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HomeMy WebLinkAboutBuilding Permit #624 - 426 ANDOVER STREET 5/14/2009BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: il Date Received '0 Date Issued: D IMPORTANT: Applicant must complete all items on this page LOCATION. / o �T. Sr4eeT /'t/r�-1`�l / ✓c u�, /y 41F'ziy Print PROPERTY OWNER �� Mi 007W -140//07W-140// Print MAP NOM PARCEL: &lx- ZONING DISTRICT:/e-,q Historic District yes n Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition eT'9Vb--QQ')r more family Industrial Alteration o. of units: --2 Commercial Repair, e I cement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District titer/Sewe DESCRIPTION OF WORK TO BE PREFORMED: r 44-W, i m zI e.cl f Slc •. a �d .J A %'11 Identification /Please Type or Print Clearly) OWNER: Name: Phone: Aririracc- CONTRACTOR Name: <—e4 r -a44 Phone: 6od3- yo l- JlrS- 3 Address: Supervisor's Construction License: Exp. Date: S S�"d!/ Home Improvement License: /4Z M- Exp. Dater 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: $ .3, Sb'y • FEE: $ Check No.: ceipt No., NOTE: Persons contracting with registered contr o do not ha c s t e guara fund Signature of Agent/Owner Si ature of contract r R VC Location `� �����xo✓�� �L_ No. Date -5 XI/ni, NORTN TOWN OF NORTH ANDOVER L • Certificate of Occupancy $ '1 -TS usEt Building/Frame Permit Fee $ e-4 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # % � �J� 22�v� 171 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 THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS HEALTH Reviewed on Signature Reviewed on Signature COMMENTS r a. Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Slignature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dum,pster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS 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 w r - 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: t_ocateo 3254 US ooa Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 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. 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 21 A —F and G min.$100-$1000 fine NOTES and DATA — (For department use ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit Li 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 o 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 o Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: INSPECTIONAL SERVICES DEPARTMENT:BPF0RM07 Revised 2.2008 ACOW. CERTIFICATE OF LIABILITY GTHIAS AMATTER OF IN oRMu►TIOR SINSUKAM CONFERS NO RIGHTS UPON THE CERTIFICATE PRODUCER (603) 882-9532 INC- ONLY AND HOLDER. THlS CERTIFICATE DOES NOT AMEND, EXTEND O BY THE POLICIES BELOW, g NC)1 ZNSt7RANCE AGENCY, ALTER THE COVERAGE AFFORDED 12 DERRY STREET gMSON, NH 03051 INSURERS AFFORDING COVERAGE NAIC _ INStiJMW%, A CO AUTO ONLY - EA ACCIDENT S INSURER A:ACADIA INSURED MD GODSYR C7LG WETS 6 CARPENTRY, INC • INSURER B: 332 MAMMOTH ROAD INSIIRERC� NH 03076 — INSURER D: INSURER E: POLICY PERIOD INDICATED. NOTWITHSTANDING A NY COVERAGES TME POIJCIES OP INSURANCE LISTED BELOW NAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE OR OTHER DOCUMENT WITH RESPECT TO WHICH TH18 CERTIFICATE MAY BE ISSUED OR LULY PERTAIN. RAC LI ED CONDITIONS OF SUCH POLICIES. REQUIREMENT, TERM Ti OF ANY CONTRACT AFFOOR RDED BY THE POLICIES DESCRIBED HEREIN IS `SUBJECT TO ALL THE TERMS, EXClU510N5 AND THE INSURANCE AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED tjY PAID CLAIMS. POUCT E POLICY ExPIRATIONRg ADD'L TYPE OF NSURANCE DATE POLICY WJWVR MIDD DATE EACH OCCURRF'NCe S GBNERAL LIABILITY DAMAGE 10 RENTED $ PREMISES (Ea occurrMM1 COMMERCIAL OENFRAL LIABILITY / / / / MFO FXP An one emm S CLAIMS MADE 0 OCCUR PERSONAL &ADV INJURY S EXCESSfUMBII LIABILITY GENFgALACGREGATE _ PRODUCTS • coMPIOP AGG $ `(I,EN'L AGGREGATE LIMITAPPLIES PER: POLICY MJFS M Loc COWMFDSINGLELIMIT 6 AUTOMOBaELIABtuTY Me 0WOent) AGGREGATE >; ANY AUTO S ALLOWNE par person 5G.HEDIJLED AUTOS INJURY s HIRED