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76 WHALERS LN - BUILDING INSPECTION The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF Massachusetts State Building/ Code,780 CMR SALEM Revised Mar 20/1 Building Permit Application To Construct,Repair,Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number. Date Applie 3 Building Official(Print Name) Signature Dat SECTION 1: SITE INFORMATION ~ 1.1 Property ddress: 1.2 Assessors Map& Parcel Numbers '7(0 / /�/ S /Q_k� I.la Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private Cl Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.% Owner'of Record: u�r� u cpouG /as /'YJ/� 0/9 ^7D Name(Print) V City,State,ZIP I '76 GcthO -x_ No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK''(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify: Brief Description of Proposed Wo 2. SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1.Building $ � 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost (Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees:$ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ oo/ 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 577�55 2 D Onr J J fm I l�� Z l z U License Number ExpiratiLon D to Name of CSL Holde 1 G k �yt�J,(„ �' List CSL Type(see below) No.and Street V 1 `�'� Type Description tyl (V1 O �-1 C) U Unrestricted(Buildings u to 35,000 cu.ft. lJ R Restricted 1&2 Family Dwelling City/Town,State,ZYIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances SI Insulation Tele hone JEmail address D Demolition 5.2 Ad Registered Home Improveviepment Contractor(HICnc - ) 0 0 - t0/ HIC Registration Number xpuatbio Dale lE7 Compan o C Re r tNtame C76T -U c(� G -ClSefVIC2S an Stre 6 11 O-2 G ^ I l j o t"1 ZY " Email address City/Town,Stag,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152. § 25C(6)) Workers Compensation Insurance affidavit must b completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuan a of the building permit. Signed Affidavit Attached? Yes .......... No........... ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES ,FOR /BUILDING PERMIT I,as Owner of the subject property,hereby authorize �A//�/J /(J/.J/(X,I ( 0—rZU to act on my behalf,in all matters relative to work authorized by this buililing permit application. �,V-2,/l 490 /QS Print Owner's Name(Ele onic Signature) Date SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION By entering my[tame below,I 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 knowledge and understanding. OJinsbohir 7,oY Print Owner's or Auth rized Agent's Name(Electrons ignature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L. c. 142A.Other important information on the HIC Program can be found at wy .mass.eov/oca Information on the Construction Supervisor License can be found at www.mass.eov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basementlattics,decks or porch) Gross living area(sq. ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" r ISPDSA� OF DES'R[S AFFMA-VI In ane®edancd jVIth tha provisions of M. G. L. u, 40, Sena 54, a condi'don of Building Permit Number is that the debris resulting from thls Work shall be disposed ®f.In a pe®pMy.Ilcens®d faciii� �� ��rAu®�,hy Mo The debris will be disposed at Salem `(I'ransW S'Eafaou owned by N09 Wdo cafto . �ig��tur� ®f P r lt�,®pElu�nt Date gam® ®f PSrmlt%Ppllcant `l15 NOFkh kaeL Salarn M- 01970 Address, CIN,� stata, Zip Code The Commonwealth of Massachusetts "y Department of Industrial Accidents v Lk Office of Investigations 600 Washington Street Boston MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contract6rs/Llectricians/Plumbers Applicant Information ` Please Print LelZibly y� Name(Business/Organization/Individual): ' 1�� a/ n I/� s 1 1 n(�11J Address: m/� QQ t� g ® /� City/State/Zip: I t 11 1 O I I O Phone #: 9 ' I U ^� q I - Nag Cai g Aree u an employer?Check the appropriate box: Type of project(required): 1.lj/J I am a employer with� 4. ❑ I am a general contractor and I 6. ❑New construction eployees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- in listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' 9 ❑ Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I L❑ Plumbing repairs or additions right of exemption per MGL myself [No workers' comp. � 12.