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HomeMy WebLinkAboutBuilding Permit #066-15 - 165 SANDRA LANE 7/21/2014 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: — Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION__ _��ul_ _�cc,�v�►2� _ Pr'nt PROPERTY OWNER �i_C lkh fCa,✓ ro Print 100 Year Old Structure yes no MAP NO: PARCEL: _ _ ZONING DISTRICT: Historic District yes no Machine-Shop Village yes no, TYPE OF IMPROVEMENT PROPOSED USE Reside Non- Residential ❑ New Building ne family ❑Acition ❑Two or more family El Industrial Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: sIdentificat' n Please ype or riot Clearly) `-Z� Z� OWNER: Name: C�c...c, /!ter tye rPhone: Address: Ce SR f'�L CONTRACTOR Name: E_ n C- pci /�7► Phone: -7 SlY 3 11� gg S� Address: Supervisor's Construction License: Y�7 ?l 77 _ - —Exp. Date:.. 1-//23/16 p p Home Improvement License: /X12..0 � _ Exp. Date: 3�12�/� 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: $ ✓�o . FEE: $ ? Old Check No.: Receipt No.: olZ 7 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 6Signature of Agent/Owner Slgilaof ture contracfo Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF.SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBody 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 ❑ ❑ I 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 Tovy;! Engineer: Signature: Located 384 Osgood Street FIRE DEPARTML-N-t Temp Dumpsteron site yes_. no Located at 124 Mair; Street Fire Departmei t,sigrnature/date ' - E c A 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 No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A-F and G min.$100-$1000 fine NOTES and DATA— For department use Ll Notified for pickup - Date Doe.Building Permit Revised 2010 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 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/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) ❑ 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 ❑ 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 apnaal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm_?ted with the building application Doc: Doc.Building Pe.cmit Revised 2012 NORT#i Town of _E 1jAndover 0% No. o h over, Mass, 71,2 COCHICKIWICK 1' CRATED S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT .......... '1..� �.G�,l.' !:.G.. a............................................................ BUILDING INSPECTOR has permission to erect buildings on l r ..�.. Foundation ................ .................. .. ........... ................. Rough to be occupied as .......... �. �r�!u L,!1. ..�1.�..... �......- ................ Chimney ../� ..... ..........I.provided that the person accepting this permit shall in every reorm to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION TARTS Rough ............................... Service ............. BUILDING INSPECTOR Final 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. mass save PAMWPARW PERMIT AUTHORIZATION FORM I, Eric Imparato ,owner of the property located at: (Owner's Name,printed) 165 Sandra Ln North Andover (Property Street Address) (City) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. X Eric Imparato( Vay 29,2014) Owner's Signature May 29, 2014 Date FOR CSG OFFICE USE ONLY Conservation Services Group has assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Date Of`CI 01 For office Usee Omly Rev. 12132011 f_. Massachusetts -Department of Public Safety 9 Board of Building Regulations and Standards Construction Supervisor License: CS487977 � ERIC W PALM 3 M.TON ST ' s Salem MA 01970= / Expiration Commissioner 04/2312016 _ Office of Cousumer Affairs&Business Regulation F WME IMPROVEMENT CONTRACTOR gistralion- 142089 Type: , piration: _3/1212016 . Ltd Liability Corpo_* Y ATLANTIC WEATHERI7ATION11.C. ERIC PALM ' fit R JEFFERSON AVE SALEM,MA 01970- Undersecretary a d Rightfax N3-2 4/18/2014 7:54 :21 AM PAGE 2/002 Fax Server CERTIFICATE OF LIABILITY INSURANCE oATEtM1R/2n1 vrn 7THISCERTIFICATE IFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. HIS TE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE C IC E OT:If the certificate holder is an ADDITIONAL INSURED,the policy((es)must be endorsed. If SUBROGATION IS WAIVED,subject to the conditions of the policy,certain policies may require and endorsement A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsemen s. PRODUCER [NAME: ONTACT EASTERN INS GROUP LLC HONE FAX 233 WEST CENTRAL STREET AIC,No,Ext): (AIC,No): NATICK,MA 01760 E-MAILADDRESS: 22MLW INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: AMERICAN ZURICH INSURANCE COMPANY ATLANTIC WEATHERIZATION LLC INSURER B: INSURER C: 61 REAR JEFFERSON AVE INSURER O:INSURER.E: SALEM,MA 01970 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: IS O CERTIFY THAT THE POLICES 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 5 SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS MOWN MAY HAVE BEEN REDUCED BY PAD CLAIMS. INSR ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (WADMYYYY) (MMDDIYYYY) LIMITS GENERAL LIABILITY ACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY AMAGE TO RENTED $ CLAIMS MADE OCCUR. REMISES(Ea occurrence) ED EXP(Anyone person) $ ERSONAL&ADV