HomeMy WebLinkAboutBuilding Permit #677-11 - 1555 TURNPIKE STREET 4/7/2011 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO:
Date Received
Date Issued: r
I ORTXiNT:Applicant must complete all items on this page
LOCATION S S ' ( �T�, 1 ' " ST.
Pr' t
PROPERTY OWNER L I
Print
MAP NO: 1074 PARCEL:6611 ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Res' ential Non- Residential
❑ New Building One family
❑ ddition ❑Two or more family ❑ Industrial
Alter ation No. of units: 11Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Other _
Demolition _
❑ Dem �x-
�bFloodplain
f S�eptie: ( tWell a ��Wwetlands o-1 �® tiWat sliedIDistrict;.
DESCRIPTION OF WORK TO BE PERFORMED:
Ylf�� L I IN 6, !9, =N— Q�4,LA u-K) :_;aj N:AI
Ident'ficatlon Please a or Print Clearly) /- ���� �
OWNER: Name: ' C Phone: `'b vP /
Address: S Tu R
CONTRACTOR Name: _Phone�goz Lf 16 -n
Addressa 0 j� ��( R C
11 V`� V ' 1✓ ( � J
j
d M�4� yu
�� U �-a Exp. Date: U
Supervisor's Construction License: �—
Home Improvement License: , I\v S Exp. Date: G a
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.BULDING PERMIT.'$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST SED ON$925.00 PER S.F.
Total Project Coit: $ ��
• FEE:PN
$ �
/I Receipt No.: c94,Check No.: 1 p
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owner ` . :.. - :_ Signature
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DIS7SAL
Public Sewer nning/MassageBody Art ❑ Swimming Pools ❑
Well bacco Sales ❑
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
i
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
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
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
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
�I
I
® Notified for pickup - Date
Doc:.Building Permit Revised 2008
i
• it
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
o Photo Copy Of H.I.C. And/Or C.S.L. Licenses
❑ Copy of Contract
❑ Floor Plan Or Proposed Interior Work
❑ Engineering g g 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
o Flo or/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o 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
o Photo of H.I.C. And C.S.L. Licenses
ci Workers Comp Affidavit
❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic aulic Calculations (If Applicable) i
❑ Copy of Contract
❑ Mass check Energy Compliance Report
I
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Yin all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
Chat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be submitted with the building application
Doc: Doc.Building Permit Revised 2008mi
Location!
No. L _I Date
NORTH TOWN OF NORTH ANDOVER
"" :•4
0 w,
Certificate of Occupancy $
SACMUS 4� Building/Frame Permit Fee $ _
s
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check
24647
Building Inspector
ORTM
TO" Of
0 .1 � _ •
Andover . ,
rM..�ur ti��1• / 1
AK
o dover, Mass.,
A- COCHICHEWICK y�
{ 7d RATED P'' C)
7 S BOARD OF HEALTH
Food/Kitchen
Septic System
-PERMIT T D
BUILDING INSPECTOR
THISCERTIFIES THAT....... ...... ....................................................................................................... Foundation
buildin s ................ 1. ''
has permission to erect............................ g -on .....�.. . .. ................................... Rough
..................................:..
to be occupied as Chimney
provided that the person 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
3 � � UNLESS CONSTRUC TARTS ELECTRICAL INSPECTOR
Rough
..... Servige
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.
SEE REVERSE SIDE Smoke Det.
