14 HEMENWAY RD - BUILDING INSPECTION (4) The Commonwealth of Massachusetts
® Board of Building Regulations and StandardsIN$pCTIONA) $ER C T V'f. $OF
Massachusetts State Building Code,780 CMR ` SALEM
p� et~� r`2011
Building Permit Application To Construct,Repair,Renovate 00111 1 a
One-or Two-Family Dwelling
This Section For Official Us my
Building Permit Number: Date App ied:
Building Official(Print Name) Signature Dale
SECTION 1:SITE INFORMATION
1.1�Property Address: n 1.2 Assessors Map&Parcel Numbers
].]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 c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal ❑ On site disposal system ❑
Cheek if yes[]
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Recor
TPd Il/lanS T-e(cj aL2.m Mt1 Otd{Z6
Name(Print) City,State,ZIP
A1,<ent°„wog,.! Alt R-7k- ?Y�f— 3-l-7 h
d Street I Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units her ❑ Specify:
Brief Description of Propposed Work': „ Spa G/ a7, S 5v /LF.W r LbkR/ /o
f enc"r a HeelS
r
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1.Building $ S 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ ❑ Standard City/Town Application Fee
❑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: $ l I1 g 0 Paid in Full 0 Outstanding Balance Due:
MMMMMM
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
5--77-3
Ghrl s �Z,�Y2y License Number Expiration Date
Name of CSL Holder
t 1 "l List CSL Type(see below)
No.and Street Type Description
50.f M 0 I q a U Unrestricted(Buildings up to 35.000 cu.ft.
R Restricted 1&2 Family Dwelling
City/Town,Stale,ZIP M Mason
ry
RC Roofing Covering
WS Window and Siding
/ SF Solid Fuel Burning Appliances
Insulation
em Telephone Email address D Dolition
5.2 Registered Home Improvement Contractor(HIC)
�&S� KV' ( 5 /V,C lbtrno9 (Q adnDat
HIC Registration Number Expiration Date
HI i/o- ^ Narne or S+Registrant Name
rr 0/
No.pnd Street Email address
0.L-f..t'�, MA- 6 19
1]D
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 .......... 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 (h ri S pB f ZJ
to act on my behalf,in all matters relative to work authorized by this building pe it application.
C —7, 3 -1�
Print Owner's Name(Electronic Signature) at
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
contaigo in this application is true and accurate to the best of my knowledge and understanding.
Ila rr -' -3, (�
Print Owner's or A horized 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.gov/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"
I
THE COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF LABOR AND WORKFORCE DEVELOPMENT
_! —
„ F DEPARTMENT OF LABOR STANDARDS
19 STANIFOI2D STREET, BOSTON, MASSACFIUS6TTS 02 1 t 4
DELEADER CONTRACTOR LICENSE
A & A SERVICES, NC.
115 NORTH STREET
SALEM MA Ot970
I
LICENSE: DC000440 EXPIRES: Sunday,June 07,20I5
IN ACCORDANCE WITH M.G.L. CH. I 11, § 19713(b)AND 454 CMR 22.03,THIS LICENSE IS ISSUED BY
THE DEPARTMENT OF LABOR STANDARDS TO THE CONTRACTOR ABOVE FOR THE PURPOSE OF
ENTERING INTO OR ENGAGING IN DELEADING WORK.
'i
THIS LICENSE IS VALID FOR A PERIOD OF ONE YEAR.
I
THIS LICENSE MUST BE MAINTAINED BY THE CONTRACTOR WHEN ENGAGED IN DELEADNG
I
WORK IN ACCORDANCE WITH M.G.L. CH. I I I C 197B(b)(2)AND 454 CMR 22.03.
