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HomeMy WebLinkAboutBuilding Permit #109-12 - 1451 GREAT POND ROAD 8/5/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NOJ 0 Date Received Date Issued: � l IMPORTANT:Applicant must complete all items on this page LOCATION Print PROPERTY OWNER 2: Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 0 One family ❑Addition 0 Two or more family ❑ Industrial bion No. of units: ❑Commercial XRepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑Other ��Septic B Well? �' t]Floodplaui Wetland"s 0 Wate shedaDistr` ct ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: U21-i � C� '�O 7Z7i/J (Identification Please Type or Print Clearly) OWNER: Name: pl2 b3,0 ,i Phone Address: /'%"l 6,Pw7' Pnemd —/-2) CONTRACTOR Name: A_)/ Y N Ar& phone: Address: Aq (,Q Supervisor's Construction License: 7/ Zy Exp. Date: Qom- /7.: z Home Improvement License: /� 2 — Exp. Date: -/—/ 2 ARCHITECT/ENGINEER Phone: A Address: Reg. No. A11P FEE SCHEDULE:BULDI RPERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. 41 Total Project Cost: $ 3 F 70a o�o3 FEE: $ �- Check No.: ✓ J Recei t No.: NOTE,1 PeYs contracting with unregistered contractors do not have access to the arae {{�iCC - � -- --- g ty fund Signature;of nt/Ownerf t. _ _.__ _ Signature of contractor J 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 sign off from Fire Department prior to issuance of Bldg Permi, 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) a 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) o Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of M.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 o Engineering Affidavits for Engineered products MOTE: 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 Doo: Doc.Building Permit Revised 2008mi L Dimension Number of Stories:_Total square feet of floor area, based on Exterior dimensions. Total land area, sq. i.: 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 I i ® Notified for pickup - Date Doc:.Building Permit Revised 2008mi J -- Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL ❑ Swimming Pools Public Sewer ElTanning/MaTanning/Massage/Body Art El 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 a COMMENTS HEALTH Reviewed on Si nature 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 Location 14 � G��-T ed n aQ No. /Q j — 12— Date �oRTM TOWN OF NORTH ANDOVER O F R f Certificate of Occupancy $ cwus•'`� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 3��5 24 � :. � Building In pecto 2011/07/18 12 : 55 :02 2 /2 ACIORhrCERTIFICATE OF LIABILITY INSURANCE °ATE` 7/18//201201YYY' 1 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(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certaln 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 NAME: Eastern Insurance Group LLC - Main PHONE AIC No Ext: 508.651.7700 AIC No: 233 West Central Street E-MAIL -- ADDRESS: PRODUCER CIJS OME C Natick MA 01760 INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERA:Continental Western Insurance INSURER B Acadia Insurance Company Moynihan North Reading Lumber Inc. INSURERcContinental Casualty Company P.O. Box 128 INSURERDIlumber Industries Self-Insured INSURER E: North Reading MA 01864 INSURERF: COVERAGES CERTIFICATE NUMBER:10/11 master w/2011 we 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. INSR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MMIDDIWYY) fMMIDDIYYYY1 LIMITS GENERAL LIABILITY PPOO84112-18 0/15/2010 0/15/2011 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 250,000 A CLAIMS-MADE OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PRO- EC LOC $ AUTOMOBILE LIABILITY AA0072816-19 12/01/2010 2/01/2011 COMBINED SINGLE LIMIT $ 1,000,000 ANY AUTO (Ea accident) $ BODILY INJURY(Per person) B ALL OWNED AUTOS XSCHEDULED AUTOS BODILY INJURY(Per accident) $ X PROPERTY DAMAGE HIRED AUTOS (Peraccident) $ X NON-OWNED AUTOS $ $ UMBRELLA LIABX OCCUR 084482880 0/15/2010 0/15/2011 EACH OCCURRENCE $ 15,000,000 