HomeMy WebLinkAboutBuilding Permit #264-11 - 238 MIDDLESEX STREET 10/28/2010 BUILDING-PERMIT of OORrk
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
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Permit N0:® (6 �- Date Received
b �9SoACHU ea��y
Date Issued: u 24-
IMPORTANT:Applicant must complete all items on this page
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TYPE OF IMPROVEMENT PROPOSED USE
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Residential Non- Residential
New Building a f �
Addition Two or more.family famil Industrial
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Alteration No. of units: Commercial
Repair, replacement Assessory Bldg Others:
Demolition Other
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DESCRIPTION OF WORK TO BE PREFORMED. ^
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OWNER: Name: ol/ 1-2 f� '!'S®/Y Phone
Address:
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ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULD/NG POMIT.$12.00 P!ERCf1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost. $ Vo FEE:
: $ �
� y 3 5
Check No. � �� � � �, Receipt No.
_ mac _
NOTE: Persons contracting withiuni egzstgi ed`conte a to s�rl0, of have access to a guaranty and
S a t entYOuvner�i _ �� 5� 4 a r
g natue
reofoator
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Building Department
The following is•a fist of the required forms to be filled out for the appropriate permit to be obtained. i
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
o 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 i
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.
I
❑ Photo of H.I.C. And C.S.L. Licenses
❑ Workers Comp Affidavit j
❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (if Applicable)
❑ Copy of Contract
I
❑ 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 Regis of Deeds. One co and roof of recording
Registry PY
P a
must be submitted with the building application
Doc:Building Permit Revised 2008
Plans Submitted Plans Waived Certified Plot Plan Stamped Plans t
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
I
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED'
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION Reviewed on Signature
I�VIVI1VIEZ
IENTS
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
I
Conservation Decision: Comments
Water& Sewer Connection/Signature&Date Driveway Permit
Engineer:
DPW Town '
� b Signature: -
Located 384 Osgood Street
Ei1"llfJ . �+' S. l:l l fefl.
may
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'.F: '.n'l•`i�u.E',tits...
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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
i
I
NOTES and DATA— (For department use)
❑ Notified for pickup - Date
Doc.Building Permit Revised 2010
I
Location= 7z MfeA��o7 s
No. — Date yl
NORTH TOWN OF NORTH ANDOVER
O?O•,•`•e '•,hOOA
Certificate of Occupancy $
HU,E<� Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # /
r
234 C"
Building Inspector
r
NORTH
01" 0 6 over
No.
aG a�o iI .0 _ _ _ __
LAK` dover, Mass., 'C Iy
I� COCHICHEWICK y�.
7� ADRATED
S U BOARD OF HEALTH
Food/Kitchen
.PERMIT T D Septic System
BUILDING INSPECTOR
THISCERTIFIES THAT....... („(A.......�.4?��.1.S.�.�............................................................................................... Foundation
has permission to erect........................................ buildings on ...a� ....�(( U441:::,�
..... L...,....... Rough
tobe occupied as...... ...... ........... ........41 . ...........c.... ................................................................................. Chimney
provided that the person accepting this permit shall in a 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
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRU UN TARTS Rough
................................... .............:......................... Service
BUILDING INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
I
Display in a Conspicuous Place on the-Premises — Do Not Remove RoughFinal
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.
12/2/2009 2 : 58 : 01 PM 8935 2 03/406
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ISSUE DATE 12/02/2009
>t,C{$ k1tlSkarAu3,} YS `,f"»t''rw^k '�A w �4M,,E� J
fi�,yt:,�",e�i��i yAY��r4r'tJ•W���,ti�+� ?.�s,•Nti'`'''s..�.?,a4,, „�,a�w,,..'�,'ir �"S`�°; ,t'`� e.,v)�,ir,�,'s gw” Ii 11i +i�� i�r•tilt.,.5�
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
Urso&Jankowski Insurance CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE
Agency Inc DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
POLICIES BELOW.
198 Mass Ave Suite 101 B
Orth Andover,MA 01845 COMPANIES AFFORDING COVERAGE
INSURED
Arthur Walsh
dba A J Walsh&Sons COMPANY A AI.M.Mutual Insurance Co
5 Pleasant Street LETTER
North Andover,MA 01845
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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.
CO TYPE OF INSURANCEPOLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LIR DATE(M M/DDrM DATE(MMIDD/YY)
GENERAL LIABILITY GENERAL AGGREGATE
PRODUCTS-COMP/OP AGG.
COMMERCIAL GENERAL LIABILITY
PERSONAL&ADV.INJURY
O CLAIMS MADE OCCUR
EACH OCCURRENCE
OWNER'S&CONTRACTOR'S PROT. FIRE DAMAGE(Anyone tire)
MED.EXPENSE(Anyone person)
AUTOMOBILE LIABILITY COMBINED SINGLE
LIMB
ANY AUTO
BODILY INJURY
' ALL OWNED AUTOS
(Per person)
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS BODILY INJURY
GARAGE LIABILITY (Per accident)
PROPERTY DAMAGE
EXCESS LIABILITY EACH OCCURRENCE
UMIIRELLA FORM AGGREGATE
OTHER THAN IIMRRF,IJ.A FARM '"''�•).s'�r'n�� ,''k j fa .fit. '�^ / +.', .'
"r�`•. }.• ,..✓�•'i+.iR' Vic, :�-.''�`t"<�".-''f?+>'R>ii�y?,,"5��. .±,il..r��'xt�"�(ti;,l,�'sr,r�,�i?�' ,jt,�5`•
WORKERS COMPENSATION AND STAT LIMITS STATE OTHER
EMPLOYERS LIABILITY x MA
THE PROPRIETOR/
A PARNERSI XECUTIVE EL EACH ACCIDENT 100,000
FFICIERS ARE: 7014648012009 11/14/2009 11/14/2010
INCL ®EXCL EL DISEASE--POLICY LIMIT 500,000
EL DISEASE--EACH 100,000
EMPLOYEE
COMMENTS/DESCRIPTION OF OPERATIONS OR LOCATIONS:
RTHUR WALSH IS NOT COVERED BY THE WORKERS'COMPENSATION POLICY.
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SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELT BEFORE THE EXPIRATION DATE
OWN OF NORTH ANDOVER THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 15 WRITTEN NOTICE TO THE CERTIFICATE
OLDER NAMED TO THE LEFT,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION
R LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES.
600 OSGOOD STREET
NORTH ANDOVER,MA 01845
AUTHORIZED REPRESENTATIVE
9480
i
The Commonwealth of Massachusetts
Department of Industrial Accidents
Pt 'n Office of Investigations
600 Washington Street
a 111.1 Boston MA 02111
www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information ( Please Print'Legibly
Name (Business/Organization/Individual):
Address: -e,/4S 0"Y S
City/State/Zip: iYd /��,0 a0eXL c>7/9-Phone#: �17�--6e-r-16737
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I atn a general contractor and I 6. ❑Newconstruction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ 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. 9. ❑ Building addition
[No workers'comp. insurance 5. ❑ We are a corporation and its
required.] officers have exercised their 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions
myself. [No workers'comp. c. 152, §1(4),and we have no 12. oof repairs
insurance required.]f employees. [No workers'
13.❑ Other
comp. insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
#Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policyy and job site
information.
Insurance Company Name: _ #l /7,V/ ma
Policy#or Self-ins. Lic.#: 7a l��,�d /2-,®,0 Id Expiration Date: /' e v
Job Site Address:
3� / �/,nUL�SS�X S'i City/State/Zip:
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 inay be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify�ains and pen !ties o per'ury that the information provided above is true and correct.
Signature: Date:
Phone#: 7� --6137
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#:
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 of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s) of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the pen-nit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple pen-nit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future pen-nits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or pennit not related to any business or commercial venture
(i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
dress tele
The Department's ad hone and fax number:p
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
Fax 9 617-727-7749
Revised 5-26-05
www.mass.govldia
.: ✓xI ea'A,z1;Vt16w>*a1111 O/AlaWadmielz
Office of Consumer Affairs&Business Regulation
XX—q, IMPROVEMENT CONTRACTOR
, .-i,Registration: . 103358 Type:
s. =—A
Expiration: 7/7/2012 Private Corporatior
A.S..-WALSH&SONS,INC
Arthur Walsh,Jr.
