HomeMy WebLinkAboutBuilding Permit #308-11 - 41 BRUIN HILL ROAD 10/11/2011 TOWN OF NORTH ANDOVER . APPLICATION FOR PLAN EXAMINATION Permit N8: d 1 L___ Date Received Date issued: 6 ' mFORTANT:AppEcant must complete all items on this page LOCATION � �cco1r0 #%// �a 4 �o Za/dyPiL Frim f ° PROPERTY OWNER Lem `� �onn�` �'llC�►sa,� — Print MAP NO: /� PARCEL: ZONING DISTRICT: Historic District yes o ! Machine Shop Village yes o TYPE OF IMPROVEMENT PROPOSED USE Resid tial Non- Residential ❑ New Building ne family ❑Addition ❑Two or more family ❑Industrial ❑Alteration No. of units: ❑Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑Other hed --.1 r♦ r..:,-,' t] Septic, ©Well t,DFiloodplainl t ,k0#Wetlands,�t, t rJ ,+iO Watersi) rict , �ft-;f :.�,,. !• - - 2 }y r,. t t U t�,��i #`+.. e ( -s "�}1 � r �i-����'' �A� .,���� .._a©r+�Tater/�e�er- �� --._._- `i a:r. :�--- - ---�- ----� , .--:.__. - z,, _� ►.� ..- . __.r. t. �. :1ct�+: ,.�, _tx.�t- ,..�; DES CR_11311 O OF W ITT�TO iiEEPEI ,01 D: (Identification Please a or P int Clearly) OWNER: Name: �� v/t/t i e 1 ��.so✓1 Phone: 9 Address: CONTRACTOR Name: Li`c 5 � Phone: 1-Y, 2 , p Address: Supervisor's Construction License: '� Q ____Exp. Date: _ Xxf,/" j Home Improvement License: ' Exp. Date: 6 ARCHITECT/ENGINEER ��o"/ Phone: Address: Reg. No. FEE SCHEDULE:B ULDING PERMIT.'$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $_ /1 �. FEE: $ 3 Check No.: ___7� Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund - _;�:��: `•_ - nafiareof•;4 Location -e MOZZ2 h� No. Date Ao �oRTM TOWN OF NORTH ANDOVER M. , , • O .. F s A Certificate of Occupancy $ Mu;t� Building/Frame Permit Fee $ Foundation Permit Fee $ x, Other Permit Fee $ TOTAL $ Check # 24 L �6 Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageMody Art ❑ Swimming Pools ❑ Well ❑ Tobacco SalesEl. Food Packaging/Sales ❑ Privat (septic tank, tc. 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 Zor ag Board of Appeals:Variance, Petition No: Zoning Decision/receiptsubmitted yes I Planning Board'Decision: Comments Conservation Decision: Comments Ili 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 1.24 Main Street Fire Department signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq.i.: _ ELECTRICAL: Movement of Meter location, yeast or service drop requires approval or Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— For department use ® Notified for pickup - Date Doc:.Building Permit Revised 2008mi Building Department The following is a list of the required forms to be filled out for the appropriate peronit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work— ❑ Engineering Affidavits for Engineered products— ,v1Iq NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit, i Addition Or Decks ❑ Building Permit Application - S ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract -ac't ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) 1 ❑ 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.L.C. And C.S.L. Licenses .❑ Workers Comp Affidavit o Include S rinkler Plan And ❑ Returned) t p Two Sets of Building Plans (One To Be R t ) Hydraulic Calculations (if Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products ff"OTE: 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 CIerks office must stamp-the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the.Registry of Deeds. one copy and proof of recording must be submitted with the building application Doc: Doc.BuildingPermit Revised 2008mi AORTH Town of o . _ -..�.� ,�.. WW' No. LAKE O . lover, Mass., A- COCMICMEWICK 7,9 A°RATED AP�,��� S V BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT...........L.4..r... ...................�...�..�. .f' )k..1!1........................................................................ Foundation oo 11 has permission to erect....................................... buildings on .....q.(.......�C.V��n►....�!��.�.�..... ,............. Rough to be occupied as.... .. .... ..!!.%.�......�i. .d�.�........y"....Il�+�l��.l!V.S..`.........................,........................... chimney provided that the pelfon accepting this permit shall�n every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final p'1�J�'• PERMIT EXPIRES IN 6 ONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUC STARTS Rough -._ ................................... _ Service BUILDING �$L'ECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE-DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE awoke Det. The Commonwealth ofMassachusetts Department oflndustrialAccidents Office ofInvestigations 600 Washington Street Boston,M,4 02111 S•� www mass gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: City/State/Zip: I&Cze-1—�.�r'� " phone#: t' 7 jr 726 Are you an employer?Check the appropriate box: 1.❑ I am a employer with 4. Typ:ddd ect(required): ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. onstruction 2. I am a sole proprietor or partner- listed on the attached sheget.T 7• eling ship and have no employees These sub-contractors have 8. ❑ ition working for me in any capacity. workers'comp.insurance. [No workers comp.insurance 5. 9• ❑ g addition ' p ❑ We are a corporation and its required.] officers have exercised their 10.❑ al repairs or additions3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑ ng repairs or additionsmyself. [No workers' comp. c. 152,§1(4),and we have noinsurancerequired.]i em to ees. 12•❑ pairsp Y [No workers'comp,insurance required.] 13•❑ *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. I am an employer that is providing workers'compensation insurance for my employ information. ees. Below is the policy antl job site Insurance Company Name: Policy#or Self-ins.Lie.#: C PP C7 /CS iP `7 (� Expiration Date:_ �ZQ Job Site Address , � "_�' City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number d expiration/ ). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a rime 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. fP j rJ' I do hereby certify under thepains and pe alties o er'u that the information provided above is true and correct Si nater '- Date: Phone#: 4 ? 2 C) I- Firl only. Do not write in this area,to be completed by city or town official. ' 1 n: Permit/License# hority(circle one): Health 2.Building Department 3.City/Town CIerk 4.Electrical Inspector 5.Plumbing Inspector son: Phone#: 91te &mmowweald Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 . Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 155795 �ias>aciiu cth- Dcp.�rt�,�eMMIL jtr ut'Pubiic SJCIc MANUEL SOUSA t �r/+ 1 Board of Building Re-ulation,and St.�ntF�trtts MANUEL SOUSA _` Construction Supervisor License 9 OTIS ROAD UNIT 15 j'7 — Lidense: CS 73301 -- BEVERLY, MA 01915 /.1' _ t ' MANUEL M SOLISA UpdateA g OTIS RD-UNIT15 —r Addre :BEVERLY MA 01915 " ❑ mss...-: .• DPS-CA1 �� 50M-04/04-G101216 ' ' Office of"�onsu°mei'' 1`a 1�13i iness egu aa'`�o License or registration valid �`'�" 'r Expiration: 11/25/2012 HOME IMPROVEMENT CONTRACTOR before the expiration date. Tr#: 7859 {'�Snunisiuner Registration: ,9.55795 Type: Office of Consumer Affairs and Business Regulation Expiration: `5/.9/2013 Individual 10 Park Plaza-Suite 5170 Boston MA 02116 M"A EL SOUSA 'Z,- ' MANUEL 9 OTIS ROAD UNIT;15 BEVERLY, MA 01915 _ ,...•, Undersecretary Not valid without signature 4fm- C �u BER MARVIH Z [CL?MPAMY Window and Door Showcase��� www'govelumber.com www.ma"inshowcase.com 80 COLON STREET-BEVERLY,MA.01915 100-B Newbury St.