11 CHURCH ST - BUILDING INSPECTION 701 it
t Y The ('urnmumcealth ut Massachusetts
{\�\ t Boutd of 13utldutg Rcgulanons acid Standards MI Nl(
�^ MaSS:IChnSCHS State 11.1ilding Code'. 780( NIR. 7"' edition til[
Building Pcrnut Applic ttiun To Construct. Re air, lZenorate Or I)emulish a , -,of
t (I\
One- or Two-Family Duelling
This ' am For O 'ticial Use Only
BuilJing Permit Numb - Dat plied: _-- ---- -_�
nature:
Building Curnmissiune In cctorot Burt Date .---_
yyy S ' ' IONS : SITE INFORMATION
Pro Ly :Address: 1.2 Assessors Nlap & Parcel Numbers ---
y t, P I rr l� Str�e * �7C)l
}
/ kla Numher Parcel Number
I.la Is this an accepted su"eet9 yes✓ art— p I
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use I_ut Area Isq fU Frontage tit)
1.5 Building Setbacks(f )
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Pim ded
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 system ❑
Public❑ Private ❑ Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
21 Owners of Record: I I C(�O1�� l�) SIYPC l 70 1
J �fAllISfnn - y
Namo.Print) Address for Service:
Signature
Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK' (check all that apply)
New Construction ❑ Exis[in�y Building ❑ Owner-Occupied ❑ Repairslsl ❑ Alteratianls) ❑ AJJiiinn ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_- Other lY Specify:
Brief Descripron of Proposed Work-: I
�v��1 � II five C5 yig( ap 1.r'irPrrlei�fi IA)w)rnu),5 _ 1
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Casts: Official Use Only
iItem - . (Labor and Materials) -
nElectrical
S L Building Permit Fee: S Indicate how fee is deterntmed:
❑ Standard City/Town ;\pplication Fee
l S ❑Total Project Cost" (Item 6) z multiplier s
�t g 3. Other Fees: $List:cal iH\'.AC) 5 cal (Fire 'Coral All Fees: 5l -
Check No. Check :\mount ('.i.h
e. Total Project Cost: t
i J " y315.L-)(D 0 Paid in Full ED Outstanding 13:d:utce Due:---._-__-_
SECTION 5: CONSTRUCTION SERVICES
r75.11icensedConstructionSupervisor(CSL) ti-7733 ram/A- Wq
Li.enn,c .N'uinher - I:Jh�iruPu`�n l):Ialo
eof C'SL- Holder /I II
List CSI.Type (seehclnw) l�
- Tv e Deseri won
1JJ r.s
C C'nresu'IeteJ�.up u,35.000 Cu. hI.i
R Resuicled I&@'_ Euntl� D%%ellinc
.Sag") _ _ \1 N1:uonr� Only
f�� RC Re+IJrm:a1 R„uline l'u,enn,,
Telephone \\'S IteaiJ.nual Rlndu„ .ind Sidin_
SP 12rmJeiuial Saud Fuel Illll'iling \ „fiance In.t.ill.uu�n
D Itn:dcuual Demolition
5.7 Regi tered Home Improvement Contractor 011C) IOftoQC? _—
HIC Company Nmnc uc fIIC Rgatrmu Name - - Re_isu"atiun Number
Add g. ' r
Lg7_�JJy Fxprauun atU e
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 provide
- this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached'? Yes .......... Ili No __....... ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN .
OWNER'S AGENT OR CONTRACTORAPPLIES FOR BUILDING PERMIT
I, TQ rl� 1 J e t l( r) - -, as Owner of the subject property hereby
authorize Chrif>JDpber zeprz-14 to act unmy behalf. in all matters
relative to work authorized by this building permit application.
X
Signor re o(Owner Date
SECTI N 7b: OWNEW OR AUTHORIZED AGENT DECLARATION
I, r hrl6+z_-)QKe r ZarzLA . as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and
behalf.
?Na
k:Pr,,,,],,n, f Owner or uthortzed Agent Date
er the pains and penalties of er'u )
NOTES:
An Owner who obtains a building permit to do his/her own work, or an o\smer who hires an unre,_,is(eied 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 he found in 780 CMR Regulations I IO.R6 and I I0.R5, respectively.
