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25 PARLEE ST - BUILDING INSPECTION FROM :BUILDINGDEPRRTMENT FAX NO. :9787409846 Sun. 29 2006 02:50PM P1 o 1 w CITY OF SALEM 0 PUBLIC PROPERTY `• �' � DEPARTMENT i:l?f9F:0.1.EY DRISl:01.1. �l� MAYOR 120 WA.SHINGTPN Slit=♦SALEM,%LVLSAGHUsh9'rS 01970 1'E1=978-745-9595 4 FAx:97&740.09" �pI ICATION FOR THE PAI RENOVATION CONSTRUCTION DEMOLITION OR CBMGE OF USE OR OCCUPANCY FOR ANY EXISTING STRUCTURE OR BUILDRic 1.0 SITE INFORMATION _ Location Name: 7 Building: S(� Qv Property Address: d PA2 jCe- S>�� Property Is located In a; Conservation Area Y/N Historic District Y/N 2.0 OWNERSHIP INFORMATION 2.1 owner of Land Name: )� — Address: Cl S (?An l(Lf S- ^Ak-� a rZ Z O Telephone: Q 1 — t 3.0 COMPLETE THIS SECTION FOR WORK IN EXISTINCS BUILDINGS ONLY Addition Existing Renovation Number of Stories Renovated Change in Use New Demolition Existing Approximate year of Area per floor (so RLNew ovated construction or renovation of existing building brief Description of Proposed Work: Ar ,q,� oSLzQ �uO�Z->.,r, i a�-t 1 4v b �s �� 1 /o //]� �fL3(-ft�ra. lvlw� pt,�tivr/s..rtis l Mail Permit to: l Ac I J N Mud Lo" CI wdm4 x)if c)3US3 FROM :BUILDINGDEPARTMENT FAX NO. :9787409846 Sun. 29 2006 02:51PM P2 What is the current use of the Building? C) C,ITG� ow man units? N�ih ? If dwelling, h Y Material of Building A� - ash Will the Building Conform to Law?\L'S Asbestos? Nu Architect's Name Address and Phone Mechanic's Name Address and Phone Construction Supervisors License# C2 Y f9fC0 HIC Registration# 7 Estimated Cost of Project$ A-CT0 Permit Fee Calculation Permit Fee$ LJ ' Estimated Cost X$7/$1000 Residential Estimated Cost X$11/$1000 Commercial An Additional $5.00 is added as an Administrative charge. Make sure that all fields are properly and legibly written to avoid delays in processing. The undersigned does hereby apply for a Building Permit to build tothe above stated specifications. Signed under penalty of perjury x Date b 6 of N e « r � f/1 a a 3. 7k W E" � c G77J a a q+ 4 O FROM :BUILDINGDEPARTMENT FAX NO. :97e7409646 Jun. 29 2006 02:51PM P3 it CITY OF SALEM PUBLIC PROPERTY . DEPARTMENT KIMBERLEY DRISCOM MAYOR 120 WASHINGTON STRa6T•SALCiM,MASIRACHUSZM 01970 T EL-978-74S.9S9S a FAX:9711-740-9846 Workers' Compensation Insurance Affidavit:Buildersicantractors/Ele4Krician$iPlumbers An licant Information Please Print Leoibll Name(6urinuWOrg^nnizatioNlndividuul): TS/L hyi)�r s Loa-"yLO 1A g Address: u City/Stara/Zip: 1-tdrw Off° Phone N: 3 ire you an employer?Chrekt�t'he°)iproprlate bax: Type orproJoct(required): 1� 1 am a employer with= 4. ❑ 1 am a general coauactor and 1 R. ❑New construction employees(Nil and/or part-tima).• have hired the sub-contractors 7. Rdli 2.E3 I am sole proprietor or partner• listed on the attached*heat.temoeng ship and have no amployces These sub-contractors have a. ❑Demolition working for me in any capacity, workers'comp.insurance, 9. [3 Building addition INo workers'comp, insurance S. ❑ We an:a corporation and its lU.El Htectrical repairs or additions rugaired.) officers have exorcised their 7.❑ 1 am a homeowner doing all work rigbt of exemption per MOL I LEI Plumbing repairs or additions myself.(No workers'comp. c. 152,4 1(4),and we have no 12.0 Roof re�I'to insurance required.)t omployces.INo workers' 13 �Othnr camp. insurance mquired.l •Any:,pplimat that chwks box ai moat also flaws dw aoctlun bulcw awwiag astir Wor nis'companuelun pinky lum ma im t tlamenwwn who atermil thle afRdavlt indlcatina they am Joins all work sad than hire wizWo eontmwora maw suhmis a new affidavit inaliewins mich. ('omrxuaa Ilea chuck Ihis box moan atlachad an aethaond alwat ahawina dw name of the mbcontmctora and their wurkan'comp.policy Infurmadon. !urn an aurpfayor that 1.r pruvldlnk rvarkars'eumprnsnden inzurmrra jar my wnpluyerz. Below Lv the polity and Job site lnjunnnrion. /� /� Insurance Compsny Name: " Policy At or Suif•ins. Lic.i!• 19`c/9 �7s �._A. Expiration Dote: lobSitoAddress, 2S PAnd!oF S�flGl Cityistate/Zip, -�� Ir zd/L Attach a espy of the workers'compensation policy declaration page(showing the policy another and expiration data). Failure w sucwo coverage as required under Section 25A of.NIOL c• 152 can lead to the imposition of criminal penalties of a tine up to S 1,500.00 and/or one-year impri*aamcm,as well as civil penalties is the form of a STOP WORK ORDER and a fine of up to S250.00 a day;tguinst ilia violator. lie advised that a copy orthis stawinunt may be furwardcd to the OlTtce of Inv.xtigaliuns ui'the DIA for insurance coverage vcrllluatiun. T 1 do hrrvby eartify[rude fhaa Painsand l rn y jprrfa that the Information provided above is true and correct Ve U J O/Jfrlal use anly. Do nor welid/n this area,to be completed by city or fmvn afjiriuk City ar gown: ....._ . ..- . .---.--... Peradvi.1cense k_,____--... ..._ - Isauing Authority(circle onc): 1. Board of Ilealth 2. Iluilding nepartowal J.Cloyfrown Clerk 4. Electrical Inspector 5. Plumbing Inppector 6.Other — Cuntaet Person: ._ .-... Phone p: FROM :BUILDINGDEPRRTMENT FRX NO. :9797409846 Jun. 29 2006 02:52PM PS CITY OF SALEM PUBLIC PROPERTY T DEPARMENT Klh41117TUAN DRISCOLL MAYI)R 120 WA511INGVON.S iEr♦ $ALEK MMSM:1 WSHTTS 01970 Tu.:978.745-9595 1 VAX,978.740-9846 Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5 Debris, and the provisions of MGL c 40, S 54; Building Permit ____ is issued with the condition that the debris resulting froth this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c 111, S 150A. The debris will be transported by: 60�5 - (name of hauler) The debris will be disposed of in : (name of facility) (address of facility) signature of pennit applicant date dchnaalYAuc. MIN 4,ANOCOVRTSURV�V$, SU®®IVISBONS M1iIbRT®qG,S gUpgVL'tlS 'Rf?'Cdl®TSR4°®LAND SURVS R pOR' Ea3CSTERE®CIVIL 6NGINZiR L08'SURV@Y$ • CONSUL,TIN® PARSONS AND FAIA, INC. 60 LEW18 STREsn* LYNN..MA59.ACHUsgTTS 099®a _ 593-7027 RmLLES e r? 6• .s s- .s— e69o� Ss►e71� a ' -i vsO�6/1�� /�� ®®__ .3 , . t" mluaa¢a, EXISTING 6'DOOR FROM NOH EXI51IN6 DECK 10'XI2'(AFFFOX) I.W Pf FRAME @ 16"O.C. 2 5/q"X 6"PT JECKIPU' 3.J015f NANGER5 EXI5TIN6 HoLff A,qXq P05T5 5.(2) HNDEIERMINED FOOfING5 12'-5" 1 PROPOSED ROOM 6,�RI 0 66 M 0CATP &RAIL5(TO X I PROP05W HPGRADE5 TO EXISTING DECK ,q _q 1,fO ADD(5) 12"0 X 48"DEEP FI65 W/ANCNOR5 OR MCHNO-P05f5 2.r0 ADD W PT TRIPLE 6EAM UNDER U fWQ # 3,TO ADD 5/q"ADVAMCH 50 PLOOR q.rO ADD 6Xb P05T5 W/ KNEE GRACE5 q Xq 5,fO ADD qXq LANDING W/5TAIR5&MII LANDING 6.TO VP 911X5' 5ECTION f0"C"WALL 1.fO ADD 5"x 1'-6"WAH,5SCTION(t3ACK Of"A"WA L 8.f0 ADD qXq LANDING W/5fNR5 9.r0 ADD 2X8 511 J01I �l PROP05ED 5 5E{XN PORCH 12'X II'(APPROX) 5TUP10 5friE ENCI.050 5"EP5+ H ROOF 5Y57EM (12' 5PAN) KEW 6'DOOR NEW 6'DOGR FROM PORCH FROM PORCH (NOf SNOJVN IN THI5 VIEW) n LJ LJ LJ LLJ SfNR&RAIL LJ LJ LJ 56"NIGH RNL ® II K II O 7-3/1 q"RISE q"13ALLII5ER WALE } Protect: Scale:I/8"-I''O" Diaawq: Bell}erliving WAGO PE51PFNCF A,I SUN ROOMS 5&PM,MA 0197 SN.EM,MA 01970 317 a adm(413)Stnoe420-0 Chicopee,(4 3) 01013 2M1 Phone(413)920-0140 Fax(913)920-0197 Date:8/17/O6 Sheet I of I :, �w N LAYOUT FLANS �3 WALL SECTIONS EXISTING BUILDING Y D _ Z Z D STUDIO SIDE WALL(A) STUDIO SIDE WALL(C) A55EM13LY DETAILS 00 o � SEE ALLOWABLE LOAD TABLE FOR DM PANEL SIZES fl� � 5.5'D 1 5.5'D ry`a�� �e��y MINIMUM SLOPE 1:12—� Y° p 1 GUTTER FASCIA h — 6 T2 ALL �4 ,Y� p .5' 5.5' STUDIO FLOOR PLAN '� �' p HEADER SUPPORT BFAM a A� OR WINDOW SLIDING DOOR. —TRANSOM(OPTIONAL) 5TUDIO FRONT WALL(B) TEMPERED GL ASS-- t ALLOWABLE LIVE LOAD TA13LE FOR 13 FT. PANEL WITH 12 FT.OP.LE55 SPAN 20 POP 25 ESE 30 PSF 35 P5F 40 PSF 45 PSF 50 PSF 55 PSF 60 P5F FLOOR CHANNEL -,"INC 31,11C 3"HC 3"1 IC+H 3"HG Ii h5"HC 4.5"HC h.5"IiGFI-I h.5"HC+hI _,'EFC 01 3"EP5+11 3"EP5+H 3"EP5+H 4.5"EPS+H 4.5"EP5+11 4.58EP5+li 4.5"EP5+li 6"EP5+11 NOTES FOR STUDIO CONSTRUCTION - DECK/5LAB 1.ALLOWABLE LOADS ARE BASED UPON 8.PANELS MAY ONLY BE USED IN ROOFS AND WALLS WHERE 16.AB15REVIATION5: - TYPICAL STUDIO SECTION f; TIhIF LESSOR OF THE ULTIMATE LOAD/2.5 CLA55 5 OR CLASS II INTERIOR FINISHES ARE PERMITTED D=DOOR CBM=CRAFT-GILT MANUFACTURING OR 7I IE LOAD AT 20. 8Y CODE. W=WINDOW FT=FEET * 2 HC/EP5 REFERS TOO C5M DM=DOOR MULLION PSF=POUNDS-/50,FOOT 8M 5'TRULTURAL 9,HORIZONTAL JOINTS BETWEEN THE ENDS OF PANELS ARE WM=WINDOW MULLION BC=BUILDING CODE PANELS WITH ALUMINUM SKINS BONDED TO NOTPERMITTED. HC=HONEYCOMB PANELS IBC=INTERNATIONAL BC HONEYCOMB/POLYSTYRENE CORES 3",4�k" UBC=UNIFORM BG. xN ( 10.CONTRACTOR TO PROVIDE FALL PROTECTION PER LOCAL CODES, EP5=POLYSTYRENE PANELS 0 .. Cl AND 6"IN THICKNE55).ADJACENT PANELS FOR 5UNROOM5 WITH A FINISHED FLOOR.LEVEL OF 30" H:THERMALLY-BROKEN NBC=NATIONAL BC 0 ARE CONNECTED U5ING VINYL CLEATS OR He. OR GREATER ABOVE AN EXTERIOR SURFACE. ALUMINUM H-5TIFFENFR 615C=5TANDARO BC �4 D,y,Fl 3.NINI'"1Y 90 MPH DESIGN WIND SPEED, P=PANEL MFG=MANUFACTURER �'•'� 0 ( ) 11.STRUCTURAL FRAMING AND CONNECTIONS TO BE INSTALLED L"=WALL HEIGHT _ '�\ FESIGN R A OR B. AXMU(CATIONS 4 a PER APPLICABLE 600E5 AND CBMTING C SPECS. MPH- IL 5 PER HOUR. MAXMA%=MAXIMUM 11 4.DESIGN ROOF PANEL DEAD LOAD=5 PSF. J,' ' 12.AND AS NEC 5 INSPECT ALL EXISTING CONDITIONS 5 DOOR AND WINDOW L PER MFG'55IZE5 ARE %tOf olds -PROJECT: CONTRACTOR: ;l t AND A5 NECESSARY REPAIR AND/OR REPLACE ALL s INTERI OF 3-WALL GEABLMAY VARY 5PEC5. qg qgj MATERIALS A5 REQUIRED TO RENDER THEM STRUCTURALLY AIG � S �,z,X 1Z' 6.POOR(OF B-OWL LAYOUT URY PER - Coss 9 w;f' DOOR/WINDOW LAYOUT UPTO 24FL SOUND AND COMPLETE ®v1.,'.. _` 9 -joss 7.PANELS MAY ONLY BE USED IN ROOFS 13.L"=96-3/8"(MAX)FOR ALUMINUM ENCLOSURE. `E srxuclURu ", 4o,z, STUDIO ENCLOSURE AND WALLS OF ONE STORY BUILDINGS OF L"=107-1/4"(MAX)FOR VINYL ENCLOSURE. �3 p q Eoixe DRAWN BY:CJJ DWG NO.: CON9TRUC NON:TYPE VB FOR IBC/NBC, eQlsl_f%c) em50-12x12 GENERAL LAYOUT ( ) 14.AUTHORIZED FOR N&SECTION HOT TO CA;&,�A= OALY. FssiuxA�le TYPE VI(FOR 58C)AND TYPE VN(FOR UBC). 75.STUDIO FLOOR PLAN&SECTION DIO'T TO SCALE SCALE:1"=4' DATE:4/30/2003 7 a 05/26/2006 11:24 16038934831 MIKEIASCONE PAGE 05 TniS Se^tiW7 to be filed out in FOn7e and Si. oned by customer Property Oc✓ne:4NSust Ccmnlete,and Sig-n This Section If Tls9ng A B=aildez as Cane of thesab`�Ct [U hereb attt r- prop Y Y hn all BetiterlivingPat10 Room a.—Patio ROOms of America) to act on or behalf, n all matters relative to work authorized by this building permit application for(add..ess of job) as J /vs � 7 signature of Ov-1er Date This section to be Completed by$etterlivin C�J-ice Staf Owner or Builder(as Agent of Owner) Must Complete and Sian This Section as Owner/Authorized Agent hereby declare that the statements d information on the foregoing application foz (address ofjob) 2S P,Ayi'j S4.� are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. r� I yk�c�c4 �i�ws Print Name i Signature of owner/Agent Date I • i 05/26/2006 11:24 16038934831 MIKEIASCONE PAGE 04 ..a_� S1I1QIi'!1�I'1'JIJ4MJ1Cd9+ucr .�� The Massaehuaetts r house additions Slate Building Code(780 CMRJ includes provisions to ensure that houses end FOi2M ' meet energy efiiMarcy standards. This supplemental CONSUMER INF s to be filed C5 pa i Of the building permit application when a buildedcontractor or homeownerR eo Special energy OnSeg a house addition with very large percentage of glass to opaque wall,seeks to utilize e special energy conservation exemption option for "sunroom" additions to an existing house (780 CMR, Appendix 1, Section JL13.3.1), This FORM Is not Intended to prevent a homeowner from selecting a sunroom1.of any size configuration,orientation, form of construction or percent glazing,but rattier is only Intended to assist homeowners in becoming aware of some of the important energy conservation end round comfort considerations involved in selecting and utilizing a"sunroom'i addition, year- The connection of "sumoom" shuctums to residential buildings consumption i may create Comfort and energyissues due to uncontrolled solar gain or uncontrolled radiation roofing of the main house.In the selection and cwnstructiott/ms illation of I'suriroo ,ms", included below is a non open-ended list Of product and design considdations that a homeowner may wish to consider before actually constructingllnstailing a"Sunrnem".It is recommended that consumers carefully review these options whit their designer, builder, or contractor, in order to minimize potential energy re and/or house ardiscomfort issues. I addition, the qualifications and reputation of the company or individuals to be hired e important considerations, PRODUCT AND DESIGN('ONcIDERATTONS RELATED TO SUNRnnM • Solar Orientation and Natural Shading • Type of Clazing • Iasalatiug Value • Solarp- _ .. ._...... --- .. • Frame material • Caazing to frame sealing and gasketlug materiay/acal durability and/or weather tightness of the suaroom • Adequate ventilation-Operable windows and fans • Applied Shading Systctus • Insulation level In floors.wails,and ceilings - • Possible Sunroom isolation frI the main house via a wall and/or door or glider • $eating and Cooling Methods:Efficieum Zonlog and Controls Homeowner Acknowledgment The Massachusetts State Building Code,Section 11.1.2,3.1, requires that the 11crualproperty owner(not the owner's agent or representative)acknowl ge receipt of this CONSUMER INFORMATION FORM prior to issuance of a Building Permit for, p Jed at includes "sunroom" additlons to en existing residential building. In accordance with th' vem the undersigned hereby acknowledges that she/he has read the information in this docum tn' nroom comfort and energy conservation. Signature of Actual Bui 1 er Date �,ina,i�ediuj• �S'i�/�,i� ���, Printrint Nam Address of Permitted Project Owner Address(if different than project location) Owner's telephone number BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number GS 081580 _ - Birth[Jat OZ19/'1950 Expires 02/19/2008 Tr. no: 16699 Restricted rO0 .1 PATRICKA STE:V.ENS r Sif . 24 FORD RD7 STERLING MA 01564 Commissi .' . ,�e L�O?HATL092[O�LLLL2 oy°✓J�cexcclzaceC�s i-"_,: _ - Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR t R gistratin 148576 s Exp�raf�on_.=_!0/612007 _ N j Type Supplement Card - NH Patio Rm(dh)Bette�Llving;Sunr Pamck Stevens 1 Action Blvd. LondonDerry, NH 03053 rL`•' t Administrator J A S U N R O O M S 1 Action Blvd.Unit 1 Londonderry,NH 03053 phone: 603-537-9256 fax: 603-537-9258 AFFIDAVIT In accordance with Article 1 Section 114.1.3 of the Massachusetts State Building Code, I certify that all debris resulting from work associated with Permit # will be properly disposed of at Betterliving Sunrooms 1 Action Blvd. Londonderry, NH 03053 licensed solid waste disposal facility as defined by MGL C11, S150A. Name&Address of Project: ��. HF-CITC O n Street Address C rA/l.�C(S c� rlSt 21r City/State/Zip -58 I l5� / iI/A Q t! 1l 7 C Name of Permit Applicant (RA-6L 541)£tiLS (please print name) Signature of Permit Applicant (please sign name) Date: Betterliving Sunrooms 1 Action Blvd.Unit 1 Londonderry,NH 03053 ACORD CERTIFICATE OF LIAEti,!U-TY INSURANCEI '�` 02/03/2006 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Joseph MCKeOre ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE JP McKeone Insurance A en Inc. HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR cy/ ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 333 _ Ann Arbor, MI 48106-0333 INSURERS AFFORDING COVERAGE NAIL S INSURED New Hampshire Patio Rooms,Inc-dba - INSURERA TFORD - Betterliving Sun Rooms of New Hampshire IIrsuRERa: AiG 1 Action Blvd Units 5 and 6 INSURER c: Londonderry, NH 03053 nusuRER G: _ INBURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERNm INDICATED. NOTWITHSTANDING 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLASMS- N sR DO'L POLICY NUIB39l POLICY EFFECTIVE POL1LYy PRATON LIMITS A GEIF""LLN`°wTM 35 SBW PD 5184 01101/2OD6 01/01/2007 EAcHDCCuRRENCE S T 00p O0p CONMERCNL uFNERAL LiPBILRV PREMISES EePm,� S TOO WQ CLAMS 161 E Fx�OCCUR MED E%P AMJ are PRIsnR) S_ 10 0OO i PERSONAL d,VVWJURY S t 0� GENERALAGGREGATE 5 2 OOO OOO GENLAGGREGATEUNRAPPI.S3 PER PRODUCTS-CONPbPAGG 4 2,000,000 POLICY PRO- LaC A AUTOMOBILE TTY 35 UEG UKS643 01/01/2006 01/01,,2007 COMBINED SINGLE LIMIT I s 7,000,0p0 i ANYAUTO (Ea Noimoq ALL DANIED AVTOS BODILY IIUURY X SCHEDtAEDAUTO3 � (Per pertonJ I$_ HIREDAUTOS BODILYINJURY I NON-0 NEDAUTOS (Prrem/Rnq PROPERTY DAMAGE S GARAGE LIABUUT AUTO ONLY-6tACGIDENT I$ 6 VYAUTD - II OTHERTHAN EA ACC S I A4IT0 ONLY: 2,000,000 EZCl45YNMSR LIAOILITY A � � � 35SBWPD6184 01/01/2006 01/0112007 EACHOCCusRDLCE $ 2000000 OxLm cusNS MADE I AGGREGATE s s DEa/cnBLE RETENTION. $ 10 000 $ B NgpNER$CONPENswT AND 2925836 01/01/2006 01/01l2007 X TVI( Tu'2- OTH. EMPLGYERB'l1NB AR ANY PROPRETORPARTNERIFXECUTNE - E.L.EACH ACCIDENT $ 50Q OFRDER?dD,LBER EYJ_LLIDEDT K yyeess EexHLa unOer E.L DISEASE-EAEMPLOYEE d SQQ QQQ BPECIAL PROVISIDNSEebw - E.L DISEASE-NOCYLWR g 5 QQ OTHER DOSCRS'TgN OF OPkTMLnONSI LOCATIONS I VE31NSE8/EICIIJSN)P6 ADGED BY ENDOMEEIENR/9PEppL PROMBgN3 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF T£ABOVE DEWRIOED POLOES Be lJ1IICFI c^BEFORE TILE EOM9ATSON Insured Copy GTE TwR .1NE t3 U NG B s REB MuL ENDEAVOR TO MAL 10 DAYS Wm _ NOTICE YO TIE CERTFIGTE MOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHAI1 B/POBE NO OBLTGAIMMf OR TAA6NJTY OF ANY RIND iPON TME WI MIBL ITS ACPMS OR IEPAiffi!TATMFS. AC'ORD 25(20011N) 0 ACORD CORPORATION 19BB 06/05/2006 07:57 16038934831 MIKEIASCONE PAGE 02 h �et erlivifl CONTRACT CHANGE ORDER Phone---518-687.2337 Customer:50-plm iqTi/NN Fax---518.687.2338 Address: At the request of the above referenced customer,the following changes to the original contract and/or previously executed change order bctween th undersigned and BLSNE,Inc.are hereby agreed to: B � X T APPROVALS: Contract Amount Prior to this Change Order: _ The undersigned agrees t e an noted � above and the Ievlal0 tb CO et amount Change Order Additional Charges/(Deductions) and payment schedu owrn. s change order New Contract Amount after this Change Order S� Is subject to all to c Lions per the n Amount Previously Paid by Customer ... . /jf (7u original con t It parties. Amount Paid with this Change Order ___... © dam Owne -- Remaining Balances (Payable as Follows) O ei' Due Prior to Ordering of Materials: y �9/�7 Design Consultan Due on Initial Delivery of Materials _—___ L-_L�� '�.// G 2 u Due on Commencement of Framing _Y, 6d• Office Use Only: luitialed by President: --_ Due on Completion -------!- • Filed by: sales file—...___— Install file i