5 SYLVAN ST - BUILDING INSPECTION � z
The Conunonwe:dth of;Massachusetts
Board of Building Regulations and Standards :1lt
MINI( III \I.I'I %
fY' r VIaSSLIChn5CIl5 State Building ('ode. 7SO CNIR. 7"'edition I'.Sl:
Building Permit ,-Application To Construct. Repair. Renovate Or Demolish a Rri„,d Ato a,i !
One- or Tiro-Fmlril v Dlrrllin,q
This Section For Official Use Only
Building Permit umber: Dare Applied: _�
Signature: -----------
�� Building CumntisSim �'hlspeaor oI Buildings Dale
SECTION I: SITE INFORMATION
Ll Proper v :Address: 1.2 Assessors Nlup & Parcel Numbers
Z VW) —
I.la Is this an accepted street? yes_ no klap Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq 11) Frontage(1i)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
! Required Provided Required Provided Required Proeidcd
1.6 Water Supply: (M.G.L c.40, §54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone? � Muniei al ❑ On site disposal osal sy Stem ❑
Public❑ Private El Zone:
if yes❑ P I
SECTION 2: PROPERTY OWNERSHIP'
Owned of Record:ail E 5 S
i ( V_Q ^ SAY vil
Nmne 1 Pricu) Address for Service: (�
6' q �V ii� 5 - 2� 1
J
amre Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction ❑ Existing Building ❑ Owner-Occupied ❑ Rzpairs(sl ❑ Alteration(s) ❑ addition ❑
Demolition ❑ Accessory Bldg. ❑ 1Number of Units_ Other ❑ Specily:
Brief Description of Prooposed Wo{k-,'�
�0
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
ILabur:md Materiolsl
I. Building 5 OIA � 1. Building Permit Fee: S Indicate how tee is determined:
❑Standard City/Town Application Fee
2. Electrical $ ❑Total Project Cost' (Item 6) x multiplier x _
i
3. Plumbing 3 2. Other Fees: $
4. Mechanical (HVAC) 5 List:
5. Mechanical (Fire
5 Total .%II Fees: 5-
Suppression)
�] Check No. Check amount: ('a,h Amount __._..
j b. Total Project Cost: G a ll a 0 Paid m Full 0 Outstanding Balance Due:____
SECTION 5: CONSTRUCTION SERVICES
5.1y1 Licensed Construction Supervisor(CSI.) F-7'7 33--
/ License Numbei I[.vpuauat U,ue
'�at t• tf C"L- I luld
1 / List CSL 7}pe(See helvw) --
Wdr . Tv e Desa i thon
L L'nreslncied top to 35.000 Cu. 1:1.1
R Restricted I,@? Fanuls Dwelluc
1.,.4.I 1f�_�L4 f-O( /G1 q R1 Rhoden Only
RC Residential R�n�line(•u�crme
Telephone 11'S Residential R'mdua .md SiJnm
SF Residontial Solid Purl liwnut�� 1 s,li;wrc Iintal Luiw�
D Residential Demoli
ti
on
5.2 RA�e ter• llome I ovement C ntractor(1110
Q I_ V Iffl I
lit 1 pun . a ale or HIC Re 1is�m N m R�,tstruuut Nmnhcr
A
9 o I boo
d r .
% - Expiration Dale
7affidavit
Telephone
: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152. § 25C(6))
ation Insurance affidavit must be completed ❑nd submitted with this application. F ilure to provide
esult in the denial of the Issu nce 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, YSbe P OnticAhlin 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.
i nature o wner Date
SECTION 7h: OWNEW OR AUTHORIZED AGENT DECLARATION
1, 0 I I n 5 � Zo r F j�- as Owner or Authorized Agent hereby declare
that the statements and in brmation on the foregoing ap •ation are true and accurate, to the best of my knowledge and
behAr'e;f
Prin _ 1 � 1,(/_ 07
Signner or uthorized.Agent Date 7 -
(Signed under the pains and penalties of perjury)
NOTES:
I. An Owner who obtains a building permit to do his/her own work, or an owner who hires tin unregistered contractor
(not registered in the Home Improvement Contractor(HIC) Program), will not have access to the arbitration
program or guaranty fund undef M.G.L. c. 141--A. Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I IO.R6 and 110.115. respectively.
T. When substantial work is planned,provide the information below:
Total flours area(Sq. Ft.) tincluding garage, finished basement/auics, decks or Porch) -
I Gross living area iSq. Ft.) Habitable nxim count
Number of fireplaces Number of bedrooms
Number of bathrooms - Number of h;tlDhaths
I'vpe of heating System Number tit decks/porches
Type of cooling System Enclosed Open --
3. "Total Project Square Footage" may be substituted for 'Total Project Cost"
J
• 2
CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
e.V7F Rill UHlit , Il
I'J\VKI uNr,lug ti t of h I SA f d4\t.u'ur I n ,r I :,
l'i is It, Ftx: 7 8•'a='18an
Workers' Compensation Insurance Affillmit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Leeibly
,V:Illtt' I nu,nn•es t hganitatlon htdn,Jual.t: A T A S e-rV(VcS, --Tr)O-
Address: 115 tIJQ h SIYe e+City,State;Zip: C-6 11M M8 D19-70 Phone #: (17 )
71� I - 0) 1 ;Z)-I
Are i on an employer:'Check�the appropriate box: Type of project(required):
1.5 .1 am a employer with-�1 l— 4• ❑ 1 am a general contractor and 1 6. ❑ New construction
employees(full andior part-time).* have hired the sub-contractors
2.0 I am a sole proprietor or partner-
listed on the attached sheet. t 7. ❑ Remodeling
ship and have no employees rhese sub-contractors have 8. ❑ Demolition
working for me in any capacity. workers'camp. insurance. q. Building addition
]No workers'comp. insurance 5. ❑ We are a corporation and its
fi 10.❑ Electrical repairs or additions
required.] officers have exercised their
3.❑ I am a homeowner doing all work right of exemption per MGL I I.❑ Plu g repairs or additions
myself.[No workers'romp, c. 152, §1(4),and we have no I'_. oof re airs
insurance required.] employees, [No workers' 13. Other
comp. insurance required.]
'Ally applicant that checks box a 1 must also fill out the section below showing their workers'compensation policy information.
t f lumeuwners who submit this affidavit indicating they are doing all workand then hire outside contractors must submit a new affidavit indicating such.
:Contractors that check this box mustattached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
l am an employer that is providing workers'canrpensation insurance for my employees Below is die policy and job site
information. /
Insurance Company Name: 'lE. Tr�V t42 ,I
Policy Of or Self-ins. Lie..#: 1_ 02�ly1, ,J,,� Expiration Date: L
job Site Address: , )I I VG n SI r Q Ciry/State/Zip: FFF O I�0
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,NIGL c. 152 can lead to the imposition of criminal penalties of
line up to S 1500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to S250.00 a day against the violator. Be advised ifut a copy of this statement may be forwarded to the Office of
fit cstigaltons of the D[A f'or insurance co%crage verification.
l do hereby certify at r r e rains nd penaltiesc of perjury that the information provided above is true and correct.
5ie11:11ure: l Date: /� —®
1'h ntc =
70fflcialuse only. Do not write in this area, to be completed by city or town officiaL
Gtv or 1-nwn: - -----..-.------..--- PermitiLicens #-------.-----
fssuing Authority (circle one):
1. Board of Ilealth 2. Building Department 3. C-ityrown Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
s
Information and Instructions
\las.achusens General L.;ms chapter I5' rcgmres:dl employers to pros ide workers' compensation fir their employees.
Ptu's u u. u In this.ta me,.m rnrPfgr'ee is defined as".. c%ery person in the set ice of another under any contract of hire.
,•y+ress or implied,oral or written."
An "nrp/grer is defined as"an indn[dual.partnership.association,corporation or other legal cmity. or:my two or more
of the foregoing engaged in a joint enterprise,and including the legal representatil es of a deceased employer,or the
rcceit er or trustee of an individual,partnership•association or other legal entity,employing employees. l luwe%cr the
uw tier of a dwelling house haw mg not more than three apartments and who resides therein,or the occupant of the
du eII ill e house oranother who employs persons to do maintenance,construction or repair work on such dwelling house
or tin the grounds or building appurtenant thereto shall not because of such employ ntcnt he deemed to bean employer."
\1(IL 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 cornmunwerlth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Addirionally, SIGL 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 e%idence 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-contractors)name(s),address(es)and phone number(s)along with their certificate(s)or
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 till out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permiVlicense 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 tilled 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 burn leaves ete.)said person is NOT required to complete this affidavit.
The of 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.
file Department's address, telephone and tax 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
Ito,iscd -,6•05 Fax # 617-727-7749
www.mass.gov/dia
�— `lassachusetts- Department of Public Safet,
Board of Building Regulations and Standards
Construction Supervisor License
' License: CS 57733
Restricted to: 00
CHRISTOPHER ZORZY
115 NORTH ST
SALEM, MA 01970
Expiration: 526/2011
f ('onuniesinner Tr#: 14751 I
_. .�-_.�—...-.. ...... ..._..... ,✓ '. J r E
- - - --•--"' - __ � � Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registration: 101609
vpiration 6/2fi2010 Tr# 257870
_Private Corporation
A&A SERVICE
hri S,iNr__ r_'_L
Cstopher Zorzy; = ;
115 North Street
Salem,MA 01970 Administrator
Commonwealth of Massachusetts
Division of occupational Safety
- Lava M.Madin,Commissioner
Deleader-Contractor
CHRISTOPHER ZORZY
Eff.Date 04/01/09 jab, ,
Exp. Date 04/08/10 _
DC000440
Member of U.N.ES.T.
BO
IIII � III I i'/ I IIII II II BOSTON-RENEW
` y
DISPOSAL 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 facifity as defined.by M. G. L c. 111, Sec.
150a.
The debris will be disposed at Salem Transfer Station
owned by Northside Carting
Signature of Permit applicant
—Date'
CEsristo9her Zo
Name of Permit Applicant
A &A Services Inc.
Firm Name
115 Forth 1tree+ Salert 6�fA 0i5r0
Address, Cray, State, Zip Code
r -
y ' { AGRd ('�wear, A & A SERVICES, INC.
S l�ll LIGE 115 NORTH STREET,SALEM,MA 01970
o If IYA I=I ITA 1 e ' • Telephone:(978)741-0424 Fax:(978)741-2012
Contractor Registration No. 101609
Federal EIN:04-3090162 Construction Supervisor No.CS057733
CUSTOM REMODELING AND IMPROVEMENT AGREEMENT
Buyer(s)Name Date of Contrail
,7oE Cov NLiN 1 / —13 —10
Buyer(s)Street Address,City,State and Zip Code
ST S9c.FM , M4 01970
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 on me accompanying specification sheets,in accordance with
the prices and terms described on the from and the reverse of Nis agreement and any specification sheets(this"Agreementi.and Buyers)have requested that such
goods or services be Installed or provided at Buyer's address listed above. A&A Services,Inc.("Cord ecrai hereby agrees b install or cause to be installed the 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 Buyers)agree to pay in
cash the cost of the goods and services purchased as describe tl h�gr in,regartlless of timing or approval of any financing Buyer(s)may seek for their purchase.
i
=/r-
3Q 82�5�n —
Purchase Price: Z y t"WDent V- /��aA� = ii y (O,r Est.Starting Date:z-/y 2-30
Down Payment: 001 __/CIF ((,'/y/CrW ZO/Oy�It'7 a Est.Completion Date:Z�30/c
�— u rarYL
�j�S DfTb JC
CqurT6-n5 = 2/zYB, ocash
Amount Due on Start of Job: check
a A//L Sys�7L5 = 300a Q Credit Card
Amount due on of Completion: No.
Amount Due on_of Completion: Expiration Date:
Balance Due on Upon Completion: /7&6yn to CVC Coda:
it is agreed and understood by andbetween the parties that this Agreement,front and 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
Buyers)hereby acknowledge that Buyer(s)has read the front 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(if)request that they be contacted via their
telephone numbers or a-mall,as listed above, in the event Contractor believes Buyer(s)would be interested in any additional quality
products or services of Contractor. DO NOT SIGN THIS CONTRACT IF IT CONTAINS ANY BLANK SPACES.
