25C-166 24 Orchard St 2013-03-25~
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INVOICE
Order Date___~3-wL-'-_'...L--~/-",,3,--____
Estimated Completion Date __________
Notes __________________
Shingles Windows Ramp ~6'X4' a 5'x4' a 54" x4' a $ o DualBlack _0 lS"x36"
o Earthtone Cedar
)( Dual Gray
_0 24" x36"'f___ 30' x36" Loft a 4'xS' a 4'x10' a 6'x 12' a ~., $
o DualBrown _0 36"x36" Window Boxes a Wood a 1S· 030' $o Weatherwood _0 36" x40'
o Harvard Slate a Vinyl 024· 036" ~ o Charcoal Gray ~,fi\.S Color
0 4..lI 10)('30
Hinges: 0 Std. ~Strap Hinges: 0 Std. ~trap 'til Site Preparation -pad size -2Lx 'J5 (subject to site evaluation) $ J I ~s ~T-. . ~ Overwllith Road Permit Fee $ yo. a[.
Loading Illustration
Subtotal $ d 3, fe,m
Trailer Truck Sales Tax $ ).1 lit) 'I, 10 CJ.t'
TOTAL $ ;;Sj 05'1. ~q
Deposit $
Balance $
P1
E-mail Address _______________
DuraTemp 11-11 0~ o In-stock Display Shed
.. To Be Custom Built Body Color ~d
Trim Color W k.'''k...
(Includes fascia &trim arounddoorIJ and windows)o Delivered Fully Assembled
o Modular A o ModularB Door Color dh ~re..ert II' Built On-site (Specify iftrim on d(]{)( is adifferent ClJlor}
u;"~-k.Comers
SOFFIT CHOICE (For New England Style Only)Size 18:. X .+;1
o Solid DuraTemp Tl-l1 Body Colorrtf New England Series o Exposed Rafter Tails Body Color o Keystone Series _ Aluminum Strip Vent Body Color
Style /lJew~lr~ UIr"""f .~J.,..~' , ..'.
Code iB"~H
o Vinyl
Body Color
Trim Color: White
(Indude:i fascia &trim around doors 8l1d windows}
Door Color
Comers
SOFm CHOICE (For New England Style Only)
o Venting Vinyl White o Venting Vinyl Brown
Base Price $ dO,bdS
Door Adjustment $ '100
Window Adjustment $ 100
Drip Edge: Kw 0 B
Single Door
Width 3'
Type T-£.
Transom
Grids: )fw OB
Shutters a Wood Color/Detail $ -Jtoo Grids: Dt'w 0 B a Vinyl ~
Double Door (l) .full sta.,.'rtA.S e $ '300
Width \0' $Type T-£.
Transom $ Ld lOJ-+ofNt>S~c:lA.r Oo.--~Grids:)OW OB
NOTICENOTICE
TOTO
EMPLOYEESEMPLOYEES
The Commonwealth of Massachusetts
DEPARTMENT OF INDUSTRIAL ACCIDENTS
I 600 Washington Street, Boston, Massachusetts 02111
\ 617-727-4900 -http://www.mass.gov/dia
All required by Massachusetts General Law, Chapter 152, Sections 21,22 30, this will give you notice
th t I (w.e) have provided for payment to our injured employees under the above-mentioned chapter by
in uring with:
T. chnology Insurance Company
NAME OF INSURANCE COMPANY
5; 00 Lombardo Center Cleveland OH 44131-2550
I ADDRESS OF INSURANCE COMPANY
~C3321269 5/27/2012 to 5/27/2013
OF INSURANCE AGENT
Ef<'FECTIVE DATES
PO Box 4889 Pittsfield MA 01202 413-562-3659
ADDRESS PHONE #
HI metown Structures, LLC 627 Southampton Road Westfield MA 01085
ADDRESS
E~PLOYER'S WORKERS' COMPENSATION OFFICER (IF ANY) DATE
I I MEDICAL TREATMENT
THe above named insurer is required in cases of personal injuries arising out of and in the course of e~ployment to furnish adequate and reasonable hospital and medical services in accordance with the
pr?visions of the Workers' Compensation Act. A copy of the First Report ofInjury must be given to the
in ured employee. The employee may select his or her own physician. The reasonable cost of the services
pr vided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably
co neeted to the work related injury. In cases requiring hospital attention, employees are hereby notified
th t the insurer has arranged for such attention at the
N~E OF HOSPITAL ADDRESS
TO BE POSTED BY EMPLOYER
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