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17 LAURENT RD - BUILDING INSPECTION Y _\ The Curnmoimealth of NIassadnrsetts Board of 13uilding Regulation ;u s td Standards : \Il'�Il'IP.\I.fll NtaSSaChnSCUS State Building Code. 780 CNIR, 7°i edition I '.SI: r �• Y Building Permit Application To CConstrurt. Repair. Rrnoc:ue Or I)rnxrli,h a RrrurLhuurtn / One- or Tiro-Fomdv Dtrellin•G �fl This Section For Official Use Only Date Applied: V BuiWine Pcnnit Number-. Pp —k�---------- - Signmwe: G BuilJiug Coin is. ones/ Inspector of Buildings Date -------- SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Nlap & Parcel Numbers I7 I�urarrf Rnnnl - I.la-Is this an accepted street? yes nu_ hlap Number P:urrl dumber 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq It) Frontage i it) 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: Zone: _ Outside Flood Zone'! h1unicipal ❑ On site disposal system ❑ Public❑ Private❑ Check ifyes❑ SECTION 2: PROPERTY OWNERSHIP[ 2.1 Owner[of�tecord: 'Rt�b. e, G. Arvt�M0 In66hl 1"7 LoUrerd di)orl Xat rint)c 4ddressfor service: v�/J (978T, �Nl - 3370 4191ature Telephone SECTION 3: DESCRIPTION OF PROPOSED WORK' (check all that apply) New Construction ❑ Existing Building ❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Specily: Brief Description of Proposed Work': Q tQ Gr5 O X/ t n qU LeS of hOix) SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) - L Building $ 1. Building Permit Fee: S Indicate how (ea is Jciernnned: ❑ Standard City/Town Application Fee - 2. Electrical ❑Total Project Cost (Item 6) x multiplier s 1. Plumbing S 2 Other Fees: $ _ 4. Mechanical i HVAC) $ - List: 5. Mechanical (Fire y Total All Fees: S Su ressiun) - Check No. Check Amount: (•.t>h b. Total Pro u[ Cost: S / �a . - J " H o. ❑ Paid in ❑ Outstanding-B;d:mre-Dar:___.,___-_ Y , SECTION 5: CONSTRUCTION SF,RVIC•ES S.l Licensed Cmtstntction Supervisor (CSL) 7- - 9 License \umbel livpirauon Date Name of CSL- I IulJcr Lul C'SL J'N pe (see below)To e De so ioon \JJr�s. -r + - L t.'mrslnrleJ nl t In 1 000 Cu. 1'I., _ - - - R Restricted I Y:'_ Fanuh Drtellme tii_natu e M maeonrt Onk - � RC ReslJcnual Roulinc('oNerun, Trlrphrine \VS Re>idcinial \F mJo't .mJ •si&nt :[ .Sohd tel Bunun,_ \r lb:mcc lu.l.ilLw��u R�.SF i D Re, dcnual De'll"ItW❑ 5y Registered Home Improvement Contractor (I11C1 �t s= r+ cj?XVIC DS =YlC Re_tstratiun Numhcr _ HIC Company Na�our HIC R�gisErant Name riAddr•�s_ _ _- -� _ (�$>7�I'Dj,+A/.' F.vplrallun Date Telephone Signature SECTION 6: WORKERS' CONIPENSATION INSURANCE AFFIDAVIT (M.G.L. C. 152. § 2506)) 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 - .... _ - SECTION lac OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIIES FOR BUILDING PERMIT Rr cha rd �f /1mq dO / O/h� as Owner of the subject property hereby I• to act on my behalf. in :III matters authorize r�SI�I�PI -f7f Z� relative to work authorized by t ' bNuilding permit application. `X C7?ZCri7zs/ Q/�X/O� Date Signature of Owner SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION as Owner or Authorized Agent hereby declare I; oing application are true and accurate, to the best of my knowledge and that the statements and information on the foreg behalf. r riot.. /p D _ �..._.,r Date Signature of 04 ner or A- hohzed'.4-gent (Signed under the -gins and penalties of Redo, 0 NOTES: I. An Owner who obtains a building permit to to his/her own work, or Lin owner who hires an unregisteied contractor (not registered in the Home Improvement Contractor(HIC1 Program), will not have access to.the arbiu-auun program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC P C10.RS, respectively. and Construction Supervisor Licensing (CSL) can be found in 7SO C'MR Regulations I IO.RG and IO. ' 2 When substantial work is planned, provide the information below: tincluding garage, finished hasement/attics. decks or p(itch)Total flours area !Sq. Ft.) Habitable room count o - Gross li ft area s Ft.) Number ut hedrooms --- Number of fireplacecgs Number oN halt7halhs umber of bathrooms Number of decks/ porncca rope of heating system 6nclnsed "1)'pe of cooling SNstem. - -_ - I ---- -- _� 3. "Total Project Square Footage- may be Substituted tier "Total Project Cost" __J CITY OF SALEM PUBLIC PROPRERTY �4 DEPARTMENT .. \L\ 'R 12- iiN,,;,INcLltII1 • �.�t; I';,1: 9-8--4;.9;9; ♦ F\x: Workers' Compensation Insurance Affidatit: (Builders/Contractors/Electricians/Plumbers Am)luant Information Please Print Legibly `;tIIle t l3u.rtrs l h_.uucm,m In Ju Jte, all: A Address: t rnr+h 5-h if e-+ c ty,srtte;z p: �IfM 1-In DIC120 Phone #: ( 17s) 7N 1 Are sou an employer:' Check the appropriate box: Type of project (required): 1.LJ 1 am a employer with�A5 . 4. ❑ 1 am a general contractor and 1 6, ❑ New construction - employees(full :mdror urt-time).• have-hired the sub-contractors P listed on the attached sheet. : 7. ❑ Remodeling _'.❑ I :nn a sole proprietor or partner- ship and have no emplovees 'Chose sub-contractors have 8. ❑ Demolition ins:,mrking_.for.me.in.,ny,impaclty;._ - workers' comp insurance. 9, ❑ Building addition .. - --- - _.j___[]-We are 3%urporation and its --" -- - -- [No workers'-cuntpwinsurance - - _ -- - - 10.❑ Electrical repairs or,additions _ - reyuired.i officers have exercised their �right of exemption per MGL 11.0 Plumbing repairs or additions 3.❑ 1 am a homeowner doing all work S P myself. [No workers' comp. C. ploy e I(.3 and we have no I'_.❑ Roof repairs insurance required.] t employees. (No workers' IIEZ"Other KnAn, comp. insurance required.] I •:\uy.,pplicant that checks box M 1 must also till out the section below showing their workers'compensation policy information. I(unuuwners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ('unvacmrs ers'comp.policy information. that check this box must attached an additional sheet showing the name of the sub-contractors and their work l ura tut employer that is providing workers'eonepetisation insurance far my employees. Belot,is the palicy and job.site _ information. Insurance Company Name: Policy 9 or Self-ins. Lic. #: Expiration Date:, — Job Site Address: City/State/Zip:/State/Zi X�1 em tM DI017© t� LLturPrrF i�oac� ry P -,-- Attach a copy of the workers' compensation 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 to S 1.500.00 and(or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a tine „F all to S250,00 a day against the violator. lie advised that a copy of this statement may be forwarded to the Office of Irn e.vivations of the MA for insurance coverage merification. 71doiflerebyter6lir n/ t n, an he id penalties:t/perjarr that the information provided above is true and Correct. - - t Date o : tlflieial use only. Do not write in this area, to he Completed by city or loom oJJiciuL k itw it lapy n;..— __-_--...- .-_.-.- Perntiti License #_..