HomeMy WebLinkAboutBuilding Permit #335 - 2 WALKER ROAD 10/23/2012 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
Date Issued-.IA,,
IMPORTANT: Applicant must complete all items on this page
' LOCATION 0'.Print
PROPERTY OWNER L ;sC
Print 100 Year Old Structure yes no
MAP NO: Q PARCEL ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
❑Addition ❑Two or more family 0 Industrial
P-Nteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District
Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
Identif ation Please Type or Print Clearly)
OWNER: Name: 1/ � '7,4 L- Cu � .�'� Phone: 97d dJS 9.?
Address:
CONTRACTOR Name:. Phone:
E
ss:visor's Construction License: Exp. Date:
Improvement License: Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: v E � _FEE: $
Check No.: V—4* Receipt No.:
NOTE: Persons contra ting with unregistered contractors do not have access to an and
Signature of Agerit/Ovvne Signature of contracto
Plans Submitted ❑ Plans Waived Certified Plot Plan ❑ Stamped Plans ❑
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools '❑
Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑
Private(septic tank,etc. ❑ Permanent Dempster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEAL'I H Reviewed on Signature
COMA, ENTS
i
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature& Date Driveway Permit
I
DPW TowEngineer: Signature:
Located 384 Osgood Street-.-
'FIRE
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located at'124 Main Street
Fire Departmerit�tignatureldate
COMMENTS
Dimension
Number of Stories:_Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
ELECTRICAL: Movement of Meter location, mast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
NOTES and DATA— For department use
Gva� C
D Notified for pickup - Date
i f E
E
Doo.Building Permit Revised 2010
Building Department
The following is a list of the required forms to be filled out for the appropriate permit to be obtained.
Roofing, Siding, Interior Rehabilitation Permits
❑ Building Permit Application
❑ Workers Comp Affidavit
L,2r"Photo Copy Of H.I.C. And/Or C.S.L. Licenses
opy of Contract
Vxr--Ploor Plan Or Proposed Interior Work
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
o Building Permit Application
❑ Certified Surveyed Plot Plan
o Workers Comp Affidavit
a Photo Copy of H.I.C. And C.S.L. Licenses
o Copy Of Contract
o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o Mass check Energy Compliance Report (If Applicable)
o Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
❑ Building Permit Application
❑ Certified Proposed Plot Plan
❑ Photo of H.I.C. And C.S.L. Licenses
o Workers Comp Affidavit
❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o - Copy of Contract
o Mass check Energy Compliance Report
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign offrom Fire Department prior to issuance of Bldg Permit
In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
that the appal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be subm`:?ted with the building application
Doc: Doc.Building Permit Revised 2012
Location VIJCc L �t U
No.- 53S--- t Date
Y
o ' TOWN OF NORTH ANDOVER
•
71
A. Certificate of Occupancy $
pQ „� r Building/Frame Permit FeeMR $
All 111
Foundation Permit Fee $
Other Permit FeeAMR N
$ -
TOTAL $
Check#
25868 Building Inspector
NORTH
Town of E �� ndover
O - to
No. top
oh ver, Mass,
coc.��cHew�c.c �1'
U BOARD OF HEALTH
Food/Kitchen
PERMIT T LD I L ^� Septic System
THIS CERTIFIES THAT ....... 1�...,r, .� ,.�'�t.�r.:..........�-.. ` BUILDING INSPECTOR
. k. ............. ..... .... ......
has permission to erect buildings on1.r-c - � —#1—g4. Foundation
Rough
tobe occupied as ......:. lr.. ............ ................../.................................................. Chimney
provided that the person accepting this permit shall in every respect conform to the terms of the application Final
on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and
Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCTION STARTS Rough
ftService
............................... ....................:....................... Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Building Rough
Display in a Conspicuous Place on the Premises - Do Not Remove Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
Smoke Det.
