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Building Permit #203 - 22 RIDGE WAY 9/9/2011
TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION 22 06z6 to J-0 -se/0 –�� Print PROPERTY OWNER .1(7Se/0 L.Lo&-_7vS Unit# Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes 100 year-old structure yes bio TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑addition El Two or more family ❑ Industrial V Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others- ❑ Demolition ❑ Other ;Septic Welk O,Floodpl'an pf Wetl`arids� #WatershedfDistnct . { W,Zjr/SewerF DESCRIPTION OF WORK TO BE PERFORMED: �+ t I NISN &tzonT usiAY, 4*us CoeAw, A&15'it/T S YS q5.3 3 t/-f 2 k 2E14..C- t=«ylSxl /-�T 7 3 /e�r�s TIS & USS ff S 1� %mint c.y/��r Gyae�Coyr /1z 41 —6111V (Identification Please Type or Print Clearly) OWNER: Name: , St`s 6 tcw6ij Phone: '? Val alb Address: `z2 fely (/ -UP.�il�i✓� — �i�il W/� Phone: CONTRACTOR Name: ���s 7P 2-710q? Address: 6d -grow T 4)09 Mr; &2d 7/' Supervisor's Construction License: 71M Exp. Date: le)S' Home Improvement License: 37442 Exp. Date: 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: $ (���(lS FEE: $ Check No.: Receipt No.: NOTE: Persons contr cting ith nregistered contractors do not have acces to th rrfu 5ignatureYof _ _owner. Signat4re_.of,1contract r Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ i Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature 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 t r' DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date 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 - Date Doc:.Building Permit Revised 2011 June/mi 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 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: Doc.Building Permit Revised 2008mi Location " No. i' I2 Date NORTIy TOWN OF NORTH ANDOVER O� f � A 4 i Certificate of Occupancy $ ,ssACNUStt� Building/Frame Permit Fee $ t Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 24565 Building Inspector NoRr1y c TONM Of ? :. Aindover ., No. X03 - ,9oIA. o , dover, Mass.,_gq AK1 COC MI CHEWICK RATED BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.........................d '.. ............... .. ..! ..Il ,.. ............................................................... Foundation has permission to erect........................................ buildings on ....2A........ .. ..... �0......T.................. Rough to be occupied as.. ...... � Chimney o. .►.�.'.'.'.�...... . w . ......... ................+.................... ................... provided that the person accepting this permit shall m 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 68 2 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO S Rough ......................... .............. ..................................Z614N SService BUILDCTOR 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. 4e 61���� J'I = Office of Consumer Affair and Business egulation 10 Park Plaza - Suite 5170 �~ Boston Massachusetts 02116 Home Improver&nth ontractor Registration Registration: 137943 _ Type: Supplement Card Expiration: 1/29/2013 OWENS CORNING BASEMENT DANIEL WALSH !° -- -• U 60 SHAWMUT RD CANTON, MA 02021 Update Address and return card.Mark reason for change. DPS-CA1 0 60M•04/04-G101216 Address n Renewal n Employment Lost Card �'k -t°ianaa z./l! o�/�aaaacLura lta Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registration! 137943 Type: 10 Park Plaza-Suite 5170 Expirations:.;1129/2013 Supplement Card Boston,MA 02116 OWENS CORN INGBASEMENT.FINISHING SYS DANIEL WALSH'.E' 60 SHAWMUT RD- CANTON, D CANTON,MA 02021 Undersecretary Not valid without signature Massachusetts- Department of Public Safetc Board of Building Regulations and Standards Construction Supervisor License License: CS 791393 Restricted to: 00 DANIEL F WALSH 488 KENDALL RD TEWKSBURY, MA 01876 C Expiration: 10/5/2011 Commissioner Tr#: 7109 ACORO0DATE(MWDW YYY) li.�. CERTIFICATE OF LIABILITY INSURANCE 5/24/2011 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 CONTACT NAME: Andrew G. Gordon, Inc. PHONE I FAX 6BO Main Street _(ac N-9.5ctl._7B-1=.65.9=22fi2___—._.._.-..___.._.___.L_Cac,No)*_3.8.1.-.659__432.5.