10 WILLIAMS ST - BUILDING INSPECTION (2) f
The Commomeealth of.Massachusetts
t Board ot'Bullding RcUulatiuns :md Standards
n,I Ml1SSdChLISet1S State Building Code. 780 CMR, 7"'edition Mt'N'll 11' \I.fll
,. I'SE
o' Building Permit Application To Construct, Repair. Renos:ue Or DentOlish a R, m,d hmuw t
One- ur Tit o-FulniN Dit ellin,1 f ooS
This Section For Official Use Only
Building Pernn Kurnber: / Date Applied:
` n Slgnat W'e: ✓� -II
JI Building Comtnusswner/ Inspector uI Huildines Dale
SECTION I: SITE INFORMATION _
L1 Property :address: 1.2 Assessorsap M & Parcel Numbers
I
I.Ia is this an accepted'street? yes - no Map Numher - P:IrCl Number
1.3`Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq to Fromage(11)
1.5 Building Setbacks(ft)
Front Yard Side Yards - - - Rear Yard
Required Provided - Required Provided Required Pru�iJrJ
1.6 Water Supply: (M.G.L c.40. §54) 1.7 Flood Zone Information: 1.8 Sefosal System:
Zone: _ Outside Flood Zone"
Public❑ Private❑ Check if yes❑ �MuniGiite disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 wner of Record-
asn_s Sire e f
,Name(Prin[V Address for Service:
q'Y-7y5-29'92 _
Signature rV h Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construe tion ❑ LExistingBuilding ❑ 'O(vner epairsls) ❑=Occupied '❑ R Altemtion(s) AJdilion ❑
Demolition ❑ I Accessory Bldg. ❑ Number of Units_ Other ❑ Specily:
Brief 9iis pti.L on of Pro/j 3)d bVA:
SECTION 4: ESTIMATED CONSTRUCTION COSTS
i item Estimated Costs: Official Use Only
(Labor and Materials)
I. Building $ etT I. Building Permit Fee: $ Indicate how ice is delerntmed:
❑ Standard City/Town Application Fee
?. Electrical ❑Total Project Cost' (Item 6) x multiplier x
is Plumbing $ -
_. Other Fees: S
4. ,Mechanical (HVAC) $ List:
i
�. Mechanical (Fire
T
S ---
Su. ression)
To All Fees: S
�� � I in
Nu. -_Check :\mount Cashh :lnuxun:—_-_- j
6. Total Project Cost: $ 7 0 Paid Full 0 Outstanding, Balance Due
� r
SECTION 5: C'ONSTRucTiON SERVICES
5.1 Licensed Construction Supervisor(CSL) 7/_ �/
fir« ��T ,/ h Liran.c Number livpu:won Dale
Name )l( L- I lulder �`V�-�—
Lnt C'SI_l)pc('cc halnwl
a
Willie
r'h Tv - Desoiwn
\dJ
/ /4\ C ('nrcxtricrt•d u t to ii.1100 Cu. ht.
r 'kai l - R Restricted L@'_ F:wulk Der ollin ,
3 m: u1ys. / C,j/ \1 Nlasonry Only
rf ( �OC / RC Residential Routine Cot trine
Telephone \1'S RnalCotial \Vmdutt .aid Sidm-
SF Residential Solid fuel llminne \ t plunge In.t.d 'al n>�
D Itesidauti:t Demolition
5 Mer�rv/j( �v�nent�optyjtctor(I11(:) /0/�O� —_
111C Company NNaame r I IC Re gi r t Nam•ICJ Registration Nmuher
a� zoio
A r•s�/ ,>, 9��7yi•ayay F. p)ration ate
Signature Telephone
SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAViIT(M.G.L.c. 152. § ?SC(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Fallttre 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
1, - Aa/ U I as Owner of the subject property hereby
authorize V to act on my behalf. in all matters
relative to work authorized by this building permit application.
