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HomeMy WebLinkAboutBuilding Permit #385-13 - 55 FARNUM STREET 11/8/2012 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO:"/,, 6/11 W Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION Pe Print PROPERTY OWNER P,4!S l/`Sfiyn�� �y P�/e q e cl elecv Unit# Print MAP NO: _PARCEL: CO ZONING DISTRICT: Historic District yes o Machine Shop Village yes o 100 year-old structure yes no TYPE OF IMPROVEMENT PROPOSED USE Reside Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other O Septic ❑Well ❑Floodplain 0 Wetlands ❑ Watershed District 0 Water/Sewer- - /DESCRIPTION OF WORK TO BE PERFORMED m Me f �P�'�K� �!�/� �/X�R��j d�.I / r�� 2',d/-_ �yi2 '77/e- i<i�f1�2��S .¢.y a� )cz 2 (Identification Please Type or Print Clearly) OWNER: Name: IPA%Z-AYS19yye 34- Pn.� ���1P, v Phone: _ Address: CONTRACTOR Name: Phone: -�27P 3�y-cPY3-7 Address: 9/'� Sols Livcy m.� Supervisor's Construction License: d7 ,1 Exp. Date: 7-/t/, -2/ Home Improvement License: /o/a'SSW/ Exp. Date: e-LS 210 i y 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: $ ' �V 06-9, " FEE: $ ­3 .5 7 Check No.: 0c) Receipt No.: Z � 7-1 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund _ignature of A- ent/Owner — - - -g - Signature of contactor Location J 15 TimLA y1 /- P-e+ No. / Date b ?/ • • TOWN OF NORTH ANDOVER • r Certificate of Occupancy $, Building/Frame Permit Fee s. 37 " . Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# o� t 25929 Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street 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 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 Doe: Doc.Building Permit Revised 2008mi r- 7 NRT OH - . .� 1�. A. . . ve: O NO. POP 2b 4"L.I. h ver, Mass, Wv 12. CoCNIC//l WICK A04ATIE S U BOARD OF HEALTH Food/Kitchen PERMIT T L D Septic System 00 THIS CERTIFIES THAT �� ..�!'!�r..... L..,. BUILDING INSPECTOR .............. . .e ,. .. ...................... .�................. Foundation has permission to erect .......................... buildings on • .........'S....................... !! ...S .................. M O Rough to be occupied as ,� .,.. e. .......... . ...L... ........................................................ Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in 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 1 PERMIT EXPIRES IN 6 THS ELECTRICAL INSPECTOR UNLESS CONSTRU ON ST Rough i Service ............... ...................................... ' ........................ Fina BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. Smoke Det. SEE REVERSE SIDE FARM FAMILY CASUALTY INSURANCE COMPANY Issuing Office - P.O. Box 656 • Albany, New York 12201-0656 CONTRACTORS ADVANTAGE BOP000916907 ® DECLARATION PAGE Policy Number: 2005XO431 Agent No: 3485 Agent Phone: 978-887-8304 UGONE JOHNSON INSURANCE AGENCY , IN 7 GROVE ST STE 201 Name and Mailing Address of First Named Insured: TOPSFIELD MA 01983-1862 STEPHEN KEISLING 9 9TH ST W SALISBURY MA 01952-1702 The Insured is: INDIVIDUAL Transaction Type: RENEWAL Transaction Effective: 03/21/2012 Policy Period: From 03/21/2012 To 03/21/2013 12:01 A.M. Standard Time Business Description: CARPENTRY Total Limit of Liability Term ADDL/RTN Business Property Coverages Premium Premium Buildings Business Personal Property $5,000 $22.00 Business Income and Extra Expense Actual Loss Sustained Not Exceeding 12 Months Other Endorsements SEE SCHEDULE BUSINESSOWNERS LIABILITY Except for Fire Legal Liability, each paid claim for the following coverages reduces the amount of insurance we provide during the applicable annual period. Business Liability Limits of Insurance Bodily Injury/Property Damage $500,000 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 AGGREGATE FOR PRODUCTS/COMPLETED OPERATIONS HAZARD Medical Expenses $5,000 EACH PERSON Fire Legal Liability $50,000 ANY ONE FIRE OR EXPLOSION Other Endorsements SEE SCHEDULE POLICY SUBJECT TO ANNUAL AUDIT: YES TOTAL PREMIUM The Declarations, Schedules and These Forms and Endorsements Make Up Your Complete Policy: BP00021299 BP00060197 BP00090197 8PO4170196 BP04190689 SP04961001 BPO5140103 BP07010197 BP10040498 BF30061103 BF40380902 BF40390303 BF40861010 BF40910708 BF40921010 BF40940510 BF41090204 BF41321008 F199020108 Countersigned By Page: -1 of 2 Authorized Representative ANX-3190 INSURED COPY Processed Date: 02/14/2012 - Massachusetts- Department of Public Safeh Board of Buildim, Regulations and Standards Construction Supervisor License License: CS 27489 K . STEPHEN M KEISLING 9 9TH STREET WEST SALISBURY, MA 01952 ;-.,:, Expiration: 7/16/2013 ('onmii��iuncr Tr-ft: 19624 ' C--lite�anrnea�t[uca�l�a��/lGusac�[[�eff Office of Consumer Affairs&Business Regulation -1$OME IMPROVEMENT CONTRACTOR eegistration: 101846 Type: xpiration: 6/29/2014 Individual STEPHEN M.KEISLING Stephen Keisling 9 NINTH STREET SALISBURY,MA 01952 Undersecretary i assscllme s l otne emen#Sample Co Q atract mLs6mmant2icm egs sc w eahmSekffwo"umC4-*=WL— m�IQ4bad=ca Wade ttxe2mW. 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L301/z.orttp oomptetiattof �/� F-�cx+ie !j,¢j S Q tafihe ([,aav{orlridsdS�jFaSmmioahlooe�r�tis toba�patt�s ) besysiaf 5 tobepaidfw tomeettbeco • mocdc $- to bepeid{m N(YTFS:.(ht gz3FSamds+sest�Isw d=any dqxmtor .eqd bYes bda�wmt omtbef tolmeibudattbeemalP ar(b)ttmcae�waoftaYsPa+dorao special edged inahaaDemaeatlx� t6oa:us _T'� �'�°''�a�eobvmcm�+�Qlra©yetatlre�altt7 . thhTtMd rasmbesttkfp too �ewmt affhti»aF Po bythvc tb�s 'Iheco�saorts�-tBtartobesaldYz�2efara� toaH �pr c�taasxcA �mg,dasdtta�mtbeootsesabnssCtogoottttaciaadaltac asyddrd llhhwa�awim :cd uid&ftd ffie aotmaetsLalltwtitttgly�gmy&eaoroiloasamrityiaf�l�beea �tl� ,Sariwvt5e �ybdotesigamgthisoc�act. e�t6mtsaadts Dm{tbegtessmedinto s�theoRaaet.Taoefaoetoread aadfdlyoad=tmdit.Askgngiif 4ibes�rarsm'�xayalidflerteo.��er,.�^ — mg8ttnt3� toberegts mdwdhdie DaatarafHome �' tttted6mQe a saad vWdmom bywtitiagtofheDhe�lm10PmkPiaMRo=51?0,Bo�.MA02116 qlimWm Yasn�ay>sapraeshautooatM37 Doestoa hmi AsrOe )orbsbst �'+,86I,,,,S81�R 28i-3757. seeacWafa'*aofofi=zwe"daru�i• ° y sott>atgemranoofiasoovaage�art�cto Ktmwgamt�a��-b�Re�ihe>monthete�esdeaf�isfmmaadgetacoltyaftheC�er Cain m the Name caattattor lacy �'�may�this agttzment if it hts bem sgrsed 8 apfape mer ttwa�ssrs aomtalldax of b ,�d yam,aot0y the *m*actoriawriftath lhertaeiaoWmarbnm*officebya&mmymapastad,hYf3d sencotbydernmy@tea.> 1 affhe thadi day thesigait�afd&ag�mt Seetbea �tiaeofeam �fmmfm� �d DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES!!! raaimpaaracoa�a,smbeoo���•��llaiLdIDmme 76ea�rmprslmEits tis bs@+e eore� �uooaa'aSi�ue � page 2-o 2— 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 not automatically afforded to a contractor,however. The contactor 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 Aff urs and Business Regulation and the consumer shall be required to submit to such arbitration as provided In Massachusetts General Laws,c 142A Homeowner's Signature Coact s Signature NOTICE:The signatures of the parties above apply only to the agreement of the 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 homeownees 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 presen'bed 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 worlananlike 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 contactor,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 contactor 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 enkecuted copy of the contract,and the three day rescission period has expired. Accelerated Payments A contactor 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 funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work Withdrawal of funds 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 frce copy of "A Massachusetts Consumer Guide to Home improvement" contact Consumer Information Hotline Office cf Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 611973-8787,888-283-3757 or visit the OCABR website at Mtn:(/«ti»..mass.�o�/ocahr/ If you want to verify the registration of a contactor or if you have questions or need additional information specifically about the contractor registration component of the Nome Improvement Contractor Law,contact: Director of Home lmprovement 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 httt):/h%%%-xc.nuass.eoi/ocahr) Go online to view the status of a Home Improvement Contractor's Registration: lrttn://db.state_iiia.us/{romeimnro,6,enienUlicenseelist zap For assistance with informal mediation of disputes or to register foribal complaints against a business,call: Consumer Complaint Section Office of the Attorney General 617-727-8400 AND/OR Better Business Bureau 50852-4800,508-755-2548 or 413-734-3114 venio,n zl-r rrzvsoho The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,AM 02111 s� www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): f-relLo/('6 x-,; Address: Cf ? 7_2� �jL P�' City/State/Zip: f.4 cll s &v,e Phone#: Q'D P 3/11 d'ys 7 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ 1 am a general contractor and I 6. ❑New construction yemployees(full and/or part-time).* have hired the sub-contractorsRemodeling 21 am a sole proprietor or partner- listed on the attached sheet.# ❑ ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.F1 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]i employees. [No workers' 1311 Other 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 Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: 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. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: 111—P-12— Phone --P"1ZPhone#: �2 -2 P 3��^ SYS"7 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#• Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to 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 Revised 5-26-05 Fax#617-727-7749 www,mass.gov/dia r o p o s a i Page No. of Pages . :.gat PROPOSAL SUBMITTED TO PHONE DATE �!(.✓;` {V .1 moi'---`-r_``'�:. 1y� t/..1"=tf`..1� L�t�r�,�,. e0,, .— STREET v' JOB NAME CITY,STATE and ZIP,CODE Y JOB LOCATION ARCHITECT DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for: i . 1�.� � � , ��`� -� ✓�r�Ie�. l.-i ..t-��.,,.�� L�Gf- � Cr ti...)�. Ali �ti�trc+f�/ �.t.'r•��' G`, ,�•.�� Y.;�^m�t3Z-i �' _rt:. u,j{[.L.�{=�� t�;�t{,:[A ,f,,,�,f:-..�Xr!" �-�.7�� �r a,,•, �y�y..�rf a, o�--'-.'_,S�p �^� Gc-7 i % j✓tr ; a7 /,' - - /� r- �•,, /, rte,/ /� �" / t, i) , r 7151.�,�''�<..., .'✓�� � �v.7' �•-->�-/ G4A`-,"�->;�:�r���/r�'C-'a fly'-,�-�cN"' ` �., r..-U ! r >�.�h^.P�(_rT'�✓��� ! t��..�. t-x--,�%�..L*.uvk:� (J� C-C.r.7:'�:,�, �Jam'�'t'7 �lJ�� �r� !� %� � -� � G�.�-a�,/-�,w:� t.�.� �•_ �.,,fl t,�... -�pry �.�� � -��? ./ . _ — Tt' ^ 'n�� .�c, ��-Ly Mr proPOSP hereby to furnish material and labor—complete in accordance with above specifications, for the sum of: Payment to be made as follows: dollars($ i All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices.Any alteration or deviation from above specifications Authorized ` /✓ ✓ . involving extra costs will be executed only upon written orders,and will become an extra Signature Lcharge over and above the estimate. All agreements contingent upon strikes, accidents lays beyond our control.Owner to carry fire,tomado and other necessary insurance. Note:This proposal may be workers are fully covered by Workman's Compensation Insurance. withdrawn by us if not accepted within days. Arreptaurr of Proposal —The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized Signature to do the work as specified. Pa ment will,be made as outlined above. l f r � Date of Acceptance: f� ✓ � � r --- Signature