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351 BRIDGE STREET - BUILDING JACKET� "tel 6�,� sP`� - - � y °ON�°1TA.sa CITY OF SALEM, MASSACHUSETTS PUBLIC PROPERTY DEPARTMENT n, 120 WASHINGTON STREET, 3RD FLOOR SALEM, MASSACHUSETTS O 1970 SNP TELEPHONE: 978-745-9595 EXT. 380 KIMBERLEY DRISCOLL FAX: 978-740-9846 MAYOR May 13, 2013 To Whom it May Concern RE: 351 Bridge Street Salem, Ma. 01970 According to our records, it has been determined that the property located at 351 Bridge Street is a legal grandfathered non-conforming three (3) family dwelling. This is to determine use only and in no way meant to confirm or deny whether said property is in compliance will all building, plumbing, gas, electrical, fire or health c des. Since460t'e ely, Thomas St. Pierre Zoning Enforcement Officer I-� y�oNorTA�o CITY OF SALEM, MASSACHUSETTS J ��. PUBLIC PROPERTY DEPARTMENT 120 WASHINGTON STREET, 3RD FLOOR SALEM, MASSACHUSETTS 01 970 EW�P TELEPHONE: 978-745-9595 EXT. 380 KIMBERLEY DRISCOLL FAX: 978-740-9846 MAYOR May 13, 2013 To Whom it May Concern RE: 351 Bridge Street Salem, Ma. 01970 According to our records, it has been determined that the property located at 351 Bridge Street is a legal grandfathered non-conforming three (3) family dwelling. This is to determine use only and in no way meant to confirm or deny whether said property is in compliance will all building, plumbing, gas, electrical, fire or health codes. Sincerely, 4A Thomas St. Pierre Zoning Enforcement Officer (11t#g IIf �zlezu, HttssttcusE##� zt#=- ublicruPr#g �Pttr#men# 'GUmeo6" 1ttltlt �P�;tMX#mert# August 28, 1972 �tnom 7, Qiit� �sll Mr. William K. Lazarakis, 354 Bridge Street, Salem, Massachusetts Re :-351 Bridge Street. Dear Sir: We have been informed that you are occupying a dwelling house at 351 Bridge Street for storage of paint and other flammables, in direct violation of the City of Salem Zoning Ordinance which designates this area as an R-2 district, zoned for two family residences. The Ordinance makes no provision whatever for storage of paints in a residential zone. In addition, the BOCA building code, classifies storage and warehousing of paint products in Group A "High Hazard Buildings - Uses" , Itructures erected of full fireproof construction. Your violating these regulations leaves me no alternative but to inform you that paint and other flammables stored at 351. Bridg Street shall be removed forthwith. This structure shall. not be occupied for any other than residential purposes. Very truly yours, nJOB:cc Copy to : Fire Prevention Dept. Inspectoro. Buildings Asst. City Solicitor INSPECTION REPORT DATE: , ADDRESS: f •' + �/�iC^ •.yF °:�'` d/y/�� OWNER:�1���CIVCG USE GROUP7�-.2 �'� �i.S 7m/GT NUMBER OF STORIES: Cap NUMBER OF ROOMS (BY STORY) : HOW HEATED: GAS: YES . NO: V NUMBER OF SANITARIES: AlW7. NUMBER OF APPROVED EGRESS DOORWAYS: /'r �•�� +��' �` REMARKS: ` � /o0 7b FEE`RErETVED-°'YES'-- NA--- y� ing Code requires that all plans filed mu: Structural Engineer registered by the Con his provision would be on plans for one a , plans for this type may be prepared b mpetent, other than a registered Architect y the Board shall be filed with the City C date of filing, the Building Inspector is ai General Laws — Section 15 — Chapter 4C n 90 days from the date of the Petition or 19 ' i STREET PERMIT ; 5Q© ..,. Citp of 6alem �rmue Office of 31ugpector of �3ui[Diugg Gily }fall r < -4 _ t l9i,...; Jermission is Aare6y yiuen to I% 1( E - t J �J to Occup 0.r purposes in fronl of eslale of sn/ea ag, of slreel. 7Sis permit is lmiletllo )C. ( 19 J. o ', su6jecl to I e prouisfons oflnie ordnances andslalules in relation!o cslreels ano'lnie gnspeclton and Gonsiruciion of J3ufldizys in lieCi y of cSa/em. i 17irec�o`Pu6/'c c$eruices ✓nspec%r ol.'