29-160 (7) BP-2022-0345
91 BRIERWOOD DR COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
29-160-001 CITY OF NORTHAMPTON
Permit: Exterior Res
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit # BP-2022-0345 PERMISSIONISHEREBYGRANTED TO:
Project# ROOF Contractor: License:
Est. Cost: 20250 NORTH EAST SPECIALTY CORP 08103 I
Const.Class: Exp.Date:09/06/2023
Use Group: Owner: LANCESON BOSTON
Lot Size (sq.ft.)
Zoning: WSP Applicant: NORTH EAST SPECIALTY CORP
Applicant Address Phone: Insurance:
148 DOTY CIRCLE (413)739-4333 VWC6003962-2021
WEST SPRINGFIELD, MA 01089
ISSUED ON:04/07/2022
TO PERFORM THE FOLLOWING WORK:
NEW 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:
Gas: Final: Final: Rough Frame:
Rough: Fire Department Driveway Final: Fireplace/Chimney:
Final: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: I
17, • • )2 - 53-11
Fees Paid: $40.00
212 Main Street,Phone(41 3)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
• A
The Commonwealth of Massachusetts APR
\ 6 2n,9, FQR
e ee Board of Building Regulations and Standards, MUNICIPALITY
Massachusetts State BuildingCode, 780 CMX)FF
�;1niN�e.� � USE
Building Permit Application To Construct,Repair,Renovate Or Deenio tsh.a ` Revised Mar 2011
•
One-or Two-Family Dwelling
This Section For Official Use Only
Building Termit Number: 6o .x2- 3 VS Date Applied:
(//o 5 5 azi
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Pr er ,Address: 1.2 Assessors Map&Parcel Numbers
7/j rkr0) l . 2`I ! (10
1.1 a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2 Own r`of orf
17a rs ki F/orr./1 Pe Ha, /44
Name(Punt) City,State,ZIP
9/ r eru.1 d
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building'! Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: e.CUD F
Brief Description of PPtoposedW ork2:
p Ke (at/iie(Ys),, KeS&DR Pep.,
,4 rid C�'� tl. (- Te�'U / Jes( �� Trj -1(�Y�I A-SO LYE � f-.
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials
1. Building $(9)w ' 1. Building Permit Fee: $ Indicate how fee is determined:
`� ❑ Standard City/Town Application Fee
2.Electrical $ ❑Total Project Costa (Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5.Mechanical (Fire
Suppression) Total All Fees: $!
Check No. /3l C&Check Amount: "i" Cash Amount:
6. Total Project Cost: $ 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervis r License(CSL) ?::./-a;//;?3
C'� ��1 r' "' ins (" mbe � pi ...
. "� , /,t ���/"� License Number ,xpira ion Date
Name of CSL Holder
' " List CSL Type(see below)
v �.✓
`27y/ (/1/� Type Description
No.and Street / yp p
1 ""• / U Unrestricted Buildin=s up to 35,000 cu.ft.)
�'Cl /"f" 1'<t r R Restricted 18a Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofin=Covering
WS Window and Siding
CY/3 / / �..�� SF Solid Fuel Burning Appliances
"�i 9'Y ' �c ! , L el/6), /h. .L)� I Insulation
Telephone Email address l y ?y r� D Demolition
5.2 Registered Home Improvement Contractor(HIC) ,-.- e
I-IIC Registration Number xpira ion Date
HICC pany.hI ,me orHIC e .str Name
LJ,. 7 ^1, J('
J �' /le _
r /2'1,7 !e' eoP
l . Email address
LS
City/Town,State,ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.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 "C No 0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize
to act on my behalf,inn all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER' OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contai ed' tl s application is true and accurate to the best of my knowledge and understanding.
gt_ d
Print Owner s or Authorized Agent's Name(Electronic Signature) Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A. Other important information on the HIC Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq. ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks!porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
. The Commonwealth of Massachusetts
i'�° W Department of Industrial Accidents
a s.: ,', 1 Congress Street, Suite 100
9� (.' Boston, MA 02114-2017
'°1,, wwua.mass.gov/dia
N' rkers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name(Business!Organization/Individual): N/ ,. e 01'�
9 ,
Address: 1 �` j ?\ (..I f.
City/State/Zip:1 . RegP.-, MA 7iMPhone#: w, '.. 7 7" (333
Are you an employer?Check the appropriate box: Type of project(required):
IX I am a employer with6employees(full and/or part-time).* 7. El New construction
2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling
any capacity.[No workers'comp.insurance required.]
3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.].i.
9. ❑Demolition
10[]Building addition
4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or arc sole 11.❑Electrical repairs or additions
proprietors with no employees.
12.0 Plumbing repairs or additions
5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet.
These sub-contractors have employees and have workers'comp.insurance.t 13.'�I�' Of repairs
6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 1/❑Other
152,§1(4),and we have no employees.[No workers'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 state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information. A-xiiii
1 c ,,
Insurance Company Name: I'1�) (
Policy#or Self-ins.Lic.#: 'V V 1�t OM 394 _t ) )1 Expiration Date: 2/2,,,,, c
Job Site Address: / r(��f.C) ���f City/State/Zip: %rei eel I'_c o)
Attach a copy oft e workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify nder the pains and penalties of perjury that the information provided/.5----A.,›
above is true and correct.
Si nature: K Date: %
Phone#: "? $f. , 3_, A:
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#:
•
,�+.."��y"1-^� N1`NW 1 ' ur-LLLJYl
ACC- )1 /7) DATE(MMlpf7/YYYYI
T^r_ CERTIFICATE OF LIABILITY INSURANCE 02r2312022
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 OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING 1NSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSURED provisions or 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 does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER 413-737 535g 'CONTACT
The Dowd Agencies LLC
J Raymond Lussier Ins Agcy Inc PHONE: 413-737-5359 1 FAX 413-732-2027
181 Park Avenue,Suite 8 INC,Na,ExtI I vac,Nei
PO Box 499 ;"AIL ms1ussier ... owd-com __._..._
West Springfield,MA 01090-049IT nDDRC ss
James J.Dowd&Sons Insurance . INsuRF;R(SLAkt-ormerp pvEatA € ... .. ._-_.
.. .. .... NAM.Q
INSURER A:Atlantic Casualty Co
•
INSURED msuRFR a,Safety Insurance Company 39454
Northeast Specialty Corp A.I.M. Mutual Ins.Co.Nescor ;INSURER C:
148 Doty Circle
West Springfield,MA 01089 • !INSURER 0:
•
INSURER E ....
'INSURER E E.
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE.POI ICIES Of INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDI rION OE ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH Tins
CERTIFICATE MAY BE FSSUED OR MAY PERTAIN, THE: INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE 1E_12MS.
OCCLUSIONS AND CONDITIONS Of SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
.
MSR ADDL SUtlR; PA U(Y I POLICY CXr'
Lift IYPE OF INSURANCEiNSD�4Y1t0 POLICY NUMBER 'Jmjr7!r7I)IYY-al IMMJUQtYYYYT: UMFi'S
A X COMMERCIAL GENERAL LIABILITY 1 1,000,000
` EAC.F OCC
URRENCE $
(:LAIMS•MADE- I X I OCCUR • � I�M261001495 07/20/2021 07/20/2022 DAMAca
1:1A R EI$L'•s LL it TO RE_4NT1.YEDIEt:CfI::V1 100,000
•:
Mt R XI>to ty ot>R j ersont s 5,fl00
PERSONA!.AADVINJURY $ i,(TdO,tNTt1
GENT.AGGREGATE LIMIT APPLIES PER 2,000,000
QENFRAI.AGGREDAI 1
PRO.
X poi icy I._._. JFr,r I_._._ La
� c; PRODUCTS cOMProPAEG t 2,090,000
(((1:R
6 AUTOMORII Er I.IALIILFFY ; COMDINEO SINGLE LIMIT 1,0m-7,6001
ANY AtIIO 2433825 03111/2022 03/11/2023; BODILY INJURY WO(PO,,tY.7 ,L$
ONCO SCHLOULEt)• ..
W
AUTOS ONLY ; X ,AUTOS • i
1 (�N WIV��} EIROptL.Y INJURY Per acudtitlt '
X At.n oS OM Y ' x' AtTrO rNJE_Y ,firer atapde xDAMAGE. `•3
UMORELLA UAfl OCCUR EACH OCCURRENCE ' S
• EXCESS LIAR .CLAIMS-MADE,
AGGREGATE.
ISF1) RI.II NIION1 • ' -__ 4
C WORKERS COMPENSATION . PER • ' . UTH. ` -�'—
AND EMPLOYERS'LIAUhLITY SIAIUII. . LU
ORA Y/N VWC6003962-2021A 07/09/2021 07/09/2022 100,1?00
ANY1'121.711dt t4INiARLNi:.IVc)(I COI fYF I_N I NtAi t:L.L'ACJIACCIDENT .i
•(Mr ntialnry in NM • L
is f UISI_ASI_-LA I'Mtq_,OVE I S 100,0�
it y..K.,,Maim u innk't 1 L
•I if:A.R11^L ION(tr :)PI NA 1 S)1,6 tx>4rw i ElDISEASE-POLICY OMIT I 600,000
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UFSCRON OF OPFlrM ION S I I.00A'IlONS I vEIIICI..En (ACORD 401,Atldttiottnl Remarks St;hodnia,may ha attached if more t(taca is,required; -r -_.—`
IP11
•
Th HOLD.R CANCELLATION
CUSTOME
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE j WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHHORIZEDD REPRESENTATIVE
_~~—M__.
yet' �"".--111 '.3**-- ^'*�'-�"`�+
ACORD 25(2016/03) 01988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
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••ffice of Consumer Affairs and Business Regulation
.1 000 Wet ill Cr1:011 St reel: ••• 8(lite 7'10
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E3oston, Massacht,i8etts 021 18
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Home Itriproverne.MContractor Registration
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lypo: Corporation
.-• • . .• Roglatrallon: 10371
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No - EAS-1 SPECIALTY COP POIRATION: , •
(•:•!,xpIriiition: 07/10/2022
0/13/A NriSCOR
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• ' •148 DOTY CIRCLE
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WEST SPRINGFIELD, MA 01089
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Offloe of Consumer Affairs&Business 114utetton
HOME 1(14 MOVEMENT CONTRACTOR
Registration valid for Individual use only
TYPtii: Corporation
before the expiration date. If found return tor
139.gillt.0.0.12.13 Explintism
Office of Consumer Affeiru and Business Regulation
. ,..ips:: •;4••::` . 07/18/2022
1000 West • •ton Street -f;3ulte 710 ....."
Non TH EASIgiltOrki4f40.111"0nATIont Roston,WI '18
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SHARON M.TAalrr•.;“ ,..
148 DOTY()IRON:,.•:,•,•;:. ...• .r.. ,••opt IP,'(.).7: ' "7'1
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WEST SPHINGFIE1.1a;;IOA:41080 '—'""'"'''''------- No V1iId without oign
Undersooretary•
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Commonwealth of Massachusetts
't r 9 Division of Occupational
Board of Buildin Licensure
Regulations and Standards
Couslotcrio St9rmrVis or
CS-081031 r
<r;' Ecpires:09/06/2023
MAT'rHEW S
PO BOX 692 AR�tISON
BECKET M ti
A�'�'�11223
.wi � '"
���l1V�t".1;�•1
Commissioner ,�1/' i
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City of Northampton
oASH.M uts,
sic
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?�il ''''`� �; Massachusetts �S. :. Gc
� DEPARTINENT OF BUILDING INSPECTIONS D T.
-:. .406:y .1
212 Main Street • Municipal Building .%. t„
Northampton, MA 01060 srj; �IY ` �C`
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, S54, a condition of Building Permit
Number is that all debris resulting from this work shall be disposed of in a
properly licensed waste disposal facility, as defined by MGL c 111, S 150A.
The debris will be disposed of in:
.�Location of Facility: (J .l G ���'1
The debris will be transported by:
Name of Hauler: USA Acz()jil
Signature of Applicant: Date: S
• •NORTHEAST SPECIALTY CORPORATION d/b/a NESCOR
All home improvement contractors and subcontractors
MA License #103713 engaged in home improvement contracting, unless specifi-
148 Doty Circle • WEST SPRINGFIELD, MA 01089 catty exempt from registration by Provisions of Chapter 142A
1-888-NESCOR-1 1-888-637-2671 of the general laws, must be registered with the
413-739-4333 Commonwealth of Massachusetts. Inquiries about registra-
nescornow.com tion and status should be made to the Director of Consumer
Affairs and Business Regulation, Ten Park Plaza, Suite 5170
Submitted � �t� Boston, MA 02116-Phone (617)973-8700
To: La n(9 I.: col-Ca,c,,
/—/wtre ..,tc.ra 1 ./.4fq (7f 06a JOB NAME c/rgf
`�
' 'j' 3 y/ 3 G 4' JOB LOCATION 9/ 6-',-':e r 4h'1�,'fc.1 Q r /��c reAC12
torjHA PHONE / //
K y6, - `q e? `.1 S 07 DATE 3/3//7 ESTIMATOR AG7 l�U(zx r`c-/ r
We hereby submit specifications and estimates for work to be performed and materials to be used:
_ X/i±5c 0 r --/c) _S-tr,,i P 'c f„-,1,f Ne (i r c c��n , �pcir-c go) an �j cr Q,p of
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..'(/ a c-uR 1 .•Act a// _ )CD_sr l..a r� 5 ,141LiEt _- c,A r'or-/ay/04
c-l_r, .a_ AJ sz f_ j4c.r '-e�r'- v:-fry-(P / ./(3",6!= (✓�^2 .2/.,fz C-, P '�G!(,cio._t S
c_ r-hs .- c_r . c j c' f Tc- r f., � r-
S 3 � � Z /(Jul y i��T _ (tj4.4-4'
'-'-'‘el., _ .�fir'V .51✓\5;(2 P7�)-/-- ,-_ p >74''-P_( ) C'U/�v r .- Q/4',r
_f�r �'�6 c ir- in,c:(,c/,t : / S 6) S' 4.0...x14,k,)3
Do not do: Construction related permits:
WORK SCHEDULE
Contr3ctozill not begin the work or order the materials before the third day following the signing of this Agreement,unless specifie herein,Contractor will begin the work on or about
5" 5 ? . (date).Barring delay caused by circumstances beyond Contractor's control,the work will be completed by ? (date).The Owner hereby acknowledges
and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor including,b notb limited strikes,Acts of God,shortages of materi-
als,accidents,and all other delays beyond its control,shall not be considered as violations of this Agreement.
WARRANTY �� •,..{s4P
/
The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period of(1i ;f t r2 following completion and shall comply
with the requirements of this Agreement.In the event any defect in workmanship or materials,or damage caused by the Contractor,its subcontractors,employees or agents,is discovered
after completion of any job,including cleanup,the Contractor shall,at its own expense,forthwith remedy,repair,correct,replace,or cause to be remedied,repaired or replaced,such dam-
age or such defect in materials and workmanship.The foregoing warranties shall survive any inspection performed in connection with the agreed-upon work.
We Propose hereby to furnis material and labor-complete) in accordance with above specifications,for the sum of:
^ * Z,r) 44.f 4-4,42A ( i(J ,,/�`fnn _ �.ca ��1 dollars($ 4.--O/ �S Q. 0.0 ).
Payment to be/ade as follows:
3--S %($ (c)c 7 5 C _)upon signing contract; NORTHEAST SPECIALTY CORPORATION d/b/a NESCOR
Name of Contractor/Designated Registrant
.?-1 %($ CSC -7 S 0 )upon completion of frie.5ti,,i-e.,. ' • 148 DOTY CIRCLE
Street Address
%($ )upon completion of • WEST SPRINGFIELD, MA 01089 413-739-4333_
City/State Phone
3Y %($ 6) ?S° )shall be made forthwith upon 103713
completion of work under this contract. Registration No. / 9
Notice: No agreement for home improvement contracting work shall require a down Name of Salesman/1-(e-;• 61,(,c) •-.i CO/(t/- CI-
payment(advance deposit)of more than one-third of the total contract price or the //11,� � n
total amount of all deposits or payments which the contractor must make,in advance, Authorized Signature �G�%I#04/l1J la/V
to order and/or otherwise obtain delivery of special order materials and equipment,
whichever amount is greater.
Acceptance of Proposal: 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 may cancel this agreement if it has been signed by a party thereto at a place other
than an address of the Seller, which may be his main office or branch thereof, provided you notify the Seller in writing at his main
office branch 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. Please refer to the Notice of Cancellation.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
Signature c.U1t1 - Date?/;//Z 2.- Signature Date