HomeMy WebLinkAboutBuilding Permit #76 - 52 PLEASANT STREET 7/31/2007TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
Date Issued: 7
IMPORTANT: Applicant must complete all items on this page
LOCATION 5
PROPERTY OWNER �,..,/ 17 n -zjn` Yja ra-
_ _ Print
MAP NO.: PARCEL: ZONING DISTRICT:
iTTT T\iAT!"�
urerrnurr nrQTAr(`T VIP n
j IrL' hl\L V1JL' Vj' LV1LLl1\V
TYPE OF IMPROVEMENT
-- - ----
PROPOSED USE
Residential
Non- Residential
❑ New Building
XOne family
❑ Addition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
epair, replacement
❑ Assessory Bldg
❑ Commercial
❑ Demolition
❑ Moving (relocation)
❑ Other
❑ Others:
❑ Foundation only
3TJON � TF �ORJ
- Strac I
TU BE PRET Mb .
l'--
'Foweip oce-VVie Vl wI
tA- 1=0LC,+0r-. 0•3st'.
Identification Please Type or Print Clearly)
OWNER: Name:
Address: sa P16 SCL"
CONTRACTOR Name:Z&a1-5 NOYYIcz!
Address: IR a-7 ! ly vylpS (l" RJ
I - 6 8g�
q, aEB4S
H- 8GO-79a-V(0�
5?rn- 753.0 4S ;L
07-- 06a7"
Supervisor's Construction License: Exp. Date: / /900^7
Home Improvement License: 14Op6O7 Exp. Date:
ARCHITECT/ENGINEER Name: Phone:
Address: Reg. No.
FEE SCHEDULE: BULDINC PE MIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON 125.00 PER S.F.
Total Project Cost FEE:$
Check No.: Receipt No.: 0
Page Iof4
t
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
Addition Or Decks
❑ Building Permit Application
❑ 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)
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
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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM05
Page 4 of 4
TYPE OF SEWERAGE DISPOSAL
Tanning/Massage/Body Art ❑
Swimming Pools ❑
Public Sewer ❑
Well F-1Tobacco
Sales ❑
Food Packaging/Sales ❑
❑
Permanent Dumpster on Site ❑
Private (septic tank, etc.
Electric Meter location to'
project
NOTE: Persons contracting with -ulvegistered c ntractors do not have access to the guara and
SignatureAgent/ wner vec Signature of contractor ._
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED
PLANNING & DEVELOPMENT ❑
COMMENTS
DATE APPROVED
DATE REJECTED DATE APPROVED
CONSERVATION ❑ ❑
COMMENTS
------------
DATE REJECTED DATE APPROVED
HEALTH ❑ ❑
COMMENTS +
FIRE DEPARTMENT, - Temp Dumpster on site yes no
Fire Department signature/date
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
Building Setback (ft.)
Front Yard Side Yard Rear Yard
Required Provided Required=Provides Required
Provided
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
NOTES and DATA — (For department use)
Page 3 of 4
Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM05
Created JMC. Jan.2006
Location
No. 26 Date 7 3/ 07
TOWN OF NORTH ANDOVER
' Certificate of Occupancy $
si,it r 9 7
�7b' ••° •'<� Buildin /Frame Permit Fee $ C
ss•►cMusE
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
2044-
Building Inspector
1
m
m
m
m
vI
m
to)
M
y
CIA Cl)
1
CD Z cops
®CL
n'
C
CA
®®CD
CD
CLc
CD
CD® CD
w w as
C� CD y
® CDy
Cc C
Q„ o
CD
o CD
a
CD
z
y
0
9
w
(c
w',i%
G
:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Apalicant Information Please Print Legibly
Name (Business/Organization/individual): Sears Hoene Improvement Products Inc.
Address: 1024 Florida Central Pkwy
--- Home 860-792-8106
City/State/Zip: Longwood, FL. 32750 phone #: Cell: 860-753-0452
Are you an employer? Check the appropriate box:
1. ❑ 1 am a employer with
4. ❑ I am a general contractor and I
employees (full and/or part-time).`
have hired the sub -contractors
2. ❑ l am a sole proprietor or partner-
listed on the attached sheet t
ship and have no employees
These sub -contractors have
working for me in any capacity.
workers' comp. insurance.
