24 PURITAN RD - BUILDING INSPECTION (2) 4WHS4011W49E AND APPROVED BY T44E
JUPFC=.PWR TD XP.1JfWT d°18INo GRANTkD
CITY OF_SALEM
No. ` V /—�
s od. 5
41 ` ward
�. Z*rft ouacr
1&Wit►L0Ca%d rn Lowtios of
BM f" &n is Mdda? Yu No 31"1"08
:? Y. No�
Permit b:
BUILDING PERMIT APPLICATION FOR:
(Circe whichever apply) Roof, Retool.ytall�S
/Reole ri 6e. :) G� Deck' Shed, Pool,
� Other /�,i��u i
PLEASE FILL Ot r LEGIBLY A COMPLETELY TO AVOID DELAYS W PROCESsIIMq
TO THE INSPECTOR OF BUILDINGS: '•
The undtarsilprsd hereby applies for a permit to build acxorcLip.to the.followinp
Owner's Name V 1 U"14 , m 64Tos`j
Address a Phone s 4M?- 07t�j 74(/- O&z/9
Amli tect's Name
Address A Phone I i
Mechanics Name 814 tv cHh'a m
Address a Phone y co3,irz AZ c97c?1 56 9-57 6 G
Tcc{{n, S6a2c)
md"at buldrrp?- Lit INJTv L p a q,for Now mmy rani?
We bukbvcpift.. to akw?iiv
t nnwraa 0 U aty umm M abua Ua A
Wature of Applicant
SHINED UNDER THE PENALTY'
OF PERJURY
DESCRWnON OF WORK.TO BE DONE '
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MAIL PERMIT TO: I BLNI ROE" CHHOUY F(
"r10ME DEPOT
4 COBL:RN RD. •'
TYIvGSBORO,b1A. Oi8i9
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CITY OF SALEMt MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
SALEM, MA O 1970
TEL. (978)745-9595 EXT. 380
04& FAx (978) 740-9846
STANLEY J. USOVICZ, JR.
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the provisions of MGL c 40, S34, I acknowledge that as a condition
of Building Permit# all debris resulting from the construction activity
governed by this Building Permit shall be disposed of in a properly licensed solid-waste
disposal facility, as defined by MGL cc III, S1500AA.
/
The debris will be disposed of at: J'4 5 (2 9,Cf N t.0 0qb �1 ) W 02 CY`�'IF 2
Location of Facility
Signature of Pemu App cant Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
Name of Permit Applicant
Firm Name,if any
� u 5 AE ►v w 00 Vy oe ci5're
Address,City& State
The above statute requires that debris from the demolition, renovation, rehab or other
alteration of building or structure be disposed in a properly-licensed solid-waste disposal
facility as defined by MGL ca S 150A, and the building permits or licenses are to
indicate the location of the facility.
t�I A
''i F- �_ �� /•ta^%tleGr .(N1 Lt�i.:,.l,L.;.(.rCf„
z 600 Washanpon Street
�s Boston, Mass. 01111
y
Workers' Com ensation insurance Affidavit: Builtiin P;umbinm Electrical Contractor,
om
name: L/. u.Nj C.H Ho LLAJ A
address `"} Co&J.v,ti c
city � 4QGsboRo te:sta I t I f�' zip:._01KI7 phone# q 76- �p� -5749
work site location(full address):
❑ I am a homeowner performing all work myself. Project Type: ❑New Construction ®R2emodel
❑ I am a sole o clot and have no one working in an ca act ❑Bu"am Addition
RAW %�/GI(/%1////GY/lOr�z�/%/
1 tam an®ployer providing workers' compensation for my employees working on this job.
