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79 COLUMBUS AVE - BUILDING PERMIT APP DATE: 0 it of ad�P17I, JAHLUEtt !/Z a PLANS MUST BE FILED AND APPROVED BY E INSPECTOR PRIOR TO A PERMIT BEING�GRANTED Location of ilding Building Permit Applicatieoo- r: — '(Circle whichever applies)( Reroof, Install Siding, Construct Deck, ion, Alteration, air lace, undation Only, Wrecking Other. PLEASE FILL OUT LEGIBLY & COMPLETELY TO AVOID DELAYS IN PROCESSING r To the Inspector of Buildings: The undersigned hereby applies for a permit to build according to the following specifications: Owners Name: ,L1P RI elD.S�r Contractor: A e A Se.rviu5Mhn_ sar7 Street Q (tA{ VQi' ,5y p - Cit} �iEUPI�U Street-15 f\Jnr4h 5". City i State. Phone (qq$) 31� 3D State M A Phone- (a78) Architect: City of Salem Lic#- 05 Street City State Lic O`aY HIP# 1©I 1,0 09 State Phone ( ) Homeowners Exempt Form_yes__L/ no Structure: (please circle Single Family Multi Family# Other Estimated Cost of job S_LI`y DI A 5-O Will building confirm to law?_ ✓ ves no Asbestos?__yes. ✓no Description of work to be done: e X l5hQn Z 00C rely laGQ_ l g 31N SQ Uare, al' new 34ah a,Suv�r rnnf,sh ales - leg /aa exi IlLiQ iC!y 6! re l Olaf roofs OJIM 5%a no Rvs�la�p � u�sfi rya ,/00rc/, U) h/f by 1rov14 .4QrC.h fly pan r 011me -)Sldn , 12eplaGn jD 7 ry vi Om are& 76Db/) � A&A S RbICES, INC. Drawin b fitted: es 1 t e no Mail Permit to: SALEM, H vHhL 41-Od2d. 1970 X �nrww.a-A?; 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 S COMMENTS: 3, . 1 No. c,� O� APPLICATION FOR ' PrR TO .., LOCATION PE MIT GRANTED P4 ,9 AP OVFD INSPECT (j OF BUILDINGS — el. _ CERTIFICATE OF OCCUPANCY " . YES NO y The Commonwealth of Massachusetts WDepartment of Industrial Accidents Of ce of Investigationsg600 Washin ton Street Boston, MA 02111 www.massgov/dia Workers' Com ensation Insuranc e ce Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print nn Le ably Name(Business/Organization/Individual): A Pam, A Cje_r yi a t Tn r Ill f Address: 11 ri Q D r-+h 13-h-e e+ City/State/Zip:_:5n ( p M Mn D19-7D Phone #: / g��1 e71A I - CH 2,N Are an employer?Check the appropriate box: J Type of project(required): 1.UV I am a employer with 4. ❑ I am a general contractor and 1 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. t 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition ' working for me in any capacity. workers' comp.insurance. 9. ❑ Building addition (No workers'comp. insurance 5. ❑ We are a corporation and its 10.f required.) officers have exercised their ❑ Electrical repairs or additions 4 3.❑ 1 am a homeowner doing all work right of exemption per MGL I L❑Plumbing repairs or additions myself. [No workers'comp. c, 152, §1(4),and we have no 12.1[]Roof repairs insurance required.] t employees. [No workers' 13.✓U Other comp.insurance required.] *Any applicant that checks box#1 must also fill-out.the section below showing their workers'compensation policy information. -- t Homeowners who submit this affidavit indicating they am doing all work and then hire outside contractors must submit a new affidavit indicating such. [Contractors that check this box must attached an additional sheet showing the name of the subcontractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name:__ t r le— Tl" ye l r�s Policy#or Self--ins �Liic.M. /(C Q/SQ X 19, [0 Expiration Date: 1,3, )0 7 r/ Job Site Address: /% LDl(//l)YJ .j �l)P_%1 lJ-- City/State/Zip: �L LZ/i // Ml 0(970 Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a co of this statem ent ment may be forwarded to the Office of Investigations of the DIA for insurance coverage verif ication. ficatiun. i Ida,hereby certify n r e pains a d penalties ofperjury that the information provided above is true and correct p Si znamre: Date: Phone#: (91 / — H a Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# _ Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone# Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association, corporation or other legal