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HomeMy WebLinkAboutBuilding Permit #640-15 - 281 BLUE RIDGE ROAD 2/6/2015J r_. BUILDING PERMIT TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION Permit N0: �' Date Received Date Issued: Z/ IMPORTANT: Applicant must complete all items on this LOCATIO 0 Print (, PROPERTY OWNER C1 h f -r`3 cS ictl1,VL -- Print MAP NO: PARCEL: 0 ZONING DISTRICT: Historic District yes Machine Shop Village ves TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ire family ❑ Addition ❑ Two or more family ❑ Industrial ri, eration No. of units: ❑ Commercial ,ePair, replacement ❑ Assessory Bldg ❑ Others: W41emolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands Watershed District C Water/Sewer S K.ftdJ-,,I (Ak-i d C 454� 0 L nn // Identification Please Type or Print Clearly) OWNER: Name: 3k0WVVVlk_1k_ Phone: Address: g �v�l41 CONTRACTOR Name: T -Phone: — Address: / �J G Supervisor's Construction License: Exp. Date: Home 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: $ ou FEE: $ 11,3:1 Check No.: I? � Receipt No.:, -7 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of A ent/Owner g g Signature of contracto _w�-- t t BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION. Permit No#: Date Issued: IMPORTANT: Anulicant must LOCATION Date Received iplete all items on this Print PROPERTY OWNER Print MAP PARCEL: ZONING DISTRICT 100 Year Structure Historic District Machine Shop Villaqe yes no yes no ves no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition 0 Two or more family ❑ Industrial 0 Alteration No. of units: ❑ Commercial 0 Repair, replacement 0 Assessory Bldg 0 Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain 0 Wetlands ❑ Watershed District ❑ Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification - Please Type or Print Clearly OWNER: Name: Phone: Address: I Contractor Name: Address: Supervisor's Construction License: 'Home Improvement Licenser Phone: Exp. Date: ARCHITECT/ENGINEER Phone: T Address: Reg. No-" FEE SCHEDULE: BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BUSED ON $125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No,,,.- NOTE: Persons contracting with unregistered contractors do not hav&access to the guarantyfund Signature of Agent/Owner Signature of contractor �% Location,Qeu Rz— No. DaP TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $- Other Permit Fee $ TOTAL $ Check # I �q 9— - t Building Inspector T ianAubmitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/13ody Art ❑ Swimming Pools ❑ Well ❑ Tobacco 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 PLANNING & DEVELOPMENT ❑ COMENTS CONSERVATION ■ ■ COMMENTS HEALTH COMMENTS Zoning Board of Appeals: Variance, Petition No: Planning Board Decision: DATE REJECTED Comments Conservation Decision: Comments DATE APPROVED DATE APPROVED 11 Zoning Decision/receipt submitted yes Water & Sewer Connection/Signature & Date Driveway Permit Located at 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date e� COMMENTS '� r I Plans Submitted ❑ Plans Waived ElCertified Plot Plan ElStamped Plans El YPF'DF SEWERAGE DISPOSAL F Public Sewer ❑ Tanning/Massage/Body Art F] Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On COMMENTS Signature_ CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decisio Comments Comme 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 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) NOTE: ❑ 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 All dumpster permits require sign off from 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 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 2008 Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 96,100.00 m $ - $ 1,153.20 Plumbing Fee $ 144.15 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 144.15 Total fees collected $ 1,541.50 281 Blue Ridge Road Master Bath and Master Closet Remodel BP #640-15 on 2/6/2015 E J W LL O Q O Po Nm Y Y O LL E N N uv a In O a z O Z_ C O =$= LL s M aJ c U LL O a Ln z (7 Z_ m J d s :3 d' _ LL O a �n Z Q V J W s to =$Z W aJ (n LL O 1 - v nW Z — Q bo 3 ro s LL W = a LU W 6L L O L Co z O D Y O n Cc F-1 O Q 2 y cc ) r S� E • Q i N r- 0 d �v �• j C o, CD r C JCD �. a co = d N N V' O E- 0) O O N V . O = . _ � n O Q r- .2 O MM m E o `4 O '=co o .p � Mn CD _ = .> o H QC.