42 MOFFATT RD - BUILDING INSPECTION (2) 1 The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY
3�
t Massachusetts State Building Code, 780 CMR, 71s edition OF SALEM
Revised Junuary
Building Permit Application To Construct, Repair, Renovate Or Demolish a /. 1I108
One- or Two-FamilP Divelling
This SO-ion or Official Use.Only
Building Permit tuber: Date Ap p 'ed:
7
Signature: 3) /#
Building Commissi /Inspector of uildin DatdT
SECTI 1: ITE INFORNIATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
L la Is this an accepted street?yes no Map Number - Parcel Number
1.3 Zoning Information: IA Property Dimensions:
Zoning District Proposed Use Lot Area(sq 11) Frontage(ft)
1.5 Building Setbacks(it)
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? Municipal❑ On site disposal system ❑
Public❑ Private[3 Zone:
if yesO P p y
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner of Recq�d:
Name(Print) Address for Service:
9G3 - s� oz
Signature 'telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK (check all that apply)
New Construction Cl Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_ I Other ❑ Specify:
Brief Description of Proposed Work'': V
i
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
I. Building $ 7 G I. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical $ SG GU ❑Standard City/Town Application Fee
❑Total Project Cost (Item 6)x multiplier x
3. Plumbing S L 5U- OU 2. Other Fees: S
4. Mechanical (HVAC) S List:
5. Mechanical (Fire S
Suppression) � Total All Fees: $
Check No. Check Amount: Cash Amount:
6, Total Project Cost: $ 93 S6w- C)O ❑ Paid in Full ❑Outstanding Balance Due:
av)q
�L,� 3 SR6�
' t
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supe isor(CSL)
RI C- flAf 0 .7 r"! l ie s Pn/ License Number Expiration Date
�'� 4,9
Name of C'SL- Bolder
" /-C OA List CSL'I'y'pe(see below)
Tyre Description
�ddr
lJ 7 Unrestricted(up to 35,000 Cu.Ft.)
R Restricted 1&c2 Family Dwelling
. ignature j// M Mason Only
`� U �y23 " ""� RC Residential Roofing Covering
Telephone WS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5:Pegisttgre)i,Home IIm r .vement Contractor(HIC)
HIC Com any Name or HIC Regiyant Na ne Registration Number
A ss G13-6 �u� to Expiration irotion Date
Signature Telephone
S CTION 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 .......... ❑ No...........❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, as Owner of the subject property hereby
authorize to act on my behalf,in all matters
relative to work authorized by this building permit application.
Signature of Owner Date
SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION
1, O X ,as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and
behaff
t c (-/a✓ lJ s�
Print N
Si atu e o Owner or opffed Agent Date
(Signed under the p ' s ncl penalties ofperjury)
ZZ NOTES:
I. 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(I11C)Program),will not have access to the arbitration
program or guaranty fund under M.G.L. c. I42A.Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I I O.R6 and 110.RS, respectively.
2. When substantial work is planned, provide the information below:
Total floors 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"
CITY OF SALEM
PUBLIC PROPRE RTY
DEPARTMENT
I%W.nt I r:,niN:uI l
\Itsdnt
I!:\t)Mrll�lilU\irs CL•T• SAIE.N,M..sSLt6111 ifl INJI'77�
1'cl.: 978.7134i')5 • Ps x. 9711-7142-93I6
1Yorkers' Cumpensation insurance .%tBdavit: Builders/Contractors/Electriclans/Plumbers
Snnlic'rnt information Please Print Leeihly
Name llivan css/Orgamntintvindrotduutl: PG LG T7�! � ) �`� h fsQl�
:Address:
City,Starcizip: /r _Ijic L Iq A/0 1'hune d: Y a Y 51
Iarc you• p layer?Check the appropriurt box: 'Type of project(required):
1.1 ;ms a empluyur with / 4. ❑ I um a gunenl contractor and 1
enlpluyccs(full und/ur pact-time).• hove hircJ the soh-cutnracwrs �' ICew construction
2.Q 1 Jill a sole pmprictoc or partner- lisrcd on the aaachecl..sheet. 7• ❑Remodeling
ship and have no clnpluyces These subcontractors have S. Q Demolition
working ti)r me in any capacity. workers'comp, insurance --9.-
0 building-addition-----------
-- -- 1No workers'-comp, insurance 5.-Q-Ws,are it mlporution and its
required.) officers have cxerris- their 10.0 Electrical repairs or additions
3.❑ I:un a homcusaur doing all work right of uxcntption par bICL I I.Q Plumbing repairs or additions
myself. [No workers'cutup. e. 152,¢1(4).and we have no 12.Q Rouf rupuirs
insurance required.) t amployces. (Ko workers'
camp. insurance reyuind.) 13
.❑UOIer
Any.,iyrhavlw that chucks,bat al must Aid till owl The wcuan below dwwina their wwktsi cumptnwuiwt policy iuturmwiun
'I Ivmuuwnan who 1411,010 this affidavit indiuuina they.tte doing all work and III=hire witida curnrmnars muss aunmis a new a1'Rd evil indiciaina wick.
d'.mtracnur that thvvk this ban mate,atachal an addiliuraid shwl u61wina the nano orthe sukronrraeiors and their workers'comp.pdtcy informariue,
/tun an gurployrr t/tut/r providing rvurkrrs'cutnprnrndon insurance jar my etnp/upeer. Below is the polity und/ob site
ilfurnruti„n. _�
Insurance Company Vvne: �� /¢ tril ror r�
Policy is or Sclf-ins. Lic.d: cjn7 u l k . .._ Expiration Date:—
Job Sits: Address: q�' �/U �G /t/f �—� / I I� Clty,Slule/Zip:
Attach it copy of the workers'compensation Palley declaration page(showing the policy numbur and expiration date).
