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HomeMy WebLinkAboutBuilding Permit #256-2017 - 132 Kingston Street 9/8/2016 BUILDING PERMIT o� NO D 'Ct t"EU TOWN OF NORTH ANDOVER o :. - APPLICATION FOR PLAN EXAMINATION ~y _ T y cc�� ,QA ' Permit No#: (9 i� Date Received �9ss^TED US Date Issued: (10 IMPORTANT: Applicant must complete all items on this page LOCATION w , Print 15j= zmkot e1xi- PROPERTY OWNER � _ di 1/r» � Print 100 Year Structure yesno MAPS PARCEL:ZONING DISTRICT: Historic District yes no Machine Shop Village ye no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Sep#�e ❑Well' ❑ Flb 1h, L]Wetlands ❑ 1111atershed ®i tnctu ❑V1/ater/Se0er " r � . DESCRIPTI0q_0 _WQRK O/VEfERFORMED: I q ificatiou-lease Type or Print Clearly OWNER: Name: I Phone: ix� Address: Contractor Name: �( � 1 + Phone: Email: Address Supervisor's Construction License: _1?_3q2_55 Exp. Date: _4 Home Improvement License: Exp. Date:_ !0-/__n� ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ � FEE: $ Check No.: � , Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 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 PLANNING & DEVELOPMENT Reviewed On Signature_ 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 i DPW Town Engineer: Signature: Located 384 Osgood Street FI REIDEPARTMENT' - Temp,Dempster on site :yes no,__ Located bt-,l 24 Maih,Street Fires Departinentsignatbre/date COMMENTS t 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 Call Email Date Time Contact Name - Doc.Building Permit Revised 2014 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 OTE: 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 Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract Floor/Cross Section/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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) �6 Building Permit Application 4- 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 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: 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 Doe:Building Permit Revised 2014 Locationr,,No. 67 6X Qr ' cii 7 / Date • - TOWN OF NORTH ANDOVER. • Certificate of Occupancy $ Building/Frame Permit Fee $ -� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ . Check# 4 Building Inspector r 1 NORTH q W. 6 m ve: . No. h " ver, MassLAI6 C OC MICA WICK �01• �.AS RATED I'll IF .(5 U BOARD OF HEALTH Food/Kitchen PERM �T LD Septic System THIS CERTIFIES T r ��� BUILDING INSPECTOR THAT ...........Y�? ......... .......................... .......................................................... �. � ... ` Foundation has permission to erect .................. ...... buildings on .............. .... �T .... .. ":0. a► t1 Jr. � Rough to be occupied as ..... ... . ... .... ..................................... Chimney provided that the person accepting his permit shall in every respect conform to the terms of the application Final on file in 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 CONSVC ON Rough Service .. .. .. .... .............. ......... .... Final BUILDING 4QSPEC OR GAS INSPECTOR Occupancy Permit Required to Occupy Buildiniz 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. Smoke Det. IIOME IMPROVEMENT CONTRAUT PLEASE READ THIS Q�rr Sold,Furnished and Installed by: THD At-Home Services,Inc. Branch Name:New England Date:o/ � d/b/a The Home Depot At-Home Services Branch Number: 31 908 Boston Turnpike,Unit 1,Shrewsbury,MA 01545 • Toll Free 877-903-3768 Federal ID#75-2698460;ME Lic#C 02439;RI Cont.Lic#16427 CT Lic#HIC.0565522;MA Home improvement Contractor Reg.