�ui/da9s i c$iyaa/ure�.7pplcaa/ ,/� - i 1�r�•A,a.b,....,-�..— .. i Sent By: DESANCTIS INS; 7819335845; 9-Oct-01 2:48PM; Page 2/3 LICENSE OR PERMIT BOND BondlOBBSBB00716 KNOW ALL MEN BY THESE PRESENTS, THAT WE The Aploon Company, Inc. 49 Denton Drive, Methuen, MA 01844 as Principal, and Hartford Casualty Insurance Comoapv as Surety, and having its principal office in the Norwood, NA 02062 as Surety, are held firmly bound unto city of Salem, MA hereinafter called the Obligee in the penal sum of One Thousand Dollars and OO/canes ------------ --------� Doi lars {$ 1,000.00 Lawful money of the United States of America to be paid to the said Obligee, for which payment well and truly to be made we bind ourselves, our heirs,executors, administrators and assigns,jointly and severally, firmly by these presents. SIGNED WITH OUR HANDS AND SEALED WITH OUR SEALS this 9th day of October 2001 . WHEREAS a license or permit has been granted by the Obligee's to the above bounden Principal authorizing him to Street Opening Bond NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION IS SUCH, that 9 the Principal shall faithfully observe the provisions of the laws, ordinances, and resolutions, governing the issuance of this license or permit , then this obligation shall be null and void, otherwise to remain in full force and effect. This bond shall become effective the 9th day of October 2001 The Surety may cancel this bond at any time by filing with the Obligee 30 days notice of its desire to be relieved of liability. The Surety shall not be discharged from any liability already accrued under this bond, or which shall accrue hereunder before the expiration of the 30 days period. The Aulson Company, Inc. Principal BY: Hartford casualty Insurance Company Surety BY: ` Chrfetin 8. Dean, Attorney-in-fact Sent By: DESANCTIS INS; 7819335845; 9-Oct-01 2:48PM; Page 3/3 THE HARTFORD HARTFORD PLAZA � I HARTFORD,CONNECT1LVraaNS Q Hartford Mire Insurance Company Twin City Fire Insurance Company Q 0 Hartford Casualty Insurance Company Hartford Insurance Company of Illinois Q RQ Hartford Accident and Indemnity Company Hartford Insurance Company of the Midwest Q Q Hartford Underwriters Insurance Company Hartford Insurance Company of the Southeast �] KNOW ALL PERSONS BY THESE PRESENTS THAT the Haunted Fha Insurance Company, Harffod Accident and Indemnity Company and Hartford Wlderwrifors lnsLgvwe Company,corporations duly organized under the laws of ate State of Connecticut; HafffW hrsumnce Company of Mhois,a corporation duly organized under the laws of the State of Illinois; Hartford Casualti Insurance Company, Twin Ciry Fire insurance Company and hiaMlrl Insurance Company of the Midweg corporations duly organized under the laws of the State of Indiana;and HeMbrd insurance Company of Ura Southeast, a corporation duly organized under the laws of the State of noride; having their home office in Hanford,Connecticut,(hereinafter collectively referred to as the'Companies)do hereby make,constUiAe and appoint up to the amount of tuthhdmd., L Robert Desarmlis, Gregory D.Juwvaa James J.Axon,Wheel F.Camey,VWderPerks.Jr., Michael T.Gilbert,Adam W.DeSanctis•Christine B.Dean Of Woburr4 MA thea tore and lawful Attorrrey(s)*Wad•each in their separate rapacity U more then one Is named above,to sign Its name as surfivies) only as delineated above by ®, and to execute, seat and acknowledge any and at bonds, undertakings, contracts and other written Instruments In the nature thereof, on behalf of the Companies In their business of guaffintee'ehg the fidelity of persons, guaranteeing the performance of corhbvats and emorling or guarantaeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. In Wiliness Whereof,and as aultwdzed by a Resolution of the Board of Directors of the