55 Pleasant St
N Andover, MA 01845
Undersecretary
License or registration valid for individul use only
before the expiration date. If found return to:
Office of Consumer Affairs and Business Regulation
10 Park Plaza-Suite 5170
Boston,MA 02116
Not vali without sigp lure
Massachusetts- Department of Public Safco
Board of Build'iw, Re,-,ulations and Standards
Construction Supervisor License
License: CS 22680
ARTHUR J WALSH JR
159A WAVERLY RD
N ANDOVER, MA 01845
Expiration: 6/9/2012 p
( unmi. i nrr Tr#: 29327
Page# of pages
CS # 022680 978-688-6737
.HIC# 103358 A. J. Walsh & Sons or
55 Pleasant Street 1-866-AJWALSH
North Andover, MA 01845
Proposal Submitted To: `' Job Name����/I►�ti� Job#
Address � / _ '.�.. Job Location���/'►`�
Date Date of Plans
Phone# /kJ Fax# ° Architect
Wehereby submit specifications and estimates for:__.._.__..._......................................._....._.._..__.._.._._._..._._...._................_..._......._----..._.-...._.._____....._...._..__..__.._.___.__.__...__._-..._............-___-.. _.._..._._........._.._.._.....
---- -= a � _-............--- __..__��� ............... __ � .--- =_-- __..__ .._ _-- _ _
_ _.........._-------_._ __ _._-. .__._-..:_. __ . _ .:_.. _; __LL !� _ _ r
.................---................- .._..__ .._ --- -' - --- - - __.....
__..........................................__.......... ...__........
_.... ................
...... ----.........-......-_......._._........._
__ _ -.._._..---... .---.._ -,- ............ _ -------- _------- _ _ __ __ _ _-----....._...._.._.....
-_._.
................_.................._._-.._......._._................._................_ _.........-----_-..........._......._...__ _....._........._._.....................__................................____ .____-__-------______ _____-_----__..........
.............. .... ................._.......__...---...-....................._..._.._...............---._-....................................._._......--- -_ ___ - -..................._...._..................._.........._-__-_. -_...._...................----.-----...-........_........._-..-.._--.------................................-...--...---....._..............._......
_ _ _ ____f -_..... � _ _ _ _ '" _ _-........____ _._............. _ _____._.-_ ___ _ __-.............
. ' __ _ _ _.___ --- _ r......--.... __......._-......._.......................__....-_..._....---.--
We propose hereby to furnish material and labor—complete in accordance with the above specification-s or the sum of:
$ °�0� v+71�� Dollars
with payments to be made as follows:
Any alteration or deviation from above specifications involving extra costs will be Respectfully
executed only"upon written order, and will become an extra charge over and submitted •/A
above the estimate.All agreements contingent upon strikes,accidents,or delays l
beyond our cohtrol. Note—this proposal may be withdrawn by us'rf not accepted within days.
.j
�cce�tance of ��o�v�r
The above prices,,specifications an conditions a satisfactory and are Ignature
hereby accepted-Yo�u re 't htorized to do the work as specified.
Payments will bade o. t'IAed abo4e.
Date of Acceptance _ _ Signature
MASSACHUSETTS HOME IMPROVEMENT CONTRACT
This form satisfies.all.basic requirements of the state's Home Improvement Contractor Law(MGI,chapter 142A),but does not include standard
language to protect homeowners: Seek legal advice If necessary. Any Person'planning home rproveme.nts should'�frrsf obtain a copy of"a
Massachusetta:consumer guide to homcimpmvement"before agtemng.to any work on your-residence:You tray obtaina free copy by'calling the '
Office of Consumer Affairs,and Business•Regulatiores Consumer Information Hotline at617-973.8787-or 1.f888-2834M
Homeowner Information 'Contractor Information
amen patty Name
AAp
Street Address(do not uses Post Office Boa address); tractor/Salesperson/OwnerName .-
atyfrowa state Zip Code. ass Address(mast include a street atklresg) .
D e P one \ '
Evening Phone- frown state Zip Code
Mailing Address(h different from above)' 5usiness Phone 116deral Employer M or S.S.Number
povemIovmcm contr
tWtmoll]nmeim• Acme Cmtrutm sea N®bc axphstim oak '
mgtmatloe e�mM d.