6&A Services,Inc. �! . /1 C (s)
Signature nUQ�..(Yt.�� /1-'"Signature
Print Name nt Name
19 C _
Si
GF4L1.)
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
AfermaniON:TM wrNaMr antl Vce Mneowmr hmeEy mubally eBree i^etivanw Xul In th ewm e11Fer pact Ffla a tliepule drcemin0 N®wntreG4 eXM1er pact may wEmi1 wcM1 Eisprle b
e given eaden bn a veil i Mllctr M¢Men el>P'mretl tlY Ne Secrebry oI Ne ExmNve OR oI Caruumar AXelrs enO Business ReeuWlbrs eM Ne aNer fwrly sM1ell Ee regwntl b auEmM b
6ufJi 0211n11nn ffi pgvetl In M.G L 410YA.
peruiliW: � Buyv'v Ni
NOTICE l eTnN [)T OF AN$
bale or Tereareor .Yw my cancel Ctle l doN x W any PenwM or oale of Transaction/—/L/0 .You may rennet bad amisaelion,wNbm any perelty or
oaiBaMn,wlNin Nde buapentlayslmm tlw eeew eau.XynewerietenyprooaMlretlm r, odrvBeuon,wnnr Nrpe MMnan Myelmm Ne eMn tlata."you dnnl,anywawMeatlardid .
eM peymmN mesa ay you ulber Ne Conlnq orSW,aM eMneB011ede inetrumem mlecuutl gato ass metlegaften1 mtlw Conhel orader bMen'falynepoMdelMrvmemeaecurs,
Lylou MllMreWmetlwXFiung oflolWwing remipldd fookelr pl yOur a cause.
and an WlMreWmetlwMin,ous 0 Mefol hangecand by a adneard,Mur ubusellv,mm�,
act act Bew.adBeraftrofyur of retr diout'IoperaderbedM. Ilyou tercel.ypemnl and any eecudy fund senin youlmpr NennWianwlllMmnnllad.Myef e9ndl,you meet
make CMlWemed Seller under recarrel or
ally Bs eoM mMiwnu WNnmvawi, any goods daBNtltlo you underroos cane.bdept or Sed;oryou m,oa,be oyou Yeah,
comply wlan ish
Me
aMunions of Meedbyoundia,M carrier Sak:myoumw.at ff
wed.iefore rpywM nd narrowed,
oferetler mother M Ca UMardir5ak;wrou a ad Me,
tOmreunder and
i L�.
u d Nated In re9es.i al rellml eMe Sate r are Orotls l Ne Sefor eryeree antl iwhucdoo,el lire ad Me oadinfl Ne velum Wpmmr cal ne BOMB le, .net evperee antiv tlo make ata Bootle Read o N NB ae4m antl Ne sells don rot pC.Nam up risk tl yuu tlo make a OOMo Nodure of co Ire aellm eM Ne SaI in does n01 pif rem updeyaMlMdele olywr NatiuMCmxallelun,pu rtuy retain or diapuse of re Brotle WNIn 2p tlysdlM tlale el your Nofce al CancelWon,you may retain or tlispve of Ne goWaNMNouMMIurnalts Ipe4m.ne BWtls w tho safer act col to do n,then yut remain Idea far performance of all b realm Ne gnE b IM Seller antl lyl b tlo de,Iran yw eman Ideas br ndormenoe of allandertheConoen TownnlW Vmgnlion,m lmdelrveraslpnwaWdalatlsyynlblbn notiedoranyoMmern en nWb m eeM a teleprem b ABA aerNcee 115 of Ne cenodiabot road or act ovok enden rofee neeM a bleprem.b A&A/Servin_g 115
m,Salem,ManaMu¢Me 0100,NOT IATER TITAN MIDNIGHT OF — "'yV Nwr Sont Ealem,Masvechended 019T0,NOT IATER THAN MIDNIGHT OF�(Dale) (Cae)
CANCEL THIS TRANSACTION. comererlaymWm Dab I HEREBY CANCELTHISTAANSAeT'ION. Omuumerk SipnWre Dab
P
AGrod
Sn.lm A & A SERVICES, INC.
E'E; i!'lam 115 NORTH STREET,SALEM,MA 01970
e e e Telephone:(978)741-0424 Fax:(978)741-2012
Contractor Registration No. 101609
Federal EIN:04-3090162 Construction Supervisor No.CS057733
MISCELLANEOUS SPECIFICATION SHEET
Buyer(s)Name Date of Contract
JOC r 5#er_-1C- Co HC,JA1 /- )3 -/G
Buyer(s)Street Address,City,State and Zip Code
S 5)L VAN S i Pn)9 61970
Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address -
978-7yS-^$�/S
The Guyette)listed above hereby jointly and severally agree to purchase the goods andlor services listed below,in accordance with the Canes 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 pan.
SPECIAL ICTIONS
DF7!%/1sa�.T �)
'QC)M1'1 L7YN f D/SQOSE aE &24"t Z bl/C LO SF��
' �cuR 3 N 3 / corvc2e 7 )rv�77/V6fS 7D CC1J&r_,
' /NS`i79LL AJe} J Q2.e-SSv2E 7r0g7FD DLr.K fieu 9-,
l llys 7tlkL A/L°w P2e35vp_ 7AeJ1-7&_0 ;Fi/� 09Z lkIA/(7 AIV4 2 x yl
9,41VO&41LL5 pti /-1w 6i,7Lv.5 7A2S /NCLV,003 J LS an:-0 CAP5 F-z7,2 A-S7-,)
f, It
° CPA/2 SiOE WMA, S%II 0977J/AI q AND RE-S70E 6 s/OE aF /bon g
Gu/T7{ EXIST///✓t��nNc`h/ GED.'3� lMPFEsS/rnU5 5)o/n/y .
' %NS77�LL 2 XY r2PTSc-/Le _/Z017PO FA14Me /e/L GoWEYL 7)27M
,*vD /N5 7??LL- PRwAa Ll (A77/cE 7Z 77,7,m, Pc z'2i Fi27�na[
L.OWOL 7-P-/rv1 W17Y /x8 APEK 9019RD ,
AlfV ASP/tALT ovf-
• rQEI+'!O ✓e r Dispose of Falri� - Pex,F /.veLuo//�e� 3�ck Ago/nvnl
/N SELL NL53U 2 CDx A 11WOV-D TO 400r- D6ZX a
/A/Sr7}LL (o /dC,t1-V �7I'7'L McM&CANE' 73 agSe o/ RoOF Derck
/NS i RGL /SL3 FEt l` Of)PEYL TD �3 7 OF Deck,
• /N5 73ZL A v 8" t)&/P LFVyE 420vNo
/A/57271 L, NG'YQ vIR__A17_ B9aT5 7-0 UeYVI- Mrs , //y57Yf-GL Iyew L.&W
A?,6UN0 CHIMA/97J (pp/A/7 //VC7 N0T )NCL_aOe'D,) //ys Nan✓
.3
c_c,6 ;o y/L Ce7z-x7r�v �'Y, 3773E sl//Nr;L� 73 /�c�F®�k aw 6c.�l)
ou_57 41 I, y lrvf,/ o3 z l f/9t,� 4z_ rowA vAi GvT/ S 4/77L�'L 7a Exr f'7i2
)�f F, A/Eyv x y O��t•v vSPC v7-s /JV Cc L vO' wi rer sys rsrvl.
1/1A.GH '5hurlpr s
e /N57)ILe- 0-) ve)v pH/25 d GUn�� C/I!:/i2D/N U/N�jL 51t(vi-IMLs 7-0
"A" 5/ocr dP AleME,
It Is agreed and understood by and between the Casettes that this Specification Sheet,along with CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,eonstnetes
the entire understanding between the parties,and then are no verbal understandings changing or modifying any of the terms.This cornered may not be Changed or its
forms modified or varied in anyway unless such changes are In writing and signed by both the Buyarm)and the Contractor. B ra hereby acknowledge that Buyers)
has mad Nis Specification SSh/heaL� lir<.(v ,
Contractor Initials: Ur/ Date: I-13—I0 Buyer's Initials: Date: xx rx 0
i