22 SUMMIT AVE - BUILDING INSPECTION (5) Fhe Conurlonwealth of (Massachusetts
Department of Public Safety __-
II ( j' \Ll,ndrhu,t•II.S SIM" Builkiilig Code(7"40 C,MIQ
1uilding Permit Application for any Building other than a One.ar'1'svo-Family Dwelling
(I his Suction For(tffir ial Use Only)
Building I'ermit Nmnber -._ l.)ate Applied: -------- Building Official:
SECTION 1: LOCAI ION (['lease indicate Block N and Lot p fur locations for which a street address is not available)
o1a_ S(�n_
\'u. .nld Stroet City /Town Zip Code Name ut bottling
SEC HON 2:PROPOSED WORK
Edilion"I MA State Code used - _ It New Gmstruttiun thcrk here❑or check,ill Ibdt,lpph' in the two nnry bvluw_ __
lixislinl{ Built ingj�� I?vimi \Iteration ❑ Addition❑ Demolition ❑ (('(vase fill uul.wd submit.\ppcnd ix 1)
Change of L'se ❑ I (•hang..of Occupaltry ❑ Other ❑ Specify:
:\m building plans and/ur auslnttliun Jd M'wucnts being supplied as part uF(his pcnuit application? Yes ❑ No ❑ -
Is an Independent Structural Ent;incertn' Peer Review myuimd? Yes ❑ No ❑
Britt Dvstriptiun of Proposed
SECTION 1 COMI'LL I E I IIIS SECHON IF EXISTING BUILDING UNDERGOING RENOVATION, AUDITION,Olt
e-t1ANGE"'USE OR OCCUPANCY
Check here it an Existing building Investigation and Evaluation is enclosed (See 780 CMIt N) ❑
E\isling Use Gruup(s): .__..___ _ Proposed Use Gnw +s
SECr10N 4: BUILDING MIGHT AND AREA
Existing Proposed
\'u.ut Floors/Stories(i ndude basement levels)dr Area Per Fluor(sq. it.) n,i
Toted Are.t(stl ft.).ual romi ticight(tt.)
SE("I'ION 5:USE GROUP(Check as a licable)
A: Assembly:\-I ❑ :\-_'❑ Nit;bhlub ❑ :\,) ❑ A4 ❑: :1-i❑ B: Business ❑ F: [educational ❑
P: Facto F-I ❑ 102❑ s 11: I Il h Hazard 11-1 ❑ 11-2❑ It-f ❑ 11-4❑ 11-5❑
I: institutional I-I ❑ 1-2❑ 1-1❑ I-4❑ M: Mercantile❑ It: Residential R-10 R-2❑ R-t❑ R-I ❑
,S: Storage 5-1 ❑ S-2❑ U: Utility❑ I Special Use❑.end please dc,tn be below:
S pee 61 Use
SECTION 6:CONS T RUCrION TYPE (check as a ([cable)
IA ❑ IB ❑ IL\ ❑ IIB ❑ IIIA ❑ 111110 IV ❑ VA ❑ \'ll ❑
.Sl:( NON 7: kit"TE I.NFOR,MA IION(refer to 781)('..\Ilt 11IA fur details on each item)
water Supply: Flood Lune Information: Sewage Disposal: Trench I'ennit: I)ebris Renwval:
Public Cl Clink It ouhide 1111,111 Zvniv❑ Indit,lte ummity'll ❑ A bench wlll not be I Irvmrdl I)i,pus,d ;il,.Cl
1'rt%.mt•❑ or mdvnlils' /vnv' r.r,nt iiv,tslcln ❑ w,joir-d ❑nr Irvnt It or,perlit
- .