SEE REVERSE SIDE
SPECIAL SERVICES CUSTOMER INVOICE Page 1 of 7 NO. 3402-195283
- - - -- - -- - -- - - - -- -- - -- -
* Store 3402 TILTON Phone: (603)286-9599
160 LACONIA RD Salesperson: LG6600
TILTON, NH 03276 Reviewer:
Name Home Phone
•
SCHUH DAVID (978) 835-9345 REPRINT
Address 2 WALKER RD Work Phone (978)835-9345
• APT 8 Company Name
•
city NORTH ANDOVER Job Description AFTER CLOSING
state MA Zip 01 845-1 943 county
2012-10-20 09:36
CUSTOMER PICKUP #1 MERCHANDISE AND SERVICE SUMMARY oldrtoc stomershttolimitthequantitiesofinerchandise
REF# W10 SKU # 515-664 Customer Pickup/Will Call
STOCK MERCHANDISE TO BE PICKED UP:
REF# SKU QTY UM DESCRIPTION PI TAX PRICFj EXTENSION
R03 480-837 1.00 EA 10'VALENCIA MILANO ROSSO CNTRTOP LH/ A Y $130.00 $130.00
R04 466-023 1.00 EA 6'VALENCIA MILANO ROSSO CNTR TOP LH/ A $82.00 $82.00
R05 481-776 1.00 EA 25-5/8"VALENCIA MILANO ROSSO CAP KIT/ $11.00 $11.00
R06 481-994 1,001 EA 25-7/8"VAL MILANO ROSSO ENDSPLSH KIT/ Y $17.00 $17.00
R07 293-350 1.001 EA MITER BOLT KIT/ A Y $4.95 $4.95
$244.95
END OF CUSTOMER PICKUP- REF#W10
VENDOR DIRECT SHIP #1
TO: CUSTOMER
S/O-MERCHANDISE TO BE SHIPPED: S/O THOMA REF# S08 ESTIMATED ARRIVAL DATE: 09/30/2012 P.O. #02500111
REF# SKU QTY UM o DESCRIPTION PI TAXI PRICE EACH EXTENSION
S0801 718-866 1.001 EA F330/F 30H/F330 FSIDES:B HINGES:B JA Y 1 $13.291 $13.29*
***CONTINUED ON NEXT PAGE***
D
WILL-CALL MERCHA P FOR WILL CALL
Will-Cali items P.,t e store for 7 days only. MERCHANDISE PICK-UP
Check your current order status online at PROCEED TO WILL CALL OR
SERVICE DESK AREA
www.homedepot.com/orderstatus
(Pro Customers, Proceed To The Pro Desk)
Indicates
Page 1 of 7 NO. 3402-195283 Customer C pyown
Copy
SPECIAL SERVICES CUSTOMER INVOICE - Continued Last Name: SCHUH Page 2 of 7 NO. 3402-195283
VENDOR DIRECT SHIP #1
(Continued) TO: CUSTOMER
S0802 718-866 1.00 EA VSD363421 FPR/VSD363421 FPR VAN SINK DRW 36W 34H 21 D FP/ A Y $449.53 $449.53*
VSD363421 FPR FSIDES:B HINGES:B
S0803 718-866 1.00 EA T138LAM12/TB8LAM12 TOE BOARD .5 LAM/T68LAM12 HINGES:L A Y $11.96 $11.96*
S08FR 506-658 1.00 KITCHEN CABINET FREIGHT A N $0.00 $0.00
VENDOR-SPECIAL INSTRUCTIONS: LINE:THMASVL2 DSTYLE:FAYETTE USTYLE:FAYETTE-PSL LSTYLE:FAYETTE-PSL FINISH:WHT-PSL DSGNR:I 660o
VENDOR WILL SHIP MDSE TO: SCHUH DAVID
ADDRESS: 2 WAKER DRIVE#8 CITY: NORTH ANDOVER
STATE: MA ZIP: 01845 COUNTY: ESSEX SALES TAX RATE: 6.250 n o $474.78
PHONE: 978 835-9345 ALTERNATE PHONE: PAGER:
END OF VENDOR DIRECT SHIP
VENDOR DIRECT SHIP #2
TO: CUSTOMER
S/O-MERCHANDISE TO BE SHIPPED: S/O THOMASVILLE REF# S09 ESTIMATED ARRIVAL DATE: 10/22/2012 P.O.#02500112
REF# SKU QTY UM DESCRIPTION PI TAX PRICE EACH EXTENSION
S0901 766-190 1.00 EA TF384/TF384 TALL FLR 3W 79.5H/TF384 FSIDES:6 HINGES:B MODS: A Y $30.52 $30.52*
W=2" H=84" D=24"
S0902 766-190 1.00 EA SLS36R/SLS36R SUPER SUS 36 RH/SLS36R FSIDES:B HINGES:R A Y $425.57 $425.57*
