187 LAFAYETTE ST - BUILDING INSPECTION Y The Commonwealth of NlasSaChusettS I ()IR
y Board of Building Rc_ulations and Standards Nll'NI( LI' \I_I I )
1v1:155aChuSC((5 State Building Code, 780 UNIR, 7"� edition till
V •. p. Ri rurJ lrn ua�rm
Building Permit Application To Construe[. Re air. Renosate Or Demolish a i -mum.v I
One- or Tiro-Family Do ellin,g
I'his Section For Official Use OnIV
Applied: - �
_ Buildim� Permit Numh Date A PI -----------
...
Signature:
Building ununissionor/ In,perior of Buildings Uwr
SECTION I: SITE. INFORMATION —-- .--
LI Property Add rcs Pelf 1.2 Assessors Map & Parcel Numbers
1191 LQ-FGUP,s --
Nla Number Pturel \'umber
I.la Is this artaccepted street? yes _ no_yes
1 : L4 Property Dimensions:
.3 Zoning Information
Zoning District Proposed Use Lot Area Isy tit Frontage tit
1.5 Building Setbacks (ft)
Front Yard Side Yards Rear Yurd
! Required Provided Required Provided Required P1...idled
i
1.6 Water Supply: (M.G.L c. 40, §54) L.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone" ,b7unicipal ❑ On site disposal system ❑
Public❑ Private❑ Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record: 1�7 Ll� uP � �IYe + Unl�a
I nl ))S RId2r�
Name(Prino Address for Scrd e:
Signature - - Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK (check all that apply)
New Construction ❑ Existing Building ❑ Owner-Occupied ❑ Repans(s) ❑ Alteruion(s) 1\dd11i0n El
Demolition ❑ Accessory Bldg. ❑ Number of units 5 Other ❑ Specify:
Brief Description of Prop sed Work-: I OVJS�
I v�StGlliV� 5 Vln�
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Costs: Official Use Only
Item (Labor and Materials) —
I. Building $ I. Building Permit Fee: $ Indicate hum fee is deiernnned:
❑ Standard City/Town Application Fee
2. Electrical $ ❑ Total Project Cost (Item 6) x multiplier x
i
3. Plumbing $ 2. Other Fees: $
- 4. Mechanical (BVAC) $ List: — —
7 Mechanical (Fire 5 Total All Fees: 5_
Suppression)
Check No. Check Amount ('a,h Amount:--- ---
j 6. folal Project Cost 5 2 �I .�i �O ❑ Paid in Full ❑ Outstanding B:d:mre Due_
J lY
SECTION 5: CONSTRUCTION SFRVIC'ES ;
5.1 Licensed Comtstnrction Supervisor (CSI.)
ZDCZI 'L_IIi CII,e Number F\hiraunn Date-1
Name of('SI_- I IulJer
C,irlp Li.�l CSLIA'pe Iced belll�cl _
\JJrrss t� I Y cI Detivrl �uult -
C L mestriitcd ,up to 3i.000 Cu. PI.
R RcstrirtaJ L@_' Rumh Ds,ellina
'i nau r �� - \t. \ta n xm Only
�1 RC ReslJentiel ROL11111C Okraut _I
-felepinnm - \1'S Re>idrnual \kmd,m .utd Siding _
1;1- Reaideinial Soli) fuel 8urnine \ >>Imur: In,t.ilLui��u
D Re.idenu;d DemAmon
5,2 Registered home Im rovement Contractor (IIIC) 'OI D9
HIC Company N n1e ur HIC gistml t Nat Reglstiauun Number
AJdress Erpp
Il j uatiun Date
S ignu!urr. Tel phone
SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152. § 25C(6))
Workers Compensation Insurance affidavit must be completed Lind submitted with this application. Fadare 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. Lp(��)�t ,L911 V!e r-Q as Owner of the subject property hereby
authorize nS"I I ) 1� L to act on my behalf, in all matters
relative to work authorized y this building permit a -ation.
