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12 FORT AVE - BUILDING INSPECTION 1 - � q - I The Commonwealth of Massachusetts INSPECTIONAL S RVIPPR OF Board of Building Regulations and Standards SALEM Massachusetts State Building Code, 780 CM.g01u NOV 13 Aawikj1far 2011 Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: Date Applied: Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers l a- >�n t-Y YfV r 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq 11) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone? Public❑ Private❑ Check if yes[] Municipal❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owners of cord: 1 ,�V� C Name(Print) City,State,ZIP i �L Fa-r+Ave . Gz9-59Y Y,s-3 No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORW (check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) 21' 1 Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work: n l • � ti 2S T 5 i ,cI, avt d 01O v%ny/ T(ace v.-f— do lo SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials L Building $ 59- to L Building Permit Fee: $ Indicate how fee is determined: ❑ Standard City/Town Application Fee 2. Electrical $ 3 ❑Total Project Cos[ (Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: S 4. Mechanical (HVAC) S List: 5.Mechanical (Fire $ Suppression) Total All Fees: $ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ 5C' I ❑ Paid in Full ❑ Outstanding Balance Due: -0 SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) ( i-1 r' . 26✓2.�{ License Number Expiration Date Name of CSL Holder List CSL Type(see below) U No. and Street b Type Description '( �I r�, U Unrestricted(Buildings u to 35,000 cu. ft.) R Restricted 1&2 Family Dwelling City/Town, State,ZIP M Mason ry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances ' 741- I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) A� HI -. 6� S2t� i�c e S Inc - LDI loo 9 'Lp - C- C Registration Number Expiration Date HIC Company Name or HIC Registrant Name No. nd Street Email address L.l w, M o igrl a City/Town, State, ZIP 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 .......... 13 No........... ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIESS FOR BUILDING PERMIT 1, as Owner of the subject property,hereby authorize �' �t y S L O✓2 to act on my behalf, in all matters relative to work authorized by this building permit application. 5--._z, �o 11 - 13- Print Owner's Name(Electronic Signature) Date SECTION 7b: OWNERS OR AUTHORIZED AGENT DECLARATION Bye ring my name below, I hereby attest under the pains and penalties of perjury that all of the information coot ' d this a I cation is true and accurate to the best of my knowledge and understanding. /!-/ 3- ry Print Owner's or Authorized gene's Name(Electronic Signature) Date NOTES: 1. 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 arbitration program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.eov/dos 2. When substantial work is planned, provide the information below: Total floor area(sq. ft.) (including garage,finished basement/attics, decks or porch) Gross living area(sq. ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage" may be substituted for"Total Project Cost" The Commonwealth of Massachusetts J z ('s Department of Industrial Accidents u t� Office ofInvesdodons yG 7 600 Washington Street, 7°i Floor e� 4_ a� Boston, Mass. 02111 -' -- Workers' Compensation Insurance Affidavit: Building/Plumbing/Electrical Contractors Applicant information: Please PRINT legibly name: _ 1 j r,5-ha.k e,- 7c;,-7 4 address'/ [ I� NO✓ t N t 7! -e Q:t �t�} �} y r / r,�7 city JOl I-e t,, � state: !'