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16 MASON ST - BUILDING INSPECTION The Commonwealth of Massachusetts W Department of Public Safety Massachusetts State Building Code(780 CNIR) Building Permit Application for any Building other than a One-or Two-Family Dwelling .(This Section For Official Use Only) — O Building Permit Number: Date Applied: Building Official: o SECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which a street address is not ax!jlable Vla Masnne5keca Sal ern 01970 9 om t No.and Street r City/Town Zip Code Name of Building(if appli le) 2>H SECTION 2:PROPOSED WORKm Edition of NIA State Code used_ If New Construction check here❑or check all that apply in the two row bellsn ^� Existing Building❑ Repair$ I Alteration ❑ 1 Addition❑ 1 Demolition ❑ (Please fill out and submit ApRgpdix I L1 Change of Use ❑ Change of Occupancy Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No'. Is an Independent Structural Engineering Peer Review required? Yes ❑ No Brief Description of Proposed Work:.QeMOVQ, 'i 'X t n or e.bedil o x' 2 O n SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CNIR 34) ❑ Existing Use Group(s): IProposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Flours/Stories(include basement levels)&Area Per Floor(.q. ft.) Total Area(sq. ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as applicable) A: Assembly A-I❑ A-2❑ Nightclub ❑ A-3 ❑ A4❑ A-5❑ B: Business ❑ E: Educational ❑ F: Facto F-1❑ F2❑ H: Hi h Hazard H-1 ❑ H-2❑ H-3 ❑ 1-14❑ H-5❑ 1: Institutional 1-1❑ 1-2❑ 1-3❑ I-4❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3 9 R4❑ S: Storage S-I ❑ S-2❑ U: Utility❑ Special Use❑and please describe below: Special Use: SECTION 6:CONSTRUCTION'IYPE(Check as a licable) IA ❑ Ill ❑ HA ❑ 111) ❑ HIA ❑ 1110 ❑ I IV ❑ I VA ❑ VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CNIR 111.0 for details on each item) Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: Public❑ Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be Licensed Disposal Site❑ required❑or trench or specify: Private❑ or indentify Zone: or on site system❑ permit is enclosed❑ Railroad right-of-way: Hazards to Air Navigation: \1A I ki .t 4- num i ..I .... w� c Not Applicable❑ Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed❑ 1 Yes❑ or No❑ Yes❑ No ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: -• Use'Group(s):_ Type of Construction:_ Occupant Load per Floor: Does the building contain an Sprinkler System?: --Special Stipulations: __ SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner , 50C Lbe.ureux to Mmop S rye+ Salem Ola '70 Name(Print) No.and Street City/'Town Zip Properly Owner Contact Information: Mr, 9 --1�a — IheureUxly3�' mad Title . Telephone No.(business) Telephone No. (cell) a-mail address If applicable,the property owner hereby authorizes Name Street Address City/Town State Zip to act on the`property owner's behalf, in all matters relative to work authorized by this building permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) If building is less than 35,000 cu.ft.of enclosed space and/or not under Constmction Control then check here and skip Section 10.1 10.1 Registered Professional Responsible for Construction Control u Name(Registnt) Telephone No. e-mail address Registration Number .ra t Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor Iq- a-sonoi 'T)O(A - — Wne-,MprV4XeV Cmw*r i789i6 fi'a 1 15�Ivy err 5o�'ly e><,A Ira Company Name �*-(°SSL-/oy�.�� E" p : Name of PersoA Responsible for Construction License No. and Type if Applicable lP-Slip. Rort6 I aS c U i CFl State D L Street Address City/Town Zip Q-79), 312 - IG?i� (1heri+h . smifig &,Cyn0II. Co Telephone No. business Telephone No. cell a-mail address SECTION 11:WUitKFK.9'COAu'ENSnrIONwSuf::wcB:uFiDiwtr M.G.L.c.152§25C6 A Workers'Compensation Insurance Affidavit from the NIA Department of Industrial Accidents must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Is a signed Affidavit submitted with this application? Yes KNo ❑ SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Estimated Costs:(Labor Item and Materials) Total Construction Cost(from Item 6)_$ I. Building $ aJ~� r Building Permit Fee=Total Construction Cost x_(Insert here 2. Electrical $ appropriate municipal factor)_$ 3. Plumbing $ d. Mechanical (FIVAC) $ Note:Minini un fee=$ (contact municipality) 5. Mechanical Other $ Enclose check payable to 6.Total Cost y 5 O OD (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below, 1 hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowle a and understanding. ril h .Smrlh W t K, G2 IQ3.2�/o Ib� Ple;Lse print uud sign name isle Telephone No. Date �I L2��le_ h�7at1 � xf)�l rM I . C7I9W Street Address City/Town State Zip Municipal Inspector to fill out this section upon application approval: '""' s-a-4,j C/ Name Dater O W rlT� 1 The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia «`orkers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual) r4 T�o[nr Address: 4 tet�I e Rd City/State/Zip: $�U t( h (� U• 9� Phone #: q 18 -312 Are you an employer?Check the appropriate box: Type of project(required): L❑1 am a employer with employees(full and/or part-time).