Loading...
HomeMy WebLinkAboutBLD-22-6323 le ? jzc/Z2_-. ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department 1146 Route 28, South Yarmouth,MA 02664-4492 n\ 508-398-2231 ext. 1261 Fax 508-398-0836 { . Massachusetts State Building Code,780 CMIR = o.o�a >' Building Permit Application To Construct, Repair, Renovate Or Demolish .. . a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: B( .I)_2 4,3 Z, Date Applied: .D.,,/'2 <`1Z,.z fAfkiel l� , RECEIVED BuildingPrintN • Signature -'-'"'PJaCe SECTION 1:SITE INFORMATION FEB 25 2022 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers _ BUILDING DEPARTMENT 1.1 a Is this an accepted street?yes T no Map Number Parcel Numbe BY __ 1.3 Zoning Information: 1.4 Property Dimensions: q 6. 66 Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) e y - 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard /J:0 Required 1 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 0 Private 0 Zone: _ Outside Flood Zone? Municipal❑ On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Recorak , Name(Print) City,State,ZIP CI 41- Cc.,ii )‘0. �y soc )719eo ADF WA Poi_, No.and Street Telephone Email Address x r3FR_ii3.+4.�c,17., SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building❑ 1 Owner-Occupied ❑ 1 Repairs(s) 0 Alteration(s) 0 I Addition 0 Demolition . Accessory Bldg. 0 Number of Units Other El Specify: Briefh, .Description of Proposed Work2: 41 >7, , ,'-}i c/ De-"--.e Clc ('<y r..JG ti - 4 1 ;a,.l l=/0 0,- ,'^�e) c,,,,- 11, 5 u ' ,1 Car" +r c_.),- Os r. tv a.,:,. o'j__1 r)r, -P---e.4;C SECTION 4: ESTIMATED CONSTRUCTION COSTS. Item Estimated Costs: Official Use Only (Labor and Materials) I.Building $ I. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee 0 Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Pees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire Suppression) $ Total All Fees:$ _ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ 2 cs�0 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 1 61? 1 ,q 9 LA UL U 4-3‘) 1 I' I c-A nei. License Number Expifation 1]tate 1 Name of CSL"IloTder List CSL Type(see below) U 11Y' No.and Street Type Description ; -- .(� -��� U Unrestricted(Buildings up to 35,000 cu.#t.) City Town,State,ZIP AY''�� R Restricted 1&2 Family Dwelling M Ivlasonry �, �,f. RC Roofing Covering r n- 1 � � I ' Corn WS Window and Siding q SF Solid Fuel Burning Appliances Sv )r 'tJ b I Insulation Telephone Email address D I Demolition 5.2 Registered Home Improvement Contractor CHIC) c( e. ( ( l4-c tom`c, HIC Registration umber Ex irati n ate FUC Company Name or HIC Registrant Name h N�dStreet �'� �'�� �'�,� 1 L-jr/ rn ! C, i 5 O ( + _Q� 5� Email address City/Town, State,ZIP C7 Telephone� SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(iVI.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 — No 0 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 )c._,.c C ,� �. to act on my behalf,in all matters relative to work authorized by this building permit application. 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 peijuiy that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: I. 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.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" The Commonwealth of Massachusetts L Department of Industrial Accidents ' 1 Congress Street, Suite 100 " Boston, MA 02114-2017 4 •'~ y � www.mass,gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): l1'7: / I I j ah P Address: je.4.--- pi„,,e 1----)/1 C'Y'el--,--e-G4-1—k) CY2-C,?___ . City/State/Zip: Phone #: .SD8 0 Z.i--1 '-)3r-- Are you an employer?Check the appropriate box: - r Type of project (required): am a employer with -.S employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in ca aci 8. ❑ Remodeling an Y p ty.(]vo workers'comp. insurance required.] 3.Q I am a homeowner doing all work myself. [No workers'comp. insurance required.]t 9. Demolition 4.E1 I am a homeowner and will be hiring contractors to conduct all work on my property. I will 1.0 ❑ Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp. insurance.' 1 •❑Roof repairs 6.�We are a corporation and its officers have exercised their right of exemption per MGL c, l4theCh r�`�()� 152,§I(4),and we have no employees. [No workers'comp. insurance required.] *Any applicant that checks box m I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 'Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: /l.r^ n )y �.�S ,-...t ' � J�,•,� � � �`5 tip,.-rY'r•t.-<_____Policy#or Self-ins.Lic.#: 'ZCUU i t^,J � �� /ç /7 j � Expiration Date;l '7 -7 Job Site Address: 4 0.rl r,,,A icy, (,�i',- City/State/Zip , t/)cfrrrr•(-n7jrh MO �� Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration d �._.� Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment, as welt as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under thepa' penalties of perjury that the information provided above is true and correct. Signature: �� Date: VI2 r2 '7 Phone#: r7 & 5 .L 4' Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: 4---- TOWN OF YARMMOUTH .t � � boa .` BUILDING DEPARTMENT • T.TXoncC A0Y 1146 Route 28, South Yarmouth, MA 02664 S08-398-2231 ext. 1261 HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DATE: JOB LOCATION: NAME S '' ET ADDRESS SECTION OF TOWN "HOMEOWNER" NAME OiVMEPHONE WORK PHONE PRESENT MAIL tNG ADDRESS CITY OR TOWN STA'I'I✓ ZIP CODE The current exemption for `Homeowner';was extended to include owner--occupied dwellings of one or two units and to allow such homeowners to engage an individual for hire who does not possess a license,provided that such homeowner shall act as supervisor. (State Building Code Section 110 R5.1.3.1) Definition of Homeowner: Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is or is intended to be, a one or two family attached or detached structure assessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner;such"homeowner"shall submit to the building official, on a form acceptable to the building official,that he/she shall be responsible for all such work performed under the building permit. (Section 110 R5.1.3.1) The undersigned `homeowner' assumes responsibility for compliance with the State Building Code and other applicable codes, by-laws, rules and regulations. The undersigned 'homeowner' certifies that he / she understands the Town of Yarmouth Building Department minimum inspection procedures and requirements and that he / she will comply with said procedures and requirements. HOMEOWNER"S SIGNATURE APPROVAL OF BUILDING OF±'ICIAL INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent, which meets the requirements of MGL Ch.142. Yes No If you have checked ves, please indicate the type coverage by checking the appropriate box. A liability insurance policy Other type of indemnity Bond OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner Agent h:homeownrlicexemp §TOWN OF YARMOUT 1146 Route 28, South Yarmouth, MA 02664 508-398-223?1 ext. 1261 Fax 508-398-0836 Office of the Building Commissioner BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Ch. 40, §54 and 780 CMR- Section 105.3.1. #4. I hereby certify that the debris resulting from the proposed work/demolition to be conducted at n rc- Work Address Is to be disposed of oat the following location: Z-O q Q r1(a-ry - 2%V o \1144 Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. Signature of Application Date Permit No. DATE(MM/DDIYYYY) ACCORD CERTIFICATE OF LIABILITY INSURANCE 02/11/2022 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: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Joe NAME: _ y Macdonald -._. _ PHOMark Sylvia Insurance Agency,LLCM"u . {508}957 2125 FAX Np) (508}957-2781 404 Main Street E-MAIL mark marks Iviainsurance.CAm ADDRESS: y - INSURER(S)AFFORDING COVERAGE NAIC# Centerville MA 02632 INSURER A: Farm Family Casualty Insurance INSURED INSURERS- i I Three Pillars Inc INSURER C: _ 11 Cassidy Ave INSURER D: { * South Dennis,MA 02660 INSURER E: INSURER F: . 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 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I - ADDL SUBR I POLICY EFF POLICY EXP — LTR TYPE OF INSURANCE i INSD WVD POLICY NUMBER i(MMIOD/YYYY) IMM/OD/YYYY)i LIMITS X i COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE J $ 1,000,000 DAMAGE TO RENTED w I1 j CLAIMS-MADE X OCCUR PREMISES(Est occurrence 100,000 --I MED EXP(Any one person) '$ 5,000 A i 2001X1781 11/4/2021 ! 11/4/2022 PERSONAL&ADVINJURY l$ 1,000,000 __ i GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY J JECT L LOC i i PRODUCTS-COMP/OP AGG_j$ 2,000,000 ` OTHER i '$ f AUTOMOBILE LIABILITY 5 COMBINED SINGLE LIMIT $ jE0 accident; ANY AUTO I BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ __ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) I �® I I$ UMBRELLA UAB OCCUR I EACH OCCURRENCE 1 I$ i EXCESS LIAB i CLAIMS-MADE AGGREGATE $ II ,QED RETENTION$ ' ! $ WORKERS COMPENSATION 'X_PEATUTE_PER t 0TH AND EMPLOYERS'LIABILITY R ANY PROPRIETORJPARTNERJEXECUTIVE YIN E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBER EXCLUDED? N NIA: 2001 W8367 i 12/8/2021 12/8/2022 w (Mandatory in NH) E L.DISEASE-EA EMPLOYE $ 1,000,000 IIf yes,describe under _ DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ 1,000,000 , DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Landscape and hardscape design,hardwood and laminate flooring installation Matthew Coleman has elected coverage on the workers compensation policy Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Yarmouth ACCORDANCE WITH THE POLICY PROVISIONS. 1146 Route 28 AUTHORIZED REPRESENTATIVE I So yarmouth MA 02664 Fax: Email: ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ,„17 ' n� tax �i¢��: .4 '° �� a ti �ao- �,a 7 • eaI#h of Massachusettsi {4 a " k ' w ` f Professional ,icensure �"T ru" s1a�A t � g egulations and tandards t eau x,: "E�a�...r F �,.. a , ructic n Supervisor ,„ ,,,,,,.,...., .„.......„. ... ..,,,.....,,,„, ,,,,,,,„.„......,,..„ , . . . • .„,,,„„., .'' • .. . .........„,....,„..„.....„......„.....:„...„...„.„.„..„....,...........„."..,,,,,..,:„.....•.,„.„....,... . ,,, , , - , , ' •• ... ...:•••• 11 / 1, at$ Expires . . ,,' D �� �- ER '- 9/2024 • • s�_ ,� ,'',',',,'‘'.'.:','''•',..-'''''''''.' ,:.,„,„:.,,,:,,,,,,,,....,,,..:,.. w 'k Jyv H �Atit. #--" - .,',,,,.:1'.,.'. ,...::'.','-'7.,":::, a 4 v : ,-if....,,...;•,..,:„..r.. ,.. ,...„2:„....:.':44, 4 ° r) 1.4,.. .0.‘ p v,ritt ...4. — 73 • t, c- 0 r/ ''; g' r- — I rn rrl rnC, ..t. 0-, -..1. r,) rn , as -0< -* -.....-`• co 70 . eh M '44 Ao ° I c-".5.> ...?.... N.\\1 r I N .,.„ ..- r,STs% Og .73 o) co 0 ss‘c i„-,, w _. C \''\• 2F kis" -: ""N, D ..t..` CO M -f --d CD - 700 i --s ..., , w cr, 3 _, (.-) ;,..'.. 01' ',.. CD G -- 0 c-) g) \ . , 00 < ,,....: , --; ._,-- < ot, ..,,,, ..'" c) .,..„, '4., CD ._.-. ...., '41 3 5' > .'*•'«, . .,. , 1, , o < co m , = .‹ o .-.• ". 4 1 g 0 Cor) CI) \Z\ ° 41'*44 g (4. 08g '-i- , 03... •-... = 0 C:) li. . 7J iv c. = 4,,k, ' 7-gc2. 3' * ' 2- 0. : , :m 1 co 4 7.4. rD ! 00. co x ..... 4.01. —). 13. ;"' sl) 111 --1 •-t• CD --.-_-......< ..".. 0 — -1 -0 CL ........:M. :co. :a... = !..,....... = 0 0 ED E (n 3 > co 1,•3 5 x-.• a. --c.,, • = ii4it' CO •• -t to CT cfi f*. — h.) sx) a = .,k‘-• 7 3 (t, E co 6, ,, 4 ..,, . ,., 4. ' r Three Pillars Inc Masonry • (Project Management •Landscape HOME IMPROVEMENT AGREEMENT Homeowner Name(s) Contractor Name/ID Albert A. Denapoli Three Pillars Inc Matthew Coleman, Owner Federal ID Number:82-341175 Home Address Business Address 9 Arcadia Way 4 Butler Ave West Yarmouth, MA West Yarmouth, MA 02673 02673 Mailing Address(if different from above) Mailing Address 9 Arcadia Way PO Box 1331 West Yarmouth, MA South Dennis, MA 02673 02660 Phone Number Phone Number 508-577-1980 508-680-2475 Required Permits CSL/HIC The following permits(to be secured by Three Pillars Inc)are required for this project This proposal is pending Building Russell Heamer Department Approval. 3811 Main ST Brewster MA,02631 Permit Type: Demolition/Exploratory Permit 508 816 5056 Town of Yarmouth Building Dept. MA HIC: 203038 MA CSL: CS-116127 Three Pillars Inc agrees to perform the following work for the homeowner: 1. Seal off room between kitchen and garage to protect the area from dust 2. Remove drywall from entire ceiling and as needed on walls, beams, and posts 3. Remove entire existing Pergo floor from the work area 4. Examine existing subfloor and remove as necessary for levelness and structural correction 5. Remove partition near garage door closest to house 6. Discontinue baseboard heat as needed to have room he open and only have base board around new perimeter 7. Consult when demolition and evaluation is complete over next steps and best framing options to achieve vaulted or cathedral ceiling 7-4ankyou fcr your iu4•ineys! Project Schedule The following schedule will be adhered to unless circumstances beyond the contractor's control should arise.These include,but are not limited to inclement weather and natural disasters,material supply chain disruptions,and permitting delays by town administration. Proposed Start Date: no later than February 18, 2022 Target Date of Completion: March 4, 2022 Project Budget Description Cost Demo/exploratory permit fees and administration 500 Demolition labor @75/hr, estimated 80 hrs 6000 Disposal fees 250/ton, estimated 3 ton 750 Dust barrier materials and misc. supplies 250 Total Estimated Budget 7500 Payment Schedule: Three Pillars Inc agrees to perform the work, furnish the material and labor specified above for the total sum of: 7500 . Payments will be made according to the following schedule. Deposit of$ 2500 due upon signing of contract. $ 2500 upon completion of ceiling demolition . $ 1500 upon completion of plumbing and partition demolition . $ 1000 final payment due upon completion of contract. Unforeseen and over contract due on completion of task or 50% deposit and remainder of balance on completion of task. P/ease make checks payable to:Three Pillars Inc PO Box 1331 South Dennis, MA 02660 2 Ti;ankyou for your usiness.l Please Read Before Signing: Acceptance of Proposal-Upon signing,this document becomes a binding contract under law. Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this contract.Ask questions if something is unclear.The law requires most home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration.You may inquire about contractor registration by writing to the Director at 10 Park Plaza, Room 5170,Boston, MA 02116 or by calling 617-973-8787 or 888-283-3757.The customer understands and agrees to pay a service charge on past due amounts of 11/2%per month(or a minimum of.50 cents on balance less than$30.00)at an 18%annual rate. The customer further agrees to pay any legal/attorney's fees necessary to collect such past due amounts.All material is guaranteed to be as specified. All work is to be completed in a workmanlike manner,according to standard practices. Any alterations, deletions or deviations from the above specifications involving extra costs will be executed only upon written orders and will become an extra charge over and above the estimate. All agreements are contingent upon strikes,accidents,or delays beyond the control of Three Pillars Inc.The homeowner or customer is to carry fire,flood,and all other necessary insurance.This contract may be withdrawn by Matthew Coleman if not accepted within thirty(30)days.It is understood that by signing this proposal/contract: I/We,the customer,am/are accepting: (a)all prices,specifications,terms and conditions as outlined above; (b)Matthew Coleman is authorized to perform all work as specified,(c)the payment schedule outlined above is hereby agreed to and shall be met,and (d)securing and compliance with all necessary permissions and permitting is the sole responsibility of the property owner. Please sign original copy and maintain an additional copy for your records. Please return one copy to Three Pillars Inc, PO Box 1331 South Dennis MA,02660 together with the initial acceptance payment as outlined in the Payment Schedule.As you review the contract, please keep in mind that we schedule all landscape construction and services in the order that we receive the signed contract.In order to assure your position in our schedule,please return the contract as soon as possible.Work cannot begin prior to signing of contract and the homeowner/customer receiving a copy. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES ) r Homeowner's ign Pure /,.. Date (-} Matthew Coleman Three Pillars Inc Date 3 76ankJou for your Lusiness! NOTICE OF CANCELLATION YOU MAY CANCEL THIS TRANSACTION, WITHOUT PENALTY OR OBLIGATION, WITHIN THREE BUSINESS DAYS FROM THE ABOVE START DATE. IF YOU CANCEL, ANY PROPERTY TRADED IN, ANY PAYMENTS MADE BY YOU UNDER THE CONTRACT OR SALE, AND ANY NEGOTIABLE INSTRUMENTS EXECUTED BY YOU WILL BE RETURNED WITHIN TEN BUSINESS DAYS FOLLOWING RECEIPT BY THE SELLER OF YOUR CANCELLATION NOTICE„ AND ANY SECURITY INTEREST ARISING OUT OF THE TRANSACTION WILL BE CANCELLED. IF YOU CANCEL, YOU MUST MAKE AVAILABLE TO THE SELLER AT YOUR RESIDENCE, IN SUBSTANTIALLY AS GOOD CONDITION AS WHEN RECEIVED, ANY GOODS DELIVERED TO YOU UNDER THIS CONTRACT OR SALE; OR YOU MAY, IF YOU WISH, COMPLY WITH THE INSTRUCTIONS OF THE SELLER REGARDING THE RETURN SHIPMENT OF THE GOODS AT THE SELLER'S EXPENSE AND RISK. IF YOU DO MAKE THE GOODS AVAILABLE TO THE SELLER AND THE SELLER DOES NOT PICK THEM UP WITHIN TWENTY DAYS OF THE DATE OF CANCELLATION, YOU MAY RETAIN OR DESPOSE OF THE GOODS WITHOUT ANY FURTHER OBLIGATION.IF YOU FAIL TO MAKE THE GOODS AVAILABLE TO THE SELLER,OR. IF YOU AGREE TO RETURN THE GOODS TO THE SELLER AND FAIL TO DO SO, THEN YOU REMAIN LIABLE FOR PERFORMANCE OF ALL OBLIGATIONS UNDER THE CONTRACT. TO CANCEL THIS TRANSACTION, MAIL OR DELIVER A SIGNED AND DATED COPY OF THIS CANCELLATION NOTICE OR ANY OTHER WRITTEN NOTICE, TO THREE PILLARS INC OR MATTHEW COLEMAN, AT PO BOX 1331, SOUTH DENNIS MA 02660 NOT LATER THAN MIDNIGHT THREE DAYS PRIOR TO ABOVE START DATE. I, HEREBY CANCEL THIS TRANSACTION DATE: HOMEOWNER SIGNATURE: 4 Tkankyou fort our I usincss!