I
it I
HEATFIER E. ROWE, DIRECTOR-:
'`%/ Yi•,,,,r„",,,,,,///.�"�l( /,,,.;,/G: t®f Massachusetts - Department of Public Safaty
jOff-ice of Consumei-Afrairs& Business Regulation %r Board of Building Regulations and Standards
:MOME IMPROVEMENT CONTRACTOR
y1' Cmtruc[nin SUI)M 1sur
.,Registration: 101609 Type:
License: CS-057733
Expiration: 6/26/2016 Private Corporatic
A&A SERVICES, INC CHRISTOPHER ZORZY_,
j 115 NORTH ST _
Christopher Zorzy SalemNiA 01970
115 North Street
Salem, MA 01970 �—
Undersecretary Expiration
Commissioner o512612095
I
ss tir * t Christopher Zorzy n 201204260ooa40
A&A Services Inc Exp 4/2 612 0,1 7
r Z A 115 North St
n t r Salem, MA 01970
The Commonwealth ofMassaehusetts
U hir ('' Department oflndustrialAcdolents
.d Office of Investigations
' _rt lid
r
600 Washington Street, T Floor
./ Boston, Mass. 02111
Workers' Compensation Insurance Affidavit: Building/Plumbing/Electrical Contractors
Applicant information: Please PRINT leeibly
name: 1•�/1,1�/ P�-rk,,e IZ�
address: s i�2Q-
city 0t12 ar state: IVI Yh zip: DI970 Phonne#7
work site location(full address): I /�-I�rA. �e iwgLAIIU, ;C tP-M M� Ql t -1..0
❑ I am a homeowner performing all work myself. Project'rype: ❑New Construction[]Remodel
❑ I am a sole proprietor and have no one working in any capacity. ❑ Building Addition
u,{ I am an employer providing workers' compensationg for my employees working on this job,
company name: /Y f -fT `S'e.Y-V
address: I l g.S I✓O ✓ S p �[ / 7
MA—
city: Sa t-Q�I( -� M'rl phone#: 2 O - 7l��7} �Q`'-/6`I ;Z-
insurance co. I hY_ 7✓0.Ve I-e f '.S Policy# oc�lLl3 AA V t
❑ 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. policv#
Attach additional sheet if necessary
Failure to secure coverage as required under Section 25A of\IGL 152 can lead to the imposition of criminal penalties of a fine tip to S1,500.00 and/or
one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. 1 understand that a
copy of this statement may be forwarded to the Price of Investigations of the DIA for coverage verification.
1 tto hereby certify un a th pains tnttt p notifies of perjury that the information provider/above is true and correct.
signaltuo A z Date
Print name ✓% r->-�Q l Or-i-a.,/ Phone#
:r,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
❑Flealth Department
contact person: phone#; ❑Other
(revised Sclo,200))
in acc®rdanc,ekrjdh �fta provisions o,mR Ge L a, 40, Sao, 54, a condi 0o� OF
Building umber is that tha debe s ,sulfirvIQ From this Work s(- j
bs dfspaamd ®fln p;operiy.Ii�er�a�d aiii �� �asa�m�,b H�o �, L oo III,
' a I
,d debar will be disposed age Saja�� gyF@RsFga S�-an
gK9Rad by NoFft do Caere
�I�FEa6°�Pe ®1 pficam
d�a ae �P koa mi¢Applicant .
A A Senrknso Sac
l� HUM seaela 8a19m A 0119ao
AodrsR32 city gtata 7 Ode
�+�p /130 .► A & A SERVICES, INC.
As $� CES 115 NORTH STREET, SALEM, MA 01970
• ''• Telephone:(978) 741-0424 Fax: (978) 741-2012
Contractor Registration No. 101609
Federal EON: 04-3090162 Construction Supervisor No.CS057733
CUSTOM REMODELING AND IMPROVEMENT AGREEMENT
Bu e s Name Date of Contract
Bu e s Street Adtlress, Ci ,Slate and Ze Code
D S c Mal 0/2,70
Daytime Tele hone Number Evenin Tele hone Number Mobile Telephone Number E-Mail Address
97g-7yE/-S/ 6 I V29-'t7?-707 a ,vej
The Boyer(s)listed above hereby jointly and severally agree to purchase the goods and/or services listed on the accompanying specification shears,in accordance
with the prices and terms described on the front and the reverse of this agreement and any specification Sheets(this"Agreement'),and Buyer(s)have requested
that such gootls or services be installetl or pmvideof 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 Buyers)address wrihen above.This Agreement represents a cash sate 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 Buyerls)may seek for their
Purchase.