pvrurt i,ant IViedl ❑
Itminmd right-4 w,ty: I larards In.\ir .\'•w igatton: ' ,
\51 \( IIrc.11dr ❑ I,�Inid lun• �d ilhm .nrpn-t.ifpriddh orva' I hlhcir rrt'irry vnlldlyd'
r CA vnd'nl to lfuiLl end lu,rd ❑ I A d', ❑ , r A'I 0 1 r, ❑ V'u ❑
SF( IIO,V 9: C(l.V I F.VT OF( tlt I lll(',\f ie OF(tCcl,'I'.\.V( Y
I ,Inln d lJd' ( �r l;mul'I,I Itlr I l: u.lnid h„ii t`ddup.intl ,.iJ la'rllo„r _
I ter. Ilir j l'odJM); nl.un.m1 -Imklar tid,lrm' ti I Inv 1.11�Upuluwn,
I�
' 4
SlfClll)N `I: 1'RUI hIt IY UWNLI
nnv,ind \,Idwssol Pro1wrtv (%knot
- - --
3o-Sh--rttuS
V,une (I'rin t)
No. aml tilrccl City/town
Prollvrty OwnrrContact htlon»ation:
.:.___..--.- ---- �-frl �---- c-mailaddress
title rphunv Nu. (business) felvphone No. (cell)
It opplicobie, thv properly owner liort•tiv ,utthoriirs
... _- ._. Name _— . tilrccl Address City/ I'owtt State zip
to lit an the property owner's behalf, in all nutters rclalive to work aulhorizcd b • this buildill+ tcrinit application
SECTION too CONS'I KUL rION LON'I'KUL(Please fill out Appendix 2)
If boil hit«is less 1h,u05,01J0 cu. It,of endowd s,ace and ur not under Construction Control then check here❑and ski r 5cdin❑ 11)I
It6l I�e'istered Professional Res onsible far Construction Control
Nome(Registrant) _--.::-I'clephonu No. c-11miLuidress Registration Number --
..__ Rnyn State Zip Discipline Expiration Date
city/strret Address y/
10.2 General Contractor
Company Name /.
Tl l�_Y?b b
Name of Person ResponsibleLicense No. and type if Applicable
for Construction _
�� �94 b£
Strcet vftlrcis City/Town State Zip
97g
rove ,hone No, business Tde phone No. cell e-mail address
SECTION11:t\, v:>.rK, It�.vi'rv.tip+,, [Nt-lINAM.L.A11 it",t'tt M.G.L.cl52. 25C6
A lVorkars"Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be tout pleled and
submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building pernit.
Is a ei+ned Affidavit submitted with this a lication? Yes 0 No ❑
SECTION 12:CONSTRUCTION CUSTS AND PERMIT FEE
Estimated Costs: (Labor
Item and :Materials) Total Construction Cost(from Item fi) ' 5----
41
I. Building S 13 b20 building Permit Fte'Total Construction Cost x —(Insert here
_. Eltctrical 5 appropriate municipal faelur) ' 5—
Note: iiii"I'll"In (cv ''S_--(.
J. \IcChanic,d (IIvAC) S ' . /
i. Mnh,ulicoi (Other) 5 O I-nclnse ihcik payable to` --- -- < —
t,. I„10 m
l Cast '+ 3 O �? (C, tait ntnniiipalit}') and tail •check number tore .._ .... _
SECTION 13:SIGNAIURE OF BUILDING PERMIT API'Ll -AN-r
Ilk rntonllt; 111% naule holow, 1 herebV attest tuttlrr tilt'pains and pcn,dlics of iwitiry that all o the itihmilation i.mt.uned of this
.tl'iliiation is true on.l act wrote to the beet of m) knot.Irdge.nul tinders Lnidin
A z 1?7$. 53(. $'3 3
I'h•.isr ivint and alpt o,u»v
_. IIAt, l,�lephoity Xo. lt,ur
tart \,I,Ircts
� 3 � Wx411.��y1 ant, f,,,.n
\hmiiipal Impeder to fill out this settiun upon .uppliculion approval: r' Nll /t'�j�✓l�p\)�
The Coinniornvealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
UIV wwwanass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/ContractorsX, Icetricians/Plumbers
Applicant Information Please Print Leeibh'
Name (Business/OrganizationAndividuap: Len Gibely Contracting Company
Address: 23R Winter Street
City/State/Zip:
Peabody, MA 01960 Phone.#: 978 531 -8234
Are you an employer? Check the appropriate box: Type of project(required):
1.® I am a employer with 12 4. ❑ I am a general contractor and 1
employees (full and/or part-time).* have hired the sub-contractors 6. New construction
2.0 1 am a sole proprietor or pamper- listed on the attached sheet.. 7. ❑ Remodeling
ship and have no employees These sub-contractors have g. ❑ Demolition
working for me ht any capacity. employees and have workers'
b > P' X t 9. ❑ Building addition
[No workers' comp. insurance comp. insurance.
