Loading...
14B HOLLY ST - BUILDING INSPECTION The ('umn,umcralth of Massacl lusctts I ()I: t Board of Building RCgulationS Mid St:u,dards U ('MR. 7°i edition . t.'� ,a� �bt.tssachusctts Slate Building Code. 78 t .til : �. r BuildinC Permit Application To CO n sl rucI. Repair. Reno\ate Or De n,oI sII a Rcw One- or Tiro-Fumil v Du elliIN. 1. _ VS This Szction For Official Use Only Building Permit Number. Date Applied: Si_iature: u- Building Commissioner/ JuSlIC for(it Buildings Date SECTION I: SITE INFORMATION 1.1 Pope Iy :kcldr•'s• 1.2 Assessors M1lap & Parcel Numbers 4� 1 II.�_�SaL�E h,M►� OtA'lo ------ Ma Number Parcel NumM1er I.1 a Is this an accepted street? yes_ nu_ P 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sy It) Frontage ou 1.5 Building Setbacks(ft) Front Yard Side Yards - Rear Yard Required Provided - ReyuireJ Pnrvided Required Pi aideJ 1.6 Water Supply: (M.G.L c. 40, §54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone:_ Outside Flood Zone!` Municipal ❑ On site disposal system ❑ Public ❑ Private ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP[ 2.1 Owner[of Record: �6 Iq 7 d Nwnc t Pn n}-0 Address for Service : c Signaturel Telephone SECTION 3: DESCRIPTION OF PROPOSED WORK' (check all that apply) New Construction ❑ Existing Building ❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ :41Jitinn ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Specily: Bri-f Description of Prupused Work' — r� SECTION 4: ESTIMATED CONSTRUCTION COSTS Estimated Costs: Official Use Only Item . II_ahor and Materials) WCost: g $ 1. Building Permit Fee: $ Indicate how fee is determined: ❑ Standard City/Town Application Fez cal S ❑ Total Project Cost} (Item 6) x multiplier x ng S 2. Other Fees: $ nical tHV:\C) $ List: ical (Fire S Total All Fees: Sun) p Cheek Nu. Cheek :\mount ('.i.h .-\n,,,une_--- Pro ut CosU S al l �O --- J " ❑ Paid to Full ❑ Outs Balance Due:___.--__ _ 1 SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor (CSL) -7-733 ,�Cr _(• I-' I7 r Licai5ue Numhet F,\pir:wom DAo ;Name ofC•SL- Ifmlder 11t� LutC'SL 1\Pelsaehelm%) _ \ Tv e Description L Citicctncied of i to 3�.00 0('it Ft. R Restricted I.@'_ Faith D%kello,L, /S iTLLiiatu'a30--77 '�`�� JJ��'1 �/� N1 Nlasonn t)nly (9 S) 1 v 1 RC Residcnual Rm duw ('Mean_ Telephone. �.. \\'S Ite>Idcou,d \\'indo'k ,o)d , lit, csidcnti:d Solid F.IcI 13urnme \>>IlauCc Iu.t.il Llw�u ' D Re'Ideuoal DCInA111,11 5.771 Regi'tered 1lon Improvement Contractor (HIC) ©)lOO9 fA �J Q�V'1'� 1?ST =�� 12e_Istratiun Nwnher HIC Company Na ne or HIC R•gistrant Name .Ad r• : /Q-•tq1 s l l _11 t l:7/J Fxp Iratwm Dane �ESrgnature� - 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 h) 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, _WQ SYA,/\& 5So, pi—'Tat, as Owner of the subject property hereby authorize_ rittDL7ber 7 r— to act on my behalf. in all matters relative to work authorized by this building permit application. _ X ` . __.: ____ wilo S � i'�gnm'uieol Ow'nerr �Dute — SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION I, r_hrl S+-C) _VV r ZLI-7-0 , as Owner or Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and behalf. � rz Print �I e � ML &ignamr-t wner_or_:lutho�12cd_Agc nt �Datca (Signed under the pains and penalties of perjury) - NOTES: 1. 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 (HIC) Program), will not have access to.the arbitration program or guaranty fund under M.G.L. c. 142A. Other important inhlrmation on the HIC Program and Construction Supervisor Licensing(CSL) can be found in 780 CMR Regulations I IO.R6 and 110_11$, respectively. 2. When substantial work is planned, provide the information below: Total flours area!Sq. Ft.) (including gurage, finished hasement/attics, decks or poichi Gross living urea 1Sq. Ft.) Habitable room count _ Number of tirepluces - _ Number of hedrooms Number of bathrooms Numberllt halt/haths I'vpe of heating system Number of deck,/ perches _-----__ Dupe of cooling s)'stem Enclosed _Upon 3. "Total Project Square Footage" may be substituted for 'Total Project Cost' J CITY OF SALEM PUBLIC PROPRERTY ?u DEPARTMENT \In• �n 12" \\' I u�t,n�� ti;ufri • 1V:�t. \l.\,U, IIc .( i :,-1'I'= fr1, 9-8.74;-�);v; F,A: )-8.'4=e)84o Workers' Compensation Insurance AfftcfaNit: Builders/Contractors/Electricians/Plumbers f li ant Information I'Icase Print I poibiV T n n A `j e—rV( U5 SI C �Ll IIle cHu,mlr',s ()rtcantianm., Indts i.lu.d l: p� C'ity,Srtte,'Zip: lrrn M)9 DICOD Phone #: .itr.-e,/%on an cloplo)er:' Check the appropriate box: Type of project (required): I.LJ I am a employer with�_ 4. ❑ 1 nut a general contractor and 1 6 ❑ New construction have hired the sub-contractors employeeslisted on the attached sheet.(full and/or part-time).` heet.. ❑ Remodeling _'.❑ I :un a sole proprietor or partner- ship and have no employees -these sub-contractors have 8. ❑ Demolition working for file in any capacity. workers' comp. insurance. -9, ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10 ❑ Electrical repairs or additions required.] officers have exercised their fight of exemption per MGL 11.0 Plumbing repairs or additions }.❑ I am a homeowner doing all work b P p myself [No workers' comp. C. 152, §1(4), and we have no 12.❑ Roof repairs insurance required.) employees. [No workers 13 ❑ Other comp. insurance required.] •\oy,applicant chat checks box#1 must also till out the section below showing their worker'compensation policy information. Ilumeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $\mtractors that check this box must an ached an additional sheet showing the name of the sub-cuntractors and their workers'comp.policy information. /inn as employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. �r1�� Insurance Company Name: 1 1'lr Tr A— s - 0,2 Expiration Date: Policy #or SelFins. Lic. #: �� � u� Ex P y Q r ��/ern / / ��% �a Job Site Address: Attach a copy of the workers' c mpensation 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 tine up m S1,500.00 and/or one-year imprisonment. as well as civil penalties in the form of STOP WORK ORDER and a fine ,tf up n) S250.00 a Jay against tale violator. Be advised that a copy of this statement may be tbnvarded to the Office of Im cstivations of the DIG\ tax insurance coserage verification. /do hereby ccrti/' uu! r the pair and pen,dtiec of perjury that the information provided above is true and correct. tl j/icial use only. Do not write in this area, to be,oinpleted by city or town ofjiciaL City or Town: -_.___ PennitiLicense #---_._-- is sing Authority (circle one): - 1. Board of llcallh 2. Building Deparinivnt i. citp town Clerk 4. Electrical Inspector 5. Plumbing inspector 0. other .___-- — Contact Perxoti: —__----- Phone #:__ Information and Instructions \I.ts,achuscits General I avn s chapter I." reyuues-all cmplo%ers to pros ide c orkers' cot tpens;uikin for their cmploPees. I'.trsu.uu to this aauue. an eurplo.ree is defined .I., ".. e ery person m the scn ice of.unuher under unv contract of hire. c\prces or implied, oral or critter." An employer is defined as '*,in indi%;dual, p.otnership, .is.,ocnation. corporation or other le-gal entity. or;uty two or more ,,f the (urrcoine enl-la_rd in a joint rntctpri>e, and including the ICQal representati%es of a deceased employer. or the rccciker or trustee of an Indiondual, partnership, association or other legal entity, employing employees. I Iocescr the _ �.•.k ner.of a dwelling house han ing not more than three apartments and c ho resides therein, or die occupant of the do clung house ofanother who employs persons to do maintenance, construction or repair cork on such dwelling house "n I'll tile urounds or building appurtenant thereto shall not because of such employ went be deemed to he an employer." \1(iL chapter 152, also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a 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. §2507)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract fix tine performance of public cork until acceptable e idence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) narne(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 Ile 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 ot'the affidavit for you to till 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 ntnst submit multiple peri—mulicense 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 ofthe 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 tile for future permits or licenses. A new affidavit must be filled 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 etc.)said person is NOT required to complete this affidavit. The office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a till. the Dvp;utntcnt's address, telephone and fans number: The.Commonwealth of Massachusetts Department of Industrial Accidents Ofitce of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE It,:ti.ed 'c>-DS 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 Cartina C8 nature of ermitApplicant Mate Christopher Zorzy Name of Permit Applicant A &A Services, Inc. Firm Name 115 North Street, Salem MA 01970 I' Address, City, State, Zip Code f -. sa. .Board of Building Regulations and Standards Construction Supervisor License License: CS 57733 _Birthilafe_,5/26/1958 ` Expiration -_:5126/2009 Tr# 13739 Restriction 00.:- 1 . I CHRISTOPHER ZpRZYLr 115 NORTH ST `\ Z. / SALEM, MA 01970 Commissioner I ,per ✓'se -�o�sinxonusealf�i o�./e/e�aeaacfivaed.�3 �\ Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 101609 Expiration: 6/26/2010 Tr# 267870 Type: .Private Corporation A&A SERVICES, INC - - Christopher Zorzy;� ' 115 North Street Salem,MA 01970 """ Administrator . e Commonwealth of Massachusetts Division of Occupational Safety Laura M Marlin,Commissioner Deleader-Contractor CHRISTOPHER ZORZY . Eff. Date 04/09/08 Exp. Date 04/08/09 DC00044009 @ b Wmherof C.O.N.ES.T. c Be II M III�III IIIII IIIII IIIII IIIII IIIII IIIII IIII�IIIII IIII II� � 905r01•LRENEWzk I t i ' I AGrade • $nce 982 A & A SERVICES, INC. SERVICES 115 NORTH STREET, SALEM,MA 01970 • • Telephone: (978) 741-0424 Fax: (97bj 741-2012 Coritractor Registration No. 101609 Federal EIN: 04-3090162 Construction Supervisor No. CS057733 CUSTOM REMODELING AND IMPROVEMENT AGREEMENT Buyer(s) Name Date of Contract Gyssq ANDF2ssar/ ,/- T.4ck 6vr-ey-wo27)f jZ _z� - og Buyer(s)Street Address, City, State and Zip Code 11l 6 57- M4 Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address: 978 - 7q1 -,T7 Y7 The Buyer(s)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 Buyer(s)have requested that such goods or services be installed 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 Buyer(s)agree to pay in cash the cost of the goods and services purchas d as described fheerrein,regardless of timing or approval of any financing Buyer(s)may seek for their purchase. !L c 370 ) , —` q Purchase Price!' Q(ob' /S� rC -S ,0012- ,�8�r Est. Starting Date: Down Payment' �a0• /F1k p�v""9Dy2 Est.Completion Date: Z— —� ❑Cash Amount Due on Start of Job: >Mheck ❑Credit Card Amount due on of Completion: No. Amount Due on of Completion: Expiration Date: Balance Due on Upon Completion^ vO CVC Code: It is agreed and understood by and between the parties that this Agreement, front anrd 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 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 date first written above. Buyer(s)also (1) acknowledge that they were orally informed of their right to cancel this transaction; and (il) 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 Contractor. DO NOT SIGN THIS CONTRACT IF IT CONTAINS ANY BLANK SPACES. A&A Services,In�� Buyer s) •n /� ���t��� By: -z > /lllT7l�yY Signature E� Q (/ (�Ls Sig Print Name riot Nam ignatuye 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 contractor and the homeowner hereby mutually agree in advance that in the event either party has a dispute concerning this contract,either party may submit such dispute to a private arbitration service which has been approved by the Secretary of the Executive Office of Consumer Affairs QZursin s R ulations and the other party shall be required to submit to such arbitration as proved in M.G.L.c.142A. Contractor initials: Buyer's Initials: Date: �� Date: NOTICE OF CANCELLATION NOTC OF�.AN . I t 4TION Date of Transactions ' You may cancel this transaction,without any penalty or Date of Transactlor/2_27 —DWRou may cancel this transaction,without any penalty or obligation,within three business days from the above date. If you cancel,any property traded in, obligation,within three business days from the above date. It you cancel,any property traded in, any payments made by you under the Contract or Sate,and any negotiable instrument executed any payments made by you under the Contract or Sale,and any negotiable instrument executed by you will be returned within 10 days following receipt by the Seller of your cancellation notice, by you will be returned within 10 days following receipt by the Seller of your cancellation notice, and any security interest arising out of the transaction will be cancelled. If you cancel,you must and any security interest arising out of the transaction will be cancelled. If you cancel,you must make available to the Seller at your residence,in substantially as good condition as when received, make available to the Seller at your residence,in substantially as good condition as when received, any goods delivered to you under this Contract or Sete;or you may,if you wish,comply with the any goods delivered to you under this Contract or Sale;or you may,if you wish,comply with the instructions of the Seller regarding the return shipment of the goods at the Sellers expense and instructions of the Seller regarding the return shipment of the goods at the Sellers expanse and risk. If you do make the goods available to the Seller and the Seller does not pick them up risk. If you do make the goods available to the Seller and the Seller does not pick them up within 20 days of the date of your Notice of Cancellation,you may retain or dispose of the goods within 20 days of the date of your Notice of Cancellation,you may retain or dispose of the goods without any further obligation. If you fail to make the goods available to the Seller,or if you agree without any further obligation. If you fail to make the goods available to the Seller,or if you agree to return the goods to the Seller and fall to do so,then you remain liable for performance of all to return the goods to the Seller and fail to do so,then you remain liable for performance of all obligations under the Contract.To cancel this transaction,mail or deliver a signed and dated copy obligations under the Contract.To cancel this transaction,mail or deliver a signed and dated copy of the cancellation notice or any other written notice,or send a telegram,to A&A Services,11 of the cancellation notice or any other wades notice,or send a telegram,to A&A Services,115 Noah Street,Salem,Massachusetts 01970,NOT LATER THAN MIDNIGHT OF North Street,Salem,Massachusetts 01970,NOT LATER THAN MIDNIGHT OF/--7——07 (Date) (Date) I HEREBY CANCEL THIS TRANSACTION. Consumer's Signature Date I HEREBY CANCEL THIS TRANSACTION. Consumer's Signature pate - + wee r 19Ez A & A SERVICES, INC. /a &A SSWICES 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 ENTRY DOOR SPECIFICATION SHEET Buyer(s)Name Date of Contract L `l S.SA �N0�25Sa'>✓ � T�►cl��v?T�2.Gv�7h< /L -29- D� ' Buyer(s) Street Address, City, State and Zip Code - // _ f}aLLy ST SVt e)� ^9 o/97c� Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address 978-711/-37 y7 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 reverse of the accompanying CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,of which this Specification Sheet is a part. ENTRY DOOR yyiRemove and dispose of# / existing entry door units. Install new entry doors# Manufacturer �� a 7zy/GtTlit/— Location _ f} cK At/J>P-y Type: ❑ Steel N SGoothStar ❑ Fiberclassic ❑ClassicCraft ❑Sliding Patio Door ❑ French Hinged Patio Door Model# Z 4Z Sidelight(s)# Sidelight(s) type/model# OPTIONS: Adjustable threshold for ThermaTru Door (Grids49Prelie-dear&. Style: N LIN]6tain Kit: Supplied to owner Expand or shrink the size of the opening Details Cover exterior trim with aluminum coil stock: Style Color Hardware: )6andelset lCbeadbolt t�I] Footbolt ❑Mail Slot O Peepsite )1/A Install oak strip at floor as needed. Caulk interior and exterior edges. Insulate around new door unit where possible. Painting is not included. Included in this proposal are set up and clean up. STORM DOOR �Jie Remove and dispose of#�_ existing storm door(s).'/ Install new storm doors# �� ������ ,,��,,��Manufacturer f4'lLyg Style C" 591 C Color � Type: ❑Aluminum Solid Core }!Location: 6,09-ck_ SPECIAL INSTRUCTIONS: jkF —PIV r7;Y-GL hkl-rT-IA� 7W OW 00eIL, ! F:bX#- 61177-eW j ,L ?-1 i197-v IAL, 32sa2_ . It Is agreed and understood by and between the parties that this Specification Sheet,along with the CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,consti. tutes 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 Buyer(s)and the Contractor. Buyer(s)hereby acknowledge that Buyers)has read this Specification Sheet. Contractor Initials: (/'/ Date: Z�`1�48 Buyer's Initials: Date:/V h52—