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HomeMy WebLinkAboutBuilding Permit #432-14 - 75 WOODCREST DRIVE 11/13/2013 I 1 I j I I ~ f t1ORTH q BUILDINGPERMIT ?opt tio' P _ o TOWN OF NORTH ANDOVER ,°� r APPLICATION FOR PLAN EXAMINATION- Permit XAMINAT O i L- v Date Received t I Permit NO. +► o9q ,� ,, , 4 Date Issued: �9SSACMUSEt�� i. IMPO TANT: A plicant must com lete all items on this age 3 i I I i TYPE OF IMPROVEMENT PROPOSED USE Residential - a Non Residential ' ❑ New Building One family t I ❑Addition ❑Two or more family ❑ Industrial KAlteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other A i I Adding 7 inches of blown in cellulose insulation to attic area I I � i � I i Identification Please Type or Print Clearly) I OWNER: Name: Nancy Macmillan Phone: 97;8-686-7834 I � ; Address: ; Fr #j t I n p k . 4� I ARCHITECT/ENGINEER Phone: Address: Reg. No. I I FEE SCHEDULE:BUILDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED Oil)PER S.F. Total Project Cost: $ 900.00 FEE: $ SO Check No.: Receipt No.: �-A NOTE: Persons contracting with unregistered contractors do not have access to he guaranty fund I r t � i TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received I Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATIONS • PROPERTY Print 100 Year OIdlStructure ye's, ono MAP�NOZONING 'ISiT7RI;CT Historic District yes, noa achine�Shop Villag w �..m.�z `� TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial i ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other _ t S ptic,� ❑WellesT € ; y d�Districtx j _ ❑ Floodplain, Wetlands i 0 Waters ;e �`�❑�V1/at�/Sewer � - _- _ DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: t •._,. _.-T - - _ _ --_ �- - - x -' ads 'CrONTR`ACT®R rP a 9 one: .� M1 tt a :&✓•eE d 4 r ' d � � R• � .. • q � � t ate,`.'J5 i, +Addiess: Y T- - , _ _, w _ Date _ Supervisoris o'q tru:ctiona License — _ __ = xp: y �E �. m , Hf orneIrnproement4License _ __ _,_ -- Exp z_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: $ FEE: $ I Check No.: Receipt No.: �I NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ,� rl Signature of Agent/Ownerr _., .F... _ . '� :.�:- ,-S�g�ature�ofconfractor�_ . __ Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ T YEl•,OF-:SEWERAGEDiSPDSAL Public Sewer ❑ Tanning/MassageBodyArt ❑. . _Swimming Pools ❑ Well ❑ Tobacco.Sales ❑ Food Packaging/Sales D Private.(septic tank, etc... ❑ -- - Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF U FORM � DATE REJECTED DATEAPPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS i CONSERVATION Reviewed on Signature COMMENTS 1 HEALTH Reviewed on Siqnature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes t 'Planning Board Decision: Comments Conservation Decision: :Comments Water & Sewer Connection/Signature& Date Driveway Permit i DPW Toww:z Engineer: Signature: Located 384 Osgood Street 'FIRE DEPARTMENT -Temp Dump'ster on site yes no Located at:124xMairt Street Fire D F. epartme►it CON�M.ENTS -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 i El Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department The folswing is-=a list of the retluired.forms to be filled out-for the appropriate.permit to be obtained. Roofil,g, Siding, Interior Rehabilitation Permits its o ` 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 NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cans if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apu%,al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm:tted with the building application Doc: Doc.Bui?ding Permit Revised 2012 Location No. i -"*Date • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ ° TOTAL $ Check# �� 27102 Building Inspector NORTH own of 1 �, Andover No. - Z h ver, Mass o > �l COC NIC M�WICK y�. S BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System 411111 1 ,` THIS CERTIFIES THAT % % � BUILDING INSPECTOR ........ ... ........... .................................................... ............................ 1� a t->c . �1t�► Foundation has permission to ere t .......................... buildings on ........Q...... .�..........5.......;..........�r........... ` Rough to be occupied as ................ ...... ...1.0�!..................... ...............................4.....................`............... 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 MONHS ELECTRICAL INSPECTOR UNLESS CONSTRUCT@ S TS Rough Service ............. ................................................................. 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 The Commonwealth of Massachusetts Department of Industrial Accidents _ W Office of Investigations w d I Congress Street, Suite 100 Boston,MA 02114-2017 °'M SV•�, www mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): TruGreen Address: 16 Progress Ave City/State/Zip:Chelmsford, MA 01824 Phone#:978-685-4200 Are you an employer? Check the appropriate box: Type of project(required): 1.W I am a employer with 80 4. ❑ lam a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. F-1 New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition -workingfor me in an capacity. employees and have workers' y p �'• 9. E]Building addition [No workers' comp.insurance comp. insurance.1 d. re uire5. F-1Weare a corporation and its 10.E]Electrical repairs or additions required.] 3.❑ I am a homeowner doing all work officers have exercised their 11.E]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 Attic Insulation employees. [No workers' 13.F Other 3 comp. insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. t 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:Zurich American Insurance Company Policy#or Self-ins.Lic.#:WC293865405 Expiration Date: 1/1/2015 Job Site Address: _7S_ Wooic m st t f. City/State/Zip: N.h,1J4y t,+- 0(64,5— Attach l$4-,5— 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. Ido hereby certify under the pains anApenalties perjury that the information provided above is true and correct. vc 3 Siarlature: Date: l f l•�/� - 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#: i ��1 ® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 0313012012 O THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS Ow 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 G REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. Q 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 w certificate holder in lieu of such endorsement(s). PRODUCER CONTACT 'C NAME: Aon Risk Services Central, Inc. PHONE (866) 283-7122 FAX C847) 953-5390 Chicago IL Office INC.No.Ext): AIC.No.): 200 East Randolph E-MAIL o Chicago IL 60601 USA ADDRESS: 2 INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER P: Zurich American Ins CO 16535 TruGreen Limited Partnership INSURER B: American Zurich Ins Co 40142 860 Ridge Lake Boulevard Memphis -TN 38120-9434 USA INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:570045720663 REVISION NUMBER: THIS IS 70 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 MAY 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. Limits shown are as requested INSR TYPE OF INSURANCE ADD SUBR POLICY NUMBER POLICYEFF POLICYEXP LIMITS INSR WVD MMIDD MM/DDl11'YY LAR GENERAL LIABILITY GLOZ938b5bU5EACH OCCURRENCE $3,000,OOO JDAMA]xx COMMERCIAL GENERAL LIABILITY REMI O EN $1,000,000PREMISES Ea occurrenceCLAIMS-MADE X❑OCCUR MED IXP(Any one person) $10,000PERSONAL&ADV INJURY $3,000,000 to0Pesticide or Herbicide Applicator Cov GENERAL AGGREGATE $5,000,000 co 0 Contractual Liability GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS AGG Included o X POLICY JECPROT- LOC 0 A AUTOMOBILE LIABILITY BAP 2938657-05 01/01/2012 01/01/2015 COMBINED SINGLE LIMIT $5 000,000 Ea accident) X ANY AUTO BODILY INJURY(Per person) Z ALLOWNED SCHEDULED BODILY INJURY(Per accident) m AUTOS AUTOS NON-OWNED AUTOS DAMAGE v X HIRED AUTOS X AUTOS er accident ti- m UMBRELLA LJA11 HOOCUR EACH OCCURRENCE V EXCESS LIAB CLAIMS-MADE AGGREGATE DED I RETENTION I B WORKERS COMPENSATION AND WC293865405 01/01/2012 01/01/2015 X WORM LIMBS ER EMPLOYERS'LIABILITY ` A ANY PROPRIETOR/PARTNER I EXECUTIVE Y/N A05 E.L.EACH ACCIDENT $1,000,000 OFF ICERIMEMBER EXCLUDED? � NIA WC293865505 01/01/2012 Ol/Ol/2015 (Mandatory in NH) WI E.L.DISEASE-EA EMPLOYEE $1,000,000 H yes•describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Additional Information *The named insured includes (but is not limited to): iy TruGreen Limited Partnership dba Barefoot Grass FEIN #36-3734669 TruGreen Limited Partnership dba EPM Lawn Care FEIN #36-3734669 'r TruGreen Limited Partnership dba Agrol-awn FEIN #36-3734669 TruGreen Limited Partnership dba Bay Country FEIN #36-3734669 R CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE +� POLICY PROVISIONS. TruGreen Limited Partnership AUTHORRED REPRESENTATIVE 860 Ridge Lake Boulevard - Memphis TN 38120 USA �'9�7 � J. ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000023893 LOC#: ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY 4EFFECnVE MED INSURED Aon Pi s;k Services Central, Inc. ruGreen Limited Partnership POLICY NUMBER See Certificate Number: 570045720663 CARRIER NAIC CODE see Certificate Number: 570045720663 DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM N UMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Additional Descdpbon of Operations/Locations/Vehicles: TruGreen Limited Partnership dba Safeguard Pest Control FEIN #36-3734669 TruGreen Limited Partnership dba TruGreen Chemlawn FEIN #36-3734669 TruGreen Limited Partnership dba Heritage Lawns FEIN #36-3734669 Additional Insured applies to the General Liability and Automobile Liability policies if required by written contract. waiver of Subrogation applies to the General Liability, Automobile Liability and workers compensation policies if required by written contract. Any party with which the named insured is contractually required to include as additional insured, loss payee or mortgagee, is automatically granted such status; mortgagees of property leased by the named insured are also automatically granted such status where required. However, coverage under the policy only applies to the ex tent of the coverage required by such contractual requirement and for the limits of liability specified in such contractual requirement, but in no event for insurance not afforded by the policy nor for limits of liability in excess of the applicable limits of liability of the policy. AGORD 101 (2008/01) ©2008 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD _— ------ i 4 - i ------------------- I Massachusetts Depar#ment of Public Safety Board of t3itiidt.n.g Regu3ai;iorss and Standards License. CS-065519 Y l FRANCIS W I.ATI.1AM - 170 WEARS STREET Lawrence MA Di843 COMMIS garner 1010212015 I I I 09/25/2013 7:49AM FAX 5085206545 TRUGREEN BOSTON WEST ID0002/0012 : :1 Office.Q�:C�spp,5U1.5 f�acr�s�8,us;rises Regnl's'lion � EI;�T CONTRACTOR I L 0 .� .. Type: I F. piratib S 4 LLP i TR RE. N LIM{TEp�4i �E3lr � ERIC MAf?It sz sEcIARvVoop -S-A1 EM,t�H Q30.79 :.•f;;;. Undcrbccretary { i TRUGREEMInsulation Service Agreement INSULATION SERVICE TruGreen.com 1-855-207-5223 Customer Name: L )A l E-mail: Service Address: dU Q City: p/ 14 e,P 4 it, State: County: ZIP Code: C� Billing Address: City: @! State: County: ZIP Code: Home Phone: ' (pU� 3 Work Phone: Cell Phone: O YES, I am interested in your insulation service but not ready to purchase today.You have my permission to call me at any of the above numbers at a later date to discuss further. Customer's Signature Date TruGreen Rep's Name Date TruGreen Insulation Service: Date of Installation: (or as otherwise agreed) TruGreen will install insulation in accessible open/uncovered designated spaces(Service Areas)of Property as described below. TotalFootage . Existing Insulation Avg.Depth R-Value Current R-Value Final Cellulose Foot�+atge (Inches) Inch R-Value Added R Value Inches Applied TOTAL 100 Fiberglass Loose-Fill 2.5 Fiberglass Batts 3.2 2 5' Z d oe R-Value Goal Cellulose Loose-Fill 3.5 Rockwool 2.8 CUET-OMCR AGREES TO SUPPLY TRUGREEN WITH ACCESS TO GROUNDED OUTLET(S) AND POWER ANG TO SHUT DOWN THE PROPERTY'S HEATING/COOLING SYSTEMS . ( ) CUSTOMER UNDERSTANDS THAT INSTALLATIONF O INSULATION MAY GENERATE DUST AND OTHER AIRBORNE IRRITANTS IN THE SERVICE AREA AND THROUGHOUT THE PROPERTY.TRUGREEN RECOMMENDS CLOSING ALL WINDOWS AND INTERIOR DOORS DURING INSTALLATION. CUSTOMER MAY WISH TO COVER OR REMOVE PERSONAL PROPERTY AND TAKE OTHER PRECAUTIONS CUSTOMER DEEMS NECESSARY TO AVOID DUST/IRRITANT EXPOSURE. SUMMARY OF CHARGES AND PAYMENT OPTIONS SUMMARY OF CHARGES AND PAYMENTS O Financing Option:See TruGreen Retail Installment Agreement INSULATION SERVICES Down Payment Option: Initial 20% down-payment of Total Investment(#1) INSTALLATION. . . . . . . . ... . . . . . . . . .. . . . .. .. . . `100, fjy by check or credit card due upon execution of Agreement.Remaining Balance (#3)due upon completion of installation. ATTIC TENT INVESTMENT.. ... . . . . . .. . . ... .. . . DA/� O Pre-Payment Option: Payment in full of Total Investment (#1) by check or credit card due upon execution of Agreement. OTHER. ... . . . . . .. . .. . . . .. .. . ... . . . . I..... . . O Payment On Completion:A one-time check or credit card payment of Total Investment(#1)due upon completion of installation. TAX.• •• ... • • • • • .• • •• ••• • • • . . . . .. . • .• •• • • 0 If paying by credit card, Customer authorizes Tru e n process credit card 1.TOTAL INVESTMENT.. .. . . . . . . . . .. . . ..... /��(/� payments in accordance wit e bove pa ent p elected by Customer o,v without further signature iz io 2. LESS$ , DOWN PAYMENT.. .. — Customer Signature; 3. REMAINING BALANCE .. . . . . . . . . .. . . . .... Best Number to Reach Customer to Obtain Credit Card Number: KES, I would like to se the se i e set forth "E7�olta Investment(#1).My agreement is subject to the terms and conditions on the reverse side. Customer's Si natu fg DateTruGreen Rep's Name C� 1s(� Z Sales Rep# YOU,THE BUYER,MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. PLEASE SEE NOTICE OF CANCELLATION PROVIDED FOR MORE EXPLANATION OF THIS RIGHT. The Terms and Conditions on the reverse side,including the mandatory arbitration provision,are part of this agreement. Key#10248 Rev 08/13 ©2013 TruGreen Limited Partnership.All rights reserved. License# In CT,#HIC.0544505.In PA,#HIC.092436,092773,092951,092672,092632, 092638,092814.In DE,#HIC.2012603915.In NJ,#HIC.13VH06966700.In TruGreen Branch address: TN,#HIC.7424.In MA,#HIC.173270.In MI,#HIC.2106203510,2106203509, E 2106203508,2106203555,2106203507,2102203465,2106203556,2106203506, See Reverse for Additional Terms and Conditions 1 / 2106203505,2 1 06203504,2106203639,2106203503,2106203502. BRANCH COPY Yt 'f wl TRUGREEN. Insulation Service Agreement INSULATION SERVICE TruGreen.com 1-855-207-5223 Customer Name: At,, LIlk ` ,ft Email: Service Address: r p City: AJA State: County: ZIP Code: C 0 Billing Address: City: QQ State: County: ZIP Code: 1114 Home Phone: �) �jC1�ry 3 Work Phone: Cell Phone: O YES, I am interested in your insulation service but not ready to purchase today.You have my permission to call me at any of the above numbers at a later date to discuss further. Customer's Signature Date TruGreen Rep's Name Date TruGreen Insulation Service: Date of Installation: (or as otherwise agreed) TruGreen will install insulation in accessible open/uncovered designated spaces(Service Areas)of Property as described below. Total Sq. Existing Insulation Avg.Depth R-Value Current R-Value Final Cellulose Footage (Inches) Inch R-Value Added R-Value Inches Applied TOTAL Fiberglass Loose- Fill 2.5 Fiberglass Batts 3.2 Z dP 0e R-Value Goal Cellulose Loose-Fill 3.5 Rockwool 2.8 CUSTOMER AGREES TO SUPPLY TRUGREEN WITH ACCESS TO GROUNDED OUTLETS) AND POWER AND TO SHUT DOWN THE PROPERTY'S HEATING/COOLING SYSTEM(S).CUSTOMER UNDERSTANDS THAT INSTALLATION OF INSULATION MAY GENERATE DUST AND OTHER AIRBORNE IRRITANTS IN THE SERVICE AREA AND THROUGHOUT THE PROPERTY.TRUGREEN RECOMMENDS CLOSING ALL WINDOWS AND INTERIOR DOORS DURING INSTALLATION. CUSTOMER MAY WISH TO COVER OR REMOVE PERSONAL PROPERTY AND TAKE OTHER PRECAUTIONS CUSTOMER DEEMS NECESSARY TO AVOID DUST/IRRITANT EXPOSURE. SUMMARY OF CHARGES AND PAYMENT OPTIONS SUMMARY OF CHARGES AND PAYMENTS O Financing Option:See TruGreen Retail Installment Agreement INSULATION SERVICES 5bown Payment Option: Initial 20% down-payment of Total Investment (#1) INSTALLATION. . . .. . . . . . . .. . .. . . . . . . . .... . . . D} 60 by check or credit card due upon execution of Agreement.Remaining Balance (#3)due upon completion of installation. ATTIC TENT INVESTMENT.. .. . . . . . .. . ... . ..... IJOAX O Pre-Payment Option: Payment in full of Total Investment (#1) by check or credit card due upon execution of Agreement. OTHER..... . . .. .. . . . . . . .. . . . . . . . . . . . .... . . O Payment On Completion:A one-time check or credit card payment of Total Investment(#1)due upon completion of installation. TAX•• • •• _ 010-6 If paying by credit card, Customer authorizes Tru e n process credit card 1.TOTAL INVESTMENT.. . . . . . . . . .. . . . . . . . .. D� payments in accordance wit , e bove pa ent p elected by Customer o without further signature r iz io 2. LESS$ I � DOWN PAYMENT.... - Customer Signature 3. REMAINING BALANCE . . . . . . . . . ... . . . .... - < Best Number to Reach Customer to Obtain Credit Card Number: �ES, I would like to h se the se i e set forth• e otf T tal Investment(#1). My agreement is subject to the terms and conditions on the reverse side. V Customer's Signatu Date �`Zb'I TruGreen Rep's Name ,." CL b " Sales Rep# 1 2 fy YOU,THE BUYER,MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. PLEASE SEE NOTICE OF CANCELLATION PROVIDED FOR MORE EXPLANATION OF THIS RIGHT. The Terms and Conditions on the reverse side,including the mandatory arbitration provision,are part of this agreement. Key#10248 Rev 08/13 C f 0 2013 TruGreen Limited Partnership.All rights reserved. License# In CT,#HIC.0544505.In PA,#HIC.092436,092773,092951,092672,092632, 092638,092814.In DE,#HIC.2012603915.In NJ,#HIC.13VH06966700.In TruGreen Branch address: TN,#HIC.7424.In MA,#HIC.173270.In MI,#HIC.2106203510,2106203509, i Q k ✓ .) f f 2106203508,2106203555,2106203507,2102203485,2106203556,2106203506, See Reverse for Additional Terms and Conditions r+—1� I C 1 I 2106203505,21 06203504,2106203639,2106203503,2106203502. BRANCH COPY tt4 M/1 , l 09/25/2013 7:50AM FAX 5085206545 TRUGREEN BOSTON WEST 20006/0012 � fibe MATERIAL SAFETY DATA SHEET SECTION I —PRODUCT AND COMPANY INFORMATION PRODUCT IDENTIFIER: Cellulose Insulation,Loose Fill Blended Formula F>PODUCT NAME: INS417LD, INS441LD, INS43OLDCAN,1NS51OLD,INS510LDCAN;INS515LO, INS550LOCAN, INS552LDCAN, INS54ILD Insulation A MANUFACTURER: US GreenFiber,LLC 2500 01stribution Street,Suite 200,Charlotte, NC 28203,USA MIN 7m Emergency Telephone Number:804.228.0024(8am-5pm EST Mon-Fri) U S A SECTION2—COMPOSITION AND INGREDIRN-f INFORMATION COMPONENT/CAS# %BY EXPOSURE LIMITS CANCER WEIGHT , DESIGNATION Newsprint Not less OSHA PEL-TWA=15mglm total dust(PNOR) None (Cellulose Fiber) than 85% PNOR-Particulates Not Otherwise Regulated or ##9004-34-6 Nuisance Dust OSHA PEL-TWA=5mg/m9 respirable fraction(PNOR) Cal OSHA PEL=10mg/m"total dust(PNOR) ACGIH TLV-TWA=i Omg/m'inhalable(PHOS) PNOS—Particulates Not Otherwise Specified ACGIH TLV-TWA=3m m9-respirable PNOS Boric Acid Not more OSHA PEL-TWA=15mgW total dust(PNOR) None H3BO3 than 10% OSHA PEL-7WA=5mg/m3 respirable fraction(PNOR) #10043-35-3 Cal OSHA PEL=bmg/m3 ACGIH TLV-TWA=2mg/m3 ACGIH TLV-STEL=6mg/m3(inhalable fraction—Borate Compounds, Inorganic) Ammonium Sulfate Not more OSHA PE1-TWA=15mg/m total dust(PNOR) None (NH4)2SO4 than 11% OSHA PEI--TWA=5mg/m3 respirable fraction(PNOR) 97783-20-2 Cal OSHA PEL=10mg/m3 total dust(PNOR) ACGIH TLV-TWA=10rnglm3 inhalable(PNOS) ACGIH TLV-TWA=3m /m3 respirable PNOS Zinc Sulfate Not more OSHA PEI_-TWA=15mg/m total dust(PNOR) None ZnSOrH2O than 2% OSHA PEL-TWA=5mg/m3 respirable fraction(PNOR) 97446-19-7 Cal OSHA PEL=10mg/m3 total dust(PNOR) ACGIH TLV-TWA=10mg1m3 inhalable(PNOS) ACGIH TLV-TWA=3m /m3 respirable PNOS Distillate Mineral Oil Not more None(Oil mist exposure not applicable in finished product) None #8042-47-5 than 20) Boric acid is classified as hazardous under the OSHA Hazard Communication Standard based on animal chronic toxicity studies. Refer to Sections 3 and 11 for details on hazards. HMIS Matin National Fire Protection Association NFPA Health 1 Red Flammablll 1 Flammability1 Yellow(Reactivity) 0 ReactlyjjX 0 Blue Acute Health 1' Personal Protection E 'Chronlc Effects i EMERGENCY OVERVIEW " Effective August 2011 Page 1 of fi W,6.4.057 Rc,-D i 6 -------------- 08/25/2013 7:50AM FAX 5085206543 TRUGREEN BOSTON WEST 00007/0012 I I I e MATERIAL SAFETY DATA SHEET Avoid extreme heat and open flame. May emit carbon monoxide gas,boric aeid.and other hazardous particulates during thermal decomposition. This product is a finely divided, light gray 1 brown materlal with no perceptible odor. It presents no unusual hazard if Involved in afire_ Ph sical Characteristics Roiling Point F Not applicable Vapor Pressure mm H Not applicable Vapor Density Not applirable Solubility In Water Insoluble:dispersible Specific Gravity(H20=1) Not applicable Reactivity in Water None Melting Point Not applicable Potential Health Effects Inhalation Slightly Irritating to upper-respiratory system. Persons with.respiratory problems should avoid breathing dust. Eyes Sli ht Irritant. In case of eye contact,flush with water. Ingestion Small amounts are not likely to cause harm. ingestion of large amounts may cause rash,diarrhea nausea. . Skin Does not normally irritate skin, in case of broken skin,wear gloves and wash dust from skin with soap and plenty of water- Large amounts absorbed into bloodstream ma cause rash,skin peeling, diarrhea,nausea,dizziness. Acute Not anticipated as discussed above. Chronic None, Cancer Neither the end product nor any of its components. AID Eyes For dust exposure,immediately flush eyes with plenty of water for at least 15 minutes. Seek medical attention if irritation persists, Skin If skin Is exposed,wash with soap and large amounts of water. If irritation persists,seek medical attention. Inhalation If Irritation or difficulty in breathing occurs,remove to fresb air. Seek medical attention it condition persists. Ingestion Symptoms may include diarrhea,nausea and vomiting. Seek medical attention If material was ingested and symptoms occur. Note to Exposure to dust may aggravate symptoms of persons with pre-existing respiratory tract conditions Physicians and may cause skin and gastrointestinal symptoms.. SECTION 5—FIRE FIGHTING MEASURES Flash Point Not applicable Method Used Combustible Material may decompose on contact with extreme temperatures endo en flames. j Flammable LEL: Not applicable UEL_ Not applicable I( Limits Autoignition Not determined Temperature Explosion None expected for product based on particle size. Note: Airborne concentrations of combustible Hazard dust, when combined with an Ignition source, can create an explosion hazard if the dust Effective August 2011 Page Z of 6 f MS-6.4-057 Rev D 09/25/2013 7:50AM FAX 5083208545 TRUGREEN BOSTON WEST 00008/0012 ■ iter - MATERIAL SAFETY DATA SHEET concentration exceeds 15 mg/m', Extinguishing Water,dry chemical and other agents rated for a wood fire(Type A fire). Use;Type A rated Media extin wisher. Fire Fighting Evacuate the area and notify the fire department. if possible,isolate the fire by moving other Instructions combustible materials, If the fire is small,use a hose-line or extinguisher rated for a Type A fire. If possible,dike and collect water used to fight fires. Fire-fighters should wear normal protective a ui ment full bunker ear and positive-pressure,self-contained breathinga eratus. SECTIONACCIDENTAL Contains water-soluble Inorganic mineral salts which may damage trees or vegetation exposed to large quantities_ Land: shovel,sweep or vacuum product. Place in disposal container. Avoid.bodies of water, Water: large quantities may cause localized contamination of surrounding waters depending on the quantity spilled. At high concentrations may . damage localised vegetation,fish and other aquatic rife. This product is a non-hazardous waste when spilled or disposed of as defined In the Resource Conservation and Recovery Act(RCRA).regulations(40 CFR 261). Refer to regulatory information in Section 15 for additional information regarding EPA and California regulations. SECTIONSTORAGE General No special handling is required. Storage of'sealed bags in a dry,indoor location is recommended. To maintain product integrity,handle on a"first-in-first-0ut"basis. Use good housekeeping and engineering controls so that dust levels are below the exposure limits listed in Section?. Storage Ambient Temperature Stora a Pressure Atmospheric S ecial Sensitivity 'None SECTION1 t PERSONAL PROTECTION General Exposure Controls No specific controls are needed_ Use standard good housekeeping practices and en ineerin controls to minimize nuisance levels. Respiratory Protection If housekeeping and engineering controls do not maintain nuisance levels below regulatory limits or dust concentratlon is unknown, use a NIOSH-'approved mask. Eye Protection Wear ANSI-approved eye protectiori if environment is excessivel�du Hand Protection If skin is broken or sensitive, use coves Other Protective Clo'thing None ; Ventilation Normal and adequate ventilation WorktHygienic Practices Standard hyglenlc,practices Occupational Exposure This product Is listed/regulated by OSHA and Cal/OSHA as"Particulates Not Limits Otherwise Regulated"or"Nuisance Dust." This product is fist by ACG1H as "Particulates Not Otherwise S ecllted." ECTION Appearance Gra /Brown,odorless fiber Boillinj;gMelting Point Not applicable Bulk Density 915/ft com'ressed Flash Point Not applicable Vapor Pressure Negligible 20°C pH X8.2 2.0% suspension 25'C J Effective August 2011 page 3 of 6 MIS 6.4-057 Rev U i 09/25/2013 7:50AM FAX 3065206545 TRUGPEEN BOSTON WEST 160009/0012 Y � . MATERIAL SAFETY DATA SKEET Solubility In Water Product is not soluble Viscosit Not applicable i SECTION 10— STABILITY Stability: Stable Hazardous Decomposition Products: None H azardous Polymerization: Will not occur Conditions and Materials to Avoid: Reaction with strong reducing agents such as metal hydrides'or alkali metals will generate hydrogen gas which could create an explosive hazard, Keep-away from strong oxidizers, 'such as concentrated nitric acid,hydrogen peroxide and chlo6m. INFORMATIONSECTION 11 —TOXICOLOGICAL BORIC ACID Eye Draize test In rabbits produced mild eye irritation effects. No adverse eye effects anticipated. Skin Low acute dermal toxicity,LD50 in rabbits Is greater than 2,000 mg/kg of body weight. Boric Acid is poorly absorbed through skin, Ingestion Low acute oral toxicity,LD50 in rates Is 3,500 to 4,100 m kg of body weight Inhalation Low acute Inhalation toxicity;LC50 in rates is greater,than 2.0 mq1Lor /m , Reproduction Animal feeding studies in rat mouse,and dog,at high doses,have demonstrated-effects on fart li Nutagerficity No mutagenic activ!tt was observed for boric acid in a battery of short-term mute enlLi assays- AMMONIUM SULFATE Eye None listed 1 Skin None listed Ingestion I TDLo,oral, human,1500 m fk ,diarrhea,nausea,vomiting,LD50,oral,rat,2840:m Ik Inhalation None reported Subchronic None repo Chronic None reported Teratology None reported Reproduction None reported Muta2enicity None reported ZINC SULFATE Eye Dose-420 ug;moderate(rabbit) Acute LD 50: 1710 mg/kg,oral,rat Ex osure LD 50: 245 m /k , oral mouse Chronic No known ingestion reaction anticipated Teratology May cause inhalation reflex brochoconstruction fSECTION 12—ECOWGICAL INFORMATION BORIC ACIP Ecotoxicity Daphnia magna,48-hr LC50-133 mg BIL "trout,32-0ay LC50=100 nig BIL Chemical Fate Boron is naturally occurring and ubfquitods in the environment. Boric Aad decomposes Information in the environment to natural borate, Boric Acid is soluble In water and Is leachable through normal soil. Effective August 2011 Page 4 of 6 MS-6.4-057 Rev D 's i i 3 E i 08/25/2013 7 50A FAX 5085206545 TRUGREEN BOSTON WEST 20010/0012 fiber MATERIAL SAFkTY DATA SHEET AMMONIUM SULFATE ECotoxicity TLm,Daphnia magna,423 mg/1-124H. Chemical Fate Not listed. Information ZINC SULFATE Ecotoxicity LC 50 rainbow trout:4.76 MG/1-148 HR,hard water]continuous flow;conditions LC 50 rainbow trout:4.6 m196 hr/fresh water 1 conditions of bioassay not specified Chemical Fate No data avaiiable for degradability,Log Bioconcentration Factor or Log OctenolANater Information artition Coefficient DISPOSAL CONSIDERATIONS SECTION 13 Dispose as a non-hazardous waste. SECTION 14—TRANSPORT INFORM ATION May be shipped normally as a non-hazardous material. SECTION 15—REGULATORY INFORMATION Superfund: CERCLAlSARA. This product is not listed under the Comprehensive Environmental Response Compensation and Liability Act(CERCLA)or Its 1986 amendments, the Superfund Arnendments•and Reauthorization Act (SARA), including substances fisted under Section 313 of SARA, Toxic Chemicals, 42 USC 11023, 40 CFR 372.65; Section 302 of SARA Extreme) Hazardous Substances 42 USC 11 Y 002, 40 CFR 355; or the CERCLA Hazardous Substances list,42 USC 9604,40 CFR 302. RCRA: This product is not listed as a hazardous waste under any sections of the Resource Conservation and Recovery Act or regulations(40 CFR 261 et seq.). Safe Drinking Water Act: This product is not regulated under the SDWA, 42 USC 300g-1,40 CFR 141 et seq. Consult state and local regulations for possible water quality advisories regarding boron and ammonia. California Proposition 65: This product is not listed on any Proposition 65 lists of carcinogens or reproductive toxicants, OSHA Carcinogen:Not listed, i Clean Water ActFederal Water Pollution Control ( n Con o Act): 33 USC 1251 at seq.:This product is not itself a discharge I covered by any water quality criteria of Section 304 of the CWA, 33 U$C 1314. This product is not on the Section 307 ust of Priority Pollutants, 33 USC 1317, 40 CFR 116. This product is not on the Section 311 List of Hazardous Substances,33 USC 1321,40 CFR 116. TSCA No.: This product does not appear on the EPA TSCA Inventory list_ Ammonium sulfate and boric acid appear on the EPA TSCA Inventory list under the CAS Nos.7783-20-2 and 10043-35-3 respectively. OSfiA/Cal/OSHA: This MSD$ document meets the requirements of both OSHA and Cal/OSHA hazard communication standards. Refer to Section$for regulatory exposure limits. IANC: The International Agency for Research on Cancer (of the World Health Organization)does not list or categorize this product as a carcinogen. Effective August 2011 Page 5 of 6 _.! MS-6.405?RI,n g I 09/25/2013 7:51AM FAX 5085206645 TRUGREEN BOSTON WEST 120011/0012 ■ Iii NTP Annual Report on Carcinogens; Not listed. MATERIAL SAFETY DATA SHEET SECTION 1 INFORMATION PRESENTED HEREIN HAS BEEN COMPILED FROM SOURCES CONSIDERED DEPENDABLE AND IS ACCURATE AND RELIABLE TO THE BEST OF OUR KNOWLEDGE AND BELIEF, BUT IS NOT GUARANTEED TO BE SO. NOTHING HEREIN IS TO BE CONSTRUED AS RECOMMENDING ANY PRACTICE OR ANY PRODUCT IN VIOLATION OF ANY PATENT OR IN VIOLATION OF ANY LAW OR REGULATION. THE USER IS RESPONSIBLE TO DETERMINE THE SUITABILITY OF ANY MATERIAL FOR A SPECIFIC PURPOSE AND ADOPT NECESSARY SAFETY PRECAUTIONS. WE MAKE NO WARRANTY AS TO RESULTS TC BE OBTAINED IN USING ANY MATERIAL AND, SINCE CONDITIONS OR USE ARE NOT UNDER OUR CONTROL, WE MUST NECESSARILY DISCLAIM ALL LIABILITY WITH RESPECT TO USE OF ANY MATERIAL SUPPLIED BY US. ABBREVIATIONS ' CAS Chemical Abstract Services(identifies specific OSHA Occupational Safety and Health Administration chemical m lm Milli rams er cubic meter PNOR Particulates Not Otherwise Re ulated LCLo Lethal concentration tow PNOS Particulates Not Otherwise S ecitled LDLo Lethal dose low PEL OSHA Permissible Exposure Limit LC50 Lethal concentration 50% _pEm Parts per million LD50 Lethal dose 50% Rf17 I Reference Dose LOAEL Lowest Observed Adverse Effect Level RTE CS Reaistry of Toxic Effects of Chemical Substances i m 1/H Milli rams er Iiter per hour TDLo Toxic dose low _ MqLkg Milligramstoer kilogram TLV ACGII.1 Threshold Limit Value rinill m Mltli rams per cubic meter TWA S hour Time Weighted Average exposure i BIBLIOGRAPHY 1. The Guide to Occupational Exposure Values,American Conference of Governmental Industrial Hygienists, 1997. j 2.. Registry of Toxic Effects of Chemical Substances, National .Institute of Occupational Safety and Health, 0-1, 1998. • 3. Dangerous Properties of Industrial Materials, Sax's, 1997 CD-Folio. 4, Hazardous Substances Data Bank,Canadian Centre for Occupational Health and Safety,4-1, 1998. 5- Integrated Risk Information System, EPA,on-line. 6. Toxicological Profiles,Agency for Toxic Substances and Disease Registry,U.S.Public Health Service, 1997, 7. TLVs and other Occupational Exposure Values, American Conference of Governmental;Industrial Hygienists, 2010. 8. 29 CFR 19 10.1000 TABLE Z-1 and Z-3 9. California OSHA Title 8,Section 5155,Table AC-1 us Grammer PJSGF)does not protide ardtidetiumt,inMKOM,&VnefiOV w hWiding sGenoe Service;and dt cwrm any re80nabd'dy with rwperA thereto. USCF does riot guaanloa,warrant or attwwt to determ'v,o whathm a bumnp 6tructrr<o,design W the use of mataul Owgin complas Wth any appficabte codes,stendaras.gu;dones or standards of workmanship. A4*g Ir+s,rlatlon to any Pet Of a b~t mwetgpa v l Sousa dunBes In air,heat and rnadSLOO flow.Tho user mUet Undarttand how the use of InaWafion we ohangv the performanca d a tlwaMag prier to hoageddon.The veer rrutntakrs me fug and mmplele rafiponabUlty b eompty%0l all 00686.laws and rpgulAone sWitable v the safe am proper use•handling and{rtste�atton of 1hd p oil 11p and shduM oorlaull w In an j archils«, gin$&.ar'ed�e sdant184 ane/or 3 ratwlor,ergy spadelmt for 36 csatspu�6n.6ee10n and Porformanoe related quewonr The Urtortn6Uon cwWn4d hwoin is belleved to be aceurata to of rho limo d preparation. Hu war.USCF makas w wamn{y cv4engny the htwrary of Ings Ml 0MAVan.WGF»W not be[able for riaur>:rat 419 b the use a'udormaticn cantalned tdergn,reper�a6t aF 1nh41her It IS CI81Mad tlnaF the IrdorlrlaMOn Of temmmmdalbn5 are Insomrala,incomplete or k166rtecl. Effective August 2011 MS-6,4-057 Rcy n Page 6 of 6 9