(Rt.1 South)-DANVERS,MA.01923 TEL(978)922-0921 TEL(978)762-0007 FAX(978)921-4522 FAX(978)782-0008 8 5 3 17 0--� CASH SALE -Ar R-or 08/13/11 06:56 01I CASH SALE SHIP BONNIE WILKERSON S 1 CONTRACTOR TO: 41 BRUIN HILL P 233 NORTH ANDOVE A 1 MISC: FRONT HOUSE W 6 C 2 P 2 CUST#: 2 .0000 DEL DATE:08/13/11 TERMS: NET - CASH FROM: 0 852631 978-256-4141 L# QTY DESCRIPTION ITEM # UNITS PRICE AMOUNT 1 125 5-1/2" CERTAINTEED COLORMATCH 41999999E 125 7.49 EA 936.25 2 25 PCS PER SQUARE 3 50 YEAR WARRANTY ON PRODUCT 4 15 YEAR WARRANTY ON COLOR 5 SILVER PLATE ROUGH 6 6 SILVER PLATE COLOR MATCH CAULK 41999999E 6 8.99 EA 53.94 7 1 COLORMATCH TOUCH UP KIT 41999999E 1 46.96 EA 46.96 8 3 5/4x6-20 PRE ASSEMBLED CORNER 41999999E 3 226.00 EA 678.00 9 9 5/4x4 W/ HISTORIC SILL SURROUND 41999999E 9 129.95 EA 1169.55 10 176 #8710FJ-RL 2-1/2" PRIMED CASING 40211400A 176 42.32CLF 74.48 11/16 11 32 lx4-RL CLEAR POPLAR 7810000A 10.68 4267.00MBF 45.57 2/16 12 2 1x8-18' CELLULAR PVC TRIM 5010800A 2 56.99 EA 113.98 13 2 1x3-18' CELLULAR PVC TRIM 5010300A 2 24.99 EA 49.98 14 2 611 x 50' FLEXABLE WINDOW WRAP 72123404A 2 59.99 EA 119.98 15 4 1x10-18' CELLULAR PVC TRIM 5011000A 4 71.99 EA 287.96 16 2 1x6-18' CELLULAR PVC TRIM 5010600A 2 43.99 EA 87.98 17 5 2x96 WHITE D/FLANGE SOFFIT VENT 54050208A 5 4.19 EA 20.95 18 3 1x8-18' CELLULAR PVC TRIM 5010800A 3 56.99 EA 170.97 19 3 1x3-18' CELLULAR PVC TRIM 5010300A 3 24.99 EA 74.97 20 4 1-1/811 x 10' ALUMINM BENT FLASH 48090080A 4 3.99 EA 15.96 21 11 1-1/811 x 4' ALUMINUM BENT FLASH 48090020A 11 1.99 EA 21.89 22 5 5/4x4-20' CELLULAR PVC TRIM 5050400A 5 42.99 EA 214.95 23 2 PVC-7435-16' 1-3/4 x 2-3/4 SILL 40817435A 2 104.99 EA 209.98 24 3 5/4x8-20' CELLULAR PVC TRIM 5050800A 3 89.99 EA 269.97 25 2 PVC-2599-16' 1-5/8 SHINGL MOULD 40812599A 2 32.99 EA 65.98 PAID BY: Deposit 4755.25 SUBTOTAL 4730.25 N DELIVERY CHARGE 25.00 TBANK YOU FOR YOUR BUSINESS !! WE APPRECIATE IT 1! D TAX HOLIDAY TOTAL 4755.25 17 HANDLING CHARGE MADE FOR STOCK GOODS RETURNED.SET UP AND SPECIAL MATERIAL CANNOT BE RECEIVED BY RETURNED. OPEN PACKAGES ARE NOT RETURNABLE. ALL CLAIMS AND STOCK RETURNED GOODS MUST BE ACCOMPANNIED BY THIS INVOICE. WE ARE NOT RESPONSIBLE FOR DAMAGE WHEN ASKED TO DRIVE BEYOND THE CURB LINE. TERMS: FINANCE CHANGE AFTER 30 DAYS ON UNPAID BALANCE 1 112%PER MONTH OR 18%ANNUAL ORIGINAL PERCENTAGE RATE. ALL PRIMED PRODUCTS ARE NOT GUARANTEED AGAINST ANY KIND OF BLEEDING. I� 1 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartinents and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers',compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees otherthan the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy;please call the Department at the number listed below. Self-insured companies should enter their ,self-insurance Iicense.number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a referencd number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current Policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The C013a.Momwealth- o,i Massaeaosetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston;MA.02111 Tel. #617-727,4900 ext 4406 or l-877-M-A.SS.AFE Revised 5-26-05 Fax#617-727-7749 WWW.mass.jZov/dia MARVIN WINDOW QUOTE WILKERSON: WILKERSON 06-16-2011 I The Marvin Window & Door Showcase 100 B Newbury St RTl South Danvers, MA 01923 978-762-0007 Version 8.111 INTEGRITY QUOTE 08/29/11 The Marvin Window & Door Showcase 100 B Newbury St RT1 South Danvers, MA 01923 978-762-0007 *** CAUTION: IT IS RECOMMENDED THAT A MINIMUM OF 1/4 INCH BE ADDED *** *** TO THE ROUGH OPENING HEIGHT WHEN USING MARVIN SILLGUARD *** *** UNIT AVAILABILITY AND PRICE SUBJECT TO CHANGE *** *** NET PRICE (in USD) *** PROJECT: WILKERSON QUOTE: 00000001 VER. 8.10 06/16/11 QTY: 9 MARK UNIT - I TDH 292.50 2,632.50 WOOD - ULTREX SERIES CN 3056 RO 30 1/2" X 56 1/4" IG - 1 LITE LoE-366 W/ARGON 