95 ORNE ST - BUILDING INSPECTION gpummw.GE fILf9#ND APPROVED BY T44E
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Rapair/Replace, Other
PLEASE RLL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS N PROCESSN O
TO THE INSPECTOR OF BUILDINGS: '
The undersigned hereby applies for a permit to build accor&ip.to the.folbwing
specifications:
Owners Name
Address d Phone Q5" OAIYw (?A �w - ✓�f��
Architect's Name
Address & Phone
Mechanics Namei�mrl,�c�a
Address 6 Phone 7,2j_ei/r�
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SIGNED UNDER THE TY'
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO:
't
APPLICATION FOR
PEFOW TO
LOCATION
PERMIT GRANTED
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INSPECT OF BUILDINGS
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Workers' Compensatioe insuramm Affida*
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do hereby•certily under the pains and peniWas d perjasy, then
1 an an employer providing workers' compensation coverage for cry cmvb*vn workbi;all
thin job.
Insurance eomparq Policy "Umber
1 am a sole proprietor and have no one working fdr am in any capafdcy.
O 1 am a sole proprietor, general contractor or homeowner (circle one) and how hired the
contractors lined below who-be" the following workers' ctirnpensation poliden
Convector Insurance Company/Polity Number
Conveor Insurance Company/Policy Nuarber
ct
Contractor Insurance Company/Policy Number
0 1 am a homeowner performing all the work myseN.
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trn'i oerrewrrwia a vot a d.r remain in dw km era STOP WORK ORDER rw a Sew of $100.00 a an Spilt se.
Signed this .
der of 2jt y�
.iccnscei Fc miuee isuildinf Gepartn.ent
Liceruinf Eearf
Seiectmens Office
=catch Geparmer,:
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PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STNttT. aNO FLOOR
SALEN.MA 01970
TILL.(978)745-noo EAT.380
FAX (676) 740.96"
STANLEY J. USOVICZ, JR..
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
In wcorda=with the pmviaiom of MOL c 4o,S34,I aclmowledge that as a caadition
of Binding Permit g .all debsia resulting firm the cmuftcban mmv*
governed by this Building Permit shag be disposed of in a properly licensed solid wuw
disposal 41014y,as defined by MOL c III,S130A.
The debris wM be disposed of at wd •
Location ofFmldy
943a
SigoaticeofP App D
(PLEASE PRINT CLEARARU L ) m>woe>aahon.
Name ofPcamit Apphcad( 'J
irm Name,if my
7,4
Aadreas,city tit state
The above statute requires that debris firm the demolition,renovation,rehab or odw
alteration of building or struc =be disposed in a
hdhW as defined by MQ,cID, SISOA,and the -h�e solid-waste dispcwt
indicate the location of the heft. �or licenau are to
is v r . 1 r " t u A %mil IL1 r lX, JJn 1 11 %—/I 1 V 1 lilt
15 Elm Street 'Danvers, MA 01923-2058
Mailing address: 72 Holten Street, Danvers, Ma 01923
Telephone(978) 774-3333 "Fax(978) 774-8709
Home Improvement License#103611 *Mass. Builders License#073375
CONTRACT
This contract,dated below,for materials and/or labor to be supplied by Browns Kitchen&Bath Center
(Hereinafter,referred to as the contractor),at the sole request and order of
NAME: Elizabeth Lutts PHONE: 978-741-3493 DATE: 02/23/04
ADDRESS: 95 Orue Street,Salem,Ma 01970
(Hereinafter referred t as the owner or buyer)to be supplied/performed at premises set forth above,subject to all of the terms and
conditions set forth on both sides of the Agreement,as follows:
Brown's Kitchen and Bath Center is happy to furnish you with a quote on your Bathroom project.
Ca en : We will remove walls to the studs. We will also remove the ceiling.
The outside walls will be insulated The walls will have new blue board and plaster.
The tub walls will have Durock(cement board)
There will also be new trim around doors and windows, and around the base of the room.
Above the vanity will be either a mirror or medicine cabinet.
We will frame new location for washer and dryer
Flooring: The floor will be prepared for owner supplied and Brown's installed tile.
Plumbing: We will install gas piping for new location for washer and dryer.
All work to be connected to existing plumbing.If any upgrades are needed a quote will be provided.
Heating: None.
Ventilation: Fan light vented to outside
E echical: We will supply and install a GFI outlet
We will supply and install a fanlight.
We will supply and install a light above the mirror.
All electric will be connected to the existing electrical service, if arty upgrades are needed a quote will be provided.
"Tile quote is based on a straight installation. Intricate patterns are higher in price for install. Marble like the is a
higher price for install.
Nothing other than stated above is included in this quote. No paint or paper. All sales tax is included All
necessary permits are Included All work Is fully insured Any debris created by Browns will be disposed of by
Browns.
This quote is good for (30)Thirty Days from date above. The owner represents and warrants that he is owner of aforesaid premises and
that he/she has read this agreement,set forth on both sides.
IT IS EXPRESSLY AGREED THAT NO STATEMENT,ARRANGEMENT OR UNDERSTANDING,ORAL OR WRITTEN,
EXRESSED OR IMPLIED NOT CONTAINED HEREIN WILL BE RECOGNIZED AND THIS CONTRACT CONSTITUTES THE
ENTIRE AGREEMENT.
It is further agreed that this contract is not subject to cancellation except by written consent of both parties.
SALESPERSON: ACCEPTED:
ACCEPTED BY:/4ry DP—(= J Lvrr X ." (� ._ E 04
(SUBJECT TO ALL CONDITIONS ON THE REVERSE SIDE)