HomeMy WebLinkAboutBuilding Permit #860 - 28 HIDDEN COURT 5/5/2012TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: v Date Received
Date Issued:
IMPORTANT: Applicant must com Tete all items on this page
LOCATION c2 g 14 ; raja✓► C
Print
PROPERTY OWNER Am MUdr--,n Unit #
Print
MAP NO: �PARCEL:�ONING DISTRICT: Historic District yes
Machine Shop Village yes ;
100 year-old structure yes
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
One family
❑ Addition
0 Two or more family
❑ Industrial
M Alteration
No. of units:
❑ Commercial
14 Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
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OWNER: Name:
Please Type or Print Clearly)
t
Address: o - y,Wdt-,, el � y
CONTRACTOR Name: J a m C JceJerA Phone: (b o;) 89 o_ 9 o/ q
Address: a/S . /�,. � ��yS c f /V ,4 Dia ),9
Supervisor's Construction License: 6,5�?7G Exp. Date: 1�IA/eZa/.Z
Home Improvement License: /.a Exp. Date:
ARCHITECT/ENGINEER
Phone:
Address: Reg. No.
FEE SCHEDULE: BULDING PERMIT. $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F.
Total Project Cost: $1� S -d S. 0G FEE: $
0I
Check No.: �Gh Receipt No.:
NOTE: Persons contracting with unregistered cocfono,htccve access to the guaranty fund
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 0
Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
El
h PLANNING & DEVELOPMENT ❑
COMMENTS
CONSERVATION
COMMENTS
,r
HEALTH
COMMENTS -
Reviewed on Signature
Reviewed on Si nature
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
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department signature/date
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 drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
NOTES and DATA — For department use
❑ Notified for pickup - Date
Doc:.Building Permit Revised 2011 June/mi
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
❑ 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
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
(VOTE: 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
Doc: Doc.Building Permit Revised 2008mi
Location JAL,
No—ar.;p 0 Date
Check
25358
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Building Inspector
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The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
' 600 Washington Street
t Boston, MA 02111
s� www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Anblicant Information Please Print Leeibly
Name (Business/Organization/Individual): 7: t S F,
Address: a 15 S. (3cGn�luM ly 5 G1r,V, . 0 3y -2S
City/State/Zip:
Phone #:(6o3) 849o- go/ S
Are you an employer? Check the appropriate box:
I. VI am a employer with 4. ❑ 1 am a general contractor and I
employees (full and/or part-time).* have hired the sub -contractors
2. ❑ 1 am a sole proprietor or partner-
ship and have no employees
working for me in any capacity.
[No workers' comp. insurance
required.]
3. ❑ I am a homeowner doing all work
myself. [No workers' comp.
insurance required.] T
listed on the attached sheet.
These sub -contractors have
workers' comp. insurance.
5. ❑ We are a corporation and its
officers have exercised their
right of exemption per MGL
c. 152, § 1(4), and we have no
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling
8. ❑ Demolition
9. ❑ Building addition
10.❑ Electrical repairs or additions
11.0 Plumbing repairs or additions
12.[] Roof repairs
13.[41'Other /�,-,_n%c,•,�,.-,•z ¢
*Any applicant that checks box # I 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 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: z.1zr,_Az A414c l
Policy # or Self -ins. Lic. #: �j/� /-/fir/S 3 yyyS-U �/ Expiration Date: 8/11,20/ -Z
Job Site Address: c7 Wden C City/State/Zip:
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 certify under the palm a_nd penalties of perjury that the information provided above is true and correct.
-.901
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. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person:
Phone #:
Z%14%ZOIL 7:O0:ZC5 tuvi e)1' {'bl°11-13 rPtVl°1: 1113 UL"d11CeVISlUiIS.CUIII—'1'V: 10034320070 raye: z UL z
---"1
'''M DO CERTIFICATE OF LIABILITY INSURANCEI
DATE(MM/DD/YYYY)
2/1412Q12
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. H SUBROGATION IS WANED, 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 endorsement(s).
PRODUCER LAKESIDE INSURANCE AGENCY
3 WALL STREET
CONTACT NAME:
MMIUDD EFFYYYI
WINDHAM, NH 03087
PHONE c No:(6m) 432-6076
E-MAIL ADDRESS:
GENERAL LIABILITY
INSURER(S) AFFORDING COVERAGE NAIC p
INSURERA:
INSURED
JAMES FREDERICK
INSURERS:
INSURER C :
DBA J & J ROOFING
352 ISLAND POND ROAD
DERRY NH 03038
NSURERD:
BiSURER E :
INSURER F :
MED EXP (Any one person) $
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 PAID CLAIMS.
LLTTRR
TYPE OF INSURANCE
DDL
SUER
POLICY NUMBER
MMIUDD EFFYYYI
MOLIC YFXP
YYY
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE OCCUR
-
DAMAGE TO RENTEDPREMISES Ea occurrence) S
MED EXP (Any one person) $
PERSONAL 8 ADV INJURY $
GENERAL AGGREGATE $
bEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO LOC
PRODUCTS - COMP/OP AGG $
$
AUTOMOBILE
LIABILITY.,
a eau t I $
BODILY INJURY (Per person) $
-
ANY AUTO
ALL OWNED SCHEDULEG
AUTOS AUTOS
BODILY INJURY Per accident)
( 1 $
_
NCN-0OWNED
HIRED AUTO S AUTOS
_
(PRa08fcdR DAMAGE $
))
S
$
UMBRELLA UABtLcAcMS.MADE
UR
EACH OCCURRENCE $
UAB AB
AGGREGATE $
DED RETENTION $
S
S
A
WORKERS COMPENSATION
AND EMPLOYERS'LIABILITY Y/N
ANY PROPRIETORIPARTNERrEXECUTNE
OFFICERIMEMBER EXCLUDED? Y❑
N / A
WC1-31 S-374445-011
8/1/2011
8/112012
-
we STATUI 11
./ TORY LIMBS ER
E.L. EACH ACCIDENT $ 100000
E.L. DISEASE - EA EMPLOYEE $ 100000
(Mandatory in NH)
If yes, describe under
E.L. DISEASE - POLICY LIMIT $ 500000
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if nrore spew is required)
Workers compensation insurance coverage applies only to the workers compensation laws of the state MA.
THE WORKERS' COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR JAMES FREDERICK
CERTIFICATE HOLDER
CANCELLATION
MELANSON DEVELOPMENT
PO BOX 564
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
10 CEDAR STREET
WOBURN MA 01801
AUTHORIZED REPRESENTATIVE
( r,
Jeff Eldridge J
v 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
CERT NO.: 12393958 Deb Derochemont 2/14/2012 6:56:44 AM Page L of 1
This certificate cancels and supersedes ALL previous Ly issued certificates. ..
Home Improvement Sam -Die
This form satisfies all basic requirements fthe state's Home Improvement Contractor Law (MGL chapter 142A), but does not include standard
language to protect homeowners !Seek legal advice if necessary. Any person planning home improvements should first obtain a copy of "A
Massachusetts Consumer Guide tol!I (Home Improvement" before agreeing to any work on your residence. You may obtain a free copy by calling the
Office of Consumer Affairs and B. siness Regulation's Consumer Information Hotline at 617-973-8787 or 1-888-283-3757 or on our website. .
Homeowner ]if brmation
Contractor Information
W.,
not use a Post Office Box address) Contractor/
City/Town State
'LIP Code . ; + Business Address (must include a street address)
�! a15 s
Daytime Phonee Evening Phone City/Town State
Zip Code
Saw. Salem
Mailing Address (It different from above) -H /I 3O
Business Phon Tederal Employer ID or S.S. Nurub er O - ,2S - op33 f
:i -
Home Improvement Contractor Aeo, Number Expiration date
Law requires that most bomo
improvement contractors have
a valid rcgisiration nnmbcr
The Contractor agrees to do the fo71owing work for the Homeowner:
(Describe in detail the work to completed, specifying the type, brand, and grade of materials to be used, use additional sheets if necessary.)
rY,-�' c,Ghe a
)gyer o�sPQ� s�(' Ps
ge roof' w, /�;? C4,>7 d r� J /� �07C 4v or ly s
Required Permits -The followinglbuilding permits are required Proposed Start and Completion Schedule - The following schedule will
and will be secured by the contractor' as the homeowner's agent: be adhered to unless circumstances beyond the contractor's control arise
(Owners who secure their otivn permits will be
excluded from the Guaranty ]Fund provisions of
6////-,?d/"Date when contractor will begin contracted work.
MGL chapter 142A.)
! 6,ZLhQW2—Date when contracted work will be substantially completed.
