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HomeMy WebLinkAboutBuilding Permit #626-14 - 53 WHITE BIRCH LANE 3/12/2014TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: (0ac,r'*-4 Date Received 4 Date Issued: *5-7J/ 7 _ it 9 IMPORTANT: Applicant must complete all items on this pa LOCATION 5,3 W + �e--- IL� , PROPERTY OWNER ., i 0 B a n 4 C o S Residential Print 100 Year Old Structure yes MAP NO: PARCEL: ZONING DISTRICT: Historic District yes o ❑ Alteration No. of units: Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District El Water/Sewer r S DESCRIPTION OF WORK TO BE PERFORMED: A4, /-0 �-L - w�1 (S e-ly- I liz- r3�� Identification Please Type or Print Clearly) OWNER: Name: �� i Ste! . a e, o Phone: 9 7fr 7L(Y-kl y J Address: 5 3 WIL. V -t- Eric W. Palm CONTRACTOR Name: 2 Mon C.,..,et Phone: Address: Salem MA 01970 Supervisor's Construction License: 7 9 Exp. Date: 3b Home Improvement License: / `LL O J' . Date: ARCHITECT/ENGINEER !'V �l/}— 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: $ / 2..06. 1� 0 FEE: $ _30 Check No.: Receipt No.: T— NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund Signature of Agent/Owner Signature of contractor Plans Submitted F1 Plans Waived n Certified Plot Plan ❑ Stamped Plans Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF .SEWERAGE.DISPOSAL Public Sewer ❑ Tanning/MassageBody 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 PLANNING & DEVELOPMENT ❑ DATE APPROVED COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS IZoning 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 To` ;2 Engineer: Signature: Located 384 FIRE -DEPARTMENT = Temp Durnoter on site yes_ no Located at 124 Mair,, Street Fire Departmeiit signature/date COMMENTS Street Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions._ Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A -F and G min.$100-$1000 fine NOTES and DATA — (For department use ® Notified for pickup - Date Doe.Building Permit Revised 2010 Building Department The foEowing is a list of the required forms to be filled out for the appropriate permit to be obtained. RoofirF,g, 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 ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apn,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.Bui?ding Permit Revised 2012 53 Location No. -�26 -/�- Check # K0,4— Date - 11211V TOWN OF NORTH ANDOVER Certificate of Occupancy $- Building/Frame Permit Fee $ Foundation Permit Fee Other Permit Fee TOTAL $ Building Inspector E w 0 F- J Q W x LL 0 m t u Y \ 0 LL n N u 0 (n OF- W d z zz m C O6 4 -6 LL t : O' Qjai C LL 0 OW. H z J d t � d' LL F- pW, N z (Q.J u J W t u (/) LL = F- u a Z Q t d' LL z uj a W W LL i m z �.+ v N + Ul u a N 7 _ _ o ca _ cc � o o. a� �a = as ¢ c E a CD E "r 0 Q q � = a J N O O N O O — p � ! _ ¢ C t t O .� Y�oo CL U) Im — c c d o � � i=L� Qpm 'S a>� m �s too `a ¢L cc -0 c 2 as Q d '� N F- O to v m O Cl) 4� W_ _ .0" O O y,. LL c y O 2 z W E a L O • V m 0.0 4) ¢ �O y o- 0 '� ;� 0 _r /�--i—i `n 'o o O _ � CLOL) > CO Z m coZ W w a - W W a. O w z z 0 m r 0 U 0=C F COZ V J M 0 M `7� 2 v v O Tfie Commonwealth ofMassachusetts Depatfinqt of industrial Aeddents O, ftce oflnvem 9adens 600 Washington Street Boston, M4 02111 t www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Piumbers Name (Business oMnizattontindividuai). -Address: City/State/Zip: LL , T T C ¢I-""�"S1'"•iRiiAl•e4+4irt/H1 1 ..1.16i11.1M ii YfiUl4tdr1iL1V!!� �V 61 R Jefferson Avenue Salem MA'0I970 Phone.#: y iJ-- Wg41613 Are ypu as employer? Check the appropriate box: 1. I am a employer with 4. 0 I am a general contractor and I Type of project (required): employees (fail andlorpa-t-tim have hired the sub -contractors ❑ 6. New constructionet.