[No workers' comp. insurance
5. We are a corporation and its
required.]
officers have exercised their
3. ❑ 1 am a homeowner doing all work
right of exemption per MGL
myself. [No workers' comp.
c. 152, § 1(4), and we have no
insurance required.] t
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling
8. ❑ Demolition
9. []Building addition
10.0 Electrical repairs or additions
l 1.1 Plutmbing repairs or additions
12.1 hoof repairs
13.M Othe�"
y
°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 anew affidavit indicating such.
tContractors 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 ml' employees. Below is the policy and jots site
information.
Insurance Company Name: Ace American Insurance Company
Policy # or Self -ins. Lie. 4
Job Site Address: 5 a.
WLRC44460798
St'e
Expiration Date: 04/01/2008
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 form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
Ido hereby cerci undue the pains algd penalties of perjury that the information provided above is true and correct
../.s/{Sears Auth. Agent } r,a,P Ad .. , '� 1 . a an ''1
Phone #:
Home: 860-792-8106 / Cell: 860-75 452
Official use only. Do not write in this area, to be completed by city or town off elat
City or Town:
Permit/License #
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone M
Board of Building Regulations and Standards
One Ashburton Place .. Room 1.301
Boston. Massachusetts 021.08
Home Improvement Contractor Registration
Registration: 148607
Type: Supplement Card
Expiration: 10/1112007
SEARS HOME IMPROVEMENT PRODUCT-
LUBOS SVEC
1024 FLORIDA CENTRAL PKWY _
LONGWOOD, FL 32750 update Address and return card. IVlarlc reason torrhsrne.�
ur -rai rnrrre .rcua«� ( Address Renewal I I Enrpinynient ; i.ost Card
. ^. �'�. �. i�%tt! tCEjJJd JJzrtXmittj/� e�.. fffrJ3r�c°itrt.Fell3 •� y ��—
Bout-d of Building Regulations nrid Standards License or registration valid for indivithrl use only
fl HOME IMPROVEMENT CONTRACTOR before the expiration elate. 1i- round return to:
Registration: 148607 Board of Building Regulatious and Standards
One Ashburton Place ]Iain 1301
Expiration: 10/11/2007 Boston, Ma. 02108
Type: Supplement Card
SEARS HOME IMPROVEMENT PR
LUR(is SVEC
1024 FLORIDA CENTRAL PKWYt�
LONGWOOD, FL 32750 Administrator Not -aid wit in it sigrratur
T+:
ckv 20 ttwr B E t3t?"'I
r r t1aV."2 t?frr kti4Z F.:ued.08.26-2003
T14OMPSON CT 66M.
04/02/2007 11:20 407-767-8536
LICENCE PERMITS SUBS PAGE 01
ACORATE OF LIABILITY INSURANCE 08/01.12007
Mumorm
03110
E OF gf$URANCE
THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION
Pm* ruc rR
" LocKTON COMPANIk$,U C -K CHICAGO
ONLY AND CONFERS NO BIGHTS UPON THE CERTIFICATE
525 W. Monroe, Suite 600
HOL.D9R, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
CHICAGO IL 60661
G� FOBRPJ L IE L[QIE_$_SELQW—
(312)312) 66M00
INSURERS AFFORDING COVERAGE
INSURED Sears Holdings Co
1062183 rporatlon
d/b/a Seals Home Improvement Products. Inc
1NSU ERA: a S=•,ri'd1lj/
1c 11� es, Ca. aiNorth America
Attn: Risk Management 85`1778
3333 Beverly Rd
T --w-m arrear.T [iCl'IRIRC€f11 THF 34R1lING
Hqffman Eau tas, IL 60179
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REOUIREMENT, 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 TME TERMS, EXCLUSION$ AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTH
E OF gf$URANCE
POLlC1f NUIIIBER
POLICY EFF
D�f�IGY E�PRJ4 N
�nS
-PGENERAL
SAC
LIAMILWY
FI__ _ ras�r me me s Excluded
w MM*ptemnS Exclude
A
X cOMmmiAL GENEm Ljl army
CLAIMS MADE 1 x 1 OCCUR
HDO G21729383
04101/2007
08/0112007
Imeo
PEitS(NdAL b ADV INJURY ,�^ 5 000.000
a 5.000 000
I_QEVL
AGGREGATE LIMITAPPLIES PER:
PRODUCTS - COMuIPIOP AGG 6 5-000,W0
PO CY m— O
A
AUTOMMLE LIAOIUTY
X ANY AUTO
I..SAH08219953
04/01/2007
09/01/2007
81NED SINGLE LIMIT
► 5,000,000
8OD LY INJURY
(P"rP'.. s xxxxxxx
ALL OWNED AUTOS
SCHEDULED AUTO$
BODILY INJURY
(Per xcWentj S ��
HIRCO AUTOS
NON-0YIINED AUTOS
ERTY �DAMAGE0 xxxxxxx
F
GARAGEWMILITY
I AUTO ONLY - EAACCIVENI S )CQQQ X
ZtERTH . JEAACC s XXXXXXX
auTo ONLY: A S QqM c
A
ANY AUTO
S.I.K. $5,000,()00
04/01/2007
08/01/2007
A
EXCE9S L�ABTLIITE
X OCCUR ❑ CLALMa MADE
XOO G23573830
04/01 /2007
08/01 /2007
EACH OCCURRENCE $ tO,Ooo,000
AGGREGATE S - 10;000000
IDORRIAi
DEDUCTIBLE ® forts
X3CX
RETENTION ¢
S xxxxxxx
A
WORKERS COMPENSATION AND
WI,RC44460737(CA)(pED.)
04/01/2007
04/01/200$
J( wGSTATU• OTT+
A
EMPLOYYLRRTUAMLffV
SCFC44460749("(RETRO)
04/01/2007
04/01/21108
E.L.EACHACCIDENT S 1.000,000
EL,otSEAN-CA W14yeal S 1.0
B
WLRC44460798
04/01/2007
04/01/2008
E.L. DISEASE - POLICY LIMIT 5 1,000,00o
B
ALL, OTHER STATES
A
OTHER
S.I.R. $5,000.000
04/OIrml
09101/2007
SIX $5,000,000
QfimaefreaI rsLiability
DESCRIPTION OF OPERATMNSII OCATMMV4 IItCLES1WCLWA Mb AWED BY ENOORSEMENTJSPECIRL PROINSIONS
Alfred w, Nymml Tr. , i ice1ISC 4OGC012533 Iocatcd tsj 1024 Florida Central Parkway, Lsngwood" FL32750 and AI%M W. Nyman, dr., License;"CMC12495X0
Iocatcd @ 1024 Florida Central PzMvay, l�Dngwood, FL. 32750
CIERTIFICAU HQ R AD R LEt r ;
2268082 SHOULD ANY OF THE AMM DZIMMMEO POLIMS BE CANCELLED BEFORE THE EX MRATION
Sears Home Improlrement ProdI t DATE TMEREOF THE ISSLM INSURERIMLL ENDEAVOR TOMAIL 30 DAYS WRrTTEN
1024 Florida Cenbal Parkway NOT= TO THE ,CERTIFICATE HOLDER NAMED tO THE LEFT,BIJr FAILURE TO DO SO SMALL
Longwood FL 32750
DIKU NO OBLIGATION OR LIABILITY OF ANY WNC UPON THE INSURER ITS AGENTS C+R
REIMESOffATREES.
AUTNORU" REPRESMATNE
ACORD26S(7/97 f0eqwmaomuffrmnaaftearnlewh exon.lam,meara�adn,u�.mann.aumxn„A�pecUytrwellan=aoee*sFa►maa. wAcmi COwdik noN19se
Received on 4/2/2007 9:22:20 AM
R
Board of BU-11diing Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registration:
iz
ld
U on: i
am
148607
10/1112007
Pubk Corporation
SEARS HOME IMPROVEMENT PRODUCTS INC.
ALFRED NYS AN JR.
-10-2-14 FLORIDA CEN-TRAL PKVVY
LONGWOOD, IFL 32750 Administrator
/ 0-/ 1
" � "
QE -3-A-0-44 170 7 -U PA vic:v=i 1 o'iiii lr•
NFRC
3Easa Klfldoa,
DhuiilE- t=actil' I antaria ire i-ciblfc ;1iii= tlii2
:trrjoit Prr �r las I _r�.�8titji'r_ 3ti=Lhr
National Fenestration
1 / 3 " (;lass 3.18 'n'tyL VI r io
Rating Council®
tl7 LaT(tirtat d aias4 ! 'SL t-j1dr10 Law Lf mdo
lav <=ids I =int raliila9
ENERGY PERFORMANCE RATINGS
EVALI IACION DE RENDIMIENTO ENERGEM0,
U -Factor
Solar Heat Gain Coefficient
Factor -U
Coefidente:Gananda de Energia Solar
lewcono
rU
ADDITIONAL PERFORMANCE RATINGS
EVAWACION SUPU MENTARIA DE RENDIMIENTO
Visible Transmittance
Transmislon de Luzftble
i e C 1
Manufacturer stipulates that these ratings conform to applicable NFRC procedures for determining whole product performance. NFRC
ratings are determined for a fixed set of environmental conditions and a spedflc product size. NFRC does not recommend any product
and does not warrant the suitability of any product for any specific use. Consult manufacturer's literature for other product performance
Information. www.nfrc.org
•---------------------------------------
Este fabrixxrta esdpula quo estoe valores cumplen con los pmced'xmfertos apticables de NFRC pain determiner et rendimlerto total del
producto. Los valores usados par NFRC son determinados par un conpmro filo de condiciones amblentales y un tamano de producto
especfflxw. NFRC no recemlenda ningun producto y no garantiza que at producto sea adecuado pare un use especlfixo. Consuite con el
folleto dei fabrhxnte para el use aproplada de este producto. www.nfrc.org
pxi Uiti r rjaa.lifie3 'Y or ;:t=tBRCY '_T R
•3o=strt
Cant -al, ga-tk•.crn.
La ."Idad CalifiCa rara la f I - 4
x
tt a y e racrL6n(mmj EVERGY STAR: Ul^rte: 3TC: c$
'-
h1L•ste Ca=itsa1, 3tr C_Atrel_ sur.
a e IUD4 Fain Q9lalas,a
y �r
Tt3tai.i-�txS:: 43" .. 30"
11 -ID: aefug:=mac= Qividrir 3-13
' — 9 E; Twaada for bado: lil. 9 Cyd x 203.2 Cyd
iG_S2 P'3 ;3ealb: 9 E73>~34 S.UCt
Keep this label for possible ENERGY STAR® rebates. To leam more visit % w.energystacgov
Guards esta etiqueta paro posibles reembolsos ENERGY STAR® Pam cower mds acerca de esto, vksite www.energystar.gov.
Sean: Home Improvement Products, Ina Location: &Zt�.
d
1024 Florida Central Parkway ♦ Longwood, FL 32750 Phone #:
FEIN 25-1698591
License Numbers: AL 5401; rL CGC01253&, LA 64194: Ilmile Improvement Protluca Job #: E.N
S6am
MA 148607; MS 50222; NC 47330; RI 27281; -- 105836;
TN 2319; GA G18089; CT HIC.0607669; OK 106641 Replacement Windows
Name:�N N Z L I N PR ft' Pnone: Res: 97P bFy—b/2� Bus. 97F— 39T— S'G 9P
Address: r2 PLOA-T tNT City: A(,ytffH �i N7��/1GR St.: tr _Zip: i l pyr
I/We, the owners of the premises described below, hereinafter referred to as "Purchaser" offer to contract with Sears Home Improvement Products
hereinafter referred to as "Contractor", to furnish, deliver, and arrange for installation of all materials necessary to improve the premises located at:
54 mic
(Street) (City) (State) (Zip)
According to the following specifications:
1. Remove existing units to be replaced. (NOTE: Removed units are likely to be damaged.)
2. Prepare openings as necessary to receive replacement units.
(No finish work other than normal installation is to be done unless otherwise noted below.)
3. Instal Sears Weatherbeater t! A -X Windows in openings described below to the following specifications:
Color. UKVhite ❑ Tan ❑ Whit tight Woodgrain Interior ❑ WhitafDark Woodgrain Interior ❑ BetgetDark Woodgrain Interior
Type: 150H ❑ SH ❑ 1 -LR ❑ 2 -LR ❑ 3 -LR ❑ PW ❑ Other
City 14 fns+-.._ city _ City— ay— City_ ft—
I IM -0-1•— —s ~ EEH a � Other
Glass: ❑ Clear ❑ Bronze ❑ OBS U, ay_ Screens, CHECK IF OTHER THAN FIBERGLASS:
l2fLm E'/Argon ❑ Gray ❑ OBS Full Oty_ (On Sashes Only) LJ Alum
❑ Tempered Ory_ ❑ Keepsafe Oly_
NOTE: Tempered glass win be installed to meet building codes.
