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3C FLETCHER WAY - BUILDING INSPECTION (2)- The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF i Massachusetts State Building Code,780 CMR R SALE 4 evl2011 @ Building Permit Application To Construct,Repair,Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only _ Building Permit Number: .Date Ap tad: ,�, _ to a M tl '5z Building Official(Print Name) � ". Signature ,D to- 5f*1 SECTION 1: SITE INFORMATION ylc 1 13Cpe yf1d� P2 w� 1.2 Assessors Map At Parcel Numbers D Mrn r Le o 1.Is Is this an accepted street?yes_✓ no Map Number Parcel Number C s 1.3 Zoning Information: 1.4 Property Dimensions: rc i _ cn, Zoning District Proposed Use• Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) 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? Check if yes❑ Municipal❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 ' r er'ofRecord: ` � 44 ll/2w76ki ! ddza O/970 Name(Print) City,State,ZIP a 3c �Le 7-C QW- No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK=(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) Alteration(s) ❑ Addition ❑ Demolition ❑ 1 Accessory Bldg. ❑ Number of Units Other ❑ Specifi: Brief Description of ProposedWork2: B /N AM64 C3CrZ� SECTION 4:ESTIMATED CONSTRUCTION COSTS - Estimated Costs: Item Labor and Materials Official Use Only 1.Building $ S7 d — `1. Building Permit Fee: $ " Indicate how fee is determined 2.Electrical $ ❑ Standard City/Town Application Fee ❑Total Project Costa(Item 6)x multiplier x 3 Plumbing $ 2. Other Fees: $ " 4.Mechanical (HVAC) $ 'List: 5.Mechanical (Fire $ SI ression Total All Fees:,,$ Check No. Check Amount: Cash Amount:: 6.Total Project Cost: $ �S 7Q ❑Paid in Full ❑Outstanding Balance Due ��j�►-.7 67 � G �c�.rr ro KNLKtN to19 " SECTION 5: CONSTRUCTION SERVICES 5.1CC/onstruction Supervisor Licensep(CSL) cc -Udw)/l �� 3� S �Jb.J 6. �AGpJj� License Number 7 Expiration Lyle Name of CSL Holder ' List CSL Type(see below)_ h/ W.4.` J,f'/Iii�dtq CJ No.a�'d Street 61 Type Description �T�/�'t UUnrestricted(Buildings up to 35,000 cu.ft. P, �A d d 013 R Restricted 1&2 Family Dwelling City/Town,State ZIP M Masonry RC Roofing Covering WS Window and Siding /� Q) .I IF Solid Fuel Burning Appliances �7 •�%�6�0— O K2�Q/UTAli�li�q/y,�4• 1 Insulation Telephone Email address F1kv ^ D Demolition 5�Registered Home Improvement Contractor(HIC) ze b 9e 6 "'`�`� ,y`A`' �`�y`'• HIC Registration Number E. mti Date HIC,Comp^, y Name or HIC Registrant Name - / 4 ���l�t c& i yd0.aw o.and Stree REmail addre N OU-1: 9a�•�y6 t •/Town,St te,z. A Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(NLG.L.c. 152. § 25C(6)) , 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 oJ the building permit. Signed Affidavit Attached? Yes .......... No........... ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorizeid to act on my behalf,,in all matters relative to work authorized by this building permit application. to I Punt er's Name(Electronic Signature) ate SECTION 7b: OWNEW 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 in this application is true and accurate to the best of my knowledge and understanding. _ Print Owner's or Authorized Agent's Name(Electronic Signaturel Oate r NOTES: 1. An Owner who obtains 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 www.mass.gov/oc Information on the Construction Supervisor License can be found at www.mass. oe v/dps 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"maybe substituted for"Total Project Cost' CITY OF S.UF.1\1, X'WSACHUSETTS BuUMLNG DEPARTMENT 130 WASHINGTON STREET, 3" FLOOR ` T EL (978) 745-9595 Fex(978) 740-9846 1Q.N{BERLEY DRISCOLL MAYOR THoaus ST.Pmma DIRECTOR OF PUB11C PROPERTY/Bu DING COSL%IrssIONER 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 111.5 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 111, S 150A. The debris will be transported by: �� 11ilAL��/✓ (name of hauler) The,debris will be disposed of in : Dqh yPAS /A4✓rSfP2 S'737/aM (name of facility) (address of facility) signature of permit applicant 9 lY b ate Jcbriw�LJx ° CITY OF S�U1 LM, 2AXSSACHUSETTS BLmimG DEPARTNIE.NT t+ 130 W:IiHiNGTON STREET,3'o FLOOR TEL (978) 745-9595 FAX(978) 7.40-9846 KINiBE LF-Y DRISCOLL ,Mt%YOR THOMAs STYIERRE DiP.ECI'OR OF PUBLIC PROPERTV/Bt:LIDNG CO',MSSIONER Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information d y Please Print )Legibly Va[nC!BusitxssOrganizatioNlndividualJ:�jtZj�lj� , 6✓J� ' �,fL� �jQL�r�1 topq Address:/ 7)q d✓! ST . City/State/ZipQAnL9.A4 Phone#:.- `�7� 77y 63�7j Are you an employer?Check the appropriate box. Type of project(required): 1.❑ 1 am a employer with _ 4. ❑ I am a general contractor and 1 6. ❑New construction ployees(full and/or pact-time" have hired the sub-contractors 2. 1 am a sole proprietor or partner- listed an the attached sheet. 7. El Remodeling ship and have no employees These sub-contractors have S. ❑Demolition working for me in any capacity, workers'comp.insurance. I S. ❑Building addition [No war'n:ers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MOL I I.❑Plumbing repairs or additions myself.(No workers'comp- c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees. LNo workers 13 ❑ Other comp.insurance rcouimd.] •Any applicant that chocks box AI most also rill out the section below showing their workers compensation policy information Y Ifnmcowne s who submit this affidavit indicating they am doing all work and then hire outs'idc contmcmts must submit anew affidavit indicating such :Comtv.:ton that check ibis box tout mtachod an?.klitb�wd shot:hawing the name of tfrsub-ccntr^W^.�and tbci:wni;.a'estop policy mic ination i am an employer that is providbtg tvorkers'cordpensation insurance for my employees. Below Is the policy andjob site information. Insurance Company Name: /�/ Policy#or Self-ins. Lie.