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HomeMy WebLinkAboutBuilding Permit #660-2017 - 14 DOUGLAS ROAD 12/20/2016 fl� TOWN OF NORTH ANDOVER roRrk APPLICATION FOR PLAN EXAMINATION � T �O 20 IV- Y Permit NO: Date Received g� SS�cHuSE� Date Issued: /,A z 0 �! "' �� �,IMPORTANT: Applicant must complete all items on this page LOCATION j l)aV S /s Print PROPERTY OWNER COILS C Vgg Print MAP NO.: PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑New Building ❑One family ❑Addition ❑Two or more family ❑Industrial ❑Alteration No. of units: ❑Repair,replacement ❑AssessorY g Bld ElCommercial ❑Demolition ❑Moviri (relocation) _ ther C-U8 ,Z77,$ ❑ Others: ❑Foundation only DESCRIPTION OF WORK TO BE PREF RMED 0-f kL- Identification P ase Type o riot Clearly) OWNER: Name: Lin Phone: Ong-86 q Address: y DO U 44JS KU /y6�Y'�1 /�'19Cl,*y,P° d ys U CONTRACTOR Name: Phone: Address: j O of �1 � 8' � S IVY d SJUJ/ Supervisor's Construction License: Cl Cf 16 1? Exp. Date: 3 Home Improvement License: / 3 y65 7 Exp. Date: / 1 -9/ - Zyj7 ARCHITECT/ENGINEER /y--q Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.•$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost :$ 5609• c b xl2.00=FEE:$ Check No.: ) Receipt No.: Page tof4 tr - NORTN BUILDING PERMIT '.. ,f, TOWN OF NORTH ANDOVER o y -"OFAPPLICATION FOR PLAN EXAMINATION n0 1 4: Permit No#: Date Received 7�Q�R.4TEO JNIV �SSgcHus�� pate Issued: LVOORTANT:Applicant must complete all items on this page - —- - }--- F �r Ar 4 may, �7 A ION - 1 a 0 !'nnt PROPERTY ®WNERR c - a Print ,- o' e 1l)D Year Structure.. a }yeS v no MAP PARCEL ._ ZQNIN bISTRICT; Histone District � yes��no Mac}iinhop`Villa e -!es r no x,,..- rx�, �r� .:�:z'<l - - - _c..�. _ �g�=--yam t � 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 ❑ Septic 1Ne11 ❑ Floodplain ❑V1letlarids D Watershed District t •- t r ❑_Water_-Sewer DESCRIPTION OF WORK TO BE PERFORMED: P Identification- PIease Type or Print Clearly OWNER: Name: Phone: a Address: _ Contractor Name`:• _ _.: Phone:: . :... . . .'C'�7+e..:�-+•f.-`Y^•roc'. .,. s tiv.c-fir ^.-r+. .,. ._o.-, _ p ,:.._,- ,_.. _ x-..,� ...- 4 :�,•rn..vQ'x+cri-'.�^'+cd'�°"ZZ �'�•�a'r--„",e`t Sup6rvisor's�Constrdetion License r�? �wF4� Exp Dater#�' *1 , �, 9.TL; �-. pr-, a-s*Z Y"i�,y^."”? ' -.Y. -- -<. • r. ,. -.+4#, ,-4�"'�ti R.}`f" . Home Improvement License'. _ &. : Exp Date v.• .._ _ ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925,00 PER S.F. I, ,Total Project Cost: $ FEE: $ Check No.: Receipt No,,- NOTE: o,.DOTE: Persons contracting with unregistered contractors do not have.access to the guaranty fund Si "natia�e_of.:A _entiO,h Si nature of contractor* Location No. f�f p Date 1 G 00 Z06 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $-19� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 1 Check# Gx •- 'i � Building Inspector L f Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ F WERAGE DISPOSAL❑ Tanning/MassageBody ArtS�rimm;ng pools❑ 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 DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signatureldate COMMENTS -imension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: :.. ELECTRICAL: Movement of Meter location, roast or service drop_yequires approval of Electrical Inspector lies 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 ate 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 o Building Permit Application o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o 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 o Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo CopY of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o 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 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 o Mass check Energy Compliance Report o Engineering Affidavits for Engineered products 40TE: 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 2014 NORT#j Town of 2 ndover 0 h ver, Mass A_ COCHIC«ewicw �. 