__.._.. E-MAIL P. O. Box 299 ADDRESS: info-gagordon.com Norwell MA 02061 PRODUCER CUSTOMER ID tl;4 4 4 0 INSURER(S)AFFORDING COVERAGE 1 NAIC p INSURED INSURER A:Peerless Insurance 124198 Bay State Basement Systems, LLC INSURER e:Pil rim Insurance Com an 60 Shawmut Road g-- — —y----- Canton MA 02021 INSURER C:Renaissance Marketing __ INSURER D_ — ------------- ------------+. INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:1325752831 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 I TYPE OF INSURANCE BR POUCY EFF POLICY EXP LIMITS LTR, IN POLICY NUMBER I MMI MMIDD A GENERAL LIABILITY j � ICBP8512851 9/5/2010 9/5/2011 EACH OCCURRENCE $1,000,000 X DAMAGE TOR NTED COMMERCIAL GENERAL LIABILITY I PREMISES Ea occurTencel $50,000 CLAIMS-MADE IX_I OCCUR MED EXP(Any one person) $10,000 r i PERSONAL B ADV INJURY 57.000,000 GENERAL AGGREGATE IS2.000,000 GENt AGGREGATE LIMIT APPLIES PER: I PRODUCTS-COMPIOP AGG 52,000,000 X POLICYEl JFGT F-1 PRO- LOC B AUTOMOBILE LIABILITY N N �PGC10007.161409 1/17/2011 1/17/2012 COMBINED SINGLE LIMIT I$1,000,000 I (Ea accident) j ANY AUTO I BODILY INJURY(Per person) is ALL OWNED AUTOS I BODILY INJURY(Per accident)!s X SCHEDULED AUTOS I I PROPERTY DAMAGE s X HIRED AUTOS (Per aodtlent) --- X NON-OWNED AUTOS I I s A UMBRELLA HOCCUR ICUB511953 19/5/2010 j9/5/2011 I FACHOCCURRENCE $1,000,000 EXCESS LIAB CLAIMS-MAGE i I AGGREGATE _ 5 DEDUCTIBLE I 1x00000 s X 'RETENTION $10,000 S C I WORKERS COMPENSATION i IWC 0371527 5/24/2011 5/24/2012 WCSTATU- �,OTH- AND EMPLOYERS'LIABILITY YIN I i $Y LIMITS I FJi ANY PROPRIETORIPARTNERIEXECUTIVE I I I E.L.EACH ACCIDENT $1,000,000 !OFFICERIMEMBER EXCLUDED? Y N I A 1 (Mandatory In NH) i !E.L.DISEASE-EA EMPLOYE $1,000,000 Ifyes,desc ibe under DESCRIPTION OF OPERATIONS below i E.L.DISEASE-POLICY LIMIT S1,000,000 i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,ff more apace Is required) sales of Owens Corning finished basement systems 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. Production Manager 60 Shawmut Road Canton MA 02021 AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD CONTRACT Customer Name /o« L /v.s /o,ter« Customer Signature SKETCH Contract Date 9Sales Representative Signature ATTACHMENT Customer Phone S 74F - 2-F 9 - .7 F/3 Contract Price 1 2 3 4 6 0 7 8 9 10 11 12 13 14 16 16 17 70 19 20 21 22 23 24 23 20 27 28 29 30 31 32 33 34 36 38 37 38 30 40 41 42 43 44 46 40 47 48 49 60 6/ 62 63 64 66 00 87 68 89 W 1 2 I >w 1 . 7 •JI` wLL 1* i o I__ E2 17 is --, eK - __ II _ 'Fh 20 2, _ _..I-.. • I fi 24 26 w - - - - i , 30 31 32 1 ; 33 I i 33 NOTES' 'Each box equals one toot unless otherwise noted.This sketch is a good faith represenlation of the work to be done,It is understood that all dimensions derived from this sketch are approximate,and that all locations of outlets,light fixtures,plugs,jacks and/or switches are subject to change If necessary, CONTRACT TO INSTALL OWENS CORNING BASEMENT WALL FINISHING SYSTEM Owens Corning Basement Finishing Division (the contractor) hereby submits this proposal to sell and install the Owens Corning Basement Wall Finishing System and related items as described herein at the residential premises set forth below.This proposal shall not become a binding commitment unless and until it has been signed by the Contractor and the Customer. Contractor: GPN CK s Owens Corning Basement Finishing Systems a division of Bay State Basement Systems, LLC. SN v!�/ Gr✓h �� f17 i-"Vl 60 Shawmut Road, Canton, MA 02021 Telephone#(781) 821-0060 Ca 4,/-t l- �T 7 G ® Facsimile#(781)821-8552 Federal Tax ID# 14-1855297 Mass. Home Improvement Contractor Reg.# 137943 Date S A/ / l Customer: Customer Name j 0 S C.4 1 ✓i S O.L ;r k S r Street Address I City, State, Zip Telephone( �f" 7e Z L/ 3 l ly► Z y 7le ' 37�d i This is a contract between the Contractor and the above named Customer to sell and install the Owens Corning Basement Wall Finishing ! System and related items specified herein at the Customer's residential premises identified below: i Installation Premises: Street Address �NG City, State,Zip Scope of Work: Are Sketches and/or specification sheets attached? ^es* ❑ No 'All attachments are incorporated into and become a part of this contract Description of Work/Specifications;iE-h 5/ti�� e�ewr &/ a/ l r, kzze ups, G/�!/ Sv�v�s, v �1 /��� r; 64Xe A"d5 16 ;�k�/.3 Work Schedule**:7 l��t i L���C G L/�Srir i ti/!C.t-L 6elK rfoeo ' 514,-Ai e— - Approximate Commencement Date: Approximate Completion Date: **The proposed work schedule is approximate and subject to change Contract Price: Total Contract Price: $ S Deposit with order: $ // ❑ Cash ZCheck# Balance Due: $ l� 1 Terms: 1,71t ash ❑ Finance (Cash terms are 106/6 deposit, 50%on commencement,40%on completion) $ L,/ Due on Commencement Due on Completion DO NOT SIGN THIS CONTRACT UNTIL ALL APPLICABLE BLANKS ARE COMPLETELY FILLED IN AND UNTIL YOU FIRST READ AND UNDERSTAND THE ENTIRE CONTRACT, INCLUDING ANY ADDENDUM ATTACHED HERETO,AS WELL AS ANY ATTACHED SKETCHES, MATERIAL LISTS OR THE LIKE,AND THE TERMS AND CONDITIONS ON THE BACK OF THIS CONTRACT DOCUMENT. YOU ARE ENTITLED TO A COMPLETE, FULLY EXECUTED COPY OF THIS CONTRACT AT THE TIME OF EXECUTION. Witness our hand(s)and seal(s) below on this �/ day of n}<IG0 J�2 _xx Bay State Ba ment Systems, LLC. thorized F 4ppresentative: Signalure and Title ` & (. I Eli(I" / /V Print Name DO NOT SIGN T )S-CONTRACT IF THERE ARE ANY BLANK SPACES Custom Customer Signature L Print Name Customer Signature Print Name Contractor may have certain lien rights in the premises until the price is paid in full. You have the right to cancel this contract,without any penalty or obligation, at any time prior to midnight of the third business day after the date you signed this contract. See the notice of cancellation below for an explanation of this right. *"'Customer acknowledges receipt of a true copy of this contract which was completely filled in prior to customer's execution hereof. NOTICE OF CANCELLATION Date You may cancel this transaction,without any penalty or obligation,within three(3) business days from the above date. If you cancel,you will not be liable for any finance or other charges, and any security interest given by you, including any such interest arising by operation of law, becomes void upon such cancellation. In addition, any property traded in,any payments made by you under the contract of sale, and any negotiable instrument executed by you will be returned within twenty(20) business days following receipt by the Contractor of your cancellation notice. If you cancel, you must make available to the Contractor at your residence, in substantially as good condition as when you received, any goods delivered to you under this contract or sale or you may, if you wish,comply with the instructions of the Contractor regarding the return shipment of the goods at the Contractor's expense and risk. If you do make the goods available to the Contractor and the Contractor does not pick them up within twenty(20)days of the date of your notice of cancellation,you may retain or dispose of the goods without any further obligation. To cancel this transaction, mail or deliver a signed and dated copy of this cancellation notice or any other written notice to: Owens Corning Basement Finishing Division 60 Shawmut Road, Canton, MA 02021 Phone: 781-821-0060 Fax:781-821-8552 1 hereby cancel this transaction. Date Customer's Signature I hereby acknowledge receipt of two copies of this Notice of Cancel lation-advising-me-o rip ht to cancel. 74 Date Cus mer's Sign at re Date Co-Customer's Signature TERMS and CONDITIONS GENERAL DESCRIPTION: By this contract, Customer agrees to purchase and Contractor agrees to sell and install the Owens Corning Base- ment Wall Finishing System and related items identified on the first page of this contract in the above identified premises,for the stated total contract price and according to the specifications and other provisions of the contract documents including(a)this contract form, (b)the Addendum, if and to the extent applicable, (c)any attached sketches, materials lists,floor plans,and/or specifications sheets. SCOPE OF WORK.Contractor shall be responsible to Customer to supply the Basement Wall Finishing System and related products and for the performance of the installation services, as required by the contract.All drywall,wood or other paintable surfaces shall be primed and ready for final touch up and paint. Painting,staining or decorating are not a part of this contract. PRICE.The Price owed by Customer is a lump-sum,turn key price,covering the Basement System and the labor necessary to install it.The Price assumes sound existing substructures,superstructures and points of attachments.The Price shall not include the cost and reasonable profit, as determined by contractor,of having to provide(i)additional products or installation services as a result of defective substructures, superstructures,or points of attachments, and(ii)any additional goods or installation services beyond those originally specified in the contract which are requested or approved by the Customer and reflected in a change order signed by the customer and the contractor. PAYMENT. Payment of the price by Customer is due in full upon the terms set forth in this contract, but in no event later than completion of the work. In the event that the Contractor declares the project completed but the customer still has some reasonable"punch-list"items, it is agreed that the Customer may be entitled to withhold 5%of the total contract price until such items are completed. ENTIRE