Si natureo(Owner Date '�•/
SE[[C,,TII/O��N/7b: O/WNEW OR AUTHORIZED AGENT DECLARATION
1, /1�.�/Ll N/(...�/ C �rZ�/.Y� —.as Owner or Authorized Agent hereby declare
that the statements and inti)rmation on the foregoing applic ion are true and accurate, to the best of my knowledge and
behalf.
r r
Print Nat
Signature u(Owner or Auhdorized Agent Date at b
(Siened 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 umeeistered 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. 112.A. Other important inti)rmalion on the HIC Program and
Construction Supervisor Licensing(CSL) can be found in 780 CMR Regulations 110.116 and I I0.R5, respectively.
2.
When substantial work is planned, provide the intormatiun below:
Total floors area ISq. FLI tincludine garage, finished hasementfattics, decks or porch)
I Gross living area ISq. Ft.) Habitable room count
NUntber of fireplaces Number tit bedrooms
Number othalhrooms - Numberot'halt/halhs
fvpe of heating system Number of decks/ p,achcs --_—_------
Type of cooling system Enclosed Open --
3. "Total Project Square Footage• may he Substituted fur"Toial Project Cost"
DISPOSAL OF DEBRIS AFFIDAVIT
i
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."
15Da.
The debris will be disposed at: &aims 'Transfer Station
owned by Northside Cardna
Si na re of ermitApplicant
Date
Chrlstooher Zorzv
Name of Permit Applicant
A &A Services Inc.
Firm Name
115 North Street Salem MA 01970
Address, City, State, Zip Code
t
CITY OF SALEM
PUBLIC PROPRERTY
bra;ll DEPARTMENT
n.Ullh 1411 ItN lit � II
\(.\.I N (�,',\\',1iI IiN41'��\tiiNl'hl • 5.11 \I, �l.\+W III +FI :+.I't
Il.l:') 8•,1 •)j9j F\X: '1"8•'*98an
Workers' Compensation Insurance Afffda%it: Builders/Contractors/Electricians/Plumbers
Itnolicant Information �± /1 V�/ �IS� Please Print Leeihly
Name I Btl,uless (tream C�rV[[auun Inds\Idti,th: A L A � r)C .
Ciry•Scue;Zip: �yyYl Mlq Diq'10 Phone #: NIS) r)JA2,H
Are �ou an employer?Check the appropriate box: Type of project(required):
I.2/1 am a employer with 4 ❑ 1 am a general contractor and I 6. ❑ New construction
employees(full and/or part-toile).' have hired the sub-cuturactors 7. ❑ Remodeling
'.❑ I am a sole proprietor or partner- listed on the attached sheet. :
ship and ha4no employees rhesesub-contractors have 8. ❑ Demolition
working for me in any capacity. workers'comp. insurance. 9. ❑Building addition
[No workers' comp. insurance 5. ❑ We are a corporation and its I0.❑ Electrical repairs or additions
required.] officers have exercised their
3.❑ 1 am a homeowner doing all work right of exemption per MGL I I.❑ Plumbing repairs or additions
myself.[No workers'-comp. . c. 152,s§'!(4),and we have no 12.❑ Roof repairs
insurance required.] t employees. [No workers' 13.[XOther [�� )
comp. insurance required.]
\ny applicant that checks box#1 most also fill out the section below showing their workers'compensation policy information.
t I lomeownen who submit this affidavit indicating they are doing all work and then hire outside conimion must submit a new affidavit indicating such.
�Cuntmciors that check this box most attached an additional sheet showing the name of the sub-contraclon and their workers'comp.policy infommation.
