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35 FORT AVE - BUILDING INSPECTION (2) 2 ` - I �« $ The Commonwealth of Massachusetts OF Board of Building Regulations and Standards CITY M Ulf Massachusetts State Building Code, 780 CMR SALE Revised Mar 20/1 Building Permit Application To Construct, Repair,Renovate Or Demolish a One-or Two-Family Dwelling This Section For Offici Use Only Building Permit Number: Date Applied: l 1 � Building Official(Print Name) Signature SECTION 1: SITE INFORMATION 1.1 Property Address• 1.2 Assessors Map&Parcel Numbers - -• J.l a is this an accepted street?yes - no< Map Number -. : - 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) 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: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check ifyes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner of Record: 'Sae �Z�1mci.v1Sk1 9-10 Name(Print) City,State,ZIP 3� co%1 Q . 1q?-714q- OS-DI No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) [1/ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work': ( r Lt i I C,A C./C t u�'1'H � r' Q p 1J l c�to a G, o�ro.a �rloa�li 1� L� i� n"JJ SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1.Building $ a 1. Building Permit Fee: S Indicate how fee is determined: ❑ Standard City/Town Application Fee 2.Electrical $ ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ ' Suppression) Total All Fees:$ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ ❑Paid in Full ❑Outstanding Balance Due: Al , A s v SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) `��7�3 3 5- r—Z� License Number Expiration Date Name of CSL Holder Gf List CSL Type(see below) Q No.and Street Type Description 5II __ U Unrestricted(Buildings u to 35,000 cu.ft. &.tomrV�, 1'q�A—U Lq-ln R Restricted 1&2 Family Dwelling City/town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 9-7 0-�7 41 1 Insulation Telephone Email address D Demolition 5.2Registered Home Improvement Contractor(HIC) l t �Q� y'y { A--�Qr✓i ULS(yyC• HIC Registration Number Expiration Date HIC Com an Name or HIC_Registrant Name 1 1 )or4-l-. . No. d Street Email address coc� KA7o (9 -7o q79--7L(n�fa�4 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 .......... d No........... ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize to act on my behalf,in all matters relative to work authorized by this building pennit application. 1`o C1 1 3 Print Owner's Name(Electronic Signature) Date SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION By enterin my n me below,I hereby attest under the pains and penalties of perjury that all of the information contain i i pplicaf Vn e and accurate to the best of my knowledge and understanding. Pnn Own s r AuthorizedName(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.eov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 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 �l "r 17 Department of Industrial Accidents t Office efllNesCt9affons 600 Washington Street, 7`'Floor a� Boston,Mass. 02111 �t'aA;".v Workers'Compensation Insurance Affidavit: Building/Plumbing/Electrical Contractors ADDlicant e1 information; Please PRINT legibly name: _C /t�IS� 4"t� �.t:`)('Z . address:: [/6- t VO✓ f N t 71 f-eQel cif -e /'` state: Ml4 zip: D/lyl9,�170 Phone# 97�- 5�i-oYay work site location(full address): .� ✓+ ilrv-e � J�C�2 ✓S-� , f ef'f't" ( 9 7 0 ❑ 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 E✓ I am an employer providing �workers'compensation`for my employees working on this job. company name: A - iq— rJ� r-V l �lLS ( dl C . address: t (ip.S !V O ✓-nt T'1 J �•7 p -7 [ f / city: Sa l e /rML MA_ Phone#: � /�O/— /lt�7t (�y`—/�`7 insurance co. I h.Ic_ f �a y-e t-e r' tS Policy# (� '7 '°r l b p � J ❑ 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: company name: address: City: phone#: insurance co. policy# company name: address: city: phone#: insurance co. Policy# Attach additional sheet if necessary Failure to secure coverage as required under Section 25A of MGI.152 can lead to the imposition oferiminal penalties ofn fine up to SI,500.00 and/or one years'imprisonment as well as civil penalties in the farm of a STOP WORK ORDER and a fine of SI00.00 a day against me. 1 understand that a copy of this statement may be forwarded to the live of Investigations of the DIA for coverage verification. Ida hereby/certify on a th pains and p nalties ofperjury that the information provided above is true and correct.-7 Signatuc5/ II-- �7 Date Print name C��(/ ,f To� ✓ L�1�2..1 Phone# 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 (rtNsed Sept.2003) THE COMMONWEALTH OF MASSACHUSETTS '•EXECUTIVE OFFICE OF LABOR AND WORKFORCE DEVELOPMENT =1. DEPARTMENT OF LABOR STANDARDS 19 STANIFORD STREET,BOSTON,MASSACHUSETTS 02114 DELEADER CONTRACTOR LICENSE A&A SERVICES, INC. 115 NORTH STREET SALEM MA 01970 LICENSE: DC000440 EXPIRES: Saturday,June 07,2014 IN ACCORDANCE WITH M.G.L. CH. 111, § 19713(b)AND 454 CMR 22.03, THIS LICENSE IS ISSUED BY THE DEPARTMENT OF LABOR STANDARDS TO THE CONTRACTOR ABOVE FOR THE PURPOSE OF ENTERING INTO OR ENGAGING IN DELEADING WORK. THIS LICENSE IS VALID FOR A PERIOD OF ONE YEAR, THIS LICENSE MUST BE MAINTAINED BY THE CONTRACTOR WHEN ENGAGED IN DELEADING WORK IN ACCORDANCE WITH M.G.L.CH. 111 § 19713(b)(2)AND 454 CMR 22.03. HEATHER E.ROwE,DIRECTOR � m ull � 11121 Massachusetts -Department of Public Safety . � V11C tQanvl)ta9ll!/ea o au'JG2ftrrJ¢Ct~J Office of Consumer Affairs&Bust es gs Regulation Board of Building Regulations and Standards - OME IMPROVEMENT CONTRACTOR I Cpnstruction Superrisnr egistration 101609 Type License: CS-057733 xpiration: 6126/2014. Private Corporatio -' - CIMSTOPHERZORZY A&A SERVICES INQ! 115 NORTH ST = -_ Salem MA 01970- Christopher Zorzy V�Y 115 North Street NIA 01970 Expiration Salem, Undersecretary - i J'�"' 05/26/2015 Commissioner �Iy Program �'r�Ilk ev 1 -.rg 'i9 a Christopher Zorzy #20120426000840 A&A Services Inc Ezp 4/26/2017 . `�•�`- 115 North St i� . it lli CHRIS ZORZy Salem, MA 01970 -- 'Matthew J',,Gibson 1 V A & A SERVICES, INC. A/I�� ,� w c�p /1C; &A Ste\ CE$ - 115 NORTH STREET, SALEM, MA 01970 •- 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 ^i N Date of Co root I✓C ,i Bu er s) SVeet Atltlress, Ci .State antl Zi Cotle CgliI 7C� Da tone Tele hone Number Evenin Tele hone Number Mobile Tsle hone Number E-Mail Address The Buy.Bs)listed above hereby jointly and severally agree to purchase the goods and/or services listed on the accompanying specification sheets,in accordance with the prices and terms described on the front and the reverse of this agreement and any specification sheets(this"Agreement"),and Buyers)have requested Nat such goods orservices be installed or provided at Buyer's address listed above.AM Services,Inc,(°Contraclof),hereby agrees to install or cause to be installed the produces or services listed in this Agreement at the Buyer(s)address written above.This Agreement represents a cash sale of goods and services.The Buyer(s) agree to pay In cash the cost of the goods and services purchosed as described herein,regardless of timing or approval of any financing Boyer(s)may seek for their purchase. Purchase Price: < Est.Starting Dale: / Down Payment 7 Est,Completion Dat Os Cash Amount Due on Start of Job: Check ,)Credit Card Amount Due on of Completion: No. Amount Due on of Completion Expiration Data: 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.Buyer(.) 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.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 Buyer(.)would be ifiterested in any additional quality products or services of Contractor.DO NOT SIGN THIS CONTRACT IF IT CONTAINS ANY BLANK SPACES. A&A Services, 1 Buyer(s) Signature rSignature �silq ��y �1©3r �f S�Y�2f1✓�El 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 explanation of this right. ARBITRATION'Ttie mningorantl tM1e tiomemmer M1ereby mutually agree In eavanre Malin Me event eitM1erperty lus a aisWte mnceming Nis mntracl,nllterpeM m3Y%ubmil suU dispute to e actuate atdtratian are i m evi m has been appomt by Me Sevelaryof Me Eumtiw ORce of Conummer Anairs and Business Regulations and Me other parry shall be roband to submit b such ve man as proved in M.G.L c 142A. Co.,mdormhias: Bamr,maw.AQe: rate: Doe: h3 ICE OF CANC ELATION 10 IC n CANCELLATION on-N Tmnmeebon .TW may®norms trznaaclion,vnMnnt anY purely cr Da@ of Transaction •.Tau maY moral Mis transallon,vnMON anY pmatty or obggetion.mtin raced sin a%aaya kom Me abn.e Bete.a yea mrof any prnperyveeee., nbuBatim,a;MM Mree sloe darn noon Me sews sate.uym mncel,dry gnpeMtmaee in, anypeysents«ede ym under Ma Control or sale,ana any nogmaue mswmard e.emtoo any Wyanta—deb you nderteconbanorsale,andanynegodaXeirawameremted by you xin be returned MMm w days folievt teaept tw Me Sister of your rsnaeoatian entice. by you and be reNmeE Who to days fideving tempt by Me seller of your.snceuaeon mice, and any Memory examen onang out of Me harrection sin be mnot.d.If you mod,you most and any matmtrinterest army,out of the bapeamon adu be crimped.It you cored,you a.rat eke available to Me sailer at year residence.and substantially in as goon mneltlon as amen aae amtlattla.to Sauer at your reside,ce,and subatanaally in as goof condition as amen remivea,any Bonds delivered M you under his commul or sale:orym mar.if you ash,mrPtr removed,any goods dmrverea to you and.,his Conbal ar sale.orym trey.It you wise.mmyly uM Me Instructions of the Biller regarding the ream shipment of Me gootls at Me Belief S arm the instmNons of to seller regarding in.ream shpment of Me goads at be Beller's membro a and!risk.If you do make Me Bolds available to Me Abler and the either fires med I eVeese and disk.If you do nuke Me goods available to Me Baler and Me Seller dead not pick Meru up entire 20 dayx of Me data of your Nods Of cancellation,you Trey Main or dispose a Me them up MNm 20 days at Me date M your Notice of Canespation,ym may retain or Disease of covers Whout any fuller abandon.If you fail To make the goods available to the Seller,or X you Me ymma euout arty NNwr oid,sem.lf you fail to make the grad%ava118e.b the Belle,in,IT area to returntog.,ED Me Beher and fat.do so.urea you main ludo for PmMW rim of you 0gree N Mum Me golds to the sellerand SEE I do aO Men you rmrein Gable for pedonrenm au obligations under Me CmuacL To cancel this transaction,mail w drives a signed ana dated of all orhomfoniwWe,Me Corbel,To coined Mis bendBNon,ail orde daMd mpY Ol lee cert�latim notire or eny Dray written noare,wsenD etelBgle A8A ropy of Me csrtr¢IletiOn noties ar eny Oter wriMI betice,ar.antl etNeg A f 15 North S7d,Belem MA elgro,NOT IATER THAN MIDNIGHT OF a ¢s 115NOM5treet Bahemoduarm NOT IATERTHAN MIONIGHTOF 7 mat I HEREBY CANCELTHOTRANSACTION I HEREBY CANCELTHIS TRANSACTION conateress"Notarthe Data Consmrels Blgna.re I A & A SERVICES, INC. MA SERVICES 115 NORTH STREET,SALEM,MA 01970 1111:0010INKROW 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 Buyers)Name Date of Coptract Buyers)Street Address,City,State and Zip Code Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address 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 Specification Sheet is a part. / ��,'/�^,, WINDOW REPLACE MENT�� �/.1\� 6�9- L f emove and dispose of# V� existing windows. 01t ,i^'f+-rr re SIfS`aS 7/. Y Install # �iveJ new Sg17T75,� windows6Wyl If Wood (Manufacturer) ^�p �� ids Options: Style Y/(YIVl i lTZ Grid pattern �} � Color Interior G(/f� Color Exterior Glass Type V Wrap exterior trim with aluminum: Style L ae- J for id A li � If All windows will be installed according to the installation procedures in the portf lo. 0Caullke*WWMMR1Iiid exterior edges. /,o-�T�y5f�//NP_tV /�i->V•� ✓�2,'pri ex/�('1!7r �lrr�° " If Insulate where possible around new units. f Insulate window weight pockets it exist,and around new window units where possible. i Included in this proposal are set up,clean up,Helps,vacuum and cleaning windows inside and out. If Building permit included. /a/,�NS1LAI/✓��''cU (JlL y1' n o/'SizlPS BAY/BOWS/CASEMENTI UNITS/ANY FULL CONSTRUCTION WINDOWS If Create new window opening by cutting through existing home and framing in opening. f 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. If 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. If Bay If Bow If Casement If Other window(s)to include new interior style trim and new exterior style trim and head flashing as needed. jrA� / S �. eco If Note: Painting and staining not included. fir/��-( �S� STORM PRODUCTS [ !K Y-�- f Remove and dispose of# existing storm window(s). 0 /,e4/,7 L P 4 Install new storm windows# - Manufacturer rlO b$2i Q Style Color Option f Remove and dispose of# existing storm door(s). If Install new storm doors# Manufacturer Style Color Type: f Aluminum f Solid Core �E1CIIAL INSTRUCTIONS: �O,lf+c2 wr evew rir— 7T� fnc1 IQn u b04-;J i ^- t u' ,ti 2LS2rS WI,t�( �/I b4eCklh .. M+f ii XS �1C'-l�a�nl�ss sl-ee! �io��lSfis�r'�� s ® rvrs!aN4 �NC�cc theentiretlantlstandighcro ntlbebveen the,and aies,rs am this Specification Shea,ding changilong ng CUSTOM REMODELING any of ING AND erms.Tiscom IMPROVEMENT AGREEMENT,constitutes the entire understanding varied between the parties,and there are no verbal and signed by changing or eds)and t any of the terms.This contract may not be changed or its terms ad this S e varietl in any way unless such changes are in writing and signed by boM the auyer(a)and the Contractor. Buyers)hereby acknowledge that auyer(e) has read[M1is Specification Sheet (�/ Contractor Initials: Date: Q/,�/3 Buyer's Initials: Date: 2311 3 Z_ �/ -