Purchase Price: Y789 Est.Starting Date:?z7 8�
s-Q tg
Down Payment' /fir
Est.Completion Date:
0 Cash
Amount Due on Start of Job:
r1.
Amount Due On_of Completion'
I
Amount Due on_of Completion:
Balance Due on Upon Completion 3//(�91s(� '
It Is agreed and understood by and between the parties that this Agreement, front and back and any addendum, cons I ute the an
understanding between the parties,and there are no verbal understandings changing or modifying any of the terms of this Agreement Buyerls)
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 dale first written above.Buyerls)also(1)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 produces or services of Contractor.DO NOT SIGN THIS CONTRACT IF IT
CONTAINS ANY BLANK SPACES. /( —
BY Serv't r c. Buyer(s)
By:
Signature
Signature �) �
Pnnt Name Ci G �.� 4/✓ 1r 7-1
Pant 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.
ARBITRATIOni mMDOorane Me Homeowner hereby mutually agree in pnAdx Nat in the euxnt eitrupparty pans a dispute mnmming this centred,either party mOy smand sea ampoum er e
e!p arboar-sM[¢W,ietheresenares.py Ne Sveradryolthe Earceius Cat Ol a ttai one Bmaness Regolatimsane the ON¢r pony spell C¢repuiree to supMlto cusp Nbourf mo ve s..in M.GL cA.Ye
comroodio Ys k Buy Inma
Oao: rpm-7 rl� Dan,
NOTICE OF CANCELLATION NOTICE Or CANCELI-ATION
Date of Trammohu. o-2�-�f.Ito may anal fWs museum,AM-,any penalty w Data of TymaonmlP�You may¢ameel thin understood,Audi any penally or
obiigauon,men them reareae ears Marine above date.n youranaLanypmpertypmeem, Calendar whin Mree buenesa donnomme above Bate.nyaramW.am palanvfaded ln.
any payrrenu mane by You meet the edmma or sale.one any negovable assurer execm¢d any payments made by you meet the eommor or Sale and any shelter instrument Ordered
by you will pe dmudi Arm 10 days Mann g receipt by Ma Soler of yam rananaupe rove¢, May you fall pe resumed vmin 10 days Maloveng receipt by the seller of your oaneella se mane.
