34 LINDEN ST - BUILDING INSPECTION The Commonwealth of Massachusetts
Department Of Industrial Accidents
Office of Investigations
tuff: % 600 Washington Street
t1s Boston, MA 02111
°7`` www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
_Applicant Information
q� Please Print Leetbly
Name(Business/Organization/Individuaq: ri Q A Sor Ul(Q S Xio o+
Address: 115 1J o r+h 3_ re e+
City/State/Zip:_5� ( p.rA M I'1 01 ?-7D Phone M / 9-n 1 TA 1 _ Qj J 9, J-4
F[No
an employer?Check the appropriate box:
am a employer with 4. ❑ I am a general contractor and 1F
of project{required):mployees(full and/or part-time).* have hired the sub contractors New constructionam a sole proprietor or partner- listed on the attached sheet. t Remodelinghip and have no employees These sub-contractors have Demolitionorking forme in any capacity. workers' comp.insurance.workers' comp- 5. Building addition
p ❑ We are a corporation and its
required.] officers have exercised their 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions
myself. [No workers' comp. c. 152, §1(4), and we have no
insurance required.] t employees. 12•❑Roof repairs
[No workers'
comp. insurance required.] 13.0 Other
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a newaffidavit indicating such.
tContmctors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
I am an employer that is providing workers'compensation insurance for my employees .information. Below is the policy and job site
Insurance Company Name: TYQ�f0 P
Policy#or Self-ins. Lic. #: WC a 3Q X 12
/r Expiration Date: "J_�1 i_j�p'
Job Site Address: 3-7 L LDO(f r' , S75"p +
Ciry/Statey
Attach a copy of the workers'compensation policy declaration page(showing the policy
S'? 7O
/L/f� y / 9 icy 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
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of tip to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby cert fy n er the ains and penalties ojperjury that the information provided above is true and correct.
Si nature: 3 b D
Dale:
Phone
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person:
Phone#•
Information and Instructions ,
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §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 with the insurance coverage required."
Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence 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)name(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
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 fill 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 must submit multiple pemvt/license 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 bum 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 call.
The Department's address, telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
Revised 5-26-05 Fax # 617-727-7749
www.mass.gov/dia
CITY OF SALEM
PUBLIC PROPERTY DEPARTMENT
THOMAS ST. PIERRE
BUILDING COMMISSIONER
ZONING OFFICER
DIRECTOR PUBLIC PROPERTIES
Tel.745-9595 Ext.5640 120 Washington Street
Fax 978-740-9846 6790
E6 �3v2�E 979 yz 3 � - _�.
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 Carting -
e J '�/
Signature of Permit Applicant
-) 1 1-7
Date
Christopher Zorzy
Name of Permit Applicant
A & A Services, Inc.
Firm Name
115 North Street, Salem, MA 01970
Address, City, State, Zip Code
jew
I UI �\ Boar)of Building Regulations and Stanrlarrls .I
I i
- HOME IMPROVEMENT CONTRACTOR
Registration 101609
Expiration:_6126/2008
Type: Private Corporation -
A&A SERVICES,INC
Christopher Zorzy
115 North Street:,;I
-.Salem,MA 01970 Deputy AJminislr ator%+
�� ✓�t¢ U/o9NimMXI.�/.rIG�` ./��ad[ude�Q
1` BOARD OF BUILDING REGULATIONS I.,
� .License: CONSTRUCTION SUPERVISOR Y;
I 't; Numbe " 057733
.=Birt ate: 05926E 958 .
x res: 1 6T Tr.no: 12633 -
�test�nN' :1
C CHRISTOPHER -
1, 115-NORTH ST
SALEM, MA.01970 N �/
$.- Commission.
Ab.
. Grade
si1982 Phone: 978-741-0424
Fax: 978-741-2012
Ap_A ICEQ w.ERV wwa-aservices.com
OVA V V V 115 North Street
• ' 11 Salem,MA 01970
March 29, 2007 Page 1 of 3
PROPOSAL FOR WORK TO BE DONE FOR
Mr. & Mrs. Thomas Calef
at
34 Linden Street
Salem, MA 01970
SUNROOM
• Remove and dispose of existing front porch; support existing roof structure
with 2X KD lumber.
• Pour six (6) new concrete footings'to.code.
• Install new 2X pressure treated frame and two (2) strong back support
beams.
• Install new 6 1/2" Therma Deck Insulated Floor Panels; floor panels to
consists of two (2) pieces of 7/16" Oriented Strand Board (O.S.B.)
laminated to 1.5 pound density Polystyrene Foam Core with an R value of
38; sunroom floor to be level with house floor minus finish flooring.
• Install '/" tongue and groove plywood for sub-floor and %" plywood for
undedayment.
• Install 9' x 14' three-inch (37) Thermal Industries DreamSpace 3200 Series
sun room with the.following specifications:
a. . Walls: Thermally,broken with an option to be four-ply to accept
vinyl siding on exterior, interior and exterior skin is vinyl Luran, kick
plate wall height is to be thirty-inch (30").
b. Windows: All windows except.picture window on wall #3 will be
Rolling Thermo Pane with Low-E glass and Argon gas; all rolling
windows have full fiberglass screen. Option: All windows have
triple pane glass.
March 29, 2007
Page 2 of 3
Calef
SUNROOM (CONT.)
c. Sunroom will have three (3) electric ready wall mullions and radius
corner posts.
d. Sliding Door: Cut-in to house wall one (1) six-foot (6') Legance II
vinyl sliding door with standard handle, key lock, and interior trim.
• Install six-inch (6") three-ply laminated studio roof to half of sunroom, other
half of sunroom is covered by existing porch ceiling; interior surface of
laminated roof will be embossed .024" aluminum with a core of 1.5 pound
density Polystyrene; included in roof is all gutter, trim, and house flashing.
• Install 2X pressure treated frame for lattice around sunroom including one
(1) access doorway to space below room.
• Install maintenance free vinyl lattice and Azek trim around base of new
sunroom.
• Install new 2X pressure treated frame in entry area, cover with new Procell
Composite Decking.
• OPTIONS:
a. House Wall: Remove existing vinyl siding within new sunroom;
sheetrock; tape and mud with three coats house wall of room;
install new interior trim to new six-foot (6') slider.
b. Install vinyl siding to exterior knee wall of sunroom.
c. Install new aluminum awning over front entry door, awning includes
aluminum side wings.
d. Include triple pane glass for all sunroom windows.
e. Include grids between the glass for all sunroom windows.
• NOTE: Permit and clean up are included in this proposal.
• NOTE: Electrical, painting, flooring, and heat are not included in this
proposal.
• NOTE: New plot plan, if required by building department, is not included
in this proposal.
i
March 29, 2007
Page 3 of 3
Calef
A &A Services, Inc. hereby proposes to furnish the materials and perform'the
labor necessary for the completion of sunroom.
All material is guaranteed to be as specified, and the above work to be performed
in accordance with the specifications submitted for the above work and completed in a
substantial workmanlike manner for the total price of sunroom only $43,114.00 minim
20% discount of$8,623.00 totaling $34,491.00. j 07;91, = s Options with discount included as fol ows:
House wall $1,402.00
V'
Aluminum Awning $ 733.00
Triple Pane Glass $1,469.
Grids Between Glass $ 490.00
Payment schedule as follows: 3857�
1. Deposit to secure scheduling $ 0 _. 74�
2. Second installment upon ordering sunroom $
3. Third installment upon starting job $ �°1S
4. Fourth installment ''Y2 way through job $ �/faYS
5. Last installment upon completion $ 9.10 5%9
Any alteration or deviation from above spec cations involving extra costs, will be
executed only upon written orders, and will become an extra charge over and above the
estimate. Any unforeseen wiring that does not conform to the local code ordinance will
be subject to fees proposed by a licensed electrician. Any unforeseen painting costs that
arise beyond the scope of the proposed work will be billed at $46.00 per hour per man.
Any unforeseen construction costs that arise beyond the scope of the proposed work will
be billed at $64.00 per hour per man. All agreements are contingent upon strikes,
accidents or delays beyond our control. Owner is to carry fire and other necessary
insurance upon above work. A&A Services, Inc. carries a $1,000,000 General Liability
Insurance Policy and Workman's Compensation. A Certificate of Insurance is available
upon request.
