Loading...
HomeMy WebLinkAbout0093 STUB TOE ROAD `A IL ©� c.L . I i ir r. yr,n �. ' ''r' ` ; v u+ f' U.S. OSTAGE�)PwrNEYBOWES {�r `�'.'37�3� 4 s"'• wdn. ,,* r F.. ,.+, Tt rt'" ."k ZIP 02601 $001.450 °. 00003364660CT. 26 2019. yk 3L"� � ac : %� `� �k '�ur' r: �txF x� d s�r,b .� �, r�.:a, s� :..�y"§ Ue tl� s'a ,e. '" yC•Mt az,q�'-fit. � +'� ,Xr«'- ..A .d�„ " 7� 'Aati - i *t*:,r.,; a � w k�' , ,.�., r ," x',, �+ * '*�' alp .a,a." Y* a aa'�.;; a '.,�ry '' �t F E : w a.� y�za °+ray?3 13 �Y � .$ ,. 5 � ,r _' ,y+ T �„° ���'� a v`y�sa ,f.�^'�. �, '�*yA,�� a• 40,� xr R t Aia t'.a.„ e" era�, +2CS w ay��" "', a' -v`,ahsp •€ ?��a r .a, ' rt�a. m p ati e: a c.: z '41y :. T w a �#� •y�� ,� 44 ,3p#"5a•,-:�s �rn*^i� �c'a, ��'� �e+-.;�, ;:r/O� � �� "'��1�'.• w .� �. ��.� ' � ,�,,, iM"" +, * ,y,y `""'� !;,� 4 4u '.d* x g r ?G'•:.v'1��k F 3. Vvx r e t L II:dw, -e•"`' S� "'��Y ."2.,.. �_.m Sy�s." «4- 'ra. 441 r, --- - - rx• ,:.y: aw'a §' a ,� Y a.a „j£° a ,. ^, ,.a .�; y,ap�"" ', 71 A ft+c. z"aw; 1 W .',a''y7r. ram,. * c r �� '� �r� � wx. a e -� � to ,°�M° .y an Gt}F' �` � c. �.?,,.,4+m.9'�r°� x a � .•� ��..a n � F�� r Fa� _ x COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation Home Improvement Contractor Program 1000 Washington Street,Suite 710, Boston, MA 02118 t CHARLES D. BAKER (617)727-3074 FAX(617) 727-3771 MIKE KENNEALY GOVERNOR www.mass.gov/homeimprovement SECRETARY OF HOUSING AND ECONOMIC DEVELOPMENT KARYN E. POLITO r r EDWARD A. PALLESCHI LIEUTENANT GOVERNOR UNDERSECRETARY Tuesday, October 15, 2019 Jeff Lauzon k 367 Main Street Barnstable MA 02601 , <;G .,,- . Contractors name: MATTHEW MASON HIC#: 0 Property Address: 93 Stuh Toe Road Cotuit MA 4 vl `itSIM1 Complainant: Jacqueling Walsh , ,D i Complaint Number: 2019-221 Dear Jeff Lauzon: Please be advised that the Office of Consumer Affairs and Business Regulation has received a complaint against the above-listed registrant. Your immediate attention to this matter is requested. In order to assist the Office of Consumer Affairs and Business Regulation in its investigation of the complaint,kindly forward any documentation relative to the above-listed property that you have in your possession to us. Please reference the complaint number and registrant in your reply. Thank you in advance for your, assistance. i Very truly yours, Office of Consumer Affairs and Business Regulation R f . COMMONWEALTH OF MASSACHUSETTS nFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATION 1000 Washington Street, Suite 710 Boston, MA 02118 ` TEL (617)727-3074 FAX(617) 727-3771 X d - W -^. /,1nn.sumer r i )r 5 2019- � ► O f�. _,��� 2.21 F% tit .E< f. j,r� -- - To file a complaint against a home improverr�vu,_______ - its form completely and submit it to .the Office of Consumer Affairs and Business Regulation("OCABR"). uuAn&will review all complaints. The submission of a complaint will not automatically result in a hearing against a contractor. If OCABR determines that your complaint is appropriate for a hearing, your complaint may result in disciplinary action against the contractor's registration and/or administrative fines. You will be notified in writing if a hearing is scheduled to address your complaint. You will be asked to testify at that hearing. Please refer to the OCABR website (www.mass.gov/oca) for additional information about OCABR's home improvement contractor complaint process. FILING A COMPLAINT WITH OCABR WILL NOT RESULT IN A MONETARY AWARD FOR YOU. IF YOU SEEK A MONETARY AWARD, CONTACT OCABR'S ARBITRATION & GUARANTY FUND PROGRAMS. 1.Your information: (Please type or print neatly) Name_]�,G C LA j LA . W A-1-5 h Current address: 3 L ca L'A'4 R�a 62�35 .Address of building at issue: ' R �'y�� �p"E 1�e� . cA L' -t-- M a o Z.�-35 Number of dwelling units in the building at issue:. Is it a residential property?(circle) es No Is the building at issue your primary residence or did you intend for it to become your primary residence?