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HomeMy WebLinkAboutBuilding Permit #123 - 1063 SALEM STREET 8/11/2009 BUILDING PERMITo "°RT 6Ati TOWN OF NORTH ANDOVER o? ' ''` o°, APPLICATION FOR PLAN EXAMINATION * tift 41l Permit NO: Date ReceivedA^_�° 7,��°gA7to IPP�,�y / SgACHUSfc Date Issued:--,,E- �/ Of IMPORTANT:Applicant must complete all items on this page LOCATION PROPERTY OWNER Aug �' t�S�i,9 Nmc.T t2 R,45/ � Print MAP NO: b (- PARCEL:CoYIT ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building ne family APition TWO or more family - Industrial p-Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: - Demolition Other t-ge-ptic Well Floodplain Wetlands Watershed District Watery DESCRIPTION OF WORK TO BE PREFORMED: CtZ�g+E No ij HA b; +A b 1 ..5f5y"q�,-E Aalg ,,-i eo w zn- L � ✓s_ L - Identification Please Type or Print Clearly) OWNER: Name: Cyqu 2;E---& a 'Aa 171.E Ati A5/ Phone Address: )1 IV., CONTRACTOR Name: ��- CZ 00 N S" eve l a Phone: 11'19- 62 z - 2n r Address; l t'w ; rT I/&- 1J . Supervisor's Constructiontioense: cS o�`� Exp. Date: 3 -l0 Home Improvement License: l Exp. Date; "1 a ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ JV '4;Z6 FEE: $ 17 fle� Check No.: % Receipt No.: 0oa 3l d NOTE: Persons contracting with unregistered contractors do not have access to the guar my fund ,Signature of Agent/Owner Signature of contract raw, Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract ❑ Floor Plan Or Proposed Interior Work 1. o Engineering Affidavits for Engineered products ,f NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) Q Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit E New Construction (Single and-Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) i ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application I Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales Private(septic tank,etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature- COMMENTS EALTH, ., Reviewed on _ Signature .� r COMMENTS „ Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments - Conservation Decision: Comments Water & Sewer Connection/Signature& Date Drivewav Permit DPW Town Engineer: Signature: 84 FIRE DEPARTMENT - Temp Dumpster on site- yes Located .3Osgood Street 84 Located at 124 Main Street Fire Department signature/state COMMENTS Dimension Number of Stories: � Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service droprequires a Electrical Inspector Yes No q approval of i DANGER ZONE LITERATURE: Yes MGL Chapter 166 Section 21A—F and G min.s1oo-s1000 fine NO NOTES and DATA— For department use) i 1 ❑ Notified for pickup - Date ......................_..........._.__..............._..........__................................- --......_...._......_. Doc.Building Permit Revised 2008 Location /049 c.YfZ✓7 No. Date NORTH TOWN OF NORTH ANDOVER fR .. 9 ° Certificate of Occupancy $ �-- 1'�s t Building/Frame Permit Fee $ s�<Mus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 223 $ V Building Inspector F tAoRTH ® of 4Andover . No. rib dower, Mass., T 0 - LA E COCMICMEWICK C oRATED PPS\ � VV BOARD OF HEALTH PERMIT T D . Food/Kitchen Septic System BUILDING INSPECTOR ......IK....... ............... ...... . ' Foundation CERTIFIES THAT ... ................ _ has permission to erect buildings on .... .� G.�.......... ....... .... ....� ......... Rough to be occupied as..)Joiik.... .. . .. 6P:0t;w..6?o ....... . .... .. �pprlca&n ................. Chimney provided that the person accepting this permit shall in every respect conform to the It on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough l , Final 'i PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONS U STARTS Rough ....... ......................................................... ........................... Service 14 BUILD Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. The Commonwealth of Massachusetts j ! Department of Industrial Accidents Office of Investigations . 600 ff ashington Street Boston, MA 02111 www.mms gov/die . Workers' Compensation Ia bnwce Affidavit: Builders/Contractors/Blectricians/Pfnmbers A r• Brant Information . . Please Print Leeibi '' Name(Business/Orgmiration/Endividual}• 2�N (2 1 o its ------------ Address: Y iy E City/State/Zip:_ N • A-N4©v14• iq�� ql ao1 Am you an employer?Check.the appropriabbox: I•L�-I 1 am a employer with_ �dl 4. I am a general contractor and T _ T�°f Pre1�(regou�. employees(full and/or part-time).