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Np. D06001693 �JOL&� { SEA �� NH Lie. No. MA Lie, No. 120456 SA ES: FOR A QUALITY & SA ISFACTION New York D pa`tment of Consumer ffai s Lic. No. No York: SERVICE/RE AIRS GUARAN EED Nassau Lic. N0�H270a15 80 -942.6111 PLEASE C LLp� Suffolk Lic. o. �964H1 Bo ton: 800-942-6111 Yonkers o ichast W 613H87 $0 -SEARS-31 I CONT Iy�rT Now Jerse LIc�No. 0975' d l Martford: C J( 18 D TO RESS, SITE AD�RESS (if -------------------- SQA APP(IED VINYL I 13 BII-Ray Aluminum tjc urian St„ ulte M1 ? A Sears Authodzr )orough, A 01581 13410 Atlantic Avenue, hl, i Work aAbove Addrelss: Zip of e ❑ Masonry ConnectiCu Do artment c Consumer ffab Lie. No. VT Llc. No. RI Lie. No. _._ ,....... _ DATE ,...,....._._PHONE (Home)._6M6_ PHONE Work ALUMINUM SIDING Corp. of Queens contractor 1 and Hill, NY 11419 West SI Approx. Start Date: Approx. Completion Date: G, J P. 01 - 4fv1�E m Street i, a) MA 0 009 Seas approved aterials will be furnl hed and Installed to these speolflcatlgn Y S PL -ASE READ Cn8EF LLY. ONLY Thl. ITFMS CHE6KF6 " S" ARE INCLUDED IN YOUR ORDEiR, 1. I I SOu ID VINvI. SIDING cove a a reaseslynaled sl no, exce t those areas des at9d below, Size Color Pattern Package [.— Custom posts Color �' 1 ❑ SID'NG will bAapplied tot a following areas nly: cam, r�on Elevation levation C Entire Details: L;wKear Elevation Left E�vation U Portia (SEE DETAILS) I..I Other U (SEED AILS) I 2 INS LATION - cover onlyfl twall areas desi q'ated for sidingwith _ 3 l:l a Sears approved GALV �IZED STEEL STARTER STRIP where Con ra for deems necessary. (Not al ailable with Nannie,). i 4. I Sitll g to be appliod over o Isting foundation. 5. C) Use Soars approved PERM TABS AND FINISH STRIP where contractordeemsnecessary in same color idi ti, OPENINGS (Not avail ble yrlth Nalllte,) _. W I ustom wrap with Sears approved vinlll Cla aluminamA_ ver Calor,!' I I :I J�Irtlp over castings with siding and 'J' ch nnel # - eviously wrap ed) I! Det FIs ,........-...._.. i 7, .1 CAI LK - all sills -with rubbe{ized ColDr cD ordi aced caulking 8f (':1 D RS - custrun wrap with F,ARS approved V NYL CLAD ALUMINUM. of Doors 1 Color { g. I GA AGE DOUR FRAMES custom wrap with SE RS approved VINYL CLADALUMINUM, Color ❑ Single r"l Doublo With Mull Double No Mull 1U LJ FAS 'IA - custom wrap with EARS approved VI YL CLAD ALUMINUM, Co or N 11. fUII (eavos/overhangs) over with SEARS approved SOLID VINYL SOF IT SYSTEM. Except area noted below, 1/a Vented, Color ^' 12. I J.I -* 1 EN WOOD -Will only b repaired or replace where speclfieA on line of m # 27 listed below. Any additional areas needing a rBp�lrwl I be estimate upon lhel� discovery and priced ccordingly, (Does �iol InClude wood studs, r exterior sheathing). 1 I I ROn ove existing material 01 exterior of (louse j I i nyl C] Aluminum I l Wood Shln¢le 0 Wood Sidifig U Other r D not Include any asbes os removal. t4, •] SFO CH CEILINGS -Cover wl h SEARS approved iSOLID VINYL CEILING MA TRIAL in the#ollowing areas ' 15. I SiC01,t1MN5 - wrap w th SEARS approveVINYI. CLAD ALUMINUM No circular or round columns . Colo 16, 1 �TERSUADERS - remo existing and repla a with nrw custom searnle s gutters and leaders, Willie) r 17, 1 Sol TTCRS - provide andinsafl__..,,, T Brow 1 :.l MA TER MOUNTS - provide rid Install for Pair SEARS d polystyrene shutters. Color e lerior h ixt r nly. Co 19. (-] GA LE VENTS -provide an Install vents. Color �'�. 20. J CLE N UP property at Com nation pf work. I No irc far or trian it vents. INS RANCE - all roquired ORKMANS COMP', and LIABILITY'to be ma malnod. l 22. 1 WA RANTY - mail to customer after cumpleti n arid full paymgnt is received. 1 Discounts �H ve eceen Applied, 23. :_) PAYMENTS - on NON-FINA CEO o�Ldo�rrs Installer is authorized to collect, progressive payments. Defeo -red 24, ALU DISCOUNTS APPLIED. �t1! 4 (o'�(, ft t) I d Payme�r1. Ihterest Will Accrue. 25. LJ AD�ITIQNAL WO$K - ngst o ftcl apgvg„ n I Lu, t;t.t ry ur property at cun�rNNrunun w wurK. .2t ) INSRANCt all required WORKMANS COMP, and LIABILITY'to be mamalnod. I Discounts Hvo een Appli�d, 22, I WA RgNTY -mail to customer after cumpleti nand full payment is received. 23, D. PAYMENTS on NON -FIN CE,DD, o d�rs Instal�v is authorized 4o collect progressive payments. Deferred Pa mein, Ihterest Will Accr 24, ALL; DISCOUNTS APPLIED, yCi C1! i. 14A Ft a i Y ue 25.' ._ U AD ITIO AL WO K - no s e 'f' da ' I Jodi Total $ A/Less dOosit 25% d Rnlnnce 13 0k) (3-t-1 ❑ FINAN ED $ does no include interest Completion 1/2 If fir arced, tidlaii4 payable In monthly installments of approxim tely $ _ per month payable b Owner" to C nUactar but i fblanced b wner then Owner will p y y y p y said amount to he lending institution plus such Interest and crcdlt service charge of said lendingl Inst ution payabl directly to the lording Inst tution loaning such monies to "Owner' a d will execute a Retail I stallment obligation and any documents required by ucl lending inst tution in conr ccti with suhh loan. —� 26. K NOT to be done. 27. . I Rep it or reply a 1610110W g woo I ! NOTI .C: If finnnwd, ivy holder of this Cone u no credit Contract Is a� lect to all claims and dnre yes which the IabtOr COlrtd assort SALESMAN HAS NO AUTHORITY TO RANGE ANY �fEiiMS� MJaln the ery OI a de or snap n oexceed OR MADE ANY REPRESENTATIONS OTHER THA CON. phid by purge not heroin or ith Ihu procnnd. hnreui. ecovexy by the defttor aha0 not exceed nirO f 1taNER t ye d EPREnder. TAINED IN THIS AGREEMENT AND "0 N R" REPR SENT 0 HAVE EAD ANb THAT NONE HAVE BEEN MADE TO R RELIED U ON EtYj R CEIVED I A DUPLICAT ORIGIN4 OF THIS "OWNEIN DUPLICATE ORIGINAL ENTITLED TH S A OYER'MAY CANCEL THS :RIMAENNST�C LYILLE A REEMEf�T AND TO E THEA THORIZEDA ENT OF TALL "OWNER " OF THIS PROPERTY ANY"YOUTIME RtIOR TSO MDNICIT OFT E ,TIRD BU NES U ON WHISH THE WORK OR THE ATERIALS DAY AFTER THE DATE OF THIS R NSACTIO . SE� A E TO BE SUPPLIED. ATTACHED NOTICE OF CANCELLA I'D FORM F R Aei N TICE TO HE HOME OWE ER(S), GUA� ANTOR(S), EXPLANATION OF THIS RIGHT. ON A L RDERS C NCEL� LE SEE(S), O-SIGNER(S).. LED AFTER THE RECISION PERIOD, US OMERS ILL B RESPONSIBLE FOR A 20% ADMINI TF ATIVE A D RE Co tractor, at he tlxpense of o nor, shall pr0ure all permits STOCKING FEE. req Ired by law}as follows: THE COMPANY WILLI ! 