11 CHURCH ST - BUILDING INSPECTION (8) - ,�✓ o� v J
1ih The ('uminonssealth of Ma1SHChLiSettS I OIt
(� 1 t Board of l3wlding Regulations and Standards III NI( IIIAH I 1
b1assachusetts State Building ('ode. 7511 CMR. 7 edition I \l,
Building Permit Application To Construct. Repair. Renoca e Or DernoliSh a Rcru„Il uw u,
i
or Two-Futnilr Du ellin 4�
One-
This SectiO 'Or Oftici I U c Onl
Building Permit Number: Date . I •d
� we:
Sl�nat
Building Conunissionrr/ Inspect() I tildings I ale
SECTION 1: SI' E INFORMATION
L1 �'r�rp y j� c nI #/n Ci 2 assessors Map & Parcel Numbers ---
r II d
. .[ Is this an accepted street? yes_ no_ Map N'uniber Farrel ,N'umhrr
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use t-ut Area(sq li) Frontage(li)
1.5 Building Setbacks(ft)
From Yard Side Yards - Rear Yard r
! Required Provided Required Provided Required Jcd
1.6 Water Supply: (M.G.L c.40. ti 54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone? Ibtunicipal ❑ On site distat.sal system ElPublic❑ Private❑ Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 vner'of Rec
Nam 1 rind - Address for Service: �1 ,
Swriature Teleph ne
SECTION 3: DESCRIPTION OF PROPOSED WORK (check all that apply)
New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ r\Jdiiinn ❑
Demolition ❑ Accessory Bldg. ❑ 1 Number of Units_ Other ❑ Specify:
Brief De tic of. r tp WorT11k?: � ` /�
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Costs: Official Use Only
- Item (Labor and Materials) -
I. Building S 701 I. Building Permit Fee: $ Indicate how fee is deicrnnned:
❑ Standard City/Town Application Fee
2. Electrical S ❑Total Project Cost' (Item 6) x multiplier x _
i
3. Plumbing S 2. Other Fees: .S
4. Mechanical IHVAC) S List: .. —
S. Mechanical (Fire S
'total All Fees: $
Ai ressiOn)
Check No Check Amount: ('a.h :\nnnun'.__.-_ I
b. Total Project Cost: $ a /5 ❑ Paid in Full ❑ Out,rmJinc Balance Uua:___.____J•
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL) '57 763 51a��011
Na
�nS �I Je Lcrnse Nwnher 1'.Npuw: au D.na
i'�a 'S/V C' --�tj/�— List C'SL'I\pc I.ca hclmcl
\JJrr . - T1 c Description
�t L I't lresincled up to 3i,000 t n. 1°I.1
R Restricted L@'_ F.muk D%kelhn_
Si m uue \1
` Masonn Only
a q1• �'� / RC RrsiJrnual Ruulin m
c Con cr _
Telephone N'S Re>idrm till \VinJuIl and Sidme
SP RrsiJrmial Solid Purl Bumm, I Ilianrr hni.ill.unni
D Residential Demolition
5.2 Re [stere Ilome Improvement Contra for (IIICI Ul G)
___[i
H 'IIC II Iny. i Ig(J ur Re t anl� l j Rr_Istratiun Number
Ex vauun Elate -
Signs ore 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. Fadure to provde
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 CONTRACT/OR APPLIES FOR BUILDING PERMIT
as Owner of the subject property hereby
authorize /'/ .0 r ti' to act on my behalf. in all matters
re at ve to work authorized by this building permit applic ion.
Signature ul'Owner Date
SECTION 7b: OWNERI OR AUTHORIZED AGENT DECLARATION
[, .S 1-7
or7�1 il�+ ,as Owner or Authorized Agent hereby declare
that the statements and information on e Foregoing application are true and accurate, to the best of my knowledge and
behalf.
S
.. Print Nal
//-
Signatu re of Owner or - thorized Agent bate
ISiened under the pains and penalties of perjU )
NOTES:
I. An Owner who obtains a building permit to do his/her own work or an owner who hires an unregistered 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. 112A. Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I l0.R6 and 110.R5. respectively.
2. When substantial work is planned, provide the information below:
Total flours area ISq. Ft.l - (including garage• finished hasement/amcs, decks or porchl
Gross living,area ISq. Ft.) Habitable room count
Number of fireplaces Numberht hedrooms
Number of bathrooms Number of halt/hallis
rope of heating system Number of decks/ perches
"Type of couline system LneluxJ _Open _
1. "Total Project Square Footage- may be Substituted for -
. Project Cost'
��
I
CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
%1.% IN I-'.NVA,l I;NI,1,IN S 1 KI-I I • S.M I M, MLt,l.11
Il:l: 9-8-,4 9;'A ♦ F IX; 'J.'g--l_-98an
Workers' Compensation Insurance Afftdacit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
`:lithe I Bu,uless t tr_anitauon InJlx idual.l: A L Yl
Address: r+h 5 Fr P + \
City',State,Zip: cA.1f T MA DI9-70 Phone oj�
F
ruu an employer:'Check the appropriate box: Type of project(required):
1 am a employer with 4• ❑ 1 am a general contractor and I 6• ❑ New construction
I (full ❑ndror part-time).* have hired the sub-contractors7. ❑ Remodeling
I am a sole proprietor or partner- listed on the attached sheet. S
hip and have nu employers These sub-contractors have 8. ❑ Demolition
working for me in any capacity. workers' comp. insurance. -9. ❑ Building addition
No workers' cum insurance . 5. ❑ We are a corporation and its(• P� 10.❑ Electrical repairs or additions
required.) ocers have exercised their
3.❑ I am a homeowner doing all work ri ffight of exemption per MGL I I.❑ Plumbing repairs or additions
myself. (No workers' comp.. c. 152, §1(4),and we have no 12.❑ Roof re airs
insurance required.) t employees. (No workers' I Other
comp. insurance required.)
•Any applicant that checks box#1 most also till out the section below showing their workers'compensation policy information.
r I lumeuwners who submit this affidavit indicating they are doing all work and then him outside contractors most submit a new affidavit indicating such.
:Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information.
I am an employer that is providing workers'compensation insurance for tray employees. Below is die policy and job site
infornmtion. -F /
Insurance Company Name: 1 �Q Vh
Policy #or Self-ins. Lic. )hCU t- H 13 13 Expiration Date: (y
Job Site Address: /
�// ( Urch (, /° /m, City/State/Zip: 7 /6
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 NiGL c. 152 can lead to the imposition of criminal penalties of a
ine up to S 1.500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
nt'up.m S250.0o a Jay against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Im estiaations of the DIA for insurance co%crage weritication.
/Ju hereby cerli a lea rIteina'and penalties of perjury that the information provided above is true and correcL
tiien.uure: �j LJ ,(� Date:
�d
Phonc a:
Official use)oily. Do nor strife in this area, to he coarpleted by city or town ojjicciaL
#—._—..----..----
ksuing authority (circle one):
1. hoard of Ileallh 2. Building Department 3. otpifown Clerk J. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person:____ -- Phone #:
Information and Instructions
%las.a:huseus(ieneral Laws chapter I" requites;ill ennplovecs to pro%ide tsorkers' compensation for their employees.
Put sauu to this >t:uuIe. .in ewph{ree is defined as c%en person in the sery ice of.nunher under any contract of hire,
cyiress or ingtlied, oral or %s ritten."
An a mpLtrer is defined as "an indit dual, partnership, ussoe i a t ion,corporation or other Ie gal entity. or an\ two or more
of the tore_going engaged in ,joint enterprise, and including [lie legal representaik es Ufa deceased employer,or the
recciser or trustee of an individual, partnership,association oruther legal entity,employing employees, flo%%e%er the
u•.%tier of a dwelling house hay mg nut more (hart three apartments and is ho resides therein, or the occupant of the
dew rlling house of:mother who ennplovs persons to do maintenance,construction or repair%%irk on such dwelling house
or oan the grounds or building appurtenant thereto shall not because of such employ ment he deemed w bean employer."
.%I(iL chapter 152, �s25C'(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 aho has not produced acceptable evidence of compliance e'ith the insurance coverage required."
Additionally, NIGL chapter 152, vS25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract f-or the performance of public work until acceptable et 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 resumed 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 sore that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
Of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill.in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town).- A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit.
The t wiice 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.
File Deparunent's address, telephone and Ft.c number:
The Commonwealth of Massachusetts
Department of industrial Accidents
OMce of Investigations
600 Washington Street
Boston, MA 02111
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
R0 iSrd 5-20-05 Fax M 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
o
Signature of Permft Applicant
Elate '
ChrlstopherZorzy
Name of Permit Applicant
A &A Services, Inc.
