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HomeMy WebLinkAboutBuilding Permit #443-15 - 295 MAIN STREET 11/6/2014 R _ Ot NORTH q 64-fut0,I'S NO BUILDING PERMIT o� TOWN OF NORTH ANDOVER ° APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received ATOU Date Issued: 1 �9SSgcHu'fMs�t�y PORTANT:Applicant must complete all items on this pagc LOCATION_ 95. AA : Print- PROPERTY OWNER OtA(1aA ' Print MAP.NO PARCEL:6 -r ZONING DISTRICT` Hist'o'ric-District yes no Machine Shop Village,/, no.. , TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building L-9 r6fTamily ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial LR6P'air,.replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic ❑Well ❑Floodplain Wetlands ;::`y 0, Watershed District ❑Water/Sewer Identification Please Type or Print Clearly) OWNER: Name: 1�( (ax to( Phone: Address: �i. CONTRACTOR Name: Phone: .. I. gal nom` ;Address: Supervisor's Construction License: Exp. Date Home Improvemen# License Exp. Date; ' ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDINGJ PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 13i OX, ­ FEE: $ t SIVO 11 Check No.: ? =T Receipt No.: 1 24 1_36' NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fr Signature ofi Agent/Owner . Signature of contracto / r BUILDING PERMIT o*N°RT 6gtio TOWN OF NORTH ANDOVER 02y APPLICATION FOR PLAN EXAMINATION '' _40. - M1 H 4 Permit No#• Date Received �q p 1 gR�reo�P �S SSACHUS�� Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATIONS a _ Prof PROPERTY OWNER __ _m _ _ . w $ _ _ Pnnt 1.00 Year structuee yes no MAf? PARCEL: _ ZONING DISTRICT:Historic District yes no _ Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family y ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others.- ❑ Demolition ❑ Other ❑ Septic Well ❑.Floodplain ❑We Watejshed pistrct. 0 Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly Y OWNER: Name: Phone: Address: Contractor Name:...__ Fs r P�hone: Address: Supervisor's Construction License . Exp. Date P p _ exp. Date:-__, Home Im rovement Licer1se._�. __ _ -- 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: $ FEE: $ Check No.: Receipt No.: p . NOTE: Persons contracting with unregistered contractors do not have access to the Pry• ,� -- • - --`� �' ,signature of Ag��nt%Ovvner Signature of cbntractc-r .1 . 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 ❑ i 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 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 DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yesv no Located at 124 Main- Street '` rtment signatureldate COM-MENhS - ' `` 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 NOTES and DATA— (For department use) ❑ Notified for pickup Call Email Date Time Contact Name ° Doc.Building Permit Revised 2014 Building Department artment i The following is a list 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 o Copy Of Contract ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ 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 Irmo 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 m ust be submitted with the building application Doc:Building Permit Revised 2014 Location tti t i� No. �( Date 4 o - TOWN OF NORTH ANDOVER Certificate of Occupancy $ , Building/Frame Permit Fee $ ,.' Foundation Permit Fee $ Other Permit Fee $ EIV, TOTAL $ r Check#28235 vBuilding Inspector NORTy Town of 21�. : ndover No. I C% ver, Mass, 61,26lq "" 'Q COCNIC„IWICH 11' A0R�TED S U BOARD OF HEALTH Food/Kitchen PERMI D Septic System THIS CERTIFIES THAT .... �► R 011 BUILDING INSPECTOR �. ... ...Kr.................. ......... .................. .. ........... ............... • ... � ..................... Foundation .. has permission to erect ..... .................. buildings on ... .... .... .... .. Rough tobe occupied as .......... . . * ........4....� §. ................................................................. Chimney provided that the person accepting t is permit shall in every respect conform to the 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 RYNffVS ELECTRICAL INSPECTOR UNLESS CONSTRUCT10 ORTES Rough Service .. ............. ... .............................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. 