-
S i enaturc of Owner Date
/l`,� j� ,,SSE1C.,TION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION
I, l Y Ln5 Y kJY 1 f Zpc7—i , as, Owner or Authorized Ag r ent hereby declae
that the statements :md information on the foreg -ig application are true and accurate, to the best of my knowledge and
behal "
Print NameV - t
/aS /08'
Signature of Owner or Authori eJ Agent .Date
(Signed under the Pains and penalties of etur )
NOTES:
I. An Owner.who obtains a building permit to do his/her own work or an owner who hires an Limegisieied contractor
(nut registered in the Home Improvement Contractor (HIC) Program). will not have access it) (he arbitration
program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program and
Construction Supervisor Licensing (CSL) can be found in 780 CMR Regulanons 110.R6 and 110.R5. respectively. _
1 1 When substantial work is planned, provide the information below:
Total floors area(Sq. Ft.) (including garage, finished ba,emenU:utics, decks nr purelu
Gross living urea (Sq. Ft.) — F:ahitable room count
Number of fireplaces Number of hedroom, — "_"___
Number of bathrooms Number„f h;llt7hath, --
rvpc nt heating system _ - dumber (It decks/ purchcs _-- ---.._- -- --
hype of cooline s)'siem Fnclused Open
3. "Total Project Square Footage' 111ay be Substituted toi"Total Project Cost"
_J
t CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
•..�I]I itlhl I,N Is, .:I I
Vl.A1, q< 1-':WA ,i iNI,: �\lI!IIll ♦ SDI:'xl,
[*I,1 : 9-g_-;;-9;9; • F\X.
Workers' Compensation Insurance Afflda-,it: Builders/Contractors/Electricians/Plumbers
� > tlttant Information
Please Print Legibly
\;Illle II II Ind)%,dual A A 6 e'rv(
Address: NO r+h Str,° of
City,S-lateizip: �lfiml. Phone ( 17S) 7� II - 0)1
Are sou an employer:' Check the appropriate box:
Type of project(required):
.— 4. ❑ 1 am a general contractor and 1 6 ❑ New construction
I all,a employer with
have hired the sub-contractors
employees(full and/or part-lime).' El Remodeling
listed on the attached sheet.
_.❑ I :tin a sole proprietor or partner- these Sub-contractors have S. ❑ Demolition
ship and have no emplovees
i workers comp. insurance. 9, ❑ Building addition
working for me in any capacity.
[No workers' comp. insurance 5. ❑ We are a corporation and its I0.[J Electrical repairs or additions
officers have exercised their
required.] Plumbing airs or additions
}.❑ I am a homeowner doing all work right of exemption per MGL t 1.❑ umg repairs
myself. [No workers' comp. C. 152,employees.
[ and we have no 12. Roof repairs
insurance required.] t employees. nc workers 13. Other Vic), �Dvx/S
comp. insurance required.]
•;any dpplicanl that checks box BI moat also till out the section below showing their workers'compensation policy infomaation.
' I lo:neownem who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new al fidavit indicating such.
Contractors that check this hos must attached an additional sheet.hawing the name of the sub-contractors and their workers'comp. policy information.
l am an employer that is providing rvorkers'coutpen.vation insurance for my employees. Below is the policy and job site
inprination.
Insurance Company Name:_ TY'CAV �'l'i✓r� gg
Policy #or Self-ins. Lic. #: i/V C-1 � ��`� Expiration Date: E t?r]s
.luh Site Address: Y P Cit /State/Zi S0rnln He a j q7U
—
Attach a copy of the workers' co ensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
tine up to S I,io0.ol1 and/or one-year imprisonment, as well as civil penalties in the firm of a STOP WORK ORDER and a tine
,d up to S250.()0 a day against the violator. He advised that a copy of this statement may be forwarded to the Office of
I in estiu ions tit the [AA for insurance coverage vcriticalion.
l do hereby tern/)•❑ der the pains and penalties of perjury drat the information provided above is true and correct.
