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HomeMy WebLinkAboutBuilding Permit #056-15 - 24 MARBLEHEAD STREET 7/16/2014 NORTH BUILDING PERMIT oFst�SO ,bgti TOWN OF NORTH ANDOVER 02Ay '`- o APPLICATION FOR PLAN EXAMINATION �0 Permit No#: O � Date ReceivedATED �gSSAC HUSE��� Date Issued: U111- IMPORTANT: Applicant mustcomplete all items on this page LOCATION,, R__ _ _ Q r A e: -5 Print PROPERTY OWNER C.Jc �_ _. 12& ` Print 100 Year Structure yes ae�' MAP� PARCELuUu _ —ZONING DISTRICT: - Historic District yeS qe,� Machine Shop Village yes_ Pte. TYPE OF IMPROVEMENT PROPOSED USE Resiskntial Non- Residential ❑ New Building P-6ne family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ©,47 of ❑ C mmercial ❑ Repair, replacement ❑Assessory Bldg Others: ❑ Demolition ❑ Other u, El Septic ❑Well ❑°Floodplain El Wetlands. q Watershed bistri . El Water/Sewer DESCRIPTION OF WO K TO BE PERFORMp: Identification- Plea pe r Print Clearly OWNER: Name: JQ� � '�- ��[ Phone: � � �� 'i Address: } Contractor'Na—rh"K- r' :$y Phone:: h Address: Supervisor's Construction Lice Exp. Date: _/' _ - - i c Home Improvement Licenser Exp. :Date- ARCH ITECT/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: $ -21700 FEE: $07 Check No.: ((/7 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner kg)d-�tture of contractor 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 d Workers Comp Affidavit ul�. Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract ❑ Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits reguire sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Li Building Permit Application o Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract o Floor/Cross Section/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 Li 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 i 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-$1000 fine NOTES and DATA — (For department use) i i ❑ Notified for pickup Call Email i I Date Time Contact Name Doc.Building Permit Revised 2014 t Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales : ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature a i COMMENTS a Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: -- - Located 384 Osgood Street FIRE DEPARTMENT - Temp,Dumpster on site yes no. Located at 124.Main Street ,. COMMENTS. 4. OJUL-16-2014(WED) 13: 14 (FRX)9785572130 P. 001/001 SAASM-1 OP ID'JY CERTIFICATE OF LIABILITY INSURANCE AT0T11 w► Ii_ 16114 site THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must bo 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). CONTACT PRODUCER phone:978 688 8829 NAME: Michaud,Rowe and Ruscak Ins. Fax: 978 557 2130 PHONE - - -- ax O.Box 188 WC,.No'FAD_._.. Not: forth Andover,MA 01845 EMAIL ADDRESS: Nark S.Rowe,CIC ,,,,,_ INSURER(S)AFFORDING COVERAGE NAIC N _ INSURER A:Travelers Insurance CompRa. INSURED Mitchell Saab INSURER B: _ 578 Bridge St. Salem,NH 03079 INayP�Rc:•_• INSURER D: INSURER E INSURER F- COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE ArFORDED.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 CLAIMSqSR . !.M TYPE OF INSURANCE POLICY NUM9ER MM ODYA MMIO rYYYYY LIMITS GENERAL LIABILITY .. EACH OCCURRENCE S COMMERCIAL GENERAL LIABILITY PRCMISGalEa ocr4rrrnnr�]__ S CLAIMS-MADC I I OCCUR MED EXP(W�ala person) $ PERSONAL&ADV INJLIRY 3 GENERAL AGGREGATE - $ CEN'LACCRECATELIMIT APPLIEUPER: PRODUCr6-COMPIOPACC I S _ POLICY JECT PHO- LOC I S AUTOMOI3ILF IUAI3I1.TY COP40INED SINGLE LIMIT 1Enpcadentl S ANY ALIT BODILY INJURYIPer person) S ALL OWNED SCHEDULED BODILY INJURYaraccldent) $ AUTOS AUTOS NON-OWNED (Per accid Y�ANIA HIRED AUT06 AUTOS (r' .. Is UMaRBL LA LIAR OCCUR EACH OCCURRENCC $ EXCESS UAB CLAIMS-MADE AGGRCGATC a -- DED RCTCNTION — $ WORKERS COMPrNSATION WC STATU• OTI.I• AND EMPLOYERS'LIABILITY Ya ••• q FR ANY PROPRIFTOR/PARTNER/EXECUTIVE 6KU558666127-13 10123/13 10/23/14 