Failure to wcury coverage as required undue Section 25A ul'JIGL c. 152 can lead to the imposition oteriminal penalties of a
611e up to 3L500.00 and/or one-year imprisonment, as well us civil Ixnaltics in the f'unn of a STOP WORK ORDER and a fine
Of up to 5250.00 a Jay.Iguinbl the violator. tic advi.dcd shut a copy of this statement may be lurwirdcd to the Of)ice.uC
hlrrangauuns of llic UTA for miur rcu covcragu t ci iticatum.
/da hereby certify under the p,r' J pr rage u/perjury thur the in/bnnetion provided above is true and correct.
rl 5_0 5S 5-;5 3 (�
U/jicial nse only. Da rini noire in MA area, to he runrplrted by city or town u/JfciaL
I
Cifr or fawn: _ PcnniolAvnsc dl
Issuing Actihorily(circle one):
L Iluard of Ilcalih 2. Ihlildio.. Ucpartlncul I.(:ilyi faun Clerk 4. L''Icctricdl Iolpcctor 5. Plumbing Inspector
6. 011tur
CmIlAvl I'hmlc 7:
Information an
d Instructions
�tassadwseus licneral laws chapter I i2 reyuirex all euyto e in the ss to ervice of anahercuuletr stay cunt Of h for their �rees
Pursuarnt to Obis statute,An emplurer is defined as"...every person
apress tar unplieJ, oral or written."
.fin employer I5 detined as"an individual,partnership, ding Afiun,corporation of other Icde every,or any two r t more
r the fOregoilIg engaged In A Joint enterprise.and IItelLLdlllg IfIC legal repreYC1119tIVC3 OI a deceased
ees.IHowever the
receiver Of l[uSlCe UI .m Illdlvldual, partnership,Association or other legal entity,employing • p )'
owner r r dwelling house having not snore than three Apartments and who resides therein,or the occupant Of the
,,welling house of another who employ,persons shall uotnbecause of suchu a do aitertunce,curigrction of repair work On �employment be deemed to be an employeh dwelling rs
or on the grounds or building appurtenant
.MGL chapter 152. Q35C(6)also states that"every state or local licensing agency shall withhold the Issuance or
renewal of a license ur permit to operate a business or to construct buildings In the commonwealth for any
duced acceptable evidence of compliance with the Insurance coverage required."
:rppllcunt wife has not pro
Additionally,NIGL chapter 152, §25C(7)states"Neither the commonwealth not any of its
political subdivisions shall
enter into any contract for the performance ul'public work until acceptable evidence of contpliarrce with the insurance
requirements of this chapter have been presented to the contracting authority."
Ayplicallts
------- — Please RII-out-the-workers' compensation affidavit completely,by checking the boxes that apply to your situation and.if
necessary, supply sub contractors)name(s), addrees(es�d phartanuntbeds)-olong-wvith-their-cerfifscatOW of
employees oth
insul+nce. Limited Liability Companies(LLC�orken'tcom Limied lebility nsationPartriership insurances([aa)LLC with o rLLP does haveer thin the
members tar partners,are not required to carry comp
en
a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
xecidents for confirmation of insurance coverage. Also be sure to sign and date the ufndavlL The allidavit should
he returned to the city or town that the application for the nos regarding the law or if yit of lice is ou
nrang requesred,to t obtain workers'
of
Industrial Accidents. Should you have any yLL
compensation policy.please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number tan the a ro riutc line.
City or Town Officials
please be sure that the affidavit is complete and printed legibly. The Department has provided u space at the bottom
Of the affidavit for you to till out in the avert the Office Of Investigations has to contact you regarding the applicanti
phase be sure to till in the Pcrtnit/license nurnWr which will be used as a referencepp
number. In addition,an AM
that must submit multiple pennitilicense applications
in any given year,
ar,need,mid only i write it o all ne affidavit
in indicating current
policy policy information of necessary) PP
town l."A copy of the affidavit that has been officially stamped or marked by die city or town may be provided to the
applicant as proof that a valid affidavit is tan rile for future permits or licenses. A new affidavit must be tilled 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 dug licence or permit to bum leaves etc.)said person is NOT required to complete this affidavit.
1 he I 111ce ul Investigations would like to drank you in advance for your cooperation and should you hove;uly yueslions,
please Jo not hesitate to give us a call.
