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Building Permit #520 - 895 FOREST STREET 1/5/2012
Permit NO: Cto Date BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received C — � �-/� IMQ►PORTANT: Applicant must complete all items on this page LOCATION O \o e° �QQDRA7ED PROPERTY OWNER / J//J (2A)0\-/ Print MAP NO: 09 J PARCEL: [ ZONING DISTRICT: Historic District yesrn Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Iwo Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial )('Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer L" Z412 1 Lei 0 OWNER: Name:. Address: CONTRACTOR CN�ame` Address: )3 I. PREFO or,Print Clearly) Supervisor's Construction License: I IT Exp. Home Improvement License: %6--� 56-7- Exp. rnone: ��i��►I�y`i Iwo Date: 1. t - • ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE. BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. 1 �J Total Project Cost: $ o�©� FEE: $ '-4 S� Check No.: I" � -A-1 NOTE: Persons contracting Signature o Agen wner-,,� Receipt No.: c� — ,tors do not have access to the gu ty fu nature of contractor's 3 Location�i�-' 1� No. Date 17, TOWN OF NORTH ANDOVEP 01 . 0 9 Certificate of Occupancy $ Building/Frame Permit Fee $-C...�— Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # r -1 2 114 % `� " Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ �r COMMENTS CONSERVATION Reviewed on Siqnature COMMENTS HEALTH Reviewed on Signature COMMENTS d 'Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NU 1 t5 and UA I A — (For department use ❑ Notified for pickup - Date Doc.Building Permit Revised 2009 Building Department The following is a list of the required formsto 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 In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: Building Permit Revised 2008 nigntrax U3-1 1/9/2012 7:37:01 AM PAGE 2/002 Fax Server ACORD. CERTIFICATE OF LIABILITY INSURANCE 01/09/2012 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: H the certificate holder is an ADDITIONAL INSURED, the PolicyCles) must be endorsed, If SUBROGATION IS WAIVED, subject to the terms and conditions of the Policy, certain Policies may require and endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CHASE & LUNT LLC POB 590 NEWBURYPORT, MA 01950 77BPK INSURED TURNPIKE GENERAL CONTRACnNG INC CONTACT NAME: PHONE FAX (A/C, No, Ext): FAX EMAIL (AIC, No): ADDRESS: PRODUCER CUSTOMER ID (t: INSURERS) AFFORDING COVERAGE INSURER A: TRAVELER$ DMEC1' ASSIGNh1IENT INSURER B: INSURER C: 239 BOSTON STREET INSURER D: TOPSFIELD, MA 01983 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUBER: THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE INSURED NAMED ABOVE FORTHE POLICY PERIOD INDICA ED. 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 SUBJECTTO ALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPEOFINSURANCE GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMSMADE OCCUR. GENT AGGREGATE LIMIT APPLIES PER: POLICY PROJECT LOC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULE AUTOS HIRED AUTOS NON -OWNED AUTOS UMBRELLA LIAB OCCUR EXCESS LIAB CLAIMS -MADE DEDUCTIBLE RETENTION $ ADDLSUBR POLICY EFF DATE POLICY EXP DATE INSR WVD POLICY NUMBER (MKDMYYYY) (MAADDIYYYY) LIMITS EACH OCCURRENCE $ DAMAGE TO RENTED $ PREMISES (Ea occurrence) MED EXP (Any one person) $ PERSONAL && ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ COMBINED SINGLE $ LIMIT (Ea accident) BODILY INJURY $ (Per person) BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ (Per accident) EACH OCCURRENCE $ AGGREGATE $ WORKER'S COMPENSATION AND WC STATUTORYLIMITs OTHER EMPLOYER'S LIABILITY YIN US-4939PI55-11 10/22/2011 10/2212012 E. L. EACH ACCIDENT ANY PROPERITOR/PARTNER/EXECUTIVE N $ OFFICEWMEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ (Mandatory In NH) It yes, descrlbs under E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTLPLCATE HOLDER AFPEC13NO NOR1mS COh1P COVERAGE CERTIFICATE HOLDER TOWN OF NO. ANDOVER 1600 OSGOOD STREET NO ANDOVER, MA 01845 ACORD 25 (2009/09) NAIC al: 1,000,000 1,000,000 1,000,000 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 Charles J Clark 1988-2009 ACORD CORPORATION. All rights reserved. LU IL-U'l-Uri 11:01 PETER SIMONSON 9786879775 >> 978 887 5875 P 1/5 239 Boston Street, Topsfield MA 01983 Phone: 978-887-5870 Fax: 978-887.5875 HIC #167567 TURNPIKE GENERAL CONTRACTING, Inc. EIN## 27.3470462 Peter Simonson Job #1: 895 Forest St. North Andover,, MA 978-621-6990 Dear Peter, December 13.2011 The following estimate is for the roof installation for the property located at the above address. The following paragraphs describe the work that will be performed. We are a GAF "Master Elite Contractor" and have the ability to provide you with an OPTIONAL warranty directly from the manufacturer. To view the benelits of Stripping vs. Going Over the existing roof, pleasc visit our website rr ��+�« i l�nq irmnlin;.:++ni. The following work is for both the main house and for the detached garagdbam. lnstdlation hmdure • Strip existing enol' on the down to the roof deck • Install an 8 inch aluminum drip edge on all leading edges (rakes & fascia) • Install ice & water on all leading edges & valleys • Transitional walls arc optional and incur an additional cost for the siding repair (typically would be done'rime & Materials) • Install new vent pipe flanges, sized as needed • Check all exposed decking for mold penetration, rotted wood or other detects • Replace any rotted or damaged decking (we allow 32SF (a) no charge, $95.170/sheet thereafter) •. Replace any rotted or damaged ledger board (we allow 30fi. at no charge, $4.