Firm Name
11S North Stres Sale--m MA 015r0
Address, City, State, Zip Code
-� :�lassachusctts- Depntnmcnt of Public >afct)
' Board of Buildim; Re�_ulations and Jntudards
Construction Supervisor License
License: CS 57733
Restricted to: 00
CHRISTOPHER ZORZY
115 NORTH ST
SALEM, MA 01970
�L 1� Expiration: 5/26/2011
i (bnunisshmer Tr.Y: 14751
omvnaar
.. .. ... _
-
. � Board of Building Regulations and Standards
77
HOME IMPROVEMENT CONTRACTOR
- - Registration:_joltsog
6/2e/z
E4piration /2fi/2010 Tr-9 257570
T e: Private Corporation
A&A SERVICES,, ...
Christopher Zorzy.
115 North Street %` 'Ic
Salem,MA 01970 Y Administrator
Commonwealth of Massachusetts
Division of Occupational Safety �
Laura M.Marlin.Commissioner a
Deleader-Contractor
CHRISTOPHER ZORZY
Eff.Date 04/01/09 $
Exp.Date 04/06/10 ."
. - DC000440 , �-'
Member of C.O.NE.S.T.- f
BO
. - III II I I I I I IIII II IIII I Illllll II BOSTON-RENEW -
vanguard NFRC Performance .
w I ND o w S Specifications
A view that works
vanguard
Our windows are tested and certified to National Fenestration Rating
Council(NFRC) standards. Product testing data can be viewed by going
to NFRCs web site, www.nfrc.org, and entering the appropriate Certified
Product Directory(CPD) number.
--�.�..�..—r-t^^ •^- Double Tilt-In Standard Casement Sliding
Hung
Slider Slider Picture Casement Awning picture Door
NFRC CPD SUW-K-1- SUW K-2- SUW-K-B- SUW-K-7- SUW-K-4- SUW-K-8- SUW-K-3- SUW-K-5-
No.
00083 00045 00047 00010 00038 00010 00038 00004
Clear MM
Glass , �p _
III, ...�- - .�..�.. ge •Su'}Ct k 5 y�,�`�.P 'C q ' J; {'J' f-4' �A-lu3,yyF �ki'' 'iU"V'C N.jRm"X95�y-. ...__.. ij m. 9k ,. v V•. ..
NFRC CPD No. SUW-K-1- SUW K-2- SUW-K 6 SUW-K-7- SUW K 4 SUW-K-B- SUW K-3- N/A
00086' 00048 00050 00012 00040 00012 00040
I, Sun- r :
Smart
Glass
NFRC CPD No. SUW K-1- SUW-K-2- SUW-K B SUW K-7- SUW-K 4- SUW-K-8- SUW-K-3- SUW-K-5-
00085 00047 00049 00011 00039 00011 00039 00005
Ultra- '
Uvss
Glass
z
M �
SUW-K-1- SUW-K-2- SUW-K-B- SUW-K-7- SUW K 4 SUW-K-B SUW-K-3 SUWK-5
NFRC CPD No. 00050 00045 00014 00042 00014 00042 . 00005
00088
Kr90 -
Glass +y y p hx "5 w: `K K1� •" �w� � �� 4t �a w F�4ID'�+u" .F�n�4/n �
r
All performance values are for windows without grids in between the panes of glass.
070507 SSI5-V3
s' U-VALUES AND R-VALUES
H ENERGYSTAR
HApvEv ,v�usrR•E=s Harvey Manufactured
anuLlaCtttred PARTNER
�• Windows and Doors
WHOLESALE PRICING
U-Values in accordance with NFRC-100 • Based on residential sizes
La
• 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
Low-E/Krypton qualify for the ENERGY STAR*program throughout the U.S.' lso9om
., Clear Insulated Low-E* Low-E/Argon*
VINYL WINDOWS U-Value R-Value U-Value R-Value U-Value R-Value
Classic D I oub a Hun Mechanical 2. 7 2.70 .34 2. 4
9 ( )
0 50 00 0 3 0 9
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
_�..�limline poubleJ lung-(W-elded_Sash,&-.Frame).--- -0.50..-2.0 A_38-_..2.63.-u-0-35._.2.86-
S1imNne.Sirrgle-Hung-(Welded ash-&.Frame)- :--
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 6.34 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
Vicon Single Hung (Welded Sash & Frame) 0.50 2.00 0.37 2.70 0.34 2.94
Voon Classic Double Hun )g(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 wnrm.harveyind.com.
�EHective 3/17/03 256
5+
Jaime A & A SERVICES, INC.