The Ucpartlncllt'Y address, telephone and fax number.
The Commonwealth of Massachusetts
Department of industrial Accidents
olflce of Investigations
600 Washington Street
Boston, MA 02111
Tel. N 617-727-4900 ext 406 or 1-877-MASSAFE
Fax N 617-727-7749
;t.•.ucJ :-'o.n5 - www.mam.gov/dia
CITY OF S.U.E.NI, NL-kSSACHUSETI'S
BULLDING DEPARTMENT
120 WASHNGTON STREET, 3iD FLOOR
TEL (978) 745-9595
FAX(978) 740-9846
Kl�(BERLEY DRLSCOLL
,MAYOR Tmmm ST.PmxRa
DIRECTOR OF Pmic PROPERTY/8LlIDLNG COMMISSIONER
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section 1 l 1.5
___.Debris,_and_the provisions ofMGL-a40,-S-54,— — -------- ---
Building Permit Al is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
111. S 150A.
The debris wi I be transported by:
(name of hauler)
The debris will be disposed of in
(name of facility)
(address of facility)
43iisecZofp&crrmnitapplican�F'—
date
fa/ KITCHEN INSTALL WORKSHEET FOR ORDER #: 214684
CHUCK , RODRIGUES Order # 214684
42 MOFFATT RD Design Description : RTS 1/25/11 2ND
DESIGN
SALEM , MA , 01970 Design File Name : 1080860A.KIT
1090C271 .KIT
Home Phone : (203) 448-0244
Work Phone : (978) 594-8321 extra.
SKU-282627 KITCHEN POINT NATIONAL.
1st Product Vendor 2nd Product Vendor
Pre-11 Construct11 ion Demolition' Removal and Haul Away Qtv I
UO 11 M
Remove cabinets, countertops, backsplash, molding, window/door casing, disconnect 35.0 Job Site Quote
plumbing/electrical
Haul away debris removed from kitchen cardboard and install debris 123.0 IJob Site Quote
Pre-Construction,Demolition,Removal, and Haul Away SubTotal : $1682.00
Per Box Basic Cabinet Installation Qt UOM..
Key the number of Cabinets to be Installed in the Quantity Section. 14.0 lEach
* Per Cabinet Installation (includes Wall, ,Base. Includes Shelves, Fillers, Scribe, Toe Kick, Handles, & Knobs.)
Per Box Basic Cabinet Installation SubTotal : S966.00
Custom Assembly or Installation Qt V UOM
Build up base cabinet to offset floor thickness (up to 3/4" in height, materials provided by 10.0 Job Site Quote
installer
this is for labor to install back splash reg style (labor only) customer to supply tile and 35.0 Job Site Quote
rout
Custom Assembly or Installation SubTotal : $1305.00
Moldin Installation 1QtY " UOM
Molding for top or bottom of wall cabinets. Each layer 72.0 Linear Foot
rived separately includes blocking at no charge)
Molding Installation SubTotal : $522.00
Electrical Qty UOM
NEW ELEC FOR FIVE COUNTER OUTLETS NEW ELEC FOR REF DISHWASHER 85.0 Job Site Quote
MICROWAVE DISPOSAL FOUR REC LIGHTS AND TWO PENDANT LIGHTS OWNER
TO SUPPLY PENDANT LIGHTS FOUR MAIN LINES BACK TO PANEL
* Electrical requirements/pricing may vary due to local codes
Electrical SubTotal : $1700.00
Plumbing
-._ Qty UOM
INSTALL NEW VENT AND DRAIN PIPE THROUGH ROOF ALSO REMOVE EXISTING 75.0 Job Site Quote
HEAT AND INSTALL AND SUPPLY NEW UNDER CAB HEATER
INSTALL NEW SINK AND DISHWASHER 30.0 Job Site Quote
* Plumbing requirements/pricing may vary due to local codes
Plumbing SubTotal : $2100.00
Appliance Installation 1QtV UOM --
* Existing appliances may not be re-usable after removal
Appliance Installation SubTotal : $0.00
Flooring Installation - Qt UOM
REMOVAL OF EXISTING FLOOR TO SUB FLOOR IN KIT AND HALL TWO LAYER 135.0 Job Site Quote
REMOVE ALL DEBRIE AND DUMP FEES SUPPLY AND INSTALL NEW CEMENT
BOARD APPROX 240 SQ FT INSTALL APPROX 240 SQ FT OF TILE OWNER TO
SUPPLY TILE AND GROUT COST STOCK AND LABOR
Flooring Installation SubTotal : $3915.00
Drywall Work & PaintingQtv, UOMP. 114
REMOVE SHEETROCK WALLS FROM FLOOR TO CEILING FOR NEW ELEC AND 80.0 Job Site Quote
PLUMBING INSTALL NEW INSULATION ON EXT WALLS SUPPLY AND INSTALL
NEW BLUEBOARD AND PLASTER READY FOR PAINT COST STOCK AND LABOR
Drywall Work& Painting SubTotal : $2320.00
Additional Charges if applicable) Q UOM
Additional Charges(if applicable)SubTotal : $0.00
Permits Qtv UOM
Electrical Permit cost 150.0 Each
Plumbing Permit cost 225.0 Each
Building Permit cost 375.0 Each
This section is for adding Cost of required Permits for the Job.
