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8 CUSHING STREET - BLDG. JACKET 8 CUSHING STREET IMMM9 l CITY OF SALEM BUILDING DEPARTMENT 'ri GTf�N si r : . 120 Washington Street, 3rd Floor, Salem, MA 01ATq FEB 21 A 4 49 ABANDONED AND FORCLOSED PROPERTIES REGISTRATION FORM PROPERTY INFORMATION Address: 8 Cushing St, Salem MA 01970 Parcel ID # Map 17 Lot 171 Square Footage of Building: Number of Stories: 2 Sprinkler System: Yes_ NoX (Operational yes/no) Pipe System: Yes_ NoX (Operational yes/no) Fire Detection System: Yes_ No X (Operational yes/no) OWNER(S) -OF RECORD ("attach additional sheets if necessary) Owner: Barbara St Pierre - c/o Financial Freedom a division of CIT Bank N.A. Address: 2900 Esperanza Crossing, Austin TX 78758 Tel. No.: 800-441-4422 E-mail: FF_PropPres@cit.com CONTACT PERSON/REGISTERED PROPERTY MANAGER Name: National Field Representatives Inc Primary Address (No P.O. Box) 136 Maple Ave, Claremont NH 03743 Business Tel. #: 866-966-0789 x3211 Non-Business Tel. #: E-Mail Address: VPR@nfronline.com Emergency Telephone# - 24hr/day 866-966-0789 IS THE PROPERTY LISTED FOR SALE? Yes No X If yes, Real Estate Agency Address: Tel. No. VACANT BUILDING PLAN: Please check which applies. 1. The building is to be demolished. 2. —The building is to remain vacant. Building is not vacant, but in foreclosure. 3. —The building is to be returned to appropriate occup ncy SIGNATURE OF OWNER(S)/OWNERS AGENT: an agent of Nations Field Representatives for FFSH DATE: 02/24/2017 REGISTRATION FEE $300 Check Cash/Money Order/Cert. Bank Check _ •&y • • • • • Inti y X. '.n +t ,` *. �U'rr�yy'4� kY�Clare', r �k. x��1r'r��yg, �'n'�t� �� ^1 7564 � ei� onto 7 VB t NATIONAL PIEiD REPRESENT TIVES,INC �Savmgs Bank F � r a54401912117 c "� r a ^'* a gy z. .. t ' PO*B0X 1480 s x i z "" '.+t, '� �'!t+' r .t• n i , 3w" � &AkbMbw,NK03Y431460 4'.:P,2(24/2017 1 ,I .?M�k"„n --ff. t' ,yF '(�+ T`x y� .. ��` aF�,''`^'�r''sf' 'ic li"`.!" '.y tfi " e M"-++'a.f"'r" 4' ' f F '�h'� .. t I, 3 aM..tr y >44 JM . x v 3x" i� �`x , d .tt 'Ya ,"'6 'iu E ^F 3 ' 3qy s' .* '• §l �$ w K � +t x s x rkq°sem a s * *M0 00 *s e, a ri"".'Fag „, Cxw r`Sr nv a ts$,r 'G` s^ Yx 4,1011 a `K gr xT5 '1c $w ex.. PAYTO THE r� City of Salem r uF./ � w!`r`.+s ej-x'` m 5**" 4 & !, +w ts+ ORDER i. ,�_ �.v �8r� ,a,�asL,i6 �'�' �Tti`ree Hundfed antl 00/1"00++ •+ ;+++++ ++++ g+�++++++++t+++ ++ pOLLARS w .. w7 # `'ro,A � 7t r�r1s4r 3` - � £94 , '3r av "g; !ikw, FCityOf,Salem ra1.'rn+P�. >. t � F L `' r i'i�?` i "�`�^° �`� x ,ss �, i'�'§� J "gi,K .w '�''m't�'•fi �� °:$,'�.f� il$ c Y r 1 0 'NP i•�, �� 4 � i �,o�,� k 3 e'`'"�s 9 r '�P, ' '` a.,[�v r r+! :r b- '� �M +�'"�y� gip` T %',ty�j(` �`au.:�ri s�i'��vs. ra(C� '�i, ��"rr�.F 4+m�'x"k�+Sr€ �x q. ��r �1 � �5`5,1•+ �F t#.K ��,� u'hr ''e �+�ii r§,� � a .' # MEMO s� "M u'OL456411' 1: 2LL470L90i:940709211' VBR 17564 NATIONAL FIELD REPRESENTATIVES,INC. 2/24/2017 City of Salem Origin Date Type Reference al Amt. Balance Due Discount Payment300.00 300.00 300.00.0 0 2/24/2017 Bill VBR Check Amount 300.00 _. :CSB=VBR Checking`"€ WO#263433 8CUSHING STREET Salem MA "w 7 + ,' R , _ Yi + „` .� 3000, 000 . f r+. cite of jttlem, Mttssttr4usetts � rro Public Prupertg igepartment Nuilding Department {One #atom C6reen 506-jai-9595 €xt 390 Leo E. Tremblay Director of Public Property Inspector of Building Zoning Enforcement Officer August 21 , 1997 David McNeilly Salem Realty Trust 8 Cushing Street Salem, Mass . 01970 RE: 8 Cushing Street Dear Mr . McNeilly: Thank you very much for your response to the letter dated on June 11 , 1997 regarding the above mentioned property . An inspection was conducted and found all the violations have been corrected. This office will notify all the appropriate departments and the Ward Councillor that this situation has been brought to a satisfactory conclusion . Sincerely, �ELeo E . Trembla�j Inspector of Buildings LET: scm cc : Jane Guy Councillor Flynn, Ward 2 Cnitu of 034ttlem, MnAsac4usetts Public Propertg Department Nuilbing Department (One *stem 016rern 508-745-9595 Ext. 380 Leo E. Tremblay Director of Public Property Inspector of Building Zoning Enforcement Officer June 11, 1997 David McNeilly 8 Cushing St. Salem Realty Trust Salem, Mass. 01970 RE: 8 Cushing Street Dear Mr. McNeilly: Due to a complaint received by the Neighborhood Improvement Task Force, I conducted an inspection and found the following violations: I have found the garage located at the above mentioned location to be unsafe. You are ordered to remove said structure by means of demolishing, or you must submit architectural drawings to this office for repairs. Please notify this department within five (5) days upon receipt of this letter, to inform us as to what course of action you will take to rectify these violation. Failure to do so will result in legal action being taken against you. Thank you for your anticipated cooperation regarding this matter. Sincerely —� Leo E. Tremblay Inspector of Buildings LET: scm .cc: Jane Guy Councillor Hayes, Ward 6 Health Department Fire Prevention • CITY OF SALEM NEIGHBORHnOD IMPROVEMENT TASK FORCE Jurisdiction Rist. Comm. Yes (3 N REFERRAL FORM Cons. Coram. Yes O ° SRA YES d Date: Address: TC/ �G_ Comoiaint: c 1 r) 7� 2el-) Cl1 .�G �rC� n�izr�n�i� rc�rt n /J � Oi ✓ !c/ P ikt `� 6 fwk, 7777,1 belle,, fJ/71✓ f f'7,O G' tY= 1LOf /�2 :GAJ '��"�� t/iL YJ ctr c (tet r Compiainant: f�i+1T f� r 1rYlJ/� Phone#: Address of Complainant: /�rr�✓J�� - � $UILDING INSPECTOR KEVIN HARVEY FIRE PREVENTION ELECTRICAL DEPARTMENT i HEALTH DEPARTMENT C= SOLICITOR ANTMAL CONTROL SALEM HOUSING AL=RPPY PLANNING DEPARTMENT POLICE DEPARTMEM' TREASUR RICOLLECTQR I ASSESSOR WARD COUNCILLOR t� Q DPW SHADE TREE ( DAN GEAR,Y PLEASE cHECK THE ABOVE REF C COMPLAINT AND RrSPZ5ND TO DAV} WITHIN ONE WEEK. THANK YOU FOR YOUR ASSISTANCE. ACTION: �i The Conunomcealth of N1assachusetts �\ BourJ of 131,111ding Rrgul.utuns and Standards 'Nit NI( IP \I Il )' �Y blassaehu Bu sCUS State ilJutg Code. 780 CNI 7" edition 51! Building Peanut Application To Construct. Repair. Reno�me Or Demolish a h n.J.L uuiu: i One- m Tit v Family Dttvffin,G This Section For Official Use Only ---- —" _� Building Pzrmi[ Number: /f Date Applied: attre Building Conunissiuned Inspector of Buildings Dale SECTION 1: SITE INFORMATION _ 1.1 Per crO , address: _ I_ 1.2 assessors Map & Parcel Numbers 1 ---- I.Lt Is this an j,:ce[)1red sine[? yes--../— nu hla— P Numher P:ucel Number 1.3 Zoning Information: LA Property Dimensions: Zoning District Proposed Use Lot Area(sq tl) Frontage t It t 1.5 Building Setbacks (ft) Front Yard Side Yards - Rear Yard Required Provided Required Provided Required Pru<i.led 1.6 Water Supply: (M.G.L c. 40. §54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone' ,Municipal ❑ On site disposal systcnp ❑ Public❑ Private❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 1 Owner'.of ecurd: Name(Print) �otk Address (or Service: rn°� vU (q�8� 7tiJ-1 — 5 057 Sienature Telephone SECTION 3: DESCRIPTION OF PROPOSED WORK (check all that apply) .New Construction ❑ Existing Building ❑ Owner-Occupied ❑ Repans(s) ❑ Alteration(,) Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Speciiv: Brief Description of Piopued Work: SECTION 4: ESTIMATED CONSTRUCTION COSTS Estimated Costs: Official Use Only Item (Labor and Materials) I. Building 5 I g I. Building Permit Fee: $ Indicate how fee is deter mtncd: ❑ Standard City/Town Application Fez 2. Electrical b ❑Total Project Cosh (Item 6) x multiplier x 1. Plumbing 5 2. Other Fees: S 4. Mechanical (HVAC) It List: " � —--- i. Mechanical (Fire I - 5 I Total :\II Fees: 5 Suppression) - Check No, Check .