PAASBMCM 115 NORTH STREET,SALEM,MA 01970
• Telephone:(978)741-0424 Fax:(978)741-2012
Contractor Registration No. 101609
Federal EIN:04-3090162 Construction Supervisor No. CS057733
WINDOWS AND STORM PRODUCT SPECIFICATION SHEET
Buyer(s)Name Date of Contract
1Feteir Kotyr#d /d 7 `y
Buyers)Street Address,City,State and Zip Code
V�7 Cl
Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address
- y
The Buyers)listed above hereby jointly and severally agree to purchase the goods and/or services listed below,in accordance with the paces and terms described on
this Specification sheet and the front and Me reverse of the accompanying CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,of which this Specification
Sheet is a pan.
,� _, WINDOW REPLACEMENT
move and diispoT se of#� existing windows.
Install # 7 Mjo new 9"Veq windows: Inyl ❑W,o•od
(Manuf cturer) extTk�orF' �1`.S$6rldS A�{�
Options: Style iC. L le. I Grid pattern
Color Interior14-1 h-4e- olor Exterior L/)111� — Glass Type 0t
❑ Wse6 exterior trim with aluminum: Style Color ��'
All cws will be installed according to the installation procedures in the portfolio.
Cau . terior and exterior edges. im �Z-.SC��P.liS
nsulate where possible around new units.
❑ In a window weight pockets if exist,and around new window units where possible.
Ind in this proposal are set up,clean up,Hope vacuum and cleaning windows inside and out.
wilding permit included.
BAY/BOWS/CASEMENT UNITS/ANY FULL CONSTRUCTION WINDOWS
❑ Create new window opening by cutting through existing home and framing in opening.
❑ Remove and dispose of existing units)in its entirety.
Note:Electric and plumbing may exist in wall and will require additional costs to customer if need to be dealt with.
❑ Install window(s)into opening(s).
Note: If Bay or Bow installation to include cable support system,new 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
f mg as needed.
Note: Painting and staining not included.
STORM PRODUCTS
❑ Remove and dispose of# existing storm window(s).
❑ Install new storm windows# Manufacturer
Style Color Option
❑ Remove and dispose of# existing storm door(s).
❑ Install new storm doors# Manufacturer
Style Color Type: ❑Aluminum ❑Solid Core
SPECIAL INSTRUCTIONS: # LN /1c�LS�G(�2tU �nSII�t-ho�
` 'S £
' 3:�" Gl ,yo UJ D�y`Por% n'IvP X'�ria5' Te/ � W l7ecf-
oce sug+QAA5
II
q �5`-6 I� �;Na Ift�ntdN fwkoY1Or sjj2pS�f!! /✓-PJCL+�P
it la agreed and understood by and between the parties that this Specification Sheet,along with CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,consulates
the entire understanding between the parties,and there ere no wrial i nderatandings changing or modifying any of the terms. This contract may not be changed or he
,arm.modified or varied in any way unless..on changes are In writing and signed by both the Buyen.)and the Contractor. Buyens)hereby acknowledge that Buyer(.)
has read this Specification Sheet / �f
Contractor Initials: LS Date: 4� Crf Buyer's Initials: Date:bZ 10'7�0/
+• Aende pJ -2
�4 u A & A SERVICES, INC.
i SERVICES 115 NORTH STREET,SALEM,MA 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
Buyers)Name Data of Contract
iii h GAA in 7 0
Buyer(s)Street Address,City,State and Zip Cade
u r i 10 Aera
Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address:
7 7 tf " -ter, A,KonrAJ M S
The Buyers)listed above hereby jointly and severally agree to purchase the goods and/or services limed on the accompanying specification sheets,in accordance with
the prices and terms described on the from and the reverse of this agreement and any specification sheets(this'AgreemenY),and Buyers)have requested that such
goods or services be installed or provided at Buyer's address listed above.A&A Services,Inc.('Contractor),trance grass to insfell or cause to be installed me prOduds
or services listetl in arms Agreement at Me Buyer(s)address rertmen above. This Agreement represents a cash a of goods and services. The Buyer(s)agree to pay m
cas=of the goods and services purchased BE described herein,regardless 0 timing or approval o my financin Buyers)m�ayy�A,eeN far air purchase.
Purchase Price: a� Est.Starting Date: �Ay✓
Down Payment: Est.Completion Date: evfl
❑Cash
Amount Due on Start of Job: ❑Check
❑Credit Card
Amount due on_of Completion: No.
