seller and to Seller does not pick them up within 20 days of the data of your Notice of Canmllalioq You may retain or deprave of the go Ws wINin 20 days of the date 0t your Noce of Cancellation,You may retain or dispose of the goods wtivid any further obligation,If you fail ro make Megcad,available b the Seller or if you agree without any furtherobllgefon. If you fail to make Me goods available to the Seller.or it you agree b return Me goods to to Seller and fail to do so.Men you remain liable for pedormence of all t0 return to goods to to Seller and tail to do so,then You remain Ilabla for p arximanm of all obligations under the Contract To Cancel this transac4on.mall or deliver a signed and tlatetl body obligations under Me Conaact To parcel the SmwaMlloq mail or deliver a signed and dated copy 0f the Cancellation notes or any parer wnHen reliCa,or Send a telegram,t0 AAA Beri IIS M Me cancellation notice or any Met written notice,or send a telegram,to A&A Barrels.I1B North Street,Salem Massachusetts 01970,NOT LATER THAN MIDNIGHT Or? North Street,Salem,Massechueerls 01970,NOT LIIER THAN MIDNIGHT 012 (Date) (Oat.) i I HEREBY CANCEL THIS TRANSACTION. Consumer's SignaWre Date I HEREBY CANCEL THIS TRANa4CTION. Coneximereagnaure Date ���p,C� �.�j c �� ���//����- ��v�� (p �< � P� i � � '..: ',. :. .� .. f .. �'� .