❑ Roof repairs insurance required.]t c. 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 submitthis affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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 anz an employer that is providing workers'compensation insurance for nzy employees. Below is the policy and job site information. l I l Insurance Company Name: ���1 1r�n(�r�l�Q}�p Policy#or Self-ins.Lic.#: N 1 I I U �` )� Expiration Date:. q Job Site Address: i a { X City/State/Zip:( /o/t / D /970 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 certi n r the pauzs zd penalties ofperjury that the information provided above is true and correct. Signafore kl�G �- n n Date: —��✓ I" 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#: i 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 ajoint 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 pennit/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: i 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-NIASSAFE Revised 4-24-07 Fax# 617-727-7749 www.mass.gov/dia t� Control No: 7 5193 3 THE COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF LABOR ]DIVISION OF OCCUPATIONAL SAFETY .. -. 19.'.S'TANfEoRD STREET,BOSTON MASSACHUSETTS 02114 DELEADER CONTRACTOR LICENSE A&A SERVICES, INC. 115 NORTH STREET SALEM MA 01970 LICENSE: DC000440 EXPIRES: Wednesday,April 11,2012 IN ACCORDANCE WITH M.G.L. CH. 1 11, § 197B(b) AND 454 CMR 22.03,THIS LICENSE IS ISSUED BY THE DEPARTMENT OF LABOR, DIVISION OF OCCUPATIONAL SAFETY TO THE CONTRACTOR ABOVE FOR THE PURPOSE OF ENTERING INTO OR ENGAGING IN DELEADING WORK. THIS LICENSE IS VALID FOR A PERIOD OF ONE YEAR. THIS LICENSE MUST BE MAINTAINED BY THE CONTRACTOR WHEN ENGAGED IN DELEADING WORK IN ACCORDANCE WITH M.G.L. CH. 1 I I § 19713(b)(2) AND 454 CMR 22.03. HEATHER E. ROwE,ACTING COMNESSIONER � Printed on Recc ycled Papv , .. ✓1 - - --. -- -0 :linssachusetts Depaiiment of Public S:d'st} ze ainmzorzwea z °y zude%(d Office of Consumer Affairs&B siness Regulation a Board of Buildin- Re:Rdations and Stami:[r' - HOME IMPROVEMENT CONTRACTOR - Construction Supervisor License Registration 101609 Type: i � Expiration: 6128I2012 Private Corporatio• License: CS 57733 SERVICES,fl NC ya. CHRISTOPHER ZORZY , 115 NORTH ST Christopher Zorzy SALEM, MA 01970 115 North Street _. v,,;__ Salem,MA'001970 Undersecretary _ �L_ y Expiration: 5126/2013 <'ummisiuner Tr#: 15935 NOV-05-2010 16: 19 Sunrise Windows AA P.02 vanguardMEE=I N A view that works Vanguard Windows are tested and certified to National Fenestration Rating Council (NFRC) standards, These are the numbers ENERGY STAIR® uses to determine how fenestration products comply with their standards, and to categorize the products for the appropriate climate zone(s). Window Glass U-Factor SHGC Type Package I ®; VG Plus 0.28 0.28 Double Hung VG 12 0.28 0.21 VG'Ar 0.22 0.22 VG Plus 0.29 0.28 Slider VG 12 0.28 0.21 VG'Ar 0.22 0.22 VG Plus 0.28 0.28 ® Northern Tilt•In Slider VG 12 0.28 0.21 fro® , r VG'Ar 0.22 0.22 ❑ NorthrCentral VG Plus 0.28 0.30 Picture VG 12 0.27 0.22 ; ❑ South/Central VG'Ar 0.21 0.22 Southern VG Plus 0.26 0.24 Casement VG 12 0.25 0.18 ( - Alternative _VG'Ar-..-. 0.21 0.19 Criteria Allowed VG Plus 0.26 �0.24 Awning VG 12 0,26 0.18 _VG'Ar 0.21 0.19 W VG Plus 0.26 0.28 Casement VG 12 0.25 0.21 Picture rai• _VG'Ar 0.20 0.22 VG Plus 0.30 0.27 _. Sliding Door I VG 12 0.29 0.20 VG'Ar N/A NIA N/A www.vanguardwindows.com This data Is accurate as or February 26,2009,Due to ongoing product changes,updated test results,or new industry standards or requirements,this data may change over time.Ratings are for sizes specified by NFRC for testing and certification.Ratings may vary depending on use of tempered glass,different orid or decorative glass options,glass for high altitudes,coastal applications,etc. 9 6 I c '•.: _ aI µ.r TOTAL P.02 AAlwrm at,» A & A SERVICES, INC. A&A SERVICES 115 NORTH STREET,SALEM,MA 01970 Telephone:(978)741-0424 Fax:(978)741-2012 Contractor Registration No. 101609 Federal EIN:04-3090162 Construction Supervisor No.GS057733 CUSTOM REMODELING AND IMPROVEMENT AGREEMENT Buyers)Name Date of Contract >e p� ;7 —�'J— ZJ 2 Buyers)Street(A dtress,City,State add Zip Code RL W Ill 5 Ms► c�1�170 Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address: 91�- W-3 z/ The Buyers)listed above hereby jointly and severally agree to purchase the goods and/or services listed an the accompanying specification sheets,in accordance with the prices and terms described on the front and the reverse of this agreement and any specification sheets(this"Agreement),and Buyers)have mquested that such goods or services be installed or provided at Buyer's address listed above.A&A Services,Inc.