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ 1 am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or addition,
myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs
insurance required.] t c. 152, §1(4),.and we have no
employees. [No workers' 13.❑ Other
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: A. I .M. Mutual Insurance Company
Policy#or Self-ins, Lic. #: 6010979012012^^ Expiration Date: 08/03/2013
Job Site Address: a:;� Cir r r+aI— t`ie c y City/State/Zip: ,C�1 1�_ , ,N
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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under theme pains and penalties of perjury that the information provided above is true and correct
Signature: � �`3lr'�—� Date:
Phone #
Official use only. Do not write in this area, to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone#:
JUL-24-2012 10.42 8ennott Insurance 978 887 2404 P.01i01
r CERTIFICATE OF LIABILITY INSURANCE °"'�o"r2412012
THIS CLRTIEZCATE TB xa BUBO AS A MPLTTte 0r n1E01a®TION mnLy AND ONILPi NO axONTS Ulm THE CEREIML B MOLDER, TBIB CERTIFICATE
DOE$ NOP ArEIRBATIVESY OR OBOATIVIMT MGM, ExTrLmo OR RIVER am c,nmahaz ArymozD By WRz POLICIES o"cn,. TRIP OBRTZEICATR or
imSURANCE DOES m0'T cQuISTITnIt A CONTRACT BETMMEN In ISBVIMR INSUBERUA) , AWEROUZW REPARSEN'PTTIVE OR PRODUCER, AHD ENE
LYB1`IIa1CATE MOLDER.
MPOATANT: IE woo certlfi.&" boldeE is sn ADDITTOMML W5URED, the VolicyliOs) most be endorsed. If SUBROGATION IR WAIVMn, suh3set
to the team, and condition+ of the V0310y, pertain POLLcisf WAY require so eBOer,ewsnt. A et.tasont on this oertiELOSto does not
ooMer elgbts to the certlfioate bolder in 11s0 of such eud"d6lantis)
erP mREOT
Eduard S Sennott Insurance rN! rM
Agenoy Inc .11.e.. dal: wc. pl.
16 South Main Street s°..fl
,amacas
Topafield, MA 01983— eD ew! Ral.
I,FYDIII An aw,AYE u0 1
VIVA. ,.wY..: A.I.N. Mutual Ineuran= CO 3375E
Len Oibely Contracting Company Inc _
23 Winter Street Rear
Peabody, b!A 01960-5941
nFRsr Li
cOUEAAOSB CERTIFICATE NUMBER:- ARVISION NUBffiER:
TRI: le To CPTTIPT nw THE P11ICIW OR IABNBABCr LISIW BELOW HAVE {a TO THE INSURED &TO ABOVE FOR THE FOLICY PERIOD INOICJITW.
HOTAITNSTAIIDINS ARY moutpeon, TIAM M covoiTFOR or RTrf CONTRACT OR �DOCVI'mNI WITH RESPECT To "ICTT IRIS CERTIFICATE NAY BE TeelCD OR EOu
t%BTAIN, ' IHSUMBCB A EORDm BY THE POLMIra DESCRIBED HENEm IS BVNICCT TO ALL THE TERMS, GLLUe TOMB ANO COMITIONS of SVCN WLICSS. LMTF SHOTQI
b4T HAVE BEEN REDVC. BY RAM CLAM.
