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HomeMy WebLinkAboutBuilding Permit #614-2016 - 148 MAIN STREET 11/18/2015 Sow NNEn - t I a3- xORTld BUILDING PERMIT OF �gLeo ,�11'O TOWN OF NORTH ANDOVER 0 - APPLICATION FOR PLAN EXAMINATION Permit No#• "` Date Received �R'�R.,TEo �SSac�+usEc Date Issued: � 1 � �� ORTANT:Applicant must complete all items on this page LOCATION �`-1 �I not PROPERTY OWNER I^ Print ' 100 Year Structure yes no MAP PARCELD ZONING DISTRICT:_ Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ Orfamily El Addition 0-Two or more family El Industrial Elati A on No. of units: ❑ Commercial i ErIkepair, replacement ElAssessory Bldg 11 Others: ❑ DemolitionElOther - �- ©dpla3in; Wetlands. ❑ t1lVate shell`®ist�icf �_ Sepfic q vugl� _. �,?�Water/Sewer,,✓ _ _ - ��:_...�.�.. _ _ _ .. � ._.�.._�... �.._-s��__...-.____-�-. _ DESCRIPTION O_ R ~TO g ERFO ED: Ide ti atio - lease ype or Print Clearly OWNER: Name: ,w- Phone: Address: Contractor Name: �(i� n�� Phone- �� —�� Email: Address: Supervisor's Construction License: Exp. Date: _ II' Home Improvement License: Exp. Date: 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. Total Project Cost: $ 5;-a -FEE: $ Check No.: Rec ipt No.: G/ I �1 ng with egistered contractors d n h e c s to the guara NOTE: Persons ontractinty fund - i w Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE O SSEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Pennanent 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 Pla�,ning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/S�nature �®ate Driveway Permit DPW Town]Engineer: Signature: Located 384 Osgood Street FIRE 0 PA_ ENT',;Temp;©umpster o site es Locazecl at 1241Main+Street tier � r,s FirelDepprtreilt= e COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes N® DANGER ZONE LITERATURE: Yesi MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine �® NOTES and DATA— (For depar°tm- t use) i El Notified for pickup Call Email Date Time Contact Name Doc.Building Penuit 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) Building Permit Application Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses Workers Comp Affidavit Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (if Applicable) Copy of Contract 4- 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 Doc:Building Permit Revised 2014 Location l` No. I� ` 2Date g ' . - TOWN OF NORTH,ANDOVER � w t Certificate of Occupancy $ Building/Frame Permit Fee $.�'�" Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 2 -55" u' r Building Inspector � c10RTF� own of t E ndover No. h ver, Mass, A—q COCHIC641WOM c 'l• 7�QE0 S U BOARD OF HEALTH Food/Kitchen PER NT �� LD Septic System THIS CERTIFIES THAT BUILDING INSPECTOR has permission to erect ................. .... ildings on .... 4?k.... > 'L.t!�. ,,,�'. Foundation .. ... Rough tobe occupied as ............. ...... .. ... .... .. .. ...... ....�� . ... ... ............................ Chimney 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, 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 qQNT ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO TA Rough Service ................... . ............... ................