11-13 KOSCIUSKO ST - BUILDING INSPECTION ��f I
(� • � The Commonwealth of Massachusetts
cJ1 '
Department of Public SafetyMa.vsarhusclts Stale BuilJing Code(7311 CNI R)
Building Permit Application for any Building other than a One-or Two-Fantily Dwelling
(This Section For Official Use Only)
Bu
ilding, Permit Number: Date Applied: Building Official: _
SEC`TIONN 1:LOCATION(Please indicate Block M and Lot p for locations for which a street address is not available)
f — 13 kas�t �1—� a� O 14=10 --
. nd Street City/Town Zip Code Name of Building,"(itapplicable)
SECTION 2:PROPOSED WORK
dition of NIA Stale Code used If New Construction check hero❑or check all that apply in the two rows below
J Existing Ifuilding Alteration ❑ 1 Addition❑ Demolition ❑ (please fill out and submit Appendix 1)
+ Change of Use ❑ 1 Change of Occupancy ❑ I Other ❑ Specify:
Are building plans and/or construction dtA'nments being supplied as part of this permit application? Yes ❑ No ❑
Is an Independent Structural Engineering Peer Review rcyu rred? Y•s�❑ No ❑
Brief Description of Proposed Work:-
SECTION S'-7' t 1 1 +Qy. „�a-� u ��Y[a:
IJ 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
n h CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CNIR 3a) ❑
Existing Use Group(s): Proposed Use Group(s):
SECTION 4: BUILDING HEIGHT AND AREA
Existing Proposed
No.of Flours/Stories(include basement levels)&Area Per Floor(sq. ft.)
Total Area(sq, ft.)and Total Height(ft.)
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A4❑ A-5❑ 1 B: Business ❑ E: Educational ❑
F: Facto F-1 ❑ F2❑ H: High Hazard H-I ❑ H-2❑ H-3 ❑ H-4❑ 11-5❑
I: Institutional I-1 ❑ I-2❑ 1-3❑ hF❑ 1 M: Mercantile❑ R: Residential R-112 R 2❑ R-i❑ R4 ❑
S: Storage 5-1 ❑ S-2❑ U: Utility❑ Special Use❑and please describe below: -.
Special Use - - +. - - '. I -
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
11\ ❑ IB ❑ HA IIB ❑ IIIA ❑ 111B0 IV ❑ 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 PIuOJ Zone❑ h+dicate municipal ❑
:\trench will not be Licensed Disposal Site❑
Pricahr❑ or indentily Zone: Or On site system required ❑or trench or specify
❑ permit is enclosed❑
Railroad right-of-way: (Hazards to Air Navigation: �i � I i"k" : , "�,,��:�..,:_ I ill,.: d i' —";
\ot ApPlicable❑ Is Structure within airport approach ama? Is their review compitled?
or C I415011t to Build enelOxxl❑ 1 es ❑ or No❑ Yes❑ ,No ❑
SECTION 8:CONTENT OF CERTIFICATE Of:OCCUPANCY
I:diliun of Code: - Use Group(s): _ k pc of Construction: . _. _. -. Occupant Load per I lour:
hors the buildingcontainan Sprinkler System.': _._ ___~pedal Stipulations:
a
SECTION 9: 1'ROI'IiR'IY OWNER AUFIIOliIZAIION '
Name and Address of Property Owner
Do?(- S� 11 J�oSs, --
Name(Print) No.and Street City/Town Zip
Property Owner Contact Information:
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 Construction Control then check here O and skip Section 10.1
10.1 Registered Professional Responsible for Construction Control
Name(Registrant) Telephone No. a-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor
L-e-. G 6 I_v CovT
Company Name
r pltt(n wu C. L( t.3
Name of Person Responsible for Construction License No. and Type if Applicable
3 F7 1�r c.v`T✓ti S'T �-eA Fi7r'�nt� ,�m9 _Q_L�b—a
Street Ad1 ress City/Town State Zip
ZB 31 �7 ,>U8 Z9y 1-4 33 91
Tcle lhune No. business Telephone No. cell e-mail address
SECTION 11: ov111 ..,A ru IN IN'AUI,'ANCk Arl-11 Mvl I M.G.L.c.152.§ ZSC 6
A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and
submitted with this application. Failure to provide this affidavit will result in the denifil of the issuance of the building permit.