AGREEMENT/CHANGES.This contract accurately states the entire agreement between Customer and Contractor concerning the Basement System and the work and replaces and supersedes all prior agreements and understandings relating thereto, both oral and written. Any additions or changes to this contract must be in writing signed by the Customer and the Contractor. WARRANTY.Customer is entitled to the product warranty provided by Owens Corning for the Basement Wall Finishing System as well as any other product warranty provided by a manufacturer of other goods or products comprising part of the Basement System installed under this contract. Contractor will provide Customer with any such manufacturer consumer warranty information. Contractor warrants that the work will be performed by Contractor in a good and workmanlike manner.Contractor's warranty for the work shall extend for a period of two(2)years from the date the work is completed or for such greater period as may be required by applicable law governing consumer warranties for workmanship. Customer must give Contractor written notice within the warranty period of any warranty claim relating to the work. Customer agrees that its sole and exclusive remedy against Contractor for a warranty claim is reinstallation in a good and workmanlike manner, including the repair or replacement of any goods or product if and to the extent reasonably necessary to correct the defective work.Customer shall have no other remedy against Contractor for a Warranty claim, including without limitation remedy for loss or damage caused by normal wear and tear, loss or damage which has not been reasonably mitigated, loss or damage caused by intentional or negligent acts, loss or damage caused by acts of God, incidental or consequential damages for lost profits, sales, injuries to persons or property, or any other incidental or consequential damages. CONTRACTOR'S WARRANTY FOR THE WORK SHALL BE IN LIEU OF ANY OTHER WARRANTY EXPRESSED OR IMPLIED, INCLUDING WITHOUT LIMITATION ANY IMPLIED WARRANTY OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. IN CON- NECTION WITH ANY WARRANTY CLAIM, CUSTOMER AGREES,AT NO COST TO THE CONTRACTOR,TO PREPARE THE PREMISES, INCLUDING THE REMOVAL AND REPLACEMENT OF FIXTURES INCIDENT TO THE REPAIR AREA SO THAT CONTRACTOR CAN CORRECT THE DEFECTIVE WORK WITHOUT UNDUE DELAY. LICENSES, PERMITS,SAFETY RULES, BUILDING CODES,ZONING ORDINANCES,AND OTHER LAWS.Contractor shall be responsible to Customer for assuring that any and all licenses and/or building permits are obtained. If Customer obtains permits on his own, Customer will be precluded from claiming against certain state guaranty funds relating to home improvements. Contractor shall also be responsible to Customer that the contract shall be performed in compliance with all applicable safety rules and all existing building codes,zoning ordinances and other laws. If a change occurs to any applicable safety rule, building code, zoning ordinance or other law which required additional goods, products or installation services to perform the contract,Customer agrees to pay the cost and reasonable profit for such additional items and to execute a resulting change order or new replacement Contract as requested by Contractor. CUSTOMER'S WARRANTY AGAINST VIOLATION OF EASEMENTS,COVENANTS,AND THIRD PARTY RIGHTS.Customer warrants that performance of this contract by Contractor will not violate any existing real property easements,covenants, or rights of third parties holding an interest in the real property being improved. UNDISCLOSED CONDITIONS IN PREMISES: Customer represents and warrants that any defect or weakness in the Premises'structure, substructure,superstructure or points of attachment that might affect performance by Contractor has been specifically and fully disclosed and described in this contract. If any undisclosed defect or weakness is later discovered after performance of this contract has commenced and such defect or weakness makes additional goods, products,or installation services necessary,Customer agrees to pay the cost and reasonable profit for such additional items and to execute a resulting change order or new replacement contract as requested by Contractor. ARBITRATION. If Customer has any questions or complaints regarding the contract, Customer may contact the Contractor whose name and telephone number appear at the top to this contract.All disputes and claims between Customer and Contractor concerning this contract which any party believes cannot be resolved informally, including without limitation any warranty