EXCESS UAB CLAIMS-MADE AGGREGATE $ 15,000,000 DEDUCTIBLE C X RETENTION $ 10,000 $ D WORKERS COMPENSATION AND EMPLOYERS'LIABILITY T11093 1/01/2011 1/01/2012 VI AND OTH- ANY PROPRIETOR/PARTNEWEXECUTIVE YIN (NH ONLY) TORY LIMITS ER OFFICER/MEMBER EXCLUDED? ❑ NIA E.L.EACH ACCIDENT $ 1.000,000 (Mandatory In Nnd EL DISEASE-EA EMPLOYE $ 1 000 000 If yes,describe under ' DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 j DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) job: install 20 windows, 1 slider - Arthur erbey, 1457 Great Pond Rd., No. Andover, MA CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, N0710E WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Building Dept No. Andover, MA AUTHORIZED REPRESENTATIVE Rosemary Fulham/DMIA1 ACORD 25(2009/09) ©1988-2009ACORD CORPORATION. All rights reserved. INS025(200909) The ACORD name and logo are registered marks of ACORD IAORTH TO'"- of No. x �0__- -�* se �o dover, Mass., %k COCHICMEWICK y�`G ADRATED P"? ♦J S V BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.. ......... .........r....... •.�.. .+..� .................................... Foundation cI has permission to erect........................................ buildings on. .SS �' ...f v R ' ..... ............. • .. ..................... Rough to be occupied as.......... . 1hV. .. ........�.............. .:..... ...:. 1 �• Chimney provided that the person accepting this permit shall in every respect conform to the terms the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6M S ELECTRICAL INSPECTOR UNLESS CONSTRUCTI ST Tj�' Rough Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. �++►` ! ---_-.. .�., _. ..... Q-..., ,fir, it 1t I F,Ei—�o Z 4. a t Ii c S. r ( rcgn or registration roalid.for individul use only U:Yr BUildmn Rlti,d ebre the expiration date,. If found return to: ;7 ;T-frons ru ti NSupervispr L en + ce of Consumer Affairs and Business Regulation rf .I•°o license: CS 37120 x 0':Park PlazA Suite 5170 ' Restncted to:. DO s ` oston,MA 0211.6+ tl1/ILIAM C� IARZYNKA ` r 251�EG1U0T ST N BI;LLERICA, M�04862.�s aR.. : -• Not valid w' out nature. xfi Ezpiration:..4/1 e�+*2 t Commissioner Tr#: 26837 ` -- 1. Restricted to:.'00 : l �uciner �aYad`tii °eiaa I oo- l~Tarestn.p d :. Office o onsumer airs meas egu a on i 1G-1':2 Family Homes HOME IMPROVEMENT CONTRACTOR Registration ,108288 Type:. A .� .. ` Expiration j$ 412012 Individual { • j M C.JARZY KA ;+ �: Failure to possess a current edition of the ° Massachusetts State Building Code r ' is cause for revocation of this license. William Jarcynka ` 25 PEQUOT ST c \ Refer to:_ VV".Mass.Gov/DPS N.BILLERICA,MA 0'T:8fi`F Undersecretary _ � :r MOYNIHAN LUMBER CO. " Moynihan Lumber of Beverly, Inc. Moynihan North Reading Lumber, Inc. Moynihan Lumber of Plaistow L.L.C. 82 River Street 164 Chestnut Street 4 P.O.Box 509 12 Old Road P.O.Box 128 P.O.Box 11.60 .. . ._._.. . Beverly, MA 01915-0509 -� -- _ North Reading, MA .01864-0126 -- (978)927-0032 FAX:(978)927-8668 9 Plaistow,NH 03865-1160 (978)6643310 (781)9448500 (603)382-1535 FAX:(603)382-1935 FAX:(978)664-0872 �- El _ . Subcontractor Workers' Compensation Waiver hereby acknowledge that I, as an independent contractor, have been asked by Moynihan Lumber Co. to provide it with a Certificate of Workers'.. Compensation Insurance coverage for myself. Based on the exemption provided by the Workers' -Compensation Insurance coverage for myself because I am a sole proprietor without employees. Therefore, I hold Moynihan Lumber Co. and it's related organizations'-and the Arcadia Insurance and or Self Insured Lumber Business = _ Association Inc._totall harmless_for_any_injuries or cost of injuries_incurred by-myself because I have voluntarily -chosen, to exclude myself from coverage by- engaging --the exemption provided under the Workers' Compensation Laws. - -- - - I have taken_this option of my own free will. - .. ._... f; _ _ a S - _SIGNATURE DATE. ' White:Moynihan Sales Contract .,..._.