E.L.EACH ACCIDENT $ 100,00 OFFICEHIMFMBI_HEXCLUDED? NIA - --•• (Mandatory In NM) C.L.DISEASE_EA EMPLOY[F, $ 100,000 WeWe,descHbe under '- , OF OPERATIONS brlow F.1• M6EASE-POLICY LIMIT S 500.00 )ESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,N more space la required) :ERTIFICATE HOLDER CANCELLATION NORTH13 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 384 Osgood Street North Andover,MA 01845 AUTNORLM REPRESENTATIVE ®'1988-2010 ACORD CORPORATION. All rights reserved. kCORD 25(2010105) The ACORD name and logo are registered marks of ACORD NORTH Town of ? E ndover 0 ..{' In No. soh ver, Mass, �� COC LAKI NICM.WICK �1• �s.9s Rwrea U BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System Q.Ne, ca�o`, THIS CERTIFIES THAT s..36.f..A............. ....... ,,,,.,,,,,. ,... BUILDING INSPECTOR ...... .................. ....... .............. ......... has permission to erect buildings on ..... %e�..!.. Foundation .......................... .... ..... .... ............. Rough .........54 .... ................................... Chimney be occupied as ........ ........ .... provided that the person accepting this permit shall in eve� respect conform to lA terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR 3 . UNLESS CONSTRUN TS Rough Service ........... ................................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Location No. �J 1 Date . - TOWN OF NORTH ANDOVER t Certificate of Occupancy $ Building/Frame Permit Fee $ v - 7 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ /1 � Check# +✓ ys 2778 Building Inspector ROOFS MITCHELL SAAB SMOKESTACKS INSULATION GENERAL CONTRACTOR TOWERS PAINTING POINTING REPAIRING 57 Bridge Street Salem, N H 03079 WATERPROOFING SIDING 603-893-6332 • Tel/Fax: 603-893-3466 PROPOSAL AND CONTRACT DATE:...... .. .....: .... r.. ....... '« .w � ��........ Type of work......... .... . ........................................... ATTN....,! t" ...t':E i✓� a �' ..,M.............. PROPERTY.......�-S�.. �`��!:"..... LOCATION..4...... ,.rr` r ...k:?................................ We propose to furnish all necessary labor, material, and equipment (except as noted below) to perform the following work in First Class workmanlike manner. Roof maintenance is req.-uiirre^d,.annually. Not responsible for water back up caused by snow and ice. Scope of wo k..,:1 -: �'rw ... . ,. . .* ?' •- .� .k•r� `- j� .. � ...................... r.. .. ........ .................................. I�, �,�..�, 4I �✓♦ 5..." frr It pl+l �' �! � i .� W! .P'...r � �.. f'* ...�i= J �� r� t L�.�' r:?aP'c . . , � r , d J''^ J,-jr'".r f r.r+ P!Y ...I...,""7"". .. t" l e:, .... .!!',J!...... . .e�:e�;tS"+•f.,.Y.. ...�n�r•,!1.. �r? ...N '.. d!'. '? ,+' ..:".",r.'..f. P.r....'a::.C'.::.,,x".:.'r�Err. .'':. ...e.... /as•s.�".'.e!.�r f ..wr"...`.Y ...... {..!:. 12 .•'� � C..k �F.:'!�!.Sc. � � J . .,� f r \ Z..�C... ... 'F..!'" '$x. l-F.- f / +�' •I�J� 1 1"�rf /'/ ..�"*•4 -r .s+w 4:. .... .wI'. ✓w �t .. ....... r r • ��im s r� .r'��,/!! ,R .+^�,.4!.'.+.;1!"��...?!.:!".`...... f' ."�;a/•Y�L"?•.! :?'�. � .,Y`:.....� .�/`.f��d' �f�T. -+...!.�.. a' ~ .. . .... ... ... ...... .. .......... For the Sum of ................{JP ...................... , ' ' , ' /�':� .. r Signed by............................................................................... J Page 2 of 2 balance not yet due may be declared due and payable because the holder deems himself to be insecure. However, where the contractor deems himself to be insecure he may require as a prerequisite to continuing said work that the balance of funds due under the'contraet,which are in possession of the owner,,shall be placed in a joint escrow account requiring the signatures of the home improvement contractor and the owner for withdrawal. 13. No work shall begin prior to the signing of the contract and_ ch transmittal to the owner of a copy of sucontract. 14. Arbitration: If the contractor determines that in the event of a dispute,the contractor wishes the dispute to be settled by arbitration,this fact must be signified on the contract and both the contractor and Owner shall sign this clause separately. The following format is acceptable(in 10 point type or larger); , j "The contractor andthe homeowner hereby mutually agree in advance that in the event that the contractor has a dispute concerning this contract,the contractor may submit such dispute to a private arbitration service w/:ich has been approved b the O PP Y ffice of ConsumerAffairs and Business Begulatron and the consumer shall be required to submit to such arbitration as provided in MGL c I42A. Owner: er Contractor t i NOTICE. The signatures of thepartics above apply only to the agreement ofthe parties to alternate dispute resolution initidted by the contractor. The owner may initiate alternative dispute resolution even where this section is not signed separatelyby the parties." i ©2011 Commonwealth of Massachusetts ' II i i I i I h _ www.mass. � _ ttP gov/. a eID—ocate _ _ _ P renin g al&L 3&LO Ho — me&Ll Consumer&L2=Home+... 9/1/2011 Required Contract Terms Page 1 ot•2 The Official Website of the Office of Consumer Affairs&Business Regulation(OCABR) Mass.Gov Consumer Affairs and Business Regulation Home>Consumer>Home Improvement Contracting> Required Contract Terms 4- Contracts all contracts over$1,000(One Thousand Dollars)must be in writing. NEWS&UPDATES v, The law requires the following FOURTEEN items to be included in any contract between a homeowner and a registered home improvement contractor for home improvement work subject to MGL c.142A: OCA Survey Finds One in Five g p P Home Improvement Contractor 1. The complete agreement between the contractor and the owner and a clear description of any other documents 1 Advertisements Placed by which are part of the agreement. Unregistered Entity 2. The full names,federal I.D.pumber(if applicable),addresses(NOT P.O.Box numbers),of the parties,the More... contractors registration number,the narne(s)of the salesperson(s)involved,if any and the date the contract was Subscribe I Learn more executed by the•parties. 3. The date on which the work is scheduled to begin and the date the work is scheduled to be substantially completed. RELATED LINKS 4. A detailed description of the work to be done and the materials to be used. 1 Yon Gid Konsomate 5. The total amount agreed to be paid for the work to be.performed under the contract. Massachusetts you Reparasyon nan Kay 6. A time schedule of payments to be made under the contract and the amount of each payment stated in dollars, including any finance charges.Any deposit required to be paid in advance of the start of the work SHALL NOT exceed one-third of the total contract price or the actual cost of any material or equipment of a special order or custom made nature,which must be ordered in advance of the start of the work to assure that the project will proceed Gula para el Consumidor de on schedule. No final payment shall be demanded until the contract is completed to the satisfaction of all parties. Massachusetts para M joras en el Hegar 7. All parties must sign the contract. ' f Gufa para el Consumidor de 8. A clear and conspicuous notice stating: Massachusetts para Mejoras en. a.That all home improvement contractors and subcontractors shall be registered and that any inquiries about a el Hog. contractor or subcontractor relating to a registration should be directed to 1 Office of Consumer Affairs and Business Regulation Ten Park Plaza,Suite 5170 Boston,MA 02116 Phone:(617)973-8700 b.The contractor's registration number must be on the first page of the contract. c.The homeowner's three day cancellation rights under MGL a 93 s 48; MGL c 140D s 10 or MGL c 255D s 14 as may be applicable. d.All warranties on the owner's rights under the provisions of and MGL c.142A.. e.In ten point bold type or larger,directly above the space provided for the signature,the following statement: DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. £ Whether any lien or security interest is on the residence as a consequence of the contract. 9. An enurneration of such other matters upon which the owner and contractor may lawfully agree. 10. Any other provisions otherwise required by the applicable laws of the Commonwealth. 11. Permit Notice:Every contract shall contain a clause informing the owner of the following: a.any and all necessary construction-related permits; b.that it shall be the obligation of the contractor to obtain such permits.- c.that owners who secure their own construction-related permits or deal with unregistered contractots shall be ex0l ed from access to the Guarantee Fund. 12. Acceleration of payment: No contract shall contain an acceleration clause under which any part or all of the O-T—'f O-T A—T-T.,.....:PDT 0/1/7()1 1 This form satisfies all basic requirements ofthe state's Homeimprovement ConttactorLaw(MGL chapter 142A),but does notindude standard 4 Ianguagetoprotect homeowners.Seeltlegal ad-Ace ifnecessary.Any person planning home improvements should 5rstobtain aoopypf"A Massachusetts Consumer Guide to Home Improvement"before agreeing to any work on your residence You may obtain a free copy by calling the ' b Office of Consumer Affairs and Business Regulation's Consumerinfnrmation Hotline at 617-973-8787 or 1-888 283-3757 or on our website. ` Itomeowner Wormatioxl Coutrsetor laformation. N CompanyName et Ad s(d use osto Boxaddress) Contractor/Salesperson/CpverName state Tip Code BusmessAddress(must include asireet address) Daytime Phone Evening-Phone Cityll'owa State Zip Coda Mailing Address(IC differeof from above) Business Phone FederalEmployerID or S.S.Number Homervlmoeo�tConteelorR�.N®bs F�.pbntioadate law regnbns tba!m ost hie tmpmremmt wnlmdms bare .-Ud r esttaeoa number The Contractor agrees to do the followingworlcfor the Homeowner; (Describe in deWl the werkto completed.specifying the type,bmud,and grade of materials to be used,mr additional ahcas ifaMMM ry) Required Permits-Tlrefollowingbuildiugpemutsareregnimd Proposed Start and Completion Schedule-The followingschedulewin and wr71 be secured bythe contractor as thefiomeownet's agent: be adhered to unless circumstances beyond the contractors control arise (Owners who secure their own permits wilt be excluded from the Guaranty land,provisions of Date when contractor will begin contracted work MGL chapter 142A.) Dale when contractedworkwM be sabslantiallycompleted. Total ContnctPrice and Payment Schedule The Contractor agrees to perform the work;finnish the material and labor specified above for the total sum o£ (*) Payments will be made according to the following schednIe: $ upon signing contract(not to exceed 1/3 ofthe total contract price or the cost of special order items,whichever is greater) 3 by / / or upon completion of $ by1/ or upon completign of upon completion ofthe contract(Law forbids demanding full payment until contact is completed to bothparty's satisfaction) The fallowing material/equipmeut must be special s to be paid for ordered before the contracted work begins in order to meet the completion sobedule.(3c) $ tobepaidfor. 1 NOTES:01)lnoluding all finance charges(**)Law requires That any deposit or down-paymentrequired by the contractor b work begins may not exceed the greater of(a)one-third ofthe total contract price or(b)the actual cost ofany special equipment or custom made material which must be special ordered is advance to meet the completion schedule. 'Express Warranty_Ls an express warranty einenrovidedbythecontractor? NoUYes(all terms ofthewarrantvmust beattachedtothecontractl Sub contractors-The contractor agrees to be solely responsible for completion ofthe work described regardless ofthe,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 atrdement ContractAcceptance Upon stgnmg,this document becomes a binding contract under law. Unless otherwise noted within this document,the contract shall not iraplythat any lfm or other securityinteresthas been placed on the jesidenw.Review the following cautions and notice$ 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 ContractorRegistratiThe law requires most home improvement contractors and subcontractors to beregisteredmdththeDirectoro£gomeImprovementContractorRegistration. You may inquire about contractor registration by writing to the Director at 10 Park Plaza,Room 5170,Boston,MA 021I6 or by calling 617-973-8787 or 888-283-3757. Does the oontractorhaveinsorance7 AslctheContractorforhisin' surance company information so thatyou can confirm coverage,or ask to sea i a copy of a`j)roof ofiastuance'document G Ifnowyourrightsandresponsibilities.Read the Ira orhantInformati P oa on the reverse side oft[us font and get a copy ofthe Consumer Guide to the Rome Improvement Contractor Law. may canoed this agreementif ithas been signed at apiece other than the contractor's normal place of business,provided you notify the actor in writing at his/her main office orbranch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the lffiLi!rdbusiness day following the signing ofthis agreement, Seethe attached notice of cancellation foram for an explanation of this right DO NOT SIGN THIS CONTRACT IF THEM ANY 33LANfta SPACES!!! Two idwticdwpiesoftb�ctmustbecomplefedaod' One eopysboeidgotothehorammer.Theotbercepyshoold I:pt meo ees Signa Contractor's Signature to Date w��•ar�Cemative to court aL Y'y1uYluesnomeownerswith the right to initiate an arbitration action(as an ction)if theyhave a dispute with.a contractor. The same right is not automatically afforded to a i contractor,however. The contractor would have to resolve any dispute he/she has with a homeowner in court unless w 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 herebymurivallY agree fa 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 thq Secretary of the Executive Office of Consumer Affairs and Business Re to omit to such arbitration as ro ' Ta Massachuse Regulation and the consumer shall be required -, eW laws,chapter 142A_ —'<-\� • omeown 's Sign NOTTCE: a signatures ofthe arts above a l only to the Contractor's Signature resolution' tiated by the contractor- The homeownermay initiut alternative ment the�ardes Iution eo terna al ven ve,dis pute re this section is of separately signed by the parties. Homeowner's Rights A homeovrnees rights under the Rome Improvement Contractor Law(MGL chapter 142A)and other consumer Protection laws U.e.MGT.chapter 93A)may not be waived in any way,even by agreement. However,homeowners maybe excluded from certain rights if the contractor they choose is not properly registered as prescribed bylaw Homeowners who secure their own buildingpelmits are automatically excluded from all GuarantyFundprovisions 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 ofinerchautability and fitness for a particular purpose. Anon 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 lights. If you have questions about Your consumer/homeowner rights,contact the Consumer Information Hotline(Listed below). �xeel�tion 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 all ank secns ee until bltiohave bn filled in or marked as void,deleted,or not applicable. One original signed copy of the contract with attachments is to and agreed be given to the owner and the other kept by the contractor. Any modification to the original contract must be in writing 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 demandpayments homeowner deems bn in advance cuthe dates specified on the payment schedule in cases where the 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.. continuing the contracted work Withdrawal of funds from said account would require the f signatures of both parties..._. Additional Information If you have general questions or need additional information about the Home Improvement Contractor Law or other° f consumer rights,or if you wish to obtain a free copy of"A Massachusetts Consumer Guide to Home Improvement" contact: Consumer Information Hotline t Office of ConsumerAf£airs r and$ ' Business Regulation IOP 1 Park Plaza,Room 5170,Boston MA 02 116 617-973-87 87,889-283-375 7 or visit the OCAS R website at h .//Wivw,n � mass.eov/ocabrl 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 i Director of Home Improvement Contractor Registration I Office of Consumer Affairs and Business Regulation 10 ParkPlaza,Room 5170,Boston,MA 02116 617-973-8787,888-283-3757 or visit the HIC web it ea t hit ://wig Q �vr mass. --P ov/ocabl/ Go online to view the status of a Home Improvement Contractor's Registration: http://dbstate.ma us/homeimnrovement/Iicenseelist asn For assistance with informal mediation of disputes or to re ' tfolcornPfermaints against a business,call: Consumer Complaint Section Office of the Attorney General 617-727-8400 AND/OR Better Business Bureau 508-652-4800,509-755-2548 or 413-734-3114 Versional-11122/2010 The comrdonwealth offfassach.usetts , - Depa�tmentof�nc��cst�rcc�Accicients . Office ofluvestigafeons 600 Washington Street Boston,.ttlA 02111 www.rnassgovIdia Wo rkex$'CompensationInsnxance Affidavit:BuRderolCod.tractors/Electriciansglt*bexr, A ixeant Info nation Please.P>fin Ire 'bX Name usinesslorganization/X &idea): 9 Address:—!—i5 p - Are anemploper?CTaecl the appropriate box: Type of project(regiulred): 1.Lam! I am a eplopex vrith r�G��- 4• El am a general contractor and.I 6. []Now construction employees full and/ox xE time � have lifted the sub-contractors ( alisted on the attached sheet;� 7• �Remodeling2.[] I am a sole proprietor or partnez SMP and`havena.employees These soh-contxactoxshave Demol S. [( ition woxldug forme in.any capacity. workers'comp.insurance, g, [l Building addition [No workers'comp.insurance 5. ❑We are a corporation and its 10 r]Electricalrep*s ox additions required.] officers have exercised.their right of exemption per MOL 11,.[[1'lumbingrepairs or additions X a�n.a homeowner doing all work g and we have no myself:[No workers'comp. c.152,§1(4), 12,P Roofrepairs ;7,�„rancerecpzired.] employees..[N'oworkers, nfl Other comp.insurance required.] Anyapplicantthatchecksbox#Zmustaisof[Ilou theseetionbeiowshowingtheirworkers'compensation.poHcyinformation. "►-Homeowners who submitibig a ftidavitiadloatingthey ase doing allworg andthea hire outside contractors must submit anew af�dayit indicating such. xContractors That cheokthis bob must attached an additional sheet showingthe name ofthe suh-contractors and thokworkers'camp.policy information. jam areempl'oyerthatisprovidingw©.1kers'cornpe gationinsuranceforfnyernpI ees .i3erawisthe alicytcr� jabsite infarmadon. _�— Iusurance Company lame: zi"mrx/._ -r „4°4 7 Policy#or gelz 7ns..Lic.9-;___ ,$���� 6 Expiration Date: �obSiteAddxess; CC -��` CitylState/Zip' o�,Sf 6l� `—/-� Attach a copy of fire workers'comp eusationpolicy declaration.page(showing.the policy number and expiration.date). Failure to secure coverage as To9kedunder Section 25A,ofMGL o.152 can lead to the imposition of crhainalpenalties of a f a up to$1,500.00 and/or one-year h apxisonment,as well as civil penalties in the form ofa STOP WORM ORDER.and a fine ofup to$250.00 a day againstthe violator. Be advised that a copy of this statementmaybe,forwardedto the Office of- hVestigations of the DIA.for insurance coverage verification. X do