7� R�TEO I►P ,`'�� S t1 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT .........C.#O.e L! ........ .... .....I, ..... BUILDING INSPECTOR has permission to erect .......................... buildings on .........J. .... . ... .. ...... Foundation Rough to be occupied as .......... .,/�� l ... , Jam,f ' x./`71.4 . . Chimney ...... ..... ... .... .. C e provided that the person accepting this 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, Alterationa Construction of Buildings in the Town of North Andover. Jaws *N q� PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CON CTI N T Rough e .. ... ...... .. Final UILDING INSPE R GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. I WOOD STOVE INSTALL VION CHECKLIST. , 1 Permit A building permit is required for the installation of any solid,fuel burniny appliance. The building permit and installation inspection are limited to the stove installation and not to the stove construction. Stove A. New x Used f B. Type/radiant Circulating "IJr C. Manufacturer N��' i — _ ab.No. � Name/Model No. CLG'4+f4 'Y�L _Crrllar size Dimensions/Height _1-ength Width Chimney A. New Existing _ B. Size(flue area) �� C. Other appliances attached to flue(Number and flue size) ._ D. Prefab(Manufacturer--name and type) �— i E. Masonry/Uned .Flue liner r ALL !j/ Unlined rvice d manulaccurerr F. Height(refer to diagrams) _ 2 r >rMe� cap OVER to ! ! AVER IG I 12r httpf. . t2 Mn 2 3`MIF( o, ►�3 3'Mitt. 12 �— ,MIN. --- (FUEL,;44-I •�c�_yy ylc� HEARTH CHIMNEY HEIGHT Hearth(non-combustible) A. Materials B. Sub-floor construction C. Minimum dimensions(refer to diagram) Clearances and Wail Protection(see stove installation clearances chart) A. Type of wall protection provided B. Clearances(refer to diagrams) 7-7ILI Ij 4� r FIREPLACE CORNIER WALL/CENTER ' 780 CMR: STATE BUILDING CODE COMMISSION j Figure 2109-4 z CLEARANCES TOR SOLID FUEL BURNING APPLIANCES CAP OAY-BVttT CHIMNEYCOO4&EFACI." UPPORT 11RACHET , j NON-COMBUSTIBLE B * I - [ MALL PROTECTION —eoxxcCTOn ►uE A COMM CTOR OVERLAP 1. i WOOOaURNI106 STOVE F 'Sill A _ 1j1 AIR SPACE � j. 12" 1 lysr. L 1� 12•• - NON-COMBUSTIBLE. - FLOOR PROTECTION STOVE INSTALLATION CLEARANCES Combustible ' I" Asbestos Mlilboard- Conerete/Masonry 4°Brick Veneer (! Stove Components Materlal Spaced Out 11• ) foundation Mall 11 Radiant Steve 1. 3 -4ront — circulating Stove 1. —Front. 2�.• i A. Radiant Stow �. —side/eacx 361• 1$1• 6.. 1 e• Circulating Store s i de/tac11 e. Sln9lt watt 2. Connector Pipe tC• 121' 6•• a•• Insulted 2" 211 211 21t Connector Pipe . Chimney 1lelgttt Three (31 f t above adjacent roof and .. i (Metal or Masonry) fee3�.above an roof ridge wlthln 10 feet If a damper Is not nc u e n the stove construction. 0 °r It must be Instal-led In the connector pipe. 1. Front: Fuel or ash access side. 2. Thimble required For passage through combustible construction. 3. Non-combustible spacers required. 4. Clearances on each side of a radiant stove with a heat shield shall be measured as if a circulating type. 1 I i i i . , i t _ I ? s ; If fit Li ( e t kf i { +'` 1 i [ i f � I � f 1 i 1 f •� a 9 E RW li. 44, 20'firepfacc opening 47 ND F� 53.000 1.5 Ib/hr in i 900-2,600 ( l Wood € 1450 lbs.with 4"PL pellet vent pipe Stan 81.7%, 1.5 g/hr �(2)134 CFM� � 22"fireplace opening 581b 41-13/16"� 32-I/8" � 29-IS/16" 5.8 Ibs/hr max sq ft pellets i surround 3"PL pellet vent pipe opti l 24"fireplace opening:64.5lb Dimensions _ Front View Top View 24-718" i io ap N M fh D i 1 14.318" 41-13116" Side View 27-518 8 r~12-3/4" e 2 Zero Clearance Side View - Q - 7. �I � 1 3. i� _ When using 3"or 4"PL 13116" vent pipe,there must be 3" 15-9/16" 14-3/8" clearance to combustibles. 29-15/16" 0earances to Combustib es Of Q -44 '3 4 E � � �looP Protdctol � ~ t zGasi surround t2� C€3ijsurrolfkid t6 # 5pa7kartd Ern6er l � I 41n+t to Sldewaf( i�trlt op to tttantei � z � ' _,� 314 tntri � ��.. 314 zr1n� y Protection-only no -+.� 12" � 12" 0" ' � 6" i 6"(from glass) Floor protection:Minimum 16-112"deep by 30"wide. 1 0 strongest -H YOUR HARMAN DEALER I5. —TKE--i—i ustry arr6an piovideg lifetime warranty on most important aspects:firebox and heat exchanger. 800-664-3119 'EPA iaod mpijS.yo,1,ul whwk It,-,dah fo hill,m M,niimiqk ptmm- - TYPE OF SEWERAGE DISPOSAL Tanning/Massage/Body Art ❑ Swimming Pools ❑ Public Sewer ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Well ❑ Permanent Dumpster on Site ❑ Private(septic tank,etc. ❑ Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund Signature of Agent/Owner �(/`�"'d 1C Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF-U FORM DATE REJECTED DATE APPROVED PLANNING&DEVELOPMENT ❑ ❑ ❑Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS Zoning PP 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 Temp Dumpster on site yes_no_ Fire Department signature/date Tile coir'i:tdiinvealtIt rf MrusaCet useus Depal-muent of in ust id Accidertts ! 0 Zce!;j 3 roves-igatiolts 600 r F {Nit in iEin S-O LeL B©ston,1.Z 0-7 1 11 �'Gl'_�:$6 �Eb {3ciES�LtE?l} t?$ Iii c�;.},is? vii: IBiillders/�o:Ltracto,S/I✓•lectrlcia.l•1$/Pt t' l_ben T-.)t. L Pau t I:Id VLn atfGri Please i j•ilE�4�I.il��-. i2 :'ii1� ('•?issiness-G':•_ ni_atiorilrci iduail: �fv � 1� �ne ,Gdlcss: Jy2, ,�A /�-y�l��- FAW r � 03 YY _- Oir G_r_nLrnpjGj,er? Cited[ o CO api)rop riatre box: { k Type of projec`r(required): I ?ai_i a enlplO;er n !� l am a genei', conn actor and I 1 - TTTT New construction l�t:l_.�.itC�'-fJ:�.'LTtT::?�=2 have hired the sub-contractors ( ? 0� � - - l ' r. 1 Remodeling ' - iisred on�e atcacl.ed sleet. 2.❑ I ant a sole proarieror or pari er- �„_z These sub-cont=actors itaVe ! Demolition sbsp anc'tiave no er 1pici _ _ 1 e _ e=iOveeS and have v, vTG n r _- i n- ?r ±o.r t:jr.aD `Cap3 !iv 'Buildtr`ad :[son. Fr r c - _ i J �o workers' comp.insurance insurance. comp. requires?.] 5. vire are a cvrporarian and lir l0 ❑Electrical repairs or additions i officers have exercised their 1 LE)Plumbing repairs a_additions _ ! I 1 am a homeorme_dole ah work i?=i Sclf. v orkers- comp. rn°llt 02 exeinptnon per 1�CT !! 12.10 r-wo'-repairs I - - _ 152; §1(t},aste tie have no 1 .seer �9/ r- - 5 &,, insurance ea_un-ea.1- i � 13 -rmloyees.No workers' i coma.msurancc regUiiFvC, i '.=.11'�:Ivi::r:in t.�et�i:c.:)•_DO?:^!t:tu _2!so alt ou:i:22�s---tior•ociow slOtFing tneIr Vforltt:•S coimi lsPt10R nolle Intortt:2eiur. _-i oaicowners who suamii this aftion-vi,hiidi-2tln�'tile:'a V doim all wo;is ulG tfl�t Ii7i�011tslt]e Cc'-rria'ctors must sUb272it c II�li'i.�dBTti iRdtG•'tiIIr Sn�Y Comrectors thai check this boF-must altEchz-d an additional slice[shot:AnQ the nmme of the sub-cont,mor 2nd state twhefner at notinose eltities have cntolovees. if the sub-cont—,actors gave employees,they must pro-vide their NoTkers'comp.police,number. �;f ltdf 8iiirr�Ci eY L`i"sGt IS provdtiiit�wor'kers�cm.njuensation iissuraiZC6}or my employees. Below is thepo C}T fTtijOb site lrtj f.•l'matiCn. J Insurance Company leame: 1v�(� S'� `1 �/1 Policy-4-r or Self-ins.Lic.=• 3/3 � f E,>pi_ratior_Date: "' � Job Site Address: �� 'J U Uri e City/State/Zip:#00K 4/Qbr r- A14 d l8yr ?iitach a copy of the workers"^_om"Pensation policy C`'eclara.tioiu page(showing the policy number and expiraiimi date). Failure to secure coverage as required under Section 25A of lviGl,c. 152 can lead to the imposition of criminal penalties of a 1.1-le up to S 1,500.00 andlor one-year inVrisonment,as well as ci;ril penalties in the forzr of a STOP WORK ORDER and a Erne Of up to 5250.00 a day a¢ainist the violator. Be advised that a copy of this statement may be fon;carded to the QfRce of IavestiQations of the DIA for insurance coverage verification. £ ICJ hei•ebj?cel tb�1 ander t`It2 i�LlifS ttifG;EifCrziES of Pei-jury fiift£ft�ZE Ii1jai'rnatioF-�7rovided aboya ZS true and c0 YEC£ Date: Z 3 I - - Siaitattire: i rn�t L.: _/ —Inq �--�-- Phone- �/ 3- q-9 Gff tial use only. Do izot Ylr'E£e Ifs this area, £4 be completed byci2;or£oml d jfCIQL City or' ot:-l'ni: Perms—WL_cense N +ssuing p-Liti?e_ity(cireie one): 1,Board.©��ealtli 2.Bul[dinb Diepartm-tent 3.C-' ILown Ciera: f.Electrical�ns€iector 5.Pltin�bi�nb Inspector G.Ether Cori act PzI sarc: Phone : Massachusetts Home Imorovement Sample Contract This form satisfies all basic requirements of the state's Home Improvement Contractor Law(MGL chapter 142AI 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 to home improvement"before agreeing to any work on your residence.You may obtain a free copy by calling the Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617-973-8787 or 1-888-283-3757. C 1 i�S wneC d o r m tion rt e tr c>�o�' elf* a arae l'F C C Company ame d{P !� Street Address(don use a Pod Office Box address) Contractor/Salesperson!Owner Name �� ddZ�il t* 61g !oz ,6tl6—F/21 Cityfrown State Zip Code I lusiness Address(must include a street address) .q? - -o om 1amjest*«s /um Daytime Phone Evening Phone I'ityrrowd State Zip Code W 1;1b_;4y1 6 2 b 3333 s'e Mailing Address(It different from above) 3usiness Phone eraI Employer ID or S.S.Number Lawreq_¢esth2rmethaneim Hcmu Kma4 Codrector Reg Number Eqn,&.dap 2meN ras+anus hat e slid rtginmim,munber I /�1 _g The Contractor agrees to do the following work for the Homeo ec ✓l J /c m allM THE WM to comp K-peMms Me ME,uFand,anu Muc 51 matenars to re use me Soultiona a ecessa Required Permits-The following building 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 mate when contractor will begin contracted work. MGL chapter 142A.) /A 4n'/b irOd Date when contracted wort: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: M Payments will be made according to the following schedule: SIO' upon signing contract(not to exceed 1/3 of the total contract price or the cost of special order items,whichever is greater) S by / 1_or upon completion of $ by ! !_or upon completion of S 6yy obupon completion of the contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction) The following materiapequipment must be special $ to be paid for ordered before the contracted work begins in order $ to be paid for to meet the completion schedule.('") NOTES:(')Including all finance charges(••)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 schedule. Express warranty-Is an mTm warranty being Provided by the contractor? No Yes fall terms of the warranty must he attached to the contractl Subcontractors-The contractor agrees to be solely responsible for completion 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 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. • 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 a valid Home Improvement Contractor Registration. The law requires most home improvement eoatmclors and subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor registration by writing to the Director at One Ashburton Place,Room 1301,Boston,MA 02108 or by calling 617-727-3200 or ' 1-800-223-0933. • Dees the contractor have insurance? Check to see that your contractor 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 Law. You maycancel this agreement if it has been signed at a place other than the contractor's nomhal 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 Seethe attached notice of cancellation fort for an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY VLANK SPACESI l l Tera mhcal cop' the oontmd letedaMsigmtl One copy should go to horn ver.The copy �kecomractw. Homeowners gna Contractor's Signature t� R 1a-16-1L ! Date Date 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. The same right isnot automatically afforded to a contractor,however. The contractor would have to resolve arty 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 same 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- theta of the Executive Office of Consumer Affairs and Business Regulation and the consumer s ' uired o mit to ch arfaitration as V vi d In Massachusetts General Law cha ter 142A. - Homeowner's Sig4ture Contractor's Signature NOTICE:The sigAtures of the parties ab a apply only to the agreement of the parties to alte ve 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( GL 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 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 until both parties have received a fully executed copy of the contract,and the three day recission 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/berseif 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 information about the Home Improvement Contractor Law or other consumer rights,or if you wish to obtain a free copy of "A Consumer Guide to the Home Improvement Contractor Law,"contact: Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 (617)973-8787 or 1-(888)2833757 If you want to verify the registration of a contractor or if you have questions or need additional information specifically about the contractor registration component of the'Home Improvement Contractor Law,contact: Director of Home Improvement Contractor Registration 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: 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 A ® DATE(MM/DD/YYYY) iill.� r CERTIFICATE OF LIABILITY INSURANCE 12/19/2016 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 Robert Bean NAME: Bean Insurance Agency LLC ACNE . (603)926-3830 FAX No:(603)926-0283 151 Winnacunnet Road E-MAIL ADDRESS:bob@beaninsurance.com P.O. BOX 660 INSURERS AFFORDING COVERAGE NAIC# Hampton NH 03843-0660 INSURERA:Ohio Security Ins Co 24082 INSURED INSURERB:The Ohio Casualty Ins Co 24074 Home & Hearth Conservation Inc INSURER C:Wesco Insurance Company 102 Lafayette Rd INSURER D: INSURER E Hampton Falls NH 03844 INSURER F: COVERAGES CERTIFICATE NUMBER:2016-17 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMIDD MMIDD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 MAGE A CLAIMS-MADE OCCUR PREM SESOEa occu RENTED $ 300,000 BKS55508551 4/23/2016 4/23/2017 MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑PRO ❑LOC PRODUCTS-COMP/OP AGG $ 2,000,000 PRO- OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident A ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDIx SCHEDULED BASS5508551 4/23/2016 4/23/2017 BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident BACEE $ X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 B EXCESS LIAB HCLAIMS-MADE AGGREGATE $ 1 000,000 DED X RETENTION 10,000 DS055508551 4/23/2016 4/23/2017 $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? N/A C (Mandatory in NH) WWC3193124 4/23/2016 4/23/2017 E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached H more space is required) Job Location 14 Douglas Rd, North Andover, MA 01845 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 120 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Bob Bean ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD I N S025 0(114n1) Massachusetts Department of Puciic Safety Board of Building Regulations and Standards License: CSSL-099169 4 ROBERT D KING 8 SPRING HILL ROAD GREENLAND NH 03840 Expiration: Commissioner 03/2812018 ?= Otficc of Consumer Affairs&Business Regulation — QME IMPROVEMENT CONTRACTOR Registration: 130052 Type: Expiration: 12/21/2017 Supplement Cat HOME&HEARTH INC. ROBERT KING 102 LAFAYETTE RD. HAMPTONFALLS,NH 03844 Underseeretary