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HomeMy WebLinkAboutBuilding Permit #Exception - 7 COPLEY CIRCLE 5/1/2018 f NOFT#1 O T�ao,a MO ° a TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION SSAtNUs�t c6 � Permit NO: Date Received: Ig Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION ri C.012" Print PROPERTY OWNER ..� •Print 01 MAP NO.: PARCEL: 7 ZONING DISTRICT: 3 TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑New Building Al One family Addition n Two or more family J Industrial ❑ Alteration No. of units: G Repair, replacement ❑ Assessory Bldg a Commercial ❑ Demolition C Moving(relocation) ❑Other ❑ Others: ❑ Foundation only DESCRIPTION OF WORK TO BE PREFORMED Identification Please Type or Print Clearly) OWNER: Name: Phone: 6%1K-5T?-0X Address: "l o��e C ;.ey� �16, CONTRACTOR Name: \Cs,,.,:�o Phone: Address: N4-- ,'v *,Z Sib....,, 1�/z A...►�.,.� jv^ Supervisor's Construction License: 053 U 4�5, Exp. Date: O(c. Home Improvement License: < -1 Exp. Date: b�-Ulj b-) 9 Toa- 3 9 2— 3 Z ARCHITECT/ NGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDEVG PERMIT.•510. 0 PER 51000. 0 OF THE TOTAL ESTLYtATED COST BASED ON 5125.00 PER S.F. Total Project Cost :$ 3�3, by CJ x10.00=FEE:$ Check No.: Receipt No.: Pare 1 of 4 TYPE OF SEWARGE DISPOSAL Swimming Pools Tanning/Massage/Body Art I_.J Public Sewer Well ❑ Tobacco Sales ❑ Food Packaging'Sales Permanent Dumpster on Site Private(septic tank,etc. ❑ Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to t/:e guarantyfund Signature of Agent/Owner Signature of Contracto Plans Submitted Plans Waived ❑ Certified Plot Plan � Stamped Pla THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF-U FORM DATE REJECTED TE APPROVED PLANNING &DEVELOPMENT Ca' SA/06 ❑ ❑Water Shed Special Permit / ❑ Site Plan Special Permit r / Other COMMENTS /(� � r' L�c �1 ,rte ,,Zjc • .csn f;!i ae� tNZ�a. u4� A— t% r Li DATE REJECTED DATE APPROVED L CONSERVATI � o Wr COMMENTS VIK 10I DATE REJECTED DATE APPROVED HEALTH ❑ ❑ 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 Temp Dumpster on site yes—no— Fire Department signature/date Building Permit Approved and Issued by: Page 2 of 4 Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided DIMENSION Q Number of Stories: ` Total square feet of Floor area, based on Exterior dimensions. Z� Total land area, sq. ft.: NOTES and DATA—(For department use) Page 3 of 4 Doc.INSPECTIONAL SERVICES DHIAR'fMENT:BPFORM05 Cmale(MIC..1a11.'_006 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 Dor.I\SPECr10%AL SERVICES DEPARTMEN'rMFORS105 Page 4 44 h r f KU7­6 J. c-.-,( h�2,j�c>tCr i553cl - ra, 'j J� .+SII ♦.�V" ♦it .. cif -!MT "I Nl r 7, 00 J' r ' pORTF1 P RT�T halt J�mbStam 0- :0 TOY H �i FRK'S 0FICE ,, 2606 SEP 21 PM �•,.,o.� TC'; u ZONING BOARD OF APPEALS NORTH Community Development Division MASSACkUSr i This is to certify that twenty(20)days have elapsed from date of decision,filed without filing of an appeal. Any appeal shall be filed within Notice of Decision Date_4MXB,d (20)days after the date of filing Year 2006 Joyce A.Bradshaw of this notice in the office of the Town Clerk Town Clerk,per Mass.Gen.L.ch. 40 17 Proat: 7 Copley Circle NAME: Walter&Pauline Schumann HEARING(S): September 12,2006 ADDRESS: 7 Copley Circle PETITION: 2006-028 North Andover,MA 01845 TYPING DATE: September 14,2006 The North Andover Board of Appeals held a public hearing at its regular meeting in the Town Hall top floor meeting room, 120 Main Street,North Andover,MA on Tuesday,September 12,2006 at 7:30 PM upon the application of Walter&Pauline Schumann,7 Copley Circle(Map 59,Parcel 87),North Andover