is a signed Affidavit submitted with this application? .Yes O No O
SECTION 12 CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor ( U(DI
Materials) Total Construction Cost(from Item 6)=S
1. Building S 1 Z � r—+' S Building Permit Fee=Total Construction Cost x_(Insert here
2. Electrical $ appropriate municipal factor)=S
3. Plumbing 5
h. Mechanical (HVAC) S Note. Minimmiln fee=S (contact municipality)
i. Mechanical Other $ Enclose check payable to
6.Total Cost S a g 5 j i7?� (contact municipaliyv)and write check number here
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
ISv entering nn•name below, I hereby altest under the pains and penalties of perjury that all of ne infurmalion co stained in this
applicnion is true and accurate to the best of my knowledge and understanding.
---r�� r �- - - - ----ZD-Z_f t 1
I'lease print and sign name Tide t �I1, e No. Date
Street Address City/Town Sta e Zip
r
Municipal Inspector to fill out this section upon application approval:
Name Date
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
-Applicant Information Please Print Legibly
?dame (Business/Organization/individual): � i�� ci ,j ��/ C � � � �. `t--t ' e �v
Address:�_3 R kA ( nth r t
City/State/Zip: E A 16 n o V MA Q t 41:1yhone #: "I S S,3
Are you an employer?Check the appropriate box: Type of project(required):
I am a employer with I a 4. ❑ I am a general contractor and I 6. ❑New construction
employees (full and/or part-time)." have hired the sub-contractors
2,❑ 1 am a sole proprietor or partner- listed on the attached sheet. 1 7. ❑ Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity, workers' comp. insurance. 9. ❑ Building addition
[No workers' comp. insurance 5. ❑ We are a corporation and its
required.] officers have exercised their ME] Electrical repairs or additions
3.❑ 1 am a homeowner doing all work right of exemption per MGL I LEI Plumbing repairs or additions
myself. [No workers' comp. C. 152, §1(4), and we have no 12.❑ Roof repairs
insurance required.] t employees. [No workers' ❑
comp, insurance require
13. Other
Ally 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,
tCntracturs that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information
I amr an employer that is providing workers'compensation insurancefor my employees, Below is the policy and Job site
information.
Insurance Company Name: y`1" V A
Policy ll or Self-ins, Lic.#: V l t�S( d [ D q r7 C1 y 1 t7 1 t Expiration Date: a 3— a Q
Job Site Address:_] ` - 13cic t ,atfsti City/State/Zip: �,A?���(vJ,
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 fore
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for nsurance coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct
Si ram_ r_ e_ Date
Phone#: S _� y
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle ones
1. Board of Health 2, Building Department 3, City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone#:
n n
VKDOLRCcm 976.6b r .- .A r v♦/�•r/waa
900 FAx 978.8b7.t�o4 TNI8 cRISATB w {!E - IIATTeR oP a+FORkwT o+l
t,Ldward F. Sennott Insgrance Agency, Inc, ONL PBRo RI iYPON THE CERTIFICATE
16 South Main Street �LOB �OCBRTIi ONDBDN6OT(TEPOUCIESBELOW.
P. 0. Box 457 THO
Topsfield, MA 019a9
INSURERS AFPORDINC COVERApE NAIL 0
^^ en 9 y ontraet ng „ nc,
23R Minter Street ' ��- t n Beat nfurenC@ 0 '
POabody, MA 01960 NauRERaI Trove ers 19038
!NCLnARa _--
i 3iQURaR 0; —' 1
COVERAGES IT'7aURERb _.._�.j
rANY nE POUCIEE OF IT,TKRM O UBTEp BELOW FIAVF BEEN 186UED TO THE INSURED NAMED ABDVE FOR THE POLICY PER100 9SOICATED.NO7Wrrns7ANaNG
LangPER7A)MINEV$VIRRA EAFFODECYTHEPANY�"lrvwlDmvf"NK�j��TUn REQEDTHE ;10A HE)(CLU910ATEmAyseISON90OSUCM
IrXO ICI ES.AOGREOATF L4YTS 81pWN bUY HAVE BEEN AeMX*D EY PAw owms. AND
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iGENERAL UAaIUTY 37 300 WTV
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CLAIMS WAM ®OCCVR { 100 OOV
PEAaONALE ADV IWVRY 7 1"000 OW
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OCCUR �CWW4VAQ6 LAaOCCURRENCE 3
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cc cc KivnoN Of 9P((RATIONE!LOGAMNa I VEIIIDLII3I E/{CLWION3 AOOEO EY ENOON9FA,ENT 1 v idenCe OT 1n9UrinGe, EPECML PAWLtgN6 - ------�
CERTIFICATE HOLDER CAN ELLATI N
i iROVW ANY Of THa AIM Mono POLNMa aE OANOELLED atiORE ThE E+rvi�Anp
NOT
TIRIIRgi YMa"U"W IAaA W'"4NOaAVQ"T9 WAK' 10 DATA W WT1TN
_. Evidence Of InsUl'Aflc6 M°110E T°TKcuLMeun NOLow MArlvTO,TNEUR,OVr iANVRE TO Do 3o xIAlt
IM►Qy.1p WY WTgN VA WWLRY 0/ALA:qMD VPON THE 1116UAEf1,ITS AOExn DA
AVINORRJ9 RiPaEfaNTAT1VE
ACURD 26 (2009/01) Rob r DIWtt _ .
®19a&2009ACORD CORPQRATIQN, All rlghta mwvod. ,The ACORO name and logo are regloll marks of ACORD
rWo-uJ-euJJ 1J:114 Sennott Insurance 978 B87 2404 P.61
.-.VVI\✓w vr• � • •• r• r•� �r•r• • •e�vv• �. 07/28/2011
VIRL9bUCER 979.887.4900 FAX 979.887.2404 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
P. 0. Sox 457 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Topsfield, MA 01993 INSURERS AFFORDING COVERAGE NAICO _
INSURED Len Gibely Contracting Co Inc, INSURER —
Z3R Winter St. ---- __ ....__.... ..._.......__.�
INSURER B'
Peabody, MA 01960 INSURER C:
INSURER 0:
NSURER E:
COVERAGES
THE POUCI ES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING
ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR NSR TYPE OF INSURANCE POLICY NUMBER DP Au yyl IVE PO yWGD�IYTY3pti LIMIIT}
('GENERAL LIAIKITT EACH OCCURRENCE 3
COMMERCIµ GENERALLIASILITY PPEMI Ea dfclYfanda 3
CLAIMS MADE OCCUR MED EXP(Any ono potion) S _
PERSONAL S ADV INJURY !
GENERAL AGGREGATE S _
GEN'L AGGREGATE LIMIT APPLIES PER:POUCV I
PRO
PROWCT9COMP/OP q00 r T
-
JECT lOC
AUTOMOBR,E LIABILITY
COMBINED SINGLE LIMIT
ANY AUTO (Ea imlfni) !
ALL OWNED AUTOS
BODILY IW URY _
SCHEDULED AUTOS BODILYaINj S
HIRED AUTOS -•.•.— __
NONOWNEO AUT09 BODILY INJURY S
IPar amldwt) ---1
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GARAGE LWBI Utt AUTO ONLY•FA ACCIDENT S
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AUTO ONLY: AGO 3
EXCESS I UMBRELLA LLIBSJTY - EACHOCCURRENCE E
OCCUR L 1 GLADAS MADE AGGREGATE ts -7
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WORKERS ER44U/SAOOM VWC6010979012011 08 ANO EMPLOYERS'LNBILITS' YIN �03�2D11 08�03�2012 X T YLIMR9 ER
ANY PROPRIETOR/PARTNER/EXECUTI
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OTHER
DESCWn DN OF OPERATIONS I LOCARDNe I VEMCI ES I EXCLUSIONS APDED BY ENDORSEMENT I SPECULL PROVISONS
CERTIFICATE HOLDER
CANCELLATION
SHOULDANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF.THE LIMING INSURER IMLI ENDEAVOR TO MAIL 10 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO 90 SHALL
- IMPOSE NO OBUGATION OR LMBILITY OP ANY HIND UPON TILE INSUREN,ITS ACEN TS OR
REPRESENTATIVES.