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. HOME IMPROVEMENT CONTRACT PLEASE READ THIS Sold,Fumished and Installed by: Branch Name:Boston North&South Date q_a_t THD At-Home Services,Inc. d/b/a The Home Depot At-Home Services Branch Number:31 and 33 908 Boston Tumpike,Unit 1.Shrewsbury,MA 01545 Tull Free 877-903-3768 1.30 Federal ID#75 2698.16(1;ME I.c#C 02434:RI Cant.lac#16427 CT Lic#HIC.0565522:MA Home Improvement Contracwr Rey,.#126893 Installation Address: ���u gt—,AJ©Aer M," olgdt) City State Zip Purchaser(s): Work Phone: Home Phone: Cell Phone: [ l [978)873-30,37 [ l [ 1 [ l [ l Home Address: (if different from Installation Address) City State Zip E-mail Address(to receive project communications and Home Depot updates): ❑1 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 fumish,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#: (t A..d Refm—i Products: Spec Sheet(s)#: Project Amount Roofing Siding U Windows Insulation Q '1 51 b []Gutters/Covers❑EntryDoors El -I W7[8 $ � Ronfing LISiding El Windows 0 Insulation ❑Gutters/Covers[]Entry Doors ❑ Roofing LISiding LJ Windows Insulation ❑Gutters/Covers❑Entry Do(xs❑ $ Roofing LJSiding 0 Windows Insulation ❑Gutters/Covers❑Entry Doors ❑ $ Minimum 25%Deposit of Contract Amount due upun execution or this contract, Total Contract Amount $ �0 Maine Purchasers may not deposit more than one-third orthe Contract Amount. Customer agrees that.immediately upon completion of the work for each Product.Customer will execute a Completion Cenificale (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 Summan: The Payment Summary#_rl_I4470 . included as part of this Contract,sets forth the 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 sersims 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. 'rHE HOMF DFPOT MAY W ITHItOLA1v1OUN fS OWED TO THE HOME DEPOT FROM THE 1)FPOSI1' PA%'Ml•'NT OR OTHER PAYMENTS MADE, WITHOUT I.IMI'rlNG'rilE HOMI,'lll?I'O.1"S O'1'Hh:R RISA41dU11:S FOR RFICOVERV t)VS(3('H AMOUNTS. Acce Wice ad Authorization: Customer agr ,and underst:uuts that[his Agrerntenth t i. e entire agrectttent hetevecn Cu.atnter and The)ntomna: o )epot with regard to the Produc[v and Installation serviecs:rod.ilxr.edc.all prior discus.ions mid agmersient..either oral or written,relating[,).aid Product,and In.iallati(nt.Thi.Agreement canna[ix assigned or amended excep(by a writing signed by Costumer and The 1 knnc Ihpot.Customer acknowledges and agrees that Customer has rend•understands,vutwuatily accepts the: terms of and has iemived a copyof this Agreement. c�'n dotloop 11:i0 Submitted by. 09/25/15 11:3AM EDT MKT2-PO55-%LQJ-UBLP X 4 . otner's Signature Date Soles Consultant's Sign Lure D'Ite ��--=— X Telephone No.. 979-771-367X Customer's Signature Date Sales Consultant License No. CANCELLATION: CUSTOMER MAY CANCEL THIS ta.apphrabtet AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO THE HOME DEPOT BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING THIS AGREEMENT. THE STATE SUPPLEMENT ATTACHED HERETO CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN CUSTOMER'S STATE. NOTICE:ADDITIONAL TERMS AND CONDITIONS ARE STATED ON THE REVERSE SIDE AND ARE PART OF THIS CONTRACT 02-03.15 While-Branch File Yellow-Customer Scan n Fb_y'CarnScanner dotloop signature verification:www.dotloop.com/my/verification/DL-123759203-5-14Ql ■ Work area will be contained NAT-19276 Pre-R.nova*m Fom awe The form w wad b dMrWA oon0-ft aiat tfka 1 11 tl YM Fdd�fAM taad8aaad Paint Ttartorapor6 RM1M►,utd t�Irtlttp Rgprtl#IE wofl r 1 Cwtomw Addrra daf►1tt�tAMlgq aT r' OCCUPANT CONFBt"TI ON ■ Dust will be minimized PamphMt t1l.C.