Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Miscellaneous - 35 BOXFORD STREET 4/30/2018 (4)
N N° 9633 Date. �'<:��TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that`-� ,(f/ �`Q-^ S. has permission to perform ....... 1Qt .�Q- ....... plumbing in the buildingsof .... ................. at ..... ��.. .�C .�.. %`.......... , Nlortt An)over , Mass. FeeA��!.i ?.Lic. No. U/f3.. 'fV......�1 b�!. ...... A` PLUMBING INSPECTOR Check # 7 WHITE: Applicant CANARY: Building Dept. PINK: Treasurer ,, MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING�1 WORK CITY _ Oc '1 OV (r MA DATE 110 ` a ` I a. PERMIT # l� JOBSITE ADDRESS 35 60X�o�d S+ OWNER'S NAME cvi AMrra�jq� P --FAX OWNER ADDRESS _ TELF� TYPE OR OCCUPANCY TYPE COMMERCIAL Q EDUCATIONAL Q RESIDENTIAL PRINT CLEARLY NEW: f RENOVATION: REPLACEMENT: Er PLANS SUBMITTED: YES ® NO© FIXTURES'l FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM I __'_'.J I ._ ____I ..... 1 __.__! DEDICATED GREASE SYSTEM —1 ..-..____I L-1 L_..___I DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM TI ._._.._._...f ( ....._..� I I ( f J ....._..._ ._ .__... _f DISHWASHER IL-,-- ___._4 -__..J DRINKING FOUNTAIN I ..____. ( _.._.___J .......... f FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR INTERIOR f .__..___i ._____.I _____._i .....__. J _ I .._.___ i ------ _.__....__f i _J ._..__._ I .__—_.. KITCHEN SINK -_I _._._.__f __-j LAVATORY --_-_--I ROOF DRAIN SHOWER STALL SERVICE /MOP SINK _-____I ._ f __�__ _-_..___i .__.____I ____._.J _ f ___..__-_! . I ______f .... ____I ..._._._i TOILET=mg-J, __.__ -.- __.I " URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPESJ_ _ _1 WATER PIPING OTHER Mi _J _.1 _.f _J f ..--_.I f .-.. I ' ` _I __.......I I _ t ' _. i ' i i INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES fTNO0 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY Ej BOND E.I 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 _1 AGENT SIGNATURE OF OWNER OR AGENT 1 hereby certify that all of the details and information I have submitted or entered regarding this application are t e d accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in c pl- ce with ertinent vision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME I c o) G S v LICENSE # _fid 1 t 3, e SIGNATURE MP --i JP D CORPORATION 0# ; PARTNERSHIP Q# ® LLC COMPANY NAME L.ElfjW_ ADDRESS Y*1}[rr n a) q { CITY c,u �^ cL i STATE ® ZIP 3 it TEL 1 -- -,4-n S FAX CELL EMAIL ,, o r -1z N ❑ w-� W CL V The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations UV. 600 Washington Street Boston, MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Hq f-(/) (j.(' d ) l C'c) Address: 317, City/State/Zip: Lo -4 Phone #: V3 6 0 3 ' a'7 _)] Are you an employer? Check the appropriate box: L ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ 1 am a sole proprietor or partner- listed on the attached sheet. I 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. ❑ 1 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.] I employees. [No workers' comp, insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13. ❑ Other *Any applicant that checks box # 1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. F am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company ?olicy # or Self -ins. Lic. #: rob Site Address: Expiration Date: City/State/Zip: attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). ?`ilure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a irre 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 ►f up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of nvestigations of the DIA for insurance coverage verification. 'do hereby certifyrd�tliekainsgnd penalties of perjury that the information provided above is true and correct. (Q—a3—Ic�, q?(� �S_? a7 -?j Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #• 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 joint 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 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 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 may be 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 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 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: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1--877-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia j�� Ll "T cc, to • LL o M LU In C) Z: r LU"'C3 0 ca 0 ZLl 0 U) cro 0 � . fj) C/) z mw LLI f Sz �N o c� c3a c 0 1 OCC >' 1 0 nom_ �e a� aa) '• cuj dor a� 2'0 0-6- w t,tj cQT.c)ca *: LL z, L 0.