109 NORTH ST - BUILDING INSPECTION 1
The Conunonwealth of MaNSaCIRISCUS R
` y Board of 13ullding Regulations :old St:mdards \II'�Il'LI' \LlII
t n NgassaClutscttS State 111ilding Code. 750 UNIR. 7°i edition Slf
/ •• Building Permit Application To Construct, Repail-. Reno\'ate Or Demolish a Rr
/ One- or Tun-Fumih, Bit ellia,S _"US
--1
is Section For Otticial Use Only
Building Permit Numbe Date Applied: L-- --- _--�
Boil ng unmissi tspeclor of Buildings Dale
SECTION I: SITE INFORMATION
LI Property :\ddr.ss: 1.2 Assessors Nlap & Parcel Numbers
) lyorf S+r-aee ----
�la Number Parcel NumM1rr
I.la Is this:m accepted street? yes_ no
P
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq III Frontage 0t)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Rzquircd Pru�iJcd
1.6 Water Supply: (M.G.L c. 40. §54) 1.7 Flood Zone Information: - 1.8 Sewage Disposal System:
Zone: — Outside Flood Zone'! - municipal On site disposal system ❑
Public ElPri%ate❑ Check it yes[]
SECTION 2: PROPERTY OWNERSHIPt `
s Record: -
T?1 Owner�`Pan/1aKd� �1J1.-/ C
Name i jtl Address (or Service:
9l)�-WG - 377h
Sion uruu Telephone
SEC ION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction ❑ Existing Building ❑ Owner-Occupied ❑ Repnirs(s) ❑ Alteruion(s :\JJitiun ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_- Other ❑ Speedy:
Brief Descriptio of Pro used Work'-
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Costs: Official Use Only
Item - 4fLabor and Materials)
I. Building 5 Q JO L Building Permit Fee: S Indicate how fee is Jcternnned:
❑ Standard City/Town :\pplication Fee
3. Electrical $ ❑Total Project Cost' (Item 6) x multiplier x
i
3. Plumbing 5 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5) Mechanical IFire S "rotul all Fees: S ----
Su? ressioni -
� i Cheek Nu. Check amount ('ash .-\nnounc__..__
0 Total Project Cost: $ 4-11417. 0 Paid in Full ❑ Outstanding BaLuwe Due:__
SECTIONS: CONSTRUC'TION SERVICES
5.1 L-icensed Construction Supervisor (CSI_) ti-7-733
_C+ Lctnse N'unihct I?spuaw�u >:ua -
Name of C•SI_- I Iulder
I( Y I y PP �(d�eLt'1 I_ut C'S I_'I)pe isce hela cl _
. I e
(ddre Dcecri nnm
. C ('nresuirtrd�u�to i;,000
R Resuietad U2 F:umh D%telhng
Signam e J \1 >1a.sonn Onlp
l "� RC Rnidenual Routing Co.cnne -
Telephune 1\'S Inca Jenual Wilidw% .mJ SiJuie -
SF Resi&iui.il Solid Fuel Ili-i- 1 thaure lu.t.il Luwi�
D Readeuual DCIniJln"tll
5.1 Regi�tered home IImprovement Contractor(IIIC) Q��ot�
SP1VCn y Sn� --
IIIC Company Name or IC Registrant Name 12cgisuatiuu Number .
\ r 1' 61Z4/ZQ
4ddre �q78 )7)1-UHO�� p
Fx tmC m Date
S signature Tele
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. F:ulurc to provide
- this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached'? Yes .......... ❑ No ........... ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR
APPLIES FOR BUILDING PERMIT
1, reQl lea /� /(.[/ pol /&S as Owner of the subject property hereby
authorize Chn to act on my behalf, in all matters
relative to work authorized by this building permit application.