#126893 l 3 Z l<w�ts`�"t M .;rte "Pi 01 Sit`" Installation Address: Y Cit State Zip Purchaser(s): Work Phone: Home Phone: Cell Phone: fL�L I I [ J [ J [ J Home Address: State Zip (If different from Installation Address) City E-mail Address(to receive project communications and Home Depot updates): ❑I DO NOT wish to receive any marketing emails from The Home Depot Project Information: Undersigned("Customer"),the owners of the property located at the above installation address, agrees to buy, and THD At-Home Services, Inc. ("The Home Depot") agrees to furnish, deliver and arrange for the installation ("Installation") of all materials described on the below and on the referenced Spec Sheet(s), all of which are incorporated into this Contract by this reference, along with any applicable State Supplement and Payment Summary attached hereto and any Change Orders (collectively, "Contract"): Job#: Ontemal Refcmnce) Products: Spec Sheet(s)#• Project Amount Roofing Siding Windows insulation $ t y$73 $ ❑Gutters/Covers Entry Doors ❑ W Go Roofing LJSiding Windows Insulation $ ❑Gutters/Covers ❑Entry Doors ❑ Roofing Siding Windows Insulation $ ❑Gutters/Covers ❑Entry Doors❑ ❑Roofing Siding U Windows Li Insulation $ ❑Gutters/Covers ❑Entry Doors ❑ Minimum 25%Deposit of Contract Amount due upon execution of this contract Total Contract Amount $ (005-1 Maine Purchasers may not deposit more than one-third of the Contract Amount Customer agrees that, immediately upon completion of the work for each Product, Customer will execute a Completion Certificate (one for each Product as defined by an individual Spec Sheet) and pay any balance due. As applicable, each Customer under this Contract agrees to be jointly and severally obligated and liable hereunder. The Home Depot reserves the right to issue a Change Order or terminate this Contract or any individual Product(s)included herein, at its discretion,if The Home Depot or its authorized service provider determines that it cannot perform its obligations due to a structural problem with the home, environmental hazards such as mold, asbestos or lead paint, other safety concerns, pricing errors or because work required to complete the job was not included in the Contract. Payment Summary. • The Payment Summary # f5 ��6 Z� , included as part of this Contract, sets forth die total Contract amount and payments required for the deposits and final payments by Product(as applicable). NOTICE TO CUSTOMER You are entitled to a completely filled-in copy of the Contract at the time you sign. Do not sign a Completion Certificate(note: there is one Completion Certificate for each listed Product as defined by individual Spec Sheets)before work on that Product is complete. In the event of termination of this Contract, Customer agrees to pay The Home Depot the costs of materials,labor, expenses and services provided by The Home Depot or Authorized Service Provider through the date of termination, plus any other amounts set forth in this Agreement or allowed under applicable law. THE HOME DEPOT MAY WITHHOLD AMOUNTS OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Acceptance and Authorization: Customer agrees and understands that this Agreement is the entire agreement between Customer and The Home Depot with regard to the Products and Installation services and supersedes all prior discussions and agreements, either oral or written, relating to said Products and histallation. This Agreement cannot be assigned or amended except by a writing signed by Customer and The Home Depot. Customer acknowledges and agrees that Customer has read, understands, voluntarily accepts the terms of and has received a copy of this Agreement. ■ Work area will be contained ,3EPA, Pre-Renovation Form Date: '�� `^ �{ NAT-19276 k(ly This form is used to document compliance with the