12A RUSSELL DR - BUILDING INSPECTION (2) C�<, 4af--%-Z z,�>
�qo I
--- I Ilk! C'onnnonweaiih of`vlasmachus ifs
1� s Board of Building Regulations and SLutdards Cl IT OF
\Massachusetts Slats: Building Codc. 780 C NIR NALl:.\I
Building Peftml %pplicillion 'fo Cbnslruct. Repair. Rcnov it- r Denxth h a /?,,1 h"d I fill''n//
one-urTuva•Piunda Uarrlliuy+
This Section For Ot'ficiu pill
Building Permit Number Date p ied:
IIuJJmy pt)laal(Pant Nmne) l [ /
. (ytature Ualc
SECTION is SITE INFORM TION
L I Property slur a: 1.2 Mies n Ma Purcel Numbers
� a oar s S EL,& ,Dr
I.la Is this an acce led sireel? es no \lop Nu°t I'urcel Number
1.3 Zoning Infierinationt 1.6 Property Dimensions:
Lousily District 1'ropuxd U---w-__ Lot Area($
4 III Pronluye(tl)
I.! BuIIJInS Setbacks(R)
From Yurd Site Yunla
RequiredProvidedroviJed Required Side
Required
Rear YardI'roviJeJ
1.6 Witter Supply:(M.G.1.u. JJ.§74) 1.7 Flood Zone informadont Lit Sewa`e Disposal System:
Ihrblic 0 Pdvme O Zone: ._ Outside Flood Zone?
Check iY cs0 Municipd O On site Jispusul s)shm 0
2.1 Ownert of Re rill
SECTION]: PROPERTY OWNERSHIP'
,
k/AI' Pr t�u/r!a c/ / SdfC G ltii
N,une 1 Pnnt) (ily.Stale.LIP
ntu..,11J.�tn:r: rely
p Etnuil AJdrcss
SECTION J: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ OwnerOccupied O Repaints► O Alteratlon(s) ❑ Addition O
Demolition O Accessory Bldg, 0 Number of Units_ Other ❑ .Spetiry:
Brief Description of Proposed \V rk°: -
0
SECTION 4: ES 'Al CONSTRUCTION COSTS
licm Estimated Costs:
i Lahur and\laterialsl 0111c1a1 Use Only
1. Building S 1. BuilJiug Permit Fee: f Indicate how tee is determined:
2. I:'Icctrical S 0 Standard City:Tusvn Applfcuion Fee
I 11lunihiitg S 0 Total Project COW(Item 6)x multiplier
1-02. Usher Fed:
J. \Iccb.mic.d ill\ U'I S List:__
�u..ressiUnl S rolal \II Fccs: S _—
n Ilual Project CO) i f Check No. _( IaccA .\nnnum: l',uh \nnwnC
( � Cf ❑ P.iid in Full Cl patsianding 11.11.mce Due:
t
SI:("PION S: ('ONtiI'RII("PION SERN'R F.";
S,I C'unstructimsSupeni.curLiccnstlC'til.) G 3CYl�tl
!�(�7.5 aT.l - I icenee Nn1l,her I
rc (_- �D J ---
N.une�dC\LlLddet �„ I tit 01. 1)pthecheluttl.__.__.____.
'I)q. Description
Description
(I IhtresvidcJtlludJill sti nt1S,U0un1. 11.1
R Il AricteJ Ia• PJmil I)ttellin
C'igill,e n.Slate.%II' RC K,ndin Cowrin
µS µ'i1,Juw.utJSiJin
-- SF solid FuulI)urniny,\ppliuns ce
oe'llulinn
Danulitiun
1'ele bout PmailadJres �q_ 3
1,2 hone toed Ilume Improvement Cuntrnclor(IIIC)
IIIC'Ite4lelr;niun Numhtr Ii.pirWiun Ume
IIIC C'tl wp Nan a ur I IIC Itcyls ant Nana
_ Emwl address
No. J Street
rvic hunt
Ci awn. Slate ZIP
SECTION 61 WORKERS'COI►1PENSATION INSURANCE AFFIDAVIT(M.G.L.e. I52. 23C(
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this allIldavit will result in the denial of the Issuance of the building Permit•
Signed Affidavit Attached? Yes .......,..❑
No...........O
SECTION 7al o%VNER.WTHORIzATiON TO 8E C0111PLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERNIIT
1, as Owner of the subject property,hereby authorize
yc c
to act on my behalf,in all matters relative to work authorized by this building permit application.
