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72-74 HATHORNE ST - BUILDING INSPECTION � The Commonwealth of Massachus�e���s RECEIVED' elTv of ° Board of Building Regulations and StaffdWCTIONAL SER IC,ES'SALEM Massachusetts State Building Code, 780 CMR 1 Reoised Mar 20// 5 Building Permit Application To Construct, Repair, RemllkMbAe lipao s One-or Two-Family Dwelling b This Section For Official se Only Building Permit Number: I Date plied: Building Official(Print Name) Signature 'Date ate SECTION 1:SITE INFORMATION 1.1 Property A/ddss: 1.2 Assessors Map&Parcel Numbers 7a-3 iTaRVV,neC 4{-. 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(ft) 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 yes[] SECTION 2: PROPERTY OWNERSHIP' 2.1 Owne I of Record: 5�o ul .07- .- 0 /9f 7 D Name(Print) City,State,ZIP - 12 gahoe„u S+ . G?S-•t`fl-a 3OI(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) d Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units I Other ❑ Specify: Brief Description of Proposed Work: (/ !n)ff doLkhLec.ev� SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1.Building $ g�!� 1. Building Permit Fee: $ Indicate how fee is determined: ❑Standard City/Town Application Fee 2.Electrical $ ❑Total Project Costa(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: $ 01-0 ❑Paid in Full ❑Outstanding Balance Due: l0 T ) la V� SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) rt-S- LUY-Z- License umber Expiration Date Name of CSL Holder � ' /� �4✓ 51-• List CSL Type(see below) No.and Street _1 Type Description S Q te m MI�F G , p 70 U Unrestricted(Buildin s u to 35,000 cu.ft. I R Restricted 1&2 Famil Dwelling City/Town,State,ZIP M Mason ry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I O 7l 1 1 a-y I Insulation Telephone Email address D Demolition 5.2 Registered-Home Improvement Contractor(HIC) LQ)(p_0 ) � � r}- ✓y f us /RL• HIC Registration Number Expiration Date kll�=''nor Erik Registrant Name No.�ttd Street S . Email address tiokLew, M6- 0r1r5- q78-7W,0`1a4 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 .......... 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 ( -A✓'e S 2Di ZJ to act on my behalf,in all matters relative to work authorized by this building ermit application. S e2_ c0,A -h--at,4- iii- a -l`f Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER' OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contain ' thi applica �true and accurate to the best of my knowledge and understanding. e - q I `t Print Owner's or Authorized Agent'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 under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass. oe v/oca Information on the Construction Supervisor License can be found at www.mass.eov/dps 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" Aidi 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.CS067733 WINDOWS AND STORM PRODUCT SPECIFICATION SHEET Buyer(s)Name Date of Contract sc — Wil S-ZS -1,f Buyers)Street Address,City,State and Zip Code -7Z HA7vokli 57 Mq 0,ri Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address 57B 235- i9rD 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. WINDOW REPLACEMENT Remove and dispose of# existing wJ'�dows. Install # 2-CO new _S(//U/L/S�/Vt/(t 970`112-0 windows: tOinyl t Wood I� 1 (Malufacturer) Options: Style D('} Grid pattern Color Interior In/H 1'71 Color Exterior (vU 14 t i z7— Glass Type Q9� La,,F Wrap exterior trim with aluminum: Style Color 1f Ze,,ft,lr,�j All windows will be installed according to the installation procedures in the portfolio. V0 Caulk all interior and exterior edges. Insulate where possible around new units. 9t t Insulate window weight pockets if exist,and around new window units where possible. Included in this proposal are set up,clean up,Heps vacuum and cleaning windows inside and out. 0 Building permit included. BAY/BOWS/CASEMENT UNITS/ANY FULL CONSTRUCTION WINDOWS t 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. t Install windows)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. t Bay If Bow t Casement t Other window(s)to include new interior style trim and new exterior style trim and head flashing as needed. �t Note: Painting and staining not included. STORM PRODUCTS t Remove and dispose of# existing storm window(s). t Install new storm windows# Manufacturer Style Color Option If Remove and dispose of# existing storm door(s). t Install new storm doors# Manufacturer Style Color Type: t Aluminum It Solid Core SPECIAL INSTRUCTIONS: /NcLvoi is )5Zz-S -7W-,0 sAsNi 0,,1/ /s7_F-Cvsz 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 partles,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.Buyers)hereby acknowledge that Buys a) has read this Specification Sheet. � Contractor Initials: a ✓ Date:`� 1 Buyer's Initials:k'V)W./l(/ Date: /�,, � 30 A & A SERVICES, INC. A&A SER ICES 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 e s Name Date of contract FS-2S- ! Bu e s Street Address.City.State and ZipCode 7z 4AT210pelikiii s 1-0`i M4 O&- 7o logairtime Telephone Number Evenin Tonle hone Number Mobile Telephone Number E-Mail Address 9- 7Y/-3o!(0 -L'3S- 9�0 lMsn% o y �2.5 vim, The Buyer(s)listed above hereby jointly and severally agree to purchase the goods and/or services listed on the accompanying specification sheets,in acco�nC� with the prices and terns described on the front and the reverse of this agreement and any specification sheets a lud'Agreement'),and Buyers)have requested that such goods or services be installed or provided atat Buyer's address listed above.A&A Services,Inc.('Contractor"),hereby agrees to install or Cause to be installed the pmdugs or services listed in this Agreement at the Buyers)address written above.This Agreement represents a cash sale of goods and services.The Buyers) agree to pay in cash the Cast of the goods and services purchased as described herein,regardless of timing or approval of any financing Buyers)may seek for their purchase, o Purchase Price: (�SI,18r Est.Starting Date:�O s/� Down Payment 7 "IO. rEst.Completion Date: Es +('Cash Amount Due on Star of Job: Check �C C/0 i Pi Credit Card Amount Due on v of Completion. t No. Amount Due on of Completion'T—p Expiration Date: Balance Due on Upon Completion: in 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 them are no verbal understandings changing or modifying any of the terms of this Agreement.Buyers) hereby acknowledge that Buyer(s)has read the front and rue reverse of this agreement and has received a completed,signed and dated copy of this Agreement,including the We attached Notice of Cancellation forms,on the date first written above.Beyer(s)also it 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 email,as listed above,in the event Contractor believes Buyer(s)would be interested in any additional quality products or services of Contactor.DO NOT SIGN THIS CONTRACT IF IT CONTAINS ANY BLANK SPACES, A&A Se rv' InC Buyer(s By: l Signature ar� n ^' Sig joint Name rind 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 whether and the harremmer hereby dautually agree in advance that In the event Leer pa h aeiswle wnceming intro wnPact timer panrrrevauomit torn eiapme too makes ardtramen sanide I.has been appmeee by me St.,of Ne Ekeatire Ofire of Conw Anao ands ftegucerintltM1e hheh comer allbe requiredreom tlto such ...a-as prove l In Ito L c 1QA. L'nnk dukhrid., ( Guyer,InitioL�� Dae '2 ram NOTICE OF CANCELLeTON (j Jj]�NOTICE OF CANCELLATbN Dale of Transaction 6-204 You may cancel Mrs hardware,werand any penalty or Data of Thousand 9-20—IY You may cancel this transaction.Wthout any penalty or Wlgation,vermin mess business days M1wnthe show tlate.Ifyaucanml,my,uppeMtraeed in, obmem.vermin Mine hu.-.it,broad above date.lfywcancelenypropenytrade]in, any wr—a.made by you underme Contract or Sale,and any negotitde inatrummtexecuted any payments made by you under the Contract m Sale.am any considerable instrument execulad by you well No returned Mmm 10 days holder,tempt by me Sean M yore wnwuatlen m4ce, by you vnll he remm H vnmle 10 days raiders mount by tee Soler u1 your ranaellation notion and any severity Interest ahsmg out of me transatlion or be ianche a d.It you cancel.sod ngsl and any records interest arising out of me command We be carneaee.It you coned,you mug Take available to me Seller at year re mpred,and sumbeenti.Lly in as gentl hundred as when make available to me sales at your residence,and wbadmit ally In as good contend as when iened,any goods defrverM to you underm's Contract or Sale;m you May,You wish,mmYy solved,any goods depwred to you undo,me Conbact or Sale:of you nay,if you koh,comply with the ihatuC4ms of me Soper describing Me remm shipment of me goods at the Soler 8 win the instructions of the toper regarding me return shipment of the goods at me Seller s expense and risk.It yW do make the goods available to the Soler and me Senn aces not pick makes and risk.11 you do crake the goods available to the Seller and be Seller does not pick Main up when 20 days of date of your Norm ofCantaloupe,You my main or disease of me them up wlmin 20 days of date 0 your Notice a Cendaretim,you may retain or dispose in goods mthom any further common.n you fal to make the goods avaaaMe to me Seller or it you the goods wmwt any former obligation ll you mil arrake me gaads oatlake to the Some ore agree 0 return me goods he the seller and lad a do wnhen you remain adds for ceremony or you agree theopernme goers he the Soler amfae to do on.men yen camel,liable forpeenmarre all doigatinds under the Contract.To dome,his tranuction.Tall a s finer a signed and dated M all shipments under into context To cancel this transaction.,rail or delivw a signed and dated copy of me rancestood noire or any other when notice,w send a toleq�w./��pb�`A'B�A S�ervices, may of the cancal her,node or any enter Breen nodce,or send a teleg A6A Services, 115 Norm Street.Salem M4 ot9]o.NOT LATER THAN MIDNIGHT OF ll�-k/— 115 No.SNew,Salem MA019]B NOT LATER THAN MIDNIGHT OF� f y theret mvrat I HEREBY CANCELTHIS TRANSACTION I HEREBY CANCEL THIS TRANSACTION Cmwrmrss,damr Oada consumer's Signature Dale: The Commonwealth of Massach usetts a (fie Departnfent of bfdustrial Aceitlents Office ofInvesfl98fons i p. 600 Washington Street, / ° Floor `_ - Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Building/Plumbing/Electrical Contractors Applicant information: Please PRINT legibly name: n�-A-Z e✓ 7C)I-Zy. address: �I NO✓I :j i 1" 6e! "J/ (/ city 5Cn le vv' stale: Mrs zip: 0l9-70 plhone# 9`7D�y--Tiaoa Vc? work site location(hill address): 2a -`j 1/QA O✓+'s-c S4 S171� W .w, Mil- 6 (q -7 0 ❑ I am a homeowner performing all work myself. Project Type: ❑New Construction ❑Remodel ❑ I am a sole proprietor and have no one working in any capacity. ❑ Building Addition [f] I am an employer providing workers' compensation for my employees working on this job. company name: A -l'- 10— urV! &'L r address: i l{{S A/O ✓ant vinn S�. (]�1 p [ ' / �i cite: So, i e (''en" . /'L'rl phone#: -t /F- 7�q7 / Q `! o`-� insuranceco. � T✓Gll./.e l e y- 1$ policy# C); I � tar b f 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 co. policy# company name: address: city: phone#: insurance co. police# Attach additional sheet ifnecessary Failure to secure coverage as required under Section 25A of hIGL 152 can lead to the imposition orerimmal penalties ofa fine up to S1,M0.00 and/or one years'imprisonment as well as civil penalties in the form ofa STOP WORK ORDER and it fine of SI00.00 a day against me. I understand[hod(it copy of this statement may be forwarded to the ffice of Investigations ofthe DIA for coverage verification. I do hereby /cerliify rout th pains nnrl p fatties of perjury that the information provider/above is truce and correct. signattlJo Date Print name Phone# 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 ❑Selectmen's Office ❑health Department contact person: phone#; ❑Other (revised Sept tom) Era acc®rdanoe with bna provlsioes of M. Ga L. 40, S= 54, coed Eon d Building Parinft Number is thg the ddbris 6 a��16i�� o��ga;�sae,�sL hall be d;spoaed ®f in a pP®pMY 'lamed fkiiity as darilled,®y F4 G. La. 956a e ddbri9 �hlili d �i�Dosed at; Salem fens 9,S-&6hg OR9,19d by Ha,—, 'gh,da cat n Date