(i'� zim LO/9-70 phone# / /D --771-�C16 work site location(lull address)' U �0✓� ll e tlt.At X4 O/ <� 70 ❑ I am a homeowner performing all work myself. Project.Type: ❑New Construction ❑Remodel ❑ I am a sole proprietor and have no one working in any capacity. ❑ Building Addition dI am an employer providing workers' compensation for my employees working on this job. nn yt- t companv name: /T -ii- ��V-V I- AAC - address, (� -7 �[ ' / , / City: a i eel("n �fM�'�I phone#: r-�f ?t S- trt r7t l/.—Q Y o7-7 insurance co I L -e ( ✓a y/e I-e � 'S polies,# V;)-q ❑ 1 am a sole proprietor, general contractor,m homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: company name: address: city phone#: insurance co policy# company name: address: cih^ phone#: insurance co policv# Attach additional sheet if necessary Failure to secure coverage as required under Section 25A of MGL.152 can lead to the imposition of criminal penalties ofa fine up to S1,500.00 and/or one years'imprisonment as well as civil penalties in the form ofa s'rOP WORK ORDER and a fine of SI00.00 a day against me. I understand that a copy of this statement maybe forwarded to the fice of Investigations of the DIA for coverage verification. l do hereby certify unt a it t pains ant!p nalties of perjury that the information provided above is trite/and correct. Signatures,/ Date Print name ✓l CQ OY ... Phone# 7 7 7 official use only do not write in this area to be completed by city or town official city or town: permit/license# ❑Building Department _ ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office ❑health Department contact person: phone#; ❑Other (rovised Sept 2003) LJ ,,q�^� //�� {/ /1 ,l AGri A & A SERVICES, INC. A&A SERY ICES 115 NORTH STREET,S.ALEM,MA 01970 • ° s Telephone:(978)741-0424 Fax: (978)741-2012 Contractor Registration No. 101609 Federal FIN:04-3090162 Construction Supervisor No.CS057733 WINDOWS AND STORM PRODU T SPECIFICATION SHEET Buyer(s)Name Date of Contract !s42R J4 Pi/C6- -/V Buyer(s)Street Address,City,State and Zip Code ��— /=ort�'T ffVL SHLc,'vvf /t/!c4 O/97(7 Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address S9y-8y53 The Buyers)listed above hereby jointly and severally agree to purchase the 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 Speodicarion Sheet is a part. WINDOW HEPLACEMENT Remove and dispose of# 20 existing windows. �t]' Install # z 0 new <SuryktSE '.C,4 7�y(/A2D windows: Vinyl t Wood Mel v nufacturer) Options: Style Grid pattern Color Interior 1&#t'77;— Color Exterior Ux 6/ ♦ Glass Type Q:u61,Lj7fA"L, Wrap exterior trim with aluminum: Style Color ff/LGory ryyHS QAll windows will be installed according to the installation procedures in the portfolio. Caulk all interior and exterior edges. 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. V Building permit included. BAY/BOWS/CASEMENT UNITS/ANY FULL CONSTRUCTION WINDOWS If Create new window opening by cutting through existing home and framing in opening. I 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. I 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. t Bay t Bow t Casement t 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 t Remove and dispose of# existing storm window(s)- * Install new storm windows# Manufacturer Style Color Option I Remove and dispose of# existing storm door(s). t Install new storm doors# Manufacturer Style Color Type: t Aluminum t Solid Core SPECIAL INSTRUCTIONS: WIA)DO-w5 /yvGLVDC_ V/N°IL L?G7k14,'&YL L32rOKM0L0 TR11✓1 5 V S 7J,—1 /A/GLVOni NL-)V VIAIV LL 5'/LL ! 