Permits SubTotal : $750.00
lead Safe Work Practices lQtv UOM
Lead Safe Work Practices SubTotal : $0.00
.Total Kitchen Installation.Project : $15260.00
THE: FINAL KITCN.EN ES UNI.ATE WORKSHEE.T NIUST BE SIGNED BY BOTH THE CILISTOMER AND ASSOCIATE AND
THEN IT MUST BE NI.ANUALLY FACED TO TI-IL+ INSTALLER, A COPY OF THE FTNI-AL KITCHEN ESTIMATE
WORKS€IEET AIUSTALSO BE GIVEN TO THE CUSTOINIER
Job will be scheduled once all materials are at the job site
Note: The Home Depot does not provide the following services (as part of kitchen installation program).
Remove,alter or build load bearing walls(other than stud wall framing)
Structural alterations or repairs
Alterations to exterior of home
Removal of vinyl flooring unless in installers professional opinion that the job meets industry standards and norms and is
manageable under The Home Depot Hazardous Materials SOP
r �
inre ;' Associate Signature: d n/lQ,tj�
)7ae l�`a5I11 Date t ,//
SPECIAL SERVICES CUSTOMER INVOICE - Continued Last Name: RODRIGUES Page 7 of 7 NO. 2686-214684
INSTALLATION #2
(Continued) REF#103
CUT AROUND POSTS OR ODD SHAPES WARRANTY ON TRAVERTINE,MARBLE OR HONED GRANITE
SUPPORT MATERIALS FOR OVERHANG(REQUIRED FOR OVERHANGS>6')
CUSTOM EDGES ON BACKSPLASH
END OF INSTALL#2
TOTAL CHARGES OF ALL MERCHANDISE & SERVICES
$23 491.18
SALES TAX $400.84
TOTAL $23,892.02
BALANCE DUE $0.00
END OF ORDER No. 2686-214684
Page 7 of 7 NO. 2686-214684 Customer Copy
SPECIAL SERVICES CUSTOMER INVOICE Page 1 of 7 NO. 2686-214684
.' Store 2686 SALEM,MA Phone: (978) 741-9299
50 TRADERS WAY Salesperson: NEK170
SALEM, MA 01970 Reviewer:
Name Home Phone
•
RODRIGUES CHUCK (203) 448-0244 REPRINT
ndaess 42 MOFFATT RD work Phone (978) 594-8321
Company Name
•
Cry SALEM Job Description FITS 1/25/11 2ND DESIGN
2011-01-26 10:53
s'a`e MA Z'p 01970 cov"ty ESSEX
VENDOR DIRECT SHIP #1 MERCHANDISE AND SERVICE SUMMARY ssooldrtocustomers rve the
right to limit the quantities of merchandise
TO: CUSTOMER
S/O-MERCHANDISE TO BE SHIPPED: S/O KRAFTMAID REF# S02 ESTIMATED ARRIVAL DATE: 03/01/201
FACTORY .086584261
REF# SKU CITY UM DESCRIPTION TAX P H EXTENSION
S0201 264-763 1.00 EA PE/PE PE-PLYWOOD ENDS %/PE HINGES:B $443.64 $443.64"
S0202 264-763 4.00 EA S3S3{V}/S3S3{V} SOLID STOCK 3{VERTICAL}/S3S3{V) HINGES:B MODS: $36.19 $144.76'
W=96" W2=96" H=3" D=0 3/4"
S0203 264-763 4.00 EA SCM8/SCM8 SOFFIT CROWN MOLDING/SCM8 HINGES:B MOD N $33.54 $134.16`
W2=96" H=1 1/8" D=1 1/8" -
S0204 264-763 5.00 EA WMTK8/WMTK8 WOOD MATCHING TOE KICK/WMT 8 � MODS: N $17.26 $86.30-
W=96" W2=96" H=4 1/2" D-0 3/16"
S0205 264-763 2.00 EA S3S6{V}/S3S6{V) SOLID STOCK 6(VERTIC ) HINGES:B MODS: N $82.36 $164.72`
W=96"W2=96" H=6" D=0 3/4"
S0206 264-763 2.00 EA CM8.NG/CM8.NG CROWN MOL G HINGES:B MODS: W=96" N $44.83 $89.6W
W2=96" H=1 15/16" D=1 15/16"
S0207 264-763 2.00 EA S3S3{H}/S3S3{H} SO D (HORIZONTAL)/S3S3{H} HINGES:B MODS: N $36.19 $72.38-
W=96"W2=96" H= -
S0208 264-763 1.00 EA WTEP84/ OD TALL END PANEL 84/WTEP84 FSIDES:B HINGES:B N $126.84 $126.84`
MODS: _ =78 1/2" D=24"