X , z4, 6G
Signature u(Owner i - Date -
/e S ION 7b: OWNEW OR AUTHORIZED AGENT ECLARATION
I, 1 �'IY�IS'�.�l�l� r 7r)1` 7-i ,as Owner or Authorized Agent hereby declare
that the statements and into oration on the foregoing application are true and accurate. to the best of my knowledge and
behalf.
r Z.
Print Na
Signs u of nrr or: uthorizeJ Agent Date
(Signed under the pains and penalties of perjury)
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered runtraaur
(nut 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 mtormadon on the HIC Program and
Construction Supervisor Licensing (CSL)can be found in 780 C•MR Regulations I IO.R6 and I I0.R5, ie.pectively.
'. When substantial work is planned, provide the intormatiun below:
Tonal Flours area lSq. Ft.) (including garage, finished ba.sement/attics. decks (or pnrchl
Gross livine :ura ISq. Ft.) Habitable room count
Number of tiieplaces - Number of hedro(ims
Number of'bathruoms Number of haf/haths
fvpe of heating systetn
Type of cooling system Fnclused (Ipen .--- -- -- .
1 'Total Project Square Footage" may be substituted for 'Total Project Cost-
The Commonwealth of Massachusetts
Department of Industrial Accidents
.Aj., Office of Investigations
600 Washington Street
"46
Boston,MA 02111
f�r www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information /� Please Print Leeibly
Name(Business/Organintion/Individual): 6 Q K Set^Vi e Q t ,_n a
Address: 1 15 rJ o r+h S 1 re e+
City/State/Zip,_5p ( LCA Mn 0197D Phone #: 2JA I —DN a �j
Are,�°u 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
employees(full and/or Part-time).* have hired the sub-contractors
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. t 7• ❑Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity, workers' comp.insurance.
[No workers' comp. insurance 5. ❑ We are a corporation and its 9. ❑ Building addition
required.] officers have exercised their 10.0 Electrical repairs or additions
3.❑ 1 am a homeowner doingall work right of exemption I L P g per MGL Plumbing airs or additions P ❑
P g repairs
myself. [No workers'comp. c. 152, §1(4),and we have no 12.❑Roof repairs .
insurance required.] t employees. [No workers' 1 Other 00,t2 �
comp,insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t I lomeowners 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 om an employer that is providing workers'compensation insurance for my employees Below is the policy and job site
information. —f�-
Insurance Company Name: _ ' r Le_ Tro VO I P
Policy#or Self-ins.Lic. 3 h'1 51 5 Expiration Date: q/I
Job SiteAddress:Z6ic/ rz4 ��j—eel City/State/Zip: t &,tw.
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 tip to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify n er,t e pains and penalties ofperjuiy that the information provided above is true and correct
Si nature ( Date
Phone#: (9-7$) ' ,q I — t]JA a
Of,icial 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 or 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 bum 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
D[SPQSAL OF DEBRIS AFFIDAVIT
in accordance with the provisions of M. G. L c. 40, Sec. 54, a condition of
Building Permit Number is that the debris resulting from this work shall
be disposed of in a properly licensed facility as defined.by M. G. L. c. 111, Sec.
15Da.
The debris will be disposed at Salem 'transfer Station
owned by Northside Carting
Signature of Permit Applicant
/D
Date
Christopher Zomr
Name of Permit Applicant .
A & A Services Inc.
Firm Name
115 North Stree Saiern fdA Ot570
Address, City, State, Zip Code -
van U a rd NFRC Performance
W 1 Ng
O W S Specifications
A view that works
vanguard
Our windows are tested and certified to National Fenestration Rating
Council(NFRC) standards. Product testing data can be viewed by going
ERERGYPERPpRMRNQMIIRGS he appropriate Certified
to NFRC s web site, www.nfrc.org, and entering t
Product Directory(CPD) number.
'RROIIWMRLPERPORMIW�MTWCR
Double Tilt-In Standard Casement Sliding
�= = Slider Casement Awning
Hung 'Slider Picture Picture Door
NFRC CPD No. SUW-K-1- SUW-K-2- SUW-K-6- SUW-K-7- SUW-K-4- SUW-K-8 SUW-K-3- SUW-K-5-
00083 00045 00047 00010 00038 00010 00038 00004
Clear g9r_ 1 t Q„4 Cif., Qr?}5 ;69 4 fl S1
Glass IMF
063r 6` 3d flS3+ ',064+ EI59 ..
44_ 45; WWIA5 46t� a2
NFRC CPD No. S 000-1- S 000-2 SUW-000-6- S 000 27- SUW-K 000 0� S 000128 S W-3 N/A
Sun- 1i3�ctt Q 2 0 2fs fl 26 4"25' 2 d23 fl 24 w/A
Smart -v
Glass
'" ..�'i.' 2,`. .42 .:; :'0;42,
NFRC CPD No. SUW-K-1- SUW-K-2- SUW-K-6- SUW-K-7- SUW-K-4- SUW-K-8- SUW-K-3- SUW-K-5-
00085 00047 00049 00011 00039 00011 00039 00005
Ultra•
,
Was Y... .. , . . ... ..... ... —
e
Glass ) y n �A
— W .ed��•FJ "=�n^ ✓�/1.;:/iy.
mom
NFRC CPD No. SUW-K-1- SUW-K-2- SUW-K-6- SUW-K-7- SUW-K-4- SUW-K-8- SUW-K 3- +SUW K-5
00088 00050 00045 00014 00042 00014 00042 00005
Kr90 Coco ift .
Glass NoW
' . .s,.. y t, xs
1A .L. gx,.."�r..afl ,Y'�r: 53r:hfl ,i^L £' z @M.aela�tom" � w�..
x & _. R 7
Ali performance values are for windows without grids in between the panes of glass.
070507 SS15-V3
V Ab e
A & A SERVICES, INC.
A&A SERVICES 115 NORTH STREET,SALEM,MA 01970
• Telephone:(978)741-0424 Fax:(978)741-2012
Contractor Registration No. 101609
Federal EIN:04-3090162 - Construction Supervisor No.CSO57733
rImTnNr RFrV*nDELING AND IMPROVEMENT AGREEMENT
Buyers)Name Date of Contract
Buyer(s)Street Address,City,State and
Zip Code
/O 0 e�7 ip -a ,— /BSI D
Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address:
r �
The Buyer(s)listed above hereby jointly and severally agree to purchase the goods ardor services listed on Me accompanying specification sheets,in accordance with
the prices and lenns described on Me from=0 the reverse of this agreement and any specification sheets(this'Agreement*),and Buyer(s)have requested Mal such
goods or services os heeded or provided at Buyer's address fisted above. ASA Services,Inc.('Contractor),hereby agrees to install or cause M be Installed Me products
or services listed In this Agreement at the Buyer(s)address written above. This Agreement represents a cash sale of goods and services. The Buyer(s)agree to pay In
cash Me coat of the goods and services purchased as described herein,regardless of timing or approval of any financing Buyers)may Beek for their purchase.
Y[/ P
Purchase Pricer Est.Starting Date:
Down Payment: 3 we Est.Completion Date:
❑Cash
Amount Due on Start of Job: ❑Check
❑Credit Card
Amount due on of Completion: No.
Amount Due on_of Completion: Expiration Date:
.Balance Due on Upon Completion:.?7dc',Cq CYC Code:
It Is agreed and understood by and between the parties that this Agreement front ODd back and any addendum,constitute the entire
understanding between the parties,and there are no verbal understandings changing or modifying any of the terms of this Agreement.
Buyer(s)hereby acknowledge that Buyer(s)has read the from and the reverse of this Agreement and has received a completed,signed
and dated copy of this Agreement Including the two attached Notice of Cancellation forms,on the date first written above. Buyer(s)also
(1)acknowledge that they were orally Informed of their right to cancel this transaction;and(11)request that they be contacted vie their
telephone numbers or e-mail,as listed above,in the event Contractor believes Buyers)would be Interested In any additional quality
products or services of Contractor. DO NOT SIGN THIS CONTRACT EF IT CONTAINS ANY BLANK SPACES.
A&A Servic , nc Buyer(s)
By:
Signal re Signature
?or7r9
Print Name Print Name
Signature
Print Name
You,the Buyer(s),may cancel this transaction at any time prior to midnight of the third business day after the date of this
transaction. See the following Notice of Cancellation form for an explanation of this right.
ARBITBAnON:Thy contractor eM the honrewmer he,eEy mm.my some In eavarrm aa11n am warm elan IbM hw a dispute mro mlrg Mls,meact,miner mm,may sunml sum men..to
e prlvele ermtromn eerirn wNixf has w.epprovetl Ely om sesmlvy W Ne Exeml M.of Cmaumw Mel,end Bmirese Rpulexons antl mor ohm Fire ftW No mo iM to aunrom to
euco m arsm es proved In M.G.L c.144A.
Commor miriW: Z Buyvt I.W.p�;J7 old-�G4 0.x: e_ �
NOTICE OF!` NC n ATION OTCFOnOF no GUICELl AT]
Dale W Trewcnon�o_d9Tmu meY Bartel Mle berWtMn,xilM1wl enY penaHY mr pale of Tnnorcimn R � .Tmu may xxmH lhU banuGlm,warm.arty rerwny a
�' yhivynon,wehln hrey aaneu says rmmme eewe aem.nyou�sncel.mlv prmpanvlred.e ln. mellpemn.wnnin hre.dumenaers fmm um emm sue.nyou wrml,my RopyMname m.
en.ou wit Ne meMlrywa ,to sip Cried Or See.W ftsnWonabblrour womossnnomr, w you wit
medim,wo n10 w fonomm or Bel•,eM sefirrof your
trumemmmle,
byrou'sino,remoso woolOdays of memmmemmllry ma seller it you
Y rotlu, Ey you om ,Wmry"tor l;aryl socrimmotio Will me Seliffymmellaxmu must
•. maemumet cox seler.Your rsdim tr,in oftmonsirry s ood control
whim roumuM —,NxI m* imeresl xfrm NxNdxxNs
denucWn will pa cencellM. nyou canal.you must
mytoodsadymtl'e Bello uYmr,sHaR,In orsam;xym qud argnkmes wnmxywm , mygood;d0mod to you el Your ru OmmormwA9enaellyu scot rndw1m,coMly wici e
mlrpmommof mr,orrmuunam we cm4vamamm ofthoumq,ro ftil ehms mr,, m id inommomof creScur utingsrow Nom,nitmem0 oxod.ntfts W.mmpNwnh and
hrslrucape of tlfa Seller reperalrq the ramm ehlqunl col me 9mas n IM Sellm esperi5e eM irrk. U cos d m SeIMr repmainp Me le Gllpum W fire p el W Seue,pP thu min
risk n you ao meNe Inn.ecWo.rallede m fix Seum min Ma$soar sow M pd u,m uv "I n da ao make nw rNW9 Ntim a m IM aeon.oM tlm Benin dou rM pkk hem goods
wmm�zO says al me arcen.ynmwin.Wcermneapn,you mar,moor e'wpom Ware lxoam wmm�zD aanmmin aemmwur Notlre WGexmleaon.yw may remin Or alspoee of the scoria
wim,n.nvmrh.r pMpauon.firm mommeke lux gppN eveileLMmme saner.orxyom.amy wiwm mwwmxr oWlsulon.ny'm wimmmxh.some Nmemecome sell.,Ornyya sense
mrammlhe lioMmmNmaelbreMfallmEo m,men,mMiorWnllaWmig mdomame Well mremmaxill thoom Selkrmd Mllmdp m,tlxn you remoin AeWemr mrldmarvxMell
ONlpatlomurtiolrotmorcr.myocm,elhbtrome,w ownlordefmmeognetl eM aabtl ap5 win.cameari Ners.ma Tyuncel Mbtrensec,or.melt.aNNmetlprW er Nofl115
oort
W Mo Cerwnm'wn noWi w any OMm wMmn rotlm,ar mrN a mlepram,m A8A _s,115 win.umrolktlm rotlu or mry Win wrMm rWu,or sect a lalearem,to � �115
,�, NOM StrM,Selem,MewechuseN al%e.NOT1ATERTHAN MIDNIGHTOF NOM amet,Boom.Muuchuoene 01970,NOT LATER THAN MIDNIGHT OF /; O
lone) (Om)
I HEREBY CANCE.THIS TRANSACTION. conomm§Sgnar, Oma I HEREBY CANCELTHISTRANSACTION. comumer'os momre Dore
r
,, /1C�
� A & A SERVICES, INC.
A&A'SERV M 115 NORTH STREET,SALEM,MA 01970
• Telephone:(978)741-0424 Fax:(978)741-2012
Contractor Registration No. 101609
Federal EIN:04-3090162 Construction Supervisor No.CS057733
WINDOWS AND STORM PRODUCT SPECIFICATION SHEET
Buyer(s)Name Date of Contract
erV d�d
Buyers)Sirevt Address.City,State and Zip Code
/0 - o�-1 'A Sak-, A4O O
Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address
The Buyer(s)listed above hereby jointly and severalty agree to purchase the goods and/or services listed below,in accordance with the prices and terms described on
this Specification sheet and the front and the reverse of the accompanying CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,of which this Specification
Sheet is a part.
1 WINDOW REPLACEMENT
❑ Remove and dispose of# b existing windows.
❑ Install # 1 new J--n/LySB 'Z2r7cy 4 Li/r windows: 9Vinyl ❑Wood
(Manufacturer) �/
' OPtIORS: Style Qo b�gf'I Grid pattern�T
�
Color Interior f�
Color Exterior 1�.9,94,,P'4 Glass Type.A2 fG lr,, P-+;,
Wrap exterior trim with aluminum: Style Color
All windows will be installed according to the installation procedures in the portfolio.
W Caulk all interior and exterior edges.
Insulate where possible around new units.
` Insulate window weight pockets if exist,and around new window units where possible.
Included in this proposal are set up,clean up,Hepa vacuum and cleaning windows inside and out.
10 Building permit included
BAY/BOWS/CASEMENT UNITS/ANY FULL CONSTRUCTION WINDOWS
❑ Create new window opening by tuning through existing home and framing in opening.
❑ Remove and dispose of existing unit(s)in its entirety.
Note:Electric and plumbing may exist in wall and will require additional costs to customer if need to be dealt with.
❑ Install window(s)into opening(s).
Note: If Bay or Bow installation to include cable support system,new roof system(matching color as close as possible)
or tie into existing soffit system.
❑ Bay O Bow O Casement ❑Other window(s)to include new interior style trim and new exterior style trim and head
gashing as needed.
❑ Note: Painting and staining not included.
STORM PRODUCTS
❑ Remove and dispose of# existing storm window(s).
❑ Install new storm windows If Manufacturer
Style Color Option
❑ Remove and dispose of# existing storm door(s).
❑ Install new storm doors# Manufacturer
Style Color Type: ❑Aluminum ❑Solid Core
SPECIAL INSTRUCTIONS:
it Is agreed and understood by and betwean the"Mae that this SpeeMcatlon Sheet,along with CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,constitute,
the emtre understanding between ere parties,and there are no verbal understandings changing or modifying any of the fame, This contract may,not be changed or he
r• terms motlgbd or varied In any way unless such Mange,are In writing and signed by both the Buyer(s)and the Contractor. Buyer(s)hereby acknowledge that Buyer(e)
has read thle Specification eheel <
Contractor Initials: G•L` Date: i '�D ' j Buyer's Initials: Date: