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Building Permit #336-2017 - 8 Woodcrest 9/29/2016
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I TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: S o 1, Date Received Ct-dL,:� -Zd /(9 Date Issued: f -d-"*;l' - 9"-& IMPORTANT:Applicant must complete all items on this page LOCATION 8 Woodcrest Dr North Andover, Ma Print PROPERTY OWNER, Peter Molander Print .MAP NO: PARCEL:_6 ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial Repair, eplacement Assessory Bldg Others: Demolition Other Septic - Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: strip and re-roof using architectural shingles, install new soffit vents Identification Please Type or.Print Clearly) OWNER: Name: Peter Molander Phone:978-682-7787 Address: 224 Raleigh Tavern Lane North Andover, Ma CONTRACTOR -Name:— Joseph Arone phone: 978-835-9483 Address: 18 Mount Vernon Drive Pelham, NH 0307+6 ' 100542 3-17-2018 Supervisors Construction License;: Exp. Date: . .Home Improvement Licenser 160710Exp. Date: 8-19-2018 ARCHITECT/ENGINEER Phone: r. Address: Reg. No. FEE SCHEDULE.,BULDING PERMIT.$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COSTBASED ON$125.00 PER S.F. Total Project Cost: $ 7,337 FEE: $ 0 Check No.: 1_71 I Receipt No.: 3 d NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner &Q4,de/ Signature of contractor. ., Plans SuhmittPtl Plans WaivPri rprfifiari Pint Plan tamnarl Plane f NORTH BUILDING PERMIT °��t`Eo TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received Permit No#: �7E0 gSSACHUS Date Issued: IMPORTANT: Applicant must complete all items on this page 'SOCA WN _s Pnnt - 1 PROPERTY OWNER -. - - _ �� Ye _ - nt — 100' Structure� yes noa Pn MAP PARCEL. T ZONING`DISTR1CT.`Histonc Distract yes, no - - - Machrne Sh© Villa a es TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family El Addition ❑Two or more family 11 Industrial El Alteration No. of units: El Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other LL Septic 1Nell; ❑ Flpodplarn ❑Wetlands' _ �:: Water shetl • e . DESCRIPTION OF WORK TO BE PERFORMED: s Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: 7 Cntr oactor Name _ r — - _ - Phone Email; - Adtlress Supervisor'sti Constructton�L'icense- _ rt syr. _ xp Date E i Hpmealmprouementicense _- � Exp Date_ FEE 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: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaf anty fund �igriature of Agent/©wner_' . _ Signature of contractor_-.._ _ _ 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 j PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS x a 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 �FIR$ED A!RTME.NT' Temp !D pstepp)_n`�site eyes , o Lo atat' g124ains , ba SreeM tIRirAQ patment b Cr:MMENTS 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 j NOTES and DATA— (For department use) i i i i i ❑ Notified for pickup Call Email Date Time Contact Name Doe.Building Permit Revised 2014 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) 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 ❑ 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 i Doc:Building Permit Revised 2014 Location 15 feu of)e-T C r ° ! !� No. �s (,n• 4 Gi 7 Date • - TOWN OF NORTH ANDOVER • • Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# {7 d J I/Z-- ILA 30966 J�Y Building Inspector NORTJI own o t 1, sAndover ' 1 AIL hver, Mass 'Q COCNICN.wKu �. s°RATED I"*V' (5 u PERMIT. T FFood/Kitchen OARD OF HEALTH eptcSystem THIS CERTIFIES THAT ............. �;� � BUILDING ........... ...... O INSPECTOR has permission to erect ...... .. buildings on ... woo C � Found t ..........�..... a ion . .... ..... to be occupied as Rough .......... ..?a.. iP.... .......I�. ... .o provided that the person accepting this permit shall in every respect conform to the terms of the application Chimney on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Final Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRUCT N START Rough Service ... .. ... ... ....... BUILDING INSPECTOR. Final Occupancv 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. Smoke Det. To: Peter Molander pmolander@ieee.org 978.682.7787 8 Woodcrest Drive North Andover, Ma 018455 Prepared by: Joseph Arone Owner Arone Exteriors joe@aroneexteriors.com 978-835-9483 'I Contract September 13,2016 Peter Molander, Homeowner, desires to contract with Arone Werlors of 18 Mount Vernon Dr Pelham, NH,to perform work on the property located at:8 Woodcrest Drive North Andover,Ma. Our Commitments. 