` ]. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in $. ❑Remodeling any capacity.[No workers'comp.insurance required.] 3.❑I am a homeowner doing all work myself[No workers'comp.insurance required.]t 9. El Demolition R 10❑Building addition 4.❑I am a homeowner,and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 1 I.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ 6.*t4W a are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other re poi r s 152,§1(4),and we have no employees.[No workers'comp.insurance required.] -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. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: 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 MGL c. 152, §25A is a criminal violation punishable by 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.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 ofperjuty that the information provided above is true and correct. Signature: iku-' e �t6 Dat p Phone#: -1 78 �l 3I Q —� MJ)- 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 Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia CITY OF SALEM, MASSAGiUSE M a BUILDINGDEPARTMENT 120 WASHINGTONSTREET,3ADFLOOR 1IEL.(978)745-9595 KMERLEYDRISOOLL FAX(978)740-9846 MAYOR TMMAS STYIERRE DIRECTOR OF PUBLICPROPERTY/BUIIAING oc)MMISSIOMR Construction Deb ris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 CMR, Section 111.5 Debris, and the provisions of MGL c40, S 54; Building Permit# is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste deposit facility as defined by MGL c 111, S 150A. The debris will be transported by: MQSG(1ry (name of hauler) The debris will be disposed of in: (name of facility) J12� Tr��✓�Offac�IlTity) as�I ( ►'YID QH3S (address q�6'-�(0 _ii, aS Signature of applicant Date i Massachusetts -DeoartmenE of=ubvc Sale y Board of 3utlding Regulations and Standards - Construction Supervisor SpeciultA License: CSSL-104227 - - - JEFFREY A SMITI 4 LESLIE RD •c'if _ - IF.SWICH MA Of938 J.��ifJCa�...�t19�• _X pk?37i3!l - Commissioner 1 212 0/201 5 ,y e �rovini nolyde'<12£2 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 159704 Type: DBA Expiration: 5/19/2016 Tree 2506U MASONRY DOCTOR JEFFREY SMITH 4 LESLIE RD. IPSWICH, MA 01938 Update Address and return card.Mark reason for change. Address Renewal Employment Lost Card sca i s zom-osm 11'l�.til����-- A a CERTIFICATE OF LIABILITY INSURANCE 3i 15 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 CERFIFTCATE 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 rights to the certificate holder in lieu of such endorsemen PRODUCER NAME: Circle Bn91ne9a Insurance ALJB PHONE FAX N 247 Newbury Street fflADDRESS:Danvers, MA 01923 INSURE $ AFFORDING COVERAGE NAIC4 IMSURERA:Main Street America Group INSURED IMURERB:Safety Indemnity Insurance Masonry Doctor Inc. INSURERC: 4 Lesley Road INSURER D: Ipswich, MIL 01938 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR Am SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICYNUMBER WMN NMDD'YYYY LINTS A GENERALLIABILI Y MPT8936G 1/24/15 1/24/16 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ SOO OOO CLAIMS-MADE OCCUR MED EXP(AM ore perm) $ 10,000 PERSONAL 4 ARV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMITAPPUES PER PRODUCTS-NhflIOP ADD $ 2,000,000 X POLICY PRO LOC $ B AUTOMOBILE LIABILITY 6222838 4/28/14 4/28/15 C MINEeDNSINGLELIMIT $ El ANYAUTO BODILY INJURY(Perperson) $ 250,000 AUTOS ALLOWNED X SCHEDULEDAUTOS BODILY INJURY adern $ TjQQ rQQQ X HIRED AUTOS X AUTOS NON-OWNED (P ag dR1�DAMAGE $ 100,000 UNBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESSLIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC uTATU- OTH- AND EMPLOYERS'LIABILITY Y I N FR ANY PROPRIEOPJPARTNERIEXECUTME ELEACHACODENT $ O CERMEMBER EXCLUDED? NIA amain w,,in NH) EL.DISEASE-EA EMPLOYE If s,deseibeender DESCRIPTION CF OPERATIONS blow EL DISEASE-POLICY LIMB DESCRIPTIONOFOPERATIONSILOCATIONSIVEHICLES (Ambck ACOR0101,Addlloml Remarksstl ub,NmmaspambmgwT ) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Joe L r HBureux ACCORDANCE WITH THE POLICY PROVISIONS. 16 Mason Street Salem, MA 01970 AUTHORIZED REPRESENTATIVE Paula Balas ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: lheureuxl43@qmail.com �,�o�x�� ��� The Commonwealth of Massachusetts Department of Industrial Accidents j Office of Investigations ;. I Congress Street, Suite 100 Boston, MA 02114-2017 May 14,2013 Masonry Doctor,Inc. Four (4) Lesley Road Ipswich,MA 01938 Notice of Decision Regarding Affidavit of Exemption for Certain Corporate Officers or Directors Pursuant to the provisions of MGL 152, Section 1 (4)as the amended by Ch. 169 of the Acts of 2002 your affidavit has been reviewed and the Office of Investigations has determined the following: NOTE: It is your obligation to submit an approved affidavit to your insurance carrier in order to complete this process. X The affidavit was approved on 5/14/2013 . Attached please find your approved —affidavit. The affidavit was rejected on . Your affidavit was rejected for the following reason(s): Related SWO Case ID#: Affidavit ID#: 155738 �i FORM 153 The Commonwealth of Massachusetts DIA Use only Department of Industrial Accidents Office of Investigations-Dept. 153 �-� One Congress Street—10th Floor,Boston,Massachusetts 02114 http:/Iivww.niass.gov/dia InvestJSWOID#: - AFFIDAVIT OF EXEMPTION FOR CERTAIN CORPORATE OFFICERS OR DIRECTORS Chapter 169 of the Acts of 2002 amended M.G.L. c. 152, ¢7(4) by adding the following paragraph: 'This chapter shall be elective for an officer or director of a corporation who owns at least 25 percent of the issued and outstanding stock of the corporation. Notwithstanding section 46, these provisions shall apply only if the corporate officer provides the commissioner of industrial accidents with a written waiver of his rights under this chapter. Said commissioner shall promulgate regulations to carry out the purpose of this paragraph. Violations of this paragraph shall subject the corporation to the penalties set forth in section 25C.- — — -- - - _ Pursuant to M.G.L. c. 152, §I(4)as amended, I/We the undersigned officers of: —(Name of Corporation an�iess) each holding at least 25%of the issued and outstanding stock in said corporation, do hereby invoke the right to be exempt from the provisions of M.G.L. c. 152, §25A and therefore are not required to carry a, workers' compensation policy covering the undersigned corporate officer(s)or director(s). I/We the undersigned do also waive any and all rights to make claims for benefits as defined in M.G.L. c. 152 for any injuries that may be sustained while in the employ of the above-named corporation. Further, I/we the undersigned do understand that, should the above-named corporation hire or have in its employ any employee(s) in addition to the undersigned corporate officer(s)or director(s),said corporation is required to obtain workers' compensation coverage for the employee(s)as prescribed by M.G.L. c. 152, §25A. I/We the undersigned have read and understand the statements and obligations as delineated above and I/we have checked the appropriate box below my/our name(s)indicating my/our desire to be exempt or not to be exempt from the provisions of M.G.L. c. 152. Signed under the pains and penalties of perjury: 'yqq f n m Print Nae Title Date(mm/dd/yyyy) AV is t exercise my right of e n or ❑ I wish NOT to exercise my right of exemption Signature Print Name&Title Date(mm/uwyy� yy) I wish to exercise my right of exemption or ❑ I wish NOT to exercise my right of exemption Signature Print Name&Title Date(mm/dd/yyyy) ❑ I wish to exercise my right of exemption or ❑ I wish NOT to exercise my right of exemption '�- ❑Signature Print Name&Title Date(mm/dd/yyyy) 1 wish to exercise my right of exemption or ❑ I wish NOT to exercise my right of exemption Note:ALL ELIGIBLE CORPORATE OFFICERS MUST SIGN THERE CAN BE NO MORE THAN 4 SIGNATURES.InStruct%ons on back. Form 153-Revised 06-04.10 pi an }` \\ At Nlv\ `i t � 1}�}: . S "t �. ,gam g. s�#'°�'1} F�„ �'*• � \\YIf T" 1 Tl 1 + aSS r yu .fir �.c y � �� � � �F �'�,�}� ®• fin. " � � A-� IJ/J`I l Yfh C - y , .: IT 1 1 j4 4 f�} h b r• I "} V i f'. .,a �+.- "t l .. t. �xh 6 � !IV, F. V cn fy-(Le4-- Pn'c,e it Masonry Doctor Inc. 4 Leslie Road Ipswich,Ma. 0 193 8 Cherith.smith@gmail.com www.masonrydoctor.com \` 978.312.1932 CUSTOMER SERVICE AGREEMENT AND WORK CONTRACT This is an agreement between Joe Lheureux (customer) and The Masonry Doctor Inc., 4 Leslie Road, Ipswich, Ma. 01938. Under the terms set forth below, Customer agrees to purchase the services of The Masonry Doctor Inc., in preparing and constructing the project as set forth in the Project Description, and The Masonry Doctor Inc. agrees to render such services. As consideration, Customer agrees to pay The Masonry Doctor Inc., the amount shown as `Total' in the Project Description(`Contract Price') in exchange for performing the services described in the Contract Description. The parties further agree as follows: PAYMENTS Customer will pay the Masonry Doctor Inc. a retainer fee of$2,085.00 with a signed contract on or before the start date of the project. The customer will pay the Masonry Doctor Inc. the remaining balance ($4,165.00) upon completion of the project. CHANGES The Masonry Doctor Inc., will make reasonable efforts to complete the contract as designed. Circumstances may arise beyond the control of The Masonry Doctor Inc., that may prevent construction of the Contract exactly as planned. The Masonry Doctor Inc., will make reasonable efforts to minimize this impact on the design and construction. Customer acknowledges this possibility and accepts the action The Masonry Doctor Inc., will take to minimize the potential change in design. If Customer wishes to change any part of the instillation after this agreement is signed, but prior to the commencement of installation, which results in additional material or labor costs for The Masonry Doctor Inc., or results in delays of the completion of the Contract, said costs will be added to the remaining balance of the Contract and billed as part of the original Contract. Any changes in the design or Contract, whether the changes result in additional time, cost or neither, must be made in writing and signed by both parties, using a Change Order Form. LIABILITY The Masonry Doctor Inc., is not liable for injuries of Customer or others on the Customer's property injured by or on machinery, supplies or work area constructed and used by The Masonry Doctor Inc. The Customer is not liable for injuries of Masons while working and completing the Project Description. The Masonry Doctor Inc., is not liable for water issues that arise from high water tables, in unaddressed areas, or due to underlying unresolved problems. PROJECT START AND COMPLETION An estimate of the number of days to complete the contracted work and expect start date are provided as a courtesy. There may be delays in the start date and completion date due to poor weather or other circumstances beyond the control of the Masonry Doctor Inc. Those delays will not alter or invalidate any part of this Contract, nor will they entitle the Costumer to additional rights under the contract. TERMINATION This agreement may be canceled by the Customer by mailing written notice to the Masonry Doctor Inc., 3 business days prior to the Start Date of the Project, as stated in the Contract. JOB DESCRIPTION Job Site: 16 Mason Street Salem, Mass. 01970 Total: $7,000.00 DISCOUNT: -$750.00 TOTAL: $6,250.00 Anticipated Completion Timeline: 1-1 '/2 weeks Project Start Date: Saturday,March 28, 2015 or Monday,March 30,2015 Project Description: Remove approx top 4' of existing exterior chimney; Grind and repoint remaining bad joints; Rebuild top 4' of existing exterior chimney; Install flashing; Dispose of debris; Clean job site • Please note that the existing exterior chimney has deteriorated over the winter. If the mason conducting the repairs deems that there is a need to replace more than the originally quoted top 4' of the existing exterior chimney then the homeowner will be contacted prior to any additional work is completed to review the project and approve a price change/work description change if needed. PAYMENTS $2,085.00 retainer fee due on/or before project start date(with signed contract) $4,165.00 paid upon completion C�e�L Make check payable to: Masonry Doctor 4 Leslie Road Ipswich, Mass. 01938 This agreement shall be interpreted and enforced in accordance with the laws of the State of Massachusetts. 3�z Customer(Print) Date 312 eC omer(Signature) Date asonry Doctor Inc. March 26,2015 T e Maso�to C. — Date ��MASOh� I IL u Cd`pRg Masonry Doctor Inc. 4 Leslie Road Ipswich, Ma. 01938 Cherith.smith@gmail.com www.masonrydoctor.com Phone: 978.312.1932 Fax: 978-412-9403 JOB ESTIMATE #2014150 DATE: Monday, March 16, 2015 CONTACT: Joe L'heureux r� JOB SITE: 16 Mason Street Salem, Mass. n \\ PHONE: 978-332-0072 EMAIL: lheureux143@gmail.com PROJECT DESCRIPTION: (option #1) Remove approx 4' of existing exterior chimney; Grind and repoint remaining bad joints; Rebuild 4' of existing exterior chimney to code; Dispose of debris; Clean job site PRICE ESTIMATE: (option 41) $6,250.00 ADD: Install flashing: $750.00 PROJECT DESCRIPTION: (option #2) Remove chimney to roof line; Rebuild chimney in existing footprint to code; Install flashing; Dispose of debris; Clean job site PRICE ESTIMATE: (option #2) $7,750.00 • Please note that we are offering a -$750.00 discount on the final billing of this project if it is scheduled in December 2014, March 2015, or April 2015. THANK YOU for your interest and have a wonderful week!