•. ::ate ;_:_. .Yi?i -- fellow• Ins rm. For I O;. . taped -_ _. Pink: -.. = Foran#1103 - . - - — - -- - OP ID: PA CERTIFICATE OF LIABILITY INSURANCE I DnT07114/11 YY) _JI 07714/11 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIF'ICALTE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFOR01-D BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSUREIZ(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the pollcy(148) must be endorsed. If SUBROCATIO14 IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement A Statement on this certificate doe; tot confer rights to tho certificate holder In lieu of such endorsement S. PRODUCER 781-598-4700 CONTACT A James Lynch Insurance Agency PHONE 297 Broadway 781-599-0580 O Lynn,MA 01904 ADDRESS, DDRL Thomas R Rose — PRODUCER gILLJ-1 INBURER(B)AFFORDING COVFRAOE NAIC# MSUItEU Bill Jalzynka Carpentry INSURMA:SafetyInsurance �-39454 25 Pequot Street INSURER 9: '' _.—.--- Billerica,MA 01821 INSURERC: M 4 INSURER 0: T INSURER 0; Y INSURER F• COVERAGES CERTIFICATE.NUMBER: REVISION NUMBER- _ THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE 1=)R THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH IRJ:SF'ECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJE-,T'rO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, ILTR TYPO OF INSURANC$-� POLICY NUMBER POLICY M/IDDnWY WRID .� LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO r4rNTIM'- A COMMERCIAL,GENERAL LIABILITY 13P00000478 05/04/11 05!04/12 pREM(S,F,�Lza !�m.._ _ 100,000 CLAIMS-MADE F]OCCUR MED F.XP(Any ono pe,.n n) s _—�~ 10,000 X Business Owners PERSONAL&AOV INJU 1Y S _ GENERAL AOGREGKre S — 2,000,000 OEN'L AGGREGATE LIMIT APPLIES PER; PRODUCTS-COMP/QP AQG. POLICY 71 PRO- LOC --—.•.. _ -- AUTOMOBILE LIABILITY COMBINED SINGLE LIM T ,• ANY AUTO (Ea eccldnnl) -^ E _— _• BODILY INJURY(Per po eon) S ALL OWNED AUTOS — BODILY INJURY(Por ens Idem) $ SCHEDULED AUTOS -^- --•• — HIRED AUTOS PROcelci nt'AMAGE W NOWOWNED AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE. a __ EXCESS L1Aa_.^ — CLAIMS-MADE AGGREGATE DEDUCTIBLE ~y A ^^ RETENTION WORKERS COMPENSATION WC STATU- 01'fl- AND EMPLOYERS'LIABILITY Y/NI TORY Llhl[r.9 _..._,.-213- ANY PROPRIETORIPARTNERIEXECUTP4E .E13_ANYPROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A --._,-,.— (Mandatory In NN) E,L DISEASE-EA EMPI OYI_E If ryc+ danorIba undor DE&LtRIPTION OF OPERATIONS below E.L.DISEASE-POLIC')' .IMI7' A _ PROPERTY - 4,20 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHtCLES (Atteeh ACORD 101,Additional Remerke Sche&143,if morn npger.I><rnquirrd) carpenter/interior CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIE�I BE;CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE MA LL BE DIELIVERtED IN Moynahan Lumber ACCORDANCE WITH THE POLICY PROVISIONS- 164 Chestnut Street TMOa12ED REPRESENTATIVE qu North Reading,MA 01884 n y� —yam ®19882009 ACORD CORPORATION, All right:a reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD Department of Indrsriad Arcide:ts Office ofInveogadons 600 Washington Street Boston,MA'02111 www.mass.goVifia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electridans/Plumtbers Ap 13� cant lnfonzatio Please PdLt J,&1Jb1y " N=.t(Boniness organizatiodtndividu4; Ai' 31�cT-2Q l✓ A Address: cp,--��p s r City/State/Zip: (c4- M-A Q I V,44 Phone#: � — l�3 — 66o L/64 Are you sn empidyer?Check the appropriate bort: 'Type of project(required): 1.Q I am 8 employer axith ,� 4 Q I am a general coacoor and I 6. ❑New con strnction employees(Rill and/or partrtitne).' have hoed the nub-aantcacoors y [3 Rimodeling 2. I Mn a S616.proprietor or partner- listed on the attached shcec ship and have no employees These sub-contraczers have 8. 0 Demolition working for me in any capacity. workers,gyp•insm=co. 9. O.Building addition (No workers' camp.insurance- 5. ❑ We are a corporation and its 10.0 Electrical repafrs or additions requhr.d.] officers have exercised their. . 3.❑ I am a homeowner doing all work right of exemption per MGL. 11.0 lfh uftg repairs or additions mysei£(No workers' comp. c. 152,¢1(4),and we have no 12.0 Roof repairs insurance required,]t_ employees.Wo workers' 13.0 Other CMM.gnat=rapi red.] •Any nppNcem tba @becks boa pl moat ciao fill out the swdon beer abowms tbeir.rot>Q o c mm=srA=policy in5oita echo t Hcamwaas wtio sit%M do affidavit wd$cedug shay an doing all work and then bite outside camactors must aubndc a mw d5davit blicasains such. w lConbutors that check this box must attaclrad.em addldG*sheat sltvw(ng this>le . offfia=b-eouutsawn and dick eradiate'=up.priocy infonrnsdon.. I am an employer that Is providing workers'ckinspemadon insurance for my employees :. daw-is the poltcy and jab site lnformatlon. Insurance Company Name: Gi Policy. or Self--ins.Lie m .) 4 Cd© �� Expiration Dmc-. 14 Job•Site Address: Cfty/State/Zim -- - Attach a copy of the workers' aompensxtion policy declaration page(showing the policy number and expiration date). Faf we to secure coverage as required.under.Sectiou 15A of MGL c.-152 can lead b the bm�sitiou of mimina(.penabies of a fine tip to$1,500.00 and/or one-year imprisonment,as well as civil penalties ih the farm of a STOP WORK ORDER and a fine of up to 3250.00 a day against the.violator. Be advised that a copy of this statement maybe finVaraded.to the Office of Investigationsbf the DIA for innl=ce coverage verification. 7 do hereby certify under the and pen of perjury that the Reformation provided above is true-and correct. �Phor}c�• • Oficial use only. Do not write In this area,to be completed by city or tvwx ofjgciaL Cl"'Pr To": y PermitlUcenseA. — Issuing authority(circle one): ' 1.3oard of Health.L Building.Department 3.ChylTown Clerk,4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone ft: I i; • i 91te -� ,,,� Board o ui ing egulaVons�dffi an �ars One Ashburton Place - Room 1301 � Boston, Massachusetts 02108 Horne Improvement Contractor Registration Reqistration: 136860 Type: Private Corporation i Expiration: 9/6/2010 Tr# 274710 MOYNIHAN NORTH READING LUMBER, IN: , JOHN MILLER JR. PO BOX 128 N. READING, MA 01864 Update Address and return card.Mark reason for change. 1-1, Address rl Renewal 1- Employment `_! Lost Card DPS-CAI 0 5OM•07/07-PC9490 MOYNIHAN-NORTH READING LUMBER, INC. "QUALITY BACKED BYA DESIRE TO PLEASE" 164 Chestnut Street FEIN:04-2261995 North Reading, MA 01861 Contractor Reg No.: 978-864-3310 1781-944-8500 Exp. Date:—//— Salesperson(s): HOMEOWNER INFORMATION Name Daytime Phone 1 Street Address(Not P.O.Box) Evening Phone City/town State Zip Code Mailing Address(f different from Street Address) WORK TO BE PERFORMED AND MATERIALS TO BE USED Moynihan-North Reading Lumber, Inc.agrees to perform the work set forth in Exhibit A for Homeowner and to use such materials in connection therewith as set forth also in Exhibit A,attached hereto and made a part hereof. The following schedule shall be adhered to unless circumstances arise beyond Moynihan-North Reading Lumber, Inc.'s control:Work scheduled to begin: Expected date of completion: La/'1 May be based upon arrival of s cial order material TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE Moynihan- North Reading Lumber, Inc. agrees to perfotrm the work, and furnish the material and labor set forth in Exhibit A for the Total Contract Price of: $ •` (which amount includes all finance charges). Payments shall be made by Homeowner according to the following payment schedule: $1"~"• Initial deposit upon signing this Contract(the initial deposit shall not exceed the greater of one-third(1/3)of the Total Contract Price as set forth above; OR the Total Cost of Special/Custom Orders as set forth below). $ : , f by—/—/—or upon completion of delivery of materials $� � 1 by_/ / or upon completion of install $ - upon completion of the Contract In order to meet the completion schedule set forth above,the following materials/equipment must be special ordered before the Contract work begins, for a Total Cost of Special/Custom Orders of$ $"-.to be paid for building permit ' 10 be paid for $` - – to be paid for �t DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Moynihan-North Reading Lumber,Inc. i Homeowner's Signature. DateContractor',, + Date � �+ + + 1, l •-- ��. L 1 1 gY; � ��� . 1 � � i� � -�,� ,tel Homeowner's Name(Printed) Name(Printed)and Title of Signatory You may cancel this Contract if it has been signed by a party thereto at a place other than an address of Contractor,which may be its main office or branch thereof, provided you notify Contractor in writing at its main office or branch by ordinary mail posted, by telegram sent or by delivery, no later than midnight of the third business day following the signing of this Contract. See attached notice of cancellation for an explanation of this right. See reverse side for additional Homeowner Terms and Conditions 1057-NR 4/09 White-Office Yellow-Sales/Service Pink-Customer Page 1 of 5 HOMEOWNER TERMS AND CONDITIONS The following terms and conditions are an integral part of this Contract between Moynihan-North Reading Lumber,Inc.("Contractor')and Homeowner. 1. All payments are due upon presentation of billing,and a late charge of one and one-half percent(11/2%)per month will be applied to past due charges. Homeowner shall pay Contractor court costs,attorneys'and paralegals'fees,and any other expenses incurred in the collection of past due accounts. 2. If Homeowner is borrowing money from a construction lender to perform the work,Homeowner represents that the construction loan fund is sufficient to pay Contractor and any other contractors performing work on Homeowner's property. Homeowner irrevocably authorizes Contractor to communicate directly with the construction lender regarding payments and loan balances,and authorizes the construction lender to make payments directly to Contractor. 3. Homeowner shall be in default if it breaches any provision of this Contract;if any warranty or statement to Contractor in connection with this Contract or Contractor's extension of credit to Homeowner is false or misleading when made;if any statement to a lending institution in connection with financing for this Contract is false or misleading when made;or if Homeowner becomes insolvent,makes and assignment for the benefit of its creditors,or files or has filed a petition for bankruptcy. 4. If the Total Contract Price includes allowances,and the cost of performing the work covered by an allowance is either greater or less than the allowance,then the Total Contract Price shall be increased or decreased accordingly without the need for a signed Change Order. Unless otherwise requested by Homeowner,Contractor shall use its judgment in accomplishing work covered by an allowance. 5. If Contractor agrees to do any installation work,Homeowner will procure at its expense and before the commencement of work hereunder"all risk"insurance with construction,theft,vandalism,and mischief endorsements attached,the insurance to be in a sum at least equal to the Total Contract Price. The insurance will name Contractor and any subcontractors as additional insured. If the project is destroyed or damaged by accident,disaster or calamity such as fire,flood or storms,Homeowner shall pay for work done by Contractor in rebuilding of restoring the project as extra work. 6. If Homeowner defaults under any of its obligations under this Contract,Contractor may: a. Stop work until any payments are received or defaults are otherwise cured. b. Terminate work upon seven m days written notice and recover as damages,at its option,either the reasonable value of the work performed through termination,or the balance of the Total Contract Price plus any other damages including reasonable attorneys'and paralegals'fees Contractor suffers as a result of the default. 7. Contractor shall be excused for delay in completion of the Contract caused by contingencies out of its control,including acts or delays of Homeowner or other contractors,acts of God,labor trouble,acts of public agencies or inspectors or public utilities,extra work,breaches of this Contract by Homeowner,problems obtaining materials from suppliers,or other contingencies unforeseen by Contractor. Under no circumstances will Contractor be liable for monetary damages caused by delays as set forth above. 8. If Contractor encounters unforeseen conditions that were not reasonably anticipated by Contractor,Contractor shall call the conditions to the attention of Homeowner and the Total Contract Price and schedule will be adjusted by the extra work necessitated thereby. No installation, plumbing,electrical,flooring,decorating or other construction work is to be provided unless specifically set forth herein. In the event Contractor is to perform the installation,it is understood that the price agreed upon herein does not include possible expenses incurred in addressing hidden or unknown contingencies found at the jobsite. In the event such contingencies arise and Contractor is required to furnish labor or materials or otherwise perform work not provided for or contemplated by Contractor,the actual cost of such additional unexpected work plus fifteen percent(15%)thereof will be paid by Homeowner. Contingencies include but are not limited to:inability to reuse existing water,vent and water pipes,air shafts,ducts,grilles,louvers and registers;the relocation of concealed pipes,riser,wiring or conduits,the presence of which cannot be determined until the work has started;or imperfections,rotting or decay in the structure or parts thereof necessitating replacement. 9. Homeowner shall be responsible for the coordination of any work performed by itself or other contractors,and shall be responsible to have the work site ready for contractor to proceed. If installation is involved,with its work through the completion date.Any work performed by Homeowner or other contractors shall not hinder Contractor's schedule. Contractor does not warrant any work performed by Homeowner or other contractors not working for Contractor as its subcontractor. 10. Homeowner understands that some products described in this Contract may be specially designed and custom built,and as such Contractor will take immediate steps upon execution of this Contract to design,order and construct those items as set forth herein. Except as provided on page one of this Contract,this Contract is not subject to cancellation by Homeowner. 11. The delivery date,when given,shall be deemed approximate and performance is subject to delays caused by strikes,fires,weather corrd:t ons,acts of God or other reasons not under the control of Contractor,as well as the availability of the product at the time of delivery. Once the delivery date is determined,Homeowner agrees to accept delivery of the product(s)within one(1)week. 12. The risk of loss,damage or destruction,shall be upon Homeowner upon the delivery and receipt of the product. If Homeowner is not ready to accept the product,the delivery payment will by made as agreed upon and an extra storage fee of Fifty Dollars($50)per week will be charged. 13. Title to the items sold pursuant to this Contract shall not pass to Homeowner until the full price as set forth in this Contract is paid to Contractor. 14. Contractor agrees that it will perform this Contract in conformity with customary industry practices. Homeowner agrees that any claim for adjustment shall not be reason or cause for failure to make payment of the purchase price in full. 15. This Contract sets forth the entire understanding of the parties. Any and all prior contracts,agreements,warranties or representations made by either party are superseded by this Contract. NOTWITHSTANDING PARAGRAPH 4 NO CHANGES SHALL BE MADE TO THE WORK DESCRIBED OR TO THE CONTRACT PRICE UNLESS AND UNTIL HOMEOWNER AND CONTRACTOR SIGN A WRITTEN CHANGE 1057-NR 4/09 White-Office Yellow-Sales/Service Pink-Customer Cage5