Duct
fnol U\saer's Nwne(Electronic Siynuturt)
SECTION 7bl OWNER I OR AUTHORIZED AGENT DECLARATION By enter' g Iin name below ereby attest under the pains and penalties of perjury that all ot'the information
calttai its lhi plicati is tru nd accurate to the best of my knowledge and understan lug.
Dual
I'riltOt+ner•i Idnuired,\yennt119ccuunit.\ ynalurtl
varESI
1 (,lot \%IIc ere in60
bhelHu building
hnprupemtntermit lCulur ttur lHlCl Proyraml.%his %ill in nn shave access to vi— hircsan theartbitntiunttractur
program or yuJI'311 l)Infonttn iunder on he Conlstruetia t 4upen iar t eform ti be found aton the C 2. Prugram,e'n`b 111, ltJ at
\\hen iubst-ol0al tvork is planned, pro%idt the inl'olti at un bclo%v: e, linished bascmm t attics, decks or porch
jy S
ft+cal Iluur area t;y. fl.l --- H;Ibitablt ruunl cmull
Urosi living area l iy. tl.l ._. .- \unlhertil hedroouls
\anther of lirehlaces .. .. _ \umber tit'half hnlhi
Numherofhadtrowni . . - \wuhcr,Il'Jecki. porches
I'i pc,Incc.11ing s),Icnl rtl'cn
I'nclo,cJ
I pt I avhng .)stem
i 1,IIIIfe 1'Pnl•11:e IIIJ. I0c IlI,♦t1ttlIc,l Itq total Project Cott'•
t f,dJl I n Iccl I
}
SPECIAL SERVICES CUSTOMER INVOICE Pagel of 7 NO. 2686-243280
------------------------------ -----------
Store 2686 SALEM,MA Phone: (978)741-9299
�y 50 TRADERS WAY Salesperson: AMC5333
SALEM, MA 01970 Reviewer:
LName Home Phone
ONT KAREN (978)741-1s90REPRINT
2A RUSSELL DR WorkPhone (978)548-8856
Company Name
ALEM Job Description 817 NRTS TV KITCHEN2012-08-1210:57
A zip 01970-6727 cw,"" j
VENDOR°D IR ECT SHIP'#1° MERCHANDISE AND SERVICE SUMMARY od'tocustomers ht to limit the quantities of merchandise
F Flft! ' f�l V T0: CUSTOMER
S/O-MERCHANDISE TO BE SHIPPED: S/0 THOMASVILLE REF# S02 ESTIMATED ARRIVAL DATE: 09/08/201 595546
"iREF# ' SKU °' .OTY. UM =="t 'i �h r=+ DESCRIPTION ePI TAX '. PRI EXTENSION '
a*e_
S0201 619-412 1.00 EA BLS36R/BLS36R BASE LAZY SUS 36 RH/BLS36R FSIDES:B HINGES:R Y 436.34 $436.34*
S0202 619-412 1.00 EA B30SS/B30SS SLIDING SHF BASE 30/B30SS FSIDES:B HINGES:B $590.71 $590.71*
S0203 619-412 1.00 EA TEP2490F1.5FPE/TEP2490F1.5FPE TALL END PNL FLR1.5 FPE 2/ $205.48 $205.48*
TEP2490F1.5FPE FSIDES:B HINGES:L
S0204 619-412 1.00 EA F330/F330 FLR 3W 30H/F330 FSIDES:B HINGES:B MODS: W=1 1 Y $13.91 $13.91*
1/2" D=24"
S0205 619-412 1.00 EA BPP12/BPP12 BASE PANTRY PO 12/BPP12 FSIDES: Y $339.34 $339.34*
S0206 619-412 1.00 EA BEPFI.5FPE/BEPFI.5FPE BASE END PNL WD 1,5 SH/BEPFI.5FPE Y $82.75 $82.75*
FSIDES:B HINGES:L
S0207 619-412 1.00 EA SB30ST/SB30ST SINK BASE 30 TILTAg&&jWST FSIDES:B HINGES:B Y $383.14 $383.14*
S0208 619-412 1.00 EA F330/F330 FLR 3W 30H/F330 INGES:B MODS: W=1" H=34 1/2" Y $13.91 $13.91
D=24"
S0209 619-412 1.00 EA BSD6/BSD6 BASE D 6W/BSD6 FSIDES:B HINGES:B Y $460.33 460.33*
S0210 619-412 1.00 EA DW362424SR W
SR DIAG 36H 24W 12D SUS RH/DW362424SR Y $413.05 $413.05*
FSIDES:B HI
CONTINUED ON NEXT PAGE***!P-
AO�
Check your current order status online at
w .myhdorder.com
Indicates item markdown
Page 1 of 7 NO. 2686-243280 Customer Copy
SPECIAL SERVICES CUSTOMER INVOICE - Continued Last Name: DUMONT Page 2 of 7 NO. 2686-243280
s P
VENDOR DIRECT SHIP#1r
A t '(COflflnUed) a ;R ax-'
o.- . TO: CUSTOMER
S0211 1 619-412 1.001 EA CT2424/CT2424 CORNER TAMB 24W 18H 12D/CT2424 FSIDES:B HINGES:B Y $224.94 $224.94'
S0212 619-412 1.001 EA W4236/W4236 WALL 42W 36H/W4236 FSIDES:B HINGES:B Y $412.35 $412.35*
S0213 619-412 1.00 EA W301824/W301824 WALL 30W 18H 24D/W301824 FSIDES:B HINGES:B Y $262.15 $262.15*
S0214 619-412 1.00 EA F330/F330 FLR 3W 30H (CUT 18"H)/F330 FSIDES:B HINGES:B MODS: W=2" Y $13.91 $13.91*
H=18" D=24"
S0215 619-412 1.00 EA F336/F336 FLR 3W 36H/F336 FSIDES:B HINGES:B MODS: W=1 1/2" H=36" Y $17.03 $17.03*
D=12"
S0216 619-412 1.00 EA W1236L/W1236L WALL 12W 36H LH/W1236L FSIDES:B HINGES:L Y $200.96 $200.96*
S0217 619-412 1.00 EA FPEB-W/FPEB-W FLUSH FURNITURE PLYWOOD ENDS/ATT:W1236L FPEB Y $70.58 $70.58'
-W FSIDES:B
S0218 619-412 1.00 EA W3018/W3018 WALL 30W 18H/W3018 FSIDES:B HINGES:B Y $208.60 $208.60*
S0219 619-412 1.00 EA W2136L/W2136L WALL 21 W 36H LH/W2136L FSIDES:B HINGES:L Y $254.85 $254.85*
S0220 619-412 1.00 EA FPEB-W/FPEB-W FLUSH FURNITURE PLYWOOD ENDS/ATT:W2136L FPEB Y $70.58 $70.58*
-W FSIDES:B
S0221 619-412 1.00 EA WSP936/WSP936 WALL SPICE PULLOUT 9W 36H/WSP936 FSIDES:B Y $352.20 $352.20*
HINGES:L
S0222 619-412 1.00 EA FPEB-W/FPEB-W FLUSH FURNITURE PLYWOOD ENDS/ATT:WSP936 FPEB Y $70.58 $70.58-
-W FSIDES:B
S0223 619-412 1.00 EA F336/F336 FLR 3W 36H/F336 FSIDES:B HINGES:B MODS:W=2" H=36" Y $17.04 $17.04*
D=12"
S0224 619-412 1.00 EA APC/APC ALL-PLYWOOD BOX 20%)/APC HINGES:L Y $820.52 $820.52*
S0225 619-412 2.00 EA TB8WD14/TB8WD14 TOE BOARD .25 WOOD/T138WD14 Y $28.52 $57.04*
S0226 619-412 1.00 EA TCD24/TCD24 TIERED CUTLERY DIVIDER 24/ATT: TCD24 Y $53.19 $53.19*
S02FR 506-658 1.00 KITCHEN CABINET FREIGHT Y $199.44 $199.44
VENDOR-SPECIAL INSTRUCTIONS: LINE:THMASVIL DSTYLE:EDEN MAPLE USTYLE:EDEN-MPL LSTYLE:EDEN-MPL WOOD:APC FIN ISH:CIDER
DSGNR:AMC5333
VENDOR WILL SHIP MDSE TO 'MX l =I DUMONT KAREN
ADDRESS: 12A RUSSELL DR CITY: SALEM
**'CONTINUED ON NEXT PAGE
' Indicates item markdown