7)4- AG //ynr ram/ li P�79K It is agreed and understood by and between the parties that Into Specification Sheaf,along with CUSTOM REMODELING AND IMPROVEMENT AGREEMENT courtesies me entire understanding between the parties,and there are no verbal understandings changing or machinng say of the terms. This contract may,not be changed or Its terms Modified or Varied in anyway unless ouch changes are In writing and signed by both the Sulains)and the Contractor. Suyar(s)hereby acknowledge that Boyarir) has read this Specification Sheet. Contractor Initials: Date: L")y Buyer's Initials: k' ._� Date:_k._��2.C��((�, A A & A SERVICES, INC. - S 115 NORTH STREET, SALEM, MA 01970 .. IBM Telephone:(978) 741-0424 Fax: (978) 741-2012 Contractor Registration No, 101609 Construction Supervisor No.CS057733 Federal EIN: 04-3090162 MISCELLANEOUS SPECIFICATION SHEET Bu er s Name Date of Contract / Ru er s Street Address.Ci .State and Zip Code v � T <f✓� 14/,ey'-1 rra 0/970 Da Tele hone Number Evenin Telephone Number Mobile Tele hone Number E-Mail Address 1577s9y-8 33 3o-Zlo-zzs6' The Buyer(s)listed above hereby jointly and severally agree to purchase the goods and/or services listed below,in accordance with the prices 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 Part. SPECIAL INSTRUCTIONS ' lQeryc r Dls�aS� cF (2) OX/s 77" Gcrvaa&-7V SaD,Nra l�urvlpSi�n //V DJ'L1vrW461 . /���oir�s �- DtSpastr of 0'LD 6y000�/��ZvWI/,V!/Wl (�VtJ S . /nJs i� Lc� N910 , 032 G�AyI�Ls f7Lr/wL,/vvr�J/ � r9t S CZvJ�YLS A,vo (jvw,v5Pr7vT5 �aI-�'L �`�wFf/ � Grvt?Y2_ ben Lf o?::: HzN-,V Zva-/W -nVEK Haw.-e Gynr 47vo Hnqy of L F:-Z1k4-51q A LIL- GyJNP 0YVS A71/0 10J6n S , ° �.oyeYL f+YLL -/x/W ltiLTN AL-C'W/nJVTNI CML, SSG'- /NC"DJAJC SGJA 60F72-0S , k'tq D-C/ t/PPPYLL II I o-iv L7 Slob: . lq;,VAIMJI A*0 Rl4k-F RETVrL/yS' , CaLca2 •' WPI iP //VS 739 G[L V I JV yL IIVVI3/-VE7vT So f=/'T Pl1 rs/&7 5 CAL o2- :uiN/7p �GV[- Z �H p� ffar�lL� !lvG/a/oINC� S ovT5/OC GO'i2AlE7LQe,92,OS , 1 O e f}yvA, )N(7 GEl l-!AJ(� GvJ 1 V V)n/'I L &S fO L>6 P0Y7-CN lghvp-LS cor-z-e'� : A/#/ 7F-, 6L'0Vgry DOW/2/5 4/aO WOS &YV A 0:41L7 &Y-SIS CL ,g G�YuvJ•�rJs i rTnec.�r HL 7 '1-T Cc-' rPLe--T/CYLI ` )NGi ✓rJF3O //v i7iJ-S ALdPOSy-L_ fIYGGs , &J[-0ir-9 tELdLp72/LFr� PILL•✓t /,-s� - r /c- I Cjq-L- /'�,-' 2 wn�+)00-maJJvnrvy d� /ZcfV2� y w/2Es5, �79S1 � SJo/n/c� /9CLt�5a8i05 LIyHI�av� Pt oT LoctCS , prt-yT2✓Sw75, r9ranfhYrisT VdwTS it is agree end understanding ad by and between NedpartiesMore am Nis Specification Sheet,changing along inn CUSTOM REMODELLING of Me t AND IMPROVEMENT A,not b chanson! or,am I entire antlenr varlea b any w me parties,and More an e i writs gunderstandingsandigeby or modifying any of the terms This contract may not be e a t Buyer(s) as tarots ad IN.tl e varied In any way unless such changes are in writing and signed by bath Me euyer(s)and the Gontmetor.Buyer(s)hereby acknowledge Mat Buyers) has read This Speciflwtien Shee[�� / L/ Contractor Initials: Date: 10 /y I Buyer's nitials: Date:)"9 Izo( I �J (� clntr5 fa0 kj-'- r-Z ( A/� ,, /� SERV C0= A & A SERVICES, INC. &A JcQ�V 115 NORTH STREET, SALEM, MA 01970 III in • -161TA a LVATUM Telephone:(978) 741-0424 Fax: (978) 741-2012 Contractor Registration No. 101609 Construction Supervisor No.CS057733 Federal