#: V'2 rfd � 1�7� �a Expiration Date: 15� 3 gc)j5 Job Site Address: 3C Aze-Tckm 6-IRh City/State/Zip: �LeM /L1,0 OJ97U r Attach a copy of the workers'compensation policy declarat lon page(showing the policy number and expiration!late), 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 S1,500.00 and/or one-year impri_scnmcnt,as well as civil penalties in the form of a STOP WORK ORDER and a fine Of up to S250-00 a day against the violator. He advised that a copy of this statement may be forwarded to the Officc of ' hivestigations of the DIA for insurance coverage verification. I do hereby certlf hider ui and penalties of perjnry that the information provided above is true and correct. Sitnamre'— Date: 9 S Phone 1-7d• 72y 62B OJjcial use only. Do not write in this area,to be completed by city or town ofciat City or Town: Permit/License# Issuing Authority(circle one): 1. Board of lleaith 2.Building Department 3.Cityrrown Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: --_---. Phone#: Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massacliusetts 02116 Home Improvement Contractor Registration —= — Registration: 100654 Type: Individual r ^— Expiration: 6/22/2016 Tr# 253484 P- IRA G. MALKIN "' � n Ira Malkin �l 180 Dayton St ` Danvers, MA 01923 Update Address and return card.Mark reason for change. aCA 1 Co 20M-05/11 Address Renewal Employment Lost Card Q++.. , Office of Consumer Affairs&Business Regulation License or registration valid for individul use only USE OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration ,100654 Type: Office of Consumer Affairs and Business Regulation xpiration 6&6616:. Individual 10 Park Plaza-Suite 5170 i Boston,MA 02116 IRA G.MALKIN _ 4r` Ira Malkinc '-'F/ 180 Dayton St :..�= Danvers,MA 01923 - Undersecretary Not valid without signature vtasszchuset=` -Da ar:`nea�i of PL; i c 3afetn Board of Building Regulations and St ndards Construcdon Supcnisor '-.: '. .. License: CS-020014 IRAGMAISQN = 180 DAYTON ST DANVERS MA 01923 ' 07t3l/2015 �er.�-r>=sicner i 9MALK01 OP ID: DO CERTIFICATE OF LIABILITY INSURANCE DA0 911 012 01 4Y) osna2ola 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 AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 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 holder is an ADDITIONAL INSURED, the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and Conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT John J Walsh Ins Agency,Inc NAME: P O BOX 4407 PHONE FAX AIC No EA): INC,No: Salem,MA 01970-6407 EMAIL John J.Walsh Ins.Agcy.,Inc. ADDRESS: INSURER(S)AFFORDING COVERAGE NAIL0 INSURER A:United States Llab Ins Co INSURED Ira Malkin DBA Malkin&Sons INSURER B: 180 Dayton Street INSURER C: Danvers, MA 01923 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 MATH 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. LTR TYPE OF INSURANCE POLICYNUMBER MMILDIDNYYY MMNDV EXP M'YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY CLISS4366C 1010312014 10/03/2015 pREMSESDEaoCNDo.. $ 100,00 CLAIMS-MADE OCCUR MEDEXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER'. PRODUCTS-COMP/OPAGG $ Included X POLICY PRO-IFCT OC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea aoeid.rrt $ ANYAUTO BODILY INJURY(per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accklent AUTOS AUTOS ) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS PER ACCIDENT) $ 8 UMBRELLA LWB OCCUR EACH OCCURRENCE $ EXCESS UAB CI-AIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION WC STATU- T, AND EMPLOYERVU ILRY YIN 1 PIER ANY PROPRIETORPARTNERJEXECUTIVE E.L EACH ACCIDENT $ RA OFFICEREMBER EXCLUDED? ❑ NIA (Mandatory In NH) E.L.DISEASE-FiI EMPLOYEE $ If yes,describe under DESCRIPTION OFOPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACach ACORD 101,Additional Remarks Schedule,N more seeds Is required) Re: Diane Newton 3C Fletcher Way Salem, MA 01970 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Pickman Park THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN c/o American Properties ACCORDANCE WITH THE POLICY PROVISIONS. 500 West Cummings Park Suite 6060 AUTHORIZED REPRESENTATIVE Woburn, MA 01801 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD SPECIAL SERVICES CUSTOMER INVOICE Pagel of No. 2686-276779 0 Store 2686 SALEM,MA Phone:(978)741-9299 r 50 TRADERS WAY Salesperson: AJL5434 ,gyp SALEM. MA 01970 Reviewer: 0 Nnne H4 Nwe y NEWTON GLENN t9�s��a4saoa REPRINT o 2 W � Amrenr 3C FLETCHER WAY """%'"'° LA W m ConrenY tJamn � � N city SALEM J"oaK460^ 7/1 NRTSINSTALL A :2014.09-1112:00 m 1m'% MA a0 01970 c"'ty ESSEX m n 0 a INS -DER �` �I MERCHANDISE AND SERVICE SUMMARY Wde�he ghtto limit the quantitiesofMerchandise r' -1i Iuii'I REF# 101 m STOCK MERCHANDISE TO BE DELIVERED: .o f�P# �: SKU:== _ DESCRIF31ON ;.:: Pl TAX. iR �A N R02 0000-966-471 1.O0 EA 9"X33-5116-WINDOW&DOOR SEALING TAPE A $17.36 17.36' o R03 0000-163-613 1.00 EA 1X8-8FT PT WEATHERSHIELD .54 .54` y R04 0000-715-499 3.00 RL MULTI-PURP 16"X48" ROLL INSUL 5.3SF Y $4.48 13.44` j w ROS 0000-617-326 7.00 LF 1X4-R/L OAK BOARD A Y $2.12 $14.84' Vm R06 0000.155-519 24.00 LF 9116 X2.1/2 PINE WM472 CASING A Y 51.29 $30.96' • R08 I 0000-249-026 3,00 EA 1.114=8 PVC 2448 BRICK MLD WHITE A Y 11.25 3.75' R09 0000.746322 2.00 EA 1 511fiX42"MILL FINISH ALUM DRIP CAP A Y $1.16 $2.32' R10 DODO-677-137 1.001 EA3/4"X5-1I2•X8'AZEKS25TRIM A Y $29.181 S29.18' � S/O -IWDSE TO BE DELIVERED: REF ESTIMATED ARRIVAL DATE: OMDJ2014 P.O.#85516014 7AX FxR1s�E EACH � : EX.TEN�ION y S1202 1000-012-813 1.00 EA NA/TRIM SET 1: F RY SATIN NICKEL PN:/400 SERIES PATIO A Y $144.53 $144.53' m DOORS 2 PA - G 25 X 82.5 S7203 1000-012-813 1.O0 EA NA 1 NA ®I SERIES DOOR 1400 SERIES PATIO DOORS 2 PANEL- A Y $130.41 $130.41' FW 7. 5 w S1204 100D-012-813 140 EA S1O AW 400 SERIES DOOR/400 SERIES PATIO DOORS 2 PANEL- A Y $5344.98 5534.98' 77.215 X 82.5 ro D :""•CONTIIYIiED'ONIIEXTPAGE"':.� � o� m N CheeM your currerd order statue online at w .hornedepot.comkrderetatus N Page 1 016 N0. 2686-276779 ' IndlCCustomerCopy down SPECIAL SERVICES CUSTOMER INVOICE-Continued Last Name: NEWTON Page 2 of 6 No. 2686-276779 o INST4LLERDELI11 C3 REF#101 y S1205 1D00-012-813 1 00 EA NA/NA SIO AW 400 SERIES DOOR 1400 SERIES PATIO DOORS 2 PANEL- A Y $534,99 $534.9V a FWG 77.25 X 82.5 w S1206 1000-012-813 1.00 EA NA/EXTENSION JAMB 1: FWG 77.25 X 62.5 INTER/400 SERIES PATIO A Y $14.19 $14.19- y DOORS 2 PANEL-FWG 77.25 X 82.5 ro S1207 1000.012-813 1.00 EA NAI EXTENSIONJAMB2: FWG 77.25X 82.5 INTER1400 SERIES PATIO A Y $28.45 $28.45" a o DOORS 2 PANEL-FWG 7725 X 82.5 SIO-MDSE TO BE DELIVERED: REF# 613 ESTIMATED ARRIVAL DATE: 10118I2014 P.O.4865178W AEF# : 5 KU, tMA`:`: : .. ' fJE$GE�IPTiON PI AX PRECEEACH '.EXT S S1301 1000-012-813 1.001 EA OBD!0BD S/O AW 400 SERIES DOOR/OBD--PS 651/4'X 6'10 A Y 5323.19 5323.19 0 U2"UD LF FRAME WHITE/PRE-FINISHED WHITE VENDOR-SPECIAL INSTRUCTIONS: THIS IS NEW QUOTE 41719 IT IS RELATED TO ORIGINAL PO#86516014 NEED RAPID RESPONCE TO STORE FOR THE CUSTOMER .. • 1 859.13 m �l � P DELIVERY INFORMATION: I DELIVERY DATE:INSTALLER WILL SCHEDULE 00 � INSTALLER WILL DELIVER MDSE TO: SITE OF INSTALLATION#101 AT TIME OF INSTALLATION. ti NOTE:UPON RECEIPT OF ALL S/O MERCHANDISE- INSTALLER WILL CALL CUSTOMER TO SCHEDULE INSTALL r 0 DATE. 41 0 -4 m REP# 101 e ESTIMATED INSTALL BEGIN DATE: 07/03/2014 ESTIMATED INSTALL END DATE: 08/02/2014 MERCHANDISE TO BE INSTALLED: \ R02 0000-966-471 1.00 EA 9"X33-5116' WINDOW&DOOR SEALING TAPE R03 0000-163-613 1.00 EA 1X8-8FT PT WEATHERSHIELD m R04 0000.716-499 3.00 RL MULTI-PURP 164X48" ROLL INSUL 5.3SF m R05 0000-617-326 7.00 LF 1 X4-R/L OAK BOARD w R06 0000.155-519 24.00 LF 9/16X2-1/2 PINE WM472 CASING R08 0000-249-026 3.00 EA 1-114 X2X8 PVC 2448 BRICK MLD WHITE R09 0000-746-322 2.00 EA 1 5/16X42" MILL FINISH ALUM DRIP CAP w "'CONTINUED 1*fEXT.PfYi.E:•�«;. - m 0 w W Indicates item markdown Page 2 of 6 NO. 2686-276779 Customer Copy SPECIAL SERVICES CUSTOMER INVOICE- Continued Last Name: NEWTON Page 3 of 6 No. 2686-276779 0 r 10.o I.NSTALLAtl6k #1 0 (CohtiRUAe1 REF#101 R10 0000-677 137 LOD EA 314"X5-1/2'X8'AZEK S2S TRIM � K112 1000-012-813 1.00 EA TRIM SET 1: FWG NEWBURY SATIN NICKEL PN: VI b 1000-012-813 1.00 EA NA SIO AW 400 SERIES DOOR N m 1000-012.813 1.00 FJ1 NA S!O AW 400 SERIESDOOR 1000-012.813 1.00 EA NA SID AW400SERIES DOOR 0%1000-012.813 1.00 EA EXTENSION JAMB 1: FWG 77.25 X 82.5 INTER1000-012.813 LOD EA EXTENSION JAMB 2: FWG 77.25 X 82.5 INTER 1000-012-813 1.00 EA OBD S/O AW 400 SERIES DOOR o a BASIC INSTALLATION LABOR: SKU DE5Gf31PTIQ QTY UM rAX RA1GEfAI*H4 :: EXTI M5lON' 0000-899 /SLIDING PATIO OR UP TO72X96 1.00 EA N $469.00 $469.00 m -854 O OPTIONAL LABOR SELECTED INCLUDES: :?C3PTION '= 'I .. .' ."L�SCRiPTION =: •:: , ;,',- QTY :.`.: U .:I:"fA7C .;OR E E%EET1SlON 1 � m i 1 HAUL AWAY OF EXISTING DOOR! 1.00 EA N 30.00 $30.00 0 13 IJAMB OR SILL EXTENSIONS UP TO 6 114° ICUSTOMER PROVIDES MATERIALS)/ 1 0.001 EAl N 1 $65.001 $0.00 INCLUDES CUS TOM LABOR SELECTED • FTL N ID TA)C Elm— EAIGH:i;.>rXTEIdStOK] 1 ICUT BACK WOOD SIDING 1.00 EA N $125. 