INJURY $ GEML AGGREGATE LIMB APPLIES PER: ENERAL AGGREGATE $ POLICY 0 PROJECT a LOC RODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE "` AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND WC STATUTORY ,OTHER EMPLOYER'S LIABILITY YM UB-56270121-14 03/20/2014 03(2012015 X LIMITS ANY PROPE MBERIPXCLUDEIEXECUTIVE a WA E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCAMONS/VEHICLES/RESTRICT(ONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 1600 OSGOOD 5T BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPR A VE N ANDOVER,MA 01845 ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD -i-90 2010 ACORD CORPORATION. All rights reserved. ACCM0 CERTIFICATE OF LIABILITY INSURANCEF3/ D /DD/YYYY) �' 10/10/2014 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 CONT NAMACT construction Eastern Insurance Group LLPHONE (508)651-7700 FAX c: 233 West Central Street E-pl : INSURERS AFFORDING COVERAGE NAIC A Natick MA 01760 INSURER AArbella Protection Ins. Co. 41360 INSURED INSURER B Arbella Indemnity Ins Co. 10017 Atlantic Weatherization INSURER C-14autilus Insurance CO 61 Rear Jefferson Avenue INSURER D: INSURER E Salem MA 01970 INSURER F: COVERAGES CERTIFICATE NUMBER taster 2014 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 POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MWDONYYY) fMMIDOfYYYYJ LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES ES Ea occurrence) $ 50,000 A CLAIMS-MADE Q OCCUR 500042816 /20/2014 /20/2015 MED EXP(Any one person) $ 5,000 PERSONALBADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2,000,000 POLICY X PRO- LOC $ AUTOMOBILE LIABILITY CEOMaBBIINED dent)SINGLE LIMIT 1,000,000 B ANY AUTO BODILY INJURY(Per person) S AALLOOWNED Ex SCHEDULED 020015871 /20/2014 /20/2015 BODILY INJURY(Per accident) $ X HIRED AUTOS OS NON-OWNED PROPERTY DAMAGE $ AUTOS Per acadent PIP-Basic $ 8,000 X UM13RELLA UAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAa CLAIMS-MADE AGGREGATE $ 1,000,000 DED I RETENTION$ 600058654 /20/2014 /20/2015 $ WORKERS COMPENSATION WC STA U- OTH- AND EMPLOYERS'LIABILITY YIN TORY"M ANY PROPRIETOR/PARTNERIEXECUTIVE OPFICER/MEMBER EXCLUDED? El N/A E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I S C POLLUTION LIABILITY PL200378602^' 0/1/2013 0/1/2014 GENERAL AGGREGATE $1,000,000 EA POLLUTION CONDITION $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,it 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 TOWN OF NORTH ANDOVER ACCORDANCE WITH THE POLICY PROVISIONS. 16000 OSGOOD STREET NORTH ANDOVER, MA 01845 AUTHORIZED REPRESENTATIVE Ronald Cleaves/SHE j���f� - ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 r9n1nn4 ni Tho annRn n2mo and Innn ow ronictorod moelrc of ARnRn The Commonwealth of Massachusetts - Department oflndustrial Accidents ~ Office oflnvestigations 1 Congress Street,Suite 100 Boston,MA 02114-2017 BWorkers' Compensation Insurance Affidavit: uildersl A licant Information Contractors/Electricians/Plumbers Please Print Legibly Name(Business/Organization/Individual): ` laj tic tl+'e-i tht' rizai.IOI?,L;,�; Address: 61 iefler-sbn Avenue City/Stat 1p: Phone Are � Y own em L1 pIoyer. Check the appropriate box: 1•LI i am a employer with Z 4. [:11 am a general contractor and I Type of project(required): 2.❑ employees(full and/ortimeart- ' * have p ). hired the sub-contractors 6• New construction I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have working for me in any capacity. employees and have workers' 8' ❑Demolition [No workers'comp.insurance comp.insurance.t 9. ❑ Building addition 3•❑ required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions I am a homeowner doing all work officers have exercised their myself. [No workers'comp. right of exemption per MGL Plumbing repairs or additions insurance required.]t c. 152, §1(4),and we have no 12❑Roo aim employees. [No workers' 13. ther_ 7JS�,[r�fi trw 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 doingall work =Contractors thatch and then hire outside contractors check this box must attached an additional sheet showing the name of the subcontractors and state whether ot submit a r n t those entitieaffidavit s avech. employees. If the subcontractors have employees,they must provide their workers'comp.policy number. lam an employer that is provrdzng workers,compensation insurance for my employees Below Mformation. is theolic and job y ob site l Insurance Company Name: Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address:1�P S JAI,n�rl� Attach a copy of the workers' City/State/Zip ensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 1 ) fin 52 can lead e up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to Investigations of the DIA for insurance coverage verification. the Office of do hereby certr u r Ore a Rtes of erlury that the information provided above is true and correct 3it?nature: _ / 'hone#: C17c� 7LJ/�/. 3 Official use only. Do not write in this area,to be completed by city or town o rciaL ff City or Town: Permit/License# ' Issuing Authority(circle one): 2.Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Massachusetts Home Improvement Sample Contract This form satisfies all basic requirements of the states Home improvement Contractor Law(MGL chapter 142A),but does not include standard language to protect homeowners.Seek legal advice if necessary.Any person planning home improvements should first obtain a copy of"A Massachusetts Consumer Guide to Home Improvement"before agreeing to any work on your residence.You may obtain a free copy by calling the Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617-973-8787 or 1-888 X83-3757 or on ourwrbsitc. Homeowner Information Contractor Information Name / Company-dame C,('i �h�► aye;7[vT TTP Sant Address(do not use a Pmt Office c address) Contractor/S on/ wet N atespers ame S Sa (1y, 61 R Je& m�A-venue CiitlTonn State Zip Code Business Address(must incl a MA 019-10 l� • d l$ lo Daytime Phone Evening Phone C_"y"Toga State Zip Code • ice.631� Mailing Address(it different from above) Business Phone IFederal Employer ID or S.S.Number Lrl)ID."tIT01t3r Ce=1=to:h_N1%h. Ev;=xod=e Lae rtge4uthat nen boar +mpm�enenr matrarr"rrBaro - _ a rand r;urr-�m oamtrcr The Contractor agrees to do the following work for the Homeowner. (Describe in detail the work to completed,specifying the type,brand,and grade ofmateriak�t/o bemused a e�dditionpt sheets if n c+rv) f7 S pavr 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 contractorwill'begin contracted work. iVIGL chapter 142A.) 3 Date when contracted work-will be substantially completed. Total Contract Price and Payment Schedule The Contractor agrees to perform thew•ork,furnish the-material and labor specified above for the total sum of U!/ M 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) S by I or upon completion of S01622 q0/' by 9t,,23/Por upon completion of__. 1Z =, / cann�G S J G�' upon completion of the contract. (Law,forbids demanding full payment until contract is completed`"tooboth party's satisfaction) The fieltowiog material(equipmem must be special Sto be ' {or ordered before the contracted wad:begins in order to meet the completion schedule.(tO) S to be aid 11 4 NOTES.(•)Including all finance charges('•)Law requires that any deposit or doua•payment required by the contractor before nark begins may not exceed the greater of(a)one-third of the total comract price or(b)the actual cost of acts special equipment or custom made material ninth must be special ordered in achance to mat the completion schedule.- Express Warranty-rs""express ma"anp•bein>`nrmided by the eontractor� \o Yes/all terms of the warrants must be-amehed to the contract) Subcontractors The contractor agrees to be solely responsible for completion of the work described regardless of the actions of apv third pain/subcontractor utilized by the contractor. The contractor furtheragrees 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 taw.Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been plated 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. Askestions if something• g i s unclear. Male sore the contractor has a valid Home Improvement Contractor Reastration.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 5 170,Boston,MA 02116 or by see a copy of a"proof of insurance"document 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 a 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 cancer this agreement if it has been signed at a place other than the contractor's normal place of business,provided you notify the contractor in writing athis/her main office or branch office by ordinary mail posted by telegram sent or by delivery,not later than anidnight of the third business day following the signing ofthis agreement. Seethe attached notice of cancellation form for an explanation ofthis right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACESM `\Two identical copies of the cow=mm be completed ural si,•aed.Onc COW should go to the hommcer.The other copy should be kept by the coauaeto:. Homeowner's Signature Contractor's Sigmatur Date 7 / Date Contractor Arbitration The Home Improvement Contractor Law provides homeowners,,vith 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 contraciormay submit the dispute to a private arbitration firm which has been approved by the Secretary of the Ex6dutive Office W Go4umer Affairs and Business Regulation and the consumer shall be required to submit to such rbittiprovided In Massachusetts General Laws,cha r 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 Lacy. 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 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 Massachusetts Consumer Guide to Home Improvement" contact: Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787.888-283-3757 or visit the OCABR website at irttnaicvzvw.mass.Roviacai 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 Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787,888-283-3757 or visit the H1C website at tnr�:/!���ala.mass.�aviocabr/ Go online to view the status of a Home Improvement Contractor's Registration: :;=.to://db.state.n;a.us/homei mnroveruent/i icenseelist.asa 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 or 413-734-3114 vii„"2 1.1,/22»_010 Location No. DAG Date 2 All . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ ' ~ _h Other Permit Fee $ TOTAL $ Check# 2Y7cop*3 `, uildifig Inspector