>"�Y01 d o a T to 41' d «r, JAN .� .� y, c0 t to j ..Q 2 3 0 o.� gt� W l a) o1 i s a fk`t 0 �o;C�ci1CNO i -rl o� 00.N(nc.:o� . - n O cil N d o. Om . Q O N'. Q r - r �r r f Date A/,?Y//Z._ . TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ..... �. vy-)... W `� iJ,............. . has permission to perform ..'' wiring in the building of .. .... �. (Z l! .� �.................. at .... 7�.. �- X c� •. _ . _ ....... , North Andover, Mas Fee ...... Lic. No. ELECTRICAL INSPECTOR Check # 11167 Commonwealth of Massachusetts Offidal Use Only " ! Department of Fire Services Permit No. G L,6 j BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINTMINK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER C'�CT 2 9 .2C) 2 By this application the undersi ed TO .the Inspector o Wires: gn gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 3S BcycFoR1� ^1 S -f��- Owner or Tenant P6 6J MA Telephone No.978 ��Rg 3ip Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building_ U Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and.Ampacity Location and Nature of Proposed Electrical Work: No. of Recessed Luminaires No. of Luminaire Outlets No. of Luminaires No. of Receptacle Outlets No. of Switches No. of Ranges No. of Waste Disposers No. of Dishwashers No. of Dryers hhty Authorization No. Overhead ❑ Undgrd ❑ No. of Meters Overhead ❑ Undgrd ❑ No. of Meters No. of Ceil: Susp. (Paddle) F: No. of Hot Tubs Swimming Pool bo e ❑ d. No. of Oil Btarrners w'r No. of Gas Burners No. of Air Cond. Tot Space/Area Heating KW Heating Appliances o. 01 Water KW No. Heaters 1140. 01 Ballas No. Hydromassage Bathtubs INo. of Motors Total 'the ollowing table may be waived by tho rn—,t,, „r u,;_,,.. ins No. of Total Transformers KVA Generators KVA In- rnd. E-1 o. o mergency ►g ng BM atteUnits i j� ARPdIS No• Of Zones tt tection and InatinDevices itiNo. EKWal of Alerting Devices _ No. of Self -Contained Detection/Alerting Devices Local ❑ Municipal ❑ Other Conneclaon ZW Security Systems: No. of Devices or E uivalent is Data Wiring: No. of Devices or E uivalent ip Telecommunications Wiring: No. of Devices or Equivalent Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Stare 1O Zy _( 2 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. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: Licensee: LIC. NO.: Signature�,y„t (If applicable, enter "exempt " in the license number line.) LIC. NO.: -%:V 4 ^,g Address: 1 CXn ROraDl.iA y hAa 83?Bus. Tel. No.: TW Wq 6 2- 21 No *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Alt. L cl. 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 Signature Telephone No. PERMIT FEE. $ oe The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Nrashing ton Street Boston, MA 02111 c j . www_mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Aoyficant Inforatation Please Print Le--ibly Name (Business/Organizafion/individual):_ V1 ffl YW N Address:_ l l Q („ i�ROAIIt )A �AV ERN t / I City/State/Zip:_ MA Phone #:. Q 78 494 G 7 9 1 Are you an employer? Check the appropriate box: I . ❑ 1 tam a employer with 4. ❑ 1 am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. � I am a.sole Proprietor or partner- .`` listed on . the attached sheet t ship and have no employees These sub -contractors have working for mein any capacity, [No workers' comp. insurance workers' comp. insurance. 5. ❑ We are a corporation and its required-] 3. ❑ 1 am a homeowner doing officers have exercised their all work right of exemption per MGL myself. [No -workers' comp. c. 1.52, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. D Demoiition 9. ❑ Building addition 10.0 Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs I3.0.0ther ��x n I must arso nn 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 outsidecontractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheat showing the name of the sub -contractors and their work,—' MTp poiic; i ;'aimation. I am an employer that is Providing: workers compensation insurancefor my information employees: Below is the policy and job site Insurance Company Name: Policy # or Self -ins. Lic. 4: Expiration Date: Job Site Address: �5 t�' GUC�Rn ST. NatttN A t 20/e 12 Ci /State/Zi ty p:__AdA Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration dare). 