35-095 (5) 15 CAHILLANE TER BP-2017-0009
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 35-095 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ROOF BUILDING PERMIT
Permit# BP-2017-0009
Project# JS-2017-000017
Est. Cost: $8357.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: PATRICK KUBALA 100114
Lot Size(so.ft.): 10541.52 Owner: BOWLER JOHN D&NANCY M& KIMBERLY A& KRISTIN THIBEDEAU
Zoning_ Applicant: PATRICK KUBALA
AT: 15 CAHILLANE TER
Applicant Address: Phone: Insurance:
5 PELL ST (413) 589-1010 WC
L U D LO W MA01056 ISSUED ON:7/7/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
FeeType: Date Paid: Amount:
Building 7/7/2016 0:00:00 $40.00
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
-- Deparbnent use only
City of Northampton Status of Permit:
1 Building Department Curb Cut/Ddveway Permit
i 1 4 212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
Northampton. MA 01060 Two Sets of Structural Plans
oc r..:. 444
ne 413-587-1240 Fax 413-587-1272 Plot/Site Plana
r a.r�en.nrn mono
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address, This section to be completed by office
1 5 CI„ ,tan )trrat Map Lot Unit
FiorenOe1 M2 oit-L Zone Overlay District
_ Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
21 Owner of Record:
John -"13 /,)lC&
Name(Pant) Ten3Mn oe—s:
13i7
-_ Telephone
Signature _
:2Au •:ze• A/en :
t, I, ku,ixti&- 5 Pt ! (th-e+ Ladle il9a oa.,z,
Name(Pr Current Mailing Address:
OP3) 5P9— /D/o
Signatur, Telephone
_CTI* 3- ,TIM•T D C. STR,Cll.SCO- $
Item Estimated Cost(Dollars)to be Official Use Only
Completed by permit applicant
1, Building 4 1/35 ,Vy1 (a)Building Permit Fee —
2. Electrical J /, t-t (b)Estimated Total Cost of
Construction From(6)
3. Plumbing Building Permit Fee
4, Mechanical(HVAC)
5,Fire Protection .fe'C' +1 �` ,ice
6, Total=(1 +2+3+4+5) int ` 5'7 �J Check Number 7b/i,..n J
This Section For Official Use Only
Building Permit Number: Date
ated.
Signature:
Building Commissioner/Inspector of Buildings Date
Section 4. ZONING ALt mformatton List Be Completed. Permit Can Be Denied Due To Incomplete information
Existing Proposed Required by Zoning
This column to be luted In In
Building Department
Lot Size
Frontage _
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg.Square Footage ,n
Open Space Footage
tfetm mimn bldg&paved
parking) w�
Y of Parking Spaces
Fill:
(volume&Lncalion)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW • YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW O YES 0
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO . DONT KNOW Q YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Issued:
C. Do any signs exist on the property? YES a NO
IF YES, describe size, type and tocation:
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO .
IF YES, describe Size, type and location:
E. WII the construction activity disturb(clearing, grading, excavation,or filling)over i acre or is it part of a common plan
that wilt disturb over i acre? YES O NO •
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
gECTION 5-DESCRIPTION OF PROPOSED WORK(check all aoplicaAle)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing pps'
Or Doors O
Accessory Bldg. ❑ Demolition ❑ New Signs [CI Decks [O Siding[MI Other[01
Brief Description-ifry .of Proposed
Work. M .n-i-gr hat. t eXt554-10,,9 R,740//d rephee i intft NrkJ,c.EtiOl
Alteration of existing bedroom Yes ✓ No Adding new bedroom Yes ✓No
Attached Narrative Renovating unfinished basement Yes y No
Plans Attached Roll -Sheet
ea,if New house and or addition to existing housing,complete the following:
dr
a, Use of building '. One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
a. is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
I. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes _No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes y No.
I. Septic Tank_ City Sewer Private well _ City water Supply
SECTION 7a-OWNER AUTHORIZATION•TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I. JOh(Cent)!eft , as Owner of the subject
property v r,,a_i {—
hereby authorize kiltnine TtT,p2avefneft
to act onn�m/yy/behalf,in I matters relative to work uthorized by this building permit
papplic]ation.
1 4 YncZz '•`- b-& f - deveA
um of Owner '/ I,, I Date ll
C K
I, PQ4k I abala. . I
_.._. ,as OwnerfAuthorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
re i e LI eitt)6 ,..1&-
Print Na e
SignatuA f or/ ent Date --
SECTION 8-CONSTRUCTION SERVICES
1 Li . sed in.tr.ction :u•ee •c Not Applicable ❑ ` +
flame of License Holder,
License Number
Address Expiration Date
Signature Telephone
ma--• aone • • . -.. u : Not�Applliicablee 0
Company Name Registration Number
PA.!! Stiee-f
Address Ex.fratl.n Date
L . . i .I1 )/ +� 2a Telephon- ia-I' 0/0
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(MCA..c. 152,§25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application.Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes sar No ❑
11. - Home Owner Exemption
The current exemption for 1 ,omeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families
and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts
as supervisor.CMR 780, Sixth Edition Section 10$.3.5.7.