The Contractor agrees to do the following work for the Homeo ter:tDOWNUEMI the work W comploCA4 BPCQ[Yulg U a
'
=Icnals to De useaLlm
Required'Tetntits-The following building permits are required Proposed Start and'Completlon Seheduie•The fdllowitig schetialewill
and will be secumd:by the contractor as the'homeownet's agent; be adhered to"unless circumstances beyond the contractor's'control arise
(Owners who secure their own permits will be
exeloded-from the:Guaranty Fund'provisions of Date when contractor will begin contracted work.
MGL chapter 142A.)
Date when contract6d .work will:be substantiaily.completed..
Total Contract Price and Payment Schedule ,
The Contractor.agmes to perform the work,fiunish the material and labor specified above for the total sum of (�)
Payments will 120 according to the following schedule:
6y .up aligning contract.(notto exceed 113 of the mtal:'contract price 2r the cos
t;of special order items,whichever is.greater)
or upon completion of
$ or upon completion of -
1. upon completion of the contract (Law forbids demanding full)Payment until.contract is completed to both party's satisfaction_)
The following matenal/equipment must be specialS e paid for .
ordered before the contracted work
'meet the. . �a aria 5�—�—.to be}mid for
to
completion schedule.( )
NOTES:(")Inciuding all finance charges law requires that any deposit or down-Payment required by the contractor before work begins may
not=coed the greater of(a)one-third of the total contract price or(b)the actual ruscost of any special equipment or custom made material
which t be special ordered in advance to meet the completion schedules
Express Warranty.Is
an-express warranty bean nmAded by the yontractorI No Yes (all te, of eh �- .t be «.tied to the cantracrt
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 laborundcr this aereement
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)ms been placed on the residence. Review the following cautions and notices
carefully before signing this contract
• Don't beressured into signing
p going the contract Take time to read abet fully understand it. Ask'questions if somjthing is unclear•
• Make sure the contractor has a valid Home Imrtmvement Contractor Registration- The leis requires most home improvement contractors and.
subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about.contmctor
registration by writing to the Director at.One Ashburton Place,Room 130L,Boston,-MA 02108 or-by.calling 617-727-3200 or .
1-800-223-0933.
• Does the contractor have insurance? Check to see that your contractor is properly insured
• Knowour rights and
Y gh responsibilities. Read the Important Information on the reverseside 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 coutractmos normal place of business,provided you notify the
contractor in writing at his/her main office or branch office o posted,by telegram sent or by delivery,not later than midnight of the.
by ordinary mail s
third business day following the signing of this agreement.See the attached notice of,cancellation form for an explanation of.this right
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES!!!
coo idmtinl oopira of fM contract mut be niaeed One copy,ahould ao to thelm other . he kit by emttmm. ..
He wner's Sit im re Contractor's Signature
Date ,�-�
Contractor Arbitration
The Home Improvement.Contmetor Law provides;homeowners with the nghvto.initiate an arbitration action(as an
alteniatrve to court actidh if they have a.d spite with a contractor. The.same right is riot automatically afforded to'a.
contractor,however:The contractor;would have tp resolve any..dispute 6ishe.kas.with a homeowner in court unless'
both parties agree to,the optionA1 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 Consumet Affairs acid Business Regulation andihe consumer shall be required
to it to such arbitration as provided InMassachusetts General Laws,c 14
o eownees Signature tractor'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:dspute resolution even where this section is not
separately signed-by-:the patim:`
Homeowner's Rights
A homeowner's rights undi r-the Hoate'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:fftness_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 du lice a 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 griginal 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 recission period has expired
Accelerated Payments
A contractor mgy not demand payments inadvance.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 Consumer Guide to the Home Improvement Contractor
Law,"contact•.
Cgnsumer Information Hotline
Office of Consumer Affairs and Business Rer:lation
10 Park Plaza,Room 5170,Boston,MA 02116
(617)973-8787 or 1-(888)2833757 _
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
Bureau of Building Regulations and Standards
One Ashburton Place,Room 1301,Boston,MA 02108
(617)727-3200 or1-800-223-0933
For assistance with informal mediation:of disputes or to register formal complaints against a busm ess,call:
Cozy'sttilier c,61hplaint'Section
Office of the Attorney General
(617)727-8400
AND/OR
Better Business Bureau
(508)652-4800
(508)755-2548
(413)734-3114