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 under the pains and penalties of perjury that the information provided above is true and correct . ficial use only. Do not write in this area, to be completed by city or town official City or Town;: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Information and Instructions , w` a 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 joint 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 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 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 -contractors) 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 cant' workers' compensation insurance. if an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be 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 numberlisted 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 ort' 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 fixture permits or licenses. A new affidavit must be filled out each year. When 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 and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-72.7-4900 ext 406 or 1-8.77-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia N- 2920 ✓l.`.:. Date.... .... �/.... TOWN OF NORTH ANDOVER PERMIT FOR WIRING -- This certifies that ......: �... . ................ ........................................... has permission to perform ...,./.......... .... ............... ..................... wiring in the building of ...:�1�.:. �r.'.�� y� ..../.� T ................................................ f / at ...... ................................ ,North Andover, Mass: Fee . /.Y�.: �....... Lic. No , 6..7 V.................................. / ELECTRICAL INSPECTOR Check # � � � / WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Official Use Oniygg No. Zy`� [Permit ccupancy & Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 1 :00 (Please Print in ink or type all information) Date 01 To the Inspe of Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work cleWlibed below. Location (Street & Number �J 3F Owner or Tenant up 1%'e Owner's Address Is this permit in conjunction with a building permit Yes ❑ No (Check Appropriate Box) Purpose of Building � I � � Utility Authorization No. Existing Service Amps Voits Overhead ❑ Undgrnd ❑ No. of Meters New Service Amps Voits Overhead ❑ Undgrnd ❑ No. of Meters Number of Feeders and Ampacity Q „�` i d ;,location and Nature of Proposed Electrical Work , r, r -- No. of Lighting OutletsTotal No. of Hot fuse No. of Transformers KVA No. of Lighting Fixtures Swimming Pool Above ❑ In ❑ grnd ❑ grnd ❑ Generators KVA No. of Receptacles Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Initiating Devices No. of Sounding Devices Nod of Self Contained Detection/Sounding Devices Municipal ❑ Other Local Connection No. of Ranges Total No of Air Cond Tons No. of Di osal Heat Total Total No. Pumps . Tons KW No. of Dishwashers Space/Area Heating KW No. of Dryers0 Heating Devices KW No. of Water Heaters KW No. of Signs No. of Bailases Low Voltage Wirin No. Hydro Massage Tuds11 No. —A Total HP INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO = have submitted valid proof of same toR the Office a P= O = If you have ecked� ES pled ,ir?,aate the type of coveragts � king the appropriate box. INSURANCE = BOND = OTHER = Please Specify) L ] / C�� �j'� / / y f Estimated Value of Electrical Work $ (Expiration D e) Work to Start Inspection Date Res uested Signed under the Penalties of perju ( / V j„� /�G 7 71 C FIRM NAME �& (f / /r h Final 2 LIC. NO. 3 f LIC. NO. Tel No. lJ(J �J>/ 't v ' v lioll '' Alt Tel. No. OWNER'S INSURANCE WAIVER: i am aw that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) (Signature of Owner or Agent) Telephone No., PERMITfEE 1175 �^NORTI{ pt �.ao ,e �ti0 F 9 -"; ,SSACMUSE� Date ...... Z/A/.... TOWN OF NORTH ANDOVER PERMIT FOR WIRING 1` This certifies that ............ $ .................� ..A .......................... has permission to perform .... ...................................................... --2 r wiring in the building of .....,.. .................. v:1. �t ......................................... at............................................................................. orth And er Fee...3 :.��.. Lic. No .............. ..................................!................... ELECTRICAL INSPECTOR l� rr ch 0 WHITE: Applicant CANARY: Building Dept. PINK: Treasurer X LAIIiII1ArilUEfllt1 Af miBBc�I�SPf�S Permitotnce uta. Only f 1ItPmtnrW of ilublic $afttg Occupancy d Fee Checliod BOARD OF FIRE PREVENTION REGULATIONS 521 CMR 12:00 3M Peaw blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massacnusetts Electrical Code, 52;7C R 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dote 0* or Town of NORTH ANDOV .R To thespector of Wir a: The udersigned applies for a permit to pe rm the electrical work de ribed below. Location (Streetumber) Owner or Tena t : Owner's Address _( r Is this permit in conjunction with a building permit: Yes _ No Q/ (Check Appropriate Box) Puroose of Building U ' Ity Authorization No. ZO Existing Serve Amos � QVolts Overhead Undgrnd No. of Meters New Servi 0� Amgs/J"Voits Overnead 'Undgrna r No. of Meters -sem Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work EZVJC%z /249 /E No. of Lignting OutletsI No. of Hct cs I No. of Transformers Total KVA Swimming Prot Above— In. r-- grna. _ grna. I Generators KVA No. of Oil Eurners No. of Gas Surners No. at Air Car.c. .plat Cris No.of Heat To:a Total Pum-cs :ons KW SoacerArea ieatmo KW No. of Emergency Lighting, Battery Units FIRE ALARMS No. of Zones No. of Detection and Initiating Devices No. of Sounding Devices No. of Sort Contained Detection/Souncing Devices No. of DryersI Heating Dev ces KW Locai ; Municipal Connection Other No. of '40. a, Low Voltage / I No. of Water Heaters KW I Signs 9ailasts Wiring V) No. Hydro Massage Tubs I No. of Motcrs Total HP V OTHER: INSURANCE COVERAGE. Pursuant :o the recuirements at %Iassacnusers general Laws 1 have a current Liaoility Insurance Policy inctuoing Camc:etec Ocerations Coverage or its substantial equivaient. YES = NO = 1 have suomiltso vat, proof of same Id the Office. YES = NO = If you nave checxea YES, please indicate the typo of coverage by checx,ng the ap, p�riate oox. INSURANCE Q BOND = OTHER = (Please Scec:��) _tr . (Exotrauon al Estimated value ! !octncal Work S Work to Start Insoecnon Date Racues:ec: Rougn Final Signed under „h Penalties of perjury: FIRM NA 5 �jG � UC. N� �G License .g-a:ure LI N Sus. Tel. No. L Adtlre AIL Tel. NO. OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee Coes not nave the insurance coverage or its sudatanttal equi awn, as to. quired by Massacnusetts General Laws, ano that my signature an :nis -ermit aoptication waives this reoutroment. Owner Agent (Please cheat onel- Teieonone No. PERMIT FEE S (Signature of Owner or Agentl ■•8Sai6, 6 No. of Lighting Fixtures v\ No. of Receotacie Outlets of Switch Outlets MyNo. No. of Ranges No. of &soosa13 Q0 No. Of Dishwasners Swimming Prot Above— In. r-- grna. _ grna. I Generators KVA No. of Oil Eurners No. of Gas Surners No. at Air Car.c. .plat Cris No.of Heat To:a Total Pum-cs :ons KW SoacerArea ieatmo KW No. of Emergency Lighting, Battery Units FIRE ALARMS No. of Zones No. of Detection and Initiating Devices No. of Sounding Devices No. of Sort Contained Detection/Souncing Devices No. of DryersI Heating Dev ces KW Locai ; Municipal Connection Other No. of '40. a, Low Voltage / I No. of Water Heaters KW I Signs 9ailasts Wiring V) No. Hydro Massage Tubs I No. of Motcrs Total HP V OTHER: INSURANCE COVERAGE. Pursuant :o the recuirements at %Iassacnusers general Laws 1 have a current Liaoility Insurance Policy inctuoing Camc:etec Ocerations Coverage or its substantial equivaient. YES = NO = 1 have suomiltso vat, proof of same Id the Office. YES = NO = If you nave checxea YES, please indicate the typo of coverage by checx,ng the ap, p�riate oox. INSURANCE Q BOND = OTHER = (Please Scec:��) _tr . (Exotrauon al Estimated value ! !octncal Work S Work to Start Insoecnon Date Racues:ec: Rougn Final Signed under „h Penalties of perjury: FIRM NA 5 �jG � UC. N� �G License .g-a:ure LI N Sus. Tel. No. L Adtlre AIL Tel. NO. OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee Coes not nave the insurance coverage or its sudatanttal equi awn, as to. quired by Massacnusetts General Laws, ano that my signature an :nis -ermit aoptication waives this reoutroment. Owner Agent (Please cheat onel- Teieonone No. PERMIT FEE S (Signature of Owner or Agentl ■•8Sai6, 6 Date ....... 