AUTOS (Pot se NON•OWNED AUTOS PROPERTY DAMAGE s DESCRIPTION OF OPERAno%"OGATIONSNEHICLIiWUCLUSIONS AMD SHOVLD ANY OF THP ABOVE DESCRIBED POLIGIMZ M GAMEu U ME- — EXPIRATION DATE THEREOF, THE ISSUING IN9VRER VALL ENDEAVOR TO MAIL 10 DAIS wRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, OUT FMLURE TO DO 50 SHALL IMPOEE OBLIGATION OR LIABILITY OF ANY KIND UPON THE TOWN OF 14ORTH ANDOVER, MA INSURER ITS AGENTS OR REM S. FAX 978-688-9542 AU*NdIZA4PAP RRseNTarne ACORD 25 (2001 /09) W ACORD CO PORATION 1988 *,M IN5025 (OE08)A6 ELCCTRONIC LASER FORMS. INC. - (800)327-0595 Pape 1 of i (P[rn Idelll) AUTO ONLY - EA ACCIDENT S G1IRAOE LUIBRJTT U ACC S ANY AUTO OTHER THAN AUTO ONLY! AGG Is / % EACH CCURRENCE $ EXCESSfUMBII LIABILITY AGGREGATE >; OCCUR CLAIMS MADE S DEDUCTIBLE S RETENTION S A� wDRKERSCOMPENSATION Am 28-33391-00132-93985). 05/07/20D9 05/07/2010 � X TUFtvj 0� EMPLOYERS' LIABILRY E j.. FACN ACCIDENT i 100000 ANT PKOPMETOPIPARTNEPIEXECU:IVE / / % % E,L. DISEASE - EA EMPLOYEE S 100000 OFFICERIMEMBER EXCLUDED? IT YPe. daoritim undM E.L. 019EASE • POLKiT LIMit i 500000 SPECIAL PROVISIONS below OTNER DESCRIPTION OF OPERAno%"OGATIONSNEHICLIiWUCLUSIONS AMD SHOVLD ANY OF THP ABOVE DESCRIBED POLIGIMZ M GAMEu U ME- — EXPIRATION DATE THEREOF, THE ISSUING IN9VRER VALL ENDEAVOR TO MAIL 10 DAIS wRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, OUT FMLURE TO DO 50 SHALL IMPOEE OBLIGATION OR LIABILITY OF ANY KIND UPON THE TOWN OF 14ORTH ANDOVER, MA INSURER ITS AGENTS OR REM S. FAX 978-688-9542 AU*NdIZA4PAP RRseNTarne ACORD 25 (2001 /09) W ACORD CO PORATION 1988 *,M IN5025 (OE08)A6 ELCCTRONIC LASER FORMS. INC. - (800)327-0595 Pape 1 of i The Commonwealth of Massachusetts k� Department of industrial Accidents :lf i, r Office of Investigations . /�� 600 Krashington Street ton Boston, MA 02111 �' www masSgov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Eiectricians/Piumbers Applicant Information / Please Print Le"ibly�N� Nanle (Business/orgmiaation/Individual); , l Address: r *T1 O City/State/Zig:_ 0-30% Phone 79 Are you an employer? Check the appropriate box: 1. ❑ 1 am a employer with 4, Type of project (required): ❑ 1 am a genera( contractor and I employees (full and/or part-time).* have hired the sub -contractors 6. ❑ New construction 2.0 I am.a.sole proprietor or partner- listed on the attached sheet $ 7• ❑ Remodeling ship and have no employees These subcontractors have working for me .in an capacity, g• Q Dern°ltiY°n y capaci workers' comp. insurance. 9.Buildi [No workers' comp. insurance 5. ❑ Weare a corporation and its ❑ ng addition required.] officers have exercised their 10.0 Electrical repairs or additions 3. ❑ 1 am a homeowner doing all work right of exemption per MGL I I.❑ Plumbing repairs or additions myself. [No -workers' comp. c. I52, § 1(4), and we have no insurance required.] T em t 12.❑ Roofrepairsees.[No workers' comp. insurance required.] fiomeowneira 13.[]Other.%y�.l.PJ 'Any applicantrswho submit this that checks bob # l must also fill out the section below showing their workers' compensation policy information, t afii'davit indicating they art doing all work and then hire outside contractors must submit anew affidavit indicating such xCorttractors chat check this box mustanached an add�itional sheet showing the name of the sub -contractors and their workers, comp. poricJ irfammdon. am an emPloyer that is provrdmg workers' compensation insurance for W employe= Below is the inforpolicy � Job sift mation. Insurance Company Name: Policy # or Self -ins. Lie, #: Expiration Date: ------------ Job Site Address: Attach a copy of the woCity/State/Zip: rkers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required. under Section 25A of MGL e, 152 can least to the imposition of criminal penalties of a - fine up to $1,500.00 and/or one-year imprisonment; as well $s civil penalties in the form of a STOP 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 WORK ORDER aa Investigations