1 mn can employer that is providing workers'compensation insurance for my employees. Below is die policy and job site
injarruadon. 1 /
Insurance Company Name:
Policy#or Self-ins. Lic.#: I D 2 4.1 3Mt '3 U� fU�t[� Expiration Dater= A0 q
Job Site Address: I D W [ I W III 1 UT _City/State/Zip:51J 0 0
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 21A of MGL c. 112 can lead to the imposition ofcriminal penalties of
= up to S 1,500.00 and/or one-year imprisonment, as well as civil penalties in the form ofa STOP WORK ORDER and a fine
of tip to S250.00 a Clay against the violator. Be advised that a copy of this statement may be forwarded to the Office of
In%esti_ations of the DIA f'or insurance cwcrage verification.
l do hereby ce•r rJw t1 nder the//pains and penalties of perjury that the information provided above is true
/arid correct
\III7i.11 llre:+ / n r ^ Date-
1
l--�yl
11 ill - o 1 U � vl l �
r
l use only. Do not write in this urea, to be completed by chy or town officiuL
fow n: ..—.-- PermitiLiccnse Authority (circle tine):
d of Ilealth 2. Building Department 3. citylTown Clerk 4. Electrical Inspector 5. Plumbing Inspector
r
Information and Instructions
%Ias,achuscns General Laws chapter I:_ require,all employers to pro,ide tsorkcrs' compensation for their employees.
Pursu.un to this.tarule, an einploYee is delincd as-.. et en person in die sen ice of,i nuher under any contract of hire.
C\I,res or implied,oral or urinen."
An elnplure•r is defined as".m indis iduaI.pannership..tuuctation,corporation ur other Icgal entity, or an)' two or more
,,I the foregoing engaged in a joint enterprise•and including the legal representatis es of a deceased employer,or the
recei%er or trustee of an individual,partnership,association or other Ieeal entity,einplo)in,,employees. I loweter the
wa ner of a dwelling house hay mg not more than three apartments and w ho resides therein, or rite occupant of the
d„tilling house of another who enipluys persons to du maintenance,construction or repair work on such dwelling house
r on the grounds or building appurtenant thereto shall not because of such emplu)nient be deemed to be an employer."
.\I(]L Chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold tbe.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."
Wditionally. MGL chapter 152, +-'5C(7)states"Neither the cummunwealth nor any of its political subdivisions shall
inter into any contract for the perlunnance of public itork until acceptable c%idence of compliance with the insurance
requirenients 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 cant'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 wtumed to the city or town that the application for the permit or license is being requested,not the Department of
Industriil 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 tilled 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 burn leaves etc.)said person is NOT required to complete this affidavit.
fhd()Ifiee of Investigations would like to thank you in advance for your cooperation and Should you late any questions,
please do not hesitate to give us a call.
the lkpart ment's address, telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Oftice of Investigations
600 Washington Street
Boston, MA 02111
Tel. k 617-727-4900 ext 406 or 1-877-MASSAFE
re•. sad _- c>-us Fax # 617-727-7749
www.mass.gov/dia
+- Massachusetts- Deptu-ttnent of Public Safet,
Board of Building Regulations and Standards
Construction Supervisor License
License: CS 57733
Restricted to: 00
CHRISTOPHER ZORZY
115 NORTH ST
SALEM, MA 01970
Expiration: 526/2011
fI { 0min iesioner Tr#: 14751 I
gj
77—
Board ofBuilding Regulations and�YStandards
— HOMEIMPROVEMENTCONRACTOR
Registration: 101609
Epiration:. 6262010 Tr# 267870
7ype:,_PrvateCorporation
A&ASERVICES,iN
Chrstopher Zorzy+ -�;
115 North Street
Salem,MA 01970 Administrator
Commonwealth of Massachusetts
Division of Occupational Safety
Lana M.Madin,Commissioner
Deleader-Contractor
CHRISTOPHER ZORZY
Eff.Date 04/01/09
Exp.Date M08/10 _
. DC0004Q
10
AManher of C.O.N.ES.T. r
BO
III III III I I IIII IIII IIII IO4I II II BOSTON-RENEW -
V
di C A & A SERVICES, INC.
S�®®
Y ICES 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.GS057733
CUSTOM REMODELING AND IMPROVEMENT AGREEMENT
Buyer(S)Name Date of Contract
ti KO,ele—n I 12-1r —i
Buyer(¢)Street Address,City,State and Zip Code
/O Gl /le/ ' -r ST C-?v! /x oC47a
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 memo of this agreement and any specification sheets(this'Agreement"l,and Suyarls)have requested that such
gootls or services be Installed or provided at Buyer's address Meted above.AAA Services,Inc.('Corllractorn,hereby agrees to install or cause to ba installed the products
or services Ilstetl In this Agreement at the Buyers)address written above. This Agreement represents a cash sale of goods and services. The Buyers)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's)may seek for their purchase.
ll�
Purchase Price. C (_ 36 Est.Stoning Date: — 4—10
Down Payment: Est.Completion Date:2-Y"/6
y� O Cash
Amount Due on Stan of Job:1 ❑Check
QQ
Amount due on_of Completion: db Car
93G3 065/3,5-ft
Amount Due on_of Completion: Expiration Date: 2
Balance Due on Upon Completion: g CVC Code: -C
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 terns 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
(1)acknowledge that they were orally Informed of their right to cancel this transaction;and(it)request that they be contacted via their
telephone numbers or e-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 TT CONTAINS ANY BLANK SPACES.
A&A S vices, c. Buyei -
�y/e ram'
Signet vL n
Print Name Print Name f
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 school odd Me somewhat hmedy minwlly sere¢In ad+Mds mat in the emdenter pall has ado"announcing me barrel either peed mar submit such module be
a private"r tim service what Ns been Vando eel by the Se core of the Erecuthe Mee of Consumer AVWM anal Business Regulations am Me Me,peed mpilll be ho ulred to submit to
such"brown as From in M.GL c.142A,
D pope. rivio al bit 1`�
/,��NOTIQF OF fANrFI I�nTpN NnTIfF nF feNCFIIe XIS1
Done of Trawctidn You may mnml the tr Ml wMON in,wrlaln Or Dare M Thousands 2-Z-y .You may camel M're benaectlm,mFd m any pens,or
smagation,w in Nreebusimndanfrommaebwadue.lty Mu l,enyprop Moaded'In, odieatm,w lnffireebuWrosadaysfrmftebavadale.pommeel,empmpegl .in,
all pavmeme made,you under Me Commot or sale,and my regoses lr ment ekacukd any payman6 mind my you under tie cwhost or Sae,and any modern inwumem esecumb
by you wall be marred wlnt'm 10 days mllowlrg receipt by me Soler d you,rencalwwn rlwca, by yes will ba returned within 10 days following m V bythe Seller M your mncelload notice,
and any aecur,lnureent"sing can of the transaction will bit excelled.If you cal you del Nm any aeour,intomm lLairg ow ame bareaa m mll w moo leel. n you aanwL you mwt
m eav McWft Selleretyalurmdde Inub ftallywgoo wMod mesh nrew . melee 0v89aN010 m05eIb 81yWr m5ubrm.in 6lr�ImtialYyw90M coMldoo BS Nino,receMtl.