S0903 766-190 1.00 EA SB33ST/SB33ST SINK BASE 33 TILT OUT/SB33ST FSIDES:B HINGES:B A Y $0.00 $0.00
S0904 766-190 1.00 EA 3DB15/3DB15 3 DRW BASE 15/3DB15 FSIDES:B HINGES:B A Y $274.35 $274.35*
S0905 766-190 1.00 EA U188424R/U188424R UTILITY 18W 84H 24D RH/U188424R FSIDES:B A Y $311.90 $311.90*
HINGES:R
S0906 766-190 1.00 EA FPEB-T/FPEB-T FLUSH FURNITURE PLYWOOD ENDS/ATT:U188424R A Y $142.44 $142.44*
FPEB-T FSIDES:B
S0907 766-190 0.00 EAJ B21 L/B21 L BASE 21 DRW LH/B21 L FSIDES:B HINGES:L A Y $166.65 $0.00*
S0908 766-190 1.o0 EA TD9R/TD9R BASE TRAY DIVIDER 9 RH/TD9R FSIDES:B HINGES:R A Y $150.161 $150.16*
***CONTINUED ON NEXT PAGE***
* Indicates item markdown
Page 2 of 7 No. 3402-195283 Customer Copy
SPECIAL SERVICES CUSTOMER INVOICE - Continued Last Name: SCHUH Page 3 of 7 NO. 3402-195283
VENDOR DIRECT SHIP #2
(Continued) TO• CUSTOMER
S0909 766-190 1.00 EA TEP2484WD/TEP2484WD TALL END PNL WD 24W 84H/TEP2484WD A Y $127.71 $127.71
FSIDES:B HINGES:B
S0910 766-190 0.00 EA W1530L/W1530L WALL 15W 30H LH/W1530L FSIDES:B HINGES:L A Y $103.50 $0.00*
S0911 766-190 1.00 EA ER302121 L/ER302121 L WALL EASY REACH 30H 21 W 12D LH/ A Y $214.36 $214.36*
ER302121 L FSIDES:B HINGES:L
S0912 766-190 1.00 EAJ FV36/FV36 FURNITURE VALANCE 36W/FV36 FSIDES:B HINGES:B A Y $31.23 $31.23*
MODS:W=32 5/8" H=4 1/2" D=0 3/4"
S0913 766-190 1.00 EA W3318/W3318 WALL 33W 18H/W3318 FSIDES:B HINGES:B A Y $135.07 $135.07*
S0914 766-190 0.00 EA W3930/W3930 WALL 39W 30H/W3930 FSIDES:B HINGES:B A Y $181.74 $0.00*
S0915 766-190 1.00 EA W3612/W3612 WALL 36W 12H/W3612 FSIDES:B HINGES:B A Y $122.45 $122.45*
S0916 766-190 1.00 EA PE/PE PLYWOOD ENDS 9% /ATT:W3612 PE FSIDES:B A Y $11.02 $11.02*
S0917 766-190 0.00 EA W2130L/W2130L WALL 21W 30H LH/W2130L FSIDES:B HINGES:L A Y $120.34 $0.00*
S0918 766-190 1.00 EA W3012/W3012 WALL 30W 12H/W3012 FSIDES:B HINGES:B A Y $117.18 $117.18*
S0919 766-190 1.00 EA W2430R/W2430R WALL 24W 30H RH/W2430R FSIDES:B HINGES:R A Y $136.13 $136.13*
S0920 766-190 3.00 EA SM8/SM8 FLAT SCRIBE MLDG/SM8 HINGES:L A Y 1 $16.491 $49.47*
S0921 766-190 2.00 EA TB8WD14/TB8WD14 TOE BOARD .25 WOOD/TB8WD14 A Y $28.761 $57.52*
S09FR 1 506-658 1 1.00 N $0.001 $0.00
VENDOR-SPECIAL INSTRUCTIONS: LINE: THMASVIL DSTYLE:LINDEN MAPLE USTYLE:LINDEN-MPL-AR LSTYLE:LINDEN-MPL-SQ FINISKCIDER
DSGNR:LG6600
VENDOR WILL SHIP MDSE TO: ISCHUH DAVID
ADDRESS: 2 WAKER DRIVE#8 CITY: NORTH ANDOVER
STATE: MA ZIP: 01845 COUNTY: ESSEX SALES TAX RATE: 6.250 ® o $2,337.08
PHONE: 978 835-9345 ALTERNATE PHONE: 978 835-9345 PAGER:
END OF VENDOR DIRECT SHIP
VENDOR DIRECT SHIP #3
TO: CUSTOMER
* Indicates item markdown
Page 3 of 7 NO. 3402-195283 Customer Copy
SPECIAL SERVICES CUSTOMER INVOICE - Continued Last Name: SCHUH Page 4 of 7 NO. 3402-195283
VENDOR DIRECT SHIP #3
(Continued) TO: CUSTOMER
S/O-MERCHANDISE TO BE SHIPPED: S/O THOMASVILLE REF# S14 P.O.#02500437