requesting a dimensional Variance from Section 7,Paragraph 7.3 and Table 2 of the Zoning Bylaw for relief of the rear setback in order to construct a sunroom addition. Said premise affected is property with frontage on the West side of Copley Circle within the R-3 zoning district. Legal notices were sent to all names on the abutter's list and were published in the Eagle-Tribune,a newspaper of general circulation in the Town of North Andover,on August 21&August 28,2006. The following voting members were present: Ellen P.McIntyre,Joseph D.LaGrasse,Albert P.Manzi,III, Richard M.Vaillancourt and Daniel S.Braese. Upon a motion by Joseph D.LaGrasse and 2"'by Richard M.Vaillancourt,the Board voted to GRANT a dimensional Variance from Section 7,Paragraph 7.3 and Table 2 of the Zoning Bylaw for relief of 4'from the rear setback in order to construct a proposed sunroom addition per: Site: 7 Copley Circle 0,4ap 59,Parcel 87),North Andover,MA 10845 Site Plan Title: Plan of Land in North Andover,Mass.owned by Walter J.and Pauline M. Schumann Date(&Revised Dates): 8/9/2006,8/10/2006 Registered Professional Scott L. Giles,R.P.L.S.#13972,Scot L.Giles,R-P.L.S.,Frank S.Giles, Land Surveyor R.P.L.S.,50 Deer Meadow Road,North Andover,Mass. Building Plan Title An Addition for the Schumann Residence,7 Copley Circle,North Andover, MA CWC,CWC Design Architectural Services,Bradford,MA Date: 3-28-06 Sheet/Drawing: C-1&C-2,E-1&E-2,A-1 throe A-5 Voting in favor: Ellen P.McIntyre,Joseph D.LaGrasse,Albert P.Manzi,III,Richard M.Vaillancourt and Daniel S.Braese. Page 1 of 2 ATT14;S`1' A True Copy P.-O Yew Town Clerk 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9541 Fax 978.688.9542 Web www.townofnorthandover.com LOCUS.NO SCALE PLAN OF LAND IN NORTH ANDOVER, MASS. B�R���� OWNED BY m WALTER J. AND PAULINE M. SCHUMANN G COBBLESTONE x LOCUS SCALE: 1"=30' DATE.81912006 o Q 8/10!1006 p 0' 30' 60' 90' o m 0 MASSACHUSETTS AVE. Scott L. Giles R.P.L.S. N,, Frank. S. Giles R.P.L.S. 50 Deer Meadow Road North Andover, Mass. THIS IS A PLANNED RESIDENTIAL DEVELOPMENT AND THE SETBACKS ARE 20'ALL AROUND. SEE PLANS#12286 AND#12330 AT THE N.E.R.D. MAP 59 PARCEL 90 COBBLESTONE REALTY TRUST N 23°-5Z-32"E 134.68' W � N N LOT#14 14' PLAN#12251 ^� - PROPOSED _ N.E.R.D. N 32'+1- ADDITION 12,501 S.F. MAP 59 MAP 46 2 "' 33, 1�% PARCEL 88 PARCEL 1 Z EXIST.HSE. 'c"V GIORGETTI DARNELL FND' 09 #7 fib` s co �o0 21' 00- SE'S 0, cm N N �s3. S 24°-11'—15"W 108.32' TO MASS.AVE_ COPLEY CIRCLE NORTH ANDD VER THE PROPERTY LINES SHOWN ARE THE THIS IS TO CERTIFY THAT 1 HAVE CONFORMED BOARD OF APPEALS LINES DIVIDING IXISTING OWNERSHIPS,AND wITH THE RULES AND REGULATIONS OF THE THE LINES OF STREETS AND WAYS SHOWN REGISTERS OF DEEDS IN PREPARING THIS PLAN ARE THOSE OF PUBLIC OR PRIVATE STREETS OR WAYS ALREADY ESTABLISHED,AND NO NEW LINES FOR DIVISION OF EXISTING OWNERSHIP OR NEW WAYS ARE SHOWN. OF DATE OF FILING: 1 DATE OF HEARING: "� fGISTERE� � L LAMS S DATE OF APPROVAL: AN ADDITION FOR THE SCHUMANN RESIDENCE 7 COPLEY CIRCLE NORTH ANDOVER, MA PERMIT DRAWINGS MARCH 28, 2006 r 6,1 TE' �E.ClA1ETsi� , i , /zsd�s� _Ex•s rive >�+C ��' FGuvoa r7 0A1_ 1 i 4=Z7.401 a a G"oPL 6Y /YQrE• /�7uwt�aq ria.!�q r/aN �.t'ow.+ r NAY 4 1994 _r DET i HE,PEaY cE,cr�fr ro ryE rlrcE/,vsaen cavo f71. or Tl� 7flE B•a�/X T.Y�JT T,�EOw'E!ll.NG�f LOicATEO O.�! TNEtoT.ls.s��r-.vA.vO T.�riToa�s GudF,G�C�rI- - /iV , !YlTH Tit/E n7ww/' O/'r�..�vGor6e 2LLVlvP. ,�E6s�CAT.12�S ,pL��•IR0/.els SETd./C•t'S FECLN S1.L'EETS�LOT Liw�E.S" /�O. �.v�o YB.E'! /V/A,� "s farn�u c�ri.� r.Y.�rT.rls o.�c�ivs is,vcr . O,PAl�it/ FO.P • GOG4TEO/� Tif�E�EGtE.CAL �A�O H�2.4.00 A.P6.4. 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Also, note Permits are required under Fire Prevention laws Chapter 148 Section I OA. The debris will be disposed of in: ( ocation of Fa ility) Signatu �itplicant Fire Department Sign off: Dumpster Permit Date The Comimnweallk of Massachusetts DepaWn►eNt of lndnstrial Accidents Office of lnvesligations ;! 6" Washington street Boston. MA 0211 r 1 waves mass.gov/dia Workers' Compensation Insurance AfIlidsvit: Builders/Contractors/Electricians/Plum#ters A t & ' P1r Print L I Name ititrKitxws/tN�;unirattiut><itr<ii4i�uul) Address:_ city/State/Zip: Phone Aryou an employer?Check the appropriate box: -----�� 1 e i am a employer with-3 ❑_ 4. 1 am a general contractor and! Type of project(ngaitYtt): employees(full and/or part-tiine),* have hived the sub-contractors 6. ❑ New construction ` 2.❑ 1 am a sole proprietor or partner- listed on the auached sheet. : 7• [] Remodeling ship and have no employes These suis-contractors have 8. ❑ Demolition working for me in any capacity. workers'comp. insurance. [No workers'camp, insurance 5- [] We are a corporation and its 4. ❑ Building addition required.] officers have exercised their 10.0 Electrical repairs or additions 3.[] ! am a homeowner doing all work right of exemption per MGL I I.❑ Plumbing repairs or additions myself, (No workers' comp, C. 152,§1(4),and we have no 12.[] Roof repairs insurance required.] employees, fNo workers' comp. insurance required.] 13-❑ Other-._,-__. — 1.AffY aWicnttt that checks tftrt fl l mtat else fill ont the section below showing their woeicers'uumPensaeiun policy infllnmtlhtn. - Noe+eWMM%wbo eabnllt"drwevit i0dicatka they am dented all wmuh end thm it ire outside Lwiinwwa smut submit a new affidavit indicating saeh. 'CYmhaetora that tduek this box mast anaChed an adelitiotul sheet showisp the name 4the sub-etontrauem snit fhcir workers'camp,fx+l icy infijrtttafion faa�tr r dW h ptntrMng worhtefrs'cornpema#vn jawrance for MY 1 Below is the policy 14 l e j acrd x insurance Company Name* �«n Policy R or Self-ire. t.ic. 0: v_ C,, _ 3 u,; ell A — Expiration Date: Job Site Address: Ce-,P�V-,, L;7 (L- City/State/Zip:. U' L�1 .�....14. Attack a copy of the workers'compeasattion policy declaration page(showing the policy number and expirstion date). Ftailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of s tine up to$1.500.00 and/or ones-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER alai a tine orup to 5250.00 a day against the violator. Be advised that a copy of this stutement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1110 clow palm and praaftm of pedury that the inforawdon provided above is Mee crud coater. F'hn�t g if' ()prim msec ordp. no rest write in thh area,to be c gelded by city or town oMejai City or Tow a: Perml#Ucease b Issuing Antbarity,(eirele ow): 1. l card of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector .4. Plumbing Inspector 6.Other Contact Person: Pbmw tr: FROM :M.P. Roberts Insurance FAX NO. :19766833147 Jul. 18 2006 11:10AM Pi Att)RD CERTIFICATE OF LIABILITY INSURANCE DA 7 ' Pkg01AdCR THIS CERnFICATE IS 18SU9D As A MATTER OF IM1104MATIOM M.F.ROURTS INSURKNCE AGZNCT INC. ONLY AND COWERS NO RltiltTS UPON THE CERTIFICATE HOLOM THIS CERTW"TE OM NOT ANIRINI, EXTEAIO OR 1060 OSGOOD STANET ALTER THE COVERAGE APORDED BY THE POLICIES BELOW. NORTH ANDOVLR ISA 01845 INSURERS A"OMW COVERAGE NAICM ""^C0 I(SVIN MURPHY BUILDING b RBMODSLING 04UNKA FROM T. 169 BOXFORD STREET RQLFY{II o, !