* have hired the sub-contractors ❑Naw construction 2.❑ I am.a-sole proprietor or partner- listed on the attached sheet,i 7. 9?�emodeiing ship and have no employees' These: sub-contractors have workingfor me in any capacity. g ❑Demolition aci workers' comp.insurance. [No workers'comp. iasttrartce 5. ❑ We are a corporation and its 9 ❑Building addition required.) officers have exercised their 10•0 Electrical repairs or additions 3.❑ I am s homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself»[No•wor6n'comp. c. L52, §1(4),and we have no insurance t 12. Roof repairs -required.] ❑ �N .em Io ] P Yees.[No workers 13. comp. insurance required.] ❑ MT `Airy eOwIapplicant that checks boz if homeowners who submit this l must 919n fill out the section beiow showing their workers'isotnpeaution policy information. ai r�id t avit indicating they are doing an work end then hats outside contactors chee Comust submit a new affidavit indicating euoit ; atraators that k this box musts.ttecke:d sn sdditionsi sheat showing•the ascot of the sub-co etactors and their work em,cer p•pcii�i infom�etion. I ant an employer that is proridurg workers'compensation insurance or a !o infortaralon. f m1' p Pees: Below is the policy and job site .. . Insurance Company Name: Policy#or Self-ins.Lie.#: (A 7 / -"S 7 Ss Expiration Bate: •f O Job site Address:______/� [�-'� • ,�i 11. �, 4� .city/SttttelZip:-P—. . A Nr� Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration da*4 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 aday 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. !do hereby cern under the en aWw of a that th P r!� e ,f m nr»tatio n provided above is true and corned n Phone#: 72 J`J 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): I. Board of Health 2-Building Department 3.City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector 6.Otbe''r / Contact Person: Phone#: I I I Information a nd Instructions Massachusetts General Laws chapter 152 requires all emp Ioyers 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 a joint enterprise,and includirig the legal representatives of a deceased employer,or the receiver or t ustee 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 mai micinance,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 iicense or permit to operate a bnsioess orIto construct buildings in the commonwealth for any applicant who has not produced acceptable evidence.ocompliance with the insunce'coverage requi f ra red" Additionally, MOL chapter 152,§25C(7)states"Neither tihe 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 preset ted to the caritracting authority." Applicants Please fill out the workers'compensation.affidavit compimtely,by checking the boxes that apply to your situation and,if necessary, supply sub-contractors)name(s),address(es):mind phone number(s)along with their eertificate(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'oc rnpensation insurance. lfan 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 theapp.iication 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' oompensation 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 Offiaah; ..�. 6 .J • F ,. Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for oil to fill out in the event the Office o . y l f Investigations has to contactre ou ding theapplicant Y �' Please be sure to fill in the permit/license number which%%-M be used as a.referencc number. In addition,an applicant thaT,must submit multiple permit/license applications iii 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.officiaily stamped or marked by the city or town may be provided to the applicant as proof that a valid af€idavrt is on file for future permits or licenses. A now affidavit must be fiDed 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 bum leaves etc.)said person is NOT.required to complete this affidavit The Office of Investig=ations would like to thank you in advance for your cooperation and should you have any questions, pie=do not hesitate to give us a=11. The Department's address,telephone and fax number.. The Commonwealth of Massachusetts Departinent of 13ndusirial Accidents Office of Lnvestisattions 600 Washington Str=t Boston, NU 02111 TeL # 617-7274900 ext 406 or 1-8.77-MASSAFE Fax#617-727-7744 Revised 5-26-05 www.mass.gov/dia KEEN,CONSTRUCTION CO. 21 HEWITT AVE. N. ANDOVER, MA 01845 (978) 691-5201 Payment,Sch"ed"u e: $1000.00 due upon sign i g contract $4000.00 due the first day of work's $4000.00 due-when insulation isinstalled $40Q0.00-due when work is.complete except flooring- $,1426;00 due at completion.of contracted work Customer understands that.the finished area will not`be used as a living area'. 