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HomeMy WebLinkAboutBuilding Permit #204-12 - 135 LISA LANE 9/13/2011 i TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION L Permit NO: o]— `2� Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION 3 S �. a / �a,�,�e �� dti �►.L�.� Print PROPERTY OWNER Unit# Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes (noT Machine Shop Village yes 100 year-old structure yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg 0 Others: ❑ Demolition ❑ Other - 0 Se tic 0 Welli ®TFlood 1 ®W elands{ 0WatersfiedlDistricts . ?Water/Sewer; y DESCRIPTION OF WORK TO BE PERFORMED: (Identification Please Type or Print Clearly) OWNER: Name: 4 Phone: r Address: s CONTRACTOR Name: 9i — 4,-,,• ; Phone: Address: !�d /.�s�► ; L•� S `tv�h r%l an ss G Cis �� Supervisor's Construction License: 4. '1.?0 / Exp. Date: 6 ACsl Home Improvement License: 6 Exp. Date: �/— Z '� 13 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: $ FEE: $ Check No.: 6 Receipt No.: a NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund I Sig nature�ofrAgent/Owner,. `' Slgnaturetof,contractor: Building Department artment -i he 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 a Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit II Addition or Decks ❑ 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) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit 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) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign offrom 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 Doc: Doc.Building Permit Revised 2008mi 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 1 COMMENTS HEALTH Reviewed on Signature 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 Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street um ster on site es no FIRE DEPARTMENT - Temp D p y . Located at 124 Main Street Fire Department signature/date COMMENTS i 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 drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$10041000 fine NOTES and DATA— For department use it ❑ Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi 1 �'3I Location J ' No. � � Date S' J �aRTM TOWN. OF NORTH ANDOVER CL i 0 s a ^e Certificate of Occupancy $ Building/Frame Permit Fee $ I"X Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 24571 Building Inspector ACO o® CERTIFICATE OF LIABILITY INSURANCE75/16/11(MMIDD/""") THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemengs). PRODUCER .NAME::: T Dana Mood Barry J. Kittredge Ins Agency PHONE 978 374-8400 1ZIX N (978) 373-3360 81 South Main Street ADDRESS: dana@kittredgeinsurance.com PO BOX 5206 PRODUCER 3700 Bradford, MA 01835 INSURERS)AFFORDING COVERAGE NAIC N INSURED INSURER A:Western World Ins Co. HI-TECH Window 6 Siding INSURER B: Installation, Inc. INSURER C: 29 Arrowwood St INSURER D: Methuen, MA 01844 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY AOPAID CLAIMS. INSR -----__.—.-_--------------- DLSUBR - LTR TYPE OF INSURANCE POLICY EFF POLICY EXP POLICY NUMBER M/ODIY MM/DgYYW UMTS GENERAL LIABILITY EACH OCCURRENCE $ 300,000 A X COMMERCIAL GENERAL LIABILITY NPP1278514-1 5/10/11 5/10/12 DAMAGEToRENTED g 50,000 CLAIMS-r1ADE OCCUR MEMISES 1E.MEDEXP(Any one person) $ 5 000 X $500 deductible PERSONAL&ADV INJURY a 300,000 GENERAL AGGREGATE S 600,000 GEN'LAGGREGATE LIMIT APPLIES PER i PRODUCTS-COMPIOPAGG $ 300,000 POLICY PRO- LOC S AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT ANY AUTO I (Eaacciderl) $ BODILY INJURY(Per person) S AL L 0 WNE D AUTOS SCHEDULED AUTOS BODILY INJURY(Per accident) $ PROPERTY DAMAGE HIRED AUTOS (Peracadent) $ NON O W NE D AUTOS $ $ UMBRELLA LIAR POCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MACE AGGREGATE' $. DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION WC STATU- 0TH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACHACOCENT S OFFICERIMEMBER EXCLUDED? N/A (Mandatory In esddescribeaunder E.L DISEASE•EA EMPLOYEE $ DES If yy , under OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Window b Siding Installation This cerificate is for quoting purposes only. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN MASTER CERTIFICATE ACCORDANCE WITH THE POLICY PROVISIONS. name of person on contract must be added here AUTHORIZED REPRESENTATIVE N. Dana Mood ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MM 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le�bly Name(Business/Organization/Individual): o � --T- Address:— 1!?3 City/State/Zip: ,#&,,, d1/ y�j Phone F2111 employer?Check the appropriate box: _ Type of project(required): employer with 4. ❑ I am a general contractor and I yees(full and/or part-time).* have hired the sub=contractors 6. ❑New construction sole proprietor or partner- listed on the attached sheget.1 7• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. [No workers' comp.insurance 5. El We are a corporation and its 9. E]Building addition required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]f employees. [No workers' comp.insurance required.] 13.0 Other *Any applicant that checks box#1 must also fill out the section below showing their-workers'compensation policy information. f 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 their workers'comp.policy information. I am an employer that is providing workers,compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: J�,4-y c e,z Policy#or Self-ins.Lic.#:T/l,V� � � � Expiration Date ///`- � /� Job Site Address:_/3 J��i �y 4,1„V City/State/Zip:_,&a V,-,'A' l�d��V�r 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. Ido hereby certify under the pains and penalties ofP erJ'urJ' that the information provided above is true and correct. Si nature: 4/ e Phone#: F7eD only. Do not write in this area,to be completed by city or town official. n: Permit/License# ority(circle one): Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspectorson: Phone#: 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 a joint 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 permit/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 bur 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: The C01--nnionwealth.of Massachusetts Department of Industrial Accidents Off ee of Investigations 600 Washington Street Boston,MA. 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax#617-727-7749 www.mass..gov/dia tCORAD s 1 1/03,1 C TE tS ISSUED Aa A MATTER OF IN ORIt ATION ONLY AND NF RS NO RIGHTS UPON THE CERTIFICATE HOLDER. TTNB CfRTIFiCATE DOES NOT AFFIRMATIVELY OR NE(-JIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE Oc INSURANCE H)ES NOT CON$TiTUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PR !DUCER,AND TLE CERTIFICATE HOLDER, IMPORTANT:M the cartifleate holder+s an A0011T70NAl IN6URED,the pollcy(Iva)must be endorsed. It SUBROGATION M WAIVED, subject tO the arms and conBltions o4 the policy,certain policies may requ4%an endorsement A statement on this certi#icste do"not confer rights to the certtflcate horde er in Neu of such rtdorsernen e, rRoouctR COMPANIES AFFORDING COVERAGE 1PAAYaCHEX INSURANCE AGENCY, INC, WiRA3S DRIVE A""" GUARD INSURANCE GROUP ROCH TER, NY t41VU0 i-� - _ - _....- ----------- -- - INWREp HI TECH WINDOW d SIDING INSTAL cow`"` P.O. gg p-X 923 HAVAILL,MA 0183S Cow r, D BMW THIS t3 TO CERTIFY THAT THE POLICIES G' I NSuRANGe LISTED yEIOW w�1vE BEEN jSS1:EC'0 T�+E INSURED MAAt£4 nBUVE FOR THE POLICY PER100 I .K.s. INOfCATED,NOTWITHSTANDING ANY REautREMENT.TERM OR CONDITION OF ANY CONTRACT Oq OTHEk UO::UUENT WITH RESPECT O W4CM THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INS JRANCE AFFORDED BY THE POLICIES DESCRIBED r+EREIN I$3U1WECT TO ALL THE TERMS EX0.U3fONs AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEC•!REDUCED 8Y PAID CLAtfAu � T"R OF WOURANCE I POLICY NUMBER j POLICY OrfIGTM I PONCY OIAatAnOk ' UMtTi ^- - - DATI?IMMrDOrYn DATE(NI)VOIF" GAMPAL U ASUJrY COMMERCIAL GENERAL LIAKITv I GENERAL AOOREWTE S E�ktNMB MADE —'--j PRODUCTS-COMPPOP AGO i jJCCUP I i I PfRSON&a ADV INJURY -- ---- OWNER'S a CONTRACTORS PROT' � l ! EAC"OCCURRENCE ; FlRE DAMAGE cMr u�+o fr.1 is AUT Cllj .E L ABILITY 1090 ExP cAC or,. f I ANY AUTO COUSINFO SINGLE LIMIT f ALL OWNED AUTOS t SCHEDULED AUTOS I i Boo+LT INJVRr ..- HiRED AUTOS (PM vMw• 'f NOsoar r INxBt► N•OVYNED AUTOS I I I PRCC+ERTY DAMAGE I S fiARAO!UAMLRY � I ANY AUTO 1 ILA�170 ONKV-EA ACCIDENT . EACH ACOOENT EXCw LlAOiLtTY AGOREGATE i UMBRELLA FORM I _EA:.H OCGURRE4CE i OTHER THANVMaRELLA FORM I -Ac;OREOATE,_��f ......___. f MOalIIIIIIl'e COelMIMTIDN AND I 4AC sratl.- OTti =W%JDVWtl ER UAJTv THIS INIMPRIlrow INCL I HIWC 115021 1 t!?0/ZO 1 t,20��t 'EL EACH AOCIDENT t I00.W0.00 _ r_ EXCL: SEL otSEAEE•°OLrCv LMA? _ - - oR�cq.Agee _ t SOO.000.00 _ EL DISEASE-EA EM?LOYEE f 100.000.00 OTFilR I � DSKRPTIDN OF oe6RATIOfIa T LOCATIONS 1 VEHICLES(AU80 ACORD IV.A490his d RNryA.schsdw4c S"wo few.I.r*QLN Vdl HICHyyINDOW d SIDING MMS'SHOULD AOF THE AeOvE pap Poucsu ss CAKCELLJm woRa tNs sxrrtATx>« INSTALLATION INC. OATS TI'IOIEOF.NOTICE WILL et WLrNllao IN AC0pt ^N=WN THE POLICY P.0. BOX 8234 PROYfiIONS.IPUT sAILU"TO KA:L SUCH NOTICa SMALL aarass No Of ,,"TM Oft HAVERHILL, MA 01835 UAMuTM OF ANY KM UPON THE CHARY In 4QLWS OR Iap+ewartATnrfs. AUrPf0ft QO REPRERWATNE L t NORT#i '9 ovm o sAndover . ...... ........ .... . - -----� o dover, Mass., • cOc MIc ME 7�S0RATED 4 BOARD OF HEALTH Food/Kitchen Septic System r. RIWIT T %j D BUILDING INSPECTOR THIS CERTIFIES THAT......................�..K !!ti i.dr.0.40................................................. Foundation has permission to ere ........................................ buildings on ....1.3.r.........W.A.14. .................................. Rough to be occupied as...... .. .....r. ..... ... Ill .. ...... .I� .t.... ....... ......iftvtf......C'.01r�.!�4.. .. Chimney ' e provided that the person accepting this permit shall in every re pest conform to the terms of the applicat n 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 Final uj PERMIT' EXPIRES IN 6 M NTIS UNLESS CONSI,RI�C ELECTRICAL INSPECTOR. Rough ..................... ..................................... Service BUILDING INSPECTOR 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 FIR_E_DEPARTMENT. Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. Massachusetts=Departmenf of`Public Siifeth Board of Building Regulations and Standards Construction Supervisor License °;.License: CS 16201 Restricted to 00 wiL.LIAM R ECHAS -+ r15 KINGSB ,URY AVE 'HANERHILL WA 09$35 Ex it p anon: 11-/16/2011 'U(mun EAhtner. Tr#: 9840 II I I 91te -� now W Office of Consumer Affairs andlAusiness Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 r `=: Home Improvement or Registration Registration: 118836 J�:3 Type: Private Corporation Expiration: 4/26/2013 Tr# 211404 HI TECH WINDOW & SIDING INS',�`AUL WILLIAM CHASE P.O. BOX 8234 HAVERHILL, MA 01835. "" e \ Update Address and return card.Mark reason for change. DPS-CAI 0 50M-OM04-G101216 Address Renewal Employment E] Lost Card �`�j q''a TtP; SIDING Y ,� '{ ~ PP� i- ech Window & Siding Inc. 0V51NES MA Reg. # 118836 ashington Street,Haverhill,MA 01832 9 MA Lic.#016201 1-800-851-0900 www.windows-siding.com Azptre MEMBER rio-ffDate: Consultan/ /Job Name: /1 Telepho e 6 f� Job Address: Town: U h d.J e CONTRACTOR agrees to start,described:;work.on/or,about weeksafter final fittings and complete described work in about - working days. CONTRACTOR shall not be held liable for delays due to causes beyond our control. The following work includes all labor and , erials neede t o plete yoyr job in a workmanship like ma C bination Job-Siding With Other Work Q PVC Coated Alum. Aluminum Building and Elec Permit ClKascia Trim Fascia Treatme t iding Removal offit Trim Fascia Color OS reparation Package E!GNindow and Door Trim Q Full Custom 0 one Accessory Package hutters Location U erlaymenGutters, $O#ftTtea#t11ie}'Ei. b. Siding ownspouts Soffit Color 1200'R-emove Debries Vd Lock.,bqc.Meter EZ2000Centgr Vent Q Fully Vented Non-Vented Priepa tion IncludQS Location WSf ort Replace Visable Rot ented as Ne d [ndflllfE?Alld abOr Castrt IF".01001 Energy Savings/Bug Guard Start r &-ndow And Door Casing Color 4. L-==-=, 0 0$ 311-Z[= Full Custom Formed J-Less Full Custo Formed A) G� age.»Glu S Blind Stop Cqpping one Color:A A Location inyl Light Blocks inyl Dryer Vents hElttQf e Vinyl Electric Outlet Blocks Vinyl Exaust Vents Shutter Color Amount rf Vinyl Faucets Blocks Vinyl Gable Vents Location G & tit . tl:tttl `;menft IftSu121torTo:Be ld +d Gutter Color ownspo C to Q Hi-Tech 3/8 Other Location 1Vk(yQ Location at+88 T 3fdt# omplete House Q Garage ilk A 5idttt 'at1 ! d Color R- .'° Bra Profile #3tetltI #fK S` . I q Bank Financing owner To HimTech to Arrange t zy c a � Q Cash Or Check 0 Master Card ',; f3rf1 #Td: B SIS' Corner Post Colorhife, 471k Total Investment 0 0 Wide Insulated. a Nor{-Insulated 1/3 Deposit ' `Regular I; u e`d Regular Non-Insulated 1/3 Payment At Halfway Point ^1 t-\ %. '' 1/3 Balapce Day Of Completion 514 j 1 x You m�cancel this agreement if if has been signed by a thereto a'I a place other than the address of the seller,which I' may be his main,officeor.branch thereto,provided you notify the setter in writing at his main office or branch by ordinary mail posted,by telegram sent,or by delivery,not later than midnight of the third business day following the signing of this agree- ment.See the attached notice of cancellation form for an explanation of this right. An interest charge of 1-1/2%per month(18%per year)will be Date of Acceptance added to any amount.unpaid.after,30;days>from invoice date. In the event of default in payment of this order or any part thereof and the account is referred` Signature to an attorney for collection,the purchaser agr es to pay reasonable attorney fees. (Homeown,r) I/We give Hi-Tech p rmiss• n n all necessary permits. Signature �nJ, .,(HiTech) "' l SignatureQ Z/,%