10 WILLIAMS ST - BUILDING INSPECTION (3) A
The Commonwealth of Massachusetts
Ulf
n Board of Building Regulations and Standards CITY OF
\�IUh��/9� Massachusetts State Building Code,780 CMR SALEM
Revised Mar 2011
Building Permit Application To Construct,Repair,Renovate Or Demolish a
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date Applied:
}�grtict ►9* A367 1.7-5- ILt
Building Official(Print Name) SignatA Dale
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
40 WiUiaw
L l a Is this an accepted street?yes__ no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
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❑ Check if yes[] Municipal ❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'o ecord:
a,r(i2. 50,�-e vv, M& 019-70
Name(Print) City,State,ZIP
kn uu-,Nti 0.ms 51 . GAS- -74S=a-99a--
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction ❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ 1 Alteration(s) 211' Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work': Ca S�n1 V nv� rP0(0.[.2>v�✓t
tN i ZL c�D.NS
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1.Building $ S 9 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:S
6.Total Project Cost: $ 4943
Check No. Check Amount: Cash Amount:
1`i 3 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) (0 S�-7 -3 3 S
I- �o'lS
_CGI✓r S Zo✓-y License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) l.(
1 15 ftJ L, ✓ St-
No.and Street Type Description
✓v\ V A. O ( o U Unrestricted(Buildings u to 35,000 cu.ft.
c.J R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Mason
ry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
Insulation
Telephone Email address D Demolition
5.2 Re�ggiistered Home Improvement Contractor(HIC) to I (0 d �n
#+ ' ! rt z �CS /AC— HIC Registration Number Expiration Date
HIC Co^m9my Name or HIC Registrant Name
�and t eet
q Vln n 19-70 � 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 .......... No...........0
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 Gh r i S
to act on my behalf,in all matters relative to work authorized by this building permit application.
<e k-"-CkLi I -9 - 1 `}
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contai - in t is ap lication is true and accurate to the best of my knowledge and understanding.
;Prin wn 's or Author' ed Agent's Name(Electronic Signature) Date
NOTES:
I. 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 can be found at
www.mass.,ova Information on the Construction Supervisor License can be found at www.mass.eov/dps
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"
A4 d
/�,, C Also.
e A & A SERVICES, INC.
A&A SERVICES 115 NORTH STREET,SALEM,MA 01970
r.grepJAIMBITAllas• 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 HEET
Buyer(s)Name Date of Contract
G(ntflle f1t�IRr aod MTV �orie,frl
n
Buyers)Street Address,City,State and Zip Code
D 1.04111aMs le,, - 0/
Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address
a.:
The euyar(s)listed above hereby jointly and severally agree to purchase the goods M RE services G AN below,In VEME T A 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 Spechcation
Sheet is a part.
WINDOW REPLACEMENT
ei-4emove and dispose of# V�r existing windows.
I Install # newjJ e(105' windows: ®vinyl t Wood
` (Manufacture n/ I^
Options: Style T)du y Awl' Grid pattern No �S
Color Interior Mir 1,1 t til Collor Exterior iA/�l I '1@ Glass Type R !K p -hiipc
� Q Al
If Wrap exterior trim with aluminum: Style Color i<l
Ct,-'AII windows will be installed according to the installation procedures in the portfolio. '
Caulk all interior and exterior edges. // S fi I Sl
t Insulate where possible around new units.
It Insulate window weight pockets it exist,and around new window units where possible.
Included in this proposal are set up,clean up,I vacuum and cleaning windows inside and out.
i Building permit included.
BAY/BOWS/CASEMENT UNITS/ANY FULL CONSTRUCTION WINDOWS
t Create new window opening by tuning through existing home and framing in opening.
t Remove and dispose of existing units)in its entirety.
Note:Electric and plumbing may exist in wall and will require additional costs to customer if need to be dealt with.
It Install window(s)into opening(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.
It Bay t Bow t Casement t Other window(s)to include new interior style trim and new exterior style trim and head
flashing as needed.
If Note: Painting and staining not included.
STORM PRODUCTS
It Remove and dispose of# existing storm windowls).
