25 GRANT RD - BUILDING INSPECTION � \ j
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APPLICATION FOR
' PER Tn
j.00ATI ON t
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PE MIT GRANTED
APPR VPp
CT OF ILDINGS
CERTIFICATE OF OCCUPANCY '
YES
NO
A
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ft
DATE:
itp DfaY�rn, aaL�juPft
PLANS MUST BE FILED AND APPROVED BY THE
INSPECTOR PRIOR TO A PERMIT BEING GRANTED
Location of Building d5 cSYgh f IQ(�QC
Building Permit Application For:
'(Circle whichever applies) Roof,Reroo Install"epair
ct Deck, Shed, Pool
Addition Alteratio lace, undation 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: Jun"—' P1IGlCrdS Contractor: A P A Sr t-VICe5le7
Street_ ('str�{�}{ V) City Street 1i pr-+h J City—" j lPp �
State-IMP Phone (q% `W 5-77l 1 State M A Phone. 078) 243 l:7,O.y a"A
Architect: City of Salem Lick J H o5
Sheet City State Lic b57 HIP#: 101609
State Phone ( ) Homeowners Exempt Form_yes__�.11 no
Structure: (please circle Single Fa • ) Multi Family# Other
Estimated Cost of job S_ ,�, (0 5 3- OC) —
Will building confirm to IawT_ ✓ ves no
Asbestos?_des jv no
Description of work to be
s �h ��sfal even
A&A SERVICES, INC.
Drawings fitted: Yes no Mail Permit to: SALEM, MA 01970
X 741-04M---'
}( W W W.A—T--A EnvIC
Siguatare of Application,SIGNED UNDER THE PENALTY OF PERJURY
CONSTRUCTION TO BE COMPLETED WITHIN SIX(6)MONTHS OF PERMIT ISSUED DATE
The Commonwealth of Massachusetts
d Department of Industrial Accidents
E1�V OJficeofInvestigations
tirr l 600 Washington Street
Boston,MA 02111
r +" www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Leeibly
Naive (Business/Organization/Individual): A A Cjor yi Lk s , Sy-)e+
Address:
City/State/Zip: f5,oa,Q,.rA Mn Df q-70 Phone#: I 923 1 2-4 I — OH 914
Are It an employer? Check the appropriate box: J Type of project(required):
1.(� I am a employer with ol,6, _ 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. 0 Demolition
working for me in any capacity, workers' comp.insurance. 9. ❑Building addition
[No workers' comp. insurance 5. ❑ We are a corporation and its
required.] officers have exercised their 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions
myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs
insurance required.] t employees. [No workers' 13.C�rOther / //
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 are doing all work and then hire outside contractors most 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 infomtation.
I am all employer that is providing workers'compensation insurance for my employees: Below is the policy and job site
information.
Insurance Company Name:
Policy#.or Self-ins.Lic.#:_ W C Q 3q X 12 57C0 Expiration Dated
Job Site Address:�.S (SrCCi?f �Q(�r'! City/State/Zip: 1 k,( LM, 09n U1170
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 tip to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify un r h pains and penalties ofperjury that the information provided above is true and correct
Si nature Date:
Phone#: 5 L{1 L-+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 of more
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 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 burn 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
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 -
Signa re of Pefrmit Applicant
Date
Christopher Zorzy
Name of Permit Applicant
A &A Services, Inc.
Finn Name
115 North Street. Salem, MA 01970
Address, City, State, Zip Code
✓/ee>°oasrmo-n+.real� o�.�aaaadu�elA
Board of Building Regulations and Standards
Construction Supervisor License
License: CS 57733
BiiAfidal /26/1958
rEz��tatian-3/3�,/2009 Tr# 13739
i 1Rt��io�rrr�J- ill
� 5
CHRISTOPHER '
ZOIg:-
115 NORTH STM` /, �rG_
SALEM,MA 01970 Commissioner
Commonwealth of Massachusetts
Division of Occupational Safety
Robert J Prezioso,Commissioner q
Deleader-Contractor 1J�§
CHRISTOPHER ZORZY
Eff.Date 04/02/07 _
Exp.Date OM01/08 my U
r
D0000440 8
Member of C.O.PLES.T.
BO
I��II III�IIIO� IIIII IIIOII�II�I'IIIl�I II� BOSTO"ENEW\
. .. r-^--`_ �/xe {oamiinane�ealU o�✓�amarleueelli.
Board of.Building Regula[io_os and Standards
. HOME IMPROVEMENT CONTRACTOR
Registration: 101509-
. Ezptrallon;4126/2608
T er pnSate Co. ora11on
A&A SERVICES, INC
Christopher Zorty -
115 North Street ;
Salem; MA 01970 Deputy Admmisn tei4
^ r �ag A & A SERVICES, INC.
A&A ICES 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 -
VINYL SWING SPECIFICATION SHEET "
Buyer(s)Name Date of Contract - -
�TvaE R1cN4aDs /0-23
Buyers)Street Address,City,State and Zip Code -
25- AD Sx{Lyyy M4 0/970
Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address
978-7VF- 77/!
The Buyerls)listed above hereby jointly and severally agree M purchase the goods arl services listed below,In accordance with the prices and terms desoribed 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 pan.
VINYL SIDING
A0 Remove and dispose of existing siding.
Note:
/14�}lemove and dispose of old wooden gutters.
Remove and dispose of aluminum gutters. -
'Install new.032 gauge aluminum seamless gutlers and down spouts as follows:
❑ Open Gutter XrThe Gutter Shutter Color: l32oY✓y✓
WCover body of home with 3/8 inch thick Dow High Performance Insulating Board.
Cover all trim with aluminum coil stock including the following: Color: / ✓Lk-S/G//✓
O window trim deluxe window trim 'upper porch trim -
$,fascia boards door trim ❑ Other:
❑ frieze boards VYake boards
Install Soffit Panels: Style: /All kii Color: LG,fS /✓
Install vinyl siding to body of home as follows: !J
Manufacturer: Grin3741NT�J Style:A07VO J11i'l Color: SA4!l A�rl 'c'WA/
Replace existing wooden attic louver vents with vinyl vents.
Cover porch ceilings with Certain-leed beaded porch panels.
1W Remove and re-install existing shutters.`ON 4orwe,IF- :a,i )
1W Install# JJ pair of Girardin new vinyl shutters.it U,Wriii S 7Y1.E, Cer�,rs.: RI-wLca r v�
'Comer Post style: 77hn ZO/4>+-O -Color: SF.QLG L3/1 ail
IcClean debris from grounds on a daily basis;clean grounds thoroughly at completion.
X Included in this proposal are the following items:
,XCBuilding and Electrical Permits
X*Basic Electrical work including removal and remounting of fixtures electric service,and wires.
1"asic siding accessories including light,outlet,spigot blocks,dryer vents,and exhaust vents.
a
SPECIAL INSTRUCTIONS: E?rTt37z 60Y— ®i?/w77"
ji 7-0 lSes 65kliiv7F0 All ' 1�r9 t�,p 3 � '/ ow.zsS, svr.rz�
S�� Fwvra_ w//-no t 4's/ate , FY1�rvT VO UGH fbsTs ,v„o [r+rrfct,
,41V.0 6Vt1ChVnD. Sc/LAgjodF- AAyn _HWn/!J St7ND 7iLL E?c7 7 - .51�-FAf�S ,
QEyL :Z-C 55ru91,L Z/VO ktic /t nv oatn/. APPr y Ol Cli c7CG4(.F/1C412Au1}
oil- &S6" P2lMe7L 7d eKpate)i SitAr woop, 19PPLLI OPl Fnv/sP CCWT
OF CRL 1 r-02,A/14 IOOZ 4c2yLlG LFF773)C AlAl TO L D'7 oF�AfN?f� L�LKHe+7p
f?7r.C19 12/M., Z c-1rr-75 7a Ew777-"/ Doenef, _
A&A Services, Inc. provides a five-year labor warranty on vinyl siding Installation to Include any re-installation of any vinyl
siding,gutters, and aluminum coverage work due to any faulty workmanship. This warranty does not cover any Acts of God
Including Ice dams,lightning strikes,falling trees,damage from vandalism,or Improper use.
N le agreed and understood by and between the parties Mat this Specification Sheet.along with CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,constltuMs
the entire understanding between the panic.,and More ere no verbal understandings changing or radio any of the tome.This contract may not be changed or Its
terms modified or varied In any way unless such changes are In writers and signed by bath the Buyerls)and the Contractor.Buyer s)hereby acknowledge that buyer(.)
has reed Mla SpeeiDeatlan Street.
(�
Contractor Initials: O'J Date: ��'T 3 0 Buyer's Initials:
A & A SERVICES, INC.
AAASEWCES 115 NORTH STREET,SALEM,MA 01970
kTiTilLilgroyi%lmclnmlg -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
wlvg- /0-L3 -0_9-
Buyer(s)Street Address,City,State and Zip Code -
2 S gn49A/'T AD SAJ!,PM M,q 0/970
Daytime
Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address -
779-7VS--7711
The Buyers)listed above hereby jointly and severally agree to purchase the goods anmor 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 REPLACEMENT
>C Remove and dispose of# existing windows.
Install # new windows:/,Ninyl ❑Wood
(Manufacturer)
Options: style SI-iM Ll A,6r Grid pattern
Color Interior W N 1 TV Color Exterior W FI I'fl± Glass Type LSO E fflrt4 Orr
Of Wrap exterior trim with aluminum- Style Color
XAll windows will be installed according to the installation procedures in the portfolio.
lX Caulk all interior and exterior edges.
9'1 Insulate where possible around new units.
Insulate window weight pockets if exist,and around new window units where possible.
/_
�7 Included in this proposal are set up,clean up,Hepa vacuum and cleaning windows inside and out.
Building 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 unites)in its entirety.
Note:Electric and plumbing may exist in wall and will require additional costs to customer if need to be dealt with.
O Install ' window(s)into opening(s).
Note: If Bay or Be.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
_ flashing as needed. \
Note: Painting and staining not included.6<067 vo-`i- S/O(/✓j. ®A*yE)
STORM PRODUCTS
❑ Remove and dispose of# existing storm window(s).
❑ Install new storm windows# Manufacturer
p -
Style Color Option
❑ Remove and dispose of# existing storm door(s).
❑ Install new storm doors If Manufacturer
Style Color Type: ❑Aluminum ❑Solid Core
SPECIAL INSTRUCTIONS:
N Is agreed and understand by and between the parties that this Speclflcaaon Sheet along with CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,mountains
the entire understanding between the fine ,and there are no verbal undentandings changing or modifying any of the terms.Man contract may not be changed or Ito
terms modified or varied In any way unless such changes am In writing and signed by baM the Buym(s)and Me Contractor. Buyers)hereby acknowledge Mat Boyeda)
has react this Specification Sheet �/ n
Contractor Initials: Date: 10-23-d- - Buyer's Initials: Date: hT� /
we
� A & A SERVICES, INC.
AeASBMCES 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. GS057733
CUSTOM REMODELING AND IMPROVEMENT AGREEMENT
Buyers)Name Date of Contract
Super P-lCHii 10--7'3-0} ~
Buyers)Street Address,City,State and Zip Code -
ZS f5gP_4 rT- Rp SALLFM MA o1970
Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mal Address:
978-745-7711
The Buyer(s)listed above hereby jointly and severally agree to purchase the goods and/or services listed on ale 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 that such
goods or services be installed or provided at Buyer's address listed above. A&A Services,Ina("Contractor),hereby agrees to instal 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 Buyer(s)agree to pay in
all the cost of the goods and services urchased as deecdb�ed herein,regardless of timing or approval of any financing Buyer(s)may seek for their purchase.
21 - - Y2 0 m -- /{
Purchase Price: r�'S�t �r.+t,/f /5 �.{�23/ZZ�r Est.Starting Date: /r-2-3 i11
Down Payment: y/ • SLIM LINE ApNOpgul (o.00�a Est.Completion Date: I2� -4
ExrMyart XWVTJ��_1�y �ZS ❑Cash
Amount Due on Start of Job:#8,V iN e / ❑Check
I or slolti4f?2,, r9 ❑Credit Card
Amount due on of Completion: 414• No.
Amount Due on of Completion: Expiration Date:
Balance Due on Upon Completion:JJ 8 NII r CVC Code:
It is agreed and understood by and between the parties that this Agreement,front an4 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 mad 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-mall,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 1F IT CONTAMS ANY BLANK SPACES.
A&A Services,Inc. Buyer(s)
By: c,!(!. .t��
Signature �d
Eo Signattye
a„ � k :r N�q• /P�N�-yea s
ww Print Name Print Name -
i
f�owlLzT /s P�war..rt FNRNL/NG 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. Bee the following Notice of Cancellation form for an explanation of this right.
P - .
AR9nHATION:TIec WM endthe Mae erherebymu War ,leasmaP2 NatMNerve eiNsrpaMhoeaelspubwmemingleisconlrW.,rarerpaMmaysumlt¢weltdisputeb
a pmente andandon urWm whitlt has de en approved by the Somali of the Ea flea Oboe of Consumer AXahe ap Buvness Repulejimu and the.per parry shall be,purred to suCmrl to
sudt eNNat'rn as pave,In Iff L c.14aii C x
wlrazrw IIc�yy atryc'a/wade /'f -
o.m. eaJ0-l2-e'1 moo:
WIDE OF CANCELLATION No OAF au Fri l slop ,
...... You may roamed ME taaeaamn,watout any penalty or Me al nanaanb o-ZY .Ypa may as 1 this transaauon,w..any pare,or
onlga.n,wlMln Nree wmraaa can/math,mow same nyea canal,dry pmpamt.ye m, theatbr wall three Wall days ham to may.date.If you cancel,try proper,,actin.
.my Payments made Wyou under tire Confect or Safe.and any reforms instrument,.seated army darmanmlada,you veer Ne Cornet or sale...any amenabe lltsrrumem..emrtad
I you.11 ba ream.within ladays know,,,receipt by Nit Salle of your mrluuatim room. byyou wuI be raNm.within la days wrimmiq recdpt Isy the S.Ibr of year u mllanon noted,
and my dow,Interest ones,eat of the lrars.ctbr will be oanDenad.n you ari you mast weary-1,entered area,,chef Me.-m..1.bad eandi ll you cams"you
mobs aammem to tea Balm,of fear td edw,in wlremruJN as gam awldan as when reaemad, mar awlable No Me Seller a your raker.M wbaantaN.good wrwrn are whom walked.
airy/%wed E.Nowd to you under In.Co.w Sela:ar you man,If you an comply war Me any goods delivered b you under Nis Commust or Sale:or you may.Il you wish.comply war Me -
Iammuctlons of she Seller spud,Me Mum shipment of the gross of the Bottom expnm aad btaWNona of iM Seller r]drab,me return 91lpn.nt at the Spot at he Sellers espenu and
ask. If you do make Me gay dwell b two ,or and it Send Wm me pick Mom up rl5k. If you as make she goods avamda to IM Sella a.Me S.Iler dome ke pick tern up
wrMin ad days A Ma date of your Note of Demolisher,You may Men ar Nsperni to goods wain ad days of Me data of your Notice of cm Bibn.you may retain udmpou of Ne each
wIMwN NMerabnaaton.nyw lailbnleke Me plWsavaimdetDNa seller.oral yin agree without any NMer obllgatbn.Il you tan to make Me g wouram to Me seller,or if you days
o,Mum the podded to Ma Se1b and fail to do as Men y reai ou mn Idow,for deadem nm ootls W uM mi of all 1.Mum Ma g b the SJl be do aD,Men you,,meth IIsi nor wed,rm-m of all
obnpam under Me Canned,To same Nis fommodon,mail oa dalMr a soma]and dated Delay spiatblw under the Conlmtl.To camel Mrs Vensec..Me or do.d Jgned aM dame copy
of the Nompla.n IgtlCy or any other wro en made,or send a bunram,as ABA Sera A 115 of the canmlldbn Mtlee or a,after winter Mum.or fond a IelegrN,b A&A Services,�115 '
NaM Must,Mom,winsomeness days.NOT LATER THAN MIDNIGHT 0r/o-24-0;' North Duke,Mom.Mms uut DIM,NOT LATE a THAN MIDNIGHT
(Deb) (D.)
I HEREBY CAN w CEL THIS TRANSACTION. Conmer's Oale HEpEdYCA Signelum INCEI_TWSMdANSACTION. Coresum.r§$,rash,. Oat.