requirements of the r Federal Lead-Based Paint Renovation,Repair and Painting Program after April 2010. Customer Address Job Numbers) Dust will be minimized "49 OCCUPANT CONFIRMATION Pamphlet Receipt I have received a copy of the lead hazard information pamphlet Informing me of the potential risk of the lead hazard exposure from renovation activity to be performed in my dwelling unit. I received this pamphlet before work began. tHome Year Built Enter the year my home was built. If the year your home was built is Pre-1978,all work will be done following lead safe work practices. Work area will be cleaned up Printed Name ofOv r-occupant thoroughly ignature of er occupa t Signa r f Person fing Lea mphlet Delivery (, SEE STATE SPECIFIC FORMS ON REVERSE SIDE i TWD At-Home Services, Inc.PRE-EXISTING CONDITIONS tI y/��,(�yn 21y' Thhiss form must be signed by the customer _ A �,, ,�A�,,/ t4 /�,,, Customer Name:���t� /Ye Job#: v L + 7U 6 Sale Date: 0 _r Address: �j 1\J ��'r'�TJV'�7 #-6./� The purpose of this form is to identify Lead Paint Status and any conditions or damage to the customer's home or property that was existing PRIOR to the commencement of work •Pre-1978 structures are assumed to contain Lead Paint unless tested •If testing is allowed, each window must be tested or multiple locations with siding,fascia or gutters(mulled windows are considered one window) •Record the results of the Lead Paint Tests in the space provided below(add additional sheets if needed) \,.� ,v4y„r`n;� w >c. A 7.7 r � t LP Cert# FIRM Cert# INSPECTOR NAME(PRINT),(Personal EPA/State Lead Paint Cert#-MANDATORY) COMPANY NAME(PRINT)(Firm Cert#-MANDATORY) .. >- ..,e.,^.^;° ,)f,^f w�, ' vti i,', . E.Nx'tt✓Y,G'1AIVI6'tZ'a�..y �,.i,. ,`; a,. re;L�l .;, Z* tz ,iia ,�w+ .� `r,`Li�A{�;.e!.h'.'ft��:ttF+�r �l�t �..0 �... 4 w,. .� ) r .,�1 +,. 4;• 4 b `a �t i ,t e�p Saye fly �`.::;�� � � t \:: v'-. Test Kit Manufacturer Test Kit Lot Test Date Test Site Test Kit Manufacturer Test Kit Lot Test Dale Test Site # (Location#I Specific area of home) # (Location#I Specific area of home) Test Results: Is Lead Present? YES NO Purchase/Assume Lead Paint Test Results: Is Lead Present? YES NO E] PurchaselAssume Lead Paint check appropoate box above check approprlalo box above Test Kit Manufacturer Test Kit Lot Test Date Test Site Test Kit Manufacturer Test Kit Lot Test Date Test Site # (Location#1 Specific area of home) # (Location#1 Specific area of home) Test Results: Is Load Present? YES F] NO ❑ Purchase/Assume Lead Paint Test Results: Is Lead Present? YES ❑ NO Purchase/Assume Lead Paint check approptlele box above check appmedalo box obovo Test Kit Manufacturer Test Kit Lot Test Date Test Site Test Kit Manufacturer Test Kit Lot Test Date Test Site # (Location#I Specific area of home) # (Location#/Specific area of home) Test Results: Is Lead Present? YES M NO Purchase/Assume Lead Paint Test Results: is Lead Present? YES [—] NO PurchaselAssume Lead Paint check amropnola box above check-seproprio14 box abeva Test Kit Manufacturer Test Kit Lot Test Date Test Site Test Kit Manufacturer Test Kit Lot Test Date Test Site # (Location#I Specific area of home) # (Location#I Specific area of home) Test Results: Is Lead Present? YES ❑ NO PurchaselAssume Lead Paint Test Results: Is Lead Present? YES [] NO ❑ PurchaselAssume Lead Paint check appmpfkdt box above check appraplete box above Test Kit Manufacturer Test Kit Lot Test Date Test Site Test Kit Manufacturer Test Kit Lot Test Date Test Site # (Location#1 Specific area of home) # (location#1 Specific area of home) Test Results: Is Lead Present? YES ❑ NO El PurchaselAssume Lead Paint Test Results: Is Lead Present? YES ❑ NO PurchaselAssume Lead Paint check appropriate box atwve ctAek appropriate bw obore ..s..-- , ,, wa a.:„, 4 t�,: ? •hh H ;.G .STCIVIP AC{LN))NLEEICIUtENZ, `... I have reviewed and/or discussed the following with my Home Depot Representative during the Inspection AND I acknowledge that the conditions listed above existed prior to the commencement of my project` check all that apply ontract(including final method of payment) MContract Amendment Pre-ExxIS1iinng.(Conditions Specification Sheet I Scope of Work Lead-Safe(if positive result) 1v l CUSTOMER SIGNATURE DATE CUSTOMER SIGNATURE DATE 7-2514 White-Home Depot Yellow-Customer THD-4006 WINDOW SPECIFICATION SHEET - Spec.Sheet#: � � Sheet: of � Customer: � �� _ Job 0:�f_(i L 0 Consultant: `_/V Date: New Window Existing Window Measurements Grids Product Options Labor Hinge Locations Options Options Left to Right Bays,Bows, Location Color Rough Opening it of bars #of bars Csmnts,1 Pnl, Use L,R or m Glass MIsC Items Hardware Code16 For doors use 0 r r ° m o ° 9 o Screens o "S'=stationary or Style Wraps � a g m `o N "X"=operating Room Floor Code (Y/N) St le Code Series Code w' 3 i S t u° a ° j =° _° I D to 1 4Z l I Y &160 W 31 ` 7, 73 3 i to c&a 4j L3 14 IP 2 p A Wv0 W W 73 z- W00 142 �3 e &100 W V 31 Lf?. ) BeD2 04 &100 W w35' 42 �� Gi00 W 2 u „ SPECIAL CONSIDERATIONS: Wrap color Interior Casing Type ' Bay or Bow window: Seatboard Materia(:(vinyl only-Birch or Oak) Bay Projection Angle (30 n or 45 n) Say Flanker Type(DH,SH or Csmnt) Top of window to soffit(inches) If tied to soffit,color of soffit material Ilia reviewed and agree with all the job specifications above and the Construct Roof(Yes or No) ' Speclal Terms and Conditions on the back of the yellow(Customer)copy. Garden Window; Seatboard Material:(vinyl only-White Pionite.Birch or Oak) t Wall Thickness,(inches) \ Customer Signature Additional Shelf(Yes or No) I.Thcro is noguerantee the[nex shln9k"+�,a match awlu:rycnlM. ssa:Wnv S•xrm White-The Home Depot Yellow Customer nm-ss VINYL WINDOW PRICING rWORKSHEET BOSTON :{ Customer: W((6,Y'A S4F Job#: Q q{ .71 0d Consultant: WINDOWS GRIDS TOTAL 1" "2" 1 x 2 "3" "4" 3 x 4 In Ows Window Size Price/ Window Price/ #Sashes Grid + Qty. Style Series Color (UI) Window Price Sash W Grids Price Grids 1 U 7 49� t1 014 1 U0 L ! v k! lot 6'(O o 5v X21 r n 3 wit b� -77 ID ?7 �g (A) TOTAL WINDOW PRICE (BEFORE OPTIONS): 12/Y?J75 VINYL WINDOW PRICING WORKSHEET BOSTON "1" "2" 1 x 2 WINDOW& GLASS OPTIONS Unit Meas. Qty. Unit Price Sub-Total Full Screen (Double Hung) Per Screen $20 Add'I Oper.Sash/deduct for Fixed Sash (Casements) Per Sash $102 Mullins Charge Per Mullion $42 9 (for DPD ) etc. Tempered Glass(see below for Garden Window) $20 (Wx H)1144=Sq.Ft. Per Sq.Ft. Obscure Glass $8 N Energy Star ProSolar Sun,Supercept,Poly Reinf Per Window $60 6500 WIN Energy Saver+ ProSolar Shade(2),Super Spacer, Per Window $140 ple Pane Metal Reinf N Sound&Security o ar Sun,Laml Glass, Supercept,Metal Reinf Per window $138 6100 WIN N Energy Star ProSolar Sun,Supercept,Poly Reinf Per Window $54 N Energy Star ProSolar,Supercept,Poly Reinf Per Door $105 ProSolar Shade(2),Super pacer, 6500 PO Energy Saver+ Per Door $427 Ty le Pane Metal Reinf N Sound&Security ProSolar,La Glass,Supercept Metal Reinf Per Door $449 6100 PO N Energy Star ProSolar,Supercept,Poly Reinf Por Door $99 WINDOW HARDWARE OPTIONS (Premium Finishes Available with 6500 ONLY) Premium Finishes are:Polished Brass, Brushed Nickel Oil-Rubbed Bronze Note on Spec sheet Premium Finish Lock&Keeper (DH,2/3 PNL Slider) Per Lock $32 Premium Finish Lift Handles Woodgrain Only I (OH,2/3 PNL Slider) Per window $39 Premium Finish Crank Handle/Hrdwr(Note"Folding"or"Non"on Spec Sheet) Per sash $160 Flush Mount Handle (Casements,Awnings) Per Sash $11 Egress Hinge (Casements) Per window $9 GARDEN WINDOW OPTIONS(see Price Book for Unit Price) Tempered Glass Per Window Additional Glass Shelf(Tempered) Per Window Jamb Depth 6"or Greater Per Window PATIO&GARDEN DOOR OPTIONS Premium Finishes are:Polished Brass,Brushed Nickel,Oil-Rubbed Bronze,Antique Brass Premium Finish Lock Handle-Sliding Patio Door(6500 Only) Each $143 Sliding Screen-Garden Door(Only with Center Hinge-Single Swing) Per screen $206 EXTERIOR COLOR UPCHARGE available only on 6500 Windows up to 120 UI Per Unit $193 Windows greater than 120 UI Per Unit $230 Sliding Patio Door Per Door S583 Mulls Per Mullion $66 (B) WINDOW OPTIONS SUBTOTAL: American Craftsman WINDOW&GLASS OPTIONS Unit Meas. Qty. Unit Priec Sub-To I Tempered Glass $14 (W x H)1144=Sq.Ft. Sy.Ft. Obscure Glass $5 Full Screen (Double Hung) Screen $17 Add'I Oper.Sash/deduct for Fixed Sash (Casements) Per sash $163 Mulling Charge for DPD,etc. Mullion $63 WINDOW HARDWARE OPTIONS 124 Egress Hinge (Casements) Window $19 VINYL WINDOW PRICING WORKSHEET BOSTON PRS 5100 WINDOW&GLASS OPTIONS Unit Meas. Qty. Unit Price Sub Total Tempered Glass (W x H)1 144=Sq.Ft. sq.Ft. $18 Obscure Glass $6 Full Screen (DH and 2 PNL Slider) Screen $18 Add'1 Oper.Sash/deduct for Fixed Sash (Casements) Per sash $89 Mulling Charge for DPD,etc. Mucron $59 N Energy Star 2 coats of Loainless Steel Per Window $54 Spacer PATIO DOOR OPTIONS Polished Brass Interior Handle Per Door $63 2 coats of Low E,Stainless Steel Per Door $99 N Energy Star Spacer C PRS5100 and AC 12 OPTIONS SUBTOTAL: "1- "2" 1 x 2 LABOR OPTIONS Qty-Unit Meas. Unit Price Sub-Total Lead Safe Renovation -Windows Per opening $35 3 Metal Window Replacement (excl.Bay,sow,Garden Window&Patio or Garden Doors) Per Window $109 Additional Charge for Steel Pan Removal Each $199 Construct Roof over Bay/Bow Window Each S657 Up to 120 UI Each $80 Window/Door Wraps:AC12,all additional wraps 121-150 UI Each $95 (or Deduction for No Wrap) Over 150 UI Each $120 Custom Color Window/Door Wrap (only if<5 windows) Per Job $76 New Interior Wood Casing Per Lin.Ft. $10 Remove&Reinstall A/C Unit Each $58 Up to 8' Each $35 Remove&Reinstall Awnings Over 8' Each Bid Remove&Reinstall Shutters Pair $23 Up to 120 Ul Each Bid Simonton Nail Fin Over 121 UI Each Bid Boston City Charge Per Job $167 Misc.Labor Call for Estimate of Hours) ( Per Hour $55 D LABOR OPTIONS SUBTOTAL: TOTAL PROJECT AMOUNT (A+ B + C + D): 5 ESTIMATED MONTHLY PAYMENT *: — S'00 •Equal to Pro'ect Amount X.019 based on the assumption of 84 months and 13.99%APR). (005-7 12/22/15 3 HOME IMPROVEMENT CONTRACT For Massachusetts Residents Only Contractor Arbitration: The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action (as an alternative to court action) if they have a dispute with a contractor. However, the same right is not afforded to a contractor. The contractor would have to resolve any dispute ute 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 satne 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 Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as prgovided in Massachusetts General Laws,chapter 142A Homeowner Sitr r Contractor Signature NOTICE:The gnature of the parties above apply to the agreement of the parties to alternative dispute resolution initiated by the contractor. Th homeowner may initiate alternative dispute resolution even where this section is not separately signed by both parties. Homeowners Rights: A homeowner's rights under the Home Improvement 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 automatically excluded from any 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 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 so implied warranty of merchantability and fitness for a particular purpose. An enumeration of these 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's rights. 