It Install new storm windows# Manufacturer
Style Color Option
t Remove and dispose of# existing storm door(s).
It Install new storm doors# Manufacturer
Style Color Type: t Aluminum t Solid Core
SPECIAL INSTRUCTIONS:
e �e 2x{��iorI _ �31tn�54nos n ,v 1,411 kil
A`LrL G'OM DO S I'1� l.✓ t '�rf -�- C'4 U l k pal b.Q S
It Is agreed and understood by and between the parties that this Specification Sheet,along with CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,constitutes
the entire understanding between the parties,and there ere no verbal understandings changing or modifying any of the terms.This contract may not be changed or Its
terms modified or varied In any way unless such changes ere In writing and Signed by both the Buyer(e)and the Contractor. Buyers)hereby acknowledge that Buyer.)
has mad this specification Sheet. //////
Contractor Initials: SL. Date: -0L/-- Buyer's Initials: Z__ E Date: J(f 1-7 Iuli
Fj
/1 A & A SERVICES, INC.
AsfA SER r 115 NORTH STREET, SALEM, MA 01970
Telephone:(978) 741-0424 Fax: (978) 741-2012
Contractor Registration No. 101609
Construction Supervisor No.C3057733
Federal EIN: 04-3090162
CUSTOM REMODELING AND IMPROVEMENT AGREEMENT
Bu e s Name _ Date of Contr 1
e o r;e i
Buyerls) Street Address,Chy,State and Zip Code
14
5+ - ` �, .(� . Uts76)
Da ime Tele hone Number Evenin Telephone Number Mobile Telephone Number E-Mail Address
7
The Buyers)listed above hereby jointly and severally agree to purchase the goods andlor 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'AgreemenP),and Buyers)have requested
Met such goods or services be installed or provided at Buyer's address listed above.Al Services,Inc.('Comractort,hereby agrees to install or Cause to be installed
the products or services listed in this Agreement at the Buyerts)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 Buyers)may seek for their
purchase,
1.91
Purchase Price: A, gi67,yi Est.Staling Date'
Down Payment: T[T��/�C(/ _� Est Completion Date:
7 Qt Ca
Amount Due on Stal of Joe: Ed/1'1 f9 eck
Credit Cartl
Amount Due on of Completion: - 73�to
i 3 0 W-�
Amount Due on_of Completion: /x�,� EkPiretion Date'--6-7zV,—
Balance Due on Upon Completion: �2 CVC CodeI Lori
K Is agreed and understood by and between the polies that this Agreement, front and back and any addendum, constitute the entire
understanding between the parties,and there are no verbal understandings changing or medifying any of the terms of this Agreement Buyerts)
hereby acknowledge that Buyers)has react 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 data that written above.Solvents)also(i)acknowledge that they were orally
informed of their right to Cancel this transaction;and(il)request that they be contacted via their telephone numbers or email,as listed above,in the event
Contractor believes Buyerts)would be interested in any additional quality products or services of Contractor.DO NOT SIGN THIS CONTRACT IF B
CONTAINS ANY BLANK SPACES.