Amount Due on of Completion: �J_ _1�-�J Expiration Date:
Balance Due on Upon Completion. rO 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.
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(s)also
(1)acknowledge that they were orally Informed of their right to cancel this transaction;and(it)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 THIS CONTRACT IF IT CONTAINS ANY BLANK SPACES.
A&A Services, c- Buye s) -
By:
Sig,isatle Signat Fe r^o���
L 4 Cl
Print Name ri� n N me
Signature
Print Name
You,the Buyeral,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. .
ARBRRATION'.The contractor etb Vre Mmeaxrer hereby mNwlry egroa m ativarca Nat In tice went elVMa pets M1ea do is mrcamlrg Had wntrecL eitl'er pvry may submit well mad.N
e ARBITRATION
Th contr ctoiewleas been appmreE by Me secretary al Ne ExecuWeruit in or Consumer AXalra h ais ReguMtiona vb Me Nher paler p be require]N submit b
sucM1 aNNe4on as proreC in M.G.L c.16lA.
Dma.LM i.ldaa: L a.yw,lwtuh
In4W&? Dan
NNT(`. ()F�F ANSFI I aTIl1N
Dale of Thader on Ld 0 .You mry cancel Nb transaction,without any Ponse,or Data of Transaction .You may mnml this madwoman,without any pevlry or
ob9gelloq vdMln Nmeb in as Eaya lmmrM eMve Eare.If you cancel,any pmpeM medv ln, abll0afion.wtlM1in Mrce bwlneu tlaya lent NeeWve Cab.It you md¢el,any pmpeM matleC ln.
aM paYhernts made ter you under the Conmael or Sale,and any negotiated formulated mecNM any payments made by you over the tented of Sall and any ne0otiare movement executed,
by you MII ba retumed WIMn 10 days Idlowimq re¢Ipt by Me Sella o1 your cerceurear edde, W you will ad reNme,wpm 10 days posing racelpt M Me octet W your mrioduadon nWm,
end am a.mNy'mbrest ad.bg M of me memaaum will m wrmnee. Ih you canal,you mull and eM mcudn mmreN.dzime aN err Me tranmmm wuI m mreelled.d you me.I,yda mint
aw ruddhe er.sel rater atywrmsichmandd or Sea;or oo maatl aavilbnmwvlywar a make eders de tp to
You myvrres CrashedoFSal or as If
wnuwnm rewWad,
any coach of the
eeB tt ram antler m coeen or sob:Dr ere may s row wiser,Series a,MN Ne any roads 0 theS to roe under th eahimn psale:a yew may,s ym wan,emlay w,N de
has. IIf you d dur e m regebue Me relr d shipment r nd Poet a an rnet expense upeer alandr If You
el the Sella good sO Me seem shipment nand1 the the S a IM1a Sellers pa thee antl
rak. If derol
do make Me your No,. of b Pe Seller and the Seller des net pkk them up dsk If you Co f the iota gems Notion ad b Me sale,end the you ealMr Cces not qck A r up
wINIn go rarylupoodisha Mymr NotimmGnmlmdon,you may rebin or dispose Ad the pwtls witNn 20 days of the tlab of yovr NormalCirear tionlsoare.toinor Sispwe If Ne 9u
ards
wNgN the goo, tothrlOn.eyau draltmake Mean Year shown tpitsfor esid iliW of At wwhenth WMar to the n.Ie you ell le make,than
you railaabbl�R eelrem,a,llyou cores
o reNm the BmCe to Its Salle,end fall to so Ad,Con yW remeln IIBab for pd.&too of ell to ream u gems b n Seller atl tail b M eo,twin you reman llama br parolmanm N AI
of thelloorsil Nerve or yottherwoaofor,mrell a call fixed atl arACaeacop5 a thelbm 1preriha Contract TocencNMiemof or,end arWhighaetio AS
enCCatedmpy
M the ceeet,Salem,
Mice or any outer 970,n Once,or my a telegram,T F Se i15 ri 1M ce set,Salem,
mrotim or any Mar outman notice,or send a Magee,b F Services,115
North Street,Salem,MazaedruxN 019]0,NOT USER THAN MIDNIGHT OF�. NomN Street,Salem.Massachusetts O1B]0,NOT LATER THAN MIDNIGHT OF
(natal (Date)
1 HEREBY CANCEL THIS TRANSACTION, Cmxsumefe Signature Data I HEREBY CANCEL THIS TRANSACTION. Camuma5 Signature oat.