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Home My WebLink AboutBuilding Permit #526-15 - 193 ANDOVER STREET 12/5/2014TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands 0 Watershed District ❑ Water/Sewer RIPTION OF WORK TO BE PERFORMED: .. I _ \ h - _ rLocation ) 1sGl��%� No.:57,& " i ,� Date Z► �� .1 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $� . Foundation Permit Fee $ { Other Permit Fee $ TOTAL $ Check 4t ,� v Building Inspector 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature �--cOMMENTS HEALTH COMMENTS Reviewed on Sianature 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: Locatea -jo4 usgooa atreet FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date 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 ❑ Notified for pickup Call Email I Date Time Contact Name Doe.Building Permit Revised 2014 i 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/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ 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 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 Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 94,771.00 m $ - $ 540.00 Plumbing Fee $ 142.16 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 142.16 Total fees collected $ 924.31 193 Andover Street 526-15 on 12/5/214 Kitchen Remodel Clic 12/05/2014 9:05:03 AM FRED C CHURCH INC - 978-454-1865 PAGE 3 OF 3 A� o® CERTIFICATE OF LIABILITY INSURANCE 121012014MMIDDIYYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Fred C. Church, Inc. 41 Wellman Street Lowell. MA 01851 (800) 225-1865 CONTACTNAME Andrea Gallagher PHONE 9783227172 FAX 9784541865 (AIC, o xt • arc No E-MAIL a alfa he fredochurch.cem ADDRESS: 9 g ° INSURERS) AFFORDING COVERAGE NAIC S INSURER A : Peedess Indemnity Insurance Company 16333 INSURED Dan Gobeil Home Improvement LLC INSURER B: INSURER C : 16 Carlids Road INSURER D : Groveland, MA 01834 INSURER E : INSURER F: COVERAGES CERTIFICATE NLIMRFR• "" R9111RIF1N NIIMRGR• 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 NTH 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. IL7R TYPE OF INSURANCE AD INS SUERPOLICY POLICY NUMBER EFF MMIDDIYYYY POLICY EXP MM/DDIYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR =GE N 100,000 PREMISES Ea occurrence $ MED EXP (Any one person) $ 15,000 A CBP2034714 11/24/2014 1124!2015 PERSONAL & ADV INJURY $ 1 OOD,DDO GENERAL AGGREGATE $ 2.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,DDO POLICY 71 JECT [79 LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident BODILY INJURY (Perperson) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ UMBRELLA LIAR Ll OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED I I RETENTION $ $ WORKERS COMPENSATION WC STATIU OTH- AND EMPLOYERS' LIABILITY YIN T RY S R E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? NIA E.L. DISEASE -E4 EMPLOYEE $ (Mandatory in NH) If yes, describe under E.L. DISEASE -POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additlonal Remarks Schedule, If more space Is required) CERTIFICATE HOLDER CANCELLATION Town of North Andover 1600 Osgood .Street North Andover, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE North THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD = f - J 2 LL p H Z O tU N Z O W O N Z u LLJ _ F G h— _A0 -_.- AV cop Dan Gobeil Home Improvement LLC 16 Carlida Road Groveland, Ma 0183 508-451-0493 C.S. 063220 CONTRACT REG. 1321.82 nulneuwner miormatlon Contractor Information ' Name ' - Company Name Dw C- '9 I � 'aq�e tree�ttAdd ss (do n t use a Post Office Box address) -l�A,,4-4- 7 Contractor/ Salespers{onn/y/O//�tmer Na�,(mee'n „ II.R6 F�f%_ (// City/Town State Zip Code -16 Business Address (must include a street address) v Yti o iS 01-d 6l �� Daytime Phone Evening Phone CiWruwn State Zip Code 4- 401.0258 ef,*-49-.fflG Mailing Address (It different from above) Business Phon Qlf -¢S (- pq `Federal Employer ID or S.S. Number Law mquirrs flat mast home Home Improvement Contractor Rcg. Number Expiration date improvement contractors have n valid rcgistmtion numhcr• ,%fv i n contractor agrees to ao tue following work for the Homeowner: (Describe in detail the work to completed, specifying the type, brand, and grade of materials to be used, ruse additional sheets if necessary.) 010Z/ZZ/1 I - I'Z uolslaA tiI£-t£L-£it.IO 8t5Z-99L-805 `008t -Z59-805 n>?aang ssolnsng mjpg 2I0/QNd 00t8-LZL-L19 Iuzaua0 Xaulolly a14l,Io aatg0 uo?loas Iurelduto0 .laumsuo0 :IlLo `ssou?snq L Isu?L�?L slu?Lldwoo leuzol lals>2a.101.10salnds?pd0uomuuls?L aoq su•Isi133su5011/IuamanoA ufiaaloq/sn•Luf•3luls•gp//: q M011-04st80�1 s jolaB4uo0 luoufanozdwj aulog u do snluls 914l ma?A 01 au?[zo 00 pgieoo/Ao s- Lul•MMM//: 14 IL altsgam 01H aqI Its?A 10 L5L£-£8Z-888 L8L8-£L6-LT9 911 ZO VW `uolsog `OL 19 m002I ` 7uld I-lLd OI uollulrl2a-d ssau?sng puu s.1i V aaumsuo0do aotdd0 uo?lu.l;sLl�a-d .zolouzluo0 Iuaulanozdull aulog d0 .l010aJ1C1 :IaLluoa `AnuZ z0I-L14U00 Iu011J0A0ldufl auzoH aiql jo luouodwoo uo?Iuzls?&z a010W;U00 3141 Inoqu ,Cjjuotj?Dads uoi u-uoju? Ieuo?1?ppL p3au .io suo?Isanb oAtu no t j? zo .lolau.fluoo E jo uo?lLals?$a.1 aqI Xj?.laA of jiwM noF jT /.igLao/AoD-ssulu•mAnnn//::4q It al?sgom -dgVD0 31411?s?A Jo L5L£-£8Z-888 `L8L8-£L6-L19 �__-_ ---91T.7-0_F7IJ7_`u01g0g'0/ TC U1001.`EZVlJ)lJ12 0T_ The Commonwealth of 9assachuseffs - Department of IndustricclAccidinfs Office of Investigaflons 600 Washington Street Foston, MA 02111 kvi www.massgov/dia Workers' Compensationbisurance Affidavit: Builders/Contractors/El Pease Print Lber AppEcant Information �Name (Business/Organization/fndividual): � e� Address: ' I tn City/Statelzip: &M�,�� Phone #• Are you an employer? Check the appropriate box: 1. ❑I am a employer with 4. El I am a general, contractor and I - employees (full and/or part-time).* have hired the sub -contractors 2& I am a sole proprietor or partner listed on the attached sheet. ship and7aave no employees These sub -contractors have working forme in any capacity. workers' camp. insurance. 5. [] We are a corporation and its [No work -Drs' comp. insurance officers have exercised their required. 3.01 am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, §1(4), and we have no employees. LNo workers' insurance required.] ? comp. insurance required.] Type of project (required): 6. [] New construction 7. [1 Remodeling S. [] Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.[] Plumbing.repairs or additions 12.❑ R.00frepairs 13.0 Other 'Any applicant that checks box#1 Mus fill outthe section below showingtheir workers' compensationpolicytnformation. ('Homeowners who submitihis affidavit indicaiingthey are doing allwork and then hire outside contractors must submit a new affidavit indicating such. TContractors that eheckthis box must attached an additional sheet showing tha name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance formy employees: Below is the policy andkb site information. Insurance Company Policy # or Self ins. Lic. #: ExpirationDato; Sob Site Address, CitylState/Zip: Attach a copy of the workers' compensat4on�policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required. under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a $ue 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- o£ Investigations of the DIA for insurance coverage verification. Off Bial use only. vo not write in this area, to �e completed by city or town official City or Town: PermitlLicense # Issuing Authority (circle one): D 1. Board of Health 2. Buildingepartment 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone M Information and Instructions ' 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 ofhire, - express or implied, oral or. written." An employeiis defined as "an individual, partnership, association, corporation or other legal entity, or any two ormore of the foregoing engaged in a joint enterprise, and including the legalrepxesentatives 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, consti action 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 applicantwhohas not prodneed.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 chapterhave beenpresentedtathe 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-contractor(s) name(s), addresses) and phone numbers) along with their cextificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are notrequired to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of ludustdal Accidents for confirmation ofinsurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town thatthe application for thepermit or license is being requested, not the Department of Industrial Accidents. Should you have any questions xegarding 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 besue thattheaffidavitiscomplete andpxiatedlegibly. The Department has provided a space at the bottom of the affidavit for you to till 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 curxent policy information (ifnecessary) 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 maybe provided to the applicant as proof that a valid affidavit i3 on file for future permits ox licenses. Anew affidavit must be filled out each year. Where ahome owner or citizen is obtaining a license ox permit not related to any. business or commercial venture (i.e. a dog license or permit to turn 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 a'nd fax number: Tho CQwpaonwalth ofybwadhwet€4 Depaftent o£kdustdaX Acoldenta Qft-e offa-Vestxgat7iom 60 Wad gtw Street Boston,M-A 02111 TO, # 617-7-2'x_4900 est 40.6 ox 1-$77-MASSAFE Revised 5-26-05 Fax# 617-727-7749 ww4v.�a��,g0vlclia. Dan Gobeil Home Improvement LLC PAGE 1 16 Carlida Road Groveland, Ma 01834 (508141-51 -0493 C.S. 063220 CONTRACT REG. 132182 CUSTOMER: Mary Kilpatrick & Cara Marshall DATE: December, 2nd 2014 193 Andover Street North Andover, Ma 01845 PLAN: Remodel Kitchen and dining room THE JOB WILL INCLUDE THE FOLLOWING: PRICE • KITCHEN: • Demo entire Kitchen down to studs. • Reframe for laundry and entry to dining. • Remove and close in side window. • Level ceiling to the best ability. • PLUMBING: • Move steam heat to accommodate cabinetry. • Move sink location to center of existing window. • Supply water to new fridge location. • Move gas line to new stove location. • Plumb for new laundry area. • ELECTRICAL: • Bring switches and outlets to code. • Provide receptacles for dryer, washing machine, dishwasher, gas stove, counter, and refrigerator. • Customer supplied pendant light in kitchen. • Customer supplied light fixture next to back door. • Customer supplied light in the porch area. • Under counter lights in all areas that will accept them. • Recessed lights over sink, and for general areas in kitchen. • AFCI and GFCI protected circuits in all areas necessary. • 60 AMP SUB PANEL FOR ALL NEW CIRCUITS. • Insulate entire area. • Blue Board and plaster entire area. • Apply new door to bath entry and applicable trim throughout. • Paint. • Install cabinets and counter according to plan. Cabinets and counter top cost $24,750.00 • Install bi-fold doors to new laundry area. NEW ITEM: $725.00 • Complete Plumbing and electrical. • TOTAL COST $63,700.00 PAGE 2 • DINING AREA: • Reframe all 8 window openings and install new double hung Harvey Classic windows. Reframe closet area with new door, Frame for new entry door, and an opening for a French door. Raise ceiling to create clipped Cathedral ceiling. • ELECTRICAL: • • • • • Supply plugs and switches to code. Install customer supplied ceiling/fan light. Install Hydronic electric baseboard heat with thermostat to control it. One spotlight outside door and one customer supplied outside fixture near door. AFCI and GFCI protected circuits in all necessary areas. • PLUMBING: • Supply gas line for free standing as fire place. • Insulate entire area. • Blue board and plaster entire area. • Apply all applicable trim. • Paint. • Apply shelving in new closet. • Install Pantry cabinets between new self -standing gas stove and closet door. • Install Hardwood flooring to dining area. • Build step to accommodate new rear door location NEW ITEM 5325.00 • TOTAL COST: $29.246.00 • ELECTRICAL: $9,280.00 included • PLUMBING: $5,800.00 included • DISPOSAL FEES: $1,500.00 • PERMIT FEES: $750.00 included • Anything above and beyond said work will be done on a time and material basis a rate of $65.00 an hour • Clean and remove all related debris. TOTAL MATERIAL AND LABOR $94,771.00 ACCEPTED & AGREED TO BY: ; Mary Kilp trick Daniel Gobeil DATE: DATE:/'"/� Dan Gobeil Home Improvement LLC 16 Carlida Road Groveland, Ma 0183 508-451-0493 C.S. 063220 CONTRACT REG. 132182 Name G contractor Information Company Name i")" (( �(J//J/Street Conrractor/ Sal esperson/ Ubwner N me d Addr (do no use a Post Office Box address) 143 s� '410'ez o City/Town State Zip Code �6,� Business Address lx t includ s eet address) f6 Cs- Il Daytime Phone Evening Phone - -2 8 9��-Lis -ANG City/Town State Wje(D1S Zip Code � Mailing Address (It Crr fr t event om above) Business Phone jM3Federal Employer ID or S.S. Number Home Improvement Contractor Reg. Number Expiration date Law inquires that most home avalid amenrationnntors have n valid registration numhcr The Contractor agrees to do the following work for the Homeowner: ! rr99 (Describe in detail the work to completed, specifying the type, brand, and grade of materials to be used, use additional sheets if necessary.) 010VU/11 FZuois.raA bit£-b£L-£Ib IO 8t79Z-99L-809 `000-M-809 nua.Ing ssauisng aallag Xo/QNV 00-V8-LZL-L i 9 luzaua0 Xaur0j4V aul,Io aoluo uoiloas lululduzoO aawnswo :Iiuo `ssouisnq u Ismu2u slululduoo luuao3 aalslOaz of aosalndspjououpauiuuo ullm aouuslsse to se•Istiaasuaoll/Iuamano.I tuiaaloq/sn•L,w-aluls•gp//: q :u01Ru.11s120g s,.I0l0tia4u00 TuauianOJduti OwOH u Jo snluls OLD malA oI aulluo 00 /age5o/Ao -ssvurAv m//: q Iu altsgam DIH atll IlslA ao L9L£-£8Z-888 `L8L8-£L6-LI9 911ZO VW `uolsog 'OL 19 wOO-d tz'Bidlilud 0 uoi la -ad ssaulsng puu szlni�d xaumsuOD Jo aoujo uollurlsl2a� .rolonnuoO luauzanoidu� auIOH JO 1oloaaIG :IoPIuoo `muZ aolou4uoO luaulanozduq auloH oill jo luouodutoo uo>Inzlsl`daz zolou.Iluoo oqi Tnogu Aliuo3?Dads uollMucijul lum pippu poau ao suotlsonb oAuq noXji zo jolo-eiTuoo u jo 110IIuJIST2oi auI X3lzaA of Iuum no,C JI /.Iquoo/Aoa•ssuut•mmm//: IIq Iu ollsgam-dgyDO auI IlslA JO L9L£-£8Z-888 `L8L8-£L6-L19 911ZO VDI `uolsog 'OL 19 mOo2I ` zuld *2d 0i yl ysachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supervisor DAN GCP.,Rr,1 COIWU License: CS -063220 DANIEL GOBEIL DAPIIEL L GOBEflL 16 CARLIDA RD E~ GROVELAND, MA 01834 16 CARLEDA RD, r s Groveland MA Of834 Expiration Convnissioner 01/31/2016 Type: DBA DAN GCP.,Rr,1 COIWU DANIEL GOBEIL 16 CARLIDA RD GROVELAND, MA 01834 Undersecretary Dan Gobeil Home Improvement LLC 16 Carlida Road Groveland, Ma 0183 508-451-0493 C.S. 063220 CONTRACT REG. 132182 Anmrnwrr ar• Tv.fr,..,.,..+:.... •.Ontractor lniormatlon •� �a .. a agrees w uu me following worm for the Homeowner: (Describe in detail the work to completed, specifying the type, brand, and grade of materials to be used, use additional sheets ifnecessary.) 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 wilt begin contracted work. MGL chapter 142A.) Date when contracted work will be substantially completed. Total Contract Price and Payment Schedule The Contractor agrees to perform the work furnish the material and labor specified above for the total sum o 771 d� Payments will be made according to the following schedule: upon signing contract (not to exceed 1/3 Of the notal contract price or the cost of special order items, whichever is greater) or upon completion of by _ /_ or upon completion of /.4�c�`�UJj 6,j n k,` $OA9_1_2� 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 a0 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 exnresswarranty being nrov'ded by the contmetoro No El Yes (ll terms ofthe warranty must be attacbed to the contractl Subcontractors The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agreement Contract Acceptance - Upon signing, this document becomes a binding contract under law. Unless otherwise noted within this document, the contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this contract. • Don't be pressured into signing the contract Take time to read and fully understand it. Ask questions if something is unclear. • Make sure the contractor has a valid Home Improvement Contractor Registration. The law requires most home improvement 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 responsibibties. 