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9 WHEATLAND ST - BUILDING INSPECTION Y ' o p fl.�►N61Nll6T�E f*9ED- ND APPROVED BY T 4E 1dSi'L=DB PWR TD.A.PERW BEING GRANTED CITY OF SALEM No. Date is Pmpady Located in Location of to Historic NOW? Yes_No_, Building 91�1tf�k7LRtJD c> is Pmpwty located In bn Canwrvadon Area? Yes No_ BUILDING PERMIT APPLICATION FOR: Permit to: (Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool, ir/R lac 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: ,/ Owners Name -D IrR/-£n17UF1_ Address & Phone � '1� f9781 7y5=gy9� Architect's Name Address & Phone f t Mechanics Name 1�1 L 2eX 1l3c'Er;�rr s'r Address & Phone 4114):-o(�2P M,+ D 1 -2 'S7 S50g1 yi�r�-qd I What is Ow purpose of WkW RaC Ae rynq/T &A AIOd ar S M"W of bolding? fr a dw"M,for how many families? r WE hAdinp cordorm to law? 45�s Mbastos? Na EWfia ated cyst 5?X�Z_C ty Ucerwa r ►J k SUM LIMM K Bowe Improvement 11- ignature of Applidqny SIGNED UNDER THE PENALTY OF PERJURY DESCRIPTION OF WORK TO BE DONE �.✓eAJfOx ✓S Ld l7 No SjbFUC,-rU2ft/ r fwwc'� ->°� Bit MAIL PERMIT TO:,i i i .t No. APPLICATION FOR PERMIT TO LOCATION g GJJfEfiTLA-�D S i PERMIT GRANTED AP OVFD INSPEQTMOF BUILDINGS SOLD, FURNISHED & INSTALLED BY Sales: 1-866-466-3853 ® ® oo Ril•Ray Aluminum Siding Corp. Service/Repairs: of Queens, Inc. 1-888-245-7294 11-232 D. 449 190 Cedar Hill Road • Marlboro. MA 01752 JOB A'5 YD9 7(9U 14 MAINE LIC.N0.D01893•NH LIC.N0. •MASSACHUSETTS LIC.N0.120456•VERMONT LIC.N0. •RHOOE ISLAND LIC.N0.13707 NEW YORN CITY DEPARTMENT OF CONSUMER AFFAIRS LIC.N0.0730686 • NASSAU LIC,P10.H2704150000 • SUFFOLK LIC.N0.21194HI •YGNKERS 1397 • PUTNAM PC934 WESTCHESTEERR WWCC0613-HB7 LONG BEACH GCC20`0011Ly't- NEW JERSEY LIC. NO, 9949269 • CONNECTICUTCONTRACT DEPAARRTMENT OF CONSUMER AFFAIRS LIC. NO. 00532774/ OW TOLD /ic-�/. .'�' ,,S�T.�//v� ',YP /CJ��,��, r7MC ■ DATE ®�?p ADDRESS ��'7`•�if©�c/NpT''"� 6 "'"� STATE �4 ZIP Q/ J 7�2 PHONE HOME, WORK( ) EMAIL JOB SITE ADDRESS (IF-DIFFERENT) APPLIED VINYL WINDOW SYSTEMS General Description of Work at Above Address: Type of House: FRAME Cl MASONRY . Date which work is scheduled to begin: Date which work is scheduled to be substantially completed: a I 1 Approved materials will be furnished and installed to these specifications. PLEASE READ CAREFULLY:ONLY ITEMS CHECKED"YES"ARE INCLUDED IN YOUR ORDER. YES NO YES NO 1. M❑ REMOVE WINDOWS from opening re they now exist on: 22. M J SPECIAL ORDER Windows(in AdditionteAbove) 2. ®❑ FIRST LEVEL #Openings #NewWindowUnits ❑3. t SECOND LEVEL #Openings #New Window Units Jf 4 ❑❑ THIRD LEVEL #Openings #New Window Units 5. 14❑ BASEMENT #Openings_7 #New Window 1 23.,g(❑ CLEAN UP-All job related debris will be removed from property 6. A❑ OTHER #Openings #New Window Units on completion of work;REMOVE AND DISPOSE of existing windows 7. ❑fit REMOVAL OF METAL or other units requiring modified installation and/or storm windows #Openings_ #of Units 24.. INSURANCE-Allworkman's compensation and liability is maintained 8. ❑� Install newPAINTABLEMOULDINGS 25. ❑ WARRANTY-Mailed to customer upon completion and full payment is received 26. A'PAYMENTS-(On non-financed orders)is payable to installer on Inside Stops :- #of Openings �/ day of installation Clamshell or Casing #of Openings P7 L>0❑ Additional Information :9. ❑ Install new MASTER FRAME #of Openings 10. a C] New window units to have FUSION WELDED SASH # 1� 11. 4❑ '.New window units to have FUSION WELDED FRAME # zl 12.A Q Newwindow units include insulated GlasO/8"total thickness with the following INSULATED GLASS OPTIONS: ❑❑ 12a.) Triple Glaze Double Low E Krypton filled R-10 rating 28. ❑ Work Notto Be Done (includes injectedloam insulatedsashes&Games)#of Units ®❑ 12b.) Triple Glaze Single Low E Argon/Krypton filled R-6 rating 2 M (includeiinjectedloaminsulatedsashes&frames).#Of Units," Q\ rQ ❑❑ 12c.) Double Glaze Single LOW EAtgon/Kryptonfilled o (includeslnjectedloaminsulatedsashes&Games) #Of Units M❑ 12d.) Double Glaze Single Low E Argon filled #of Units Q❑ 12e.) Sun Clean Glass(onexrerior) #of Units 7 13..X(;❑ New window unhsto have CAM LOCK(s)or LATCH LOCK(s) TDtal Sale Price $ 14. ❑ New window units to have NIGHT/VENT LATCHES ,,. „IN01CATE FORM OF PAYMENT p 15. ❑�g N wwindowunhstohaveOBSCUREDGLRS 01/2 Deposit With Order < Q 16. O❑ New window units to have HALF(1/2)SCREEN Payment on (lullscreenon casementrype window) Measure Or Start � T rl 17 'M❑ Windows to have GRIDS Colonial`; Iamond Balance Due on ❑ 7Full D41/2 Additional info 8.��� 46"i2v" Substantial Completion T 18. II❑ Install PVC COATEDALUMiNUMto window frames Total Amount of Color e #ofopenings Balance to be Financed $ 19. ❑ CAULK AND SEAL windows with 3 point system If financed, balance payable in monthly installments of 20. ❑ COLOR OF WINDOWS to be NWhite ❑Timbertone ❑Sandtone approximately $ per month, payable by "Owner" to contractor, 21. ❑❑ Total#Double Hu.- �j Total#Two Lite Sliders Z but if financed by Owner then Owner will pay said amount to the lending plus such Total#Casements Total#Three Lite Sliders interest and credit service charge of said lending Institution payable Total#Hoppers Total#Dead L to/Pictures directly to the lending institution loaning such monies An pill Have Total#Awnings .�_ Total#Basement Sliders to "Owner" and will execute a Retail Installment eeengppnea. Standard or Equal obligation and any documents required by such ieterrea PSpmen6 q lending institution In connection with said loan. Jnteresrvrlp;Aanree.. *CONTRACTOR IS NOT RESPONSIBLE FOR ANY EXISTING SECURITY SYSTEMS.PLEASE REMOVE ALL SHADES,VERTICALS, BLINDS, CURTAINS, DRAPES OR WINDOW MOUNTED AIR CONDITIONERS,PRIOR TO THE INSTALLATION OF YOUR NEW WINDOWS. INSTALLERS ARE NOT RESPONSIBLE FOR THE REMOVAL OR INSTALLATION OF THESE TYPES OF ITEMS. Notice:If financed,any holder of this Consumer Credit Contract is sub eGf to•allL CONDENSATION INSIDE THE HOUSE DOES NOT INDICATE A WARRANTY PROBLEM. claims and defenses which the debtor could assert against the seller ollgoods or services obtained pursuant hereto or with the proceeds hereof. Recovery by the SALESMAN HAS NO AUTHORITY TO CHANGE ANY ITEMS OR MAKE ANY 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 RELIED UPON THIS AGREEMENT AND TO 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. NOTICE TO THE HOME OWNER(S),GUARANTOR(S),LESSEE(S),CO-SIGNER(S)." "YOU,THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO Contractsigntesagre agreement of eorey you readitocure or ontainuian blank MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. 1.or not sign this agreement before you read it or if it contains any blank spaces SEE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS or y it does not contain everything agreed upon. RIGHT.ON ALL ORDERS CANCELED AFTER THE RECESSION PERIOD,CUSTOMERS 2.Anypersanwhoothisagreemsignedebyacceptdobebo bound any credit agreement. WILL BE RESPONSIBLE FORA45%ADMINISTRATIVEANDRESTOCKINGFEE." or note relating to this agreement hereby accepts to be bound by this agreement. 