13 WILLIAMS ST - BUILDING INSPECTION (2) DATE:_
. itp Of `er7 YPlTC, a aL U Ptt�
a
PLANS MUST BE FILED AND APPROVED BY THE
INSPECTOR PRIOR TO A PERMIT BEING GRANTED 1
-
Location of Building_/3 W �/ arn5 S�Qe-{ .
Building Permit Application For:
'(Circle whichever applies) Roof, Reroof, Install Sj�Deck, Shed,Pool
Addition, Alteration, epau/Replac Foundation Only, Wrecking
Other. :4
PLEASE FELL 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:_b�LyVV b ow Arl eS Contractor: A 2 A 5ervice5/(!4n5 fd r7
Street_1,3 City eM Street 15 Nnr4h 5S . _City (gym
State Phone 0q q45-9y(nS State MA Phone- N78) 741:7-Q- AH
Architect: City of Salem Lick NQ5
Street City State Lic � HIP# 10I to 09
State Phone ( ) _ Homeowners Exempt Form_yes_.kl no
Structure: (please circle) mgle Family, ulti Family# Other
Estimated Cost of job S-4 000. 00
Will building confirm to law?_yes no
Asbestos?__yes✓no
Description of work to be done: Z951 U 11 {7 Ve_ I!5) Vll)LL! V v 0/C2l'n M e e7'
U
1A)IrdOt t 15.
A&A SERVICES, INC.
Drawings S mi ed:_yes no Mail Permit to: SAL_EK I A_01970
% _ lo7a�7
41 0 424,_.
}( WWW�- A-AHD
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 Mep/Lot
Permit fee$
COHMMS:
j
No. cog/-per
APPLICATION FOR
PEAW TO
LOCATION ,t
PEqM.IT GRANTED
LROVAfD
INSPECT , OF BOIL NG5
CERTIFICATE of OCCIIPANCY .
YES _
NO
i t
1
{-t ..�. { ..� •k -
The Commonwealth of Massachusetts
III W
Department of Industrial Accidents
OfceofInvestigations
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/Organization/Individual): A Q A Se-r vi GQ ,Ty-)0
Address: lip; Q or+h 5brr e+
City/State/Zip: 5Q ( Ll`A , M 11' 01970 Phone #: / 01'%`b 1 211 —DH 9,�A
J
F
an employer?Check the appropriate box: Type of project(required):
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
I am a sole proprietor or partner- listed on the attached sheet. t 7• ❑Remodeling
ship and have no employees These sub-contractors have g. Demolition
working for me in any capacity. workers' comp. insurance. 9. Building addition
[No workers'comp.insurance 5. ❑ We are a corporation and its
required.] officers have exercised their 10.❑ Electrical repairs or additions
3. I am a homeowner doing all work right of exemption per MGL 1 LQ Plumbing repairs or additions
myself. [No workers'comp. c. 152, §1(4),and we have no 12.❑ oofrepairs
insurance required.]t employees. [No workers' 13 Other
comp.insurance required.]
•Any applicant that checks box#1 must also fill out.the section below showing their workers'compensation policy information. --
t I lomeowners who submit this affidavit indicating they am doing all work and then hire outside contractors must submit a new affidavit indicating such.
(Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information. t
—f�"
Insurance Company Name: t r e-- Tm VO I P
Policy#.or Self-ins. Lic.M. C Q %3q X 12 Cp Expiration Date: q 13 O-7
Job SiteAddress:_3 M111611'Y15 S{ re + City/State/Zip: ,4S9IGlMI ✓ )n 01970
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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certly,un a th pains and penalties of perjury that the information provided above is true and correct
ISi nature: Date: -d
I Phone#: 9 1$ /4 — 0K9AJ
FFContact
only. Do not write in this area,to be completed by city or town officiaL
n: Permit/License# _
hority(circle one):
Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
son: Phone#•
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 anytwo or more
of the foregoing engaged in a joint 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 burn 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 5-26-05 Fax # 617-727-7749
www.mass.gov/dia
• e e
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 the debris resulting from this work shall
be disposed of in a properly licensed facility as defined_by M. G. L. c. 111, Sec.
150a.
The debris will be disposed at: Salem Transfer Station
owned by Northside Carting -
Signature of Pe it Applicant
Date
Christopher Zorzy
Name of Permit Applicant
A & A Services, Inc.