� cj CO U o N . O O = H = as CL N H O N O m m W = •'a - O O � Li -2 .Q � N O O ~ n +�+ Z v O LU E o 0-0 4a)cn ai y� o r= O oUH Z af- > 2 z O m CDz cnW w/ a. W W CL rw DO O CLQ ca c� J Ccto O z CLN c HOME IMPROVENLNT AGREEMENT Agreement made this 14th day of January,2015 between Henehan Construction LLC., having a principal place cf business located at 61 Brown Street, Andover, Massac:usetts (hereinafter "Contractor"; and Chris & Joanna Skowronek of North Andover, Mass. (hereinafter "Homeowner"). SECTION ONE SCOPE AND DESCRIPTION OF WORK Contractor agrees to perform for the Homeowner ertain alterations and improvements in and upon the home of the Homeowner located at 2851 Blue Ridge Road, North Ando-er Mass. in accordance with the specifications set fort_ in the attached list of labor and materials which is he ebv incorporated into this Agreement by reference. See Attached Exhibit "A" Estimates Vs 251 & 261 SECTION TWO CONTRACT PRICE Homeowner will pay Contractor for the performan the work described in the specifications set forth i attached list of labor and materials as follows: $19,220.00 20° upon the execution of t. agreement. $9,610.00 10% upon demo complete $28,830.00 30% upon rough inspections Complete $9,610.00 10% upon plastering complet $9,610.00 10% the flooring tile Complete $9,610.00 10% upon painting complete $9,610.00 10s upon final completion o Work (refer to Section two) $96,100.00 Total Payment e of the is the Initials: Contracto Homeowne Homeown�r ''7` T If any installment under this Agreement is nor paid when due, Contractor may require as a prerequisite t continuing said work that the balance of funds due under the contract, which are in the possession of the Homeowner, shall be placed in a joint escrow account requiring he S4 of the Contractor and the Homeowner for withdrawal. No payment due shall be detained due to any par items) needing special attention i.e.: defective, d or backordered items such as cabinet doors, moldings drawers or fixtures provided work is in progress. icular maged The price agreed upon herein does not include possible expenses entailed in coping with hidden, unknown, or incidental items not included in pricing. (example: inspector or engineer requirements or overlooked conations found after Contractor has commenced the work.) In the event that such hidden or unknown conditions are fou d after Contractor has commenced work, and Contractor is required to perform additional alterations and improvements not set forth in the attached list of labor and materials. Homeowner agrees to pay all costs thereof upon completion of any such work. The Contractor shall inform homeowner of any such conditions in the form of an additional work authorization. (see attached copy). In the event that the Homeowner does not pay anT installment or biilrng when due, the Homeowner agree to i pay eighteen percent (18%) per annum upon any unpaid balance. If it is necessary to file suit for the collection of any amounts due from the Homeowner under this Agreement, the Homeowner shall pay the reasonable Attorney`s fees, together with court costs for this collection. At the completion of the agreement the Contractor with the Homeowner will prepare a punchlist of any work needing special attention ie: miscellaneous adjustments, replacements or repairs to any item(s), and/or the installation of any item which might be backordered. once a punchlist is agreed upon, final payment must be paid, less a hold back for the punchlist items. Completiot of Agreement to be defined as a space or remodeled area that is operable and functional. Miscellaneous items to 1e completed are part of the "punchlist". 2 Initials: Contracto Homeowne ( Homeown r The hold back_ amount will be equal to the value amounts of any item(s), which have been backordered or needs to be replaced or repaired. The hold back amount will include anv labor involved and will be determined by the Contractor at that time. If after the initial punchlist additional items are found to need attention, they will be considered "Wa ranty Work" which will be followed up after the balance of the contract has been paid in full. SECTION THREE TIME OF PERFORMANCE The work shall commence on or about the 01/26/2)15 and shall be substantially completed on the 04/26/2015 Contractor shall not be liable for any delay or nonperformance caused by weather, strikes, unavailabILlity of materials, alterations or modifications initiated by the Homeowner, or any other contingency beyond his contr{i. SECTION FOUR CANCELLATION In the event Homeowner cancels this Agreement a ter the execution of this Agreement, Homeowner shall for eit the amount of the down payment given to the Contract3r at the time of the execution of this Agreement, and in addition, shall pay to the Co<�tractor such proportio, of the total Agreement price as the amount of labor and materials furnished bears to the total amount of labDr and materials agreed upon to be furnished under this Agr ement, including any and all items On order which cannot be returned for full credit, the same to be paid within thirty (30) days from the date of such cancellation. In th event the Contractor is unable to complete the performance of its obligation under this Agreement due to act of God, s rikes, unavailability of supplies or materials, or any other contingency beyoI'id its control., Homeowner may at its Option cancel this contract, in which event, Homeowner shall be ' liable to pay Contractor the amount of labor and mat rials already furnished. Such payment is to be made withi_ thirty (30) days after the date of such cancellation_ SECTION FIVE ALTERATIONS OR MODIFICATIONS 3 Initials: Contractok_a� Homeowne Homeown r ;`'" Any alterations or modifications initiated by the Homeowner must be agreed upon between the parties and the price fixed by them before work on such alteration o modification shall commence. Payment for such alteration or modification shall be made before the order is pl ced or the work is commenced. SECTION SIX PERMITS AND LICENSES Contractor is responsible for securing the foll necessary permits and licenses for the work at its o and expense: Building Permits Electrical Permits Plumbing Permits )wing ,in cost Homeowner acknowledges that Homeowners who secu e their own permits will be excluded from the guarante fund provisions of Massachusetts General Laws Chapter 142 . SECTION SEVEN LIMITED WARRANTY Contractor guarantees that the work will be constructed in accordance with accepted home improvement practices, and it will guarantee against defects in workmanship and materials for a period of one (1) year from the date of its completion. This Limited warranty does not cover damages or defects which are the result of characteristics common to the materials used, or conditions resulting from condensation, expansion, or contraction of such materials. Warranty work will be completed within sixty (60) days from the date of receipt of written equest from Homeowner. Please note that this Limited Warranty specifically excludes consequential and incidental damages and there are limitations in the duration of imolied warranties. his warranty is extended to the above Homeowner and is not transferable to succeeding homeowners. Contractor hereby passes through and assigns to Homeowner any and all manufacturers` warranties on all appliances and equipment supplied by Contractor in the home. 4 Initials: Contractor Homeowner i Homeown r ' c, i • Contractor specifically does not assume responsibility for any of the following items, each of which is specifically excluded from this Limited Warranty: 1. Most people are aware of the "natural" characte J-L.L s i of wood. Since no two trees are exactly the same, wood is a unique material and natural Variations in grain, texture and color are the ingredients that create the "beauty of wood". These variations can also cause noticeable differences between yCur sample and your finished callneL sJ. These grain and tone differences are a natural and acceptable condition of quality wood finishes and wi l be even more pronounced in a complete kitchen. Our suppliers only use select woods to insure their quality. 2. Defects in appliances or pieces of equipment wh ch are covered by manufacturers' warranties. As these will have been assigned directly to Homeowner, each manufactur is warranty claim procedure must be followed where a de ect appears in any of those items. 3. Damage due to ordinary wear and tear, abusive a e, misuse, or lack of proper maintenance or the home or its component parts or system. 4. Defects which are the result of characteristic ommon to materials used. Such as, but not limited to: } al warping or deflection of wood; b} fading, chalking and checking or paint or stain due to sunlight; c; cracks in concrete due to drying and curing of concrete plaster, brick or masonry; and d) drying, shrinking and cracking of caulkino and weather stripping. i S. Defects in items installed by Homeowner or anyone other than Contractor or its subcontractors at Contractor's order. i 6. Work done by Homeowner or anyone other than Contractor or its subcontractors at Contractor's order. Defects in items supplied by Homeowner. Loss or injury due to elements. Initials: Contractor Homeown r Homeowner 9. Conditions resulting from condensation on, or contraction of materials. All implied warranties including, but not limitd to warranties of merchantability and fitness for a part c—u ar purpose, are limited to the one year warranty period as set forth above. j This Limited {warranty is the only expressed warranty given. In the event that any of the provisions of 4 -his Limited Warranty shall be held to be invalid, the remainder of the provision of this Limited Warranty shall rema n in full force and effect. SECTION EIGHT ALTERNATIVE DISPUTE RESOLUTION PURSUANT TO MASSACHUSETTS GENERAL LAWS CHAPTER 142A The parties acknowledge and declare that the Contractor may initiate alternative dispute resolution through any private arbitration services program approved by the secretary of the executive office of consumer affairs and business regulation under Massachusetts General Laws Chapter 142A, sub -section 4, -o consider any di plite between the parties concerning or arising from this Agreement. We, the Contractor and the Homeowner, have read the above provision and both have signed it as our free act and deed, thereby assenting to the procedure. �OMEOWNER .-' ��,.._ Date f (; f HOMEOWNER �,.. � - : �, `, 'IV Date ; CON TRACTOR Date i S� t SECTION NINE O� OTHER NOTICES REQUIRED PURSUANT TO MASSACHUSETTS GE RALa LAWS CHAPTER 142A All contractors and subcontractors must be regi tered by the chief administrator of the board of building regulations and standards, an agency within the exec t)ve Initials: Contractor Homeowne r "�S Homeowner '`>" office of public safety, estab fished by Massachusetts General Laws 6A, sub-sec-uion 1-9. The Contractor holds Hoke Improvement RegistratIon The salesperson who solicited and/or negotiated Agreement is john Henehan .1 ab.! _.jf =sur.nce is proG�C.ded 'b Henehan Construction, LLC. For their employees and subcontrac A certificate of insurance will be provided to the c: upon request. SECTION TEN ENTIRE AGREEMENT this tors. stomer The parties acknowledge and declare that this Agreement contains the entire agreement between the rarties hereto and that there are no agreements, promises, t rms, conditions, or understandings and representations, or inducements leading to the execution hereof, expressed or implied, other than those herein set forth and that no oral statement or prior- written matter extrinsic to this Agreement shall have any force or effect. Any changes or alterations in this Agreement shall be valid and eff dive only if agreed upon in writ In -a between the parties . Please review care�u_1y all pairs o. your agreement which includes your kitchen/bath agreement, drawings and quote, to assure their accuracy for scope of work, cabinetry layout, pricing, and terms of agreement. With kitchen planning, design, and/or remodeling the work scope is quite detailed and individualized, in some cases more than others, and our agreements are presented and formatted to describe the work proposed as best as possible in a simplified and descriptive manner. Several options, ideas, and suggestions have been presented and this agreem-e t summarizes all the final decisions discussed and agreed upon and any verbal discussions are not part of this agreement and if purchaser fee's anything needs clarification, we would be happy to put it in writinj at this time. The attached Exhibit "A" which may include draw'ngs and 'List of labor and materials, if any, are hereby incorporated into this Agreement by reference. 7 initials: Contracto Homeowne Homeown r> DO NOT SIGN THIS AGREEMENT IF THERE ARE ANY BLANK SPACES! v':'c« Fe Contractorand -he Homeowner, have read the above Agreement on this 24th day of January, 2015 and UnQe-7titans its terms ane both have signed 1t as our free act and deed at 282 -Blue Ridge Road in North Andover, Massachusetts. HOMEOWNER CIONTRACTOR(�4"J, (wi-- HOi 'OWNER THE HOMEOWNER ACKNOWLEDGES RECEIPT OF A COPY OF THIS AGREEMENT HO-ill'EOWNER DATE HOMEOWNER DATE ,.lir e, -.e .. L` / •' Homeowne Homeowner X 11 1 t c TI t i � a Q5 X AC" O CERTIFICATE OF LIABILITY INSURANCE 2i�i2oDD5YYY) 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 - SOUCY INSURANCE AGENCY P. O. Box 4467 85 Lafayette Street Salem MA 01970 CONTACT jOan Street NAME: PHONE (978)744-7170 FAX AIC No:(976)7A1-2059 A1MAIL vjsoucyQsoucyinsurance.com INSURERISJ AFFORDING COVERAGE NAIC# INSURER A. -Western World INSURED Henehan Construction, 1,130 61 Brown Street Andover MA 01810 INSURER 13:Saf ety Indemnity 3618 INSURER C: INSURERD: INSURER E : 1 INSURER F ; COVERAGES CERTIFICATE NUMBER:CL1412302279 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 NiAY 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. INSR TYPE OF INSURANCE ~F S- ADDL SUBR POLICY NUMBER POLICY EFF MMIDD(YYYY POLICY EXP MM(DOtYYYY LIMITS A GENERALLIABILITYEACH X COMMERCIAL GENERAL LIABILITY ! - CLAIMS -MADE a OCCUR7,1. I . NPPI375865 /1/2019 7/1/2015 OCCURRENCE $ 1,000,000 DAMAGE 0 RENTED 50,000 PREMISES Ea occurrence) $ MED EXP (Any one person) $ 5,000 PERSONALRADV INJURY S 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: ' X POLICY n PRO LOC PRODUCTS - COMPIOP AGG $ 11000,000 $ B AUTOMOBILE X LIABILITY ANY AUTO ALL OWNEDSCHEDULEq', AUTOS AUTOS Ix HIRED AUTOSNON-OWNED AUTOS 6226071 1/13/2014 1/13/2015 COMBINED SINGLE LIMIT EaaccidentL_ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident PIP -Basic $ UMBRELLA LIAB EJ(CESS LIAR OCCUR-.-. CLAIMS -^.':ADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY `J,1 N ANY PROPRIETORIPARTNERIEXECUTIVE .' - OFFICERIMEMBER EXCLUDED? _ (Mandatory in NH) �- 11 yes, describe under DESCRIPTION OF OPERATIONS below N f A VYC STATU- OTH- T2fZY LIMITS ER E.L. EACH ACCIDENT $ E,L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) [hR►ailiC�l_\�a Town of North Andover 120 Main Street r North Andover, MA =01845 ACORD 25 (2010105) INS025 (201005).01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE A _ Paul Soucy/PAL ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Massachusetts -Department of Public Safety ,goRegulations and Standards Board of Building 9 , Construction Supervisor License: CS-061755��, .. JOAN J AENEHAi� t% 61 Brown StreeL' Andover MA 01810 -� w0612015 Commissioner -. Jf O7111)lall CltQAal �– n91" ! Regulation Office of Consumer Affairs & Business TOME IMPROVEMENT cONTRACTOR Type. registration: 172582 LLC Expiration -71912016 .- e ..�7 HENEHAN CONSTRUCTION LLC JOHN HENEHAN g—= 61 BROWN STREET Undersecretary ANDOVER, MA 01810 Y "It- The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers uplicant Information Please Print Leeibb Name (Business/Organization/Individual): v w Address: ( I ;� 1' Gwo 15)yi CL, City/State/Zip: 4uCF Va_fV) ✓V� G 1 � I0 Phone # Are you an employer? Check the appropriate box: L ❑ I am a employer with 4. ❑ I am a general contractor and I T ±m",a yees (full and/or part-time).* have hired the sub -contractors 2. sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.* required.] 5. ❑ We are a corporation and its 3. ❑ I am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152, §1(4), and we have no employees. [No workers' comp. insurance required.] LLP_ - 7 �-7 - o1r)-_ Type of project (required): 6. ❑ New construction 7. 2�emo ling 8. molition 9. ❑ Building addition 10. EXIectrical repairs or additions 11. ElAl'u"mbing repairs or additions 12.❑ Roof repairs 13. ❑ Other *Any applicant that checks box # 1 must also fill out the section below showing their workers' compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors 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: Policy # or Self -ins. Lic. #: Job Site Expiration Date: City/State/Zip: 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 under the pains, and penalties of perjury that the information provided above is true and correct. 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 #: 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 MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NOTES and DATA — (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 No 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/Cross Section/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 NOTE: All dumpster permits require sign off from 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 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: Building Permit Revised 2014 Permit N0: Date Issued: Z., TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received I IMPORTANT: Applicant must complete all items on this Daae I LOCATIONF-/ RAJ' Print PROPERTY OWNER_ 04S .SKotv.Pcw,E,K 1.0 - Print MAP NO: _ PARCEL:,41.. ZONING DISTRICT: Historic District yes Machine Shop Village ves no— TYPE TYPE OF IMPROVEMENT PROPOSED USE R Non- Residential New Building (–__Onef;Jav Addition Two or more family Industrial Alteration No. of units: Commercial cem Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: �,�„✓ne�,�_s 1��,tl�,v,.., ,Jets Phone:�•2-a Address: 6Nhz ,�� r�•z Ott Bl �� �---- Supervisor's Construction License: 0&2 M-2) Exp. Date: f,9- Z.c --,o Home Improvement License: Z-11 7 7 K Exp. Date: /1 —ad- - </ ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BULDING P, RMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $-3/.000 — FEE: $ r� �3 Check No.: 551,?—Receipt No.: rl NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner &, - Signature of contractorz.--A c..---- Location 0(fl el No. Date Check # TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL 2-3 Building Inspector 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 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 Signature COMMENTS T 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 C� 0 O z I x i --i v A o Cc: Q w coo w a u U W z cn —ca w x v o°4 w z W W4 ' cin D cn LU am o 4 c �0 0 C H O C � O a� 1 `p cm •Z O r +,r O � vEQ •.. _o r r v yam, a Q � c ^x`00 CD m o 3 c :o�� c �, y c E o L `'►0o av LA m m *4r =ID c C y Q C1 y O CS '� Z ca : •Coo • r�bb a f- o 0 rc ~ r N W �+�+-0 •N r EL A c oc .E c3 m CO) � o om c CO a O O� 2 A y a 4- m E if y s r y p 0 CO c v .7 ca In ac CD m `o a c �c N 0 S O Z Q g O U O O v v Im O Om i O CO2 O O 'i m m t C-10 .O O G O O d CL CM< c CO2 _ /c/q O c z CD CL O C rel LLI U) 19 W W C9 W U) i --i Q GQ z U O O v v Im O Om i O CO2 O O 'i m m t C-10 .O O G O O d CL CM< c CO2 _ /c/q O c z CD CL O C rel LLI U) 19 W W C9 W U) The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): ?elk w`, AA Z w S QVLd Dt)o rs I AC . Address: q s_ pD, 4 % U. City/State/Zip: k'ki1/ MA 0193-1 "`1Ph6 i&#:• ; �� 26,x•72 SS Are you an employer? Check the appropriate box: 1. I am a employer with 2. Jr- 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. $ ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. ' [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t - employees. LNo workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12. ❑ Roof repairs 13.❑ Other__ ;Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. fi Homeowners who submit this affidavit indicating they are doing a1 work and then hire .outside contractors must submit anew affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: ed C. C k V r ee Policy # or Self -ins. Lic. #: ®'S W G N L J 7A4 Z Expiration D:.T _Z010 Job Site Address: City/State/Zip:. 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 copy6f :this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: ti,,i ,! - Al C--- Date: 6 r Phone #: 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 #: ACO RD,M CERTIFICATE OF LIABILITY INSURANCE DAT2009 1 DIYYYY) 06/30/2009 16:20 PRODUCER (800) 225-1865 Fred C. Church, Inc. Fre 41 d C. Church, Street THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS. NO. -RIGHTS. UPON -THE. CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. POLICY NUMBER Lowell, MA 01851 800-225-1865 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Citizens Insurance Company of America INSURER B: Hanover Insurance Company New England Window & Door LLC 45 Fondi Road Haverhill, MA 01832-1302 Mhusetts Ba Insurance assac INSURER C: y INSURER D: Wausau Underwriters Insurance Company INSURER E: MED EXP (Any one person) $ 10,000 GUVtKAUCb 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR DD' F POLICY NUMBER POLICYEFFECTIVE POLICY EXPIRATION 7/1/20! 0 LIMITS EACH OCCURRENCEA $ 1,000,000 A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE a OCCUR P ZBN1161407 1/112009 AUE TO REN PREM SES Ea occurence $ 100,000 MED EXP (Any one person) $ 10,000 PEaSONAL S ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - CCMP/OPAGG $ 2,000,000 GEN'L AGGREGAT E LiMIT APPLIES PER: POLICYX PRO• LOC ! AUTOMOBILE X LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ALL OWNED AUTOSI BODILY INJURY $ (Per person) C I SCHEDULED AUTOS ADN8162169 7/1/2009 1!1/2010 j HIRED AUTOS BODILY!NJURY (Per accident) $ Ij��"; j NON -OWNED AUTOS — PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ THAN EA.vCC $ AUTO ONLY: AGG $ ANY AUTOOTHER B EXCESSIUMBRELLA LIABILITY X OCCUR CLAIMS MADE UHN8167305 7/1/2009 7/1/2010 EACH OCCURRENCE $ 9,000,000 AGGREGATE $ 92000,000 $ $ DEDUCTIBLE D X RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE BINDWC 7/1/2009 1/1/2010 $ STATU- OTH- X TWC RY L MIT E E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 OFFICERIMEMBER EXCLUDED? If yes, describe under E.L. 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C m y 0 CD CD M O A r� D nCD O A CCD UG » b p b 0 ?r CD 0 o yo c mom .� CD w m a. O CD A� '*CD CD t, O woCD v, O A 'raj o' fi�Q SCD 10 CD R �. a 0c 0 CD a z 3 c� W CL CD z c m G) C) CO N O CD z c 3 m c. co Na CD 0 O m N n O 7 03 A C CD T). m Q N tQ CD V El a `, CDc CL n D S 'B n O pr N Uj � S N f�A c S N ID CD 3 CD alv0 o kCL 0 o d y '* x Cp 1 s x cn —1 G CD CD C (A 0 Er N W CL 0,0 � W 69 4.9N CA CT 0) W N O N A A W 7a v CSO N -N CO O CO CO O �I v A O Cn ID CD a CL q Z c 3 a m c) 0 N C O CD Z c 3 [S m c A o N to PELLA WINDOWS AND DOORS CONTRACT 1. TERMS AND CONDITIONS These Terms and Conditions are an integral part of the contract set forth on the Product Order (the "Contract") between New England Window and Door LLC dba Pella Windows & Doors, Inc. ("Pella") and the person(s) identified on the Product Order ("Owner") to supply the products (the "Products"), and perform the work (the "Work") described or referred to in such Contract. For Product Only purchases, a signed "Product Only Addendum" is a required part of the contract. 2. OWNER Pella is not responsible for any existing security systems. Owner shall remove all shades; verticals, blinds, curtains, drapes or window mounted air conditioners, prior to the installation of the Products. Pella's installers are not responsible for the removal or installation of these types of items. Pella is not responsible for pre-existing window coverings fitting on newly installed Pella windows. The Owner shall provide complete access to the work site between the hours of 7:00 a.m. and 6:00 p.m. (Monday through Friday) for Pella's installers to deliver the Products and perform the Work. 3. PELLA Pella will be responsible for and have control over construction means, methods, techniques, sequences and procedures and for coordinating all portions of the Work. Pella will be responsible for the Work of its Pella Contractors who will install the Products. Unless provided otherwise in the Work description, Pella will provide and pay for all labor, materials, equipment, tools and machinery, transportation, and other facilities and services necessary for the proper execution and completion of the Work. The materials and equipment furnished under the Contract will be good quality and new unless otherwise required or permitted, the Work will be free from defects not inherent in the quality required or permitted, and the Work conform with the requirements of this Contract. Pella shall not be responsible for damages or defects caused by abuse, modifications not executed by Pella, improper or insufficient maintenance, improper operation or normal wear and tear. Pella will keep the premises and surrounding area free from accumulation of waste materials or rubbish caused by performance of the Work. 4. CHANGES The Owner may order in writing changes in the Work consisting of additions, deletions, or modifications ("Change Order"). Any Change Order shall include an adjustment to the Price and the Substantial Completion Date, as determined by Pella. Pella reserves the right to approve or disapprove any Change Order and any such Change Order must be signed by both Owner and Pella to be effective. SUBSTANTIAL COMPLETION Owner understands and agrees that the Substantial Completion Date is an estimate only and that the actual date on which the Work is completed may be extended to allow for Change Orders requested by Owner or if the time to complete the Work is affected by conduct of the Owner, weather, labor disputes, availability of subcontractors, acts of God, fine or other causes reasonably beyond Pella's control. If for any reason the Work is not fully completed by the Substantial Completion Date (including any extensions contemplated above), but is substantially completed by such date, i.e., the Product has been installed, but minor parts or components are missing or need to be replaced or repaired, a hold back proportionate to the cost of remaining parts or work to be completed is acceptable. However, the holdback will not exceed the amount of the completion costs or 10 % of the remaining unpaid balance of the Price, whichever is less. 6. FINANCING If payment of the Price is financed with a financial institution through Pella, all financing paperwork must be completed upon signing of this Contract and the requisite approvals and authorizations for the full amount of the requested financing shall have been received from the financial institution. PAYMENTS Pella shall be entitled to stop the Work upon written notice to Owner for any material default or failure by Owner, including but not limited to, the Owner's failure to pay Pella the amount due within seven days after the date payment is due. CORRECTION OF WORK Pella shall correct installation Work not in conformance with the requirements of the Contract, if notified in writing by the Owner within two years after the Completion Date or, if earlier, the date on which the Work is substantially completed and payment of the Purchase Price made subject to a holdback as provided above. Correction of Work as herein provided shall be Owner's sole remedy for defective workmanship, and is provided in lieu of any and all other remedies. Pella's obligation to correct Work is conditioned on Pella's prior receipt of all payments then due. LIMITED PRODUCT WARRANTY Pella shall warrant all Pella products, but only in accordance with the Pella Windows & Doors Limited Warranty. THIS LIMITED WARRANTY SHALL BE THE SOLE WARRANTY WITH RESPECT TO THE PRODUCTS AND PELLA SPECIFICALLY DISCLAIMS ALL OTHER WARRANTIES, EXPRESS OR IMPLIED, WRITTEN OR ORAL (INCLUDING WITHOUT LIMITATION ANY WARRANTY OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE). 10. NO CONSEQUENTIAL DAMAGES UNDER NO CIRCUMSTANCES SHALL PELLA BE LIABLE FOR CONSEQUENTIAL, INCIDENTAL, INDIRECT, OR SPECIAL DAMAGES, WHETHER FORESEEN OR UNFORESEEN. 11. HOME IMPROVEMENT CONTRACTORS All home improvement contractors and subcontractors shall be registered with the director of the Home Improvement Contractor Registration Program administered by the Board of Building Regulations and Standards. Pella and any of its subcontractors identified in this agreement have been registered. Any inquires about Pella or any of its subcontractors relating to registration should be directed to: Director, Home Improvement Contractor Registration, One Ashburton Place, Boston, MA 02108.617-727-8598 12. PERMITS (MA c-ustowers only) Pella is obligated to and will obtain the following permits for this project: Homeowners who secure their own permits will be excluded from the guaranty fund provisions of Massachusetts General Laws, chapter 142A. In addition to the rights and warranties enumerated in this agreement, you may have additional rights under Massachusetts General Laws, chapter 142A and 780 Code of Massachusetts Regulations R6. 13. NOTICE OF CANCELLATION 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 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. See the attached Notice of Cancellation for an explanation of this right. Do not sign this contract if there are any blank spaces. Customer signal!.; ,P2, Z l Date DISPUTES Job Name CIS r % S S (o l H"eK Date 5 2:2 —10 THE CONTRACTOR AND THE HOMEOWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT PELLA HAS A DISPUTE CONCERNING THIS CONTRACT, PELLA MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUTIVE OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATIONS AND THE CONSUMER SHALL BE REQUIRED TO SUBMIT TO SUCH ARBITRATION AS PROVIDED IN M.G.L.c. 142A Contractor omeo avner NOTICE. THE SIGNATU'_2E OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE SETTLEMENT INITIATED BY THE CONTRACTOR. THE OWNER MAY INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THIS SECTION IS NOT SEPARATELY SIGNED BY THE PARTIES.