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7 SURREY RD - BUILDING INSPECTION �L�M�T1ifN�Mi1M A/IUgVip�iilE TDAMl AMMKi fL11 WkD CITY OF SALEM /o :l lod' Wed am%Owe as w in Pa1111�b: BULDrq I �l APPUrA7W PAS Of"Wdoum IWA nw. PNOA Wo 8wft �i011O111� Qom, $IMF, P001, iwlsirRoplsoa, OMiw: ��V' L 1✓/R/m(p wS PLam mL our umLY i OOIwum L.YTo AYOw DRAM M PROOMma TO THE POP®CTM OF BU L DL4M- ftoy opw for a pw" b ho tRpaelonp b tlia.toMowYip AdrUass i Phar '7 S' �=, (q* 7 K-//4,2Mhboes Non Addisss• Phar ( 1 INsohwifos Nora Address i Phony ( 1 11�11IIr.1 -- w6 ow a rr.11b for her sir IwM.t STT ��.asw■b Uwt �.e..�e., 8tawn a Appfowrt DeAcwr11 N op"To n o" °� r 1Av4 v �w XArn2Xc61;4 nil co No. APPLICATION FOR powiro LOCATION PERM ORAN TED gr8P6cTOR OF 6NILONMI EINl$HEO 4JNSTALGED BY ,I i-1 tJ t W,§,.EI0SjQnr k SEARS- ,, j BII-Ray l►luminum`Siding Corp. HahfordAtea 8004SEARS-99 of Queens, InC Providence Area:888-SEARS 51 Nome S r i ' sr„. New HampsFire:800 829 2375s.,;- - '" 'AISEARS'AU-HORIZED CONTRACTOR^-'" .- JOB#_ 113 Cedar Street, Unit'S3 • Milfortl, MA 01757 FI D. No. 11-2320449" MAINE DC.N0.DD1B93,NH LIC NO ;MASSACHUSETTS LIC NO.120456 f VERMONT LIC NO. - ' -•.RHODE ISLAND LIC.NO.13707' NEW YORK CITY DEPARTMENT OF CONSUMER'AFFAIRS LIC.NOA730686"'NASSAU LIC:N0.H2704150000'-, SUFFOLK LIC'NO 21194HI`YEONKERS 1397 i.1UTNAM PC934' WESTCHESTER WCO613-He7 ? LONG BEACH GC2001 •'NEW JERSEY LIC:_NO.9949269 CONNECTICUT DEPARTMENT OF CONSUMER AFFAIRS LIC. N0. 00532774' f �IND WCONTRAC �J T - z p oS SOLD / f�� DATE TO F. _ ADDRESS 'v2+24ZZ CITY c � STATE G/ PHONE "JOB SITEACIDREcr(iFntcrFaFnm �� ' >,: ° -r « i ` •}' I r � APPLIEDVlplyLNVI"14DI&Q SYSTEMS General Description of Work at Above Address N ��LJJ Oi-)S Type of House/ afTOME O NRY Datewhichwlorkisscheduled,tobegin- !�� "- b " DatewhichwarkisscheduledltpI asubstantially.completed._!' �� QS� a Sears approved materials will be furnished and installed to these specifications. PLEASE READ CAREFULLY.ONLY ITEMS CHECKED"YES"ARE INCLUDED IN YOUR ORDER. YES N YES NO .. 1 EMOVEWINOOWSfromoperd hemfiteynowetlSton r ` r -22 ❑ �B, CIAfORDERWindows(inAdddlontaAbove) '- 2 FIRSTLEVEL #Openings #N& iind' UnLs 3. SEC DLEYELI #0 mngs #Ne iindowUnts " 4 ❑p 7 ROCEVEL #Op�emngs #New iindowlJhds p p +� 5 ❑ MENT #0pemngs #New WindowUnds 23 . CLEANUP=Alljob related debris willberemoyedfrom t0 e 6 -El THEfl " #Openings #New WindowUnds cncomplehonofwork REMOVE AND OISPOSFofewsdngwindows 7. REMOVALOFIA T orotlier:unds requtnngmodifiedinsiallahon INSURANCE wos #0 mns #ofunhs 24 INSURANCE`Allwolanari'sc6mpensatiouandliabll'dyismalmained Pe 9 —�— 25 MY-Maledtocustomerupon completionandfullpaymentisrecelved B ❑�nslall newPAINTABLE MOULI]INGS 26 ❑ AYMENTS (On non financed orders Is payable to installer o Ins,&St- , #of Openings dayofinstallation CI IlorCasmg M#of0 erungs I It.,, �✓Z. / 1 P , s 27 Addm6if"nformation 9 ❑ all new MASTpfOpenings 10 1-77 ew Window undsto have FUSION WELDED SASH' # 11 New windowundsto 'e,FUSIONWI:WEDFRAME # sC r A./ n .1 12 NewM4ndowundsmcludelnsulate.Glas i/S totaithickness e �p wi fliefollowngINSULATED GLASS OPTION S: (GL cp� ❑ a.) Tdpledlazdbouble LowEKrypto'filled R-1Draling,.. 