Firm Name
115 North Street, Salem, MA 01970
Address, City, State, Zip Code
�'/ae TOomnwruoe� o�./�aaaac%uoelld
• Board of Building Regulations and Standards
Construction Supervisor License
License: CS 57733
y f
8irffiila3e V5/26/1958
I �tfon /?r¢/2009 Tr& 13739
PKilark-tib 001
CHRISTOPHER
115 NORTH ST •\gi .rj�_ �i/J
SA.LEM,MA 01970 `—'� Commissioner
Commonwealth of Massachusetts
Division of Occupational Safety
Robert J.Pre=o,Commissioner �u
Deleader-Contractor
CHRISTOPHER ZORZY
E Date 04/0 /0
AIML
Exx p.Date 04/01/0
8
DC000, 90
Wmberof C.O.N.ESX. 0
" f
BO
IIIIII IIIII III�IIIII IIIII III�IIIII IIII�IOII I�IIIuI �BOSTON-RENEW
i. q Tie YG'GN'skA'i09ww,OAr�c o�,a22o4Q[rC�L[t6E(�`L -;' �
Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registration 101809
Expuatwn 6/26/2008 I
Private CPrporafion
RA&A SERVICES INC;; -
{ Christopher Zorry -
' - 115 North,Street.
i Salem;-MA 01970 Deputy Admmmtr .'lor
AA & A SERVICES, INC.
A&A S CES 115 NORTH STREET,SALEM,MA 01970
Telephone:(978)741-0424 Fax:(978)741-2012 r „
Contractor Registration No. 101609
Federal EIN:04-30 901 6 2 Construction Supervisor No.CS057733
WINDOWS AND STORM PRODUCT SPECIFICATION SHEET -
Buyers) e / Date of Contract _
�✓iG1 /YC.S - d
Buyers)Street Address,City,State and Zip code
Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address
The Sevens)listed above hereby jointly and severally agree to purchase the goads anNor services listed below,in accordance with the prices and temre 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 pan. '
�� WINDOW REPLACEMENT
Zm Remove and dispose of# existing windows.
❑ Install # 1� new S'vn rf.,, windows: Vinyl ❑Wood
��5� (Manufacturer)
Options: Style & Grid pattern
olor Interior / Color Exterior �'1^ Glass Type L _
Wrapexteriortrim with aluminum: Style d_ CePgIE Color L-,1s°A2
Mo
I windows will be installed according to the installation procedures in the polio. `
Caulk all interior and exterior edges. d !,JQ
i r Insulate where passible around new units. L — ✓3.,e„
yr Insulate window weight pockets if exist,and around new window units where possible.
veluded in this proposal are set up,clean up,Hepa vacuum and cleaning windows inside and out.
Building permit included.
BAY/BOWS/CASEMENT UNITS/ANY FULL CONSTRUCTION WINDOWS
❑ Create new window opening by cutting through existing home and framing in opening.
❑ 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.
❑ Install window(s)into opening(s).
Note: If Bay or Bow installation to include cable support system,new root system(matching color as close as possible)
or tie into existing soffit system.
❑ Bay ❑Bow ❑Casement ❑Other window(s)to include new interior style trim and new exterior style two and head
flashing as needed.
❑ Note: Painting and staining not included.
STORM PRODUCTS -
❑ Remove and dispose of# existing storm window(s).
❑ Install new storm windows# Manufacturer
Style Color Option
U Remove and dispose of# existiny storm door(s).
O Install new storm doors# Manufacturer -
Style Color Type: ❑Aluminum ❑Solid Core �7
SPECIAL INSTRUCTIONS:�hL ' ���- //
/% 414
/
It Is agreed and communal by antl ba veam nn pamm that mi.SpacMpatlan Saai along with CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,amennuter,
the entire understanding between me parties,and More are no varied understandings changing or modifying any of the same.This Contract may not be changed or she
terms modified or varied In anyw unlace such changes are In writing and Signed by both the Bunate)and tee Contractor.Buyerls)thereby acknowledge Nat Bayer,.) _
has hired this Specification s Contractor Initials: Date: Buyer's hridals: b —A- Date: V ��7
,, /� �9 A & A SERVICES, INC.
A&A ICES 115 NORTH STREET,SALEM,MA 01970
� Telephone:(978)741-0424 Fax:(978)741-2012 a
Contractor Registration No. 101609
Federal EIN:04-30901 6 2 Construction Supervisor No.CS057733
CUSTOM REMODELING AND IMPROVEMENT AGREEMENT ,
Buyer(i)N e Date of Contract
Buyers)Street Address,City,State and Zip Code
Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address: w
III 9 Fr�S�� 9Y1o5
The Buyers)listed above hereby jointly end Severalty agree W purchase the goods and/or services listed On to accompanying specification sheets,in accordance with
the prices and terms described on me front and the reverse of this agreement and any specification sheets(this"Agreemern,and Buyers)have requested that such
goods or services be installed or provided at Buyer's address listed above.A8A Services,Inc.('Contractor'),hereby agrees to install or cause to be installed to products
or services listed in tie Agreement at the Buyers)address anthem above. This Agreement represents a cash sale of goods and services. The Buyers)agree to pay in
cash the mat of to goods and services purchased
off deewirribed herein,regardless of timing or approval of any financing Buyers)may seek for their purchase.
Purchase Price:..2rr<L„L_ n / Est.Starting Date: ,7�-asn
7// /��
Down Payment: ^' y SOU Est.Completion Da�te: a� _
OLrash �Oil
Amount Due on Stan of Job: Check
//Pr/) ❑Credit Card I S Q
CAmount due on/ of Completions0 No.
Amount Due on of Completion: Expiration Date:
Balance Due on Upon Comp ll��letion:a�CQa CVC Code:
I it Is agreed and understood by and between the portico 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 Buyer(s)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(ii)request that they be contacted via their
telephone numbers or e-mail,as listed above,In the avant Contractor believes Buyerts)would be Interested In any additional quality
products or services o n actor. DO NOT SIGN THIS CONTRACT IF IT CONTAINS ANY BLANK SPACES. ^ _
ll� A&A Services,or
c. Bayer(s
By:
Signature Signatu ,
Print Name _ Print Name
ll l.l' Signature
Print Name - -
I
You,the Buyers),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.
AaenRAnan:The manor ono ma nwnvxre,nereby mulualM egnoe in aMenw uu In Ina nam miner a abpuu m i,y'feeuml e'fee e ter l,ea pond may auemn euah abpub of
a prvaM1 amarapan Mu ee wri wa d,her been appro by Be eevelary mare OXFB OI CCnau Hv mbA Rand B+'nev Repula and mor pany Nall way waranowl sweradto
a df an ae p,oweamrn.o.L
caw.w m:aw: earanhi
D.N: o.r�
NnrrF nL(�gEl_T OrJ NOTICE OF CANcEwTION
te d Da Tner per ar�C]�
.L—.Yrw may earcN Mr.o-aneaetwn,without any pnaM or oN d Torwasa n .you mey rams N3 normal w roar any parity a
ahlga4an.worm twee,befinxv can"a Me aM'a rime.It you cal end amper,lreaaa in, obllgatbn,amn man bwr.drys hoer me..dab.it You rem,any,prober,tweade,
any parmence...by you under Me Contactor sale.and any Unmade inebumem mxvM any daym.nte made by you anax the Corked meal.,and re
liable elia m ble moment a:ivW
W^xill be bWmeaw in la card wimne mmlpl by ilia Sean of your cancoabn mad, W you vsll be ransom Winn to dan foaming more by to Serb,of your tlnudlatlon mtice.
rvN mt/56:u,ily imiandinury w1.1tral 9utla,wil,beoencelltl.Il Yeu camel,You mum and cry aeadN lmomar a/Iaing oat m No M1M..wA Wrvlwbod. ltyoa a arml,nu mutt
mew au.to me say.myas miaerw,N wNurleelry we goad....as.named. ree. Yeabw to me ea0n ad yourrmtlerce.in wbanaalM as Boas awal ea wren,cerium.
any pa daliveM ro you under sea conhad or Saw:a you may,it You wish,mm"M the any Saes a&rvared to you under Me Cormed,or ems:a you may,H Ni wish.amay win me
IrrsOu n.of Me Bear regaMap Me note.Mlpmanr,M Me goWa as do selleri evpenaa end Inam,one be m seller regarding Me warn anownew m Me Scope of Hw Seller elaenw and
,tole H you so way me pools aastatle to be Seller and Me SeINr does nor pkk mom up reK H you m.aka NB S0.tle avaiwble b Vie$ewer aW Me Sella dJe9 rM pbk Mem up
.in al days of Me data of your Note9 of Caweeadow you may.win in d¢gagol Me Bps men So Men of Me sae W vtu Notlm d Canmlwtlm,y—my man a means of to Mood9
vnMON cry NMaooagabpn.IlyW lyllo make ma gCWa evyleble.11le Seller,gilyou eplae armour a,y pacer preform.if you ON W make Me goMs sweleble to new Sets,or it you aSM
Io team to foods.1.Be.and tell b do w.dow you remm liable to paft.YMa of ml 1.AWm Map 1e tO me Seller and we to do do.Man ywa...rapid for pmbrmanad M all
obligation under Me contract Ta rarlml the trawasnow.mat m delMr a spred ado mod my congadrap under they Contra,To cancel me amount mat Or bear a signed mot dmBd Wpy,at ad aB aanMllefon MXCB or mr mha written Neste,w eeM a blprLR b PBA 115 0l Me CaMl'at—or bly omb wMBn mea a Sans a Reform,to'���' na
Nam Sbeel.Stlere.M--pleaalb 01970.NOT t R THAN VdMIG11r OF NqM Baea,Sewm.Alavwchwdm Oncra.NOT L WIN LITER T WONIOM OF,Q_��
laalel mate)
I HEREBY CANCELTNIS TMNSACTON. Cwuurnneagnafure Oma HEREBYCM'CELTHISTRANSACTION. Coneumeh SlgnaWn Date