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HomeMy WebLinkAboutBuilding Permit #598-14 - 27 OAKES DRIVE 2/19/2014 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION G� f Permit NO: J `� I� Date Received ` 1 Date Issued: d2 I t 14 IMPO TANT:Applicant must complete all items on this page LOCATION �r ' I Print PROPERTY OWNER wl U Y+7 So L'i so,- Print 100 Year Old Structure yesno MAP NO: PARCEL:W ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Reside 'al Non- Residential ❑ New Building godne family ❑Addition ❑Two or more family ❑ Industrial Cof{(teration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer D SCRIPTION OF WORK TO BE PERFORMED: �"l�Sula �►.� bInAAV CC,(14-0 - J`-3 Gt `r Se Id.entification Please Type or Print Clearly) OWNER: Name:__ W i l" (a p" .3ON SQ Phone: F7 a• Q�-- ?3S7a Address: ,Z7 Q G.kS br• Al • A,-,d& 4� CONTRACTOR Name: fn -r P,1 m Phone: ?7 �--ALq- kl" fT Address: R-7 OGkS `fir. Supervisor's Construction License: $17 7-7 Exp. Date: LY/P-3//Y �61 20Lr Cf Ex 3// Z Home Improvement License: p. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ ADO. FEE: $ 3C) — Check No.: " 6 b Receipt No.: �� 5- NOTE: Persons contractin ith un,re istere.kf contractors do not have access to the guaranty fund ;Signature of Agent/Owner nature of contractor &4 C 44L7 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans 11 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 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 i Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW'I ow;� Engineer: Signature: Located 384 Osgood Street FIRE-DEPARTMENT - Temp Dumpster ori site yes-. no Located at 124 Mair, 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 El Notified for pickup - Date 3 Doc.Building Permit Revised 2010 Building Department i The foE swing is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits i ❑ 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 apo%-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.tted with the building application Doc: Doc.Building Permit Revised 2012 Location} No. Date 2 19 jiLl . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ r Check# t %_0 Building Inspector NORT#hj own of t E ndover o No. Z� '� �t 201q ver, Mass, COC MIG r.e WfCK I- % �.9 A�RATEO 07p,`�(5 S V BOARD OF HEALTH PERM T LD Food/Kitchen Septic System u I T THIS CERTIFIES THAT .................�... `. !.!' ............� .....A..........IiN­ ........................... BUILDING INSPECTOR has permission to er ct ; 1) '$.... Al!! Foundation p ....................... buildings on;l ............ ............ Rough to be occupied as .... .. ... . ...1�'—s� ..-... ...��. �..... ......................... Chimney i hall in eve respect conform to the term�the application provided that the person accepting this permit s every pFinal on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough .... Service ..................:f �""' :.`::":::...................... 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. SEE REVERSE SIDE AC<>RVCERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDJYYY) 4/26/20133 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 NAME:NTACT Construction Eastern Insurance Group LLC PHONE (508)651-7700 1 Fldh ac o: 233 West Central Street E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC A Natick MA 01760 INSURERAArbella Protection Ins. Co. 41360 INSURED INSURER B Arbella Indemnity Ins Co. 10017 Atlantic Weatherization INSURERCNautllus Insurance CO 61 Rear Jefferson Avenue INSURERD: INSURER E Salem MA 01970 INSURER F: COVERAGES CERTIFICATE NUMBERMSTER 2013 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. ILTR TYPE OF INSURANCE A POLICY NUMBER MMIDDY EFF MM/DDY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTE5_ PREMIE Ea occurrence $ 50,000 A CLAIMS-MADE a OCCUR 8500042816 /20/2013 /20/2014 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2,000,000 POLICY X PRO LOC $ AUTOMOBILE LIABILITY COMBINED BINSINGLE-LIMIT ED E $ 1.000,000 B ANY AUTO 80DILY INJURY(Per person) 5 ALL OWNED X SCHEDULED 020015871 /20/2013 /20/2014 AUTOS BODILY INJURY PeraccideM) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS Per accident S PIP-Basic $ X UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED I I RETENTIONS 600047820 /20/2013 /20/2014 5 WORKERS COMPENSATIONWC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N I A (Mandatory in NH) . E.L.DISEASE-EA EMPLOYE $ If es,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S C POLLUTION LIABILITY CPL2003786001 0/1/2012 0/1/2013 GENERAL AGGREGATE $1,000,000 EA POLLUTION CONDITION $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF NORTH ANDOVER ACCORDANCE WITH THE POLICY PROVISIONS. 1600 OSGOOD STREET NORTH ANDOVER, MA 01845 AUTHORIZED REPRESENTATIVE Rosemary Fulham/PMA " ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 rgninnsi m Tho A(nPrl name 2~1 Innn 2w►oniefomrl ma►Irc of ArnPr) Rightfax N2-1 3/11/2013 4-55 : 57 AM PAGE 2/002 Fax Server CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) IFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICAT OLD R. 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•tr .-5 and conditions of the policy,certain policies may require and endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).. PRODUCER CONTACT NAME: EASTERN INS GROUP LLC PHONE FAX 233 WEST CENTRAL ST (A/C,No,Ext): (A/C,No): E-MAIL NATICK,MA 01760 ADDRESS: 22MLW INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A. AMERICAN ZURICH INSURANCE COMPANY ATLANTIC WEATHERIZATION LLC INSURER B: INSURER C: INSURER D: 61 REAR JEFFERSON AVE INSURER E: SALEM,MA 01970 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: PLICIES OF INSURAIME LISTEDTO 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 PAM CLAIMS. - INSR ' ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MMkDDIYYYY) (MMWMYYYY) UMTS GENERAL LIABILITY ZACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE r7 OCCUR. EMISES(Ea occurrence) ED EXP(Arty one person) $ ERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: ENERAL AGGREGATE S POLICY =PROJECT Q LOC OQUCTS-COMPIOP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAROCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION ANDX fL"ITS STATUTORY OTHER EMPLOYER'S LIABILITY YM UB-58270121-13 03202013 03202014 ANY PROPER rrORIPARTNERIEXECUTNE N�'- NIA E.L.EACH ACCIDENT $ 500,000 OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESIRESTRICTIONSISPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. 4' CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED 1600 OSGOOD ST IN ACCORDANCE WITH THE'POLICY PROVISIONS. AUTHORIZED REP NORTH ANDOVER,MA 01845 J • r ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved. ? Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Super►isor License: 0548.7977 � ERIC W PALM't 3 EKTON Sir- SALEM MA 01970 = _ f 951ei..— " j.,1.1 Expiration Commissioner 04123/2014 Office f on tr a." n�5iness Reguf n HOME IMPROVEMENT CONTRACTOR Registration: -142089 Type: Expiration: 3%12/2014 Ltd Liability Corpor . A IC WEATFIER!-Z;kTI0N cL.-C. V. ERIC PALM - 61R JEFFERSON AVE _ SALEM,MA 01970 Undersecretary ' t _F' acuauesau ozsicregUhe,,,ab of&e . L uage{oprotecthomenmers Seek Ie 'sHome&TrOwmautC�corZavr(MG.eb etts tbnsiaaerGddetDIIoM d necassa 74ypeMQaPl�gb � 2A�6u tdoesnaflucIndesLrndard e of CansumerAfEusandBasiaessIteSnlatioa'sCbnmm aBTeangioanyvorkosYomresid Youm ould{asEobtainacoPYo`A Zo."lceownepT atiaaHoflianaE6i79738787ar ob�aa�mscoPYbYcajifag$e _tL€oizaa�oa Z-888-2833757 oroz onL•gebsiie. e Goa 2cfor VOR � ��'IYName st<°'L adzss(doaaLLrceaPosLOtam$a )` a sf . enzation,LLC T4codn IIIIIIIIIIIIII Bnsi;�ddess(r-utiac. sas i O D;:�q``-Fam, EvSalem l 7 - �� .?Lane carona j 01970 '76 TiP Cde Lrl- ate) _ Dm'- �cs iderziFc PloyciD a S S.I+vmbu eCoafra �a rtndoiaefoIIowingrrorItf0. eZomeotvner escnb_in d wmplete�sp citg the LY9 9 b=d,andgmie of axtarizts to banse4 nssadd t. zd] � 12equiredPenmt's-The I Y Ser i N andbe Ij°wiogbo7dnesae.w_ steed bythecoatectras thei ProporedStar:aud C P-Y'3e:—bWh0sectjr8ffi , o2eowaeisagt be ton,T c� etnzSccdale-tie pOTIIgscneacIe � e.T own Pette ir�II Ge ----s the �) co3b-rxLwSe-&tided frona ae GeU2 '4d , zo�s of,aP-Ee. ? trol e • ��e whet conSacforzvnl be' n gm coa`act,d ToContracEPriceandP ` I Dakrivucoac aYmentSchedulebYcoamIeted Ttalhe Coniracfaragms topEd= the Rve;fm'Lch the MaCM and labor sPaaffadabove,orthetauttumor' p 5meatsranI beazdezcmxihzgto the fon � oraiagschedale: Up°n'i€�49COutract aatto t eacoed 1/3 of&e fo&t conh2cLPrice tx$e costofsoecial order E by / / items,wh cbeveais ar ater) Or completion of S by on congletion of s �d upna c.oIetion dth.caabacb (Lawforbias demaadiagfunPaYsrat ins, � bespaciai s cmba Lu�mpletedtobothp V.,s-fi�5rdOn) o :oel a ecPM Ell oa nhxctedq ba9nsm°rdx to ba 'dfor 0n sebedula,(aa) S to paid!' �gaHfmMce notexceedy1e ' (es) law tegresthatny Positardo M orbic$amtb-�'oi(a)oao-thirdofthetotalcoahacL �'9+ne.sequrradbytbacontrc'•otbefore -sPeialordered inadvametomcat the co. Sam ed 1�alcastofaVspecialeuuipmentor blm`y. matt ial E en IrInjill I, Sub confraetors- ° °7" rovidedbvth afncfo PAY/subconbact rum agreestab esolel omuetionoftoe es(211fer ofthew rraa must a chedfi eco tract) by&e ems'��c(�n�ec a8rees to be sol d edess oftbe actions ofau zc dIpt r er elYresPonst6lefaran a tbud ConiiactAcceptaace-noon sigaiag Ibis PaYmmenis to aitynbcoafmctarsfor cont:actshailnot' I thaE ume3tbecomes a6inddia$Caat2CE oatehffybe SPY aaylienorothersecurii3'luteresthasbet<tPTacedoath'mderlaw.Uales;o$tnrvvlseaoiedwltbiatbisdoamtent;fhn . gdag&isconhact residence Review&efellol �geautioas andnctices ° Dan`tbnpze�uediatosigaingthecontr�ct.Tatra ' ° clot a ttmetore��iandfvlty;mdetstaadit Ask gnestionsifsomethingisaac)ear subconbachQstobsregisteredytbaDaectorofgome Re ti The7aw gtothe Zmnro UI Coaba 1e4uires mostba"k"-.,vvemmt contractors aad ° D@sbat coubmcairhavaiumaueetotatlOPE&Plaz%Roomi170,BostngM4021I by n�'iaouireaboutooutractor sea �a�� �sor�nce7AskthaCoabzctorforhisioswancn g617A73-8787 or 888-2833757. ° �PYofa`¢eofoiinsivaa *docomeat 'MNRYiOEboloasotbat G aeYOW-ightsaadto$e fegM=I itfes.Readthe7mportantIaiormatieaon&e' SaacancoaFamcot oras'tto fmmnveaeuEConirExad the reMesde ofthisformaudgata cam,ofthe Consoaer Y�m`����a��eIILuiihasbeeasi _ �a'DTm =gathislher Saedataplaceotherthaathecoubactprsnotmal thirdbusmessdayfoII matnoi cs-orbranchofiicebyordiaarYmaH ost plaMofbusinessprovidedYonn awngffiesigningofthisagreement Seethe attacbednoiiceofcacclQWon LorbydelivetynoElEterthaa�am toftbe DO NOTSIG.NT�r,�CONCT]y1�1'moi forma or�uexnlana�oaoftbis�igbt ^T`e°LofLiaeoahzctzstta �1Tct�aadsi�C,aavpps5aeiagoaar_Latram-r.AWaoBsS.i„- IjSP�C'�'►j� $omelow er's Std 112 I/� s8igoataravli Date Date ineliomelmprovement confmaorimiprovides homeowners withtherightto initiate anarbifraiion action(as m , aikmative to court action)if,heyhave a dispute with a contractor. The same right is not automatically affordedto a I contractor,however. The contractor would have to resolve any dispute helshe has with ahomeovmex is courtunless bothpartiesagree to the optional clause provided below. This clausewovidgivethe contractorlhesamer&to arbitration as is affordedtothehomeownerbytheHomelmprovement ConiractorLaw. The contractor aadthe homeovroerherebymubWly agreein advancetbatiathe eve-U&e contractorhas a dispute concerningthis contract,the contractor may submitthe dispute to aprivate arbitration f irm,which has been approvedby the Secretary of the Executive Once of CorsumerAffaim and Business Regulation and the consumer shall be required to submit to such arbitration as providedIa Mmsachusetts General Laws,chap`a r i4 I omeownees Signature Cantractor's Signature I`OTT%-:The s1gnatores ofthepardes above apply onlyto the agreement of thapardesto alternative dispute resolutioninitiatedbythecontractor. Thehomeownermayinidmaltemativedisputerzsolutionevenwherethis section is not separately sigiedbytheparties. Homeownel's Rights A homeowner's rigbfs underthe Home Improvement Contractor Law(VIGL chapter 142A)and other consumer protection laws(i.e.MGL chapter 93A)may notbe waived in any way,even by agreement However,homeowners maybe excluded from certaiarights if the contractor they choose is not properly registered as prescribed bylaw. Homeowners who secure their own building permits are automatically excluded from all Guaran�trFundprovisions of the Home Improvement Contractor Law. The contractor is responsible for completing the work as described,in a timely and worlimanblo manner.Homeowners may be entitled to other specific legal ruts if the contractor guarantees or provides an express varran`y.1ftworkmanship or materials. In addition to guarantees or warranties provided by the contractor,all goods sold inMassachusetts carry an implied warranty of merchantability and fitness for a particular purpose.An enumeration of other matters on which the homeowner and contractor Iawfiilly agree maybe added to the term,of the contract as long as they do not rastmict a homeowner's basic consumer rights.Myouhave questions about your consumer/homeownerrights,contact the ConsumerInformationHotlme(tistedbelow). F,,Sec-atron oI Contract The contract must be executed in dunlltate and should not be signed until a copy of all exhibits and referenced documents have been attached. Peres 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 contractwith attachments is to be given to the owner and the other kept by the contractor. Any modification to the original contract mustbe inwiiting t and agreed to by both parties.Contracted workmay not begia until both parties have received a fully executed copy of � the contract;andthe three day rescissionperiodhas expired: Accelerated Payments A contractormay not demand payments in advance ofthe dates specified on the payment schedule in cases where the homeowner deems him/herself to be fmancfaliy insecure. However,m instances where a contractor deems bim&erself ` to be financially insecure,the contractor may require thatthe balance of fends notyet due be placed in ajoint escrow account as a prerequisite to continuing the contracted work. Withdrawal of fiords from said account wouldreguire the signatures of both parries. Add,Wonal Worniation } Law or other you have general questions or need additional information about the Home Improvement Contractor consumer rights,or ifyou wish to obtain a free copy of"A Mas sachusettsConsumer Guide toIlmnelmprovemerN ; contact: Consumer informationHotline 1 Office of ConsumerAffairs andBusiness Regulation 10 ParkPlaza,Room 5170,Boston,MA 02116 617-973-8787,888 283 3757 or visit the 0CA] Rweb siteathttnJ/vmrw.mass.eov/ocabd If you want:to verify the registration of a contractor or if youhave questions or need additional information specifically about time contractor registration component of the Rome Improvement Contractor Law,contact ' Director ofHomeTmpmvement Contractor Registration Office of ConsomerAffairs andBusmessRegulation 10 ParkPlaza,Room 5170,Boston,MA.02116 617-973-8787,888-283-3757 orvisit the EIC website at htto-//or mass Qov/ocabr/ Go online to view the status of a Home Improvement Contractor's Registratien: btWIMb state ma.us/lromeimn rovementtlicenseelist.asn For assistance with mfonnal mediation of disputes or to register fbsmal complaints against a business,ea1L- Consumer Complaint Section Office of the Attemey General 617-727-8400 AND/OR Better Business Bureau 508-6524800,508-755-2549 or 413-734-3114 v, a��r-mvaaa2omo The Commonwealth ofMassachusetts i Departmel:it of Industrial Accidents o,f,free oflnvesdgadores Y 600 Washington Street Boston,M14 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please PrintLet?MY Name (Business/Organizationadividual):- l-1aa Y+ reaffi c fza VS,T JT e -Address: 61 R Jefferson Avenue Salem MA-01970 City/State/Zip: Phone.#: 2k 7u1-t-2/y 3 Are ph an employer?Check the appropriate box: I -Type of project(required): 1. I i3n a employer with �,� 4. ❑ I am a general contractor and I r * have hired the sub-contractors e• ❑New construction employees(fu.I snd/orpa�t time). .2.❑ I him a-sole proprietor or partner- listed on the attached sheet 7, ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition wdrking for me in any capacity. employees and have workers' c iastiran. t• 9. ❑Building addition [No workers'comp.insurance comp. required.] 5. ❑ We ue-a•corporation and its 10.❑Electrical repairs ar additions 3.❑ I ami a homeowner doingall work officers have exercised their 11. Plumbin ri t of exemption er MGL ® g or additions myself[No workers'comp. p 12.❑Roo airs insurance required.]t c.152,§I(4),and we have no � � employees.[M)workers' i3. Other comp.insurance required,] *Any applicant thatcheeks box#1 most also fill out the section below showing their workers'compensation policy infonaation. t Homeowners who submit this affidavit indicating they are doing all work sad then hire outside contractors must submit a new affidavit indicating such. *Contractors that check this box must attached an additional sheet showing the name ofthe sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp•policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and fvb site informadonr '7] � � Insurance Company Name: ZZ4 V-(CA �/ Policy#or Self-ins.Lic.# '� 802 7 0 �. Expiration Date: 20 Job Site Address: 07 O Ct 1— bsr.. City/State/Zip:_M•/Jr-Jqa t4 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failum 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 maybe forwarded to the Office of Investigations of the DIA for incnrnnce coverage verification. Ido hereby ce under Waig enaldes of perjury that the information provided above is true and carrece i Sattire: ' —� Date: _ e2 3 1114 Phone# !7�- 7 04.13 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: Phond#: oaae 3 of 4