(circle) Yes No Day phone: (;6 Z Itf Fax:(. ) E-mail AV ) 4 2. Contractor Information: Contractor name: +-�/�l Q4 h _163 M EtS 6 N Business name if an 6[�4 c Business address: Phone: U f?-. 71 j— 0:3 . 6d Date contract signed:6 15 / 07 / ZO ] 'Amount of contract: $ Home Improvement Contractor Registration(HIC)# 1( To the best of your knowledge,has the contractor filed for bankruptcy?(circle) Yes No 3. Other Information: If you have included photographs with your complaint,do you want OCABR to return them to you later?(circle) Yes No C/� 1 (Failihg aint Information: Please circle the number of any of the following acts that you allege took place in your dealings with the . You:must circle at least one allegation. ng without a eertificate of registration; F ning or failing to perform,without justification,any contract or project engaged in or undertaken by a registered contractor actor,or deviating from or disregarding plans or specifications in any material respect without the consent of the owner; o credit to the owner any payment they have made to the contractor;or his salesperson in connection with a residential g transaction; �4. qaking any material misrepresentation in the procurement of a contract or making any false promise of a character likely to nfluence,persuade or induce the procurement of a contract; 5.Knowingly contracting beyond the scope of the registration as a contractor or subcontractor; ' 6.Acting directly,regardless of the receipt or the expectation of receipt of compensation or gain from the mortgage lender,in connection with a residential contracting transaction by preparing,offering or negotiating;or attempting to or agreeing to prepare, arrange,offer or negotiate a mortgage loan on behalf of a mortgage lender; 7.Acting as a mortgage broker or agent for any mortgage lender; �8.Publishing,directly or indirectly,any advertisement relating to home construction or home improvements which does not contain e contractor's or subcontractor's certificate offegistration number or which ds contain an assertion,representation or statement o� fact which is false,deceptive,or misleading;'__V�o 6 17k f, C tZ f''S 0' 0 iA S e-- W 0 LU4?j- e P_h\ Is Sl 0 io 9.Advertising in any manner that a registrant is registered under this chapter unless the advertisement includes an accurate reference to the contractor's or subcontractor's certificate of registration; Al 10. iolation of the building laws of the commonwealth or of any political subdivision thereof,If your complaint alleges structural violations of Massachusetts State Building.Code, those allegations will be referred to the Board of Building Regulations and Standards(BBRS), within the Department of Public Safety(DPS),for possible action against the contractor's construction supervisor license or you may proceed by filing your own separate complaint to DPSIBBRS 11.Misrepresenting a material fact in obtaining a certificate of registration; 12.Failing to notify the OCABR of any change of trade name or address as required by section thirteen; 13. Conducting a residential contracting business in any name other than the one in which the contractor or subcontractor is registered; 14. ailing to pay for materials or services rendered in connection with his operating as.a contractor or subcontractor where he has received sufficient funds as payment for the particular construction work,project or operation for which the services or materials were rendered or purchased; 15.Failing to comply with any order,demand or requirement lawfully made by the administrator or fund administrator under and within the authority of this chapter; 16. emanding or receiving payment in violation of clause(6)of paragraph(a)of section 2), which states: "Any deposit required nder the contract to be paid in advance of the commencement of work under said contract shall not exceed the greater of one-third of the total contract price or the actual cost of any materials or equipment of a special order or custom made nature,which must be ordered in advance of the commencement of work,in order to assure that the project will proceed on schedule.No final payment shall be demanded until the contract is completed to the satisfaction of the parties thereto;" 17.Violating any other provision of Chapter 142A. (Please specify below) a. Failing to present the homeowner with a written contract for residential contracting work exceeding$1,000 as required by section 2 b. Failing to include required terms in a written contract for residential contracting work exceeding$1,000 as required by section 2 c. Other provisions of Chapter 142A(pleasespecify in your detailed narrative in Section 5 of this form) 2 a,. ` 5.Please provide a detailed narrative of the acts or omissions committed by the contractor that lead you to file this complaint.If necessary,please attach any additional pages. Your complaint will not be processed without a detailed narrative. • r r 6.I hereby affirm that the information contained in this complaint package is true and accurate to the best of my knowledge and belief. Signed under pains and penalties of perjury: ign ture Date `please submit the complaint application,and all supporting documentation,e.g.,building application,court judgments,contract, photographs(limited to 5 photographs),and the like(the documents or photographs should NOT be stapled)to: Office of Consumer Affairs and Business Regulation Program Coordinator HIC Complaint Program 1000 Washington Street, Suite 710 Boston, MA 02118 1 6 )IRS �J� J I 3 +�' q e � o h t r A r]II[ INN Family First Contracting P.O. Box 422 Barnstable, Ma 02630 Phone: (774)534-6199 "Where customers are considered family" Proposal Submitted To: Phone: Jackie Walsh Date: 508-428-9142 Ma 71,7 2019 Street: Cell,Fax,E-Mail: 93 Stub Toe Rd I, City, State and Zip Code: Job Location: Cotuit,Ma We Hereby Submit Specifications and Estimates For: Side Walling Strip all shingles on the b3ides of the house discussed with owner,repaper all strid areaglesth wi appropriate spacing and using appropriate tools pe s,install new shin Windows (A� WWP Two windows to be removed and replace in areas discussed with owner Trim 0 J, Address all rotted areas,remove rotted areas properly to prevent any damage to the roo install new PVC board 'where wood trim was removed,plug all nail holes so they are prepped to be painted all areas $9,750.00 tutEt(" .dy-CkA - POO.— r NOTE:Family First Contracting is not responsible for any unforeseen areas that need to be addressed.If any other areas need to be addressed Family First Contracting will discuss with owner immediately.Family First Contracting is not responsible for any delays that might occur due to unforeseen circumstances. -70-ZV Ca - I �_j 2.�� Note: All men insured with Workmen's Compensation and Liability insurance. We propose hereby to furnish labor-complete in accordance with above specifications for:thum of Dollars - J,4`/(s ZD j C�� 9-/9 Please sign/date and return copy for work to be scheduled. Patent to be made as follows: S_)Q F-)I ST 50%Down/Balance Upon Completion.Final check a `3 0b' tD �We Acce t• Cash and Check P yment to be given xo a crew member completion. Family First Contracting is not liable for any unforeseen issues that might be existinh the prope i I Thank you,Matthew Mason/Pre lent rty sid Authorized signature: �r - �' ACCEPTANCE OF PROPOSAL-The above prices,specifications,and conditions are satisfactory and are hereby accepted.You are authorized to do the work as specified.Payment will be made as outlined abo ve. ! Customer Signature: Z O I C \ Date of Acceptance: o ; signature \ Signature v-- ` t It �• � r •f-�d t !e, r -Yr.. r• '"`i sW ts�•v� � . - � � tn�•"� r$y a HE3 rim F i All fi }} S p.„v1 - i s ��F. i f F F P'1{n•P - - -x'— -_ � tf��i�t!fif(�(,i',.i►�"f``i�f�ff`��[t'(.i��;if:f.�Ij�'#k,i<<3t��t'i'it�`� ; �,,:�,;�� ��', .,�,�;� ��__-�; .