entity, or any two or rdore . of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the.permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permittlicense 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 Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia ' e r DISPOSAL OF DEBRIS AFFIDAVIT In accordance with the provisions of M. G. L. c. 40, Sec. 54, a condition of r 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, Sea 150a. The debris will be disposed at. Salem Transfer Station owned b Northside Cartin Y 9 Si natu a of Permit Applicant 9 PP R -Is -V Date Ch ristopher her Zo a rry Name of Permit Applicant A &A Services, Inc. Firm Name 115 North Street, Salem, MA 01970 Address, City, State, Zip Code � T� �rvmnnonaiea�e �✓ll Board of Building Regulations and Standards Construction Supervisor License License: CS 57733 - I Bi_rtfi2ate_5/26/1958 , Exelration 5/26/2009 Tr# 13739 Res#nsNon 00 r CHRISTOPHER ZQc� 0 . 115 NORTH ST �t„��,�-A/ ___` SALEM, MA 01970 "`-� Commissioner Commonwealth of Massachusetts Division of Occupational Safety Robert J.Prezioso,Commissioner szq , Deleader-Contractor 11f CHRISTOPHER ZORZY oYu Eff.Date 04102107 _ - Exp. Date 04/01/08 3s - DC000"D 08 Memberof C.O.N.E.ST. 13 0 is i I (IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIII IIIII IIII IIII # BOSTON-RENE ✓ok T I L/OmN)EINL[IMOA�/L 6�✓/�LRd02Cli.(tdeQr� Board o[Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration 101609 Expire on:,6_ . /26/2008 1 - Type: Private Corporation - A&A SERVICES INC-: - Christopher Zorzy - - - 115 North Street - i - Salem-MA 01970 Deputy AdmimsN for-r v . wnw A & A SERVICES, INC. / &A-SUMCES 115 NORTH STREET,SALEM,MA 01970 - a Telephone:(978)741-0424 Fax:(978)741-2012 g ' V0�� AVe 79 � '� �•.� Contractor Registration No.0101609 57733 Federal EIN:04-3090162 S I N� Construction Supervisor No.CS067733 �ltSPECIFICATION SHEET - Buyers)Name Date of Contract D Buyers)Street Address,City,State and Zip Code ' CAf-fil Sk , 01 9 1 SS Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address 9-R--3I —Da30 The Buye%s)listed above hereby jointly and severally agree to purchase the goods anal sawices listed below,in a,ca dance arm to prices and temp al.dbad on Nis Specification sheet and Me front and the reverse of the accompanying CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,of which this Specification Sheet is a part ❑ Remove and dispose of# existing entry door units. ❑ Install new entry doors# Manufacturer Location Type: ❑Steel ❑SmoolhStar ❑Fiberclassic ❑ClassicCraft ❑Sliding Patio Door ❑French Hinged Patio Door Model# Sidelight(s)# Sidelight(s)typelmodel# OPTIONS: ❑ Adjustable threshold for Therma7ru Door ❑Grids for patio doors: Style: ❑ Stain Kit: Supplied to owner ❑ Expand or shrink the size of the opening Details ❑ Cover exterior trim with aluminum coil stock: Style Color Hardware: ❑Handelset ❑Deadbolt ❑Footbolt ❑Mail Slot ❑Peepsite ❑ Install oak strip at floor as needed. C6vW'NUIIe& Fr6fA k BBa"a(O� r � . ❑ Caulk interior and exterior edges. , Y LA-- 10E AC.C� � S _1 Pw-f(' Is"A ❑ Insulate around new door unit where possible. 4y P i+JP_ i X S"Ir�--1` .S�;�C-fit� dStft Sadsq� 14thca. ❑ Painting is not included. .�-v�, ,�-`L ❑ Included in this proposal are set up and clean up. I A(IY5lC'✓ 5j7 jil9,�c)-GUd)� (& 6 IN�ttzRL A+-*!W12fS IUAW iYll�s a7horortgh "C/ wQ iyKht�¢d •{�z9mit inch• `I ❑ Remove and dispose of# existing storm door(s). N tuL o7/'�g ❑ Install new storm doors# Manufacturer • Or.,r��n� �` `�'"'`n 109 fY]C�(wb _ I Style Color Type: ❑Aluminum ❑Solid Care " ❑ Location: SPECIAL INSTRUCTIONS: si(fJVr*"rccRsgstan '0 ReAlove *Y)A 'D-is F t�waoLe vorch S+r'(c 2 Li L(Pfto-r 1'b620ntM porch BBNUS RIO*in tac�Fs+rKckccQ� Dig AvA- �cw- 6-7 Ueu�cbtacr2i2 �rrsEr�s crib Dztid taw pXiC_b nu A-S 2c rf "n 1au)i Q'T' 7 Yo F-rA 04-w efh � LAGIZ "&y A A-A�t. ia,r CnAa'- $�r S$ ) S i l H S a nI.agreed!a nderetoad g and een the partied Met MIS no versed understandings Street,along afthchanging Me or