' When substantial work is planned, provide the information below:
Total floors area(Sq. Ft.) tincluding garage, finished hasemenl/attics. decks or porch) -
Gross living urea(Sq. Ft.) Habitable room count _
Number of fireplaces Number of hedrooms
Number of bathrooms Number of halUh; ilt.
rvpe of heating system Number of deck./ porches
Type of cooling System Lnclosed Open
3. "Total Project Square Footage" may be Substituted tot Total Project Cost"
=` Job#: Salesperson: �—
'ds
Sent to Owner: IN R31 i edition
' Mass Biting Dept: Mailed: tib:
Fax: GT/PU: ite Or Dcnxrlish a Rrw
13uiWin_ Perin B Fee: /. -'cos
Y�
This Section For Official Use Only
Building Permit Number: Date Applied: -- ---
Signature: - --- --
Building Commissioner/ Inspector of BuddingS Date ._---�
SECTION 1: SITE INFORMATION
LI Property :address: 7 1 2:assessors Map & Parcel Numbers
I �Inc ,v—/'In �'•rrYQ.�"�"' 4 /Q I — 1 � .
Ma Number Parcel Numho
I.I a Is this an accepted street'? yes� nu_ Map
L3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area Isy ft1 Frontage ifu
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided - Required Provided Required Prm dcd
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 s)'stcm ❑
Public ❑ Private❑ Check if yes[]
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner of Record: + ( C'(r)t J 1rC f/1 Sf1�2�-t _70 f
o ;-Ct j�.i[Isnn
Address for Service:
Name iPrint) -
(q7s) -7,+5 -
A !n 73
Signature TelephoneJ'
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction ❑ Existing Building ❑ Owner-Occupied ❑ Repairs(s) ❑ Alterttinn(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other 19 Specify: (?0r_)t1t7
Brief Description of Proposed Work'':
�� alf fii�P [5 Vl�nf0rfn-nryfi IA It�nlowS
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Costs: Official Use Only
Item - (Labor and Materials)-
Building Permit Fee: $ Indicate how tee is detenttutcd:
1. Building
❑ Standard City/Town Application Fee
2. Electrical $ ❑Total Project Costa (Item 6) x multiplier x .
3. Plumbine $ 2. Other Fees: $
4. Mechanical (HVAC) $ - List: --
5. Mechanical (Fire S I Total All Fees: S -
Sut ression)
Check No. Check .-lmuunt.
a
"b. Total Pro er Cost: 5
J L4315.D(D 0 Paid in Full (3Outsrut B ding ulanee Due ---.__-
��� CITY OF SALEM
3 }�ia
PUBLIC PROPRERTY
�;G''r J DEPARTMENT
MA 'K 12: A \,I6\1,l„N S1itI f1 • 1.\I It ,! 1 ;, =1'I .
Workers' Compensation Insurance Afridacit. Builders/Contractors/ElectriciansiPlumbers
A t llnant Information Please Print Legibly
N:t the mu>inc,; l lreantrtu,m ludo;Dual l: n T n
Address: NJo(fh Sire t°+ \
In ( 7S7aj- a)A
City,State'Zip: �
.tire son an employer:' Check the :appropriate box: Type of project (required):
1,I�1
,�/I am a employer with 4. ❑
❑ 1 am a general contractor and 1 6. New construction
art-tile).
employees (full andior p • have hired the sub-contractors
2.❑ I :fin a sole proprietor or partner-
listed on the attached sheet. 7. ❑ Remodeling
,hip and have no employees These sub-contractors have 8. ❑ Demolition
working for ale in any capacity. workers' comp. insurance. -9. ❑ Building addition
tNo workers' comp. insurance 5. ❑ We are a corporation and its 10 ❑ Electrical repairs or additions
officers have exercised their
required.] 1 1. Plumbin re airs or additions
i.El am a homeowner doing all work right of exemption per MGL ❑ g P
myself. [No workers' comp. c. 152, §1(3), and we have no 12.0 Roof repairs
insurance required.] r employees. [No workers' 13 [YOther Vil lnd D( 15
comp. insurance required.]
•,.\ny eppltcant that cheeks box NI must also till out the section below showing their workers'compensation put icy information.
if tomeuwners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such.
:Coat racturs that check this box must attached an additional sheet showing the name oft he sub-contractors and their workers'comp. put icy information.
/ant an employer that is providing workers'Compensation insurance far any employees. Below is the policy and job site
information. /
Insurance11y,
1''�Company Name: 1 t ` e�.,�, r� t
Policy #or Self-ins. Lie. #: t Q,2't'I' t 1 5�__5 U� !"1 Expiration Date: 1, t Dq
Job Site Address: ffrP,4 1_70I City/State/Zip:�em, rnp O1 q 7D
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 ofcriminai penalties of
tine up m S 1.5110.00 and/or one-year imprisonment. as well as civil penalties in the firm of a STOP WORK ORDER and a fine
fit up to S_250.00 a day against tile violator. Ile ads iscd that a copy of this statement may be tbrwarded to the Office of
Im cstieations of the DIA for insurance co%crage verification.