3. Owner(s)represents that the contents on the back of this agreement is a true SEE REVERSE SIDE FOR ADDITIONAL TERMS AND CONDITIONS.BY SIGNATURE part hereof and has been read and accepted by Owner. BELOW,CUSTOMER AGREES TO THE TERMS OUTLINED ON THE REVERSE OF THIS 4,ALL INSTALLATION LABOR GUARANTEED I(ONE)YEAR. CONTRACT. DATE d�o Z �U ContractorAccepted Prinl Salesman's Name y// Signature (Cu ne 'gn Nere) Saleman's License No. Signature C2004 BO nap G.o All All neserved 0904 (C"s omen Sign r¢J Board of Building Begulatiuns and Standards. License or registration valid'for individnl use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards Re .20456 - one Ashbui=ion Place Rm 1301 7P008 Boston,Ala.02108 ptement Card 81L4?AY.Al_.UM PAUL GATCf . 40 ELMONTNY ,1A03 .;�,dminiytratar Not valid without sign�tu� The Commonwealth of Massachusetts VDepartment of Industrial Accidents office of Investigations 600 Washington Street Boston, MA QZIII w1vW.Mass.govIdia Workers' Compensation Insurance Affidavit: Bufllders/Contractors/Eleclr cians/Plumbers ADnlicant Information f Please Print Lesibiv 1_�IamB (Busmessrorn�anizatien/Indtvidua�tJ): Address: [ 3 cc t > 7 City/State/Zip: ��t � r �41 Are you an employer?-Check-the approptiate box: - - - Type of proIject(required): 1- I am a employer with 4. ❑ I`am a general contractor and I6. ❑New construction employees(fUR and/or part-time).*_ - have hired the siib-contractors 7. Remodeling 2. I am a sole proprietor or partner- listed on the attached sheet $ "' - ship and have no employees These sub contractors have - 8: ❑Demo/I lit on working forme many capacity. workers' cow.inctrrance. q- $ding addition [No workers' comp-insurance 5. ❑ We are a corporation and its 10:❑Electricalrepans or additions required_] officers have exercised their . - ri� t of ex on er MGL 11.❑Phmabmg repairs or additions 3. I am a homeowner doing all work emPtr. P I Myself. NO workers' comp., C. 152„§1(4), and we have no 12.❑Roof kepairs insurance requirad_].t employees. [No workers' 13.D Other comp.insuurance xegnired_] *Any applicantth st checks box#!must also fill out the section below showing their worker'compensation policy nuc=arion ' Homeowners who submit this afndsr it indicating they are doing all work and then hire outside contractors must submit a new afndavit indicating such. LCoutraacrs that check this box must attached as additional sheet showing the name of the sub-contractors and their workers'comi policy inioumation. I am an employer that is providing workers'compensation insurance far my employees Below is the policy and jab sire information fn Q surasP Company Name- ,11,f/i rxw14 Policy#or Self-ins I.ic-#: t-j C- 7s in 'S ... Expiration Date: 1� / — -0pcezp Ci ; /State/ Sob Site Address_ R O�EATL.9 r�U S 1 Attach a copy of the workers' compensation policy declaration page(showing the policy'nnmber and expiration dafe). Faihae to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of II criminal penalties of a fine up to S1,500.00 and/or one-year imprisonment, as well ascivil penalties in the-.fog of a STOP WORKORDER and a fine of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations o�lie DLA forincntanev coverage verification. Z do hereb c under the pains and penalties of perjury that the information provided above is trfuc�e and correct 5`i afinr bate; CU Phone Official use-only. Do not write in this areq to be completed by city or town official City oI Towr. Permit/IA'ause#. Issuing Anthority(circle one): 1.Board of Health 2.Bu/ding Department 3. City/Town Clerk 4.Electmcal Inspector 5.PiumbE:bisp]eLtor 6.Other i ContacfPerson• £hone.#; '%3'X412095 16:24 5160295057 , scs PAGE 02 . GATE SLiMIDDiYYYTI p �+ A .e1 h •pig �-�q[ �,p �, !+ OP In D9/1a 1p5 c ACC1 ,� tiERT FIS�f-'�� � C.,S- L�CL7lLe 1 ` H6'r� '�6 'r+1�TE IS _D AS A MATYfi OF=NFORMATION PRDnUCEa QNLY AND COIS CFRMF1C NrERS NO RIGHTS UPON THE C_RTiF1=ND RpLDER.THIS CERTIFICATH DOES NOT AM=ND.=�T=ND OR SCS Agaacv, Ina. AL•�R7HE�COVERAG5 AFFORDED OY TWE FOLIClSS BELQW. 'P.O. 8Cx 220693 NAIG 11 G-an' Aoeaae - finitE 300 `Beat Neck NY 11022-Dh93 INSURERS AFFORDING COVERAGE ahoaecE16-a_8b_g007 axxE16-889-58.57 INSUR�LA! wmLnege xv.vsevee �°°� a.9305 INSURED - INSURERA wciv.n um. a.svu�v^ m. INSURER Ct ...Lab•xu:svu xaeve.m. [b. 3i1 8ny A-�� gtdiag �pa` • INEuRER a0 paaaat}8 INSURER'E: F.3mOLt AY 2.1003 CDVERAC=-S UPAN_ HAr BEEN ISEUWTO THE WsupMm NAMED All RF9PaTTO WHICHITHIS RCERSIFINC A0.r EL9EU-c NOTWITHSTANDING TIIE POLICIES OF INS�M ORLC➢N6!110N O ANY cOENIss ➢R OTHER DOCUMENT TERMS,E=LUSION6 AND CONDITIONS OF SUCH ANY aEOUBLRAEN ii� AFFORPPF�BYTHc PDUCIES fY^.SCRiBE➢Hc-REIN LS SUBIELT'10 Al-1-THe I L0.m ANYPERiA1N.TtE INSURANCE UCEO BY PAID CLAIMS. ➢nT IMMI➢DIYY eT Dpp,ODO FJUCI�-AGGREGATcllMR9 SH➢WN MAY HAVEEEEN FlED ` 4 POLICY NUM➢SP. I DATefMMlOOA'Yl EACH OCOURRENCE I- -` LTR NSAn TTPE OF INSURANCE _ Gonna- p6/25/D5 OB/25/D6 MEDRE"E-(Any P+ E 5,000 a 89A7 B-tl 5 M[D FJ(P(AAYmx,�A1 R Y- cDMAr-x➢IAL➢s1ERALLUaILnY 8GL- PE s1,DOp,Dpp CtAIALS L1Atk OCCUR PERSONAL S A➢ir.B' 93,DDD•UDD EENEruLABGReGA-M ATE a2i00A,D00 PRODUCT3-COMPIDP A= Gv'TaAGGF�GA-MUMITAPPUE5PER:n JE�6r LOG COMBINED 9MGLEtA1IT ,5 POLICY IFs ec3dFT1) AUTOMOBILLIASILITY ANY AUTO - ( Pm-)RY 9 A OWNMAUIOS. licEDHEDULEDAUSDS pe➢rzimiuK AU S HIRED AUTOS NON•DWNEDAUD35 (Pat= AMAGE E ml) AUr6 ONLY•EA ACCID_TR S 1 EAA= T7WN II}�G--A•TR,ACELL4BIL7i7 ) ONLY: AL�GIS HAMYA RO EACHODCURRENCE $ A=R-GATE 5 EXCES➢NMEREL• UADILDY - s OCCUR �CLASASMAOE 9 s DEDucTIB1E . .. IT'OFi1'IaMrrs > t H•rION ; A, FL rACHACJ➢ENT 51DDp Dp YlORNERSCOMPEN9A•aQN.At>D D9l24/05 tl9j2-/05 51DD000 EMPLOYEPSLUU3ICFTY SCC93DEgS3 Ed•DISEASE•EAEMPLOY A FRD +ETDRIPAR'f�lEWF UTNE EL➢LSEAEE•POLCY'UMR 55DDDDD Exc oEv N allll alder IALpp➢yLSIDNBheIAw Sta✓4=iA=Y - 1D Dy./05 i0t aYmnE C IIisahiT_ity I1794038 OESGR1l,ION➢F'OPFRAMOHE Ip.LCCATfONS I YcNICLES fEXCLiL+IDHS A➢➢ID EY ENDORSEMENT I�ECIW-PRON9IDNE . CANCELLATION - REPOREDAYN WPIRATID CERTIFICATE HOLDER TDWSOb= 6HDVL0 AIt OFTHEAaDVEOMOR,, ,L ENF531DATO MAIL' D OAYB WaRT�1 OATETHEREOFrE13SU1N0INSURER WILL EN00AYORTO MAIL LVaETD D09O 9HALL NDC OETO•THr pmn- ICATB HOLDERNAMEDTO T'MLEFT,BUT FAI - IIdP➢SENO OBLIGl+TIOH DROaBWTY OF ANT WOM IL'ON THE INSURER,ITS AGEHTE''OR BkPfcf?ENTIdI'lu>� J Affl'HORiLE➢REPRE9ENTAT / / @ AGORD CORPORATION 19 $ ACIIRD 25(20011138) - REF 4 r+g- taNirt . 1 _ oKl&ng�t�s;s Ms I }pGH Rr� O 'MA NE'WRY J,.M&ch Amon®m!?fP4m' AP_ .ln1A E REI savmgs;will�+eyepdnlAu �P e rile toP�eandltrgyle �I�ns�I-c'�IG�s web On. rnrinnre-�r¢urmainnl�il�=8[iB-'7�-'-'� . r _ -1N11 i ✓ LLnl li " . _ I' aol N ; 1 14 ,... '. d�hl 43cAC� dtuW�,n�annimg' la =SbPUL�rz Vim.rmnos nrm 3o aep vvnole.pmduc�enersS'P•�°�e..NBC rdnng=�.de�rmm..d�atcedc���rnimnuo:�T i co�d}notGazidsps;�mcWndu,^cseYS. s E '