+Pt 1 have focwved a Cagy d M trod hazed rdM%*M plrtpdM talpmfiltQ AM of Ow Pow" M& of the tad ftam a, "M:tram""Ov lim 000*0 to PrAofmad in rtry drrdaq unt t n"n*d rtu pwv*V Wkn ova bogm NGoma Year ate ��+� EMrr tt+m year my trxr*wet hysh. 1t my Worw Year burr ft Pre 1918 my hon*fmffet W i pow UNOV b drWrow wbOhtr ia:a4„ant yitt4 Przw.-,ro ars rwwtttary fret EPA or UW*raqulationa ■ Worm area will be cleaned up ittnyNwm fear Bxhn 1979 ofghe*LbW.Salewo&PtK*cnr torattrad thoroughly .R.,.,d--0 f doUoop verified dodoo1511 fieri EDT LC8Q-EUU4-0890-ZDAC d,Pawn #w•+1 0AM040 Gw.«� ! SEE STATE SPECIFIC FORMS ON REVERSE SIDE Scanned by CamScanner �w/iilM�9t �#��41�C+�F�I� �'°� :-..�":. ten,w5`„� �s_s� �-�`�•�'4;� rr 3n��� � 2 = 11�w1egR � �� .r.•"ne.0� laallo�e - 4 CAW Irose mu)� 3e tad! sella K,r 3!1� a 00 50 lqloi q to ff LQ r 1 Fibft 1,v<W 45 i ? G ( , 1 Q w 1 3a 45 77 F } w G 1 ?a # b a l ' cT et Y Y L Ott iI tori !D Gcl 1 D W03 U+1 L 1 WEOX C M trip[ob! trM�a C+,*9tM iy—Tf 4M.SNV Cvrvai _ Y[slwM-Ft'.mndccAtr!ute,a f ,+v.e.nwwdw .+m,ane W'�T ASW�+�h+abee�aes4Ti Cax"ncx Rldf,'Halinl ' dodoop verified 0925/15 11:30AM EDT exbowea4xWs..•Marym.a.PwaaF++«tA�lr �/t 7"C7 e' DG95-ENQV-YVVX-CZK4 .Hill\curt iK<Sw.! � � - G+¢ame.3q!+Rwrt SRM'tHcftb• .,....... whs.tM.xNOm p1o,..Cuumew +wow Scanned by CamScanner dotloop signature verification:www.dotloop.com/my/verification/DL-123759203-5-14Q1 IN-HOME SALE OR SERVICE NOTICE OF CANCELLATION z 14 � x YOU MAY CANCEL THIS ENTIRE TRANSACTION OR ANY INDIVIDUAL PROG"KAS SPEC SHEET,WITHOUT ANY PENALTY OR OBLIGATION,WITHIN THREE BUS m, 9bA1��� HOLIDAYS) OF THE DATE OF THE "HOME IMPROVEMENT CONTRACT" (SALES+I.ON1' # CANCEL,.ANY PROPERTY TRADED IN,ANY PAYMENTS MADE BY YOU UNDER Irk ' C AND ANY NEGOTIABLE INSTRUMENT EXECUTED BY YOU WILL BE RETURAD-WIT T to)a" DAYS FOLLOWING RECEIPT BY SELLER OF YOUR CANCELLATION NO'I'1C , AN INTEREST ARISING OUT OF THE TRANSACTION WHA BE CANCELLED. THERE M-Cj CHARGE EQUAL TO TEN PERCENT (10"/x) OF THE TOTAL, CONTRACT AMOUNT I�YO . TRANSACTION AN I'ER THE THIRD BUSINESS DAY FOLLOWING THE DATE OF S' 1I," B MATERIALS ARE ORDERED.THERE WILL BEA SERVICE CHARGE EQUAL TO TWENTY (25%) OF THE TOTAL CONTRACT AMOUNT IF YOU CANCEL THIS TRANSACTION AFTER ARE ORDERED. IF YOU CANCEL,,YOU MUST MAKE AVAILABLE TO SELLER AT YOUR RESIDENCE,IN S11189 :. AS GOOD CONDITION AS WHEN RECEIVED, ANY GOODS DELIVERED 'TO YOU UNDER CONTRACT,OR YOU MAY COMPLY WITH THE INSTRUCTIONS OF SELLER REGARDING TI OF THE GOODS AI'SELLER'S EXPENSE AND RISK. IF YOU MAKE THE GOODS AVAILABLE TO SELLER BUT SELLER DOES NOT PICK THEM,0,".. DAYS OF THE DATE OF YOUR NOTICE OF CANCELLATION, YOU MAY RETAIN OWD1SV GOODS WITHOUT ANY FURTHER OBLIGATION. IF YOU FAIL TO MAKE THE GOODS Ami SELLER, OR IF YOU AGREE TO RETURN THE GOODS TO SELLER AND FAIL TO DO' g REMAIN LIABLE FOR PERFORMANCE OF ALL OBLIGATIONS UNDER THE SALES CONTRA01 TO CANCEL THIS TRANSACTION, MAIL OR DELIVER A SIGNED AND DATED COQ v CANCELLATION NOTICE OR ANY OTHER WRITTEN NO'T'ICE TO HOME DE -01 AT'I'H1G THE TOP OF THE SALES CONTRACT NO LATER THAN MIDNIGHT OF *DATE MUST BE Ifl THIN THREE BUSINESS DAYS OF DATE CONTRACT IS SIGNED, EXCLUDING HOLIDAYS TO CANCEL,EACH PRODUCT;CHECK APPROPRIATE PRODUCT(S)BLOCK BELOW LI<WE SHEET#AND CHECK CANCEL JOB BLOCK(YES) � Job#: internal Reference) Prod is Spec 3h#0(0* Roofing LISiding indows U Insulation Q I ❑Gutters/Covers []EntryDoors ❑ 6 Roofing Siding ElWindows Inst don ❑Gutters/Covers ❑Entry Doors ❑ Rooting Siding Wndows Insulation u ❑Gutters/Covers ❑Entry Doors ❑ `a Roofing Siding Windows insulatioft ❑Gutters/Covers ❑Entry Doors ❑ ; ACkNOWLEDC>;AiF T OF RECEIPT OF NOTICE OIFQWMXT F Y, 211L'e iterevy aclato>vtedge receipt of nv t completed once c tl IrIGtt15 Of 81U'fljrtit t0 iX1llCel. dotloop verif ed ;t 09/25/151130AM ._ �` 33�' EDT BCVO-ENTL-5019-ZFVO k E Date onrer Sigtuntre Date Ontonurr Sigtutum I HEREBY CANCEL TWS TRANSACTION: Iat4x , r � , 06a-14 SFC White—.1-tommDoW Yellow—Gu*1-7 1 wK, o�z, w Scanned by CarnScanner VINYL WINNOW PRICING WO MEET BOSTON GOWN : Job u: q pc/7 �iA11M11�ttt: ,I WINDOWS SII GRIDS y TOTAL Or yy I� *Ar Window Slz* Prfco Window PMA/ os- op �Ifd f a sod" Color Ut Window Pdcu 40* w, Price addsul Woo jXj 7 1 1.33 as la ..l9 I t1 / (A) TOTAL WINDOW PRICE (BEFORE OPTIONS): (spy Scanned by CarnScanner VINYL WINDOW PRICING WORKSHEET BOSTON •1• Z• 112 MASS P N unit Maes. u"Fifa arrbdow Full Screen 10ouble Hun Pa Boson Sig Add9 4 r.Sssh i deduct for Fixed Bosh Casements Per sash $99 Mulling Chars for OPD oft.)_ Par MOW $41 Te red Glass tee below for Garden Wndow $19 (W x H)1144 a Sq.FL Par a4.Ft. Obscure 01 Advancs Energy Prosolar Sun,Superew,Poly Paint Par Vwndow $58 6500 WIN Energy Saver piwor upsr Specer, Per Wndow $136 TrfRbLrjno.Metal Point N Sound S Security FosolamiliI N am glass, ups P«vanocw 5119 8100 WIN N Energy Star PfoSolar,Supercept,Pay Reim Per window $24 Advance Energy ProSolar Sun,SupsmA Poly Point Per Door $204 8500 PD N Energy Star ProSolar,Super Spscsr,Poly Reim Per Dow 6102 Energy Saver* PiMlar KWOSuper 5pacer, Per Door rl a stat N $415 N Sound d,Security Metal ROW r,Iff"I glass,3upst 3psosr. Per Door $436 N 8100 PD Energy Star ProSolar,8upsr 8paoet,Pay Paint Per Dao $98 WINDOW HARDWARE OPTIONS (Premium Finishes Available with 5800 ONLY) Premium Finishes ore:Polished Brass 8e Nkkel Oil-Rubbed Bronze ote on SpecSh Premium Finish Lock 6 Kasper (ON,213 PNL Slider) Per lock $31 Premium Finish UR Handles Woodgnin Only (DH,213 PNL Slider) P«MAW $38 Premium Finish Crank Handle/Hrdwr .Note"Foidin or"Non`on 8 Shset Per sass 158 Flush Mount Handle (Casements,Awnings) p,se,h $11 Egress Hinge CaementsPer window $9 GARDEN WINDOW OPTIONS(see Price Book for Unit Price) Ta red Glass Per Wind,,,,, Additional Glass Shell a red Per WrdDw Jamb DO 6"or Greater PW Winds,, PATIO 6 GARDEN DOOR OPTIONS Promhtm Rnishes we:Polished Baas,Brushed Nickel,O!f-Rubbed Bronze,Mdque Brass Pren lura Finish Lock Handle-Sliding Patio Door 6500 on EsCh 5739 Sliding Screen•Garden Door(Only with Center Hinge-Single Swing) Per screen $200 EXTERIOR COLOR UPCHARGE favellable only on 0600 Windows up to 120 UI Per Un" $167 KYlndows greater than 120 UI Per unn $223 Sldng Petro Door Per Door $SSS Mulls Per mwwn 1 $64 (B) WINDOW OPTIONS SUBTOTAL: Scanned by CamScanner VINYL WINDOW PRICING WORKSHEET BOSTON American Craftsman WAMP b GLASS OPTIONS unit Maas. ay. Urill Pd. aWTOW $14 (w+►x H)1144=Sq.Ft. as a ..._tfterne $5. Full 9cro0n^ Double Hung scorn $17 Add`i O per.Sssh I deduct for Fixed Sash Cessments Per Sash $163 1110 Charge for DPD etc. Munon $63 WINDOW HARDWARE OP71ONS Egress*lge Casements vNrhdow $19 PRS 5100 WINDOW 4 GLASS OPTIONS ural Me". ar. una Price Sub-TOW 0►r4har G ass18 ghncum 0181 r (W x H)11M■8q.FL Sq.FL $0 Full Screen OH and 2 PNL Slider Screen $18 Add'i Opal;Sash I deduct tot Fixed Sash Casements Per sash 1 1 $89 Mullin Charge for DPD,etc. Mugbn $59 PATIO DOOR OPTIONS Polished Brass Interior Handle Per Door $83 C PRS5100 and AC 12 OPTIONS SUBTOTAL: "1" -!- 1 x Z LABOR OPTIONS urx MUS. city. unit pries sub-Total Land Safe Renovation -Windows PTI openIng $35 Metal Window Replacement excl.H How GMden VMndow 8 Patio or Garden Doom Per VhAndow $109 Additional Charge for Steel Pen Removal each $199 EEI Construct Root over Be /bow Window Each $657 n ow Door Up to 120 UI each $80 121-180 Ui each $95 lot Deduction for No Wrap) Over 160 UI Each $120 Custom Color WNndowlDoo►Wrap on It<8 windows Per Job $76 New Interior Wood Casing, Per Lan.Ft. $10 Q Remove A Reinstall AIC Unit each $58 ,,^O Remove 6 Reinstall Awnings U to 8' Each $35 �- �1 Over 8' Each Bid , ( ` Remove A Reinstall Shutters Pah $23 kin Simonton Nail Fin Up to 120 UI Each Bid Over 121 UI Each Bid ' BostonCI Cha a Per Job $167 M Mlec.Leber Call for Eaftate of Hours Par Hour l $55 SS D D LABOR OPTIONS SUBTOTAL: TOTAL PROJECT AMOUNT A + B + C + D): 103 ESTIMATED MONTHLY PAYMENT *: E ual to Pro t Amount X.01f based on the assum tion of 84 months and 1�.89'b APR Scanned by CarnScanner dot loop signature verification:w .dotloop.com/my/verification/DL-123901006{-Z91Y 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 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 the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided in Massachusetts General Laws,chapter 142A dotloop varied n,�,� dotim'verified 09/25/151:52PM EDT °l�—^-y--- 09/251151:14PM COT Homeowner Signatu FJO6H5FY-CYi0-CMF2 ntracror Signature 3Er5-HY25-%NIZ-C2AD NOTICE:The signature of the parties above apply to the agreement of the parties to alternative dispute resolution initiated by the contractor. The 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 maybe added to the terms of the contract as long as they do not restrict a homeowner's basic consumer's 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. 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:If you have general questions or need additional information about die Home Improvement Contractor Law or other consumer rights,or if you wish to obtain a free copy of"A consumer Guide to Home Improvement Contractor Law" contact the Consumer Information Hotline at: Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston MA 02116 (617)973-8787,888-283-3757 If you want to verify the registration of a contractor or if you have additional questions or need additional information specifically about the contractor registration component of the Home Improvement Contractor Law,contact the Director of Home Improvement Contractor