end any ee arrly interest wising mt of he turnaround fall to ancelkd.II you ranr¢I.you must and any sxMN interest ae9ng out of Me a deturan All be wncellee.It yen wheel,you mml
make offered b NB Seller at your residenw,and substantially in as gone condition as when make available to Me Betler at your daemon,and wpsumedlly in as goof condition as Amen
monved any goods delivered hem under NB Contract or sale',oryoumry,if you.oh..yly recervetl,any foods formed dowu underthe Contract w saee:orym hey.iM you As,were,
AM Me ins4uNons M the Seller¢yaNing Me return shipment of Me goods at abe seller's AM ape Mainfr0me of the Seller.,role,the rearm Arpmer e t of H g.a a1 Me seller's
expense and risk.If you do make the goods available b Me SNIT and the Seller does nod pick eapeni and risk.It you do mgke the from,available to the Seller and the Sale,does ram pick
Main up Anne 20 days of Me use of your Notice of Cencallaron.you May retain or dividee of the them up rain 20 days of Me due of your Notip of communist,you may retain Or d'ripowa
goods vadvat any enter odigadon.If you fail b make Me goods aveilaire to me seller,or 11 you me gads MMWl arty further oblea(ron.If yW fall to make the goods available to she Seller.orif
a,—arelum Me goods to the Server and Sol to do re then you remain liable for perfomen¢at you agree to return the goods he are Soler and fail 0 do so,Men you tenant fable for pmomannc¢
all ONiga4ons under Me Cmba¢I.To ranrH this amnsaafm,nail m defvtt asiigned and dated of all Obligations under Me Conforso TO eased its transaction read Or deliver a operaand dated
de of Me Wnmlbbon nnum or any other t hen noice,or send a teI r A6A Servivcs, Copy of and derfuladon nods m any Whet written notice or send a 1eI 8A Services,
115 North setael,$Wem MA 019]O,NOT LATER THAN MIDNIGHT OF Y„_zn_f L� 115 NOM 51ree1.Salem MA0tgT0.NOT lATER TXAN MIpNIGHTOF - .0
I HEREBY CANCELTHIS TRANSACTION I HEREBY CANCEL THIS TRANSACTION never
Consumers SignaNro a.,.,_ Consumer Signature— Dale:
w^ w A & A SERVICES, INC.
/'16W S 115 NORTH STREET, SALEM, MA 01970
- Telephone:(978)741-0424 Fax: (978) 741-2012
Contractor Registration No. 101609
Construction Supervisor No.C3057733
Federal EIN: 04-3090162
MISCELLANEOUS SPECIFICATION SHEET
We s Name Data of Contract
t l yAOV MANS Flex o
Bu er s Street Address, City,State and Zip Code
°I E7l/Ll/l9'�I �Q S?ttow, /�i9-
Da ime Tele hone Number Evenin 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 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
Shasta a part.
SPECIAL INSTRUCTIONS
,^
AV L'13 9-tL 1'eoo --
�6�Go✓LT t- Dt oxr E?crs/7Al y AS IiO6- r0e6493&W
- /ni s i� New D2 n y
- /NS J7n l�L Ni3�v v/ F)13�ao972-Q V/VO4'Z- Nit/ old
- f?iti 5Z5- = vp f cLe>a-r1,1-VP 11V6w0J'0
to 1 7- /5 6 n/G[,v0 e-yo
/� P
AFF 1L-Y21c�
/J1s��21c�=�32N1 ,
j o b D r 5 C1vv-j-?OIL, cs 7-qq[r
f
jUOM end ZN9--vP
CLtl -S u!:l � LT7 ✓z5 *7V-D DOV,/N Ya-L/-7--�5
e S w r T)4 Tl�2 t L6-)9-t2 /-LL- Co,2ry&nL-S t 5p 14 Ct�-S ,
Gox)T /n�Sr�� G�u1 L W1 7�f LIAJ-5e-En OIL- t i39-2
,$/790
%e i�'L Pn.���i 1D21e�=�Y781
ICU
It is agreed and understood by and between the parties that this Specification Sheet,alongwith CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,constitutes
the ween entire understanding bet 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.Buyerls)hereby acknowledge that Buyer(s)
has read this Specification Sheet.�} /
Contractor Initials: "° " Dater Buyer's Initials: Date:X Z-7
30
Phone: 978-741-0424
A&A SER Fax: 978-741-2012
www.a-aservices.vices.comom
115 North Street
Salem,MA 01970
July 3, 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 Ted Mansfield, 14 Hemenway
Road, Salem, MA.
I have enclosed a check for $40.00 based on your fee schedule of$7 per
$1,000.00 plus a$5 administrative fee. The tonal for the job was $4;789.00.
Please send the completed permit to A & A SerSices, Inc. at ll-5 North Street,
Salem, MA 01970.
If you have any question" s, please contact me at (978) 741-0424.
Thank yowfor your/sistance.
Sincerely,
Barbara Zorzy
Office Manager