EIN: 04-3090162 CUSTOM REMODELING AND IMPROVEMENT AGREEMENT Bu r s Name Date of Contract Bu er s Street Adtlress, Cit ,State and Zip Code /Z orL T /�i/� S,1z-�^ Min a/g 7 o Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address q7B-.S9 -8YS3 S�F�NY/K�79S�T�T er Coy The Buyer(s)listed above hereby jointly and severally agree to purchase the goods and/or services listed on the accompanying specification) an sheets,in redounded with the paces and terms be rose l d the front and the reverse of this agreement and any specification('on sheets")his"Agreement"),and Buyers)have requested t hat such goods or services be in stalled or rementet the Buyer's address listed above.ve. Services,Inc,("Contractor"a hereby agrees o install or secause to be u,illetl the a to pay or services cost f this Agreement at the Buyers)ed as described written above.This Agreement represents o cash sale n goods and services.The Buyers) agree to pay in cash the cost of the goods and services purchased as tlescribed herein,regaMless of timing or approval of any financing Buyer(g)may seek for their purchase. �r p Purchase Pri .7 J Est.Starling Date:2-7 is 7- 4l. Down Payment: /d coo, Est.Completion Date: �EL Cash Amount Due on Start of Jo "��1�..��Check Amount Due on l,� Cfeoff Card of Completion r 6t/iN GHT No. V Amount Due on of Completion: / r� Expiration Date' tion: 0% ZJ / Balance Due on Upon Comple 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 fine parties, and there are no verbal understandings changing or modifying any of the terms of this Agreement.gaver(s) 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.Buyers)also(i)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 email,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 CONTAINS ANY BLANK SPACES. A&A Se i Inc. Buyer(s) By' V Jam. X Signature Signature �o /�vaye k ��hfQ Print Name PnffName Signature Pont Name You,the Buyer(s), may cancel this transaction at any time prior to midnight of the third business day after the dale of this transaction. See the following Notice of Cancellation form for an explanation of this right, ARBITRATION:The wnlracbrana the Mmeowner herMy mutually agree in ativanco tion in Heaven centrally,has a dispute ranceming this contract,eanerpary may submit such dispute to a None,atnitrafon service oundr has been approved by we Se gNNe Execes—Modest Coreconer Affair and fingeress Repulavode and Ind Then pony she to earned to suard b such arandidon as proved in M Cl C.1 2A. `?�A,A,�dsa no, NOTICE OF CANCEULATION NOTICE OF CANCELLATION Dale of Transaction —7_7 .You may cancel Nis banwOon,wfwour any penally or Dale of Transaction 7—�K.You nay cancel inns trensachon,wltho r any penalty of cbligation,upon three bu9ness days fmmwe above day,lfyourancol,anywoltettytradedin, obligation,enthinwreebu9nessdays homwe anon,date.ItyoucanretanypmpY,tradMln, any paytrenn made by you local me Cement Or sale.and any negotiabe Instrument eaemted any psymams node by You undo,the Consul or sale.and any negotiable uncommon exewted by you vng Me remmed vnwm 10 days fobaing receipt by we Serer of your canrenadon opercal by van Ain be retumed vnlnm m days funceang receipt by Me Sella,of your cancellation novae, and any semnry incest aping Out Of lne o-en>aaipn will be..