CONTINUED ON NEXT PAGE"•
V D ,
Check your current order status online at
w .homedepot.comdorderstatus
Indicates item markdown
Page 1 of 7 NO. 2686-214684 Customer Copy
SPECIAL SERVICES CUSTOMER INVOICE - Continued Last Name: RODRIGUES Page 2 of 7 NO. 2686-214684
VENDOR DIRECT SHIP #1
(Continued) TO: CUSTOMER
S0209 • 264-763 1.00 EA U362460BUTT/U362460BUTT UTILITY 362460BUTT/U362460BUTT FSIDES:B N $637.23 $637.23*
HINGES:B
S0210 264-763 1.00 EA SK3624{A)/SK3624{A) SHELF KIT 3624{FIELD INSTALLE/ATT:U362460BUTT N $74.05 $74.05*
SK3624 A FSIDES:B HINGES:B
S0211 264-763 1.00 EA TF3.84/TF3.84 TALL FILLER 3 84"H (TALL)/TF3.84 FSIDES:B HINGES:B MODS: N $37.52 $37.52*
W=3" H=78 1/2" D=24"
S0212 264-763 1.00 EA B18L.FH/B18L.FH BASE 18L FULL HEIGHT/B78L.FH FSIDES:B HINGES:B N $227.13 $227.13*
S0213 264-763 1.00 EA BMS18R/BMS18R BASE MIXER SHELF 18R/BMS18R FSIDES:B HINGES:R N $387.86 $387.86*
S0214 264-763 1.00 EA TEP1 1/2L.84/TEP1 1/2L.84 TALL END PANEL 1 1/2L.84/TEP1 1/2L.84 N $83.35 $83.35*
FSIDES:B HINGES:B
S0215 264-763 1.00 EA TF3.84/TF3.84 TALL FILLER 3 84"H (TALL)/TF3.84 FSIDES:B HINGES:B MODS: N $37.52 $37.52*
W=1 1/2" H=84" D=24"
S0216 264-763 2.00 EA BF3/BF3 BASE FILLER 3{BASE)/BF3 FSIDES:B HINGES:B MODS: W=1 1/2" N $20.59 $41.18*
H=34 1/2" D=24"
S0217 264-763 1.00 EA B18L/B18L BASE 18L/B18L FSIDES:B HINGES:L N $260.34 $260.34*
S0218 264-763 1.00 EA BWBT18.2/BWBT18.2 BASE TOP MOUNT WASTEBASKET 18.2/BWBT18.2 N $436.34 $436.34*
FSIDES:B HINGES:B
S0219 264-763 1.00 EA SDI18/SDI18 SPICE DRAWER INSERT 18(FACTORY IN/ATT:BWBT18.2 SDI18 N $36.52 $36.52*
FSIDES:B HINGES:B
S0220 264-763 1.00 EA SB42/SB42 SINK BASE 42/SB42 FSIDES:B HINGES:B N $0.00 $0.00
S0221 264-763 1.00 EA SBDSU42R/SBDSU42R SINK BASE DOOR STORAGE UNIT 42R/ATT:SB42 N $141.46 $141.4W
SBDSU42R FSIDES:B HINGES:R
S0222 264-763 1.00 EA B24R.2DXFWT/B24R.2DXFWT BASE 24R W/2 FULL WIDTH DEL/ N $457.58 $457.58*
B24R.2DXFWT FSIDES:B HINGES:B
S0223 264-763 1.00 EA CD24/CD24 CUTLERY DIVIDER 24{FACTORY INSTALL/ATT:B24R.2DXFWT N $20.59 $20.59*
CD24 FSIDES:B HINGES:B
S0224 264-763 1.00 EAJ BD15/BD15 BASE FOUR DRAWER 15/BD15 FSIDES:B HINGES:B N $406.78 $406.78*
S0225 264-763 2.00 EA WSC1818/WSC1818 WINE STORAGE CABINET 1818/WSC1818 FSIDES:B N $186.62 $373.24*
HINGES:B
S0226 264-763 1.00 EA WR3612BUTT/WR3612BUTT WALL REFRIGERATOR 3612BUTT/WR3612BUTT N $263.66 $263.66*
FSIDES:B HINGES:B
S0227 264-763 2.00 EA WF3.30/WF3.30 WALL FILLER 3 30"H (WALL)/WF3.30 FSIDES:B HINGES:B N $20.59 $41.18*
MODS: W=1 1/2" H=30" D=12"
S0228 264-763 1.00 EA W1830L/W1830L WALL 1830L/W1830L FSIDES:B HINGES:L N $192.60 $192.60*
S0229 264-763 1.00 EA W30156UTT/W3015BUTT WALL 3015BUTT/W3015BUTT FSIDES:B HINGES:B N $222.81 $222.81*
S0230 264-763 1.00 EA WB3.30/WB3.30 WALL BOX 3.30/WB3.30 FSIDES:B HINGES:B I N 1 $44.17 $44.17*
S0231 264-763 1.00 EA WFOL3.30{A)/WFOL3.30{A)WALL FILLER OVERLAY 3.30/ATT:WB3.30 N $32.21 $32.21*
WFOL3.30 A FSIDES:B HINGES:B
**CONTINUED ON NEXT PAGE***
* Indicates item markdown
Page 2 of 7 NO. 2686-214684 Customer Copy
SPECIAL SERVICES CUSTOMER INVOICE - Continued Last Name: RODRIGUES Page 3 of 7 NO. 2686-214684
VENDOR DIRECT SHIP #1
(continued) TO: CUSTOMER
S0232 • 264-763 1.00 EA V75CV/V75CV VALANCE COVE 75{WALL)/V75CV FSIDES:B HINGES:B MODS: N $100.28 $100.2W
W=72" H=5 1/2" D=0 3/4"
S0233 264-763 1.00 EA W3330BUTT/W3330BUTT WALL 3330BUTT/W3330BUT-F FSIDES:B HINGES:B N $312.80 $312.80*
S0234 264-763 1.00 EA W1530R/W1530R WALL 1530R/W1530R FSIDES:B HINGES:R N $179.64 $179.64*
S0235 264-763 1.00 EA OSC8/OSC8 OUTSIDE CORNER ACCESSORY /OSC8 HINGES:B N $20.59 $20.59*
S0236 264-763 1.00 EA S3S6/S3S6 SOLID STOCK 6 ACCESSORY /S3S6 HINGES:B N $82.36 $82.36*
S02FR 506-658 1.00 KITCHEN CABINET FREIGHT N $151.42 $151.42
VENDOR-SPECIAL INSTRUCTIONS: LINE:KMFRAME DSTYLE:CHOSEN DOOR STYLE USTYLE:MTC4 DWRSTYLE:NO OPTION WOOD: PE FINISH: KAC
DSGNR:NEK170
VENDOR WILL SHIP MDSE TO: RODRIGUES, CHUCK
ADDRESS: 42 MOFFATT RD CITY: SALEM
STATE: MA ZIP: 01970 COUNTY: ESSEX SALES TAX RATE: 6.250F FIT, m s $6,564.87
PHONE: 203 448-0244 ALTERNATE PHONE: 978 594-8321 PAGER:
END OF VENDOR DIRECT SHIP
INSTALLATION #1
REF# 101
ESTIMATED INSTALL BEGIN DATE: 01/25/2011 ESTIMATED INSTALL END DATE: 02124/2011
BASIC INSTALLATION LABOR:
SKU I DESCRIPTION OTY I UM I TAXI PRICE EACH I EXTENSION
282-627 IKITCHEN POINT-NAT/ 0.001 EAJ N 1 $0.011 $0.00
OPTIONAL LABOR SELECTED INCLUDES:
OPTION DESCRIPTION OTY UM ITAXI PRICE EACH EXTENSION
1 KITCHEN CABINETS WORKSHEET POINTS FOR DEMOLITION, DEBRIS REMOVAL, 336.00 EA N $29.00 $9,744.00
ELECTRICAL, PLUMBING AND APPLIANCES(UTILIZE THE KITCHEN POINT WORKSHEET
TO OBTAIN TOTAL NUMBER OF POINTS)/
'—CONTINUED ON NEXT PAGE***
Indic
Page 3 of 7 NO. 2686-214684 * Customer
Copy
SPECIAL SERVICES CUSTOMER INVOICE - Continued Last Name: RODRIGUES Page 4 of 7 NO. 2686-214684
INSTALLATION #1
(Continued) REF#101
2 • PER CABINET INSTALLATION (INCLUDES WALL, BASE, PANTRY, PENINSULA OVEN & 14.00 EA N $69-00 $966.00
APPLIANCE CABINETS. INCLUDES SHELVES, FILLERS, SCRIBE, TOE KICK, HANDLES&
KNOBS.) KEY THE NUMBER OF CABINETS TO BE INSTALLED IN THE QUANTITY SECTION./
3 PERMIT AND ADMINISTRATIVE FEE QTY X $1.00 / 750.00 EA N $1.00 $750.00
5 PER POINT- PLUMBING AND ELECTRICAL ONLY/ 190.00 EA N $20.00 $3 800.00
INSTALLATION SITE NAME: IRODRIGUES, CHUCK INSTALL LABOR CHARGE: $15 260.00
ADDRESS: 42 MOFFATT RD TRIP CHARGE: $0.00
CITY: SALEM STATE: MA ZIP: 01970 CREDIT FOR DEPOSIT/MEASURE: $49.00
COUNTY: ESSEX SALES TAX RATE: 6.250 TAX: Merchandise- Y LABOR- N -_ _ e o $15,211.00
PHONE: 203 448-0244 ALTERNATE PHONE: 978 594-8321
BASIC INSTALLATION LABOR INCLUDES:
'AN INSTALLER SITE ANALYSIS IS REQUIRED FOR PROPER FIT SITE ANALYSIS FEE IS APPLIED TO THE PURCHASE.
OF KITCHEN CABINETRY AND OTHER PRODUCTS TO BE INSTALLED. - 'THE FINAL KITCHEN POINT WORKSHEET MUST BE SIGNED BY BOTH
DURING THIS CONSULTATION THE INSTALLER WILL CHECK FOR THE CUSTOMER AND STORE ASSOCIATE.A COPY OF THE FINAL
UNUSUAL SITUATIONS WHICH MAY REQUIRE ADDITIONAL LABOR. SIGNED KITCHEN POINT WORKSHEET MUST BE GIVEN TO THE
'DAILY CLEAN UP OF JOB SITE CUSTOMER AND INSTALLER.
'THE SITE ANALYSIS FEE IS NON-REFUNDABLE
'IF CUSTOMER PURCHASES LABOR FROM THE HOME DEPOT,THE
UNLESS STATED ABOVE THIS INSTALLATION DOES NOT INCLUDE:
ADJUSTING OPENINGS OR ANY WORK INVOLVING LOAD BEARING WALLS ALTERATIONS TO EXTERIOR OF HOME
REMOVE,ALTER OR BUILD LOAD BEARING WALLS(OTHER THAN STUD WALL REMOVAL OF VINYL FLOORING
FRAMING)
INSTALLING SKYLIGHTS
STRUCTURAL WORK
SPECIAL NOTES:
...CUSTOMER MUST BE PRESENT DURING THE INSTALLATION(MUST BE WILL NOTIFY THE CUSTOMER WHEN THESE ITEMS WILL BE UNUSABLE&
AN ADULT OVER THE AGE OF 18 PRESENT.NO WORK WILL BE DONE FOR WHAT LENGTH OF TIME.
WITH UNSUPERVISED UNDER AGED MINORS PRESENT). ...CUSTOMER IS ASKED TO DESIGNATE PARKING,ENTRANCE AND EXIT
...CUSTOMER IS RESPONSIBLE FOR DISARMING ANY SECURITY ALARMS ACCESS PREFERENCES FOR THE INSTALLER INCLUDING RESTROOM
"'CONTINUED ON NEXT PAGE
Page 4 of 7 NO. 2686-214684 Customer Copy
SPECIAL SERVICES CUSTOMER INVOICE - Continued Last Name: RODRIGUES Page 5 of 7 NO. 2686-214684
INSTALLATION #1
(Continued) REF#101
...NO WORIJ WILL BE DONE ON SUNDAYS OR LEGAL HOLIDAYS. ACCESS).
...ALL WORK WILL BE DONE WITH PROPER PERMITS AND UP TO LOCAL ...CUSTOMER IS RESPONSIBLE FOR SECURING PETS AWAY FROM THE
CODES AND ORDINANCES. WORK AREA THROUGHOUT THE INSTALLATION PROCESS.
...ALL WATER AND GAS SUPPLY LINES MUST HAVE INDEPENDENT ...NO WORK WILL BE DONE IF EXISTING JOBSITE CONDITIONS DO
SHUT-OFF VALVES. NOT MEET LOCAL CODES&ORDINANCES.
...THE JOBSITE MUST BE SECURE AND COMPLETED,INCLUDING ALL ...CUSTOMER IS RESPONSIBLE FOR ANY UNFORESEEN CONDITIONS
EXTERIOR DOORS AND WINDOWS IN PLACE. WHICH MAY ARISE DURING INSTALLATION.
...CUSTOMER MUST REMOVE ALL ITEMS FROM CABINETS,COUNTERTOPS "'THE FINAL KITCHEN POINT WORKSHEET MUST BE SIGNED BY BOTH
AND BREAKABLES FROM JOBSITE AREA,WALKWAYS AND ACCESS POINTS THE CUSTOMER AND STORE ASSOCIATE.A COPY OF THE FINAL,
...CUSTOMER MUST UNDERSTAND THERE WILL BE A PERIOD DURING SIGNED KITCHEN POINT WORKSHEET MUST BE GIVEN TO THE CUSTOMER
THE INSTALLATION WHEN THE JOBSITE AREA WILL BE COMPLETELY AND INSTALLER.—
UNUSABLE.ASSOCIATE WILL SPECIFY AN ESTIMATED TIME FRAME AT "'NOTE:THE HOME DEPOT DOES NOT PROVIDE THE FOLLOWING
THE START OF THE JOB.OTHER ARRANGEMENTS MUST BE MADE BY SERVICES(AS PART OF KITCHEN INSTALLATION PROGRAM)—
CUSTOMER DURING THIS TIME FOR ACTIVITIES USUALLY HELD IN THE ...ADJUSTING OPENINGS OR ANY WORK INVOLVING LOAD BEARING
JOBSITE AREA. WALLS
...THE WORK AREA WILL BE CLEANED UP DAILY,BUT DUST AND ...REMOVE,ALTER OR BUILD LOAD BEARING WALLS(OTHER THAN
CONSTRUCTION RELATED DEBRIS&NOISE WILL BE INEVITABLE STUD WALL FRAMING)
THROUGHOUT THE INSTALLATION.ALL POSSIBLE STEPS WILL BE ...INSTALLING SKYLIGHTS
TAKEN TO MINIMIZE SPREAD OF WORK AREA DUST TO OTHER PARTS ...STRUCTURAL ALTERATIONS OR REPAIRS
OF THE HOME CUSTOMER SHOULD CHANGE FURNANCE FILTER BEFORE, ...ALTERATIONS TO EXTERIOR OF HOME
DURING AND AFTER INSTALLATION. ...REMOVAL OF VINYL FLOORING
...WATER,GAS AND SEWER MAY BE TEMPORARILY TURNED OFF TO
ALLOW INSTALLATION PHASES TO BE COMPLETED.THE INSTALLER
END OF INSTALL#1
INSTALLATION #2
REF# 103
ESTIMATED INSTALL BEGIN DATE: 01/25/2011 ESTIMATED INSTALL END DATE: 0 212 4/2 01 1
BASIC INSTALLATION LABOR:
CONTINUED ON NEXT PAGE."
Page 5 of 7 NO. 2686-214684 Customer Copy
SPECIAL SERVICES CUSTOMER INVOICE - Continued Last Name: RODRIGUES Page 6 of 7 NO. 2686-214684
INSTALLATION #2
(Continued) REF#103
SKU DESCRIPTION OTY UM TAX PRICE EACH EXTENSION
772-078 IGRANITE 3CM-NAT/ 1 36.081 SFJ N 1 $0.011 $0.36
OPTIONAL LABOR SELECTED INCLUDES:
OPTION DESCRIPTION OTY UM TAX PRICE EACH EXTENSION
7 EDGE DETAIL- GROUP A/EASED 12.00 LF N $0.00 $0.00
20 REVERE STAINLESS STEEL SINKS - STANDARD MODELS/NCFU3118 DOUBLE BOWL 1.00 EA N $258.00 $258,00
27 RADIUS CORNERS/RADIUS ENDS >3/4" &UP TO 18" / 2.00 EA N $30.00 $60.00
50 *PROMO 10/28-1/26/11 NATL* SPECIAL BUY W/MIN PURCH OF 25 SF.ORDER PAID BY 36.08 SF N $44.00 $1,587.52
1/26/11-ADJUSTMENTS BY 2/23/11.00MBINABLE WITHBAR CODE COUPON ONLY. STD FAB
& INSTLTN CHRGS APPLY. NO CREDIT APPLIED IF OFFR RFSD./BAINBROOK-NO ORDERS
AFTER 1/12
INSTALLATION SITE NAME: I RODRIGUES, CHUCK INSTALL LABOR CHARGE: $1 905.88
ADDRESS: 42 MOFFATT RD TRIP CHARGE: $0.00
CITY: SALEM STATE: MA ZIP: 01970 CREDIT FOR DEPOSIT/MEASURE: $0.00
COUNTY: ESSEX SALES TAX RATE: 6.250 TAX: Merchandise- N LABOR- N = o o $1,715.31
PHONE: 203 448-0244 ALTERNATE PHONE: 978 594-8321
INSTALLER SPECIAL INSTRUCTIONS: COLOR IS BAINBROOK BROWN ON SPECIAL TIL 1/26
BASIC INSTALLATION LABOR INCLUDES:
"IN HOME INSPECTION TO VERIFY LAYOUT,MEASUREMENTS,SPECIAL *EASED EDGE ON BACKSPLASH(ALL EXPOSED EDGES)
INSTALLATION REQUIREMENTS AND TEMPLATING "SUBTOP OR SUPPORT STRIPS
•BASIC INSTALLATION OF COUNTERTOP "GROUP A EDGE DETAIL
"ONE SINK OR COOKTOP CUTOUT(TOPMOUNT) PER PROJECT "FINAL CLEAN UP OF ALL DEBRIS RELATED TO INSTALLATION
•FAUCET HOLE DRILLING(UP TO HOLES) *DELIVERY WITHIN 30 MILE RADIUS OF STORE
•WALL SUPPORT CLEATS AS NEEDED AT CORNER CABINETS
*EASED OR RADIUS CORNERS UP TO 3/4"MAX
UNLESS STATED ABOVE THIS INSTALLATION DOES NOT INCLUDE:
WINDOW SILLS/GARDEN WINDOWS AND PASS THROUGHS MILEAGE BEYOND 60 MILES FROM STORE ONE WAY
CABINET BUMP OUT REPAIR OR ALTERATIONS TO EXISTING CABINETRY
CONTINUED ON NEXT PAGE
Page 6 of 7 NO. 2686-214684 Customer Copy
SPECIAL SERVICES CUSTOMER INVOICE - Continued Last Name: RODRIGUES Page 7 of 7 NO. 2686-214684
INSTALLATION #2
(Continued) REF#103
CUT AROUtAD POSTS OR ODD SHAPES WARRANTY ON TRAVERTINE,MARBLE OR HONED GRANITE
SUPPORT MATERIALS FOR OVERHANG(REQUIRED FOR OVERHANGS>6')
CUSTOM EDGES ON BACKSPLASH
END OF INSTALL#2
TOTAL CHARGES OF ALL MERCHANDISE & SERVICES
= _ • ;
$23 491.18
SALES TAX $400.84
TOTAL $23,892.02
BALANCE DUE $0.00
END OF ORDER No.2686-214684
Page 7 Of 7 NO. 2686-214684 Customer Copy