, t
eotn tiY nemei ., G .. . D'M w I 0 e, .P ?vI cto- S
cf � °�03 / honeN: :.: .: .6 _. J19�
trsuce Co. ; . A. .F NS Yak ra
nem
El I am a sole proprietor,general contractorfor homeowner(circle one)and have hired the contractors listed below who
havr,the following workers'compensation p6 iges:
CoMpIniv mime•
addmoo
ems• .. . Dhone#• -
Comoetiv came: .
address:
city: .:. . . - Phone N: .
tOaYraOEe CO. lie N
ligg
001
Failure to accure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal pemitin of■fine up to SI,f00.00 and/or
one years'imprisonment as well ss civil penalties to the form of a STOP WORK ORDER and■fine of$100.00■day against me. l undealand that a
copy of this statement may be forwarded to the OMce of lavestigotiana of the DIA for coverage verification
do hereby certify under thepains and pennaliies ofperjuty that the information provided above is true and correct
Sipature +, '`••�/"�- Date
Print nerve L".• f �J n' AD hone tF 7rt • rj/'G _ J`7 /-
i
omcisi we only der not w Ile in(hit area to be completed by city or lawn official
city or town: permitlticemep ❑Building Department
r
❑Licensing Do,ed
❑check if immediate response It required ❑selectmen',0 Met
❑Hesit6 Dcpaumeal I:.'
contact person: phone H; ❑Other jT
(rtw,d Sept M) is
f,
r04/i33/2005 22:15 5094762511 PAGE 04
HOME IMPROVEMENT CONTRACT
/ Sold,Furnished A- and Instilled by:
Date: —f 1 0 a THD At-Home Services,Ina.
Branch Name: (ire The Home Depot Al-Home Services
/J / 345A Greenwood Street,Worcester.MA 01607
'3 1 dub p: 9oN-9 Tell Frec(900)657-5182; Fax:508.756-2859
Branch Nnmti Federal 104 75-).699460 ME 6ic M C 02439 RI Can[LaJo 16427
C r I.cu 56552.2',�M/A�ilnmc lmp�ro+lvcmcm(:nnwemr Ree M 126893
Installation Address:
02 City e Zip
Work Phnnc: IA me Pho^c:
Perchielt I: Driver's Lic.H$ES Dale: ( ) V.pl_711/ QQrr
I Alr „„6 SCf7/S/3S Ig �_ ( 77755 ( )�
VIr nTbc�,
Home Address: City State _ZIP
(if different from Installation Address)
he
tallation
Pro'ecl Imo: LW elYou("Purchaser) to enmv tp famish,dclo c alocated atnd flrtanga Cor above ins
eyl ato
tion of address.
matcnalsr&I
contract with Home Depot U.S.A.,Inc.("I 9sp,DsR ) _ incorporated herein by reference orsd made a part hereof.
described on the Rlachcd Spec Sheet#: �t10"ly6p�—
Home Depot reserves the right to cancel this contract if,upon roinspection of the job,Home Depot determines that it
cannot perform its ohhgn4ons tine to n structural problem with the Imme nr beCAuse work reyUlred to complete the jab
was not included in tM1e contract.
pF.POSI'i PAYMENT OPTIONS
(Subject m fund vcriticminn Doti/nrcrtdit aFprnvn.l
p�yp I. Check Cashiers Check or uS Postal Scrviee Monty Oracr
CONTRACT AMOUNT S Z1"f IMude payable to The home oe1o0
Gti' 2. Cedh Card•ard/orotherpeymml.options•Cirde One Below ,
•LESS DEPOSIT S� Visa d Discover Ametcan Expmsa
BALANCE DUE he Home Derws l lemc Improvement L The IICMc Dcpol Credit Cord
ON COMPLETION $ 394— n sllab ,J K, (HIL&HDCC ONLY)
'Minimum 25%of Contract Amount title upon execution Alefli- a(�Cxp,Done f this contract
Name us it anpcars on wrJ.
Indicate Payment Method Por •By my/on,ignemrc below.Ilwc"ce to allow Home Depot In charge the above
rcfcmnccd crtJir onrd fi`r the dcpOSit nd¢amd, AWO
BAI.,ANCE DUE ON COMPLETION: rese,renced t e i,,.d I the
dCTidholder'a Sifnatur, ` am
—HIL or HDCC Authori Tit Codes
De osit Final Po ment
Purchaser agrees that,due.immediately
upon agrees toot comply bonof ld severally obligated and lie ork,Purchaser able execute
0 Completion Certificate
r.