Page 2 of 7 NO. 2686-243280 Customer Copy
SPECIAL SERVICES CUSTOMER INVOICE - Continued Last Name: DUMONT Page 3 of 7 NO. 2686-243280
E,
1�I VEND0R DIRECTS 1 `
:�t, (Continued ,> � TO: CUSTOMER
STATE: MA ZIP: 01970- COUNTY: ESSEX SALES TAX RATE: 0.000 • • $6,244.92
6727
PHONE: 978 741-1890 ALTERNATE PHONE: PAGER:
,SEND OF VENDOR DIRECT,SHIP ARM
INSTALLATION,#1 i t
`I;�s�° �...,'
.k nsS teG' 4'1'.�=t ? ' 1Rf �ss.11 yl. REF# 101
ESTIMATED INSTALL BEGIN DATE: 08/11/2012 ESTIMATED INSTALL END DATE: 09/10/2012
BASIC INSTALLATION LABOR:
'SKU #' m N t�`a`�� � DESCRIPTION " �f,�:', ��'1 QTY �°:° UMW TAX RRICEEACH=' aEXTENSION,
�°.
282-627 KITCHEN POINT-NAT/ )01 EAJ N 1 $0.011 $0.01
OPTIONAL LABOR SELECTED INCLUDES:
:OPTION! 1 '�u' fi = u&.... ts,..:.m', =` DESCRIPTION iG° - kF:.lIFIFQTYN W UM - TAX 'PRICE EACH f F"EXTENSIONi
1 KITCHEN CABINETS WORKSHEET POINTS FOR DEMOLITION, DEBRIS REMOVAL, 119.50 EA N $29.00 $3,465.50
ELECTRICAL, PLUMBING AND APPLIANCES(UTILIZE THE KITCHEN POINT WORKSHEET
TO OBTAIN TOTAL NUMBER OF POINTS)/
2 PER CABINET INSTALLATION (INCLUDES WALL, BASE, PANTRY, PENINSULA OVEN & 11.00 EA N $69.00 $759.00
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/ 600.00 EA N $1.00 $600.00
5 PER POINT- PLUMBING AND ELECTRICAL ONLY/ 104.001 EA N $20.00 $2 080.00
INSTALLATION SITE NAME. DUMONT KAREN INSTALL LABOR CHARGE: $6 904.51
ADDRESS: 12A RUSSELL DR TRIP CHARGE: $0.00
CITY: SALEM STATE: MA ZIP: 01970-6727 CREDIT FOR DEPOSIT/MEASURE: $0.00
COUNTY: Essex SALES TAX RATE: 6.250 TAX: Merchandise- Y LABOR- N • $6 904.51
PHONE: 978 741-1890 ALTERNATE PHONE: 978 548-8856
Page 3 of 7 NO. 2686-243280 Customer Copy
SPECIAL SERVICES CUSTOMER INVOICE - Continued Last Name: DUMONT Page 4 of 7 NO. 2686-243280
N n e
INSTALLATION #1 ; ;`
(Continued) Ie REF#101
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:
INSTALLING SKYLIGHTS REMOVAL OF VINYL FLOORING
STRUCTURAL MODIFICATIONS MUST BE APPROVED BY REGIONAL SERVICES VENT IN WALL
MANAGER OR INSTALL MERCHANT
ALTERATIONS TO EXTERIOR OF HOME
SPECIAL NOTES:
AN ADULT OVER 18 YEARS OF AGE WITH THE AUTHORITY TO MAKE CHANGE FURNACE FILTER BEFORE,DURING AND AFTER INSTALLATION.
DECISIONS ABOUT YOUR INSTALLATION MUST BE PRESENT DURING THE -WATER,GAS AND SEWER SERVICE MAY BE TEMPORARILY TURNED OFF
INSPECTION(WHEN APPLICABLE),DELIVERY AND INSTALLATION DURING THE INSTALLATION PROCESS. THE INSTALLER WILL NOTIFY
`NO WORK/DELIVERY TO BE DONE ON SUNDAYS OR HOLIDAYS THE CUSTOMER OF AN ESTIMATED LENGTH OF TIME FOR THE SERVICE
•ALL WORK WILL BE DONE TO LOCAL CODES AND ORDINANCES TO BE UNAVAILABLE.
'ALL WATER AND GAS SUPPLY LINES MUST HAVE INDEPENDENT 'CUSTOMER IS ASKED TO DESIGNATE PARKING,ENTRANCE AND EXIT
SHUT-OFF VALVES. ACCESS PREFERENCES FOR THE INSTALLER(INCLUDING RESTROOM
JOBSITE MUST BE COMPLETELY ENCLOSED WITH ALL WINDOWS, ACCESS).
DOORS,INTERIOR WALLS,ROUGH PLUMBING AND ELECTRICAL WORK 'CHILDREN AND PETS MUST BE KEPT AWAY FROM THE WORK AREA
COMPLETED PRIOR TO THE INSTALLATION 'CUSTOMER IS RESPONSIBLE FOR ANY UNFORESEEN CONDITIONS
'THE WORK AREA MUST BE CLEAR AND ALL VALUABLES AND WHICH MAY ARISE DURING INSTALLATION.
BREAKABLES MUST BE REMOVED FROM THE WORKSITE PRIOR TO WORK 'THE FINAL KITCHEN POINT WORKSHEET MUST BE SIGNED BY BOTH
BEGINNING 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. 'NOTE:THE HOME DEPOT DOES NOT PROVIDE THE FOLLOWING
CONTINUED ON NEXT PAGE `•+"
Page 4 of 7 NO. 2686-243280 Customer Copy
SPECIAL SERVICES CUSTOMER INVOICE - Continued Last Name: DUMONT Page 5 of 7 NO. 2686-243280
3 _ = INSTALLATION #1 '`
4 .fin .(Continued) �,I. 'Adim, y
REF#101
CUSTOMER MUST UNDERSTAND THERE WILL BE A PERIOD DURING SERVICES(AS PART OF KITCHEN INSTALLATION PROGRAM)
THE START OF THE JOB.OTHER ARRANGEMENTS MUST BE MADE BY 'ADJUSTING OPENINGS OR WORK INVOLVING LOAD BEARING WALLS
CUSTOMER DURING THIS TIME FOR ACTIVITIES USUALLY HELD IN -REMOVE,ALTER OR BUILD LOAD BEARING WALLS(OTHER THAN
THE JOBSITE AREA. STUD WALL FRAMING).
THE WORK AREA WILL BE CLEANED UP DAILY,BUT DUST AND 'INSTALLING SKYLIGHTS
CONSTRUCTION RELATED DEBRIS AND NOISE WILL BE INEVITABLE `STRUCTURAL ALTERATIONS OR REPAIRS
THROUGHOUT THE INSTALLATION. 'ALTERATIONS TO EXTERIOR OF HOME
ALL POSSIBLE STEPS WILL BE TAKEN TO MINIMIZE SPREAD OF 'REMOVAL OF VINYL FLOORING
WORK AREA DUST TO OTHER PARTS OF THE HOME.CUSTOMER SHOULD
tea` ` END OF INSTALL#1 "=
INSTALLATION'#2 E
REF# 103
ESTIMATED INSTALL BEGIN DATE: 08/11/2012 ESTIMATED INSTALL END DATE: 09/10/2012
BASIC INSTALLATION LABOR:
"SKU ` ••. ' DESCRIPT1or4mm:_.__ =s:,_ n '.` �;�.,Tti'g`, V ``'UM TAX "sPRICE EACH= §EXTENSION
U.�.
133-441 CORIAN SOLID SURFACE-NAT/ 1 0.001 SFJ N 1 $0.011 $0.00
OPTIONAL LABOR SELECTED INCLUDES:
OPTION h1i,.,=>.> _�kW.P.� h DESCRIPTION ._ y :=- .• : = �! ., � . :f' h1OTY•= :' [UM 1,1 TAX vPRICE EACH` `#IEXTENSION=`
7 EDGE DETAIL-GROUP A/BEVEL 12.00 LF N $0.00 $0.00
19 STAINLESS STEEL SINKS- STANDARD MODELS/NCFU2115 SINGLE BOWL 1.00 EA N $269.00 $269.00
23 UNDERMOUNT INSTALLATION -STAINLESS STEEL(LABOR ONLY- FINISHED EDGE, 1.00 EA N $173.00 $173.00
MOUNTING AND CRADLE)/UNDERMOUNT INSTALLATION - STAINLESS STEEL(LABOR
ONLY- FINISHED EDGE MOUNTING AND CRADLE
81 'PROMO 4/30-7/29/12 NATL"SPECIAL BUY W/25 SF MIN PURCH. ORDER PAID BY 7/29/12- 33.00 SF N $72.00 $2,376.00
ADJUSTMENTS BY 10/22/12. COMBINABLE W/BAR CODE COUPON, NATL ATTACH, REGNL
OFFERS. NO CREDIT APPLD IF OFFER REFUSED. STD FAB&INSTALLATION CHGS
APPLY/WITCH HAZEL
INSTALLATION SITE NAME' DUMONT KAREN INSTALL LABOR CHARGE: $2 818.00
CONTINUED ON NEXT:PAGE
Page 5 of 7 NO. 2686-243280 Customer Copy
SPECIAL SERVICES CUSTOMER INVOICE- Continued Last Name: DUMONT Page 6 of 7 NO. 2686-243280
INSTALLATION #2
>'(Conanuoa
,ir im
.�u�� 0 REF#103
ADDRESS: 12A RUSSELL DR TRIP CHARGE: $0.00
CITY: SALEM STATE: MA ZIP: 01970-6727 CREDIT FOR DEPOSIT/MEASURE: $99.00
COUNTY: ESSEX SALES TAX RATE: 0.000 TAX: Merchandise- N LABOR- N • $2 447.10
PHONE: 978 741-1890 ALTERNATE PHONE:
BASIC INSTALLATION LABOR INCLUDES:
IN HOME INSPECTION TO VERIFY LAYOUT,MEASUREMENTS,SPECIAL `FAUCET HOLE DRILLING(UP TO HOLES)
INSTALLATION REQUIREMENTS AND TEMPLATING 'WALL SUPPORT CLEATS AS NEEDED AT CORNER CABINETS
•BASIC INSTALLATION OF COUNTERTOP •SUBTOP OR SUPPORT STRIPS
•ONE SINK OR COOKTOP CUTOUT(TOPMOUNT)PER PROJECT •FINAL CLEAN UP OF ALL DEBRIS RELATED TO INSTALLATION
•GROUP A EDGE DETAIL •DELIVERY WITHIN 30 MILE RADIUS OF STORE
•EASED EDGE ON BACKSPLASH(ALL EXPOSED EDGES) •FINAL INSPECTION WITH CUSTOMER INCLUDING INSTRUCTIONS ON
•FINISHED EXPOSED ENDS(FLAT FINISH NO EDGE DETAIL) CARE AND/OR TEST PRODUCT TO ENSURE PROPER OPERATION
EXAMPLE:NEXT TO RANGE OR REFRIGERATOR
UNLESS STATED ABOVE THIS INSTALLATION DOES NOT INCLUDE:
WINDOW SILLS,GARDEN WINDOWS AND PASS THROUGHS REPAIR OR ALTERATIONS TO EXISTING CABINETRY
CABINET BUMP OUT BORDER EDGES,DIFFERENT COLORS,DECORATIVE COLORS, DECORATIVE
INLAYS
CUT AROUND POSTS OR ODD SHAPES INLAY AROUND SINK(BEAUTY RING)SITS AT TOP OF INTEGRAL BOWLSINK AND
BELOW DECK
SUPPORT MATERIALS FOR OVERHANG(REQUIRED FOR OVERHANGS>6')
CUSTOM EDGES ON BACKSPLASH
SPECIAL NOTES:
•CHILDREN AND PETS MUST BE KEPT AWAY FROM THE WORK AREA FROM THE WORK AREA PRIOR TO INSTALLATION
•CANCELLING APPOINTMENTS WITH INSTALLERS OR MISSING `ADDITIONAL CHARGES AT THE JOBSITE MAY BE NECESSARY TO
SCHEDULED APPOINTMENTS MAY LEAD TO ADDITIONAL CHARGES COMPLETE THE JOB AND/OR BRING THE INSTALL INTO COMPLIANCE
REFER TO PRODUCT MANUAL FOR SPECIFIC WARRANTY AND WITH LOCAL AND/OR STATE CODES
MAINTENANCE INFORMATION. •THE INSTALLER MAY DECLINE TO INSTALL THE JOB IF IN THEIR
•IF UNFORESEEN LABOR IS NEEDED TO REPAIR DAMAGE FROM WATER, PROFESSIONAL OPINION IT SEEMS UNSAFE,IN VIOLATION OF STATE
TERMITES,ELECTRICAL OR PLUMBING PROBLEMS,THERE IS AN ADDED OR LOCAL CODES OR CANNOT BE PERFORMED TO INDUSTRY STANDARDS
CHARGE WHICH MAY NOT BE AVAILABLE FROM HOME DEPOT SO THE •CORIAN'S PRIVATE COLLECTION INCLUDES MARTHA STEWART
=`•*'CONTINUED ON NEXT PAGE *`
Page 6 of 7 NO. 2686-243280 Customer Copy
SPECIAL SERVICES CUSTOMER INVOICE - Continued Last Name: DUMONT Page 7 of 7 NO. 2686-243280
e
IN'STALLATION'42
y " (Con(mued) ar_m ; REF#103
CUSTOMER MUST HIRE THEIR OWN CONTRACTOR TO MAKE THE REPAIRS. LIVING)OFFERS TEXTURE AND MOVEMENT COMPARABLE TO STONE AND
AN ADULT OVER 18 YEARS OF AGE WITH THE AUTHORITY TO MAKE MITERED SEAMS ARE RECOMMENDED(ADDITIONAL CHARGES APPLY).
DECISIONS ABOUT YOUR INSTALLATION MUST BE PRESENT DURING THE SEAMS MAY CAUSE CHANGE IN PATTERN DIRECTION.
INSPECTION(WHEN APPLICABLE),DELIVERY AND INSTALLATION
ALL BREAKABLES AND/OR VALUABLE OBJECTS MUST BE REMOVED
END OF INSTALL"#2
TOTAL CHARGES OF ALL MERCHANDISE & SERVICES
PAYMENT TERMS : " • " ' • $15 596.53
Refer to the Home Improvement Agreement for payment terms. SALES TAX $0.00
TOTAL 15 596.53
BALANCE DUE $7 768.84
END OF ORDER No.2686443280 t
W L I
.Yr"
Page 7 of 7 NO. 2686-243280 Customer Copy
Customer Signature:, , s Associate Signature:
Date_�� it 2 Date
CITY OF S.U.E,,l, L-kSSACHUSETTS
' BUILDNG DEPARMEINT
3 N 130 VPASHINGTON STREET, 3iD FLOOR
TEL (978) 745-9595
F.ax(978) 740-9846
KI.NiBERLEY DRISCOLL
,bi.�YOR THo%w ST.PtERPE
DIRECTOR OF PCBLIC PROPERTY/SUMO \G COSLMISSIONER
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 t L5
Debris, and the provisions of MGL c 40, S 54;
Building Permit # 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
I It, S 150A.
The debris will be transported by:
< tr (-/,a r D f�C�ISG'A
(name of hauler)
The debris will be disposed of in
(name of facility)
(address of facility)
sign' re of permit applicant
s_ i2- �--
datc
Icbrul(d,x
CITY OF SM_E,%I, .\/L-�SSACHLSETTS
B1:ILDING DEPARTMENT
120 WASHINGTON STREET, 3"FLOOR
TEL (978) 745-9595
FAx(978) 740-9846
KI.%[BERL.EY DRISCOLL
MAYOR T Ho,%w ST.PIFAR/3
DIRECTOR OF PUBLIC PROPERTY/BCILDLNG COS11M3S8IONER
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Informatinn Please Print Le ihlp
I ,
Nalne(Busiii si rorganizatiomindividual): t G N Ar D J�_ /71/T 19 /
Address: �? h140156/"/ Ayr= /
City/State/Zip: 6' 6 Ll L N/V 0 Phone 1t: L23A-Fr fo
Are you r player'?Check the appropriate box:
F6. 10�Ncw
7construction
uired):
1. am a employer with 4. ❑ I am a general contractor and 1ionemployees(full and/or part-time).• have hired the sub-contractors2.❑ 1 am a sole proprietor or partner- listed on the attachedsheet,I ship and have no employees These sub-contractors have working for me in any capacity. workers'comp. insurance. on[No workers'comp. insurance 5. ❑ We are a corporation and itsrequired.) officers have exercised their irs or additions
3.❑ 1 am a homeowner doing all work right of exemption per MGL I LCI Plumbing repairs or additions
myself.[No workers'comp. C. 152, §1(4),and we have no 12.❑ Roof repairs
insurance required.)t employees.[No workers'
comp. insurance required.l 13.0 Other.
•Any applicant tha dimits box el most also rill out the section below showing their wotkea'compemalion policy inlurmaliom
'I bnneownen who submit this affidavit indicating they am doing all wok and then hire outside cenlncton mtul submit a new amdavit indicating such
:Contmctun that chuck this box must anach ai an addiounul Awl showing the name of the mb.:omndon and their worken'comp.policy information.
I am on employer that is providing workers'compensation insurance for my employees. Below!s the pulley and jab site
inform slioa.
Insurance Company?lane: I t ` ��/g t^% f�G r 1p
Policy N or Sclf-ins. Liic. dn/:__nO I&C_ 14910/� Expiration Date:
Job Site Address:—/ g A +�( ( G F� I l// City/State/Zip:
,%ttach a copy of the workers'compensation policy declaration page(showing the policy number and expiration data).
Failure to wcurc coverage as required under Section 25A set'MGL c. 152 can lead to the imposition of criminal penalties of a
tine up to S 1,500.00 undlor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine
of up to S230.00 a day against the violator. Ile advised that a copy of this statement may be forwarded to the Office of
Investigations ut'tlic DIA for insurance coverage verification.
I du Itereby c ertif under t e puins a lenolde of perjury that tire h1furmuNon provided above its true and c orrecL
Uarc:
OJJicial use only. Do nor turite its Niis area,to be completed by city or town afjlciuL
Citynr'I'own: _,._,.. Permir/f,lcense;t
Issuing Authority(circle one):
1. l3ourd of Ileallh 2, Building Department 3.Cilylrutvn Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact 1'crson: Phanc Ii:
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100"
All dimensions_size designations This is an original design and must Designed: 8/11/2012
given are subject to verification on not be released or copied unless Printed: 8/11/2012
job site and adjustment to fit job applicable fee has been paid or job
conditions. order placed.
fk000031 ILegend Drawing#: 1 No Scale.
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Note: This drawing is an artistic Designed: 8/7/2012
interpretation of the general Printed: 8/7/2012
appearance of the design. It is
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Note: This drawing is an artistic Designed: 8/7/2012
interpretation of the general Printed: 8/7/2012
appearance of the design. It is
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fk000031 ILegend I Drawing #: I
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All dimensions-size designations This is an original design and must Designed: 8/7/2012
given are subject to verification on not be released or copied unless Printed: 8/7/2012
job site and adjustment to fit job applicable Fee has been paid or job
conditions. order placed.
tk000031 El 1\2 Drawing#: 1 No Scale.
=777-
Note:This drawing is an artistic Designed: 8/7/2012
interpretation of the general Printed: 8/7/2012
appearance of the design. It is
not meant to be an exact rendition.
fk000031 Legend Drawing #: 1
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All dimensions-size designations This is an original design and must Designed: 8/7/2012
given are subject to verification on not be released or copied unless Printed: 8/7/2012
job site and adjustment to fit job applicable fee has been paid or job
conditions. order placed.
flc000031 El 1\1 Drawing#: 1 I No Scale.
d�ui.•F:Cim ess l'esu
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Reg ly, ,ion �-118509. lvir _
j rxpu ion 31'912013 DBA- r
,,�Q J CONSTRL TjOW`�=3
�.,ICHARD-MADISONK
MA.DISON AVE
1 OVE LAW, MA 0183 Undersecret v
L a
Massachusetts Department of Pubbl 5 dctN
Board of Buildul r Rl,-nlatnnt9 and St uu1 trds
Construction Supervisor License
License: CS 30000
RICHARD J.MADISON
3 MADISON AVE c
GROVELAND;,MA01834`
Expiration: 7/21/2013
- Trtt: 18274