.REF# SKU QTY UM I DESCRIPTION PI TAX PRICE EACH EXTENSION
S1401 766-190 0.00 EA B18L/B18L BASE 18 DRW LH/B18L FSIDES:B HINGES:L Y $188.31 $0.00
S1409 766-190 0.00 EA TEP2484WD/TEP2484WD TALL END PNL WD 24W 84H/TEP2484WD Y $158.67 $0.00
FSIDES:B HINGES:B
S1410 766-190 0.00 EAJ F330/F330 FLR 3W 30H{CUT 12"H}/F330 FSIDES:B HINGES:B MODS: Y $17.44 $0.00
W=2" H=12" D=12"
S1412 766-190 0.00 EA W1830L/W1830L WALL 18W 30H LH/W1830L FSIDES:B HINGES:L Y $133.39 $0.00
S1414 766-190 0.00 EA W2130R'/W2130R WALL 21 W 30H RH/W2130R FSIDES:B HINGES:R Y $149.51 $0.00
S1416 1 766-190 0.00 EA W2730/W2730 WALL 27W 30H/W2730 FSIDES:B HINGES:B Y $200.51 $0.00
S14FR 1 506-658 1.00 N $0.00 $0.00
VENDOR-SPECIAL INSTRUCTIONS: LINE: THMASVIL DSTYLE:LINDEN MAPLE USTYLE:LINDEN-MPL-AR LSTYLE:LINDEN-MPL-SQ FINISKCIDER DSGNR:
LG6600
S/O-MERCHANDISE TO BE SHIPPED: S/O THOMASVILLE REF# S15 ESTIMATED ARRIVAL DATE: 10/22/2012 P.O. #02500438
REF# SKU QTY UM I DESCRIPTION PI TAX PRICE EACH EXTENSION
S1501 766-190 1.00 EA B18L/B18L BASE 18 DRW LH/B18L FSIDES:B HINGES:L Y $154.46 $154.46*
S1509 766-190 1.00 EA TEP2484WD/TEP2484WD TALL END PNL WD 24W 84H/TEP2484WD Y $130.14 $130.14*
FSIDES:B HINGES:B
S1510 766-190 1.00 EAJ F330/F330 FLR 3W 30H{CUT 12"H}/F330 FSIDES:B HINGES:B MODS: Y $14.31 $14.31*
W=2" H=12" D=12"
S1512 766-190 1.00 EA W1830L/W1830L WALL 18W 30H LH/W1830L FSIDES:B HINGES:L Y $109.41 $109.41-
S1514
109.41*S1514 766-190 1.00 EA W2130R/W2130R WALL 21W 30H RH/W2130R FSIDES:B HINGES:R Y $122.63 $122.63-
S1516 766-190 1.00 EA W2730/W2730 WALL 27W 30H/W2730 FSIDES:B HINGES:B Y $164.471 $164.47*
S15FR 506-658 1.00 N $0.00 1 1 $0.00
VENDOR-SPECIAL INSTRUCTIONS: LINE: THMASVIL DSTYLE:LINDEN MAPLE USTYLE:LINDEN-MPL-AR LSTYLE:LINDEN-MPL-SQ FINISH:CIDER DSGNR:
LG6600 TO FINISH PO #02500111 PLEASE PLACE ON RAPID RESPONCE
VENDOR WILL SHIP MDSE TO: ISCHUH DAVID
ADDRESS: 2 WALKER RD CITY: NORTH ANDOVER
***CONTINUED ON NEXT PAGE***
Indicates Page 4 of 7 NO. 3402-195283 * Customer lnCopydown
SPECIAL SERVICES CUSTOMER INVOICE - Continued Last Name: SCHUH Page 5 of 7 NO. 3402-195283
VENDOR DIRECT SHIP #3
(Continued) TO• CUSTOMER
STATE: MA ZIP: 01845 COUNTY:.ESSEX SALES TAX RATE: 6.250 l ,.D o $695.42
PHONE: 978 835-9345 ALTERNATE PHONE: 978 835-9345 PAGER:
END OF VENDOR DIRECT SHIP
INSTALLATION #1
REF# 113
BASIC INSTALLATION LABOR:
SKU I DESCRIPTION QTY UM ITAXI PRICE EACH EXTENSION
282-627 IKITCHEN POINT-NAT/ 0.001 EAJ N 1 $0.01 $0.00
INSTALLATION SITE NAME: ISCHUH DAVID INSTALL LABOR CHARGE: $0.00
ADDRESS: 2 WALKER RD TRIP CHARGE: $0.00
CITY: NORTH ANDOVER STATE: MA ZIP: 01845 CREDIT FOR DEPOSIT/MEASURE: $0.00
COUNTY: ESSEX SALES TAX RATE: 6.250 TAX: Merchandise- N LABOR- N ,. I aA` - .o..„ a $0.00
PHONE: 978 835-9345 ALTERNATE PHONE: 978 835-9345
BASIC INSTALLATION LABOR INCLUDES:
*AN INSTALLER SITE ANALYSIS IS REQUIRED FOR PROPER FIT SITE ANALYSIS FEE IS APPLIED TO THE PURCHASE.
