221 LORING AVE - BUILDING INSPECTION DATE:
LANS MUST BE FILED AND APPROVE THE
ECTOR PRIOR TO A PERMIT BEING G NTED
-cation of Building
Building Permi pplication For:
'(Circle whichm pplies) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool
Addition, Alteration, Repair/Replace, Foundation Only, Wrecking
Other:
PLEASE FILL OUT LEGIBLY & COMPLETELY TO AVOID DELAYS IN PROCESSING
To the Inspector of Buildings:
The undersigned hereby applies fora permit to build according to the following specifications:
Owners Name: Contractor: Chri stnnnar Znr7.g
Street City Street 11 5 Nnrrh Straat City__Calem
State• Phone ( ) State MA Phone(9 78) 741-04 24
Architect: City of Salem Lic# 14 0 5
Street City State Lic#0 5 7 7 3 3 HIP# 101609
State Phone ( ) Homeowners Exempt Form yes_no
Structure: (please circle) Single Family, Multi Family# Other
Estimated Cost of job S
Will building confirm to law?des no
Asbestos?_yes no
Description of work to be done:
SERVICES
Drawings Submitted:_yes no Mail Permit to: 11b NORTH STREET
% PAT.F ,�u r
X a=eye
,`-'Signature of Application,SIGNED UNDER THE PENALTY OF PERJURY
CONSTRUCTION TO BE'COMPLETED WITHIN SIX (6)MONTHS OF PERMIT ISSUED DATE
Department use only: Permit# Zoning Map/Lot
Permit fee$
COMMENTS:
12)
f^' 1
5 l
DATE: SI a a I D 5
Citp ]of '4&ate ' �ffla'E;'�;arbm;Etta
PLANS MUST BE FILED AND APPROVED BY THE
INSPECTOR PRIOR TO A PERMIT BEING GRANTED
Location of Building as )-0r/nq / t uLl7U-e—
Building Permit Application For:
'(Circle whichever applies) Roof,Reroo , Install Sidin onstruct Deck, Shed, Pool
Addition, Alteration, epair/Replace, Foundation Only, Wrecking
Other: F
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:
Owners Name.. Thn lle' fy)/q(![)an0J0J Contractor: Chr; stnp'nar 7.nr7.N
Street City Ltd Street 1 15 N n r t h S r r a a r City_S a l a m
State.m� Phone 78i 7H/4 -k1l 17r7 State MA Phone (9 7 g) 7 41-0 4 2 4
Architect: City of Salem Lic# 14 0 5
Street City State Lic#057733 HII'# 101609
State Phone ( ) Homeowners Exempt Form_yes_Zno
Structure: (please circle in le Famii • Multi Family# Other
Estimated Cost of job S /0, R q/ , 00
Will building confirm to law? yes no
Asbestos?_yes/no
Description of work to be done:
Z04,122 rl -1JP )ve and a hQ14- t 0 'la) 54 are-,.
soul SiOIIr�G _
ERYICE$
Drawings Aktt :, i yes no Mail Permit to:% 2.16 NORTH STREET
EM AZA-A:879
X
Signature o Applic 'on,SIGNED UNDER THE PENALTY OF PERJURY --
CONSTRUCTION TO BE-COMPLETED WITHIN SIX (6)MONTHS OF PERMIT ISSUED DATE
Department use only: Permit# Zoning Map/Lot i
Permit fee$ j -
COMMENTS:
I '
I,
j LIIU IIIr'i��IlI. c-i��r-IL�IiI�L �
. � �� ?�ubiiL �rnpatg �zII�;rlma2�
ab;�,��.- $uililinn ar�7L'IIIirni
Lbar rialr_� 6rrz:c -
508-735-3555 svc:. 330
D_S?OSAL OF DEBUTS AFFIDAVIT
In accordance with the provisions of 14CL c 40, S54, I acknowledge that as a
condition Of Building ?erm1t : , all debris reSu iLing -' the
COnStruction acLivi ty gOverned by Lijs Building ?erf:St shall be disposed of
a properly licensed solid waste disposal facility, as defined by MGL c III,
S 150A. -Salem Transfer Station owned by:
The debris will be disposed of at: Northside Carting
location of iac_:Sty
Rlaa os
Ddt�
Signature of ?e PliCznL
_ _ np
Fully conplete the following inforaation:
(?lease print clearly)
Chkibt8phetcZo;2yc.
Name of Permit Appiicant
A & A Services , Inc .
Firm Name. if any
115 North Street , Salem, MA 01970
Address . City b State
The aOOVe SLatL'te :-nuiris that debris rrorm Lhe demol irion. renO-�ation. reha7
or other alteration of building or structure be disposed of in a properly
licensed solid waste disposal facility as defined by MGL cIII . S150A and tha
building permits or licenses are to in the 1oC2L1On Di the facility aL
�\ The Commonwealth of Massachusetts
Department of Industrial Accidents
o/J/ce o//aresdoodoos
600 Washington Street
Boston,Mass. 02111
4
Workers' Compensation Insurance Affidavit
name:
location:
city phone 0
I am a homeowner performing all work myself.
❑ 1 am a sole proprietor and have no one working in any capacity
I am an employer providing workers' compensation for my employees working on this job.
comoanvname; A & , A�':Services , Inc .
address: 115 North Street
city: Salem, MA 01970 phoneq• 978-741 0424': 'ram'° `"thy« r�' `
� -et;?t3fa'74.
insurance co. The Tradelers policy WC939X1256
O 1 am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who
have
the following workers' compensation polices:
Company name -, C RIM.,
address:
city:
hone q• r d
wi 4 ,
insurance cm olie
company name
address,' ;, l
city: - .•t :phone q: 'i:r aM '"•3'cJ.
�Y
insuranceco::; policy q.r:
Failure to secure coverage as required under Section 25A of MCL 152 can lead to the imposition of criminal penalties of a fine up to s1,500.00 and/or
one years'Imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a
copy of this statement may bee/forwarded to the Office of Investigations of the DIA for coverage verification.
l do hereby certJfy u r rh pains enalties of perjury that the Information provided above is true and correct.
Signature l/. L`�V/// Date
PrintnameChristopher Zorzv, President Phoneg978-741-0424
(contact
fficial use only do not write In this area to be completed by city or town official .
ity or town: permil/license q flBuildiog Department
❑Lkensiog Board
❑check if Immediate response is required ❑Seleetmeo's Office
❑Health Department -
person: phone q; nOther
✓ice ��z� ��� o�,
BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR r
Number: CS 057733
Birthdate: 05/26/1958
Expires: 0512612005 Tr.no: 12224
- Restricted: 00
H ZORZY
115 NO
115 NORTH ST �
SALEM, MA 01970 Administrator
��1
Board or Rui Wing;Regulations and Standards
Ika,
HOME IMPROVEMENT CONTRACTOR
Registration: 101609 _
t� Expiration: 6/26/2006
Type: Private Corporation
A&A SERVICES, INC -
Christopher Zorzy
115 North Street
Salem,MA 01970 itd miuisl r:mn'
COrMnOnWealt
... ... .......
h of M.assachusetts
Division of occupational Safety
Robed J.Prezioso,Commissioner
Deleader-Contractory
CHRISTOPHER ZORZY Y�
Eff.Date 01/14/05
DC000 t4e001/13/O6 ® �
DC �
Wmber of C.O.N.E.S.T
80
I
IIIIIII IIIIIIIIIIIIIIIIIIIIIIIII IIIII IIIII IIIII IIIIIIII BOSTON-RENEW