"LIVE VVICZA POLICE Err POLICY M LAIISS
TYPE Or INSUPAncz OVwmm Ww,wen
OEXQUou LSMILITY ¢,q coccu,m
R.a, 1—1— L,ASIUTY own re
❑❑cu.re.Me QoDcn raPnmw..asmnYw °
❑ IINCYK f W „JO,R H
❑ ro Luux RPPLT,a,A. www cm,eu 1
❑nn.,r..A❑rx r pu,. vamacr, -can/w .m 1
A,ITDYIBILE LIAS.1 " cmnwa ....
7— w11 I...eet0 M' !
�nCL OAM0 ntttpi 599,1T C , 10.!Mlwnl
�gOH>n0.¢o w,m DOPTtr..0..aCw.nU 1
�ina:-rswn A.inn r Y�rr one 1
m w+as 0•• rml
❑unoalLu ,wb O;/AtR aAq OWa,NFB /
�CeK C! mine � ('IAMf MLO AW9mr! C
OP6TEMION % E
MVEV O'EP SAr ION aw'
AAD mwYEEs zzARairr
THE PROPRIETOR/PAN'TNSM/ RL. ru,court E BDD,DDD
A EXECUTIVE oYY,CSNa AR8
❑ inc) ® EXCI 6010 97 9012 012 .L. a.7 -room L,wr 1 500,000
08/0�/2012 OB/03/2013
n°aImu a 500,000
I
CB.RTISICAT3 BOMM CANCEI.T ATION
Evidence Of Insurance tN0t1 WE of TER' AND MSCRIaER ¢PDLICIFA BE CAAMM IsloWs TI
091RATIoN MTE TWRIDE, MOPIQ WILL BE DELIVERED IN ACCO®LRCE WITH THEE
MLICT PPCI•TBIORB.
am.oYllw.r n! /J/T
TOTAL P.01
JAN-24-2012 14:35 Sennott Insurance 978 G87 2404 r.0,
•v r r rP __ _ ._ _ . _ — .. _ _. _. _
01/24/2012
PRODUCER 979.887.4900 FAX 978.387.2404 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Edward F. Sennott Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
16 South Main Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P. 0. Box 451
TOpsfield, MA 01983 INSURERS AFFORDING COVERAGE NAIC t
INsuREu Len Gibely Contracting Co. , Inc. - INSURER Catlin Specialty Insurance Co__. _ _ _
23R Winter Street INsuRERs. L19033
_ _
Peabody, MA 01960 INSURERC: -
IN_SUR_ER_D: --
MSURERE;--_.__.___..
COVERAGES `J
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.
ILTR "A TYPE OF INSURANCE hav ^' POLICY NUMBER P IGY EFFECTIV FOUCYEXPIRATION
D TE MMRIDIYYYV DATE MM/00/'/YYY LIMITS
OEMERA .LABILITY 370030I015 01/29/2012 01/29/2013 EACH OCCURRENCE i 11000,00
X COMMERCIALGENERALLIABILITY H'PREMISES EeT�Row r renE�e __LOOJ O_
CLAIMS MADE aOCCUR MED EXP(AAYv Wr ) ! 5.00
A PERSONAL A AOV INJURY S 11000,000
_.. GENERAL AGGREGATE A 2,000.000
GEN'L AGGREGATE LIMITAPPLIES PER: PRODUCTSCOMPIOP AGG 7 Z 000,00
POLICY PRO-
EC1
LOC
TAUTOMOBILE UABIUTT ANY AUTO i OM&Wdo 191NGLE LIMnALL OWNED AUTOSBODILY INIURV0 SCHEDULEDAOTOS (Pwpel Ben) t
X MIRED AUTOS
X NON-0WNEO AUTOS (Per Aeeltluv)
- -^ FROPERTY OAMAGE
(Per eectlanq
DARAOELABWTY AUTO ONLY EAACCIUENT
ANY AUTO
- I OTHER THAN EA ACG i
AUTO ONLY: AGO S
EXCESS I UMBRELLA DABIUTY EACH OCCURRENCE e
OCCUR CLAIMS MODE AGGREGATE S
OEOVCTIBLE -- f ----��- .
