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Home My WebLink AboutBuilding Permit #302-15 - 415 CHESTNUT STREET 9/25/2014 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: � 1� I Date Received i Date Issued: IMP RTANT:Applicant must com Tete all items on this page LOCATION- L-f/5' C e 11►t4 Print PROPERTY OWNER c�_S _ - - _ -- - Print. 100 Year Old Structure yes no MAP NO: L: Z_ONINGDISTRICT: Historic District yes no Machine Shop Village yes I no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑Addition ❑Two or more family ❑ Industrial ❑Altpration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 11 Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District 11 Water/Sewer I // DESCRIPTION OF WORK TO BE PERFORMED: �/V3L4 I a7� _A`J blcA� A4'f'c- Identifim ion I ase Type or Print Clearly) OWNER: Name: G [A. I PleaS Phone: o2 ' '5'7L Address: �lS Cl--eSfrr�c7�— CONTRACTOR Name: i!i C' ..�4/11, _ Phone: ' 7W- RAI 3 Address: Supervisor's Construction License: . �l7 '7 Exp. Date: ._ Home Improvement License: /X12 Ll Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. S FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ C — FEE: $ Check No.: �Z__' Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access t he guar my f d - -- - - - - - - --- -— -"�r�.... "00 P Signature of Agent/Qwner Sigature of contractor - Plan-, .i ihnnittari n Planc 1NaivPri n ('.PrtifiPri Pint Plan n StamnPri Plans n Location No. 3a —I`7 Date t e TOWN OF NORTH ANDOVER • �"` ` Certificate of Occupancy $ Building/Frame Permit Fee $�!o--- Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 28U57 . Building Inspector 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 El 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 r COMMENTS Zoning Board of Appeals:Variance Petition No: Zoning PP n ng Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature Date Driveway Permit I DPW'Torso Engineer: Signature: Located 384 Osgood Street I FIRE DEPARTMENT =Temp Dumpster on site yes no Located at 124 Mair,.Street Fire Depdrtmeiit.sigriatureldate rN, 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 ofElectrical 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 D Notified for pickup - Date Doo.Building Permit Revised 2010 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofh-gig, Siding, Interior Rehabilitation Permits u Building Permit Application u Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses u Copy of Contract o Floor Plan Or Proposed Interior Work u 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 u Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) a 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 o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit u 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.BuiUing permit Revised 2012 Ir 7NORTH . w_ 1 . _ _ 2 t �.� A- ic - - ve- No. - 5iy "h ver, Mass, qr cochic..ew�c.c - 1' U BOARD OF HEALTH Food/Kitchen PER T Septic System THIS CERTIFIES THAT L D BUILDING INSPECTOR ........... ... ..�.1.......... a. �.�. ......... ......... has permission to e4et ............... buildings n � . . t!.� .�. !�... Foundation . Rough to be occupied asY.� 1!: .. .........Q ►,• �. .. . ...........L.................. Chimney provided that the person accepting this 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 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIT S 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. 1Y 1 Massachusetts-Department--2f Public Safety Board of Building Regulations and Standards Construction SupeiTisor License:CS-087977 ERIC W PALM 3 HELTON ST [ Salem MA 01970= r 0IJ Expiration Commissioner ' 04123/2016 /etos�r��rovrunall/r of n✓lla�rac/rr��efl� 12�_+ Office of Consumer Affairs&Business Regnlatioa ME IMPROVEMENT CONTRACTOR z istration: 142089 Type: piration :31-1V2016 Ltd Liability Corpo 4 ATLANTIC WEATHERIZATION`L:L.C. ERIC PALM 61R JEFFERSON AVE a-- SALEM,MA 01970. Undersecretary a ,a►C40R vim® CERTIFICATE OF LIABILITY INSURANCE14 s�70/0 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 endorsemenk A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NCAMNTEACT Construction Eastern Insurance Group LLC PHONE (508)651-7700E- Fax o 233 West Central Street DlE