-Amount (':uh b Total Project Cost: M Q ! J �U � ,� � 0 Paid in Full ❑ Outstanding Balanrr Due:__ I SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor ICSI.) License Number Date rh Names LI_- Ilul M V] -To C'SL'I'c(e (co hrlm l _ \d rc rl Tye Desrri �uon L ('nrestncicd up w 35.1100(-u. H R Restricted I.@'_ fanuh D,krllme . nag rc - .\1 \gaunt llnlr 12C Re,idrnu:J Routine ('u�crm,,. Trlrfihunc \l'S Rea J.•nu.t \\'niJus .mJ ;;ding - ' SI: ReaJenlial SuliJ I .n•I liununu \ i ileurce bt.i.ilLaii D Readenlial Demuluuu 5.�Rfg%} S red Ilorne Improvenent Contractor (HIC) rI0 I I � PYVLCQS J 1 HIC Cuntpufiy Van e ur tl Rcgrr m iN'm tt - 'Re,nsliauun Number r lob Gx uutiun Uatc Siglmure Tei phone 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 prucide 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.,CtO,NTRACTORAPPLIES FOR BUILDING PERMIT I, Rbber 1l -bf' ki Y ara 5LRi r- -- as Owner of the subject property.hereby authorize ( to act on my behalf, in all matters relative to work authorized tly this building permi 1pplication. /" AA Fi/SA/2 CI 17eS 1no)pad H brheljLWf% �� Sienature of Owner Date -- fS,,ECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION /1(_ I, t Y FAGWPY 1P r 201rZ-tJ as Owner or Authorized Agent hereby declaoe that the statements and information on i foregoing application are true and accurate, to the best of my knowledge and behalf. (enatur , Y / Sie of caner r Authorized Agcnt - Date - tSwned under the ams and penalties of perjury) NOTES: I. An Owner who obtains a building permit to do his/her own work, or an owner who,lines an unregistered contractor (nut registered in the Hume Improvement Contractor(HIC) Program). will not have access to.the arbitration program or guaranty fund under M.G.L. c. la'_A. Other important information (in the HIC Program and Construction Supervisor Licensing (CSL) can be found in 780 CMR Regulations IJ0.R6 and I I0.R5, respectively. '. When substantial work is planned, provide the information below: - Total floors area )Sq. Ft.) )including garage, finished hasement/anirs• decks or porch; - Gloss living area ISq. Ft.) .Habitable room count Number of fireplaces Number of hedroom.. Number of hathmoms Number of halt/hash, — ----_—.— fvpe tf heating system - dumber of decks/ porches _.___ Type tf cooling system BnclnseJ Uput 3 Total Project Square Footage may be Substituted to, "Total Project cost- CITY OF SALE`'I Oda PUBLIC PROPRERTY DEPARTMENT .. H 12; AC'. 'idN,,I • S.UI V, AI.A"v 111 .i-I '. =l'h� I't1: 9-8--.r o;9; ♦ Fvx. 'zg.'� 't,4iu NNorkers' Compensation Insurance Affldacit: Builders/Conirrctors/Electrici nsiPlnt Legibly t thtant Information `;IlIle 1 nuanrs t rrganit:unm InJn:Ju.dl: A !?, A Serv[ C1t5 Sic Address: H15Nor+h City,Salte,zip: 1;nl M (Jn DI°-1Q Phone #: \rree(%on an employer? Check the appropriate box: Type of project (required): I.(J I suit.a ampluyer with_ _ 4. ❑ 1 am a general contractor and I 6 ❑ New construction ampluyees(full undtur part-time).* have hired the sub-contractors 7. ❑ Remodeling listed on the attached sheet. '.❑ I ant a sole proprietor or partner- ship and have no employees These sub-contractors have 8. ❑ Demolition working tits me in any capacity. workers' comp. insurance. 9, ❑ Building addition [No workers' comp. insurance _ 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions I equired.] officers have exercised their right of exemption per MGL 1 1 ❑ Plumbing repairs or additions i.❑ I am a homeowner doing all work b p p myself. [No workers' comp. c. 152, $1(3), and we have no 12. Roof repairs__ insurance required.] 1 employees. [No workers' 13. .,her \AiIl'd0V✓-5 comp. insurance required.] ':\ny applicant that checks box NI must also till out the section below showing their workers'compensation policy info mtatioa. I lonnowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this hex must attached an additional sheet showing the name of the sub-contractors and their workers'comp. policy information. l tills an employer that i.s providing ivorkers'conspen.sation insurance for my employees. Below is the policy and job site information. Insurance Company Nantes_ ��r� '" �� ✓2�1� � policy # or Self-ins. Lic./4::y�(_L-�.J.�'tl- -L6 -- � Expiration Date: .tub Site Address:—i (',US h[Y1C� ��P 2�' City/State/Zip: � - 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 tine up to S I Sollmo and/or one-year imprisonment, as well as civil penalties in the finnt of a STOP WORK ORDER and a tine t,f up to S2?0.00 a day against the violator. Be advised that a copy tit this statement may he forwarded to the Office of In\ratillatitills of the DIA for insurance coscrage verification. l tlo hereby rerril. ter the p ins and penaties of perjury that are information provided above is trite nand correct. ll'I:Jtlll d: )are: Phone = o(/ieial sae on(p. Do not write in this area, to be rtnnpleted by city ur town OjJiLiaL Olv or Tussn: - l'ennitiLicense #_.__._..___----_-------- Issuing Authority (circle one): I. Huard of Ileulth 2. Building Department 3. C'ih>fown Clerk J. Electrical Inspector 5. Plumbing inspector 0.Other _ ---- — Contact Persuti:._—.- ---- -- Phone e Information and Instructions \las,.tcttuse u s (n'nerlI Lavvs:]Ia pier I requires ale cntp lover; to pro\ide workers' compensation for their en tplo)'ces. I'.usuant to this .tatute. .m emplo Yee is Joined .is"_ ev cry person in the xen ice of. It aher un :u der tv contract of(tire. cvhre<s or implied. oral or written." An emplo,ler is delined as ",fit indit idual, parmership. .tsso:tation. corporation or other legal ciuity. or ;uty two or more . ,,I the foregoing engaged in ajoint enterprise. and including the legal rcprrescntatives of a de:eased employer, or the rccciscr or trustee of an indicldual, partncnhip. association or other legal entity, employing employees. However the ,�•.vner of a dwelling house having not store than three apartments and who resides therein, or the occupant of the ,Iw clling house Of another ve•ho employs persons to du maintcn:mcr, construction or repair work on such dwelling house Or 011 the _rounds or building appurtenant thereto shall not because of<uCt employment be deemed at he an employee" \It iL ch;tptcr Is?, � iC(6) also ;tales that "every state or local licensing ageney 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 bus not produced acceptable evidence of compliance with the insurance coverage required." Additionally, \IGI- chapter I i?, vs_'iel') +tares "Neither due:onvnunvvcalih nor any of-itspolitical subdivisions shall enter into any contract fi)r the perfixntau:e