Evidence of Insurance AVTHOPUD RCPRCSCNTATIVC
Robert Sennott
ACORD 25 (2009101) o 1980-2009 ACORD CORPORATION. All rights msemed.
The ACORD n8m9 and logo are registered marks of ACORD _
be NEbI 0.ITaiM"printing,<re so, am Par w,z.tN,awmupn,a,Ors vi,v m v"r uoa opal,
Page No. of Page:
LEN GIBELY CONTRACTING CO., INC. PROPOSAL
23R Winter Street 22731
PEABODY,MASSACHUSETTS 01960
All home Improvement contractors and subcontractor.
(978)531-8234 Fax(978)531-9304 engaged in home Improvement contracting,defeat
www.lengibelycontracting.com specifically exempt from registration by Provisions o
Chapter 142A of the general laws, must be regislerel
SubmiueE C/ with the Commonwealth of Massachusetts.Inquiriet
10:_ QG_ SO,(-M+�Qf�d_I—J- //1.Q..I_(-- about registration and status should be made to thr
Director,Home Improvement Contract Registration
On
_l_l-I LOSS I�S_Ik-W- S One Ashburton Piece,Room 1301,Boston,n,MA MA 02101
evil
(ons) ]2]-8598. owners who secure their owl
M O I 9 contractors related permits or deaf with unregiGuaranty
_�. _ I __�V—_ —.____-___ contractors will be excluded from the Guaranty Fort
-�-^�---_�-� Provision of MGL C.142A.
PHONE MTE FEORMNORON NO,
MA.REG. 100811
so NMI JOB LOCATION
BTI S1I- 96c?/ - Dom SH
We lterebysubnul epedgcadon eMean. thawork parrigglesed f2forbeffird.to be urea '74—
Cdnsaucdon related pBunlls.
WJnI<aCXEOUIEC,Om('E(/Ile'll' lX/or�✓4/d�-�/O
Corn II I o rder Me D b M1 TI Ire day follow ng 0 9 0 I tDl Ago p f/Ij OfM1 'u C t JI b yl M1e we,1 o
e0ou1 I�1 Ban ng d y a by umslances beyond C I t 1 I,N k 'I D pl I d Dy eUpl 1 T owner Dor
xJtnOW' a ea al a M1odul nB deleaa eapprOx meta end tlbt auto delays 11101 ere nolaWltlaNe by lee wmructo,eDBll Ibo cons tlered as vl Nb OI NS ABIoemen
WARperRY c
1nB COnlraclOr wa p teal ins work Iuml9Ded nBrBUMBr sluff be Tree Irom tlB1oCl61n mBlerlel eM vrorkmananip bra period o✓yvr bllowmg to PI.I.N and dred comply,
Ne"ah"emente OI Nis Agreemonl.ln In0 event any delad in workmenaMP Or maledeb.Or damage causal by Ne Oontmcloc Ns sums tf ctors,emplgees or agents,a discovered wi
y. ne year i n,curpord:n of enyf W bdudi,q clean up,Ne eomratlor snail,al his area ,broach a—"repair,coped,replace.Or cause to be remodlee,reported,m replay
}ta such damage er seen delod In frommib o,wohmanshlp"a to
exping wombed,anal,sury mr,implied.Redeem.In connection with the agreed-upon work.
We Propose hereby to furnish material and labor-complete in accordance with above specifications,for the sum of:
dollars($
Payment to be made as follows:
%IS 13 l upon sienbg comrMc -
� N.m.Bmemronorrpa9bnn,ea neaupam
%( )uponromplinde of 1 1 _. _.
evoa mamas
9:(s l ddin mmplallon -
Ci ehote Piano
y(s 1 uresnare be mule brewib upon
completion Of work wear this correct. Pont. raaamno N.
Notice: No agreement for home improvement contracting work snail require a down al eplfil r
payment(advance deposit)of more than one-third Of the total cvnirocl pace or I -
IBbI amount OI all deposits or Pro marre which the contractor mual mdke,in etivdnc ,col Spnalure
to Order and/Or otherwise obtain delivery of special order materials and equipment, r
wniabeve amounl Is menimr. Nob:Tne prepared may bo.'.are—av us ll no,eccap,ad an.
Acceptance of Proposal I have read both sides of this document and accept the prices,specifications and conditions stated.I understa
�i that upon signing,this proposal becomes a binding contract.You are authorized to do the work as specified. Payment will be made as outlined paper
{ You,the Buyer,may cancel this transaction at any time prior to midnight of the third business day after th
date of this transaction.Cancellation must be done in writing.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
e. ) pare 4 I ber arv. am.
'^\
L
curomcu uutvlriHc.I HVIa uU., INb. . . --_ ray.: -
23R Winter Street 22412 PROPOSAL
PEABODY, MASSACHUSETTS 01960
All home Improvement contractors and subcontractor
(978)531-8234 Fax(978)531-9304 engaged in home Improvement contracting, unless
www.lengibelycontracting.com specifically exempt from registration by Provisions o
Chapter 142A of the general laws,must be registers,
Submitted' ,4/ZO L S //I t/� with the Commonwealth of Massachusetts.Ingather
T,-C—___—._ p__ about registration end statue should be madly to the
Director, Home Improvement Contract Registration
//"/•3 �` OS< /USk/ ST One Ashburton Piece,Room 1301, Boston,MA 02101
-- -------- (617) 727-8598. Owners who secure their owl
construction related permit.or deal with unregistere,
-- -- — - contractors will be excluded from the Guaranty Fun,
Provision of MGL C.142A.
P QNE ✓ ° q , / PATE pE0151aATI0N N0.
_ / / // " Z Ste'// MA.REG.100811
due NM1eMo 10.Lacnrlory /
si4ME /js /d,5n✓F
We hereby fourth spe bovegons and �/N mr rk co b pa.moo sni.Zcz be used:
2°Dr �c�/° cP ✓T
/--
�e"-��// 19
ovvel�ia S. ��`'•-E !/jLzCE.TS.s��/ --�'iS // _
o
fjtl tS 1hsJ o/� S�o �a4P S// L
� L rr9S"//'-J
C1•-/nclif OU4- Ar-.ce- /�c=Zc'A9rf Chyivinc �hcf�f� CG�H/-✓z,
/ES
/Li g c_ U1 'IT
/Zr"- tisf_d
T(/O- /J/S_1� -C/�czcK Ati� Sc'cu 3 G � -S13,
- -
--- —
WORN OUL / - -
con rat �ra m I b t m to e al
n - 'u M.S. n rk on o.bow (a 1�.a -a away a dy - t Y b y g e c ° g I In i 1,11 1 kl In bo<ompinl a by data) Tn Own.,np,oe atlenowlag a e Man me testae ._• �- ._ _ - . . .mau tIx aema II tN Aq Y evold wTY tort
TM1e c0 t 1 n OOm k lu tea M1 n, d tollowin ole Ion era stall CO,riPIY w M1O,pp lemonlS Otms Aer on1.In NO went eny 0etl �,/t �, Ll �/�/�
uctone yast aa,nalturcompleaon of any job,Incluaing ClOon op, `//J/(�(� ///"� ,o acoao,Ctius0�oo0aa:amOOIW.I LS NaCweroa laco0.
ge.1..In dole.:In m.lOnala Ot W,kmarrod, T'/ •locta toarhrcause to be
work. nonskedo ,ep
at
We Pf0(108e hereby to furnish male 1 `i /�-c/(� r specifications,forthe ssum of: 1-
norma l to be made as follows: 7I"OIra dollars($J U /
—%ls ,.pot aigmng comran: c
�% pagbl,anl
a IS )upon completion of=
Is—)upon completion of
1 Of wiN Ph-
%I§ t Shall bromphIIOn 01am loreur0 (�OV (M( //
Wmpl¢ work under II
Notic¢: No agreement for home improvement cane
paymont(ad farce deposU OI more Nan one third 6
lbal amount of all deposits or payments which Vie n
t0 order and/or Whom e.Obtain date.,of spatial
•-h'chovera ny5yrl:gtgy
o:)n P{)+.a,)�I,as be aumr..,to u,� Plea.nlel„ _ran
Acceptance of Proposal I have read both sides of this document ana aoc% I the prices,specifications and Conditions stated.I understand
that upon signing,this proposal becomes a binding contract.Vou are authorized to do the work as specified. Payment will be made as outlined above.
You,the Buyer,may cancel this transaction at any time 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.
fiprow,. are 91r ( Signalu,a Oale
IMPORTANT INFORMATION ON BACK Mil
LEN GIBELY CONTRACTING CO., INC.+�� All home improvement contractors and subcontractors
220 6 PROPOSAL
PE
• 23R Winter Street ,
ABODY, MASSACHUSE rTS 01960
h engaged in home improvement contracting, unless
II (978)531-8234 FaX(978)531.9304 specincalry axempt from registration by Provisions of 1
www.lenglbalYCOnVBeling.COm Chapter 142A of the general laws,must be registered
with the Commonwealth of Massachusette.Inquiries
Submitted UU U,( SQI r��1 f / aro' �j�//td 11 about registration an stotus should ba made at the
To: C1 J lL.. Director, Homo Improvement Contract Registration,
One Ashburton Place,Room 1301,Boston,MA 02108
(617) 727.8598. Owners who secure their own
construction related permits or deal waIt unregistered
S� r M A Cj contractors will be excluded from the Guaranty Fund
/ Provision of MGL c.142A.
PEos'.01.Ne.
MA.RF.G. 100811
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We Propose hereby to iumish malarial and la r-complete 1 eccada t aove apac
nce wibilioahons,(or the Sum ut:— —)
iPaymem to bo r do as iolitnvs:
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`� .e i3_— 1-von wmpiencnal� .--- aryrucw� "'.
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Acceptance of Proposal I have read Irolh sides of mis document and accept the prices,specilicalions and condlitiens stated I UnOcks"nd
that upon signing,this proposal beCGmes a bincing contract.You are 3utheriII.`d to do me,work as specified. Payment will be made es ci:tmed above.
You,the Buyer,may cancel this transaction at any time prior to midnight of the third business day after the
date of this transactio ancellation must be done in writing.
p SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
(L
ItaiPORTANT INFORMATION ON BACK �
I
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• .................... ... '.......v................._.......
:�laxsuchuscn. - Ucp,trnncnt of Public�Su(ct�
Board of Building Regulations and 51andvds
Construction Super:reor License
License: CS 94763
Restricted to: 00
THOMAS R DOBBINS
19 CEDAR HILL DRIVE 'ti^
t
DANVERS, MA 01923
Expiration: 5/1 412 0 1 2
!� - /( ouunisimuy Tro: 23757
✓fir 'Vanwiurr !�✓l'�iwJuc/«de��a --..._.._._.__
Ufrirc of Consumer Affairs let Bushicss Rquiatlon License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Office of Consumer Affairs and Business Regulation
Registration:.,100811 Type: 10 Park Plaza-Suite 5170
.. Expiration: f/23/2012 Supplement Card Boston, MA 02116
CONTRACTING CO:, INC.
nOMAS DOBBINS
rdiuin strUel ---
P6,01960
'" '' UnJersrrretary Not valid without signature