7 COUNTRYSIDE LN UNIT 1404 - BUILDING INSPECTION � The Commonwealth of Massachusetts
p a Board of Building Regulations and Standards CITY OF
Q Massachusetts State Building Code,780 CMR SALEM
' Revised Mar 2011
Building Permit Application To Construct,Repair,Renovate Or Demolish a
One-or Two-Family Dwelling
t This Section For Official Use Only
Building Permit Number: - Date App ed:
n(1 Building Official(Print Name) Signature Date dA
�\ J SECTION 1:SITE INFORMATION v
V V pe1Aress: C' dam sors Map&Parcel Numbers
n . sses
nP3 0wok p r
1.1 a Is this an accepted street?yeses no Map Number Parcel Number = r
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft) ,r--
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record: //�� -�
Sdn � S l�-_2✓t Sg. I� w\ t�fi 01�7U
Name(Print LJaI�- City,State,ZIP
�oo,t+ry S+`fie G ✓` tqq 97b- 70
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK=(check all that apply)
New Construction❑ 1 Existing Building❑ Owner-Occupied ❑ Repairs(s) Alteration(s) ❑ 1 Addition ❑
D I Number of Units I Other ❑ Specify:
Brief Descri tion of Proposed Wor
h !A l l Ic Chevt 111 0 + t b
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1.Building $ 4� 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $
C3 Standard ChyiTown Application Fee
❑Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $ Total All Fees:$
Suppression)
q Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ /r R— ❑Paid in Full ❑Outstanding Balance Due:
rnAi l_t_0 1N S-P S>✓ . > Z t
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) /� cm
I`0 &8e-21] .wr License Number`l Expiration Date 4'
Name of CSL Holder
I -? R- � �� L v-\ List CSL Type(see below)
No.and Street Type Description.
U Unrestricted(Buildings up to 35,000 cu.ft.
City/Town,State,ZIP "1 R Restricted 1&2 FamilyDwelling
M I Masonry
RC I Roofing Covering
WS I Window and Siding
UDI-(�a9 ��f39 SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Imprgvement Contractor(HIC) 1 Q ( 191?
Ht m� HIC Registration Number Expiration Date
HICI gay Ni?or C Regiment Name_
No:and t5eet
i APP.u1�66r}G MA- olJy. 1f Dl`6�1'�-oZ t{ Email address
Ci /Town,State,ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§25C(46))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes .......... No...........0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
/,PL,1'
I,as Owner of the subject property,hereby authorize r 4' ECJ l"
to act on my behalf,in all matters relative to work authorized by this building perinK application.
C / / - '03— !S
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained d{in this applicartion is true and accurat to the best ofluy knowledge and understanding.
F V 10,r_[L ,,U ()d
tJ�A t Lc. ( /- 2 3-/5
Print Owner's or Authorized Agent's Name(Electronic Signatur Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
%vww.mass.eov.oca Information on the Construction Supervisor License can be found at www.mass.eov/dgs
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
' 1
' Tile CoarcwroMMMI&eMM&CIzeseft
Deparft2zeal ofitdtsi fed A=Wen&
®JFZeeaj atteg
— -. 600 WaskinaganS' e¢
.+Ro5_o!aP AM 0°21-7t
- -
'' t^JF1PNl a2^.iS^a�'f9tP�fciFff
V' 0Fi-eF3' COMpeaasaid oa?Instwanee Affidaviftd> e�e�s/EQlQfiaaet��s/�9�ro�ee�asas/ 'H�°
_ Please Print F etzr7ol!v
U(1217e(13usincss/Om_anizationgndividmd): 0jlt 4- A/9-ng--
Address: qoR 60540 ���nnV�Nptke,
City/State/Zip:_ y�vr , /tll - 0/6-4/br ?hone: SD19
Are you an employer?Check the appropriate hos: Type of project(required)-
El 1 am a employer frith :1_ I am a general contractor and I 6. ❑New construction
employees(full and-or part-time).-- have hired the sub-contractors
2.[] I am a sole proprietor or parmer- listed on tits attached sheet= 7. Remodeling
ship and have no employees These sub-contractors have a. Demolition
working for mein any capacity. workers-comp.insurance. 9_ Building addition
[No workers'comp_insurance 5_ We are a corporation and its
required.] officers have exercised their IOC]Electrical repairs or additions
3. I am a homeowner doing all pork right of exemption per MGL 11.0 Plumbing repairs or additions
myself.[No workers'comp. c 152. §1(1),and we have no 12.0 Roof repairs
insurance required_]4 employees.[No workers' 131 0 Other
comp_insurance required_] 1.
"Any applicant tba chcclm box 01 most also hill outthesection below shottine theirundm s'cumpmsaaion policy mfmmatiom
'ilomen mem who aittbmit this ah'tdavh indicatine they amdoimall mark and then him ooWdecmnmetoa mastsubmitantem atridarit imlicaftsuch.
=Contractors that check this box mustmtached an additional sheet shown=the name ofthe sub-comotctoa and theirnmilm'comp,policy infmmation.
I alrr asGrrsptOPG'i fIt[it i.L'prrrviding rvorlrers'conpenration insrrrancefar ray ePtplayeer. below is trte poCrcy enc job sP
itJer,:t¢rinrz I
insurance Company Name= `�+1 r/��Gy �r'J�/i e -f
Policy 1t or Self-ins.Lii/c �Ci ® 1 / / J 1Y [ 3 Expiration Dam:
Job Site Address- 7 00 v4*,-: �r�Jc9 City/State/Zip: s [� ✓h /� A
Attach a copy of the workers'comps ensation PONCy declaration page(showing the policy member and expiration date).
Failure to secure coverage as required trader Section 25A of MGL c_ IS?can lead to the imposition of criminal penalties of a
fine up to S 1500.00 and/or one-year imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine
or up to 5250.00 a day against the violator_ Be advised that a copy of this statement maybe forwarded to the Office of
Investigations ofthe DIA for insurance coverage verification.
I co her ebb;ceimvg�imiteer/rt1ke nauzs mrd penaWes q,�pequo that tie iatfis,-te&M provided eb/ave is&me ane car:ect
Sistmture: �t V w� �'t``^�e Date:
Phone 8:
lJ,rICkI rase onIV. ?-3O r<at 19.&a bz�iis area,ro be r_ortl7leferf by car or raPln offr_cf¢i
City os Fot^fin:- 8'erutit/l.icense#
issuing Authority(eirde one):
.1.!Board of slcaitlr 2.Building Department 3,Cit-yrowa Cleric n Eleetrscal inspector S.Plumbing lasneetor
6.Other
Contact Person: Prone ii
�d CERTIFICATE OF LIABILITY INSURANCE DA-��DDnYYY,
02124/2015
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMD, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
SELow. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT; If the certificate bolder is an ADDITIONAL INSURED,the pokey fles)must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and Conditions of the policy.certain policies may require an andorsemem. A statement on this certificate Does not confer rights to the
certificate holder In Rem of such endorsements).
PRODUCER CONTACT
MARSH USA INC. PHOFAX
TWO AUJANCE CORER Ha-
$660 LENOX ROAD,SUITE 2400 E44M
ATLANTA GA 30326
INSU AFFORDING COVERAGE I NAIL
10D492-HoMO-GAYMS-16 iNSURERA_Slendfaetlremanre C-Vany 126367
INSURED IN B:Zmlth ARM=kwaan Co Jim
THD AT-HOME SERVICES,INC.
OBATHE NMEOEPOTAT40MESERNCEB UIBURERC:NBDr118mp51tilE Els CD 12311
2690 CUtABEf iLAND PARI(WAY,SUITE$00 IxsURanD_amob Wwd Umlrsnoa Company 123817
ATLANTA.GA 30339
If0.9URER B:
COVERAGES CERTIFICATE NUMBER: ATL-003242685-09 REVISION NUMBER:7
THIS is TO cERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
R YPEOF P oL f LIMITS
A GENERALLIAILIY GLO48MI446 031012015 MMI12016 EACHOCCURREI4C'c Is 9ADO,000
COh1h1ERCIAL OENERAL LULaRM ENWAGETORENTtU P ne2a1 VS 1.000,000
I 1 1
CLAIMS-MADE o OCCUR UMfTSOFPOUCYXS MED EXP Anyone 23MDOJ 15 EXCLUDED
�— OFSRi:S1MPER000IS 9,000,000
PERSONPLSA[NINNRY
GENERALAGGREGWR Is 9•OwpD
GENT AGGRE�GA—TE1 UNMr APPLIES PER ! I PRODUCTS-COLINOP Ace I S 9,000,000
X POUCYI 1JEC• n LOC I I $
8 I AUWrAOeILE L 111LITY BAP2938869.12 0310112015 I03M 016 COMB' 1 stAKEWT 1,000,000
—X I�AUTO I IF*SOMLYI"N.lul RY(P—spam) $
ALL OWNED I 8 EUULED SELF INSURED AUTO PHY DMG I BODILY INIURY(Per au.'denglS
AUTOS ANS
NON-0WNED 1 PROPERTY DAMAGE S
HIREDAUTOS 1 AUTOS ` 1 P t
I 5
UMBRELLALIAB OCCUR / EACH OCCURRENC_ S
EXCESS UPS (CLAI1S MADE AGGREGATE S
G I I Is
CI WORMS COMPENBAneN IN 14 ( J I 15 16 X wC MTU• O
C IANO EMPLOYHl3'LIReRNY WC0177$1495
ANYpRoaRlErowPARTNewE7SCunvE YIN (AK KY,HH,NJ,VT) 0310112015 03)0112(116 1,000,000
OFRCERn¢s1BEstExCLUOEOt M NIA E FISEASE GENT IS
D paandaunyle xHl -_ ... WC017731494(FL) 103101/2015 03N12016 Fy, -�Q.Mpta S 1,000A00
a rs.aeaole ummr
tinea 00ARnwedun AddlLEL OI3EPSE•POUCY
onalPage 1 1, D0,000
DESGRIPnON OPOPERATI LIMIT s
{
OEseRwnONOFCPOM'noNSILOCAMNSIVEHICLES[AVaMAC'ORD1%,ARNUonal RmnmlS 5d1Mub,Rnn>respar le mpam l
EVIDENCE OF INSURANCE
CERTIFICATE HOLDER CANCELLATION
THO ATdiOME SERVICES,INC. SHOULD ANY OF THE ABOVE OESCRIBaD POLICIES BE CANCELLED BEFORE
OBATHE HOME OEPOTAT-HOME SERVICES THE EX'PIRAMOM DATE THEREOF, MOTTOS WILL BE DELIVERED IN
2455 PACES FERRYROAD ACCORDANCE WITH THE POLICY PROVISIONS.
ATLANTA,GA MM
AUTHORUED REPRESENTATIVE
of Mmeh USA h,A
i ManaW Mukher)se _JA.&L%AOa% r. �jd„F.tt.AAA�.es.
01988.2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD
�ylei
— _ aq
-
� .�:`m -C..��.t✓ �p�-}a���,���1z��re�.r,��� ��
' Office of Consumer Affairs and Business Regulation
10 Park Raza - Suite 5170
Boston, Massachusetts 02116
Home Improvenippi..,Contraetor Registration
Registration: 126893 Type: Supplement Card
Expiration: 8/3/2016
THD AT HOME SERVICES, INC
MARK NIADNA ;`: ; .: ----_:._._-•---.__.__.__.__.�.__....__..
2690 CUMBERLAND PARKWAY SUiT ' O,A.„ ..
ATLANTA, GA 30339 -
i
Update Address and return card.Mark reason for change.
SCA 1 4 POM-05111 Address (�j Renewal Employment rC`^_•( Lost Card
r•'.✓!<(' y'lJJl d/4lf}NtY(�!'!/f��jlfi♦•.N/f!(l4.iC��.3 '
u
-�-. 2tOcc of Cementer Affairs&Business Acgmado» License or registration valid for individul use only
OA1E IMPROVEMENT CQNTRACTOR before the expiration data. I£found return to:
Office of Consumer Affairs and Business Regulation
Reglstratign::.12'6893- Type: 10 Park plaza-Suite 5170 i
Explrattaini;: 26.6. , . Supplement Card Boston,MA 02116
THD AT HOME SEjtV10E,S;,1k; :
THE HOME DEPOj;AT, Fr SERVICES
MARK NIACNA
2690 CUMBERLAND PARK1V4Y S 4 --}`LL L=p.`� ( l� {�—___
X%%M,GA30339 Undersecretary As validwithou signature
t'
Massachusetts-Department of Public Safety
Board of Building Regulations and Standards
Construction Stipenicnr S{icciath• _
License:CSSL/0898'A9
Ii1 ry�F .�
ROBERTMCZO)IUT ---
272SL
SalmMA 01970
i
fi... .11 /i to tb Expiration-
. Commissioner 07/088018
i
��- CrI Y OF SALEA MASSAa iLJSE TTS
{ S BuaDINGDEPA=axr
120 WASHINGTONSMWET,3D FLOOR
7kL.(978)745-9595
FAX(978)740.9846
KIMBEI2LEYDRIScbLL
MAYOR Tl omm ST.PIERRE
DmEc roROPPLMIJCPROPERTY/BLIILDING OOMOSSIOMR
Construction Debris Disposal A,ffidavit
(required for all demolition and renovation work)
in accordance with the sixth edition of the State Building Code, 780 CMR, Section 111.5 Debris,
i
and the provisions of MGL c4Q, 5 54; Building Permit# s is issued with the
condition that the debris resulting from this work shall be disposed of in a property licensed
waste deposit facility as defined by MGL c 111, S 150A.
The debris will be transported by: OU L `tp ua
(name of hauler)
The debris will be disposed of in:
(name of facility)
(address of facility)
I
Signature of applicant
It-- 2D - �S
I
Date
1
Simonton Windows
F�- F Vantagepainie
` hs,-cc C.asa^lan' Vingt-V8-`GlSss Argon Lr,.iE-I Lantira;ed Class No
Gnc,
�i' f>sii3sMat r: . Ventana batlenteViniio-3.18 mm Vidno ni gdr Los, E Sin vidrio
laminado-Sin rejIllas
i951ai1Y1"'•�
- CPD:SBP-A-61-10331-00001 08-09 CS
ENERGY PERFORMANCE RATINGS
EVALUACION DE RENDIMIENTO ENERGETICO
U-Factor i—? SnEar Heat Gain Cne'ficient
Fzctor-U ,
i C arL;lerte:Gansr:va d5 E.- o Scis
0.26 1 .48 0.23
{USII-Pl (M0?ricor:Q
ADDITIONAL PERFORMANCE RATINGS
EVALUACION SUPLEMENTARIA DE RENDIMIENTO
a Visible Transmittance
._ TWS.S=ion de Loa VI59Gte - i -
0.44
Manufactu.ar stlpuieles tnaf nose raPngs conform to aCpliCab!e NFRC pNCEdJres for defemtlring Mole Product perforMailq¢.
NFRC roti rgs are detorm r.ed for a[xed s s of acv.mrmenta!conditoos and a spsoi(C prcduot alna.NFRC does not rgcarlmore
any Product w does notivffirars Pte sodab%f of ary prcdoct for ar;,spn;T,c u33_cdlrsm't man. CNraYa dtefditd5¢:r Me, - -
Este fabdca ce despots qua vaIW95 Nmtplan Nrtbs ptoeewnAeaPs apucalas de Al°P.0 Ear3 da'.cre!i,Wr et;aWimlara'q sial Gil
mducto.Los t2lGes usados per f,FRC son detenamadd5 po,or corryunto f jo da cmd.c,ones alntientaies y on tam2no de
Product esoe6fico,NFRC no recom emia ningu:product y no garsntlTa qua el product sea adecuado para or use e:peCifco.
cWSsUte con ce fast.debt iabrlcW14 p313 el Use eprope"o de Este proctudr W.WV rdno erg
' � y
Unit qualifies for ENERGY
STARe region(s):Northern
North Central,South Central, -
'' Southern.
SIC:29
`v D'uel:fiev
j DP.+55 -55 - IND:RTested i e:36"x72"/C-R55
!
i J!
Florida Product Approval:FI-1007
Applicable Test Standard(s): ANSI/AAMA/NVVVVDA 101A.S.2.97,AAMAMVDMA/CSA
101A.S.2/A440-05,AAMA/VDMA/CSA 101A.S.21A440-0$
A440Si-09 Canadian Suppl
r
9664606/04-1 J0049 BASOPS THDShrewsbury - 8842340 _
Keep this label for possible ENERGY STAR•e rebates.To learn more visit w.rvw.energystar.gov.
Guards esta etiqueta posibles reembolsos ENERGY STARa•.Para conocermas acerca de esto,visite -
t
9
Simonton WIr.dv,vs
61 DO 'Vantag Pwf
Pzi— Ipere� ,rot 5 Arwor _ - gh
Glass `;Vi;T;Grids
•:a
Pueria de patio, V!, iic-3.13 mnt`,uiriv rar:;pladc 4rgdn-L ,E .Sin
✓idric(arY inado Con retili''s
"�r7aili6Ly.i'
GPD:S6F-A-39-01895-00001 06-08 PD
ENERGY PERFORMANCE RF.TINGS
EVALUACION DE RENDIMIENTO ENEFGETICO
U-Factor ! S.Aar Heat Gain Coefficient
.n or-U ;oefcipnte'Gana,;,d?E::ergls
0.301 .70 0.27
I
s" ADDITIONAL PERFORMANCE RATINGS
EVALUACION SUPLEMEMARIA DE RENDIMIENTO
Visible Transmittance^
Tr.,nsmmon lv UZ'V LSihle
0.50 {
I
blBncfJtur rstir.JEtBS Ihat[n?sS reIrCE CJn`orntc:ry vri' Ie NP JploCshr?5 fs'd�a:nnlr 7 .i.t_protlu�pfrranca-
\FRC .-e3B[ern:neY . 2I-6c 5.t f,=rvnr"Flmanya idk,is er]JsN f yx..'fr3i Y i NFRC d>esr l na;.mnend
319J(' 1liY 9il he9:?l!Yt&O�rCLte Ufd IIt,C:&5;(MJI' f.Y3rV5l19ti t`C 6'_.i_.n5W[rl IJ ,,d"rvl'. iI?-. J. .fOr nlhBr
E:,N Inc r,_-aCF.la'tc '. ..ma :�. i��Garcei r t'aWi tela•da NFFC para at r''. ?,-enc Le,.,a! '
prorh Il L olarcs a.,i hs dor NFF%' rl :at=rninaivs(rr*un aanjunto V p I. .vrlken-s drrtaientaHS' a w aarw i?
9i:r» "'7 i•3J3.NF'F 'r ravriaadonr�m',C•M.e;Iyh �xa,G que Il r�i.'_t 'au a;rc^-n 11'r,u ,eClftr.
Consult,,•;ca3 el f dleto del fsbrlcanta para el u3?nUropladp de est?product.vmnv.ntrc,vi
Yf/ �
fw
3 s,
Unit qualifies for ENERGY W�Pmm"%
STARO region(s): Northern,
r�
IBM- ''� ' +r r fir' North Central.South Cer„rai,
Southern.
STC:27
cr,
DLaF:ii H6
IND:Rein E5/C,ass ProSolar/SD-R35DP.+3 /�35
Tested..tze:71.25'x 79.5”
Florida Product,Anproval: FL7612
TDI#TDI-DR 138
Applicable Test Standard(s): AN&AAMA/NMDA 101A.S.2-97,AAMAJWDMAtCSA
10U.S.21A440-05,AAMAAWDMAICSA 101A.S.21A440-08,
A440SI.09 Canadian Suppi
9662430101 K0042 HS THD Shrewsbury 8844863
Keep this label for possible ENERGY STARd,rebates.To team more visit www.energystar.gov.
Guarde esta etiqueta posibles reembolsos ENERGY STAR,.qs.Para conocer mos acerca de esto,visite
or
0!
11OMF IMPROV'KYIFNT CO\1'RAVT
j' IY,BASF:RF ILD VIIIS
Brunch iSxrne:Hasten North&,yXrth IhltaV 0 0 1� �tlld.fail l.lNyl and InUNI1N NY
_._ "III)At Htmk Scrvura.In..
Branch NuIlIber:Jl ail l lVNtr 1'hc lhvnc Cleply,\l.l harm Snvcc,
•tdli RustMl11lnlplkC.(:1111 1,Slucwahuly,NIA 11154SI.
lid( Frm 877 stl 1768
I.,l vol It,A 7t:r nXaHl,Nil Ix A C117a w.XI('.x.l.I Ira 11l)1
CTth'a litt"Ir 13`2;NIAlhrne It"PoI\CllYml l7rllnugr get.a 1'0.Yu1
Instxllatlon Address:
__- __—.--
City Ate )}p
Yumbaserisl:
\1'lvk 1`Mnm: tlmtle PMmo YMwn:
finale Adders: _
(If different from Installation Addressl City --.�... --��Saute ._!IP
F-nail Addmt3(lo tctriw police,alnlnlanicnrilms and I lomle 1",Al uplfatcsl:
❑1 UO NOT wish hl rtkcirc any trice ing email lnun'Ihc I lunm ovixa _--- - ------��
Project Inrornaliom lhxlcrsignld 1"Cuctonler''1,the owners of the pal eriv ItIl ill the aMsr installation ndlhe%s.agrn•Y i.Nov,
:tilt 1111)At-1 iunve Services.Inc.it"Ille Honme Hclmt")agrees nl tumish,1k611T and arrange sir the unrnilahon f"Iinx111athm"1 All
all maln'ials Jeswllll tm the below and on the lelevenctM Spas:SheollsL all til which are inc.Y'Ix.rantl into Ila, (Ai la Ny this
reference,ahmg with any applicable Stale Suptleanml Had 1`4ynlcut Stably a(tachM herill and ally Ch:agt akJrrs LsJln"II-
"Cmxlrucl"1:
,Inh All
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�. []Guicry/Clnen ❑F:ntn•Uxas [�_^�rv.__ 5
QXdiiln• lxbn• N'utdnws . ..... __- -.
0ClateN�I-C1�'orsrrs
R��ainb• UJidmg \\lndlwx�]Iroalaii:n -
❑Uulters/C'over, ocalryflxln ❑•__w�___
MlnMnrro Zarb Iklxrnit M('<aN1ixY Aoxunl due uYlxlrsravthn IAUk nannM.
maple Famhasom amt alt 41"pai nuarilmn tdrddlhe Cargill Anxamt 1
pulnl Cartl•nel Anulunt
Cushuner agrees la[ ianlc�li:ucly ulxm amnpletion or the wtvk for met' Prlxtocl.Cushmmr will eslxule it Coaplelion Cenilicale
Iunc liar each Ikltllucl as dclat s] by in individual Spat Sheaf aid Iuly any h earl title. As applicable.each Qalonmr under this
C'oulraaYagrces to It juinllylulA semrully uhligal d cent liable hen unlit.
llie I Imne llepla ralenrs the right to issue a Change Order or ternliniae this Contract or any individual Pnxital( i inctudal herein.at
its distretidR.iClhe 1lo no U{lMa Ill 11]:Iiffitirmki wT\'1R po llh'r ticalralllle[lisp it C'U'l1W PLThA 111 its obligallm]title Ill a stractural
pruhlcnl wail(lie home,cnmr.antcnvd h:raids such as All ashxun or laud Imine.allia salety vImnee is.pricing emir,Air because
work mparml It,tvnnpitte the job was ata includsil in-Srhe/Cjlav�rnqa.
Payment Nunlnulry: The. IllSununay A_{a3� 3 , inclmlal as pial of this Qaamct, sets fmh the Ictal
C maoc(ampunl and paymcnts icyuinst by the detxwils and final Imvinonls by Iltxluet las applicable).
NIl'1 RT lYl CUSTOMER.
Vora art entitled to a crmrplelely nllLd-In copy or the Cnniract nt the time yml sign. Io m
fnot sign x Cmpletinn Certincnic trade:
there Is otic Completion Certificate far Arch listed 1'rlxluel its dcllned by Individual Spec Shares)M4im•work an that Pr rluct
Is clanpicle.
In the Arent of Ierminnlinn ld Ilds Cataract,Cucmacr agrees to IRA) The Boom Depat the amts of nalerllds,labor.expenses
and iorvices prmided by Tht Maine Depot or Auahurlaed Sordes Prntider through the date of termination, pilo any other
unornnls sat birth In this Agrevia l or allowed ule low,trader applit THE HOME.11F:YO'F MAY' \YI I'll 1101,I)AI\I6UN'lS
OWED '171 '1'l Ili IIOMli 111;1411' FROM '1'111•: (ll•INISI'I' v,%li IF.N'1' (1R (1'1'lll•:H PAYA Il' MAUI•;, \\'1'CIIOUr
LIM I'llNI:'1•Itli I1OMF;I)VI91'1'CS"OIlIFR REMIKOWS FOR RFaY/\'h:RY'tIF'SIICII a\h1U11N'1'S.
Aev,johaleeltd And,0, ion: Cuamner ngrt cs and undenraulis Ihnl (Iris Avee-taaa is the rnlirc agretutent between Caslonwr
aad The I Iarae rp,a wu 1 rep:ud(o the Ihtxluas:wJ Inslallntilm.rn nts mal sgt•rxvles:J1 pnity Jiy'ussinns:rad an\�aculs,rilh.r
al lx wrllll'n,lclallag IU Oui.l N'uixib cent Iualullali.Yr. Utis:\gr\nmlll Ca1nnN It•Ih.ignpl Jr anlaldtvl C\lrPl h\":1 llriling Fignfil
by Ct luster olid The I balle l h iva, CusonuT n:Anoaltslgcs nnJ ugrx•s Ihm tluitnrvr Iola mud. •uuuuls. vlduularit) u.vopl,(he
hTas ul'l al hos recelved a copy of Itis Agreenuan.
Alyepl y w /— /3 ;brain 1,:
t ntlnAl}`,Pr'1 SIXI' 112 •� Trt`�lllll OO,:,. 1CV 1Ia11{yh�\llClitllci^n' �pr�—�I>:ae
_ rtlellin No \`1?
('u a fir's
Signal Uutt _— Sales('os
ndf: u License No.
t' N_Q_ 1,� ION: CUSTOMER MAV l'ANCFI. THIS IPs upla4.14 l^
AG RiCF:M F:N'I'tV 1'1'1llll rl'1•I':NAI:1'1'OR OI4I,IIL\'Ilt1N
HY IIF,I,IVF:I(IN(: WHITIT'N NOI'R-11.-ill TIIF: IRIME
Dill By N711)NI1:H•1 (IN '1'111{ '1'IIIR11 IIIISINFNS
IIAV AF'I'VR SICNINI: 'CIItS ACREVN1FN7'. I'lle,
Sl All! SI.II.1.1ENIFXr ATUACIII:ll 11FRh:'1'l1
('IIN'IAINS A FORNI TO USI: IF ONE IS
AI•1,111•ICALI,Y PkENCRIIIFII BY LAW IN
l'l lti'l l/AIF.1<•%Ji1'A'1'P;.
1u111'41 Al.np 1 n IN AI.TliaMd ANTI I'<)x111'I'IUNN AMI:ill'%I ED uN l'lIX XA\XXTF'Xn1X A91r ANf:1'.aN 1'O!r111N tY1N IN 11`1 ,
6� MaM1a Al-kNtuMb 14N Ylluw ,cuxxoNr
job 0
1
1 Tb whom it may t'o11 rri,
1
f
1 Re: Wren: 1r��.4 /AIX f
Concerning the above location, We give the Home Depot approval to install
Number of windows
Style ( Double Hung Casement, name type) '� ��
Color (ti► C(IcNJ' �` 4J
., Manufacturer t~ S
.ab
Exterior finish as agreed to be PVC (wrap trim)?
t�)k:Z- color
We agree to the grid or lack of grid configuration
Are grids between the panes of glass?
As stated these proposed windows do meet with the Condo Management approval,
Sign&j'2!k!j!� Print name C�•,�rh7,!/f/# Jf(�(I�(�
Title Phone qFL
Date: ��f �•Y/mad 3
— ®
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CA
y
fidxy �`"`s*..r'$+•�«,yt.. e =^° .�r, 'ai.'°$ "•�-� ..�p" ,�li'.s is.eY`
kn.• .�,- 'mss:-. ',e,� ,�.,�'ti.a. ,�, arm ., r3S. ��
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