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37 WINTER ISLAND RD - BUILDING INSPECTION (5) The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF Massachusetts State Building Code,780 CMR SALEM Revised Mar 2011 Building Permit Application To Construct,Repair,Ren emolish a q One-or Two-Family Dwelling ovat 0% This Section For Official Us y Building Permit Number. Date App ed: Building Official(Print Name) Si a c 'Date SECTION 1: SITE O N 1.1 Property Address:vs) (n��-�, 1.2 sso ap &Parcel Numbers '2`1 �iC,-1'F)r \S�QiK1t 1G(� 1.1a Is this an accepted street?yeses( no Map Number •Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq R) Frontage(It) 1.5 Building Setbacks(it) 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: Zone: Outside Flood Zone? Public❑ Private❑ — Municipal O On site disposal system ❑ Check if yes0 SECTION 2: PROPERTYOWNERSIHP' 2 L Ownerr of Record: `,Qlat--kN.)T( V-OAEQ ? I'D �t A 1, 0v— MCC)Q Name(Print) City, //State,ZIP No.and Street I CZµ,.; Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s)`gj I Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units_ I Other ❑ Specify: Brief Description of Pro sed Work2: {-eRr- (JCA&. ' ) eyk S-F nq- al�(Y m-A' CeY\a SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ �� 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑ Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Su ression) Total All Fees: $ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ 3 DOD ❑Paid in Full ❑Outstanding Balance Due: 1-1616. Z'a AJ Wooer SECTIONS: CONSTRUCTION SERVICES S.��I/,C�enelruaebn SupeniwrWttax(CSL) Q�L 'Z41 fs `V•lC1XQ 6('l l[[f.l .._.. . __ I:cmro Nnmhcr r:aplmtinn nnc Nnmo nfecC lkldu C� ,, /�j/�� lln(29nICIW nuilain• u m.}$Nat qi,J. N st-1 _ �,]4{iR_ ._— N ua.mcul lA2 famuv l>welrn IA City!fmmna..$nte,)If M Manury RC Roofm Covarin wS I windme and siding St' Wid fuel Wming Aylrlianms _- I lamlrlw, 'rdctrh.am Lmvl oaArea. -- D Uundiliw. I fllatrrod Fla.IImp,mvmml Cnntriselor(HIC) ��� 1�v411znyNamacorlCrt„i 1'1IC Regimnains Number Kim iim Dale p�nyNaroeorli1CtltBzemtNamcltreutEm9ilcould. vo :cote.%IP rai MaeECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.I.e,I$L§3SC(6)) C'omprneation laswntee effi b.,4,m.i.,Mnompleted wW xulwniunl vita JUy application. rAum a.provide dacit Will rewh in the tlimial of Use I:nusnee nl'Jtc t Ailing permit. Signed Affidavit Attached') Yeu.........1� IIn...........0 SEC'T(ON la;OWNER AUTHORIZATION TO BE COMPLETED W I.Ia:N OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDINC PERMIT 1,a.Ownur of the subject property,hereby amlwnze�� (,`1(IY� to;wl on my behalf,in all mmun fubdi9u to work authorized by thi9(wilding pemlil application. Ca\:1Q ldh wit ul� w 0 J we c•L Print Owner'•Nutte(Elacnion c Sgutura) SECTION lb:OWNER'OR AUTHORIZED ACFYT DECLARATION Ov entering easy nootc Wbw,I hash.unuxt mdn nor dcuus and penalties of perjury Jwt all ullhe iulbnnutimt eon siiuidled in this application is We ad aceumle to Use hest of my Lmwictlge nud undmiunding, rim un — ... post a of Audn.dzml Attest'.Nawe(ll<aliolie Siguoure) Data NOTES: L Ali(I wr%vlto obinbm a building daunt to do li Mer wen wears•or on tiv ncr who himv to nnrctti.tere(l wntrnetor (not tegintu,Of in the Htnuangnuvemantl Cunlmewr 0i1c)program).will AM love".cs.It.die 1lrbiemtiml itu(trum ur gwrmy fatal wtdn M.G.L.c.)12A.Othu+:mpnmm infommiwn on the IBC Pfogruw sun h 1'ntwd nl y.nwtttwv.aovnra lnfermolion on the Construction Supe"mm Lien.can lino fn.md n1 uauv mnra nncgl r. 2. When*ulnWmial work is phuutud,provide the infonmtion Wow: Total floor area(aq.IL) (including garape.finned haecmad!allicq tksku or pomh) Gross bvi%area(aq.A habitable room count Nunher of nraplaea+ Number of bedrooms Namur M•balbrooma ... Number of lwl(fiotlla ._ ....... Tmiu of Iwatiog xyxe:m Nu.nlcr ardecl./porches Tvpe of cooling yatem___. linclo9ed CAaill 1. —lotul Project Square Fooingc'trmy be substituted In,'Toul Pnject Cos" E d 8S18ZE08L6'ON/6L :SL '1S/OZ:SL LLOZ 6Z Nnr(03M) SAOS Jo; awoN Jawwnid NOHA SECTIONS: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) -2- ' 1 _ c��aXCjlll�i'1 License Number Expiration Date Name of CSL Holder List CSL Type(see below) o.and Street T Description Unrestricted(Buildings up to 35,000 cu.R. R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5. Registered Home Improvement Contractor(HIC) cad Sm-rah HIC Registration Number xpiration Date HIC pany Name or HIC Registrant Name -ASit(r � 111�f- d Street Email address Ian__ C(-I� ,Ni c 3� gqg 44 _ Citv/I'own State,ZIP J Telephone 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. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes ....... 1. 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�� (_� �; �`-3C%\A CTt C?0 to act on my behalf,in all matters relative to work authorized by this building permit application. (a �2G\�11 Print Owner's Name(Electronic Signature) Date SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. 2C"" H IDIza� 11 Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: 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 m3yE mass.eov/oca Information on the Construction Supervisor License can be found at LA .mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq. ft.) (including garage,finished basement/attics,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 &UF.,\4 .L%'LxSSACHUSETTS • BUILDING DFPARTCNT j t V W.kSHNGTON STREET, r FLOOR TEL. (978) 745-9595 FAX(978)740-9846 KIdBERLEY DRISCOU. ;MAYOR T Ho&w ST.Pmxm DIRECTOR OF PCBUC PROPERTII/BuI DLNG CM12MISSIONER Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Anplicant Information Please Print Legibly Name (Businestiorgani:ationAndividual): l,)Oclo CQL, �I chi al \f\C-. Address: �= `X:� \"lCoq City/State/Zip:`3CAo.t--1 . t.)k-c C9ip---p Phone t#: act �� flfr&F, Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with.� 4. 1 am a general contractor and 1 employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction2.❑ 1 am a sole proprietor or partner- listed on the attached sheet: 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers'comp.insurance. 9• Building addition [No workers comp. insurance 5. [] We are a corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their 3.0 I am a homeowner doing all work right of exemption per MGL 11.0 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' comp. insurance required.] I3.®Other G11c � ( *Any applicant that dU%*S bon 81 most also fill out the section blow slowing their worker'compenwion poli y infumrtim 'I toms:ownem who submit this affidavit indicating they are doing all work and then hire outside comractms must submit a new atdavit indioing strch :Comr ;umt that Lhmk this bwt must anxhed an addidord sheet showing the name of the subcontmdtxs and thei t workm'comp.policy intamuim. l am an employer that is providing workers'compensation insurance far my employees. Below is the pulley and fob site information. Insurance Company Name:_ LLDGc mu-- PolicyPolicy u or Self-ins.Lie. #t t JGo'33\S�:7--;�kctC)a I Expiration Job Site Address:/�—) LA);nr r in)i_ X bA V City/State/Zip:—"0— 0t l AAA 0\q--)0 ,mach a copy of the workers'compensation policy declaration page(showing the policy number and expiration Irate). 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 S1,500.00 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 that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. l do hereby certify under the pains and penalties of perjury that the Information provided above is true and correct Sien...._..!a� Dole:. (R���`O o g� OKieial use only. Do not write in this area,to be completed by city or town official City or Town• Permit/License t# Issuing Authority(circle one): 1.Board of health 2.Building Department 3.Cilyffown Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other— Contact Person: _. Phone q• CITY OF S�ULE; , l'L'�SS.ICHL�SETTS • BUMDIING DEPART\IE.v'T 130 W ksH ,NGTONI STREET, 3' FLOOR TEL. (978) 745-9595 FAX(978) 740-9846 KI.-,iBERLEY DRISCOLL INfAYOR THomAs ST.P[ERRB DIRECTOR OF PUBLIC PROPERTY/BUUMMG CONL\RSSIONiER 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 from 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: (name of hauler) The debris will be disposed of in : L L -'� S (dame of facility) �al_SLM t\ru (address of facility) signature of permrt applicant Q29 date debrisafP.dw to t0® DATE IMMIODIYYYY) CERTIFICATE OF LIABILITY INSURANCE 3/9/2011 PRODUCER (603)432-6414 FAX: (603)432-3852 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Financial Insurance Services Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR PO Box 950 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Derry NH 03039 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A:Peerless Insurance Co A J Wood Construction Inc INSURER B: PO BOX 1769 INSURER C: NSURER D' Salem NH 03079 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 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 OPSUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POLICYEFFECTIVE POUCYEI(PIRATION LTR NSRC TYPEOFINSURANCE POUCYNUMBER DATE MMmDIYYYY DATE MIDDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 X COMMERCIAL GENERALLIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 A CLAIMS MADE I—XI OCCUR P8706685 8/16/2010 13/16/2011 MED EXP(AM one person) S 15,000 PERSONAL B ADV INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 GENT AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGO S 2,000,000 -XI POLICY PRO- LOC JECT AUTOMOBILE LIABILITY ANY AUTO l O aBCNMeOI SINGLE LIMIT S 1,000,000 A ALL OWNED AUTOS nAR693505 7/8/2010 7/8/2011 BODILY INJURY dXXX SCHEDULED AUTOS (Per Person) S HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) S PROPERTY DAMAGE (Per accident) S GARAGELWBILTTY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN EA ACC I S AUTO ONLY: AGG S A EXCESSIUMBRELLALIABILITY EACH OCCURRENCE S 3,000,000 X OCCUR CLAIMS MADE AGGREGATE S 3 000 000 e0209e 10/19/2010 0e/16/2011 s � DEDUCTIBLE S X I RETENTION S 10,000 S WORKERSCOMPENSATION WC STATU- GTH- AND EMPLOYERS'LIABILITY YIN TO S I I ER ANY PROPRIETORRARTNEWEXECUTIVE❑ E.L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? (Mandatory In NH) EL DISEASE-EA EMPLOYEE S If yes,describe under SPECIAL PROVISIONS below E .DISEASE-POLICY LIMIT S OTHER DESCRIPTION OF OPERATIONSI LOCATONS I VEHICLESI EXCLUSIONSADDED BY ENDORSEMENTI SPEC WL PROVISIONS CERTIFICATE HOLDER CANCELLATION _., SHOULD ANY OF THEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Sam Fragala/PAT ACORD 25(2009101) ©1988-2009 ACORD CORPORATION. All rights reserved. INS025(200901) The ACORD name and logo are registered marks of ACORD {,! sz A CORD. CERTIFICATE OF LIABILITY INSURANCE GATE(MNR D YYYY o3/os/zo11 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Matthews Insurance Agency HOLDER. TH S CERTIONLY AN FICATERDO IGHTS S NOTAM ND,UPN THE CERTIFICATE AOR 182 Parker St ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Lawrence,MA 01843 978-681-1112 _ INSURERS AFFORDING COVERAGE NAIC# INSURED A.J.Wood Construction,Inc. INSURERA: Libertv Mutual Ins. P.O.Box INSURER B: Salem,NH 03079 NsuRERc: IW^URER O .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 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 CLAIMS. , Xi6R D POLICYNUMBER POLICY EFEEOTNE POLICY PXPIRATION - ITS rFRODUCTS.COMPIOPAGG ENCE S GENERALOABILITY COMMERCIAL GENERAL LM1UTY yccwDnce7, E CLAIMS MADE 71OCCUR nn pereonl f , OV INJURY S R£GATE x OENLAGGREGATL-LIMIT APPLIES PER: OMPIOPAGG S POLICY PRO. LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ IFS A[eWBnU ANY AUTO ALL OWNED AUTOS BODILY INJURY E (PA,pmean) SCHEDULED AUTOS HIREOAUTOB BODILY INJURY S (Par oaWonll NON-OWNED AUTOS '— PROPERTYDAMAOE E (Per nrddenl) GARAGE LIABILITY ALTO ONLY.EA ACCIDENT ANY AUTO OTHER THAN FA ACC x AUTO ONLY: AOG E MCLLASIUMBRELLAUABILIVY EACH OCCURRENCE f OCCUR n CLAIMS MADE ADGREGATE S _ b _ DEDUCTIBLE - f RETENTION S _ S WORKERS COMPENSATION AND WC2-31S-353819-021 02/23/2011 02/23/2012 EMPLOYERS'LlAsUffY E,L,EACHACCIOF-Ni S =000oO AWPROFRIETORIPARTNERJXECVTNE E.L.OISEASE-EA EMPLOYEE S 500.000_ OPFFICERIMEMBER EXCLUDED? SPEC AL ROVIBoids lrel� E.L DISEASE-P000Y LIMIT x SO 000 OTHER OF-SCRIPTgN OF OPERATIONE I IACATION$I VEHICLES I EILCW SIGNS 400ED R'r ENDOPSEMCM T 9PEGAL OILOVLBION4 CERTIFICATE HOLDER CANCELLATION SHOULD ANY or THE A6oW DE&CR18ED PDLIcIES BE CANCELLEO BEFORE THE EXPIRATION BATE THEREOF,THE NiSUING INSURER WILL ENDEAVOR i0 MAIL_DAYS WRITTEN _ - NOTICE To WE CERTIFICATE HOLDER HMdED TO THE LEFL BUT FAILURE TO DO SO 9XALL IMPOSE,NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR - - REPRESENTATIVES. AUTHORRBD AT ACORO 25(2001106) / A ACORD CORPORATION IVOU r Office of Consumer Affairs and Business Regulation i 10 Park Plaza - Suite 5 170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 106603 Type: Private Corporation expiration: 7/24/2012 T&- 297944 AJ WOOD CONSTRUCTION, INC. — Richard Smith PO BOX 1769 SALEM, NH 03079 Update Address and return card.N-lark reason for change. Address -1 Renewal 7! Employment Lost Card ors-c.Ai s Office of Consumer Afflirs&B shiess egu ation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 105603 Type: Office of Consumer Affairs and Business Regulation Expiration: 7124/2012 Private Corporation 10 Park Plaza-Suite 5170 Boston,iV*1A 02116 ATW000 CONSTRUCT tON.INC. Richard Smith 4 RUSTIC LANE DERRY,NH 03038 Not valid without signature Commonwealth of Massachusetts 'tx Division of Occupational Safety 11 HeatharE Rorie.Acting Galvinesimer 70882 Deleader-Contractor -to: Go RICHARD S. SMITH 7—� Eff.Date 06/23/10 RICHARD J SMITH Exp.Date 07110111 P0 BOX 1769 00001 721 SALEM, NH.03079 so (IfI 'I II 111 I 19314 712812011 11 oil I ------------------------------ ----------- 0/ Telephone: (603)998-4468 CONTRACT Cell: (603)235-7624 Toll Free: (800)459-44" Fax: (603)8986942 A.J. WOOD CONSTRUCTIONS INC. P.O. Box 1769 Salem,New Hampshire 03079 Email: info@ajwoodconsbuction.net Website: wwwajwoodconstruction.net ROOFING a SIDING•WINDOWS a DECKS•KrrCHEN&BATH REMODELING Workmen's Compensation and General Liability Carried on All Work Date_ June 29.2011 1 (we), the undersigned, hereby accept your proposal to furnish Labor and Materials to perform the following work on premises located at the following address: No. 37 Winter Island Road(The Plummer Home For Boys) Salem tviA 01970 (Street) (City) (State) (7ipcode) Owner's Name do Jamcs Lister Tel._(978)774.1099 Address SAME AS ABOVg Email lwi well mmerhome.o 6n cow k/ S me-e Left {rortZ • Tear down existing chimney and rebuild new chimney $3,000.00 • Transport lift $500.00 The contractor agrnS to perform the work furnish the materials and labor specified above for the Total Sum Of$3 500 00(Three Tho usasd Five Hundred Dollars and 00/00) _ Pavmeats will be made according to the following schedule: _ 113 due with signed contract. S 1.750_00(One Thousand Seven Hundred fifty Dollarg and 00/100) Balance Due When Project is 1001/ Complete$l 750 00(One Thousand Seven Hundred Fifty Dollars and 00/100) Required permits — The following building permits are required and will be secured by the contractor as the homeowners agent. Proposed start and completion schedule will be adhered to unless circumstances beyond the contractors control arise. The contractor will start the project within 30 days and the project will be done within 60 days of the start day. (') Including all fuunce charges (••) Law requires that any deposit or down payment required by the contractor before any work begins may not except the greater of(a) 113 of the contract price or(b) the actual cost of ally special equipment or custom made material which must be special ordered in advance to meet the completion of schedule. You may cancel this agreement if it has been signed at a place other than the contractors normal place of business, proved you notify the contractor in writing at his/her main office or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing of this agreement.See attached notice of cancellation form for an explanation ofthis right. t d 89IEZE0818'0N/6t :9I '1S/OZ:9t IIOZ 8Z NM(03M) sA08 101 aweN jawtanld NOVA DO.NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACESM Two identical copies of the contract must be completed and signed.One copy should go to the homeowner.The other copy should be kept by the contractor. • All home improvement contractors and subcontractors shalt be registered and that any inquiries about a contractor or subcontractor relating to a registration should be directed to: Office of Consumer Affairs and Business Regulation—(617)973-8700 4 10 Park Plaza,Suite 5170 Boston,MA 02116 Owner agrees that the title or equity in this property is his and is security for this contract. IN WITNESS WHEREOF the undersigned has(have)hereunto set his(their)hand(s)the day and year first above written. Buyer(@)Acknowledge Receiving a Completed Legible Copy of This Contract. This contract may be voided by the Owners giving written notes to the Conbactar by ordinary mail within three full business days following the daft hereof. (Richard J. Smith,President) (Legal owner of property to be improved) 337 Haverhill Rd.,Chester,NH 03036 Plummer Home For Boys FID:20-0487037 WC#: 106603 Z d 99LEZE08L6 '0N/6L :9L '1S/0Z:91 LLOZ 6Z Nnf(m) SAog Jot ailoH jammnid NOSA