/do herebyIe i/•i ider thi,ruins and penulties of perjury that the information provided above is true and correct.
ii I our --1 /` Date'
Phone l 714 1,
--ollieial a.ce only. Do not write in this area, to be roanpleted by city or mrsvat official
Ciiv or -fnlxn: —
Ixsuing authority (circle fine):
I. Board of lleolth 2. Building Department 3. (,ihvTo+vn Clerk J. Electrical Inspector 5. Plumbing Inspector
6. other _----- —
Contact Person:_____----- _-- Phone #:__ -
Information and Instructions
N1.raChnseus (kue[aI Laws Chapter I rcgtures:rll cnIPIO%ers to pros ide porkers' compensation tirr their emplo)ees.
I',usu,uu to this statute, an entpluree is debited -is ".. e%er} person in the sers ice ff.nnuher under anv Contract of hire.
C\prras or inip I iCd, oral or prirtcn." .
An einj-dr�ter is delined as "an indis;dual. p.umcr.,hip, .tss()Cration, corporation or other le gal entity. Or asp hvo or more
,,Itile tbregomg engaged in ajoint eniciprise, and including the legal representatives of a of of employer. or the
rCcei%er or trustee of an individual, partncnhip, association or other legal entity, cmploving employees. Ifopcser the
n.�tier of a dp elling house having not more than three :ip;utntents and p ho resides therein, or the occupant of the
,h%Clung house of another who entplos s person, to do maintenance. Construction or repair pork on such dwelling house
(tt iat the wounds or huddirg appurten:mt thereto Shull not beCallse of SUCK eutplo)went be deemed to be an employee"
\1(iL Chapter I52, s2506) 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 eommomnvcalth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
additionally, MGL chapter 152, §25C17) states "Neither the Commonwealth nor any of its political subdivisions shall
cater into any contract for the pertbrmance of public pork until acceptable e%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-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 cityor 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 till 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 permiblicense applications in any given year, need only submit one affidavit indicating current
policy intormation (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
We. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
The t)(rice of Investigations would like to thank you in advance for your cooperation and should -ou have any questions,
please do not hesitate to give us a Call.
the DCp:utmCrtt's address, telephone and lax 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
Rc'.tSCd 5-'b-U5
Fax # 617-727-7749
www.mass_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.
150a
The debris will be disposed at. Salem Transfer Station
owned by Northside Carting -
Signature of Fermit Applicant
Date
Christopher Zorzv
Name of Permit Applicant
A &A Services, Inc.
Firm Name
115 North Street, Salem, MA 01970
Address, City, State, Zip Code
i
- - � ✓�te TOommw�xeae¢� o��/lZadOoc�zude�d
Board of Building Regulations and Standards
Construction Supervisor License
j License: CS 57733
BirMItila"te«-5/26/l 958
Igefration�126/2009 Tr# 13739 I
CHRISTOPHER ZAR, 'g
115 NORTH ST %
,I
SALEM,MA 01970 4y `-' Commissioner
_ � . . ._... _. . .. ..._- .. ✓fie iJa»rareareu aw .��aners<�cueet7d
Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registration: 101609
lug Ezplration , 1126/2010 Tr# 267870
-;.-.Type: .Private Corporation
A&A SERVICES,tNC=
Christopher Zorzy.Z
115 North Street _
Salem MA 01970 Administrator
Commonwealth of Massachusetts
Division of Occupational Safety
Laura M.Marfin,Commissioner
Deleader-Contractor
CHRISTOPHER ZORZY
Eff.Date 04/0 /0
Exp.Date 04/08/09
DC000440
s
I 09
OIm6er ofIlC.O.N.ES.T L II �I II II �
OIIII IIIOIIIII III IIIIII OIII IIa�0I11II IIIIIIII BOSfONRENEW,.