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 normal place of business, provided you notify the contractor in writing at his/ber main office or branch office by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this agreement. Seethe attached notice of cancellation form for an explanation of this right TTlT Wn'P QT11XT 1 n �. - - - _� • •, �.n. , u lulu Even, AIN Y tsLA1NK SPACES!!! Two identical copies of the contract must be completed and slimed. One copy should go to the homeowner. The other copy should be ke rbc contracror. Homeowner's r ature Contractor's Sig nature Daze Date TT— Company Name Ad r ( 061W Street r (d n use a Post Office Box addressOwner Co ctor/Salesperson/ wnerN me r a3 � City/town State Zip Code - Busmess Address (m st include a sear address) (6 I� (/[!�/I Daytime Phone Evening Phone Citynown State Zip Code 1 - - 2 ss-�h6 O /9 Mailing Address (It different from above) Business Plrone f % Federal Employer ID or S.S. Number Uw p.1u1 iIlett most home 1lm Home Improvement Contactor Reg.Number Elphli°n date Th. i`,. improv:menseomr ,.e avalid registraHen number ///,,, /�, ¢ o /� J/! 14 VV •� �a .. a agrees w uu me following worm for the Homeowner: (Describe in detail the work to completed, specifying the type, brand, and grade of materials to be used, use additional sheets ifnecessary.) 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 wilt begin contracted work. MGL chapter 142A.) Date when contracted work will be substantially completed. Total Contract Price and Payment Schedule The Contractor agrees to perform the work furnish the material and labor specified above for the total sum o 771 d� Payments will be made according to the following schedule: upon signing contract (not to exceed 1/3 Of the notal contract price or the cost of special order items, whichever is greater) or upon completion of by _ /_ or upon completion of /.4�c�`�UJj 6,j n k,` $OA9_1_2� 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 a0 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 exnresswarranty being nrov'ded by the contmetoro No El Yes (ll terms ofthe warranty must be attacbed to the contractl Subcontractors The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agreement Contract Acceptance - Upon signing, this document becomes a binding contract under law. Unless otherwise noted within this document, the contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this contract. • Don't be pressured into signing the contract Take time to read and fully understand it. Ask questions if something is unclear. • Make sure the contractor has a valid Home Improvement Contractor Registration. The law requires most home improvement 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 responsibibties. 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 normal place of business, provided you notify the contractor in writing at his/ber main office or branch office by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this agreement. Seethe attached notice of cancellation form for an explanation of this right TTlT Wn'P QT11XT 1 n �. - - - _� • •, �.n. , u lulu Even, AIN Y tsLA1NK SPACES!!! Two identical copies of the contract must be completed and slimed. One copy should go to the homeowner. The other copy should be ke rbc contracror. Homeowner's r ature Contractor's Sig nature Daze Date TT— 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 be financially insecure, the contractor may require that the balance of funds not yet due be placed in ajoint 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 hM://www.mass.gov/ocabr/ 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 61.7-973-8787, 888-283-3757 or visit the HIC website at hLtP-://www.inass.gov/ocabr/ Go online to view the status of a Home Improvement Contractor's Registration: htp://db.state.ma.us/homeimprovement/licenseelist.asp 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 Version 2.1 -11122/2010 I j 2 p � . mLU t Y LCL ai > v U Ln O vai Z z > m G O m m O L cr T O C U LL O Z Z z > J C L cr LL 0 0. z Q cc W J W L OC N U (n LL O LU Z L w LL z LU w W LL Q y m O z ++ N N Gl N ''wwn VI C� OR O V O _ y+ Q t to Q V S E O r Q. 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