8 Work NMto Be Done V_ (Included',Rctedlnaminsular@dsashes&frames) #of Unds ❑ 2b) Tnple Glaze Single Low E ArgoNKryp'on filled R 6 rating (mGudesin1ectedtoam/ruu/atedsashes&frames) #of Unds 1&) Double Glaze Single LOW EArgoM(ryp[onfilled � +/�, tit 'r (mdudeslnjacfedloaminsulatedsasfies&/James) #of UnffS` 1 ❑� Double Glaze Single Low E Argon filletl #of UnRs \ ❑ e) Sun Clean Glass(on wledor) #of Units ,- L k ti 13. ewwmdowuMsto have CAM LOCK(s)orLATCHLOCK1 ) T' �D E� Sir tf h1CR��Y 1 14. New WindowundstohaveNIGHTIVENTLATCHES alc+rFonuo P"TMee 15 ❑ ewwmdowunitstohave088CUREDGLASS �� '° DeposltlNlth Order 3 $ Q �r (Ell ❑12+ 16. .I .:Newvnndawundstohav W, ,il(1f2SCREEN'+ PaymentQn f (lu on casemeltlypeevndgw)# ) i +, MeaSUEC.Or Start 77 17 ❑ mdowstonaveGRIDSI Colonial Diamond Balanff@ueOrr ✓ , � fi ❑Ful ❑ii2 Addmonalinto SubstantialCompletf61( -`349^ $ 1---= 18. [ j Instal PVC oA AWMINNMtowmdowirames TotalAinbUntOf openings Balance to be Financed _ _' f 19. LKANI�SEALvnndowswdh3 , system If�fmzpc'etl balanc , a 'ble in monthly �Instaliments.of.. 20. LOROFWINDOWgStobe; i[e` OTimhertore 'f7Sandtone apprortmately $ "per�month payyah18 to Owner'-[o contractor,'* Z1. Tdal#Double Huns Total#TwoLKe Sldeis but rf financed by Owner then Owner will pay sold amountto the lending plus such Total#Casemerds Twal#ThreeLi[eStitlers merest and credit service charge of said lend g institution payable Tdal#H em Total#Dead Dte/P cWm directly to the lending Institution loaning:such mON R ulsesusla{aaaa y oPP to Owner and will execute a Retall'Installme uAaeriA Total#Avmings 11eLE. Total#Basemerd5gdekzA obligation and any documents required by s a�,nadea m ` Standard -- or Equal iendmg Ioshluhon m conhecfien with sir d loan. i� vnF " }rf15 iE$1N ANXSTI fs. p ,F SEA E � 5. dD BLINDS CURTAINS, DRAPES OR WINgOW,MOLiNTED AIR GQNDYnQNERS PRI(!R f0 TNE';.INSTALLATIQN O +YDLIR N WINI>OJYS. INSTALL ERSARE;`NQT£iESE±ONEfi, FORTi�EpEN10\IALOEIIEISfAL J►TIQNaFTHESETXPESOFITEMS.'. Notice:If financed,anyy holder of this Consumer Credit Contract Is subject to all CONDENSATION INSIDE TH E HOUSE DOES NOT INDICATE A WARRANTY PROBLEM. claims and defenses which the debtor could assert against the seller of goods or ,SALESMAN HAS NO AUTHORITY TO CHANGE ANY ITEMS OR MAKE ANY services obtained pursuant hereto or with the proceeds hereof. Recovery by the debtor shall not exceed amounts paid by debtor hereunder. REPRESENTATIONS OTHER THAN CONTAINED IN THIS AGREEMENT AND "OWNER REPRESENTS TO HAVE READ AND RECEIVED A DUPLICATE ORIGINAL'OF "OWNER" REPRESENTS THAT NONE HAVE BEEN MADE TO OR BELIED UPON THIS AGREEMENTANDTO BE THE AUTHORIZED AGENT OF ALL"OWNERS" OFTHIS' BY"OWNER".YOU ARE ENTITLED TO A COMPLETELY FILLED IN DUPLICATE PROPERTY UPON WHICH THE WORK OR THE MATERIALS ARE TO BE SUPPLIED. ORIGINAL OF THIS AGREEMENT. NOTICETO THE HOME OWNER(S),GUARANTOR(S),LESSEE(S),CO-SIGNER(S)." •"YOU,THE BUYER, MAY CANCEL.THIS TRANS ACTION AT ANY TIME PRIOR TE Contractor,at the expense of owner,shall procure all permits required by I= MID NIGHT0FTHE;THIRDBUSINESS DAY AFTERTHE13ATE0F THIS TRANSACTION 1.Do not sign this agreement before you read it or II it contains any blank spaces SEE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THI£ or If it does not contain everything agreed upon: .. 2.Amperson who shall have co-signed,guarardeedorslgg nod any credit application WILLBERESPONST. ERSCANA45%ACELED ADMINISTRATER THE TIVE or note relating to this agreement hereby accepts tobeLoundbythlsagreement IBLEFOf1A45%ADMINISTRATIVE AND RESTOCKING FEE. 3.Owner(s)represents that the contents an the back of this agreement Isatrue SEE REVERSE SIDE FOR ADDITIONAL TERMS AND CONDITIONS.BYSIGNATURI part hereof and has''heeri read and accepted by Owner. BELOW,CUSTOMER AGREES TO TH E TERMS OUTLINED ON THE REVERSE OF THII 4.ALL INSTALLATION LAP ORG ARANTEEDI(ONE)YEAR. CONTRACT. A F fj �A , r b G >w Cortfrecfor Acpepfed ; �° Salesman's Name + + 2 k. (Custom re Sl lHeris Saleman'e u gq: , Cicensa PfpIgn"ature 1177777 LIT i.r (Customer Sigh�lrere)` OZOe4 ei Cflry '1� Y' k j 1�5 d 41 �} �:p __ roY�rP NI�6a"meG 69e4 I . 6 ; , J� - Board ofBuildmg Regnlatidas License or registra on valid for indMdul use only HOME.1 OVEMENT CONbefore the expiration.date.. If found return to: Beg : t2©466Board of BuRdmg $vl2thand Standards tine AshburtaA a Hm1301Boston;Nia.1121B6 lement B[L-RAYALUMPaul McDonald ..4€tRp .ELINS7NT NY 11EL�; 'p' 1 a't at re 1- ,i l The Commonwealth,of Massachusetts D:epariment_of IndustrialAccidents Office of Investigations a 00 Washington Street Boston,TALI 02111 www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lezibly . Name(Busmesa/o gamzationtladividual): '�� I' co f G0 F V .. y \l I Address: 1 City/State/Zip:,/)1, N T `E Are you an employer?,Cheek•the appropriate b9 Type of project(required): El1. I am a employer with 4. I am a general contractor and I 6. ❑New construction employees(full andtorpart-time).* have htredthe'sub-contractors 2.El am a sole proprietor or partner- listed on the aziched•sheet. t 7• ❑Remodeling ship andhave no employees These sub=contractors have 8: ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp_insurance. 5. ElWe are a corporation and its required.] offices have exercised ffielr 10.0 Eiectncal.repairs.or additions,. 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑'Plum mg repairs or additions myself. [No workers' comp. c, 152,,§1(4), and we have no 12.❑ Roof repairs insurance required.l 1. employees [No workers' 13 ❑ OtheiI comp insurance,regtnred.] *Any applicant that checks-box.#1 most also ffiI out the section below showing their workers'compensation policy information) t Homeownets who submit this affidavit indicating they ate doing all work and than hire outside contractors must submit a new affidavit indicating such. ;Contractors that check this box must attached an additional sheet showing.;the name of the subcon9 acturs and their workers'comp.'policy imbact ion. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name; 1t'1 �7 U Policy#or Self ins..Lic #: 9�?"6 -9Z Expiation Date: ! / Job Site Address U rtr l/ !(� 11.. CitytState/Zip: f d Attach a copy of the worker's',compensation policydeclarntion page(showing the policy number and expiration.date). _ Failure to secure coverage as required under.Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civtl'penalties in the form of a STOP RK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of die DIA.for insurance coverage verificatiop. I do hereby certify rider the pains and penalties ofperjury that the information provided above is true and correct Signature: qq�C/11. � l'A 9 k j t" Date.. �0 � Phone#: Gk v 0 Official use only. Do not write in this area,to be completed by city or town official City or Town: PermitUcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#; 09/14/2005 16:24 51BE295857 SOS PAGE 02 17P IO DATE IMMR1nlryYY) A_CORD CERTIFICATE OF LIABILITY I' SUR NCE Ex Las_i De 1A Ds THIS CERTIFICATE 7S ISSUED AS A MATTER OF INFORMATION PRODUCER ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE $CS Rgeacy, Ina, HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 13.0. B= 22"93 - ALTERTHE.CDVERAGEAF FORDED BY[THE POLvESBELOW. Great Hark RY I1D23-0+}33B 300 Phoae:E16-4Sb-6067 FEcx:516-fl29-5657 INSURERS,AFAOROINGCOVERAGE HAIC Tf INSURED INSURERAJ n.mLeese m.oreyve �o.vY IN90FARIL Am.ele.n I4v Ywvu..fb. . 305 INSURER C! SImLeL.xa.elvm xnitie.ve.N. 19 Sil Rap AlXOOi4= 8idiag Cow.Road esNRERD a0 Elmoat S],maat RY 11003 - INSURERS: COVERAGES - - KAM ABOVEFOR . ANY RECURiEMENT97ERM RLCONOrtiON OP HANYCONTRACT OROTHEREOR1o90 MPM�NIN RESPSCI'ia HCOY 7NL9 RCERi1FICCA7EMR 9NETSSUEDaAImINd eeAYPERTAIN.TNEIN9UPANCEAFPORDFD BV7HE FOUC�9 OESGRISEO HEREIN 6 SUBJECTTOALLTHETFRMS.E%CLU9fON6 ANO CONDITIONSOF SUCH POLICIES.AGGREGRTELIMRS SNCWN MRY MAVERF'FNR�11CSO BY PAID CNRAS. - �� ROLICY NUMBER DATe DATE NVODIYT LTR NS TTPE OF BiSURANOE .. EACHOCCURRENCE Is1.000,ODO .iRJ'JPJ+ALUABLLRY PREMISES avmlPllca 5 100,0'00 DB/25/05 Oflf35/D6 . q, 8 cDMMERavuREUPJwLUBwTY SGL489A79-tl5 mow HnVm P�n1 9 51000 DIAIS106TADE ®OOCIIR PBt9ONAL AM INJURY S1r000,D0O G6t�RAL/�BORBsATE 53,ODO,.0010 PF==-,;,-CO MPIOPAGS 92.000,000 GENLAGCREG4[ELiMITAPPLIEBvEa: POLICY. :JEL�'T ,IAC - OOWINmI9RJOLE UMIT AIJUNWWLE RYLIABIL - ISAacidenf) S ARYAUTD BODILY INJURY 9 ALLOYANEMAUTOS (PG 9CHEDULEDA= HRalDAUeOS lRem:WYI � S I NOW4LVNEOAUR79 pRDPERTY CANAGE s ,(PefaztldmH - AUTaDN1IY.mACCIDENT S DARAGELIASILUT - EAAOG a ANYAUTO AtIT�DN6Y.J AOG 9 - - EACHDCGURRENOE S . e=25 RIMBRELV.LIABILRY AGGREGATE S OCCUR ❑-CLAWLN'MAUE - s OEDUMMM IF REMITION 9 - TORY LIMITS ER IWaDs CNN �gCg305933 09f24ID5 09/24/Db EL ECH $ Ac�ENT S1DtlIfDO yp�NE E.LCSE¢BE•EAEIPLOY 91000DO H dem®vamkr EI OBEhss•vouDYuMrt s$DDOD. OTHER s�cuu:PROULsmN9:hewo+ C. iiity 1.79038 10/D1/05 10/01fOfi Btat¢torg - DESCRIPTION OF OPEAATIONS J LCCATION5I YENICLEO f E==ONS AO➢ED BY ENDORSEIAENf 19P ECIAC PR9NBR7NS I CERTIFICATE HOLD ER CANCEI:GJLTION TOi4NOMI BHDULDANTOFTREAaOVEDP90RIBm pOLIGIE99ECANGELLBD BEPDRETNEE%PIRA'RDN CATETHEREOFrTNE ISSUING INSURERMLL ri DEAVCRTO MAIL 30 DAYS WAITM NOICETO THEGP.RiIMMOEHOLDPSNAMEDROTHE LEFTS BUTPNLUAETO D09D 6NALL - Repose NOOBUGATION aR WiBUUTYOF ART1MNO UpONTHES99DREJL FiS AGENT60R RERfff9ENTATN�. AUTKQRIZW RBPRE9EITATIVIE - Q ACORD CORPORATION 1M ACORO 25(2001M) Lor [ . >dlt7H PF.•RPARMANGz'WItmAW&DPPR S(E7rM5 �i Ll Soot LIT T3 1I3�1] tin . GPtI ! 'E �er38��axDlxl�@1�1��Pecdic�l-�e+i�N��1� Y� � fAtmgley�dmmaGml�s��G$(II�,782�F7'�rans� C'sPue65H�•� � - .. . 1So"IaN�Gam 7r�.,,initian lA�`41 - �'L�'dd0e[SIIPII�ES'$I�"�1E"�I�9S D�f�.�E12IIIIpIDd'1�fH;'�d�dBgPlf➢llmE1��; __ . — - — - - axhoc®d�m$�.�P�'e •�- taltngs . - .. � ... .. �' IL.�Y^.L'S��' ^�F �`+Hr>_Y+w'r••...T++1�+f.twJ/" •s$c'c 'Po$�#5.+ g ir.l u l .zn .�'�c, Al r