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Building Permit #703 - 85 SOUTH BRADFORD STREET 4/4/2012
BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received O�tt�ec �agti� 32 b..r�5�• `• ��'• sb O 1 TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ;K One family ❑ Addition ❑ Two or more family. ❑ Industrial No. Q Commercial ❑ Alteration of units: )� Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition xE Os,S"e tfC ®Ir ` ` a ❑ Other lol lain, fQ1Nilat�ds� F. u, N.^ttix` '�: '.�' �}G 'ek+y�`�s� ci' ✓� �' # C! 5 a'�' ffi'LC � "11 ''.i �� , £ �.y,75u' .}t�°4JCL', �'� '3,h, 3 Z k � - t6 d ,�e+" � �'t �', + .'S�sa ) G �` � � .7.��� t '4 :i�s.l E?�.�L..A-.a .. Z! ..3`. L...^fd4�a.`+^....a•. 4 ❑�Wa�er`/�..JGWGr. � %'a.�, vYd .�.? t�.,;:f5,u�.s ... .Z=:.. F.. Yyf._„4��w, 1�"Y.4 ? -Nam 3 :1 nF :,3i�.E..iv-.. i., s. <.✓ .•.l .�.-��.r�wwr-rte. DESC IP ION OF VVUKK IU C t'K VRIYIGU. 4.,� �IC,,C 5,�. OWNER: Name: Please Type or Print Clearly) �l K1 Phone: -1 1 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F. Total Project Cost: $ -11, �� �'i ` FEE: $ Check No.: ` <J � `TZ5 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access t �t�eguarantyfund 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 r , INTERDEPARTMENTAL SIGN OFF - U 'FORM ` PLANNING & DEVELOPMENT ❑ COMMENTS CONSERVATION ❑ COMMENTS DATE REJECTED DATE APPROVED L DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS : Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Sk'nature & Date Drivewav Permit Located at 384 Osgood Street 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) ❑ Notified for pickup - Date Doc.Building Permit Revised 2007 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit a I 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 ca iw �yc� c g-vyrL vil re4 ) /fV7 A- 3aItz 4�itd, —te/e^-�Ie..'p Vi Vl 0 (D 0 E -- 1!2 r rD C Date..��.2-. 14 ................ TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION .t.... ... II I� f This certifies that . ... ...................................................................:........................................ .. has permission for gas installation ... fl .... V in the buildings of .......!.'^^�.......:......... ............................................................ ate..t�.....!!�``'�..`. North Andover, Mass. ..--... Lic. No.� Fee ......... .......................... Y."..!............................................................. GAS INSPECTOR Check # 5c;k c( 0 9713 Date ......... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............. '51k4zle'- ......................................................................... :�( ............................... has permission to perform ........... �['� ...................................................... . !�� ................... wiring in the building of............,......................................................................... at .......................... FS . So ................ SS. . ..... ........... .... North Andover, Ma Fee............................. ... .......... Lic. No . ................. ....................... ... ............. .................. . . .......... ELECTIUCAL TO Check # 30 r7 Ht'h'LIVA I ium rut[ rcmivii i I v rr-mrynivt r-L..cv i m%opAi- vvvr%tx All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 y.- ct'17 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: � j L& �G- City or Town of: &�4 %,,, /- To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 9$ a�4 kldL� Jam) O*P,er or Tenant J- y)Y cw Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No J4 (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number.. of Feeders_and. Ampacitx Location and Nature of Proposed Electrical Work:�� t"mmnlatinn nftha Allnwina table may he waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil. Susp. (Paddle) Fans No. of of al Transformers KVA No. -of Luminaire Outlets No. -of Hot Tubs Generators KVA No. of Luminaires Inf Swimming Pool Above ❑ grad. - ❑ o. ond. BatteryUnits cy ig g No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o• o eteng D an Initiating Devices No. of Ranges Total No. of Air Cond: Tons No. of Alerting Devices No. of Waste Disposers p eat Pump Totals: umber ons - _,,,,- `w No. o - ontaine Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW munipal Local ❑ Connection ❑ Other No. of Dryers i'Y Heating Appliances KW ecysterns: NNoo.. of Devices or Equivalent No. of- atera.-o Heaters KW No—of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications No. of Devices or or E uivalent OTHER: Attach aaamonai aermt tI aestrea, or as regwrea oy we tnspec,vr q/ rr,rea. Estimated Value of Electrical Work: G (When required by municipal policy.)