of the DIA for insurance coverage verification,of 1 do hereby under the rid p es of penury that the information provided above is true and correct Si tore: / Phone #: DateLp P _ �0/ _ _ Metal use only. Do not write in this area, to be completed by city or town official 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 #: �Q /P 2 z Information and Instructions Massachusetts General Laws chapter 152 requires all empIoyers 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, assadiation, 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 ort mstee of an individual, partnership, association or other legal entity, employing employees. 'However the owner.of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work m such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an crnplayer." 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, MOL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of complian= with the insurance requirements of this chapter have been presented to the eordracting 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 other than the members or partners, are not requiredito 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, notthe 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 numberlisted below. Self-insured companies should enter their self-insumnce'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 your 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 reference number. In addition, an applicant that must submit multiple permit/Iicense 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 frritae permits or licenses. A new affidavit must be filled out each year. When 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 bum 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 as a call. The Department's address, telephone and fax number. The Commonwealth of Massachusetts Department of Industria! Accidents Office of Investigations 600 Washington Street Boston, MA 02111 TeL # 617-727-4900 ext 406 or 1-8.77-MASSAFE Fax # 617-727-7741 Revised 5-26-05 VAIVy.Mass.gov/dia 4q -* CIO � w O Z 0 U � a O � W a COD x H � CA u ci .c -Qx v r- w w U w w C7 w w o z cn Q a, cn D J z CLM c c ® c .cam o 0 c y O C _v V C c ev � m c ;= O . O � C m b' $ y o m �+ C 0 Ufti c aid E m mm a cc a ce � 3 CM 67 H _m o o: y 0 t Eo 4CDLC.D CDCD wmI wof : � •c c amo c 1 y •_ m f01 M O i � c :ymc •o = m CL:5 N � o c ca = L •• c o F- yC._..�- 2 W •E S -mcp V •N O CO o. m O CD 0 E 0 L O V Z CD CL O y � C co cm C C h p 'C CD H m m .� CD 0 CD CL +�+ Cal CD CD0 O e_cv o a C C2 ccc �C. cc Z t5 CD 0. u h c C C � C c CLy 0 0 C4 W W 19 LU n Board o' BLailling Regulations ao l st filbrkk 40ME IMPROVEMENT CONTR3ArTOR 1 Registra#ton � 150706 Expiration 512!2010 Tr# 266540 7lypet ndividual FREDRICK A FREDRICK GODBYR 3i /� 332 MAMMOTH POLI IAIv1, NH 03076 �" ✓ Admiuisti`aiun- . .-. _..... ...: ...n 144 '� ., ...�..�. Massachusetts - Department of Public Safeti Board of Building Re!-ulations and Standards Construction Supervisor License License: CS 92009 Restricted,to: 00 FREDERICK A GODBYR 332 MAMMOTH RD PELHAM, NH 03076 Expiration: 5/5/2011 ('ummi"dolier Tr#: 13606 v� The Official Website of the Eyecutive Office of Public Safety and Security (EOPSS) Mass.Gov Public Safety --__. some. > ;.'.orsury,. = oieciior: S .E:usirersoy Bu;ir.� �: a, eG> oimnroveme n nifactof > - ma• ........ .. .....: Home m rtt Carltraotor eg:stratlon Program Contracts - all contracts over SLODO One Thousand Dollars) must be in writing. t The law requires the following FOURTEEN items to be included in any contract between the homeowner and registered home improvement contractor in a] contracts for home improvement work subject to MGL F: ] 42A t 1. The complete agreement between the cont actor and the owner and a clear description of any other documents which are part ofthe agreement , 2. The full names, federal I.D. number (if applicable), addresses (NOT P.O. Box numbers), of the parties, the contractors registration number, the name(s) of the salesperson(s) involved, if any and the date executed by the parties, the contract was 3. The date on which the work is scheduled to begin and the date the wort: is scheduled to be substantially completed. 4. A dctailed description of the wort to be done'and the materials to be used. 5. The. total amount agreed to be paid for the work to be, performed under the contract 6. A time schedule of payments to bee made under the contract and the amount of each payment statein dollars, including all finance charges, if any. Anydeposit required to be paid in advance of the start of the work SHALL NOT EXCEED one-third of the total contract price or the actual cost of any material or equipment of z special order or custom made nature, which must be ordered in advance of the Stan of the wort to assure that the proiect will proceed on schedule. No final payment shall be demanded until the contract is completed to the satisfaction of al] parties: 7. All parties must sign the contract. S. There shall be a clear and conspicuous notice stating; a. That all home improvement contractors and subcontractors shall be registered and that any inquiries about a contractor or subcontractor relating to a registration should be directed to; Registration Divison, Program Coordinator One Ashburton Place Room I301 Boston, Ma 02108 Tel: (617) 727-3206 ext. 25239 b. The contractors registration number must be on the first page of the contract C. the homeowners three day cancellation rights uIlder MGL c 93 s 48; MGL c 140D s 10 or MGL c 255D s 14 as may be, applicable. d. All warranties on the owner's rights under the provisions of 780 CMR R6 and MGL c 142A C. In ten point bold type or larger, directly above the space provided -for the signature, the followin= statement; DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. f. Whetlrerany lien or security interest is on the residence as a consequence of the contract 9. An enumeration of such other matters upon which the owner and contractor may lawfully agree. 10. Any other provisions otherwise required by the applicable laws of the Commonwealth. 11. Permit Notice: Every contract shall contain a clause informing the owner of the following; - a. any and all necessary construction -related permits; b. that it shall be the obligation of the contractor to obtain such permits a the owner's agent. c. that owner's who secure their own construction -related permits or deal with unregistered contractors shall be excluded from access to the Guarantee Fund. 12. Acceleration of payment No contract shall contain an acceleration clause under which any part or all of the http://wwvt;.mass. Dov/?paaeID=eopstermiral&L=4&LO=Horne&L1=Consum er+protection page 1 of 2 12/5/2008 rage —1o2), balance not yet due may be declared due and payable because the holder deems himself to be insecure. However, where the contractor deems himself to be insecure he may require as a prerequisite to continuing said work that the balance of funds due under the contract, which are in possession of the owner, shall be placed in a joint escrow account requiring the signatures of the home improvement contractor and the owner for withdrawal, 13. No work shall begin prior to the signing of the contract and transmittal to the owner of a copy of such contract. 14. Arbitration: If the contractor determines that in the event of a dispute, th a contractor wishes the dispute to be settled by arbitration. this fact must be signified on the contract and both the contractor and owner shall sign this clause separately. The following format is acceptable (in 10 point type or larger); "The cantractor and the homeowner hereby ntutualh'agree in advance that in the event that the contractor has a dispute con.cernin this contract,'the contractor mat' submit such dispute to a private arbitration service which has been appy bt°the Office of Consumer Affairs and Business Regulation and the consumer shall be required to sub it such arbitr ' it as provided in MGL c I42A. Owner: '0M Contractor: NOTICE The signatures of the parries above apoh nit- to the agreemart r of the parties to alternate dispute resolution initiated bt- the contractor. The owner ntav initiate alternative dispute resolution even where this section is not signed separaleh% by the parties, " © 2008 Commonwealth of Massachusetts http://wurw.m ass. gov/?p a(,BIB=eopsterminal&L.