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12 HARTFORD ST - BUILDING INSPECTION (3)
_ 1 The Commonwealth of Massachusetts CITY OF Board of Building Regulations and Standards SALELM I I� Massachusetts State Building Code, 730 CMR Revised Mar 2011 Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Tivo-Family Dwelling This Section For Official U my Building Permit Number: Date App ed, Building Official(Print Name) _ Signat Date SECTION I:SITE INFORMATION L I Pypger Idd r� 1.2 Assessors Map& Parcel Numbers 1.1a Is this an accepted street?yes_ no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: 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? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2:; PROPERTY OWNERSHIPL 2.1� f KOwnert of Record:` q p. 0147D r 1 e-r . ..)Govt-r V { Name(Print) City,State,ZIP 12 1ltr11;rj .S I 781-608-7368 No. and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WOR.W(check all that apply) New Construction❑ Existing Building K Owner•Occupied td 1 Repairs(s) �L I Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ 1 Number of Units_ IOther ❑ Specify: Brief Description of Proposed Work': jute "4 o S 1 3 DC 2 V SECTION 4: ESTENLATED CONSTRUCTION COSTS- Estimated Costs: Official Use Only,, Labor and Nlaterials y. 1. Building s 1 ` -00 11. Building Permit Fee.S ' Indicate how fee is determined: 11.Standard,City/town Application Fee 2. Electrical $ ❑Total Project Cost(Item 6)x multiplier x 3. Plumbing s 2. Other Fees: 3 i. Mechanical (1IVAQ s List: S. Mcclmnical (Fire s Sn , ncssion) 'lbtal:\Il Fees! s_ —Lam---- -- Check No. Cltce{c Amount: ---Cash :\utonnC 1'11t:11 Project Cost 3 00 ❑ I'ai l in Fall 11 Outstanding llalancc Dud: r , SECI'ION5: CONSfRUCTIONSERVICES 5.1 Cmtstruciion Supervisor License(CSL) License Number E.epiratimt Date Name of CSL I loldcr List CSL Type(see below) No. and Street TypeMRootrtnCoverin Description U ted �uildin s u to 3i,000 cu. Il. _ R d 1&2 Funil Dwellin City/:Totvn,State, ZIP VI RC overinWS andSidinSF t Burning Appliances .lVe hone Email address D Demolition 5.2 Registered Home Improvement Contractor(H[C) MC Registration Number Expiration Date I11C Company Name or I IIC Registrant Name No.and Street Email address City/Town, State, ZIP Telephone SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.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 of 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 authorize to act on my behalf, in all matters relative to work authorized by this building permit application. M a,r a rN-4,tl Print Owner's Name(Electronic Signature) Date SECTION 7h: OWNER' OR AUTHORIZED AGENT DECLARATION 7entertinrige below, Ihereby attest under the pains and penalties of perjury that ail of the information i is true and accurate to the best of my knowledge and understandding..r red:\gcnt's Name(Electronic Signature) Daft 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 find under M.G.L. c. 142A. Other important information on the HIC Program can be found at www nMS>.aov;'oca Information on the Construction Supervisor license can be found at ww•w.nrtis.