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HomeMy WebLinkAboutBuilding Permit #51-15 - 53 BEAR HILL ROAD 7/15/2014BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received Date Issued: ORTANT: Applicant must complete all items on this page LOCATION S3 3 e !� ►1 - Print PROPERTY OWNER�-- ,Print 100 Year Structure yes MAP PARCEL: 4SE ZONING DISTRICT:- Historic District yes 1 Jr Machine Shop Village yes n TYPE OF IMPROVEMENT PROPOSED USE Resi ential Non- Residential ❑ New Building M. One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial Repair, replacement ElAssessory Bldg El Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer - DESCRIPTION OF VVUMM i u tst rtrcruraricu: lqw i)?LSC- f•✓f �l� Identification - Please OWNER: Name: or Print Clearly Address: �� S L 7Z b Contractor Name: —A C &Y' Phone: Address: Z.' �. %✓ f! Supervisor's Construction License: C,� 04?6 276 Exp. Date: t ` I-�, Home Lmprovement License: � 7 � / Exp. Date: -&----2& 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: $ ®T � �® FEE: $ (3Lq Check No.: Receipt No.: a7 � NOTE: Persons contracting with unregistered contractors do not have access to gran f d Signature of Agent/Owner Signature o_con Location 6� i I No. Date V / .� TOWN OF NORTH ANDOVER Certificate of Occupancy $—. Building/Frame Permit Fee $ Foundation Permit Fee Other Permit Permit Fee $ TOTAL $ Check # �� 27778 Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ _T_Y-P_ly_OF—SE-V0—RAGE_DIS.P_OS. AL— Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMMENTS CONSERVATION 'COMMENTS HEALTH COMMENTS Reviewed On Signature Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decisio Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: FIRE DEPARTMENT - Temp Dumpster on site yes Located at 124 Main Street Fire Department signature/date COMMENTS Located 384 Osgood no --D1mens110n 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 NU I t5 and UA I A — I I -or department use ❑ Notified for pickup Call Emai Date Time Contact Name Doc.Building Pen -nit Revised 2014 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 Li Building Permit Application Li Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work a Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Li Building Permit Application o Certified Surveyed Plot Plan Li Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o 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) a Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Li Copy of Contract :i Mass check Energy Compliance Report Li 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 Doc: Building Permit Revised 2014 The Comrrtonwealth of -MaswOuseils , DepuYimei✓tt of Xnc��s�it�r.�lccrrte�% Office of ffivestigaiiong 6001 ayhington,S'treet Foston, .MA 02111 -wmmassgov/dra 'P grkexs' Compensation Youxance Affidavit: Sui Zeas/Contractors]Fleci-ricians/Pl*ber.o Y •Y Y N'ama (Business/Organi'zaiionll'n&idud): 2!tJ !t -A2 / Address: % '? %- )A) /3 City/State/Zip: A Phone : 791 5-4K - -70 Are you an employer? Check the appropriate box: Type of project (required): 1. [( T am a employer with 4. ❑ lam a general contractor and l 6, E]New constxuctloa employees (falland(orpart-time).* have Bire d the sub -contractors Xisted on the attached shoot. 7• ❑Remodeling 2. IST am a sola proprietor o7:' partner ship and`haveno.employees These sub -contractors have 8. [� Domolition working forme in any capacity. workers' comp, insurance, g• o $uilding addition [No work ere comp. jnsuraace 5, ❑ We are a corporagon and its officers have exercised.their 10.[] Electrical repairs or additions required.] 3. EJx am a homeowner doing all work right of exemption per MGL 11. [(Plumbing repairs or additions myself ago workers' comp. insuranceregahed.a t c. 152, §1(4), andwehaveno employees. [No workers, 12,❑ Roofxepairs 13.Other comp. insurance required,] Any applicant that checks box#1 mustalso A11 outthe seeiion below showingthok workers' compensationpolicy information. Homeowners who sabmitibis affldavit fil&catingil cy ge doing 4worN and then hue outside contractors must submit anew affidavit indicating such. TContractors that checkthis bob mustaftaehed anadditional sheet showingthe name ofthe sub -contractors andthdrworkers' comp, policy information. I am an employer that is providing workers' cornperisation insz�rance for my e�rcployees Bat W is the policy attd! h s Me information. Tusuxance CompanyName: policy # or Selz ins.Lic. ff ExpiratloaDate: lob Site Address: City/State/Zip: Attach a copy c,10e workers' coznpensationgrolicy 6eclaxallon page (shopving•the policy number and expiration. date). FAure to secure coverage as requiredunder Section 25A ofMGL o.152 can lead to the imposition of criminalpenaliies of a fine up to $1,500.00 and/or one�year imprisonment, as well as civil penalties in the form of a STOP WORD ORDER. and a fine ofup to $250.00 a day against the violator. Be advised that a copy of ilvs statement may be forwarded to the Office of Investigations ofthe DTA. fax i> ranee covexOge vexifeation. I do hereby W tliatMe informadon,provided above is true and correct �+se aniy, Do not write in this area, to be compieted by city or toren official City or Town: Permit0cense Issuing Authority (circle 6110- 1. Board of Health 2. Building Department 3. CityiTown Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - - - Iufaxmatzau and Instructians . Massachusefts General Laws chapter 152 requires all employers to provide workers' compensation for the>x employees. Pursuant to No statute, an e��pfoyee is defined as ",.,every person id the service of another under any contract of hire, express ozimplied, oral or -mitten." An. eMplctyOs defined as "an individual, partnership, association, corporation ox otherlegal entity, or anytwo ormore Of the forer oin engaged in a joint ente rise and including the le al re resentatives of a -deceased employey, or the g.�d �� 9 g g p receiveror*.i seeofauindividual,painerslyip,associaiionorotherlegalentify,employing0 ployees. H06,verihe owner of a dwelling house having notmore than tbxee apartments and who resides therein, or the occupant o£the dwellinghouse of another who employs persons to dormaintenance, consfiuction, or repair work on such dwelling house or on the grounds orbading appurtenant thereto sh�lliiot`beeamo of such employment be deemedfo be an employes." MGL chapter 152, g25C(6) also states that "every state ox local Weusiug agency shall withhold the issuance or renewal of a license or p ermit to operate a business or to construct bu9ldfngs4n the comr nbnwealth for any applicant who has not pro duced.acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states'Weither the commonwealth not any of its political subdivisions shall enter into any contract for the performance ofpubLc work until' cceptable 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-confractor(s) name(s), addresses) andphomenumber(s) along With their eertfficafe(s) of insurance, iimitedLiabilityCompanies (LLC) orLimifedLiabilitypartaexships (LLP)withno employees otherihattihe members or partners, are notrequired to carry workers' compensationinsutance, lfanLLC orLLP does have employees, a policy is required. De advised thattbisaffidavit may tosubmitted tothe Department ofIudusfrial Accidents for confirmation oflusurance coverage. Also be sure to sign and date the affidavit. 1he affzdavitshould be retommedto the city or town that the application for the permit or license is being requested, not the Department o£ Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain, a*orkers' compensation. policy, please call the Department at the number listed below. Self-insured companies should enter their self hBurance license number on the appropriate line. City or Town OfUcials Please be sure that the affidavit is complete and pxinfed legibly. Tha Department has provided a space at the bottom of the afixdavitfoxyeu io fill out in the event to Office of Investigations has to contact youregardiagthe applicant. Please be -sure to lid inthe pexmit/11cense number whichwili be used as a reference number, In addition, an applicant thatmust submitmultiple permit/license applications in any givenyear, need only submit one aflxdavit indicaft current Policy information (if necessary) and index "Sob Site .Address" the applicant should write "all locations in, (city or town)" .A. copy of the affidavit thathas been officially stamped or marked by the city ortow may be provided fo the applicant as pxflo£that a valid aitxdavitis on file i'or futirre permits or licenses. Anew affidavit must b e idled out each year, where altome owner or citizen is obtaining a license oxpermitnotxelatedto anybusimss or commercial venture (Le, a dog licenso or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Tnvesugatfons would like to thankyou in advance for your cooperation and should you have any.luestions, please do not hc&& to give us a call. The Department's address, telephone audfax number: - A-parlmu tt afzudu*!a1 Accident Offce oUAWSUP &M 6Q4 WaAiagtm Stcmt BpSlon,. 0.2111 Revised 5 26-05 ' w�w.�la��,g�vfclZa � /w �\ )o « «\ � e \ � 2 2 o � _� j § L, § m \» ®F ~ 2 o: 99�. { ] �. \Ul(DC-4 , _ \ �. CL P. o e � ` � @ / 2 2 \ %» U)� j. 0 m 0 ¥m/ . o § U) �M \§k \ j §R� Imo\. \ 0Co � . /0 CIL( «\ � e o � \Ul(DC-4 . \�sm$.Q.<\/ §> / sy2 G G . y�§§:�ƒ©, .1 r,.; —Z « . m 0 ¥m/ . o § § / / � \ j \ Imo\. \ 0Co JET DEVELOPMENT and CONSTRUCTION 27 Linden circle, Georgetown, Ma. 01833 Phone : 781-589-7077 E-mail jtace(a jet-development.com Payment Schedule Bill To: Rod Kurtz 53 Bear Hill Rd N. Andover MA Work performed at: 53 Bear Hill Rd N. Andover MA 1. Material deposit on commencement 7800.00 2. Progress payment upon completion of siding replacement 9000.00 3. Final payment upon completion of all measures 3709.00 Total: Paid: Balance Due: Additional measures: 20,509.00 JELOPMENT & CONSTRUCTION 27 Linden circle Georgetown, MA 01833 781-589-7077 itace@jet-develol2ment.com Proposal of work to be performed To: Rod Kurtz 53 Bear Hill Rd. North Andover MA Work to be performed at: 53 Bear Hill Rd. N. Andover MA Proposed Measures: Remove and replace siding 1. Remove all existing fiber board siding from three sides of house. Includes street facing, rear facing and garage end. Excludes east facing end where siding has been replaced. 2. Install new pre -primed finger jointed cedar clapboard siding with 4" exposure to aforementioned areas. Install Tyvek or equivalent house wrap to these areas. 3. Scrape all loose paint from all exterior trim on all sides. 4. Prime one coat on all scraped or bare wood. 5. Replace rotted window trim with pre -primed solid pine. 6. Replace rotted corner blocks in two places. 7. Apply two coats of Sherwin Williams premium exterior paint to all siding and trim. 8. Remove and dispose of all related debris. Leave all areas clean. 9. Includes all necessary permitting. TOTAL COST FOR PROPOSED MEASURES: 20,509.00 Date: 4/25/14 Thank you for your consideration. JET DEVELOPMENT and CONSTRUCTION Georgetown, MA 01833 781-589-7077 MA CSI. # 096278 AIC Reg. # 166729 AGREEMENT AND TERMS 1. All work shall be performed in a workman like manner. All work areas shall be cleaned at the end of workday within confines of work in progress. All areas shall be kept in a safe condition during construction. Any area marked as caution or barricaded in any way shall be considered prohibited, therefore any person entering this area will be considered at their own risk and any resulting injuries are not the responsibilities of JET DEVELOPMENT and CONSTRUCTION'. All work areas shall be completely cleaned and all debris removed at completion. 2. All price quotations are based on work described as work to be performed. Any additional work required or requested shall be subject to a change work order. Such said change order shall be submitted to customer within a reasonable amount of time (one day for work to be performed by JET DEVELOPMENT and CONSTRUCTION, two days for work requiring sub contractor services.) Work would reconvene within one day of the approval of the change order by customer. Work requiring sub contractor services may be delayed longer. 3. All price quotations are given based on what can be determined on a visual inspection. Any additional work arising after demolition would be subject to a change order as described in paragraph 2 and additional charges. We use our experiences to try to best anticipate situations but we are unable to know in all instances what is behind walls, under floors and within masonry structures, etc. 4. Upon notification of additional work required and advisement of additional cost, the customer may choose to have work performed by JET DEVELOPMENT and CONSTRUCTION or a qualified sub contractor solicited by same, in this case terms described in paragraph 2 would apply. In the event customer chooses to perform said work themselves or to solicit their own sub contractor, original work would reconvene after said additional work is completed, and inspected by JET DEVELOPMENT and CONSTRUCTION and deemed satisfactory to complete original work order_ 5. MASONRY CONSTRUCTION: Any damage caused by misuse (ie. chopping ice, overloading, moving refrigerators, etc.) would not be covered under warranty. Damage caused by the use of rock salt for ice removal would not be covered (calcium chloride is recommended for ice removal). Damage caused by direct water flow left uncorrected (ie. leaking gutters, incorrectly routed downspouts, etc.) would not be covered under warranty. Construction of masonry stairways DOES NOT include refinishing, repair or reinstallation of wrought iron railings unless specified. In the even railings are required or requested, a qualified sub contractor can be referred to the customer on request for an independent quotation_ Estimates on chimney reconstructions are from the roofline, in the event there is further deterioration below the roofline, the customer will be notified of additional cost, except in cases where the chimney can be viewed from inside the attic. Chimney reconstruction does not include new flashing unless specified. DESIGN: JET DEVELOPMENT and CONSTRUCTION will provide design services upon request. A list of design service costs will be provided. Design service charges should be paid in advance and would be reduced from the cost of total quotation upon agreement to commence. In cases of rebuilding to existing dimensions we would conform to existing dimensions wherever feasible and in accordance with local and state building code requirements. In case where existing dimensions are altered to suit customer desires or to conform to building standards or codes a change order would be submitted 7. LABOR RATE: Estimates submitted are based on standard labor rate of $75.00 per hour for work requiring one skilled person. Additional help required would be charged at a rate of $47.50 per hour for non skilled personnel. An hourly break down of charges will be provided upon request, on change orders only. 8. MATERIALS: All materials shall conform to applicable design specs. And stock lists etc. In the absence of specified design specs or stock list, materials of suitable quality shall be offered for customer acceptance and approval prior to installation. In the event of customer supplied materials and fixtures JET DEVELOPMENT and CONSTRUCTION assumes no responsibility for default or defectiveness of materials and fixtures not related to installation. 9. RE -LANDSCAPING: JET DEVELOPMENT and CONSTRUCTION will back fill any areas excavated to facilitate construction. Any landscaping (ie mulching, grading or leveling; loam, removal or disposal etc) requested would be at an additional charge. 10. SCHEDULING: A non refundable scheduling deposit of $200.00 shall be required on orders over $2000.00. This deposit shall be credited to initial payment on day of commencement. Rescheduling would require TEN days notice. 11. TERMS: Unless otherwise specified with an attached payment schedule. See attached payment schedule 12. This form satisfies all basic requirements of the state's Home Improirement Contractor Law (MGL chapter 142A), but does not include standard language to protect homeowners. Seek legal advice if necessary. Anyperson planning home improvements should first obtain a copy of "A Massachusetts Consumer Guide to Home Improvement" before agreemg to any work on your residence. You may obtain a free copy by calling the Office of Consumer Affairs and Business Regulation's Consumer Information Hofline at 617-973-8787 or 1- 888-283-3757 or on our website. 13. Required Permits - The following building 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 own permits will be excluded from the Guaranty Fund provisions of MGL chapter 142A.) _7/17114 Date when contractor will begin contracted work. _8/17/14 Date when contracted work will be substantially completed. 14. Express warranty - Is an express warranty being provided by the contraetoO 11 No 11 Yes (ail terms of the warranty must be attached to the contract) Subcontractors - The contractor agrees to be solely responsible for completion ofthe 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 lien or other security interest has been placed on the residence: Review the following cautions and notices carefully before signing this contract. • Don't be pressured into signing the contract. Take time to read and fully understand it. Ask questions if something is unclear. • Make sure the contractor has a valid Home Improvement Contractor Registration. The law requires most home improvement contractors and subcontractors to be registered with the Director of Home Improvement 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. • 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. • 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 has been signed at a place other than the contractor's normal place of business, provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this agreement. See the attached notice of cancellation form for an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES!!! Two identical copies of the contract must be compicted and signed One copy should go to the homeowner. The other copy should be kept. by the contractor. I the undersigned do agree to have work performed described as PROPOSED MEASURES for the amount described as TOTAL COST OF PROPOSED MEASURES. I do hereby agree to the terms and conditions of this agreement unless otherwise specified. HOMEOWNER: RodneyKu CONTRACTOR: John Tace Contractor Arbitration DATE: July 10, 2014 DATE: July 14, 2014 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 not automatically 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 would 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 firm which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided In Massachusetts General ws, chapter 142A. fac�� �ivat:s �eseabovc C toes Signa NOTICE: T of apply only to the agreement o e parties to alternative dispute resolution initiated by the contractor. The homeowner may initiate alternative dispute resolution even where this 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. 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 work as described, in a timely and workmanlike manner. Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for workmanship or materials. In addition to 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 exhibits 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. 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 he financially insecure, the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted'work. Withdrawal of fiords from said account would require the signatures of both parties. Additional Information If you have general questions or need additional information about the Home Improvement Contractor Law or other consumer rights, or if you wish to obtain a free copy of "A Massachusetts Consumer Guide to Home Improvement" contact: Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza, Room 5170, Boston, MA 02116 617-973-8787, 888-283-3757 or visit the OCABR website at http:/fNkivtiv.mass.goviocabr/ If you want to verify the registration of a contractor or if you have questions or need additional information specifically about the contractor registration component of the Home Improvement Contractor Law, contact: Director of Home Improvement Contractor Registration Office of Consumer Affairs and Business Regulation 10 Park Plaza, Room 5170, Boston, MA 02116 617-973-8787, 888-283-3757 or visit the HIC website at http://%k,vw.mass.gov/ocabr/ Go online to view the status of a Home Improvement Contractor's Registration: http://db.state.ma.us/homeimprovement/licen,wclist.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 508-6524800, 508-755-2548 or 413-734-3114 version 2.1 - 11/22/2010 NOTICE OF CANCELLATION YOU MAY CANCEL TIES TRANSACTION, WITHOUT PENALTY OR OBLIGATION, WITHIN THREE BUSINESS DAYS FROM THE ABOVE DATE. D YOU CANCEL, ANY PROPERTY TRADED IN, ANY PAYMENTS MADE BY YOU UNDER THE CONTRACT OR SALE, AND ANY NEGOTIABLE INSTRUMENTS EXECUTED BY YOU WILL BE RETURNED WITHIN TEN BUSINESS DAYS FOLLOWING RECEIPT BY THE SELLER OF YOU CANCELLATION NOTICE, AND ANY SECURITY INTEREST ARISING OUT OF THE TRANSACTION WILL BE CANCELLED. IF YOU CANCEL, YOU MUST MAKE AVAILABLE TO THE SELLER AT YOUR RESIDENCE, IN SUBSTANTIALLY AS GOOD CONDITION AS WHEN RECEIVED, ANY GOODS DELIVERED TO YOU UNDER THIS CONTRACT OR SALE: OR YOU MAY, IF YOU WISH, COMPLY WITH THE INSTRUCTIONS OF THE SELLER REGARDING THE RETURN SHIPMENT OF THE GOODS AT THE SELLER'S EXPENSE AND RISK. IF YOU DO MAKE THE GOODS AVAILABLE TO THE SELLER AND TBE SELLER DOES NOT PICK THEM UP WITHIN TWENTY DAYS OF THE DATE OF CANCELLATION, YOU MAY RETAIN OR DESPOSE OF TEE GOODS WITHOUT ANY FURTHER OBLIGATION. IF YOU FAIL TO MAKE THE GOODS AVAILABLE TO THE SELLER, OR IF YOU AGREE TO RETURN THE GOODS TO TT -1E SELLER AND FAIL TO DO SO, THEN YOU REMAIN LIABLE FOR PERFORMANCE OF ALL OBLIGATIONS UNDER THE CONTRACT. TO CANCEL THIS TRANSACTION, MAIL OR DELIVER A SIGNED AND DATED COPY OF THIS CANCELLATION NOTICE OR ANY OTHER WRITTEN NOTICE, OR SEND A TELEGRAM TO [Name of Seller], AT [Address of Seller's Place of Business] NOT LATER THAN MIDNIGHT OF (da#e). I HEREBY CANCEL THIS TRANSACTION. 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