16 LEE ST - BUILDING INSPECTION (3) 3�3 CV— Z 7 Z--
14
The Commonwealth of Massachusetts
e Board of Building Regulations and Standards RECEIVED
Massachusetts State Building Code, 780 CN#PECTIONAL SE F VICE,
Building Permit Application To Construct, Repair, Renovate Or Demolish a e . Sept 2014
One-or Two-Family Dwelling 2815 OCT -1 P I :
This Section For Official Use Only
Building Permit Number: Date Applie .
O
Building Official(Print Name) Signature Date
I SECTION 1: SITE INFORMATION
Ll Property A�1r�ess: 1.2 Assessors Map&Parcel Numbers
44 I n� �iY ey 1S�L�2YY1
111 1.la 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 8) Frontage(fit)
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? Municipal❑ On site disposal system ❑
Public ❑ Private❑ Check if yes❑ p p y
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner o Record:
1h1� Kau,t-enas 5Qlevy) , MA 01 -ta
Name(Print) City,State,ZIP
Ilo L cr.Syett' Q7Q- r'91y Slag'
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORKZ (check all that apply)
New Construction❑ Existing Building 41 Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) V1 Addition ❑
Demolition ❑ Accessory Bldg. ❑ 1 Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work': A Qf V iYL vc-t
twl i I �e 5
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1. Building $ 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 (FVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fees: $
Check No. Check Amount: Cash Amount:
6. Total Project Cost: $ I I l U o ❑Paid in Full ❑ Outstanding Balance Due:
)vIc,, t t_IEDo % 3 Pk t A 101 l3
I
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License (CSL) CS -0 57733 .S ace I aan
�1✓ ISTA ID hP License Number Expiration Date
Name of CSL Holder '
(I S
List CSL Type(see below)
Na�`,'h S�'eet
No. and Street Type Description
n D I n�O R Unrestricted(Buildings2 Fml u el ing cu. ft.)
/"1 -1 R Restricted I&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
97Q'7t{{-ogAl I Insulation
Telephone Email address D Demolition
5.2^Registered Home Improvement Contractor(HIC) 161(009 (? avP 41
/--1SPral cf s HIC Registration Number Expiration Date
HIC
i I�C omn �> egistrant Name
No and Street Email address
SA:1P rtn6 mA o (9�6 �l��- 1 Lit -6��
City/Town, State,ZIP Telephone
SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L, c. 152. 5 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 ( A' r S 70 ;7X
to act on my behalf, in all matters relative to work authorized by this building permit application.
1 - CC) ^-+V-�f—(VcL"� leA„ C, S7 OCT 0 7 2015
Print Owner's Name(Electronic Signature) Date
SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION
By entering my name below, 1 hereby attest under the pains and penalties of perjury that all of the information
contained i is plication is true and accurate to the best of my knowledge and understanding.
d
Prtr t'Owner's-or Authorized` geni's Name(Electronic Signature) 1
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contralat
(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 foun
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.eov/des
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"
01970
n^ w (� �/ (� A & A SERVICES, INC.
115 A&A SE VICES Telephone:: (978)74RTH �1'--0 24 Fax:978)741-2012
Contractor Registration No. 101609
Federal EIN:04-3090162 Construction Supervisor No.CS057733
WINDOWS AND STORM PRODUCT SPECIFICATION SHEET
Buyers)Name Date of Contract
D i)7 S S alb
Buyers)Street Address,City,State and Zip Code
1�O S
Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address
The Buyer($)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 Iron and the reverse of the accompanying CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,of which this Specification
Sheet is a pan.
WINDOW REPLACEMENT
""''�� ) h �jjG�c&
Remove and dispose of# G� existing windows. SS QO�GLT,f,C1C
Install # new �S�aLYi.i�\/ANa;xh windows:/f Wnyl t Woo G ) �rl
(Manufactu �U d {)cyl.
Options: Style booxLbLu4'¢j��-efrid pattern
139 Color Interior :a-P Colo r Exterior Glass Type Z.
Wrap exterior trim with aluminum: Style L eeA,),A— /i'_ t"A Color a A.
t' II windows will be installed according to the installatid procedures in the portfolio. L'V✓e�-
aulk all interior and exterior edges. /}-rC3 0N.65qs
QInsulate where possible around new units.
fj nsulate window weight pockets if exist,and around new window units where possible.
Included in this proposal are set up,clean up,Hepa vacuum and cleaning windows inside and out.
wilding permit included. (' r
x� �IAA rel yI BABOWS CASEMENT UNITS ANY FULL CONSTRUCTION WINDOWS
f 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.
It Install window(s)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
f Remove and dispose of# existing storm window(s).
t Install new storm windows# Manufacturer
Style Color Option
t Remove and dispose of# existing storm door(s).
f Install new storm doors# Manufacturer
Style Color Type: t Aluminum If Solid Core
SPECIAL INSTRUCTIONS:
cG�S
a UP I c�P l 1 A 17 it la�Pil rA-n�rzc i s l e_S y� (c?