:I
Total Contract Price and Paymemt!Schedule
The Contractor agrees to perform the work, furnish the material and labor specified above for the total sum of:
Payments will be made according tothe following schedule:
!i
upon signing contract (not to exceed 1/3 of the total contract price or the cost of special order items, whichever is greater)
$
by or /_; or upon completion of
$ by / or upon completion of
l —upon completion f the contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction)
The following material/equipment must be special $ to be paid for
ordered before the contracted work begins in order
to meet the completion schedulee (**) $ to be paid for
NOTES: (*) Including all finance charges (**) Law requires that any deposit or down -payment required by the contractor before work begins may
not exceed the greater of (a) one-third of the total contract price or (b) the actual cost of any special equipment or custom made material
which must be special ordered in advance to meet the completion schedule.
i x ress Warranty -Is in ress warenn beinpr provided by the contractor?
❑ No Yes all tof the warran tract
Subcontractors -The cerms must be attached to tite con
ontractor agrees to be solely responsible for completion of the work described regardless of the actions of any third
Party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for
materials and labor under this agreement
Contract Acceptance - Upon signing, this document becomes a binding contract under law. Unless otherwise noted within this document, the
contract shall not imply that any lieu or other security interest has been placed on the residence. Review the following
cautions and notices
carefully before signing this contract i g
ii
• Don't be pressured into si
• going the contract. Take time to read and fully understand it. Ask questions if something is unclear.
Make sure the contractor has alvalid Home Ira rovement Contractor Registration. The law requires most home improvement contractors and
subcontractors to be registered with the Director of Home in Contractor Registration. You may inquire about contractor
registration by writing to the Director at 10 Park Plaza, Room 5170, Boston MA 02116 or by calling 617-973-8787 or 888-283-3757.
o Does the contractor have insurance? Ask the Contractor for his insurance company information so that you can confirm coverage, or ask to
see a copy of a "proof of insurance" document.
e Know your rights and responsibilities. Read the Important Information on the reverse side of this form and get a copy of the Consumer
Guide to the Home Improvement Contractor Law.
You may cancel this agreement if it
contractor in writing at his/her main
third business day following the sim
DO NOT SIGh'ii
Two identical copies ofthe contras
been signed at a place other than the contractor's normal place of business, provided you notify the
ice or branch office by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the
of this agreement. See the attached notice of cancellation form for an explanation of this right.
THIS CONTRACT 1F THERE ARF ANY BLANK SPACES!!!
t must be completed and �;o -d, One copy should go to the homeowner. The other copy, should be kept by the contractor.
ntractor's Signature
Irate/
Contractor Arbitration
The Home Improvement Contractor Law provides homeowners with the right to initiate an' arbitration action (as an
alternative to court action) if they have a dispute with a contractor. The same right is nota tomatically afforded to a
contractor, however. The contractor would have to resolve any dispute he/she has with a homeowner in court unless
both parties agree to the optional clause provided below. This clause world give the contractor the same right to
arbitration as is afforded to the homeowner by the Home Improvement Contractor Law.
The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute
concerning this contract, the contractor may submit the dispute to a private arbitration firms which has been approved by
the Secretary of the Executive Office of Consumer Affairs_ and Business Regulation and the consumer•shall be required
to sub to such arbitration as pro 'ded assachusetts General Laws, chapter 142A.
0—Y ,
!::�j "llo
omeowner's i e ntractor's Signature
NOTICE: The signatures of the parties above apply only to the agre ent of the parties to l alternative dispute
resolution initiated by the contractor. The homeowner may initiate alternative dispute res li tion even where this
t•.
section is not separately signed by the.parties.
Homeowner's Rights
A. homeowner's rights under the Home Improvement Contractor Law (MGL chapter 142A) and other consumer
protection laws (i.e. MGL chapter 93A) may not be waived in any way, even by agreement. i However, homeowners
may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law.
Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of
the Home Improvement Contractor Law. ,The contractor is responsible for completing the iwbrk as described, in a
timely and workmanlilce manner. Homeowners maybe entitled to other specific legal rights if the contractor
guarantees or provides an express warranty for workmanship or materials. In addition tb guarantees or warranties
provided by the contractor, all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for
a particular purpose. An enumeration of other matters on which the homeowner and contractor lawfully agree may be
added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have
questions about your consumer/homeowner rights, contact the Consumer Information Hotline (listed below).
Execution of Contract
The contract must be executed in duplicate and should not be signed until a copy of all exliiibits and referenced
documents have been attached. Parties are also advised not to sign the document until all blank sections have been
filled in or marked as void, deleted, or not applicable. One original signed copy of the contract with attachments is to
be given to,the owner and the other kept by the contractor. Any modification to the original contract must be in writing
and agreed to by both parties. Contracted work may not begin until both parties have received a fully executed copy of
the contract, and the three day rescission -period has expired. - - -- j-1 ---
Accelerated Payments
A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the
homeowner deems him/herself to be financially insecure. However, in instances where a contractor deems him/herself
to be financially insecure, the contractor may require that the balance of fields not yet duel be placed in a j oint escrow
account as a prerequisite to continuing the contracted work. Withdrawal of fhtids from said account would require the
signatures of both parties.
Additional Information
If you have general questions or need additional information about the Home ImproveContractor Law or other
consumer rights, or if you wish to obtain a free copy of "A Massachusetts Consumer Guide to Home Improvement"
contact: I
!I
Consumer Information Hotline
Office of Consumer Affairs and Business Regulation ! j
10 Park Plaza, Room 5170, Boston, MA 02116 j
617-973-8787, 888-283-3757 or visit the OCABR website at http://wwwAass. rov/ocabr/
If you want to verify the registration of a contractor or if you have questions or need additi� nal information specifically
about the contractor registration component of the Home Improvement Contractor Law, clontact:
Director of Home Improvement Contractor Registration
Office of Consumer Affairs and Business Regulation i
10 Park Plaza, Room 5170, Boston, MA 02116
617-973-8787, 888-283-3757 or visit the HIC website at http://www.mass.gov/ocabr/
Go online to view the status of a Home Improvement Contractor's Registration:
bM2:Hdb.state.ma.-Lis/homeimprovement/licenseelist.asp
For assistance with informal mediation of disputes or to register formal complaints against a business, call:
Consumer Complaint Section
Office of the Attorney General
617-727-8400
AND/OR
Better Business Bureau j
508-652-4800, 508-755-2548 or 413-734-3114 j
s
Version 2.1 - 11/22/2010
li
;I
Cell: 603-235-5731
PREMIER ROOFING & PAINTING
By Jonathan N. Lee
215 South Broadway, # 145, Salem, NH 03079
e -
www.Rremierroofingnh.com
Proposal
Office: 603-890-9019
Submitted to: Kathy Norton Date: 04-21-12
28 Hiddon Ct Home: 978-655-1928
N Andover, MA 01845 Cell: 978-204-7561
Job Location: 28 Hiddon Ct N Andover, MA
We hereby submit svecilications and estimate for the fo/%wino:
Roof repair:
• Strip roof of 1 layer of shingles.
• Re -nail all loose sheathing.
• Replace plywood as needed for an additional cost of $45.00 per sheet installed.
• Apply GRACE Ice and Water shield three (3) feet up from edges of roof.
• Apply GRACE Ice and Water Shield in valleys.
• Apply IKO Cool Gray to remaining roof surface up to ridge.
• Install 8" aluminum Drip Edge.
• Replace two (2) pipe boots. Size: 3"
• Reroof with IKO Cambridge 30yr shingle.
• Install Trim Line. Rigid Roll Plus ridge ventilation.
• Re -lead Chimney. (if needed $450.00)
• Clean up and removal of waste and debris.
• Magnetic sweep of property.
• Walkways and drive ways swept of debris.
• Dumpster provided and included in job price.
Notes: Remove 3 vents; put in #1 mursham vent; skylights $1,100
We Propose hereby to furnish material and labor - complete in accordance with the above specifications, for the sum of:
Twelve Thousand Five Hundred Sixty -Five ($12,565.00) 1 I
Skylights: Eleven hundred ($1,100.00) S L� � 0 n s e 5k4
If needed chimney #2: Four Hundred fifty ($450.00) ac'
Payment is to be made in full upon completion of job.
(Make check payable to Premier Roofing & Painting.)
All material is guaranteed to be as specified.
All work to be completed in a workmanlike manner Authorized
according to standard practices. All agreements contingent Signature_
upon accidents or delays beyond our control. Owner to carry
fire, tornado and other necessary insurance. This company
is covered by General Liability and Worker's Compensation insurance.
Certificate of insurances will be sent directly from insurance agent to ensure validity.
(Note: This proposal may be withdrawn if not accepted within 90 days)
Acceptance of Proposal - The above price, Specifications and conditions are satisfactory and hereby accepted. You are
authorized to do the work as specified. Payment will be made as outlined above.
Signature Zca Z c Date of Acceptance
Please sign and return one copy.
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