-- — - -- kcuin,g, \uthority (circle one I. Huard of Ilealth 2. Building,Department 1. City/Fown Clerk J. Electrical Inspector 5. Plumbing Inspector 6. other _—. -- ('untact Pcrsuti: —_--_-- _— — Phone N:__ Y a Information and Instructions \L,s.achuscits General 1_aws chapter I requu'cs :ill empl m pros ide porkers' compensation for their cntplo)ccs. I'rtrsuant to this .tatute, an employee is defined as :r% person in the <ei%ice of.mnilier under any contract of hire, c�htc<s or implied, oral or tsrinen." %n rntplu rer is delisted as "an indit idual. liminership. .rssocuation. corporation or other legal entity, or any two or more i'f sue foregoutg :ngaged in a joint cntetprise. and includine the Ie"al rcpre;eniati%es ufa deceased cmpluaer. or the rccci%cr or trustee of an individual, partnership. association or utter legal entity, employing employees. Huwe%er the ,•,%ter of a thselIin6 house hav in not more than three apartments and w hu resides therein, or the occupant of the dttclling house of another who employs persons to do maintenance, amSMCHon or repair work on such dwelling house ,it on the grounds or building appurtenant thereto shall not because of such employ merit be deemed to he an employer.-' - \I(iL chapter 152, :25C(6) also states that "every state or local licensing agency shalt 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, MGL chapter 152, �2SC(7)states"\either tie convnurnvealth nor any of its political subdivisions shall enter into any contract for the perionnance of public cork until acceptable eN idence of compliance with the insurance - rcqunenients 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�iame sh�a�dr�ss(es) and,phgne numbers) alung with their certiticate(s)-of._a_—..- -------- -. . . .. . . - - - - - - insurance. Limited Liability Companies 1LLC) or-Limited Liability Partnerships(LLP).with no-employees-other thanthe - -- - -" 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 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,if the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permiulicense number which will be used as a reference number. In addition, an applicant that must submit multiple pemmulicense 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 of the 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 file 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. Tl1c t Mice of Investigations would like to thank you in-advance for your cooperation and should you have any questions, please du not hesitate nn give U.S a call I he D,:partntent'., address. telephone and faux number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel.'#k617-727-4900 ext 406 or"1-877-MASSAFE Fax 1# 617-727-7749 Rey i>ed 20-05 www.mass.gov/dia 1 1 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 b Northside Carlin Signature of Pdrrmit Applicant i0/8ID Fe Date Christopher Zorzv Name of Permit Applicant A &A Services, Inc. Firm Name 115 North Street, Salem, MA 01970 Address, City, State, Zip Code f j Board of Building Regulations and Standards Construction Supervisor License I License: CS 57733 Birthdge _5/26/1958 ". Ec=p�ratioM (26Y2009 Tr# 13739 I,•. { T s "-REs-trl 9WOi CHRISTOPHER ZOR 115 NORTH ST •'`%a� '-%�'% �'G-- T i�Jai'• , •I SALEM,MA 01970 _ ' Commissioner - . . � - ._ _. ,... _. .. .._.,. .. _ .. ._ _ ✓die-fOolnmMw/s¢Us� .�.amarr+ueetA - - -- - - - --- -- � - 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 Zorzp:.. 115 North Street — Q- Salem,MA 01970 -" Administrator Commonwealth of Massachusetts Division of occupational Safety Laura M Marfin,Commissioner Deleader-Contractor CHRISTOPHER ZORZY Eff.Date 04109108 .� • Exp.Date 04/08/09 09 DC000440 Member of C.O.N.ES.T. 9 - �• SO II II I' III ' ` •" `. . IYIIII IIIIIIIlII IIIIIIIIII IIIII�IDDIUIIIIIWIIII 1 BOSTON-RENEW 1 �+ R(vtle �y� '�✓ �%g A & A SERVICES, INC. ' CCES 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 RtclV t 17MRM019 LmPolAInr 9'Zt/-OS Buyers)Street Address,City,State and Zip Cade /7 LAUR ENT RD SAte M 4 0l970 Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address 978- 7Yy-3 3-70 The Buyans)listed above hereby jointly and severally agree to purchase Me goods antller services listed below,in speamence 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 Spedficebon Sheet is a part. ROOFING SPECIFICATION . Strip Roof of# A e'- layers of shingles t nstall 6'of ice and water shield at base of roof where nstall 15.1h felt paper to roof. possible. Install 18-24"of ice and water shield in valleys. t lash chimneyaevtisiIi•d.(no repointing included). t Install$'perimeter drip edge to rakes and fascia areas. L'Pristall vent pipe boots and seal as needed. Flash valleys as needed �T Install rollout type ridge vent. t lanks/plywood replacement under 32 SO FT included, 'If more is needed there will be an extra charge of$ 8 per hour for labor plus the cost of materials. Dumpster/Disposal Included: ®Other: Czl L SL/470 &-e)/QL'- Location: ®Rl yirkl;IT% Install new roof: Manufacturer Cpn-Ml /7rT,-, ?0 yr Style/type /gXz#/7zrr4/17zAL— eluded in this proposal are thorough cleanup,building permit,and company/manufacturer warranties. RUBBER ROOFING SPECIFICATION t Strip Roof t Not Strip Roof t Install 1/2"High Density Fiberboard to existing roof using t Flash obstacles as needed. screws and plates. t Install .060 membrane EPDM(Black)rubber roofing to it Install 3x3 aluminum drip edge to perimeter of roof with fiberboard.s seam tape. t Flash up sidewall as needed. Included in this proposal are thorough cleanup,building permit,and company/manufacturer warranties. SPECIAL INSTRUCTIONS: l kl C 779 LL 3 A114k/ ff'L(IN„NVI-7 (/gryrs %✓ rl3ac,�slOc� p�/�Co� /n/s ziYW 3`r yea/7.S 177VO nik�v VIAll Ve?vvibW s FFir (elex/7DYf. V&Iyvz) oat "r�'f t"Drr syo� Sof�i TS /9i7cys ///LL✓O(-J lGnti -7 Ano`7 147vo "6IIS/100- Lw77L% AoaFS RgVO BACK /2V000H vE0 it is armed antl understood by and between the parches Nat thin specification Sheet,along what CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,WnstlWfes the share underetanding between ate phrase,and Mere are no verbal understandings changing or row"'Ing any of tie terms.Thin contract may not M changed or lm terms madlRad or varied in any way unlace such changes are In writing and signed by bate the Bu,ens)and Me Contractor. Buyers)hereby acknowledge that Barents) - Me read atls specification She`ed.fit/� p Contractor Initials: r/ .i Date: Buyer's Initials: Dater T A & A SERVICES, INC. A& A S CES 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 - CUSTOM REMODELING AND IMPROVEMENT AGREEMENT Buyer(s)Name Date of Contract /1 rcH + AmmvoA LAPOIAJT6 q-2 it Buyers)Street Address,City.State and Zip Code !7 LAUREwT R� SALEi✓1 /+�A 0/97U Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-mail Address: 97$-74Vl'3370 The Buyers)listed above hereby jointly and severally agree to purchase the goods and/or services listed on the accompanying specification sheets,In acommance was the prices and terms described on the front add the reverse of Mis agreement and any specificaton sheets(this'Agreement'1,and Buyat(s)have requested Nat Such goods or services be installed or provided at BuyOr's address tested above.ASA Services,Inc.('Contractl hereby agrees to install or cause to be installed the product or services listed in Mis Agreement at the Buyers)address written above. This Agreement represents a cash sate of goods and Services. The Buyers)agree to pay in cash the cost of the goods and services Purchased as described herein,regardless of timing or approval of any financing Buyer(a)may seek for Moir purchase. r = /9,/Soo Purchase Price:ON67ZOr Est.Starting Date:/0-2 //- A p t p Down Payment:L y Est.Completion Date: - 7-08 u Casn Amount Due on State of Job: heck a Credit Card Amount due on of Completion: No. Amount Due an of Completion: /oo Expin don Date: Balance Due an Upon Completion: 9�OOa CvC Code: It