U-VALUES AND R-VALUES
' �_ ENERGY STAR
a,av®.�o„STR,ES Harvey Manufactured PARTNER
Windows and Doors
WHOLESALE PRICING
i
U-Values in accordance with NFRC-100 • Based on residential sizes
• U- and R-Values are subject to change without notice • Whole window values _
F
All Harvey vinyl windows with Low-E/Argon and all Majesty double hung windows with
Low-E/Krypton quality for the ENERGY STAR®program throughout the U.S.* Isosom
Clear Insulated Low-E* Low-E/Argon*
U-Value R-Value U-Value R-Value U-Value R-Value
VINYL WINDOWS
Classic Double Hung (Mechanical) 0.50 2.00 0.37 2.70 0.34 2.94
Classic Double Hung (Welded Sash) 0.50 2.00 0.36 2.78 0.33 3.03
Classic Double Hung (Welded Sash & Frame) 0.49 2.04 0.36 2.78 0.33 3.03
Classic Acoustical Double Hung ST040 0.23 4.35 0.18 5.56 0.17 5.88
Signature Double Hung (Mechanical) 0.50 2.00 0.37 2.70 0.34 2.94
Signature Double Hung (Welded Sash) 0.50 2.00 0.37 2.70 0.34 2.94
Slimline Double Hung (Welded Sash) 0.51 1.96 0.38 2.63 0.34 2.94
-.- ,5imJnR-Qo.LbleHung-.(WeIdecL-Sash.&-F-rame.)----n0.50_-2.00 0.3a&--2.63 .A,35_..2.86--
- - --Slimlinre-S7n te-Hun Welded-Sash�Frame - --
-- --- 9 9=f )-- - 0.50_ -
Vinyl Casement/Awning 0.47 2.13 0.34 2.94 0.31 3.23
Vinyl Casement/Awning and Thermal Panel 0.31 3.23 0.25 4.00 0.24 4.17
Vinyl Designer Shapes 6.49 2.04 0.34 2.94 0.30 3.33
Vinyl Hopper 0.47 2.13 0.35 2.86 0.32 3.13
Vinyl Picture Window 0.46 2.17 0.31 3.23 0.28 3.57
Vinyl Welded Deadlite 0.50 2.00 0.34 2.94 0.31 3.23
Vinyl Roller - 2 Lite and 3 Lite 0.50 2.00 0.36 2.78 0.33 3.03
Clear Insulated Low-E* Low-E/Argon*
VINYL NEW CONSTRUCTION WINDOWS(pg190-231) U-Value R-Value U-Value R-Value U-Value R-Value
Vicon Double Hung (Welded Sash & Frame) 0.50 2.00 0.37 2.70 0.34 2.94
i.
Vicon Single Hung (Welded Sash & Frame) 0.50 2.00 0.37 2.70 0.34 2.94
Vicon Classic Double Hung(Welded Sash&Frame) 0.49 2.04 0.36 2.78 0.33 3.03
Vicon Casement/Awning 0.47 2.13 0.34 2.94 0.31 3.23
Vicon Picture Window 0.47 2.13 0.32 3.13 0.28 3.57
Vicon Designer Shapes 0.48 2.08 0.32 3.13 0.29 3.45
Temp.Clear Temp Low-E' Temp.Argon
PATIO DOOR (pg 257-260) U-Value R-Value U-Value R-Value U-Value R-Value
Harvey Solid Vinyl Patio Door 0.49 2.04 0.40 2.50 0.37 2.70
Low-E/Argon* Low-E/Krypton*
WOOD WINDOWS (pg 261-270) U-Value R-Value U-Value R-Value
Majesty Double Hung N/A N/A 0.35 2.90
Majesty Fixed Casement (PW) 0.37 2.70 N/A N/A
Majesty Casement/Awning 0.42 2.38 N/A N/A
Majesty Picture Window (DH) 0.34 2.94 N/A N/A
*The use of tempered Low-E glass may effect ENERGY STAR®qualification in your region.
U- and R-Values are subject to change without notice.
Not all products stocked at all locations. Call your local branch for availability.
Pricing and information are subject to change without notice& may vary from reqion to region.
For current pricing, call your local branch or visit www.harveyind.com.
�.Efledive 3/17/03 256
j7F.
A & A SERVICES, INC. --------
AAA f
S ES 115 NORTH STREET,SALEM,MA 01970
• ° • • Telephone:(978)741-0424 Fm:(978)741-2012
Contractor Registration No. 101609
Federal EIN:04-3090162 Construction Supervisor No.CS057733
WINDOWS AND STORM PRODUCT SPECIFICATION SHEET -
Buyerls)Name Date of Contract
Buyer(.)Street Address,City,State and Zip Cade
// G h ,rc it, S 4- �t /
Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address
4764 7 .�=4 73
The Buyer(s)listed above hereby jointly and severally agree to purchase Me goods and/or services listed below,in accordance with the prices and terms described on
this Specification sheet and the front and the reverse of the accompanying CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,of which this specification
Shasta a part.
WINDOW REPLACEMENT
Remove and dispose of# existing windows. n
Install # �I V�_ new U -N windows: f ✓inyl IfWood oY
CI ff K (Menu acturer) r P aey- d.
Options: Style Drgrth e 1AlUG Grid pattern 4-1 4cuer I I 'a? rGOW ;d
Color Interior ,A)k I k--- j Color Exterior tAtV r �2 Glass Type
If Wrap exterior trim with aluminum: Style Color
111 jjjAll windows will be installed according to the installation procedures in the portfolio.
Caulk all interior and exterior edges.
Insulate where possible around new units.
If Insulate window weight pockets if exist,and around new window units where possible.
Q 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 PULL CONSTRUCTION WINDOWS
f Create new window opening by cutting through existing home and framing in opening.
f Remove and dispose of existing unit(s)in its entirety.
Note:Electric and plumbing may exist in wall and will require additional costs to customer if need to be dealt with.
f Install window(.)into opening(.).
Note: If Bay or Bow installation to include cable support system,new roof system(matching color as close as possible) "
or tie into existing soffit system.
f Bay If Bow If Casement f Other window(s)to include new interior style trim and new exterior style trim and head
flashing as needed.
f Note: Painting and staining not included.
STORM PRODUCTS
f Remove and dispose of# existing storm window(s).
f Install new storm windows# Manufacturer
Style Color Option
If Remove and dispose of# existing stone door(s).
If Install new storm doors# Manufacturer
Style Color Type: If Aluminum If Solid Care ,
SPECIAL INSTRUCTIONS:
r ,I 440 iJ W:.rdaw I de oral .
Il' rQU42/Uole'eto 4Zp l%7 Yndr '� —/Ye ftf'H/-aF 44EW cdpVQ'4njf,o
�NcI u�.i
ItlaagreeEand undemtead byand between Me parties that this epeclncatlon Sheet,all arm CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,oonat". '
the endre understanding between Me parties,and there era no verbal undmatandings changing or modifying any of Me terms.This contract may not be changed or Me
terms modified or varied In any way unies.such changes are In writing and signed by both Me Sunni and Me contractor.B.,q.)hereby acknowledge Mat Buyerls)
he.read one specification sheet. ),�qq
Contractor Initials: Date: !V 0� Buyer's Initials: Date:���
Vim` YY 0
sake f9.2
A & A SERVICES, INC. �t
A&A 115 NORTH STREET,SALEM,MA 01970
,am Isa 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
Buyers)Name Date of Contract
Buyers)Street Adtlress,City.State and Zip Code
l Id're,14 F- 01
Dayfime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address:
The Buyers)listed above hereby jointly and severally agree to pumhase Me goods antllor services listed an the accompanying specification sheets,in accordance with
Me pdcos and terms described on the front add the reverse of this agreement and any specification sheets(this'Agmemeal antl Buyers)have requested that such
goods or services be ihratetl or provided at Buyer's address listed above.A&A Services,Inc.(Contractcun,hereby agrees to install or cause to he resu led the products
or services listed In has Agreement at the Buyers)address written above. This Agreement represents a cash sale of goods and services. The Buyers)agree to pay in
BY the cost of the gootls and sa9yp pyy�re based as describe herein.regardless of from,or approval of y financing Byyedid may seek for�purchase.
ARC
13D
It IMP"
Purchase Price: o' Est.Starting Date: 'Ir�`�
Down Payment: Est.Completion Date:
❑Cash
Amount Due on Stan of Job: ❑C k
,edit Card
Amount due on of Completion: No. `J-7 a9�Q6.3/
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 -
Buyeds)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
(1)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 e-mail,as listed above, In the event Contractor believes Buyers)would be interested in any additional quality
products or services of Contractor. DO NOT SIGN THIS CONTRACT IF IT CONTALNS ANY BLANK SPACES.
A&AServicesYine. Buyer j�
By: /7L �p�J.! YV
Signature Sig�e
_"4 L- (al vl mil-
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 after the date of this
transaction. See the following Notice of Cancellation form for an eiplanation of this right.
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I HEREBY CANCEL THIS TRANMPCTIOR Cmwumntei9mlue age I HEREBY CPNCELMIS TRANSACTION. Candumery Signed to