84 PROCTOR ST - BUILDING INSPECTION 1�411
The Commonwealth of Massachusetts
��) 1 OF
Board of Building Regulations and Standards CITY M
Massachusetts State Building Code,780 CMR - SALEM
Revised Mar 2011
Building Permit Application To Const pair, Renovate emolish a
One- or Two-F mily el/Ing
s+� c • nfor-0 cial U my a.a';':., a..,.;1- '„�'"
Building Permit Number: = A A:OlVd:,
'.€ ns'..
"i1
•, u Building Official(Print Name) za = r , '. Sig afore m�:¢ • :;, Y >g fit:.... Date --
"SECTION 1:S E INFORMATION,F
1.1 Property,,AAddress: 1.2 Assessors Map&Parcel Numbers
R4 Procter �f
I.la 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❑ Private❑ Zone: _ Outside Flood Zone? Municipal ❑ On site disposal system ❑
Check if yes❑
ECTION.2: ROPERTYOWNERSHIP,r,.# m .;T „ ti �=
2.1 Owner'of Recurd•
.rn ,mA, 01910
Name(Print) City,State,ZIP
2L Prr,�tnc �� Q1rn h
No.and Street TelepRUnh ne Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ FAddition ❑
Demolition ❑ Accessory Bldg. ❑ 1 Number of Units I Other EkSpecify:
Brief Description of Proposed Work': irvswk ,Av—
f S r
a'SECTION4:ESTIMATED_CONSTRUCTIONCOSTS,
Item Estimated Costs: r, ';. ,Offict9l Use Only -g j Ir"
Labor and Materials ..._.,
L Buildin $ - 1 Building Permit Fee $ 5 Indicate how fee is determined:
g
2.Electrical $ ❑StanKdard City/Town Application Feep :a
t
❑Total Protect Costa(Item 6)z multiplier ar t x w
3.Plumbing $ 2 Other Eees $
a- z 8s}r-
4.Mechanical (HVAC) $ List MnY
5.Mechanical (Fire
Suppression)
$ Total All Fees $ "- ' Tkz
�. r „
Check No,,'-- Check Amount A!T-, Gash Amoant F
6.Total Project Cost: $ 6rAOQ ❑Paid in Full 0 Outstanding Balance Due „
_SECTION5:-CONSTRVCTIONSERVICES a ,'-
5.1 Construction Supervisor License(CSL)
G1tn6-% f Lice umber Expiration ate
Name of CSL Holder
a List CSL Type(see below) y
[YID( 4G In
No.and Street �Type a � Deserpnon_,,,-, b21,
p / U Unrestricted(Buildings u to 35,000 cu.ft.
tY'Ve��A ih� n�� 1 R Restricted 1&2 Family Dwelling
City/Town,Stale,ZIPM Masonry
RC RoofingCovering Window
in
WS Windoow andnd Siding
y >^ SF Solid Fuel Burning Appliances
rj7O (1`�.� 6Q (�}J2. ( •LQ`Cj V'�4 6.6,.C6W—f- I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor IC
�j j 1 (L` K1y�sz
�t(ann 81 Ci_ S\Hl( 1 �O �� HIC Registration Number Expu non Date
HIC Company Name or HIC Registrant Name
Pt7 l5o k. 4�� -woa &61 •co S's—
No and Svv��et 91� �,��L7 Email address -
�ayeti v,/m6�( 15b City/Town,— -` ate,ZIP Telephone
SECTION 6c WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M G.L.c 152.§ 25C(6))i= ri---�
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 .......... ❑ No........... ❑
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 (Atn r'n RR�1Jt�Q1 ,
to act on my behalf,in all matters relative to work autho d by this building permit application.
J< S6V1 0 c 16 �
Print Owner's Name(ElectroniE
gnatureT I Date
-SECTION 7b OWNEW.OR AUTHORIZED AGENT DECLARATION "
By entering my name below,I hereby attest under the pains and penalties of pepury that all of the information
contained in this application is We and accurate to the best of my knowledge and understanding.e -
Print Owner's or Authorized Agent's Name(Electronic Signature) r-- Dates e
a w L L...t...:.