mods REMODELING any of the AND INPSCVENEMAGBEEMEW,,coal totes Me entire understanding vaned in any nay p,dbq eM Mere ero no verbal ng and signed y beat or modifying any of the terms.Thie contract May nal be changed or ye term, mad this or veiled M any wry antes,such changes are In writing eeW elgnatl by poet Me auyar(,1end Ma Contractor. safaris)hereby acknowledge Met suyeris)tree road Mla SpecMlutlsn Sheet h Contractor Initials:��_ Date: �Cl /''-] Buyer's Initials:.._ Date( rd\ -{/L'Og ,, A c ^� �`� A & A SERVICES, INC. A&A CES 115 NORTH STREET,SALEM,MA 01970 im 'e Telephone:(978)741-0424 Fax:(978)741-2012 • Contractor Registration No.101609 Federal EIN:04-3090162 `]CA1VMWS*R__ Construction Supervisor No.CS057733 tq eL" 1"A,014 7O ROOFIN SPECIFICATION SHEET Buyers)Name Date of Contract - I �)kvf& P r8Ax,S 8 2 07 1 Buyers)Street Address,City,State and Zip Come S of Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mal Address 1a The Buyer(s)listed above hereby jointly and severalty agree to purchase Me goods and/or services listed below,In accordance with Me prices and terms described on this Spautication most and the from and Me reverse of Me accompanying CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,of which this Specification Sheet is a pad. ROOFING SPECIFICATION Strip oof of# layers of shingles Install 6'of ice and water shield at base of roof where If Install 15.b Felt paper[o—Tf roof. possible. Install if1"of ice and water shield in valleys. 3"F'Iqb chimney as needed(no repointing included). nstall perimeter drip edge to rakes and fascia areas. nstall vent pipe boots and seal as needed. 56,!ash valleys as needed ❑ Install rollout type ridge vent. Planks/plywood replacement under 32 SO FT included, `If more is needed there will be an extra charge of$ O per hour for labor plus the cost of materials. , ❑Dumpster/Disposal Included: - ❑Other: Location: E 3 Install new roof: Manufacturer yr Styleftype ' Included in this proposal are thorough cleanup,building permit,and company/manufacturer warranties. RUBBER ROOFING SPECIFICATION Loci jOry FTOM—t-nwc S[" Roof ❑ Not Strip Roof Install 1/2" ensity Fiberboard to existing roof using 1141ash obstacles as needed. screws and plates. Install .060 membrane EPDM(Black)rubber roofing to nstall 3x3 aluminum drip edge to perimeter of roof with fiberboard.s seam tape. - Flash up sidewall as needed. Included in this proposal are thorough cleanup,building permit,and company/manufacturer warranties. SPECIAL INSTRUCTIONS: ,_..f IA t' r y a /—_41k M L40/7 #o 0&✓ dAtsf de o�laoA�- f LO/YJ2 Dtt/f/ r �,Oxtiiq_ OC,.i-�}....rye- PS S IkkmA ark g Is agreed and unc antood by and between Me pmtlea that this specume l in Short,thong with CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,consUtutea Me entire understarMleM monsoon the Panes,and Men are no verbal uncerstandings changing or metlxying am of Me tonne.This wmrecf may net be changed or Its comma modified or varied In any way unless such changes ere In wdgng and signed by both Me Buyar♦e)and Me conbacldr.Buyeninhereby eebmarmi Mat Buyer(s) has reed Mis Spe nficagon sham. p� Contractor Initials: �L- Date: '�� Buyer's Initials: _ D-A _01-6 �1 / sere t/ star & A SERVICES, INC. S° CES 115 NORTH STREET,SALEM,MA 01970 Telephone:(978)741-0424 Faaxx:(978)741-2012 r peck tcna7Y��h Contractor Registration No. 101609 Federal EIN:04-3090162 pl nq ea leAuoif J"i 74 Col w,bA5 elvw— Construction Supervisor No.CS057733 CUSTOM REMODELING AND IMPROVEMENT AGREEMENT ' Buyer(s)Name Date of Contract Buyers)Street Address,City,State and Zip Crate Q ¢ Sl- Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address: w 978-3 3 The Buyer(.)listed above hereby pimy and severely agree B purchase the goods and/or services listed on the accompanying specification sheets,in accordance with Me prices and terms described on me from and the reverse of this agreement and any specification sheets(this'Agreement'),and Buyers)have requested that such goods or services he installed or provided at Buyer's address listed above.AAA Services,Inc r-Contrasted,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 9uyer(s)agree to pay in cosh me cost of ma odds anq som lean purchased as described herein,regardless of timing or approval of any financing Buyers)may seek for their purchase. Purchase Pa {. 1L R6 ` 3� Est.Starting Date: Down Payment:_t z �- Est.Completion Date: Tc+4i-- '3T P 7V(y�n ❑Cash Amount Due on Start of Job: 0 Check 94 ❑Credit Card Amount due on—R�Ar��fC��t crier: No. j tg Amount Due on of Completion:rj Expiration Date: E L� Balance Due on Upon Completion: ������T CVC Code: Z I 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 _ li and dated copy of this Agreement,Including the two attached Notice of Cancellation forms,an the date first written above. Buyers)also (i)acknowledge that they were orally Informed of their right to cancel this transaction;and(li)request that they be contacted via their telephone numbers or email,as listed above, In the event Contractor believes Buyer would be Interested in any additional quality products or services of Contractor. DO NOT SIGN THIS CONTRACT WIT CONTAINS LANK SPACES. Servfbea Buy r( By: By: i _ Signature cM nature CTC9T � �Av1D T `RREyJSTEP� rtt 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 tarn for an explanation of this right. ananMTON:The commas proof th Mummer M1ereq mutually qm In edrenre MY in Ne a ad Nmn pan,ova a dnpm can dra ma ofnow.NNer pry may wu,M rend EupNa ur ' a prva.ud 1.mad.wbiar av been applwM by m0 Ramada,MNpEN-u.Oran.1 conwmer Male erv]aueinea9 Reputation.pad do parepuy shad be nood.to...m wM arblba5n es proms m M.G I-C.14M Gmpacmr tnmW: L apya,��,: Norrcp 0�^I tr,� N - OM al TranmNpn �vpu and,carm,n.oensec .mend.arn,seraly or D.o1 TrweNm nn.You meY Canm11M Irsomadon,wMON any mealy m plpamn,w lnm 9bL6amysmmueabwedem.ll>wnanca,erypmperybadeoln. bblbaabn,vMlln mane bvelmue6n tram uaemve a.m.cyan aam.l,uy plpperlybeaaa ln. v,y pm—au nude by rdoumer do Conlrea or seta and"lwumale llnaumenl..w.vmd env peymn en rem.I you wort me Comman of se d re,eonny m agarwa l e lndurro anced of youwonmI.lumad wlmin la den lama r m xp—to dr me seep.,Youradaudn not.. do You wig a.BMmedwNn to der•mlmind BaMplM ms seller m your mnaddlerdn dodo.. and any mmary interest ad9re antl of Me tensandon won be car—dem if your celml,You mWl um par aecudy demand arising out a meinformation Mll de mantled.n you Camel.you mWl meFe rvtllBgOmme$deb atplrrmgerae.ln wdsmmwymgcwmMadn as wlv aoivW. mere avetmde m-seYx-rya ltlmema.InAWlanm6y as Band mamend as xfien salved. any 9mGa defn'eM my9u Moat ma Contend or Sale:or you ana,it You wba,amply'dla and anY dumm MNaM m^union am contract Wsup;or You am,if roo woo,marry WN as national a no seller rpaNing ma loom moormnd d Ne Boole Is tlu caller ayeNe Yd Ina9umars of Ne seller reparong me rtaan aMpmenl of are Boas at me Salim eo ame and ciao 11 ypu do sure pro Ilmom painful b on,antler end on,Serer dam M pG lamm up If II you W make me gCctle avvldM9 m Me Sella 4N Na.ellx Mm M ptG tlwm up Mtltin$e Nyad NB dLe Myour Nplm NCuvallWm,ysumpyreWnadamfoo4Nmpvla Mtron al drys of the oars of our room d curommin,You now Basin or common,Mme lloadd - vdlAManyourvemlianod yW lylmmeke dB gmda evelledbbtl¢9&Ier.a MpN erase wltuN-ylusnd-dialon IlyW 1911mmeke meant mtilWbblm 561bm.IXllyW eryee m maun me Boom or me eMb and ar,Is M W.rend Wu mono es,.lu pea —of is to oom me rands of me seal,and led redo aO,tan You random llWleM dradd aM..1a polgetiare uMa Me Convm.Tpc ciao baruad,.reap.."Rrd, AB end Galati may oGgetlma under Ne CCrNM Tommalma denuclun,nuYordelMrasynedeMdMdm15 r add NomeSne d%Smen.worcary Ot0MNOT e.wmMe mlagiem,to P&h NMmrcalleam lnlbuaq Omer wMmn mtlM,6.eNel.leBrem,mP5A$eras,115 Nord,Sleet SeMm,`••+-^Ma-"•e18N,NOT IATER TNgN MIONIGM OF � NMa street SMem,Mesaacalrmm mB]dl,NOT UTEfl THPN MIONIGMOF (Dm) (Dare) I HEREBY CANCEI-r-a TRANSACTION. CNwrmmSSl®IeNm Om HERE.ICMICELTHIa TPANSaCTION. CanwmrtYSgmore Dal.