13.50 121.50 WH SASH LOCK 0.00 0.00 SCREEN 15.75 141.75 STONE WHITE SURROUND 0.00 0.00 CHARCOAL FIBERGLASS MESH 0.00 0.00 NAILING FIN 0.00 0.00 4 9/16" JAMBS 0.00 0.00 WHITE INTERIOR 38.25 344.25 STONE WHITE EXTERIOR 0.00 0.00 TOTAL NET PRICE 360.00 3,240.00 v e AS VIEWED FROM THE EXTERIOR NON-MARVIN: NON-SYSTEM GENERATED PRICING QUOTE: 00000002 VER. 8.10 08/01/11 QTY: 1 MARK UNIT - 1 SP686BT 3-0x6-8 RHIS DOOR W/ 2 (14") SL BRISTOL 4-9/16" JAMB DOUBLE BORE BRONZE SILL NO CASING. BB HINGES BRASS CAMING SATIN NICKEL 2,155.78 TOTAL PRICE 2,155.78 NON-MARVIN: NON-SYSTEM GENERATED PRICING QUOTE: 00000003 VER. 8.10 06/16/11 QTY: 1 MARK UNIT - LARSON DOOR 3-0x6-8 3149-04E FULL VIEW STORM DOOR BRUSHED NICKEL HANDLE SET 352.00 TOTAL PRICE 352.00 CONTINUED ON NEXT PAGE Version 8.111 INTEGRITY QUOTE 08/29/11 The Marvin Window & Door Showcase 100 B Newbury St RT1 South Danvers, MA 01923 978-762-0007 *** CAUTION: IT IS RECOMMENDED THAT A MINIMUM OF 1/4 INCH BE ADDED *** *** TO THE ROUGH OPENING HEIGHT WHEN USING MARVIN SILLGUARD *** *** UNIT AVAILABILITY AND PRICE SUBJECT TO CHANGE *** *** NET PRICE (in USD) *** PAGE 2 PROJECT: WILKERSON NON-MARVIN: NON-SYSTEM GENERATED PRICING QUOTE: 00000004 VER. 8.10 06/22/11 QTY: 1 MARK UNIT - HANDLE SET NASHVILLE 4312 SATIN NICKEL EMTEK HANDLE SET ELAN BRASS INTERIOR HANDLE SET 205.70 TOTAL PRICE 205.70 NON-MARVIN: NON-SYSTEM GENERATED PRICING QUOTE: 00000005 VER. 8.10 08/01/11 QTY: 1 MARK UNIT - ENTRANCE TRIM B-9 PILASASTER RIM KIT WITH B6D DENTAL HEADER 594.50 TOTAL PRICE 594.50 QUOTE: 00000006 VER. 8.10 06/22/11 QTY: 2 MARK UNIT - RO 60" X 56 1/4" - 2W1H 0.00 0.00 **Al I TDH 292.50 585.00 WOOD - ULTREX SERIES CN 3056 IG - 1 LITE LoE-366 W/ARGON 13.50 27.00 WH SASH LOCK 0.00 0.00 SCREEN 15.75 31.50 STONE WHITE SURROUND 0.00 0.00 CHARCOAL FIBERGLASS MESH 0.00 0.00 **A2 I TDH 292.50 585.00 WOOD - ULTREX SERIES CN 3056 IG - 1 LITE LoE-366 W/ARGON 13.50 27.00 WH SASH LOCK 0.00 0.00 SCREEN 15.75 31.50 STONE WHITE SURROUND 0.00 0.00 CHARCOAL FIBERGLASS MESH 0.00 0.00 CONTINUED ON NEXT PAGE I i Version 8.111 INTEGRITY QUOTE 08/29/11 The Marvin Window & Door Showcase 100 B Newbury St RT1 South Danvers, MA 01923 978-762-0007 *** CAUTION: IT IS RECOMMENDED THAT A MINIMUM OF 1/4 INCH BE ADDED *** *** TO THE ROUGH OPENING HEIGHT WHEN USING MARVIN SILLGUARD *** *** UNIT AVAILABILITY AND PRICE SUBJECT TO CHANGE *** *** NET PRICE (in USD) *** PAGE 3 PROJECT: WILKERSON NAILING FIN 0.00 0.00 4 9/16" JAMBS 0.00 0.00 WHITE INTERIOR 76.50 153.00 STONE WHITE EXTERIOR 0.00 0.00 TOTAL NET PRICE 720.00 1,440.00 v v e o AS VIEWED FROM THE EXTERIOR PROJECT TOTAL NET PRICE: 7,987.98 i I ' Massae ,usetts Home Improvement Sam le 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 ISeelc legal advice if necessary. Any person planning home improvements should first obtain a copy of"A Massachusetts Consumer Guide toy 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 li Name Com ny Name Street Address(do not use a Post Office Box address) Contractor/ alesperson/Owner Name oQol ea~c 0 0, 57 e City/Town State Zip Code Business Address(must include a street address) onDaytime Phone Evening Phone Ci /Town �' State Zip Code �, Mailing Address(It different from above) Bev usiness Phone Federal Employer ID or S.S.Number requires that most home Home Improvement Contractor Reg Number Expiration date - Lary improvement contractors hive n valid registration number The Contractor agrees to do the following work for the Homeowner: v� F (Describe in detail the work to completed,specifying the type,b�rtand, land grade of materials to be used,use additional sheets if necessary.) Rea Q.0-2 S t evl Ct 00 H cl, ,-)5 Required Permits-The followingjbuilding 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 beyond the contractor's control arise (Owners who secure their own permits will be excluded from the Guaranty Fund provisions of tQ � Date when contractor will begin contracted work- MGL chapter 142A.) 'I:Date when contracted work will be substantially completed. Total Contract Price and Payment:Schedule q �/ The Contractor agrees to perform the work,furnish th material and labor spec ied above for the total sum of: ` ! y, o�3 e,� P c- I G� rrXA+e_,r_t'c(s +,0 ' 0 to 1 x-:0 r� 1--oS ) Payments will be made according to the following schedule: t _ 0 1 0 $ upon signing contract(not to exceed 1/3 of the total contract price or the costof special order items,whichever is greater) $ by //_ or upon completion of $ by //_ or upon completion of I QQ' 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 ordered before the contracted,voile 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 j(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. Ex ress Warranty-Is an ex ress wa Hlanty beirw i3rovided by the contractor? El No Yes all terms of the warrantymust be attached to the contract Subcontractors-The contractor agrees to be solely responsible for completion of the work described regardless of the actions of an third Party/subcontractor utilized by the contractor. The c Y contractor further agrees to materials and labor under this a eelment lu be solely responsible for all payments to all subcontractors for Contract Acceptance-Upon si P p ging,this document becomes a binding contra t 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 carefully before signing this contract! following cautions and notices i • 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 aldalid Home Im rovement Contractor Re istration. The law requires most home improvement contractors and subcontractors to be registerediwith 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 of this form and get a copy of the Consumer Guide to the Home Improvement Contractor Law. I You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business,provided you notify the contractor in writing at his/her maim office or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing of this agreement. See the attached notice of cancellation form for an explanation of this right. O NOT SIGN THIS CONTRACT IF THERE ARF•ANY BI, SPACES!!! identical copies of the contract must he completed and signed. One copy should go to the homeowner. The other copyh dbe kept by the ontractor. __:: t omeowner's Signature �Wao:rtor`,Signature 9 Date a � � �— Date it Contractor Arbitration The Home Improvement Contractor Law provides homeowners with the right to initiate aniarbitration 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 jconsumer shall be required to submit to such arbitration as provided In Massachusetts General Laws, chapter 142A. Homeowner's Signature Contractor's Signature NOTICE:The signatures of the parties above-apply-only to the agreement of the parties to-alternative dispute resolution initiated by the contractor. The homeowner may initiate alternative 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 hnprovement 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 Hotliine(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 fiords not yet duel be placed in a j oint 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: i Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 j 617-973-8787, 888-283-3757 or visit the OCABR website at http://www.niass.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.1-n*.gov/ocabr/ i Go online to view the status of a Home Improvement Contractor's Registration: b=://db.state.ma.us/homeimprovement/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 j 508-652-4800,508-755-2548 or 413-734-3114 j Version 2.1-11/22/2010 I ;