and pay any
a including lancing�C'fi agreement,
nain the comZ agreement
byb'tPartis
E reee l na writing 5aAttiE
md o fa esT
1ecnt crt a c f
rlo7nixtP� P✓ N �
o M
NOTICE TO PURCHASER
Do net sign this contract hcfore you rend it you ere entitled to a completely filled-in copy of the contract at the time you sign. Keep
't to protect your rights. De not s'g^any Completion Certificate or aCrecmcnt44slatingpp that yoU ere Is Co satisfied with the micro project
hefors this Dr^3rlerstocom slete. Law
nmpktinin sof fhcmwark la be performeduecer thaI,can lraelAeecPtinga Competion Certitkate.Signed
by the own<r P g
youeellnbnn se,an explanafinn of this right There will b .erviec churge epud l0 25% of the contract amount if the job is
You may cancel this transaction at any time prior m midni ht of the third business Jay alto the dale of this contract. See Notice o
cancelled by Purcaaacr AFTER the third business day c a s
BY RECEIPT OF AICOI Y OF IBIS OW,TIE CT AND TWO CUMPf LE'BO CUNIF.S OF THE NY THE TERMS OF I OTICE OF CANCELLATIONNOWLEUGF.
REVIFW OF MY/OUR
CREWIOUs CRY ANDRIM1VF AUTHORIZ UNDERSTAND
DFPOT All FIORIZED CONTRACTOR,l'0 VfcftiF OANU REVIEW MY/OITY
UR
DIT
MCURR D FROM NIADIV ERTEN7 OMISSIONS OR TING �GENCY AND RE1.17ASE ERRORS.RDU NOT SIGN THIS CONTRACT IFTIt THERE HERE ARE ANYM FROM ALL A1sLANR
SPACES. Date
1� /SUBMITTED BY'._aPtC 1
Bat C'. s Imnt
C'.
ACCEPTED jlnmc~ilwner j
Date._ -
F.510E AND ARE FnaY OF Tnr4 CONTRACT
NOTICE,ADDMONAL TERMS,CONDITIONS AND WARRANTIES ARE STATED ON 771E a EVERS
Whia-Rmnob Hilt VIII-Cnaemm Fiut-St"Cannprnnl
10-7-04 G-sC
t e[fQ� l WINDOW SPECIFICATION SHEET - Spec. Sheet#: W 80459 Sheet: 1 of a
m
Customer: $, Job ft:I59515,0 Consultant:�a ck I�Ia Zrrf Date: y
Existing Window New Window
a r
easurements Gritls Pattemt Pattern`'z Patternf� Window Hinge LocationsGlass MISC. Cemt,CPC,Bay,Bow,
ough Opening o R o g oa2 Location Style Metal Styia Series `o m o r 6 Options- items Patio h Garden goers
J_ (Room/Fhwr) `Code" Y!N "Code" "Code° Oth Height U! U > _ .°� > _ > x 'Code" 'Code' (from outside,um BU
1 .K4944a 17l d�J aFN w 3& - r t 7 1 3
66 a
a !'th rd- 3a' Sy1
6 i L S�
71 A I� 90 5Sf 86 3
h
39 3� 6 a
LL2. 65—a, - I I —L
Grld'Paftern and Location MUST be indicated. COlor
Of )❑�,
z If a single window w mulled windows mgLAm multiple grid Patients,indicate location and pattern in the additional spaces provided. WlndoW Door Wraps (/"'r
s For Csmts,CPC,Bay or Bow,use'L',"R'oT'S'(Stationary)_ For Patin&Garden Doors,use"S"(Stationary)ur'X'{Operating).
BAY/BOW WINDOW GARDEN WINDOWS
N
tD Projection Angle: (6ey:3a°or 0.5°) Top of Window to Soffit(inches) WALL THICKNESS° (Inches)
r
m BayVAndoW flBnkers-DH/Csmt. Width of Overhang(Indtea) SEATBOARD MATERIAL
m
Seellmard Matwiai-Birch or Oak n tied to Soffit,color of Soffit materlal iSpecity Birch or Oak Veneer or White Pionire
New Interlor Casing(BayMow7GardenlPatio Doom) Construct Boof 3(Yesi No) °Additional charge for wall thick....of 6"or more.
In
ti Clarnshell(CL)or COlonial(CO) 3 There is no guarantee that new shingles will match existing color-
1 have reviewed and agree with all of the
SPECIAL CONSIDERATIONS: job specifications described above.
m
CustaInar signature Date
m
515-03SA-W-SD