Date: 7 b
11 CILIIUt"e: Q
Phone _- O ?-4I 14
-
ollicial u.se on(P. Do not write in this urea, to he completed by city or town officiaL
City ore tuna: .
fssuing Authority (circle one):
1. Board of Health 2. Building Department 3. Cigd row n Clerk J. Electrical Inspector 5. Plumbing Inspector
h. Other -----------
('nnlact Person:__-___--. ---- Phone #:_--
f
Information and Instructions
\i.ts.achusetts General l..;nvs chapter I5' tcquues all cniplo%crs to pro%ide workers' compensation for their employees.
I':.trsu.un to this auute,,m emplo t'ee is Joined is en person in the sera icc of.mother under anv contract of(tire,
c\press or implied. oral or written."
.\n :injilorer is doI"mcd as ";lit indo,iduaI.pal nernhip. .tesocia[ion, corporation or other !e_aI entity, or an} nwo or more
,It the I,itcgUltlg eng:igc•d in a joint cmetprise. and including the IcgaI rcpresen(at i%es of a deceased employer. or the
rccci�cr or Iru.,tee of an indivtdua 1, partnership. association or otter legal entity, :inploN in,, cmp Ioy ees. Ilowe%er the
o•,k ner of a dwelling house hav ing not more than three aparnncros and who resides therein, or the occupant of the
,I\ccllim_ house ofar.other w4xt eniploss persons to do.maintrn:mce, construction or repair work on such dwelling house
III un the grounds or building appurlenanf thereto ;hall not because of such employ nest be deemed to he an emploter."
\It I.. chapter t5?, �25C(6) 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 )vith the insurance coverage required."
Additionally, %I(;L chapter 152, �25C(7)scares "Neither the cxnnnionwealth nor any of its political subdivisions shall
enter into any contract for the performance ot;public .%ork until.acceptable_eN idence of compliance with the insurance.
reyuiremeins of this chapter have bceri presented to the contracting au[hority.•'
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) name(sl, 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.afffdavit. 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 till out in the event the Office oflnvestigations has to contact you regarding the applicant.
Please he sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant
that most submit multiple penniulicense applications many given year, need only submit one affidavit indicating current
policy intm oration (if necessary) and under"Job Site Address" the applicant should write "all locations in (city or
❑acvn)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
:applicant as proofthat a valid affidavit is on tile for future permits or licenses. A new affidavit must be filled out each
}'car. 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 (Mice of Investigations would like n) thank you in advance for your cooperation and .should you has C any questions,
plea.e do not hesitate to give us a call. -
1 he 1)cpartmcnt•; address. telephone and I`.tx nuniher:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 0211
Tel. tt 617-727-4900 ext 406 or 1-877-NIASSAFE
Itc.,<cd 5-'6-ii5
Fax # 617-727-7749
www.inass.gov/dia
' i
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, Seca
150a.
The debris will be disposed at. Salem Transfer Station
owned by Northside Carting -
Signature of Pe (it—Ap—plicant
Date
Christopher Zorzy
Name of Permit Applicant
A & A Services, Inc.
Firm Name.
115 North Street, Salem, MA 01970
Address, City, State, Zip Code
,' Board of Building Regulations and Standards
Construction Supervisor License
License: CS 57733 ^
BirthdMe: 5/26/1958 r i
Expuatfon 5/26/2009 Tr# 13739
1.r
Restnctfon 00' F �
CHRISTOPHER
115 NORTH ST � >:�:—,a-•;' i"G�" i` /� I
SALEM, MA 01970 ``�� Commissioner -
I
✓�e ZJOonmxooui/eeA.GldL ¢��Laddacfume.(ta
Board of Building Regulations and Standards
_ HOME IMPROVEMENT CONTRACTOR
' Registration: 101609
Expiration: 6/2 612 0 1 0 Tr# 267870
Type: Private Corporation
A&A SERVICES, INC-
Christopher Zorzy i "E
115 North Street \`',�. v- _ C�...�"
Salem, MA 01970 "" Administrator
Commonwealth of Massachusetts
Division of Occupational Safety SLI
Laura M.Marlin,Commissioner
Deleader-Contractor
CHRISTOPHER ZORZY
Eff. Date 04/09/08
Exp. Date 04/08/09 3
DC000440 d
Wmberof C.O.N.E.S.T. 09
BO
IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII BOSTO RENE
i 4
U-VALUES AND R-VALUES
° ENERGY STAR
HAINOUSTRIES Harvey Manufactured PARTNER
Windows and Doors
�. WHOLESALE PRICING
k tf
g • U-Values in accordance with NFRC-100 • Based on residential sizes
• U- and R-Values are subject to change without notice • Whole window values
All Harvey vinyl windows with Low-E/Argon and all Majesty double hung windows with '
19099�01
Low-E/Krypton qualify for the ENERGY STAR* program throughout the U.S.'
Clear Insulated Low-E* Low-E/Argon*
VINYL WINDOWS U-Value R-Value U-Value R-Value U-Value R-Value
Classic Double Hung (Mechanical) 0.50 2.00 0.37 2.70 0.34 2.94
Classic Double Hung (Welded Sash) 0.50 2.00 0.36 2.78 0.33 3.03
Classic Double Hung (Welded Sash & Frame) 0.49 2.04 0.36 2.78 0.33 3.03
Classic Acoustical Double Hung STC40 0.23 4.35 0.18 5.56 0.17 5.88
Signature Double Hung (Mechanical) 0.50 2.00 0.37 2.70 0.34 2.94
Signature Double Hung (Welded Sash) 0.50 2.00 0.37 2.70 0.34 2.94
Slimline Double Hung(Welded Sash) 0.51 1.96 0.38 2.63 0.34 2.94
Slimline Double Hung (Welded Sash & Frame) 0.50 2.00 0.38 2.63 0.35 2.86
Slimline Single Hung (Welded Sash & Frame) 0.50 2.00 0.38 2.63 0.35 2.86
Vinyl Casement/Awning 0.47 2.13 0.34 2.94 0.31 3.23
Vinyl Casement/Awning and Thermal Panel 0.31 3.23 0.25 4.00 0.24 4.17
Vinyl Designer Shapes 0.49 2.04 0.34 2.94 0.30 3.33
Vinyl Hopper 0.47 2.13 0.35 2.86 0.32 3.13
Vinyl Picture Window 0.46 2.17 0.31 3.23 0.28 3.57
Vinyl Welded Deadlite 0.50 2.00 0.34 2.94 0.31 3.23
r Vinyl Roller - 2 Lite and 3 Lite 0.50 2.00 0.36 2.78 0.33 3.03
Clear Insulated Low-E* Low-E/Argon*
VINYL NEW CONSTRUCTION WINDOWS(pg190-231) U-Value R-Value U-Value R-Value U-value R•Value
Vicon Double Hung (Welded Sash & Frame) 0.50 2.00 0.37 2.70 0.34 2.94
Vicon Single Hung (Welded Sash & Frame) 0.50 2.00 0.37 2.70 0.34 2.94
Vicon Classic Double Hung (Welded Sash&Frame) 0.49 2.04 0.36 2.78 0.33 3.03
!' Vicon Casement/Awning 0.47 2.13 0.34 2.94 0.31 3.23
Vicon Picture Window 0.47 2.13 0.32 3.13 0.28 3.57
Vicon Designer Shapes 0.48 2.08 0.32 3.13 0.29 3.45
Temp.Clear Temp Low-E Temp.Argon
PATIO DOOR (pg 257-260) U-Value R-Value U-Value R-Value U-Value R-Value
Harvey Solid Vinyl Patio Door 0.49 2.04 0.40 2.50 0.37 2.70
Low-E/Argon* Low-E/Krypton*
WOOD WINDOWS (pg 261-270) U-Value R-Value U-Value R-Value
Majesty Double Hung N/A N/A 0.35 2.90
Majesty Fixed Casement (PW) 0.37 2.70 N/A N/A
Majesty Casement/Awning 0.42 2.38 N/A N/A
Majesty Picture Window (DH) 0.34 2.94 N/A N/A
*The use of tempered Low-E glass may effect ENERGY STAR®qualification in your region.