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 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 Buyered and the contractor. Buyeds)hereby acknowledge that Buyers)
moment this Specification Sheet.) Q �1 1 /
\ btor Initials: 9L. Date: a /.�// Buyer's Initials:��(� Date:
111 [[[
� �c0c A & A SERVICES, INC.
A&A�7Lf{Y GJ 115 NORTH STREET, SALEM, MA 01970
E in• a:loivi a IT, Telephone:(979) 741-0424 Fax: (978) 741-2012
Contractor Registration No. 101609
Construction Supervisor No.CS057733
Federal EIN: 04-3090162
CUSTOM REMODELING AND IMPROVEMENT AGREEMENT
Bu r s Name
Dale of Contract
Bu eNpo Street Atltlress,City,State and Zip Code
Da ime Tele hone Number Evening Too hone Number Mobile Telephone Number E-Mail Address
�/T r
The Buyers)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 Buyehs)have requested
that such goods or services be installed or providetl at Buyers 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 written above.This Agreement represents a cash sale of goods and services.The Boyers)
agree to pay in cash the cost of the goods and services purchased as described herein,regardless of timing or approval of any financing Buyers)may seek for their
purchase.
� �y
I Purchase Price: n Est.Starting Data
J Down Payment:: Est,Completion Date: /
J 01 Cash
Amount Due on Start of Job: tw Check
Credit Card
Amount Due on of Completion: No.
Amount Due on_of Completion: Expiration Date:
Balance Due on Upon Completion: 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.Buyers)
hereby acknowledge that Buyers)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.Buyers)also(i)acknowledge that they were orally
informed of their right to cancel this transaction;and(a)request Nat they be contacted via their telephone numbers or email,as listed above,in the event
Contractor believes Buyers)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, ne. - Buyer(s)
By: -
Sign re
Sigig at
N L� ti /_-C( J1S
Print Name —� Print Name
Signature III
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 night.
ARBITRATION:The wlnraewrand the namememer hereby mrlm dy ogre M advence mat m the event enter pany boa a dispute anrem ng this anbea,althar pall may submit such dispute to a
private aMbabw eeMae which has earn appmvee by the Season,Of Me Esemthat Once of Cdndp a Atlaas and Bu- as Regulations and the other base shall es remained M sober to such
mcmeOne;pmvM in to G L rM2A.
loyr
nvWln riu��_ Darcy L�l �i S
NOTI CANCELLATION N L OF E L !ION
Date a Tram or 3 �y tinsel Mh em—cen.wmout a,y penalty or Date a ua,eacasn must cum vsamsn.w;Mout am penally or
obligation.vnMm Mree bu'ress cow o-om Me above dew.If wuaancel,any grocery daaee in, obiigavon,wiMin Mree bore avd rmmtne above Gate.nwucanca,am pmpBM them M.
any payments made by you on me cMpect or Sale and any Moderate mavament executed any paylrems made by y er Me comment or sale.and any negoomme instrument esacr ed
try,you will be reamed vain 10 Bays Plate,...lot by Me seller pf your ancalaron nonce, by you Mu be rammed alum o days mgovmng acelpt by the Soler of your camrellamen notice,
and any becurty Interco anvog out o1 the transaction ma be canceled,if you canal you must and any security interest anding out of Me bansi cHm ma be cencegad.g you cancel.you must
make available b the Seller at your residence and smatm eWly in as dose mnradn as amen make availabe b Me Seller at your residence,and subsnndally In as good candles,as eMen
ceiv ,anygwesdWivmdwwuuner M'¢OonhOctw SBle:oryou,ey,itwuvnsh,mrryiy recimood,anygoosMllve to ,under Nisconecia Sale;orymmagifywworappogly
vAM Me msWcrans or Me Evier regarding Me nlum shipment of Me goods at to Guam vise the insWshum of me Seller regarding the rearm Oimont sl Imo Beech at to Sellers
eayense and nsk.11 you do make Me Booed available w Me Sens and Me Sollm does net pick expense and ask.If you d0 make Me goods available to Me BHier and me Seller does not pick
Mein up Minn 20 date of Me date of woo Notice of comealation,you nay retain or dispute of the Mem up Oruro 20 days of the data of your Notice of Cancalanw,you may retain or biaodae of
goodsviNsutanyfuMeroblOaeon.Ifyou he wmske the goMsavailade forme Serer,orlwu the goods vaout any fuller oteigmion.if you tail he nuke Me gwc,available to Me Seller.Or
w atomturn MegM sMthesvlmat Miltodoso.Menwummingableforcedornenceof you agrre tonlum Me gads lOMesellerand Fail to do so,Men you remain gebiebrpeatw tie
all des gaper under the Contract.To cancel this operates mail or deliver a speed and dated of all obligations under the Conrad.Tocancel Mis transition,ma0 orderom,vgned antldated
copy of the Grsellation robou or any other aTnn"emir as ram a wleg l copy V Me concvlaeon notice Orany outer—Nam nonce,or send a mission.