Gr .v ,„! a s. .. _.."t:. : ...� - `._!NOTES _ `^d ..rn„
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.eov/dos
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basementlattics,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"
�. CITY OF SMETNi XLksSACHUSEITS
• BL'IIDPIG DEPARTMENT
120 W ASHLNGTON STREET,Sao FLOOR
TEL (978) 745-9595
FAX(979)740-9846
DRISCOu
x1amERI.EY
MAYOR DIRECTOR
Sr.P�.RRE i
DIRECTOR OF PUBLIC PROPERTY/BUILDLNG CONDUSSIONER
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information ) Please Print Leffibly
s Name(BusinuOrganizatioN /1lndividual):
Address: PQ NX 4Q
City/State/Zip: b 1" Phone fie �1 SC qZ'1 S9 (u
Are you an employer?Check the appropriate box: Type of project(required):
I.LI am a=player with_1 4. ❑ 1 am a general contractor and 1 6. ❑New construction
employees(full and/or part-time).' have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet.t 7. ❑Remodeling
ship and have no employees These subcontractors have S. ❑ Demolition
working for me in any capacity. workers'comp.insurance. 9, ❑Building addition
[No workers'comp.insurance 5. ❑ We are a corporation and its
required.) officers have exercised their 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions
myself.[No workers'comp. c. 152,§1(4),and we have no 12,❑ Roof repairs
insurance required.)t employees.[No workers' 13.❑Other
comp.insurance required.)
•Any applies emu chocks box el mutt also fill out the sectim below showing Ihca workers'compensation policy infurmadon.
+I imxownen who submit this affidavit indicating they arc doing all work and thm hire ottnide controcmes most submit a new affidavit indiating_such.
'Commuta that check this box most attached an additional shell showing the nante of thtt subconuacw a and their workers•comp.policy infnmution.
I um an employer that Is providing workers'compensation Laurance for my employees. Below Is the policy and Jab site
information. _ \\
InstranceCompany Namc: TCO.YQ.\CCS �(\t�•prr,nl�tn
Policy#or Self-ins.Lic.th t)13—4Zi79 F G 4%—%o Expiration Date: i�
Job Site Address: $4 QCpfNe l S t City/State/Zip: S M k lgl— )
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 u to S1,500.00 and/or one-year imprisonment,as well as civil penalties in the P Y P P� form of a STOP WORK ORDER and a lino
of up to S250.00 a day against the violator. Be advised that a copy of this statemeol may be forwarded to the Office of
investigations of the DIA for insurance coverage verification.
I do hereby 7`1'�cer�dfy under the p� t� /[
a[las�and penah/es of pedury that the fnformaden provided above is true and correct
r.Sia iiiji � C � D�0./V Dole, r 10 [1
G
Pho C#: \_1% 0117) &R
Official use only. Do not write in this area,to be completed by city or town oJJJcial,
City or-Town: Permit/I.1cense#
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#•
Massachusetts - Dcp:n'nucnt of Public tiefct%
Board of Buildin_ Rc_uLttions and $tan(kirds
Construction Supervisor License
License: CS 2123
Restricted to: 00.
GLENN R BATTISTELLI
11 BROADWAY-R/PO BOX 496
BEVERLY, MA 01915
Expiration: 5/24/2012
(' nuni.*iner - Trk 27684
�t����l��><��i1A(/GGfICiTiLV'
1IOffice of Consumer Affairs and usiness Regulation
� 10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 104352
Type: DBA
Expiration: 7/13/2012 Tr# 298688
GLENN BATTISTELLI CONSTRUCTION
Glenn Battistelli
PO BOX 496
Beverly, MA 01915
Update Address and return card.Mark reason for change.
❑ Address ❑ Renewal ❑ Employment Lost Card
DPS-GA1 0 50M-04/04-G101216
�� mm�er Affairs
°stion b License or registration valid for individul use only
�, Office of Consumer Affairs&Business Regulation g y
_ HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
-I{Registration: 104352 Type: Office of Consumer Affairs and Business Regulation
�` I Expiration: 7/13/2012 DBA 10 Park Plaza-Suite 5170
Boston,MA 02116 -
GLENN BATTISTELLI CONSTRUCTION
Glenn Battistelli - -
11 BROAD WAY REAR T.Q. BOX Qo
!t-
Beverly, MA 01915 Undersecretary Not valid without signature
05/16/2011 10:02 9789227650 STERLINGINSURANCEAG PAGE 01
ACORD CERTIFICATE OF LIABILITY INSURANCE OATe(MM/DD"'"")
R - 05/16 2011
PRODUCE
(978) 922-6600 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Sterling Insurance Agency, Inc, ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
306 Cabot street P.O. Box 493 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW-
Beverl MA 01915- INSURERS AFFORDING COVERAGE NAIC R
INSURED INSURER A:SCOttEICIE 1E1 Inaurance
Glenn Battiatelli LLC INSURER B:
11 Broadway
INSURER C:
INSURER D'
BeVBrl MA O191S- INSURER E'
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY
REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT MATH 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 CLAIMS.
INBR ADD' POLICY EFFECTIVE POLICY EXPIRATION LT R TYPE OF INSURANCE POLICY NUMBER GATE MM/DOIYY DATE !! AT T LIMITS
A GENERAL LIABILITY Ces1172209 02/26/2011 02/26/2012 EACH OCCURRENCE $ 2,000,000
X CoIUAERCIAL GENERAL UABILT' DAMAGEE TO RENTED
PREMI9E3 E. o menee S 50,000
DIAIAE MADE 91 OCCUR / / / / MED EXP M ona rem 6 -5,000
PERSONAL&ADV INJURY 6 1,000,0001
OENERILAGOREGATE 6 2,000,000
F13EKL=AGGREGATEUMIITAPPUES PER: PRODU TS-COMpIOP AGO 6 2,000,000ICY JECT LOC
AUTOMOBANY ILE OUABILfTY COMBINED SINGLE LIMIT :
(Ea ar.kgM)
ALLOVAWDAUTOS / / BODILY INJURY
SCHEDULED AUTOS (Pw pere ) 6
HIREDAUTOS / / BODILY INJURY
NON-OYMEDAUT06 (Pere¢Ic(vnC $
PROPERTY OAMAGE
(Per wcident) S
GARAGE UAMUTY
AUTO ONLY-FIA ACCIDENT 6
ANY AUTO / / / / OTHER THAN EAACC S
AUTO ONLY. qGG 6
EXCESSRJURIIELIA LIABILITY / / / / EACH OCCURRENCE $
OCCUR CLAIMS MADE AGGREGATE S
S
DEDUCTIBLE / / / / $
RETENTION S 6
WORKERS Al
EMPLOYERS'LIABILITY
AND / / / / TIT OR
ANY PROPRIETORIPARTNERMXECUTIVE E.L.EACH ACCIDENT S
OFFICERIMEMBER EXCLUDED? / / E.L.DISEASE•EA EMPLOYE S
I Yae,oe6CMM Wglel
SPECIAL PROVISIONS Wow E.L.DISEASE-POLICY LIMIT =
OTHER
DESCRIPTION OF OPERATKINSILOCATIONSNEHICLEVEXCLUSION6 ADDED BY ENDORSEMENTISPECIAL PROVISIONS
Workers Compensation oertifioate will be sent under a separate Dover.
CERTIFICATE HOLDER CANCELLATION
(978) 921-9202 FAX ( ) - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEU-EO EEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT
PAILVAS TO DO 60 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
Dave Soulard INSURER,ITS AGENTS OR REPRESENTATIVES-
84 proctor St. AUTHORIZED REPRESENTATIVE
Salem MA 01970-
ACORD 25(2001108) ®A RPORATION 19811
�,�INS025(otae)w ELECTRONIC LASER FORMS,INC.•(800)3274545 Pape 1 of
- RightFax 141-2 5/17/2011 6 : 56 : 22 AM PAGE 2/002 Fax Server
ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 05/17/2011
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 INSURER(S),AUTHORIZED REPRESENTATIVE
OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT:It the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. U SUBROGATION IS WAIVED,subjectto the
terms and conditions of the policy,certain policies may require and endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
NAME:
PHONE FAX
STERLING INSURANCE AGCY (A/C,No,Ent): FAX
(A/C,No):
306 CABOT ST E-MAIL
ADDRESS:
PO BOX 493 PRODUCER
BEVERLY,MA 01915 CUSTOMER ID If. _
22PSC INSURER(S)AFFORDING COVERAGE NAIC#
INSURED INSURERA: TRAVELERS INDEMNITY CONIPANY
INSURER B:
GLENN BATTISTELLI LLC INSURER C:
INSURER D:
P.O.BOX 496 INSURER E:
BEVERLY,MA 01915 INSURERF:
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.
NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT W ITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED
OR MAY PERTAIN. THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALLTHETERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.
UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADDLSUBR POUCYEFFDATE POUCYEXPDATE
TYPEOFINSURANCE POLICY NUMBER (MMOD\YYYY) (MMBD\YYYY) UM79
LTR INSR WVD
GENERAL LIABILITY EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED $
CLAIMS MADE OCCUR. PREMISES(Ea occurrence)
MED EXP(Any one person) $
PERSONAL&&ADV INJURY $
GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
POLICY PROJECT LOC PRODUCTS-COMP/OP AGG $
AUTOMOBILE LIABILITY COMBINED SINGLE $
ANY AUTO LIMIT(Ea accident)
ALL OWNED AUTOS BODILY INJURY $
SCHEDULE AUTOS (Per person)
HIRED AUTOS BODILY INJURY $
(Per accident)
NON OWNED AUTOS PROPERTY DAMAGE $
(Per accident)
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DEDUCTIBLE $
RETENTION $ $
WC STATUTORY LIMITS OTHER
WORKER'S COMPENSATION AND
EMPLOYERS LIABILITY YIN UB-4250P048-10 06/00/2010 06/08/201I E.L.EACH ACCIDENT $ 100,000
ANY PROPERITOR/PARTNEWEXECUTIVE Y E.L.DISEASE-EA EMPLOYEE $ 100,000
OFFICEWMEMBER EXCLUDED?
(Manaalory In NH) E.L.DISEASE-POLICY LIMIT $ 500,000
II yes,describe under
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/RESTRICTIONS/SPECIAL ITEMS
TILLS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE.
CERTIFICATE HOLDER CANCELLATION
DAVE SOULARD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE
84 PROCTOR ST WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
SALEM,MA 01970 Charles J Clark
ACORD 25(2009/09) 1988-2009 ACORD CORPORATION. All rights reserved.
•Sa47 °nY pq yoz y ✓ i ?4lTr'- RT _"l6:-yy� ra'.,; .;Yl,`n -n .'A,•.,� c ., y._ -,.. .. _
GLENN BATTISTELLI P.O. S
BEVERLY, MASSACHUETTS 01915
PAINTING—ROOFING—SIDING—INSULATION—CARPENTRY (978) 922-6338 (978) 927-8956
I/we,the owner(s)of the premises mentioned below,hereby contract with and authorize you as contractor,to.furnish all necessary materials and
labor and to install the Improvements on said premises according to the following specifications:
Owner's Name. e C ......
o2 C.......' ^. ......................................................;...................Tel......I............................................. ` f `a2 $
JobAddress.......... ..•,...... ................ .:....::............................... City— 1fOV..............:.....State.A%ff .............................
r 1. Secure Building Permit with the Town of
2.All necessary electrical work will be done by a licensed Electrician. �� [�rfnA y�9— O l4el
3.All work is to be continuous. e�
4.A clean job site will be reasonably maintained at all times. i�%C
5.All necessary strapping is included
6.Secure loose wood to obtain an even surface.
7.Allow proper space as to allow for expansion and contraction.
8.Galvanized nails to be used to apply siding.
9.Contractor has all necessary Public Liability and Workmen's Compensation.
10. install.. 0..5�"..C' / G a Of:�C ✓rr f2 �/ . . s%'.. .rL .. / S/'� F �7.............................
P4. I { /�/l �f�/1 -art 'Y � r_ ...............................
?fisriJ7 .r.'yu 2 i1 �.g!/...,.�c 7_2.............
-............................................� ..............//J�
....
4 LsV if:..(36'G'h'-.�
�Jy
..... u' C" Li/7 >�"�.. ............................... ..RI�..... .62 C f ./........f.� f' ..........:...
....................................................................................................................................................................................................�.
.................................................................................................................................................................................................. ....`....j..:�..�....V............
...........................................................................................................::............................................:..............:..��, K.................... ...............
...........................................................................................................................................................................................�' �':.9.d.�.._.....
.............................................................................................................................................................................................. ..... ....... ...............................
..................................................................................................................................................................................................... ................:............:..........
.................................................................................................................................................................................................................................................
Inconsideration of the labor and materials supplied by the Contractor,the Owner(s)agree(s)to pay to the Contractor the sum of
:.............................................................................................................................................................Dollars......................................................................
Payable...................................................................................::..................................................:............................................................................................
The contractor shall be liable forany defect of material or labor only if it falls to repair same within thirty days after receipt of written notice,.but not
otherwise and in no event shall the contractor be liable beyond the cost to it of the labor and material required
The contractor shall be paid by the owner(s),all cost,attorney fees and expenses,In addition to the amount unpaid,that shall be incurred in enforcing
the terms and conditions of this contract and/or any lien in connection therewith.
Owner agrees that in event of cancellation of this contract before work is started,but after expiration of recession period,owner shall pay to contractor
on demand all costs Incurred by the contractor plustwenty-five percent of the face amount of the contract.
i
No work to be done on this property other than that specified herein without additional charge.All parties by their signatures hereto covenant and agree
with each other that there are no representations or promises of work of any nature other than what appears within the four corners of this instrument..
Receipt of a co of this contract is hereby acknowledged.Company agrees to furnish guarantee upon request at completion of contract.
INSURANCECOVERAGE
This contract is subject to strikes,accidents,or other delays beyond our control. -
Glenn Battlstelli Co.hereby agrees to perform all work In a workmanlike manner.Workmanship Is guaranteed to be of the highest quality.
RECESSION NOTICE:You may cancel this agreement if it has been consummated by a parry thereto at a place other than
the address of the seller which may be his main office or branch thereof, by written notice directed to the seller at his main
or branch office by ordinary mail posted, by tele_qram sent or by delivery,not later than midnight of the third day following the
signing of this agreement. See the attached notice of cancellation/for an explanation of this right.
IN WITNE W EREOF the parties taw hereunto signed their names this / O"" day of 201--
Lf ....^ tF�+r ff ...........................................:................................. ..... .......................................
Representative )
r
Accepted:
... .. .....:t,. - OW�1€R:Sig .. ..� ........................................
By....................................................................................................................Signed....................................... ................................................................
OWNER