Registration at: Director of Home Improvement Contractor Registration Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170 Boston,MA 02108 (617)973-8787,888-283-3757 For assistance with informal mediation of disputes or to register formal complaints against a business,call: Consumer Complaint Division Office of the Attorney General (617)727-8400 d9/25 v1:14P 09/25/151:14pM EO SUBMITTED By: "-Ille "'5k ATaJ GFS3 uv>rJKIG Date: Sales Consultant ACCEPTED BY: Date: donoopp ruled 09/25/751:52,.EDT FGH3GI,T-TDIu-HHTa Date: Purchaser 05-10-12 White—Branch File Yellow—Customer The Commonwealth of Massachusetts u W Department of IndustrialAccidents d I Congress Street, Suite 100 Boston,MA 02114-2017 www mass.govldia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Aimlicant Information F Please Print Le ibl Name (Business/Organization/Individual): `) WW P16Address: � �( 1A City/State/Zip: Are you an employer?Check the appropriate box: Type of project(required): 113 I am a employer with employees(full and/or part-time).* 7. F1 New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. E] Remodeling any capacity.[No workers'comp.insurance required.] IFJ I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10F] Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.F1 Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the t ached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance. 14.61_'"ter !)) tJ, 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Vdl , Policy#or Self-ins.Lie.#: �_,()/"0 Expiration Date: Job Site Address: (10 0PCity/State/Zip: ;GJ6,2,1-14 Attach a copy of the workers' compensationpolicy eclaratioe(s ow n paging the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine 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 of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify der he ins a d penalties of perjury that the information provided above is true and correct. r. Simnature: Date: Phone#: [� Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: f - :�"�' ? ..a"'i, -� .,-,.� r.�i.v^ i fp �J''f�,•. ;".y?,,�-��-.l�,•�,�:;i�i.•,'F`,ri:�(.�::^ ,..-,1:_ ^:�i-i•i� �=w { "-+-� �-fit:� r3 �,�� --�. ,-.• Tatic card SERVIC THD AT H �61O.-CUMBEgMEf-pA,RIMAY SUITE HO Addy j R,Mwvn] J aip J ids l�f•�r31Jf.NTI!P:I�1�fi C-� {��Jit/CJ17 J� •�>ioY�v 3i � i� iari!3��rap,OROY =�.� T1s:xFs.�TCon��rs'�.;s�ia��ls3n513�=R..�ida�a� Ll��fi�orra d' wo L���(a��; ��� PIWI Ar �L`f3U�a�rU: icpoc�tz rc,fti��► 0�'fi SUPPI cn�nt av Boston'. Au[� CLIMB LAP�LI'FARMAys � ,� p�ns3�r�crEias`y •. . : .. � slue' � •s�gga • ' y'• ....... .. • +. � ' A- 071[l W, 01; i CERTIFICATE Or` LIABILITY INSURANC,--E ?}ilS CEs�tTsFICATE IS ISSUEID AS A MATTER OF INFORl49Ann N GNLY AND GONFrr�S SIO Rf�HiS UPON THE CErZiIFIC;�ir iQL_DEtZ THIS � i Cc_RTIFIGAT E DOES:N6T bi`FII NTA?IYELY.OR-:NE€,ATIVE,t_Y-AMEND EXTFt4D OEC ALTER THE COMER AGE ArFflF DED 8Y THE °OLiC1ES ELO;IU: t1IIS-: ERTIF3E 7E OP.IAlSL1RA'MCE.DOES'NOT CONS�ITUTE A CQNTr�AGT BF'tVEEy THE ISSUING )t43URER a AUTHORIZED F?FPRESE?4-A'hVE-OR,PROi1UGER,A�D.THI CERTfF1CATEi QLISER (�}' f t►4TF'Gt RZ I TANT: If the certitseate holder is an Ai30ffiONSUREI3,�the policy(iee)must be endorsed. Ii SUBR©GA-nC)N IS VI]A)VED,subjsct to I the Eerms and cand)tions o€,fhe policy,certain ga((ci� tray.re4ufi'e an andoriernent: A stat�ma tit an this certificate.does not confer rights to the ce"tl'Thcate holder-In 1166 of Such endoi�serlent(s), C 51ARSHUSA'IrJC:._. . . . ..