0 $125.00 v 1NMAi.LAT OWWTEAAMtij GLENN NEWTON INSTALL LABOR CHARGE: $624.00 r ADDRESS: 3C FLETCHER WAY TRIP CHARGE: $0.00 CITY: SALEM STATE: MA 21P: 01970 CREDIT FOR DEPOSITIMEASURE: $30.00 COUNTY: ESSEX SALES TAX RATE: 6.250 TAX: Merchandise-Y LABOR- N $594.00 y W PHONE: 978 744-5403 ALTERNATE PHONE: 976 979-8469 a BASIC INSTALLATION LABOR INCLUDES: ' PRE-INSTALLATION JOBS ITE I N SPECTION -INSTALL NEW INTERIOR CASING AND EXTERIOR TRIM+BRICKMOLD DELIVERY WITHIN 30 MILE RADIUS OF STORE OF THE NEW DOOR WHEN THE CASINGTRIM I S THE SAME SIZE OR w 'REMOVAL OF EXISTING DOOR UNIT WIDER(CUSTOMER PROVIDES) 'INSTALL NEW PATIO DOOR UNIT -INCLUDE NON-COLORED STUCCO PATCH UP TO 4"FROM JAMB AFTER INSTALLER TO PROVIDE NECESSARY FASTENERS. SHIMS AND EXTERIOR MOULDING IS INSTALLED.WHEN APPLICABLE E0 - w EONTiH1J pH.P1EJCTPAGE.*:";':. m 0 A Page 3 of 6 NO. 2686-276779 Customer copy ti SPECIALSERVICES CUSTOMER INVOICE- Continued Last Name: NEWTON Page 4 of 6 No. 2686-276779 0 r INSTA LA' ION #1. REF#101 D CAULKING 'FI NAL CLEAN UP OF ALL DEBRIS RELATED 70 INSTALLATION per. 'INSTALL NEW OR EXISTING LOCKSET AND KICK PLATE(IF 'FINAL INSPECTION WITH CUSTOMER INCLUDING INSTRUCTIONS ON APPLICABLE)ON NEW DOOR(CUSTOMER PROVIDES) CARE AND/OR TEST PRODUCT TO ENSURE PROPER OPERATION b ADJUST DOOR TO ENSURE PROPER OPERATION N 'DRILL HOLE IN JAMB FOR ALARM WIRING IN SAME LOCATION AS Opp ti EXISTING DOOR N � w UNLESS STATED ABOVE THIS INSTALLATION DOES NOT INCLUDE: INSTALL DOORS OVER 96X96 STUCCO PATCH GREATER THAN 4",PAINT AND STAINING rr� INSTALL FIXED ARCH TRANSOM LITE IN EXISTING OPENING DISCONNECT AND RECONNECT OF SECURITY SYSTEMSPIMAING REPAIR CARPENTRY TO EXISTING OPENING WORK ON SUNDAY$OR HOLIDAYS .. PLASTER.DRYWALL OR SIDING WORK F+ b SPECIAL NOTES: m ELECTRICITY MUST BE ACCESSIBLE TO THE WORK AREA CUSTOMER MUST HIRE THEIR OWN CONTRACTOR TO MAKE THE REPAIRS. 'O ,gyp IT MAY BE NOISY DURING YOUR INSTALLATION •AN ADULT OVER 18 YEARS OF AGE WITH THE AUTHORITY TO MAKE - 'THE INSTALLER WILL BROOM CLEAN THE IMMEDIATE WORKAREA DECISIONS ABOUT YOUR INSTALLATION MUST BE PRESENT OURINGTHE A e BEFORE COMPLETING THE INSTALLATION.AIRBORNE DUST IN OTHER INSPECTION(WHEN APPLICABLE),DELIVERY AND INSTALLATION _C:� b PARTS OF THE HOME IS A NATURAL OCCURRENCE AND IS THE 'ALL BREAKABLES AND/OR VALUABLE OBJECTS MUST BE REMOVED A RESPONSIBILITY OF THE CUSTOMER- FROM THE WORK AREA PRIOR TO INSTALLATION - w 'CHILDREN AND PETS MUST BE KEPT AWAY FROM THE WORK AREA 'ADDITIONAL CHARGES AT THE JOBSITE MAY BE NECESSARY TO V m CANCELLING APPOINTMENTS WITH INSTALLERS OR MISSING COMPLETE THE JOB AND/OR BRING THE INSTALL INTO COMPLIANCE V SCHEDULED APPOINTMENTS MAY LEAD TO ADDITIONAL CHARGES WITH LOCAL AND/OR STATE CODES O 'REFER TO PRODUCT MANUAL FOR SPECIFIC WARRANTY AND 'THE INSTALLER MAY DECLINE TO INSTALL THE JOB IF IN THEIR MAINTENANCE INFORMATION. PROFESSIONAL OPINION IT SEEMS UNSAFE,IN VIOLATION OF STATE IF UNFORESEEN LABOR IS NEEDED TO REPAIR DAMAGE FROM WATER, OR LOCAL CODES OR CANNOT BE PERFORMED TO INDUSTRY STANDARDS TERMITES,ELECTRICAL OR PLUMBING PROBLEMS,THERE IS AN ADDED H CHARGE WHICH MAY NOT BE AVAILABLE FROM HOME DEPOT SO THE `C b REF# 114 BASIC INSTALLATION LABOR: w ">CUN7{NUEt?