1 WOODSIDE ST - BUILDING INSPECTION -�i�� �� ���-�y
� ----- — �hc ('��minum��alth ul �t�s,:ichu�ru� �
� � � IivarJ ul Uml�inE Nr�ul�iiuns ��n� ti1�nJar�� I c lll
.� � t :� ; .. ��I�Vll�ll' \I Ill '
i � �1:isSa�llusr[LsSf:tl� 13Ui�ding (�u�C. 7SU('�1R. 7��� CJili�rn � .ti� ,
�, V• �
. . , l3ui:din� P�rmu Applira�iun Tu ('unctrurt. Rrp�u. R�nor:ur Or I)rnx�li�h :i K� �n� J l�,u�,�n �
Onr- �n T�ru-l��ui�il� �r i � l -�����' �
- ---�
This Secii�m F� Otfi�•ial Us Onl �
—1
13wlJing Perinii Niimhrc :�m r : _ ----- - - __ _ ,I
,�,�,:�����: __ � l d-a i do�-�_ I
— ' — ----. _
I3wldinE Ciinunn.innav In>prr1�r o�13mlJings Ualc _ __—_---_--.....--_'
tiEC"1'ION 1: 517'E IVF'1)R�I:\'I'lON
Ll Properly :\ddress: -1-- --- L? Asse+surs �lap F Nar.el �wubcn ,
_-�W O�d SidG. S� .- - ---.__..- --�� �
'.la Is Ihis an aCreNltd �UrC19 ;c's�_ nu__ M1lap Numbrr P:irrrl \�wnhrr
-L-. — _ —_. —____
i 1.3 Z.oning Information: 1.a ?roperty Dimens;ons:
Lonine Uistri:� PrupuseJ U,r -- (��t ,\rc_I+q �•., .._ I�iun:agt Uil i
_
-__.__.-___ 'I <
1.y Building Setbacks (fU -----�-��-�---,--.-----�-� — � - -�
j Frun� Yurd Suir YarJs _" Rc�r 1�urJ �
! Reyuirrd Fruvidcd Rcy�i�reJ Pruvidrd � RrywrrJ Pni�iJrJ
L -- ,
� E.6 1�'a[er Supply: iM.G.L e. �10. §>�1) L7 Flood Zone Informalion: 1.8 Sewage Disposal S}�strm:
Zonc: OutsiJe Fla>d Zonc'. �iunici �I ❑ On aitc Ji,�ocal + +i�in ❑ I
� 'ruhfic ❑ Priv�ta i7 � Chtck il yes❑ � � }
SECTI+ON ?: PROPERTYOWNERSIIIP�
2.1 Oaner�uf Recxrdi � / (� C)l�� S � I . S y i
T�1bf^CS p` o�e� � -- -- I
�-_�- Address for Srrvice:
I N.urc i Printl . . .
/— ,!n��1��v 5-----
� Sign:�mrr _ Tekphune __ � �
SF..i T10N 3: DESCRIPTION OF PROPOSE'li WORK=(chcck a0 thnt apply) j
Ne.µ�Constn•c!ior ❑ �si:sting Bwiding ❑ I Owner-0ccupied �§� Repairslsl ❑ Alrer.itiun(s) � �\J.liti��;: ❑ i .
�_--' _.._ ------7
�Demohhon (E i ��_cesyury Bldg. ❑ � Number uf Units__ Other ❑ Spiuiy __ � 'i
Briel f'fles;ription �t ^r>posed W��rk':_� .. .�V ZN .. �`....-. - NdNy�.- I,
� l7
t�.�74�_._ _/�-fL�, iN'�"0 Aj—. 2 ���" �i,/'i -�' _
I _--__�'��.fZ�l.s�i, a ..'/.'�7 I
_—__—__'—_ �_'_—" ,
I
'_'___'_.'_'—__—' .' . __ ___.—"_'�
.6:('77C�N a: ES�iit[:!TED COR�STRUCTl�?N COJTS i
; __.___ _ � -.—, — _----- — -- --
i i ,�irr';.< ' C .s.s � . . j
i6.m :i:�:.:i.:� LSC ::O�.Y
, ., I.ah��i ,i�-�d :....::.�,,�,!::1 . - J
;~--- L(/, 1. 6ui!ding Permit Fte: $.___ Indicaie hua Irc i., �c�crinuirJ' .
II 13i��ldin@ � ��G �-- v '
----- — —�O Standard Ciiy/Tuwn :\ppliranun Fee
' 2. F.lectneal y ❑ �n,eal Project Cost� (Ilem G) s multiplier r ___. '
i �' Plumbmg Y NJ j� '. Other Fees: 'S �
1. �bferh;miral IHV:ICI S � Li,r ---------
i
i l. �'�ClhJlllid� IFII'C � — '
. i Sii � fc��u�nl � _I I��HaI All I'ee�: ti
j— i I l'`,rck No. ---ChzrA .\muunc _ (::,h :\m��uni�__ _ .
j 0 ��ut:�l Projccl lbtit I y 2 Gl�U� � 'i G Paid in Pull ❑ Outstan�in�� 13;J:mrr I)ui:.___-..__ J.
tiEC"I'ION 5: CONSTRUC'PION SF,RVICF:S __ _�
S.i I.icensed Construclion Suprrrisor ICtiI.) l
' ' l`f S 7u-1--- ---7//-�/-`�—�� �
�e._T t' l� -e(-Q.. Licrmc Nuiuhtt . I`.�pu.uiun U.u: I
i X.unr o(C'SL� IIuIJrr / {' Cf"G,�i ' �
/-� G A /JND/✓ )'�J �� � �f l,) f��f�-/Pjl� I.ul CSI..�I\��r i.er hrlii��I 1/l.l (GS �'__
I \.ldrre. Tv c Utsiri �uon
' l l'nrt�u'iclyd�u r 1�� ?i.IN1U('u. I�l � — 1
. j — � — R � RrstrirlrJ i.@_' f.mul� D��illiu¢ _�
I ]i�i � wrt l \1 �I:nonn Unh I
.g7� 3���� / KC Rc,id.nnal Hii�i�iuc l'm:iin` _� .
frli'phiine - q'S Kr.nl.nu.il \11n�u�� .�nJ .�iJin_ .
]F R:.iJ:nii.�IS�di.11'urlliwuiue \ >>li.inr: lu_i.ilLiin^_�
D Ra�id:uti.il Urniuli�iun . __ _ I
i.2 Regi<lereLllnme Improvrment Cun[ractor IIIICI � � �/ `yg �
�� � l�,-cl-2. _ ° — -- --
HIC C- u�puny .Vainr or HI Rc�istr il Nam Rreutrauun Vuinhrr
�_� c�,n� fvor� ��; 1� Qx�',- y r� _ 09
�,,�«,G{o.�-I ,�fi� dJ�s��' 97��3>��t�,3� -- �
e.���:���„„ u:��.
ISignawrc 'fckphunr
SECTION : WORKERS' CONIPENSATION INSURANCE :�FFIDAVIT(M.G.L.c. 152. § 25C(611
Wurken Cumpens�tiun Insur�nce a((id�vit inwt br cumpletcd :md ,ubmitted �vi�h ihis ;ipplicativa F:ulure a� pn��idc
this affidavit will result in the denial u(the Issuance uf Ihe buil�ing permiL .
Signed Aftidavit Attaehed'? Yes ..........f�1 No ........... ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUfLDING PERMIT
�, _ , as Owner of ihe �ubject pruperty hcreby I
. I au[hurizr to act un my brhalt. in all m:itterti �
i re!ative tu w�.nk authurized by Ihis building permit application. � �
i
I
Si n�wreu(Owner Dute
SECTION 7b: OWNER� OR AUTHORIZED AGENT UECLARATION
�, , as Owner or.4uthorized ����ent hereby �erl:ire
that the statements and infixmation un the foreguing applicution are vue and accurate, tu ihe best uf my knuwleJge �nd
behalf.
Print Name -
Signawre of Ownrr ur AuthorizcJ Agcnt Datc I
(Si neJ undar tBt ams�nd enallies of rr�u I �
NOTES•
I. An Owner who ubtains � building permit to du his/her uwn ��ork,ur ;m u���ner �o�hu hires an unre�i,iarcd �unira..i�rc�
� �not regismred in the Hume fmpru��ement Cunir.ici��r (HICI Prugr�ml, will wnt ha��r ucees, t�� inr :�rbitr;ui��n I
progr�m ur guoranry fund unJer �1.G.L. c. 11'_'A. Other impurwrn inGamuiiun nn the FII(' Prneram ,ind . I
Construciiun Supervisur Licensing (CSU ran be linmd in 730 CMR Regulatiuns I IO.RG ;md 1 I O.RS. re.pern�cl}'. �
i ' W'hen +ub�tanu�l wurk is plonned, pn�viJe the inlbrmanun beluw: � �
� TUIdI I�UUfS :IfC:11S(,. FI.) IIf1CIlllllfl� L:If��C. �It115I1C1J h8�C111Cf1U:1IfIC1. JCCA1 uf �lufClli �
! (ini.�s livin� area i5y. Ft.l H:ibitable rn��m cuunt _ __ _._ �
INumber��f lirrplares Vumber uf hrJn��nn+ ------------- ,
� I Numbar.�(hethnwms � Vumber��lh.iltih.uh. --------------- --
l\'�>C ��fhe:mn@ ,p.tem ---- VumberulilC�k�/ ��ui�h�� __'_ _____"____—__ '
�1�tt u� �UU�I11�S 1\'�fCR1 �Jh�u�CJ ___ _l)�K❑ _.
i. .T��uil Prnjrc� Syuarc fuut:ige" m:iy be �Uh�UI11IC, fuf ����rt:�� ��fn�CCf ���i�(�� _JI
�•' = '� CITY C)F SALL:M
`l ..�*
� ,x ,.. PtrBLIC PRc�PRERTY
��;
=;; . _.-� '
�,..��� D E P:�K'I''�I E N T
�.. . , ,
•.1 .. �. ��; U ��.��,.,�..��•.1i.;iir � 1)ii ��. \I.�„�i . .. i . • :I•� �:
' I I I 'I'\.'J;.��;��; � I �C. 'i'8.'J. '�iJ�� .
) ('onstruction Ucbris Uisposal .aftidavit
_ � (r�•yiurr� liir all �cnwliti�m an� rcno�:uiun �vwk)
' I11 :ICiUfll7lll'l' ��f�l� �hc six�h �Jiiion oFihc S�atc BuilJing Codc, 7S0 CA1R s�ctiun I I I._� _.
Dcbris, anJ the provisiuns uf �1GL c �0, S 54;
[3uilJing Prrmit # is issucd wi[h the conditiun that thc dcbris resulting fron�
ihis �vurk shall bc �li,puscd u�i�i a propurly liccnscd �vaste ilisposal lacility �s dctincJ by MCiL c
( l l, S I SUA. �
The debris �aill be tr.�nsport�J by:
I��I�'z
Inamc uf haultr)
Y hc clrbris will br disposcd uf'in :
_ N_�_. �rs.�s.-��
h�ainru(I` ility) .
��C7 �G257�q\ � .
luddrea. ul�l]cilitv) �
1 L(i�l"/ M .1"�N� .
- i ua c ��f p:rnut.ip��lic nt
�la�r _
;: .��� CITY OF SALEM
� `�,�:, ,�; PUBLIC I'ROPRERTY
, �' _,'
?`�-r� DEPARTMENT
�?.., py.
�=;`n�
'..I\IL:K!Ill':)NISCVI.1.
�{���i�n 12C W n,r+��i:ro�Sn<ecr � S,�t.[�a.M.�i+.u:i n�sr:n s G197�
"t'�:�.:978-.'4i9i9i � P:�s: 978J+�784G
Workers' Compensation Insurvnce :�ffidavit: L3uilders/Contractors/Electricians/Plumbers
� > >Insnf Infonnrtion
Plcace Print Leeihlv
V81Td lBusiiicss�OrganizatioNlndividual): �
.Q� G r1
A�Idress: J r�o �� vc'�'z
c��y;s�:,��;z�n� hr�l a��� N�" 0� i�n�,nr ,�: �7 �- `37,5-.��l3 )
:�rc y��u •rn cmploycr'.' Chcck thc appropriale bux:
'P7Pc uf projcct(requireJ):
I I.❑ I am a employcr wiih
4. ❑ I am a gcncral coWracwt and I !>. ❑ n�w construction
ha��c hircd thc sub-cuntracwrs � �Ramodeling
employres(full �ncllur p�ri-tintt).' ]istad un rhe attachcd shcct. �
?.`�J am a sole propric[nr or panncr- Q
These sub-connactors have 8. Demoliriun
ship;md hav�no cmpluyccs . ���orkera' comp. insuranca 9. � puiiding additiun
working fbr me in uny cap:uity. �. ❑ We are a co�porution and its
(Ko workers' wmp. inwrance 10.� 6lectrical rtpairs ur additions
rcquircd.] UtY1CCfS I18VL`OYCI"CIYC(I(I1CIf
right of cxcmption per MGL I I.Q Plumbing rcpairs or udJitions
3.❑ I am a homcowncr duing all work c. 152, y l(4),and we have no 12.0 2uuCrepairs
mysclf. (Ko�vorkcrs' cump. cmploycc.. �Ko worktrs'
insurance rcyuirtd.J r 13.❑ Ol1�Cr
comp. insurancc roquindJ
•�,ry:,pplic�nt�hm nc�cks boz NI O1Y51 AISU IIII Out IIIC�l'Cp�lll�H:IUW SIIOWI�1�tAClf Nb(Itl'IY cumpenwtibn puliry inliirrtwtiun.
T IIJTCIIWfll:ff\VAY Sl1IlO11I 1I115 0I�1(IBVII IOtI1CllIV1✓r IM1C)':IfC�I0111�f YII\YUII(fl11fI IIICII I11I1 OU111(IC l'Ulllf.'KIOf3�OUJI auhmii a new al'fiUvi�indiut�ng..uch.
..0 a'l cs Ih I �1 �'k Ih's box munl a[lach�d�m addiliwul ah<el �h � g Iho n�mc of ttm subKonlrxWrs and Ihcir«urkcrs'cump.policy inturmatiun.
/am un ruipluyerlhat is pr�vidirtg rvurkers'compensnnnn uisurruue fa uiy eioplayec... Belnry n �he puluy und/ob vte .
iujaru�uliun. ��/.�0/`�5--G�U�--
Ir..i�raucc Company Vame:���� . . . ..
Pulicy�i ur Sc)f-ins. LiC.*: .. . -- -.---�-
Expiration Date:
----.. .
Job Sitc Address:
/ Wc�cs-� -ti��- S�' C��y;s�;,�ortp: �A1-�r� f�Fl b1470
.\ttach a cupy o(���e �rorkcrs'cumpcnsatioa pnlicy dcdar•rtion page (showin�;thc policy nu�nbcr •rnd cxpiratiun d•rtc).
I�ailurc w sccure cover,�ge as requimd under Scdion 35A ol'`[GL c. 152 can Itad to the iropusition of criminal penalties of a
- tina up to SI,SOO.OQ anJ/or one-year imprivonmcnc, �n wcll �s civil pcnulUcs in ihe 1'orm uf a STOP WORK URDER and a Fine .
�fiip ��>>'jp.pp u day ngui�u� �he �iul:uor. I)e advi.cd�hat a copy uf this,iutcment muy be furwarJed w �he C>(lice of
luvrntigati�.ms ol thc DIA lor insur:u:c� �oocra�c �crilicat�un. .
/do herehy cr�liJV uniler d�e paine'und priudfics ujprrjury thu�d�e injonnutiun pruvidcJ uGove is trrm uud correc�. ','
D�tc' �
Sicnamrt: _ I
Ph�a:c!i:
O[riciul ux ady. Do nnt n�rire in d�i.c ureu.tu be cmup(rlyd by city or�oivn oJJiciul.
Pcrmit/I.iccnsc�--_..... .
, _ _. __... ..
Cifv or fo�rn:--.._ - �-
Ixsuing:\Whuri�y (circle one):
I. IS��arJ uf IIe:J�h ?. 13uildin� Dcparuncul .l.(:ilr/fo���n Clcrk �. Llectricnl lusperfor j. Pluinbin�; Inspcctor
G.Olhcr ._ --... _ .
CuuWct Pcrson: __.. . � ---
Phonc p:
Information and Instructions
;\]os;:ichu:etts Gcneral I,aws rhapttr 1�2 reyuires all einployers to provide workers' compensation tix thcir employees.
Pur,u:uit w �his�iawie, an einplu�•re is lefined as"...evzry pei;son in�hz scrvice of anaher under any conn:�et of hire,
cxpress or implicd, oral o�wri[ron." - �
:\n c�np/oper is dctincd�s"an individual,partnership,associatiou, corporation ur other legal cntiry, or any two or more
oi the forecoing engaged in ajoint cnrcrprise, and incluSing the legal rzpresentatives oPa deceaszd employer,ur the .
recaiver or vusiec uF:m individual,p:umership, associa[ion or other legal enuty,cmpbying tntployees..However the
- owner of a dwelling house having not more than three aportrnents and who resides therein,or the occupant of the
. dwclling housz of anorher who employs persons N So mainern�ncr, cunwuction or repair work un such dwelling house
or on rhe orounds or building apputtenant thereto shall no[ because of such employment be deemcd W be an empluyar."
`1GL ch�pter 152, �?SC(6) also states th�t"every state or local licensin�a�ency shall Ni[I�hold the issuance or
renewal uf a littnse or pennit tu upernte a Husiness or to construct buildings in the commonweal[6 for any .
��pplic•rnt who has not produced accepfable evidence uf compli•rnce wi[h the insuronce coverage required."
.additiunally, bIGL chnpter li'_', 525C(7)sr:ites"Neither the conunonwealdi nor any of its political subdivisions shall .
encer into any coneract tbr[he perY'om�ance uf publie work until acceptable evidence otcompliance wich the insurance
requirements uf this chapter have been prescnted to the contracting authority."
ApNlicants �
Please fill out the workers' compensation�at�idavit completely,by checking dte boxes thu[apply to yuur si�uation and, if
necess�ry, supply sub-contractor(s) name(s), address(es)and phona number(s) along with their certificate(s)uf
insmwice. Limited Liability Companies(LLC)or Limiced Liability Partnerships(LLP) with no emp(oyees uther than the
members or partners, are nut required[o carry workers' compensacion iiuurance. If an LLC or LLP does have
employees,a policy is required. Be advised that[his attidavit may be subinitted to the Department of [ndustrial �
.Accidents for contimiation of insur:u�ce covurage. Also be sure tu sign and dn[e�he al'tiJavit. The aflidavit should
be reninied tu the city or rown that the applicxtion for the permit or license is being requested, no[the Department of
InJustrial Accidents. Should you have any yuestions regarding the ]aw or if yuu �re reyuired to obtuin�workcrs' -
cumpen,ation policy,please call the Dep:utment at the number lis[ed below. Self-insumd companies should enter their -
sclf-insurance license number on die appropriatc line. �
City or Town Offlcials
Plcase hc sure that the affidavit is complcte and printed Iegibly. The Departmen[has prbvided a space ut the bottom .
oF d�o aftidavit for you tu fill out in tlu event lhe ORice of Investigations hsss to conWct yuu regarding the applicant.
Plcase be surc to till in�he penniVlicense number which wifl bz useA as a reference number. [n addicion,an applicant
❑i:�t must submit muitiple permio7icense applications in auy given year,need only submit one.�Ffidavi[indicating current '
policy inf'ormation (if necrssary):md undzr'7ob Site Address"thn applicant should write"all locations in (city ur �
town)."A cupy of the aftidavit that has been officially stampcJ or marked by cha city or town may bc proviJed to [he
applicant as proof that a valid affidavit is on file fbr tLture permits or licenses. A new attid�vit ivu,t be filled out each
year. Where a home owner or citizen is obtaining a licenst or permit not related to any business ur commzrcial venmre
(i.e. a dog licanse or permit to burn leaves ete:)said persun is VOT required to complete this affidavit.
�I�hc 011i�c oC lnvesti�ations �suuW tike w tlmnk you in �dv:ume Eor your cooperacio�i and should yuu havc any yuesiions, .
pleo�z du not hesimtz [o give us a ca1L �
The Ucparunent's addtess, telephone and fax numbec
The Commonwealth of Massachusetts
Department of Industrial Accidents
Otflce of Investlgallons
600 Washington Street
Boston, MA 02111
Tel. i! 617-727-4900 ext 406 or 1-877-MASSAFE
a,��.�d �-�r,-us
Fax #617-727-7749
. www.mass.gov/dia
k
. � � � � � � Page No. � of .�. � Pages
LEGERE CONSTR�CTIOR!
� Serving Customen WH� QuafiEy& Pride
�5 CANNQN HILL ROAD EXi.
GROVELAND, MA 01834
Cell 1-975375-G431
PROPOSALSUBMITfEDTO PHON�6oa — S�c��-aI '�ATE �jr� /��
�!�Ar �A►`� !
STREET JOBNAME
1 W ant� 6�G.. 5'�' �rJ 6 Av� /�/3 f1�.
QTY,STATE antl ZIP CODE JOB LOCATION
�S�les1.. c�,.�1 fi r''�-
ARCHITECT DATE OF PLANS � JOB PHONE
We hereby submit specitications and estimates for:
��}� Sur�r�+��� ; yN �A� apt•. /-�a�tirW� , Nv-� d�r /<rlch�N R �cfl
. � j�s.-ktio ��AS�'er2 �A�'1�5 A ni c� C�ciS�7 N� Wfl l!S �nl f� �'�o �rJt' rW M S
,ba�l:roorti �- tia�lv��I. �e �Ar�e- �� Ne�,.� hA-ii�.�c�r�. r>.w�-l-t-. s l.�ow e�, �r�N�fiyJ
t �i(e,t_ F�Me- i N NeW c�o� � CeXi�nca�.2l� � i�� SN/A� A�eA - �rar�c, a clos�s
- �1�� A I�ur►df�/ G�s�-_ ��r�e.. � n) e�s,f���- a�ar�cS . ,�Zx�6/e., w�n�or�.►
fio b� cl�se-� :N �� -q ��lte/Z �; re._ -�z� flc,c6,K�date.� he,�,
�/,uN.b�N`� = /�cx��1. ; n� -�c- sG,�u.,et� �ran>if.,�, tbile,t, '�.Avr�c�� �- �tse
�c� jn e flf . ��n�'-J� '�'t3 SC�jCi�� S�c��2��'Oi ��-�- � jt C�� � Y A�v i"tZa �-��Y.
U
�c,�'CQS � vWNe.12-S > �'�P�.�"iG /�y, l�nre.�5
U
1n5sul�l=�or► ' �ltl e�ca'���+2 walls -l-o �- ��svlat�-d -}� cnde .
�/�'iZ -t- �Nrsl�s� fll ( w�il/s -tv be ca,e�e,�c� w cf� `/a .6/�2.lx�c--�.1 �
�S N�'M G13A�" ��4df�'�,2- C e i/i N�S �t7 ,� SG.j iK-/ �N i s� �
:���'e.a.ar2 -f�;rti. �v ,� �erw.R.� �v<r� c�e.Mo fln�� c-e�s�.� �s��
� �,e /x� �,.��-N� a t�,4e.. r�.j 1 a� n� f� M.A+c,�.. e�ci si-� r� M��+� s��
- W2 PPOpOSe hereby to furnish material and labor—complete in accordance with above specifications, for the sum of:
dollars($ )� �
Payment to be made as follows:
All material is guaranteed to be as specified. All work to be completed in a workmanlike AuthOrized
manner accortling �o stantlard practices. Any aHeration or tleviation from abova specifications Signatufe
involving eutra costs will be axewted only upon written orders, and will becrome an ezira
charge over and above �he estimate. AIl agreements contingen� upoh s�rikes, acciden�s or
de�ays beyond our conirol. Owner m wrry fire, tomado antl other necessary insuranre. Our Note:ThiS pfoposal may be
, workers are fully covered by Workman's Compensation Insurance. withdfawn by us if not accepted within deyS.
., ACCP.pLaI�CP. OI PrOpOS�I —Theaboveprices,specifications � /
and conditions are satistactory and are hereby acceptetl.You are authorized to do the Signat e �
work as specified.Payment will be made as outlined above.
Date ot Acceptance: �" , � Signature _ � � '�
U
� � � � o Page Na � o�f�� Pages
♦ ��� rr"�.,
LEGERE CO(dSTRUCTIAP!
• sorni»g casromen tYlrn pr►s�ity a Prldr
_ > .• 15 CANNON HILL ROAD EXT.
"' GROVELAND, MA 01834
Ccll 1•97II-375-6431
PROP�#1S' •� I�O f '^�!"" PHONE /V� �S'/�� ~VT�. DATE 7f��f .yf.
� q i � �}
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STREET � JOB NAM � . /�����
I W+=�c�CS �t�+C. 5'�'" � �
CIT',STATE antl ZIP CODE JOB LO ATION
` .�"�'SS1�'h't. t''r`,.L1 _.S''t�.n�--
ARCHITECT DATE OF PLANS JOB PHONE
We hereby submit specitications and estimates for.
�a � � s�-� b� a -�«� �f' �Al� W�l1S ANc� �'ovNd. co//oMS , t
A�sy' fl bcn k s l�e,l-�' �v be. b ui t�` � � L�u/ ►.� �are� o
�=JaS/z�s=�c.� oo� �loo ss �'v be_ �/,'�s�<.� c� n�� c!e�,��.� �-►k•
-��d� rL. � hc- �-fi�-r2 L�,.�oI c�r`., fl� +,1� a
�
We Propose hereby to furnish material and labor—complete in accordance with above specifications, for the sum of:
� Q�n7C1 ��Y-� dollars($ rJ'������ ).
Payment to be made as tol ows:��
R" oW �f'>1�e bcs�c�
b c� �i' r`sln 6 c> >� r-ar1 ��1v
All material is guaranteetl ro be as specified. All work to be comple�ed in a workmanlike -
manner according to standartl prac�ices. Any al�eration or deviation from above specitications /luthorized� � � `s� � _
involving ezira cosis will be executed only upon wri�ten ortlers, and will become an exira Signature �"��—Z
charge over and above the as�imate. AIl agreemenis con�ingent upon s�rikes, accidents or
1 � �
delays beyontl our wMml. Owner �o carry tire, tomado and other necessary insurance. Our NOte:This prop0 I may be
workers are fuly coveretl by Workman's Compensation Insurance: withdrawn by us if not aCcep[ed within �� d8y5.
ACCP.p�aI�ICP. O� PCOpOSaI —Theaboveprices,specifications ^
antl conditions are satisfactory antl are hereby accepted.You are authorized to do the Signatur � �
work as specified.Payment will�m��as ou i ed a� �y .(n'
Date of Acceptance: . �S ��a Signature '�`�� `�^� �
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