Grids:
Col
Top
Yes ❑
S 3Q0
S Vlance
❑
No F°1
o this day of 20 a.
Full
_ty
atve�ruse 01r .rwieaenaWW-Wbyth a .100 m,acre0 s, ,rc0.W,#1.Wgayeo. N.
Bottom
S 9391
s«Iro ca slat Diamond
White
Tan
Wd Grain
Brass
Warranty: ltkAn rer's Warranty sem upon completion.
4. Existing units oWbe reptaced: 3 WIMP -N-4 !N PR.oNr l.J`'FT I s l FL0d'1t
C0VrP) _- 4-0tsr vvf.NPow- ati etl &fm- i i r rworf SaA>(' AEAK P0it;0f
5. If applicable, after completion of project, the application and removal (storage) of shutter panels shall be the responsibility of the purchaser. In the
event the project requires the installation of storm shutters or egress windows, Contractor will not re-instalf any effected security bars.
6. Special instructions:
7. Clean up job related debris and provide necessary permits and insurance.
8. If applicable, in the event that Contractor is unable for whatever reason to obtain the proper permits prior to tho commencement of any work,
Contractor shah refund any previous payment and this transaction shall be automatically cancelled.
9. Allow approximately 3.6 weeks for installation.
TIME FOR COMPLETION OF WORK. Contractor shall commence work within approximately twenty (20) days from the date shown herein and will be substantially
completed within forty-five (45) days thereat er 7671
nI es a different estimated completion date is shown herein.
Approximate starting date is: 1 f 0 Approximate completion date is: _--a-A-3.107
NOTE; THE WARRANTY PROVISIONS AS STATED ON THE REVERSE HAVE BEEN EXPLAINED AND yWE UNDERSTAND THEM
ADDITIONAL PROVISIONS AND WARRANTIES ARE STATED ONTHE REVERSE SIDE AND ARE A PART OFTHIS CONTRACT.
Please read the following bold type and initial corresponding line.
Verbal understandings and agreements with representative shall not be binding. All understandings and agreements must be set forth in
writing in this Contract Due to climatic conditions, Irlterfor condensation may occur. Purchaser Initials:
3 i#
0
To be financed LJ Cash upon completiope
Contract Pric
SatexsTax (%)
S 3Q0
S Vlance
jContradPrice
Po In witness whereto the Iauyer nos entered into this trensaMionstate
t
390
o this day of 20 a.
(N applicable)
_ty
atve�ruse 01r .rwieaenaWW-Wbyth a .100 m,acre0 s, ,rc0.W,#1.Wgayeo. N.
Total Contract Price
S 9391
10% Preferred Customer Discount (PCO) awarded for any future Sesn Home Improvement woduets PaMssea- Caarenl pricing available for one (1) year.
If this Is a rradn tmnsaxinn, the agreement for credit is contained in a separate dneument which is Incorporated herein by reference and made a pad
hereof. IMfe the undersigned are hereby authorizing Sears Home Improvement Products, Inc. to verify and rerinew, mytour credit record with an independent
credit reporting agency and release them from all liability incurred from inadvertent omissionsor errors.
IN WITNESS WHEREOF Purchaser(s) have hereunto signed their names) this day of , 20—q --and adurowledge
receipt of a true copy of this Contract and unless otherwise specified, it is understood that the ownerg),ady work to begin.
THIS MESSAGE APPLIES TO DOOR-TO-DOOR SALES ONLY: You the Purchase ase m cancel this transaction any tifne
prior to midnight of the third day after the date of this transaction. See accompanying notice of cancellation form for an
explanation of this right.
Licenses held by or on behaff of Sears Home Improvement Products. Some services and Installation performed by SHIP
associates. Other services and Installation performed by SHIP -Authorized licensed contractors; additional SHIP license
Information available upon request.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES
ftnslure artvred below acts as receipt that Purchasertsl received separate cancenaeon forms.
agMrtT#O9,Y: Aepresenteeve Dat Punch Dat.
61 -
VAdOEPTEDeYAgersfio,4kMmvenem Prowers, i— Date P..h _.._.
E2 -SO (ALARCTFL.GA.KY.LA.MA,ME.MS.NC.NH,R.SC,TN.VTi NO