�: CONSUMER AFFAIRS&BUSINESS REGULATION 1000 WASHINGTON STREET, SUITE 710(DPL) �X.x BOSTON, MA 02118-6100 a Return Service Requested Barnstable Building Department 367 Main Street 1 Barnstable, MA 02601 60880ZZ4-J6b0 804Z0dIZ 5K0. 099.000 OkOZ/R/G6 �ibw ssti��-isai� �,x�daau I • f j i Y , .�rAid . FROM —� TOWN OF BARNSTABLE BUILDING DEPARTMENT '•♦ lx . Francis LxY•teine 1p.eYy.rT+�?�('•F VF'1f'y 7J�-r'@##�M'AKfR 367 MAIN STREET HYAN#d#$, MA 02W1 Phone: n6-1120 . . -4W4'fT#•GB$M.;+6+�+1?- `m'3:6 Ff�F.-#.4!4t fr.9i SUBJECT: * *^ox FOLD HERE },Ip DATE , Oar 19, 1984 MESSAGE Please release - �#Vs.wi.►!+a♦at..lwr iM K+d..4l..,3P Y^I.wTe4�...�"P`A i�i#'aY A:Ar'4�,a.p^?s%T sr w,ri�f 4 e DATE REPLY . SIGNED N87-RMI RECIPIENT:RETAIN WHITE COPY,RETURN PINK COPY PRINTED IN U.S.A. SENDER: SNAP+OUT YELLOW COPY ONLY."SEND WHITE AND PINK COPIES WITH CARBON IN •-TOWN OF BARNSTABLEA.� Permit No 2537� Building"Inspector l SAUSTast Cash ' - >� �9 1 OCCUPANCY, PERMIT ,Bond. , Issued,to P:ddress,. t'rxar �lr�rAc RAaI+v'Trs,ct Lot 37, 931Stub Road,,CbtlAt Wiring Inspector -�' .�/ Inspection date`./_ice Ph:�inbing Inspecto� f' f Inspection date'. Gas Inspectort::y i'{� f rer a� .. Inspection date N Engineering'Department` J •Inspection date,' 18 �4� Board of Health Inspection date j,�j-� � kv A/ THIS PERMIT WILL/`NOT BE VALID, AND THE BUILDING SHALL NOT-BE.'OCCUPIED UNTIL SIGNED ,BY THE BUILDING INSPECTOR 'UPON 'SATISFACTORY COMPLIANCE'�.WITH "TOWN REQUIREMENTS-AND IN ACCORDANCE. WITH SECTION 119:0 OF THE MASSACHUSETTS STATE. BUILDING CODE.'. . 04-, I�Y4_A-0/z" .......................... 1 J............ `• G or Building Inspect uxt TOWN OF . RARNSTABLE. WITNTITLE B'U I L D I N G,�,,`- W S?E C T OR Construct TOWN REGULATIONS TO THE INSPECTOR OF BUILDINGS: The undersigned her eby applies for a permit according to the following information: Residential 24 Great o. Yarmouth, Ma. same Name of Builder' -------------------.--.A66nso ---------.----...—.------~—.--.. NameofArchitect 0/���-------------------..A66,es .................................................................................... ' 5 ou� d te Numb erof Rooms ----------------------.Fpun6otion —']�--'/�—..����/��/�------_-----' � Exlerior ------o��ar ob—ioo.le-----.------'xoo�mg ----��oo�alt ob�' � �—e................................. .. � . I�l o��e Floors -------��������----------------|ntehor -------����!��.-----_---------- 1 l/� bath ^ Heating -----_!���--------------.�um6ing ----..=^-----..��--_--.—.------- � Fireplace one �25 OOO -------_-----------------_—'Approximote [os —�—^=.�----.-----,.,_~__.,_ Definitive Plan Approved by Planning Booi6 lQ 73 . Area ......�—�q�~� ' �°�� x~n� � Diagram of Lot and Building with Dimensions Fee ___ ____ SUBJECT TO APPROVAL OF BOARD OF HEALTH ' . ~ � / � - y#011 � � ' . . . ' ~ ' � � � ' ~ ��w~ � � � � � . � . ` ' � . . ^ OCCUPANCY PERN\IT8, REQUIRED FOR NEW DWELLINGS � | hereby agree to conform to all the Rules and Regulations � t� �� of Barnstable regarding the above oon��uc�on. ' � , ` / � CONST SUP. I,IC OI668l. . . � ' r . No ~ ' ~~~'^��*».u�r�,�r ' `^ - u�' Q7 1. - - ',DAR ACRES REALTY TRUST N25877 it One Story ................. Perm for .................................... Single Family Dwelling ............................................................................... Location ...Lot 37, 93 Stub Toe Rd. ............................................................. .................Cotuit.............................................................. Owner .....Cedar. . ...Ac.res...Re.a.l.tv.... .. ........T.rust .... .. .... ..... ....... ..... .. . ... Typetof Construction ....Frame ...................................... ...........................................................I.................... Plot ............................ Lot ................................Dec. 15, 83 Permit Granted ........................................19 Date of Inspection ..............19 Date Complet7d ri ; 19 . ................. /o i4ssessor's map and:lot number ....... 1 -..t.c�!.5.. .;���. ,�. ' '�'''t� y' ' `� .... . �pF THE r0� Sewage Permit number ... �.c .'..`��-Q ............................ Z BABBST/IDLE, i House number ......................................�.. 9�0 639 ♦� 9 �MAYa` TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO .........Construct ............................................................................................:......... TYPE OF CONSTRUCTION .................. ood..Frame........................................................................................ thF '1 a'•: ........!...............19....0 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .......T ot...��....�t�,�,, mn ��-T� ram+,. �- .� , ................................................ .................................. �• ProposedUse .......Residential........................................................................................................................................ RC Fire District Cotui t, Ma. ZoningDistrict ......................................................................... .............................................................................. CMdPtZ 19Cr*"S Pv-&,.7- 24 Great Pond Dr. , So. Yarmouth, Ma. Name of Owner ....' :.n:n:..:C. ...........Address Name of--Builder' Sce .............................Address .,A Name of Architect .... .......................................................... Address .................................................................................... Number of Rooms ......................................Foundation poured concrete cedar shingle asphalt shingle Exierior ....................................................................................Roofing .................................................................................... Floors Plywood sheetrock ............................................. Interior .................................................................................... Heating' ...............F ... ..gas...... .......................................Plumbing ...............1.j2..h3th.r...................... .................... Fireplace one ...............Approximate Cost S25.r.00(I,.................... Definitive Plan Approved by Planning Board __Sept. 21----------V9__ 3_. Area Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH Vt 9 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. r CONTT. SUP. LIC. 016681 z: ;� � Name ... .....................`... ....!"...!I.f .................... d J CEDAR ACRES REALTY TRUST A=�4.0-105 No 25877 Permit for ,,,, One Story ................. ........... Single Family Dwelling ............................................................................... Location ,,,Lot 37, ...... 93. ...Stub. . ...Toe. ....Road .. .. .. .... .. .. .... ..... Cotuit ....................................................................:.......... Owner ....Cedar Acr.�'.p...Ra.�.t.�?...2'>;L1S.t Type of Construction ....Fr.aerie......................... ................................................................................ Plot ............................ Lot ................................ Permit Granted ...Dec. 15,................19 83 Date of Inspection ....................................19 Date Completed ......................................19 1� ©C(MGYGCXI- ,R., r - o OF j E. a Z RAYMONB Ir �' 0.2,583�a . lq�A $up On 0 UJ x Zrr LOT. 37 055 � t �o o41 x _ CC , vo � t - 14 I <-Z0 a Q 5--u.Qs To E 40 Ir .� � . Cal 37' 'Syr � `T'�E�'��c�,�� �'" �•. •�u'(y�- /✓'-�`�`� l/1�'�G�f' �y'�/C Ufr.. • �� a. .� � r�r 1, Y N:#A1Y .. ✓ - :. ♦ r k�.w ��..ae.w.. —r.. a.w .i' ...�- ..... .wr— 1 ♦ - t lZ.T y � }� Town of Barnstable ,Permit Reulato Se Expires 6mo m' e g rY rvices Fee MAW • snxrsruua, , Thomas F. Geiler,Director rFp Mp4� i Building Division e ' Tom Perry,CBO, Building Commissioner 1- 200 Main Street,Hyannis,MA 02601 www.town.ba_rnstable:maus Office: 508-862-4038 Fax: 508-790-6230 EXP SS PERMIT APPLICATION RESIDENTIAL ONLY s Not Valid without Red X-Press imprint Map/parcel-Number Pro rty Address Residential Value of Work I l Minimum fee of$35.00 for work under_ $6000.00 Owner's Name&Address {j 1 (14 A Contractor's Name Telephone Number '7c/' Home Improvement Contractor (� hcable License# if a 9 f) o P Pp � ) �/ / S 3S Zt ruction Supervisor's License#(if applicable). / q .T 0 orkman'sCompensationInsurance -PRESS �C�M�p'� Check one: PERMIT ❑ I am a sole proprietor 0 j>!am the Homeowner J U L 31 2012 L�7 I have Worker's Compensation Insurance Insurance Company Name Aj U: F BARNSTABLE Workman's Comp.'Policy# 7` ZS �®V a Copy of Insurance Compliance.Certificate must accompany each permit.; Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not.stripping. Going over existing layers of roof) El -side �. #of doors Replacement Windows/doors/sliders.U-Value V. (maximum.35)#of windows _.❑,,Smoke/Carbon Monoxide.detectorsa4-floor_plans.:marked,with,;red,Sand.inspectionsxequired._.:_._, ._ Separate Electrical&Fire Permits required. 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e,Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors'License&Construction Supervisors License is required. SIGNATURE: Q:\WPHLES\FORMS\building permit forms\EXPRESS.doc Revised 053012 71 The Commonwealth of Massachusetts Print Form Department of Industrial Accidents Office of Investigations 1 Congress Street,Suite 100 ;r Boston,MA 02114-2017 d www mass.gov/dia Workers"Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):-M a0vi Ad&ess: //3 Dr—Lve City/State/Zip: o-ep-.4 a1�T" Phone#: qn f-6 7 0 Are you an employer?Check the appropriate box: Type of pr ' ct(required): 1.9 I am a employer-with �L a 4. ❑ I am a general contractor and I employees(full and/or part-time)..* have hired the sub-contractors 6. ❑ w construction 2.❑ I am a sole proprietor or partner- listed on the attached'sheet. 7. emodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. " employees and have workers' insurance.t required.] . 9. ❑ Building addition [No workers comp.comp.insurance p• re 5. ❑ We are a corporation'and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions 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. �T Insurance Company Name: } Policy#or Self-ins.Lic.#: Q, Y7 731 F3, Expiration Date: o� Job Site Address: S I ('L�0' City/State/Zip: 4 o �� i 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ceryft under the gains and penalties o e 'u that the information provided above is true and correct. Sitntatttre: . . _._: __ '" _ -- '"' — ... . - DateJ. y. Phone Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Build;ng.Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: E LIABILITY F THIS CERTIFICATE 0 A IItATT�aa � T� .r A#� U T ^� T EXTEND O€�ALTER THE COVERAGE CEi3Ti41TE l A�#iTEIiEtY ?81tELy E£� THE # 1lt+K3 16fik3=tER#9}, ALMAM BELOW. Tom, f#CATIc la CCI#F1T#JT>; A fqEPRES8$TATr&OR PRODUCIM AND THE CERt*#CATE WOUTL E 3 TIC to WA#O M to I RTANn ttaldW is Pol#�f A eww"a� en fldcu mt coast rwft pow &dF►ter and OfOW,cmr4a3n po#lcies rm Ps�ults; e141c�te t #e�##su afi stre3s ertderee ssor Hula .tr IFEc. 401-7 5021 s ` RI{0� P.G.BOX 9 UNTAt4s�, 1 e '1479 sssu� Woo ®c#s lnc,'-- &A.A.Ml blaimmnm.co, # ponewals By And eron 9_ 1137"East 0 : . Woonsocket, Rl 02895a. ft"loN mialsm PEFWG C CgKfl TM 3d1JNS �F'OR TF FAY TWS tS 70 CERTIFY TM97, THE P"OuclEs OF IIVSIlFNT LISTED 86--w t+A"E E�Fnit 1S3E$[z Tfl T}+E iNSFi� p� 18EQ kFFElN iS SL1F3 JEG f TO Ai.1 TFiE TERMS, 1401CATED,�NgTNMfSTAH Y P QgEMRTAPL TT�=N AI F'ON OF ANy Q 'TEE POI.ACES R CTHF:R r1F]dT+FUCI�i FECT TOIEC TO gnR�rCH TFii ERT1FtCATE MY,BE .5�1�3 OOR m (CLU50NS AND OON2DFT'ONS OP Sih:H peyF�C�ES.UAA!TS SYGk�itd' MAY 1iA�BEEli�iEYaUCEB BY PAID CU4J tA�ri� Lwy uues�e� Y1�riatOP 996fl6 RAR9C8 Wei OCCUFRENCE 1,229l6RAL i AIR STY V ►� f'—; faS26�i$ O RS 99 6VW12 F awsEs tF' gWwaa g 4 , A f� Gti h�e+EaCiAC€�AdF3�L itl$+L:"r i?