OF KITCHEN CABINETRY AND OTHER PRODUCTS TO BE INSTALLED. *THE FINAL KITCHEN POINT WORKSHEET MUST BE SIGNED BY BOTH
DURING THIS CONSULTATION THE INSTALLER WILL CHECK FOR THE CUSTOMER AND STORE ASSOCIATE.A COPY OF THE FINAL
UNUSUAL SITUATIONS WHICH MAY REQUIRE ADDITIONAL LABOR. SIGNED KITCHEN POINT WORKSHEET MUST BE GIVEN TO THE
*DAILY CLEAN UP OF JOB SITE CUSTOMER AND INSTALLER.
*THE SITE ANALYSIS FEE IS NON-REFUNDABLE
*IF CUSTOMER PURCHASES LABOR FROM THE HOME DEPOT,THE
UNLESS STATED ABOVE THIS INSTALLATION DOES NOT INCLUDE:
INSTALLING SKYLIGHTS REMOVAL OF VINYL FLOORING
STRUCTURAL MODIFICATIONS MUST BE APPROVED BY REGIONAL SERVICES VENT IN WALL
MANAGER OR INSTALL MERCHANT
***CONTINUED ON NEXT PAGE***
Page 5 of 7 NO. 3402-195283 Customer Copy
SPECIAL SERVICES CUSTOMER INVOICE - Continued Last Name: SCHUH Page 6 of 7 NO. 3402-195283
INSTALLATION #1
(Continued) REF#113
ALTERATIONS TO EXTERIOR OF HOME
SPECIAL NOTES:
*AN ADULT OVER 18 YEARS OF AGE WITH THE AUTHORITY TO MAKE CHANGE FURNACE FILTER BEFORE,DURING AND AFTER INSTALLATION.
DECISIONS ABOUT YOUR INSTALLATION MUST BE PRESENT DURING THE *WATER,GAS AND SEWER SERVICE MAY BE TEMPORARILY TURNED OFF
INSPECTION(WHEN APPLICABLE),DELIVERY AND INSTALLATION DURING THE INSTALLATION PROCESS. THE INSTALLER WILL NOTIFY
*NO WORKIDELIVERY TO BE DONE ON SUNDAYS OR HOLIDAYS THE CUSTOMER OF AN ESTIMATED LENGTH OF TIME FOR THE SERVICE
*ALL WORK WILL BE DONE TO LOCAL CODES AND ORDINANCES TO BE UNAVAILABLE.
*ALL WATER AND GAS SUPPLY LINES MUST HAVE INDEPENDENT *CUSTOMER IS ASKED TO DESIGNATE PARKING,ENTRANCE AND EXIT
SHUT-OFF VALVES. ACCESS PREFERENCES FOR THE INSTALLER(INCLUDING RESTROOM
*JOBSITE MUST BE COMPLETELY ENCLOSED WITH ALL WINDOWS, ACCESS).
DOORS,INTERIOR WALLS,ROUGH PLUMBING AND ELECTRICAL WORK *CHILDREN AND PETS MUST BE KEPT AWAY FROM THE WORK AREA
COMPLETED PRIOR TO THE INSTALLATION *CUSTOMER IS RESPONSIBLE FOR ANY UNFORESEEN CONDITIONS
*THE WORK AREA MUST BE CLEAR AND ALL VALUABLES AND WHICH MAY ARISE DURING INSTALLATION.
BREAKABLES MUST BE REMOVED FROM THE WORKSITE PRIOR TO WORK *THE FINAL KITCHEN POINT WORKSHEET MUST BE SIGNED BY BOTH
BEGINNING THE CUSTOMER AND STORE ASSOCIATE.A COPY OF THE FINAL,
*CUSTOMER MUST UNDERSTAND THERE WILL BE A PERIOD DURING SIGNED KITCHEN POINT WORKSHEET MUST BE GIVEN TO THE CUSTOMER
THE INSTALLATION WHEN THE JOBSITE AREA WILL BE COMPLETELY AND INSTALLER.
UNUSABLE. *NOTE:THE HOME DEPOT DOES NOT PROVIDE THE FOLLOWING
*CUSTOMER MUST UNDERSTAND THERE WILL BE A PERIOD DURING SERVICES(AS PART OF KITCHEN INSTALLATION PROGRAM)
THE START OF THE JOB.OTHER ARRANGEMENTS MUST BE MADE BY *ADJUSTING OPENINGS OR WORK INVOLVING LOAD BEARING WALLS
CUSTOMER DURING THIS TIME FOR ACTIVITIES USUALLY HELD IN *REMOVE,ALTER OR BUILD LOAD BEARING WALLS(OTHER THAN
THE JOBSITE AREA. STUD WALL FRAMING).
*THE WORK AREA WILL BE CLEANED UP DAILY,BUT DUST AND *INSTALLING SKYLIGHTS
CONSTRUCTION RELATED DEBRIS AND NOISE WILL BE INEVITABLE *STRUCTURAL ALTERATIONS OR REPAIRS
THROUGHOUT THE INSTALLATION. *ALTERATIONS TO EXTERIOR OF HOME
*ALL POSSIBLE STEPS WILL BE TAKEN TO MINIMIZE SPREAD OF *REMOVAL OF VINYL FLOORING
WORK AREA DUST TO OTHER PARTS OF THE HOME.CUSTOMER SHOULD
END OF INSTALL#1
TOTAL CHARGES OF ALL MERCHANDISE & SERVICES
$3,752.23
SALES TAX $219.19
TOTAL $3,971.42
BALANCE DUE $130.87
Page 6 of 7 NO. 3402-195283 Customer Copy
SPECIAL SERVICES CUSTOMER INVOICE - Continued Last Name: SCHUH Page 7 of 7 NO. 3402-195283
TOTAL CHARGES OF ALL
MERCHANDISE & SERVICES
#1
(Continued)
Policy Id(PI):
A: 90 DAYS DEFAULT POLICY...................................................................«........•
'The Home Depot reserves the right to limit/deny returns. Please see the return policy sign in
stores for details.'
r END OF ORDER No. 3402-195283
Page 7 of 7 NO. 3402-195283 Customer Copy
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24" 27" 36" 2411111 18 e
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All dimensions_size designations This is an original design and must Designed:9/23/2012
given are subject to verification on not be released or copied unless Printed:9/23/2012
job site and adjustment to fit job applicable fee has been paid or job
conditions. order placed.
flc000018 All Drawing#: 11 No Scale.
Massachusetts Rome Improvement Sam' elle Contract
This form satisfies all basic requirements of the state's Home Improvement Contractor Law(MGL chapter 142A),but does not include standard
language to protect homeowners. Seek legal advice if necessary. Any person planning home improvements should first obtain a copy of"A
Massachusetts Consumer Guide to Home Improvement"before agreeing to any work on your residence.You may obtain a free copy by calling the
Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617-973-8787 or 1-888-283-3757 or on our website.
]homeowner information Contractor Information
Name Company Name
Street Address(do n6tuse a Post Office Box address) Contractor/Salesperson/OwnerName
4citywn State e 9 .Zip Code Business Address(must include a street address)
D'aytimePhone Evening Phone City/TownState Zip Code
nn
r,Jad—7-d a/
Mailing Address(It different from above) Business Phon / oe I Federal Employer ID or S.S.Number di
Law requires flint most Home Home Improvement Contractorlieg:Number Expiration date
•
improvement contractors Have
a valid reglstration number
eg
The Contractor agrees to do the following work for the Homeowner:
(Describe in detail the workto completed,specifying the type,brand,and grade of materials to be used,use additional sheets if n_ ecessarv.)
e2d911�� t o ,�!i' ,v c 0 1 h u J
Required Permits-The following building permits are required Proposed Start and Completion.Schedule-The following schedule will
and will be secured by the contractor as-the homeowner's agent: be adhered to unless circumstances beyond the contractor's control arise
(Owners who secure their own permits will be
excluded from the Guaranty Fund provisions of I-14 A. S Date when contractor will begin contracted work.
MGL chapter 142A..)
Date when contracted work will be mbstautially completed.
Total Contract Price and Payment Schedule
The Contractor agrees to perform,the work,furnish the material and labor specified above for the total sum of
Payments will be made according to the following schedule:
upon signing contract(not to exceed 1/3 of the total contract price or the cost of special order items,whichever is greater)
$ 22 4J by /a i2 c or upon completion of
6 by �`� /� / 1-2- or upon completion of
$ upon completion of the contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction) .
The following material/equipment must be special $ to be paid for
ordered before the contracted work begins in order
to meet the completion schedule.(P*) $ to be paid for
NOTES;(s*)Including all finance charges Law requires that any deposit or down payment required by the contractor before worlcbegins may
not exceed the greater of(a)one-third of the total contract price or(b)the actual cost of any special equipment or custom made material
which must be special ordered in advance to meet the completion schedule.
lx ress Warran -Is ane ress wan an beim rovided b the contractor? 1Vo Yes all terms oithewarranty must be attached to the contract
Subcontractors-The contractor agrees to be solely responsible for complet n of the work described regardless of the actions of any third
party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for
materials and labor under this a Bement
Contract Acceptance-Upon signing,this document becomes a binding contract under law. Unless otherwise noted within this document,the
contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notices
carefully before signing this contract.
o Don't be pressured into signing the contract.Take time to read and fully understand it. Ask questions if something is unclear..
c Malce sure the contractor has a valid Home Improvement Contractor Re 'stration. The law requires most home improvement contractors and
subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor
registration by writing to theDirector at 10 ParkPlaza,Room 5170,Boston,MA.02116 or by calling 617-973-8787 or 888-283-3757.
o Does the contractor have insurance? Ask the Contractor for his insurance company information so that you can confirm coverage,or ask to
see a copy of a"proof of insurance"document.
o Know your rights and responsibilities. Read the Important Information on the reverse side of this form and get a copy of the Consumer
Guide to the Home Improvement Contractor Law.
You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business,provided you notify the
contractor in writing at his/her main office or branch office by ordinary mail posted,b telegram sent or U deliv
third business da following the signing gr p Y Y ery,not later than midnight ofthe
Y � g going of this agreement See the attached notice of cancellation form for an explanation o£this right.
DO NOT'SI GN TMS CONTRACT IF THERE ARE ANX BLANK SPACES►i r
Two identical copies of the contract must be completed and signed. One copy should go to the homeowner. The other copy should be kept by the contractor.
j � _. :
Homeowner's ignaturo Contractor's Signature
'Date
Date
Contraetor A rbif ration
The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action(as an
alternative to court-action)if they have a dispute with a contractor. The same right is not automatically afforded to a
contractor,however. The contractor would have to resolve any dispute he/she has with a homeowner in court unless
both parties agree to the optional clause provided below. This clause would give the contractor the same right to
arbitration as is afforded to the homeowner by the Home Improvement Contractor Law.
The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute
concerning this contract;the contractor may submit the dispute to a private arbitration firm which has been approved by
the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consuuner shall be required
to submit to such arbitration as provided In Massachusetts General Laws, chapter 142A.
Homeowner's Sijnature Contractor's Signature.
NOTICE:The signatures of the parties above apply only-to the agreement of the parties to alternative dispute
resolution initiated by the contractor: The homeowner may initiate alternative dispute resolution even where this
section is not separately signed by the parties.
• i
Homeowner's Rights
A homeowner's rights under the Home Improvement Contractor Law(MGL chapter 142A)and other consumer
protection laws (i.e.MGL chapter 93A)may not be waived in any way, even by agreement. However,homeowners
may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law.
Homeowners who secure their own building permits are automatically excluded'from all Guaranty Fund provisions of
the Home Improvement Contractor Law. The contractor is responsible for completing the work as described,in a
timely and workmanlike manner. Homeowners may be entitled to other specific legal rights if the contractor
guarantees or provides an express warranty for workmanship or materials. In addition to guarantees or warranties
provided by the contractor,all goods sold-in Massachusetts carry an implied warranty of merchantability and fitness for
a particular purpose. An enuuneration of other matters on which the homeowner and contractor lawfully agree may
added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have
questions about your consumer/homeowner rights,contact the Consumer Information Hotline(listed below).