(10/fl. thcres ft) • Install 15 pound felt paper on all areas that is not covered by ice & water shield • Install new GAF Timberline 30 -year Architectural shingles • Install new rail ridge vent system • Re -use existing flashings at the (4) existing skylites. We are not replacing the skylite units. 44ftonoadl rotlans • l lomcowner to choose color of shingles COLOR: • Garage is a mansard roof and will require additional nailing/ fastening. per GAF. • Our dumpsters are sent to a recycling facility: therefore no additional trash may he placed in them. The transfer station will charge us a fee for additional lm -h which will be passed on to the homeowner. • Chimney re -pointing and relcading is not part of the roofing contract and will be quoted separately. • A new mof does not guarantee them will be no ice dame - lee dams are caused by poor attic insolation and not enough ventilatitm • During a roof job, the nails could break the sheathing during the nailing of the shingles • We are not responsible for any ol'the tracks that may arise in any walls or ceilings • Please cover all your Floors in your attic to protect from dust and debris • We will remove all of the job related debris from property and dispose in designated waste facility • Permit costs vary from town to town and are not included in this bid P14ye !nidal all oarions Ea aro choosing below: Cost for Labor & Material for Roof: $20,400.00,_ Pavment'l' 113 deposit due upon signing contract: $6,732.00_ 1/3 payment due upon Mart of Job: S 113 payment due upon completion of job: $ (within 3 days) Total Amount Agreed To Be Paid: S_20,400.00 Please sign and date aM pages Remk to: Tarapfke General Contrading Inc. - P.O. Box 36S, Topajel$ MA 01983 The following schedule will be adhered to unless circumstances beyond Turnpike's cuniml arise: Work Scheduled to Begin: _-,.—TBD Job expected to be completed within 4 days of actual start date. Warranty: Turnpike General Contracting Inc. guarantees all work perIbrmed for a period of one year. If any problems occur we will cover the cost of all labor and material to correct the problem and meet the customer's satisfaction. Terms and Conditions: Thgo t Is s to the and c nditions of paragraphs 1 through 14 attached hereto i grporsted herein by reference e Pro ec cu is -u i-uD i ru i Ft I tK SIMUMUN 9786879775 >> 978 887 5875 TURNPIKE GENERAL CONTRACTING, INC. Roofing — Siding — Painting - Masonry oMee 97&887-5870 239 Boston Street — Topsfield, MA 01983 fax 97&887-5975 TERMS AND CONDITIONS This Contract Is subject to M.G.L. c. 142A, et. seq. which mandates certain inclusions. 1. WARRANTIES: Turnpike General Contracting Inc. ("Contractor") hereby warrants that the materials and workmanship provided hereunder shall be free of defects for one year from the date of completion of the work. Contractor, within said year period shall undertake to repair or replace, as required, any portion of the work or materials found to be defective when reported within said period to Contractor. This warranty shall not apply to any work or materials adversely affected or damaged by any work, manipulation or other processing to said work or material by persons other than Contractor. 2. REGISTRATION: All contractors and subcontractors must be registered by the Administrator of Board of Building Regulations and Standards. Any inquiries about a contractor or subcontractor relating to a registration should be directed to the Administrator. 3. HOMEOWNER'S CANCELLATION RIGHT: Homeowner has a three (3) day cancellation right under Section Forty -Eight of Chapter Ninety -Three. See attached "Notice of Cancellation. 4. CONTRACTOR'S DISCLOSURES: Contractor hereby informs Homeowner of the following: (i) it is the obligation of Contractor to obtain any permits to complete the work as Homeowner's agent, the cost of which permits are not included in the Total Contract Price set forth in this Contract and which permits shall be paid for by Homeowner and; (ii) homeowners who secure their own permits or deal with unregistered contractors will be excluded from the Guaranty Fund provisions of M.G.L. c. 142A; (iii) it is the obligation of Contractor to commence and complete the work by the dates set forth in this Contract, weather permitting and subject to Force Majeure events. 5. FORCE MAJEURE. Any delay in the Work caused by or resulting from labor difficulties (including, but not limited to, strikes, materials shortages or delays in delivery of materials, boycotts, or inability to obtain a sufficient number of competent laborers) or from acts of God, including, but not limited to, extreme weather conditions and/or other natural causes that lie beyond the reasonable control of Contractor, or by any act or omission of Homeowner, shall result in an extension of the Expected Completion Date for the same number of days for any such delay. Contractor shall notify Homeowner promptly if a force majeure condition exists. S. CONTRACTOR'S FINANCIAL INSECURITY: Should Contractor deem itself to be insecure with respect to further payments hereunder, Contractor may then require as a prerequisite to continuing said work that the balance of funds. due under this Contract, which are in the possession of Homeowner, be placed in a joint escrow account requiring the signature of Contractor and Homeowner for withdrawal. 6. NONPAYMENT: Contractor shall, in the event of non-payment under this Contract, be entitled to establish a lien pursuant to M.G.L. e. 254, in order to secure said payment. In the event it becomes necessary for Contractor to employ an attorney to enforce any of its rights pursuant to this Contract, Homeowner agrees to pay, in addition to any balance due, all costs associated with the assertion or enforcement of those rights, including, without limitation, reasonable attorneys' fees, court filing and processing fees, and interest at the Default Rate (hereinafter defined) from the date such payment was due. In addition, if any payments required to be made hereunder arc not received within fifteen (I5) days of the time for payment as set forth in this Contract, interest at the rate of eighteen percent (18%) per annum (or the maximum interest rate permitted under applicable law) shall be charged on such unpaid amounts until paid. In addition, if any amount due hereunder is not paid in full within twenty (20) days from the date of the time for payment, Contractor may terminate all services under this Contract upon prior notice to Homeowner. P 3/5 4u Ic-U I -U0 I W I rt I M NMUIVJUIV `J/dbb/y//5 >> VU illi/ bb/5 TURNPIKE GENERAL CONTRACTING, INC. Roofing – Siding – Painting - Masonry office 978-887.5870 239 Boston Street – Tonsfield, MA 01983 fax 978-887-5875 NOTICE OF CA&F-I1,ATION 6 .,Qrn 2a t Z (Date) You may cancel this transaction, without any penalty or obligation, within three (3) business days from the above date. If you cancel, any property traded in, any payments made by you under the agreement, and any negotiable instrument executed by you will be returned within ten business days following receipt by the seller of your cancellation notice, and any security interest arising out of the transaction will be cancelled. If you cancel, you must make available to the seller at your residence, in substantially as good condition as when received, any goods delivered to you under this agreement; or you may if you wish, comply with the instructions of the seller regarding the return shipment of the goods at the seller's expense and risk. If you do make the goods available to the seller and the seller does not pick them up within twenty days of the date of your notice of cancellation, you may retain or dispose of the goods without any further obligation, if you fail to make the goods available to the seller, or it you agree to return the goods to the seller and fail to do so, then you remain liable for performance of all obligations under the contract. To cancel this transaction, mail or deliver a signed and dated copy of this cancellation notice or any other written notice, or send a telegram to: Turnpike General Contracting Inc., 239 Boston St. - Topsfield, MA 01983 Not later than midnight of J u'� 6(-2– . (Date – 3rd DAY AFTER) 1 hereby cancel this transaction. Date Homeowner's Signature Waiver of Notice of Cancellation 1 would like to waive my right to three (3) business day Notice of Cancellation. I would like my project to start as soon as possible. r. 1 2?iV Ifs Date Homeowner's Signature P 5/5 LU IL -U 1-Ut) I W I Pt I tK SIMUN5UN 9785879775 >> 978 887 5875 TURNPIKE GENERAL CONTRACTING, INC. Roofing — Siding — Painting - Masonry office 978-887-5870 239 Boston_51reet — Tonsfield. MA 01983 fax 978-887.5875 7. ARBITRATION: M.G.L. c. 142A delineates certain homeowners' rights and Section 4 implies a right in the Homeowner to apply for private arbitration of disputes relating to this Contract and governed by regulations approved by the Director of the Executive Office of Consumer Affairs and Business Regulations (M.G.L. c. 142A, Section 1). S. EXCLUSIONS FROM SCOPE OF WORK: The following items are not included in this estimate and would require a Change Order signed in accordancc with the provisions hereof. asbestos removal and any rot that is discovered that may require replacement. The scope of these items are impossible to predict and therefore are not included in this estimate. 9. DESCRIPTION OF WORK: Homeowner and Contractor agree that the work description set forth herein covers all items of work, labor and materials needed for the remodeling and/or construction of improvements and appurtenances on the property and that Contractor is not responsible for furnishing any improvements other than as specifically stated in the wnrk description. 10. CHANGE ORDERS: Any changes in the work description shall be authorized by a written Change Order signed by both Owner and Contractor. 11. GOVERNING LAW: This Contract shall be construed and enforced under and in accordance with the laws of the Commonwealth of Massachusetts. 12. INDEMNIFICATION: homeowner agrees to indemnify and hold harmless Contractor, its officers, shareholders, agents and employees from any and all liability, loss or damage, including, but not limited to, court costs and reasonable attorneys' fees that Contractor may suffer or incur as a result of any and all claims, demands, actions, costs or judgments against Contractor arising out of or in connection with this Contract, except to the extent caused by Contractor's gross negligence. 13. BINDING EFFECT: This Contract shall be binding upon and inure to the benefit of the parties hereto and their respective heirs, personal representatives, successors and assigns. 14. LEGAL CONSTRUCTION: In case any one or more of the provisions contained in this Contract shall for any reason be held to be invalid, illegal or unenforceable in any respect, such invalidity, illegality or unenforceability shall not affect any other provision of this Contract and this Contract shall be construed as if the invalid, illegal or unenforceable provision had never been contained in it. P 4/5 JAN-09-2012(MON) 11:01 Office (FAX)978 887 5875 P.002/008 2012-01-06 11:01 PETER SIMONSON 9786879775 >> 978 687 5875 P VS 239 Boston Street, Topsfield MA 01983 Phonu: 978-887-5870 Fax: 978.887.5875 HIC 0167567 TURNPIKE GENERAL CONTRACTING, Inc. EIN# 273470462 Peter Simonson Job 0: 895 Furcal Sl. North Andover, MA 978.621 4990 Door Peter, December 13. 2011 The following estimate Is for the roof installation Ibr the property loetted at the above address. The ibllowing perographs describe the work that will be porlbrmod. We an a OAF "Master Elite Contractor" and have the ability to provide you with an OPTIONAL warranty directly from the manuflcl=r. To view the boncilts of Stripping vs. Going Over the existing roof, please visit our wobsitc @ ������ i+I; nq�irit++Hin_,.nm. The following work Is Ibr both the main bouse and for the detached gtuage/bam. • Strip casting rtKri'an the down to the roof deck • Install an 8 inch ahuninum drip edge on all leading odps (rakes R 1L8eia) • Install lee do water on all leading edges 4t valleys ■ Transitional wells ere uptiunal and im:w an addltionel cost for the siding nlpair (typically would be done'rime dt Materials) • Install naw vont pipe flanges, sized as nocdcd • Chock all exposed decking fbr mold penetration, rotted wood or other detects • Replace any ratted ur damagcd thwking (wd allow 32SF @ no charge, S95.00ishest thereafter) e. Replace any ratted or damaged ledger board (we allow 30f1. at no charge, S4.001fi. thereafter) • Install IS pmrnd felt papor on all Arses that is not covered by ic•c A water shield ■ Install now GAF Timberline 30 -year Architectural shingles • Install new rail ridge vent system • Rowse existing flsahinab at tha (4) existing skylites. We are not replacing the skylite units. AddiecrhAt ■ l lometrwner to choose color of shingles COLOR; • Garage is a mansard roof and will require additional nelllnSI fattening- per OAR. • Our dumpsten AN teat to a recycling facility; thcrcfam no additional trash may be plaoed in them. 'rho tronster station will charge w a f'oe for additional Lnmh whish will be passed on to the homeowner. • Chimney rc-pointing and wleading ie not part of the rooting contract nod will be quoted separately. ■ A new rhnt'does not guarantee there will be no iso dame - Ice demi are caused by poor attic Insulation and not enough ventilatirm • During a roof Job. the nails could break the sheathing during the nailing of the shingles • We are not rceponeible ror any 011116 creeks that may arise in Any walls or ceilings • please cover all your Roan in your attic to protea from dust and debris • We will remove all of the Job related debris from property end dispose in dcsig/►ated waste fttoility • Permit ousts vary from Iowa to town sod are mot included in this bid Pilose /Allis/ ed Q plotu You are ch o osl o bdaw. (:oat for Labor dr Material for Roof. $20,400.00 Pavmont Torr= 1/3 deposit due upon signing eoalrneir 8 6,y32,00� 1/3 payment due sport start of job: 3 1/3 payment due upon completion of )ob-. 5 (within 3 days) Total Amount Agreed To Be Paid: $_20,400,00 Please dga awe dire all peen Ron& for lbr*ke GF019d COWMding rot. - P.O. Bar 36S, Tope) *14 MA 81993 The following schedule will be adhered to unlms circumstances beyond Tumpike'a control arise., Work Scheduled to Begin: __TBD Job expeoted it) be completed within 4 days of actual start dote, Warranty: Turnpike General Contmoting Inc. guarantees all work porlimned for a period of pile year. If any problems occur we will cuvw the coat of all labor and material to cumd the problem and meet the cuttoroer's satisfaction, Tgrf„� A CoaditiWM, Thi at 11&9 et to the ad o editions of paragraphs 1 through 14 atUchsd hereto I ' pormed herein by rrhronoe JAN-09-2012(MON) 11:01 Office (FAX)978 887 5875 2012-01-06 11:01 PETER SIMONSON 9786879775 >> 978 887 5875 239 Boston Street, Topsfleld MA 01993 Phone: 978.887.5870 Fox: 978.887.5875 Tumplke Oenerel Contraving Inc. Date Nammmnu Date P. 003/008 P 2/5 JRN-09-2012(MON) 11:01 Office (FAX)978 887 5875 P.004/008 2012-01-06 11:01 PETER SIMONSON 9786879775 >> 978 887 5875 P 3/5 TURNPIKE GENERAL CONTRACTING, INC. Roofing — Siding — Painting - Masonry office 978-887-5879 239 Boston Strgfj =Igmfield, MA 019$1 lax 97&1187-5975 TERMS AND CONDITIONS This Contract Im subject to M.G.L. c. 142A, eL seq. which mandates certaln Inclusions, 1. WARRANTIES: Turnpike 0eneral Contracting Inc, ("Contractor") hereby warrants that the materials and workmanship provided hereunder shall be tree of defect$ for one year tom the date of completion of the work, Contractor, within said year period shall undertake to repair or replace, as required, any portion ni1Mw U)"10 0%4- warranty shall not apply to any work or materials adversely affected or damaged by any work, manipulation or other processing to said work or material by persons other than Contractor. 2. REGISTRATION: All contractors and subcontractors must be registered by the Administrator of Board of Building Regulations and Standards. Any inquiries about it contractor or subcontractor relating to a registration should be directed to the Administrator. 3. HOMEOWNER'S CANCELLATION RIGHT: Homeowner has a three (3) day cancellation right under Section Forty -Eight of Chapter Ninety -Three. See attached "Notice of Cancellation." 4. CONTRACTOR'S DISCLOSURES: Contractor hereby informs Homeowner of the following: (i) it is the obligation of Contractor to obtain any permits to complete the work as Homeowner's agent, the coat of which permits are not included in the Total Contract Price set forth in this Contract and which permits shell be paid for by Homeowner and; (il) homeowners who secure their own permits or deal with unregistered contractors will be excluded from the Guaranty Fund provisions of M.G.L. c. 142A; (iii) it is the obligation of Contractor to commence and complete the work by the dates set forth in this Contract, weather permitting and subject to Force Majourc events. 3. FORCE MAJEURE. Any delay in the Worts caused by or resulting from labor difficulties (including, but not limited to, strikes, materials shortages or delays in delivery of materials, boycotts, or inability to obtain a sufficient number of competent laborers) or hom acts of God, including, but not limited to, extreme weather conditions and/or other natural causes that lie beyond the reasonable control of Contractor. or by any act or omission of Homeowner, shall result in an extension of the Expected Completion Date for the same number of days for any such delay. Contractor shall notify Homeowner promptly if a force in jeure condition exists. 5, CONTRACTOR'S FINANCIAL INSECURITY; Should Contractor deem itself to be insecure with respoct to further payments hereunder, Contractor may then require as a prerequisite to continuing said work that the balance of funds due under this Contract, which are in the possession of Homeowner, be placed in a joint escrow account requiring the Signature of Contractor and Homeowner for withdrawal_ 6. NONPAYMENT: Contractor shall, in the event of non-payment under this Contract, be entitled to establish a lien pursuant to M.G.L. e. 254, in order to secure said payment, in the event it becomes necessary for Contractor to employ an attorney to enforce any of its rights pursuant to this Contract, Homeowner agrees to pay, in addition to any balance due, all costs associated with the assertion or enforcement of those rights, including, without limitation, reasonable attorneys' fees, court filing and processing fees, and interest at the Default Rate (hereinafter defined) from the date such payment was due. In addition, if any payments required to be made hereunder are not received within fifteen (I 5) days of the time for payment as set forth In this Contract, interest at the rate of eighteen percent (19%) per annum (or the maximum interest rate permitted under applicable law) shall be charged on ouch unpaid amounts until paid. In addition, If any amount due hereunder is not paid In full within twenty (20) days from the date of the time for payment, Contractor may terminate all services under this Contract upon prior notice to Homeowner. JRN-09-2012(MON) 11:01 Office (FAX)978 887 5875 P.005/008 2012-01-06 11;01 PETER SIMONSON 9786879775 >> 978 887 5875 P 4/5 TURNPIKE GENERAL CONTRACTING, INC. Rooting — Siding — Painting - Masonry office 978.867.5870 ?239 Bostgn Street— Tonsfleld, MA 01983 fax 976.867.5674 7. ARBITRATION: M.G.L. c. 142A delineatca certain homeowners' rights and Section 4 implies a right in the Homeowner to apply for private Arbitration of disputes relating to this Contract and governed by regulations approved by the Director of the EXQCUtive Office of Consumer Affairs and Business Regulations (M,O.L, C. 142A, Section 1), 6, EXCLUSIONS FROM SCOPE OF WORK: The following items are not included in this estimate and would require a Change Order signed in accordance with the provisions hereof, asbestos removal and and therefore are not included in this estimate. 9. DESCRIPTION OF WORK: Homeowner and Contractor agree that the work description set forth herein covers all items of work, labor and materials needed for the remodeling and/or construction of improvements and appurtenances on the property and that Contractor Is not responsible for furnishing any improvements other than As specifically stated in the work description. 10. CHANGE ORDERS; Any changes in the work description shall be authorized by a written Change Order signed by both owner and Contractor. I I . GOVERNING LAW: This Contract shall be construed and enforced under and in accordance with the laws of the Commonwealth of Massachusetts, 12. INDEMNIFICATION: Homeowner agrees to indemnify and hold harmless Contractor, its officers, shareholders, agents and employees from any and all liability, loss or damage, including, but not. limited to, court costs and reasonable attorneys' fees that Contractor may suffer or incur as a result of any and all claims, demands, actions, costs or judgments against Contractor arising out of or in connection with this Contract, except to the extent caused by Contractor's gross negligence. 13. BINDING EFFECT. This Contract shall be binding upon and inure to the benefit of the parties hereto and their respective heirs, personal representatives, successors and assigns, 14. LEGAL CONSTRUCTION: In case any one or more of the provisions contained In this Contract shall for any reason bo held to be Invalid, Illegal or unenforceable in any respect, such invalidity, Illegality or unenforceability shall not affect any other provision of this Contract and this Contract shall be construed as if the invalid, Illegal or unenforceable provision had never been contained in it. JAN-09-2012(MON) 11:02 Office (FAX)978 887 5875 P.006/008 2012-01-06 11:01 PETER SIMONSON 9786879775 >> 978 887 5875 P 5/5 TURNPIKE GENERAL CONTRACTING, INC. Hoofing — Siding — Painting - Masonry 239 Boston Street _ Tnrnxfietd_ MA n1 41A N0TI .l 4 3QN 2.01 Z, (Date) Vnir Ter. nenwa) Alm �arns.wt:.... ...:rl.....• .... rw..wb., .� .U:,...:.. ._.:.�:_ .�--- i�r r. the above date, - office 978887.5870 If you cancel, any property traded In, arty payments made by you under the agreement, and any negotiable instrument oxecuted by you will be returned within ten business days following receipt by the seller of your cancellation notice, and any security Interest arlaing out of the transaction will be cancelled. If you cancel, you must make available to the seller at your residence, in substantially as good condition as when received, any goods delivered to you under this agreement; or you may if you wish, comply with the instructions of the seller regarding the return shipment of the goods at the seller's expense and risk, If you do make the goods available to the seller and the seller does not pick them up within twenty days of the date of your notice of cancellation, you may retain or dispose of the goods without any further obllgatlon. if you fail to make the goods available to the seller, or it you agree to return the goods to the seller and fail to do ao, then you remain liable for performance of all obligations under the contract. To cancel this transaction, mail or deliver a signed and dated copy of this cancellation notice or any other written notice, or send a telegram to; Turnpike General Contracting lnc,, 239 Boston 5t. - Topefleld, MA 01983 Not later than midnight of C TGA i , (Date -- 3" DAY AFTER) 1 hereby cancel this transaction. Date Homeowner's 5ignaturc Waiver of Notice of Cancellation 1 would like to waiva my right to three (3) business day Notice of C llation, 1 would like my project to start as soon as possible. Date Homeowner's Signature JRN-09-2012(MON) 11:02 Office (FAX)978 887 5875 P.007/008 RightFax 103-1 1/8/2012 7;37:01 AM PAGE 2/002 Fax Server ACORD. CERTIFICATE OF LIABILITY INSURANCE 01/09/2012 7418 CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, T141S CFR71FICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THIS CERTIFICATE THE POLICIES BELOW. OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING OR PRODUCER, AND THE CERTIFICATE HOLDER. INSURER(Sh AUTHORIZED REPRESENTATIVE IMPORTANT: It the cmnllloate holder Is an ADDITIONAL INSURED, the pellcyGee) must be endorsed. 11 SUBROGATION 19 WAIVED, subject to the terms and conditions of the Polley, Oedeln P6110iae may FeWirs and mrmdorlemarit, A statement on this catH(cale dess not confer rights to the certificate holder In lieu of such andorsement(s). PRODUCER CONTACT NAME: CHASE & LUNT LLC PHONE FAX (A/C, No, Ext): FAX POB 590 (A/C, No): EMAIL ADDRESS; Ponnurro 77HPIt CUSTOMER 10 m INSURER(S) AFFORDING COVERAGE INSURED NAIC R INSURER A: TRAVELER& DMM ASSIGNbS.Nf TURNPUM GENIMUL CONTRACTINO INC INSURER B: INSURER C. 239 BOSTON STREET INSURER D: TOPSFINLD, MA 01983 INSURER E; INSURER P: COVERAGES CERTIFICATE NUMBER; REVISION NUMBER: THIS 18 TO CaKnFYTHATTHi POLICIES OFINBURANCli LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWfrHOTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH AROPECT TO WHICH THIO CERTIFICATE MAY BS ISSUED OR MAY PERTAIN. TMS INSURANCi AFFORDOD BY THE POUCINS DESCRIBED HEREIN I9 SUBJECT TO ALL THE TERMS, SXCLUO)ONS AND CONDITIONS OF OUCH POLICIES. LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMO. INBR ADDLSUDR POLICY EFF DATE POLICY 1XP DATE LTR iINSUgANCi POLICYNUMBER (MMIDD%YYYh (MNADDIYWY) MEN WVO UMITO GENERAL LIATBILIABU TY COMMERCIAL GENERAL LIABILITY EACH OCCURRENGS S CLAIMS MADE. OCCUR. DAMAGE TO RENTED S PREMISES Ma occurrence) MED EXP (Any one person) $ GENT AGGREGATE LIMIT APPLIES PER: PERSONAL S8, ADV IwURY S POLICY PROJECT IAC GENERALAGOREOATE $ PRODUCTS - COMP/OP AGO S AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE $ ALL OWNED AUTOS LIMIT (Ea cacldont) SCHEDULE AUTOS BODILY INJURY $ HIRED AUTOS (Per person) BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE. S (Per aecldont) UMBRELLA LIAR OCCUR EXCESS LI48 CLAIMS-MADE EACH OCCURRENCE $ DEDUCTIBLE AGGREGATE S RETENTION $ $ WORKER'S COMPENSATION AND WC STATLTTORYLINI" OfNEA EMPLOYER'S LIABILITY YIN UB-493913158.11 10/222011 10/224012 E. L. EACH ACCIDENT ANY PROPERITORIPARTNF=WEXBCUTIVE N $ 1,000,000 OPFICEWLIEMBER EXOWDED7 E.L. DISEASE - EA EMPLOYEE S 1,000,000 (MandatoryIn NH) Ilya&.dasorlbeunder E.L.DISEA9E•POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS b■IoW DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLIWRESTRICTIONSISPECIAL ITEMS THIS REPL►CH9 ANY PRIOR CRRTOCAT$ ISSEMD TOTHECERTFPICATEFFDLDER AFPwnN0 WORXFSRB COW COVERAOP. CERTIFICAT@ HOLDER TOWN OF NO. ANDOVER 1600 OSGOOD STREET NO ANDOVER, MA 01845 ACO RD 23 (2008/08) 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 Charles 7 Clark 1866.2002 ACORD CORPORATION. All rights reavved. JAN-09-2012(MON) 11:02 Office (FRX)978 887 5875 P.008/008 AC Ra" TURNP-3 OP ID: SC CERTIFICATE OF LIABILITY INSURANCEDA (NMmolYYYY) THIS CERTIFICATE 19 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS F01/06/12 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 p0llcy(le9) must be endorsed. If SUBROGATION IS WAIVED, subtract to the terms and conditions of the policy, Certain policies may require an endorsemant, A statament on this Certificate does not confer rights to the certiflcata holder In Ilau Of such endorsement(el. PRODUCER Chase 8. Lunt LLC P 0 Box 690 47 State Street Newburoort, MA 01860 Marcos W. Shaner 239 9oston Street Topsfield, MA 01983 ./...V l4VYCNiGC NAIC e rNsuR�Ra:Scottsdale Insurance co. INSURER 0:t;OmmerGe Insurance Companv I D vvrcrwyG;D 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 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. Lip TYPE OFINSIJRANC6 POUC NUMBSR P GENERAL LIABILITY D LIMITS A !JTMERCIAL GENERAL LIABILITY BCS0020060 EACH OCCURRENCE S 1,000,0 10121111 10/21/1 Peocc�,ne CLAIMS -MADE � OCCUR ReMI 8 b0A EI A --I OEN'L AGGREGATE LIMIT APPLIE8 PER' POLICY X PRO- LOC AUTOMOBILE LIABILITY ANY AUTO SCHEDULED AUTO' NON OWNED Oa X HIREDAUTOS ALL O4LIA1a UMBR�( OCCUR X EXCBSCLAIMS-MADE N/A BDBRJM XL8007789t1 10/20/11 10/21/11 I PhRSONAL B ADV INJURY S GENERAL AGGREOATE $ PRODUCTS-COMP/OPAGO 6 6 10/20/12 M131 den! LE U 80DILY INJURY (Par parson) S 8OOILY INJURY (Par..Ident) S PE dem E 6 10121M2DE _ EACH OCCURRENCE S O WORKERS COMF9N9ATION AND EMPLOYERS' LIABILITY OFFICEWMEM ERRSXCkVDED�IEOUTIVEYa (Mandatory In NH) If yrre dePeTIION OFO TIONS bel E AGGREGATE $ ; WC STAT _ PTH, ITOR E.L. EACH ACCIDENT B.L. DISEASE• CA EMPLOYE 6 E, L.DLeEA&E-pnrirvrunT e DESCRIPTION OF opePATIONS I LOCATION® I VEHICLES (Alt ch ACORD 101, Additional Romarl.e Schedule, If more :PaOe Is raqutrea) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL Be DELIVERED IN Town of No, Andover ACCORDANCE WITH THE POLICY PROVI®IONS. 1800 Osgood Street No. Andover, MA 01845 AUTHORIZED REPRBSBNTATIVE Marcos W. Shaner ACORD 26 2010/08 . IV n%.v ( ) The ACORD name end logo are registered marks of ACORD A W t�3 w A ¢� v u w° U) U w° U w w w W U cn cu w O w W A C w� o z �' cn v Q o co 91 UJ CL7 r c o as c o c O 16- (A y O_ C O vV c m ® C •= O W Oil l O Ea m c m =V s .� CD c. E a $ cm CL= L m R m V co C2 CO) V1 co y O O E y � m mo acs .: m p1 c oQ ♦+ y 'O •m O C3 'y o . M•�Z o cm C O. O C te' : - C 'C =G3 `O mI. ys,,, ocoo w N t W 0 4 y...A .■.. MD 1. O c •fy O.= C mZ =+" •y v .m C3 Cie IS F. W C' 4D. 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N ._ �11� a C �i C GVO GC � a Y WN Y z fn P W CO 0 X W W Z p p c in Y Q W rn s± a z m a O' th F- N Q 2012-01-05 11:11 PETER SIMONSON 9786879775 >> HIC 0167567 TURNPIKE GENERAL CONTRACTING, Inc. F.IN# 27-3470462 Peter Simonson Job #: 895 Forest St. North Andover, MA 978-621-6990 P 1/1 Dear Yater, December 13, 2011 The following estimate is for the roof installation for the property located at the above address, The following paragraphs describe the work that will be performed. We are a GAF "Master Elite Contractor and have the ability to provide you with an UPI'IUNAI. warranty directly from the manufacturer. To view the benefit.% of Stripping vs. Going Uver die existing root'. please visit our website (it) oi, nips 11.1.1 41-- The following work is for both the main house and for the detached gurage/barn. l sr I • Strip existing roof on the down to the roof deck • Install an 8 inch aluminum drip edge on all leading edges (rakes & fascia) • Install ice & water on all leading edges & valleys • 'transitional walls arc optional and incur an additional cosi for the siding repair (typically would be dune Time & Mutcriul.$) • Install new vent pipe flanges, sized as needed • Check all exposed decking firr mold penetration, rotted wood or other defects • Replace any rotted or damaged decking (we allow 32SF (ii) no charge. 595.00/sheet thereafter) • Replace any rotted or damaged ledger board (we allow 3011. at no charge, 54.00/6. thereafter) • Install 15 pound felt paper on all areas that is not covered by ice & water shield Install new GAF Timberline 30 -year Architectural shingles • Install new roll ridge vent system • Re -use existing flashings at the (4) existing skylitcs, We arc not replacing the skylitc units. Additional S i nations • Iiomeowncr to choose color of shingles COLOR: • Garage is a mansard roof and will require additional nailing/ fastening- per GAF. • Our dumpslcrs art sent to a recycling facility: therefore no additional trash may be placed in them. The transfer station will charge us a kc for additional trash which will he pasted on to the homeowner. • 0dinney repointing and rc-leading is not pert of the rooting contract and will be quoted separately. • A new ruuf does not guarantee there will he no ice dams - fee dams are caused by poor attic insulation and not enough ventilation • During a roof job, the nails could break the sheathing during the nailing ol'the shingles • We arc not responsible fiw any of the cracks that may arise in any walls or ceilings • Please cover all your flours in your attic to protect from dust and debris • We will remove all of the job related debris from property and dispose in dcsignalcd waste facility • Permit costs vary from toren to town and ars not included in this bid Please initial all options you are d w_sina b"I m Cost for Labor & Material fur Roof: WV3,04_ Payment Terms: 1/3 deposit due upon signing contract: $ �6 O 0 1/3 payment due upon mart of job: $ > p 4 fJ V 1/3 payment due upon completion of job: S r; ?oei (wilhin 3 days) -Total Amount Agreed To Be Paid: S^2%1;S4:31V Please sign and date all pages. Remil lo: Turnpike General contracting inc. - P.a Box J65, Topsfield, MA 0/983 The following schedule will be adhered to unless circumstances beyond Turnpike's control arise; Work Scheduled to Begin: _THD ____ Joh expected to be completed within 4 days of actual slut date. Warranty: Turnpike General Contracting Inc. guarantees all work perIbrmed for a period of one year. If any problems occur we will cover the cost of all tabor and material to correct the problem and meet the customer's satisfaction. Contracting Inc. [rate I lumcowour DAIC / The Commonwealth of Massachusetts Print Form Department of Industrial Accidents Office ofinvestigations =1 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass gov/dia Workers' Compensation Insurance Affidavit: General Businesses Applicant Information Please Print Legibly Business/Organization Name: Address: )_�l i $01i !�I_" City/State/Zip: Are you an employer? Check the appropriate box: 1.X I am a employer with employees (full and/ or part-time).* 2. ❑ I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required] 3. ❑ We are a corporation and its officers have exercised their right of exemption per c. 152, §1(4), and we have no employees. [No workers' comp. insurance required]* 4. ❑ We are a non-profit organization, staffed by volunteers, with no employees. [No workers' comp. insurance req.] • fi Business Type (required): 5. ❑ Retail 6. ❑ Restaurant/Bar/Eating Establishment 7. ❑ Office and/or Sales (incl. real estate, auto, etc.) 8. ❑ Non-profit 9. ❑ Entertainment 10. ❑ Manufacturing 11.❑ Health Care 12.Other C Vj *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. * *If the corporate officers have exempted themselves, but the corporation has other employees, a workers' compensation policy is required and such an organization should check box #1. t I am an employer that is providing workers' compensation insurance for my employees Below is the policy information. Insurance Company Name: Insurer's City/State/Zip: 0/jro Policy # or Self -ins. Lie. #7P7 UJ5— 417 P 07,9 Expiration Date: �� Attach a copy of the workers' compensation policy declaration page (showing the policy number nd expiranon date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify, 4 er the ns and p n of erjury that the information provided a ove '/ true and correct Si nature: Date: f 5 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. Licensing Board 5. Selectmen's Office 6. Other Contact Person: Phone #: www.mass.gov/dia 4 . Massachusetts - Department Of ?Uhli�c SIfet - " adiou Regulations and Standards Board of Btli 1� or License (;onstruc +;en supervis . License'. CS 1 74818 KEN LAMBERT 66 DEER HILL RD BRENTWOOD, NH 03833 Expiration' 212712013 12474