=4&LO=Home&L 1=Consumer+protection... 12/5/2008 ftl N Massachusetts Home Improvement Sample Contract 4 Tllis 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 it 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 obtaina free copy by calling the Office of Consumer Affairs and Business Relnilation's Consumer Information Natuna a,O1I=973-8767 err ]-885.283 3757. Homeowner Information Contractor Information Name Sweet A Is (do not u e a Post. ce Box.addresa)ContractorlSalespasan 0 State ad 4 � Sri, F ..Cityflown zip Code usmess Address (must inctude a street address) .4 / . Daytime Phone.. EV ingPhone . - '71 roavn State Zip Cade ..link Address (tot different fr above) -A W W �7e wetness Phone ederal Employer ID or S.S. Number. Lw reGyy�Iher moa tome en. Fame al'(.aooanm hsg. l+omev E[P'o•ton dC t wateann mw e The Contractor agrees to do the following work for the Hnmeo mer:sm�� �� Zg'� ern e o m P c YPe, raw /C/eW a ir• AfCa--Avweter 4-1/ 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 beyond the contractor's control arise (Owners who secure•tbeir own permits will be excluded from the Guarang1 Fund provisions of /16 f! MGL chapter MIA.) Date when contractor will begin contracted work "I� / Dam when contracted work will be substantially completed. Total Contract Price and Pavment Schedule The Contrnctot agrees to perform the work, insli the material and labor Specified above for the ental sum of.. (*) Payments will be made according to the following schedule: upon signing contract (not to exceed 113 of the total eonu-act price or the Cost of special order items, whichever is greater) $ by _� / or upon completion of -t-, cY _1_i_ or upon completion of $ upon completion of the Contract (Law forbids demanding fall payment until contract is comp,Ieted tA. both party's satisfaction) The following mattrial/egtipmem must be special S . - ordered before theeontracted work to be paid for to meet the completion schedwe.("*)� order s to be paid for - NOTES: (•) Including all finance r]rarges'(••)Law rmuires U=any deposit or dowa•pavment ragweed ov the contractor before work begins may not exceed the greater or (a) onatlurd of the taut coattatt.price a (b) the acrua1 cost of any speciai equipmeorar custom made material wlucb must be special ordered h advance to meet the completion Schedule: E s Watrxhry - !s ori r rase warrar tv hei rav'ided bv.tbecontraeter? Nn .Yet ell terms of the wanenrvmost.he a shed m the contract Subcontractors -The contractor agrees to be sdlely responsible for co le tion of the work described petty/subcontractor Utilized by the contractor, The contractor further a� regardless of the actions of any third taria1s and labor under this freement ms`s to be solely responsible for all payments to all subcontractors for Contract Acceptance -Upon signing this document becomes a binding contract under law. Unless otherwise noted within this do contract shall not imply that any lien or other security interest has been placed on thcimtent the carefully before signing this contract e residence Review the following catrrions and notices Don't be pressured into sighing the contract Take time to read and full Make sure ty understand it Ask questions if something is unclear. •the contractor has valid one 1 rovcment Con res r e 'small The law requires most home improvement contractors and subcontractors to be registered with the Director of Home improvement improvement Contractor Registration, you may ingtdreabcontractor registration by writing to the Director at One Ashburton Place, Room 1301, Boston Nut. D2108 or by caliing 6l7.727.3200 or 1-800-223.0933. • Does the contractor have insurance? Check m see that your connector is properly, insured • Know your rights and responsibilities. Read the -Important hrformadon on the reverse side of this form and get a copy of the Consumer Guide to the Home improvement Contractor law. You may cancel this agreement if it has-been Signed at a place other than the contractor's normal piece of business, provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted by telegrams or by delivery, provided ter than midnight of the third business day follow' the sighing of this agreement See fire attached notice of c ncclla form for an ex D OT SIGN THIS CONTRACT IF THERE p of this right r I espies of We eosuraet. c mPlud.nd ' Ons 'Y BLAH A ESM mPY shouldgos eho . The orhe M, be Y We or. Homeowner's Signature Contractor's7../tgna�m/re/ Date V / Date N, 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 bomeowner 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 Contractoflaw. 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 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 nights 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 im any way, even by agreement However, homeowners may be excluded from certain rights if the contractor they chnose isnot properly registered as prescribed by ]aw. Homeownerswhosecure 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 w rkmanlike manner. Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides anexpress 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 consumerlhomeowner 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 recission 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 notyet 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 consu mcHights, or if you wish to obtain a free copy of "A Consumer Guide to the Home Improvement Contractor Law," contact: . Consumer htformation Hotline. Office of Consumer Affairs and Business Regulation 10 Park Plaza, Room 5170, Boston, MA 02116 (617) 973-8787 or 1-(888) 2833757 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 Bureau of Building Regulations and Standards One Ashburton Place, Room 1301, Boston,.MA 02108 (617) 727-3200 or 1-800-223-0433 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 (508)652-4800 (508) 755-2548 (413) 734-3114 C7' 1_/7O'%/7q%ZO%ZC�1G(NA/G' O�✓l!GQQ6P.I.1u tii Board a,' i3ui[_ling Regulations gni, Stnnc iirJa y HOME IMPROVEMENT CONTfi4CTOIR Registration 150796 Expiran 5/2/201D Tr# 266-140 Type Jndividual ; I FREDRICK A GODBYR11 FREDRICK GODB'R _? ref 332 MAMMOTH PEUiAM, NH 03076 Admuustr5aor` i Massachusetts - Department of Public Safetc Board of Building; Re!ulations and Standards Construction Supervisor License License: CS 92009 Restricted,to. 00 FREDERICK A GODBYR 332 MAMMOTH RD PELHAM, NH 03076 --' —=--- Expiration: 5/5/2011 ('man issimi,er T r#: 13606 Permit Date Issued: BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received/ - IMPORTANT: Applicant must complete all items on this page OORT1f Qt�TLeo �6 ��.0 C ti A L* .LOCATION ^% � MPrint ��/l PROPERTY OWNER , Print MAP NO: PARCEL: &vs- ZONING DISTRICT: /� Historic District yesn;i Machine Shop Villaae ves ( no J TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition (TW—b_�?r more family Industrial AlterationWo—of units: -2 Commercial Repair,(ce I cement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District titer/Sewe , Utbk;K11'11UN Ur- WORK TO BE PREFORMED: /.//kd C .0-W, Ale Identification Please Type or Print Clearly) 2 OWNER: Name: Phone: Address: CONTRACTOR Name: r.uy A Phone: 6d3- yd Address: �3 A Supervisor's Construction License: ljo O 9 Exp. Date:S S' dam!/ Home Improvement License: I-PM- Exp. Date: 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: $ , S� • FEE: $ 1� 3 Check No.: / > NOTE: Persons contracting 5ignature of Agent/Owner ceipt No.• °`gyp do not ha ac Tt;e guara fund re of contract r IL