a,Bores delivered ro you under has commot or ask;or you may,1 you Msh,comply wit the any 90.'ds delivered to you under Me CoMaR or bale;or you may,If you wish,mm*with Ne
iromentons of the Seller regarding me return moment of the goods at the Sellers experts¢von Missour ale M me seller ragerom the realm shipment Of 00 goods A Me Sellers exwns,all
risk. If you do asks the goods evellabk on Nit Seller and the Seller does rot pick them up dsk I you do aside Me goods woubble to Cce Seler and Me Seller doss not pi mum up
Within M days of the me N your Notice M Cancellation,you may,retain or dispose of Me goods within Be days of Me time of your Notice it Gossamer,you may retain Or memo of me game
waned any further obligegem.It you tail to now the goods waleda to Me Soler,or ll you agree WithMeny fuller obligation.Myl fail to make the mail"WMble to the Seller,or if you agree
t0 romm Me godd bAe Seger Ivd fell he do so,then you remain liable M perfonmeds,dell to ratum ill weds to Vw Bear ell fee 10 d0 W.rem you remain Ikble for pedmmvxa of all
obfpelbnsudderme Contract TDmmel Nsbmue m.mall or dMher migrant all dowel ropy obligations uMerlM Con aad.Tome-11H.trandectbn,mail ordeMereeyrred erM rlaia]mpy
of the mnmlabon mom Or airy ono,writer now.or ww a telegram,to osA servlcm.115 M tlw mxelleLLan notka or any ognr wrillm notlx,ar wnd a telegram,m A6A Servlus.115
Norm Sued,Sekm,Manufacturers 01970.NOT LATER THAN MIDNIGHT OF -2Y I 0 Hart Strew.Sam.Mwwd1Mm a 01970,NOT LATER THAN MIDNIGHT OF Z'Z
(Date) (Data)
I HEREBY CANCEL THIS TRANSACTION, Consumer's SlgreWrO Dde I HEREBY CANCEL THIS TRANSACTION. Consumer a Sigromp Dole
n. V AG�rade
®p�� ��®��{y,e ,}S'"' A & A SERVICES, INC.
A&A SE Y V ISLES 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
WINDOWS AND STORM PRODUCT SPECIFICATION SHEET
Buyer(s)Name Date of Contract
/G5R N ,ecft/E l�- -2 /-a`j
Buyer(s)Street Address,City,State and Zip Code
la ( /_L/_14M5 977.
5�c�r�(, nt4 elP?a
Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address
778 29F2 S 9n r e//�+2u�H�stos
S� -vs_a)zc-
The Buyer(s)listed above hereby jointly and severally agree to purchase the goods and/or services listed below,in accordance wit the prices and terms described on
this Specification sheet and the front and the reverse of to accompanying CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,of which this Specification
Sheet is a part.
N/INIM REPLACEMENT
�Df+ Remove and dispose of# existing windows.
t)Install # 3 new iyfrl L L/.a --- 0 windows: t�nyl f Wood
(Manufacturer)
Options: style be&,act- l�r.,--r Grid pattern
Color interior b-1 t7%r Color Exterior Lti- 7L— Glass Type A:5R_ 5 C,
t Wrap exterior trim with aluminum: Style Color
U All windows will be installed according to the installation procedures in the portfolio.
Caulk all interior and exterior edges.
insulate where possible around new units.
(,,Insulate window weight pockets if exist,and around new window units where possible.
G' Included in this proposal are set up,clean up,Helps vacuum and cleaning windows inside and out.
C>Building permit included.
BAY/BOWS/CASEMENT UNITS/ANY FULL CONSTRUCTION WINDOWS
t 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.
t Install window(s)into Gpening(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.
f Bay f Bow t Casement If Other window(s)to include new interior style trim and new exterior style trim and head
flashing as needed.
f 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).
If Install new storm doors# Manufacturer
Style Color Type: f Aluminum f Solid Core
SPECIAL INSTRUCTIONS:
��re�ft 3 C7erSncC wiL �o�-S L Give jv 1. s,7V1Le
R119IA-L ,eR!2137 -_o
/Z�L-L— M-L 1zr SR-R LM�� o6Y72tS -
it Is agreed and understood by and between to partas tat this Specification Sheet,along wit CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,constitutes
me enre understanding between the Parties,and Mere are no verbal understandings changing or modifying any of the terms. This coned may not be changed or Its
terms modified or varied In any way unless such changes are in witting and signed by both the Suyar(s)and the Contractor. Buyers)hereby scMnowledge that Buyer(s)
has read this Specification Sheet.
Contractor Initials: 1�0C Date: l2—2/—� Buyer's Initials: (f H Date: I A 21