114§ 0 0 TOWN OF NORTH ANDOVER PERMIT FOR WIRING C> C! ru ,SS/1CMUSEt This certifies that ......... k.f..vi ...... .............................................. has permission to perform ................... ...... A ........... wiring in the building of ..... Ani, ........................................ at ...... li ......... WJ ....5t .:.............. .North dq ,Mass. Fee.,.. 14. . ........... Lic. Nora. .... ...... ELECTRICA INSPECTOR (4 WHITE: Applicant CANARY: Building Dept. PINK: Treasurer J Sof LL 0(D m O t av_ Y \ O O LL Y TO N U O_ v N V w a z z o m C ra 'LS 7 O LL tC : O � cu E t U f° O LL O W can z z m 2 J n t � O K O LL 0 W a cn ? Q W W t O O d' O U N N to O Ll- oC O �- U a Z N t to O OC AA. Z W LU 0 LU LU 6L v 7 m O Z �, N a N dl O E Ln O a C') Z m U Z N O Cfl Z V W CL Z X O UJ U W LLI -j a Z ti a L7 w ti w The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 UT www.mass.gov/dia Workers' Compensation Insurance Affidavit: General Businesses Applicant Information Please Print Legibly Business/Organization Name: Mo r {at, Z::x Address: ZE zol,1 64,, v f t1Yn Kik- -- City/State/Zip: &©9Se# dZl?� 03/0(c Phone #:C&C3 ,9S" Are you an employer? Check the appropriate box: 1.X I am a employer with If 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.] 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 10.0 Manufacturing 11.0 Health Care 12. ❑ Other *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. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy information. Insurance Company Name: n y C " is Insurer's Address: /V 04-.,, CS 791>CI City/State/Zip: 3s S f - ,t/- &QI i,e ® C kyr Policy # or Self -ins. Lic. # MO kIC 579,/a- 0 Expiration Date: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify, under the pains and penalties of perjury that the information provided above is true and correct` Phone #: ( 603 ) 0c, 95 'v? Q ?oa— 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 ACP ,C CERTIFICATE OF LIABILITY INSURANCE OD4ATE(MM/DD/YYYY) THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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 ri certificate holder in lieu of such endorsement(s). ghts to the PRODUCER PAYCHEX INSURANCE AGENCY, INC. 150 SAWGRASS DRIVE ROCHESTER, NY 14620 INSURED MORGAN EXTERIORS LLC 1306 ROCKINGHAM ROAD LONDONDERRY, NH 03053 Paychex Insurance Agency Inc IANC. jo EXT). 877-266-6850 E-MAIL Certs@paychex.com @paychex.com INSURER(S) AFFORDING COVERAGE INSURER A: NorGUARD Insurance Company INSURER B: INSURER C: INSURER D: INSURER E: 585-389-7426 NAIC # 31470 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH 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. uSR TYPE OF INSURANCE DDL UBR POLICY NUMBER POLICY EFF POLICY EXP TR NSR NVVD ___ LIMITS IERAL LIABILITY COMMERCIAL GENERAL LIABILITY =)CLAIMS-MADE[=]OCCUR EN'L AGGREGATE LIMIT APPLIES PER: = POLICY = PROJECT= COMBINED SINGLE LIMIT (Ea accident) $ LOC AUTOMOBILE LIABILITY PROPERTY DAMAGE (Per accident) $ ANY AUTO NED SCHEDULED AUTOS AUTOS HIRED AUTOS O AUONpOWNED AGGREGATE $ UMBRELLA LIAB J OCCUR EXCESS LIAB CLAIMS -MADE DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) YN N/A K yes, describe under EACH OCCURRENCE $ DAMAGE TO RENTED PRFM MCPS ( a o $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) E.L. EACH ACCIDENT $ 100,000.00 E.L. DISEASE - EA EMPLOYEE $ 100,000.00 E.L. DISEASE - POLICY LIMIT $ 500,000.00 CERTIFICATE HOLDER CANCELLATION ATTN BUILDING DEPT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRA710N 120 MAIN STREET DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY NORTH ANDOVER, MA 01845 PROVISIONS, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 (2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ EACH OCCURRENCE $ AGGREGATE $ MOWC578120 09/15/2014 09/15/2015 WC STATU- Olz- X I.. DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) E.L. EACH ACCIDENT $ 100,000.00 E.L. DISEASE - EA EMPLOYEE $ 100,000.00 E.L. DISEASE - POLICY LIMIT $ 500,000.00 CERTIFICATE HOLDER CANCELLATION ATTN BUILDING DEPT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRA710N 120 MAIN STREET DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY NORTH ANDOVER, MA 01845 PROVISIONS, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 (2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS -092194 Construction Supervisor MARC W COUTURE 42 SHERMAN DR RAYMOND NH 03077 r--j^M l- Expiration: Commissioner 07/17/2017 d,�M7-je W Office of Consumer Affairs and Business Regulation 10 Park Plaza -Suite 5170 Boston, Massacl�tzsetts 02116 Home Improvement C�ftor Registration Registration: 146964 t j - / Type: Ltd Liability Partne yTIf",I IL;� Expiration: 6/2/2017 Tr# 265529 MORGAN EXTERIORS LLC. MARC COUTURE 78 LONDONDERRY TURNPIKE HOOKSETT, NH 03106 ' SCA 1 0 20M-05/11 Cf>/ze �pom-inumureal� o��/iaae�zclu�aeao Office of Consumer Affairs & Business Regulation OME IMPROVEMENT CONTRACTOR egistration: X964 Type: xpiration :^6z Ltd Liability Partne MORGAN EXTERION` __ t ite Address and return card. Mark reason for change., U ",duress Lj Renewal E] Employment E] Lost Card License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, MA 02116 MARC COUTURE 78 LONDONDERRY TtR3ff;:` HOOKSETT, NH 03106-,,,r.r Undersecretary Not valid without signature Morgan Exteriors LLC 78 Londonderry Turnpike Unit E-1 Hooksett, NH 03106 August 14, 2015 David & Pam Amiralian 35 Boxford St. North Andover, MA 01845 Dear Dave & Pam, Thank you for the opportunity to bid on your home improvement project. I would briefly like to tell you about Morgan Exteriors, LLC and why you should choose us for your remodeling project. Morgan Exteriors protects your property by covering you with $2 million of Liability Insurance. Workers Compensation Insurance covers all of our employees so you are not exposed to any liability. We are registered in the state of New Hampshire and licensed and registered in Massachusetts. Home Improvement Contractors Registration #146964, Construction Supervisor License #CS -092194, and Lead -Safe Renovation Contractor License #LR001659. We are members of the Better Business Bureau (BBB), and the National Association of Remodelers. We have been awarded Angie's List Super Service Award as well as Elite Pro Status with Home Advisors. All of our window mechanics and estimators are certified installation experts, and attend pre -approved on-going training to keep them up to date on the latest technological advances in windows including the local building codes and window specifications. As a legitimate and dependable remodeling company, we maintain these affiliations and credentials to provide you with the highest level of confidence and customer service. With a permanent place of business and over 17 years in the remodeling industry, we take pride in our quality workmanship and specialty services offered to our clients. Very Truly Yours, Lou Chalifour 978-973-8375 (mobile) Morgan Exteriors LLC Tel: (603) 895-2092 Fax: (603) 895-1140 Email morganexteriors@yahoo.com 1�, Morgan Exteriors LLC 78 Londonderry Turnpike Unit E-1 Hooksett, NH 03106 This project has been specified in accordance with local building codes, industry standards and the manufacturer's specification requirements. Certified craftsman will install all work, to insure qualification for the manufacturer's Lifetime warranty. Standard window install consists of: • Remove interior trim stops from the sides and top of the windows. • Care is taken to cut the paint line to minimize chipping of the interior finish. • Expect paint to chip at the joints. Touch up of the interior trim is not included. • Remove the existing wood sash top and bottom. • Insulate any cavities with fiberglass or low -expansion foam insulation where possible. • Remove the parting bead if existing at the sides and top. • Apply Silicone sealant to the interior of the exterior stops. • Insulate the base/sill of the wood openings. • Insulate the head expander of the new window system. • Install the new replacement windows plumb and square. • Screw the new windows to the