claims, shall be resolved by binding arbitration conducted by a single arbitrator under the auspices, rules and procedures of the American Arbitration Association and in accordance with applicable federal and state arbitration statutes.The arbitration shall be held in the city or county where the premises are located or in such other location as the parties may mutually agree. No discovery shall be allowed except as may be agreed to in writing by the parties. Either party may demand arbitration,and the arbitrators final award shall be issued within ninety(90)days after the service of the arbitration demand on the other party. It is agreed that all arbitration costs shall be borne by the party that does not prevail. REMEDY FOR BREACH. If Customer breaches this contract, Contractor shall be entitled to recover the greater of liquidated damages in the amount of 20%of the total contract price or such actual damages as the contractor may prove.Also, if Customer fails to pay the Price in accordance with this contract,Contractor shall be entitled to recover its legal costs, including reasonable attorney's fees, in connection with arbitrating, obtaining judgment on an arbitration award, or otherwise pursuing Customer for collection. In the event that the Contractor cancels this contract, a written notice will be sent within 30 days of contract date and all deposits or monies on account will be promptly refunded to the Customer. UNAVOIDABLE DELAY OR FAILURE IN PERFORMANCE EXCUSED.Any delay or failure by Contractor in performing this contract because of strike,fire,floods, acts of God, inability to obtain goods, or any other causes beyond the reasonable control of the Contractor shall be excused and shall not be breaches of this contract. MISCELLANEOUS.Th r I a contract shall be interpreted under and governed by the law of the state where the premises are located,without reference to its choice of law provisions. If any provision of this contract is contrary to any law to which it is subject, such lawful provision shall be ineffective without invalidating the other provisions which shall remain in full force and effect. All home improvement contractors shall be registered,and any inquiries about a contractor or subcontractor relating to a registration should be directed to: Director, Home Improvement Contractor Registration One Ashburton Place, Room 1301 Boston, MA 02108 Tel. (617)727-8598 MOLD RESISTANCE.Customer acknowledges that although the Owens Corning Basement Finishing Components are designed to resist the development of mold,they are not capable of preventing mold if the conditions for mold growth otherwise exist in the basement. Customer further understands that virtually all basements require dehumidification in order to maintain an appropriate humidity level,and that a failure to dehumidify could result in mold or mildew development in the completed area and upon the contents. By initialing here customer acknowledges that they have reviewed and understand the terms and conditions of this contract: Customer Customer The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MM 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leg>bly Name(Business/Organization/Individual): aAddress: City/State/Zip:_ it ,OA) Mi4 Q Phone#: `7SI P2/ d6(lo6 [2. re u an employer?Check the ppropriate box: � ('� Type of project(required): I am a employer with 4. ❑ I am a general contractor and Iemployees(full and/or part-time).* have hired the sub-contractors 6 ❑Ne onstruction❑ I am a sole proprietor or partner- listed on the attached sheet.# ? Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. [No workers' comp.insurance 5. El We are a corporation and its 9• E]Building addition required.] officers have exercised their 10.❑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.E]Roof repairs insurance required.]t employees. [No workers' comp.insurance required.] 13.0 Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. i Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and 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: K�Qf}7z4Aa Policy#or Self-ins.Lic.#: i�)t; Expiration Date: 521f Job Site Address: 22 • �/i 'lJ City/State/Zip: 0, &� fl/� /'//9` d Attach a copy of the workers'compensation 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 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 t DIA for insurance coverage verification. 71:dohere;by ertify d sins and penalties of perjury that the information provided above is true and correct. atur Date: Phone#: `7kl Rj 2 1 .60� Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: