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203 1-2 NORTH ST - BUILDING INSPECTION I MWt {*gEg Ao APPROVED BY T44E Mpgagi 1 pp" TD A.PF_AMIT BEING GRANTED CITY OF SALEM Date -7 '3 No Is Located h y Location of 3/�R WWW Datdd? Yas__No ,/ Building p20 ftw Ii NOfi7 lii S 7'" is Pq"located in VA Qrmarvati M Anil? Yes No BUILDING PERMIT APPLICATION FOR: Permit to: (Circle whichever apply) Roof, eroo Install Siding, Construct Deck, Shed, Pool, Repair/Replace, 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: Owner's Name M&WAl- COR i I A Address & Phone a'4 , oneril !g—j Architect's Name Address & Phone f Mechanics Name 1311 /j3c& .9-K 57- Address & Phone .rn/1-Fo2D a2A 6 J76-Z_ fIW l 73�9 7212 wha Is uw P UPow a WNW MOMM of b dki ? n a dw"ft,for how many families?_L Wig farldirw conform to law? Aaftaetos?N D Eat maw cost l d S go— Gty ucom r N a am Uoansa# Rom l nto....nt Lie. 11 a�s�/S6f ISignature of ApplicanVJ SIGNED UNDER THE PENALTY OF PERJURY DESCRIPTION OF WORK TO BE DONE IZ-" F �� as s9 y/'NW cS)D1IJ.fir i3a MAIL PERMIT TO: 1)3 GzDA2 57- /y7/4Fo RO 1'nh D)75"7 No APPIWWWr ON FOR PEO RE�a � LOCATION. p � NaRTN sT PERMIT GRANTED zb AP ROVED INSPECTO OF BUIL INGS ';; SOLD FURNISHED '& INSTALLED BY ' �Ii ' ' ,Sailes f 866 466 3853; ® 411-2320449 Bit=Flay Aluminum Siding Corp. Service/Repairs: 1-88.8-245-7294 ® of Queens, Inc. F.I.D. No. 190 Cedar Hill Road • Marlboro. MA 01752 :.JOB# MAINE LIC,N0.001893 •NH LIC •. MAS SAC IIUSETTS LIC.N0.120456•VERMONT LIC.No. - e RHODE ISLAND LIC.NO.13707 NEW YORK CITY DEPARTMENT Of CONSUMER AFFAIRS LIC.NO.0730686 • NASSAU LIC.NO.H2704150000 • SUFFOLK LIC.NO 21194HI YONKERS-1397 - PUTNAM PC934 WESTCHESTER WC0613-H87 LONG BEACH GC2001 •NEW JERSEY LIC. N0. 9949269 • CONNECTICUT DEPARTMENT OF CONSUMER AFFAIRS LIC. N( '774 ROOFINO :CONTRACT " /� / SOLD ^ �j Ise) (�.. TO L) 'I Z© A DATE ADDRESS_ rZ /_ "L I! � 7'IK STATE' /�ZIP �! PHONE HOME 677 _ —'EMAIL .. JOBS TE ADDRESS (IF DI FERENtT) - .,- 1py 1'14-LG b7N0126DA.APPP} IED ROOFING SYSTEM b � 2 r Type of House: O Frame ❑Masonry General Descrip0on of Work a A ove Addr ss. (REQUIRES .APprOX,$tart;pate. ...,_. ,.....,.,Appro%CoUnpletIon.Date NIATHERAMATERIACSPERMPEENG), -.; : ,.+ri : FIRRIN,GJ. I ' Approved materials will be 1.furnished and installed to these specifications. 011411 PLEASE READ CAREFULLY: ONLY ITEMS CHECKED "YES"ARE INCLUDED IN YOUR ORDER. YESNO YESND - YES NOS�.. . ,-:. . 1. ❑'p REMOVE EXISTING P ers of roofing down to -15 ❑'�'APPLY.ROOF LOUVERS 24.❑ Q'CARPENTRY-REPLACE FASCIA BOARD. wood deck of WOOd lots - son ly ❑ FontElev.- ❑ RearElev, ❑ Left Rev. O 1X6 ❑.1X8 Specify O kont Elev� ❑ R or Elea. O LeNElev Areas: ❑Alght EleV. ❑ Other-,,,. 29:0 El CLEAN UP Pfoperty at COmpletion of work. Areas: ❑ RightElee ❑ re P vial q Ent 16.❑ `o SOLID VINYL SIDING Cover only flatwall 26.Or❑JNSURANCE';{lll workrgan s compensagon O pormer(s) _ areas designated far siding ' nti Ilablljty to be maintained ❑-Other - Size—: color 27 �❑ WARRANTY/ M@Il ro customer,aflen , Pattern Package J. Lt Complegon RPd,.full paymeptals received b 0 Details Custom comerppsecolor <' rr - , 28 La ❑ PAYMENTS,on.NDN FIRANCEq prders " 17.❑ Ed SIDING ON DORMERS&/OR ADJACENT AREAS e ,.,,. 2. ER00 moue an curled or disfigured roof specify ❑ RontElev. ❑ Rear Elev. ❑ LENElev. " installer IiVd pay L Hed t.",", ect'„ - es &discard a discretion of Installer Areas: ❑ Right Elev. ❑ Parfial ❑ Entire ' Progressive payments Specify RontElev. arDel.. Qrr1'itElev. El Dolmans) 29.❑❑ EREEASTING CONDITIONS OR LEAKS NOTED Areas: ighiFJev. q rtiel ❑ Enhre' O Other ❑ ❑ ADDITIONAL WORK Not Specified Above Dormers) t s P'._-' ❑❑Work Not to Be Done U Derails ❑ ❑:Repair or kep lace the Following -❑ othA 'Fill❑ t ' Derails •� . " 18.❑ GUTTERS/LEADERS Nor res onsible tar damage ❑ Remove Existing ..wring removal 3. ❑,Q APPLY NEW POOR N SHINGLES .; -❑ Discard ❑ Save for Homeowner - 'O Re Install Existing Brand . -- L7L:. _ -❑ Replace with new custom seamless Style ` gutters &leaders: OWhite ❑ Browne - Cmor ' I2 4 C, C.TL4 - Other _ 4. ❑ O NEW ROOFING SHI GLES will be applied 19.❑ Ill APPLY VALLEYS Cl 9" ❑ 10" _ - to he following r a only 20.❑ Cl ATTIC FAN-No Electrical - Specify aril EH". ear Elev. 94eft Elev. 21.N ❑ SKYLIGHT(S) - Apply Flashing 1 Rr6 F�' Areas: ighlDay. O anal ❑ Entire ' 22 ❑ ❑ SOFFIT-Cover with a proved Dormers) L /'r - SOLID VINYL SOFFIT SYSTEM. 1/3 Vented. - - - ❑ Other Ar AL S Color .. O Details .23.❑ ❑ FASCIA Custom wrap with approved - - - UM. 5. ❑ FfARPLY GS Flintiasli Cold Applied Modified.;-. ' - ' ' " ` .. :,. . � •'�' VINYL CLAD ALUMINUM. Color Bitumen Rubber Ro fing Mop-appliedwlDptlon 4 • ' - r • ' a 'uE g . ,: a 6. ROOF DECKING- .a.> '$/.Ly .}/. 30 Year Manufacturing Warranty Tok�� Furnish&Install 5/ COX Plywood #1 .12 Year Full Labor Warranty INDIpAATE TE'MM of :. 7 ❑ ❑ SHEATHING, Repl ce any damaged sheathing at A additional C'B t of$ per squat Mf9 - . - Deposit With Order Y'-` 35gO.- 8 ❑ APPLY ICE &WAT R BARRIER at eaves, Style Color - >, ! aLL �', valleys around sk ights and pitch changes Total Investment $ : Payment on t „ .3 $ �L�,r-t (includedwirh MastalHe Package) BAP QA✓ Measure or Start 9. '-7`-' APPLY NEW ALUMINUM DRIP EDGE ( = r - Balance Due on .� ` at eaves & perime r of roof ar@as,4f'F ,/,M Year Manufacturing Warranty Substantial Completion 34%$�lo__L__ 10.0 WAPPLY UNDERLAY ENT ❑ S nglemateaD #2�L Year Full Labor Warranty Total Amount of ❑ 30th Fell Paper W 15110 Felt Paper M1 /_ �J�(d rr. Balance tome RgaQCed L-. ,ax.,$ 1 1Q APPLY NEW VENT IPE BOOTS g i f u: Ih 1 ss s 1V❑ NEW COUNTERFLA HING AROUND CHIMNEY(S) Style If hdanced'balance payable in - monthly ❑ Lead ❑ Capper ❑Aluminum Total nveslment $ jnstallmlinls of approdmately$, per month, ❑ Fiber Roof Cement ae[ If W*rII _ payable by"Owner to id-an tmount but it ttending by Owner suc then Owner will pay said amount to the lending plus such 13,❑ AM APPLY RIDGEVENT TO RIDGES r r interest and credit service charge of said lending institution Year Manufacturing Warranty ❑ COgra,�d ❑ Other— .,µµ .. payable djrecgy,to the legd(RQ jDsaWbon loaning such monies Specify ❑ RontElev. ❑ Rear Elev. ❑ Left Elev. 1f1 Year Full Labor Warranty to Owner"''arid will execute @ A ., Areas: ❑ Ri htElev. ❑ Other h i rh Retail Installment ohligatloq and 1 r , ,A air t '"I g Mfg „ any docurragtemgWredbysucll - s•01'ss "t 14.❑ AVE VENTILATIO - v L ` " ' e Style Color lending Inslitughn m cannecgan '�IstW Supply and Install "Round Vents Total Invest ent $ With saldloan -FINISH: I7 Mill' L Black ,!n 17 'CONTRACTOR IS NOT'RE PONSIBLE'FOR ANY•PAINTING,SECURITY SYSTEMS vACCE5SOR1ESiSQTELLITE OISNES�t'ANlrENNASrfECECTRICAALYEIXTURESi'70R:'( ANY DAMAGE DUE TO Vil RATIONS.' PLEASE REMOVE ALL WINDOW TREATMENTS, WINDOW MOUNTED.AIR CONDITIONERS PICTURES,"OR ANY OTHER'.' ITEMS OR PERSONAL EFF CTS FROM THE WORK AREA. INSTALLERS ARE NOT RESPONSIBLE FOR THE'...... L OR INSTALLATION OF THESE TYPES OF ITEMS. CONTRACTOR NO RESPONSIBLE FOR LANDSCAPING, SHRUBBERY, FLOWER BEDS OR OTHER OUTSIDE ITEMS IN THE WORK AREA. NOTICE:It financed,an p holler of Nis ansumer gedlt Conbacl Is suhiecl to all claims and defenses which the SALESMAN HAS NO AUTHORITY TO CHANGE ANY ITEMS BB MAKE ANY REPRESENTATIONS OTHER THAN debts,could assed against the Seller of goods by services oblamed pursuant hereto or with the Proceeds hereof. CONTAINED IN THIS CONTRACT AND"OWNER"REPRESENTS THAT NONE HAVE BEEN MADE TO OR RELIED UPDX Recovery hY the debtor shall not ease¢ amounts Paid h1 debtor hereunder. BY"OWNER".YOU ARE ENTITLED TO A COMPLETELY FILLED IN DUPLICATE ORIGINAL OF THIS CONTRACT. OWNER REPRESENTS TO HAVE READ I NO RECEIVED A DUPLICATE ORIGINAL OF THIS CONTRACT AND TO BE .you THE THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD THE AUTHOR17ED AGENT OF ALL"OWNEIS"OF THIS PROPERTY UPON WHICH THE WORK OR THE MATERIALS ARE BUS IN ES DAY AFTER THE DATE OF THIS TRANSACTION.SEE ATTACHED NOTICE OF CANCELLATION FORM FOR TO BE SUPPLIED. AN EXPLANATION OF THIS RIGHT.ON ALL ORDERS CANCELED AFTER THE RECESSION PERIOD CUSTOMERS NOTICE TO THE HOME OWNERrSI,GU RANTORISI,LESSEEIS11,CO-SIGNEIR I 00 NOT SIGN THIS CONTRACT 'WILL BE RESPONSIBLE FOR A 45%'ADMINISTRATIVE AND RESTOCKING FEE." BEFORE YOU READ IT,OR IF IT CONTAIN ANY BLANK SPACES OR IF IT DOES N6T CONTAIN EVERYTHING AGREED ` UPON ANY PERSON WHO SHALL HAVE O SIGNED,GUARANTEED OR SIGNED ANY CREDIT APPLICATION OR NOTE SEE REVERSE SiOE FOR ADDITIONAL TERMS AND CONDITIONS,BY SIGNATURE BELOW,OWNER AGREES TO THE RELATING TO THIS CONTRACT HEREBY CCEPTS TO BE BOUND BY THIS CONTRACT TERMS OUTLINED ON THE REVERSE OF THIS CONTRACT TI Ccntraotor AcGe ted u h r m u f it t aaBTrroll" o St ':e DATE _ ' J P `sd ,gnat and, _ Printer >N'/ ic'-'sAg� Salesman's,Narne , , ,. Slgpa�Ur� —I yIB .,yr§11 to Saleman's - 1 , + License No. $IDnature" 1 r�'"^-� .r;,,,, ., :n, -n- r 1 d, '_: ,; I, .,I ,.,(Custbn&HSdfi 'Herb)!' .,all Bllflay a,ou0 A111aM Resnwed 10111 r . . ✓�ie'�nmvino�wrea/�� o�✓a�vaoanurer� . . ..� - �--- . BoardofBuilding Bea datidasand Standards License or registrationvalid for indhidnl use only tIOME IMPROVEMENT CONTRACTOR - before the e8pirationtlate, If found return to: �',�� Board of Building B.egulations and Standards i€4 _ kg tj &-620456 One Ashburton Place Rm 1301 ^� P008 Boston,ffia.02108 1 plement Card _ 4�ALIL I? � c.G....�'i �..4 ,� ���./�—PLJ._/a�1 - . ELMCNT`N'I ;7Ati3 out .: t ator T�`uLvalid with :,fad, s sig4atu The Commonweaith of Massachusetts r — Department ofl'ndustriadAccidents Office oflnvestigations w � 6­00 Washington:Street u Boston, MA 02111 0 www.mass.gov/dia Wors;e:s' b✓ompensationT-nsuiance-Aindavlt: l$uilders/Contraetors/E+lectricians/Plumbers A DDlicant Information Please Print Legibly Nzatie vsmessior gantzauonflndividual): n Cb. - Address: l 3 ce St C' /State/ 1 /�1 �a: Ot?-dine :..: .. Q 13.7 7 � Are you an employer? -the wppropnate box-' - - - Type of project(required): - 1. I am a employer with� 4 ❑ I'am a general contractor and I 6. New cO. cuon croployees(full and/or parr-mine).* have hued the sub-contractors 7 Remodeling 2_❑ I am a sole proprietor or partner- listed on the attached sheet $ " - ship andhave no employees These sub-contractors have 8: ❑Dem lition working for in any capacity. workers' camp.insurance. g. Buiidmg addition [No workers' camp-insurance 5. ❑ We are a corporation and its 10:❑Eledncal repairs or additions required.] officers have exercised then I 11. Plumbing repairs or additions 3_❑ I am a homeowner doing all work right of enemptronper MGL 0 myself. [No warkers' comp.. c.. 152,§1(4), and we have no 12.❑ Raofaepair5 _ insurance required-I.1 employees. [�T0 workers' 13.E Other coma insurance required-] �9ny applicant that checks box 1 must also h-Il Out the section below showing their workers'compensaaen policy InIOtmarioniI outside contmcion must submit a new amdavit indicating such. _ _ o all work and then hire ' ?iomeowaets woo submit this amdavit indicating fury nal doino - ' coma-Voile iniormanon. sheet a of the sub-contract rns and their workers Y +Contac[or that check this box must attached an additional she-_showing the�aaa I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job sire information. Insurance Company Name: t4 �` - .... - ate. -(�q,36tion D 7 7 � _ �,. . � F..prra- 20li�#or Self-ins.I.ic r. �.(� � �� .: C' /State/Zip: Sob Site Address_zW; a NO 2� Sr .. - . i - Attach a copy of the workers' compensation policy declaration pane(showing the policy'number)and expiration datf a i �e as re d under Section 25A of MGL c. 152 can lead to the imposition O{i criminal penalties of a Failure to secure coveraa quire civil penalties in the form of a STOP fine un to$1,500.00 and/or one-year imprisonment as well as Y�T,ORg ORDER and a fine t - that a co of this statement may be forwarded to the Office Of 250.00 a da a�_-ainst the violator. Be advised copy o�up to S Y _ Investigations o� lie M forinsurance coverage verification. _ I do hereby certify under the pains and penalties ofp,rju Y that the information provided above is true and correct . . Date• �],/.g�� . S2cnatLi+-P_ Phone#_ Official use only. Do not write in this area, to be completed by city or town o717City or Town_ erceuseIssuing_4zd:hority(circle one): - - - ector1. Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical xnspec IIIsp 6.Other Contact Person: - . .Phone#, - • scs PAGE e2 �:' 9F'14i295 .16:24 5168295H57 ❑ATEIMNIDTRYYYT) ' 0131705 _ h 1 E-��{ 0�'�� s,��C 3SLP.h-1 �3waJ CFR'f"jr-lCA7t ©F LRYi 6Lii f HiSC=�TIFICATEISISSU=DASAMATR07INFORMATION �5 _ RTIFICA:" f�— ONLY AN➢CONFERS NO RIGHTS Ui+nN 7H=ND PRDauaE� HOLDER THIS CER.TIFICP.Tx:DOES NOT AMEND,E),T_'ND OR 3� Ageacyr In=� ,yT`RTHEC�VERAGEAFFORDHO.BYTHEPOLICIE58cLOW. ?.O. B= 220�93 NRIC '. venue - Snita 300 11 G=aca A 7y022 Od93 Great Neok I3Y -�.., 516-fl29-SBS7 IWSFIRFRS AFFORDING COVERAGE ahoae:516-g'Dfi-600� �' INBUTJSTA! wai.AeSe xwRxvssc. t�.?T INSURED INSUFTEA 9: ._...J°uI �� A`sAn.... c.- I 19305 ' - INSURER Ct weiAA•+aA�."a xnw--.�• '1i. 3i1 may r1TJTSiT1>•�T g3diag Co_—Q. INsuRER>r _ I 90 s3mnaC Road INSURER€: s^slmont S3Y 7.1003 AN❑ME COVERAI�=S NAWEOABo'=•FORTHEPOUCY P£RID❑INOdA gE t95UED OR cDNTRACT OROTHER❑OCUMENT WIhI REBPAALLTH TEWa.SX:LUS OW HA4_B�TJ ISSUED TOTHE INSURm tONE AND CONOTDONs OP 6UCH THE POLS:JES CF WSURAN�LIS O 0 OF ANY TEEMS.EXCLUS ANYREDUr`MAMNTi TERM OR CON BY7H-P❑SJCI�OESORIEEO HEREIN LS SUBJECT TO ALLTHE UMRS r MAYPBAAIN.THEINSUPANc=AFPOFDE❑ v,BFxNRSiY•EO BY PAID CLAMS. - �.,. I <T DOO.000 ❑AT=INNJO❑IYT I- _ FOLICIEE.AGEREGATe mrrs OFINSURANC5 YFIA "I POLJ.Y NUMSER I AT INMID❑KY! EACHOCCURW. E yy T'fPE 6P INSURANCE IS IOU,0'00 L-R INERa Ofl/^d5/06 PTEEMISES IE?>r-yR�� GENERAL UASILB'Y D6/25/65 s 5,OD0 O EKP(AAY0MPm-6) s1,D00,D00 $ ODUNEROIAL GENERAL 8GEaa B9A79'05 _ PERBONALS AOV INJURY CLAIAL4-MAC OCCUR G S 3,DDO,nDn g.IERALAGOREGATE PRODUCTS-COMPIOPAGG s2rII0n,D00 GENLAGGREGATF IJMTTAPPUIi$PER: T� �-I t>d nLoC OOMBINSINGLE IA7R S 1 1 POLICY I I d'cDT IEs edd=crl) AUTOmOSILRLIABILRY AN AUTO BODILY INJURY - S IPv pe90I1) ALLYOWNwn AUTOS 1 RY S---N Du1EOAUT;Z (per Izemumi) I S HBCD AUTOS NotxOWNm AUTOS IP60t octddwi) AGE E AUTO ONLY.EA AMDEN11 S EA ACC I S EARAGELIABILDY AUTO ONLY: A13G I S ANY AUTO EACH DG:URFC3JOc _ S A EGAT S EXCEE8N�7BRELLAWABROY 4 COLOR �CLAR6MADE s S DEDllcTa l� ER I TORY LimrrS RETENTION i L Ofl El EACH ACcIOE14T S10D066 Ti 6912�J/ - s 1n0000 WoRi I :gx.Aem ygC,D305913 05 E.L am9 BE•EAEMP $ IRO GcO BCTDpfpAF.'RfE�R1==UTWE E.tDmsAss•roUCYtIMr s 500000 PJfc N LALPRO PROVISIONS StatTta=a=F gP=,:,'IpLPRwIsroNE6etw 10j01/ns OTHER 10/Oy.i OS ^,•v 179403 B C D5.8 'T- OESCRIr LION 6'r OPFAA7IONE I LDCATICNB 1 yEHICLESf QCLtR10N5 AD9ED 8Y EHDORSBAENT1$PELTAL PRDNBIONE .. CANCELLATION CER7IPW^ATc HOLD=R TO'K2iOMt SHOIP❑pNYOFTRE A60VED=SDWa WILL ENDEATTOBTO MAM 3n �DAYS WRITTEN OATETHEREOF,THE f$SUIHO INSURER HE LEFT,BUT FWLURETODD So$HALL NO UETD THE[,ERTRUAM HOL❑EROF NNYTOT IMPOSE ND OBLIGATION OR IIABWTY'OP. TYTBNO UPONTIiE INSURER ITS ACEIiTe OR . - AUTHUl EDREPRE9EFITATN r/ m ACORD CORPORATION 1S7 ADDRD zs tzBGarBB) n .� t x-