SCOMPENSATg AND EMPN - - --
AND EMPLOYPAS'LIABILITY YIN TOgY LLMIT& ER
ANY PROPRIETOWPARTNER/EXECUTIVEE E.L.EACH ACCIDENT F �_
C 0FFICERIMEMSER EXCLUDED?
(MenAetary In NH) EL DISEASE-EA EMPLOYEEI A I'a
II s.deMY1De Vntler
SPECIAL PROVISIONS balm EL DISEASE•POL,CY LIMIT 1 S
OTHER
ESSDENCEOFO 2011 EXATIONS RENEWTAILBCOVESI LRAGECLUSIONS ADDED BYENOORSEMENTI SPECIAL PROVISIONS
1
I
CERTIFICATE HOLDER CANCELLATION if
SHOULD ANY OF THE ABOVE D96CRIBEG POLICIES BE CANCELLED BEFORE I HE EXPEW TION
DATE THEREOF,THE ISSUINO INSURER WILL ENDEAVOR TO MAIL 10
UAYS WRIIIEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE' SO SHALL
IMPOSE NO OBLIGATION OR LABILITY OF ANY RIND UPON THE INSURER.ITS AGENTS OR
REPRESENTATIVES,
AU MORQED REPRESENTATIVE
Sennott Ins. Agency
ACORD 25(2009101) 9)1988-2009 ACORD CORPORATION. All rights maervsd.
The ACORD nar?e and logo am rsgistsred marks of ACORD
Page No. of Pages
LENGIBELY:CONTRACTINGCO., INC. PROPOSAL
23R.Winter Street 24210 ,
PEABODY'MASSACHUSET-rs 01960 - -
b All home Improvement and subcontractors
engaged In home Improvement contracting, unless
(978)531-8234 'Tax�(978)531-9304 specifically exempt from registration by Provisions of
w$yw.lengibelycontrecting.com .f._,,.p; Chapter 142A of the general laws, must be registered
with the Commonwealth of Massachusetts. Inquiries
Submitted C about registration and.status should be made to the
TO: yyyL� GO�/�`SYI
.G Director, Home Improvement Contract Re9lstration,
AL One Ashburton Place;•Room 1301, Boston, MA 02108
(617):727.8698. Owners who..secure their.own
construction related permits or deal with unregistered
contractors will be exclutled from the Guaranty Fund
_ / Provision of. c.1 .A.
PHONE MTE eEO18TaATION NO.
/ � _ �_-•� Z MA.REG. 100811
i JOB LOCATION
f ,,., '->9 �^-ti^.r'.e.•.t±fdLlt�w. ,..;•..M.s,.�A/'•� •r.. -
We hereby submit apeclgcagone we estimates for work W be pedormad erW materials to be usetl
9 !
/a /'.evs__/ Pl6ca
arc dd�+�d ro�az/ 3�0!'a ln7avfcQ/' • f06 ' 6h �K�� a or .2. Tr4l�
rt•o�& 01�' �� yli6*7 " ON,.. .. L�F�T �r�� iA-�i.oL bol�l.•eQ y�
Q/Y„n Lltr�ds� v y 1 �,s�1 �1 DarL 2 uV.'4
/��H �. �. t
�hic�r� o�t✓. , S-alz�;Il"S 9`� `... !•y tJ.a/!8y/,s' A-�Qr,� ��v�+��
`�=P( ( /�[� FE�O'�.a� e✓ 1nt�o G� . Qj.�f Whi7LE �L riP �'6��C+---C
.--» °'"a~..�s:Q�<.dk" SSA`• ' i B . :-�I9Sli : ,r 1 ns�a/!