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 until both parties have received a fully executed copy of the contract. 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 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: That all home improvement contractors and subcontractors shall be registered and that any inquiries about a contractor or subcontractor relating to a registration should be directed to: Office of Consumer Affairs and Business Regulation Ten Park Playa,Suite 5170 Boston,MA 02116 Phone: (617)973-8700 SUBMITTED BY: Date: f �� Con ACCEPTED BY-\ Date: j} Purchaser Date: Purchaser 06-24-13 White—Branch File Yellow—Customer The Home Depot At-Home Services CUSTOMER REMINDER For ROOFING Projects: 91 Home as a Construction Site ❑ Your home will be a construction site during the installation of your roofing and it will be noisy. 0 There may be a significant amount of job debris associated with roofing installations, most of which will be cleaned up and removed. However,some debris may fall between the roof decking boards and into the attic or an open garage. We are not responsible for cleaning up your attic or garage after the installation has been completed. 0 We suggest you cover or remove any items that may need protection in order to avoid damage. Items such as grills, patio furniture,lawn and garden decorations, automobiles,items stored in the attic,etc. should be covered or moved.In addition, all windows should be closed during the installation. Trees, Bushes, Flowers&Shrubbery ❑ If you have low-hanging branches over your driveway or roof,trimming may be necessary. Our crews will only cut back branches that limit their ability to do a safe and efficient job. 0 If any bushes,flowers or shrubbery need to be protected, please let us know. We will take proper precautions to keep your landscaping intact. Rotten or Deteriorated Wood ❑ The exact condition of your roof deck cannot be verified until we remove your existing shingles. ❑ If rotten or deteriorated wood is discovered AFTER removing your existing materials, additional charges will apply. Please review your Roofing Spec Sheet for details. 0 Repairs to your roof deck may conflict with the original(estimated)completion date. Gutters, Satellite Dishes and Other Exterior Mountings ❑ Although we will make every effort to protect your existing gutters,some minor damage(scratches and/or dents)may occur.At our discretion and expense we will replace a section of gutter if we do more than minor damage, but we cannot be held responsible for small scratches and/or dents. ❑ "Gutter guard"or gutter helmet type materials attached to your roof that carry their own warranty need to be removed and replaced by an authorized service company so the warranty is not voided. ❑ Satellite dishes or solar panels mounted directly to the roof may need to be moved to allow us to properly install your new materials.You will have to contact your satellite or solar company to reinstall these items and/or realign your dish. ❑ Lightning rods,weather vanes,AC units or other mounted projections may require disassembly and reinstallation.You may have to contact your installation company to reinstall and/or realign.We are not responsible for the condition of these items during removal or reinstallation. Skylights ❑ Where necessary we can replace your skylight(s)with a stock skylight that is sized as close as possible to your existing skylight, however we do not create or modify openings. ❑ The skylight replacement will not require the installer to enter your home. Interior trim work or painting will usually need to be done after the installation of the skylight(s). You will be responsible for this work. Job Site Access 0 Please let us know where you would like us to stage your materials(where to place the materials,dumpster, park vehicles, and where to store our equipment). ❑ Keep in mind that everything we use needs to be as close to the house as possible,and our workers need access to a grounded electrical source in order to run their equipment. ❑ Please ensure all pets/animals are properly secured. ❑ We will attempt to protect the surface of your driveway, although minor scratches or cracks may occur. ❑ Please notify us prior to starting the job if you have a sprinkler system,septic field or well,and if so,the location(s). Wood, Slate or Multiple Layer Removal ❑ When we remove wood,slate,or multiple layers of composition shingles there may be a slight gap where the existing siding meets a roof line.This gap can be between 1"to 2"depending on the thickness of the shingles and number of layers being removed.Although we will install metal flashing to prevent leaks,we cannot be held responsible for the change in appearance. Job Completion ❑ Upon completion of your job, you will be asked to sign a Completion Certificate and pay the balance due on the job. Please note that our installers are authorized to receive the final payment. ❑ If you are paying by check,please make the check payable to"The Home Depot". ❑ Service issues found after job completion will be handled as part of the applicable Product or Craftsmanship Warranty. NOTE: Verbal promises cannot be honored. Please verify that everything you expect is detailed in the Home Improvement Contract or Spec Sheet that you signed. Customer Name: Customer Signature Date: Job#: D Rep Initials 07-15-14 White—The Home Depot Yellow—Customer THD-509 :the Commonwealth of Massachusetts Departurent`of Industrial Accidents Office of Investigations 600 Washington Street .Boston,MA 02111 www.rnass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organizadon/Individual): Address. City/State/Zip: hone#: �' � Are you an employer?Check the appropriate b Type of project(required): 1.E:1I am a employer with 4. i am a general contractor and I 6. ❑New.construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. Building addition [No workers' comp.insurance 5• ❑ We are a corporation and its 10.0 Electrical repairs or additions required.] officers have exercised their 3.El I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. (No workers'comp. c. 152,§I(4),and we have no 1�,0 repairs insurance required.) t employees. [No workers' t I3. Other comp.insurance required.) Nny applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing-all work and then hire outside contractors must submit a new affidavit indicating such. .. .ontractors that check this box must attached an additional sheet showing the name of the sub contractors and their workers'comp.policy information. irm an employer that is providing workers'compensation insurance for my employees Below is the policy and job site formation. surance Company Name: Expiration iration D _531) 7 tlicy#or Self-ins.Lic.M ( i� lh P ate: b Site Address: %A A411, City/State/Zip: :tach a copy of the workers' compensation 04 cy declaration page(showing the policy number and expiration date). ilure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a e up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of restigations of the DIA for insurance coverage verification. o hereby ce i nd r th pains and penalties of perjury that the information provided above is true and correct. nature: Date: ane#: Official use only. Do not write in this area, to be completed by city or town officiaL City or ToWh: Permit/License# Issuing Authority (circle one): 1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector i. Other :�ontact Person: Phone#: ' O ffice of Consumer Affairs and Business fZejulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 _ Home Improven Contractor Registration eq • 126 893 R iy-tration. J�---- - mentCard Type: SuPRfe Expiration: 8/3/2018 THD AT HOME SERVICES, INC. RICHARD FALLONE 455 PACES FERRY ROAD, HSC1 �- ATLANTA, GA 30339 Lpdate-tddress and return carr mark reason for change. j - Address _ Renewal — Emplogment Lost Card tradon valid for individual ase only Reaalation License or regis ffice of Consumer fairs&Basing before the expiration date. If found return Regulation ENT CONTRACTOR office of Consumer Affairs and Business Regal _ Smte 5170 #COME IMPRO�FEM Type_ LO Park Plaza- - ---- - - s� Registratca7 -- Supplem =-ent,.Cacd- - Bostoti '114n" -- Exp TIHD AT HOME SE-;- < THE HOME DEP VICES t� RICHARD FALLON -.. __ _ -- �FSC v lid wit of valid t si ture 2455 PACES FERRY F�f3 [indersecre9 qTVANTA,GA 30339 A`COR" DATE(MMIDDIYYYY) CERTIFICATE 4F LIABILITY INSURANCE 02/242016 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 CONTACT MARSH USA,INC. NAME: TWO ALLIANCE CENTER PH_IAICNNo Ext• aC No: 3560 LENOX ROAD,SUITE 2400 E-MAIL ATLANTA,GA 30326 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# 100492-HomeD-GAW'-16-17 INSURER A:Steadfast Insurance Company 26387 INSURED INSURER B:Ztifth American Insurance Co 16535 THE HOME DEPOT,INC. HOME DEPOT U.S.A.,INC. INSURER C:New Hampshire Ins Co 23841 2455 PACES FERRY ROAD,NW Illinois Natural Insurance Company 23817 BUILDING 0-20 INSURER D: P Y ATLANTA,GA 30339 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-003741310-08 REVISION NUMBER:o 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 TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DD MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY GL04887714-06 03/01/2016 03/01/2017 EACH OCCURRENCE S 9,000,000. CLAIMS-MADE a OCCUR DAMAGE TO RENTED PREMISES Ea occurrence S 1,000,000 LIMITS OF POLICY XS MED EXP(Anyone person) S EXCLUDED OF SIR:SIM PER OCC PERSONAL&ADV INJURY S 9,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 5 9,OOD,000 X POLICY❑JELOC PRODUCTS-COMP/OPAGG S 9,000,000 OTHER: S B AUTOMOBILE LIABILITY BAP 2938863-13 03/01/2016 03/01/2017 CEaOMaccBINED SINGLE LIMIT S 1,000,000 ident X ANY AUTO BODILY INJURY(Per person) S _ ALL OWNED SCHEDULED SELF INSURED AUTO PHY DMG AUTOS AUTOS BODILY INJURY(Per accident) S NON-OWNED PROPERTY DAMAGE HIREDAUTOS AUTOS Per accident S S UMBRELLALIASOCCUREACH OCCURRENCE S EXCESS LIAB HCLAIMS-MADE AGGREGATE S DED I I RETENTIONS S C WORKERS COMPENSATION WG015519215(AOS) 03/01/2016 03/01/2017 X PER OTH- C AND EMPLOYERS`LIABILITY YIN STATUTE OR _ ANY PROPRIETORIPARTNER/EXECUTIVE ❑ WC015519217(AK,KY,NH,NJ,VT) 03/01/2016 03/01/2017 EL.EACH ACCIDENT S 1,000,000 D OFFICERIMEMBER EXCLUDED? N N I A (Mandatory In NH) WC015519216(FL) 03/01/2016 03101/2017 EL.DISEASE-EA EMPLOYE S 1.000,000 If yes,describe under Confinued on AdcHonai Page1,000,000 DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 16000SGOODST_ THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN NORTH ANDOVER,MA 01845 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukhedee _1A_JX Aaaral-L ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD 6/21/2016 Custom CSI-png Q T.7 . J Requiation-s anni CSSL-099823 DIMIRR Y NOVAK 70 NORTON AVE MANCHESTER NH 031" Nee"I rTmissioner 06/2612018 -7 AZ hUps://maiI.googie.com/mai1/u/O/ffinbox/I557394129c8f270?projector=1 1/1