24D-010 43 HAYES AVE BP-2019-0481
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map.-Block:24D-010 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:window replaced BUILDING PERMIT
Permit# BP-2019-0481
Project# JS-2019-000778
Est. Cost:$7191.00
Fee:$40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor., License.
Use Group: SERGIY SUPRUNCHUK 104327
Lot Size(sa.A.): 25831.08 Owner: ROSEN SEYMOUR M&LAURA M PRAVITZ
Zoning:URB(100)/ Applicant: SERGIY SUPRUNCHUK
AT. 43 HAYES AVE
Applicant Address: Phone: Insurance:
526 EAST ST NCA TAT QT ?z�6' C PC � (413) 883-3802 WC
CHICOPEEMA01020 ISSUED 0N.-10/19/2018 0:00:00
TO PERFORM THE FOLLOWING WORK.-REPLACEMENT WINDOWS IN ALL WINDOWS
EXCEPT 2 BATHROOM WINDOWS
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: Qil: 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:
FeeTyae: Date Paid: Amount:
Building 10/19/2018 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
RECEIVED wpvoffwls
Department use only
City7ofNort amLnt
Sta us of ermt:
' Building De art � 1a2018 Cur GuU riuoway Permit
212 Main tre r/Se tic Availability
Room 00 DEPT.OF 13UILDING INSPE �tertt/Ve I Availability
Northampton. THAMPTON,MA01
Cyt wo ets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
� Other Specify
APPLICATION TO CONSTRUCT,ALTER; REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION 6 jo l�—q l
This section to be completed by office
1.1 P/r�operty��jjAddress: ��f
`13 1T e Rye Map- ,Aqo�..� Lot 010 Unit
v Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: `
Name(Print) Current�' iii d es& ZCg
Telephone
Signature
2.2 Authorized Agent:
Name(Prin Current Mailing Addr ss:
t3 8 3 3802
icnature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Iters Estimated Cost iDollars)to be Official Use Only
completed by permit applicant
Building 04L3G�O (a) Building Permit Fee
Electrical (b) Estimated Total Cost of
Construction from (6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection LV Z
6. Total= (1 +2+3 +4+5) Qty Check Number
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature t0 fia i r,
Building Commissioner?inspector of RUildings Daie
EMAIL ADDRESS (REQUIRED, EITHER HOMEOWNER OR CONTRACTOR)
Section 4. ZONING All :formation Must Be Completed. Permit Can Be Denied,Due To incomplete Information
Proposed Required b\ /onino
I C01UH-M W k't'll)"i in r,,%
I of S lze
..............
sethacl\s
..........
lllki�. SiJLIW-C footage
Open�pacc
ol
Ebst I ..................
........................................................................ . .................................................................... -1.................................................................................. ........... ................
A. Has a Special, Permit/Variance/Findit ver been issued for/on the site?
NO \0 DON'T KNOW YES 0
IF YES, date issued:
IF YES: Was the permit recorded t the Registry b Deeds?
NO5V�x DONT OW 0 YES 0 4�
IF YES: enter Book Pag and/or Document#
B. Does the site contain a bro , body of water or wetlands? NO DON'T KNOW 0 YES 0
IF YES, has a permit be n or need to be obtained from the Conservation Commission?
Needs to be obtaine 0 Obtained 0 Date Issued:
C. Do any signs exist o the property? YES 0 NO
IF YES, describe Jze, type and location:
D. Are there any pr posed changes to or additions of signs intended for the property? YES 0 NO
IF YES, descri e size, type and location:
E. VV II the ccnst?uition activity disturb(clearing, grading, excava*Lion, or filling)over I acre orisit part of a common plan
that will disturb ever 1 a--,e? YES 0 NO *9
IF YES, then a Northampton Storyq.. Water Management Permt from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement windows Alteration(s) ❑ Roofing
Or Doors j4 I
Accessory Bldg. ❑ Demolition ❑ New Signs [o] Decks [0 Siding [o] Other[13]
Brief Descri n of Proposes
Work f to UA. K 20 S ijejfSoxK
3 di e- d . Z
Alteration of existing bedroom Yes No Adding new bedroom Yes _.__�No
Attached Narrative Renovating unfinished basement Yes ,,,,,,_,_. No
Plans Attached Roll -Sheet
6a. If New house and or addition to existing housing,complete the following:
a. Use of building One Family Two Family X ®Other
b. Number of rooms in each family unit Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories? 2-
f,
f, Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? ~
h. Type of construction
Is construction within 10G ft, of wetlands? Yes Na. Is construction within 100 yr. floodplain Yes XNo
j, Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes 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; as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
1
Signature of Owner Date
1
ems(
as Owner/Authorized �
Agent hereby d I that the statem its and information on the foregoing application are true and accurate;to the best of my knowledge i
and belief.