�£+c"7iP flasY a+�pelsaryt 3 —T'1 OCiS4PR "__ AGORWATTE Q PR0r8-t`sR ---- 2,�s AM.AC4-R GA^t LMrf APPYE3 PEPLmff f ; OWLYWARYMW au'Ct�tFt °t �926bi9 f t}4J18+4i �F}/96(}3 _ A 16 Wray Ass'b E Fl LY fNSSAPX(Peg ssol Ai C,0AEDAU,Cti �' f _ S s _ Loot F3 i A UAL X 1 OCCUR � _ fgx4: � .C€12� 1 tl9f�Fat#'I iS142 a 7CT 89 E xi dttg 6 Emu T ` � L 3 3 �� p PIpLO'i@wmilLm visa wC 47 731 E3042 iE�#�S4 { tF�lt#8 �C r p SOO i � �vr�eaoasuuera;€�> .�c::?a.•�'k r �,+� E�oc •eaFs��ore:i s � oma-MammR Y r�s �erioe u^tler ' { RTJjN QF OP ERAMNS Wee "' CEg 6X�??fl?f op d94Wfa P WCATM CAM �BE IN I'm wwuw DATEninw, W= Ids . 99�&Z #3 KC$]Rf3 OO Ttt4;�3. All ftfi s r630W9<L ACORD ACORS r#sms and"Jo am ragged #4csrtf �CC��z�j21a®9tQ�p k1 ce'ai'soa,er 'AW-ir", "s`' 'l Wtsitioss 1 gula(f Poston, Massachusetts 02 l 16 Typ I•'l�to C - et.l:�? ., • - Y• - _ 7,124:21S3.. Tt6 773411 . 40C3.N ASSOC WCJAMES MOON , 1W PARK,FAST DR. l�C�ONS6CKET, Rf 02895 , ptfate.#ddeess aed rctusn cvstl !64gris t reaam rcr rii4':tc- Addres Urn mal Eippi-i-n:ert lAwxa Curd ( [A:fce alNt."'wsr.`erarr ►�abn 4 1xu�+iisa'es Cteeo �Yt�,o" ' f•i�ense Or regis'ir' tiau vidw hu fridleldalt6su481� _ HOME IMPROVEMENT CONTRACTf�R before the ripiretinu dste, If t+wrrd rtEisfra to: i; Rnagiste-dioh: 1 t9r3 ipfa ; (Hike d Uw:,,,nmaT&Ozin ursd RuAnco RegaWior• y:_ .E�pitagotr- ? .4^�)•.3 F rnahr r ertFird::�? itt P&rk Pima:Some 4 f 7Q • S isron.MA 021 tO 713,FAP;' EeS1 PYR ja Qf� '<KIC Not iul-af wiaitorn ivDaAvry ' rn:4s*«'L�'it Ptefi xtg- +t�'•.lrS ^.;q, tr.i::l , .�:•<.:. :,=1 j Pr# ,a4ib. S yir " JAMS S Mt ! PAFN RRr `"'R Cumberland�ti f l • • k.` try ... - .. ,ataaY v+ ara OU2312614, 4 � fta•at'llled i 0 C:SSt'WS W' inaows Arid St4ing CSSL-RF- Roofing i { Failure to posie-ss a carrent edition of it*masw1jusetts r State Building Code is m4se for revocation of this'iicenso. • 4cDr f)F'"S krcertetrt�arttt�rriacutadr v+ctt wc�rrs bM1.Rat.6rJv/i}l>S . i } .ram, - • erg wa l —J der se RlN0:S3259 +5 1'31 Eas:rtrw Lead Haearri Control F xsn , CT HIG,Ori527Z'? Wtzl iKCf R n License,OLHICF-doss r WINDOW REPLACEMENT anAmler, ;10,,,mrrxns' itlAHir11k5 S�lg7g.gG tjx,��67i-;42 Purcfiaser(5)Name. nn6 y ,• .. --r-Z Installation Address.. t Making Address, City St Zip; -- Home Pho .S69 12 F I _ Work Prone; im,jwrsp C 11 Phone: liar/M,r31 ' Email Address: Taxes Paid in, �/�if N 1 d� A`n, :nC),*,put ma�tr{s)f'Pu!rnaserrsl and me'ow+tens;,;Inn:the Ea'unZr, f in e rtb{'k'rty t.r.dtrcS sr Me 3mn-axf Fe II,.eT"ry j{eniiy ano 5t'",rmy":y ,Mimd ic--1C lir'�f i.*,s'k' "y',''.^.fra.r.,4eAE,.uyr Gy A 0ersen`.ant ac t In fU $h.q}e ve r7 d;tnska;l all r!e!endts as aewiced In his:3It9eP?nt('AgePrrenr'i,the 21�l Ed 4GF Ircf➢n,Sr>eetts)and S'a�s Summary,and any dagr-amfst Wn(t ale t S+IbNr aherf"+n]oy re/f�ereence arts?l made a;.N:t Re.n'af A Com!eiex.n Cei-q I e wit rr executed lc,!.,•t KQr;S fit ale erNI Of 11We 4t0$ah`n / s"2� .So.y_3�p Agreement Amount; 1 t'.Cheek.Cashier's Check,or Money Order. CHECK � D 0 Less Deposit(nax 33%): /'8' ®''r 2.Credit Card'(circle) VISA MASTER CARD DISCOVER Balance Due upon.Completion: pef nl fee;Ci?,tc ea a dnaro parance) Account Nflmber. Est-Start Dace: Est Finish Date W Exp Date: ( ) Security Code: ( . nvx:ate oatinenl inelhod for balarre ;FINAWWNG: Bank .. } AccountlAppriovaf Number". i-Nm agme.D3 al rwr Cv.-,,-.xz s7..::are 3ric-e?nlenre,cIed s..Zva V qFa i rrr 1Q t,.r r_,..m..... ;t t �" � .,$', a, "] - ..'��.0:.;t,�n ttr+-!"el:. .. ,-:.1ta..e:,f•t,Se_eiiCw_ Customer has reviewed product o&rrags and has been made of glass toss that ociurs with the installation of replacement windows 3! av Ti yr.�. h [ ...,�y�.� K, `v ya:' r%-..N W � K,. ��J+!��•• �y` 1 gyd Y b 1 - '" 4� � f �r )k}'. n ait �S1;. �� ff/r✓ ! g • yr, l� � ,Nf T r: ? ,s;:W:i r•�, svr<. : .. i=�{t'r .ri. .n., a, i`~ .< y_-,''^. ,fir'..1 �?S, a„1 ..Y...su. ,,ri:;' 'f,x?'