lie�eby ser uncle flee pains and penalties of perjury treat tris information proviclecl alcove is true ancZ corxeet, - Si afore• ` Date: y Thone## O,fficial use ostly. Do not write in this area,to be co,m. feted hy city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Tgealth 2.Building 7D►epartment 3.0tylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.other Information and Instructions - Massachusetts General Laws chapter 152 xeq*es all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is del7xted as",..every person id the service of another under any conftact ofhire,• express orimplied,oral orwxitten" An entplayea<is defined as"an individual,partnership,association,corporation or other legal entity,or any two oxmore. ofthe#`oxegoingengaged inajointenterprise,and includingthelegalrepresentativesofa'deceasedemplQyez,.oa the xeceivexorttusteaofanfndividual,pattnerslyp,associationorother legal entity,employing employees. Howevexthe owner of a dwelling house having notmore than three apartments and who resides there4 or the occupant of the, dwelling house of another who employs persons to do maintenance,constraction ox repair work on su6h dwelling house or onthe grounds orbuilding appurtenautthereto shallnot because of such,employmentbe,deemedto bean employer_" MQL chapter 152,§25C(6)also states that"every state or local Xic-easing agency shall withhold the issuance or renewal of a license or permit to operate a business or to constraint buildings in the commonwealth fox any applicant who has not produced.acceptable evidence of compliance with the insurance coverage required:' Additionally,MOL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shalt enter into any contract for to p erformaace ofpublic work until acceptable evidence of compliance with the insurance requirements of Us chapterhave beenpreseutedta the confracting authority." Applicants Please ill out the workers'comp ensailon affidavit completely,by checking the boxes that apply to your situation and,it iieeessaxy,supply sub-confractox(s)name(s),addresses)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 orpartners,arenotregt*cdto caxryworkers'compensationinsurance. Han LLC orLLP doeshave employees,apolicyisrequired. Be advised thattbisafidavitmaybesubmitted tothe Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. he affidavit should be retained to the city or town that the application for the permit or license is being requested,riot the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain,a*orkers' compensation policy,please call the Department at the numberlistedbelow Self-insured companies Aoutdenter tbeir self insurance license number ora the appropriate line. City or Town.Officials Pleasebe sure thatthe affidavit is complete audprinted legibly. TheDeparfmenthas provided a space atthe bottom. of the affidavitforyouto a out in the eventthe OfCce of Investigations has to contactyouregardingthe applicant. Please be-sure to fill.inthe permit/license number whichwill be used as a reference number. fu addition,m applicant thatmust submit-Multiple permit/license applications in any givenyear,need only submit one affidavit indicating current PORGY information(ifnecessmy)and under"i'ob Site Address"the applicant shouldwxite"all locations in (city or copy ofthe affidavit thathas been of�.idallystamped ormarked by the city or townmay beprovided to the applicant as p"of`fhat a vaUd affidavit•is ou ftle for futae permits or licenses. •A new affidavit must be ftlled out each year.'Wh ere a home owner or citizen is obtaining a license ox permit not related to any business or commercial venture (i.e.a dog license orpermit to burn leaves etc,)said person is NOTxequired 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 aind fax number: Tfho CQouoat osz..c!uSPlf� Depa�xtextt o.�Zndu�x��l,�.cc.�cla�.t;� • Office of)5RV"ttga.-ao.)n.,% a 0oww' , eek Tei, 61M-2'�,490Q QxM06 Ql 1.877-W _ Revised 5-26-05 617-727-7749 Wwwaaagovlchd 90S1• 1l1 tide Boca Rson,FL 33137 (M)x-4123 X24.20'12 AffrCHELL SAAB E f CnW DAA lX92 sMaRKMSTREET mDotmossm. 20-7CW4-1MM53 SMEMM03079 FED ID MUMM APPUCATM W: 28834940 I� i W& AM WtOYM UA IM ICY DWM w"IstoacbmwWts &an 0r pmmmpqmmt=dWr Wcovarage owaxp to hers C=mmwefmn k=wugwoPlan kr"S of MW HAIAPSHM Camrage is pwdded tud ritris bier,big 412-01 A &on the effm&m&*a ,and wth the t fwd 1 8t�d ill 4n P� t� tZ{8 poi y I�3Coveragets t t#m wybewm[dart ter i of NEW HA M mid efsuch - as�to in am Uzi PM nft&EffV%w3lsbWcuweMeJSaISDPMVMd. toumstanuu &Oft PMmbW in ft tic Uaxs4 ttftm bgherkoft have boort mwaskd in womdwmewithtm Pkn n f f,Via i f+3s ofitis cmffWe LM ym mehm yomPOky. CONNIAM.- TPAVELEW RiDELOMY CO a4LUMFVW 24MG TA OfUAtADO.FL X514 fKPAW-- LOCPAUD RO EAND MJSCAK RISUPMUMASSOCIATM M PO ENOX 180 t40MANDOVE tAA0184"l08 IMIS OP.RTIFICATE IS*SUED AS A MATTER OF WFOR!AATKM ONll.Y AND GOWICKU nu r MIO yr vm ..,� ..�•�....•�•� •,•••��••• CERTIFICATE ODES NOT AFFIRMATIVELY OR MEOATMS-y AMEND, EXTEND OR ALTER THE COV.IMW AFFORDED AY THC POLICIES BELOW. TINS CERTpgCATE OF it=RANCE ROES NOT CONSTITUTE A CONTRACT RMVM THE iSSUNG WSURER(8), AUTHOR'= REPRESENTATIVE OR PRODUCER,AND THE CERT TE HOLDER. iMpORT r. If the csrWW*trr Holder ie>�AilD17ii7NA1 INBt7REO,the polar y(les} mt+st be endorsed. GROGAnON iS WANW,""out to the tonyW-andeondllie"of ttre policy.aomin policies may rgqulM*n endamsiment. A statement on this earbYeato doss not confer rights 110 the grtlfiram teoldsr In lle11r of such FRODUcNAM CoWsn eR PaoNE 521 AM CoMran tnalranoe Agency,ba72-9A5t 358 Main sbvd to m HawMI MA 01830 c Att8111C Cmaft ItOUHt� tlta�tte0 lee Saab SM LIdge Street Salem Illi MINI Bonn v LEI— COVERAGES C�ATE NiJgumt. REVtSM NUM13M. THIS IS TO CERTIFY THAT THE POUGIES OF INSURANCE LISTED 138-OV11 HAVE BEEN!S:UED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONC(TION OF ANY CONTRACT OR OTHM DOCUMENT Vffti RESPECT TO WHICH THIS CERTIFICATE MAY BE !SSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESGRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.I&=SWM MAY HAVE BEEN REDUCED BY PAID CLAM. INSR I rME OP PISURANCE umrs 41AIUIs�ulnoe x xcua 0448000891 04WB 0114 (t14t82!?RM6 0�iF„Ia,,o�eeerm� 5000 I t :pEa _gAjwwuRy s 30D.000 t ( QEM9F ALAOOREOAT6 s 0 N i L A(I UMIT 1q. Put ' i - /C7P AGG 5 @00 X ?Q'ICY 'FRO. i ! ' L Ai:'IOMOOM 6IAOILITY t i CQiilelMEO (?t.E tIh1T ANY;%UTO r ! 'BQDILYRLURYSPxpeel I S Al O Mj i 30ME(I&W 'WMLY ftwe Per eodCm�1.s AMOS O 4 NrRE:ldJ(G: ��AUTOS ' E UTs UMBRELLA6tH@ i OCCUR ! EACH o s EXCESS 1643 ir < AGOPECATE ! $ tIYORtftE1lSGOliPt�i$A'IION i ��JTIy. I AND ENPLOYERS'IJABIUIY jamY AQNY Q_FFh EXCLUDED! rvto N/A I (i EE.LL EAC A$fOO-EDAEEQhTpLdY S irfatow& OR 0 WOMMMaEL EN E•POi1CY R t f t i ! DeSCR(MM OF OPERATKIMIS i LOCdTIDIrs(VVIOC1.0 i tech ACORO 1101,AddM*W Ramps Senad+ls.ItAlols FFm A nofto t Rssidslrlt4l re contractor. CERTIFICATE HOLM 0ANCt3LATMON SNOULIGANYOFTIiEABOYEOESCRi9EQPOLtCIESEtE C/UdCELLF.QBI:FORE THE EXPIRATION DATE THEREOF, Mal= VWL L BE DELIVIMW IN ACCORDANCE 11Yf1'H THE;PWCY PROVISIONS. AUntORI�RIMTA114E 0 1191W211111 ACORD CORPORATION. All l!!$hf8 lege ved. ACORD 26{2010109) The ACOM name and logo are Trod Wracks o>=ACORD 1 , 1 a : lot Office of Consumer Affairs&Business Regulation a — ME IMPROVEMENT CONTRACTOR gistxation: 171835 Type: – < - piration: :.4/24/2016 DBA MITCHELL SAAB GENERAL CONTRACTOR MITCHELL SAAB 57 BRIDGE ST SALEM.NH 03079 Undersecretary _ �tisrdmgga - tYt�oar -- _ a�i�•T� in ;SafHetyaied m°p' - ^ u vane end'dakej- Massachusetts-Department of Public Safetyi S Board of Building Regulations and Standards Construction Supcn-iiar License: CS-020864 MITCHELL L SAO !� 57 BRIDGE Sr f = SALEM NH 03079 � y it r.1'l Expiration Commissioner 07/23/2015