U- and R-Values are subject to change without notice.
Not all products stocked at all locations. Call your local branch for availability.
Pricing and information are subject to change without notice& may vary from region to regime.
For current pricing, call your local branch or visit ww rn w.harveyind.co .
�Eiffedive 3/17/03 - 256
Zd/o' any« r 766
DxW ''
' PROPOSAL ��K 3v¢GL
,4s,r A & A SERVICES, INC.
115 North Street
- ._. Salem,MA 01970 � -
-- -- - _ Tel.:(978)741-0424 Fax:(978)741-2012
MA Home Im rovement Contractor's License No.101609/MA Construction Su eNisar License No.CS057733
Submitted to: 1'1• j S R i U•� Work to be performed at:
-Street: o, 8o,4 3 Street: SVeit
City: Citys
State: Zip: State: Zip: p
Home Telephone: Wj $ - Work Telephone:
We hereby submit specifications and estimates for: -
WINDOW&IMPIMREPLACEMENT
WINDOWS:
Storm Windows:# Carefree:❑ Tru-Channel:
Color.
Vinyl Windows:# -V---- lmilin �Comfort Plus: Majesty:
Color W Lh It e Other: i c X j
Options for windows:
Grid Pattern_/-' Low E Argon Gas: Foam Filling: El
Wrap Exterior Trim with Aluminum Coil Stock:❑ Other.
DOORS:
Storm Doors:# Aluminum:El Solid Core:
Style Name: Brass Hardware: Beveled Glass:
SPECIAL INSTRUCTIONS:
o D'r dsFaF
Fne HArvew t4i vl'tiuJ )1',bh-H"J JP�jAccr,oin+ ,.)imb u wn �s
L 6 'r 117-ss ,
-
n4o }'
10NG %ANO&O 1) 'o be ",<I Iffo' 1n IP I I y-e O y�rP� hofbn.r h
aid FaInQ }� H1955
1as�/,q�wv_;gtitr`.a. r r� ,arou,O,l n/cw un 1-s -cAu 1 k inl;eriar-+ex•lerior S
se eR v nn` d
All material is guaranteed to be as specified, and the above work to be performe l in-accordance-with-the -
- specifications submitted for above.work and completed in a substantial workmanlike manner_for the sum of.-
Dollars - - •- -
_ .�,. . _..a...__...�.. . ..... -
with payments to be made as follows:
gu ,v
Any alteration or deviation from above specifications involving Respectfully submitted
extra costs,will be exerted only upon written orders,and Sales Representative
will become an extra charge over and above the estimate. All Agent for A&A Services,Inc.
agreements contingent upon strikes,accidents or delays beyond
our control. Owner to carry fire,tomado and other necessary NOTE: This proposal my be withdrawn by us if not accepted
insurance upon above work. Workmen's Compensation and within ninety(90)days.
Public Liability Insurance on above work to be taken out by
A&A Services.Inc.
ACCEPTANCE OF PROPOSAL
The above prices,specifications,and conditions are satisfactory and are hereby accepted. You are
authorized to do the work as specified. Payment will be made as outlined above.
Signature Date
Signature Date
—You may cancel this transaction,without any penalty or obligation,within three business days from the signing of '
this proposal.—