A&A Serv' es,IBe. Buyers)
By: ei
Si nature
Signature
.,�
Print N TIC —� Print 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:Ted convedar,and Ue Mosownar hereby mutually agree in advance that In Pe event either Deny has a eispNe concerning Ills mnbad,either parry My submit such depar,to a
private a..,.n aeMw(rid,has bee..,Waved by Ne Semetaryol Ne Executive Otte¢of Consumer Atlatre and GBusiness Regulations and Ne other pmly shall be required I,sufml to such
a..-es prevM in M GL c.142A. 1[ C— I-A
Cn � Buy[ry unit,I[ I
D.e:
NOIICECFCANCELLATION N TIL OF CANCELLATON
Dale of Traffic a 7 as y..voa may.vandal uaz ua�sacoon.wltnay ear penalty o Data m Tom...,. / 7 � mar ranml mIz nareramm.willwm am cenalty or
obligation,re;simhre. days from me abofe a:ie.If randel;:rev Drepemaadad m, oblie.tion,wilmn mreee ne eayalomfheahwedole.nyuranwtanrpreereaddir
anypaytm a merneebyyoo under are Correct orS.R,and any negomble inswtmm xem are eted any payments made by ym under Consent m sale and any negotiant¢ me mawmexecuee
W you.ngb.shared Athm 10 days mnowng raceipt by me seller m your wmmorenmace, by you.in be returned frontier 10 days agree,remio by me Seller of Your canrellation notice,
and any sewefy innerest aching and m me monsoon fail be Modified.It You ca rel,you mum and any semnry imerem awing out of me WeisaNm fin be rsnwuee,It you ra cel'ryu must
Mae available ed are Seller at your residence,and substant kily In as goad wndNon as when make available Io the Seller at your familen®,and substantially in as good condition as yean
Caved any goods delivered W you under may Contract or SBIB:Or YOU may,11 you wish,comely draddeved.any goods delivered W You under its Conked an Sale:or min nay.it you Msh,cprely
MIh the instructions of the Seller regedmg the rein shipment of the g-do at IM Seller's vent the instruc0ms of the Seller regarding ad return shipment W the goads at me Ever a
expense and ask,If you do make the gw]s...liable to the Seller and me Selic aces rem pica expense and risk,If You do make the goods available dome Seller and me Seller does not pick
menu,Mihin 2n days Dime dam of your Notice of CancNlaaon,yaumreY reteinmtlisreca ollhe them up wfmin 20 days of the date of your Notice of Communion.you my rater or disposed
goods without any Inner obiigation.If You mil Weeks me golds availade to the Salon or it you me grads and oN anyWMe obhgaaon.Il you oil to its theca avelade to the Seller or if
egme to realm the goods to the Soler and tail W do so,men YOU remam liable for cedomance of you agree of return fine goods W me Seller and fail to do de,teen You reman liable for peawmenm
all obligations under me Contract To cancel this transaction,nail or deliver a signed and rated of all Obligations under the cocoon To Moral Nomosactim,nail ardelivema greed and dated
deny 0l the reralladon noted or any other wa n mddo orsenls.1did ra ar Services, copy of To ranrellatim no0ce or any omen vniden notice or Mi aHegram A8A
115 North Street Salem MA0t W0,NOT LATER THAN MIDNIGHT OF�y— 115 NOM 5ireet Salem A41019]O,NOT LATER THAN MIDNIGHT OF
of me
I HEREBY CANCELTHRTRANSACTION I HEREBY CANCEL THIS TRANSACTION
Cwsumerds"makre Dnle: Consmrers Signature Date'.
Di POsAL OF-DEB IS AFFID,�-VIT
In acc®r'danoe with the provisions of K lea L. c,40, Sec, 54, a cond"'ion 619 .
Building Permit Number is th I r i�dd� result
ing from this wDit sh ii
be disposed of:In a properlytloensad'facility as defined.by M 0. Lo �0 9 9, SAID.
ISO&
Ths-debris will M dis Dsed ate sa&am
Carfla
Signature V,Pei ®pliant
Date -71
Name ®f Pormit Applicant .
A &A S&rU12ase inpo
Firm
HOEth MEMOL 8210Mo MA 0i�a0
AddraRsq C!4o State, dip Code
.F .vv: + •, -. r", , ` •nl Hi r'x' •ai ' 1d1 2'. ks' rv'S «>"°" t' Y
,. THE COMMONWEALTH OF,MASSACHUSETTS
EXECUT V2 OFFICE OF LABOR AND WORKFORCE DEVELOPMENT
,1. DEPARTMENT OF LABOR STANDARDS
19 S'TANIFORD STREET,BOSTON,MASSACHUSETTS 02114
DELEADER CONTRACTOR LICENSE
A&A SERVICES,INC.
115 NORTH'STREET• ,
SALEM MA 01970
LICENSE. DC000440,, EXPIRES: Saturday,June 07,2014
IN ACCORDANC&WITH M.G.L.CH. I11, § 997B(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 NfUST BE MAINTAINED BY THE CONTRACTOR WHEN ENGAGED IN DELEADING
WORK IN ACCORDANCE WITH M.G.L. CH. 11 I § 197B(b)(2)AND 454 CMR 22.03.
r
HEATHER E.ROWE,DIRECTOR,
u
e�poncm:o-,zuealC/a�UL�waaefreuetla 111MI Massachusetts -Department of Public Safety
Office of Consumer Affairs&Busihess Regulation Board of Building Regulations and Standards
OME IMPROVEMENT CONTRACTOR Construction Supervisor
egietration 101609 Type: License: CS-057733 k
xpiration: 6f26/20]4_ Private Corporatie ,-
` � CHRISTOPHER ZORZY
A&A SERVICES I
115 NORTH ST _
- Salem MA 01970�
Christopher Zorzy
115 North Street — �'+
Salem, MA 01970 - - i 95/1 jJ/ y- '� Expiration
Undersecretary 05126/2015
Commissioner
I
la+c; i4`y 1292.7 -
(8fl) 174-1274 :a
� m
ly 3 I
Christopher Zorzy #20 E20 26000840
- OB
A&A Services Inc6/2017
115 North St
Ct n paT=IDSalem, MA 01970 'Matthew J Glbson
ra,�n cuiractrriova�
SFr
3 The Commonwealth of Massachusetts
dal Department of Industrial Accidents
office ofinuestfgadons
600 Washington Street, ;'I'Floor
�q Boston Mass. 02111
Workers'Compensation Insurance Affidavit: Building/Plumbing/Electrical Contractors
Applicant information: / I Please PRINT legibly
name: C n /hla r e� Lt) ZX,
address: /�J l o r I li sh- & r� p
city a 12 V state M A
work site location(full address), �O JA)I O I GI e�S S'f- `7Q�-Q v[n f•c �97d
❑ 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. ElBuilding Addition
F, I am an employer providing workers'compensation for my employees working on thisjob.
company name:t''A -F �4- r���•IrrV-!
address: f l ..J lv0 ✓�nf ,Iny (']-7 p [ ' / �7 /
city: S a � e ("I /44 phone#, -t r 0 - 7 (�}" O W-
insurance co �-�-.1/ T-�'0.U2I r- ',$ nolicv# �e ry
❑ I 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. - policy#
company name:
address:
city: phone#:
insurance co. Policy#
Attach additional sheet if necessary
Failure to secure coverage as required under Section 11A of DIGL 151 can lead to the imposition of criminal penalties of fine up to$1,500.00 and/or
one years'imprisonment as well as civil penalties in the form ofa STOP WORK ORDER and a fine of$100.00 a day against me. 1 understand that a
copy of this statement maybe forwarded to the �fiee of Investigations of the DIA for coverage verification.
I do hereby/certify un a th pains and p nalties of perjury that the information provided above is true and correct.
Signaum Date �ry�9p' ( I, /
Print name �.. ✓% f�00 OYZ../ Phone# f7O -77 -QZ,-V
official use only do not write in this area to be completed by city or town official
city or town: permit/license q _
❑Building Department
[]Licensing Board
❑check if immediate response is required ❑Selectmen's Office
❑Health Department
contact person: phone#; ❑Other
(revised Sept 2003)
30
pq� 19 Phone: 978-741-0424
-2012
A&A S \e S Fax: 9vlces. om
www.a-aservices.com
115 North Street
Salem,MA 01970
January 10, 2013
City of Salem
Building Dept.
120 Washington Street
Salem, MA 01970
To Whom It May Concern:
Enclosed please find the permibapp ical 'tion for Charlie Heaps, 10 Williams Street,
Salem, MA to replace windows.
I have enclosed a check for$47.00 based on your fee schedule of$7 per
$1,000.00 plus a $5 administrative fee. The total for the job�was$5,943.00.
Please send the completed permit� to I, A Servil ces, lnc. at+115_North Street,
Salem, MA 01970. /
If ou have any question' s, please contact me at (978){r741;0424.
Thank you�for your/assistance. �J
Sincerely,
n F
Barbara Z zy
Office Manager
Y
Cf �
p[+1