obe? Fla-Me A A A AdClPe �, tray, Grate, Zip cods THE COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF LABOR AND WORKFORCE. DGVELOPMENT DEPARTMENT OF LABOR STANDARDS %Z' 19 STEwIroRD STREET, Bos'rON, MASSACHUSETTS 02 114 _ I DELEADER CONTRACTOR LICENSE II A & A SERVICES, INC. 115 NORTH STREET SALEM MA 01970 j� -v - LICENSCi DC000440 - EXPIRES: Sunday,June 07,2015 i IN ACCORDANCE WITH NLG.L. CH. I 11, § 197B(b) AND 454 CMR 22,03, THIS LICENSE IS ISSUED BY THE DEPARTMENT OF LABOR STANDARDS TO THE CONTRACTOR ABOVE FORTH E PURPOSE OF ENTERING INTO OR ENGAGING IN DELEADING WORK. j THIS LICENSE IS VALID FOR A PERIOD OF ONE YEAR. I THIS LICENSE MUST BE MAINTAINED BY THE CONTRACTOR WHEN ENGAGED IN DELEADING WORK IN ACCORDANCE WITH M.G.L. CH. I I I § 19713(b)(2) AND 454 CMR 22.03. II � i HEATHER E. ROWE, DIRECTOR Int Massachusetts - Department of Public Safety Office of Consumer Affairs& Business Regulation VW Board of Building Regulations and Standards � AOME IMPROVEMENT CONTRACTOR Construction Supen ism .v ,= 1 egistration: 101609 Type: License_: CS-057733 y,Expiration: 6/26/2016 Private Corporatic' ,,'y% A&A SERVICES, INC CHRISTOPHER ZORZY, - J t15 NORTH ST f Christopher Zorzy Salem MA 01970 115 North Street Salem, MA 01970 Undersecretary ! l Commissioner 05126/2 0 1 5 S. 1 I I ' Christopher Zorzy #20120426000840 > l A&A Services Inc Exp 4/26/2017 LL rr 77 115 North St ;, L� 1-�i _ 7,. _ Salem, MA01970 -';-F Jul 24 14 03:59p The Insurance Advisory 7814493511 p.1 CERTIFICATE OF LIABILITY INSURANCE °AE"" '°"""' 72a/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS RTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED PRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s)- PRODUCER - CONTACT NAME: The John M.Sullivan Insurance Agen - PHONE 781449-9330 FAX P.N0.eedham, MA Box 92A 02492 ac,N, 781 d443511No Need nuoness, sullivan.insadv@verizon.net INSURE S AFFORDING COVERAGE NAICtl INSURER A: The Travelers Indemnity CD 11347 INSURED INSURER B: A&A Services, Inc INSURER C 116 North Street INSURERD: Salem, MA 01970 INSURER E: ' INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR, POLICY EFF POLICY EXP LTA TYPEOFWSURANCE POLICYNUMBER MfDDIYYYV MNADIYYYY LIMBS G ENERAL LIABILITY EACH OCCVRRENCE s COMMERCIALGENERALLIASILRY a A PREMISE' Ea oralRencel_:s CLAMS-MADE OCCJR [PEtRScNAL&ADVIWURY perscni Is IWURY S ATE 1 GEN'L AGGREGATE Ll MI—APPLIES PER P/OP AGG i POLICY PROLOC s UTOVAOSILE LIABILITY LIMIT i _ ANY AUTO BODILY INJURY(P.,Gerson) S ALL OWNED j SCHEDULED AUTOS I.AUTOS BODILY INJURY(Ref ac 3 ol) 3 VON OWNED 1 FPROPERTY OAMASE $ H:RED AUTOS AUTOS I IPeraptldentl I S UMSRELLAUAB OCCUR _EACH OCCURRENCE $ EXCESS LU16 CLAIMS-MADE AGGREGATE S DED RETENTIONS S WORKERS COMPENSATION W—TMC BTAN- OTH- AND EMPLOYERS'LIABIUTY YIN; 9/13/2013 9f13/2014 ANY PROPRIET]RIPAP.TNERIEXECUTIVE E...EACHACCIDEN: S 500000 A (IA ICERIMEMBER EXCLU ❑.N/A 6KUB-0243M81.5-13 f yes,d.s IoL antler EL.DISEASE-EA EMPLOYE S QQ DESCRIPTION OF OPERATIONSM[w E.L.DISEASE-POLICY LIMIT s I I I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Amch ACORD 101,AUdlUonal Remarks Schedale,it mom spaco Is required) CERTIFICATE HOLDER CANCELLATION The City of Salem SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE DATE THEREOF, 120 Washington Street CCORDPANCEI WITH THE POLICY PROWSIONSE WILL BE DELIVERED IN Salem, MA 01970 • AUTHORRED REPRES�IVE „w^" ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD • w�^ _ Phone: 978-741-0424 A&A `� S Fax: 9vices. om J www.a-aservices.com 115 North Street Salem,MA 01970 March 21, 2014 City of Salem Building Dept. 120 Washington Street Salem, MA 01970 To Whom It May Concern: Enclosed please find the permit ap�tion for Scott Weller, 72-74 Hathorne Street, Salem, MA. I have enclosed a check for $147.00 basid on your fee schedule of$7 per $1,000.00. The total for the jjob`was $20,818.00. r Please send the completed permit to A &A Services, Inc. at.,1-1-5-North Street, Salem, MA 01970. If you have a`ny" question" s, please contact me at (978) 741-`0424. Thank you,for your Sincerely, b `,-Z� ` Bar ara Office Manager