/VX7')i "4 t'lbo
The Commonwealth of Massachusetts FOR
n Board of Building Regulations and Standards MUNICIPALITY
Massachusetts State Building Code,780 CMR,7`"edition USE
Building Permit Application Revised
Jamiary I, 2008
This Section For Official Use Only
Building Permit Number. Date Applied:
Signature:
Building Inspector Date
SECTION 1:SITE INFORMATION
Residential ❑ Commercial ❑ Other Description:
1.1 Pro ertx"ress: 1.2 Assessors Map&Parcel Numbers
� _S: iQgzN1�>\�E �
1.1aIs 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 ❑
Commercial-"Service-Size _ Check if yes❑
SECTION 2: -PROPERTY OWNERSHIP'
2:1 Ownerl_ co Red: '
Name(Print) 'JWLO)"Qx�� C1 a-(0 R,
Address for Service:
Signature I Telephone-
SECTION
elep oneSECTION 3:DESCRIPTION OF PROPOSED WORW(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory BIdg.❑ Number of Units I Other ❑ Specify:
Brief Description of Proposed Work:
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs:
(Labor and Materials) Official Use Only
1.Building $ 1. Building Permit Fee:$
2.Electrical $ 2• Indicate how fee is determined:
❑Standard City/Town Application Fee
3.Plumbing' $ ❑Total Project Costa(Item 6)x multiplier x..
4.Mechanical (HVAC) $ 3. Other_Fees: ,$
5.Mechanical List:
(Fire Suppression) $
Total All Fees:$
6.Total Project Cost: $ �� Check No. Check Amount: Cash Amount:
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL) V ( a
S. License Number Expiration Date
Name f CSL-Holder List CSL Type(see below)
Add r ss �� Type Description
U Unrestricted(up to 35,000 Cu.Ft.)
R Restricted 1&2 FamilyDwelling
Signatu:re–
Telephone
M Maso Onl
Gu —��CSd RC Residential RoofingCovering
WS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
2 Registered Home IrAprovement Contractor(HIC)
HIC Co anygame or C Rtrent ane Reg_istra�tion Number
dre s 2 S69_ q�O- ()o k iration1Date
igna Telephone
SE_ . _ .ON 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6))
Workers Compensation Insurance affidavit must b completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issu ce 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
as Owner oithe subject property hereby
authorize IC T S� P ����`�1rn r�tiC_ to act on�ny behalf,in all matters
relative to work authorized by this building permit application.
Signature of Owner Date
SECTION 7b:O
W
N
ER'OR AUTHORIZED AGENT DECLARATION
as Owner or Authorized Agent hereby declare that
the statements and information on the foregoing,application are true and accurate,to the best of my knowledge and behalf.
Print Name
% 3 1
Signature of Owner or Auth a Agent Date
(Signed under the pains and penalties of perjury)
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 fund under M.G.L.c.142A.Other important information on the MC Program and Construction
Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.R6 and 110.115,respectively.
2. When substantial work is planned,provide the information below:
Total floors 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
The Commonwealth of Massachusetts
Board of Building Regulations and Standards
Massachusetts State Building Code,780 CMR,7d'Edition
Building Permit Application To Construct,Repair,Renovate Or Demolish a
One-or nvo-Family lAvelling
SECTION 8:ADDITIONAL APPROVALS
1. Ballardvale Historic District Commission: Date:
2. Board of Health: Date:
3. Conservation Commission: Date:
4. Design Review Board: Date:
5. Electrical Permit Number: Date:
6. Fire Prevention: Date:
7. Planning Board Lot Release: Date:
8. Preservation Commission: Date:
9. Zoning Board of Appeals: Date:
wlo>t'd ofBsiFJ)ng Re2altllaas and SiaodnrEc Llctow or Mi0ratiem valid dor imOWdal uwe 4-151}
HOME IMPROYCMCNT CONTRACTOR btfaea tho e,iplrawrom da1r: It fai nd rclurn ta:
Ragistralion: 182111 BuardoCSaitdtnCRegulatloncmecpnmarJs
` 's". fuplraUom 11am�01 w Tex 3SOSC� tint Afturlon Pryer Rlm 1701
Iroltm 412.02108
TyT+t: i'�xo Ca�aa:�en
NUT S19P oVINC1.INC.
CLAYTON SCt1UI cF
25 DAYDOV.AVE.GTN KL [_,;?e a as J
BOSTON,MA 022co AdmF-hlealvr ••?49i,olid wittiest Opaturc
�
X7r ou 4H d i n�g Regulat.ams�d Standa rds
One,Ashburton Place-Room 1301
Boston.Massachusetts 02108
Hone Improvement Contractor Registration
Regiyrgian 182111
1W- , Private Corporellm
cxl+iration Gi17f2®31 Trs 2787in
NEXT STEP LIVING INC.
CLAYTON SCHUTLER
25 BRYDOCK AVE.5TH F L
BOSTON,MA 02210
UplLtwe Address amd recarm card.Mvl.msoa far cb"ge.
A60015 Rterwal Empimnenl ime Cold
_w�c�• a.eane�snscasurc�e>ata,ata,aua
dlaka we6ma:tts-vcpa almost of Public Safclt
noaw•d of swidi"g.Re;otalie"s uatl Standard!,
CAnstruclion Supervidw License
dlCCtlie:
CS IgM} -
AastrlCwediae OEI
TJ OJQ AS d PlirrauY Plr
32 WINTER Or
MIDDLEBORO,MA 02344
: -•.-•►�,� Naplran0a:g1?i2o1, •
l':V/![-//[V•/!L{f:t.4LL
Office of Consumer Affairs K BGsincss Regulation
i.. HOME IMPROVEMENT CONTRACTOR
til �I I' Registration: 136253 Type:
�i Expiration: 6/26/2012 Individual
GEORGE S.GARWOOD
GEORGE GARWOOD
29 RODMAN RD.
W. BROOKFIELD, MA 01585
Undersecretary
tilassaChu.ctts - I)i.partniew of Public �afCt�
Buartl of Buildin_ RC'—jJIatitlnN and 'st.tn(lard-"
Construction Supervisor License
License: CS 81022
Restricted to: 00
GEORGE S GARWOOD
BOX 538/29 RODMAN RD
W BROOKFIELD, MA 01585
Expiration: 7/16/2011
( „uun;.•;,nor Tr=: 17306
�V vo 1HU 17:04 FAX 617 393 2415 --
MEDFORD BUILDING DEPT.
16 005
► `• The Commonwealth ofMassachrrsetls
Ae artment o
P flrtdtvstrialAcciderrys
J,' 001ce OfInvestiSations
600 Washington Street
BOStott,MA 02111
WWW-
Workers' Compensation Insurance Alidavits gurtders/Contractors/Elcxtnicians
A lice t Informatiolo /Plumtbers
Please Print Lc 'bl
NaWC(BuriDeas/Organi2Htion/lndividual):�
Address:
� -
City/State/Zip: 0-111-0—
Phone#: G, ,d Gl e -6 7�01
Ejam
an employer?Check thea ro nate box:
aem 1 PP p
p oyer with 4. h'pe ofproject(rt gairtod):
loyees full and/or = � 1�"ageneral cont7actor and i
( part-time). have hired the sub-contractors 6- ❑Newconstruction
a sole proprietor or partner- listed on the attached cheek t 7. ❑Remodeling
and have no employees These sub-contracWrs bavehV for me in any capacity. workers ❑Demolition
orkers'oom . ' 'gyp•insurance. []Building addition
p msarance S- ❑ We are a corporation and itsred) officers have exerciser)their 10•❑Electrical repairs or additions
homeowner doing slt workright ofexemption per MGL 1 I_Q Plumbing repairs or additions
lf.(No workers'comp, c. 152,§t(4),sad we have o0nce t �
fe9ud) employees-(No workers' t2 a Roof rs
comp.insurance required.) 13.gl Others g���.,�6_��
•AoY gpplicant that checks hex>11 must also till out Ute section bd ow Showing their workers,compenmion policy inforaration.
t oonroo"---who suhtan this affidavit indicating They am doing all Work and)hen Amo oulsido eermaaets must submit a new affidavit urdicalla sue
�Cor»rauors that check.this boY must attushed an additional shit showing Ibe rrmttt ofibe sub eealraclors yrd��workers'
g b.
ram an employer that is providing workers'eo ten•policy itlfomtation
ufor►raation. mlP�+sa'tion inaw,lv►rce jot ney eniP[ayep; Btlow is Ike,policy mrd job szte
Inswance Company Name.
Polity#or Self-ins.Lic_
--__
.lob Site Address; Expiration Date: —1L—)
.+itacb a copy of the workers'compensatio>a o6 Ctty/Statemp'
railune policy declaration page(showing the policy number and expiration date).
W secure coverage as required render Section 25A of MCI.c_ 152 can lead to the imposition
fine nP to$1,500 d and/or one-year unprisonment,as well as civil penalties in the form of7,0p WORK ORDER and of a
Of up to$ZS0.00 a day against the viol �
Iavestigations of the DIA for Be advised that a copy of this Statement may be forwarded to the OflSce of
�� v e erification.
I do hereby cam,under th
P
i afper%ury that the information provided above a true and corntc4
acme:
Daft:
Phe a#:-11,11,1111.111,11 CL �6(I-) �7 a.9 I
DeiQl use only. Do trot write in Ibis area,to be co leled b
mp y r11y or town o,07ua1
City or Town:
Permit/I,i
Usaing Authority(circle one): ccosc#
I.Boats of Health �_Bteildiag�partrnent 3.Ci I'i'
6.other ty own Clerk 4.Clactrical Tttspector S.Plumbing Cnspecbr
Contact Person:
Phone 0.
Client#:5042 NEXTSTEDATE(MNUDONYYY)P
ITtilACORD- CERTIFICATE OF LIABILITY INSURANCE 111111114010
PRODUCER
runrcriF�ICATEIS�ISSUEOAS A MATTER OF INFORMATION
P
William Gallagher Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
Insurance Brokers,Inc. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
470,Atlantic Avenue
Boston,MA 02210 INSURERS AFFORDING COVERAGE, NAIC#
INSURED INSURER A: Federal Insurance Company 20281
Next Step Living,Inc. INSURER B: Great Northern Insurance Compan 20303
25 Drydock Avenue INSURER c: Safety Insurance Company 39454
5th Floor INSURER D:
Boston,MA 02210.2600 INSURER E:
COVERAGES
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
_ .=_Jy1/11C PEtt7AIN;THL=1NSl)LiANCEAFEORDED$Y-INEi•EOL-IGIE- -J]EtiSCRISED�IEREIN:IS=SUBJEMT9.O_AL•L-T-H&T-ERM_Sr CL•t1SIQNS�INC)GONDLTIONS-0F SU.C6L—_==.. : . . .
POLICIES.AGGREGATE'LlMITS SHOWN MAY'HAVE'BEEN-REDUCED-BYPAID-CDOINS-""
POLICYEFFECTIVE POLICYEXPIRATION LIMITS
LTR NSR TYPE OF INSURANCE POLICY NUMBER GATE MMIOD DATE MMRID EACH OCCURRENCE $1,000,000
A GENERAL LIABILITY 35904463 1111112010 11111/2011 DA AGE TO RENTED
$1,000,000
X COMMERCIAL GENERAL LIABILITY
MED EXP(Any one person) $10,006
CLAIMS MADE a OCCUR
PERSONAL&ADV INJURY $1,000,000
GENERALAGGREGATE s2.000.000
PRODUCTS-COMPIOPAGO s2.000.000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY JECT LOC
C AUTOMOBILE LIABILITY TBD94446 11/111201 O 1111112011 . COMBINED SINGLE LIMIT $1,000,000
(Ea accident)
ANY AUTO
ALL OWNED AUTOS BODILY INJURY $
(Per person)
X SCHEDULED AUTOS
X HIRED AUTOS (p r'.IaINJURY $
X NON-OWNED AUTOS
PROPERTY DAMAGE $
(Par.accident)
AUTO ONLY-EA ACCIDENT $
GARAGE LIABILITY EAACC $
3ANY AUTO. OTHER THAN
— — AUTO ONLY: AGO S
A EXCESS 1 UMBRELLA LIABILITY 79870050 11/1112010 11N 112011 EACH OCCURRENCE 4,000 OOO
)( OCCUR D CLAIMS MADE AGGREGATE s3,000,000
$
DEDUCTIBLE
$
RETENTION $ 10111H_WC 5TATU-
B WORKERS COMPENSATION AND 71733288 11/1112010 11/1112011 X
EMPLOYERS'LIABILITY E.L.EACH ACCIDENT S500,000
ANYcPROPRIETOERRIP �UDEOT ECUTIVE
Apandj �BN) LNJ E.L.DISEASE-EA EMPLOYEE.$600,000
U es,desedha under E.L.DISEASE-POLICY LIMIT $500,000
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
NStae Gas Company Is included as an additional insured on general
liability as their Intersts may appear per written contract.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
Star Gas Residential DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL _30_- DAYS WRITTEN
EFI-N
EFI N Rebate Program NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT.FAILURE TO 00 SO SHALL .