RESPECTIVELY SUBMITTED ' Date 3/29/07
Ed Burge, Sal s Associate
NOTE: This proposal may be withdrawn by us if not accepted within (90) days.
ACCEPTANCE OF PROPOSAL
The above pri es, pecifications, and conditions are satisfactory and are hereby
accepted, yo are thorized to do the work as specified. Payment will.be made as
outli b
c Date
Dt
Mrs. Dina Calef Date
-You may cancel this transaction, without any penalty or obligation, within three
business days from the signing of this proposal. A contract that is cancelled after three
business days from its signing is subject to a service charge.
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REFERENCE5 :
DEED, 5601 /17�4
PLAN : 7561 3c0
,Vlr A �7DV�s N�ae��gC� �P
I HEREBY CERTIFY , THAT MORTGAGE INSPECTION - PLAN
THE VWtU-I"56HOWN HEREON
+s LOCATED ON THE GROUND /N
AND THAT rr
ON ORM5NTO THE ZONINCzr
BYLAW5 of THE 61rY OF PREPARED FOR
SAc.o*•A7 WITH REGARD TO
FRONTAGE, AREA , AND SETBACKS V/ti!A 0( -rHomps GALS l;:::
AT THE TIME OF CONSTRUCTION
AND THAT THE Pwree�AJ4 5HOWN SCALE : I "
HEREON is Ivor LOCATED WITHIN
A FLOOD HAZARD ZONE A5 RURAL LAND SURVEYS
DELINEATED ON THE MAP OF 130 CENTRE 5T. DANVERS, MA.
COMMUNITY NO. Lrs4az
MAS,ACHU5ETT5. AS. q � NOTE : THIS PLAN 5HOULD NOT 13E
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FEDERAL. INSURANCE W TI N:
BOUNDARY . LINES.' FOR TITLE
1 27878 INSURANCE PURPOSES THIS , PLAN
° I HA5 NOT BEEN PREPARED BY AN
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�avorra.�o CITY OF SALIEM, MASSACHUSETTS
BOARD OF APPEAL
120 WASHINGTON STREET. 3Ro FLOOR
SALEM, MASSACHUSE ITS O 1970
TELEPHONE: 978-745-9595
DDT
FAX
: 978-740-9 4 8 6
KIMBERLEY DRISCOLL
MAYOR - I- -
O O t
Tl j
T
VJ �
July 10, 2007
Decision
Petition of Tom Calef and Dina Calef Requesting a Variance
for the Property at 34 Linden Street
City of Salem Zoning Board of Appeals
A public hearing on the above petition was opened on June 20, 2007 pursuant to
Massachusetts General Laws Ch. 40A, §§ 10 and 1 I and the City of Salem Zoning
Ordinance. The following members of the Salem Zoning Board of Appeals ("Zoning
Board of Appeals") were present: Robin Stein(Chairperson), Elizabeth Debski, Richard
Dionne and Steve Pinto.
The petitioners, Tom and Dina Calef("petitioners"), sought a variance from the 15 foot
front yard setback under the existing zoning ordinance to a 4 foot front yard setback for
real property at 34 Linden Street, Salem, located within a two-family residential (R-2)
zoning district. Petitioners also sought a variance from the maximum lot coverage of 35
percent to 42.5 percent.
The Zoning Board of Appeals, after careful consideration of the evidence presented at the
public hearing, and after thorough review of the petition submitted, submits the following
findings of fact:
1. Petitioners' property is a single-family located within a two-family
residence district.
2. Petitioners sought a variance from the front yard setback of 15 feet under
the zoning ordinance to 4 feet, and maximum lot coverage of 35 percent,
under the zoning ordinance to 42.5 percent. The variance will enable the
petitioners to expand and enclose an existing porch.
On the basis of the above findings of fact, including all evidence presented at the public
hearing, including, but not limited to the Petition, the Zoning Board of Appeals concludes
as follows:
1. The petitioners' request for a variance does not constitute substantial
detriment to the public good nor does the requested relief nullify or
substantially derogate from the intent or purpose of the zoning ordinance.
2. A literal enforcement of the zoning ordinance would create a substantial
hardship to the petitioner.
3. In permitting such change, the Zoning Board of Appeals requires certain
appropriate conditions and safeguards as noted below.
In consideration of the above, four(4) members (Stein, Debski, Dionne and Pinto) of the
Salem Zoning Board of Appeals voted to grant the petitioners' request for a variance, and
zero (0) members voted to deny the petitioners' request for a variance, subject to the
following terms, conditions, and safeguards:
1. Petitioners shall comply with all City and State statutes, ordinances, codes
and regulations.
2. All construction shall be done as per the plans and dimensions submitted
and approved by the Building Commissioner.
3. All requirements of the Salem Fire Department relative to smoke and fire
safety shall be strictly adhered to.
4. Petitioners shall obtain a building permit prior to beginning any
construction.
5. Exterior finishes of the new construction shall be in harmony with the
existing structure.
6. A certificate of occupancy shall be obtained.
7. If necessary, petitioners shall obtain proper street numbering from the City
of Salem Assessor's office and shall display said number as to be visible
from the street.
8. Petitioner is to obtain approval from any City Board or Commission
having jurisdiction including, but not limited to the Planning Board.
9. Unless this decision expressly provides otherwise, any zoning relief
granted does not authorize petitioner to demolish or reconstruct any
structures(s) on the property to an extent greater than 50% of the structure
i
as measured by floor area or replacement cost. If a structure on the
property is demolished by any means to an extent of more than fifty
percent of its replacement cost or more than fifty percent of its floor area
at the time of destruction, it shall not be reconstructed except in
conformity with this Ordinance.
k"
Robin Stein
Salem Zoning Board of Appeals
A COPY OF THIS DECISION HAS BEEN FILED WITH THE CITY CLERK
Appeal from this decision, if any, shall be made pursuant to Section 17 of the Massachusetts
General Laws Chapter 40A, and shall be filed within 20 days of filing of this decision in the
office of the City Clerk. Pursuant to Massachusetts General Laws Chapter 40A, Section 11, the
Variance or Special Permit granted herein shall not take effect until a copy of the decision bearing
the certificate of the City Clerk that 20 days have elapsed and no appeal has been filed, or that, if
such appeal has been filed, that it has been dismissed or denied and is recorded in the South Essex
Registry of Deeds and indexed under the name of the owner of record or is recorded and noted on
the owner's Certificate of Title.
DATE: — --C
�itp of Tn' jEa5eacL�U Ott
r
PLANS MUST BE FILED AND APPROVED BY THE
INSPECTOR PRIOR TO A PERMIT BEING GRANTED
Location of Building 3q �/nder) Strap l
Building Permit Application For:
(Circle whichever applies) Roof,R�A"JterafloZ, i'paidlkeplace,
ing Construct Deck, Shed, Pool
Additio FoundaVan Only, Wrecking
Other._
PLEASE FILL OUT LEGIBLY & COMPLETELY TO AVOID DELAYS IN PROCESSING
To the Inspector of Buildings:
The undersigned hereby applies for a permit to build according to the following specifications:
Owned Name: -b/rQ ( j I e-T Contractor: A I?A Serou 51an5 ZQ r7,
sweet Jly /-#-deo �, city5{/f-m Street j l� M nr4h S�. City l
State Phone 7yQ - 97A3 State Mfl Phone MS) 7y 1 ,p/I,Z
Architect: City of Salem Lic# 1,11Q5
Street city State Lic 0577,33 HIP# 1011,o09
State Phone ( ) _ Homeowners Exempt Form_yes_ll no
Structure: (please circle Single Fa � hi Family# Other
F.sti uaied Cost GY joL S,- 3 5YQmih- ' o 0
r
Will building confirm to law?-Z yes ro
Asbestos?__yea_,1,:� no
Description of work to be done:
Chi �,l �, exl5fir�C) t7 a i:h Or)o ln5/nrr
0 '
A&A SERVICES, INC.
Draw Submitte `: es no Mail Permit to:sA � � 1 SALEM, MA 01970
YYW 1 qj7 t'kiVT�ES.t UM
Sign re of Application,SIGNED_UNDER THE PENALTY OF PERJURY
CONSTRUCTION TO BE COMPLETED WITHIN SIX(6)MONT$S OF PERMIT ISSUED DATE
Department use only: Permit# Zoning Map/Lot
Permit fee S
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