of public .vork until acceptable ev idence of cuutpliance with the insurance rcyuirentatts of this chapter have been presented to the contracting auth'ority." Applicants - Please-fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractors) naute(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies ILLC) 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 he 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 permtitilicense number which will be used as a reference number. In addition, an applicant that must subunit multiple penniulicense applications in any given year, need only submit one affidavit indicating current policy inf'onnation (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 ctc.) said person is NOT required to complete this affidavit. -file t Mice of Investigations would like to thank you in ad ance for your,cooperation and should you have any questions, plctse do not hesitate to give its a call the I)cp;utmcnt'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 RcvizeJ i-'true Fax # 617-727-7749 www.mass.gov/dia 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. 150a. The debris will be disposed at: Salem Transfer Station owned by Northside Carting - Signature of Pe it Applicant 5-1- 09 Date Christopher Zorzy Name of Permit Applicant A & A Services, Inc. Firm Name 115 North Street, Salem, MA 01970 Address, City, State, Zip Code T � aae Board of Building Regulations and Standards Construction Supervisor License License: CS 57733 Birthdate 5/26/1958 iT Expiration 6/26/2009 Tr# 13739 Z., ,.Restriction; 0a CHRISTOPHER ZORZY 4 115 NORTH ST _ SALEM, MA 01970 Commissioner ' ° y,` ✓�ze:(ao�mrre�iceteall�z a�✓ZZraa:M.cfeeae%Zri. " Boa4oL Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR ' Registration: 101609 7 Expiration: 6/26/2008 i Type: Private Corporation j A&A SERVICES, INC - ? r- Christopher Zorzy 715 Nortfr'StreeF ��,..eCJ.a•�-:.:; i. lem MA 01470 Deputy Admmstrnf. ` Commonwealth of Massachusetts Division of Occupational Safety Laura Marlin,Commissioner w Deleader-Contractor CHRISTOPHER ZORZY E Date 04/0 /0 - Exx p. Date 04/08/09 ! DC000440 s Nlemberof C O.NES T. 09 i; 130 (IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIII IIII BOS ON RENEW vanguard NFRC W I N U O W S ' . . :A view that works ' a. vangua d Our windows are tested and certified to National Fenestration Rating Council (NFRC) standards. Product testing data can be viewed by going ENERGY PFRFOpMANCE RATNOS to NFRC's web site, www.nfrc.org and entering the appropriate Certified 11 ENMGY AO) SdarHNIWN[celfi eirc ) . � Al m ; Product Directory(CPD) number. AOOIf10NAL PUFORMAN%RATINa vale Gen nt nx [<aFagtNSn%S�. -.ender:nid�ReN.suivx::r . - Double Tilt-In Standard Casement Sliding Hun Slider Slider Picture Casement Awning g Picture Door Iri£Itration Rate, ,'. 0 03 a0 09,'; 0.03 0:01�� " §0.03 0 03 f 0,01 s, x 0.12 R NFRC CPD No. SUW-K-1- SUW-K-2- SUW-K-6- SUW-K-7- SUW-K-4- SUW-K-8- SUW-K-3- SUW-K-5- 00083 00045 00047 00010 00038 00010 00038 00004 Clear ,U-Factor Oy44 0 45 `0 45: g ,0.45 r r t"`0=3'0 {°, 0 43 Glass INSHGC 0 61 O 60 0'51 0 51 ,; 0 61 w VT 0.63 0.63 0.63 0.66 0.53 0.53 0.64 0.59 NFRC CPD No. SUW-K-1-. SUW-K-2- SUW-K-6- SUW-K-7- SUW-K-4- SUW-K-8- SUW-K-3-1 N/A 00086 00048 00050 00012 00040 00012 00040 Sun- U Factor Smart I SHGC u # 027,A, 3 026, tp26 ' " ,. '0.28 0.23 028 027 l wN/A Glass VT 0.50 0.49 0.49 0.52 0.42 0.42 0.50 N/A C�R x "r 50 61 62 64 fi465 �' 64 t ' NlA x NFRC CPD No. SUW-K-1- SUW-K-2 SUW-K-6- SUW-K-7- SUW-K-4- SUW-K-8 SUW-K-3 ySUW-K-5 00085 00047 00049 00011 00039 00011 00039 00005 Ultra- U-Factor �s 0 28 Y v, 0 29 ;; # 0 28 �`0 28 0:26 0 26 I 0 26 vss x U x;��SHGCah028 028 , 028 IL0.30:� 0.24� 024 028 028 Glass ,. _ VT 0.54 0.54 0.53 0.56 0.45 0.45 0.54 0.52 .} NFRC CPD No. SUW-K-1- SUW-K-2 SUW-K-6- SUW-K-7- SUW-K-4- SUW-K-8- SUW-K-3- N/A 00084 00046 00048 00009 00037 00009 00037 Omega I U Factor w' 0 28 ; ; 0 28 '}? 0 28,,, 0 27a '0,25 0 26 'zQ L7LL 0 25 N/12 A' Glass !; �BHGC 021 021t 0.21 0.22} u0.18 018M `°0.21ra NY VT 0.50 0.50 0.49 0.52 0.42 0.42 0.50 N/A CRa 57 fi 59T a60 . 62 . ..41 62'� :'58 A//performance values are for windows without grids in between the panes of glass. 070507 SSI5-V3 i A & A SERVICES, INC. A&ASMVIGES 115 NORTH STREET,SALEM,MA 01970 Telephone:(978)741-0424 Fax:(978)741-2012 Contractor Registration No. 101609 , Federal EIN:04=3 0901 62 Construction Supervisor No.CS057733 WINDOWS AND STORM PRODUCT SPECIFICATION SHEET Buyerls)Name Date of Contract a3�RB�2� tRo3cr�i �'r, J�/c-r1a� y-y- off Buyerls)Street Address,City,State and 21p Code - LusHwcy sr, SH&&kVi Mlq a/970 Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address W The Buyerls)listed above hereby jointly and severally agree to purchase the goods and/or services listed below,in accordance with the pnces and terms described on - - this Specigcaron sheet and the front and the reverse of the accompanying CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,of which this Specification Sheet Is a pad. - WINDOW REPLACEMENT Fion2 ..2- , XRemove and dispose of# �� existing windows. 19'Install # /-3 new s1wR/S(i windows Xvinyl ❑Wood (Manufacturer) Options: Style DH I/H.uy041_10 Grid pattern'I ///,U %� Color Interior Go`l TL- Color Exterior id Jv 775— Glass Type I'Wrap exterior trim with aluminum: Style L-/3oyoU 5 Color AJOI9_49�7- IAll windows will be installed according to the installation procedures in the portfolio. Caulk all interior and exterior edges. ek Insulate where possible around new units. Insulate window weight pockets if exist,and around new window units where possible. Included 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 windows)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. ❑ Bay ❑Bow ❑Casement ❑Other windows)to include new interior style trim and new exterior style trim and head flashing as needed. Note: Painting and staining not included. STORM PRODUCTS ❑ Remove and dispose of# existing storm window(s). !i p Install new storm windows# Manufacturer .-.. a Style Color Option ❑ Remove and dispose of# existing storm door(s). ❑ Install new storm doors# Manufacturer Style Color Type: ❑Aluminum ❑Solid Core _ r SPECIAL INSTRUCTIONS: It is agreed and understand by and between the lumber that this Specification Sheet along with CUSTOM REMODELING AND IMPROVEMENT AGREEMENT constitutes ' the entire understanding between the parties,and there are no verbal understandings changing or modifying any of Me terms. This contract may not be changed or its terms mod red or varied in any way unless such changes are In writing and signed by both the Buyens)and the Contractor.Buyer(e)hereby acknowledge Mat Buyer(a) has read this Specification Snae�t'�yL [,{ p (� Contractor Initials: �/ l Date: /' /'-�✓ Buyer's Initialsx /�Dat . �_ DS „ ��A �� A & A SERVICES,'INC. ACs SUPACES 115 NORTH STREET,SALEM,NIA 01970 a Telephone:(978)741-0424 Fax:(978)741-2012 Contractor Registration No. 101609 Federal EIN:04-3090162 Construction Supervisor No. CS057733 CUSTOM REMODELING AND IMPROVEMENT AGREEMENT ' Foyer(s)Name �j Date of Contract Buyers)Street Address,City,State and Zip Code c1976; Fz-ai _L Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address: WK 979-7yN-S0557 47B7yy Si30 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 reverse of this agreement and any specification Sheets(this'Agmemenfy and Buyers)have requested that such goods or services be Installed or provided at Buyer's address listed above,All Services,Inc.('Contmclor],hereby agrees to install or cause to be installed the products or services listed 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 co t of the goetls and services pure Seth as describe tl herein,regardless Of timing or approval of any financing Buyer(S)may seek for their purchase. �c . = 3 SRO lY3, ` Est. S 7 Purchase Price:- g Date: _9 Down Payent: . �� ' Est.Completion Date:s”Z3 d m ❑Cam Amount Due on Start of Job: Lbaneck O Credit Card Amount due an of Completion: No, Amount Due on of Completion: d Expiration Date: Balance Due on Upon Completio¢ -1 y&/r CVC Code: 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 partles,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. Buyer(.)also (i)acknowledge that they were orally informed of their right to cancel this transaction;and(11)request that they be contacted via their telephone numbers or a-mall, as Ilsted 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 IT CONTAINS ANY BLANK SPACES. A&A Services,Inc � J y//1 By: /.`1i—yc_ �. _n,1?w na 4'dje7 '8.il�P/ Signature 5 > �� Sig na�ire � ui .. Y�r rb rArl S� 1'l�erre- Print Name '>Print Name Signature - Print Name You,the Buyeful),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. p AHBITXernoul Tl,emntl randthe M1ameowner M1erebymmwlyagreeinetl mtat Inme Arent emer party has a dispute wrcaming this mnew,either wou may submit I Gra�eb a gNefe albapponservicewM1kM1 has been Aprmedbythe Secretaryorthe Ea% ouicareconsumer AHaireend Bus Xe is. MNeolhu,p shellMrequlmdtowbmlt la aucM1 abl-.n Me proved in M.G.L.or. yy-+�@ Due ado _ Dies,.."board_JI_ + . 71 �� ./��Cn�TfE nF f:ANCFLLeTON NnTIb OF Carl I TBN Data A Templeton�.You may Carl his tmnseNon,worms any pareltts or Data of Trnandown .You may canml IM1b tmmcl n.MIMut any penally Or Wlgaaon,witM1in tM1ree Wainasa EayB M1Om lne above date.Ilyaomnml,enypmpeMbaded in, obllgards,within Mre9 W,In..days Fein Me.data n you corral;any pmpeM waded in. any payments rose by Ad under the Garrett or and,and Any royal lnormal exewted any mymenu mMd.by Wu under I.Wnhazt or SM.,antl arty esptleNe Instrument expanded _ by you an be reamed min to days lalayeark receipt by Me Sauer a>wrcenulleuan nmlm. by you win ba reNmad within to days lmavnne roompt b,the seller of yours,a wlapn anuee. . and any mcuny Inbreel ensue Din of Me happen-win to mnmuee.If you morel.you must end alv:odrsmy Imerept pnNnm vet mine lreneaallon will be mrcmled. nvwr,Lust.vwr mast any seveikhrversa Serer vyarr readwo,in orSaannelyuar Vmmlaonuwlnn,pawed, mM goods dbel W yesoravers,hechanel or Said ryu gad you wars wm Iwoi ded any gownseopor oritheM top omatin Mb remon sommusit w Sera;m he mole,it you sm.n.inspemply r.M And any orrdde 0 the d N you under in Corm ship Sete; f theu may,.1 war,mmpl Ave and. risMcf you d the ssl the regarding the,m,m ate Sell m Me mead.mr Ads I ack the am mmrsmDoum Me maSauke regains me reNm i Spos m Ind theme at Me Selbre pyopnse and risk, if you days make me grads evaion at N Me Seller prof may Salley dins dal pkk them ropea ask. If you do make died goods houinstase Of ro du Selby end a rishay dine ma pink Mem up uppen andes,"luof Nedateolycur Nation at CanCBlladpdNupe owddjlsoi the diefAspll Loa ina is dayamMedLeol yourNdidtoake thenon,yWmayls,as th or e Seller ollMgcI to mutam luMds hllgation.er 11 en la Ad por do foam¢doarmadilemtM1e Set ler,orilpu Alag,ea wMONa me good obllgetbrtnywfall to do onM1 men you vampon roMeor peaar ll you of on redid Pe meads N the Seller and M i b do d n you remain Il ab ,pedwm .al mI of figs Me mm]s N ea Selby ouwa b trm,Men you remain ruble for pB.datedWca of ell oblgetlone under Me Convetl.TacanwmMB trenmtlian.mat ordalNereegnetl eMdafed mpy of mad bmundertne too or a.y offer 1hermurder orsend ar dedWoer esignedt Soda cape m tM carcallat en rand.w any plop,women miba,w vend a 1.1,—,fo ASA SeMcee,115 OI Ma mmm�atbn nodes or any ender antler mtlw,or send a telegryn,N ABA Servims,115 Non Strut Sister Musachusmb 01970,NOT LATER TXAN MIDNII OF�_/�i�i Nunn SYOBL Salem,Massa td..a D15N.NOT ll TXPN MIONKA T OF (wbl I HEREBY CANCEL TXI$TRANSACTION. CAnsumaiB 51gne1re to IHEPEBY CANCEI NLELTIIS TRANSACTION. consumers 5igitaN re Dele pnd�sdp A& A SERVICES, INC. A OE 115 NORTH STREET,SALEM,MA 01970 Telephone:(978)741-0424 Fax:(978)741-2012 Cqntractor Registration No. 101609 Federal EIN:0 4-30 901 6 2 Construction Supervisor No.GS057733 WINDOWS AND STORM PRODUCT SPECIFICATION SHEET Buyens)Name Date of Contract 6`tP-& M +ko3 rzT Sr, PEaz� /-IS-OB Buyerls)Street Address,City,State and Zip Code Q CUSI-//N ST, S4L&7" 1416 o1970 -*i Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address - wK 97�-7Yy-.SDS 7 978-7YY-Sl3u The Buyerls)listed above hereby jointly and severally agree to purchase the goods antl/.,services listed below,in accordance with the prices and terms described on this Specification sheet and the Iron)and the reverse of the accompanying CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,of which this Specification - Sheet is a pan: WINDOW REPLACEMENT F/.BO+x- 7— Remove and dispose of# /L existing windows. ��`��`,��,,"""""" Install # /d new S'vNxPlS� windows: inyl U Wood (Manufacturer) Options: Style i VANiy L'N'2Ij Grid pattern Color Interior W#1 Color Exterior LUH17V Glass Type . Wrap exterior trim with aluminum: Style L—L1DU OS Color lvfl/f 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. H"Insulate window weight pockets if exist,and around new window units where possible. Included in this proposal are set up,clean up,Hope vacuum and cleaning windows inside and out. `❑'Building permit included. - /� BAY/BOWS/CASEMENT UNITS/ANY FULL CONSTRUCTION WINDOWS ❑ Create new window opening by cuffing 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 it need to be dealt with. ❑ Install windows)into opening(s). Note: It Bay or Bow installation to include cable support system,new roof 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 trim 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 a Style Color Option ❑ Remove and dispose of# existing storm door(s). ❑ Install new storm doors# Manufacturer Style Color Type: ❑Aluminum ❑Solid Core SPECIAL INSTRUCTIONS: It is agraed i n l understapd by end bahveen the parties that this Specification SheBL along with CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,conwhutea the entire understanding between me parties,and there are no verbal underalandings changing or modifying any of the terms. This contact may not be changed or it. terms modified or varied In any way unless such changes ere In writing and signed by both the Buyerls)and the Contactor.Buyerls)hereby acknowledge that Severe) ban read this Sptuffa gpn Sheet..Contractor Initials: O'J Date: L/ /� —0 U Buyer's Initials/`/ Date 5� A & A SERVICES, INC. E ; Ar 115 NORTH STREET,SALEM,MA 01970 a• a Telephone:(978)741-0424 Fax:(978)741-2012 Contractor Registration No. 101609 . Federal EIN:04-30 901 6 2 Construction Supervisor No.CS057733 - CUSTOM REMODELING AND IMPROVEMENT AGREEMENT - Buyers)Name � Date of Contract �I/L13A2A +I�o3sn.T �t, Y'!e�/Ltr Lf—/S-bb' - Buyers)Street Address,City,State and Zap Code 8 c us Hya sr, 01I 2 Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address: 971 7Ny-S0 67 W97K8-Pill—s/30 The Buyers)listed above hereby jointly and severally agree to purchass the goods and/or Semites Ilsted on the accompanying specification sheets,in accordance with the prices and terms described on the front Bad the reverse of this agreement and any specification sheets(this"Agreement"),and Buyers)have requested that such goods or services be installed or provided at Buyer's address listed above.A&A Services,Inc,('Contracmfy,hereby agrees tO Install of cause N be Installed the products or services listed in this Agreement at the Buyers)address written above. This Agreement represents a cash sale of goods and Services. The Buyer(s)agree to pay in cash the cost of the goods antl services purchased as describetl he reir,regardless of timing or approval of any financing Buyers)may seek for their purchase. a c - O 17031 Purchase Price 0/0/2, Est.Starting Date: Down Payment: Zwxro , Est,Completion Date:S ZS O ❑Calighh Amount Due on Stan of Job: fDCfeck ❑Credit Card Amount due on of Completiouri No. - Amount Due on of Completion: Expiration Date: Balance Due on Upon Completion: -S'3 r` CVC Code: 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.Entrails)hereby 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. Buyer(s)also (i)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-mall, as listed above, in the event Contractor believes Buyers)would be Interested in any additional quality products or services of Contractor. DO NOT SIGN TES CONTRACT IF IT CONTAINS ANY BLANK SPACES. A&A Services,Inc. <� Buyer(s) ey: d � O car vL1J Signature -� E Sign��ty�,,'a ED C3v2S, ' Mrh5 M Print Name Print Name Signature Print Name You,the Buyer(a),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. ARaITRnnoN:ma mnvmmrane tin nam.orhe.,naturally to—In sewn-..In undremm cite peen nos a aid,.. ..In,the-11. she,parry now s erne sucn oiswtam a pMem eM,o- SSNIM whim h-Oman appmrod M Me secrerary W me Eeeculoe OMro al consumer Aneim oneene eua WlrMe.Aoa tha Wnor party shall be required to submit m ouch eNNarpn es rumored in vii 01a}A ll�lFF// Cunn¢emr we„e y_ Dow lvituI� r ^ p.m. Dare. NODI OF N eTION NOTICE OF CANT TIr1N cam of hersomdian y-i r-os�.Yw may I'arcal 1Ms Pawactbn,withoN any panBl{y or Date o1 TrenseN ron , /5�d e You may den-1 Nis tau on,whence any penalty or national within three bush days ham the above data 11 you-mock any pmt trabod in, oblagman,mmin MreabuvnnadayalramtheaWBaem.ll you-nrol,any pmpeM o-eaea ln, em/peMo.rraae by ysotaer Me Commct or Sale,ell any adsorbed morchent e.—. any Payments meae by you under the Conr or Sala,and any nego4eWe inslrumeM execuMa ' by You MII be reNmed enmle 10 Maya cut",ranee,by the Be.W your--Ill.no., by you will be reNmed within 10 days reforms receipt by Me Seller OI your canwllal n moms. yq Myseaa[y inmresl enslrp oN olmabansaNcn call Ce l'ancelled.Ilya-ncel.yoreent amid any model Interest among out W the movement wit he®cellm,It you mmi you must nuke evalabk mine sell.L year rome-B.In auRSfiWe for gtN-Mllbn an warm moment. make a+eileb191.she Sauer of your reaidamor in wbWa Ut ea gM O}kMon of On mrolemk ' any goMs Malawi to you under are contract or saw;or you maw it you wlah,mmpty wen we any grcN doorman to you ureter has cause or S.e;or you may.0 ya wish mmply with the - in¢MFCJM W In.Seller recording Ma mWm miprreW Of Me collet et the..lam mp,I and Inslrutlwna at Me seller estimates to room enigmas of Me galls at Me Sellem nap m and do. 11 you do make Me goaea wadable to the Seller and Me Seller leas at SIG them up milk. It you do mmke the gall¢available to Me Seller end the Seller due.not park theme up wimin Rp dey901 M9 dam alym Notica al Cormelmaon,youmayrl nor NscsaWOeg s wMm ad date W Me dab W your News Of Canditatem,you may mmn or akp-e of the Books e.ul-y.h.1.1lipetbn.I(Auhlltemake..gaada rvawblem Mas.oh,re ilyouagme wMmldremserabllgdem.Ilym lailmmake MegmMsava401em Me selle[wif you agree b9mme waste m tenSeller and roll m do so,Men you mmiintable far peMrmece W all to return the goods to Me seller all roll m do an than You remein how M pmmrman®Ot all - obllgmomuMorooC kct Tomry lMis Ranaactian,mWil dellveraygndwddWodmpy callgatmns under Me partner.To-n l the samurai mail m dBlFrer a signed and rice-Py W Me®nice in notice W my Other wdtmn force,an send a thowam,b AAA provided,1111a5�, of Me-ncelmtmn rou-or any other wrMen maw,or NOW a mbgam,la Al SeM-s.115 HereStreet Salem.Mess r.tta.1 WO.NOT LATER TIAN MIDNI0HT OF m/-/Q-/JTf No.Sao.Salem.Ma¢sachuaetls 01910.NOT LATER THAN M1. Kam OF I)( (Dame I HEREBY CANCEI_mla TRANSACTION. Commoners signaium as I HEREBY CANCEL THIS TRANSACTION. c.tsumer a Signature Oam The Conunomcealth of Massachusetts I t tl: Board of BUIlding Regulations and Standards M('\R'IJ' \I.I 11" l Itlassuchusctts Stan Building ('ode. 7511 ( MR. T'edition I'.S1 Building Permit Application To Construct, Repair. Renovate Or Demolish a Rcrur,l hunr1rn One- or Tien-Funid.v Dvrllinq This Section Fo ticial Use Only Building Permit Number. Da e Applied -------- —� Si"natnre: Building Cununissioner/ Inspector of Buildings ate SECTION 1: S E I OR.91 AT[0N 1.1 7,r .A dresnCM 1- 1.2 Assessors Map & Parcel Numbers ---- CS T P:ucrl Number I.1 a Is this:m accepted v rt? yes_ nu_ bIa P Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sy It) Fromagc Uit 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard ! Required Provided Required Provided Required Pro%idrd 1.6 Water Supply: (M.G.L c.40. §54) 1.7 Flood.Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone'.' Municipal On site disposal systnn ❑ Public El Private❑ Check if yes[] SECTION 2: PROPERTY OWNERSHIP[ 2.1 Owner[of Record: n r Ss L, f Nan ri U ,.7 I' r Address for Servicel- + q1U1-1L4L4 - Signa are Telephone SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) Nev Construction ❑ Existing Building ❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s r1JJi(iom ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Specify: Brief Description of Proposed Work-: - M - SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) I. Building S I a ZQ 1. Building Permit Fee: S Indicate haw Izz is Jc(crnuneJ: ❑ Standard City/1-own Application Fee 3. Electrical S El Total Project Cosh (Item 6) x multiplier x 3. Plumbing S 2. Other Fees: S 4. Mechanical (HVAC) $ List: -- 5. Mechanical (Fire S Total :\II Fees: S Su. ression) Check Nu. Check Amount: ('ash :\nuuun:__---- j b. Total Project Cost: S a ❑ Paid m Full ❑ Outst:mJine Balance Due:_____ J I SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction — .1'53 License Nuviher � lispu.uauln ):ua Nan�aofCSL- IIOJ, 2K0/f Lut C'SL'P)pe I+re helmcl \ r. T r e I Descri)(nut C I Unrestricted up to :i.000Cu. 1-1 R Restricted &2 Famth D"elhne en t o N l ^ � S1 Residential Unls G 12C Re+IJrnlial Itw,l7ne Co�enn_ Telephone \\'S Readeuual \vuid'm and Sidme SF R2 s deiuial Solid Fuel Bill mne \ i�liaucc Imt.il Lunn D Reeidenlnd Demuhunn Sj� gt' ered ll� V n`.p p( �p�etit i unj{ac[or (I11C') lit Cum :my hanle ur II Regis a Name lieguuauun .\unihrr • , 1�/ 9�1��11-n�2N ��0 as �a F.cpiration Date Signature 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 pioeide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached'? Yes .......... O No ........... ❑ - SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, I JQ CQ (�,� F( D I r, as Owner of the subject property hereby authorize��h 1 n ('7 �� to act on my behalf. in al matters relative to work authorized by this building permit ap ication. Signature of Owner Date SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION /� I, l ,h r _Yo r 7 ,as Owner or Authorized Agent hereby declare that the statements and information on the fore.going application are true and accurate, to the best of my knowledge and behalf. of oPnntName //�caner or Author ed Agentr the sins and enalties of er u ) NOTES: ner who obtains a building permit to do his/her own work or an owner who hires an ume_isteied contractor (nut 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 and Construction Supervisor Licensing(CSL)can be found in 750 CMR Re`eulations I IO.R6 and I IO.RS, respectively. 2. When substantial work is planned, provide the inflrcmation below: Total floors area(Sq. Ft.) (including enrage, finished base men Uattics, Decks nr porch) Gross livine area iSq. Ft.) Habitable room count _ Number of fireplaces Number of hedromns Number of hathrooms Number of halt/hullIS ._._ rvpe of heating system _ Nwnher nidecks/ punches rypc of cooling system Enclosed open 1. "Total Project Square Footage" may be substituted for "rotal Project Cost' I . s CITY OF SALEM PUBLIC PROPRERTY .. r DEPARTMENT I_':\t•,1illi]'t,l0\tiiltl'hl 01.11i\I, \L\"V III ,hI :,-I') - I'F.I: ♦ F\\: 7"8--4---•)8do Workers' Compensation Insurance Afrida%it: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeaiblY Ninie 113u.ulrss I tr_amtauon 61JIs Iduala: A 7. A S e [ l.J�� J-l�� Address: 115 N12t+h 5+ye e+ City,State;Zip: �;QIffn Miq 019-70 Phone #: ( T7s) 71HI - D)J 2)A Are sou an employer:' Check the appropriate box: Type of project (required): 1.Cj�I am a employer with d. ❑ I am a general contractor and 1 6. ❑ New construction employees (full and/or part-time).• have hired the sub-contractors 7. Remodeling _'.❑ I am a sole proprietor or partner- listed on the attached sheet. t ship and have no employees rhese sub-contractors have 8. ❑ Demolition working for me in any capacity. workers'comp. insurance. q, ❑ Building addition No workers' cum insurance . 5. ❑ We are a corporation and its [• P- 10.❑ Electrical repairs or additions rcyuired.J officers have exercise) their 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself.[No workers' comp. c. 152, w'1(3),and we have no ? oaf repairs insurance required.] t employees. [No workers' 131-1 Other comp. insurance required.] Any applicant that checks box#1 must also till out the section below showing their workers'compensation policy information. t I lomeuwners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. �Cmilmctors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. l con an employer that is providing workers'compensation insurance for my employees. .Below is the policy and job site information. insurance Company Name: Policy#or Self=ins. Lic..�#: t O� ' M—$ 1113 Expiration Date: Jn lb Site Address: u S in J' City/State/Zip: :�10AA Attach a copy of the workers' compens ion 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 tine up to S 1.500.00 andor one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a Jay against the violator. Be advised that a copy of this statement may be finnvarded to the Office of Imcstitatiuns of the DIA fur insurance coverage verification. l do hereby certify it r t e puins ind penalties of perjury that the infarntution provided above-i.s true mid correct �iL,Ilalure Date' ' O/ ) Phone 9nk--7uI -DLP2�J F only. Do not write in this urea, to becootplctedby chyorrown ojficiaL n: _ ---- PeriniliLicense#_._.—hority (circle one): -- _— Ilealth 2. Building Department 3. cityirown Clerk a. Electrical Inspector 5. Plumbing Inspector rson:------- — -- f hone#: Information and Instructions \Lts..tChusrns (frncrtl Laws chapter I 2 reyunesall amplovera to pro%ide workers' compensation for their cmployces. I'orsuant m this aatute, an emplo'ree is defined as ••.. every person in the sere ice of another under anv contract of(tire. ,•\press or implied.oral or written.•' .\n employer is defined as "an individual. parmtcrship, association-corporation or other legal entity. or any two or more of the torcgoing engaged in ajoint enterprise,and including the legal representatives ofa deceased employer, or the resew er or trustee uf.m individual, partnership. association or other leeal entity,ctnploy in,,employees- l low'e%er the ncr ofa dwelling house hw mg not more than three apartments and a ho resides therein, or the occupant of the dw tilling house of another who employs persons to do maintenance,construction or repair work oft such dwelling house or on the grounds or building appurtenant thereto shall not because of such cutpluy mem he deemed to he an employer." \I(;L 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, %I(;L chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall cnter into any contract for the perfunnince of public avork until acceptable ev idence 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-contractors) 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 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 leases 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. rite Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents OfRce of Investigations 600 Washington Street Boston, MA 02111 Tel. M 617-727-4900 ext 406 or 1-877-MASSAFE Itet scd :-26-u5 Fax # 617-727-7749 www.inass.gov/dia 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. 15Da. The debris will be disposed at: Salem Transfer Station owned by Northside Carting Signature of Permit Applicant / b - 2,-07 Elate ChrEstooher Zorzv Name of Permit Applicant A & A Services, Inc. Firm tame 115 North Street Salem MA 01970 Address, City, State, Zip Code (�� 3assaehu,etts - Department of Public Safety 1 Board of Buildin- Re'�ulatiun, and Standards Construction Supervisor License License: CS 57733 Restricted to: 00 CHRISTOPHER ZORZY 115 NORTH ST SALEM .MA 01970 ---_ _— - -•L �y!�� Expiration: 5/26/2011 ('ummieviunrr Tr#: 14751 - ... .. '. ..... _ _._.-��._..... w _ _. �/} 0.1fNn0•Rd/e .ddd6CIWIdESr�b' . .- ...._... .. ..._............ .. ... -.. _......:-. .. .. o m oos an Standards --- � Board rB ']ding Regulations dStaad d - HOME IMPROVEMENT CONTRACTOR Registration: 101609 Ezplridon 6/26/2010 T4 267870 -:_Typd:_private Corporatipn A€A SERVICES,i-NC= - Christopher Zor_ryiY. =�-t�Q 115 North Street Salem,MA 01970 - �" Administrator _ Commonwealth of Massachusetts Division of Occupational Safety Laura M Marlin,Commissioner o Deleader-Contractor CHRISTOPHER ZORZY Eff.Date. 04/01/09 _ tv Exp.Date 04/OB/10 N a - �'L DC000440 Memberof O.O.N.E.S.T. - �=- �Ff F ' BOep IIO�II��I�i��I�IBIII�I�II IIII I��I�IICIiIIII �IIIi�I BOSrONRENEW - 1 say C A & A SERVICES, INC. S��p Y ICES 115 NORTH STREET,SALEM,MA 01970 • 1 ETA 01111Tel FA WX rd Mi Telephone: (978)741-0424 Fax:(978)741-2012 Contractor Registration No. 101609 Federal EIN:04-3090162 Construction Supervisor No.CS057733 CUSTOM REMODELING AND INTROVEMENTAGREEMENT Buyers)Name Date of Contract 3ae3ff1-iaA T9 -29-0 Buyer(s)Street Address,City,State and Zip Cade $ Cars 111fil 57-, _54beYsi A14 O/970 Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address: 979-7gq-S057 The Buyer(s)listed above hereby jointly and Severalty agree to purchase the goods and/or services listed on the accompanying specification sheets,In accordance with the prices and terms described an the from and the reverse of this agreement and any specification sheets(this'Agreement'),and Buyers)have requested that such goods or services be Installed or provided at Buyer's address listed above.A&A Services,Inc.('Contractor'),hereby agrees to install or cause to be installed the products or services listed in this Agreement in the Buyer(s)address written above. This Agreement represents a cash sale of goods and services. The Buyer(s)agree to pay in casIn the cost of the gootls end services purchased as Easonbatl herald,regardless of timing or approval of any financing Buyers)may seek for their purchase. e, _ J9 /S SC Purchase Price: IZ bBO Est.Starting Date: io /d Down Payment:AY� • Est.Completion Date: ❑Cash Amount Due on Stan of Job: heck - Credit Card Amount due on_of Completion: No. Amount Due on of Completion: Expiration Date: Balance Due on Upon Completion ��• CVC Code: 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 Buyers)hereby acknowledge that Buyer(s)has read the from 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. Buyer(s)also (1)acknowledge that they were orally Informed of their right to cancel this transaction;and(IQ 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 TIUS CONTRACT IF IT CONTAINS ANY BLANK SPACES. A&A Services,Inc. ( Bu ) By: � 1d ^/L_ A .1 Dh_Ap� Signature Q� -� SignsPe i q� Print Name 'Print Name Signature Print Name You,the Buyer(s),may cancel this transaction at any time prior to midnight of the third business day attar the date of this transaction. See the following Notice of Cancellation form for an explanation of this right ARBITRATION:The mnbece,am Me'Mmeawner dif muluaih Wires In aaverne Met in the amm amm pact has a e¢qM corceming this contrast,year parry may submit wcn alapub to a pirveto vnNdfl i ad.which.Gcen Whowel by the Socroerlof 1M a.Olfira of Consumer Afford act BuldMa Regulatl ct wie a Me arm party WWI be nedin alm.ubmitad uch W1ddWhnWawym InMG.L.dlg a/ P Con.armalh: SeyerlvitlW: ~ ae -r Dow q )p NOTICE OFCAu E11ADO �N upTl OF pN FTrrww Des of Thermalna.(—0.Yw may canal me ttenasurer,wMWN any iensday o, otle W TWwacWm 9 Z .Vou maY aervzl tiva harweNon,wMnN ell pariallY cr obligation,w In OmebusneaaapfmmtMa dab.nycu tercel,enY POWMtreasl ln, oNip ,wllFin Wes Wslrc daptommea dN.nyau ceticel.eM pmpeMtrWaea ln, byy Will dm act lnrmatl.comrea ar sae,amaM llerofWurnWmnl ewChM by you me as awn nMama ceno-er or sae,or,ftater, 0 bm mduamam made av ranwinseremmret metocop thawingcteWbr reaelmrd,pard Wishost yomm:, reps Wn Wrammed,atmto Sep the ma recWplM cosseashyvace.1..Daum, enaanywcunh Interest Bear yir ethe o-anaection Will ae Mods d. nyouurcel.reumeat anal aecaRy intend, at hoftlwe,In oclbnssi Ix sgoescareal!conform nyau cancel,recmeat anyrhag ins nilabmmod aNkr Undertis Cnw.NwScal red myd sMHiear,mn co ply vWMwd, ah,So lbNpmfedto you unceitscommnt wsee;wyti may.0 y wi con,f,andin s'un ft enyoseve,ofthe tltoy revarder mitt hirmn lwaab;w . des theou MI wnplywM tice dMBOWadrts of Medmroutrain,th Canbecl oment:f my they.nyw wishmmodands me risk s IF red d the tim th Model lad remm ahipmase of ma Bade a the m mot Ba the ell Me, N we me Soler notelrq ill remm e e Sell h Ill Me a al do selhot excanre ell risk n pu do make 1M gwas evaicab C de Bases antl tlro Salim dreg Trot 0 t them up M1thi H pu co mall Ill gaou Nothor f m re Seller vM a Serer dxa not pick them up Worm 20ye Wm Vredarm.0 Naticeh ode the umayreWna dNaaehtlre gala within 3p Sep of me data of your Nplka MCenullat'an,you they reminadiepaae al has goods wlNM any miter cblgalwi.Hpu mil to meMatM pvas eveibale to tic 5¢Iler,anyou eB,ee wMWaethe pass Me Warm leala do yo horem btlnor derorHrou agree to realm me galls 1a tln Boller and tail m do n Ill,ym remain INde lo,arbmlance of M b remm the Bw-da m o e Seller end tail cos to,tlwn you reman r a for arbr daWpt W One items MCmor anyarsrciande venaeaim.mellpraeiWaeaignad Wna aaeamts dYIBaHore undarma Cano-acL To oadvel WSVenide,or andatelosmaslBn Serdmlcopy h lne sere,,Soo notice or any Doer wraen OTJf E dam a lMlIDNIG T F BeMcas,2 h re event,aaan notice er ell ss wdnan rafts,or wne a mlapram,m AM s-7 tts NOM Street,seism,MeasechuaeN elB]D,NOT LATER THAN MIDNIGHT OFlO-2-O� Nana Shea,aakm,MasvC�l,eatla 0lg]o.NOT LITER THAN MIDNIGHT OF�o-2—� (Dee) (Dow) I HEREBY CgNCELTHIS TRANSACTION, Canaumers&gnature Dete I HEREBY CANCEL THIS TRANSACTION. Cormnd%sihnim, Inve r nano w^ A A & A SERVICES, INC. A&A SERVICES 115 NORTH STREET,SALEM,MA 01970 • � 1 • Telephone:(978)741-0424 Fax:(978)741-2012 Contractor Registration No. 101609 Federal EIN:04-3090162 Construction Supervisor No.CS057733 ROOFING SPECIFICATION SHEET Buyer(s)Name Date of Contract &.4a& - A S'trP,en-p.e 1 -z9-off Buyer(s)Street Address,City,State and Zip Cade 8 GUSNIIry 62 S 1, sni,& VI Miq 0/970 Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address `j'7B-7V'/-s'os7 The Buyens)listed above hereby jointly and severally agree to purchase the goods and/or services nMed below,in accordance with the prices and trams 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. ROOFING SPECIFICATION Strip Roof of# 14//L layers of shingles $ stall 6'of ice and water shield at base of roof where Install 15.b felt paper to roof. possible. Install 16-24"of ice and water shield in valleys. Ot)Flash chimney zg.ReeAed(no repointing included).C2 Install e'perimeter drip edge to rakes and fascia areas. nstall vent pipe boots and seal as needed. Flash valleys as needed nstall rollout type ridge vent. $ Ianks/plywood replacement under 32 SO FT included,m "If more is needed there will be an extra charge of$ per hour for labor plus the cost of materials. Dumpster/Disposal Included: $Other: C4YLoy9_; $7 q, /1 PV#i 7!T Location: LtSFTS/og- Ag 1!gtit/19'y Install new roof: Manufacturer G3Y77791AJ 7$LsYJ 30 yr Style/type Included in this proposal are thorough cleanup,building permit,and company/manufacturer warranties. P2s 64y.4'QW. -0- 7W RUBBER ROOFING SPECIFICATION OF 01.4w 200% ®Strip Roof $ Not Strip Roof LV 12AInstall 1/2"High Density Fiberboard to existing roof using Flash obstacles as needed. screws and plates. (Tinstall.060 membrane EPDM (Black) rubber roofing to Install 3k3 aluminum drip edge to perimeter of roof with fiberboard.s seam tape. 3t Flash up sidewall as needed Included in this proposal are thorough cleanup,building permit,and company/manufacturer warranties. SPECIAL INSTRUCTIONS: 9 � 41ZOri10 7MP 2vR/dI3�_ 4/lAa4 It Is agreed and understood by and between the Donbas that this Specification Sheet,along with CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,ooneatulas the entire understanding between the partite,and there are no verbal underetandings changing or modifying any of bus terms.This contract may not m changed or its terms modified or varied in any way unites such changes ere In writing and signed by both the Bavaria)and the contractor. Buyer(.)hereby ecknowktlge,that Buyar(a) has read thle Specification Sheeel.r�IS a [p cl Contractor Initials: Date: 7—Z9—B� Buyer's Initials: The Conunonwealth of Massachusetts i Board of Building Regulations and Standards Pe)R %II NI('lPALI II" +.! MassaClutsetts State Building Code. 780 CMR. 7"' edition list. y ^. e Building Pcnnit Application To Construct. Repair. Reno ate Or Demolish itRr 'i,rJ./ n u, QOne- m Tn'o-Fumil, Dt ' G This Section Fo fticial Use Only Building Permit Nw er: Da PPltz }/�J O Signalurz: Building(7Unll➢ISSIOne nspeetur of Buildings Date SECTION 1: SITE INFORMATION _ 1.1 Property Address: 1.2 Assessors Map & Parcel Numbers I.la is this an accepted street'? )es_ no Map Number Parcel Number -- 1.3 Zoning Information: 1.4 Property Dimensions: — -- Zoning District Proposed Use Lot Area(:y li) F!,+none I'i 1.5 Building Setbacks (ft) Front Yard Side Yards Rear Yard ! Required Provided Reyutred Provided Required Provided - �- S" u 1.6 Water Supply: (M.G.L c. 40. §54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone? Munici al ❑ On site dis osal s stem ❑ Public ❑ Private ❑ Check if yes❑ P 1 Y SECTION 2: PROPERTY OWNERSHIP[ 2.1 Owner of Record: r f ! (Print) Address forService: dd _.y Signature Telephone SECTION 3: DESCRIPTION OF PROPOSED WORK(check all that apply) New Construction❑ Existing Buing ❑ Owne ldir-Occupied ❑ Repairs(s) ❑ Alteration(s) y!E Addition El Demolition ❑ Accessory Bldg. ❑ Number of Units Other X Specify:NA1VDiCAIP lP9640 rBriet rrNScrintion of Proposed \York.':,_-_/1V$[-,F�11._ �A t° 12 HMT /✓1 _( £1.>Z A fl A _ __. I SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) I. Building $ 1. Building Permit Fee: $ Indicate how fee is determined: j ❑ Standard City/Town Application Fee 2. Electrical $ ❑Total Project Cost' (Item 6) x multiplier x i 3. Plumbing $ 2. Other Fees: 4. Mechanical (HVAC) .$ List: 5. Mechanical (Fire $ Suppression) Total All Fees: $ ! Check No. Check Amount: Cush :\mount: _ j 6. Total Project Cost: $ QO� ❑ Paid to Full ❑ Outstanding Balance Due:______ as.o SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor (CSL) License Numher Ispiiation Dato Nance of CSL- Holder List C'SI_'f)pc (see heloal _ "rype Descri pion \JJress C Unrestricted(Lie to 35,000 Cu. Fri - R Restricted I:c'_ FannIN' D%%ellmg Signature .M Nlasonry Only RC Residential Rooting C'o�enne Telephone \1'S Residential \b'utdom:utd Sidon_ SF Rrsidcntial Solid Fuel looming \ >>b:mee Inu.dlawni D Residential Dennihuo❑ 5.2 Registered Home Improvement Contractor(HIC) HIC Company Name or HIC Registrant Name Registration Nuinher — Address [xpiratiun Date Signature Telephone r SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. I52. § 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure nt pm, dt• this affidavit will result in the denial of the Issuance of the buiiding permit. Signed Affidavit Attached'? Yes .......... ❑ No ........... ❑ _ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject pr,,perty hereby authorize ___—._.._ _to act on my behalf, in all matters _.. reiauve to work::utlwmizd by this bui:;ink: permit app!ic;xion. Signature of Owner --- ---- - _— -- Date SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION 1, -• - , as Owner or Authorized Agent herehy declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and behalf. I Print Name — — _ - — Signature of Owner or Authorized Agent Date (Signed under the pains and penalties of perjury) 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 Lu bitranon program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program Lind Construction Supervisor Licensing(CSL)can be found in 730 CMR Regulations 110.R6 Lind 110.R5. respectively. . I '_. When substantial work is planned, provide the information below: Total flours area(Sq. Ft.) - (including garage, finished basement/attics, decks or porchi Gross living area (Sq. Ft.) Habitable room count _ Number of fireplaces Number of bedrooms Number of h:nhrooms Number of halt/b:uhs Type of heating system Number of decks/ porches Type of cooling system Enclosed Open 3. "Total Project Square Footage- may be substituted tor 'TuCd Project Cost" { 'y CITY OF SALEM -; tL �•,,. � (,�l PUBLIC PROPRERTY DEPARTMENT 12,' \X.N;t �N rni.i r 5.0 Im, 11 n;i.0 Iu I�IfI: v'y.?;;-o;•h � Pits: 978 '4J9S46 Construction Debris Disposal Affidavit (required fur all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 Cv1R scction_1 11.5 Debris, and the provisions of MGL c 40, S 54; Building Permit It is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c t 11, S 150A. The debris will be transported by: (name of hauler) +. The debris will be disposed of in 5AL614 A 3rfA-f 1 O U (name of facility) (address u(facdily) - signature of permit applicant date .Icbii.�IT,2ni Work Order:720137 *Renewal 2020* CITY OF SALEM ;tla BUILDING DEPARTMENT 120 Washington Street, 3rd Floor, Salem, MA 0108 DEC 2 3 A 9 3} ABANDONED AND FORCLOSED PROPERTIES REGISTRATION FORM PROPERTY INFORMATION Address: 8 Cushing ST Salem, MA 01970 Parcel ID # Map 17 Lot 171 Square Footage of Building: Number of Stories: 2 Sprinkler System: Yes NoX (Operational yes/no) Pipe System: Yes No X (Operational yes/no) Fire Detection System: Yes _ NoX (Operational yes/no) OWNER(S) * OF RECORD (*attach additional sheets if necessary) Owner: Barbara A. ST Pierre c/o Celink Address: 2900 Esperanza Crossing, Austin TX 78758 Tel. No.: 866-727-4303 E-mail: austin_proppres@reversedepartment.com CONTACT PERSON/REGISTERED PROPERTY MANAGER Name: National Field Representatives Inc Primary Address (No P.O. Box) 136 Maple Ave, Claremont NH 03743 Business Tel. #: 800-639-2151 x2421 Non-Business Tel. #: E-Mail Address: VPR@nfronline.com Emergency Telephone # - 24hr/day 800-639-2151 IS THE PROPERTY LISTED FOR SALE? Yes No X If yes, Real Estate Agency Address: Tel. No. VACANT BUILDING PLAN: Please check which applies. 1. _The building is to be demolished. 2. _The building is to remain vacant. * UNKNOWN* 3. _The building is to be returned to appropria occupancy or use. SIGNATURE OF OWNER(S)/OWNERS AGENT: Ct � Tabatha Clark an agent of National Field Representatives DATE: 12/19/2019 REGISTRATION FEE $300 Check Cash/Money Order/Cert. Bank Check