Companies on September 12th,2000, Ne Companies have caused Nese presents to be signed by its Assistant Vice President and its corporate seals to be hereto of ibed,duly attested by its Assrslarht Secretary. Further, pursuant to Resolution of the Board of graders of the Companies,the Companies hereby unambiguously affirm that They are and wig be bound by any mechanically applied signatures applied to this Power of Attorney. .k resp . • � Paul A.6argenlwlix,Ass- ant Seaalary John RF "Cl,Assistant Vm President STATE OF CONNECTICUT s& Hartford COUNTY OF HARTFORD On tits 10day of September,20DD,before me porsonallycame John P.Hyland,to me known.who tieing by me duly sworn,did depose and say:fiat he resides in the Courtly of Hartford.State of Comwetiart that he Is the Assistant We President of the Companies. the corpomtiens described in and vAhioh executed the above instrument that he k4ows the seals of the said corporations; that the seals affixed to the said instruwmt are such corporate seals;that they were so affixed by authority of the Boards of Directors of said corporations and that he signed No name thereto by Ike autadly. jWM H,vwwhlak ( 7�1DUE NWM PUWe ply Cansiisrbe a om June 80,2004 I,the undersigned,Assistant Vice President of the Companies,00 HEREBY CERTIFY that the above and foregoing Is a We and correct copy of the Power olAttomey executed by said Companies,which is still in full force eteceve as of Q r bre Signed and sealedat the City of Hartford DIV 0 a seer .pwdGJ" �iYM lot$ n • Colleen plastruianrd,Assistant Vice President t; ,.—S A,\ The Commonwealth of Massachusetts I, } Department ofPublic Safety Massachusetts State Building Code(780 CMR) 4 Building Permit Applicatio or any Building other than a One-or Two-Family Dwelling Section For Official Use Only) .. Building Permit Number: >56e Applied:. Building Official: SECTION 1:LO TION(PI indicate Block#and Lot#for locations for which a street address is not available) No.and Street 1 /Town Zip Code Name of Building(if applicable) SECTION2:PROPOSED WORK Edition of MA State Code used If New Construction check here O or check all that apply in the two rows below Existing Bnlildin RepaiV I Alteration ❑ 1 Addition❑ 1 Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No Is an Independent Structural Engineering Peer Reyiew requir�d?1 / J Yes ❑ NoJ Brief Description of Proposed Work:�enr 2 �� VC-/-tiP G�+ .h/��V S V C d t j^4 SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR , - CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑ Existing Use Group(s): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) Total Area(sq.ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as applicable). A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ 1 B: Business ❑ E: Ed caHonal ❑ F: Facto F-1 ❑ F2❑ 1 H: High Hazard H-1 ❑ ^ H-2❑ H-3 ❑ H-4❑ H-5❑ I: Institutional 1-1❑ 1-2❑ 1-3❑ 14❑ M: Mercantile❑ R: Residential R-10 R-2❑ - R- R-4❑ S: Storage S-1 ❑ S-2❑ U: Utility❑ Special Use❑and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA ❑ 1813 IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ IV ❑ VA ❑ VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) -' Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: Public❑ Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be Licensed Disposal Site❑ required❑or trench or specify: Private Cl or indentify Zone: or on site system❑ permit is enclosed❑ Railroad right-of-way: Hazards to Air Navigation: NIA Historic Commission RcvivW 1,70cess: Not Applicable❑ Is Structure within airport approach area? Is their review completed. or Consent to Build enclosed❑ Yes❑ or No❑ Yes❑ No ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code Use Group(s): Type of Construction: Occupant Load per Floor: Does the building contain an Sprinkler System?: Special Stipulations: SECTION 9: PROPERTY OWNER AUTHORIZATION ame and AtIckress of Propprty Owner L-C, �" ^�P�e�✓rcc�. �LIV�1rN1a� Name(Print) No.Ad Street I City/Town Zip Property Owner Contact Information: lYrtle P",4 NC— Q, Telephone No. (business) Telephone No. (cell) e-mail address If applicable One prdpert�wner hereb authorizes 1 , F Ir To L �2� l e, o I v Name St -yet Address City/Town State Zip to act on the property owner's behalf,in all matters relative to work authorized b t� ermit application. .., SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix,2) If building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here❑and skip Section 101 10.1 Registered Professional Responsible for.Construction Control' Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor - �.r �L `ol,JV1�P Company Nat p Name of Pe>son Re�spo Bible for.Cxnstruction License No. and Type ifi�icable _ -Street Address City/Tow Slat Zip Elr <<.��� Telephone No. business Tele hone No. cell e-mail address SECTION 11:NOf KEIS'COMP 6 VSAI'10\ INSURAN(1,AFFIDAVIT M.G.L.q.152.§25C 6 A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Acc dents must be completed and submitted with this application. Failure to provide this affidavit will result in the denial oflhf issuance of the building permit. Is a signed Affidavit submitted with this application? Yea No ❑ SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor o-r and Materials) Total Construction Cost(from Item 6)=$ 1.Building $ Building Permit Fee=Total Construction Cost x_(Insert here 2.Electrical $ appropriate municipal factor)=$ 3. Plumbing $ 52 0-0 4. Mechanical (HVAC) $ Note:Minimum fee=$ (contact tn uci 11ity) 5. Mechanical Other $ Enclose check payable to 6.Total Cost $ (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is trued accurate to tile ss e b f lily r 'dgeaand understanding. sign V YG I Title ' Telephone No. Dot /� Street Address 1 City/Tows / a "�gZiip� Municipal Inspector to fill out this section upon application approval: . - Name... . Date C i W The Commonwealth of Massachusetts Department of Public Safety Massachusetts State Building Code(780 CMR) Building Permit Application for any Building other than a One-or Two- (This Section For Official Use Only) ' Building Permit Number: Date Applied: Building Official: SECTION 1:LOCATION(Please.,indicate Block#and Lot#for locations for which a street address is no -a a e S C'/X2 C No.and Street City/Town Zip Code None of Building(if applicable) SECTION 2:PROPOSED WORK - Edition of MA State Code used If New Construction check here❑or check all that apply in the two rows below Existing Butldung❑ Repair Alteration ❑ Addition❑ Demolition ❑ (Please fill out and submit Appendix 1) Change of Use. ❑ Change of Occupancy ❑ Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No ❑ Is an Independent Structural Engineering Peer Review required? Yes ❑ No ❑ Brief Description of Proposed Work: ff SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING.RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑ Existing Use Group(s): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) Total Area(sq. ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as applicable)- A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A4❑ A-5❑ 7 B: Business ❑ E: Educational ❑ F: Facto F-1 ❑ F2❑ 1 H: High Hazard H-1❑ H-2❑ H-3 ❑ H-4❑ H-5❑ 1: Institutional I-1 ❑ 1-2❑ 1-3❑ 1-4❑ 1 M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R4❑ S: Storage S-1 ❑ - S-2❑ I U: Utility❑ 1 Special Use❑and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as applicable). IA ❑ Ill ❑ IIA ❑ IIB ❑ IIIA ❑ HIB ❑ IV ❑ I VA ❑ VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) - Debris Removal•it h Pe rmit;erm : Water Supply: Flood Zone Information: Sewage Disposal: Trench Disposal Site❑ Public❑ Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be P Private❑ or indentify Zone: or on site system❑ required❑or trench or specify: permit is enclosed❑ Railroad right-of-way: Hazards to Air Navigation: MA t listnric Commission Rov ,, Pr occ s: Not Applicable❑ Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed❑ Ycs❑ or No❑ Yes❑ No ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s): Type of Construction: Occupant Load per Floor: Does the building contain an Sprinkler System?: Special Stipulations: e r � SECTION 9: PROPERTY OWNER AUTHORIZATION, Name and Address of Property Owner Fri e_ l C 141 n 2 3 s-/ Name(Print) No.anti StreR City/Town Zip Property Owner Contact Information: Title - Telephone No.(business) Telephone No. (cell) e-mail address If applicable, the property owner hereby authorizes Name Street Address City/Town State Zip to act on the property owner's behalf,in all matters relative to work authorized by this building permit application. - SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) If building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here❑and skip Section 10.1 10.1 R g istered Professional Responsible for Construction Control Name(Registrant Telep=� e-mail address Registration Number r Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor C� Company Name Name of Person Responsible for Construction r Licensee No. and Type if Applicable a L� Street Address City/Town State Zip 12-_-ulf XF95 Gam-P00- ��--2- Telephone No. business Telephone No. cell e-mail address - SECTION 11:to C1t LF.It9'conlf FNSA'1`10N INSURANCE AFFID AVI1' M.G.L.c.152.§ 25C 6 - A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents 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. Is a signed Affidavit submitted with this application? Yes❑ No ❑ SECTION 12:.CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)_$ 1. Building $ / 'r' Building Permit Fee=Total Construction Cost x (Insert here 2.Electrical $ appropriate municipal factor)=$ 3. Plumbing $ 4. Mechanical (FfVAC) $ Note:Minimum fee—$ (contact numicipali ) 5.Mechanical Other $ Enclose check payable to w\ 6.Total Cost $ — y // (contact municipality)and write check number ere SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT - By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. Please print and sign name Title Telephone No. Date Street Address City/Town State Zip Municipal Inspector to fill out this section upon application approval: Name aw _ CITY OFS,Uz66m, JA.kS&wHUSETTS Ot:tL vr. 0EP.IR" MNT 120 WAS.HLYGTON STREET, J1 Roca T L (978) 743-9595 EY D RISCO LL F-Vt(973) 7-W-9344 woft 1110nU ST.PIERM MAECTOR OF PCOUC PROP ERTY/8t.'t vc.COJLNIc55IO,V ER Construction Debris Disposal Affidavit (required for all demalition and renovation work) In accordance with the sixth edition of the State Building Coda, 730 CMR section l l LS Dcbris, cuid the provisions of b(GL c 40, S 54; ©wilding Permit fs is issued with the condition that the debris resulting from this %York shall be disposed of in a properly licensed waste disposal facility as defined by NIGL c 11 I, S I SOA. The debris will be transported by: piame hauler) The debris will be disposed 0f in W-tA_o2- (namr of acuity) —�=-- ;i;uamra �t prrmit dpplic.mt CITY OF S.•1 .&M, NWSACHUSETTS BCMDLN'G,DEPARTNMNT 120 WASHOVGTON STREET,3aa FLOOR TEL (9.78)745 9595 FAX(978)•740.9846 KIMBERLEY DRISCOLL MAYOR THOA4IS$T.PIERRA DIRECTOR OF PUBLIC PROPERTY/1iUMb1NlG CONWIMONER Workers' Compensation insurance Affidavit: Builders/Contractors/Electricians/Flumbers Alifilieditt Information Please Print Le ibl Naine(BusittnssiOrganimtiotvindividmI GIJ r Address: City/Statc/Zip'. 2-/1 Phone!E: Are you an employer.'Check the appropriate box: Type of project(required): 1.❑ 1 am a employer with+ 4. ❑ 1 am a general contractor and l 6.loth New construction atyploy'.ees(full and/or part-time).• have hired"sub-contractors 2.Cs am a sole proprietor or partner listed on the attached sheet.t 7. Remodeling ship.and have no employees These subcontractors have( S. Derriolition working;;fur me In any capacity., workers'comp.tnsrirsnce' qOuiltiing addition (No worker comp.insurance' S. [] We are acorporarion and its, officers have exercised thew,., 10Electrical repairs of additions 3.❑ I am'a homeowner doing all work right of exernptionper MGL " 1 IPluirtbing repairs or additions myself.(No workers'comp. c. 152 §1(41;.and we have no ; 12. Roof repairq insuranca regmred.i), employees; [No workers'. 13. er fi Yl� comp in atrance required:) •Any appllram silo chaks hex tl-mrtu also rill out tha seaiao below showing their waken'mmpenradon policy inrurmallor.' 'I hvneownen whosubmil this itfldavu indicating they are doing all work and thwhifa omiide eatimseem,most submit a new affIdnrit indicting such ' Contractors that ihcsk this box must ailachc4 an ar4liaurml sheet yhowina the name of the"bacontradmis and Chair workimV wmp,pul10 intermatiun. lam as employer that(r providing workers'ranprnratlort hrrurrtnea jot ruyemployeWs'Be1uw is rhs policy dnd Job site lujornnutiow Insurance Company Name:�c=j ' Policy#or Sclf--ins:Lic.#: isJ C-'7- — �'__ S— //��(/� —U2 z Expiration Date: Job Site Address: City/State/Zip: (�7 Attach a co of the workers'compensation policy declaration a ii shownn the oil number and expiration date PY P P �T P,g ( g P cY P ). Failure to secure coverage as required under Section 25A of MGL c. 152'can lead to the imposition of criminal penalties of a tint up to S1,500.00 and/or one-year imprisonmen4 as well as civil penalties in the form of a STOP',WORK ORDER and a fine of up to$250.00 a day against.the violator. Be advised that a copy.of this statementmay be forwarded to the Office of Investigations of the DIA for insurance crivcmga verification:: f de hereby cord under tllns and p� / ena(tJer of pdrJary that the brjormurton provrdeed above is true and correct 5i'm 2 o OJJic hd use only. Da not write Jn this area,robe cennpleted by city or town oJJ1cial City or'Tuwn: PermiUi.lcenxe# Issuing Authority(circle one): I. Board of Health 2.Building Department 3.Cityfrown Clerk 4. Electrical Inspector 3. Plumbing Inspector 6.Other Contact Person: -------- _ Phone#• vi �C ToL.ine_ WENDOWS CORP* y✓I9 p ( �7 v '• It's the Law! / 12r1 Federal law requires that individuals receive p p Q certain information before renovating six square feet or more of painted surfaces in a room for interior prn ects or more than twenty square feet 68-6996 of painted]surfaces for exterior projects in housing, child care facilities and schools built 1 before 1978. No Certificate,assuming Lead Paint. X "� Job Order#: D p Telephone: 7 rry yam_ Expected date of installation: /, Unit Total Unit Size Price S le Color Price i- io3, 13 r 3 y� Z z- 0111 f / Total Unit 4( _ Tax Wood Molding Total 3 `x Capping ( ) Less Deposit e`U �° Steel Casement ( Night Lock ( ) Remaining Balance —r Brick to Brick ( ) * Includes screen and installation * Invoices are to be paid within thirty days of issue.All amounts overdue will be assessed a finance charge of 1 1/2% per month or 18% per annum. Customer agrees to pay all legal fees and expenses associated with the collection of overdue invoices. . * The company has the right to withhold 5% of the contract price from the deposit if the order is cancelled within 3 days after this contract is signed. No refund will be returned to customer after the three-day period is over. (Screen warranty only 15 days) Customer Signature: Company Authorized Agent = Date: Date: S=3I—)3