. ;td sat of all old unit;and clean up of all)ob related tlebns. �-(� Any Pr 7tiN andtnr$tabling of windows,turn or Ovals I tallers will leave windows clear of smudges and`FngOrpnrts • r 9ttvtnr�fort rtLre ansf obverts a�+ay;rwt vindovu5 p N to installatton I An iy,;ttding pem+s required by town for wtndow and door nstatiatton The removal and reins!allation of any exlshng alarm systems Customer to tali alarm cc t , y lead-sate work,practices.it applicable,as required by R(State Law` f The riaioval and reinsallation of any window AC units,unless checked below Ad ;a:tr,xr.�,�s9 oinVwACowllsl T,h _;_.- Customer allows Renewal by Andersen to use Shatograpns of prt>Eeot IC•r future ��- e removal and reinssa5ation of window Treatments g llaraciiem,unless cne aeo below marketing rnatetiass v ? PBA ro remove and rein'sr7 r w ndaw treatme.Ys 3 Dracke!s t cs ayraaa h f aria bet seen rho pa tres±ha tivs Agreement di&:Pxe,st.:r,e a yr,lne Prt?{e4'3r'ecrpc:dwn$srct,sirs: ec,hE enure wlderSeliaaK vx?we r,the parres,and METE are NO VER..S urrd rsiar�Iffs ha tJ rg 5 r}�ng the terms at this Agreemt nt.Pu taserts)hereby a kn�wledges!het !)qt tr r serrsl Has reed rt e Marx artd revere or this agra one K.and ties r8o•!'red a axnpttete signed and datecr ct'),y of Nis Agreemtrit,which includes the Notice of Cantetfanar msmuxalris aertlw,on the dale first wr&terr,abava and zi was ands,olbrniedor purdlW(S)fight to cancel this hansadlott.Pw0 awful and Renewer,)) Andersen agree that rha Agreement(iriclud ng the Protea spse rrcrt ion Shut.and ar atrauie,xenisl ss rPe rru r rrx Cass o r of our ag arm nr,+n+d is the romrkern ansf-orcfvsiae sreteimrrt cf our terns and condaans of the agrsetrletlt and supercgdes all r�reemenis.u[tdr3rsrandrngs ar drstus5,trs.wrarl�r vrar:lr wrr(ra,n.r?r,�,-,U x cxYerrgrrA2rnavisty wAia,mn agrgt!rr�at Tl�s&.,vs+emantrr�yna t�rrwttf�d ar ernr��tttf:arra,�s rr .. •• „ - wnRr,a Igrwrrtay 1,lrerTstand Re';G,;v-�H c Arriiersp, - .. Snovw 3.r,rna,14af2;1vnha Or v au:+ „%1tai Wkince Ma_urtL$Slue,S t---rifle, DO NOT SIGN THIS AGREEMENT IF THERE ARE ANY BLANK SPACES,SEE REVERSE SIDE FOR TERMS AND CONDITIONS OF THIS SALE. .:._ - •_.<.. ., :,,,: .,,�... .. . ..:::... �a.r,.,.. -.,:_..-._. e. ',::.... , - .> .. nte?er4.cix r'�:-rwsYmfs,..a.a.>... ... RCHASER PURCHASER CONTRACTOR SPECIALIST 1 s,21u lgnature /, nal Ftllit Name r PlinI Name Prins N YOU,THE BUYER(SI,MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY,A ER THE DATE OF THIS Y TRANSACTION.SEE THE NOTICE OF CANCELLATION FORM BELOW FOR AN EXPLANATION OF THIS CONSUMER RIGHT. There will be a service charge of 10%of the Agreement amount it the job is cancelled by PurchaW,s)AFTER the third buslnew day,but BEFORE mabK* were ordered.There will be a service charge of 33%of Agreement amount h job Is cancelled bu Purchaser(s)AFTER materials'ire ordered. -------------------- ---.......... -- ------------ - - _--- ------- ----- ---------------------------- - Notice of an ellation l!otice of Cancellation _ DATE OF TRANSACTION: DATE OF,TRANSACTION YOU,THE BUYER(S).MAY CANCE HI ZANSACTION.WITHOUT ANY YOU,THE.BUYER(S),MAY CANCEL THIS TRANSACTION,WITHOUT ANY PENALTY OR OBLIGATION,WITHIN THREE BUSINESS DAYS FROM THE PENALTY OR OBLIGATION,WITHIN THREE BUSINESS DAYS FROM THE j.ABOVE DATE.IF YOU CANCEL,ANY PROPERTY TRADED IN,ANY PAYMENTS ABOVE DATE:IF YOU CANCEL,ANY PROPERTY TRADED IN,ANY PAYMENTS € MADE BY YOU UNDER THE AGREEMENT OF SERVICES,AND ANY MADE BY YOU UNDER THE AGREEMENT OF SERVICES,AND ANY NEGOTIABLE INSTRUMENT EXECUTED BY YOU WILL BE RETURNED WITHIN NEGATIOBLE INSTRUMENT EXECUTED BY YOU WILL BE RETURNED WITHIN 10 DAYS FOLLOWING RECEIPT OF THE SELLER OF YOUR CANCELLATION 10 DAYS FOLLOWING RECEIPT OF THE SELLER OF YOUR CANCELLATION NOTICE.AND ANY SECURITY INTERST ARISING OUT OF THE TRANSACTION NOTICE,AND ANY SECURITY INTERST ARISING OUT OF THE TRANSACTION WILL BE CANCELED.IF YOU CANCEL,YOU MUST MAKE.AVAILABLE TO THE WILL BE.CANCELED..(F YOU CAMEL,YOU MUST MANE AVAILABLE TO THE SELLER,AT YOUR RESIDENCE„ANY GOODS DELIVERED TO YOU UNDER SELLER AT YOUR RESIDENCE,ANY GOODS DELIVERED TO YOU UNDER I