2 LARKIN LN - BUILDING INSPECTION (2) 4
�1�NBI&WIlE f WkW APPROVED BY TW
WPEC=-PWR TDA'P.ESYI7 1MING GRANTkD
CITY OF SALEM
NoOde
.
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w 1 Ward
ft Wtlale omm?� Yak.No
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Is Pvopsrly locobd in
ftCanauvasonAMR? Yak_Now,
Permit to: NG R:
BUILDI PERMIT APPLICATION FOR:
(Circle whichaver apply) Roof. ReW. UI-S1idfnp. Contt�x peck, Shed, Pool,
Repair ,�IOther.
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROCEgSMq
TO THE INSPECTOR OF BUILDINGS: '
The undwsignsd hereby applies for a permit to build aocortLig,to the following
speoiflcatiorw: /
Owners Name C,Un//�+�, �/ 141 C L
Address A Phone ( L.Ae/C, / (97S) -7 tf
Architect's Name
Address a Phone ( )
Mechanics Name H r-I o
Address 3 Phan � 6ttto&,
AV qc: b,)r-U
What Ia Mla P Pm a tarww
I�A�W W a tRidrq? V,A, yc- t/jr 1v,�o 05 ff a dwa- g,br how many hndMT
WE bAdIng cation,to law? Aftmbs?
Edmalad scat I �, Cpy Lk n r ebb •
a� tspt�t
I 3 SowWrs of Applicant
SIGNED UNDER THE PENALTY'
OF PERJURY
RIPTION OF W TO/BE1DONE
_ E
MAIL PERMIT TO: BUNROEUN CHHO"JY I
HOME DEPOT
RD
4 COBURN RD.
TYNGSBORO,ML 01879
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I
CITY OF SALEMP MASSACHUSETTS
1' PUBLIC PROPERTY DEPARTMENT
120 WASH INGTON STREET, 3RD FLOOR
SALEM, MA 01970
TEL. (978)745-9595 ExT. 380
40 FAX (978) 740-9846
STANLEY J. USOVICZ, JR.
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the provisions of MGL c 40, S34,I acknowledge that as a condition
of Building Permit# ,all debris resulting from the construction activity
governed by this Building Permit shall be disposed of in a properly licensed solid-waste
disposal facility,as defined by MGL c III,S 150A.
The debris will be disposed of at:
Location of Facility
Si ature of Permit Applicant Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
�?p
Name of/Permit Applicant
Firm Name,if any
F�'iywazS Si,
Address,City& State
The above statute requires that debris from the demolition,renovation,rehab or other
alteration of building or structure be disposed in a properly-licensed solid-waste disposal
facility as defined by MGL cIII, S 150A, and the building permits or licenses are to
indicate the location of the facility.
vLS
Dcpertment of Indwstrial
M rr EN
600 Washirigion Stl-eet
---- ---- Boston, Mass. 02111
Workers'wom Com ensation Insurance Affidavit;Bu=Mn JumbinVElectrical Contractors
WIN /wo"Eff"
name: 6w-j C H Ho LA�-1
C 0 ij
city I 1J Gf SP-->0 P,6 state: 1 r I A zip:-0 1 phone# 7S- -,5 710 VJ
C -A
work site location(full address)'
El I am a homeowner performing all work myself. �VrqjoctTypc: El New Construction ENRemodel
❑ 1 am a sole proprietor and have no one
MMo ""M W"MMMMwMorl d n in a n ca aciM.M KOE Bui l din=Addition
IAWMm
lama employer providing workers compensation for my employees working on this job.
come alma: t TA A�P-9-
str
921D, 65
AMA-.
0�6:v�,a
hau sic 961im I -
MWOMMUNIMEM
El I am,a sole proprietor,general contracto;rcor homeowner(tirele one)and have hired the contractors listed below who
have the following workers'compensation-polices:
4d as:
elty. ohoae
it.
in
$Mr-ran Co. An Je%
COM]Dntivi-lamt!:,
address,
eft, aihone#iaiunoce co. tic 'q
Failure to secure coverage as required under Section 25A ofMGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or
one years'intiorbousuent is well as civil penalties to the form of a STOP WORK ORDER and a two of$100.00 9 day against m. I understand that a
copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
I do hereby certify under thepalus and penalties ofperistry that the information provided above is trite and correct
signature
Print name LA CWHO, Phone#
97MM.l.MI.a only do not"Ite in this area to be completed by city or lows official
city or to,,vu: percult/liccuse Department
_E]Bui]dWg Department
Boa
OLIcensing Board
Office I
E)check ff immediate response,Is required 11selectmetils Oftice
011-1th Dep.rtwe"(
contact person: phone#; _00(ber
(tweed scarXM)
Ar,
A_fit
------- ....
3&0 HOME IM111'ItOVEh1 F.NT CONTI2AC'1'
.6 _
4'�f��/1��M hs Sold.I''umished rant Insudle(i h1-
e Branch Nome:_j,/,r Date: 2 (/$ THD At-I None m,''ices,Nr.
d/bN The Hnme D p n AI-lit m S n l
��T/ •, 345ACrce Oqb)) Strct Wvax:SI htA 01 n'
-fee000)I,L 51R2 1t': ita 7s( +c"
Puccml IUx)5 Nvawro MI,Lea[ u d. m;
Cl Lice Sh5522; MA Homelmpnnvmenl CnmrwU'r Rer.Al.`on:+
Installation Address: — �`�..._...Z
— City State Zip
Drlvnl Lie N&Rx .Dntee __ W hone: Holne please:
E
Home Address: ---
([(differentfrom Instillation Address) City State Zip
Project Information: 1/We/You("Purchaser'),tbC owners of the property located at the above installation address,of let to
contract with Home Depot U.S.A.,Inc Ho c Depn ) )sh,deliver and arrange for the installation ol'all mmcrial,;is
described on the attached Spec Sheet a: '��s(_ __.incorporated herein by reference anal made a pan hCl'cd:
Home Depot reserves the right to cancel this contract if,upon re-inspection of the fob,Home Depot determines that it
cannot perform Its obligations due to a structural problem with the home or because work required to complete the job
was not included In the contract.
DEPOsi,r PAYMENT OF[IONS
/�/ y)�)ISuhied to('and verification andlor creditnppr eeal.I
CONTRACT AMOUNT $� Sj� 2 `�J"""•l'ashit,o Check-r US PoaUI selice Moncy ONcr
��- (Made payable to l'he Home Depot[.
`LESS DEPOSIT' $ 2. Credit(:aid*anchor other payment opuon.v�Ili tie One delun
Visa l/aaar['aid Discover American l.xPmax
BALANCE:DUE
ON COMPLETION $�19� "I he theme Dcpol I tome hnplovaulfa Lean I he Il.nnc 0m,I('redo laud
Assitvble C Pcob:c (ell.&He('I 0\1 PI
Minimum 25%of Contract Amount due upon execution
f this contract. Accdl' E.p.Wm:......__..__ _..
Numc as it appears an cord:__......
Indicate Payment Method For •ny ntY/'fur signxmrc lwno»,I/wc aarccmallow Hnme{hoot .d..:.
BALANCE
/DUE
.IO�N�C�O}f,'MPLETION: r<rzremm�credo coal lbr dlc dc11.4 indmmcd.
`-w 1/`^� v Cardholder'-'Sigmnnrc
_Ill[,or HDCC Authorization Codes
Deposit ______..__-___Final Pa'mmot
# #
PUCIDISe[agrees that,immediately upon satitilhctory completion of the work,Purchaser will execute a Completion Cceillcatc
and pay any balance due. PnrCID Ser also agrees to he jointly and severally obligated and liable hereunder.
Entire A rcerne'n I:"this abreclnele and it,roaclan cut,. including:my financinq agreement,contain the'Irn fete a6we nenl
etween t e parties and can not be amended or modlf ied--less I,,Writing in a separate agreement signed by hot Tin ies.
NO110E 1'0 PURCHASER
Do net sign this contract before you read it, N an are entitled(a a completely'filled-in copig of the contract al the time ynn sip-. Keep
It to protect your rights. Do not sim,-ny Completion Certificate or agreement stnting Ihat yen are satisfied with the entire project
before this project Is complete. Law prohibit;home repair contractors from reuuesdng or accepting a Completion Certificate signed
by the owner prior to the actual completion of the work to be performed tinder the Contract
1'o m u mat aad Ihia Ir:msartiort at aIn lime Prior In Inhibit at the third hnsinrss day after the date of ibis emormi. .See Nonce of
Cancellation tin an I%planation of Ihis right. I acre will Ile a service charge equal'w 25'l'o of the vunlract amount i1 the lots 11
cancelled by Purchaser AP'1'Ell the third business do,.
BY MYIU(Ill SIGNA'IU RE BELOW.I/WL AGRElll'U Ill`.IIDCND BY I I I E"I'FRMS OF TI[IS('')N'I RACI'. bW I.M hN(Itt I I J:[r.
RECEIPT OP A COPY OF THIS CON OR ACT'ANT)1WO('11M['[.I.MD COPIES Of TIIF NO'I'III:OF(:AN('1'11 A I ION,
BY MY OUR SMNAIVRE ❑GLOW, UW'E UNDLRS"l AN 1) '1'1IA'1 UII.. AGR EhMEN"f IS St.IUEC'I'"Il) RIi VIEW In M)YDUR
CR.F.DI'f UIS'I'ORY AND I/WE AU'rilORIZE HOME DPPOI'AUI HOIIIZED CONI'RACTUR,'fO VLRII'Y AND III%it W h1l,OUR
CREDIT REC'ORO WII"H AN INDEPENDENT C'RLDII' RF11OR'1'IN6 AGfN('F' AND RFI-EASE.IIHiM I'ROhl ALI. LIAM1,11Y
INCURRED PROM INA 12I2AIENTT!'/OMISSI( RROR {/
SIIBMII I U-D BY' 11snM `a - Date
Snit C'c
ACCEPTED RY' Date: . _
V a.oanu
_ Date'.
H-mcnvncr
N(1'I'IC4::AnurreivsAi,I'¢RM$come rIONS AND N'ARR.1N1'IF%ARK Sl Al No 0\for RFVFRFr:Site'ANI ARA PAWI'e1V l'"III Ill'I'RM'I
Mal,-I1
(rm1,161du N.11-, f....... l'in4 F"J..r'umuleml
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518-04 C-SC
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gt.,sse ISVOLL"L61. Ut"U)ZE:0E:00 oET0SO0Z 910S Offal :-1
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VAN SPECIFICATION SHEET - speo shear 167 3 90 Sue,- os
� N
i � ` {�Ci"t N ili
Cusp: A Job A 1 i& W GB�tulle� . 4
I m
MMldow New Window _ 1n
Daum Pattern" Ynndow !,Hinge l.ocedona' j m
Meesureniwrfa Gtlda I I 5 a ODBGWS lOeate Ca1eRCivic.tarnec"K
h Rrao a Garden not es
E -ca0e-pton i(trm mw4.Lr m R)Coda
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swill
to / e Cotlr ra 411�
E 32 a SL j
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z vlo�'
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N
11
2
'Grid Pattern and LaeaGon MUST be indkated. Window/Dorx Wmpa
m
'd a Bugle window or Wled wnWow I regime muaili grid patterns.indicate location and pattern in the addn',onal spaces provided.
'for Csmta,CPC,gay or Boa.use'L',,W.or'S'(Statomary).For Patio&Garden Doors,use-S'(Stationary)or"X'(Operating).
N
BAY!BOW WINDdw GARDEi WINDOWS 1 CD
P oje lion Angle_(Bay:30°or 45') I Top of Window to Soffit(inches) (WALL THICKNESS (inches) ?
Width of Overhang(inches) SE 'TBOARD MATERIAL -4
Bay Window Renters-DH I Canon. I -4
(Specify Birch or Oak Veneer or White Ponite I N
geetboerd Materiel-Birch a Oak j If lied to Soffit,color W Soffit material '
s 'gdditbnal charge for waa Miekness d 6'or Hare. m
New Interior Casim feav1B0w/Gardsn(Pau0 Ooo6) Conslruct Roof (Veal NO)
m
orCobrtial(CO) -There is no guam reee that new siingles Ml matt""!Ving cab'
ClamsheM(CL)
1 have reviewed and agree With all or thefil S
CONSVERATICIIIIII: job apecHloWwW dmo bed above.
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