�'�yy-A/NT�fceQ L.9 h[IM/J✓.�^"'/v✓�'+w,e^"'si�/Lr '-�C-,$':*.-. TeM :d-c�&6C ,. .�.n�S—-
dW
_(rDOF _� 17
6eeesaekeayelete
All, 0K ail
WOPx 5C,aE�DI�U�LE ���-••fss the lariats bef0 a Ne Ihlyd day following the signing of this Agreement.unless p c d l aJn wring Ov for O k or
Conlraclo CJ°� InJle Ard M1 b
bout a�� m B delay caused by eireumsta ces beyond Contract s eo t of IM1 wok II I by (d e y
acknowletlges and agrees ihal0e echetlul ng dates ere pproalmate end Net such delays met a of oidatl by iM1 coot cl she not be can tlered as v Olatlgns o - s,
WARRANTY follow n cOmplgl AJ
on tl shall comply cold,
The Contractor wertanle that the work furnishetl hereunder shell be free Irom tlefecte le malarial end workmanship for a PerlOtl o 9
1M1B ryearrakerncomipletion of erry igtbi InClutlingncleen up,e irate Co eclor�ehell�,rel hla'own exp nsealonhwaM1 remted COnirecbl,M1ie subF 9e,oo�.`se Po�eemmedgied1ro s dleq or repiWCOtl.
pe< �Y,rePalr,correct,rs grae Pair
6Pch Damage or sucM1 tlelncl In materas or wodmensM1lPThe loregonB wenentes'shal survive erry ins lion dormed In connection wltM1 lM1ee tl-upon work.
We Propose hereby to furnish material and labor complete in accordance withabove specifications,for the sum8lo O c .
{ n 'I *,r:•+r 14: , ,:dollars($ � n )
Payment to be made 9a Wilms
($ q )upon signing Cmtrac N al Ocnl2Wadg 6slgreleeFaglslmnt
_%(s Aa;x 1—)upon completion of JJJJJJ� sireel Adareav _ --—
w
%($ )upon completion of Oiry Score Phone
shall be made fcrewith upon _ _
..'.M F• -2 Federal D N -
IS )completlod of wark under drb cgmffid.{�.�t w d•_ AEI
Notice: No agreement for home Improvement contracting work shall require a down Nam a Sal an
payment(.&once deposit)of more Nan one-third of the total contract"price or the _
total amount of all deposits or payments which the contractor must make,In advance, '`Au rb d ha
to order and/or otherwise obtain delivery of special order materials and equipment.• days.
whichever cot Is creates. ,5"nV.2; to: P el be withdrawn by as 0 n t ecceptaa wllM1in
�' 4y •r�: •w Y.dYJ^9�'_ levy �. y ._
Acceptance Of-PrOposal`I have read both sidds of this:dr cument,and apt the prices,specifications and conditions stated.I understand
that upon signing,this proposal becomes a binding contract.You pre authorized to do the work as specified. Payment will be made as outlined above.
You,the Buyer,may cancel this transaction at anytime prior to midnight of the third business day after the
date of this transaction.Cancellation must be.done in writing. .
DO NOT SIGN THIS CONTRACT IFTHERE ARE ANY BLANK SPACES.
sienelme�� v t r le r V signewre Dare
IMPORTANT INFORMATION ON BACK
i r
ti •
t� Massachusetts - Department of Public Safety
Board of Building Regulations and Standards
Caid�uai„n Supvni+or fir'
License: CS-094763
,1 1f n,.
THOMAS k Im�BINS i. J,
rl,
19 Cedar HBLDrNOR ip,1 i
Danvers MA-01923 ' T r
Expiration
Commissioner 05/14/2014
niu.nnnrnr,r/// I/ u n.�l.JJ [/use
]. Office of Consumer Affairs& Business Regulatimr License or registration valid for individul use only
before the expiration date. If found return to:
j���—, ME IMPROVEMENT CONTRACTOR
egistration: 100811 Type: Office of Consumer Affairs and Business Regulation
?Mlxpiration: 6/23/2014 Private Corporation, 10 Park Plaza-Suite S 170
Boston,MA 02116
LEN GIBELY CONTRACTING CO., INC.
Brian Dobbins
23 R WINTER ST. `
PEABODY, MA 01960 _ - --"--- / -- --- -
Undersecretary Not valid w• 'ut �ignalure