Definition of Homeowner: Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there
is,or is intended to be.a one or two family dwelling,attached or detached structures accessory to such use and/or farm
structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner.
Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official that he/she shall be
responsible for all such work performed under the building permit
As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon
completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152(Workers'Compensation) and Chapter 153(Liability of Employers to
Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for persons)
you hire to perform work for you under this permit.
The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code.City of
Northampton Ordinances.State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111, S 150k
Address of the work: I5 Ca k 1 Ila ,P I cryA Cr c,
The debris will be transported by: Ktka is l cvne Z7>L�JIrnimnent
The debris will be received by: ( ylpIPt rlhpoSr r i, F l4I ji1�CP,
Building permit number:
Name of Permit Applicant�ph,Ck
Date Si a ure o Permit Applicant
I Ci �AG' (po/nvi/2wneveaid o/0/7aJoadbe,G1PGG.1-
'net` Office of Consumer Affairs and Business Regulation
i l) 10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 150118
Type: DBA
Expiration: 3/7/2078 Tr# 419291
PATRICK KUBALA HOME IMPROVEMENTS
PATRICK KUBALA
5PELL STREET - - - - - - - - _ -._
LUDLOW, MA 01056
Update Address and return card.Mark reason for change.
—
scAi 0 zom. Address 'i--1 Renewal r Employment Lost Card
otin _
CIL t..nesse(st,reaGAr, - ((ur,rhr„rio-
_& OOice of Consumer Affairs&Business Regulation License or registration valid for individul use only
51 - (110ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
g Registration: 150118 Type: Office of Consumer Affairs and Business Regulation
/Expiration: 3/7/2018 DBA 10 Park Plaza-Suite 5170
Y Boston,MA 0211•
PATRICK KUBALA HOME IMPROVEMENTS
-
PATRICK KUBALA
5 PELL STREET '
�_•---
LUDLOW,MA01056 Undersecretary - signature --' -
of valid wit ut
STATE OF CONNECTICUT
DIPIR T UEV I OrCONS, III R PROTE(Tfo,A
HOME IMPROVEMEN CO RA e' _
PATRICK KUBALA
5 PELL ST
LUDLOW,MA 01056-2762
PATRICK KUBALA HOME IMPROVEMENTS
LIC /REG NO EFFECTIVE EXPIRES
HIC.0619y1i� 12/0 2015 11/30/2016 —
sICNED�' eif
\
Massachusetts Department of Public Safety CERTIFIED INSTALLER
II Board of Building Regulations and Standards LEVEL: RLC-I
License: CS-100114 INSTA I�o
Construction Supervisor
,,, , ., ,t /
PATRICK t - ,..
SPELL STREET:EETJ qqqqqq
LUDLOW MA'011-56 it ANis
til Certified Since'. 2006
.' ' #700002175
o I Kubala,
Patrick
Expires: DB/01/18
Co,,,N �_ I 44 Broolaela Road Sponsored By
F pi ration: AlaFrteclual Testing.Inc
Commissioner 09/09/017 exmmam,m,ssocwun:amto
ACCT�® CERTIFICATE OF LIABILITY INSURANCE otos 2G s
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE Or INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT; If the certificate holder Is an ADDITIONAL INSURED, the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate doss not confer rights to the
certificate holder In lieu of such endoraement(s),
PRODUCERcomae!
d13-566-0028 413-066-OOSO SAME; Richard R. Green Insurance Agency, Inc.
Richard R. Green Insurance Agency, Inc. PHOvier,no Fu.413-566-0028 � AS
,j�NO 413-866-O090
32 Somers Road Wass,rlchardereenins�ta charter.net
PRODUCER --"
.031381ERJG"'
Hampden MA 01036 INSURERISLMFFORDWGCOVERAGE ?MICR
INSURED INSURER A:State Au(4 in3urance Cos
Patrick Kubala msuReR 3:Commerce ins ancg
dba Patrick Kubala Home Improvements INSURER C:Utica National
5 Pell Street INSURER D:
Ludlow,MA 01056 INSURER B:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INCHOATED, NORMTHSTANDING ANY RECUIREMENT.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 THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
!NSR %,ISVUBRi MOOIIR'Y EFF POLICY Exp �..
