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44 LINDEN ST - BUILDING INSPECTION (2) The Commonwealth of Massachusetts a Board of Building Regulations and Standards CITY OFSALEM I Massachusetts State Building Code, 780 CMR, 7"' edition Revised January n I Building Permit Application To Construct, Repair, Renovate Or Demolish a I, 2008 (, One-or Two-F ' Dwelling ` This Sperion For Official Use y Building Permit N ber: Date A ed: / Signature: ///T/XD Building Commissioner/Inspector 1294 g -Date SECT N 1: SITE INFORMATION L Prop�= Lt A 1.2 Assessors Map &Parcel Numbers 1.1 a is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: y Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 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? Public❑ Private ❑ — Municipal ❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.��,,,O,,�,�wn�e�r'of Record: ������ C n 0� L/m�J�Q��2z�d�� cJ Name(Pant) Addre for Service: 9l9tl y- 351 �3 Signature Telephone SECTION 3: DESCRIPTION OF PROPOSED WORK (check a at apply) New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Descriptio�f Propose W rk2: ^� SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials) 1.Building $ tJ bD 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 (HVAC) $ List: 5. Mechanical (Fire Suppression) $ Total All Fees: $ Check No. Check Amount: Cash Amount: 6. Total Project Cost: $/y FYJ 10 ❑ Paid in Full ❑ Outstanding Balance Due: /0 5 i SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction strru/ction Supervisor 57733 ^(CSL) 3y / J (k V rz u/1 License Number pirati n Date Nap of CSL- o d r List CSL Type(see below) Addr /� Type Description U Unrestricted(up to 35,000 Cu.Ft. R Restricted 1&2 Family Dwelling `7/7 k //e`/ O M Mason Only '/7 RC Residential Roofing Covering Telephone WS Residential Window and Siding SF Residential Solid Fuel Burning Appliance Installation D Residential Demolition 5.;"red,Uome Improvement Co ract r(HIC) HI Company Name og Re istran ame Registrat+tiiioonn Number 0 I' s9� 741MV0 EApiratiorf Date Signature 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 to provide this affidavit will result in the denial of the Issua a of the building permit. Signed Affidavit Attached? Yes ..........V No ........... ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, , as Owner of the subject property hereby authoriz' Z to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of er Date SECTION 7b: OWNEW OOR AUTHORIZED AGENT DECLARATION 1, / "�/ S 1Y�i�I-e- zl z,4/ , as Owner or Authorized Agent hereby declare that t t�e sWements and i formation on the foregoing albKcation are true and accurate,to the best of my knowledge and behalf. Z Print Na /�-30 �p Signa ore of Owner or Authorized Agent ate (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 (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 and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.R6 and 110.R5,respectively. 2. When substantial work is planned,provide the information below: Total floors 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"maybe substituted for"Total Project Cost" `- The Commonwealth of Massachusetts y Department of Industrial Accidents �1 Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information �/ Please Print Legibly Name (Business/Orgmization/Individual): o c a si Address: I 1 City/State/Zip: 1 / y d 1 1 O Phone #: 9 q u 0 U a "1 Are u an employer?Check the appropriate box: Type of project(required): 1.E I am a employer with __ 4. ❑ I am a general contractor and I 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g" ❑ Demolition working for me in any capacity. employees and have workers' 9 ❑ Building addition [No workers' comp. insurance comp. insurance.# ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] 5. 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plu airs or additions myself. [No workers' comp. right of exemption per MGL 12. oof repairs insurance required.] t c. 152, §1(4), and we have no 13.© Other employees. [No workers' comp. insurance required.] *Any applicant that checks box Nl most 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 anew affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. '�i n� T / ) �7 r C Insurance Company Name: ] �� 1 �y(��r�llQ 1 X i Jn — Policy#or Self-ins. /Liicc.