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HomeMy WebLinkAboutBuilding Permit #799 - 1 GREENE STREET 5/1/2018 BUILDING PERMIT 0* NORTH q OSt.l D.qb• �O TOWN OF NORTH ANDOVER ,�? o APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received �gSSACHUS�� Date Issued: IMPORTANT:Applicant must complete all items on this page AmW PRC3PERTY OWNERS SPS 'ri MAP 210 PARCEL ZONING DISTRICT His#oric District yes .�IVlachine S#�op Village yes ono TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial e air, re p Iaceme Assessory Bldg Others: Demolition Other ':Septic Well, '=Floodplain . ' W.:etlands 11atershed°District 1Nater7,$ewer ' DESIPTION OF WORK TO BE PREFORMED: 14-_ b �%� `\ S'e r,, 1 t,.. 5' 6v 4e-4''�5' Identification Please Type or Print Clearly) "� OWNER: Name: � � �� \�- - Phone q7*/ V-5-- V 7 Address: 4 S /\J0,V 4, 4- r a , ��.a c_ CONTRACTOR Narne. S ? f?hbne:. > e Address. _:X Wt Spervisorsct ' Construon`License W Ep. .Date �; / l O' Home Improvement.lice�se '� ���.. Exp. Dates ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ C) C6 O FEE: $ 2j Check No.: Receipt No.:_ � NOTE: Persons contracting with unre 'stered contractors do not have access to the guaranty fund a��� ;5���.- f��RC✓� `- Signature of Agent/Owner PSgnature o contracto �' Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application o Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract o Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract a Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler p p kler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) Li Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2008 I, Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL .r Public Sewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales Private(septic tank,etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF -UFORM ;•, DATE REJECTED ' DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: ° Located 384 Osgood Street ` FIRE DEPARTMENT Temp Du npster�on site° yes , no Located at�124 Mintreet �'� 0,N Fire, ejpartment signature/date r F+ C© MENTS M ._ Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) ❑ Notified for pickup - Date Doc.Building Permit Revised 2010 Location ! No. �— - — Date d � f & j0*Th TOWN OF NORTH ANDOVER F • • • � •, Certificate of Occupancy $ � Building/Frame Permit Fee $ �cHus Foundation Permit Fee $ s+. Other Permit Fee $ F TOTAL $ Check # 232b1 Building Inspector Locationl�2�✓ ala. Date ` t C� TOWN OF NORTH ANDOVER 00 F 9 • Certificate of Occupancy $ si + ♦ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # i, 23250 - 'building inspector SIGN PERMIT APPLICATION 1600 Osgood Street—Building 20, Suite 2-36 TOWN OF NORTH ANDOVER ' Map Parcel DATE SUBMITTED_ <?^ J6 Site Owner d�&Ck Applicant *a. Tel Site Address_ g' �_ /Up/1C`e— Size of Proposed Sign 12 X 2a L411' I INTERNALLY ILLUMINATED SIGN PROHIBITED How attached: a) Against the wall' b) Roof Illumination: a) Not illuminated ✓ c) Ground ✓ b) Externally illuminated d) Other Materials: C49RA 13©fi4j F®Am Proposed Colors: Background t,y�t�� s Lettering K G, 6 � Border % _ y'?? Required Attachments: Photographs of building Note_ No permanent/temporary sign shall be erected,or enlarged until an Material sample application on the appropriate form furnished by the Sign Office has been Color sample filed with the Sign Officer containing such information including Site or Plot Plan (Required for all free-standing signs) photographs, plans and scale drawings, as he may require, and a permit Drawings of proposed sign for such erection, alteration, or enlargement has been issued by him. Other, specify Such permit shall be issued only of the Sign Officer determines that the sign complies or will comply with all applicable provisions of the By- Law. Will sign overhang any public road or walkway Yes ( ) No (v j ` If Yes, Name of Agency who will provide liability insurance: AN INCOMPLETE APPLICATION WILL NOT BE ACCEPTED" DATE FILED: SIGNATURE OF APPLICANT f NORTti , O � NORTH ANDOVER BUILDING DEPARTMENT ss 1600 Osgood Street North Andover Tel: 978-688-9545 Fax: 978-688-9542 B USINESS FORS FOR TOWN CLERX DATE: NAME: ADDRESS: . ZONING DISTRICT: TYPE OF BUSINESS: BUILDING LAYOUT PROVIDED: YES N AVAILABLE PARKING SPACES: ZONING BY LAW USAGE: YES NO CgRTIFICATE NUMBER /0 3;7 THE COMMONWEALTH OF MASSACHUSETTS f pORTH 1 - ♦i nn y - - ♦off. _ ` ! - SSACHUSE . TOWN OF NORTH ANDOVER - TOWN CLERK BUSINESS CERTIFICATE IN CONFORMITY WITH THE PROVISIONS OF CHAPTER ONE HUNDRED AND TEN, SECTION FIVE OF THE GENERAL LAWS, AS AMENDED, THE UNDERSIGNED HEREBY DECLARE(S)THAT A BUSINESS UNDER THE TITLE OF: C fi;,Yr� .mac S-1 IS CONDUCTED AT: IN THE TOWN OF NORTH ANDOVER, MASSACHUSETTS. BY THE FOLLOWING NAMED PERSONS: NAME RESIDENCE SIGNED�j ° SIGNATURE SIGNATURE SIGNATURE SIGNATURE ESSEX COUNTY DATE PERSONALLY APPEARED BEFORE ME THE ABOVE NAMED: � lf�!' d�klr�/cf �iir� f NORTh 0 Sb ye 9� � L F- T o NORTH ANDOVER BUILDING DEPARTMENT US�Z1 s g 1600 Osgood Street 9SSNCH North Andover Tel: 978-688-9545 Fax: 978-688-9542 BUSINESS FORM FOR TOWN CLERK DATE:- NAME: ADDRESS: ZONING DISTRICT: TYPE OF BUSINESS: BUILDING LAYOUT PROVIDED: YES nN AVAILABLE PARKING SPACES:--A x ZONING BY LAW USAGE: YES NO BUILDING INSPECTOR SIGNATURE BUSINESS FORM FOR TOWN CLERK 2.40 Home Occupation(1989132) An accessory use conducted within a dwelling by a resident who resides in the dwelling as his principal address, which is clearly secondary to the use of the building for living purposes. Home occupations shall include,but not limited to the following uses; personal.services such as furnished by an artist or instructor, but not occupation involved with motor vehicle repairs, beauty parlors, animal kennels, or the conduct of retail`business,or the manufacturing of goods,which impacts the residential nature of the neighborhood. 4. For use of a dwelling in any residential district or multi-family district for a home occupation, the following conditions shall apply: a. Not more than a total of three (3) people may be employed in the home occupation,one of whom shall be the owner of the home occupation and residing in said dwelling; b. The use is carried on strictly within the principal building; c. There shall be no exterior alterations, accessory buildings, or display which are not customary with residential buildings; d. Not more than twenty-five(25)percent of the existing gross floor area of the dwelling unit one thousand 1000 square fee is devoted to such use. In used, not to exceed >y so ed, ( ) q connection with such use,there is to be kept no stock in trade, commodities or products which occupy space beyond these limits; e. There will be no display of goods or wares visible-from the street; £ The building or premises occupied shall not be rendered objectionable'or detrimental to the residential character of the neighborhood due to the exterior appearance, emission of odor, gas, smoke, dust, noise, disturbance, or in any other way become objectionable or detrimental to any residential use within the neighborhood; g. Any such building shall include no features of design not customary in buildings for residential use. Signature Date ` f pORTFI O� esti■o 1 �{► k...w,b�6 QOA TOWN OF NORTH ANDOVER '� +, « �� •�`� �` SIGN PERMIT rao �4sSACHus DATE : June 8. 2010 PERMIT: S01-10 THIS CERTIFIES THAT PC Repair Walter Birch has permission to erect. -Ground Sign 12" X 22 on 8 Turnpike Street provide that the person accepting this Permit shall in every respect conform to the terms of the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Sign Regulations in the Town of North Andover. ` Violation of the Zoning o Sign Regulations, Section#6, Voids this Permit. INTERNALLY ILLUMINATED SIGNS ARE PROHIBITED Inspector of Buildings ATLANTIC DESIGN 6,8i10 Phone: 978-423-9920 Fax: 978-312-1446 Homeowner.Information Contractor nformation Name omprny. ams.e. F' C�C /) tel ©6'i �) `` C-0 7C Street Address(do not use a Post Office Box address) Contractor/Salesperson/Owner Name Cityrrown State Zip Code lusiness Address(must include a street addres) 97j - q55 - 351147 u,tc 4 NI 01cX3 $ Daytime Pboue Evening Phone Pityrrowfi State Zip Code 975.- -3•'-9920 ®t3--6Y-627 6 Mailing Address(ll different from above) Business Phone ederal Employer ID or S.S.Number Lw requites that mod tame ba- Hama LWovecacuiCanuacturlicS.Niusba linimlimt dam .. provemeat eounwan have a Abd�eaian'•ti�a�anber �� _ •. .I - 13 1. C The Contractor agrees to do t1►e following work for the Homeo ver: 30 W01`9 W mp g '30 01 lie w S�Cicc(.r.S'S. lu,�:.a•, Required,Permits-The followinif.bui,lding permits arc required Proposed Start and Completion Schedule-The following schedule will and ill be secured by the contractor as the homeowner's agent, be adhered to unless circumstances beyond the contractor's control 'se sY - Y an (Owners who secure their own permits will be. excluded from.the Guaranty Fund provisions of /0.l Date when contractor will begin contracted work MGL chapter 142A.). U �o Date when contracted work will be substantially completed. Total Contract Price and Payment Schedule ' The Contractor agrees to perform,the work,furnish the metirial and labor specified above for the total sum of 0 (+) Paymentss will be made according to the following schedule $ 1 upon signing contract(not to exceed 1/3 of the total contract price pr the cost of special order items,whichever is greater), S _ _ by _/ !_ or upon completion-of. S 7 by _/ /_ or upon completion of $ upon completion of the contract (Law forbids demandant;full payment until contractlis to to both patty's satiafaction) .. -,, . The following material/equipment must be special $ to be paid for \ ordered before the contracted workbegins in order S to be paid for to meet the completion schedule.(04) NOTES:(0)Including a0 finance charges(04)Law requires that any deposit or down-payment required by the contractor before work begins may not exceed the greater of(a)one-third of the total contract price or(b)the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedulExpress Warranty-Is an'exuress warEinty being e, Provided e e attached to the contra�n Subcontractor`-Thelvontractor agrees to be solely responsible for.compleuou of the work described regardless of the actions of any third party/subcontractor utilized by the contractor. The contractor further Agrees to be-solely responsible for all payments to all subcontractors for maledals and labor under this aereemcnt Contract Acceptance-Upon signing,this document becomes a binding contract under law. 'Unless otherwise noted within this document,cite 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 contrack ' • Don't be pressured into signing the contract Take time to and fully understand it. Ask questions if something is unclear. • ' Make sure the contractor has a valid Home Improvement Contractor R cAstration. The law requires most home improvctneat contractors and subcontractors to be registered with the-Director of Horne ltnprovement Contractor Registration+You may inquire about contractor registration by_writing to the Director at One Ashburton Place,Room 1301,Boston,MA 02108 or by calling 617-727-3200 or 1-800-223-0933. • Does the contractor have insurance? Check to see that yourcoutractor is properly insured. • Know your rights and responsibilities. Read,the Important Information on the reverse side of this form and get a copy of the Consumer Guide to the Home Improvement Contractor uwa . You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business,provided 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..Sea the attached noticc'of cancellation form for an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY.BLANK SPACESM Two idnttical copies of thacontract must be completed and signed.',one'cW should go to tdu homeowner. The other copy abbmild be kept by the cowraaot. Homeow s Signa C actor's Signature jo Date' Date Contractor Arbitration The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration-dction(aslan..- alternative tacourt action)if they have a dispute with a contractor. The same right is not automatically afforded to a {, contractor,however. The contractor would have to resolve any dispute he/she has with a homeowner in court unless both parties agree to the optional clause provided below. This,clause would give the contractor the some right to arbitration as is afforded to the homeowner by the Home Improvement Contractor Law. The contractor and the homeowner hereby mutually agree in.advance that in the event the contractor has a dispute concerning this contract,the contractor may submit the dispute to a private arbitration firm which has been approved by the Secreta of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall.be required to submit to uch arbitrrti as provided In Massachusetts Gener:em ws,chapter A. Homeown s Sig tura ntractot's Signature NOTI :The signatures of the parties above apply only to,the aent of the parties to alternative dispute resolution initi ed by the contractor. The homeowner may initiate alteinative dispute resolution even where this saction is not separately signed by the parties. Homeowner's Rights A homeowner's rights under the Home Iumprovement.Contractor Law(MGL chapter 142A)and other consumer protection laws(i.e.MGL chapter 93A)may not be waived in any way, even by agreement. However,homeowners may be excluded from certain rights if the contractor they choose.is not properly registered as prescribed by law. Homeowners who secure their own building permits are automatially excluded from all Guaranty Fund provisions of the Home Improvement Contractor Law. The contractor is responsible for completing the work as described, in a timely and workmanlike manner. Homeowners maybe entitled to other specific ljegal rights if the contractor guarantees or provides an express warranty for workmanship or.materials. In addition to guarantees or warranties,provided,by the contractor,.011 goods sold in Massachusetts carry an implied warranty 'o f merchantabilityand fitness for a particular purpose. An enumeration of other matters on which the homeowner and contractor lawfully agree may beIadded to the terms of the contract as long as they do not restrict a homeowner's bisic consumer rights. If you have questions about Your consumer/homeowner rights,contact the Consumer Inforination Hotline(listed below). Execution of Contract The contract must be executed in du Lica and should not be signed until.a copy of all exhibits and referenced documents have:been.attached. Parties are.aiso advised not to sign the document until all blank sections have been filled in or marked as void,deleted,or not applicable. One original signed copy of the contraci with attachments is to lie given to the owner and the other keptby the contractor. Any modification to the original contract must be in writing and agreed to by both parties. Contracted work may not begun until both parties have received a fully executed copy of the conhact, and the three day recission period has expired. Accelerated Payments A contractor may not demanda p yrnents"in advance of the dates specified on the payment schedule in cases where the homeowner.deems him/herself to be financially insecure. However,in.instances where s.contractor deems him/herself to be financially insecure,the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work. Withdrawal of funds from said account would require the signatures of both parties. Additional Information If you have general questions or need additional informatmomabout the Home Improvement Contractor Law or other consumer rights,or'tf you wish to obtain a free copyof Ho f A Consumer Guide to the me Improvement Contractor. Law,"contact: Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaid,Room 5170,Boston,MA 02116 (617)973-8787 or I-(888)2833757 ,. If you want to verify the registration of a contractor or if you have questions or.leed additional inforntatio about the contractor registration component of the Home'lmprovement Contractor Law,contact: n specifically Director of Home.improvement Contractor Registration r Bureau of Building Regulations and Standards . One-Ashburton," Place,Room 1301,Boston,MA 02108 (617)727-3200 or 1-800-223-0933. For assistance with informal mediation of disputes or to register formal complaints against a business,'call: a Consumer Complaint Section Office of the Attorney General (617)727-8400 AND/OR Better Business Bureau (508)652-4800 (508)755-2548 (413)7.34-3114 NORTH o o over f And No. G�► = - o A K E o dover, Mass., COCMICMEWICK �-1 7�S RATED BOARD OF HEALTH Food/Kitchen PERMIT T Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.:........ .! ....... ,.. ....................................:..................:................:.............:. .•'•• Foundation has permission to erect........................................ buildings on ....I.......... ...................................... - Rough < �'s�v ..... Chimney to be occupied as............ i'...... i . . ................... ............ ......... . . . . . . . . provided that the person accept g this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU TS Rough Service ................... ..................................................................... BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final .No Lathing or. Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. ATLANTIC DESIGN 618/10 Phone: 978-423-9920 Fax: 978-312-1446 c Homeowner Information' Zortractor nformation Name Company Name. . v SCG x Street Address(do not use a Post Office Box address) tractor/Salesperson/Owner Name City/Iowa State Zip Code usiaess Address(must include a street addres) 97$ -- 95 9, 3 7 C_1, 114A 0LC- 3 Daytime Phone Evening Phone ItyrrowL State. Zip Code 971 - 2.3' Ct9z© Cyt';.-6Y-626 Mailitig Address(lt different from above) 3usiuess Phone gederal Employer ID or S.S.Number taw requites that moa home ern- Boma .vemmtm Caaetar[reg.Wim6er tixpim iso date =l and¢giataati coohaGon haver a I o•suuahc "� The Contractor agrees to do the following work for the Homeo iter: pmt 23 e mp g - (^ \� 3tDt —( pt 's• C7Cj> ho �y/►54 i'l'�w S�k.rt�CSS Required.Permits-The following building permits are required ProposM,Start and Completion Schedule-The following schedule will and will be secured by the contractor as the homenwnet's agent, be adhered to unless circumstances beyond the conbractoes control arise (Owners who secure their own permits will be excluded from,the Guaranty Fund provisions of to I' Date when contractor will begin contracted work. MGL chapter 142A.) ? kd Date when contracted work will be substantially completed. Total Contract Price and Payment Schedule The Contractor agrees to perform the work,furnish the material and labor specified above for the total sum of. �� � �v 0 (•) Payments will be trade according to the following schedule: $ upon signing contract(not to exceed 1/3 of the-total conUart price QF. the cost of special order items,whichever is greeter) 3 by /_/ or uponcompletionnf_. p +i 5 3; � 3 by _1_/ or upon completion of hG C $ upon completion of the contract. (Lees forbids dernandtng Ertl payment until contractus completed to both p party's satisfaction) The following malaiaUequipment must be special S to be paid for ordered before the contracted work'begins in order. S W be paid for to meet the completion schedule.(#$) NOTES:(•)Including a0 finance charges('•)Law requires that any deposit or down-payment required by the conlraaor before work begins may not exceed the greater of(a)one-third of the total contract price or(b)the actual cost of any special equipment or custom trade material which must be special ordered in gdvance m meet the completion schedule FivrissWarrauti-Issn'exuresswe Ann Pravided byech to the'Coutracii $ubfontraetori-Thdtantractor agrees to be solely responsible for.compleUon of tho work described regardless of tine actions of any third party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this amment Contract Acceptance-Upon signing,this document becomesa bmdtng contract under law.Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest ba been placed on the residence: Review the following cautions and notices carefully before signing this contract - •. Don't be pressured into signing the contract Take time to read-and fully understand.it. Ask questions if something is unclear. Make sura the contractor has s valid Homer improvement Conttactnr Ret'stratior The law requires most home improvement contractors and subcontractors to be registered with the Director of Home 1mvcment Contractor.Registration You may inquirc about contractor registration by:writing to the Director at One Ashburton Place,Roam`1301,Bostmn MA 02108 or by calling 617-727-3200 or 1-800-223-0933: • Does the contractor have insurance? Check to sm.that your:contracWr is properly insured.- Know nsured:Know your rights and responsibilities. Read the Important lnforn)ation on,thereverse side ofthis form and get a copy of the Consumer Guide to the Homer Improvement Contractor Law. You may cancel this agreement if it has been signca at a place other titan the contractor's-normal place of business,provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted,by;tclegtam sent or by delivery,not later than midnight of the third business day following.the signing o€this agreemeuC-See the attached notice of cancellation form for an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE ARE AI NY BLANK SPACES!!! Two idrntiul wjiics of Ihcconuaet must be completed and sigoed Ihte'capy should 8o to the hdpuowner.The other copy should be(rept by the wrunaar.. Homeow s Sign tuff C actor's Signature 61 ,3110 Date Date Contractor Arbitration The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration detion(ascan alternative to-court action)if they have a dispute with a contractor. The same right is not automatically afforded to a contractor,however. The contractor would have to resolve any dispute:he/she has�wtth a homeowner in court unless both parties agree to the optional clause provided below. This clause would give the contractor the some right to arbitration as is afforded to the homenwner by the Home Improvement Contractor.Law. The contractor and the homeowner hereb triutuall 'a ` y y gree in-advance that in the event the contractor has a dispute concerning this contract, the contractor may submit the dispute to a private a the p arbitration firm which h Secreta of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall.be aqua dy to submit to uch a itrati s provided In Massachusetts General Laws,chapter A. � . Homevwn s Sig tore chapter .Signature NOTI :The signatures of the parties above apply only to thea ement of the parties to alternativedispute initi ed by the contractor. The homeowner may,initiate alternative dispute resolution even where this cion resolution not separately signed by the `ariies: Homeowner's Rights A homeowner's rights under the Home Improvement Contractor Law(MOL chapter 142A)and other consumer protection laws(i.e.MGL chapter 93A).may not be waived in any way, even by agreement However;homeowners may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law: Homeowners who secure their own building permits are automatically excluded from all Guaranty.Fund provisions of the Home Improvement Contractor Law. The contractor is responsible for completing the work as described,in a timely and workmanlike manner. Homeowners may be entitled to.other specific hegal rights if the contractor guarantees or provides an express warranty for workinanshiporanaterials., In addition to gnatantees or warranties providguaraed,by the contractor,e11 goods sold in Massachusetts carry an impliedwarranty of merchantability and fitness for a particular purpose.' An enumeration of other matters on which the homeowner and contractor lawfully agree may be added to the terms'of the contract as long as they do not restrict a homeowner's basic con su Your consumer/homeowner rights,contact the Conmer rights: If you have questions about sumer Information Hotline(listed below). Execution of Contract The contract must be executed in du lick and should not.be signed until.a copy of all exhibits and referenced documents have been.attached. Patties are.also advised not to sign the document until all blank sections have been filled in or marked as void,deleted,or not applicable. One original signed copy of the contract with attachments is to he given to the owner'and the other kept by the contractor. Any modification to the original contract must be in writing and agreed to by both parties. Conracted work,may begin until both parties have received a fully executed copy of the contract, and the three day recission period has expired. Accelerated Poyinents A contractor may not demand g .. p yntetits in advance of the dates specified on the payment schedule in cases where the homeowner deans'him herself to be financially insecure: However,in instances where a contractor deems him/herself to be financially insecure,the contractor may require that the balance of funds not yet due be placed in a.joint.escrow account as a prerequisite to continuing the contracted wOrIG. Withdrawal of funds from said account would require the signatures of both parties. Additional Information If you have general questions or need additional informatiom about the Home Improvement Contrac for Law or other consumer rights,or tf you wish to obtain a free copy of "A Consumer Guide.to the Home Improvement Contractor Law,"contact: Consumer Informationr Hotline Office of Consumer AHaiis'and Business Regulation .10 Park Plaza,Room 5170,Foston,MA 02116 (617)973-8787 or 1-(888)2833757 If You want to verify the registration of a'contractor or if you have questiottS 01,i1t;Cd 8dd1tl0llttl itlfOlfiat1011 S about the contractor registration component of the Home Itnprovement.Contractor La specifically Law contact: Director of Home Improvement Contractof Registration, , Bureau of Building Regulations and Standards One-Ashburton Place, Room 1301,Boston, MA 02108 (617)727-3200 or 1-8007223-0933 For assistance with informal mediation of disputes or to register formal complaints against a business call: , Consumer Complaint Section Office of the Attorney General (617)727-8400 AND/OR Better Business Bureau (508)652-4800 .(508)755-2548 (413)734-3114 The Commonwealth of Al'assachusetts Department o f Industrial Accidents Office of fnvestegations 600 Washington Street Boston, M4 02111 www.nzassgov/dia Workers' Compensation Insurance Affidavit: Bt lders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organiza6on/Individual): C(3 .. x �'\ , , Address: AIA 3 S' City/State/Zip �c-K.� /Iq c)I q 3 Phone#: Ss Are;1am an employer?Check the appropriate boa: 1•LI a employer with �-- 4. ❑ I am a Q Type of project(re7d)eneral contractor and Iloyees(full and/or part-time).* have hired the sub-contractors 6. ❑New constru 2.[] m a sole proprietor or partner- listed on the attached sheet t 7• ❑Remodeling ship and have no employees These sub-contractors have working for me in any capacity. workers' comp.insurance. 8. Demolition [No workers' comp. insurance 5. ❑ We are a corporation and its 9. ❑Building addition 3.❑ required.] officers have exercised their 10.❑Electrical repairs or additions 1 am a homeowner doing all work right of exemption per MGL11.❑Plumbing repairs or additions myself. [No workers'comp. C. 152, I(4),and we have no in..sura ce required.] t employees. [No workers' 12.[]Roof repairs POMP.insurance required:] 13 ❑ other `AnY aPplicant that checlas box#1 mus!iso T,--, se- ^tion below shea9 their workers'comp— Y mac,Y 'on. t Iiomeowners who submit this affidavit indicating the,,a,p��:��-n.. — +Contractors �:_ -- `E a""er"and urea hire outside comtractors must ..submit a new affidavit indicating such. that check thus box must attached an additional sheet showin.-the name of the subcontractors and their workers'co o' comp.policy information. I am an employer that is providing workerscompensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: P 1111 11. 111111 -� Policy#or Self-ins.Lic.#: Q Expiration Date: Sob Site Address: T-9-C,7 City/State/Zip:, , AAjye.-- fj Attach a copy of the workers'compensation policy declaration.pane(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imp fine up to$1,500.00 and/or one-year imprisonment, osition of criminal penalties of a as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 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 1 do hereby terrify under pains and penalties of perjury that the information provided above is true and correct Signature: 2/ Phone#: F01ther only. Do not write in this area, to be completed by city or town ofj1ciaL n PermitUcense# hority(circle one): I. Health 2.Building Department 3. Citv/TOwn Clerk 4. Electrical Inspector 5.Plumbing Inspector son: Phone n: �� I Information an- d Instructions Massachusetts General Laws chapter 152 requires all employers tc provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire express or implied,oral or written." ' An employer is defined as"an individual,partnership,association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including t1he legal representatives of a deceased employer, or the receiver or trustee o.an individual,partnership, association ox-other legal entity,employing employees. However the ee apartolentr and who resides therein,or the occupant of the owner of a dwelling house having not more than thr dwelling house of another who employs persons to do mainte;3amce,construction or repair work on such dwelling house or on the grounds or budding appurtenant thereto shall not because of such,employment be deemed to be an employer." MGL 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 c onstruct buildings in the commonwealth for any applicant who has not produced acceptable evidence of co:Impliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)stages"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the Performance of public work un7til acceptable evidence 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-contractor(s) name(s), address(es) and phone number(s)along with their certificate(s)of 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'comp ensation 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 ivtutuvd to the city or toH ri that the auv"catiJn for the pert QT license is be222g"egtteSF.ed not the DaJE.TL^:e!!t OI Industrial Accidents. Should you have any questions regardir�g the law or if you e reYuire3 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 fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license 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 perces or licenses. Anew affidavit must be filled out each year.Where a home owner caner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license orermit to bum leaves etc.) said erson is P NOT required to complete this affidavlt The Office ofInvestigations 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 The Department's address,telephone and,fax.number....._ . The Commonwealth of Massachusetts Department Of Industrial Accidents Office of Inyesfigations 600 WashmP ton Street Boston,MA 0.2111 Tel. # 617-727-4900 east 406 or 1-877-MASSAFE Revised 5-26-05 Fw. #617-727-7-749 vmrV,.mass._aovfdia 71. �-\ Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR � y I fieglstration: 143213 Expiration: 6/23/2010 Tr# 268351 .Type: DBA ATLANTIC DESIGN CUSTOM HOMES JASON WILCOX j 24 NEWBURY RD �;p�,,,,,` IPSWICH,iMA 01938 Administrator 9•ate. Massachusetts- Department of Public Safet% Board of Building; Regulations and Standards Construction Supervisor License License: CS 69513 Restricted to: 00 JASON A WILCOX 24 NEWBURY RD IPSWICH, MA 01938 o-- J Expiration: 8/24/2010 Coommi..iuner Tr#: 2410 .1 08/08/2010 11 :28 FAX 4001/001 CERTIFICATE OF LIABILITY INSURANCE "*NCO (780 72-6306 FAX (791)272-136206/08/2010 THIS CERTIFICATE IS wsuEn As A MATTER OF wF01>MATION W. LOCHS InSurante Agency , Inc. ONLY AND CONFERS NO RIClITS UPON THE CERTIFICATE 113 Cambridge St. HOLDER.THM CERTMICATE DOES NOT AMEND,EXTEND OR Burlington, NA 01603 ALTS THE COYERAt;E BY THE POI lC1Eg BELOW. INSURERS AFFORDING COVERAGE NAIC MIANREo At antic Designs INSURER A; CaaarCe ins. Co. 347S4 24 Newbury ad. Ipswich, INA 01936 114URERC: INSURER at INSURER E THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INOICATED.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 13Y THE POLICIES DESCRIBED I IEREIN 15 SUBJECT TO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE L(MITS SHOWN MAY HAVE BEEN REDl10ED BY PAID CLAIMS, TTPE OF INSYRANCE POUCY NURBBIR PtxlGY EiM1ATlp1) LBrfB GENERAL uAan nY BC KCS 02/04/2010 02/04/2011 EACH OCCURRENCE a Low, X COMMpRGAI GENERAL LIABILITY DAMAGE TO RENIED 9 100r CWMS MADE D OCCUR MED ExP(A++r one person) a s A PERSONAL&AIN INJURY a 1.000/ LIMUTY GENERAL AGGREGATE a 2 000 l3ENL AGGREGATE LWT APPUES PER: PRODUCTS-COMPIOP ASG a 2 ON, PONCY LOC � � CONINNED SNUE LIMIT ANYAUTO a ALL OWREO AUTOS GODLY IN,II/RT r SCHEDULED AUTOS (Pet penes) HIREDAUTOS NONAMNED AUTOS Lego MN.AY i PROPERTY 004WOE a (Per ems) GAnAGQ LIABUTT AUTO ONLY-EA ACCIDENT a ANY AUTO EA ACC a oTIErR Tww AUTO ONLY! AW a OICENINNBRELLA LIMIT EACH OCCURRENCE a OCCUR DAMS MADE AGGREGATE a a DEOI>t,TIBLE a RE?ENiroN a a WORKRISCOMP1114A710111AW ATLL MPLOYER$LLABBITY ANYPR ARS UTNE E.L.EACH ACCIDENT a FFMERIMERIKER E.L.DISEASE-EA EMPLOYEE a 8l 9DVISrm bow' EL DISEASE-POLICY LMMT a OTNER iagro7gN OF OPE RATIDNS I LOPATB S I YlNICLEa I Excuarm AODEO sY ENDONSIMUCNT I 6116CIAL PRRDYIa1011s GERTIFICATE HOLDER CANCELLAMN aNOULo ANY OF TN!A90YE DEK=B o FOLKM BE CANCELLED WPM THE EIPIRATION DATE 1IMIE F.THE ISSUING INSURER PILL EJROFAYON TO NAB. Tarn of N. Andover DAYS MT fM NOTICE TO THE CERTIFICATE HOLDER IWIED TO TWE LEFT. 1600 Osgood Street. BLDG 20 OUT rALLURB To NAIL such myf=SHALL BNPOBE No QKmTm an mou" Suite 2-36 OF ND UPON TEN NSgNK US AMENTs OR REPRESENTATIVES, N. Andover. 14A 0194S �wi=mljim!q R�pRTATNE Gochis - —J-4L� WORD 25(i001IfM) FAX, C978)68a-9542 VACORD CORPORAT i 4989 6/6/2010 11:44 AM FROM: Cooney Agency James L. Cooney Insurance Agency, Inc. PAGE: 002 OF 002 GRANITE STATE INSURANCE .COMPANY 0070510-00 WC 006-38=7240 13102 013-66-0809-oo INIA JASON WILCOX 24 NEWBURY RD IPSWICH, MA 01938-0000 EXECUTIVE OFFICES: 70 PINE STREET,NEW YORK,N.Y. 10270 SEE EXTENSION OF ITEM 1.OF THE INFORMATION PAGE-WC9=10 l 0;) JAMES L-COONEY INSURANCE WORKERS COMPENSATION AND EMPLOYERS 327 GORHAM ST LIABILITY POLICY INFORMATION PAGE LOWELL, MA 01852-3310 INSURED IS PREVIOUS POUCY NUM ER INDIVIDUAL RENEWAL 002509803 OTHER WORKPLACES NOT SHOWN ABOVE: SEE EXTENSION OF ITEM 1.OF THE INFORMATION PAGE-WC990610 MW 2 POLICY POWD 12M A.M.slemdard time at the tnoureft . malenp&Meese FWM 08/21/09 To 08/21/10 d s A. Workers Compensation Insurance:Pert One of the policy applies to the Workers Corrfpetgatlon Law of the states listed here: MA S. Employers Liability Insurance:Part Two of the policy applies to the work In each state listed in item R.A. The litnits of our liability,under Pert Two pro Bodily Injury by Accident$ 100,000 each accident Bodiiy.lnjury by Disease S SOO.000 policy limit Bodily Injury by Disease S 100,000 each employee C. Other States Insureace:Part Throe Of the policy applies to tate states,H any,listed here: SEE ENDORSEMENT - WC200306A D. This policy Includes these SEE EXTENSION OF*ITEM S.D.OF THE INFORMATION PAGE-WC990612 treu4 The premium tar this policy will be datermined by our Manuals of Rules,Classifications, Rates And Rating Plans. All information reaukad below is subject to verification and change by audit. Estimated Total Rate per Estimated Ctaa>fifloatlon4' Code Number Remuneration $106 OF Re Premium Annual a year muneratbn Annual 11 3 Year SEE EXTENSION OF ITEM 4,OF THE INFORMATION PAGE-WC/754 TAXES/ASSESSMENTS/SURCfARGES $11 EIPEM CONSTAW(MM 91111M APPUCABLE BY STATES $159 MA MINIMUM PREMIUM SSOO MA TOTALOnMATEDPREMIUM SSOQ_ R ladleated below.Interim adjustments of premlum atoll be made: • Semi-Amualyr Q: ®uartedy D Memthiy DEPOW PREMIUM . 08/18/09 ASSIGNED RISK 66 IKYO este Isaulnp OINoe Authdrtaad Representative We 00 00 01 39007(Rwd 0440) PDF created with FinePrint pdfFactory trial version http;hviww.fineprint.com