original wood frame. • Adjust the expander on both sides to remove any bow in the master frame. • Insulate both sides of the new windows with low -expansion foam insulation. This will prevent air movement at the perimeter of the window and reduce any drafts. The insulation also reduces noise infiltration. Interior Finish: • Reinstall the original interior trim. • Caulk the perimeter of the interior with paintable Silicone sealant. • Clean all windows upon completion and vacuum work area when done. • Canvases are used during installation when needed. • Replace any rotted framing lumber at $6.00 per foot. • Replace rotted sills at $70.00 each. 2 Morgan Exteriors LLC Tel: (603) 895-2092 Fax: (603) 895-1140 Email morganexteriors@yahoo.com Morgan Exteriors LLC 78 Londonderry Turnpike Unit E-1 Hooksett, NH 03106 Window Specifications: OKNA 500 Series Insul-Tec Deluxe Glass Type: XR-5 Double -pane with Argon ..... U -Factor: .25 XR-9 Triple -pane with Argon ..... U -Factor: .19 Remeasure, order, inspect, and install: Qty: 5 Style: Double Hung Qty: Style: Qty: Style: Qty: Style: Interior color: white Ext. Color: white Wrap exterior trim with aluminum.... Style: Grids: _contour flat Color: Solid UPC Vinyl Construction Will not scratch, dent or corrode like aluminum and wood materials. • Fully Welded Frame and Sash Eliminates separations and air leaks, supplying maximum strength and energy efficiency • Foam -Filled Frame & Sash Adds Improved Energy Efficiency � Power LiftTm Balance System Smooth Window Operation -Never needs adjustment Full Interlock with Triple Weather -Stripping Provides Low Air Infiltration for Increased Comfort and Thermal Efficiency. This Window has an air infiltration rate of 0.02cfin/ft2 which is 15 Times Less Air Draft than Industry Allowed Air Infiltration Rate of 0.3cfii4JP • One Piece Sloped Sill Eliminates Clogged and Frozen Weep Holes -Stops air infiltration and chimney effect drafts. • Insulated Extra-Strenath Glass Package Increased Strength and Sound Reduction. A- HeatSeal® Warm Edge Spacer Guarantees Your Home the Warmest Glass and Least Condensation Possible. • ClimaGuardTm Heat Reflective Coating Keeps Your Home Cooler in the Summer and Warmer in the Winter. This Reduces Heating and Cooling Costs and Significantly Reduces Harmful UV Radiation. This Window has a U -Value of .25 which is the Lowest in the Industry for Double Pane Windows. Push Button Spring -Loaded Night Latches Adds Security While Allowing Both Window Sashes to Remain Partially Open for Ventilation. Factory Installed Half Screens Thru Vision Plus Fiberglass Screens are Removable for Convenient Seasonal Storage. 3 Morgan Exteriors LLC Tel: (603) 895-2092 Fax: (603) 895-1140 Email morganexteriors@yahoo.com Morgan Exteriors LLC 78 Londonderry Turnpike Unit E-1 Hooksett, NH 03106 General Details: 1. Dispose of old windows and scrap material. 2. Work area shall be kept neat and clean on a daily basis and returned to normal upon completion of the project. 3. All work shall have a Lifetime workmanship warranty. 4. A Lifetime materials warranty shall be provided upon receipt of final payment. 5. We are a Lead -Safe EPA Certified Renovation firm and follow all lead -safe work practices as required by law. If your house was built prior to 1978 and lead paint is detected on the windows that are being replaced, there will be an additional $75 charge per window in order to comply with these laws. 6. All work will follow local building code requirements and any permits required will be obtained by Morgan Exteriors, LLC. Actual cost of these permits are the responsibility of the homeowner and will be added to the final bill. (owners who secure their own permits will be excluded from the Guaranty Fund provisions of MGL chapter 142A.). 7. We maintain a current General Liability and Workman's Compensation Insurance Policy. A copy is available upon request to verify coverage. 8. Windows will be installed 4-6 weeks from the day of re -measure (please add 2-3 weeks for custom colors or tempered glass), and will take approximately 1-2 days to be installed. Special Instructions: Replace sills and exterior brick mold casing for all five windows (included). Shrink one opening from bottom (frame, sheathe, insulate, sheet rock interior, tape and one coal seams). Finish coat and painting not included. 4 Morgan Exteriors LLC Tel: (603) 895-2092 Fax: (603) 895-1140 Email morganexteriors@yahoo.com Morgan Exteriors LLC 78 Londonderry Turnpike Unit E-1 Hooksett, NH 03106 Contract Acceptance: Upon signing, this document becomes a binding contract under law. Unless otherwise noted within this document, the contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this contract. Don't be pressured into signing the contract. Take time to read and fully understand it. Ask questions if something is unclear. A- Make sure the contractor has a valid Home Improvement Contractor Registration. The law requires most home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor registration by writing to the Director at 10 Park Plaza, Room 5170, Boston Ma 02116 or by calling 617-973-8787 or 888-283-3757. Does the contractor have insurance? Ask the contractor for his insurance company information so that you can confirm coverage, or ask to see a copy of a "proof of insurance" document. Know your rights and responsibilities. Read the Important information on the next page and get a copy of the Consumer Guide to the Home Improvement Contractor Law. 5 Morgan Exteriors LLC Tel: (603) 895-2092 Fax: (603) 895-1140 Email morganexteriors@yahoo.com Morgan Exteriors LLC 78 Londonderry Turnpike Unit E-1 Hooksett, NH 03106 Certifications & Affiliations: Angie's List Super Service Award Winner 2014-2012 Energy Star Retail Partner Elite Pro with Home Advisor New Hampshire Better Business Bureau (BBB) Factory Direct OKNA Window Dealer Factory Direct Authorized Sunspace® Dealer INVESTMENT TOTAL FOR SPECIFIED WINDOWS We hereby propose to furnish all labor and materials in accordance with the above specifications for the sum of: $4,264 rnix r►u.auucs do uuupuns anu uiscounis. 1/3 Due at acceptance of proposal Deposit received: Date: 08/14/15 2/3 Due at completion Check #: 3944 Amount: $1,422 DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Homeowner's Signature Date 08/14/15 Homeowner's Signature Date Contractor's Signature Date 08/14/15 "You, the buyer, may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction. See the attached notice of cancellation form for an explanation of this right." Terms and Conditions Since this contract is for made-to—order goods, it is not subject to cancellation other than the inability to obtain financing or proper permits. If you cancel this contract any time subsequent to the third business day after the date of the contract and prior to the start of work. You agree to pay us the difference between our estimate of the cost of material and labor and the amount of the total sale. (Our lost profit) You agree to pay according to the above schedule of payments. If you fail to pay according to the terms above then you must pay a collection cost equal to our actual costs of collection up to 15% of the total amount you owe. Plus attorney's fees and court costs. Any unpaid balances will incur interest charges of 18% annual or 1.5% monthly. 6 Morgan Exteriors LLC Tel: (603) 895-2092 Fax: (603) 895-1140 Email morganexteriors@yahoo.com Morgan Exteriors LLC 78 Londonderry Turnpike Unit E-1 Hooksett, NH 03106 NOTICE OF CANCELLATION YOU MAY CANCEL THIS TRANSACTION, WITHOUT PENALTY OR OBLIGATION, WITHIN THREE BUSINESS DAYS FROM THE ABOVE DATE. IF YOU CANCEL, ANY PROPERTY TRADED IN, ANY PAYMENTS MADE BY YOU UNDER THE CONTRACT OR SALE, AND ANY NEGOTIABLE INSTRUMENTS 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 YOU'RE RESIDENCE, IN SUBSTANTIALLY AS GOOD CONDITION AS WHEN RECEIVED, ANY GOODS DELIVERED TO YOU UNDER THIS CONTRACT OR SALE; 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 CANCELLATION, YOU MAY RETAIN OR DESPOSE OF THE GOODS WITHOUT ANY FURTHER OBLIGATION. IF YOU FAIL TO MAKE THE GOODS AVAILABLE TO THE SELLER, OR IF 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 MORGAN EXTERIORS AT 78 LONDONDERRY TURNPIKE UNIT E-1 NOT LATER THAN MIDNIGHT OF 08/18/15 HEREBY CANCEL THIS TRANSACTION. Date: Buyer's Signature: 7 Morgan Exteriors LLC Tel: (603) 895-2092 Fax: (603) 895-1140 Email morganexteriors@yahoo.com EL ERGY STAR`'QualifiedENERGYSTARIn A1150 States 11