17 NORTH ST - BUILDING INSPECTION (3) C-K
RECEIV
The Commonwealth of Massachusetts I IUHAL S-Rvi FS
Board of.Building Regulations and Standar AY OF
L/) ,g � APR 21 SALES[
; �� Massachusetts State Building Code, 730 CV �S
`� Q
(`O Building Permit Application To Construct, Repair, Renovate Or Demolish a
(� One- or Ttvo-Fancily Dwelling
r This Section For Official Use Only
^1 Building Permit Number: Date plied:
�J 1 1� 1-5—
Building OFficial(Print Name) Signature Date
SECTION 1:SITE INFOPMATION
LI Pope Address- }� L2 Assessors iVlap& Parcel Numbers
1 IO✓ Irt .StTrq
1.1 a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zonine District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(rt)
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:
Public ❑ Private❑ Zone: _ Outside Flood Zone?
Check if yes❑ Municipal❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2 Owner of Recor
V21 to,V � C 0.�t' Vvx
Name(Print) City,State,ZIP
11 (volt Sh y 239- 3(-o 8- e'79b
No. and Street Telephone Email.Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building ❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ I Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work':
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs:
(Labor and Materials) Official Use Only
1. Building $ $ 0 aS 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 —
Su ression) $ Total All Fees: $
Check No. Check Amount: Cash Amount:_
6. Total Project Cost: $ gt d a s ❑Paid in Full ❑ Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) Gil-7 bG
-- : License Number Expiration Date
Name of CSL Holder/.S IVo lt1 51
List CSL Type(see below) LA
No. and Street Type Description
U -7 b U Unrestricted(Buildings u to 35.000 cu. ft.)
R Restricted 1&2 Family Dwelling
City/Town, State,ZIP
M Mason
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
����(7��� I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
A +- 6�S�t�� C. Inc. - IDtlPo9
HIC Registration Number F,xpimtion Date
HIC Compani,Name or HIC Registrant Name
U. M0 /'ri
No nd Street M i pl_
�nd Lel✓y_\ 1'l O lC�_J G Email address
City/Town, State,ZIP 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 Issuance of the building permit.
Signed Affidavit Attached? Yes .......... 13/ 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 authorize
to act on my behalf, in all matters relative to work authorized by this building pe it application.
c;;,et2 Cox jy- t -'- t S
Print Owner's Name(Electronic Signature) Date
SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION
Bye ring my name below, I hereby attest under the pains and penalties of perjury that all of the information
cont ' d this a lication is true and accurate to the best of my knowledge and understanding.
rtr\� - 4
Print Owner's or Authorized gent's Name(Electronic Signature) Date
NOTES:
L 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 tinder M.G.L. c. 142A. Other important information on the HIC Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.massASov/dos
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"
nb.
bOVe A & A SERVICES, INC.
Sin[ .,
A&A SERVICES 115 NORTH STREET,SALEM,MA 01970
- o ••o Telephone:(978)741-0424 Fax: (978)741-2012
Contractor Registration No. 101609
Federal EIN:04-3090162 Construction Supervisor No.CS057733
ENTRY DOOR SPECIFICATION SHEET
Buyers)Name Date of Contract
iFVE1. E1/V mck y—
Buyer(s)Street Address,City,State and Zip Code
/-7 NOYZ 77 W 5T ;4- y Sic ewr MP1 - o/�7P
Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mai!.Address
33y-369—z791�
The Buyers)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.
ENTRY DOOR
,Remove and dispose of# / existing entry door u� ?-nits.
n�
A Install new entry doors 9 " Manufacturer//7b7LO` 727 L/ /series Sly�T l-,"i ln/Z—
Location D/N lry�7 /l.wry r/�ry-T70 /) 5h�
Type: ❑,,S//te�eell+,,�X�FFiberglass ❑Sliding Patio Door French Hinged Patio Door i r/
Model ff. Sidelight(s)# SiAeliQpt(s}F�e{model# 5- X FL?
OPTIONS: T'°
f Adjustable threshold for door. XGrids for patio doors: Style: P 7 Xb,'V L�i%�y✓2i CYL qal L ii
Prefinished Ayes ❑no color: interidr"/r�xterior_,rZr,1--T y/L&L`T/
❑ Expand or shrink the size of the opening Details
❑ Cover exterior trim with aluminum coil stock: Style Color
Hardware: ❑ Lockset ❑Deadbolt OFootbolt ❑Mail Slot ❑Peepsite Detail ? /N S'OL IS 7N�
Replace interior trim as needed. Details Siil 4'6F /N. T,.. �'r%-,OC�'�f
X Replace exterior trim as needed. Details SRIV9 G 9X7_; H,-)9-O(?2'_ /,'Fg -
4 Yit w
' 18. Install oak strip at floor as needed.
XCaulk interior and exterior edges. ro
*w4
Insulate around new door unit where possible.
Painting is4mincluded. Details /a L�y ( / �PYf'7 Ci [.Ca"��C /(Vj(�YL(rn"� O
Included in this proposal are set up and cleaNpl 7-0 //V7P'LLL'12- /7-�v/, c
STORM DOOR
❑ Remove and dispose of# existing storm door(s).
❑ Install new storm doors# Manufacturer /series
Style Color Type: ❑Aluminum ❑Solid Core
❑ Location:
❑ Hardware style Q� Color
SPECIAL INSTRUCTIONS: �r`�YVlWl3 T/R1LS/NS iJ9"LL Lac/S �MC7 SCaeVW ,
1?&YA 712ST (_..E -/ntS L!_ L�C'(S/r7 N(� A67- /2Chry ai+fL.I Al
/P�-y/V S 9Y/-L-L � /N 71j�Z iG✓L Ffyl/O L?�r7L�^i o✓L �/%'b L'Yl S
/i7LY'/71/0
/iv 6 m-L L /I/L'Lv / /7 e), 7-0n(CY4� PVC M1 n-I O /1/7 cva/J Ly /
!wo 2 S7S i�,Y✓I
n- _ f �v� I -J_ /AlGli✓7yr��
It Is agreed and understood by and between the parties that this Specification Sheet,along with the CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,consti-
tutes 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
of its terms modified or varied In any way unless such changes are In writing and signed by both the Buyers)and the Contractor. Buyer(s)hereby acknowledge that
Buyers)has read this Specification Sheet.
Contractor Initials: 42� Date: N_/S-/6' Buyer's Initials: %/. Date'x_�l"/ f/f7
�1r A & A SERVICES, INC.
A&A SERVICES 115 NORTH STREET, SALEM, MA 01970
W as•l IVA In I IT,I:1.111111TA a IV,I Telephone:(978) 741-0424 Fax: (978) 741-2012
Contractor Registration No. 101609
Construction Supervisor No.CS057733
Federal EIN: 04-3090162
CUSTOM REMODELING AND IMPROVEMENT AGREEMENT
Bu er(s Name Date of Contract
ELFC y/vMCI
Bu r(s) Street Atldress. Ci Slate and 2i Code
/7 Nv1v S T 9t- Ip rrvalFl 07970
a
D.vtanne Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address
332-3i3O-079D -LI'yAlSAfOk0il
The Buyers)listed above hereby jointly and severally agree to purchase the goods and/or services listed on the accompanying specification sheets,in accordanceC4
with the prices and terms described on the front and the reverse of this agreement and any specification sheets(this'Agreemenl'),and Buyer(s)have requested
That such goods or services be installed or providetl at Buyer's address listed above.A&A Services,Inc.('Contractoi hereby agrees to install or cause to be installed
the products or Services listed in this Agreemenl at the Buyers)address wnnen above.This Agreement represents a cash sale of goads and services.The Buyer(s)
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 their
purchase.
�.p� /nla�,sp Bra:f�u�7 79Y
Purchase Price.�t%p�1 I I N(✓��/21« - p_O2s— Est,Starting Dales/�5 5
Down Payment z / `/Qa j0—/
Y � Est.Completion Date:
Amount Due on Start of Job'
Amount Due oD_af Completion'.
Amount Due on_of Completion:
Balance Due an Upon Completion
6wLWr..0 SS
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(s)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.Buyerts)also(i)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 email,as listed above,in the event
Contractor believes Buy ns)would be interested in any additional quality produces or services of Contractor. DO NOT SIGN THIS CONTRACT IF IT
CONTAINS ANY BLANK SPACES.
A&A Services;Inc. Bulrer(
6v: x
Signature V y-
S gnatu e 0
�J /5✓RGY(: �
Print Name ), r_,�-d-`�"/✓ i Y
riot Name
Signature
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 mmrcanm and the Mrre er hereby mulially agree In advance that the even I enterprise has areacte mnmming mis wnear,arler pan,may hatrant such dispute ae
private she"lion samce vMich has been appoved by a.S.caal.gN the Executive Goods of Consumer AXai 71go,alations and the other party her be not ire0 to smi it to such
arderatier ed proved in M.G L 1.142A.
rnn,rnamr,igkim.. �� rayon can la'
Data: N_IS-1S re':
r
NOTICE OF CANCELLATION NOTICE OF CANCELLATION
Dale of Transaction —IS'1 .You may cancel this trenaaction,vnNool any penally or Dale ul Transaction-q-/S-1�You may cancel Ibis transaction,without any penally or
obligation.solve three businesschancel
days from the above ads.If you ncel any proped,r ailed in, Abea4on amid three business days Rom the above date.If you cancel,any ma=Raoetl in.
any payrrents Made by you antler the Camara or Sale,antl any negotiable lnsvumnt executed any paymanus made by you untler the Contract or Sale,and any negoGaMe index executed
by You All as returned xlmin 10 days lollovang receipt by Me Seller of your cancellation notice, by you will be returned wits,10 us,lot—.,recall by the Sella,of your ranwlla4on-,.ad,
and any eeadty titre.arising M of Inc transaction will be cancelled.II at cancel,yea mace and any auddly mean t arisng out of the theracdon Ad be cancelled.If you cancel,you must
move available a Me Seller at Year mudenee,and summit in as gmtl condition as when make availade 10 the Belle,BI you,dro ende,and substantially to as good condition as when
received,any goads delivered to you under they Contact or Sak;or you may,4 you avian,Simply her any g.Ma delivered to you under is Correct or Balel or you May,it you Ash.comply
war me Insl coons of the Seller regarding the return shiptrenl of the goods at the Wier wit,the Instructions of Me Seller regarding the rearm shipment of the goods at the Seller's
eryensd and risk.If yet do make me goods evadable to the Seller and the Seller does not pick depose and at,II you do Make In.golds.-.,able to the Seller and Ne Seller does not old
them up wthtn 20 days of the date of your Notice of Cencaddon,wumaymiainordispose.11o. them up Arm 20 data mine date of your Notice of Cinmlll you may reen of dispose of
cads AMout any further pbligatian.It scar lall red—a,I',gootls availade to a he Sellec or tl you the BocEs-Mo.,any lunar o bl"Numn Il Yet and to rake the gsds available to Oe SHlec or
.Brat to return Neg.Us Ind Me Sell el and lalad do ao,then you remain Issue for pyearnce of you agree to return the goods to me Seller and fail to do so,then You rennin liable for pefformance
all obligadms under the Contain To.11H this remainder mail or deliver a stoned and dated of all obliBawns under the Contract.To cancal this transactiion.Mail or beliver a signed arm baled
an y N me mnmlladon notice or any other Added notice,or send a tale A&A$ copy of the cancellation nonce or any other wren notice,Or send a telegram As,Be is
115 North ebeel,Salem MA 019TO NOT LATER THAN MIpNIGHi OF�/-fVi~/t'rermy 115Normareel Salem MA019]O.NOT LATER THAN MIDNIGHT OF V as
mmnl
I HEREBY CANCELTH1s TRANSACTION I HEREBY CANCEL THIS TRANSACTION carrot
Consumer's Signature Data consumers Signature Dale:
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Address C-+ a5A•
��� bl�sP� kegs' ZIP cod's
Certificate No: A043066
I
THE COMMONWEALTH OF MASSACHUSETT,S
EXECUTIVE OFFICE OF LABOR AND WORKFORCE DEVELOPMENT
DEPARTMENT OF LABOR STANDARDS
19 STANIFORD STREET,BOSTON,MASSACHUSETTS 02114
DELEADER CONTRACTOR LICENSE
A &A SERVICES, INC.
115 NORTH STREET
SALEM MA 01970
I
I
LICENSE: DC000440 EXPIRES: Sunday,June 07,2015
IN ACCORDANCE WITH M.G.L. CH. i 11, § 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.
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. 1 I I § 197B(b)(2)AND 454 CMR 22.03.
HEATHER E. ROwE,DIRECTOR:
��VVkkTTIIIIJJ i .r.,
board o 9wlding gul a[;o r3 aloj ata 7a J; Orlice Of Consumer Affairs&Bu mess Regularan
( n,trucn,,n tiupcn r a `HOME IMPROVEMENT CONTRACTOR
cent= CS-057733 < .„. — —Registration: 101609 T7&e:
CHRISTOPHER ZORZY Expiration. 62612016 Private C o ooratio
t l5 NORTH ST . S,g � � • A&A SERVICES, INC
zl .
Salem hIA 01970' � f
Christopher Zorzy
115 North Street
Sal
J,,�..,. JIiSC�. '_c?'ral•on Salem, MA 01970
Commriio�=_�
05126/2015 Undersccretan
The Commonwealth of Massachusetts
pl 6 Department of Industrial Accidents
t Office offnitesff9affons
r `` _„ � 600 6t ashingtoa Street, 7"'Floor
Boston,Mass. 01111
Workers'Compensation Insurance Affidavit: Building/Plumbing/Electrical Contractors
Applicant information: - Please PRINT legibly
name: _C�,f i:S p r- ��/lZy-
address: NO✓-1 H A ISfY-el&t
cite �a �'e o" state: MA zip: 0/770 phone#
work site location(full address): 17 t V Or-M &f-?* L1. 5 tkt-f M 01 Vq G 191-70
❑ I am a homeowner performing all work myself. Project"type: ❑New Construction❑Remodel
❑ I am a sole proprietor and have no one working in any capacity. ❑ Building Addition
[� I am an employer providing
�w^orkers' compensation for my employees working on this job.
company /-name: -tt- APT JIQ.A-V 1 (�S t �d'L C .
address: ( /p.S /V O V-tl-) S+. [
city: S Q. .i-��1(m, . MA phone# nr: r-�( S- t-7 7 �/ -/6 Ll X V
insurance co. 1 t-.k. 'T 0.a yR '� r-3 nplicv# I)-lLl '? m b 1
❑ 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:
address:
city: phone#:
insurance co. police#
company name:
address:
city: phone#:
insurance co. Police#
Attach additional sheet if necessary
Failure to secure coverage as required under Section 25A of MGT, 152 can lend to the imposition ofcriminal 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 S100.00 a day against me. 1 understand that a
copy of this statement may be forwardeJ to the ice of Investigations of the DIA for coverage verification.
/do hereby
cerfify ua t/t pains and p nalties of perjury that the information provided above is true and correct.
signaturN t- �7 LY Date 4spa'--� J� ei /
Print none ✓is Top , O Phonc# 7 D - 17 y v 7]
official use only do not write in this area to be completed by city or town official = >
city or town: permit/license# ❑Building Department
❑Licensing Board
❑check if immediate response is required ❑selectmen's Office
❑flealth Department
contact person: phone#; ❑Other
r (revised Sept.2003)
O Phone: 978-741-0424
wez-zmz Fax 978-741-2012
p & p S E RV I www.a-aservices.com
/IL�Sl11 illillf `Ylr ILLS \V/ 115 North Street
• . . S Salem,MA 01970
April 24, 2015
City of Salem
Building Dept.
120 Washington Street
Salem, MA 01970
To Whom It May Concern:
Enclosed please find the permit applications for Evelyn McKay, 17 North
St., #4, Salem, MA.
I have enclosed a check for$56.00 based on your fee schedule of $7.00
per $1,000.00.
Please send the completed permit to A & A Services, Inc. at 115 North
Street, Salem, MA 01970.
If you have any questions, please contact me at (978) 741-0424.
Thank you for your assistance.
Sincerely,
Barbara Zorzy
Office Manager