11/06/2014 10:16 FAX 781 942 2226 GILBERT 1@001 Ra a® CERTIFICATE OF LIABILITY INSURANCE I DATE(MNUDDIY I 11/6/207.44 HIS 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(les)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms andconditions 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). I PRODUCER NAME Barbara McDonough Gilbert Insurance Agency, Inc. PHONE (781)942-2225 FAX (761)942-2226 137 Main Street: EMAIL bmcdonough@gilbertinsurance.coml INSURERS AFFORDING COVERAGE NAIG# Reading MA 01867-3922 INSURER A=Hari evill® Nationwide 26182 INSURED jNayRr=La;P1ymouth Rock Assurance CO 004154 Duval Roofing, LLC. INSURERG;Travelers Ins. Co. 0031 P.O. Box 637 INSURER D: INSURER E I North Reading MA 01064 IN3UItERIr: I COVERAGES CERTIFICATE NUMBER:CL1422601329 REVISION NUMBER: i 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 POL CY NUMBER_ AUULZUbK MMI�DNYYY MMlDDNYYP LIMrr5 GENERAL LIABILITY EACH OCCURRENCE ' $ 1,000,000 DAMA E TO R X COMMERCIAL GENERAL LIABILITY a oea,re100,000 A CLAIM84VADE F OCCUR SLOO0000641SAG 10/23/2014 0/23/2015 MED EXP(Any one person) S 5,000 PERSONAL BADV INJURY S 1,000,000 GENERAL.AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG' $ 2,000,000 POLICY 0 PRO- LOCI $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 500,000 i3 ANY AUTO BODILY INJURY(Per person) S ALL OWNED X AUTOS SCHEDULED RCOOOOI003799 10/23/2014 0/23/2015 90DILY AUTOS INJURY(Por arcldent) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUT06 Unlneured molorlk BI e m IImII, 100,000 UMBRELLA LIAR OCCUR EACH OCCURRENCE i 2 EXCESS LIAS. CLAIMS-MADE AGeReOATe I IB DED RETENTIONS 5 C WORKERS COMPENSATION To Be Provided directly WG THII AND EMPLOYERS'LIABILITY YIN TORY LIMITS ER ANY PROPRIETORIPARTNERIEXECUTIVEN/A the worker's E.L.EACHACCIDENT S 100,000 OFFICER/MEMBER EXCLUDED? om en4titi0si C3rrjO7C. 3/11/201Q /11/2015 (Mandatory In NH) P E.L,DISEASE-EA EMPLOYEE 100 000 Ir yes,descnDe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000 I DESCRIPTION OF OPCWITIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remerka Sohedule,If mora apace In mqulmd) Evidence of Coverage 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 M Gilbert, CIC/RARRAR ACORD 26(2010/06) ®1988-2010 ACORD CORPORATION- All rights reserved. INS025 poiow).oi The ACORD name and logo are registered marks of ACORD The e Co_m__m_onweolt_h_ of Afassaehusetts Department of Industrial Accidents h Office of Investigations 1 Congress Street, Suite 100 Wa Boston,MA 02114-2017 °°y www.m�ssgg��/diu Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Duval Rooifng, LLC Address: P.O. Box 637 City/State/Zip: North Reading, MA 01864 Phone#:978-664-2557 Are you an employer? Check the appropriate box: Type of project(required): 1.0 I am a employer with 8 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors ' FI New construction listed on the attached sheet. 7. Remodeling 2.El I am a sole proprietor or partner- lid hh ❑ g ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers' comp. insurance comp.insurance.1 � required.] 5. We are a corporation and its 10.F71 Electrical repairs or additions ❑ 3.❑ I am a homeowner doing all work officers have exercised their 11. ' Plumbing repairs oradditions myself. [No workers' comp. right of exemption per MGL 12.M Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.0 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.afl;davit:indicating:they:,are doing allw.ork and,then hire outsidecontractors.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 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 job site information. Insurance Company Name:Travelers Policy#or Self-ins. Lice,#:7PJub-0230N91-14 Expiration Date:3/11115 Job Site Address: & / // a-w City/State/Zip: X)LT 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 fide up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORD ORDER and a fide 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 the DIA for insurance coverage verification. I do hereby certi er the pains and penalties of perjury that the information provided above is true and correct Si a Date: /�/z n!:/ Phone#: 978-664-255 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#: 7 i Page No. of Pages royasa Builders License # 58443 Home Construction Reg. # 167338 (Vucol ro O nnO 8A& (781)944-1994 (978)664-2557 READING NORTH READING P.O. Box 637, North Reading, MA 01864 Please visit us at www.duvalroofing.com PROPOSA UB ED TO D f ONE DATE STRE _ 74' CITY,STATE AND ZIP CODE We hereby submit specifications and estimates for: ❑Rip&Remove all existing roof related debris from roof as well as job site with our own disposal truck. NO DRIVEWAY DUMPSTERS LJ1 layer of existing roof shingles U 2 layers of existing roof shingles ❑3 layers or more of existing roof shingles Replace any damaged roof decking; not to exceed 32sq.ft. (additional at$1.70 per sq.ft.) 0 Install 8"Aluminum Drip-edge/Rake-edge along entire perimeter(Choice of White, Brown or Mill) LJ/Install ICE&WATER UNDERLAYMENT on all horizontal eaves, sidewalls, skylights,chimney flashing and valley areas f 1 D'Install a premium base sheet underlayment(felt)that is in compliance with the asphalt shingle manufacturer chosen by the homeowner ©'Install The Homeowner's Choice of the selected Tamko/IKO or GAF Limited Lifetime Architectural Roof Shingles See individual manufacturer's warranty•for specific details or please call us with any questions Replace all existing bathroom louver and/or exhaust pipe(s)with new aluminum flanges 0 Chimney(s)-counter-flash and re-step existing flashing ❑Cut& Install new lead flashing i]Install a continuous low profile Ridge-Vent on all ridge lines ❑Soffit-Vents ❑ Roof Louver-Vents ❑Seamless Aluminum Gutters-Custom fabricated on site with our own gutter machine ❑ Downspouts at additional ❑Leaf Guards ❑'Other -------- Oro 0 ` ❑Roof Insulation- Increase existing R.value to R.value f We Propose hereby to furnish material and labor-complete in accordance with above specifications,for the sum of: Total price not including options. dollars($ 1 J, q V Payment to be made as follows: 30%deposit required before ordering materials.Balance due in full upon day of completion. Please make all payments out to Kenneth Duval, mailed to: P.O. Box 637, No. Reading, MA 01864 r Final Payment is due upon day of completion and is subject to the Authorized supplemented Terms&Condition sheet when scheduling. Signature i4.1"Ir THIS PROPOSAL IS VALID FOR =/ `)" DAYS DUE TO FLUCTUATIONS IN MATERIAL&DISPOSAL PRICES. Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Dome Improvement Qontractor Registration Registration: 167338 1 Type: LLC P Expiration: 9/10/2016 Tr# 256221 DUVAL ROOFING LLC. ,s KENNETH DUVAL t W P.O. BOX 637 NO. READING, MA 01864 5 ^.` Update Address and return card.Mark reason for change. SCA 1 0 20M•05/11 - Address Renewal ❑ Employment E] Lost Card tauolssiwu►03 uoc;e.tidx `� ► i98101 VW�l�mr�x is 1 is liUxou zL . " 06[xoa oa a Iua"W' £VV8So-W :asuaol,j aosi.uadns uo!vnjaruo;) splepue;S pue suoiWin6aU 6uipltrs£l 10 R'eO$ A;a}eS allgnd 40;uaw:pedaa- suasnyoe:sseIN i i �I NOTICE NOTICE TO a TO EMPLOYEES t CC� EMPLOYEES A d � The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 Washington Street, Boston, Massachusetts 02111 617-727-4900 — http://www.mass-gov/dia As required by Massachusetts General Law, Chapter 152, Sections 21,22&30,this will give you notice that I (we) have provided for payment to our inured employees under the above mentioned chapter by insuring with: THE TRAVELERS INSURANCE COMPANIES NAME OF INSURANCE COMPANY P .O. BOX 1450 MIDDLEBORO MA 02344-1450 ADDRESS OF INSURANCE COMPANY (7PJUB-023ON91-9-14) 03-11-14 TO 03-11 -15 POLICY NUMBER EFFECTIVE DATES GILBERT INS AGCY 137 MAIN ST READING MA 01867 M_ NAME OF INSURANCE AGENT ADDRESS PHONE d_ DUVAL ROOFING LLC 184 PARK STREET o= —� NORTH READING a� —� MA 01864 EMPLOYER ADDRESS N- '— EMPLOYER'S WORKERS COMPENSATION OFFICER(IF ANY) DATE 0. MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers' Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the services provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably `—' connected to the work related injury. In cases requiring hospital attention, employees are hereby notified that the insurer has arranged for such attention at the NAME OF HOSPITAL ADDRESS 004315 W20MG02 TO BE POSTED BY EMPLOYER c- c Massachusetts Home Improvement Sample Contract This form satisfies all basic requirements of the state's Home Improvement Contractor Law(MGL chapter 142A),but does not include standard language to protect homeowners. Seek legal advice if necessary. Any person planning home improvements should first obtain a copy of"A Massachusetts Consumer Guide to Home Improvement"before agreeing to any work on your residence.You may obtain a free copy by calling the Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617-973-8787 or 1-888-283-3757 or on our website. Homeowner Information Contractor Information I Nam parry Name Street Address(do not a Post Office Box address) Contract lesperson/Owner Name 5� cam"/ — City/Town State Zip Cade usiness Address(must include e a street address) -73- V051 a/S_�y M� Daytime Phone Evening Phone ity/fown to Zip Code 4141- 1 Mailing Mailing Address(It different from above) Business Phone Federal Employer ID or S.S.Number Home Lnpmvemeat Comream Reg.Nmnhv ExpiCum,dace Law requires that nmrt home '.'(] 2 imp Iuantrnviranomhave _713 V� ,�J /,� •olid registration number The Contractor agrees to do the following work for the Homeowner: (Describe in detail the work to completed,specifying the type,brand,and grade of materials to be used,use additional sheets if necessary.) Steal Required Permits-The following building permits are required Proposed Start and Completion Schedule-The following schedule will and will be secured by the contractor as the homeowner's agent: be adhered to unless circumstances be orad the contractor's control arise (Owners who secure their own permits will be i 6Y 'D ��(�{� excluded from the Guaranty Fund provisions of Date when contracto 1tt�b gm contras woklF. 1 MGL chapter 142A.) ��pp ,�� Date wHen, cZfntia'cted-w�k will b ubs tial y comp] ed.D Total Contract Price and Payment Schedule (� The Contractor agrees to perform the work,furnish the material and labor specified above for the total sum of: Payments will be made according to the following schedule: $ oa, upon signing contract(not to exceed 1/3 of the total contract price Q the cost of special order items,whichever is greater) $ by_/_/_or upon completion of $ by_/ 1_or upon completion of $-7?( _upon completion of the contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction) The following material/equipment must be special $ to be paid for r ordered before the contracted work begins in order to meet the completion schedule.(**) $ to be paid for NOTES:(*)Including all finance charges(**)Law requires that any deposit or down-payment required by the contractor before work begins may not exceed the greater of(a)one-third of the total contract price or(b)the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule. Express Warranty-fs an express warranty beine Provided by the contractor? ❑No OrYes(all terms of the warranty must be attached to the contract) Subcontractors-The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this affeement Contract Acceptance-Upon signing,this document becomes a binding contract under law. Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this contract. • Don't be pressured into signing the contract.Take time to read and fully understand it. Ask questions if something is unclear. • Make sure the contractor has a valid Home Improvement Contractor Registration. The law requires most home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor registration by writing to the Director at 10 Park Plaza,Room 5170,Boston,MA 02116 or by calling 617-973-8787 or 888-283-3757. • Does the contractor have insurance? Ask the Contractor for his insurance company information so that you can confirm coverage,or ask to see a copy of a"proof of insurance"document. • Know your rights and responsibilities. Read the Important Information on the reverse side ofthis form and get a copy of the Consumer Guide to the Home Improvement Contractor Law. * r ou may cancel this agreement ifit has been signed at a place other than the contractor's normal place ofbusiness,provided you notify the ntractinwritingat his/her main office or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight ofthe ird business day following the signing of this agreement. Seethe attached notice of cancellation form for an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES!!! Two id cal copies of a Contract must be con pleted and signed.One copy should go to the homeowner.The other copy should be kept by the contractor. l/ Homeowner's Si tune 'Contractor ignatur �J 61 Date Dae , L Contractor Arbitration The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action(as an alternative to court action)if they have a dispute with a contractor. The same right is not automatically afforded to a contractor,however. The contractor would have to resolve any dispute he/she has with a homeowner in court unless both parties agree to the optional clause provided below. This clause would give the contractor the same right to arbitration as is afforded to the homeowner by the Home Improvement Contractor Law. The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract,the contractor may submit the dispute to a private arbitration firm which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required IJV to submit to such 'tration as provided In Massachusetts General Laws,cha ter 142A. Homeowner's Si tore Contractor's Signature NOTICE:The si atures of the parties above apply only to the agreement of the parties to alternative dispute resolution initiated by the contractor. The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties. Homeowner's Rights A homeowner's rights under the Home Improvement Contractor Law(MGL chapter 142A)and other consumer protection laws(i.e.MGL chapter 93A)may not be waived in any way,even by agreement. However,homeowners may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law. Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Home Improvement Contractor Law. The contractor is responsible for completing the work as described,in a timely and workmanlike manner. Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for workmanship or materials. In addition to guarantees or warranties provided by the contractor,all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for a particular purpose. An enumeration of other matters on which the homeowner and contractor lawfully agree may be added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have questions about your consumer/homeowner rights,contact the Consumer Information Hotline(listed below). Execution of Contract The contract must be executed in duplicate and should not be signed until a copy of all exhibits and referenced documents have been attached. Parties are also advised not to sign the document until all blank sections have been filled in or marked as void,deleted,or not applicable. One original signed copy of the contract with attachments is to be given to the owner and the other kept by the contractor. Any modification to the original contract must be in writing and agreed to by both parties.Contracted work may not begin until both parties have received a fully executed copy of the contract,and the three day rescission period has expired. Accelerated Payments A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure. However,in instances where a contractor deems him/herself to be financially insecure,the contractor may require that the balance of funds not yet due be placed in 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 Massachusetts Consumer Guide to Home Improvement" contact: Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787,888-283-3757 or visit the OCABR website at http://www.mass.gov/ocabr/ If you want to verify the registration of a contractor or if you have questions or need additional information specifically about the contractor registration component of the Home Improvement Contractor Law,contact: Director of Home Improvement Contractor Registration Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787,888-283-3757 or visit the HIC website at http://www.mass.gov/ocabr/ Go online to view the status of a Home Improvement Contractor's Registration: htU2:Hdb.state.ma.us/homei=rovement/licenseelist.asp For assistance with informal mediation of disputes or to register formal complaints against a business,call: Consumer Complaint Section Office of the Attorney General 617-727-8400 AND/OR Better Business Bureau i 508-652-4800,508-755-2548 or 413-734-3114 vm;en 2.1-11n2n010 i NOTICE OF CANCELLATION FOBLIGATION, U MAY CANCEL THIS TRANSACTION,WITHOUT PENALTY OR WITHIN THREE BUSINESS DAYS FROM THE ABOVE DATE. OU CANCEL,ANY PROPERTY TRADED IN,ANY PAYMENTS MADE BY YOU UNDER THE CONTRACT OR SALE,AND ANY NEGOTIABLE INSTRUMENTS EXECUTED BY YOU WILL BE RETURNED WITHIN TEN BUSINESS DAYS FOLLOWING RECEIPT BY THE SELLER OF YOU CANCELLATION NOTICE,AND ANY SECURITY INTEREST ARISING OUT OF THE TRANSACTION WILL BE CANCELLED. IF YOU CANCEL,YOU MUST MAKE AVAILABLE TO THE SELLER AT YOUR RESIDENCE,IN SUBSTANTIALLY AS GOOD CONDITION AS WHEN RECEIVED,ANY GOODS DELIVERED TO YOU UNDER THIS CONTRACT OR SALE; OR YOU MAY, IF YOU WISH,COMPLY WITH THE INSTRUCTIONS OF THE SELLER REGARDING THE RETURN SHIPMENT OF THE GOODS AT THE SELLER'S EXPENSE AND RISK. IF YOU DO MAKE THE GOODS AVAILABLE TO THE SELLER AND THE SELLER DOES NOT PICK THEM UP WITHIN TWENTY DAYS OF THE DATE OF CANCELLATION,YOU MAY RETAIN OR DESPOSE OF THE GOODS WITHOUT ANY FURTHER OBLIGATION. IF YOU FAIL TO MAKE THE GOODS AVAILABLE TO THE SELLER, OR IF YOU AGREE TO RETURN THE GOODS TO THE SELLER AND FAIL TO DO SO, THEN YOU REMAIN LIABLE FOR PERFORMANCE OF ALL OBLIGATIONS UNDER THE CONTRACT. TO CANCEL THIS TRANSACTION,MAIL OR DELIVER A SIGNED AND DATED COPY OF THIS CANCELLATION NOTICE OR ANY OTHER WRITTEN NOTICE, OR SEND A TELEGRAM TO [Name of Seller],AT [Address of Seller's Place of Business]NOT LATER THAN MIDNIGHT OF (date). I HEREBY CANCEL THIS TRANSACTION. Date: Buyer's Signature: