11 CHURCH ST - BUILDING INSPECTION (36) ,
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DATE:
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PLANS MUST BE FILED AND APPROVED BY THE
INSPECTOR PRIOR TO A PERMIT BEING GRANTED
Location of Building P,(/LI ra- S1 o 1,t -30!J
Building Permit Application For:
'(Circle whichever applies) Roof, Reroof, Install Sid' c Deck, Shed, Pool
Addition, Alteration, Repair/Replace, oundation Only, Wrecking
Other:_
PLEASE FILL 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: �II�i-(^ �JUi�_ Contractor: Christnnhar Znrz.y
Street It,
0^, UL(-6,2Sf, ��-3��Ci[�' �)f(JIQdNt Street119 Nnrth StraatCity Salam
State VVW Phone 0-1 -7LO -27L9 State MA Phone(978) 741-0424
Architect: City of Salem Lic# 14 0 5
Street City State Lic#0 5 7 7 3 3 HIP# 101609
State Phone ( ) Homeowners Exempt Form_yes no
Structure: (please circle) Single Family, Multi Family# Other CffKAO
Estimated Cost of job$
Will building confirm to aw?�es no
_ \/
Asbestos?_ yesnno
Description of work to be done:_ ',-ko sw dw U (Z) UI k vt (eJ to
lNI yJ GU)
SERVICES
Drawings ubmitted:_yes no Mail Permit to: fl15 NORTH STREET
X OAT
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 Map/Lot
Permit fee$
I
C0124MS:
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The Commonwealth of Massachusetts
Department of Industrial Accidents
#NCO8118 91offe6s
600 Washington Street
Boston, Mass. 02111
Workers'Compensation Insurance Affidavit
name:
location:
city phone#
I am a homeowner performing all work myself.
1 am a sole proprietor and have no one working in any capacity
I am an employer providing workers' compensation for my employees working on this job.
companyname: A & , A_"Seryices , Inc .
address: 115 North Street +r k"Wlp•+;
city: Salem 1tiA 01970 978-741' 424 y'' 1't'.
s - phone#:. Q n v,1a�ltiTrlht� e r ;.,
insurance co. The TraVelerS policy# WC939X1256
I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who
have
the following workers'compensation polices:
� 4
company name: ��*Y� i
a{r?w tlJtt� N
address: 4'u`<3P t1S3e7ad
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city:
hone q ir�tY7"
,r ,y
finsurance cm policy# `•. ` 'ii'dk i "h+
Company name
address. . t `„/.4`. ' .
• t �,: to a•"' , 3'���h.
city: , "home#:
insuranceco: oil' # + a � ,{
Failure to secure coverage as required under Section 25A of MCL 152 can lead to the imposition of criminal penalties or fine up to$1,500.00 and/or
one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of SI00.00 a day against me. 1 understand that it
copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
I do hereby certijy, nd r the pains and penalties of perjury that the information provided above Is true and correct.
Signature- f16- / Date
Printname Christopher Zorzv, President Phone# 978-741-0424
official use only do not write in this area to be completed by city or town official
city or town: permit/license# nBullding Department
❑Lfeensing Board
❑check if immediate response is required - ❑sefeetmen s 0>ree
❑Health Department
contact person: phoned; flOther
j LII17 III rIIJEnj, r��IIrZL�IIIIIE
�uaiit �raptrig �:su�rrm�t:
• �aa,,:,;� i�uil�inn a�rnrtni
5zlv-: 35-5595 EV.. ssb
DIS?OSAL OF D:33I5 AFFIDAVIT
In accordance with the provisions of 14CL c 40 , 554 , I acknowledge that as a
condition of Building Permit ; all debris resulting from the
construction activity governed by this Building Permit shall be disposed o: i.
a properly licensed solid waste_ disposal facility, as defined by MCL c III,
S 150A. Salem Transfer Station owned by:
The debris vill be disposed of at : Northside Carting
n � location of fac_ __ ty
GA 1
` •r Date
Signature of ?err Appl_cznt
Fully com?lete the following information:
(?lease print clearly)
BhkiAt8pheicSo;iyc.
Name of Permit Applicant
A & A Services, Inc .
Firm Name, if any
115 North Street , Salem, MA 01970
Address, city 6 State
The above StarL'te 'equ=re-: that debris from the demolition. renovation. reha'
or other alteration of building or structure be disposed of in a properly
licensed solid waste disposal facility as defined by r:CL cIII. S150A and tha
building resits or license's are to indicate the' iocation of the facility at
U-VALUES AND R-VALUES
GY S eAR
RV INDUSTRIES Harvey Manufactured CNERPARTNER�
Windows and Doors
WHOLESALE PRICING
• U-Values in accordance with NFRC-100 • Based on residential sizes
• U- and R-Values are subject to change without notice • Whole window values
All Harvey vinyl windows with Low-E/Argon and all Majesty double hung windows with "tee
Low-E/Krypton qualify for the ENERGY STAR® program throughout the U.S.' isosool
Clear Insulated Low-E* Low-E/Argon*
VINYL WINDOWS U-Value R-Value U-Value R-Value U-Value R-Value
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 STC40 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
Slimline Double Hung (Welded Sash & Frame) 0.50 2.00 0.38 2.63 0.35 2.86
Slimline Single Hung (Welded Sash & Frame) 0.50 2.00 0.38 2.63 0.35 2.86
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 0.49 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.S6 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-Vatue R-Value
Vicon Double Hung (Welded Sash & Frame) 0.50 2.00 0.37 2.70 0.34 2.94
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 Casemept/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 region to region.
For current pricing, call your local branch or visit www.harveyind.com.
EMeaive 3I17/03 256
�� ✓Iut Uld)lNIHYIlllN.�UL O�/('/FlQ4J/4ffldfad
•='+� Board or Building Itcgulafinns and Man"ards
u HOME IMPROVEMENT CONTRACTOR
Registration: 101609
Expiration: 6/26/2006
Type: Private Corporation
A&A SERVICES, INC
Christopher Zorzy
115 North Street
Salem,MA 01970 Administrator
Commonwealth of Massachusetts
Division Of OCCUP3fional Safety
Rdenj..Prewso,DepufyDmdor
Deleader-Contractor
CHRISTOPHER ZORZY
Eff.Date 12/19/03 '
Dale 12/IO/04
DCO
' DC000440
Member d C.O.N.E.S.T. /
so
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BOARD OF BUILDING REGULATIONS t
+. License: CONSTRUCTION SUPERVISOR {
Number: CS 057733
N
{ Birthdate: 05/26/1958
Expires: 05/26/2005 Tr.no: 12224
Restricted: 00
CHRISTOPHER ZORZY
115 NORTH ST ( Bali�i
SALEM, MA 01970 Administrator
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