* _2. ❑ I am a tole proprietor or partner- Iisted on the -attached sheet. 7. ❑ Remodeling ship and have no employees These sal''-contractars have 8. Demolition working for me in any capacity. employees and have workers' insurance. ' 9. 0 Buffdm addition o workers co [N comp. gtstrraace required.] comp. 5.0 We ue-"orporation and its 10.0 Electrical repairs or additions 3. ❑ I ala ahomeowner doingall work myself [No workers' comp. officers have exercised their right bf exemption per MGL IL Plumbin ❑ g repairs or additions insurance reguired.] t c. 152, §1(4), and we have no 12.[] Roo airs 11 13h employees. [No workers' . er Ot a,�Gc✓1 r comm. insurance reaWred.l *Any spp&aat dmtchecks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this aff davit Micatft they are doing all work and then hire outside contractors must submita new affidavit indicating such. xContmctors thatcheck flus box must ettacbed an additr'onal sbeet showing the Hama ofthe sub -contractors and state whether or act those eatwcshave employees. If the sub -contractors have employees, they must provide their workers' camp. policy number. I am an employer that isprovid&g workers' compensation haurancefor my employees: Below is thepoluy and job site infbrmadoi. Insurance Company Name. L't r i c,' Policy # or Self -ins. Lic. # 7 a % 0 Expiration Date: 512011,11 Job Site Address: r//p. IJ Attach a copy of lire 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 fine up to $ I,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a foe Of up to $250.00 a day against the violator. Be advised that a copy -of this statt: hent maybe forwarded to the Office of d do hereby c : u oder ofpedwy that the information provided abov is true and correct. Date. W4 `� ` f OJYI'Ckl use only. Do not write hi chis area, to he comp ed by city or town of xkL City or Town: PermitUcense # IssuingAuthorlty (circle one): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing inspector b. Other Contact Person: Phoni A nada 3 of 4 A41000RDIFCERTIFICATE OF LIABILITY INSURANCE DAnDDIYYYY) TYPEOFINSURANCE 4/226/26/2013 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 POUCIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Eastern Insurance Group LLC 233 West Central Street CONTANAME: CT Construction PHONE IA No(508) 651-7700 FAC o: AE-DMRIL INSURERS AFFORDING COVERAGE NAIC # Natick MA 01760 INSURER AArbella Protection Ins. Co. 41360 INSURED Atlantic Weatherization INSURER B Arbella Indemnity Ins Co. 10017 INSURER C Nautilus Insurance CO 61 Rear Jefferson Avenue INSURER D: INSURER E Salem MA 01970 INSURER F: COVERAGES CERTIFICATE NUMBERNASTER 2013 R[=VICinW h111MRCD• 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 LTR TYPEOFINSURANCE ADD SUBR POLICYNUMBER POLICY EFF (MM/DQIYYM POLICY EXP fMMfDDfYYYY)LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Q OCCUR 8500042816 /20/2013 /20/2014 PREMIE Me occurrence $ 50,000 MED EXP (Any one person) S 5,000 PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICYx JECTPRO- LOC $ AUTOMOBILE LIABILITY Ea a INED SINGLE LIMIT $ 11000,000 BODILY INJURY (Per person) $ $ X ANY AUTO ALL OWNED X SCHEDULED — AUTOS HIRED AUTOS X NON -OWNED AUTOS 020015871 /20/2013 /20/2014 BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident PIP -Basic $ X UMBRELLA LIABX OCCUR EACH OCCURRENCE S 1,000,000 A EXCESS LIAB CLAIMS -MADE AGGREGATE $ 1,000,000 DED I I RETENTIONS $ 4600047820 /20/2013 /20/2014 WORKERS COMPENSATIONWC AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE I I OFFICER/MEMBER EXCLUDED? NIA STATU- OTH- E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L DISEASE - POLICY LIMIT $ C POLLUTION LIABILITY PL2003786001 0/1/2012 0/1/2013 GENERAL AGGREGATE $1,000,000 EA POLLUTION CONDITION $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) TOWN OF NORTH ANDOVER 1600 OSGOOD STREET NORTH ANDOVER, MA 01845 ACORD 25 !20101051 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Fulham/PMA"'" n iaRR_9n•In Arnon rnoDnoATjnu INSO25r?ninnstm Tho anni2n name anel Innn aro roniefororl markc of Anopn Rightfax N2-1 3/11/2013 6455:57 AM PAGE 2/002 Fax Server CERTIFICATE OF LIABILITY INSURANCE LATE(MM/DD/YYYY)nn/i TNL&PERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE OLDER. 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 thetr -. -,s and conditions of the policy, certain policies may require and endorsement. A statement on this certificate does not confer rights to the ce`ttificate holder in lieu of such endorsement(s)., PRODUCER CONTACT NAME: PHONE FAX EASTERN INS GROUP LLC 233 WEST CENTRAL ST (A/C, No, Ext): (AIC, No): E-MAIL NATICK, MA 01760 ADDRESS: 22MLW INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: AMERICAN ZURICH INSURANCE COMPANY ATLANTIC WEATHERIZATION LLC INSURER B: INSURER C: INSURER D: 61 REAR JEFFERSON AVE INSURER E: SALEM, MA 01970 INSURER F: COVERAGES CERTIFICATE NUMBER. REVISION NUMBER: -THISISTO IOUCIES OF INSURANCES 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 CERTIFICATE MAYBE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCR93ED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAD) CLAIMS. INSR LTR ' TYPE OF INSURANCE ADD L SUB R POLICY NUMBER POLICY EFF DATE (MMU)DIYYYY) POLICY EXP DATE (MMlDD1YYYY) LIMITS GENERAL LIABILITY =ACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY CLAIMS MADE F-1 OCCUR. REMISES EAGE TO a occurrrence) $ ED EXP (Arty one person) $ RSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: ENERAL AGGREGATE $ POLICY 1:1 PROJECT LOC nRODUCTS - COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT (Ea accident) BODILY INJURY $ ALL OWNED AUTOS SCHEDULE AUTOS (Per person) BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DEDUCTIBLE $ $ RETENTION $ A WORKER'S COMPENSATION ANDX EMPLOYER'S LIABILITY YIN US -58270121-13 0320!2013 03/202014 WC STATUTORY LIMITS OTHER .. E. L. EACH ACCIDENT $ 500,000 ANY PROPERROR/PARTNER/F.XECUrIVE a OFFICERIMEMBER EXCLUDED9 (Mandatory in NH) NIA E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 500,000 K yes• describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIRESTRICTIONSISPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTWO WORKERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED 1600 OSGOOD ST IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPR TA 'J:-".—•:.:. NORTH ANDOVER, MA 01845�.r.-+v-±.4. ... y ACORD 25 (2010/05) The ACORD name ano logo are reglsterea marKS OT AcvnU IV00-4VIV A91Vnv �'%Jmrurw IIVIN. /An ngnrs reserveu. satisfies all basiontlyfmmeafs oftre Atafe's Home,MxVe;n egs bPrufectfiomeowners Mt Contot Seek legal adviceifumessary,, yrP g � �'�Pful42A) but does nothrludestandard ConsumerOdd. toHomelmpiovemeat°before �Pr*vementssbouldfustobtartaco bmsumetAff*smdBm nMRe �mgtO-y�oayourresidenc,youmayobtaiaafreeco PYOf "A 8ulatous Coasmmerlaticn8otliee of 6I7A73-8187 or 1888 283-3757 of on onrwebge Homeowner irtfo�tauorz - - - --s � rrS �q aro Bade of materizTs fa be used, e a difional sheets ifne Requiredpermiis-The llowiagim7di�P�iisam andwiXbeSecuredbytreco ctmasthefiom ProposedSfattaadComplag"nSccedaIe-TherotTo rjogschw To (O,Ylzez s rrlZo secure ei� 2=zz—ss be adhered io mIe� cites b and the Ccmtrcws control arise excluded from the Gu8 alI fpl+nd �rovFsions ox 3 IXGL chp£e?;?4-),,) Data wfien conitacfarv2tlbegin confractedSros Date when cmtractedwo&cwM be sub Total ContractPriceand p ��Ycompleted. the Contractor agrees toaymeaeSchedule paformthuori5fumishthemat ialaadlaborsp-Zedabovefbrthe tofalsM a 06 Payments will be made according to thefollosvingschedule. upon signing oonh2ct (notto exceed 1/3 Of the tofat contractce $ Pri Athe cost ofspecialorderiteml�whicfieverisgreater) —`---�' ��' , /oruponcomple$onof /"-' s�/. t ^ /_1__/ orupon completion of uponcompletmofthecmtract`— (orbidsdemandiaghUPaymentunticontractis Thetbllowiag material/ compleiedto bottparty's satisfaction) ordertdbeforetbeconiractedwork S to be Pad to meet the completionscbednia(a) in order S tobspai for "OTES* 7nclodingall finMCO cbarges(es)taw rel urestbatmydeposit ordown nofcxceedthegreaterof(a)one-f*dofthetoWco�rct wor pamalcost farWsheCp pmeut rcur kbe9-may v6c hmust bespeeiel ordered is advanceto meet the completion schedules dual cost ofaay special egrupmeat orcus'em medemalwiel Subcontractors -The ccntracfm „ re red thews r? U No I] Yes fall terms o thewarra tvm 11 119 the PAY/sobconiracforuhlired eesiobesolelyresponsibleforromptcdonoffheworkdescnlredre ewe ma, dIab huftUz PYthff COD�ctor. The oonfractorfmtheregrees to be soIe2 mess of the actions of any third Yrespensible for an payments to all subcontractors for ConfractAccepfance-upon signing this document becomes abh ding c�tract corderlaw. Unless otherwisenoted etbPly*ataaylieaorotfiersecorityinterestbasbeeaplacedontberesideace Raviewtbefoll Y gig ibis contract vithnr this docume the owing cautions andwim, ° Don4bepressurediutodgaingthecontractTaketimeforeadandfull ° Make+thecon�ctorhasavalidHomeTmorovem� Yanderstandit Askquestionsifsamret�ingisunclear. soocontractorsfo bene tCont err, u, e h 7belawre registration 8>SteredwrthtireDuectorofHomolmpmvementContractorRe ' �esmosthomeimpanveroentcontractorsor and bY�gtotheDhecforatlo-p-kPlaza,Room5170,Bo m on Xourrrayiuquireaboutcontract ° Does theconimcf rLaveiasnrznce? Ask the Conhactorforhisinsuraaoe�'�02116orbycWling617-973-8787or8s82833757. Seca copy ofa`Proofo£insorance" document C°mP�Yiaformatioa so that _57. can confirm coveragr, or . fo �WtDtbc Dme-r rmvemibrtCOm Read thelmportant7nfa�ahonontherevarse deoftbisfohmandgetacopyoftheConsuma Guide io tteHomeImprnvemeai ConFrac�rLaw: urrmisoeeusignedataplaceotrerthanirecoatracinfsn, 11 1'1'', 11 11 "sines s, actor is writing at higher main office or branch office thirdbuskessdayfoII byordmarymai p by tele s, Provided you notifythe owing8te silpriagofthis &am seatorbydelivery, not later &an midadotofthe agreement SestheattachednoticeofcancellafionfomzforangcpIaaatioaoftbisright DONOT�IGiVTH CONTRACT.IETHEREAREANYB Tisola icopesoftbeconhxtmmtbe�apT.t�mdsigc4 (tyc�yshwlagototb:hom� LANKRACE'11! TLeoQ¢rcopysben'3h kern .Homeowner's Srgaafine S Sigaahue Date --__'"_ Date ilia tiomeimprovement Confractor tavrprovides homeowners with the right to initiate an arbitration action (as an aitemative to court action) iftheyhave 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 withahomeownerincourtuniess bothparties agree to the optional clause provided below. This clause would give the contractor the same right to arbitration as is afforded tothehomeownerbytheHomeImprovement Contractoriaw. The contractor and the homeommerherebyrrutoally agree !a advancethat in the eventthe contractorhas a dispute• concemingthis contract, the contractor may submitthe dispute to aprivate arbitration firm whichhas been approvedby the Secretary of the Executive Office of Consumer Affaafrs and Business Regulation and the consumer shall be required to submit to such arbitration as provided7n Massachusetts General Laws, chaptf r 1 Homeownees Signature Contractor's Signature TNOITC) : The signatures of the, parties above apply only to theagreement ofthepa— to alternative dispute resoludoniniiiaWbythecontractor. The homeownermayinitiate altemativedispute resolution evenwherethis 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 I -a -m (i.e. MGL chapter 93A) may not be waived in anyway, even by agreement. However, homeowners maybe excluded from certain rights if the contractor they choose is not properly registered as prescnbed bylaw. Homeowners who secure their own building permits are automatically excluded from all GuarantyFundprovisions of the Home Improvement Contractor Law. The contractor is responsible for completing the work as described, in a timely and worlcmanble manner. Homeowners 'maybe entitled to other specific legal rights if the contractor guarantees or provides an express vrenanty for workmanship or materials. In addition to guarantees or warranties provided by the contractor, all goods sold inMassachusetts carry an implied warranty ofinerchantability and fitness for. a particular purpose. An enumeration of other matters on which the homeowner and contractor Iawillly agree maybe added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have questions aboutyour contm.r/homeownerrijits,contacttheConsumerInfnmmationHotline(lisiedbelow). Esecation of Contract The contract must be executed in duplicate and should not be signeduntil a copy of all exhibits and referenced documents have been attached. Parties are also advised not to sign the docurnent uatil all blank sections have been f Iled in or marked as void, deleted, or not applicable. One original signed copy of the contract with at#acbments is to be given to the owner and the other kept by the contractor. Any modification to the original contract must be in vPriting and agreed to by both parties. Contracted workmay notbegin until both parties have received a fully executed copy of the contract; and the three day rescission period has expired. Accelerated Payments A contractormay not demand payments in advance ofthe dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure. However, in instances where a contractor deems him/herself to be financially insecure, the contractor may require thatthe balance of funds notyet due be placed in a joint escrow account as a prerequisite to continuing the contracted work Vithdrawal of fiords from said account would require the signatures of both parties. Additional af'ormatioa If you have general questions or need additional information about the Home Improvement ContractorLavr 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 ParkPlaza, Room 5170, Boston, MA 02116 617-973-8787, 888-283-3757 or visit the 0CAM website atlL4J/w%vw.mass.eov/ocabr/ If you want to verify the registration of a contractor or if you have questions orneed additional information specifically about: fire contractor registration component of the Home7mprovement Contractor Law, contact - Director of Home Improvement Contractor Registration Office of Consumer Affairs and Business Regulation 10 ParkPlaza, Room 5170, Boston, MA 02116 617-97 3 - 87 8 7, 888-2 93 3757 or visit the BIC website athtt ://wwvr.mass.gov/ocabr/ Go online to view the status of a Home Improvement Contractor's Registration: bM://db state ma.us/homeimnrovement/licenseelist asu For assistance with informal mediation of disputes or to registerf nal complaints against a business, call: Consumer Complaint Section Office of the Attorney General 617-727-8400 AND/OR Better Business Bureml 508-652-4800,508-755-25A8 or 413-734-3114 Vesioa 21-1ll2212010 Massachusetts - Department of Public Safety Board of Building Regulations and Standards Con%truction Super► icor License: CS -087977, $RIC W PAihf'; a' 3 EKTON S� f=; SALEM MA -01970 — Cbmmissioner Expiration 04/23/2014 Office Ab sumer yrs d`,-e/s II"eg a - = HOME IMPROVEMENT CONTRACTOR -- = Regisiration: 142089 Type: Expiration: 317212014 Ltd Liability Corl A C WEATIgE�iZA'ftQ ERIC PALM 61 R JEFFERSON AVE--.--f--,- SALEM, VE`` SALEM, MA 01970 -_ Undersecntary f'