-0N NEXT.BA�IE"""; m ` o N Page 4 of 6 NO. 2686-276779 Customer Copy SPECIAL SERVICES CUSTOMER INVOICE-Continued Last Name: NEWTON Page 5 of 6 No. 2686-276779 0 r INSTALL,IgTFQII! #2 { � REF 40114 0 SKU', DESCRIPTION lY' Um:,A*Axl PFTlCE EACI:I : .EXTENSION a 0000.899 PATIO DOOR-NATISLIDING PATIO DR UP TO72X96 0.00 EA N 3469.00 $0.00 CA e -854 7NSTALLATION:8404AM GLENN NEWTON INSTALL LABOR CHARGE: 0.00 ^� m a a ADDRESS: 3C FLETCHER WAY TRIPCHARGE: $100.00 per. o CITY: SALEM STATE. MA ZIP: 01970 CREDIT FOR DEPOSITIMEASURE $0,00 COUNTY: ESSEX SALES TAX RATE: 6.250 TAX: Merchandise- Y LABOR- N'Olm INSTALL TOTALDUET0-00 PHONE: 978 744-5403 ALTERNATE PHONE: 978 979-8469 '1 INSTALLER SPECIAL INSTRUCTIONS: NEW PO FOR LOST DAY PATIO DOOR ORDERED INCORRECTLY ..A ELATED TO ORIGINAL PO#86461531 tI TA,LLAI 011,0 'I -4 REF# 115 m BASIC INSTALLATION LABOR: KU SCAiPT10[41 s {LTY.: . UAA . 1AX PHIGEEACl1' . EX .E "C?tf::i 0000-899 PATIO DOOR-NATISLIDING PATIO DR UP TO 72X96 0.00 EA N $469.00 $0.00 e $54 -4 n iONMM44AM G-LENN NEWTON INSTALL LABOR CHARGE: 0-00 v m ADDRESS: 3C FLETCHER WAY TRIP CHARGE: $45.00 0 CITY: SALEM STATE MA ZIP: 01970 CREDIT FOR DEPOSIT/MEASURE: $0.00 COUNTY: ESSEX SALES TAX RATE: 6.250 TAX: Merchandise- Y LABOR- N • $0.00 PHONE: 978 744-5403 ALTERNATE PHONE: 978 979-8469 INSTALLER SPECIAL INSTRUCTIONS: 2ND NEW PO FOR LOST DAY FOR PATIO DOOR ORDERED INCORRECTLY--RELATED TO ORIGINAL PO#86461531 y '` i� It'1lST7lCl#3 m LQ 0 u m m 0 m I Page 5 of 6 NO. 2686-276779 Customer Copy SPECIAL SERVICES CUSTOMER INVOICE-Continued Last Name: NEWTON Page 6 of 6 NO. 2686-276779 0 0 10 TOTAL CHARGES OF ALL MERCHANDISE & SERVICES 0 3.73 Policy Id (PI): � o 0 A: 90 DAYS DEFAULT POLICY SALES TAX $116.20 a TOTALI $2 569.33 ti REFUND OWED ro 91.61 m 'The Home Depot reserves the dght to limit/deny refums. Please see the return policy sign in stores for details.' m N p. o A N I i : '' ENb`UF OpDER No.2686-T76M c m m,o pp e y N r o r e -4 w n v m v •- v $ N N y r• 9 o w ro w w 0 .Q N V Page 6 of 6 NO. 2686-276779 Customer copy 10/03/2014 10:39 FAX 19787620581 N01/001 American Properties Teat, Inc. TO: 3C Fletcher Way FROM: Jennifer Pappas, Property Manager RE: Slider Replacement DATE: June 30, 2014 Please be advised that the Board of Trustees for Pickman Park has approved a replacement slider for the above referenced unit. This approval is contingent upon it matching the existing slider, fitting in the existing opening and being the same in appearance from the exterior. The Board will not allow grids, etc. unless they are removable. You should also be aware that your contractor is responsible for painting any new trim/clapboards as a result of the installation. Should your contractor find any rot or damage during the slider installation, it should be reported to my office immediately. We also require that permits be pulled in advance(regardless of what your contractor may tell you), and then a copy of the final approved permit once completed must be sent to APT for the nit file as welt. In addition, we recommend that owners obtain a certificate of insurance from the licensed contractor. You will need to bring a copy of this letter to the Salem Building Department in order to receive Your permit. Should you have any questions or require additional information, please feel free to call me directly at(781) 569-2675. cc: Unit File 5C!04vF5T CUMPAIhG$PAFiiS SU!Tt 50'.i0 WOFURN MA 01801, 781-932-9229 ,FAX781-93-94289 To: 19787620581 From: 167BB175200 Date: 09/11/14 Time: 2:47 AM Page: 02 Rightfax N2-1 9/11/2014 5 : 47 :03 AM PAGE 2/002 Fax Server CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDM/YYI T T IFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS),AUTHORIZED OR PRODUCER.AND THE CERTIFICATE HOLDER. MPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(7es)must be endorsed. H SUBROGATION IS WAIVED,subject to he terms and conditions of the policy,certain policies may require and endorsement. A statement on this certificate does not confer rights to he certificate holder in lieu of Such endorse s. PRODUCER CONTACT NAME: JOHN J WALSH INS AGCY PHONE FAX P.O.BOY 4407 WC.No,EAt): (AJC,ND): EMAIL SALEM.MA OI970 ADDRESS: 26HTH INSURER(S)AFFORDING COVERAGE NAIC R INSURED INSURER A: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA MALKIN,IRA G DBA MALKIN&SONS&N E INSTALLS INSURER B: INSURER C: INSURER D: ISO DAYTON STREET INSURER E: DANVERS,MA 01923 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOT WITHSTANDING ANY REQUIREMENT,TERM ON CONDITION OF ANY CONTRACT OR OTHER DOCIIMEM WIN RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 1S SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICES, UMRS SHOWN NAY HAVE BEEN REDUCED BY PAD CLAMS INSR ADD SUB POLICYEFFDATE Po EXPDATE LTR TYPE OF INSURANCE L R POUCYNUMRER (MENDmYYYY) (MMMOIYYY17 LIMITS GENERAL LIABILITY CH OCCURRENCE COMMERCIAL GENERAL LIABILITY AMAGE TO RENTED $ CLAIMS MADE OCCUR. REMISES(Eaocmrrenm) VIED EXP(Any one person) $ PERSONAL B ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: ENERALAGGREGATE $ ID POLICY [::]PRO1ECT aLOC RODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIREDAUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) I UMBREIIA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ 4 WORKER'S COMPENSATION AND �, WC SIATUTOHY OTHER EMPLOYER'S LIABILITY WINUB-2E3270R0-14 00/31/2014 OR131/2015 LIMITS ANYPEOPERITOR/PARUIEWE UTDED? CIVE OFFICEWM R EXC 1,1 El N/A E.L.EACH ACCIDENT $ 100,000 E ITO DADdatoryin NH) E.L DISEASE-EA EMPLOYEE $ 1 D0,000 tt VM des[dbe UMw DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMB $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONSIVEMCLES/RESTRICTIONSISPEGAL BENS 'PINTS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTINICATB HOLDER AFFECTING WORKER$COMP COVERAGE. THE WORKERS COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR MALKIN,IRA G. RE:DIANE NEWTON 3C FLEICHER WAY SALEM,MA 01970 CERTIFICATE HOLDER CANCELLATION -..._._...._ ---_.._...._.__.._.__.__-----_ —. PICKMAN PARK SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED C/O AMERICAN PROPERTIES BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 500 WEST CUMMINGS PARK SUITE 6050 AUTHORIZED REPRESENT yV WOBURN,MA 01801 - ACORD 25(2010l05) The ACORD name and logo are registered marks of ACORD 1988.2010 ACORD CORPORATION. All rlghts reserved.