1. Owners wh secure their own ormits will be 0 eluded from tho DEPOSIT ALL Mt NIES RE EIVED A FROM guaranty f nd provisions of M L Chapter 142. IN ANESCROWACCOUNTATCHASIE A HATTAN ANK 2. Any perso who shall have c signed, quare teed or signed #105-1-062089, W17HI F VE BU I ES DAVE FITS any credit pplloatloa or note r lating to this agreement haropy RE651PT'. accepts to a bound by this a rooment. j 3. Owner(a) r presents that the c ntants onthe b4k of this agree- pate mont Is a t ue pan hereof and as boon read Ond accepted by Do net sign thilS a reemt3nt bef0 a ou read t or lit Owner. It contains any blank space or I it d es not certain a. ALL INSTALLATION LARD UARANTEED 1 (ONE) YEAR, everything agreed upon. I ; S losman's Na via C: Ci Signator S lesman's I (Customer Sign Here) ! Li ense No, i Signature ! SEE EVERSE SINE FOR ADIDIT1O AL TERMS AND CONDITIONS A In ./ IQNe9nOflllM __ ✓ KA _ kms_' a QI f�:1 70 . t 0 U rz >Ou> p _ L , O� qZCC 1�r ¢ W"W 0 Fi�oeLL L{� © u u S }: w rr i x�G O �1 C 0 0 7, U c t ul IRS f- u I j- t- w U 1 Lu J z II! }: 0 Lu J Lu VeIOQw rz >Ou> p _ L O� qZCC 1�r ¢ W"W 0 Fi�oeLL L{� © u u S }: w rr i x�G O �1 C 0 0 7, U c t ul IRS f- u I j- t- w U 1 Lu J z II! }: 0 Lu J Lu VeIOQw o ; N H E-+ ti k G � Q ✓ ON :.i lJZZQ w LU LU r NW 4V ~'J d•W OwG U H rili�'-0� �S u L)Co 'tiruQUw 0 Cil uC r- y ��c1 J�yO } 7 } Zl } L irfN�ul 1NU�C.: r.� uc{ �s+ O t F— ,.:w LU 0 U O U U ;;llp[iarj 4�LL•pW }=! yiti rz >Ou> oyI O� qZCC 0 Fi�oeLL L{� © u u S rr i x�G O �1 C ti I _ 7, H c t 1 Lu J z H Lu VeIOQw H E-+ ti k G � Q ✓ ON :.i lJZZQ Ul H m H !L U 0ri _ uC r- y ��c1 J�yO >u Ll = C w r G C71 n CZ 1 r. o IL u I-- ri !� r CJ CT% o w cn !- it • Z ` � t nW.. K >W � W Fr I.W.. ■ O w b W C •.+ o a..J 1'� 6� a� �c -• v � y � r.+ r tit+. Z 1 1 0 •� I 1 1 r 1 , •-. 1 , 1 1 • � t I 1 1 1 I I 1 1 1 I 1 r 1 r r • 1 1 1 1 , ; 1 1 1 1 �� 1 1 1 t •. 1 -+ 1 1 • t 1 I 1 1 1 1 , 1 I - � 1 1 r • t 1 I 1 " 1 L r . ••r 1 , I 1 7 r 1 • 1'e r .! n� I r l ?[-. 1 1 O W 1 `1. •I 1 1 1 N. � y J l r r I J I ,•,• 1 nl I p V I 1 �+ 1 �f. 10 �' J at: t I O L I O ar• 1� 1 .. L n / I l V 4oc u 1 O •••• 1� 4 1 O d 1 1� V 1 1� J• • -• 1 1 1 7f 1 f7 1 1 •� 1 1 1 1 1 • 1 1 1 • u �y 1./ 1 t 1• E- � f+ 1 � 1 1 I 1 0 O 1 1 1 I 1 I R ti I n 1 1 1 1 t >~ 1 0 1 1 1 I f 1 1 1 1 1 1 1 !• 1 rn 1 � 1 1 •.. r• �-. 1 1 1 6 .• 1 n I 1 I 1 t , t i 1 1 1 1 1 1 1 1 1 I 1 1 I 1 1 1 1 � W 1 1 1 a Z 1 1 � 1 1 1 1 t 1 1 I � 1 1 1 I • O 1 1 1 f 1 I 1 r 1 V • i 1 1 1 1 • 1 1 f 1 f 1 � 'r• reC O i ; I 1 t 1 1 • 1 .� V oe 1 1 1 ^0 1 •�•• I 1 y> 1 1 I I • •• 1 ,� � 1 i � 1 -J �.• 1 I 1` 1 "• r r 1 1 syu r 1 1 f-• , 1 � , N .•.. 1 a-. -c 1 K 1 K I r N N N 1- 1 •r I W � 1 ]- >� W 1- - •� y O• 1 L I 1 v _ 1 1 I •. i n .J �I.1 .� 1 I O nn1.. I+.1 1 _. 1 1 h 1 1 I .I . r ;• I .• � I -1 v •J •.1 1 m u W I Z I I K i ...•-_. 1 1 •r 1 •t I- 1 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: �- / Date Issued: VI -2 7— Date Received IMPORTANT: Applicant must complete all items on this nage LOCATION �Z 11 1 Y6�4 PROPERTY OWNER /I MAP NO.: P5 PARCEL TVPF. AND IJSF OF Rilii.n]NG Pd vEn 'Print I?E.5, 4 r Print 2__2 ZONING DISTRICT: uic•rnurr nrcTurr r vVc n �� ��`" '•.'tea of Residential Non- Residential ❑ New Building ❑ Addition ❑ Alteration TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ Addition ❑ Alteration ❑ )ne family JF Two or more family No. of units: ;. ❑ Industrial epair, replacement ❑ Demolition ❑ Assessory Bldg ❑ Commercial ❑ Moving (relocation) ❑ Other ❑ Others: ❑ Foundation only iunai,rur i iviv Or wvtut 10 BEY .EllUKMtL) Identification Please type or Print Clearly) p rz OWNER: Name: �a u 0,071V Phone: Address:' 17� ,• ,,ttom� . CONTRACTOR Name: J /r Phone Address: Supervisor's Construction License:g/� j !�f Exp. Date: Home Improvement License: 13 / Z.j O Exp. Date: f f1 i 4 ca' ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. �— FEE SCHEDULE: BULDIN ERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost S• FEE:$ Check No.: Receipt No.: a� Page I of 4 TYPE OF SEWERAGE DISPOSAL Tanning/Massage/Body Art ❑ Swimming Pools ❑ Public Sewer ❑ ❑ ❑ Tobacco Sales Food Packaging/Sales ❑ Well ❑ Permanent Dumpster on Site ❑ Private (septic tank, etc. Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to t1:e guaranty fund Signature of Agent/Owner Signature of contractor Z Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT ❑ COMMENTS DATE REJECTED Q DATE APPROVED DATE REJECTED DATE APPROVED "CONSERVATION ❑ CUMMENTS Q DATE REJECTED HEALTV ❑ ❑ COMMENTS ' FIRE DEPARTMENT DATE APPROVED Temp Dumpste�� , ygs��— no, Fire Department signature/date% � 3 22 COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit Building Setback (ft.) Front Yard Side Yard Rear Yard Required t -- Provided Required Provides Required Provided 4— Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: 1V V i LN and VA l A — I i+ or department use Page 3 of 4 Doc: INSPECTION Created JMC. Jan.2006 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 Addition Or Decks ❑ Building Permit Application ❑ 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) New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan o 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 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:BPFORM05 Page 4 of 4 Locatio�e l kv No. Date Check # qb TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 20157 Building Inspector The Commonwealth of Alassachuselts Department of Industrial .lecidents Office of Investigations l F 600 Washington Street ' Boston A1.4 02111 www.mnss.gov/din �t Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name tt�tt,incss,urzaniiatinn;huh�i�►ua1): ,address: t% City: State.Zip:4 � NA!/456 4w/FwPhone # Are you an employer? Check the appropriate box: ' I . ❑ I am a employer with 4. [11 am a general contractor and iiployces (full and,'or part -tune).* have hired the sub -contractors 2 1 am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. workers' comp, insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per %MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 3. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.[] Plumbing repairs or additions 12.&Roof repairs 13.0 Other_ `Any applicant that checks box; I must also til10 tit the section below showing their workers' compensation policy information. + I lonteowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. Contractors that check this box must attached an additional :,heet showing the name of the sub -contractors and their workers' comp. policy information. I um tin employer duU is providing workers' compensation insurance for my emplgpees. Below is the policy and job site information. Insurance Company Name:_ Policy 'I or Self -ins. Lic..`f:— Expiration Date: Job Site Address: City State,'Zip:__ Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well its civil penalties in the form of a STOP WORK ORDER and a tine 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 DLA for insurance coverage verification. I do hereby certdly under the pains and penalties o 'perjury that the inl4rmation provided above is true and eorrect. J)�jiciul use only. lAu trot trrite in this' rrrc�a, ru hey �.'nmplcled hp r'i!►' r�r rrrtun ,�/ficial. C ity or Tow n: ?!vmit/License # Issuing ,Authority (circle one): I. Hoard of Health 2. Building Department :t. City/T,)wn Cleric 4. Electrical Inspector 3. 1lurnbing Inspector 6. Other Cnnt:tct "*,.ron: Phone #: E W Co Q y `oo 0 C z Ca "" v CCL Ct y CM O C O Cm It Vz c y W m :o _ acs Ca O O .16 O a O y Z ev m &NCmaC O •c H = m tC rw,Liu 30 W 5 ID a Zs=z �*U. c •- N dt O C • V m V m r•� h CL :32 1-- z Saw m [[[�U) ' (qY y C 11��11 O W Cm m C: Cm O Cm C C N CD .65 O ' 2 O g 0 cCm C h m m � H= �3 .o moo !O O d C Q c ev c Z CL V CO) O c c COD U) U) 19 W 19 W U) c o o o_ a a M C3 -d'O CLC to CU m C x .. V) w 5 .9 w VJ = w Ea a � ju x aWU U r�4 G w � w0 w cA cn o cn Q y `oo 0 C z Ca "" v CCL Ct y CM O C O Cm It Vz c y W m :o _ acs Ca O O .16 O a O y Z ev m &NCmaC O •c H = m tC rw,Liu 30 W 5 ID a Zs=z �*U. c •- N dt O C • V m V m r•� h CL :32 1-- z Saw m [[[�U) ' (qY y C 11��11 O W Cm m C: Cm O Cm C C N CD .65 O ' 2 O g 0 cCm C h m m � H= �3 .o moo !O O d C Q c ev c Z CL V CO) O c c COD U) U) 19 W 19 W U) c o o_ C O ice C N O C M C3 -d'O CLC to CU m C .. O VJ = y Ea � r0+ C O O •• y0, c E C Q y `oo 0 C z Ca "" v CCL Ct y CM O C O Cm It Vz c y W m :o _ acs Ca O O .16 O a O y Z ev m &NCmaC O •c H = m tC rw,Liu 30 W 5 ID a Zs=z �*U. c •- N dt O C • V m V m r•� h CL :32 1-- z Saw m [[[�U) ' (qY y C 11��11 O W Cm m C: Cm O Cm C C N CD .65 O ' 2 O g 0 cCm C h m m � H= �3 .o moo !O O d C Q c ev c Z CL V CO) O c c COD U) U) 19 W 19 W U) A!"40"2v!7• rPOTICIrAT= f1C I IAOil I-IV IM0111nAkII^r7 i �.�i.�ai ��. �. .. ■v. . ■ r v■ �■nr■r■ ■ ■ ■■\VV■\A■\V` �-� DATE(MM/DD Fo9/14/20 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Internet Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 522 Chickering Road North Andover, MA 01845 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. A INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER n NORFOLK 8 DEDHAM NORMAN BLAD 4 40 FERNVIEW AVE #10 NO. ANDOVER, MA 01845 INSURER B: INSURER C: INSURER o: PERSONAL & ADV INJURY $ 1,000,000 INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR INSR9 TYPE OF INSURANCE POLICY NUMBER Y EFFE DAT MM/DD POLICY EXPIRATION DATE (MM/DD/YY) LIMITS A GENERAL LIABILITY COLAAERCUAL GENERAL LIABILITY ri CW1I5 MADE ✓� OCCUR 20155 09/14/2006 09/14/2007 EACH OCCURRENCE $ 1,000,000 PDAMAGE TO REMISES Ea RENTED occuree $ 1(]0 000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN1 AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY nPROJECTM LOC AUTOMOBILE LIABILITY AMY AUTO COMBINED SINGLE LIMIT $ (Ea accident) AL_OWNED AUTOS . :.e� SJLED AUTOS Per per erson) INJURY $ ( p V HIRED AUTOS q NON -OWNED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ 19(CESSIUKBRELLA LIABILITY O1R CLAIMS MADE EACH OCCURRENCE $ AGGREGATE $ DEXCnBLE $ R�iH.iION $ $ WORKERS COUPENSAT.ON AND WL; EMPLOYERS! LIABILITYlm _ LIMITSEl ER ANY PROPRI'O-'D OFFICER/NEUSER EXCLUDED? E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ If yes. describe uxw SPECIAL PROV•SIONS below - E.L. DISEASE - POLICY LIMIT $ OTHER CERTIFICATE HOLDER .VI. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 (20Q1/08) © ACORD RPORATION 1988 T i H BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 016141 Birthdate: 03/15/1947 Expires:. 03/15/2008 Tr. no: 20180 Restricted: 00 NORMAN BLAD 40 FERNVIEW AVE #10 N ANDOVER, MA 01845 Commissioner Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 131950 Expiration: 10/13/2008 Type: Individual NORMAN L. BLAD NORMAN BLAD 40 FERNVIEW AVE #10 N. ANDOVER, MA 01845 Deputy Administrator rODlat Page # of ..3 pages Norman L. Mad 40 Fernview Ave. #10, N. Andover. Tel: (978)687-6263 Lic. #016141 - MA Reg# 131950 Proposal Submitted To: /� Job Name Job # Address � / Job Location Date / G O Date of Plans / . ! 7 O Phone #O�8 d 2_ �G,� I I ::D/I Fax # Architect We. hereby. submit. pecifieations.anoestimates for: + MIR We propose hereby to furnish material and labor — complete in accordance with the above specifications for the sum of: /150 with payments to be made as follows: S Any alteration or deviation from above specifications involving extra costs will be executed only upon written order, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents, or delays beyond our control. Respectfully submitted ��`�/? �"• Note — this proposal may be withdrawn by us if not accepted within days. acceptance of Proppol l The above prices, specifications and conditions are satisfactory and are Signature hereby accepted. You are authorized to do the work as specified. Payments will be made as outlined above. _ bate of Acceptance 3 ' D % SignatureY