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HomeMy WebLinkAboutBuilding Permit #716 - 1511 GREAT POND ROAD 4/9/2012 Nvn�ry BUILDING PERMIT °f�*``° TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION � 04q coc.w.iwww��? Permit NO: Date Received � ORATf°)IpP • �SSACHUS�� � Date Issued: IMPORTANT Applicant must complete all items on this page -tt! Cc "'se , � � s41 4 € � rpt , � Y -� Y"' Sys L`OV .t122 �9eTr � tiTa r f7 " rY ^� {���k� 4 " ^tea F rsf zsvi LrT as tin Aj �•j�k�,�.� T y§. a�� ti'`G� '�-`� ... �`�.•r 4L� L� � �.,:°F.��n ��T��-�F G r^ � .. t �r� Lfi,Y.3 �' f�r+'s. t s a..•.. {.e _x. •rr"F. a ..x ei i'^ } ae.;. :. 3 -r ., �� ,�..' ' PR 'EROW � � _ t 0 MAPI�b >� PARCEL O 1(C�'11ISfRlCT � P HistoriL3is#F "�=-•,z�.�'�S..s '..a.��-.z.v.-. .:•.."'.`.t b«_�t:'�.'�.�'rM',. s.,e7 vr .,>.r�r TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑Addition ❑ Two or more family . ❑ Industrial P-Alteration No. of units: Q Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ftbUlla 'r'shedDii;t;i�t� ®rS'ept�c "�Illfe1t Ffi 4t � Flobdlain ajVl/etlan M7. � z2 rt �` -r - .a�r d ,y v z+.. s - r `5 ::u7' a,' - r '1•�' s t'� }"r` r Y y".��.3 ... �stsr rr?:' -y. `` y.C't I e,..;L`Ji V�V a�P.l-��_ew�rTu-.�.��',<..,.� st+ ��„ } '^��'.3 ,w :''` _'t.,.,�:r.,.t,... ":`�.;..a? _.-. �>.., ....,:7�__. ! .teary«. .a.......:a;.�t.:._..0 m r..,t•'•.`.-. r�.'3 7�."i` DESCRIPTION OF WORK TO BE PREFORMED, Identification Please Type or Print Clearly) t9t l�J d3 OWNER: Name: �`�� c1'1'\r1�- r�\�Sc. t'klc\\<kk�-1 Phone Address: '4 "x°s :3 S kk aye 1 ac i-:ry L-'tirop r:1 ' sr° 'Y, ,°`• �,t .r,� ��" y>:ry { i�� `"-c e� a k z� - � ✓._ rr x� �,.�."p �� L L` " '3` °`s �#�`.n; CONA TRCT �S r. •+. � { cy�3 � u -+ � � �. v _a q r i. t r,� R '�c S..! �.fi ,�s'"^.f�`�",�sr Y y 4��. Ad �� •y. sE T :-'y/ Y+� .a 5.t- *+, 5s k .1 � } .� -r-,i rt -. x Sr' '�" 3F gr rfi ,'Ta*artd.. 3 7 ,P .-• -3 '«. ` at`� ��.�d`��r-•ti2 Yi�; i.�. ' n UpS.a,: � �yXp S�Gll�i, '"SupervlsorKsKns-fI C{�p �Llcerlse r � t �' i � '�' x'�� ARCHITECT/ENGINEER 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: $ pOd. y FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with nregistered ntracto s do not h cess t the gu�ar�antyfund enlLOwner Signate o con r: Si nature of Ag 3 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. i Roofing, Siding, Interior Rehabilitation Permits o Building Permit Application o 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 Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ' ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) o Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. one copy and proof of recording must be submitted with the building application Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 1 I-ECI- O- 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 - Date i Doc.Building Permit Revised 2007 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS p s Zoping 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 Located at 384 Osgood Street FIRDEPA°RTMENT' l"etp Dumpster oh=site` es' f ' w nor, ' F `� =R � t:f i ik 'n L`ocated;at��2Q�MainStreet � 5 Frre�Departnenu signature/date` sxt Location /S// No. Date_L � • . TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $� Foundation Permit Fee $ " Other Permit Fee $ TOTAL $ Check 25166 Building Inspector NORTfq Town of . , 0 No. - I = - _ __ _= o dover, Mass., �I � a ' 1a-► O '= LAKE /� T COCMICH;.C.ORATED Dpa� C) qs E� BOARD OF HEALTH Food/Kitchen Septic System PERMIT T D BUILDING INSPECTOR THIS CERTIFIES THAT................ ........... .. .. ................................. Foundation has permission to ........................... ......... buildings on ...I.C.11......0 !! ._....p�. ......................R... Rough to be occupied as....... ..... !... l.... .. ................1..a....: l.li,.�........ ...Ir1..l�.1 .............................. Chimney e provided that the person accepting this permit shall in every respect conform to the terms of 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 �b�• PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR. UNLESS CONSTRUCTI S 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. .f r 1 i r aA\� T-Ni-ay \\ 11 •fit � I i I i i ACC)R" CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 111.1 � 1 04/09/2012 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,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 CO TACT NAME: NORTH ANDOVER INSURANCE AGENCY, INC. a"c°,"N, E=t; (978) 686-2266 FAX No):(978) 686-6410 M.J. FOSTER INSURANCE SERVICES ADDRESS: cfernandez@nafins.com PRODUCER 163 MAIN STREET RODDEN CARPENTRY CUSTOMER ID #. NORTH ANDOVER MA 01845-2508 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A :MERCHANTS INSURANCE GROUP 3329 RODDEN CARPENTRY INSURER B :TECHNOLOGY INSURANCE CO 47 PRESCOTT ST INSURER C INSURER D INSURER E NORTH ANDOVER MA 01845— 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 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. IUBR LTR TYPE OF INSURANCE S POLICY EFF POLICY EXP INSR NND POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYYY) LIMITS A GENERAL LIABILITY BOPI054995 2/01/2012 02/01/2013 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 500,000 CLAIMS-MADE Fx I OCCUR / / / / MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: / / / / PRODUCTS-COMP/OP AGG $ 2,000,000 rx-1 POLICYPRO LOC / / / / $ A AUTOMOBILE LIABILITY KCA7015515 7/16/2011 07/16/2012 COMBINED SINGLE LIMIT $ 1,000,000 ANY AUTO / / / / (Ea accident) BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ X SCHEDULED AUTOS / / / / PROPERTY DAMAGE $ X HIRED AUTOS / / / / (Per accident) X NON-OWNED AUTOS / / / / $ $ UMBRELLA UAB OCCUR / / / / EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE / / / / AGGREGATE $ DEDUCTIBLE / / / / $ RETENTION $ / / / / $ B V40RKERS COMPENSATION TWC3302016 1/01/2012 1/01/2013 X WTOCRY STATU- OTH- AND EMPLOYERS' LIABILITY I LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N / / / / OFFICERIMEMBER EXCLUDED? ❑ N/A E.L.EACH ACCIDENT $ ZOO OOO (Mandatory in NH) / / / / E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under - DESCRIPTION OF OPERATIONS below / / / / E.L.DISEASE-POLICY LIMIT $ 500,000 _T1 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. TOWN OF NORTH ANDOVER 120 MAIN STREET AUTHORIZED REPRESENTATIVE NORTH ANDOVER MA 01845- ACORD 25(2009/09) ©1988-2009 ACORD CORPORATION. All rights reserved. INS025(200909) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of lndustriglAccidents Office of Investigations go 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance.Affidavit:Builders/Contractors/Electricians/Plumbers _Applicant Information Please Print I,eizibly Name(Business/Organization/Individual): Address: 1-01 , t Cb47k>, City/State/Zip:k• "2 k,�-k(ae k�' Phone#: Q7 �� 72)C1 " Are yo n employer?Check the appropriate box: Type of project(required): 1.Lirl am a employer with 1 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.x 7• ffRemodeling 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 required.] officers have exercised their 10.El Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers'comp. c.152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' comp.insurance required.] 13.❑Other 'Any applicant that checks box#I 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. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name O �_S Policy#or Self-ins.Lie.#:_ �1,!J e. 3 Expiration Date: Job Site Address: 1611 -Pity/state/Zip:_' Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA.for insurance coverage verification. l do hereby c i un a' dpenaldes ofperjury that the information provided above is true and correct. - &M Date: 1 E 1 Phone#: Q �� 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.CitylTown Clerk 4.Electrical Inspector 5.PIumbing Inspector 6.Other - - - Contact Person: Phone#: Inform.ati®n and Instructi®nS Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,• express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a j oint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. lir an LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance.for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: Tho Conu?a mwealth of Massachusotts Mpaftent o£Zndustriat.A.ccidonts Office of investigations 600 Washing-tori Stzcot Boston,MA.0211 t Tet,#617-727-4900 est 406 ox 1-877�,MASSAFB Revised 5- - Fax#617,727-7749 26 05 www.mass,gov/dia Page 1 of 1 RODDEN CONSTRUCTION License # 28538 47 Prescott Street Expires: 9/5/13 North Andover, MA 01845 (978) 687-2934 PROPOSAL TODAY'S DATE JOB NAME 4/9/12 Baddu Vasanth and Alison Martin DATE OF PLANS/PAGE#'S JOB LOCATION 1511 Great Pond Rd. North Andover Ma. 01845. We propose hereby to furnish material and labor necessary for the completion of: Make alterations to the existing 12'x 12'sun room. Remove three existing double hung window units and install a new Andersen 5'french door unit with two 24"deadlites on either side. Remove the existing ext.door unit and install one of the removed dbl.hung units in its place.Remove and replace all ceiling wall and flooring materials. Remove and replace existing fiberglass insulation. Elect.will include some new outlets and switches ect. Heating will be forced hot water off of an existing zone. New flooring to be tile,walls to be skim coat plaster and ceiling to be bead board.Work will be done on a time and material basis plus a fixed fee of 2,000.00.The fee is to be paid with 1,000.00 at job start and 1,000.00 at completion.All material and subcontractor invoices will be billed at contractor cost with no markup.. I i We propose hereby to furnish material and labor-complete in accordance with above specifications for the sum of: Est. cost of 22,000.00 including fee. dollars ( $22,000.00 ) Payment as follows: Upon invoice receipt All material is guaranteed to be as specified. All work to be completed in a substantial workmanlike manner according to specifications submitted,per standard practices. Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders, and will become an extra charge over and abQ�ve the estimate. All agreements contingent upon strikes,accidents or delays beyond our control. Owner to carry fire,tornado and other necessary insurance. Our workers are fully covered by Workmen's Compensation Insurance. If either party commences legal action to enforce its rights pursuant to this agreement,the prevailing party in said legal action shall be entitled to recover its reasonable attorney's fees and costs of litigation relating to said legal action,a�determined by a co rt of cDWetent jurisdiction. Authorized Note: this proposal may be withdrawn by us Signature f� if not accepted within days. ACCEPTANCE OF PROPOSAL The above prices, Signature specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Signature Payment will be made as outlined above. Date of Acceptance �1 Z WWW.THECONTRACTORSGROUP.COM&Dune Derns Ente•P :ur 2C34 PROP-CCta Coc Rev'J:74 Mailing Address(It different from above) Business Phonegs72,6 Phone , 3 Federal Employer ID or S.S.Number�j.?,3 OOf Home improvement Contractor Reg.Number Expiration date Lav requires that most home J improvement contractors have a valid registration number The Contractor agrees to do the following work for the Homeowner: (Describe in detail the work to completed,specifying the type,brand,and grade of materials to be used,use additional sheets if necessary.) W-acYLIC8 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 Date when contractor will begin contracted work. MGL chapter 142A.) Date when contracted work will be substantially completed. Total Contract Price and Payment Schedule f The Contractor agrees to perform the work,furnish the material and labor specified above for the total sum of: (*) Payments will be made according to the following schedule: I upon signing contract(not to exceed 1/3 of the total contract price or the cost of special order items,whichever is greater) $ by _/ / or upon completion of $ by _/ / or upon completion of $ upon completion of the contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction) The following material/equipment must be special $ to be paid for ordered before the contracted work begins in order to meet the completion schedule.(**) $ to be paid for 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 express warranty being provided by the contractor? ❑No❑Yes fall terms of the warranty must be attached to the contract) 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 contractors 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 10 Park Plaza,Room 5170,Boston,MA 02116 or by calling 617-973-8787 or 888-283-3757. • Does the contractor have insurance? Ask the Contractor for his insurance company information so that you can confirm coverage,or ask to see a copy of a"proof of insurance"document. • 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 may cancel this agreement if it has been signed at a place other than the contractor's normatoce 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. See the attached notice of cancellation form for an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES!!! Two identical copies of the contract must be completed and signed. One copy should go to the homeowner. The otli copy should be kept by the contractor. i I Homeowner's Signa re Con actor's Signature v- 9 Z �. 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 is not automatically afforded to a contractor,however. The contractor would have to resolve any dispute he/she has with a homeowner in court unless both parties agree to the optional clause provided below. This clause would give the 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. Homeowner's Signature Contractor's Signature NOTICE: The signatures of the parties above apply only 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 the parties. Homeowner's 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 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 rescission period has expired. Accelerated Payments A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure. However, in instances where a contractor deems him/herself to he financially insecure_the contractor may reauire that the balance of funds not vet due be placed in a joint escrow Massachusetts Home Improvement Sample Contract This form satisfies all basic requirements of the state's Home Improvement Contractor Law(MGL chapter 142A), but does not include standard language to protect homeowners. Seek legal advice if necessary. Any person planning home improvements should first obtain a copy of"A Massachusetts Consumer Guide 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 or on our website. Homeowner Information Contractor Information Name Company Name Street Address(do not use a Post Office Box address) Contractor/Salesperson/Owner Name 161 t GNke City/Town State Zip Code Business Ad ress(must include a street address) Daytime Phone Evening Phone City/Town State Zip�ode y� 4 r/ l