is agreed and understood by and between the parties that this Agreement,front and back and any addendum,constitute the entire understanding between the parties,and there are no verbal understandings changing or modifying any of the terms of this Agreement. Buyer(s)hereby acknowledge that Buyer($)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($)also (i)acknowledge that they were orally Informed of their right to cancel this transaction;and(11)request that they be contacted via their telephone numbers or e-mail, as listed above,in the event Contractor believes Buyer($)would be interested in any additional quality products or services of Contractor. DO NOT SIGN THIS CONTRACT IF IT CONTAWS A,NY BLANK SPACES. A&A Services,Inc�� Bgg as By. Signature Print Name Print Name Signature Print Name You,the Buyouts),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 farm for an explanation of this right. ARenRAnoN:That mwsmor end to from¢or.harmer midways agree in exams the in Me were eiNm Fa,has a d wmad mnmrm,g role mness,either IteM may auenut aura dispute m a pMua a..ai whkX wa who eppued W the sonata da we Ea..job-al Cgnwmer Mursir; Wawhws antl lM wharpeny who we warmest to suds to ¢u¢X ad'rdetlm ea aboard in Mi d 14p [�'� Canoecar • '� a,s ludW pI do.. 7 had�.a.ylr afVQ owe of Moderated -2q-0$Yoe may,warm this dear viden,reform any prole or Data of rnortewn -2V-08mu may wn¢el this ttemaecWn withom any wrmn or oblyetan,within whe busineu dive h¢m the adave dam.If yen wnCel.any hadhow,nWM I.. al§.,earm three duvna¢s days fmmtne frome dam.nyw mom,,on,,tMm It, for whowerve made by ow mWmtne Candewor SW.and vn negotiable m¢random moral any wvmew madaty you under the Command or Me,eM arty nowshowinam,ment ewerwad � dy,ow art be hammed worm 10 do"ohooine.i,By,Me Gal.M your wnwua6m whose, by you Wn N hammed would to days fmbwins rewwt by um seller of your wrcmlktiM maw, end ran memory mtdael www met w Ne darwmun Mn as wormand.m you nande.you muff .any wwrM Nmmtl adnby out m I..brew:cu,nib ow n 1'..if you vinyl.you must M.avower mine stale or your reerands.Nwb..n as grad-.I-as ww,rewired make wool m me Seem at your reydenw,In wremndmly be gave,Wndmon wr xden observer, ¢try 9fords deMmred as You morn tn4 Comm or Mai or your may,It you wiM,dropsy won me any owdr wlaw.to you mode Mee Comm.or Sol or you bey,it You...wmpty war me nwuctlon¢of Be Seller wpardmp me remm anlpmms.l Her gw]s M the Sailers mtgnx end ....be his Soler rpaMng the mmm womew of the grad to the Seems a.Ponae and Mo. X you as make Me gmla awastow to as Seuer and ve Better dw¢M olr'w Mara up, risk, if jot do mob am 9.a.1.to ue Saber and was Salk,Wes rim I.them up wlmm A dap of the was of your Had¢of""or you"whow mdbµVa rime golds Sutton 200en of the date of ywr N.0 Canwasurn.you may.omen or drspow M the 9was wn omanymnl igO n.Ifpufylmmakeuega 3¢ la I.Wm eSelkror Xyauagme wibmmanymMerobbgedon.nyvufailmmahe Megwdv evellaMem Ne$alien oru you agree to haWT Me Made be M.seller and le,bmsum Man you wartin ishe W peMrnanw dell be2mm Me grade is Me Setae mq oil as m on,Man you.&slays gad.be basis nnan-ofm Botswana modm Me Cwdaa m member Mk weremnnai now or Moder aaigned and dated may oblpafiwa mode.Me ConmaG ha Marcel Nee throuddrion.now of Lauver a signed and dated mew a Ne seacoast rwwas or am o vonen=fo.or draw a branow'moReservlms.115 of Me crosswalksronw or an,NMr w n parrs,a k sew a mMrem so ABA Eshowe.Eshow ns Who Somme.seem.MsaaaMu»wa 01970,NOT LATER THAN MIDNIGHT OF 277-nR North Strom.Sokra,Mazsecbu¢an¢manif NOT IATER THAN MIDNIGHT OF — —0 (Dare) Pam) I HEREBY CANCEL THIS TUNSACTION. Cw,suma'9 agesure 0. 1 HEREBY CANCEL Time TRANSACTION, Cotuwner's Sgmbre Dam