i
I
Signed under the pains and penaltie f perjury.
t
Signature o wnerlri Date
SECTION 8-CONSTRUCTION SERVICES
8,1 Licensed Construction Suvervisor: Not Applicable 0
Name of License Holder
License Number
"'LA C
3 :7 1IL2!91 ( 9
A',dd, Expirafidn Date
(dephone
9.Rwistexed Home Improve ent Contractor: Not Applicable El
Company Name Registration Number
LAA4
Address 0 Txpiration-bate
WI '*—T
&,"-A I elephone 39C do
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6))
Workers.Compensation Insurance affidavit rnUst 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—.... No....., 0
City of Northampton
.t
MassachusettsF' _
DEPART?1SNT OF BUILDING INSPECTIONS
112 Main Street • Municipa: Building J rb
Northampton, MA 01060
AFFIDAVIT
Home Improvement Contractor Laws
`opplement to Permit Application
l he(.)ftice of COrisunl or.A t-fairs and Business Regulation("OCABR") regulates the registration of contractors and
suhcontractol-s perflorming irmpr•ovements or renovations on detached one to four tainily horses. Prior to
perfonning work on such Mimes, a contiactor must be registered as a Home hnprovement Contracts}r('HIC").
M.G.L. Chapter 142A requires that the"reconstt ir„tion, alteration. renovation. repair, inodernization. conversion.
trnprovernent, removal demolition, or constrixtior,of an addition to any pro-existing owner-o,'cupled bijildbog containing
at least one kart not more than four dwelling units....or to struclUt-es which are adjacent to stick residence orbuilding; be
done by rem red contractors.
Aute: I1 the homeowner his contracted with a corporation or LLC,that entity,nut.V Ire registered.
1.i,1 e o1'Wotc k: R .4 e0
;address of Work: _ La ............TTaeS_
E7
Date of Permit Application:
I herebv cetilk,that:
lReoistralion is not required for the followino reason(s):
lk'ork eac.ludCd b% 1aW fexplair�}:
Joh under• 1.000,00
Oxvner obtaining own pemit(expl,in): - —
- -
E31.1ilding not oiVner- •cupled C
()tlrer(spccifv):
ONS HERS OBTAINING; THEIR ON\'N PERNIF OR ENTERING INTO CONTRACTS WITH UNREGISTERED
CON I RACTORS Oil SLBCON I R.AC;TORS FG}Il,A1'PI.ICABLE IIOilIE: 1NlPRO` 1..N1 ;N'T N 0 RK ARE NO'l
ELIGIBLE FOR AND DO NO] HAVE ACC ESS TO THE ARBI"FRATION PROGRA11 OR C.1`A11AN"T1 I-'t`ND
I NDI R I.C.L. Chapter 142A.SUCH OWNERS ALSO ASSUME 'I'llE RESPONSIBILI TES FOR ALL WORK
PERFORMED UNDER THE: BUILDINC PERNIII SEE NF,Y"C PAGE FOR:MORE INFORMATION.
tii`mcd under the lyer7alties oi`laerjtrr-:
I hereby app1\1 for a bitildinrg permit as the z gent of the owner:
Date Contractor Name 111C Registration No.
OR:
Nomithstanding the above notice. I hereby ffly for,r building permit as the owner of the above property:
Date Owner Name and Signature
City of Northampton
Massachusetts ='f
DEPARTbSNT OF BUILDING INSPECTIONS h,
212 Main Street •Municipal Building
Northampton, MA 01080
Debris Disposal Aff idavi"C
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 PVIGL c 111. S 150A.
The debris from construction work being performed at:
e �
(Please print ase number and street name)
Is to be disposed of at:
o/ oke HP O"wt
(Please print name and locatio f facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
1011gj1'V
Si atur of Permit Applicant or Owner Date
If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.
............... The Commonwealth qf Massachusetts
tts
Department of Industriial Accidents
I Cort,ress.S°tr-eel, Suite 100
ostrrn. 11.4 02114-21117
// www nrnss.-rrt�ldta
Wiwkers'Compensation insurance.Affidavit: Biiiiders/Cotetrac:tors/T:Iecaa-iciinsll'haanbers.
O BE (AITD N\TTII THE PERkIi-ITINta Al'THORITY.
Applicant Information Please Print Le Ni
M111e s IIll,, lIat:ir itionilrI'lilr,aI l: 16tNl 11,0110011"Q
.........
Address: � e
. l/�^... ..� .............. ......._ �... ............. _.. ......... .. ..... .........._ ......... ....... ...........
tiff t�tl ; � C4L>_-- Pholic: k(3 88�
Ate 1oti an cnxploper?(heel=the appropriate box: Type of project(required):
Ic, ,S i tuL a.,:i%o:tea fi . ❑ "ev,con,
-7
trUCtlOn
❑I 011 i t,r or t t U 1 r :r I :a" no ci r0o%, wort ii toy r in 8, ❑ Remodeling
a.i.� c�t a it;.('tit r,orkci� <crr:p. i�ti�u:cz: 4q,,i,ud.l I
❑ Demolition
❑I ;t nconi r 9;i iaa� »scI l^uhruxr°rs ui t,. es M11,4i2luu
I Et❑ Building addition j
❑1 ::.i n c,t� s i uxt vi I c Iii-int-, i u,lctor In c=ot iucr all .tau k,or m, plt l' .iv I fa i l
I If Aectrical repairs or additions
Drfr lli015 tGi l_tl{.�•;tY�lO�.' S. I
I I Plumbing repairs or additiim;
❑l n ,to I ita; 1 , h R e t. si ached shc�a
13. hoof repairs
the i actn hac 17,plo t iit]:in mikc cmp. n s tris.
Xher _e.�?j.�114o S�/S
: ,❑tx, n�,i;ra;or...i,nr.�, i. _.1":�;. I..u�:�� ci,cd'iiri�i ;tof.,..t.ptior� .. :'v9t:�i_r: - �
ha re-o cmplo ke,i comp ;ttr,i., ,,qun
�r arp:icantULU L_t.ti:.wy 41 rnuat alsoii:ort the scerion belot% �til�m a, inoir worker��eanrpan5ario pofic�. lilw!r MOIn
t o n.,oti•.r �.va hU�,i.,t: pus .silo:»it i-..c< ir-it, ale no. ,:: 'wit and then I.,.e outside co.LraC,,i:, .:a 11110.. i a. idat it❑,,l.ratm c.iclr_
t film Lori,t.it:ted,this La.c r,:;, tttac ice an ada"It)r al ah..t ;n>ri1i�t}tC _IMW o M:'�Uh.e,n[racto.,•..., :;t Itt_, u. 111'ihosc have
e1rrlw�:,s_ [�thesul ��rt.r�tctorsl..,'2sm, leeas.tlicymust .hcr a.:�rK: .oi_:p,poh,vratro�:er.
I(in)ata ernPloYer that is Providinn workers`compensation ittsarance frrr m,l,emplot e s. Below is the policy'and job site
in f arnwtI on. � ,/'
Insurance Compan} Mine: � � �Jl/Q. ��S u I ) � �e0__..__
�a.�I yn _................
policy ;,aj•Sell,ins.Lic. : P 3Q Ei 2 E piration Gate:
.lib Site Address: � e � Cit} State "Lip:NOr' /Z
Atiaclt a col)} of the workers' com eusation policy declaration Mahe(showing the policy,number and exp• atiou date).
Failure to securee coverage as required under NKA.c. 152, is a criminal violation punishable by a fine up to$1,,500.00
and'o,one-year imprisonment,as well as civil penalties in the form of a SA OP WORK_ORDFR acid a line of up to S250.00 a
day against the violator. .N copy of this statement may he forwarded to the Office or Investigations of the DIA for insurance
coverage verification.
I do her•eht•c=erti e pai _ r Pena •es ofPer,jur;r that the information provided above is true and correct.
St ti itrrc _ Date
......_. _............ __..._.. ...._....__. __.
...........
Official use only. I r1 not write in this area,to be completed 1?p citt,or tenon of cial.
Citi or Town: Permit/License#
Issuing Authorit;v(circle one):
1. Board of health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector S. Plumbing inspector
b.Otber
Contact Person: Phone 4:
Office of Consumer Af alrs and Business ReBuisdon
10 ftrk Pim-Sub 5170
Bolton, aftuaft 02110
Horne Replon
ALLIANCE HOME IMPROVE
oiYlf vie
375 Chloopee Et
ChloopN, MA 01013
. �`n '$'' + Mldr�ltteetMrd. Feltt'MMellior
MAL
NOME IMPI�OII�M/Ifl' W"for indh►"wr orhr
TYMt 004woon
a dabr N fated ra4ttn ioR
orae.oe W Ato Wd l�tdl I PAN*"
10 htklMteMt•Ndhdls0
s MAW
AJ.LWcl INC
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Chb"N,MA0
Ue�eeetdttn4fy �� .
CotnmonwNith M iaaatwi"M
0Mgan of Itroft..lwW Li
toadand*tnt�diude
of SUM*
co :or
Com404317 y � �lroa:1112 1t
SERMY SUP N
375 C 0
CHICOPf!!MA
oresi:��i"�b
Comntlssie�'
AC9*:f CERTIFICATE OF LIABILITY INSURANCED o,1�D 8"!
THIS CERTIFICATE 18 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO R13HTS 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 INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the cab holder Is an ADDITIONAL INSURED,the pollcy(les)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 does not conbr rights to the
cartificate holder In lieu of such endome e.
Jerry
PRODUCER Neill&Neill Insurance Agency Inc P Darmh vid
862 Riverdale Street413.732.4137 Noll 413.731.8629
West Springfield,MA 01089 . ftneillins.com
BNWRE APFORown vam" NA R
-NO=A; State Auto Insurance Companies STA
INSURED Alliance Home Improvement,Inc u, s; SAFETY INSURANCE COMPANY 39484
375SerC c pee Street
INsuRERc, Acedia Insurance Company A0235
375 Chicopee Street
Chicopee,MA 01013 INSURERD:
INSURER E
NUMIR 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
INDICATED. N07WTHETANDING ANY REQUIREMENT,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 SHOVIM MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TYPE of N IURANOE ADM Mw
ARMLIMITS
A 09WML LIABILITY PBP2689283 03/12/2018 03/12/2019 EACH OCCURRENCE a 1,000.000
COMMERCIAL GENERAL LIABILITY a 300,000
CLAIMS-MAN 12 a OCCUR MED EXP ft one a 5.000
PERSONAL&ADV INJURY a 1.000.000
OENERALAGGREGATE a 2.000•000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS•COMPIOP AGO a 2,000.000
POLICY El MRLOC a
B AUTOMOSI.ELImBILITY 6226483 12/04/2017 12/04/2018 1,000,000
ANY AUTO BODILY INJURY(Per pwm) a _
AUT D SCHEDULED
UCT� BODILY INJURY(Per addenl) a
OS HIRED AUTOS AM
a
a
VALLA LIAR OCCUR EACH OCCURRENCE a
EICESS LUaI CWMSd11ADE AGGREGATE e
S
C woram ewe m'IIoN MWP300825 12/05/2017 12/05/2018 TA
AND EMPLOYERS'LIABILITY
ANY PROPRIETORIPARTHERMSIDUTIVE VIM
N E.L.EACH ACCIDENT a 500 000
OBFIOERMEMBEREXCLLIDE04 71 NIA
(Maeda"M NH) e,L.aDaeEA3L'•ew EaePI oYEE a 500,000
e MP "NSPOWPERATIONE.L.DISEASE-POLICY LIMIT IS
DEscRI nm OP OPLR IWNS i LOCATUM I VENICLaE tAgwh AcoRo 1aDt,AatgEe:a1 RemaarNe sohedeN,B mwe epee h n9 d1
CERTIFICATE IS FOR PROOF OF INSURANCE PURPOSES ONLY
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DE8CRIBED POLICIES BE CANCELLED BEFORE
Alliance Home Improvement,Inc THE EXPIRATION DATE THEREOF, NOTICE NRLL BE DELIVERED IN
375 Chicopee Street ACCORDANCE Wrl`H THE POLICY PROVISIONS.
Chicopee,MA 01013
AUTHOM MO REPRESENT
®1988 2010 ACORD CORPORATION. Alhgft reserved.
ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD
u W�lLl tom• All home improvement contractors and subcontractors engaged in
home improvement contracting, unless specifically exempt from
registration by Provisions of Chapter 142A of the general laws,
must be registered with the Commonwealth of Massachusetts.
Inquiries about registration and status should be made to the
.4AiluaeHorne linpromemenr r Director. Home Improvement Contract Registration, One
fro,,,veur:moa:rwurn mo,rrwnor. Ashburton Place,Room 1301,Boston,MA 02108(617)727-8598
375 Chicopee St.
Chicopee,MA 01013
Phones:(413)883-3802
(413)331-4357 , "AA Lic»154218 CT Lict#0635847
Fax:(413)331-43S8 u can pay more,but you can't buy bert�r
www.AllianceHomelnc.com (,
SUBM D TO: Phone: �,�" —�Q 7,K Cell:
11 k t
0'�
Email:
We hereby submit specifications and estimates for work to be performed and materials to be used:
ai
A.
/s7
i s 7
/ f
Aluminum Tri ❑Alliance Trim ❑Flat Coil ❑PGC Coil rAG8CoII Color. jaw rl Corners Color
WINDOWS Grids:❑YES []NO []Flat ❑Contour ❑Colonial []Diamond ❑Other:
0 Tow many? 17
❑D/H ❑PIC [3LLS 23LS_L_ ❑Csmt ❑2Lt/Csmt ❑3Lt/Csmt_
❑AWN ❑HOP ❑BOW(4 or 5 lines) ❑Bay Full Screen:❑YES ❑NO
❑Wood grain Interior: Color: Exterior Color:❑YES 0'100 Color. Mull:❑YES ONO ❑How many?
❑Glass Option: Type: ❑ClimaTech ❑ClimaTech TK2 ❑ClimaTech TG2
❑ENTRY DOOR:❑YES ❑NO [:]Type: ❑Style:
❑STORM DOOR:❑YES ❑NO ❑Type: ❑Style:
❑Material Location: ❑Waste Disposal:
WORK SCHEDULE
Proposed start and Completion Schedule-The following schedule will be adhered to unless cirfugrstances beyond the�ractor's control arise:
Date when contractor wm begin contracted work / r / nate when contracted work will be substantially completed.
Contracted wort may not beginontil both parties have received a fully exsected copy d the contract,and the day resdssion period has expired The Owner hereby acknowledges and agrees that the scheduling dates
are approximate and that such delays that are not avoidable by the Contractor including,but not limited to strikes,Ads of God,shortages of materials,accidents,and all other delays beyond its control,shall not be
considered as violations of this Agreement.
WARRANTY
All materials have warranty or as otherwise specified by manufacturer.Labor and workmanship have a warranty of one full year from the date of installation-
All work to be completed in a workmanlike manner according to standard practices.Any alteration c.deviation from the above specifications involving extra costs will be executed only upon written Orders,and wird
become an extra charge over and above the estimate.
PAYMENTS We propose hereby to furnish materia d labor-complete in accordance. ith
Payments to be made as follows:
l I ju abo�re specification for the sum of:$ upon signing Contract, .t ff0
-7 c� ,
%($ upon delivery of materials; ($
%($ )upon jobcompletion; Name of Salesman
l •' UM��,
7G($ � � )shall be made forthwith upon
completion work under this contract Authorized Signature - -
The customer hereby understands and agrees to pay finance charge of 1.5%per month(or annual percentage rate of 18%)on the outstanding balance not paid within 30 days after completion of work.Ali payments
received after 30 days after completion of work shall be applied first to unpaid finance changes and then to outstanding balances.In the event of default,customer hereby understands and agrees to pay,in addition to the
outstanding indebtedness,all costs associated with collection including reasonable attorney's fees.
Acceptance of Propt¢al:I have read E��
document and accept the prices,specification and conditions stated.I understand that upon signing,this proposal becomes a binding contract-You are authorized to
do work as speed Payments will
med above.You,the Buyer,may cancel this traMaction at any time prior to midnight of the 3rd business day after the date of this transaction.Cancellation must be done
in writing. DO NOI SIGN THIS CO IF THERE ARE ANY BLANK SPACES.
Signature j Date —Il— V Signature Date
NOTICE OF CANCELLATION:YOU M CANCEL THIS TRANSACTION,WITHOUT ANY PENALTY OR OBLIGATION,WITHIN THREE BUSINESS DAYS FROM THE ABOVE DATE.IF YOU CANCEL,ANY PROPERTY
TRADED IN,ANY PAYMENTS MADE BY YOU U THE CONTRACT OR SALE,AND ANY NEGOTIABLE INSTRUMENT EXECUTED BY YOU WILL BE RETURNED WITHIN TEN BUSINESS DAYS FOLLOWING RECEIPT BY THE
SELLER OF YOUR CANCELLATION NOTICE,AND ANY SECURITY INTEREST ARISING OUT OF THE TRANSACTION WILL BE CANCELLED.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:ALLIANCE HOME IMPROVEMENT,INC.,375 CHLCOPEE ST,CHICOPEE,MA 01013
(Date.Sunday and holidays excluded) 1 HEREBY CANCEL THIS TRANSAMON (Buyers signature)