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HomeMy WebLinkAboutBuilding Permit #554-11 - 148 MAIN STREET 2/7/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO:L5-�-/ Date Received Date Issue 4=�&R�TAN�T:A licant must complete all items on this page LOCATION Print PROPERTY OWNER `�I �,, Print MAP NO: 7 U_PARCEL: ZONING DISTRICT: Historic District yes no j 3 Machine Shop Village yes no j TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑9tfe family ❑Addition ®'Two or more family ❑ Industrial ❑A ration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other - .,,r,-..-- 4,y';"` - -- .. .�- ...r•_-. .:�.•'�—`=P`-.ice. -s:.[f 1i-' r '� f i { iFloocl laih1Oi�UiWetlaicls? 1 ';® 3WatershecllDisfrict:` - �; � Sept.c� t(]kViTe�l,�„ :r �.fi �� - - •- -�p- _-�- - �, � ,�-. •- k _. _ ���Water/Sewer - - -- - - - -- DESCRIPTION OF WO TO BE RFO D: Nfl ��fu Idenfific$Pn P she_Type oy Print Clearly) OWNER: Name: `�1�2- .��1 1 nPhone: �s t ( Address: `21 '-ii-�� � � '��� ' L�� • Phone: CONTRACTOR Name: �� Flo Address:-V-9 Supervisor's Construction License: - �/ Exp. Date: 41A Home Improvement License: al„Eq 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: $ a FEE: $ Check No.: `? Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access he guaranty fund - Si nature ofcontracfor:= 5 i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ 1 Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster 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 HEALTH Reviewed on Siqnature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes i Planning Board Decision: Comments Conservation Decision: Comments i Wates'& Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: ' Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date j 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.$10041000 fine NOTES and DATA— For department use ® Notified for pickup - Date Doc:.Building Permit Revised 2008 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 ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor 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 ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ 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 ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products DOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit n all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals iat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording Lust be submitted with the building application I Doc: Doc.Building permit Revised 2008mi i Location/ #- /*//, Sr— No. Date ^TM TOWN OF NORTH ANDOVER F O� Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ s+CHust 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL. $ Check # 2 y O Building Inspector THD AT HOME SERVICES, INC. 33021 PERMIT ACCOUNT 64- 2690 CUMBERLAND PKWY STE.300 BRANCCHH 0 038 3846 ATLANTA,GA 30339 Date Pay to theI ---- order J Faaluni Doffs s an Sack. { VOID AFTER 90 DAYS II WACHOVIA NOT VALID OVER$500 Wachovia Bank,a clivislon of Wells Fargo Bank N.A. \, FOR a6,11,1D '5EPiI I - -- 1100330210 1:06 1,000 2 2 71: 20000 1 5 2 58 5 L 511' NORTH Tvm o of 6Andover o over, Mass., I�O COCMICFEWICK 7 RATED ��� '9S BOARD OF HEALTH Food/Kitchen .PERMI. T T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT........... .. .....e.......TD,to_ 4:1:t C D ..... ,/I �� " Foundation has permission to erect................ ..................... buildings on �.'C� 1/&/.!!I...S4...........�.,�Z:6............. Rough .... ........... to be occupied as...... ... �......... 1'�'."i .......... �. � ............. Chimney 1...................................................... y provided that the perken accepting this permit shall in every respect conform to the terms of the application on file in Final 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 CONSTRUCTIPN S ARTS Rough ............................. Service BUILDING INSPECTOR • Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. ILl SEE REVERSE SIDE__Jl Smoke Det. r r 4 i,--.-•i"3 d.3--.�� �:1 .�- iia. ,- I 7�'.�!-o Gy F 711 N U-�a:�cr SciarHeat------------ ain ' ••F.c•,.,r•u C+a��C,u+�cad4:rt.Ya:c�r x : 2.9 A,DOMONALPERFORMANCE RATINGS ', lcWl,(1�CtON SilPlfa(EMJIAI.4 Od AE}IDt1AFI:lTO ' V(sihleTralismittance ' ,• . ' pu=twdj(ia4lAk uai�ctn,ovi,ds,Mtie i,;eVcrtxmb WC-pa rt ArdrW4ijwtnr"c�+dv i6ct�+,nsfd�c '•tttli�pt st b�eKn+rba tr t•I�,e wt d nM4onmirat oni'tlan r+d s�ptadu?fn:?RIG�not nmom.tid nr ptodus•: ss!does rot warrvR Qtisuaab�d�v��*7�u�iWcsftrtn'hcirir`s ae�nara kr ca+�pcoaud p�essxri•- •Fs�i liE�1 uti.ycii a,i at;;V"a�cn b p.te*+sda p4�E1n d,FFAC pn d er sl r +leio 11ht dd p�odtisL lna v.ksn�isear ar t�1C sn dArcnraa vcr un m�u�b I�o d as�:b�n�+w Y�si�t.no d�Wit" Ifi1G m nmenitda rtpt�pad<rta T ro si�Qa a xodcb i!sdcad?pra y+up rtgalla QM6 aQt i . •• •.:' •lo�la dr rOrk�nY pert d tis WOO ck wY Fit&W04AUn • �` •, -�:�� • • UALt cNaLLitij toe •L?16RCY ltiA et4ioA(-�)s liactKtrA, wactK • _ ' C&Atw31.,•50utK CaAtwAL, fo%tArrn. <-6'EAW STAR L� un1Ld c3L1.fLoa pa+A lx(a) • ra.�LDA(asl :t7fIERGY �ULLl: 1loeti, f'a `�• Hocte C►Atc3L. !uc Caiteil., Sic L -: • • • ` ' Ttttk 9Lat: 31'rx 63` ' 'IND: almAc2a 00/Y1dcLc 2.3t UxtK-%R43 • gP'• -L451_4 ' iv►+1Ao. ctibada: lL:� cx E69��9�(C1. •�ai�3. ,•K� Hofflun z�sllta. • IMF A'abbi 1upcaik aim iw m6oG.I. um.41 It rW.WAly tvr. ` 6wrda a!o tll�ta para Pads nart+ba6as ENE1�Y SUC talo mnwam aatm dl eta;rd�)a twrciei�tpac - ,yam ✓die•�am�mzaou�ea�e o�,/uQaurcluaelta .'I: , \ Office of Consumer Affairs&Business Regulation OME IMPROVEMENT CONTRACTOR Registrat(on K}26893 Ty ph Expirafion -gr3FZp1.2_. . Supplement The Home Depof;At^-16,,Services - RICHARD FALLONE�`'=, ,��`= 2690 CUMBERLAND,.PAFfKWAY S g At'LAKTA,GA 303391'=`` '` Undersecretary AC �' CERTIFICATE ` i 111 I CATE(MMiDDIYYYY) CE CATS G) LIABILITY INSURANCE 02/ 9110 PRODUCER 1-404-995-300;; l THIS CERTIFICATE IS ISSUED AS A. MATTER OF INFORMATION Marsh USA, Inc' j ONLY AND CONFERS NO RIGHTS UPON ThE CERTIF!C'`- homedepot.ca_t- i HOLDER THIS CERT:r IC = DOES NCT AM:- ID: �;<TE)JG~u =5'-- t?marsh.com TE '-� "t:ERAC= AF=-O" )cL; o T ,- T•�'c• Alliar_c_ Cs.`„ 3560 Lencx Road, Suit 2400 1 K v- --- -----=-=-=_--_----� '. ,'aX - - _ _._ .,�,._ .,.vim ^'A 1 C - -'-I Ho::a ct, I:. _*RER A- nd`-.s- --Is Co dcme Depot U.S a, no, JsuR_RB ur ch A=erican Ins co _ 5. 2455 Paces Ferry Road NW r-- ----- -------------.__.----._.... i Building C-20 INSURER C:New Hampshire Ins Cc23 9341 Atlanta, GA 30339 I INSUFj :R p:NpTIONAL UNION FIRE_Ii7S C_0_ OF PITT_S_- 19445_ - I(INSURERE:Illinois Union Ins Cc =7960 COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITITSTANDING 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD'L ----- ------------ ---- TR POLICY NUMBER POLICMMFDDNYIYE D POLICY MMIDDIYYYOYN - LIMITS A GENERAL LIABILITY GL04887714-00 03/01/10 03/01/11 EACH OCCURRENCE____ $ 4,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Eaoccurrence $.I,000,000 CLAIMS MADE X OCCUR MED EXP(Any one person) $_EXCLUDED_- PERSONAL&ADV INJURY $ 4,000,000 GENERAL AGGREGATE _ $ 4_000_000___ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS•COMP/OP AGG $ 4, 0001000 X POLICY PRO- LOC ------ ---------'-----... T El B AUTO MOBILE LIABILITY BAP 2938863-07 03/01/10 03/01/11 X ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 ALL OWNED AUTOS --------'--- —'---------- BODILY INJURY $ SCHEDULED AUTOS (Per person) _ HIRED AUTOS -------- ------------------ $ NON-OWNED AUTOS BODILY INJURY(Per accident) X SELF INSURED AUTO -------- - ------- - PHYSICAL DAMAGE PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO - — -------- OTHER THAN ' EA ACC $ AUTO ONLY: A AGG $ EXCESSIUMBRELLALIABILITY GL04887714-00 03/01/10 03/01/11 EACH OCCURRENCE_ $ 5,000,00__0_ X OCCUR CLAIMS MADE ]_!AGGREGATE $ 5,000,000 ----- --------$----- ...- DEDUCTIBLE ...._...... RETENTION $ ...._'-- .._e.____._...__---' C WORKERS COMPENSATION $ AND EMPLOYER;'LIABILITY WCO20342355 (AOS) 03/01/10 03/01/11 X WCSTATU- YIN - TORY IM1TS D ANYPROPRIETORI EXCLUDED? WCO20342356 (CA) 03/01/10 03/01/11 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? E (M es.de;(jibeund WCO20342.357 (FL) 03/01/10 03/01/11 E.L.DISEASE-EA EMPLOYEE $ 1 000_000 If yes.des�.ribe under -- _ _- __M -_ SPECIAL PROVISIONS below --- --.___._......... OTHER E.L.DISEASE-POLICY LIMIT $ 1,000,000 E TX Employers Excess TNSC46242373 (TX) 03/01/10 03/01/it D Workers Compensation Occurrence/SIR 30M/2M p WC0910566 (QSI) 0.3/01/10 03/01/11 C Workers Compensation WCO20342358(KY,MO,NY,WI, ) 03/01/10 03/01/11 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS RE: EVIDENCE OF COVERAGE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION THE HOME DEPOT, INC. DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN HOME DEPOT U.S.A., INC. NOTICE TO THE CERTIFICATE HOLDER NAMEO TO THE LEFT,BUT FAILURE TO DO SO SHALL 2455 PACES FERRY ROAD NW IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR BUILDING C-20 REPRESENTATIVES, ATLANTA, GA 30339 AUTHORIZED REPRESENTATIVE P.CORD 25(2009/01) TthorntonUSA (D 14401889 ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents r i ice; Office of Investigations �1 'J 600 Washington Street Boston MA 02111 `` << www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information PIease Print Legibly Name(Business/Organization/Individual): Address: a(,: '0 L4 1M" City/State/Zip: Phone #: Ar;tan employer?Check the appropriate box: Type of project(required): 1. a employer with 4. ❑ I am a general contractor and I employees(full and/or * have hired the sub-contractors -time). 6. ❑New construction part listed on the attached sheet. 7. E] Remodeling 2.❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance, comp.insurance.: required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' ' 13.b-6therla lJQpM comp. insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. f Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. xContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:_ 11(,v Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: ` 1 in� ;2I., City/State/Zip: 00 Al Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). 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$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify u d r Ithaihs d penalties of perjury that the information provided above is true and correct. Signature: Date: Phone#: tk)I QaG— �D— / 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#: Smear rs-T -1 License: CS 29328 Restricted to: 00 RICHARD L KEYES 11 16 LAWRENCE RD SALEM, NH 03079 Expiration: 9/11/2011 (,I)it till ksion cf- Tr#; 2273 Jan 28 11 01:04p p,1 HOME IMPROVEMENT CONTRACT PLEASE READ THIS Sold,Furnished and Installed by: Branch Name: Boston Date: THD At-Home Services.Inc. �— WO d/b/a The Home Depot At-Home Services 345A Greenwood Street,Unit 2,Worcester,MA 01607 Toll Free(800)657-5182:Fax(508)756-8823 Branch Number:31 Federal ID#75-2698460;M£Lic#C W439;RI Cont.Uc#16427 CT Lic#H1C.0565522;MA Home Improvement Contractor Reg.#I1_6893 Installation Address: �ptiiK S->-l:rb ns �°0 �i5 --Sic-1l�'s C- i t_0—t state 2ip tj Purchaser(s): Work Phone: Home Phone: Cell Phone: .7Z 6F�lj [ I log -7-nociJ[ ] Home Address: (If different from Installation Address) City State Zip mail Address(to receive project communications and Home Depot updates): / DO NOT wish to receive any marketing emails from The Home Depot iV// Project Information: Undersigned("Customer"),the owners of the property located at the above installation address,agrees to buy, and THD At-Home Services,Inc.("The Home Depot")agrees to furnish,deliver and arrange for the installation("Installation's of all materials described on the below and on the referenced Spec Sheet(s),all of which are incorporated into this Contract by this reference,along with any applicable State Supplement and Payment Summary attached hereto and any Change Orders(collectively, "Contract"): Job#: (mmmr aQav m) Products: Spec Sheet(s) #: Project Amount ❑Ruofmg ❑Siding Windows Insulation ❑ 4 Gutters/Covets ❑Entry Doors ❑ ❑Roofing ❑Siding ❑Windows ❑Insulation []Gum=/Covers ❑Entry Doors ❑ Roofing OSiding Windows ❑Insulation ❑Comers/Covey ❑Fmry Doors Q []Roofing ❑Siding Windows ❑Insulation ❑Gutters/Covers ❑Entry Doors ❑ $ I M>'dmum 25%Deposit of Contract Amount due upon emcn6on of this contract MamePtudasersmayuotdepostmorethanonef6irdoetheContractAmount. Total Contract Amon Customer agrees that,immediately upon completion of the work for each Product,Customer will execute a Completion Certificate (one for each Product as defined by an individual Spec Sheet) and pay any balance due. As applicable;each Customer under this Contract agrees to be jointly and severally obligated and liable hereunder. The Home Depot reserves the right to issue a Change Order or terminate this Contract or any individual Product(s)included herein,at its discretion,if The Home Depot or its authorized service provider determines that it cannot perform its obligations due to a structural problem v%ith the home,environmental hazards such as mold,asbestos or lead paint,other safety concerns,pricing errors or because work required to complete the job was not included in a Con Tact. Payment Summary: The Payment Summary# 19 C —_, included as part of this Contract, sets forth the total Contract amount and payments required for the deposits and final payments by Product(as applicable). NOTICE TO CUSTOMER You are entitled to a completely filled-in copy of the Contract at the time you sign. Do not sign a Completion Certificate note: there is one Completion Certificate for each listed Product as defined by individual Spec Sheets)before work on that Product is complete. In the event of termination of this Contract,Customer agrees to pay The Home Depot the costs of materials,labor,expenses and services provided by The Home Depot or Authorized Service Provider through the date of termination,plus any other amounts set forth in this Agreement or allowed under applicable law. THE HOME DEPOT MAY WITHHOLD AMOUNTS OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Acceptance and Authorization: Customer agrees and understands that this Agreement is the entire agreement between Customer and The Home Depot with regard to the Products and Installation services and supersedes all prior discussions and agreements,either oral or written,relating to said Products and Installation.This Agreement cannot be assigned or amended except by a writing signed by Customer and The Home Depot.Customer acknowledges and agrees that Customer has read,understands,voluntarily accepts the terms of and has received a copy of this Agreement. Ar:epted Su hy, k-�/-.,- X C m 's Signature Date Sales consultznt's Si nature Date; X Telephone No. Customer's Signature Date Sales Consultant License No. CANCELLATION: CUSTOMER MAY CANCEL THIS W applicable) AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOrTICE TO THE HOME DEPOT BY MIDNIGHT ON THE THIRD BUSINTESS DAY AFTER SIGNING THIS AGREEMENT. THE STATE SUPPLEMENT ATTACHED HERETO CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN CUSTOMER'S STATE. N(MCE:ADDITIONAL TERMS AND WNDrrIONS ARE STATED ON THE REVERSE SIDE ANDARE PART OF THIS CONTRACT 10-18-10 GSC White—BranchFle Yellow—Qtstomer