#: y I I U 0 J Expiration Date: Y 3 �yy� Job Site Address: 7 �� � �� City/State/Zip: e1 /q /7 O 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 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 up 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 certify upler to ains ¢d penalties ofperjury that the information provided above is true and correct. Si nature: rl (�G Date: 1'9 Phone#: q " l o - ( L4 0 g a Y Official use only. Do not write in this area,to be completed by city or town offfciaL 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#: i I 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 ajoint 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 permit/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 4-24-07 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 Elie debris resulting from this work shall be disposed of in a properly licensed facility as defined.by M. G. L.c. 111, Sec. The debris will be disposed at: Salem 'transfer Staidon owned by Nor`hside Cargmg Signatur_ of P rinttApplicant Elate Chrlstoohar zcarr�v Name of Permit applicant . A &A Services. Inc. Firm Name 115 North Street. Salem. MA 01970 Address, City, State, zip Code Nlassachusetts- 9DepatYnaent of Public Safety: 4g Boaid of RnildiiiI Regrulations and Stanilards, ?� Cdnstructiori$tlpervisor License " License: CS 57733 , t Restricted to: 00 CHRISTOPHER ZORZY . 115 NORTH ST SALEM, MA 01970 c��� �• Expiration: 5/2 612 01 1 <'ununissiuncr Tr#: 14751 . ✓k emvnxaaxure¢t'C� a�✓ yaa�ZuaeC� Office of Consumer Affairs&B siness Regulation VHOME IMPROVEMENT CONTRACTOR Ragestrat!on 101609 Type: Expiration: 6726/2012 Private Corporatio ASERIVICES,mb,._-- Christopher Zomy \ 115 North Street 4 _ Salem, MA 01970 --- '� Undersecretary Commonwealth of Massachusetts Division of Occupational Safety Laura M.Marlin,Commissioner y Deleader-Contractor IptIUh�Ua", CHRISTOPHER ZORZY Eff.Date 04/14/10 Exp. Date 04/13/11 * DC000440 Nemherof O.O.N.E.S.T. BO IIIIII�IIII II�II I�III III�I I�III IIIII IIIII�IIII IIII I��I BOSrON-RENEW Armed Strobl. A & A SERVICES, INC. A&A SERVICES 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 Buyers)Name Date of Contract Lgvm11 T67fnA 0I fi- SveCoIt14AA-1 /0 - z7-/0 Buyers)Street Address,City,State and Zip Code FL/Ij LLAiOeyx./ ST # 2 S"ALl m4 01 Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address: 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 Buyer(s)have requested that such goods or services be installed or provided at Buyer's address listed above. AtIA Services,Inc.('Contmcior'),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 purchased as described her ,regardless of timing or approval of any financing Buyers)may seek for their purchase. �.r L Purchase Price: 883 �a y°� Est.Starting Date: /� s //-3 p Down Payment: /�• Est.Completion Dater YS/ Cis ❑Cash Amount Due on Stan of Job.— Check Credit Card Amount due on of Completion: No. Amount Due on of Completion: p Q5 Expiration Date: Balance Due on Upon Completion: 983 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 mad 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 (1)acknowledge that they were orally Informed of their right to cancel this transaction;and(if)request that they be contacted via their telephone numbers or a-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,Inc. // Buyer(s) By. Signature may,/�w� �- gnaar � X tit rein Print Name Print Na Signature U X Sbt] L317ae CJfl��iR/� 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 all the Mmeoimer hereby mutually ag,ae In aroance Net In me event either parry has a dispute Wnearomm his=from either pall may submit such dispute to a pinata arbitration service which has been approved by are sanatory m the pernotion,ice of Consumer Affaire and Xs rrillauI lions and the Other party shall be required to submit to such admiration as proved in M.G.L.u14Y. 'Jr``J Command,mniol Buyer'fromi Dam; LD Z7—Il127_I!1 oar: odJlof NOTCE OE CANCELI.ATON NOT - Of OF AANN.FI Date of Tmnarprod 0—Z7-1D.You may marnmel thte taneaaon.withmn any penalty or Oate dt Tranaarnod 0-27—/8.You may burval this tmnsamon.without any penalty or obligatlan,within three business days win the above date, If you rearcal,any property traded in, obligation.within three Business days from the above date. Ifyoumncel.anypropO"trade in, any payments made by you under fire Combat or Sale,and any nagouddle Instrument eaemLLW any payments made by you under the Burbazl Of Sak,antl airy negonabte doodurrom executed by you will be Monad within 10 days following Index try the Seller of your cancellaton notes, by you will Be returned wltFln 10 days Tendered rasipt by the Seller of your commutation nOtke, and any security Interest ending out of the banswlim will he rebounded. If you cancel,you mum and any secant,interest arising out of the transaction will ba cancelled If you camel,you most mapseemed 0 the Witter yn. MO..I.substantiay as goon dermton as when received, make evLlable to to Seller at your Inform d,in substantially as good condition as when received, any goods deliveretl m you under this Common or Sue;or you may,d you Msh,mmpy with fine any cop me delivered to you under the Comran or sale;or you may,It you wlmt comply and,are ,deductions of the Seller regarding the return shipment of the goods at the Sellers expense and instructions of the Seller regarding the return sldpment of the goods at the Salem expense all risk. If you do make the goods available to the Seller and the Seller does not pick Nero up risk. It yoo do make the goods available to the saner and the Seller does not pick them up within po den of data of your Nuie»nf expl nation,you may retain or dlapeae of the Beek within 20 days at date a your Noted omarrelated,you may retain or maeaw of the goods without any fuller obligation It you fell to make the lMWs awmable to Na Seller or if yw agree widoNany NnM1erobngalbn.If you rill to make tM goMa available to Me Sellep aril you agree to return the goods to the Belled and fail to rb so,then you remain liable for anomalous of all to return the goods to the Seller and fal to do an then you remain liable for performance of all odllgetlonsunderthaCopact To cereal geld transaction,mint or deliver a signed aW dated copy obligations underihe COndem,To Cancel mst9n5ation.mall ordoiner adlgned and dated body of the ranculation fore or any other women noted,or send a telegam,No A&A barrows.115 of the cancellation notim Or eery Other written entice,or send a telegram,to AAA Services,cols North Street,Salem.Massachusetts 01970,NOT LATER THAN MIDNIGHT OF(Q—'-3o—LO North Strain,Salem,Massachusetts 01970,NOT LATERTHAN MIDNIGHT OF C— d— (J (Date) (Date) I HEREBY CANCEL THIS TRANSACTION. Consumer's Signature Date I HEREBY CANCEL THIS TRANSACTION. Cwsumer's Signame Dote A I& A SERVICES, INC. AAA SERVICES 115 NORTH STREET,SALEM,MA 01970 • r Telephone:(978)741-0424 Fax,:(978)741-2012 Contractor Registration No. 101609 Federal EIN:04-3090162 Construction Supervisor No. CS057733 ROOFING SPECIFICATION SHEET Buyers)Name Date of Contract /4rvey 2 -7 - io Buyers)Street Address,City,State and Zip Code yL( L1/y.0tr) / s #Z Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address 978- 7Yy-3S/3 78l-367-Y9Y 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. ROOFING SPECIFICATION Strip Roof of# L/, layers of shingles - nstall 6'of ice and water shield at base of roof where fi Install 15.b felt paper to roof. possible. Install 18-24"of ice and water shield in valleys. ®Flash chimneys et d (no repointing included). T Install 6"perimeter drip edge to rakes and fascia areas. Install vent pipe boots and seal as needed. Ovlash valleys as needed itInstall rollout type ridge vent. $ Planks/plywood replacement under 32 SQ FT included, w 'If more is needed there will be an extra charge of$�_ /peer hour for labor plus the cost of materials. &Dumpster/Disposal Included: vOther: ( oO -olL 57yji2 fN�/% Location: .SI/J LS 1�2I VEM9:L! Install new roof: Manufacturer "az-fni"1Y")''7> 0 yr Style/type Included in this proposal are thorough cleanup, building permit,and company/manufacturer warranties. RUBBER ROOFING SPECIFICATION T Strip Roof $ Not Strip Roof 1t Install 1/2"High Density Fiberboard to existing roof using $ Flash obstacles as needed. screws and plates. t Install .060 membrane EPDM(Black) rubber roofing to T Install 3x3 aluminum drip edge to perimeter of roof with fiberboard.s seam tape. '? Flash up sidewall as needed. Included in this proposal are thorough cleanup, building permit,and company/manufacturer warranties. SPECIAL INSTRUCTIONS: • %F}rier 0Fr- 0XV '%� "StOC� o/,-- • 1� 2©0r-- /UG s- -n, lSr3 %� -SiYer+77R J� �.vsi7tl� Z ° cyx- PL-Yu1&-v,0 It Is agreed and understood by and between the parties that this Specification Sheet,along with CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,constkutes the entire understanding between the parties,and there are no verbal understandings changing or mo iltying any of the terms. This conhact may not be changed c r Its terms modified or varied in any way unless such changes are In writing and signed by both the Buyer(s)and the Contractor. Buyers)hereby acknowledge that Buyers) hea read this Specification Sheet. X. /' 7, Contractor Initials: Vyl? Date:`®-Z 7`io Buyer's Initials:-L Aw Date ik /0 .7- /9