M ,Ia�Brl ae
115 NoStreetSam le MA 01 ST0,NOT LATER THAN MIDNIGNT OF 115 North Sleet, M401970.NOT LATER THPN MIDNIGHT OF
Or
I HEREBY CANCEL THIS TRANSACTION I HEREBY CANCEL THIS TRANSACTION
\\ imer a 5ignaWre Date Consumer d Signawre Data
� 1
The Commonwealth of Massachusetts
gl� t _—�z DepalIment of ludustl•ial Accidents
1� �-1 -
:'' U1Scee1lnvestlgatioas
r / 600 fftishingtan Street, 1" Floor
Bostoet, Abyss. 02111
-' Workers' Compensation Insurance Affidavit: Building/Plumbing/Electrical Contractors
Applicant information: Please PRINT leoibly
4
address'
Cay `-)o f [sttate
crock - It�I yiv 1`I7G i7hone
site location Ifidl address)' V .t 9 -e— J-y Ca VC t ✓ -F1� MIL 01 '7 /0
❑ I am a homeowner performine all work mysel C. Project Type: ❑ New Construction ❑Remodel
❑ I am a sole proprietor and have no one workins in any capacity'. ❑ Buntline Addition
_
I am an employer providin. workers' compensation for my employees working on this job.
company mule fT 'f' �`rV i
address: ( / .� 1`v/� i, �-r. [
city: �!.0 l lz (�� _ PI6- (( PI eH, C /-7 -/ 79- / /(�-OL-f ;-L--
insurance co. 71,. _ f ✓a'- .e IzY � nal'••H C qq �)'9 C5 S
❑ I ana a sole props elor, general contractor,of homeowner(circle one) and have hired the cone actors listed below to ho have
the following workers' compensation polices:
company name:
address:
city:
rhone t♦'
insurance co. policy k
company name:
address:
ci(N.: phone
insurance co. _ policy 9
Atbich additional sheet of necessary
Failure to secure coverage as required Under Section 25.A or.NIG(. I52 can lead to the imposition oferiminal penalties pro fine up to S1,500.00 andror
one years'imprisonment as well as civil penalties in the form ill it S'rOP WORK ORDFR and it fine of S1o1/.00 it day against me. I understand that it
copy of this statement may be forwarded to the ff.ce or Investigations of the DIA for coverage verificatinn.
/r/a/rerebv certifyu enr Ih'pains curl p nn//ies ojperjurP that the infnrnxrlion provided above is true and correct
Si gniLlin I OCT 0 7 2015
Dale
Print name (JI / i fen r 2G✓ Phone y t17 �7 f�=(i`�• l� _
official use only do not write in this area to be completed by city or town official
city or town: permit/license H ❑Building Department
❑Licensing Board
❑check if immediate response is reyuired ❑selectmen's Oflice
❑health Department
contact person: phone H; ❑Other
ir—sedii,i IDml
Certificate No: A044298
THE COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF LABOR AND WORKFORCE DEVELOPMENT
e �" DEPARTMENT OF LABOR STANDARDS i
I
19 STANIFORD STREET,B05TON,MASSACHUSETFS 02114
DELEADER CONTRACTOR LICENSE I
j
A& A SERVICES, INC.
115 NORTH STREET i
SALEM MA 01970
LICENSE: DCOOP440 EXPIRES: Saturday,June 25,2016
i
IN ACCORDANCE WITH M.G.L. CH. 111, § 197B(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.
THIS LICENSE MUST BE MAINTAINED BY THE CONTRACTOR WHEN ENGAGED IN DELEADING
WORK IN ACCORDANCE WITH M.G.L. CH. I I I § 197B(b)(2)AND 454 CMR 22.03.
I I
WILLIAM D.MCKINNEY,DIRECTOR
c.-//,r f-�������r�.�<�.�r�///o�n/(n;;.,��/�r.,r�/O Massachusetts -Department of Public Safety
Board of Building Regulations and Standards
-Ofrice of Consumer Affairs&Business Regulation
{HOME IMPROVEMENT CONTRACTOR Crnrruc
i� IRegistration: 101609 Type: License: CS-057733 f '�
'� =;Expiration: 6/2612016 Private Corporation
4 CMUSTOPHERZ,b
P/6 4&A SERVICES, _ Ylf 115 NORTH ST I@
9 Salem MA 01970% `
Christopher Zorzy
115 North Street sa
Salem, MA 01970 Undersecretary ^' Expiration
t Commissioner 05/26/2017
I
A&A SERVICES,INC.
115 NORTH STREET
SALEM,MA 01970
� Phone: 978-741-0424
- Fax: 978-741-2012
//'3i, /A�fl `\/ .N(`\i�/ ��Y// 115 North Street
® : . Salem, MA01970
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 property licensed facility as defined by M.G.L.c. 111, Sec. 150a.
The debris will be disposed at:
Republic of Boston, Dumpster Service
at
115 North Street
Salem, MA 01970
Signature of P rmit Applicant
Christopher Zorzy, President
Name of Permit Applicant
OCT 0 7 '2015
Date