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183 LORING AVE - BUILDING INSPECTION �\ The ConunorMealth of N'1assachusC1t.S Bom"d of 13ullding Regulations and Standards MLISSaChl-I5Ct15 State Building Code. 7SO CN1R. 7°i edition tit[ Rr1 i.wd hum.0 I Building Permit Appl ieat ion To Construct. Repair.air. Renovate Or Dc loutish a _IIIIR One- or Ti o-FumilY Du elling This Section For Official Use Only it Date A lied: tIBLIi,11ding, Permit Number. PP -- I Building Cununiesir lei pectur of Buildings Dale SECTION 1: SITE INFORMATION L1 roper[y :address:h 1.2 Assessors Nlap & Parcel Numbers ono 2 S A OIG -__ - Nln Numher P:uecl N'umher 1.I a Is this an aecepted street? yes_ no p 1.3 Zoning-Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sy it) Fromage(li) 1.5 Building Setbacks(ft) Side Yards Rear Yard Front Yard ! Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c. 40. §54) 1.7 Flood Zone Information: l.s Sewage Disposal System: Zone: _ Outside Flood Zone" Iv1unicipal ❑ On site disposal system ❑ Public❑ Private❑ Check If yes❑ SECTION 2: PROPERTY OWNERSHIP' \ 2.)MOwnerl o`4- , : m on �( I�j J 'f1Yl(� �ye �1em l Name(Print) 4�Idress for Service: ©q �0 S i mature Telephone SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction ❑ Existing Building ❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) &KIAddition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Spcci fy: Brief Description of Proposed Work'': SECTION 4: ESTIMATED CONSTRUCTION COSTS Estimated Costs: Official Use Only Item (Labor and Materials) X S 3 Q r_ 1. Building Permit Fee: $ Indicate haw fee is determined: I. Building lD ❑ Standard City/Town Application Fee 2. Electrical $ ❑Total Project Cost' (Item 6) x multiplier x i 1. Plumbing S 2. Other Fees: S 4. Mechanical (HVAC) S List: 5. Mechanical (Fire S Total All Fees: S - Su? ression) - �o Check No. Check :\mount. X j t,. Total Project Cost: S 3 Q -- ❑ Paid in Full ❑ Outst;mdine I3al:ince Due:__.___._ i SECTION 5: CONSTRucrION SF,RVIC ES struction Supervisor (CSLI ;f7 e NUInherr SL 1'y.pe tsee hclolvl% \ n,. lnresuided iu t iu?> 000 Cu. Ft.i Restricted 1 fit'_ FL.... Da alline - '"� 0 RC ReaidenI it 1"o, Ie t'o.rune Telephone - %CS RCSI&Inlal \Vinduw -ad Snline SF Rcsidaiuial Solid Purl Bmnun! \ „Irmrr Imt.ill.nl�ni D Ra,idenlml Demolition 5ffle ' teVlome li rovement m tractor (IIIC) 101670 9 ����� -- H nnp;n N t e r I pit Name - Registration Nunhcr 0 A eg _.e Iran m D:ue Signature Telephone SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M., L.c. 152. § 25C(6p 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 .......... ❑ No ........... ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN . OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject property hereby authorize 71 to act on my behalf. in all matters relative to work authorized Sy this building permit appli Ion. Kay/ ) U Signature of Owner Date SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION a ,/' - 7 r ,as Owner or Authorized Agent hereby declare that the statements find d information on the fol0ifloing application are true and accurate, to the best of my knuwled.geand behalf.' i .. Print Na Sienatureof Owner Jr Authon ed Agent Date I SieneJ under the sins and pelaltieS of er u ) NOTES: I. An Owner who obtains a building permit to do his/her own work, or an owner who hires an unregistered contractor (nut registered in the Home Improvement Contractor (HIC) Program), will not haze access to,the arbitration program or guaranty fund under M.G.L. c. 1-i'_A. Other important information on the HIC Program and Construction Supervisor Licensing (CSL) can be found in 750 CMR Regulations I IO.R6 and 110.RS, respectively When substantial work is planned, provide the information below: Total flours area(Sq. Ft.) rincludine earage, finished hasement/attics, decks or pot Gross living area (Sq. Ft.) Habitable room count Number-uf fireplaces ?lumber of hedrolnn, Vumber Utah:uhruums Number„t hall/h:uh.s rvpe of heating system Number tit decks/ perches ----_----. I Type of coining system Lncloaed Open .-_-- -- — 3. "Turd Project Square Footage" may he substituted for "Total Project Cusl" _j 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 wort:shall be disposed of in a properly licensed facility as defined,by M. G. L c. 111, Sec. 15ba. The debris will be disposed at Salem 'transfer Sfafiots owned by hlorthside Carting Signature of PamiltAppiloant Date Christooher Zorzv Name of Permit Applicant . A &A Services Ina Firm Name 115 North Street, Salem MA 01270 Address, City, State, Zip Code CITY OF SALEM PUBLIC PROPRERTY ?a DEPARTMENT ,.11fn-RI I1 uR ht „I I 12.' %VW[iN(,1',INti ItII1 0S. 1:\1, \1 l't1: 9-8-,4 9;,A • F\\: ')'8--4.-9831) Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers AI)pllcant Information /� /± y o / /1 Please Print Le-Obly Name IBu..i fie,s t irgamtahon Indn lducaI l: A L A �e.rV[ c e5,, �no— . lddress:�]r IJOK--� h f M P �� \ City,State'Zip: S dfm 1-18 12I2-70 Phone #: ( iZSS ) 7� I - 0)� �4 1,re von an employer:'Check the appropriate box: [7. ype of project(required): I.d I am a employer with a• ❑ I am a general contractor and ( . New construction employees(full and/or part-time).* have hired the sub-contractors _'.❑ I am a sole proprietor or partner- listed on the attached sheet. ❑ Remodeling.ship and have no employees Thesesub-contractors have 0 Demolition working for me in any capacity. workers' comp. insurance. Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions required.] ofiicers have exercised their 3.0 1 am a homeowner doing all work right of exemption per MGL 1 LQ Plumbing repairs or additions myself. [No workers' comp.. c. IS?, §!(4),and we have no I'_.0 Roof repairs insurance required.] t employees. [No workers' lOther - comp. insurance required.] 'Any applicant that cheeks box#1 must also fill out the section below showing their workers'compensation policy information. 'I lumeuwners who submit this affidavit indicating they are doing all work and then hire outside contactors most submit anew affidavit indicating such. :Cuntmctors that check this box muse attached an additional sheet showing the name of the sub-contactors and their workers'comp, policy information. /air an employer that is providing workers'compenvation insurance for my employees. Below is the policy and job site information. / I Insurance Company Name: . Policy#or Self-ins. LLiic. #: I'- oval M'� (_113 Expiration Date: 0 Job Site Address: 0� Lnr In� ye S )I\ u I MR 0ig 70City/State/Zip: 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 NIGL c..152 can lead to the imposition of criminal penalties of a ine up to S 1.500.00 anyor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up ro S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Iln esti_ations of'lhc DIA for insurance cOlerage Cerlficatton. - /do hereby cerVidr the sins and penalties of perjury that the information provid of ub ce i.v true an c•orrecit - \I YI1.If 11 rC: Dale: O fieia/use only. Du not write in this area, to be cornpleted by chy or town officiaL City or Tow n: #_._—.---,.—_-- lssuing.\uthurity (circle one); _ 1. Board of health 2. Building Department 3. C•it%irown Clerk a. Electrical Inspector 5. Plumbing Inspector 6. Other Information and Instructions %I.is,achusens(Ielural Laws chapter l5_ requuer:Ill enlpluyers to pro%ice ttorkcrs' compen;uion for their employees. P!nnsuanI to Ibis statute• .uf emphq•ee is delincd as ".. c�en person tilt I it: sort,ice of another under a ny ca)turact of hire. c%luca ar implied.oral or written." .\n errrploter is dclined as -an iudit ideal.parnlership.associatloll,corporation or other Id al entity. Or 311y I1vo or inure of the IW'e_l'oing engaged in a)oint enterprise, and Including the legal representattles of a deceased employer,or the receit er or trustee of an individual, pannership,association or other legal entity• employ in,,employees. l lowc%cr the o•a tier ofa duelling house'hai,mg nut more than three apartments and oho resides therein, or the occupant(if the dt1 clling house ofanother who employs persons to do maintenance,construction or repair work on such dwelling house ur tin the eruunds or building appurtenant thereto shall not because of such employment be deenied to—to-an-employer." -- ,I(iL 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, %IGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public cork until acceptable es idence 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-contractors) name(s),address(es)and phone number(s)along with their certificates)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 aMdaviL The affidavit should be renamed 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 Oftidals 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 Jog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The office of fnvestigations 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. fhe Department's address, telephone and lax number. The Commonwealth of Massachusetts Department of Industrial Accidents CiMce of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE R,e%iscd 5•_6-05 Fax # 617-727-7749 _ www.mass.gov/dia Maissachusetts Department of Public Safety BoaM of Buildm ,.Regulations and St oditrth;i _ Construction Supervisor License License: CS 57733 t Restricted to: 00 CHRISTOPHER ZORZY 115 NORTH ST SALEM, MA 01970 Expiration: 5/26/2011 ('ommissiunn' Tr#: 14751 r- - ( � . ,per — ✓� 6a� a/r� a ✓G �� �\ Board of Budding Regulations and Standa ds HOME IMPROVEMENT CONTRACTOFt. i Registration:; 101609 Expirations- 6/26/2010 Tr# 267870 Type Private Corporation A&A SERVICES, INC' ��Christopher Zorzy I `I iD North Street ,Salem;MA 01970 Administrator Commonwealth Of Massachusetts Division of Occupational Safety Laura M.Marlin,Commissioner tr Deleader-Contractor YpIWF�UY CHRISTOPHER ZORZY Eff.Date 04/14/10 Exp. Date 04/13/11 �r DC000440 Ilr91I Wmherof C.OAE.S T. 80 IIIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIII IIII BOSTON REN v + AGrzde I / �--� f � ;az A & A SERVICES, INC. VV// A&A SERVICES 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 CUSTOM REMODELING AND IMPROVEMENT AGREEMENT Buyers)Name Date of Contract CIII � I O Buyer(s)Street Address,City,State and Zip As (--or;m �Alrl Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address: z�r q�v The Buyers)listed some 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 find 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,Inc.("Contractor"),hereby agrees to Install or cause to be installed the products or services listed in this Agreement at the Buyer(s)address written above. This Agreement represents a cash sale of goods and services. The Buyers)agree to pay in cash t e cost of the goods and services purchased as describetl herein,regardless of timing or approval i grain B yer(s)ma�yy'seek f [ air purchase. '7 Ql h4�N llf- C� Purchase Price: go Est.Starting Date: rTit coo_)FT a Down Payment: Est.Completion Date: ❑Cash Amount Due on Start of Job: ❑Check ❑Credit Card Amount due on of Completion: No Amount Due on of Completion: ^�7,(B�•'-.r((�/�^'' Expiration Date: Balance Due on Upon Completion:- ba 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(s)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. Buyer(s)also (i)acknowledge that they were orally informed of their right to cancel this transaction;and (II)request that they be contacted via their telephone numbers or e-mail, 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 IF IT CONTAINS ANY BLANK SPACES. A&A Services,Inc. //�, Buyer(s) By: Signature Signature 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:The mnlracror and the homeowner hereby mutually agree in eWenre can In the event tinder paM has a dispute concerning this mntrazt either party may submit such dispute to a pawn.estimates service which has been approved by Me Secretary doe Executive Gilles M Consumer Affairs and Business Regulations and Me other paM shall be required to submit to such aNilration as proved in M.G.L.c.142A. Can-..,I nvls'. � Buyv'v tnitialy: Dar Oe p OTr FF CANCEIL&I NnTlr`F OF�Lf.ANf.FIIeK`QN Gate 01 Trerush radion O You may carwrel this irunsac'ipn,wiNON any century or Date of Tnnsetlan .You may cancel this 4ansaction,without any penalty or obllgetlon, ru ihFree sum daystmm theabove date.Ifyou cancel,any property traded in, obliga0on,within two business days from Me above date.It you cancel,arty property traded in, any payments made by y u under the Conrad or yak,and any carbonate Instrument executed any payments made by you under the Combed or Sale.and any nego0able informed exr:sed by you will be returned within 10 days following receipt by the Seller of your eanmllabon notice, by you will be returned wthin 10 days IWlowing receipt by Me seller of your cancellation noire, and any se udry interest arising out of increases will be canmlkd. If you cancel,you must am any secudry interest anteing out of tan iactim will be cancelled. It you cancel,you must make mailable bide seller at your residences.In wb=ftany as good wndtion he when recaNed, make available to the seller at your meitlenmJn substmtally as good common as when reshred, any goods delivered to you under this Conrad or Sale:or you may,if you war,comply with the any goods deMered to you under this Conrad or Sale:or you mag I you wish,comps with Me mun29ons of the Seller regarding Me mmm shipment of the Samoa At Me Sellers eamenm and instructions of the Seller regarding the reNm shipment of the goods at the Sellers expense and Me II you do make Me goods.vedette t0 the seller and Me Seller does not pick them up nsk. If you do make the goods available M Me Seller and the Seller does not pick them up within 20 do,of the der..1 your Notice of Camarro m.you may.,in.1 discount of the gmtla within 20 days at Inc dine of Ans,N.C.of essentials-,you may retain or d epown.l the Bonds wlmot any further obligaon.IfyoulWItomaw MagocdsavMlffieMthe Selle[orifywagoe without any further obligodds,If you fail to make the goods available to Me Sellep or if you agree M arm they gooks to the Seller and fail M do so,then you remain liable for mammonist of all to reNm the goods b Me Seller and tail to do so.Man you remain liable for oortormartce of all caligators under Me Conrad.To named this tansaction,mail cadavers signed and date]copy obligations under the Contract Tocancal Mistransection,mail or deliverasigned and datedcopy of the cancellation notice or any other whiten maim,or send a telegram,M A (1. 15 Ak Seemm of the cancellation notice or any other acres notice,or send a telegram,M A&A Services,115 North Street.Salem,Massachueatte m9M,NOT LATER THAN MIDNIGHTOF 4 o Nunn Susan Salem,MkxAwhmwma Wgi NOT UsTER THAN MIDNIGHT OF (Date) (Data) I HEREBY CANCEL THIS TRANSACTION. Consumer s SgnMum Data I HEREBY CANCEL THIS TRANSACTION. Consumer's Signature Dan. '.. pp��, p/ � gyp` /� A & A SERVICES, INC. A&A SERVICES 115 NORTH STREET,SALEM,MA 01970 iTiTilliDTOITIT&ImginmTelephone:(978)741-0424 Fax:(978)741-2012 Contractor Registration No. 101609 Federal EIN:04-3090162 Construction Supervisor No. CS057733 ENTRY POOR SPECIFICATION SHEET Buyer(s)Name r c �/_ Date of Contt Buyer(s)Street Address,City,State and Zip Code �.) I S-3 N Op p 5 PJ — , O(/77V 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 pad. ENTRY DOOR Re a and dispose of# oN existing entry door units. Install new entry doors# Manufacturer Location 1 rren Type: Steel ❑SmoothStar ❑Fiberclassic ❑ClassicCratt ❑Sliding Patio Door ❑French Hinged Patio Door Model#AW _Sidelight(s)# Sidelight(s)type/model# O INS: 7 �� justable�hreshold forZ*mmwWM 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 c tock: Style Color Hari CA-Fland�et eadbolt ❑Footbolt ❑Mail Slot eepsite Inst ak strip at floor as needed. 1 ��1 Wit S(.u71��p(-CCOI or- C/aul-k terior and exterior edges. I=n/sul'ate around new door unit where possible. �j[F-- yl�Il W i'h1 : Pat g is not included. �XCQQ^} j1C�.p�y pmf M`9 1 S� ncluded in this proposal are set up and clean up. !7 STORM DOOR Remove and dispose of# ANC--� existing storm door($). ❑ Install new storm doors# Manufacturer Style Color Type: ❑Aluminum ❑Solid Core ❑ Location: �SooS�17+iv1 �xx?utcd�crr SPECIAL INSTRUCTIONS: r 26ALAAo5;7 scam i-w (�-- L..cnl t ) sfi!-i(�"Ra f 1 Frnrr'�`raT ra� f3r�ss ocks a <d >Qlv;��-4 RQ'�nS�JI F V1�261�1''N'ilt/l / a a��e i( �w „ r,s� Iwo( �y siecK ettAejr cq rasa'yA,95 wig Oew htrld dt ' P74� C edi� s �csab(e P6�FC�cT It Is agreed and understood by and between the parties that this Specification Sheet.along with the CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,coast!. Mes the entire understanding between the parties,and there are no verbal understandings changing or modifying any of the terms. This contract may not be changed or its terms modified or varied in any way unless such changes are In writing and signed by both the Buyers)and the Contractor. Buyers)hereby acknowledge t Buyer(s)has read this Specification Sheet. Contractor Initials: J.L ., Date: Buyer's Initials:V "