•.at�'dL 2. When substantial work is planned,provide the information below: Total Floor area(Sy. It.) (including garage, tinislied basement/attics, decks or porch) (lroS; living ;uca(Sy. tT.l -_ Habitablo room Count — — NumLcrnflirrpLtces ----- _-- Numberofbedruoms ____---------_--_-- Number of b,uhroumS Nunthcr of h;dubaths _ - ----------- Ibpu of lte.tting iyitent . -- Nnntber of decks/porches I' pc ot'Cooling svitent Eucloset prat j 1. ` of tl hoj, Ct iyu trt f.il I io act Co_t" ' I . Knot i �" urty h� iuL;hhrt� I t i_' � _ • I ' CITY OF S.1 zm; 'AASSACHUSETTS !- :t•jy -� ' ©t:ILOLYGDEP.IA .NT .]•�b 4 1?0 WASHNGTON STREET 31 FLOOR " TEL (978) 745-9595 uNIMR1 RY DRISCOLL FIL<(978) 7.1U-9346 bL�YO,i DIOAU ST•PtEAU DIRECTOR OF Pt;xic PROP ERTY/BLaMLN(;CONL\INSIO.NER Construction Debris Disposal Aff7davit (required for all demolition and renovation work) In accordance will' the sixth edition of the State Building Coda, 730 CD,IR section It 1.5 Debris, and the provisions of tb(GL c 40, S 54; Building Pennit A 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 NIGL e 1 11, S 150A. The debris will be transported by: Pl9l S y/1 S (name of haulur) The debris will be disposed of in : C-,r--Sf,4�, ,w, (name of racaity) Cp'7 LAi4 440 0 17ua�� (iddress of(eality) signature urpermit applicant d.nc -- The commonwealth.of_Hassacftusetts Department of Industrial Accidents _ Jffee oflnvestizations�' 600 Wizshina rzn Street Barton Mz. vld _ zv ma -7111 ss gov/diaia o hers' Compensation L35ur-nCe-�''�`avit. Builders/Contractors/Electricians/Piumbers Please Print Le6ibly lfcantinformation t � Sa of ie — 77 y 63P I}f1U2aQC /° P G!7- Phone#: EapIOver? Check the apnr .e t'n' Type of project(required): .a general contractor and 1 6. New construction ✓_.—< -'c th © _ — _ iced the sub-contractors "roTP4 7. ❑ Remodeling a on the auacbed sheet $ 8 Demolition sub-contractors have e'-�'-ov`" —n' comp-insurance. 9. ❑ Building addition �ay � — _ _ a corporation and its 10-[] Electrical repairs or additions cow.=, S — _ - - N„have exercised their 11 ❑ Plumbing repairs oz additions of exemption per MGL '=d' -" `-' a andwehaveno 12-El Roof repairs ca - ;oyees. [i Ia workers' 13.� Other insurance required) ovrin�their workers'compensation policy infottnation: ae;:t�e then hire outside contractors must submit a new affidavit indicating such . _--- :ooirg tbe nerve of the sulrcoamctors ana their workers'comp-policy informstion raeruatiart insurancefor my employees. Below is thepolicy and job site � !( ! 