('Contrrpi hereby agrees to install or cause to be installed the products or services listed in this Agreement at the Buyer(.)address written above. This Agreement represents a cash sale of goods and services. The Buyer(.)agree to pay in - cash the cost of the goods and services purchased as do scribed herein,regardless of timing or approval of any financing Buyer(s)may seek for their purchase. Purchase Price�r,[ rIMS?�' :/1a� Est.Starling Date: - 20 � - Down Paymenl!f1^n''r' /ICJt'Nef ESL Completion Date: ❑Cash Amount Due on Stan of Job: �•J'� �t O Crack .Atlleftl�jrrT�p 2 ✓pOfs red Amount due on of Completion: id Card.I Amount Due on of Completio :_ '^ ^',•r Expiration Date: Balance Due on Upon Compieti0 CVC Code: v It is agreed and understood by and between the parties that this Agreement,front and back and any addendum,constitute the entire understanding between the parties,and there are no verbal understandings changing or modifying any of the terms of this Agreement. Buyer(.)hereby acknowledge that Buyer(.)has read the front and the reverse of this Agreement and has received a completed,signed and dated copy of this Agreement,Including the two attached Notice of Cancellation forms,on the date first written above. Buyer(.)also (0 acknowledge that they were orally Informed of their right to cancel this transaction;and(II)request that they be contacted via their telephone numbers or e-mail, as listed above, in the event Contractor believes Buyer(s)would be interested In any additional quality products or services of Contractor. DO NOT SIGN THIS CONTRACT IF IT CONTAINS ANY BLANK SPACES. A&A Svic yfc. ` Bu� Ii X - �� By: �zn s e 'lure na -QJ y 'IrVM) �-0nlarr Vr� C Js;Gr1�, Print Name Print Name r� Signature Print Name You,the Buyer(s),may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction. See the following Notice of Cancellation form for an explanation of this right. ' ARBITRATION:The con4emor and the homeowner hereby mutually agree In am arm Net In the rveM elNer party has a d omme mnceming this counn ,either panty may submit such dispute to a prrvale counsel nervier whidi has been approved by Me Secretary of Me Executive OMw of Consumer Affairs and Business Regull and Me other paM shall as required b submit b such arbitration as proved in Ulu rAIsc, C.rep, mr wda Due:vlv,s. Dore: Est ^ �f NOTICE OF CANCELL>T ON NOTf'.[nF['PNf %TON Oats,of Tranasaion y 1 3�(?.�may oera el His banseeare wnMYt any penally or 0.o1 Tramormi ^I�^/Z.You may cancel we transaction.wiuwl any penalty or oblation,whir three business days from me algva date, n you cancel,any property traded in obugauon,within three business days from the News,date.if you cancel,any property o-aded in, arry payments made by you under Me comment or sale,and any negotiable lnsimment selected any payments made by you under the Conant or sale.and any negotiable lnswmem executes by,you will be resumes wlmm m says fmlmving neceipt by the Seller of rout c erentadon notice, by you will be reversed.when TO days talowing remlpt by the Seller W your mrce ludear met tied any security inte%t anaing out of Me transaction will be cancelled If you cancel,you must and any.-my inbreed anion,rim of the 4 arearton will re Concalled. It Has—1,you must male,avanathe to Me seller m your residence,In substantially as pad miNidon as when received, make available to me Sever at your Measures,in suarmandialy as good motion when received, any goods delivered to you under His Commct or sale:or you may,if you wish,comply with the arty goods delivered to you under this Conduct or saw;or you may,if you wish9wmply wiir Me interactions,of Seller regarding the return shipment of aonw in Me severs expense aM bawetmrs,of one Seller.,.Win,the reNm shipment W Me .We at me sailers aq,am-and dou If you so mass the goods available to the Seller and the Seller does not pick Main up nes. ff you our make the goods availffiw as the Seller antl Me Seller does net pick them up within M days Ot the date of your Notlm of Cancellation,you may retoln or diamere of the gwtls withe 20 days W Me date 0 your Notice of Cancellation.you may retain or dielcea of the goods wXMWerry"wrobligalion. Il yOY wllbmake the gaMsavalleble tube Seller or it you agree wimomanyfumerobingation.Ifyoulellbmake Negwdeevalawetothesaller,orlfyouw.. to mount the goods to to Seller and wil TO do ad,Men your remain liable bar yammer.Mall to Mum Me goods b Me Seller and bit to do so,ten you remain liable for penonnarm M ell obligations under Ns,Conlratl.To cancelthis traneadion,mail or deliver a signed aM dated wpy obligation under the Contract To arall this banaction,mail or dew r a signed and de4N copy of the circulation notice or any Other written real m send a teafgram,to ABA Servic 115 of to Cancellation ranks Or ary other written notes,ormind a telegram,to Services,115 North Sheer,Salem ss,Maacrox.01970.NOT LATER TIAN MDNIGHT OF -1 N nth Street Salem,Massachusetts 01970,NOT LATER THAN MIDNIGHT OF (Doe) (See) HEREBY CPNCELTHIS TRANSACTrON, Consumers Signature Date I HEREBY CANCELTHIS TRANSAOTION. Consumer's Signature Dee r "_�te° A & A SERVICES, INC. AsI:A SERVICES 115 NORTH STREET,SALEM,MA 01970 Telephone:(978)741-0424 Fax: (978)741-2012 Contractor Registration No. 101609 Federal EIN:04-3090162 Construction Supervisor No. CS057733 WINDOWS AND STORM PRODUCT SPECIFICATION SHEET Buyers)Name Date of Contract WeA Buyers)Street A%gress,City,State and Zip Code n� i ��o WIt JMVMryi,4 r7 c) Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address q­��- '1 392I The Buyers)listed above hereby jointly and severally agree to purchase the goods and/or services listed below,in accordance with the prices and terms described on this Specification sheet and the front and the reverse of the accompanying CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,at which this Specification Sheet is a pad. WINDOW REPLACEMENT ORemove and dig2ose of# _ existing windows. Q Install # new �Af.� JAYta(/ArJ windows: inyt If Wood (Man�er) I`4I t Options: Style 8\4&I �iV1(1J�t! Grid pattern V1 C— Color Interior Wtt"t?I Color Exterior Glass Type ' t Wrap exterior trim with aluminum: Style Color OAII windows will be installed according to the installation procedures in the portfolio. - DCaulk all interior and exterior edges. Insulate where possible around new units. (J) Insulate window weight pockets if exist,and around new window units where possible. Q Included in this proposal are set up,clean up,Hepa vacuum and cleaning windows inside and out. Building permit included. BAY/BOWS/CASEMENT UNITS/ANY FULL CONSTRUCTION WINDOWS If Create new window opening by cutting through existing home and framing in opening. If Remove and dispose of existing units)in its entirety. Note:Electric and plumbing may exist in wall and will require additional costs to customer if need to be dealt with. T Install window(s)into opening(s). Note: If Bay or Bow installation to include cable support system,new roof system(matching color as close as possible) .. - or tie into existing soffit system. t Bay t Bow If Casement t Other window(s)to include new interior style trim and new exterior style trim and head flashing as needed. If Note: Painting and staining not included. STORM PRODUCTS t Remove and dispose of# existing storm window(s). t Install new storm windows# Manufacturer Style Color Option t Remove and dispose of# existing storm door(s). It Install new storm doors# Manufacturer Style Color Type: t Aluminum t Solid Core SPECIAL INSTRUCTIONS: �Xte/'`°' tr15t'YiGG tht 3C.� (,vyn�3 triAi wok � ,P�sr• ll��.so.>, . fJ7�� r f It Is agreed and understood by and between the parties that this specification Sheet,along with CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,constitutes the entire understanding between the Parties,and there are no verbal understandings changing or modifying any of the terms. This moo a u may not be changed or its terms modified or varied in any way unless such changes are in writing and signed by both the 9uyer(s)and the Contractor. Buyers)hereby acknowledge that Buyers) Spec has reetl this Initials:on Sheet !y A�� � Contractor Initials:'i^/r>� Date: ` I i Buyer's Initials: Date: