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Home My WebLink AboutBuilding Permit #463 - 10 NADINE LANE 12/8/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: �� Date Received Date Issued: " - IMPORTANT:Applicant must complete all items on this page LOCATION r® /lfX�n/� I1 7-. Print PROPERTY OWNER �!�1�1/' ��r Unit# Print MAP NO: 06 S G PARCEL: 6ZONING DISTRICT: Historic District yes 6no Machine Shop Village yes 100 year-old structure yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑Addition ❑Two or more family ❑ Industrial ❑AI eration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition _ ❑ Other Septic Well F® lood lain ®IWetlands �s_ P..,.___. .� �T,a,� 0 Watersheci�D strict' �� Water/Se DESCRIPTION OF WORK TO BE PERFORMED: �1 I&P V1 G (Identification_Please pe or Print Clearly) j I OWNER: Name: Chhl.S r � i�, Phone: Address: CONTRACTOR Name: i tn Phone: Address: �� ' r I� ' )-n/Kr Supervisor's Construction License: ��--Z?j j Exp. Date: ,� -8 R o/3 Home Improvement License: _ � Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PF,RMIT:$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ Z � FEE: Check No.: I�� Receipt No.: a q 6&:: -_o NOTE: Persons contracting with unregistered contractors do not have access to a guaranty nd Signature,ofATgent/O,wner .. Signature�of�confractor J, Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL 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 - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS 4 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 Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS 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 I ❑ Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi i 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 ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sinoff from Fire Departmentriot to issuance of Bldg Permit p g mlt Addition or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler 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) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ 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: Doc.Building Permit Revised 2008mi Location f No. � Date ' NORT1y TOWN OF NORTH ANDOVER F i Certificate of Occupancy $ _ CNUS Building/Frame Permit Fee $ jo 3 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 24870 Building Inspector AC:ORV� DATE(MMfDDIYYYY} CERTIFICATE 0 LIACILI7Y INSURANCE 11/28/2011 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 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 N AMeACT Tracy LOeschen DeAngelis Tnourance PHONE (978)682-3397 .(478)481-0773 1283 Merrimack Street -MAI L INSURER(S)AFFORDING COVERAGE NAIC 81 Methuen MA 01644 INsuRP-RA:Travelers Yndemit INSURED INSURER 0: James Gallagher, DBA: James Gallagher INSURER C; 352 Howe Street INSURER O: INSURER 9: ,Methuen MA 01844 INSTAR RF: COVERAGES CERTIFICATE NUMSER:2011 term 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 RECUIREMENT, 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, PETF-I Y EFF POLICY LIMITS LTR TYPE OF INSURANCE POLICY NUMBER YY .[MM/QQ)YYYYI GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 X. COMMERCIAL GENERAL LIABILITY R MISE Es occur r $ 300,000 A CLAIMS-MADE a] OCCUR fieD2611R322 6/10/2011 /10/2012 MED EXP(Any oneperson) S 51 000 PERSONAL EADV INJURY S 11000,000 GENERA.LAGGREGATE $ 2,000,000 G EN'L ACGRRF-GATE LIMIT APPLIES PER: PRODUCTS•COMP/OP AGG S 2,000,000 Y. POLICY PRO LOC $ AUTOMOBILE LIABILITY C IINdoniSINGL6LIMIT j ANI',:U"C. BODILY INJURY(Per person) $ ALL OWNEDSC IECULEO BODILY INJURY(Prraoeldent) S AUTOS AUTOS $ NON-O'ANED P r PERT n DAMAGE HIRED AUTOS AUTOS S UMBRELLA LIAS OCCUR EACH OCCURRENCE $ EXCESS LIAB CI.AIM$-MADE AGGREGATE S DED RETENTION S A WORKERS COMPENSATION 1VC STATU- DTH - AND EMPLOYERS'LIABILITY YIN FR ANY PROPRIETOR,iPAA 1 NERI6XECUTIVE E.I.,EACH ACCIDENT $ ICFFICER'MEMBEREXCLUDi NIA 6/1,0/2011 6/10/2012 (MandateryInNH) 6A02611P.32� E.L.OISEASE.EAEMPLOYE S if Yyr,.;,describe under DESCRIPTION OF OPERATIONS Celo": E.L.DISEASE-POLICY LIMIT S I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Ramarks Schedule,if more space Is requlrod) Certificate is issued in the interest of the named insured and holden listed below. Subject to company conditions and exclusions. Workers compensation coverage excludes Names Gallagher I I I CERTIFICATE HOLDER CANCELLATION (9 7 8) 62 3-832 0 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES AS CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE D8LIVERED IN Town of Andover ACCORDANCE WITH THE POLICY PROVISIONS. 36 Bartlett Street Andover, MA 01810 AUTHORIZED REPRESENTATIVE i David Segsl/SLL �� AC ORD 25(2010105) t?1988-2010 ACOPD CORPORATION. All rights reserved. INS025(251C(15).01 The ACORD name and logo are registered marks of ACORD � lob NORTH T0VM Of Andover .. . No. dover, Mass*,___ e Q >- LAKE COCHIC EWICK V ��A0RATE D P? CO �S BOARD OF HEALTH Food/Kitchen PEnMIT T D Septic System - BUILDING INSPECTOR THIS CERTIFIES THAT............... . . ...�............ ........ ... E' ess.,�1...j.•••............... .....i......................................... Foundation N buildings on �1. �.............................. Rough has permission to erect.................................... g ' ......... .... .. . .... ..... Chimney r .... ............................................................. to be occupied as.................. .......... Xs�perm: ...... ....... .......... provided that the person accepting tshall in everyrespe onform to the terms of the application on file in Final- this inalthis 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 CONSTRUC ST S Rough -_ .:........... ............................................................................................... Service BUILDING INSPECTOR Final Occupancy Permit Required t0 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. The Commonwealth ofMassachusetts Department oflndustrialAccid'ents Office of lnvesfigations' 600 Washington Street Foston,MA 02X11 www-MassyY ovIdia Workers' Compensation Insurance Affidavit:Buil ers/ContractOrs �'IectricianS/P A licant Information lumbers Please Print Le ibI Name(Business/Organizationffndividual): Address: l(f2 S r .City/slate/Zip: U / Phone#: rE] I an employer?Check the appropriate box: a employer with 4. ❑I am a general contractor and I Type of project(required): loyees(full and/or part-time).* have hired the sub-contractors 6. ❑N construction a sole proprietor or partnerlisted on the attached shget. 1 7. em.odeling and have no employees These sub-contractors haveing for me in any capacity, workers'comp.insurance. 8' El Demolition workers'comp.insurance 5. ❑ We are a corporation and its9 ❑Building addition ired,] .officers have exercised their 10.❑Electrical repairs or additions a homeowner doing all workrightof exemption per MGL 11.❑PI bing repairs or dditions lf.[No workers' comp. c. 152, §1(4),and We have no ance required.]r emPIoYees.[No workers' 12. ofrepairs COMP,insurancerequired.J 1311 Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. on. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy infoation. I am an employer that isproviding workers'compensation irm information. nsurance for yny employees Below is the policy rrnrZjob site Insurance Company Name: Policy#or Self-ins.Lic.#: C2 1 t7 Ol Expio ration / J ration Date: Job Site Address:_ / 6 NyVewl � s� �r i�u.V�` 7 � Attach a cony of the workers'cCity/State/Zip: �� ompensation policy declaration page(showing the policy number and expiration d Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penaties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDS Of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office R and a fine Investigations of the.DIA,for insurance coverage verification. of Z do hereby cert under fire pal and ena les ofperjury that the information provided ahoy nature: is true and correct. i 3i •. Date: V 'hone#: Offrcial use only. Do not write in this area,to be eoinpleted by city or town official City or Town: • Permit/License# Issuing Authority(circle one): L Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. 6.Other P Plumbing Inspector Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to 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 the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartinents and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building 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 construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the.commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic work until 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, checking by the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)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'compensation insurance. If ant I Cor LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,;please call the Department at the number listed below. Self-insured companies should enter their ,self-insurance.license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding e PIease 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 fixture permits or licenses. Anew affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related for any business or commercial venture (i.e.a dog license or permit to bum leaves etc)said person is NOT required to complete this affidavit. The Office of.Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The C01-0M0!'Cwealtjgt of JNfa,ssachj Setts Dep.admeat Of Industrial A.ccideats Office Of InveStIgatio.US 600 Washington Street Boston}.MAS 02111 Tel.#617.727•-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax#617-727-7749 WWW.Inas&g-QvMa i E� _ Page No. of Pages JIM GALLAGHER CONSTRUCTION 352 Howe Street (` r MET UEN, MASSACHUSETTS 01844 �� J - (978)686-8163, PRl7POSA)t MITTW I � F � PHON -n '"3� / :DATE STREET f I JOB NAME ' CITY, STATE AND1 CODE JOB ION 2W Pczo ARCHITECT DATE OF PLANS Jna PHONE We hereby submit specifications and estimates for. i r�'147"_ 1 ale .t — 1 —,Z9/9 S6 ra ` _ H Pin kid 40 Ird At r f v0 �/BOG----- --- - ---".�---'---P--;�-• �� t��`tom__._--__ �P C V118P hereby to furnish material and labor—compide in accordance with above specifications, for the sum of: . ..... _ _. - - dollars($. Payment to be made as follows: r _:A15 materlsi.is guaranteed to be as specified All work to be completed in a workmanfte �nanner:according to standard practices.Any attention or deviation from above speciflca- Authorized . .x .:�.im'C€v`r. .extra costs win be exe Aed only upon written orders.and will become an Signature ..extra arraoverandabove the:stimate.All agreements contingent upon straces,accidents No�.fhis proposal may be W C�'3 beycad our ccntrm owner to carry fire,tornado and other necessary insurance. withdrawn P Y s C=XRem ase hay covered by Workmen's Compensation Insurance. withdrawn by �f not accepted within days. ti. A —The above prices,specifications = ' tsciss ice satisfactory and are hereby accepted. You are authorized Signature 3: to:!-_-f-*werk as specified.Payment will be made as outlined above. - Signature Signature I D.-L.of Acceptance: i 6LOL :#al ��u�itisiuuun.) t u01rea1dx .•, f7tSLO bW 'N3f1H13iN 1S 3MOH ZS£ 213HDV-n E) V S3vyv ££Z6S so :0su031-1 asuaDI-1 JOSIAJadnS uolhnj;suo0 sp.ncpuras put! suoiar.ln')aa ;>uI pl!ng.}o p.nu)g �1�.4rS mltlnd.;o auawLirctaa -cllacny�rssr.1N s d usiness Regulation .' Office of Consumer Plaza and 5170 fa assa ' 1 chusetts 02116 Boston, M y nt -C--RITA— c-to--r Registration Home Improveme 111863Registration: j Type, DBA s Expiration: 1/11/2013 Tr# 208587 JIM GALLAGHER CONSTRUCTIQ'N -- , i t � ' JAMES GALLAGHER = . ' 352 ST HOWE ` 01844 �� - •� r.,� � METHUEN, MA .`, —^ Al`'�•;.,, .,_„ „�.',flUpdate Address and return card.Mark reason..forLost Card '- Address E] Renewal [J Employment 1 DPS-CAI io 50M-04/04-G10121 °� License or registration valid for individul use only Office of consumer Affairs&B smess Regulation before the expiration date. If found return to: usiness Regulation HOME IMPROVEMENT CONTRACTOR office of Consumer Affairs and Bi Registration: 111863 { DBA Type: . 10 Park Plaza-Suite 5170 eExpiration: 1_/11_2013 a Bost'n,MA 02116 JI ALLAGHER CONSTRUCTION', S � t JAMES GALLAGHER ,' a 352 HOWE STS g Not valid without sig a re METHUEN, MA 01844 Undersecretary � I MassaeImprove.nsetts Home i Imeat Sample Contract This form satisfies all basic requirements ofthe state's Home Improvement Contractor Law(MGI,chapter 142A),but does not include standard ' language to protect homeowners(Seek legal advice if necessary. Any person planning home improvements should first obtain a copy of"A Massachusetts Consumer Guide toII (HIome Improvement"before agreeing to any work on your residence.You may obtain a free copy by calling the Office of Consumer Affairs and Bt)siness Regulation's Consumer Information Hotline at 617-973-8787 or 1-888-283-3757 or on our website.. Homeowner hiformation Contractor Information Name i Company Name Rall Gicrive- ,� Gg I la, kk COO Street Address(do not use a Past Office Box ad ss) Contractor/Salesperson/Owner Name 6 ��n Gee S City/Town State ' Zip Code Business Address(must include a street address) Daytime Phone EveniI ng Phone C" own state Zip Code Mailing Address(It different from abov7e) Business Phone I±ederal Employer ID or S.S.Number ' Lmv requires thmt most home Home Improvement Contractor Reg,Number Expiration dat, improvement contractors havea valid / I r�6 m valid registration number ( ( The Contractor agrees to do the following work for the Homeowner: (Describe in detail thework to complete specifying the type, rand and grade of materials to be used,use additional sheets if necessary.) i � Required Permits-The followinglbuilding permits are required Proposed Start and Completion Schedule-The following schedule will and will be secured by the contractor:as the homeowner's agent: be adhered to unless circumstances beyond the contractor's control arise (Owners who secure their own permits will be excluded from the Guaranty Fund provisions of � a2 �e when contractor will begin contracted work. MGL chapter 142A.) . i ate when contracted work will be substantially completed. Total Contract Price and Paymedt!Schedule Q �"' The Contractor agrees to perform the work,furnish the material and labor specified above for the total sum of: c/ d�✓ Payments will be made according tothe following schedule: oupon signing contract(not to exceed 1/3 of the total contract price or the cost of special order items,whichever is greater) $ by // or upon completion of by l i ; or upon completion of j $ upon completion of the contract. (Law forbids demanding full payment until contract is completed to both P party's satisfaction) The following material/equipment must be special $ to be paid for ordered before the contracted wocic begins in order to meet the completion schedule(**) $ to be paid for NOTES:M Including all finance charges(**)Law requires that any deposit or down-payment required by the contractor before work begins may not exceed the greater oft(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 schedule. Ex ress Warran -Is an a ress warranty beinE nrovided by the contractor. � ❑Nms of the warran y must be attached to the contract Subcontractors-The contractor agrees to be solely responsible for completion of the works 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 materials and labor under this agreement Contract Acceptance-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! li • Don't be pressured into signing' ' the contract.Take time to read and fully understand it. Ask questions if something is unclear. • Make sure the contractor has alvalid Home Improvement Contractor Re 'stration. The law requires most home improvement contractors and subcontractors to be registered) ith 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. Does the contractor have insurance? Ask the Contractor for his insurance company information so that you can confirm coverage,or ask to see a copy of a"proof of insurance"document. • ICuow 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 Law. . j 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!gffice 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 the attached notice of cancellation form for an explanation of this right. DO NOT 11 THIS CONTRACT W THERE ARE ANY 13LANK SPACES!!! Two identic op'es o£ contract must be completed and signed. One copy should go to the h owner. Theo y shoul a keep the contractor. i Homeowner's Signature j Co actor's The e l �� a Date Date Contractor Arbitration The Home Improvement Contractor Law provides homeowners with the right to initiate aniarbitration action(as an 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 with a homeowner in court unless both parties agree to the optional clause provided below. This clause would give the contr'alctor the same right to arbitration as is afforded to the homeowner by the Home Improvement Contractor Law. i ! 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 fmn which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided In Massachusetts General Laws, chapter 142A. ! . Homeowner's Signature Contractor's Signature NOTICE:The signatures of the parties above apply only to the agreement of the parties toy alternative dispute resolution initiated by the contractor. The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties. Homeowner's Rights A homeowner's rights under the Home Improvement Contractor Law(MGL chapter 142AJ and other consumer protection laws(i.e.MGL chapter 93A)may not be waived in any way, even by agreement.i However,homeowners may be excluded from certain rights if the contractor they choose is not properly registered,',s prescribed by law. Homeowners who secure their own building permits are automatically excluded from all Garanty Fund provisions of the Home Improvement Contractor Law. The contractor is responsible for completing thework as described,in a timely and workmanlike manner. Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for workmanship or materials. In addition to guarantees or warranties provided by the contractor,all goods sold in Massachusetts carry an implied warranty 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 consumer rights. If you have questions about your consumer/homeowner rights, contact the Consumer Information Hotline(listed below). Execution of Contract The contract must be executed in duplicate and should not be signed until a copy of all exhibits and referenced documents have been attached. Parties 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 be 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. Contracted-work may not begin imitil both parties have receivIed a fully executed copy of the contract,and the three day rescission period has expired. Accelerated Payments A contractor may not demand payments 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 a contractor deems him/herself to be financially insecure,the contractor may require that the balance of fiords not yet duel be placed in a j oint escrow account as a prerequisite to continuing the contracted work. Withdrawal of fiends from said account would require the signatures of both parties. Additional Information If you have general questions or need additional information about the Home Improvement!Contractor Law or other consumer rights,or if you wish to obtain a free copy of "A Massachusetts Consumer Guide to Home Improvement" contact: Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787, 888-283-3757 or visit the OCABR website at http://www.mass.aov/ocabr/ If you want to verify the registration of a contractor or if.you have questions or need addi�ip nal information specifically about the contractor registration component of the Home Improvement Contractor Law,contact: Director of Home Improvement Contractor Registration Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787, 888-283-3757 or visit the HIC website at http://www.mas5.gov/ocabr/ Go online to view the status of a Home Improvement Contractor's Registration: bllp://db.state,ma.-Lis/homeiMprovement/licenseelist.asp i 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 j 508-652-4800,508-755-2548 or 413-734-3114 j Version 2.1-11/22/2010