'U-�1 o`.Expiration.Date'. City/state/Zip: S�fa •• r>-yv o/S a R oykzrrrFtht t m- y, dos policy declaration page(showing the policy number and expiration date). Z�eulion 25A of MGL c- 152 can lead to the imposition of criminal Penalties a a Y r enL as well as civil penalties in the form of a STOP WORK ORDER and a fine �e dvyed that a copy of this statement maybe forwarded to the Office of everificadon. s an[ ;:ettfes ofpedury that the information provided above is true and correct. S -2s•-�1� Date: '- =fttt� - f% -- 7Q rat ;rKe s thLT area,to be completed by city-or town official PermitUcense#? one): - - �_r� iildina D apartment 3-City/Town Clerk 4.Electrical lnspector 5-Plumbing Iaspector Phone#: . office of Consumer Affalrs andusiness Regulation ,., 10 Park Plaza - Suite ^J ;{ Boston,Massachusetts'02116 ent Contractor Registration Home improvem Rppis,ra idual tion:. 1006 Type, Individ Tr# 223598 Expiration: 612Z12014 IRA G: MALKIN Ira Malkin 180 Dayton St Danvers, MA 01923 nge- Update Address and return card.Mark reason for t t Card Address Renewal fJ'' Employment nPs-CA1 to i0M-041Q1.G101210 p --- ll� lanon License or registration valid for individul use only ✓/e n:,,; r AffAi ff& a'ness Regn before the expiration date. If found netsRtegulation Office of Consumer.afta"1rs&B rs and Business e CONTRACTOR office of Consumer Affai ' GHOMEIMPnOVEM� CONTRA Type: 10 Park pIM-Suite 5170 a `--Ra istratio - Individual Boston,NIAo2i16 Expira0on: 61W2014 IRA MALKIN. .. Ira Malkin 18o Dayton St —� Not valid without signature Danvers,MA 01923 Undersecretary -- - ---- >ias;achusctt>- Dcp:u'tmcnt of Public >arcl} Bnard of Buildin_ Rculutian. andtandurd>. Construction Supervisor License License: Cs 20014 IRA G MALKIN 180 DAYTON ST DANVERS, MA 01923 Expiration: 7131r,013 �iG—mod 7r- 17976 <'ununi<iunrr .�� 9MALK01 OP ID: DO CERTIFICATE OF LIABILITY INSURANCE F DATE(M WY) 05/24/1 4/13 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 phone:978-745-3300 CONTACT NAME: John J Walsh ins Agency,Inc Fax:978-745-9557 PHONE FAX P O BOX 4407 A/C N Ext: Salem,MA 01970-6407 E-MAIL John J.Walsh Ins.Agcy.,Inc. ADDRESS: INSURER(S)AFFORDING COVERAGE NAIL O INSURER A:United States Llab Ins CO INSURED Ira G. Malkin INSURERB-Travelers DBA Malkin&Sons 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 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. NSR IUDDL TYPE OF INSURANCE POLICY NUMBER MUBR POLICY D EFF POLININUDDIYYTY LIMITS LTR GENERAL LIABILITY EACHOCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY CL1564366A 10/03/12 10/03/13 DAMAGE TO RENTED PREMISES Ea orcurrencel $ 50,09 OLAIMSMADEA I OCCUR MED UP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GENERALAGGREGATE $ 2,000,00 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ 2,000,00 POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANYAUTO BODILY" RY(P.r person) $ ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS AUTOS PeraccitlerM1 $ UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE IS DED I I RETENTION$ S WORKERS COMPENSATION WC STATE TW AND EMPLOYERS LIABILITY TORV LIMITS ER B ANY PROPRIETORJPARTNEMXECUTIVEY/N PJUB-203X968-2-12 08/31/12 08/31/13 E.L.EACH ACCIDENT S 100,00 OFFICERJMEMBER EXCLUDED? NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,00 It yes,descrme under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ 500,08 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Addltbnal Remarks Schedule,If more space is required) CONSTRACTORS EXECUTIVE SUPERVISORS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Jennifer Masello THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 12 Hartford Street ACCORDANCE WrrH THE POLICY PROVISIONS. Salem,MA 01970 AUTHORIZED RE P R ESENTATIVE v s ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD 'I SPECIAL SERVICES CUSTOMER INVOICE Page 1 of 5 NO. 2686-256017 Ln �,-�, Store 2686 SALEM,MA Phone: {978} 741-9299 N a 50 TRADERS WAY Salesperson: MLE05N SALEM, MA 01970 a Reviewer: FMA�SELLO '- wTae)5 REPRINT JENNIFER {s17}s4s-DeesRTFORD ST Rb*PMne (781) 608.7368 M °eS"="n' EXTERIOR DOOR 2013-05-24 07:47 �P 01 970-1 034 ca'"h ESSEX INSTALLER DELIVERY #1 MERCHANDISE AND SERVICE SUMMARY sod to astthe er ght to iimi[the quantaies of merchandise REF# 101 STOCK MERCHANDISE TO BE DELIVERED! - REF SKU OTY UM DESCRIPTION PI Nff EXTENSION o 902 0000-966.471 1.00 EA 9"X33-5116'WINDOW&DOOR SEALING TAPE A $19 29 $19 29 R03 0000-163 Bi3 3 O'D EA 1X8-BFT PT WEATHERSHIELD 57.27 7.27 ti R04 0000-715-499 3.00 RL MULTI-PURP 16-X48- ROLL INSUL 5.3SF Y 4.65 $13.95 It R05 ODDD-156.043 8.00. LF 1/4 X2-1/2 PINE WM263 LATTICE A Y $2.25. 18.00 o RO6 0000-249-026 3.00 EA 1.1/4 X2X8 PVC 2448 BRICK MLD WHITE A Y $13.84 $41.52 R07 0000-677-401 1.00 EA 314"X7-1/4"X8'AZEK S2S TRIM A Y $37.25 $37.25 R08 OWO-677.038 1.00 EA3/4'X3.1/2'XB'AZEKS2STRIM A Y 17.94 $17.94 RO9 0000-157-287 1,00 PC 112 X4.5/8X72 OAK 473 SADDLE A Y 519,85 $19-85 RIO ODDO-914-835 2,00 EA 1X8-8 NO PREMIUM PINE A Y $10.75 1.50 Rif 0000-153-508 24.00 LF 11116X2.112 PINE WM351 A Y 51.24 S29.76 R72 0000-154.687 24.00 LF 11/16 X3 112 PINE 4 NG A Y $1.90 _ 45.60 R13 0000-161-713 1.00 EA 2X6-8FT#2 T SPF 'A Y $5.19 55.19 � S!O- MDSE TO BE DELIVERED: REF# S15 ESTIMATED ARRIVAL DATE: 05/29/2013 P.O. #86505447 o c a co 10 a� G\`itl rn Check your current order status onfine at N WWW.homBdepoLoomlorderstatu8 L O age 1 of 5 NO. 2686-256017 Customer Copy O N SPECIAL SERVICES CUSTOMER INVOICE - Continued Last Name: MASELLO Page 2 of 5 NO. 2686-256017 � � O Ln INSTALLER DELIVERY #1 (Conlinued) _ REF#101 _ REF # SKU _ i OTY UM I DESCRIPTION PI TAX PRICE EACH EXTENSION S1501 0000-106-270 1.00 EA NA/<> R.O.:52 1/4"X 82 1/8" /(#1)<> R.0.:52 1/4" X 82 1/8", ENTRY WITH A Y 32,004.00 $2,004.00 SIDELITE`VERSION:7.2.8'PRODUCT CATEGORY:ENTRY DOORS"PART NUMBER:SP J 3G 3"BOX:BOX CONSTRUCTION AND 1/2" SPREAD MULLION`CONFIGURATION:SINGLE WI SIDELITE RIGHT SIDE'PRODUCT TYPE:ELEGANT MAHOGANY WOODGRAIN'SWING S1502 0000-106-270 1.00 EA NA BASE I"ATT TO f#1}`PRIMED JAMB DEPTH:5 1/4' A Y $35.00 $35.00 S1503 0000-106.270 1.00 EA NA I BASE/'ATT TO(#1}'BOX CONSTRUCTION SETUP WITH SPREAD A Y $61.00 $61.00 MULL 1/2" OR 1' V ENDOR- SPECIAL INSTRUCTIONS: 7.2.8:: S/O - MDSE TO BE DELIVERED: REF# S16 ESTIMATED ARRIVAL DATE: 05(2312013 P.O.