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DATE: /0 -130- a 3
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PLANS MUST BE FILED AND APPROVED BY THE
INSPECTOR PRIOR TO A PERMIT BEING GRANTED
Location of Building �,qb gansOrn Sf1 e2�
Building Permit Application For:
'(Circle whichever applies) Roof,Reroof, Install S tract Deck, Shed, Pool
Addition, Alteration pair/Replace oundation 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: Eleanor 1�11-) Contractor: ( h r; s t nph P r 7.n r 7.;z
Street &P YdO-51') Sf City l Street_11 5 North StrPPt City Sal Pm
State_ /t-//4 Phone 7///, _ -7g3! State N� Phone(978) 741 -0424
Architect: City of Salem Lic# 14 0 5
Street City State 1100 5 7 7 3 3 HIP# 101609
State Phone ( ) _ Homeowners Exempt Form_yes no
Structure: (please circle Single Family, uld Family# Other
Estimated Cost of job S
Will building confirm to law?,dyes no
Asbestos?_yes v"' no
Description of work to be done: �h Sfr�l �i�teei'1 /! /ilJYy 5
14nu1_ ,Sldinnn fall 67J52yPr1 virliil I l)/lJ�vn� o� ,f
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ERVICES
Drawing ubmitted:_�es_� no Mail Permit to: 1.15 NORTH STREET
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Signature of A plicst ,SIGNED UNDER THE PENALTY OF PERJURY
CONSTRUCTION TO BE COMPLETED WITHIN SIX (6)MONTHS OF PERMIT ISSUED DATE
Department use only: Permit# qz% -Z%nmg Map/Lot
Permit fee S ( G K to�3 33
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.=.CamHARVEY /N�USTR/ES
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U-Value and R-Value Test Results
• U-Values in accordance with NFRC-100 - Based on residential sizes
• U- and R-Values are subject to change without notice •Whole window values
All windows with a U-Value of.35 or less qualify for the Energy Star program REV 5/l/00
WINDOWSHARVEY MANUFACTURED DOORS
Clear Insulated Low-E AdvantEdge
WINDOWS U-Value R Value U-Value R Value U-Valui R-Value
•Classic Double Hung(Mechanical) 0.51 1.96 0.40 2.50 0.35 2.88
•Classic Double Hung(Welded Sash) 0.61 1.96 0.39 2.58 2.86
r Classic Double Hung(w/ProWeld Technology) 0.4-9 2.04 _0.38 2.63 0.34'-2§C7
•Classic Plus DH W/CF1N `0.33-3A3 0.26 3.57 0.27 3.70
•Signature Double Hung 0.51 1.96 0.39 2.56 0.35 2.86
•Signature Double Hung(Welded Sash) 0.50 2.00 0.39 2.56 0.35 2.86
•Slimline Double Hung(Welded Sash) 0.52 1.92 0.40 2.50 0.35 2.86
•Slimline Double Hung(w/ProWeld Technology) 0.50 2.00 0.38 2.63 0.35 2.86
•Thermal One Single Hung 0.53 1.89 0.40 2.50 0.36 2.78
•Majes"uble Hung 0.54 1.85 0.44 2.27 0.40 2.50
•Majesty Fixe, .0 sement(PW) 0.53 1.89 0.40 2.50 0.37 2.70
•Majesty Casement/Awning 0.86 1.16 0.45 2.22 0.42 2.38
•Majesty Picture Window(DH) 0.53 1.89 0.43 2.33 0.38 2.63
•Vinyl CasemehUAwning 0.47 2.13 0.36 2.78 0.33 3.03
•Vinyl Casement/Awning&Thermal Panel 0.32 3.13 0.26 3.85 0.25 4.00
•Vinyl Designer Shapes 0.49 2.04 0.34 2.94 0.30 3.33
•Vinyl Hopper ._..0.47 2.13 0.36 2.78� 0.33�3.03
�_ � -.:
Vinyl Picture Window -0.48 2.17 0.33 3.03 0.30-3.33�
•Vinyl Picture Window Deadl@e 0.51 1.96 .. 0.37 2.70 i0.33 3.03
•Vinyl Roller-2 Lite&3 Llte 0.50 2.00 0.38 2.63 0.35 2.86
VICON SERIES
New Construction Vinyl Window
•Vieon Casement/Awning 0.47 2.13 0.36 2.78 0.33 3.03
•Vicon Picture Window 0.46 2.17 0:33 3.03 0.30 3.33
•Moon 1000 Single Hung 0.53 1.89 0.41 2.44 0.37 2.70
•Vicon 2000 Double Hung(w/ProWeld Technology) 0.50 2.00 0.38 2.63 0.35 2.88
•Vioon Classic Double Hung 0.51 1.96 0.40 2.50 0.35 2.86
•Vicon Designer Shapes 0.49 2.04 0.34 2.941 0.30 3.33
Temp.Clear Temp Low-E Temp.Argon
HARVEY PATIO DOOR u Value R-Value U-Value R-Value U Value R-Value
•Solid Vinyl Patio Door 0.50 2.00 0A1 2.44 0.38 2.63
The Commonwealth of Massachusetts
Department of Industrial Accidents
011lte 8I1ft"SB081/00S
600 Washington Street
Boston,Mass. 02111
4
Workers' Compensation Insurance Affidavit
name:
location:
city phone#
❑ 1 am a homeowner performing all work myself.
❑ I am a sole proprietor and have no one working in any capacity
❑ I am an employer providing workers' compensation for my employees working on this job.
company name: A & , A 'Services , Inc, i ,iyit ,
address: 115 North Street L~Mk'tr�
^yy �k 1 Yd 11Y L bFSi�£
city: Salem, 'MA 01970 ohoneN• 978-741=0424'
insurance co. The ' Trayelers oolicvR WC939X1256 ' krx'" I
❑ 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: r Phone q 4.0
0,
insurance co: policy N .
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company name: "
address: r'.�iK1 f
L y
city: a hone A• s ah �.*r•
-11
insuranceco: olkc :N:. is a fE ins.
Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1.500.00 and/or
one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a
copy of this statement may be forwarded to the Office of Invesltgallons of the DIA for coverage verification.
I do hereby certlj der he pains an penalties ojperjury that the Information provided above is true and correct.
Signature Dale _.ID - 30 —0--3
Printname Christopher Zorzv, President Phone# 978-741-0424
Official use only do not write in this area to be completed by city or town official JDepar"tment
city or town: permit/license N flBuilding❑Licensin❑check if immediate response is required OSelectme❑Health D
contact person: phone N; flOther
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 Cardna
Signature of Perm• Applicant
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ate—
Christopher Zorzv
Name of Permit Applicant
A &_A Services, Inc.
Firm Name
115 North Street, Salem, MA 01970
Address, City, State, Zip Code
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BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR t
Number: CS 057733
Birthdate: 05/2611958
Expires:0 5/2612 0 0 5 Tr.no: 12224
Restricted: 00
CHRISTOPHER ZORZY
115 NORTH ST ( °
SALEM, MA 01970 Administrator
Commonwealth of Massachusetts
Division of Occupational Safety
. Roterl J.Pronoso,Deputy Director FO
Deleader-Contractor
CHRISTOPHER ZORZY
Eff.Date 110102
Date 1120103 DC O
DC000440
Mwitvrd C.O.N.E.S.T.
3
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Board of Building Resulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registration: 101609
- Expiration: 6/26/2004
Type: Private Corporation
A&A SERVICES,INC
Christopher Zorzy
115 North Street
Salem,MA 01970
Administrator