�O �FAC,:-•T TWO ALLIANCE CEN-i ER exDHE FAX NOLENOXROAD,SUITE 2400 AIC 101: ATLAJgA,.GA.30326' ADDREss: i 0002-H01 eD•GAl1Tl-j5.16 INSURERLS1 AFFORDING COVERAGE NAIC A INSURED ., INSURER A:S)eWfast hjSL14nl 0 CO.MPMY 26397 7HD AT(TOME SERVICES,INC. t►isliii e:h ►An►en_c lhsurance Co . 16535 OSA THE kME OV&.AT�i.QME SERVICES ' Ixsultl R c dew Haiiipshie Itis Ca. 269Q OUMBEFQ b.PAREL4yAY,SUITE 300 - 1 ATLANTA,GA 30339. iNsuR o:Blinpiss National Insurance Company 13917 11r50REFt F�-•-:o.-•. . COVERAGES CER71FtCATE NUMBER: - l11t 7466dit13 ,:. .. _REVISION:4U9$ERZ9... THIS IS TO CERTIFY VAT THE POL1ClES.flE iN5•CIRANCE t1STED EELOW HAVE B __,i U TO E INSURED NAIu1E(}At30a1E FOR THE POLICY PERIOD INDICATEC7.";ilOTWICFISTANE)I1VG AIV`(REQC►1f2EIlAENi', $%UE INS MAY fSSUED Q(i hIAY.FERTAITV,'THE INSUFZ4N E A FDRDE F8 h}E� C . E jg D k ETN 5poCUMENT 5i )ECT WbT TO ALL 7ERA�S, EXCLUSION AND CONDITIONS OF SUCH i'& IES,LIMITS Sf lOVjM MAY HAVE BEEN REDUCED 61(PAI,[i.GLAI 15. INSR LTR PEOFINSURAMCE AOD BR TY ..... 'PO Cr Ell .0LICYEFE: PO YEXP A I X COMMERCIAL GENERALLIABIUTY MIODrt MIND GL04B87714=05 D31DjhOj5 X310112016 CLAIMS-MADE OCCUR �l+�.N.QCEy!?RENCfi, S 9,000,000 LIMITS OF POLICY XS !?I�EFAISES Ea.o rrence $ - i3Obp,DCO .oak.ri;K=iy:'i:t":�:':�y OF SIR:$1 M PER OCC MED EX[?(Arty brie person) 5 FXCI..DED GEN•L AGGREGATE LIMIT APPLIES PER: PERSOF(AL, AbVihj RY S g,OQUODO X POLICY PRO-JECT LOC GE NEFL4LAGGl?FGA7E S 9.00D,ODD. PRODUCT-COMP%OPgGG S 9,000,000 .OTHER: _ 0 AUTOMOBILE UABILtrY S 6AP2938863-12 . 03101/2015 0310112016 COM8INED.SINGLELIMIT S X ANY AUTO Ea accident 1,000,000 ' ALLOWNED SClIEDULED BOQILY115dURY(Perpeison) 5 auTos Auros SELF INSURED AUTO PHY DMG NON;OWNED 60DILY1NJUpY(Pa�racdd..[) S Ti1RE0 AUTOS Auto$ PROPERTY DAMAGE . Per aedden S UMBRELLA UAB S OCCUR - EXCESS UAB E,(CH•OCCURRENCE S • CLAIMS- DE � • _ AGGREGATE - • 1 DE0 _ RET EN770N S :S C WORKERS COMPENSA.TIQN WC017731493(AOS) - S C AND EMPLOYERSuAeIU7Y 0310112015 0310112016 X PER ANYPROPRIEfdR)PARTNEROCECUTIVE Y r N. C017131d95(AK,KY,NH,NJ,VT) Q310112015 b3101/2016 A� -ER D OFF10EFj/j(EFiSA��lgCLUDED? N!A EL EACHACGtOENT• S 1,OOQOCU (Manddlory b tend 0017731494(FL) 0310112015 03/01/2016 ' I!yyes, IPTIe)eunder EL01SEiISE-EA EMPLOYE. ; 1,0 0,000 DESCRIPT OP!OFOPERATIONS below Conilnued on Additional Page E.L DISEASE-POLICY UMiT' S i3OCU10• DE5CR1PnON OF OPERATIONS LOCATIONS!VEHICLES(ACORD 101,AddiUonal Remmics Schedulq may b'-e attached i1 more space is required) EVIDENCE OF INSURANCE CERTIFICATE fi4LDER = - • •• - - CANCELLATION THD AT HOME S&GES,INC DBA THE HOME DEPOT AT-HOME SERVICES SHOULQ ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 2455 PACES FERRY ROAD THE EXPIRATION DATE THEREOF, *NOTICE WILL BE"bEL1VtRED IN ' ATLANTA,GA 3D339 ACCORDAWCE WITH THE POLICY PftOVIS10N5: AUTHOR=-ItEPRESENTAT WE i I Massachusetts Department of Public Safety Board of Building r} Regutafso.s a;jcj Standards G;�nstrurri��n Supervisf>r Specialty License: CSSL-099823 DZAHTRY BROVJi 70 NORTON AVR' Manchester NH (0109' n c ,;u E.xpiratia:n Cc)mmissioner 06/26/2016