#86505448 REF# SKU OTY UM DESCRIPTION PI I TAXI RICE EACH EXTENSION S1601 0000-693-165 1.00. EA 26927 I<>36'W X 80" H - D, R.O. N/A/26927 (#1}<> H4THO-36WHE, IA 11 Y $339.00 $339.00 SPECIAL ORDER ONLY, STORM DOOR,ANDERSEN, FULLVIEW, 4000 FULLVIEW WITH INSULATING GLASS WITH OIL RUBBED BRONZE o HARDWARE LOW-E 36" X 80" WHITE 26927 _ 'VENDOR-SPECIAL INSTRUCTIONS: 12.1.0:: n • 2 716.12 DELIVERY INFORMATION: DELIVERY DATE:INSTALLER WILL SCHEDULE INSTALLER WILL DELIVER MDSE TO: SITE OF INSTALLATION #101 AT TIME OF INSTALLATION. NOTE: UPON RECEIPT OF ALL S/O MERCHANDISE-INSTALLER WILL CALL CUSTOMER TO SCHEDULE INSTALL DATE. r` — o INSTALLATION #1 REF# 101 ESTIMATED INSTALL BEGIN DATE: 0511 W01 3 ESTIMATED INSTALL END DATE: 06/21/2013 MERCHANDISE TO BE INSTA!lED: REF# SKU OTY UM DESCRIPTION 0 1 co co r LR r r _ M N O o age 2 of 5 NO. 2686-256017 Customer Copy Rl SPECIAL SERVICES CUSTOMER INVOICE - Continued Last Name: MASELLO Page 3 of 5 No. 2686-256017 n n 1 INSTALLATION #1 !Continued} REF 4101 W06 0000-966-47'1 1.00 EA 9"X33-5/16"WINDOW&DOOR SEALING TAPE 0000-163-61. 3 1.00 _EA 1X8-8FT PT WEATHERSHIELD_,— 0000.715-499 _ 3.00 RL MULTI-PURP 16"X48' ROLL INSUL 5.3SF _ 0000.156-043 8.00 LF 1/4 X2-1/2 PINE WM263 LATTICE 0000.249.026 3.00 EA 1-1/4 X2X8 PVC 2448 BRICK MLD WHITE 0000-677-401 1.00 EA 314"X7-114"XS'AZEK S2S TRIM 0000-677-038 1.00 EA 314"X3-1/2"X8'A7EK S2S TRIM0000-157-287 1.00 PC 1/2 X4-5/8X72 OAK 473 SADDLE R10 0000-914-835 i 2.00 EA 1X8-8 NO.2 PREMIUM PINE R11 0000-163-508 24.00 LF 11116 X2-112 PINE WM351 CASING R12 ODOO-154-687 24.00 LF 11/16 X3-1/2 PINE WM444 CASING R13 0000-161-713 1.00 EA 2X6-8FT#2113TR KD-HT SPF S1501 0000-106-270 1.00 EA <> R.O.:52 1/4"X 821/6" S1502 0000-106.270 1.00 EA BASE S1503 0000-106-270 1.00 EA BASE S1601 0000-693-165 1.00 EA <> 36"W X 80'H- D R.Q.NIA r BASIC INSTALLATION LABOR: SKU DESCRIPTION OTY UM TAX PRICE EACH . EXTENSION 0000-8 98 IPRE-HUNG DOOR UP TO 72X96 1.00 EA N $498.00� $498,DDI OPTIONAL LABOR SELECTED INCLUDES: OPTION DESCRIPTION OTY UM TAX PRICE EACH EXTENSION 1 HAUL AWAY OF EXISTING DOOR/ 1.00 EA N $20.001 120.00 23 INSTALL NEW STORM/SECURITY DOOR {APPLICABLE ONLY DURING INSTALLATION AT 1.00 EAj IN $97.00 $97.00 THE SAME ADDRESS AT THE SAME TIME ; CUSTOM LABOR SELECTED INCLUDES: OPTIONT DESCRIPTION I OTY I UM TAXI PRICE EACH I EXTENSION r a 0 a V V n n V A age 3015 No. 2686-256017 Customer copy v SPECIAL SERVICES CUSTOMER INVOICE- Continued Last Name: MASELLO Page 4 of 6 NO. 2686-256017 n i INSTALLATION #1 (Continued) _ REF #101 _ _ 2 DISPOSAL OF OLD STORM DOOR AND DEBRIS 1.00 PA N $10.00 j$625E)00 INSTALLATION SITE NAME: MASELLO JENNIFER INSTALL LABOR CHARGE:ADDRESS: 12 HARTFORD ST TRIP CHARGE:CITY: SALEM STATE: MA ZIP: 01970-1034 CREDIT FOR DEPOSITIMEASURE:COUNTY: ESSEX SALES TAX RATE: 6.250 TAX: Merchandise- Y LABOR- N o PHONE: 781 608-7368 ALTERNATE PHONE: 617 548-9818 >1 BASIC INSTALLATION LABOR INCLUDES: ' PRE-INSTALLATION JOBSITE INSPECTION OF THE NEW DOOR WHEN THE CASING+TRIM IS THE SAME SIZE OR T 'DELIVERY WITHIN 30 MILE RADIUS OF STORE WIDER iCUSTOMER PROVIDES) 'REMOVAL OF EXISTING DOOR UNIT 'INCLUDE NON-COLORED STUCCO PATCH UP T04"FROM JAMB AFTER 'INSTALL NEW SLAB OR PRE-HUNG EXTERIOR DOOR UNIT EXTERIOR MOULDING IS INSTALLED,WHEN APPLICABLE INSTALLER TO PROVIDE NECESSARY FASTENERS, SHIMSAND 'PRE-HUNG DOOR UP TO 72X96 INCLUDES DOUBLE DOORS AND DOORS CAULKING WITH SIDELIGHTS(FACTORY MULLED) I•INSTALL NEW OR EXISTING LOCKSET AND KICK PLATE(IF 'FINAL CLEAN UP OF ALL DEBRIS RELATED TO INSTALLATION :5 APPLICABLE)ON NEW DOOR(CUSTOMER PROVIDES) 'FINAL INSPECTION WITH CUSTOMER INCLUDING INSTRUCTIONS ON A '.ADJUST DOOR TO ENSURE PROPER OPERATION CARE ANDIOR TEST PRODUCT TO ENSURE PROPER OPERATION A 'DRILL HOLE IN JAMB FOR ALARM WIRING IN SAME LOCATION AS EXISTING DOOR r `INSTALLNEW INTERIOR CASINGANO EXTERIORTRIMIBRICKMOLD UNLESS STATED ABOVE THIS INSTALLATION DOES NOT INCLUDE: INSTALL DOORS OVER 72X96 STUCCO PATCH GREATER THAN 4', PAINT AND STAINING T INSTALL FIXED ARCH TRANSOM LITE IN EXISTING OPENING DISCONNECT AND RECONNECTOF SECURITY SYSTEM&WIRING REPAIR CARPENTRY TO EXISTING OPENING WORK ON SUNDAYS OR HOLIDAYS PLASTER, DRYWALLOR SIDING WORK SPECIAL NOTES: 'ELECTRICITY MUST BE ACCESSIBLE TO THE WORK AREA WITH LOCAL ANDIOR STATE CODES 'IT MAY SE NOISY DURING YOUR INSTALLATION 'IF UNFORESEEN LABOR IS NEEDED TO REPAIR DAMAGE FROM WATER, THE INSTALLER WILL BROOM CLEAN THE IMMEDIATE WORK AREA TERMITES, ELECTRICALOR PLUMBING PROBLEMS,THERE IS AN ADDED > BEFORE COMPLETING THE INSTALLATION,AIRBORNE DUST IN OTHER CHARGE WHICH MAY NOTBE AVAILABLE FROM HOME DEPOTSO THE CONTINUED ON NEXT PAGE O D V V R I n - V n `Wage 4 of 5 NO. 2686-256017 Customer Copy V SPECIAL SERVICES CUSTOMER INVOICE - Continued Last Name: MASELLO Page 5 of 5 NO. 2686-256017 Y � I � QL r-QL INSTALLATION #1 _._. _ (Corttinued) -- ---- ----- _ iREF 4*I01 PARTS OF THE HOME IS A NATURAL OCCURRENCE AND IS THE CUSTOMER MUST HIRE THEIR OWN CONTRACTOR TO MAKE THE REPAIRS. RESPONSIBILITY OF THE CUSTOMER. 'CANCELLING APPOINTMENTS WITH INSTALLERS OR!HISSING 'AN ADULT OVER 18 YEARS OF AGE VJITH THE AUTHORITY TO MAKE SCHEDULED APPOINTMENTS MAY LEAOTO ADDITIONAL CHARGES DECISIONS ABOUT YOUR INSTALLATION MUST BE PRESENT DURING THE ' REFER TO PRODUCT MANUAL FOR SPECIRC WARRANTY AND - INSPECTION(WHEN APPLICABLE},DELIVERY AND INSTALLATION MAINTENANCE INFORMATION. i ALL BREAKABLES AND/OR VALUABLE OBJECTS MUST BE REMOVED 'THE INSTALLER MAY DECLINE TO INSTALL THE JOB IF IN THEIR FROM THE WORK AREA PRIOR TO INSTALLATION PROFESSIONAL OPINION IT SEEMS UNSAFE.IN VIOLATION OF STATE CHILDREN AND PETS MUST BE KEPTAWAY FROM THE WORK.AREA OR LOCAL CODES OR CANNOTSE PERFORMEDTO INDUSTRY S-ANDARDS 'ADDITIONAL CHARGES AT THE JOBSITE MAY BE NECESSARY TO COMPLETE THE JOB AND•'OR BRING THE INSTALL INTO COMPLIANCE END OF INSTALL#1 TOTAL CHARGES OF ALL MERCHANDISE A SERVICES_ o Policy Id(PI); $3,347,12 A A:90 DAYS DEFAULT POLICY«......... — .«.««..««.«..«....«....«• SALES TAX' $169.76 TOTALI $3,510.88 r BALANCE DUE $625.00 PAYMENTTERMS: Refer to the Home Improvement Agreement for payment terms• b a The Nome Depot reserves the right to Rmlf/deny returns. Please see the return policy sign in stores for details.' END OF ORDER No 2686-256017 z :0 b .n ti h n h v n ' age 5 of 5 No. 2686-256017 Customer Copy