INSURERS AFFORDING COVERAGE NAIC p Natick NA 01.760 INSURER AArbella Protection IAS. CO. 41360 INSURED INSURERS Arbella Indemnity Ins Co. 10017 Atlantic Weatherization INSURERCNautilus Insurance Co 61 Rear Jefferson Avenue INSURERD: INSURER E: Salem MA6 01970 1 INSURER F: COVERAGES CERTIFICATE NUMBERMaster 2014 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. INSR TYPE OF INSURANCEADDL WEIR POLICY EFFr/2012015 ICY EXP L POLI NUMBER MM/DD D LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 kCOMMERC1%AL GENERAL LIABILITY P MAGE Ea occurrence S 50,000 AClA1MAGE OCCUR 500042816 /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 ]( PIrCT ElRO- LOC $ AUTOMOBILE LIABILITY COMBINdEDDISINGLE LIMIT 1 000 000 c BANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED 020015871 /20/2014 /20/2015 BODILY INJURY Per accident) S AUTOS AUTOS X X NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Peraccident $ I PIP-Basic $ 8,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE S 1,000,000 DED I I RETENTION$ 600058654 /20/2014 /20/2015 1 $ WORKERS COMPENSATIONWC STATLI- OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ I'M t yes,describe under DESCRIPTION OF OPERATIONS below E-L DISEASE-POLICY LIMIT S C POLLUTION LIABILITY PL200378602^ 0/1/2013 0/1/2014 GENERAL AGGREGATE $1,000,000 EA POLLUTION CONDITION $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Addhional Remarks Schedule,H 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 Ronald Cleaves/SM �/�� ACORD 25(2010105) 01988-2010 ACORD CORPORATION. All rights reserved. INS025 mmnnsim Tho ike npn name and Inn^aro ranietnend mania^f annIan Rightfax N3-2 4/18/2014 7:54:21 AM PAGE 2/002 Fax Server CERTIFICATE OF LIABILITY INSURANCE DATE fMM/DDIYYYI� T- _ IFICATE 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- HO IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms 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 WS GROUP LLC PHONE FAX 233 WEST CENTRAL STREET i(AIC,No,Ex* (A/C,No): NATICK,MA 01760 E-MAIL ADDRESS: 22MLW INSURER(S)AFFORDING COVERAGE NAIC_# INSURED INSURER A: AMERICAN ZURICH INSURANCE COMPANY ATLANTIC WEATHERIZATION LLC INSURER B: INSURER C: 61 REAR JEFFERSON AVE INSURER 0: SALEM,MA 01970 INSURER.E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: IS ISTO THATTHE POLICES OF IN SURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIIFICATE MAYBE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 14 SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITION OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD SUB POLICY EFF`OATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MMIODIYYYY) (MMIDDIYVYY) LIMITS GENERAL LIABILITY rACH OCCURRENCE $ rrG111L:AA:GGREGATE MMERCIAL GENERAL LIABILITY CLAIMS MADE M OCCUR. AMAGE TO RENTED $ REMISES(Ea occurrence) ED EXP(Any one person) $ LIMIT APPLIES PER: ERSONAL 8 ADV INJURY $ ENERAL AGGREGATE $ POLICY 0 PROJECT❑LOC RODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY ANY AUTO MBINED SINGLE $ IMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS 80DILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAR 0 OCCUR EACH OCCURRENCE $ EXCESS LIAR LJ CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND X WC STATUTORY OTHER EMPLOYER'S LIABILITY YIN UB-SB270121.14 03/202014 03r20t2015 LIMITS ANY PROPECEWMEMITORIPARTNERlEXEcuTIVE �NIA E.L.EACH ACCIDENT $ 500,000 OFFICEFVMEMBER EXCLUDED9 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 It yes,describe under DESCRIP71ON OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERAMONS/LOCATIONSNEMCLESIRESTRICTIONSJSPECIAL ITEMS THIS REPLACES ANY PRIOR CERT)FTCATE ISSUED TO THE CHR'ITFTCAT6 HOLDER AFFEC MG WORKERS COMP COVERAGE CERTIFICATE HOLDER CANCELLATION ----------------- TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 1600 OSGOOD ST BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPR N ANDOVER,MA 01845 �^ 7 ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988=2010 ACORD CORPORATION. All rights reserved. The Comme,.Iwealtlr of Massachusetts Departsnelit ofJRdustr&I Accidents '~ Office of Investigations _ I Congress Street,Suite 100 Boston,i�LA 02114-2019 workers'Compensation Insurance Affidavit:Builde s/C Applicant Information otl>h'actors/Eiectricians/Plumbers / Please Print Le -blv Mame(Business/organization/lndividual): r � Address: Cv t /2• ems,�Uy,� City/StatelZip: f yl.� p/�?'7 U Phone#: g'? - 7W. k1y 3 A�r-e yo employer?Check the appropriate box. I.2 1 ama a employer wi 4 Type of with .I am a general contractor and I Project(required). 2•❑ employees(full and/or part time). have hired the sub-contractors 6. ❑New construction I am a sole proprietor or partner- listed on the attached sheet. 7. [],Remodeling ship and have no employees These sub-contractors have working for me in any capacity: employees and have workers' $' Demolition [No workers'comp,insurance comp.insurance.t 9• ❑Building addition required.) 5. [] We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their ' Myself [No workers'comp. right of exemption per MGI, i 1.❑Plumbing repairs or additions insurance required.]t c. 152,§1(4),and we have no 12.[, 1 Roof repairs employees.[No workers' 1J•L�'Uther_�� COMP.insurance required.] *Any applicant that checks box-41 must also fill out the section below showing their work ers'compensation infotmatlon. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new aindavit indicating such. 'Comractors that check this box must attached policy an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub•cont acwrs have employees,they must provide their workers'co tPlfpriYlattp)t, camp.policy number. .1 am an employer That is pr--d g workers'compensation uisurance for my employees Below is the policy and job site Insurance Company Name: U,i^; C Policy#or Self-ins.Lie, // Expiration Date: 3/20//67- 9 Job Site Address: � eS j t.L4— - ^ Ci • /7�✓�(U PiL `� Attach a copy of the workers'compensation policy declaration page(showing ty/State/Zip: the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal Penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine Of up to 5250.00 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. ra„hereby=do hereby cern" der the was a e allies of er,rery that the information provided above is true and correct Si Phone#: l 7 7G/L/- ?Ily 3__ -- Official use only. Do not write in this area,to he completed by city or town offtcia, City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing In 6.Other Contact Person: Phone#: Massachusetts Nome Improvement Sample Contract this form satisfies all basic requirements of the slates Home Improvement Contractor Law(MGL chapter 142A),but dots not include standard language to protect homeowners.Seek legal advice ifnecessary.Any person platmiug home improvements should first obtain a Massachusetts Consumer Guide to home Improvement"before agreeing to any work an your residence.You may obtain a free copy by calling the Office of Consumer Affairs and Business Regulation'sConsumer Information Hotline at 617-973-8787 or 1.888-283-3757 or on our website. - Homeowner Information Contractor Information 4`7 � - �^ ompany Name ress(do not use a Post office Boz ) Cnntraetorf Salesperwn6`r�f t C e fit . N JecW'earsm Ave'' CitylfownPe Smdo rare ZipcoBusinessAddmss(mustiact Dolmie Phone Evening MOM State �( y/f _ Zip Code o• 7 Mailing Address pt differem Crum altown) Business Phone Federal Empltrya 1D or SS.Number tin nqd-aur man flame r9"�0`�O9[mrrzt•rlieg.NmnSe Esp'vuiondsc imPmrmimt amtne•n hne The Contractor agrees to do the following work for the Homeowner. (Describe in derail the Nark to completed,specifying the type,brand,and grade of materials to be used,use additional ehtets ifm• --.) Required Permits-7he following building permits are required Proposed Start and GompletionScWale-The following schedule will and well be sectsed 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 ofU S Date M en contractor twill begin contracted MGL chapter 142A.) p wwr[: I Date when contracted work will be substantially completed. Total Contract Price and Payment Schedule The Contractor agrees to perform the wwnrk,firnish the material and labor specified above for the total sum of ✓t�UIJ Payments will be made according to the fallowving scbedule: 5`v=u upon signing contract(not to exceed I/3 of the total contract price or the cost of special order items,whichever is greater) , S by /+/ !cr upon completion of S,01-Q6 —by L�/�/L hruPon completion of_ ' S 3""� �(�j� upon completion of the contratt(Law forbids demandin full g , paymen until contract is completed to both party's satisfaction) Tho following malerial/equipment must be special � StAz -9 d f ordered before the contracted anrk begins in order' to med the campletion schedule.('•) s d ar NOTES:M including all fmance charges(••)Law requires that any deposit ordowtn-payment not exceed the greater of(a)one-thud of the total contract price or(b)the actual cost o{��the contractor beforework began may which must be special ordered in advance to meet the completion schedule B°}special equipment orcustom made material Ex ress wnrrnpn•-is an ores_nnrranly ha rovided by the mntraetor� IVa�Yes fall terms of the warrants mast beattachedlo ibecontracil DubwntraMots The contractor agrees to be solely responsible for completion of the evork described re lam'/subcontractor utilized by the contractor.The contractor further a 1�ym en the actions o any third at a u d is a ant to be solely responsible for all payments to all subcontractors for Controet Acceptance-Upon signing,this document becomes a binding contract under law.Unless otherwise noted within this document the contract shall not imply that any lienor other security'interest has beet placed on the residence Review the following potions 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 ifsomcftg is unclear. • Make sure the contractor has a valid Home 1wroverment Contractor R—c istm* subcontractors to be The law requires most home improvement contractors atter registered with the Detector of Home Improvement Contractor Regisvation.You.may ingtrhe abort contractor registration by writing to the Director at 10 Park Plaza,Room 5170,Boston,MA 02116 of by calling 617-973-8787 or 888-283.3757. • Does the contractor have insurance?Ask the Contractor for his insurance company see a copy of a•proof of insurance"document information so that you n confirm coverage,or ask to • Know your rights and responsibilities.Read the"Pon=Information on the reverse side of this form and get a copy of erre Consumer Guide to the Home Improvement Contractor Law. [zo7ntmcior ncel this agreement if it has been signed at a place other than the contractors normal lace of busfn n nTiting at his/hrrmain office or brach office ordin P ass providedyou notif-v thess fottowin the si °�I P°ded by telegram sent or by delivery,not later than midnight of the � g going of this agreement.See the attached notice of cancellation form for an explanation ofthis right. DO NOT SIGN THIS CONTRACT'IF THERE ARE�,BLANK SPACES!!! Tan idmtiW eopiao(the wattxt most be CAmplcted aM siped.the cop;-shovldgarothC hvmmaacr•Tftc CDP-%shautd he tb.•th• . kP wrmmetac aA.41A� f% . --aj— Q— Homcovimcrls Sigtanae qq Contractor's Signature 0 1 II Date v I '"I Date 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,die'contractor may'submit the dispute to a private arbitration firm which has been approved by the Secretary of the Executive'Offit a of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitratign.as providCd In Massachusetts General Laws,chapter 142A. - Homeowner's Signature V Contra tors 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 Avay,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 worlmtanship or materials. In addition to guarantees or warranties provided by the contractor,all goods sold in Massachusetts carry an implied warrantyof 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 ofthe 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 A citing 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 i f 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 OCA13R website at—hop >>-,,-j-,ass ass<_r,.r,rabL If you want to verify the registration of a contractor or ifyou 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 Part:Plata,Room 5170,Boston,MA 02116 617-973-8787,888-283-3757 or visit the HIC website at hitli: ,�ti, .a,ias m::'a.abri I Go online to view the status of a Home Improvement Contractors Registration: hitna fdli.Si1t2.1n9.L3��f IGi17�i379�fQNC iSiin`t.'i iCZn�c:211Si.?Sn 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 ARID/OR Better Business Bureau 508-652-4800_-508-755-2548 or 413-734-3114 Version 2.1-1 IP-101 0