_ Work to Start: ah Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. a CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I cert, under the pains and penalties of erlury, tI �to informatfon on this application is true and complete: FIRM NAME: !✓ �jd., o /la'IS GLC- LIC. NO.: Licensee: ei j%,94% Signature LIC. NO.: v7i %Oj applicable, enter "exempt" i the,,1p�' ens number line. ,/ I // Bus. Tel. No.• Ur - (If Address: i GI%tl�^ /��x. , /�%��'� /�nr/%Ih'/- 14 Alt. Tel. No.: *Per MGL. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE. $ Signature Telephone No. APIrUt,A I IVIV rum rcmivii i i v ramr%imm cL-cv i r%mortr_ vvvr%F% All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: City or Town of To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) Owner or Tenant Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ' ❑ No M (Check Appropriate Boa) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number.r of.Feeders.and_Ampacity- Location and Nature of Proposed Electrical Work: romnletion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Cel Sus addle Fans p (Paddle) of Total Trransformers KVA No. -of Luminaire Outlets - No. •of -Hot Tubs Generators KVA No. of Luminaires Swimming Pool Bove ❑ - ❑ d. d. o. o mergency �g ng Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners D and o. o Initiating Devices No. of Ranges No. of Air Cond: Tons No. of Alerting Devices No. of Waste Disposers p eat Pump Totals:` . uer mb ons -� --t I - ontaed No. o e m Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Municial Local ❑ Connection ❑ Ot1er No. of Dryers i'Y Heating Appliances , ecun ystems:* No. of Devices or Equivalent No. -of- atero.- Heaters KW °•-° Si s Ballasts Data Wiring: No. of Devices or Equivalent Hydromassage Bathtubs No. of Motors Total HP MecNo. No of Devices r u* g' No. of Devices or E uivalent OTHER: Anach additional detati tI desired or as required by we inspector ql mires. Estimated Value of Electrical Work: (When required by municipal policy.), Work to Start: Inspections to be requested in accordance with NEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penaltieJs oferfury, I z to informatfon on this application is true and complete FIRM NAME: !✓ S . l - �l �- t'dral o �lo''iS GLS LIC. NO.:% r Licensee: SignatureLIC. NO.: v71 90Z!7— (If j—(If applicable, enter "exempt " i. the l' ens number line. �f /� Bus. Tel. No.: Address: 9 w� Z-1— Nora' 1(nr�t�' ME ����{%� Alt. Tel. No.: `i�,�'��`i-=��� *Per MGL. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lie. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability, insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. A 1 DATE: I AIA 1� LOCATION: OWNERS NAME: J6`/Ge-, GENERATOR kw ;�� 4 NO INSTALLATION OR GROUND DISTURBANCE BEFORE APPROVALS* CONTRACTOR: oF S ri �,v PHONE NUMBER: �'7�` ��7� %`� - �1�� S��I`sw Ge%11 ELECTRICAL GAS RESIDENTIAL COMMERCIAL TEMPORARY LOCATION OF GENERATOR:. l5, .� S w, ),64st *ZONING DISTRICT: *PLANNING APPROVAL (IF IN WATERSHED) *CONSERVATION APPROVAL W�Uti.R_iW,i✓� SO �Cc.L1.2.0 D✓� TYNE OR. PRINT CLEARLY �PPLIANCE�S BOILER HEA OVEN MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING iNOR _.. CITY (�r�o�a� MA DAT 1 1l P _. acli RMITI'lm( JOBSITE ADDRESS � � _ •t7�-�1. OWNER-$ NAME OWNER ADDRESS 5 TES ��50 rJsi=AX OCCUPANCY TYPE COMMERCIAL,",.! .` l ELUCATrCItiAL RESIDENTIAL 1! NEtN � RENOVATION: , ', REPLACEMENT. a FLOORS » ii;t i 3T 4� INSURANCE COVEf2AGE I have current tiabili Insurance policy or Its substantial equivalent which meets the requirements of MGL. Ch.142YES „%" No I IF YOU CHECKED YES, PLEASE INDICATE THE. TYPE OF COVERAGE BY CHIECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY , .. OTHER TYPE INDEMNITY , BOND . OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ; ..... SIGNATURE OF OWNER OR AGENT Y .: AGENT I hert�hy cert€lu that g of the d roast grid info Performed n i haveunder r the per it issued f regarding this a,�t ircati �n are true cxrirt' accurate 10 the t est or my knotaicerlge and that all ptumGtng wark antt instailati€anb performed under the permit issued far this agfatatron Ertl be #n cx�P�flcewith~a!1 Pertirattt provis+on a1 the !Massachusetts State P€umbing Code and Chapter tat of the General Lau�� PLUMBER•GASFIT7ER NAhELeonard A Halt?'LICENSE ..� 8673 SIGNATURlf MP,_11 MGF JP JGF I LPGI CORPORATION i,. . _.w.. I 1# 1 4iv— PARTNERSHIP COMPANY NAME:. 1 ._.. LLC � # Opti umb+Neat€n ADDRE RE S ,,I2 Rochambault Street I CITY ' Haverhtl I STATEIiA 'ZIP' 0 183 iTEL 9�8 3i2 $3C3 ( FAX 978-521-1438 rn _ ..... j CELL" EMAIL 12/2/2014 Division of Professional Licensure: License Search The Official Website of the Office of Consumer Affairs and Business Regulation (OCABR) A Division of Professional Licensure Mass.Gov Home State Agencies A -Z Topics Home > Division of Professional Licensure > Check A Professional License By the Division of Professional Licensure LICENSEE Name: LEONARD A. HALL ATKINSON, NH NEW SEARCH "This Licensee has additional Licenses, click here to view them." Licensing Board: PLUMBERS 8 GASFITTERS License Type: MASTER PLUMBER License Number: 8678 Status: CURRENT Expiration Date: 5/1/2016 Issue Date: Exam Date: School: This web site displays disciplinary actions dating back to 1993. This license has had no disciplinary actions taken during this time. The page above has been generated by the Division of Professional Licensure web server on Tuesday, December 02, 2014 at 11:38:14 AM. O 2007-2011 Commonwealth of Massachusetts Mass.Gov ONLINE SERVICES Check a License Locate a Licensed Professional Online Address Change Contact the Agency More... REFERENCES & RELATED INFO Disclaimer Regarding Website License Searches Glossary of License Status Codes More... Site Policies Contact Us http:14icense.reg.state.ma.us/publiclpubLicenseQ.asp?board code=PL&type_class=_M&license_number=000008678&color=&Ib=PL 1/1 12/2/2014 Division of Professional Licensure: License Search The Official Website of the Office of Consumer Affairs and Business Regulation (OCABR) Division of Professional Licensure Mass.Gov Home State Agencies A -Z Topics Home > Division of Professional Licensure > Check A Professional License By the Division of Professional Licensure LICENSEE Name: LEONARD A. HALL Business: UPTACK PLUMBING Et HEATING INC M 8678 HAVERHILL, MA NEW SEARCH Licensing Board: PLUMBERS Et GASFITTERS License Type: PLUMBING CORPORATION License Number: 1415 Status: CURRENT Expiration Date: 5/1/2016 Issue Date: 9/27/1984 Exam Date: School: This web site displays disciplinary actions dating back to 1993. This license has had no disciplinary actions taken during this time. The page above has been generated by the Division of Professional Licensure web server on Tuesday, December 02, 2014 at 11:38:42 AM. 2007-2011 Commonwealth of Massachusetts Mass.Gov ONLINE SERVICES Check a License Locate a Licensed Professional Online Address Change Contact the Agency More... REFERENCES & RELATEDINFO Disclaimer Regarding Website License Searches Glossary of License Status Codes More... http:/Aicense.reg.state.ma.us/publiclpubLicenseQ.asp?board_code=PL&type class=_C&license number=000001415&color=&Ib=PL Site Policies Contact Us The Commonwealth of Massachusetts , - -' Department ofIndusfrig[Aeeidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass gov/dia Worker' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Xnformation Please Print I-egiblu Name Business/organization/In.dividual): Address: 3 /1?C)C-,t6AM Sr `` DJPVy 28'- -f ?2 City/State/Zip: /-e r`/�< �� M Phone #• Are y an employer? Check the appropriate box: 31- 4. E]I am a general contractor and I 1. I am a employer with employees (fail and/or part-time).* have hired the sub -contractors 2, ❑ I am a sola proprietor or parbler listed on the attached sheet. ship and'have no employees These sub -contractors have working .for me in any capacity. workers' comp. insurance. 5. ❑ We are a corporation and its [No workers' comp. insurance officers have exercised their required.] 3. ❑ i am a homeowner doing all work right of exemption per MGL myself. LNo workers' comp. insurance required.] ; c. 152, §1(4), and we have no employees. PTo workers' comp. insurance required.] Type of project (required): 6. [] New construction F 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions I L E ] Plumbing repairs or additions 12.❑ Roofxepairs 13.❑ Other *Any applicant that checks box#1 must also fill outthe section below showing their workers' compensation policy information. f -Homeowners who submit this affidavit indicatingthey a're doing all work and then hire outside contractors must submit anew affidavit indicating such. zContractors that cheekthis box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. jam an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. 17 Insurance Company Name: Policy # or Self ins. Lie. #: W C—�d 10 Expiration Date: Job Site Address:. h�06�0 ��` City/State/Zip: /%�i%O©(/e/ Attach a copy of the workers' compensation.-polley declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder 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 STOR WORK ORDER. and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby Phone #: pains and penalties ofperjury that the information provided above is true and correct. Official ttse only. Do not write in tlib area, to he 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. EIectrical Inspector 5. Plumbing Inspector 6. Other - Contact Person: Phone Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, - express or implied, oral ox written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives ofa•deceased employer, or the receiver or trustee of an individual, partnership, asso ciatlon or other legal entity, employing employees. however the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced. acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements ofthis chapter have been presented to. the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificates) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit maybe submitted to the Department of industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. the affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will. be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit id on file for future permits or licenses. Anew affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: Tho Cmm. onw. Cam.ealth of'M:a<<ssarhvsPtf� Department of WuMal Armidauts ofte ofIu 001gationa 600 Wae gton ftec�.t Boston, MA 0.21. It Tel # 61.7-7.2.7-4.900 QA 406 ox- 1-$77-MASSAFB Revised 5-26-05 Fax # 617-727-7749 wWW-Mu%g4v1clia Jv uL VY V7 fb #3 Bank p°` "`'' ACCT# 8245912840 DATE: 04/23/2012 America's Most Convenient Bank® TD BANK NA P 0 BOX 1377 LEWISTON, ME 04243-1377 TOWN OF NORTH ANDOVER DEPOSITORY ACCOUNT 120 MAIN ST NORTH ANDOVER MA 01845 800-747-7000 THETOLLOWING ITEMS) THAT WERE DEPOSITED INTO -ACCT --4 8245012840 HAVE BEEN RETURNED UNPAID. WE HAVE DEBITED YOUR ACCOUNT AS INDICATED BELOW. THE ASSOCIATED FEES WILL BE REFLECTED ON YOUR MONTHLY ANALYSIS STATEMENT. IF YOU HAVE ANY QUESTIONS OR CONCERNS, PLEASE CONTACT US AT THE NUMBER LISTED ABOVE. CHECK# DEPOSIT DATE CHECK AMOUNT REFERENCE# RETURN REASON `Q 8/ 311034359SUFFI T FUNDS 4417 04/18/2012 594.00 713408926 NON SUFFICIENT FUNDS 4425 04/18/2012 594.00 713408916 NON SUFFICIENT FUNDS *211274450* 04/23/2012 000000712351981 This is a LEGAL COPY of your check. You can use it the same way you would use the original check. NOT SUFFICIENT FUNDS Cash Letter 1 of 1 Bundle 1 of 1 Item 2 of 3 TOTAL ITEM(S) 3 TOTAL AMOUNT $1,286.75 C H-& '3 or- tL - rd E3*211274450* ru ru NSF —0 rU � 04/12/2012 000000703312226 0. ThbhltECJLLcowarar -D fU C3' nOEIN S1C y�7h.SYbf '.(12 I. y Y�/nn; Mf.�!9441►� ::• �� � � �11',G, '" .,. .. �/,1a%/ %��k'. 4�h� Gmrzj co ehxlc You ran w l lr wnl r*/YWwtlroryiW O� gGRlif Qf.f•.:'K! lrEaot n4y V�+ 1 "L:A ; :.b ilf S C3 Ihk�O N, RETURN R ON (A) S rawroKwexux 781,!....1,, w„wma — M NOT SUFFI T FUNDS sp MY tott� Ir �••ltlllM r -9F9 ortt�twta+ dca lYMWN 711., 1Ln vw4ppwi' F” ,., •Y Fr 2419 p 0 —0Or M Op TOWN Or NORM ANDOVER f800 OSGOODSSTREET O �� Off: ..'. •%f:�d �f �'r/ f� M O m �t!rr=�', . d, .til u ira• 0 L0.1 M0044i7r 1:21134it,47M 224000 7 r._ M 0 6-4 n10044 17e' 4f: 2 i L 3? 144?f: 2 2?000 LO? 2n' 0100000 59400.' 11600 4 4 1, 711' 411: 2 L L 3 7 1,44 71: 2 2 7000 10 7 2116 11'00000 S 9 400 10 #3 Bank ~; ACCT# 8245912840 DATE: 04/23/2012 America's Most Convenient Bank® TD BANK NA P 0 BOX 1377 LEWISTON, ME 04243-1377 TOWN OF NORTH ANDOVER DEPOSITORY ACCOUNT 120 MAIN ST NORTH ANDOVER MA 01845 800-747-7000 THE FOLLOWING ITEM(S) THAT WERE DEPOSITED INTO ACCT-# 8245912840 HAVE BEEN RETURNED UNPAID. WE HAVE DEBITED YOUR ACCOUNT AS INDICATED BELOW. THE ASSOCIATED FEES WILL BE REFLECTED ON YOUR MONTHLY ANALYSIS STATEMENT. IF YOU HAVE ANY QUESTIONS OR CONCERNS, PLEASE CONTACT US AT THE NUMBER LISTED ABOVE. CHECK# DEPOSIT DATE CHECK AMOUNT REFERENCE# RETURN REASON 203 04/18/2012 98.75 311034359 NON SUFFICIENT FUNDS 4417 04/18/2012 594.00 713408926 NON SUFFICIENT FUNDS 4425 04/18/2012 594.00 713408916 NON SUFFICIENT FUNDS *211274450* 04/2.3/2012 000000712351986 This is a LEGAL COPY of your check. You can use it the same way you would use the original check. RETURN REASON (A) NOT SUFFICIENT FUNDS Cash Letter 1 of 1 Bundle 1 of 1 Item 3 of 3 TOTAL ITEM(S) 3 TOTAL AMOUNT $1,286.75 e��� ,NSF C3 *211274450* NSF .D r9 04/12/2012 000000703312221 ti 0 •7•, -:— r-9 tTbwalEoa.COrY AYev axes. Ya, can ueenma was raN 00.. •�Pt%�f�0{44 t'' r.• %�y:.. .7, /nn. /, :.; c^pt�� u �'�'�/'� !///� l � hbJ� ..� /r.• , .'� :'" % •'/ �� % /' ' `.:hl C3 weyyw-oL =ft lowl a o Ln 'i"s r rew701.89MK 95to3n ; i' . j n /l 'n, .... r �� " M RETURN REASON (A) NOT SUFFICIENT FUNDS raS SO AAWA12 nYro tw r- R' G.nLaMrlal lA� u,i r�i%,{!,'.i',jl,'r 'M`�'�n'r.%et •f l l/ C3 Bundw 1 a t namla: 0 rnra m pm dnd Nln YY(tr �.» .M..««.«........ pp,Aq , Q M p TOWN OF NORTH ANDOVER Oa000D O'q O C3 law MEET KANDOVEij MI), 01M6 � �y [. Cru 3 07 C3 r=1IJ rOD41.25r y21i371�49i. 2270001 r M C3 Ld 11@00442549 124 2 L L 3 7111004 2 2 7000 L0 7 211' 00044 2 Sul 44 2 L L 3? 144 71: 2 2 7000 L0 7 2V 0'00000594000' 111100000S9400 BUILDING PERMIT TOWN OF NORTH ANDOVER APPS (CATION FOR PLAN EXAMINATION -03 Date Received P—Mit NO• . TYPE OF IMPROVEMENTI PROPOSED USE Residential Non- Residential ❑ New Building ❑ Addition ❑ Alteration Repair, replacement Demolition \k ?, One family ❑ Two or more family No. of units: ❑ Assessory Bldg ❑ Other 7P ION OF WORK TO E n.� ❑ Industrial Q Commercial ❑ Others: ORMED: Identifyation Please 'Type or Print Clearly) '� c OWNER: Name: Jo z t v1 Phone: -1 -1 b 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: $ 1 t FEE: $ A—�-YuU 6heck No.:V% Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access t �t e guaranty fund Location �. u S '' L j Srlpe No. b 2-- Date 2 -- Check # U b t 4 25283 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 51,yx Foundation Permit Fee $ Other Permit Fee $ TOTAL $� �Ouilding Inspector TOWN OF NORTH ANDOVER OFFICE OF THE TREASURER/ COLLECTOR P.O BOX 124 NORTH ANDOVER, MA. 01845 TEL: 978- 688-9550 DATE: April 17, 2012 INVOICE TO: GEHI INC 132 Charles St. Ste 301 Newton, Ma. 02322 Dear Sir or Madam: Please be advised that check #4417 issued by you on March29, 2012 has been returned by your bank. We are redepositing this check today. Under Chapter 432 of the acts of 1989, Commonwealth of Massachusetts General Laws Chapter 60, Section 57A the PENALTY FOR TENDERING AN INSUFFICENT FUNDS CHECK AS PAYMENT FOR A MUNICIPAL ASSESSMENT OR SERVICE IS $25.00. Please remit your check for $ 25.00 to the above address in payment of this charge. Your cancelled check will be your receipt. Should you have any questions, please call my office at the above number. Sincerely, g Gail C. Tierney Principal Clerk TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building A One family ❑ Addition ❑ Two or more family. ❑ Industrial ❑ Alteration No. of uNts: 17 Commercial 'Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other _ _ _ .+TN 't4 r 1 Y� x=` Welt" k{ r: ���� �a Y� 2 .. J: S •l -'`^'L :F i2 S �- _ I S$ d C�FIoDdp�ain>❑ Ul���tlands„F i ' ? f ��f-B 1 .JZ V�lateshe�.Di ef� a {� Z;-3' . '�v``'s.. � >q� {� J xi.`l ❑.{:1151a`ter`/Sewer- 1V -r r• .r5 � .i� r'ff ,a .e f `_d. a��'. r a t-. [..FI �.. -7.- ..Y_ �,..1_._c+ c DES/C IP IUN Ur VIIUKK i U Or- a OWNER: Name: Jo UKIVICU: A r &, fic-A( 9A. tion Please Type or Print Clearly) Wm Phone:9'-� �- -UTiS6) ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BOLDING PERMIT., $12.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ "1 tFEE: $ r 01`iI X -Z- 6heck No.: l I Receipt No.: 1 _ — NOTE: Persons contracting with unregistered contractors do not have access t (t a guaranty fund I a3 O D3 r ru O r r O O O X T O r O -3 W, O W r O P7 75257 ! M 2614352 N 0 o til 0 ..3 Z -0 0-0 S D D. W �'1i 0 O m m .z y O v -13 �y�C 0 m� , moZo M-> Z �0 r � n .'o Z X m m M> r m °�3ro�o O �er� Z' m o t h CC7 Z man q Z FZ3E �0 m n Omz q�� H om O tvzc TKx �J otiC�o m r' m"<>Cp m rnLn -3 m mon>�h > .m r 6 ¢ az^o C [ 01 C) n Htvn ¢ p z o GZr�. O Z, m %t:l � o m N O O >a� m C: m c O x m C) -o = m m N nc (D M M! x a)Cf)D= CCD) G� O> S m -Ti jj( D m d 0 o Cf) T! D a) O6 m o i H mO D1 '.� z , 1-1i m m cn �i i� �Oc i OG) 4j). j �M 0') m m t N mO ' O m 2 O mm cnCf) m j J' o< i mm N O O ek 0 > C2 77� �j ek 0 > 0000000000 000000000000000 r r I • 6un Vot 3-i LlcAs7cL �& s -Soyer caum b 4R- Cl eA may lad-, s�� rtml a-'aoS• ° sA orlo m Ov oo t7' S • . FE o Sao cr�°° °" '�¢°oOp CD 0 cr CD + CD o o�. CDo' CD �` � CD CD CD N °�CD A� �o a� CD Ua �.CD p'�. �• �CD U c o' c' P C S7 -Q- ° O -CD Q- CD CL o �.CD ¢ '1 CD p O �' CD GQ O C CL o N COD CD m p '� �'•-' va - o CD �. 4. � 0 o 0 "•�' .. \ Q,C A� CD ,.?' a. -. CL �' °� o (D n w, n CD cru o ¢ `�° CD c o C u C' oz CD y PN � CCD P °,uCD4 ¢ o o CD z c o �. � o a En U4 p ° ''n p, O � P° CD - o r-�. CD �• o .�o o a p Esrv�4�� qQ ��° CA ��o Q CD CD CD A? w ¢ U4 ° O O CCD w A'. V CD CCD C CD CCD (7 CD 0 CD .�O CD ¢ ` CD CD O 0 ri CDCD ..Q CD CD W CD 0 CD Q- En �.h� CD CD C o o o' o � O o aN CD CD O C7 ^° � CD O 0 O w 0 o CD SCD '`a,,.. cnIn-CD o En N CD a rn Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, - express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a j oint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 1.52, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced -acceptable evidence of compliance with the insurance coverage required" Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (ifnecessary) and under "Job Site Address" the applicant should write "all locations in (city or town)" A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or' -permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance. for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone anal fax number: Tho Cox onwealth of Massachuse"tts Dop.artment of Zndustdat Accidents Office QfInvestigations 600 Washington Street Boston, M.A. 02111 Tel, # 61.7-727,4900 oyt 406 or 1-877 ATASSA.FB Revised 5-26-05 Fay, # 617727-7749 www-mass,govaia The Commonwealth of Massachusetts Department of IndustriglAccidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):y �L , V 1\C Address: City/State/Zip: A,,), a a Phone If: �I" - 6%-5S 13 Are you an employer? Check the appropriate box: Type of project (required): 1. [ I am a employer with 0 �_-- 4 . ❑ I am a generacontractor and I l 6. El Now construction ' employees (fall and/or part-time).* 2. ❑ I am a sole proprietor or partner- have Hired the sub -contractors listed on the attached sheet. x �• Remodeling ship and'have no employees These sub -contractors have 8. ffDemolition working for me in any capacity. workers' comp. insurance. 9. E] Building addition [No workers' comp. insurance 5. ElWe are a corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their 3. ❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, § 1(4), and we have no 12. ❑ Roof repairs insurance required.] i employees. [No workers' 13. ❑ Other 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 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. , A „ Insurance Company Policy # or Self -ins. Lic. WC -ALC" W WC 063ao Expiration Date: a Job Site Address: b ���� �fc� C t� S t �� Pity/State/zip :A,, N_,J J VLC , `V1� ©l y s Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder 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 Investigatii6 * of the DIA for insurance coverage verification. Ido here under thepains andpenaldes ofperjury that the information provided above is true and'correct. Sianature: Date - S, - ate: S,- �_ ��[ 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. PIumbing Inspector 6. Other - - Contact Person: Phone P O v -C u 0 B w U) O u w 01- w :3 w U x F4 CA x P-4 0 —cz O —cz W 0-4 6 uo 0 CO m J 0 E� � 0 4 O C3 ci •CL cm ev c!* C, CD E CL E.S co: 1 0 S. cmo. E ca cnj 320 :=Cc ::No .0. i; maaCO) Co cc 0 ,E= co Amo 4 s CLacsL� C" -10 4) ml CM OQ C.) Z CD CA 0 CL W CO) -CD %5 te 30: 1- 41 0 CL 4— CD L.0 2 g . M• . P . E Me IDI Lu 0 C(A C) L cm O MM, 99 I v`0' CERTIFICATE OF LIABILITY INSURANCE I DATE(MMIDD/YYYY) 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(les) 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 Mason & Mason Insurance Agency, Inc. CONTACT Brenda G i 1 I ette aHCo"N Ext: 781 .447.5531 ac No): 781 .447.7230 458 South Ave. Whitman, MA 02382 E-MAIL ADDRESS: PRODUCER Brenda Gillette INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Western Wor I d 000071 GEH I , Inc. INSURER B: Phoenix Insurance Co 25623 DBA: DBA Hartwell Remodeling INSURER C: Star Insurance 000204 1 Kiddie Drive INSURER D: Avon MA 02322 INSURER E: INSURER F: AUTOMOBILE X X X LIUVCICALIC0 "KIIrIGAIL NUMtftK: lL/ 1S UL. ll/7L 5A & Irl: 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 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. INSR LTR TYPE OF INSURANCE ADDL INSR SUB WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYW LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR NPP129925 01/22/2012 01/22/2013 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 50,000 MED EXP (Any one person) $ 1,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GE N'L AGGREGATE LIMIT APPLIES PER: POLICY JET LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ B AUTOMOBILE X X X LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS BA7133NO2811 SEL 06/26/2011 06/26/2012 COMBINED SINGLE LIMIT $ (Ea accident) 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per accident) $ UMBRELLA LIAR EXCESS LIAB HOCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N OFFICER/MEMBERANY ECUTfVE OPRIET EXCLUDED? XCLUDEXECUTIVE (Mandatory In NH) Nes , describe under DCRIPTION OF OPERATIONS below N / A N/A WC0632071 OFFICERS ARE INCLUDE 04/26/2011 04/26/2012we sLTATU- oTH- TORY LIMITS ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) **Office Copy*** GERTIFIGATE HOLDER CANCELLATION GEHI, Inc. 1 Kiddie Drive Avon, MA 02322 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 Phi IiD W All riahts ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD CONTRACT WORK SPECIFICATIONS Initialing this page indicates receipt.of the CONTRACT TERMS AND REQUIRED 40TICES_as page 1 of is agreement Owners Names Is'— PhoneU — ,0. 2nd. Phone Job'Site Address 11'0� Green E--Xnevqv�o��-, 50 GetchelfWay, Canton MA e781-898-9513 Email Address Other Contact_ . . -------_..__--_------------ __- - Details of work to be performed and materials to be supplied:follow G��te�s N�� 5mj�n IV slpou�-5 Initials Acknowledging this page: Homeown \ Homeowner — Date JE HOMEOWNER: Do not sign this contract if there are any blank spaces. You have a right to a copy of this contract. Page of Salesman contract date Job x Product COMMISSION 8REAKq—OWN - effective -9/6/2011 SALESMAN Retail Amount ................ OvenAmount o . .... ver /.(Yhder) ........ Maximum `4 -11.2.1-4 X Start up ; Pr'rmit(s?; Electric, in surance, Waste : Job.: $1,260,00i @ Cit start .—Y .... . t- q9p.,; $315.00i @ Hatcli Plank Wi dow Y�ao J -Less: per $1.2112.00".1 .,Green .E.norqyThermal Wall, 54 $1,050.00; XXT .25Panel - 318" Insulation - 3 Week delay Sg9 -1 8,00L-11- .Coventry !at or Veflical S q - $ 844 00 @ Charier Oak Sid ing' q $929.00 . Stakes - 3/8" Insulation foundrySq Lft si, i4.66 !* Siding project aver 30 Sq. - diSCOUnt Pr 0 05-; @ Gutter & Protection bo $43.00 @ Sill Only qr 112 Casing no Sill Ea44 ......... .. . . . ..... 112 Casr+ng With Sill Ea $86.00" Wrap 1 @ Window Ea $125.00 Wmt) Single Door #(ap Single Garage or Patio Door Ea ............... � .... . Ea ,!rip & Dispose , vinyl or Wood (per layer) S!rip,Quimj?�tef Feestrippin9 Wi dow Y�ao J -Less: per Ea .5. . ..,b..... .. $190,0 J . only qrttent c Job • $1,347.001 @ Ea $218.00! @ Wood Fascia Lft $t600 CrD Out Window or Door Frames Non -Masonry Ea $54,00 @ ci a. Lft $1500 C Shuitt'Ors- New Louvered w/siding Pr soffit 7. ?4'• over see sqqarage) Lfl 500 @ Remove & Reinstall - Storm Windows Soffit Porch Ceiling Trim & Soffit Combo (Sottit to 24-) Sq Ft, Lit $11 00f? 60 .............. i New Gutter Lit $19.00;! Soffit Porch Ceiling, Sit .ptler Remove & Re -Install Lft Lit $114.00'I" Dentil Molding Gutter Protection Do U1 Lit $32.00t @ t, g7-66 Ea ........ ; ..........<1 1 Gutter & Protection bo $43.00 @ Sill Only qr 112 Casing no Sill Ea44 ......... .. . . . ..... 112 Casr+ng With Sill Ea $86.00" Wrap 1 @ Window Ea $125.00 Wmt) Single Door #(ap Single Garage or Patio Door Ea 5125,M V $179 Oq Prap,-, Double Garage Door Ea $27. 0.0 f. Wi dow Y�ao J -Less: per Ea .5. . ..,b..... .. $190,0 Door .Wrap - J-Les's.. per opening Ea $190.00: cc Wind'ow Mantels - Trim Up. to 44' Ea $218.00! @ Window Mantels `• Trim 45"-88" 'build Ea $449 00 Out Window or Door Frames Non -Masonry Ea $54,00 @ Trim only adcfail % 0.1 5i 0 Shuitt'Ors- New Louvered w/siding Pr Remove & Reinstall - Shutters' Ea Remove & Reinstall - Storm Windows Ea @ __�iove & Reinstall Storm 0 0 OrS Ea $68 001 @ Remove Reinstall Aw ings. Ea . ......... $204,00� 0 Soffit Porch Ceiling, Sit 1.001 0 i .rap Porch Post or Beams Lit $114.00'I" Dentil Molding Lit $14M! 0 1 Ooor Surround With Pediment Ea $802.00i @ New Gable Vents t a i77.001 @ Replace flattedr Waal • PJYW99d stt .......... fjeiq h't' Over 32 Sq 16f99i Tyv Sq ....i. ..Hou 00: @ 318" Insulation Deduct uninsulated space Sq i104.061 add trim build out $136.001 TOTAL PROJECT LIST PRICE Retail Adjustment SUbiotai Finance Adjustment (2.5%MC VISA 3 5%Amrry pr Of RETAIL CONTRACT CASH PRICE T l 05c; r�_Nr>r\ — CONTRACT TERMS AND REQUIRED NOTICES Notice: All home improvement contractors and subcontractors engaged in home improvement contracting unless specifically exempt from registration by the provisions of Chapter 142A ofGreen Enevg i the general laws, must be registered with the Commonwealth of Massachusetts. Inquiries �. �e .- y about registration and status should be made to the Director, Home, Improvement Contractor ;! � ' er i, t Registration, One Ashburton Place, Room 1301, Boston, MA 02108. i/We hereby agree and authorize you as contractor, to furnish allnecessary materials, labor 50 Getchell Way, Carlton MA 02021 781-898-9513 and workmanship, to install, construct and;place the improvements according to the specifications, terms and conditions, on the premises below described which I/We represent that we have good record title in our own name. Owners I Job Site Massachusetts Contractor Registration # 162266 ode Is aad Contr r Re ' ration # 19178 Work Specifications described attached on pages: of of of 4 Permits: The contractor agrees to apply for and obtain all construction related permits but shall not be deemed responsible for delays in the work described in this agreement caused by regulatory, permit granting or inspection agencies authorities or individuals. Notice: The homeowner who secures hit; own permits maybe ex+ctuded from the guars e , fund of MGC Chapter 142A. Price: The contractor agrees to do all work described by the contractfor;the total price of $ 9 - Notice. No agreement for home improvement contracting work shall require a down payment (advanc) deposit) of more than one-third of the total contract price or the total amount of all deposits or payments which the contractor mu t make, in advance, to order and/or otherwise obtain delivery of special order materials and equipment, wh' ever is great° a Payment Terms; Advanced Deposit $ Interim Payment 1 Interim Payment 2, ,$ Final Balance $ Security Interest.- Yes No - To be held in Payable on si ning of contract t O -LM 57 Q y Paya, . r .t ► r r 1%. Payable U, Payable 1�1 (JJv i of a UCC -1 form to be filed only if payment is not made, on completion. Notice: The contractor does not have the right to request payments in advance of the times set forth in this agreement, although, by.agreement, the parties may jointly agree to escrow any portion of the contract amount.,In the event that it becomes necessary for the contractor to employ:an attorney to collect any balance due hereunder the owner agrees to pay in addition to the said balance, the costs .of collection and reasonable attorney's fees. If you refuse to permit the company or 'Its representative to proceed with the work herein, or inthe event of any breach of this agreement, for any reason whatsoever, shall cause the homeowner to,paya sum of money equal to fifty percent of the price agreed to Herein, as fixed liquidated and ascertained damages, and not as a penalty. Work Schedule: The contractor wi n t be ow or order materials before the third day following the signing of this agreement unless specified in writing. The contractor will be�wor about / 1 dale). Barring delays caused lay circumstances beyond the contractor's control, the work wilt be substantially completed in/days. The homeowner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are .not avoidable by the contractor shall not be considered as violations of this agreement. The contractor shall not;be liable for any delay, or non-performance caused by strikes, accidents, weather or any other contingency; beyond its control. Insurance: The contractor agrees to maintain workers compensation and comprehensive general liability insurance during the operation of this job to cover the acts of its employees and or agents. Warranties: The contractor warranties its workmanship for up .to a period of seven years and assigns the rights to any manufacturer's warranties to the homeowner after the substantial completion and payment of the contract terms. You may cancel this agreement if it has not been consummated by a party thereto at a place other than an address of the contractor, which may be his main office or a branch thereof, provided you notify contractor in writing at his main office or branch by ordinary mail .posted, by telegram sent or delivered, not later than Midnight of the third business day following the signing of this agreement. See the reverse side of this form for an explanation of this right. This instrument and any and all other documents attached hereto and signed by the parties set forth the entire contract between parties and may be modified only by a written instrument executed by both parties. Receipt of a copy of this contract and duplicate notice of cancellation. and explanation thereof is hereby acknowledged. HOMEOWNER: Do not sign this contract if there are any #bilapk spaces. IN WITNESS WHEREOF, the parties hereunto signed their names this tt day of � .; 1 20L GEHI Representative .ti -_ - Homeowners ° L✓ Accepted GEHI, Inc. Page 1 of HOMEOWNER: You have a right to a copy of this contract. CONTRACT WORK SPECIFICATIONS Initialing this page indicates receipt of the CONTRACT TERMS AND REQUIRED NOTICES as page 1f this agreement, Owners Names u C�l Im Phone 2nd Phone (arisen FE-Ine-vig home improvemer, ct S 50 Getchell Way, Canton MA 02021 781-89M513 Job Site Addr'ess -S. suuaT i city x, MDOVTn SyAzpoii�6 Email Address QtherContact ---------- Details of work to be performed and materials to be supplied follow R�n ef-� I �Zel\ov�SC�o��,; rx\s�1�t.�! 1(�'�l. S l`C�j N C, Ate �n `1�h1;'1 �i �nc��e;, ._��� �1S'�a s� F���r�, S�avfifi�� '0 �GotiS 1JUClvr Uva CAcv,ce CUt�gi� Initials Acknowledging this page: HomeowvZvXne. Homeowner --- Date HOMEOWNER: Do not sign this contract if th e are any blank spaces. You have a right to a copy of this contract, Pageaf7 —) Location �-57• S. 6"" A"h No. Date C T �? U3 Check # 2� 25153 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ �.-- Other Permit Fee rive $ TOTAL $/ Building Inspector