W rization Washington ReSt.Suite 2000 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
Westborough,MA 01581 REPRESENTATIVES.
AUTHORIZED REPRESENTATI E
ACORD 25(2009101)1 of 2 #S1856351MIS5611 O 1 8 •200 CORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
nationalJ rid
The power of action"
Conservation Services Group This service is brought to you through support from your local utility
This Agreement is made by and among
and
\WAYNE S MARCEAU MassSAVE
1555 TURNPIKE ST Conservation Services Group(CSG)
NORTH ANDOVER MA 01845 6218 40 Washington Street, Suite 3000
Customer ID:S10000893307 . Contract ID:0342011C Westborough,MA 01681_
'
i
I. DESCRIPTION OF WORK TO BE PERFORMED
CSG will perform or cause to be performed the following work on the"Premises"known as 9 , Wt S/ ,in a
jprofessional manner and in accordance with the terms of this Contract,including the attached recommendations/work order
describing the work in detail(the"Work")which are incorporated herein by reference:
i
ascription Quantity Location
ttic Floor 6.25"Fiberglass Batting 560 AFL $963.20
Garage Calling 5"Cellulose 253 GARAGE $417.45
Door:Potylsocyanurate 2" 1 HALLWAY $56.35
Building Performance Package 1 $132,00
Sub Total: $1,569.00
Energy Efficiency Incentive -$1,176.75
Net Sates Tax After incentive $0.00
Total $392.25
e 1.CUSTOMER allirms that they have received no Incentives during the last 12 months. Initial here
• 2.The Energy Efficiency incentive offer noted above is limited to this contract. The incentive Is dependent upon the package purchased and/or prior
Incentive utilization.Changes to Individual line items and/or previous incentives may increase or decrease the amount of the incentive.
3.CUSTOMER affirms that they have received the Participating Contractor list for National Grid's Gas Weatherizatiorl Program and understands
that the Energy Efficiency Incentive and Weatherizatlon Program Rebate offers are mutually exclusive.Initial here
• II. PAYMENT
CUSTOMER agrees/to pay CSG for the Work as follows: Printed 02/03/2011 Page 1 of 1
Payment#1: $
Deposit upon signing the Contract(Not to exceed 1/3 of the total retail costs or actual costs of special orders,whichever is greater)
Additional Payments and Final Invoice:$ 4
Additional payments for the Work shall be due 30 days from the date shown on the Invoice. Final payment for the Work shall be
due 30 days from the date shown on the Final Invoice.
You may cancel this agreement if it has been signed by a party thereto at a place other than an address of the
seller,which may be his main office or a branch thereof, provided you notify the seller in writing at his main
office or branch by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third
business day following the signing of this agreement.
DO N T SIGN THI CONTRACT IF THERE ARE ANY¢3 K SPACES.
CustpI i na ure
All-1)4A-O,14A
G Stgnaturd Me Name of CSG Representative
The Terms of this Agreement are contained on both sides of this page
Conservation Services Group•40 Washington Street•Westborough,MA 01581 a 800-480-7472 Wia