1. Job Description: See attached proposal. 2. Payment Terms: Full payment upon completion. 3. Time of Performance: To be determined by contractor and homeowner. 4. License Numbers: Construction Supervisor License 100542 and Home Improvement Contractor Registration 160710. 5. Permits and Approvals: Arone Exteriors will be responsible for determining and obtaining necessary permits,as well as the costs incurred. 6. Materials: All materials shall be new, in compliance with all applicable laws and codes, and shall be covered by both the manufacturer's warranty and a 15 year warranty on installation through Arone Exteriors. 7. Change Orders: Should unforeseen events alter the original cost estimates,or should the Homeowner decide to change any part of the attached proposal,those items shall be discussed and a'Change Order' form will be signed by both parties outlining the new details. 8. Site Maintenance:Please indicate any specific requirements: Materials shall be stored in the following location: Dumpster shall be placed in the following location: Work shall be performed between the following hours:7:30am-7:30 pm We agree to use equipment(generators,pneumatic guns,etc.)only during these hours. We will use our own equipment but may request the use of an electrical outlet. 9.Point Person: Joe,our owner,is the contact person on your job. Should you(or your neighbors) have any questions, concerns or comments during your project, please do not hesitate to bring them up to him. After hours,his cell is 978-835-9483. What We Ask of Customers.- 1. ustomers:1. Payments: In general, we do not require any payments before work begins. The exception being if products requested require a special order. In that instance,we would have to collect a deposit for the order. 2. Safety: Please be mindful to avoid construction areas,especially with small children and animals. 3. YOUR VALUABLES: (Roofing) Customers may want to cover items in the attic as unavoidable small fragments of asphalt will fall through the deck boards. items may need a vacuum upon completion of work. (Roofing&Siding)Customers may want to remove fragile valuables from interior walls. 4. Utilities: Depending upon the type of project,we may ask for access to an electrical outlet or a hose. 5. Additional Notes: Verbiage required in our contract by the State of Massachusetts: All home improvement contractors and subcontractors shall be registered (which we are, see license numbers at the top of this contract) and any inquiries about a contractor or subcontractor relating to a registration should be directed to: Office of Consumer Affairs and Business Regulation,Ten Park Plaza, Suite 5170,Boston,Ma 02116(617.973.8700). Owners who secure their own construction-related permits or deal with unregistered contractors shall be excluded from access to the Guarantee Fund. Failure to pay in full for the work completed may result in a lien or security interest on the residence as a consequence of the contract for the sum of labor,materials and lawyer fees. The contractor and the homeowner hereby mutually agree in advance that in the event that the contractor has a dispute concerning this contract, the contractor may submit such dispute to a private party arbitration service which has been approved by the Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided in MGL c 142A. The signatures of the parties apply only to the agreement of the parties to alternate dispute resolution initiated by the contractor. The owner may initiate alternative dispute resolution even where this section is not signed separately by the parties. The homeowner has a three day cancellation option under MGL c93 s48:MGL c 140Ds 10 or MGL c255D s 14 as. 1111111111117,77 77 q , E,. Total Asphalt Roof Replacement $7,750 Obtain all necessary town/city permits. Install tarps from the edge of the roof to the ground to protect your home and landscaping. Strip up to two layers of roof to bare wood to reveal any defects that might otherwise go undetected. Nail loose deck boards and provide a flat surface to lay new shingles for a better looking roof. Replace any rotted wood,up to 32 ft.of material and labor free and$50 per sheet installed thereafter. Completely strip lead flashing and install new step and lead flashing around chimney to divert water away. Replace pipe boots with rust free aluminum boots on all vents. Paint vent pipes to match roof(when applicable). Adhere 6ft(double Code requirement)of Ice&Water Shield to deck eaves,valleys and all protrusions to protect against the elements as well as ice dam build ups. Apply synthetic underlayment to the remainder of exposed deck boards offering a 600 '0 stronger tear strength than 30#felt paper while allowing your roof system to breathe. Install eight inch metal drip edge along all rakes and eaves to direct water off roof and prevent wicking under the shingles. Lay a starter course at the base of the eaves to prevent leaks and wind blow off. Install the customer's choice of GAF Timberline,Owen's Corning Duration or Certainteed Landmark architectural shingles,which includes a Lifetime limited warranty. Install ridge ventilation to prevent condensation problems,deterioration of deck,mold growth and premature aging of shingles.(Note:soffit vents need to be installed on most houses for a proper ventilation system). Cap ridge vent with matching shingles. Provide.a dumpster to remove all nails and debris from the property and neighboring properties. Remove debris from all gutters. Total Subtotal $7,750 Total $7,750 Total Mise Install soffit vents. $499 Angie's list and senior discount. -$912 Subtotal -$413 Grand total $7,337 General Details • All proposals are valid for at least 90 days. • No payment is required up front,unless there is a special order item. • For smaller projects,payment can be made in full upon completion. • For larger projects,any payment plans requested will be outlined In a contract before commencement of work. • Proposals include labor and materials. Contract Signatures There are no other documents as part of this contract. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Contractor Signature Joseph Arone September 13,2016 Homeowners Signature Peter Mofander September 13,2016 Peter Molander September 13,2016 NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordancg with the provision of MGL c 40 S 54, a condition of Building Permit at: q t000&,-&&T -DI, is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section I 0A. The debris will be disposed of in: 89 Lowell Rd Salem, NH (Location of Facility) Sign` e of Permit Applicant Date The Commontrealtla of A9assaclansetts Department of hidtistrial Accidents Office of Jaarestigations I Congress Street, Sasite100 Boston, AIA 02,114-20,17 `y tt=n>�r.,iatass.,�o®�Itlia Workers'Compensation insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Intl®rmation Please .Print Lepibly Name(Business/Org:ini7ationlindivdual): Arone Exteriors Address: 18 Mount Vernon ®rive Ci1y/Sljte1Zip: Pelham, NH 03076phone 978.835..9483 Are you an employer?Check the appropriate box: Type of project(required): I. I am a employer with 2 4. [:] i ant a general contractor and 1 employees(fuif and/or part-time).* have hired the sub-contractors 6. E]New cctrtstructicin 2.F11 am a sole proprietor or partner. listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have S. 0 Demolition working, for me in any capacity. employees and have workem' 1 - 9. E] Building addition [No workers' comp. insurance camp. insurance.+ � We are a co required.] 5. ration and its t Q.(l Electrical repairs or additions rlxa 3.❑ 1 am a homeowner doing ail) work officers have exercised their 1 LF] Plumbing repairs or additions myself. JNo workers' comp. right of exemption per MGL 12.® hoof repairs insurance required.]` c. 152.c 1(4),and we have no employees. [No workers' 13.0 Other contp..insurance-required.] *Any applicant that checks hox n 1 must also fill an the section Wow shoming their workers'compensation policy-inl'nmta1io a. t I lonae(miltn's++ho suhanit this attidatit irdicaiint they ire doing all a,irik and then hire initside cmitraaoos niust submit a n+w\%nfdat R indie-linc such. :Coninctor5 that check this hox must attachid an additional sheet slienving the naive 4f the suh-contractors and Still'whether or not 1.hnsc entities have employceS. lrthe sub-contraettzrs have cmployccs.they milt provide their wmkeis'cimp,policy number: 1 amt an emtp/nt er thin is proriding it-orker.++,''compensation insuraitre for nt1'emph 1=5. Beloir is tltc polis�•attd jnh site ittformatiom Insurance Company\lame: Chase and Lunt Policy#or Sell=ins. 'Lic. : R2WC755972 Expiration Date: 01/01/17 Job Site.Address: 266 Salem St C;ity/StatOZip: Andover ala 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 N461,c. 152 can lead to the imposition of criminal penalties of a line up to S1,500.00 and/lar one-year imprisonment.as well as civil penalties in the form of a STOP WORK ORDER and a line of up to S250.00 a day against the violator. Be advised that a cop),of this statement may be forwarded to the Office of Investigaations of the DIA for insurance coverage verification. d0 IiNPNhI'certify Lander the Exons and penalties rtf perjure!that the ittfitratatinn provided abore is tare aril correct. Sipnature: 44�✓� Date: 8-23-16 Phone n: 978.835.9483 Official ave cjttla. /)at ant write its this•area,to he contpleded h).ci{t'or unlit$official. City or Town: Perraaitll.icense# Issuing,authority(circle one): 1.Board of health 2..Building Department 3.City/Town Clerk 4. Electrical Inspector =.Plumbing Inspector 6.Other -- -- -- Contact Person: Phone#: ARONE-1 OP ID:AC DATE(MNWDrYYYY) - - CERTIFICATE OF LIABILITY INSURANCE 10/06/2015 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. 11 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 Cp EA T_Nicole_Boggo_Ch Chase 8'Lunt LLC PHONE 65 Parker Street ,,Ext);978.462-4434 --Y-.fes NO:978-465-6204 _ w Newburyport,MA 01950 E-MAIL Select Business Unit — TSURERIS)AFFORDING COVERAGE I MAIC INSURER A:R T Specialty,I_t_C F 1'WUAEO,joseKAr6nedba INSUREae AmGUARD_lnsurance Gompeny,�_ Arone Exteriors _ 18 Mount Vernon Drive t1tsURER C: Pelham,NH 03076 INSURER 0: t IIISURER E 111"ER F COVERAGES CERTIFICATE NUMBER: 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 THS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES'DESCRIBED HEREIN IS SUBJECT TO ALL THE TER?in, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. L I TYPEOFINSWRANGE —A6DL SURRA POLICY NUMBER .. !!PbIJCY EF07VVY) .;W VYYY i -.. LIMITS GENERAL LJAGKM } 1 EACH OCCURRENCEI S 1,000.0 + WS225370 { s b1/01/2017 DAVAO,E'TQRNTED __ .�.5s A X I COMMERCIAL GENERAL LIARILITY + 01/01/2016 PREMUSEs urrer�ccl 100, , I CLARAS-MADE. OCCUR MED EXP(Any'mo porson) S 5.0 1 PER SON-AL s ADV INJURY �S 1,000,00 Ac.GREGATE {s 2,000.0 GEN'LAGGREGATE LIMIT APPLIESPER' i PRODUCTS COMPIOPAGG S 2.000, X ;POLICY 1-�PR0. �`.,LOC AUTOMN®AUTO ABILnY - { k p SEaaIaRmdm a�itKiLE LIMIT i 5 1 BODILY INJURY{ISer SOn Pgr ) is 7-�AALL AU UTOS OWNED _SCHEDULEDULBODILYINJURY(P=a=don7)1 S I-- NON-OWNED + PROI�ERtY'DifAA'GE HIRED AUTOS AUTO5 {PCR ACCIiIL=NT) �i�I S t r 11 _. UMBRELLA UAB OCCUR. I EACH OCCURRENCE I S EXCESS LIAR _ C_1A11AS-MADE i AGGREGATE I S + 'DED , �RETEIST70:15 __•_.T�� WORKERS COMPENSATIONf t STATU OTH AND EMPLOYERS'LIABILITY YIN I R2WC755972 01/01/2016(01/01/2017:._ TO,RYL1M8TS.I _LER_l _� ANY PROPRIETORIPARTNERr9:ECUTWE-I I; ;E L EACH ACCIDENT Is 100,000 i OFFlcEP%grlARER£X.CLUOED? Y NIA I I rte. I(Mandatory In NH) E L DISEASE EA EMPLOYEE S 100,000 flye-d(moftevndrr I - OESCI(.IPTION OF OPERATION'S below � I �E L DISUZE•POLICY LIMIT I S DESCRIPTION of OPERATIONS I LOCATIONS I VEHICLES IARaeh ACORD tat,Additional RemsNcs schedule.It more space Is required) 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. AUTHORIZED REPRESENTATIVE C 1998-2010 ACORD CORPORATION. All rights reserved. ACORD 2512010/05) The ACORD name and logo are registered marks of ACORD _ -- 1 Massachusetts Department of Public Safety Swardof Building Regulations and Standards License: CSSL-100542 Construction Supervisor Specialty I JOSEPH M ARONE r , 18 MOUNT VERNON DRIVE PELHAM NH 03076 =zN Expiration: Cor.mlissioner 03/17/2018 1 Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improvement C njiactor Registration Registration: 160710 TVPe: DBA Expiration: 8/19/2018 Trtt 419291 ARONE EXTERIORS / JOSEPH ARONE 18 MOUNT VERNON DRIVE r PELHAM, NH 03076 Update Address and return card.Mark reason for change. SCA i 0 20M.05111 Address Q Renewal E]Employment E]Lost Card Office of Consumer Affairs 8 Business Regulation License or registration valid for individual use only G HOME IMPROVEMENT CONTRACTORbefore the expiration date.if found return to: Registration: 160710 Type: Office of Consumer Affairs and Business Regulation 101 Expiration: 8/1972018 DBA 10 Park Plaza-Suite 5170 Boston,MA 02116 ARONE EXTERIORS JOSEPH ARONE 18 MOUNT VERNON DRIVE PELHAM,NH 03076 .• r Undersecretary Not valid without signature