Execution of Contract
The contract must be executed in du licate and should not be signed until a copy of all exhibits and referenced
docuunents have been attached. Pa-ties are also advised not to sign the document until all blank sections have been
filled in or marked as void, deleted, or not applicable. One original signed copy of the contract with attachments-is to
be given to the owner and the other kept by the contractor. Any modification to the.original contract must be in writing
and agreed to by both parties. Contracted work may not begin until both parties have received a fully executed copy of
the contract,and the three day rescission period has expired.
Accelerated Payments
A contractor may not demand payments in advance of the dates specified on the.payment schedule in cases where the
homeowner deems him/herself to be financially insecure. However,in instances where a contractor deems him/herself
to be financially insecure,the contractor may require that the balance of funds not yet due be placed in a j oint escrow
account as a prerequisite to continuing the contracted work. Withdrawal of funds:From said-accouunt would require the
signatures of both parties.
Additional Information
If you have general questions or need additional information about the Home Improvement Contractor Law or other
consumer rights,or if you wish to obtain a free copy of "A Massachusetts Consumer Guide to Home impiovement"
contact:
Consumer Information Hotline
Office of Consumer Affairs and Business Regulation
10 Park Plaza,Room 5170,Boston,MA 02116
617-973-8787, 888-283-3757 or visit the OCA13Rwebsite at 11t ://ww"v.mass;gov/ocabr/
If you want to verify the registration of a contractor or if you have questions or need additional information specifically
about the contractor registration component of the Home Improvement Contractor Law, contact:
Director of Home Improvement Contractor Registration
Office of Consumer Affairs and Business Regulation
16 Park Plaza,Room 5170,Boston,MA 02116
617-973-8787, 888-283-3757 or visit the 1.31C website at lbM://wwnv.mass.gov/ocabr/
Go online to view the status of a Home lmprovement Contractor's Registration: .
11t )://db.state.ma.usA-tomeimprovement/]icenseelist.asn
For assistance with informal mediation of disputes or to register formal complaints against a business,call:
Consumer Complaint Section
Office of the Attorney General
617-727-8400
AND/OR
Better Business Bureau
508-652-4800 508-755-2548 -
or 4.13-734 3114•
Version 2.1-11/22/2010
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www mass.gov1dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): `' iAlleT /,t/( a L ,
Address: r i TAlli
�i�a
City/State/Zip: lz r .. �(,Q 0'L d Phone
l
Are you an employer?Check the appropriate box: Type of project(required):
I F�h am a employer with 5 4. ❑ I am a general contractor and I 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
Z. I am a sole proprietor or partner- listed on the attached sheet.$ ? ❑Remodeling
,0.' ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. workers'comp.insurance. 9. ❑Building addition
[No workers' comp.insurance 5. ❑ We are a corporation and its
required.] officers have exercised their 10.❑Electrical repairs or additions
3.E] I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions
myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs
insurance required.]t employees. [No workers' 13.0 Other ill-f 4 t�.-
comp.insurance required.]
kny applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
:ontractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
am an employer that is providin workers'compensations surance for my emplo ees. Below is thepolicy and job site
formation. 4R Zo
tsurance Company Name: 2
:)licy#or Self-ins.Lie.#: Expiration Date:
►b Site Address: - / City/State/Zip: �(/.
ttach a copy of the workers'compensation p licy declaration page(showing the policy number and expiration date).
tilure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
ae up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
vestigations of the DIA for insurance coverage verification.
to herebycert' a;det12e ains and alties ofperjtrry that the information provided above is true and correct.
nature: 2z�
'
Date: 7
rone#:
-c-
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required;
Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority." ,f,
Applicants
Please fill out the workers' compensation affidavit completely,by checking the boxesthat apply to your situation and,if
necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
Tel. #617-7274900 ext 406 or 1877-MASSAFE
-vised 5 Fax#617-727-7749
-26-05 ,,,
„�...�..--�--- --- .
JAW
\ Office of Consumer Affairs&B smess Regulation
__ HOME IMPROVEMENT CONTRACTOR Type.
Registration: -114006
. �' 9 Individual
�E Expiration> -7/27J2013
SA /ATORE LAT(NA
SALVATORE LATINA
30 PRINECTON ST:-' ga B'
.BOSTON,MA 02128 Undersecretary
11u>,acht„.
Grh;trrtrttint
g,�arci r,tBuildin;; Rr_ul�tiir,n. .;ncl eta?: ' •�, .
-” Construction Supervisor L;o
ense
License: Cs 20790
SALVATORE A LATINA
80 PRINCETON ST
EAST BOSTON, MA 02128 �•
txpira;ior,: 7/24/2013
nn,i..;,na•r
2149?