4 Customer; - Ken 66:,B.;B."Keen .` i j Date / Date - Page 2"of 2 KEEN CONSTRUCTION CO. 21 HEWITT AVE. N. ANDOVER, MA 01845 � (978) 691-5201 Murray, Brian & Laurie 1063 Salem St. N. Andover, MA 01845 978-686-8368 Contract#5016; Appendix A Date: 7/15/2009 Create Non Habitable Storage area: • Frame interior walls to create approx. 300 sq. ft. finished area • Frame wall next to stairs creating/� wall toward the bottom • Supply& install R-13 fiberglass insulation in exterior walls • Supply& install blueboard on walls and skimcoat plaster to smooth finish • Re-plaster stair walls to smooth finish •" Supply& install three interior door units • Supply& install trim to match existing • Supply& install two hopper vinyl windows • Supply & install 2' x 2' revealed edge Cortega suspended ceiling • Supply & install approx. 24 sq. ft. of ceramic tile at bottom of stairs ($3.25 sq. ft. material allowance, standard installation • Supply & install carpet in remaining finished area ($1276.00 allowance) • Paint walls and trim (2 coat finish, 2 neutral colors) Electrical: • Supply& install electrical outlets to code • Supply& install one cable outlet and one phone outlet • Supply& install eight recessed ceiling light fixtures • Supply& install switching to code Total Price: $14,426.00 (fourteen thousand four hundred twenty six dollars) Extras: • Move proposed finished wall approx. 5' forward -$650.00 • Supply& install forced hot water baseboard heat from existing boiler $2100.00' • Supply& install electric baseboard heat $450.00 Price does not include cost of permits, plumbing, heating or boiler make-up air. ..-r, UD/11/ZUUV UV:41 rAA ?01 N4L GLLD V1LDLI11 1140LIMAtll ILjVV ACDR, CERTIFICATE OF LIABILITY INSURANCE oai11/2ro200 PRODUCER (781)942-2225 FAX (781)942-2226 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Gilbert Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 137 Main Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Reading, MA 01867-3922 INSURERS AFFORDING COVERAGE NAIC# imuRm Kenneth B. Keen INSURERA: NORFOLK & DEDHAM INSURANCE 23965 DBA: Keen Construction Company INSURERS: Granite State Ins. Co. 0077 21 Hewitt Ave. INSURERC: North Andover, MA 0184S INSURER O: INSURER E: CO_VEMQES 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. 1 R DO' YYPE OF INSURANCE POLICY NUMBERPOLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY ND-P-010078/000 03/13/2009 03/13/2010 Ema,OCCURRENCE f 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED S S01000 CLAIMS MADE ff]OCCUR MED EXP(Any one person) S 51000 A PERSONAL L ADV INJURY s 1,000,000 GENERAL AGGREGATE 1 21000,000 GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG S Z 000 000 X POLICY j� 7 LOC AUTOMOBILE LIABILITY (EBawd�ISIwbLEUM1T f ANYAUTO ALL OWNED AUTOS BODILY INJURYf SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON-0WNEDAUTOS (Peraocldenl) S PROPERTY DAMAGE S (Por aczidrnl) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTOEA ACC S OTHER'THAN � AUTO ONLY: AGG f EXCESWUMBRELLA LIABILITY EACH OCCURRENCE 8 OCCUR EDCLAIMS MADE AGGREGATE f DEDUCTIBLE g RETENTION S S wOAWRS COMPENSATION AND 6371378 08/03/2009 08/03/2010 X I wCSTATU- OTH- EMPLOYERS'LIABILITY Pit- E.L.EACH ACCIDENT S 100 000 g ANY PROPRIETORlPARTNER/E%ECUTIVE . OFFyFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYE S 100,000 dacribe SPIAL PROVISd er ECIONS below I E.L.DISEASE-POLICY LIMIT I S 500.000 OTHER DESCP/PrION OF OPERATIONS I LOCATIONS I VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS riginal workers compensation certificates to be issued by company forthcoming. ertificate holder is included as additional insured on the general liability with respect to Aerations of the Named Insured. CERTIFICATE HQLRER CANCELLATMN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,TME ISSUING INSURER WILL ENDEAVOR YO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Town of North Andover BUT FAILURE TO MAUL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 120 Main Street OF ANY KIND UPON T14E INSURER ITS AOENYS OR REPRESENTATIVES. North Andover, MA 01845 AV"10M MIRRESENTATNE Mark Gilbert CIC ACORD 25(2001/08) ©ACORD CORPORATION 1998 ---------- ;/�ie "(!�arnimoozurea� �,•/v�adcc`'�iccae�a �` ,. Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Regist twny 108383 Expnat' &%18/2010 Tr# 272473 Type DBA' KEEN CONSTRUCT-ION CO Kenneth Keen -3 I• 21 Hewitt Ave No.Andover,MA 01845 Administrator +`�waim-ss�:F:,.,.c. ......... �✓l�u�t« � Board of Building Regulati s and Standards Construction Supervisor License License: CS 58245 Expiration 3/24/2010 Tr# 17840 Y'. Ressti is#ion: KENNETH.B KEEN 21 HEWITT AVE N ANDOVER,MA 01845 Commissioner _.. r ✓fze �ji anrmca�uuecc�i a`'��`?,aoarrc�uae�`Gs Board.of Building Regulations,and%Standards Construcbon:.Supervisor•License. License: GS 76691 Bi rth�late—8/16/1'968 Ezpir tion-$/I1612009 Tr# 3859 "'Restriction; Ob:, . ROBERT.A KEEN='. G 12 E WATER ST i N ANDOVER MA'.0.184'S Commissioner Ui KEEN CONSTRUCTION CO. GP a 21 HEWITT AVENUE PROPOSAL NORTH ANDOVER. MA 01845 Tel: (978)691-5201 All home improvement contractors. and.subcontractors engaged in home improvement contracting, unless Fax: (978)682-3231 specifically exempt from registration by Provisions of Chapter 142A of the general laws,must be registered with Submitted the Commonwealth of Massachusetts. Inquiries about To: —ori—C, )_��`..._.-._................�_�^,�+�__...._ registration and status should be made to the Director, Home Improvement Contract Registration,One Ashburton Place, Room 1301, Boston, MA 02108 (617) 727-8598. Owners who secure their own construction related permits or deal with unregistered contractors will be excluded from the Guaranty Fund Provision of MGL c. 142A. PP ONE DATE REGISTRATION:NO. EIN NO. 7Z/ !5 0 9 IVIG. H.I.C. 108383 26-0462904 > C/S= Customer Supplied S+ I =Supply+ Install See Attached Appendix A We hereby submit specifications and estimates for work to be performed and materials to be used: �^ J _.. ------ onstruction related permits: WORK SCHEDULE _...._................. Contractor 'I not e . the work or order the materials before the third day following the signing of this Agreement,unless specified here rpjn C tractor will begin the work on or about (date). Barring delay caused by circumstances beyond Contractor's control,the work will be completed by 7 (date). The Owner hereby acknow ed es and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall no be cdhsidered as violations of this Agreement. WARRANTY The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period off ollowing completion and shalt cornply with the requirements of this Agreement. In the event any defect in workmanship or materials,or damage caused by the Contras r,his subcontractors,employees or agents,is discovered within one year after completion of any job,including cleanup,the Contractor shall,at his own expense,forthwith remedy,repair,correct,replace,or cause to be remedied, repaired,or replaced,such damage or such defect in materials or workmanship.The foregoing warranties shall survive any inspection performed 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 `C'�? i.i c11 i ... ($ ( ted). V) dollars J Payment to be made as follows: ($ ) upon signing Contract; KENNETH B. KEEN / ROBERT A. KEEN Name of Contractor/Designated Registrant ($ A ) upo c l o0 of 21 HEWITT AVE. Street Address ($ pon completion of ; N. ANDOVER, AAA 01845 City/State � ('$ ) shall be made forthwith upon (978) 691-5201 (978) 682-3231 completion of work under this contract. Phone Fax Nouse`'°;No agreement for home im rovement Cahtf•actin 9 p 9�work-°shalhrequlre4l._.- - >down payment(advance deposit)of more than one-third of the total contract"price Name et S!es n"' or the total amount of all deposits or payments which the contractor must make, in I advance, to order and/or otherwise obtain delivery of special order materials and Autnodrda Signature - equipment,whichever amount IS greater. Note: This proposal may be withdrawn by us if not accepted within days. Acceptance Of Proposal -I have read both sides of this document and all attached documents and accept the prices,specifications and conditions stated. I understand that upon signing,this proposal becomes a binding contract. You 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. D, T SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Signature !F .2^''r "�-�w Date Signature. - Date IMPORTANT INFORMATION ON BACK -1111110- i6ldS .abfis3x}. r' s' t '` it a "t '< � axK � .,,,:a a+xr.�...rywn_,iwgs.,#a*ww.savk�- ^" -r^Em Pew+rdkk.;xr",,rres-Tr:�°a+?':+-wa>.d �„+�F�..�..�a-r,5"w:mu°ww..v�-,-.-,�ern,.e-.-,.-r •^C�s:..�: w�:r)r