— ..... .. __ NORTH ANDOM, M# 01845 COVERAGES TME POUCGS OF 916URANCE UBTED BELOW HAVE BEEN*SMD TO THE MURED kAMEO ABOVE FORIV POUCY PMOO INOICATeO.NOTWW""ANDIN6 ANY REQUOSENT,TERM OR CONOfrION OF AKV CONTRACT OR OTHER DOCUMeNT WRH RESPECT TO WHICH THIS CGArtFUII:MAY A8 tBSUEO OR MAY PERTAIN,THE 04LPANCE AFFORDED By THE POU0E9 DEMAND HEREIN 16 BUMOT TO ALL THE TERMS.EXCLUOWO ANO.CONORION3 OF SUCH POMIeS.N36REGATE LWfr3&WWN MAYIVIV!BUN REDUCEOBY PNO U AIMS. � .. Pmev Numm a LIMITSOEN8111u UARKITr { 1 000 '_ ,000., GMI,pICIAt aIOIEnAl I.1AW.ITV ow. Pwm= 1 1000Q0 �.. I aAn,.luar �acctlR {ICDaotvR+FF.7Aro , 5j000 t A: CPPOOGOBGB-01 11/22/05 11/22/06 FOIRowaAmkm"*Y , .1 0 00 -. .... lm� AOORIIOATE � .Q.:: M&A A0011MAY8UNX?APKMPIN: •cOM►q►A00 2,.QF�m 0 0 oOtIC Loc AuraroR,Rwnmm AWAWO ITI: 500,000 AuoweeoAUToo - . __.� ecaILYW�UItY = SGEDULM Anti PI/PMwe) B NMAUTIN 7AM0277013608 1/23/06 1/23/07 OODIIYIIWM i s i NON4MMEDAItflIS �pM�eO 1 (IRO.tRTr OAMr•6�' { i _...._....�...... paAmOrnC OARAM UA<,.tTY AI.ROON r•EAACOroEwI 1 ANYAUYo OT►lR TNN RA ACI: f AUTf7ONtw AGO f t1fCEleblMlRKIA UAOILIIY FACH OtC11 KNOE f OCCUR E'CWMENAOE A001164ATE y _ 1M0111fRIllOO,MNI{MIONAlA AMr MUNC530339 7/01/06 7/01/07e.LEACNACCIt1fNT I T 500 r 000 D °11"'"ftv"F"V"0`p1 LL IMEEAbE.u BAN& x :, _0,000 : IIYd,r.w.rea !►lOu►/110YM10NEnMeY. ek D1dCA1k•vouer l.wrT i s5000 . OTnER I OUCRIPTIONOY OPCRATIOIb/lOp1T qNa rv1e�OLQorIptCLW NkgAOOIib�Y EnOOREEMENtriFfC1AL*I¢OYU dM i � 4 { t CERTfR"TE HOLDER CANCELLATION Vy y� �}yy 4'"X"ANY OF TNF MOVE DESCI NiO OMMi/EE CANOSIAM alM"TNF OXP�POIMN TOWN wOF ANYO`R pli�, 1 OME"WtW F.TW Il MMM 1 UNWR VA.L VIONAVM To MAIL 10 f1AYA W*!TTP,N dARTI.ETT STREET NOTCE Tone wrr.ewx.IwtXR+N OW YO TIP Uwr.RUT FAA.WR IU U0 tlV a...a ANDOVER, M1 01810 "00-M NO Ok4AYION OR LIR""OF ANY KMI)Uh1N Tit I NYS OR BUILDING DEPARTMENT I!lPt�lNTA Ats?"64mr AYNt I ACORDli(2001lBB} ©ACOROCORPORARON"U I rd at Kevin Mushy HS M0,8" Building Contractor • FAX:W1&4 6-7M7 Proposal Ta Wafter&Paula Shuman 7 Copley Circie AM Monne tmproverrmrC«maMs00 6WbGW*Ra= worth Andover, Ma. 01845 wedficalyewi ftmwqdmbwbyPm"—cfChwter • tA2A 0/r sx gerwal le,�s.mmt be reyistEred wig ste Carpnon osM of MaWa&UW ts.WqUhn atxwt M9Wn W and SW"W=1d be merle to ft Dfrerlor,Moms Impmveffwt Conrad Registration,One Asheurtm Piece, Frons Kevin Murphy Room isai,a000n.MA 02106.(017}727 rise M. Date: 4/27/2006 Job: Sunroom addition Date of pWm none to date Ae radlec to be determined Locatiom same Section 1-Work Schedule Contractor will begin the work or order the materials before the third day following the signing of this agreement, unless specified here in writing contractor all begin work on or about 51151106. Barring Delay caused by Circumstances beyond Contactors control,the work vdg be Completed by 9/30/06.The owner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shalt no be considered as violations of this agreement. Sectlorr 11-Wbmrrty The Contractor warrants that the work fumnshed hereunder shag be free from defects in maWlE fs and � n9 completion and shahhis drip for a period of 1 year Apmwwt damage caused by the Contractor, his ssuubconhaaa� �of t In the event any doW in worlvnanship or materials.or including cleanup,the Contractor shag,at his own a plow or agents, is discovered within one year after completion of any job, replaced, such dam xpense,forthwith remedy,repair correct,replace,or cauee to be remedied,repalred,or Connection with the �or such defect in materials or wodunanship. The foregoing warranties shall sunave any inspection performed in agreed-upon work, Section 111-Scope of Work Kevin Murphy Building Contractor Page 2 of 4 16g8WftdSUJWk Nwth Podovw,MA 01845 PH:9788865335 FAX 978688 OoN General Building permit will be provided by contractor. There has been no allowance made for variance or conservation approvals if required by town. Plans/plot plan to be provided by owner. Foundation New 12"x48"poured concrete footings will be provided to support new room. Building All frame, roof, and siding materials will be provided to match existing/meet building code. Floor joists will be 2x12, walls will be 24, rafters will be 2x10. All floor, wall, and roof sheathing will be fir plyw , (3/4 on floors, 1/2 on walls, 5/8 on roof) Siding and roofing to match existing. Ice&water sheild to be installed at all valleys and first three feet of roof. Tyvek or equivalent to be installed on all walls. Six Harvey doublehung windows, one Harvey transom, one Harvey nine foot slider, and two fixed Velux skylights will be supplied and installed as shown on plans. New Tx1S' deck and stairs will have pressure treated frame, with mahogany decking and railings. Electrical Electrical work required to wire addition to meet code will be provided. Six recessed lights have been included. Additional recessed lights can be added at an additional cost of$75 per light. Phone, cable, computer lines will be roughed-in by electrician, to be connected by their service provider. Other surface mounted fixtures(ceiling fan,etc.)to be provided by owner. HeatinglAir Conditioning Separate electric heating / air conditioning unit to be supplied and installed in new room. Heating unit to be reviewed/approved by owner prior to rough. Insulation Addition will be properly insulated to meet or exceed code. ( R-30 in floors and ceilings, R-19 in walls) Plaster Sunroom will be blueboarded and skimcoat plastered. Ceilings will be textured to match existing. Walls will be smooth. Interior TrinuDoors Pre-primed interior trim will be supplied and installed to match existing. Waste Removal All construction/demolition debris will be disposed of by contractor. Kevin Murphy Page 3 of 4 Budding Contmator 189 Bo d"d Strem MorM,At d%w,W OJW PH:9784698.5 FAX 978as.)Q XX Painting -- ----... -- No allowance has been made for any painting. Items Not Included There has been no allowance made for any flooring. Kevin Mtsxphy Page 4 of 4 sanding Contractor 189 604ad street No&Andover,W 01 W PH:978-6885335 FAX 97MM-XXXX Section IV-Price Schedule We hereby propose to furnish material and labor-complete in Accordance with above specifications for the sum of... ... ... ... ... ......... ... ..........$ 38,000 Payment to be made as follows: Percentagelltm Dewription Amount • 1 Permit obtained $3000 2 Roof framing complete $15,000 • 3 Siding /windows installed $10,000 4 Plastedng complete $7000 5 Job 100% complete $3000 Total 5 $38,000.00 *Waaw.No apreer-1 fa Marie Wrprovanen►conCeCtb+ wft shall inquire a dawn par wi(a*w-depalit)d more amt Crw4wd d r,e%W oonractprioe d ft morel emorrM d NI depa 0r perm Ms%hch to col IND tor nud rusks,h sdrs M,to order wxMDrofww*8 dAm delivery d wpe W order.,ON b end ewp Tat whidrever 1s MAW Contractor: Kevin Murphy 169 Boxford Street No.Andover,MA 01845 Registration No: 101874 Section V—Acceptance Acceptance of Proposal—I have read this document and accept the prices,specifications,and conditions stated. I understand that upon signing,this proposal becomes a binding contract.You are authorized to do the work as specified. Payment will be made as outlined above. You the buyer may cancel this transaction at any time prior to midnight on the third business day after the date of this transaction cancellation must be done in writing DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Signature Date f U Signature Date