-If..It you carrel,you rust and any secmby interest an ing on,of we bansacgon A n ch cancened if You onad,you moat coke avanal to Me seller at your rears nce,and su ddine ny in as goad wndldon as¢Ten make available to the Seller at your radia ca and auchannally in as gave condition as when received,any goods covered to you under Nis Layout a,sale:or you nay.if you mish,soul di n ved.any goods delivered to you under this Contract or sale:ar you may you M anm ahply With the m e stmmme w to Seger re9ardm9 m rcm od e m shoucent of we gos at we Series sN me insWmans of we Seller regaNing we return anipmem of me goods at the Seller a asperse and ask.If you do make we¢olds avagaNa m by,seller and the Soler aces net pick expense and oak,If you do make me goods avagabd to the sole,and we Color does net pick hem up wimhr 20 days of the date of your Nonre oCancellation,you nay reain or disltoseonne mom up were 20 days of me data of your Notice of C merstabon,you may retain or Mapcoe of goods wheat any fuller odignm.If You her To make the goys available to the Seller.or if you Mega..Mwoul any harbor obligation,if you fall to make the Mom—liable b he Geller,or it Agree to return me goods to McSClear and fail Bo do ea.than you remain Bade for pedomNnw of you Ogden to drum me goods To the Senor and oil to do On wen you remain l,sun for gedwmance all migabons under the Contract To once this transaction,mail m deriver a signed and dated M all eblieffons under Ford Corm,TOcanell this ranscend,mail ordel'rvera signed and dated copy of the wncellason retire or any other omen ho sad or sand a telegram to ABA Services, copy of the canwllaeon novre Oo any Othpr wntlen redo¢,Or Send a telegrzm,fo.Services, 115NOrn SbM.Salem MA01970.NOTlA RTHANMIDNIGHTOFi/—/Q_7f/ 115 North Street,Salem Yet 01970.NOT LATER THAN MIDNIGHT OFu-7��7✓ I HEREBY CANCEL THIS TRANSACTION ,Tons, I HEREBY CANCEL THIS TRANSACTION n t -Consumer s Signature Date: - Cmaurrers Bi iracry Date: oE� Ow Ila F IT I ao ;in accordance?%elth the MKS of K Ch L m 40, Sam dAe oo;u91eaon v �alL q The c1ay's w0l be t o;pT1."Applican-, �°nQ�:moo 9P�€5 E�T3I$�t��73�i1t� A I A SmFyonag, BEu� Fir Rd ® Control No: 33262 THE COMMONWEALTH OF MASSACHUSETTS .DEPARTMENT OF LABOR DIVISION OF OCCUPATIONAL SAFETY 19 STANIFORD STREET, BOSTON, MASSACHUSETTS 02114 LEAD-SAFE RENOVATION CONTRACTOR LICENSING WAIVER A & A Services, Inc. 115 North Street Salem, MA 01970 WAIVER: LW 000318 EXPIRES: February 12,2015 IN ACCORDANCE WITH M.G.L. C. 111, § 197(B)(b) AND 454 CMR 22.03(3)(b), THIS LEAD-SAFE RENOVATION CONTRACTOR LICENSING WAIVER IS ISSUED BY THE DIV. OF OCCUPATIONAL SAFETY TO THE CONTRACTOR ABOVE FOR THE PURPOSE OF PERFORMING LEAD-SAFE RENOVATION WORK. THIS LEAD-SAFE RENOVATION CONTRACTOR LICENSING WAIVER MUST BE MAINTAINED BY THE CONTRACTOR IN ACCORDANCE WITH M.G.L. C. 111, § 197B(b) AND 454 CMR 22.04 WHEN PERFORMING LEAD-SAFE RENOVATION WORK. * S� /` 2 HEATHER E. ROWE,ACTING COMMISSIONER i �t Massachusetts -OepaRment of Pubic Safety Board of Building Regulations and Standards Adv- '• ram Construction SupervisorPro Licensa: CS-057733 Certainfeed 4 CMUSTOPHER TOR;b+, RTHS Salem�i�ta otv7o 1 Christopher Zorzy 1«20120426000840115 N i. 1 f ° _ A&A Services Inc Exp 4262017 115 North St Salem, MA 01970 ,� J.C.•• -.diSrJc- O expiration Commissioner 05126/2015 ? Matthew J Gibson t taap canxm.`k . Administered by Data Works International.Inc. Office of Con.sumer,A(fairs& Business Reg ula�tion a-1id_HOME IMPROVEMENT CONTRACTOR Registration: 101609 Type: "m'.SEzpi ration: 6/26/2016 Private.Corporatic A&A SERVICES, INC Christopher Zorzy 115 North Street �•�. ��_ Salem, MA 01970 Undersecretary