LTR TYPE CF INSURANCE INSRIWYD POLICY NUMBER NYYYYI LIMITS
GENERALUASIUtt
A EeAATCI"�TE,E ORRREF*E. S 1,910-0.10____
COMMERCIAL GENERAL LIAEIRITY PREMISES fEP 0Pneunwt_ `5,�I 10-01
CLAIMSMADE Ir�lOCCUR MEI]ERR Innr mo pOr_ _5
I ,000
B0P2738247 05/0512016 05/0512017 PERSONAL 8.ADV INJURY 5 ,QQQ OQQ
._
GENERAL AGGREGATE 5 0-0-0-,0®
GENL AGGREGATELIMITAPPLIES PER PRODUCTS.COOP IOP AGG 152,001]000
POW}Y yll:a i LGi 1
AUTOMOBILE UREICTY I COMBINED SINGLE LIMIT
I IEE acadenn s7,Op0,Opp
I ANY AUTO -- --
- 60DILY INJURY(Nr Orion) 5
ALLOMIED AUTOS '--"'--"'—
8 66MJ33 90/01/2016 00/012017 BOORT INJURY IPOrncenenp S
f SCHEDULED AUTOS PROPERTY DAMAGE
HIRED AUTOS Pe'eaieen0 5
I, NOfOVMEO.WTOS 1S
S
UMBRELLA WaOCCEACH OCCURRENCE
EXCESS LIAO NIRt CLAIAISMAOE
AUGRER+iE S
DEDUCTIBLE S _
RETENTION S ! 5
WORKERS COMPENSATION '✓ nCSTATV-
ANOEMPLOYERS'LIABILITY Mt IMO OTB
Ci AfarOPPpRMAAEM9 PEJCI,NEEEGYEC� e{ NM EI EACHACCIDEND 5500,00D __
IMWAndetory In NHI 4897961 1012>J2015 ID127/2016 E.I. asEASE.a^Ewxoye s 500000
UEesdIP¶O _— —
OO OPERATIONS enmw E L.DISEASE.POLICY LIMIT S5000000
i
--
DESCRIPTION OF OPERATIONS I LOCATIONS!VEIXCLES IRM]ACORD f,Annlllonai PomM1
ac 5 cAedule,II loan m m
ApaIs yullael
Subject to policy terms and conditions.
The owner is excluded from the Workers Compensation policy as a sole proprietor.
CERTIFICATE HOLDER CANCELLATION
—
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Patrick Kubala Home Improvements THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
p ACCORDANCE WITH THE POLICY PROVISIONS.
5 Pell Street
Ludlow. MA 01056 AUTHORIZEOREPRESENTAPIVE
Richard R. Green Insurance Agency, Inc.
I
191988-2609 ACORD CORPORATION. All rights reserved,
ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD
The Commonwealth of Massachusetts ',0ti itfontt
• �,.—____ �l Department of Industrial Accidents
= rill=; Office of Investigations
Zit he•= f = I Congress Street,Suite 100
"-
If=a
._�•=,L.� Boston,MA 02114-2017
"'••-'� www.mass.gov/dia
Workers' Compensation Insurance Affidavit; Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual):Patrick Kubala Home Improvements
Address 5 Pell Street
City/State/Zip:Ludlow,MA 01056 Phone#:(413)589-1010
Are you an employer?Check the appropriate box: Type of project(required):
1. I am a employer with 4 4. 0 I am a general contractor and I
employees(full and/or put-time).* have hired the sub-contractors 6. 0 New construction
2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. Q Remodeling
ship and have no employees These sub-contractors have g. 0 Demolition
working for me in any capacity. employees and have workers' 9. Building addition
[No workers'comp.insurance comp.insurance.tg
required] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions
3.0 1 am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. No workers' comp. right of exemption per MOL 12.0 Roof repairs
insurance required]t c. 152,§1(4),and we have no
employees.No workers' 13.0 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.
tConraclors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
enyto}ns. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'congrensation insurance for my employees. Below is the policy and job she
information.
Insurance Company Name:Utica National
Policy#or Self-ins.Lit.�#7:4697961 Expiration Date:10/27/2016
Job Site Address: ISCt th t I kine ell7i i'f city/state/ziP 'Q'(QtJthij p1/n, 0/0k,9—
Attach a copy of the workers'compensation policy declaration page(showing the polity number and expiration date).
Failure to secure coverage as required under Section 25A of MOL 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•: against the violator. Be advised that a copy of this statement may be forwarded to the Office of
investigations of the k•akin insurance coverage verification.
I do hereb cent.. • Xatc.- .•: and• aides o :: 'u •that the in orotation provided above is true and correct
Silk --.
_ _ -:-..._ —_ r ate "JL+.:fi/Iz'(i�L�
phone p:(413)56.1017•
.
Official use only. Do not write in this area,to be completed by city or town ojfrciaL
City or Town: Permit/License 0
I.. Issuing Authority(circle one):
I.Board of Health 2.Building Department 3.City/ own Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone S:
PATRICK KUBALA HOME IMPROVEMENTS AR home improvement contractors and sub tractors engaged home improvement
contracting,unless specifically exempt from registration by Provisions of Chapter 142A
MA HIC#150118 of the general taws. must be registered with the Commonwealth of Massachusetts.
5 Pell Street Ludlow, MA 01056 inquiries about registration and status should be made Co the Director. Home
improvement Contract Registration, One Ashbunon Place. Room 1301, Boston, MA
413-5891010 ozlox(617)727-8598
Submitted .?
To:-.SQtt Kb f tta,,i _ r'r !r�� [/'' /(�/''o
�r^ lob Name:SAC Rsf r" L
( 5 Cahttfcve_ ' lerzex4, �`
jjo,tsn,c, O(06 a - Job location: Sri._
Phone Date , � t //�-/
1t 3-310 3-77 /
( 3 6--15-/ 4Estimator t o}fxff
We hereby submit specifications and estimates for work to he performed and materials to be used: /
�? r rr i - . r .rz W i,tt # r5` 4 'o.i 5 64.3. �*
1 a/i S'�11 f� r [.G ,C 1---air .�S ...u�...x _ 3a d Yhln-�'.Jfl e {ire. O'ciii.
earn .iae ? -' rt .a , ,r.-Mt ' �.,j� 1' . ,i. y�sy-
_ it MA 4 'a/ , r ��'a�i_!'.� .� ,0 t 1 .Art--
t i�o � Se. Amy �(cP � art c y i cr rc.� ;'; • +
ifi
�:t. ln; t2r( —2r,Ga� /}`rt s':c - , eat .r. . . 3 tr --
WORK.SCHEDULE
Co rtrt/fgf will n , gin the wank or order the matbolhre the third dayfollowing the signing of this agreement unless specifiedContractorhteiPPviii being the work on or
about ate). Baring delay caused bycircumstances beyond the contractor's control. The work will he completed by p4 y1(dat L The owner hereby
ackno ledges and agrees that scheduling dates are approximate and that such delays that are not avoidable by the Contractor including but no lt d to strikes.Acts of God.
shortages'of materials,accidents,and all other delays beyond the Itscontrot,shall not be considered as violations of this AD-fitment. t,
WARRANTY • le tt
hit contractor warrants that the work frndshed hereunder shall he free from defects in materials and workmanship Dr a period efirttlln,efodowing completion and shalt
comply with the requirement,of this Agreement. In the event any defect in workmanship or materials.or damage caused by the Contractor, its subcontractors,employee,or
agents,is discovered after completion of any job,including clean up,the Contractor shall at its own expense,forthwith remedy,repair,correct,replace or cause to he remedied,
repaired or replaced.such damage or such defect in materials and workmanship. The foregoing warranties shall survive any inspection performed in connection with the agreed,
upon work.
We Propose her•b to funtish material/and laborjJ-complete� in accordance with above specifications,for the sum-} of:
ite S li l ore,/"TAK.t-1 lv ruyf "T)-rj n dollars(S �t 51 _).
Payment.to be�e as follows.
c %(_ 04-3 )upon signing contract; PATRICK KUBALA HOME IMRPOVEMENTS
%(,./'—; _J upon completion of--P—th / 5 PELL STREET
%( 0,1200 _)upon completion of trLn5', f/3Ei_ LUDLOW, MA 01055 413-589-1010
�-- %L. 150 )shall be made forthwith upon.--eh4Ln 6 MmelAsMA HIC 15011�� f/ {
completion ofwork under this convum.O- 'Ck�'rr 14 aiesperson: C./T/cC
Notice:No agreement for home improvement contracting work shall require a down payment ,
(advance deposit)of more than one-third the total contract price or the total amount of all
deposits or payments which the contractor mustmake,in advance,to order and/or otherwise Authorized Signature:
obtain delivery of special order materials and equipment,which everamount i5 greater
Acceptance of Proposals I have read both sides of 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 of the third business day after the date of this
transaction. See notice of cancellation form for an explanation of this right. Please refer to the Notice of Cancellation that accompanies
this contract;contents of which are referred to above and incorporated herein by reference.
�/(� DO NOT SIGN THIS CONTRACT/ //"" IIF THERE ARE ANY BLANK SPACES
Signature (/j/ylyyf_/c Dates �/J 7�ignature —_ -- —Date