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Building Permit #209-11 - 41 MOUNT VERNON STREET 9/10/2010
_3 4 BUILDING-PERMIT F tAORTy TOWN OF NORTH ANDOVER z o��tLED"6 APPLICATION � FOR PLAN EXAMINATION t - * _ Permit N0: Date Received ��> a Date Issued: Q �`� �'�sSgcrE HusE�-cs IMPORTANT:Applicant must complete all items o _ - Vim:. h rt; .. :,..• n this ^.S"'•'•-- -r=+x'•�3z_=r`'•f�' -- ��+lr. ,__''��^:�?r;. �i4".%' �n'cr -.'- ,•,'x3Y;i,:., •cse:r:.: a e --- .}{'�.:.�-_n _ r^'k_ _ ;_ 'K__.�.T_==r�- ;� .y�nJ�• w_Ar, �_;r- ,,i1� P g +`� .=:w.��ca*<•:F-i•:%= - ,_;•.r,=t? _ c"::i�='" `" ':a _ rr_rs�•. •r.pr?•� r-.r.=.=.:.•r• _ �?-s-•..�^_''r ..d�' �.:f..=: �:.'�,;+;.•i; _ _ �I ra R: - ,:e ^ - �'Vu..__X .-�s-._--i _',�- _'t �-.:Lrr,-• -- :.u.��9f"-i tYZ,�-•g ;r'f:o4.�,-....,..�t.e::-�ieR.. - -��a-�'_`�:''.��,:• �'''J�''�_>_ i1 `�'� -- - �,:R„"� •:,�. _ - T-;cue- �;.:rt`-'`:. _ .�„n_>.,. -- _�ti_,.__sa.:=-_:,•:' _ .���1'Otl�=..t..:. 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Y.�ri•,�.+;>�'l'- :-i�A� °"� �il'?V��-' �[[+�-_�L];•(i�t-�_,�Y,;.� _ -;�,;, �5��,'+.:,.�c.,�-.� r„ ,1 :r��i:^�-Ja1Y �•mr,,-•tie,.'4.- .� .�Sr..,,.,s;: ^•a. .n:,: - - - =J.J7nl•:�6Zlr�t1:+._�_:.v'.r. - ti'`-°'eT:, _ t��s,ir ,.-M�,....:?., -���:5-. �.r:�"�.A ,rv4" .,v:Yr r,�t���fi:,r._? _ r-;„�1. p t'}T.�j� �,:~` r.�;:•=Ja:,s.;._,�rv�..:a�.. .�l/' �•r:t_- -1='�-'`.T.1:T.. .,_.C:•:, -. .rz�.""-�''}.R•S•:r^ - y,•.Y'T-.�•r :�y,...s!L%i�r'w�`;a.:�:....n^y...�.� -_ - 7��.1.'V.�➢V",1!.y e-J"`-YLi.zr-_r�,:_ �.'r•s�1=:. r,:�-s�'�:��, �:,,."�.- �-.-r`'��;:r.�,,,,I�a'�r,�y,�.:. .ii'u:ru::. 3 rt...7,F+�._;�' ,s-� .�-»sr=bra_i�w_�� _ �lY��� -•`t=" -_ -,x:._ �3+r .e.,����'-.:�.�; nd�'-:s.� .�fr_i�'R�nr=,i - ;�N:,a:":r:it�...s"_ -,ni.�-_u"t:�r,,,; ••'t.T��S_^.A.' :;�-}:.,z„�:,•�_c�rt�._.g. �.�'..�' Log V - _ .,11 3i;•.ti.Li.� -::�s�l:����:.v- =.^"iii^s�:: z%G1� v..Fs.J�:'•x.�,.'.h.:.tu'�`:�.e.,1.qN.: - _ - �•X�i'-�.rrzs-- :, _.�:i_�5�{dl,•I ^.,,�=-){h•_ _ - - _ .sJ�:�-1s.:,.it'�:r`�'�:�_.�'�"":,�v:t1:l::;�','; 'tn<F��Lr�fj.�{-a 7`��}�,i,� -/�-_ .rl,;'''•-frs,�."`��::L�.a='��n'�`�.�_ W'.`'".+._r,�. ^1-'s-.._..[:�we+r_„^��%l, .b:�•+1L:i>��J'_IM1G �i�/D y fm� I� Y �,.. Y��-u�: ' TYPE OF IMPROVEMENT PROPOSED USE Residential No Residential New Building One family Addition ' Two or more family � Alteration �� �� r, Two of units:_ Industrial � • Repair, replacement Assessory Bldg Commercial Demolition Other Others: '�y„y�'��.�+��py�v!,�.d ��:l��•�'"`L.,�I..��'✓' ''•:''p''iu-.�LZj�J�a��,�, ��t �? F -�K+-•_r��s`-.w�r„-•,''.x i>"a�.`ri:T•z .',r^„ :Y:-�^_ __ _`_•'�C'u?' =j7J� .{.7 •t•� -�N}"r_. i"'ia.._.'`d.,r-".'...^' �<;,-•,.•..:,ter. (T : _ '_=1'-=���C:.=�}=:;Ct,htw.,�b� .. ��}�ia'i-.�,,.J��•C:�• � - __E�'�-1L,I�IN����: .�..t�ri��v � r- } •r.', _ <a +G-:;c�ai< 'z 3'�_�SC+ �ri{ �,F> Sr��r.� �l_�- 'or- .��2z' _�-*-� F•:='e �:s,.�'T.. ,l0 �-'.�' •�•�iLe�. ..,_ _ =•-�.;r._ 5:'+rc;Sn. � -r�ri a 4..:� ...•!:-.,... �� �.� `�•e7�ry7 ,� �•,t� _r.?-� `z,." _ .. :Y!'�r� �.;��1?. <,"��'�'-`e'3�)<�:��t,�._'I��"+-�".x_-J"_!'` -� ;� f7. Ra��J::es 'z�-r.'•,�_s-rY.....-. �:. ""��a7LL'I���'i:1�='�,s-��4�.5: re:-„dam'e.a -�:..,nr >.e}F� f• �. .. 7-,,., .e�,..e ESCRIPTION OF WORK TOB , •� ��� ����� •� M1��.�� :. -� ��--�� • ���'n r 2c,rf�' �� ;� � ,� E PREFORMS©: - - -_ � �'�7'r✓I.Se'C i t7rjC ILOPdentificati� ease Type or t Clearly) OWNER: Name: • -. s Phone: - Address: -.tea t'_ r Y°''' - -Az:aw. L}'- m >_; _ L r kd - r..._ .. -Mi : ie�55�!"_?,i€-:s.r'x�=��=-�- 'r�-.=-{^.'-4^,�:"--+ !a! ,s.:v ,Y-;�a�° .r-wz='::-..'.,, .;2.�tia.,,- .'e�.`.- .� ::s,...� - .'Jy`�1y�'-' �^..Yf� `S•,L55 •'-'.=1.r.,, ' �y^, -'£-` N":, ctr...'v.�� '...._ . 's.y `'r'F ��;';:tfir, u.�'f.S�=,rdd',A` J'. `�.15•1ra 'c-rn ' ' T.� 17fu -� it 1�' `s:�G�.7ri,y .• T��<��'n .. 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No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125,00 PER S.F. Total Project Cost: $ 0 7\ " FEE: $ Check No.: �� �` Recen NOTE: Persons contI`actcng with unregistered contractors do not have ' o not have acc ss to a gzr ran nd PREIS znrr� ? : 1en �a��y� Tom'=::.: -==K_ - _- ✓ r Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/MassageBodyArt 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 i { CONSERVATION Reviewed on. Signature L'uivilv►ClV Ts HEALI A Reviewed on Signature COMMENTS Zoning Board of Appeals.Variance, Petition No: Zoning Decision/receipt submitted yes Pianning aoard Decision: Comments Conservation Decision: Comments Wafer & Sewer Connection/ ermit DPW Town Engineer: Signature: _ Located 384 Osgood Street - - - _ - p i _ r. ' fi Tie` D,ir . :;ferr�,._ .._ ' - tip::'.`_-.."`=:�1;�- -- V.r=t::e:v=... - s �.��.._-_•-..:r_'•_== ^•t_..,_ _.ess -`;:f - ':T- ::�-•::s�..- -__- .;.nom- _ -_ - :1+;=� - -oi �1�11a1; :•� - - ;r:; .a� � �.G�i�t�s .a^!::ts =:1�-�'. - .-{_mss'�''.;t.��:-•�Z;:^?�:+'3��__ --vl'a'-Gi�`n:'- - i.y*%•;= - :':?%; - rte:4.:. �i:sl--� - -a_ra'_:� _ _ _ ti i�. .r..M1., o-r•�%.:':�„+-- - _ - _{fir•:. ?,y.. - .F' - - -1 - - •-C^ `1:JA L Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: i 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) i ❑ Notified for pickup - Date Doc.Building Pemut Revised 2010 f Building Department The following is'a list of the required forms to be filled out for thea ppropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits I ❑ Building Permit Application - 1 ❑ 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 { ldg Permit Addition Or..Decks ❑ Building Permit Application ❑ Certified Surveyed Piot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract iiFloor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan A Hydraulic Calculations (If Applicable) nd ❑ 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. g Permit - 'New Construction (Single and Two Family) Q Building Permit Application • ❑ ... Li..e.,t Proposed Plot Pjai r ❑ 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 neerin g Affidavits s fo r 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 CIerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant mast then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the-building application I . Doc:Building Permit Revised 2008 Location _41-t-13 U e .N O>A No. L Date 10 ^ t NORT1y TOWN OF NORTH ANDOVER .. 9 i + ; ; Certificate of Occupancy $ '- ��s Building/Frame/Frame Permit Fee $ sAcMuse 9 • Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # Building Inspector The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street >> MIJ111 1EBoston,MA 02111 s4 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please PrintLegibly Name (Business/Organization/Individual): ,Lf Address: City/State/Zip: /�( r Y Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with _ 4. ❑ I am a general contractor and I 6. E]New construction employe and/or part-time .* have hired the sub-contractors 2.El am sole proprietor or partner- listed on the attached sheet. # ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in an capacity. workers' comp.insurance. 9. Building addition Y ❑ g o workers' comp.insurance 5. ❑ We are a corporation and its p 10.❑ Electrical repairs or additions required.] officers have exercised their 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 re trs n insurance required.]t employees. [No workers' 13. er 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 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 Namei/��'��1 Policy#or Self-ins.Lie. Expiration Date: Job Site Address: .F�3 / ( �� 0 0Y City/State/Zip: 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 forin 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 hereb ertBfy der t e pains a penalties eijury that the information provided above is true and correct.' Signature: Date: � ' /' p Phone#: S O i Official use only. Do not write in this area,to be completed by city or town offrcial. 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#' 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 aparhnents 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 cavy 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 surd 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 pen-nit/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 burn 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 5-26-05 w4vw.mass.govldia t ,i ---- -` �/ze �am�maau�ecr,� �✓�a�aacfuiaeltaR s Office of Consumer Affairs&BJsi.ness Regulation HOME IMPROVEMENT CONTRACTOR x Type Registration: i �. >� 'Expiration: .6/29%2612 Private Gorpom RA OND E DAM H ASSE=JR 4 SONS Raymond Damph'ditsts�r 75 Butternut Lane � . Methuen, MA 01844 'c Undersecretary § �Ytassachusctts - Delaartmcnt of Puttlic Safety Beard or Building Regulations .ill(1.Stxnd: Construction Supervisor License t1-(]N i Lirvense: CS. .46636 Restricted to: 1G RAYMOND E DAMPHOUSSE J 1 75 BUTTERNUT LANE i METHUEN, MA 01844------------ = Expiration: 6/2/2011 (ummis.incr Tr#:.16386 5 Ak TRAVELERS J WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY TYPE AR INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER: (6KUB-663X466-A-1 0) RENEWAL OF (6KUB-663X466-A-09) INSURER: THE TRAVELERS INDEMNITY COMPANY NCCI CO CODE: 11347 1. INSURED: PRODUCER: RAYMOND DAMPHOUSSE & SONS PERRY INSURANCE AGENCY ROOFING CO INC 522 CHICKERING RD 75 BUTTERNUT LANE NORTH ANDOVER MA 01845 METHUEN MA 01 844-1 91 2 Insured is A CORPORATION Other work places and identification numbers are shown in the schedule(s) attached. 2. The policy period is from 08-22-1 o to 08-22-11 12:01 A.M. at the insured's mailing address. 3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers Compensation Law of the state(s) listed here: MA ` B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each state listed in o� item 3.A. The limits of our liability under Part Two are: 0o Bodily injury by Accident: $ 100000 Each Accident Bodily Injury by Disease: $ 500000 Policy Limit Bodily Injury by Disease: $ 100000 Each Employee C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, if any, listed here: COVERAGE REPLACED BY ENDORSEMENTWC 20 03 06A o. D. This policy includes these endorsements and schedules: SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE o. 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All required information is subject to verification and change by audit to be made ANNUALLY. DATE OF ISSUE: 08-30-10 LA ST ASSIGN: MA OFFICE: ORLANDO INDUS AFF 161 PRODUCER: PERRY INSURANCE AGENCY 753XF 000284 NORTH F 0 of _ Andover �. _ LAKE O dover, Mass., 9 • .� a I� COCHICHEWICK 7d AD"'ATED PP�,��� S BOARD OF HEALTH Food/Kitchen Septic System ....PEtiMIT T Nor BUILDING INSPECTOR 'L / /� THIS CERTIFIES THAT..............I...........I�..�1..~..�v-............................... ...v...G`...f✓'.'..I��.............................................. Foundation has permission to erect....................................... buildings on ..qf.. . . m� ( /..... .. .......V 4.��.✓`............... Rough .. . .. .. . .. "ft Chimney to be occupied as ............�.......................... ... .. ............................................................................ ........... ..... provided that the person accepting this permit shall in every respe onform to the terms of the application 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 y PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRU N TARTS ELECTRICAL INSPECTOR Rough Service .. ........ . ................................. BUILDING INSPECTOR Final Occupancy Permit Required to Ocatpy 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. RAYMOND E. DAMPHOOSSE, JR. AND SONS HOOFING CO., INC. ]BOX 431 LAWRENCE P.O. MA. CONSTRUCTION LAWRENCE. MA 01812 SUPERVISOR LIC. #048M TEL: (978) 683-4588 NOME IMPROVEMENT REG. #101862 ROOFING — SIDING — INSULATION y Date From: DQ cJ 6— G tJ��� :N , ,.� _ -7� (Nen#) (Address) To: RAT111I31 E DA17111M, A. A4 SINS 11IFOIS CO., 1YC.,'BOX 431 LAWRENCE P.O., LAWRENCE, MASSACHUSETTS 01642 I (we) hereby authorize the Contractor to furnish all �t dials and labor necessary to Install, construct and place the Improvements described below In-on building located at No. / 1-1 3 /a"2_ V lir 0" Slreel, C,Ity r- /7V 0 b✓,�" Stale -9 1 -1' In accordance with the following specifications: We will remove all roof shin);les off t roof area up to two layers Replace any boards or sheathingat t ad- ditional cost. A new 8" clear or white aluminum drip edge applied on all edges. Approx. 6ft of ice and water membrane applied on eaves, 3 f in valleys, strips around skylights, along chimney flashing and sidewall junc- tions. A new base sheet applied.A Ileo 30yr Cambridge architechual or standard roof shingle installed. Install new vent pipe boot flashings. Waterproof existing chimney flashing and remove debris. 4/2e,Al�-- �' T l'��✓`� N ,'��e� i vY C� Optional Products Roof Over Shingle Ridge Ven Existing Roof G t,r Soffit Vents _ .�c r� ,z 1 ,� r �^7— c3 All of the above work to be done In a good and workman-like manner. All men and equipment Insured. Promisee to be 1e11 clean upon complollon of work, For the total sum of dollars. Entire Sum to be paid Immediately upon completion In accordance with plan as shown below. / /' TOTAL CASH SELLINGPRICE DOWN PAYMENT IN CASH . `3cDEFEF114ED BALANCE 975 f v' x UPON COMPLETION ..... The undersigned agrees to keep property mentioned In this agreement properly Insured against loss by fire Including the Contractor's Interest therein. This agreement shall become binding only upon the written acceptance hereof by sold Contractor, and upon such acceptance this shall constitute the entire contract and be binding upon the parties hereto, there being no covenants, promisee or agreements, written or oral except as herein set forth, 11 Is the Intention of the parties hereto that this contract shall be binding upon their respective heirs, executors, administrators, successors and assigns. Customer agrees to pay a reasonable sum as attorney's lees and Court Costs If placed In hands of,attorney for collection. The owner further agrees that In event of cancellation of this contract after acceptance by the contractor and before the work la commenced the OWNER agrees to pay 20% of the total consideration herein named as liquidated damages for breach of contract. Said contractor shall not be responsible for damage or delay,due to strikes, fires, accidents, or other causes beyond his reasonable control. We, the undersigned, certify that we are the sole owners of the property herein described on which said work or repairs are to be performed. IN WITNESS WHEREOF, the undersigned has lhave) hereunto set his ((hsl►) hand(s) and seal(e) the day and year written above. Accepted By ,,Id RAYMOND E.DAMPHOUSSE,JR.AND SONS l ROOFING CO.,INC. Mall Address M#�. Vern-,, 5t. (if Vivant born above) (SiQnslurs and Two of Officio)