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HomeMy WebLinkAboutBuilding Permit #643-14 - 55 HEATH ROAD 3/19/2014TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO:rl Date Received Date Issued: 1q IMPORTANT:IMPORTANT: Applicant must complete all items on this page LOCATIONS PROPERTY OWNER 3 - - ---- T� V � 'Print - PROPERTY -Print- 100 Year Old Structure u yes no MAP -NO: PARCEL: ZONING DISTRICT. Historic District yes no Machine Shop Villaqe yes r no TYPE OF IMPROVEMENT. PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial epair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well - p Floodplain p Wetlands ❑ Watershed Qistrict� Cater/Sewer RIPTION OF WORK TO BE PERFORMED: eD/vc.� axis Ti� 1� �%N /gra T ge- �s� pPli�nlces e Kre� T- (�e�Friq er�� o r"a, NrVJ Sj�/°N/exr s/N/�l 9Y9N1,% e �avNler' Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: R D 1--c> w -e rs Address:ro2j��3Nvi`�le— Supervisor's -Construction License: C,5— D ¢?g 1 6 -Home Improvement License: >/� �- 7 7 3 - a 3 s- 79<? �# Exp. Date: Exp. Date: j©. "" 16 -o?D At 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 a 6, FEE: $ Check No.:_ a S Receipt No.: NOTE: .Persons contracting with unregistered contractors do not have access to the guaray�y fund Signature of Agent/Owner . Sigature, ofcontracto C Plans Submitted � Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ - -Plans Submitted ❑ .Plans Waived ❑- Certified Plot Plan ❑ Stamped Plans ❑ TYPE :OE ;SEWERAGEDiSP"OSAL" Public Sewer ❑ Tanning/MassageBodyArt ❑ .. .Swimming Pools ❑ Well ❑ Tobacco.Sales -Food Packaging/Sales ❑ Privatet(septic tank, etc._permanent Duinpster on Site 11 THE. FOLLOWING SECTIONS FOROFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM -DATE REJECTED: DATE:APPROVED PLANNING & DEVELOPMENT` ❑ ❑ COMMENTS -CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes - Planning Board Decision: Comments e Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Tow;! Engineer: Signature: Located 384 Os o d Street FIRE DEPARTIlIIEN :-.Temp Dumpster on site yes no - Located'at�124-Mair, Street: Fire "Departmeritsignatute/date t{ COMMENTS I/ .Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions._ _Total land area; sq. ft.: :ELECTRICAL: Movement of Meter location, Wriest or service drop requires approval of ,Electrical Inspector Yes No DANGER ZONE LITERATURE:. -Yes No MGLChapter°166.Section 21A -F and G min.$100=$1000fine NOTES and DATA — For department use ® Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department The following W'a-1st of the required.forms to be filled out -for the appropriate permit to .be obtained. Roofirg, 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 o 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 cas<s if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apryaal 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.Buiiding Permit Revised 2012 Location No. Date Check # 1 27362 TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee TOTAL Building Inspector Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 44,326.00 m $ - $ 531.91 Plumbing Fee $ 66.49 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 66.49 Total fees collected $ 764.89 55 Heath Road 643-14 on 3/19/2014 Kitchen Remodel E LAJ = O O CO t ' U Y \ O O LL E -O N to U ❑. N Ln o U LLI Z Z OLu = m O coN -O 7 O LL .0 7 O W C E L U f9 LL 0 W 0. aLLI Z C7 m J d t j 0(u OC N LL 0 d Z R " ~ W J W S j K N U N V) f0 O LL O 0. Z H (7 L j O OC t9 O LL z W a W o 25 Li i W i 7 m Z a+ N Y N N u O N .V � O Q. a� ea �o E O L d � O C �H t/) J CD CL An m r °f `W (D o 0 > �n — � U Q c � N O E %o C cc QU)z N g0 " U) 3 . r-Lownwo .� c a c a i iVCN G1 N QOm N � O ujN ., W = -0 w O O ,F LL 'N 2 to O O 0- O 'E = a r j O W CD L Q co Q_ N �j to M O `� O L3 O L = O H F+ CL V > VI Z V W Ccn L w0 �w az 0 F- C.) W IL U) z 0 z s J_ m �E CD E o o a z O AA�C c •y„ a0�_ m O �+ v O O O Q �a o C M CL 0 rz O L) tU m a CL U) 0 03/18/2014 15:59 FAX 603 382 3387 JOSEPH HILLS AGENCY INC Z 002 POWDBAI OP ID: ST '4 6, CERTIFICATE OF LIABILITY INSURANCE F!r,23/,,,14(MMIDDNYYY) 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(les) 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 endorsemen s). PRODUCER THE JOSEPH S. HILLS AGENCY INC 603-382-8211 129 MAIN STREET, PO BOX 300 603-382-3387 PLAISTOW, NH 03865-0300 CONTACT Sharon J. Tonal VHONE FAX .603-382-9211 Arc No): 603-382-3387 E-MAIL ADDRESS: sharon@hilisinsurance.com INSURFR,(El AFFORDING COVERAGE NAICf1 02/04/15 INSURER A: Main Street America Assurance 29939 PRr�MISjkJELqMLTqncsI $ 500,00 INSURED Bradley Powers, Jr. dba Brad Powers Construction 22 Wyman's Landing Danville, NH 03819 INSURER 61; INSURER C : INSURERD: GEN'L AGGREGATE LIMIT APPLIES PER: POLICY f X PRO- LOC PRODUCTS - COMPIOP AGG 8 2,000,000 INSURER E; INSURER F: AUTOMOBILE LIABILITYCOMBINED ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIREDAUTOS AUTOS COVERAGES CERTIFICATE NUMBER: 14-001 REVISION NUMBER: 001 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, _ I TYPE OF INSURANCE ADDL$1013 POLICY NUMBER ucv o YYYY 02/04/14 M/DD/YYYY LIMITS GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE IJ OCCUR MPS9290S 02/04/15 EACN OCCURRENCE $ 1,000,000 PRr�MISjkJELqMLTqncsI $ 500,00 MED EXP (Any one person) $ 10,00 PERSONAL & ADV INJURY $ 11000,00 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY f X PRO- LOC PRODUCTS - COMPIOP AGG 8 2,000,000 $ AUTOMOBILE LIABILITYCOMBINED ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIREDAUTOS AUTOS SINGLE LIMIT Ea ecddenl BODILY INJURY (Per portion) $ BODILY INJURY (Per sCCldenl) $ R Y DAMAGE $ Pereocident UMBRELLA UAB EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTIONS $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/FARTNER/EXECUTIVE Y7 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A I I �WCCSTATLL OTH- IMITS ER E.L. EACH ACCIDENT $ El, DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Ahnch ACORD 101, Additional Rom -arks Schedule, Ir more space Is requlred) Carpentry residential Town of North Andover 1600 Osgood Street Bldg 3120 Suite 2-36 N. Andover, MA 01845 NOANOV1 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 REPRES�ENTATNE ,r V 1988.2010 AGORD COKPOKA 1 ION. Ali rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD �( Massachusetts - Department of Public Safety �f Board of Building Regulations and Standards Construction Supervisor License: CS -04,8810 IS BRADLEY E POWkRS JR ' 22 WYMAN S LAfVDI1iG.�� DANVILLE NH 83819 ! i Expiration Commissioner 08/03/2015 Office of Consumer Affairs & B�fsiness Regulation HOME IMPROVEMENT CONTRACTOR Type. Registration. ,A22776 DBA Expiration 9r01a:612014 B POWERS EONSiF2VCTON t�R ;. BRADLEY POWERS 22 WYMANS LANDING DANVILLE, NH 0381 Undersecretary v 1111=10 vaacvvaiu 1.01%juiun,y wi vuvn%.aac vvan. 111" 1 36" 36' 1: 9� STW3657 STW3657 h STW3657 I A ani;t o5� 2) n N A - , V NS� NWS gad N rtw -1 ofD0 <s�' rt N x rt 7 Ort 0 0 0 T, p O 90 o Nz3 3a)C- f D 0 31 fD o aB CL gz aW, o �m 7 0 1 CL rt C .D•.1 m m 1 rt� 0 a N O 0 �• —art d= m 7 Mm 3 m� U) 0 rt imp a0 N C .. ......... W PI) OD 0 O r a ?�bZ9 0 O m � (ma w EEbZM 91 OEM ICC91.M n _ AFL r 05.3 CL ffZ(D(8 O ON m Z CD rt m- '. /D (A K C z A =.rtN�o0 N,0 �S7 �.-�. m m (D r-5 7 CD 0 '< C rto � 0 9 C .. ......... W PI) OD 0 O r a ?�bZ9 0 O m � (ma w EEbZM 91 OEM ICC91.M n _ AFL The Commonwealth ofMassachusetts • - Department oflndustriglAccidents Office oflnvestigations 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractor6/ElectricianslPlumbers Applicant Information Please Print LegitblY Name (Business/Organization/In fividual): Pot,,), e r S Co PJ 7.-r u c 71-p 1v D x # Address: o2 p2 Wj MgN y City/State/Zip:_ i9N V%lle Nd 03? l % Phone #: X03 Are you an employer? Check the appropriate box: Type ofproject (required): 1. ❑ lam a employer with 4. ❑ 1 am a general contractor and 1 ' 6. �] New construction ,9wployees (full and/orpart-time).* have Hired the sub -contractors 2. I am a sole proprietor or partner- listed on the attached sheet. x 7• emodeling ship and'have no employees These sub -contractors have 8. ❑ Demolition wonting forme in any capacity. workers' comp. insurance.g, ❑wilding addition [No workers' comp. insurance 5. El We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3. ❑ 1 am a homeowner doing all work right of exemption per MGL 1 l.❑ Plumbing. repairs or additions myself. [No workers' comp. c. 152, § 1(4), and we have no 12. ❑ Roof repairs insurance required.] employees. [No workers' 13.0 Other comp. insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers' compensation policy information. 7 Homeowners who submit this affidavit indicating they are doing,911 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. lam an employer that is providing workers' compensation insurance for my employees Below is thepolicy andf ob site information. Insurance Company Policy # or Self -ins. Lie. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL o. 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 $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. X do hereby cert under the pains andj7gnalties ofpepry that the information provided above is True andcorrect. reo-,Vd,i, // _ Date: .?::. — /(5p,— % Phone#: 60i _ to23S— -7%df6 / Official use only. Do not write in this area, to be completed by city or town official. City or Town:. Permitucense # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town CIerk 4. Electrical Inspector 5.Plumbing Inspector 6. Other - - Contact Person: Phone Information and Instruction's 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 ofhire,• 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 apartments 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 of public 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-contractor(s)name(s), address(es) and phone numbers) 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 required to carry workers' compensation insurance. Iran LLC orLLP does have employees, a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. AIso 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 license 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 reference 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 (i£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 maybe provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew 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 anal fax number: The Gomxanozawoaltb. o£MossacbvsPtts Dop.afteat of fadustdai .A,ccidouts offloe ofInvestigatitou 6QO WasbiVo,. Street Boston? MA. 021.1 x Tel, # 617-7.2 ,4900 eY,t406 or 1-8,77 NUA.SSAFJ3 Revised 5-26-05 Fax # 61W727-7749 www.mass,gov dia PKI This form. satisfies all basic requirements Of -the slate's Home Improvement Contractor Law (MGL chapter 142A), but does not include standard language se protect homeowners. SeeIc Iegal advice if necessary. Any person plariT;Tg home iripxover 142 should First obtain l copy standard Massachusetts Consumer Gtiude to Home Improvement" before agreeing to any work on your xesidence. You may obtain a free copy by calliugthe Office, of �'onstlmer A'CfairS and Business R egulation`s Consumer lnfomlation Hotline at 617-973-8787 encor xU may 83-3'157 eon copy by c site. -ROMP-Ow•Iler .�folrllti:ID.atiolm COJ Mt ra,ctolr Illi®] Irn n -Lints Street.A,ddress (do notuse a2ost r Co lvs u c- Ti N L15WA, .i w,1- �IVILbL4ULur agrees •co ao the foIlowing work for the Homeowner: (Describe in detaiithe woxlcto completed, specifyingthe type, brand, and grade of materials to be used, use additional she ifnecessa / P I4C� ^lu /, / ) Q v� i2 (JS��Jo!/I-t (foe sC9�iNe�'S fi�l %rl New. �Sf�r�e Y �'/'' exCe� T- r� �'ri��e/"•�To/�.. /Ve-w siAjl< CouNT•cr ??�� �gck-J-Pl-i rk T!/�:. Co�NTev ?'6F i s 9r�N/'�'e- ri��e is 3 Do';N/ess. ,5lNjG !'1 9/.ro STgiNIe.S.l. lltequireci Permits • The followvig building permits are required and will be secured by the cdntractor as•the homeowner's agent: (Owners who secure their own PerinS.ts :WM be excluded from the Guaranty Fund proylsxons O:r MGL chapter 142A,) Total Contra";Xriee and Payment Schedule The Contractor agrees to perform, the work, furnish the Proposed Start and Completioxx Schedule - The following schedule Will be adhered to unless circumstances beyond the contractor's control, arise Date when, contractor will, begin, contracted work. ¢bate when contracted work will be substantially completed. Payments will be made according to the following schedul• C� Tot hmN�� c�wNe?' �e s�oNri6/L a a $ oop upon signing contract (not to exceed 113 of the total contract price or the cost of special order items, whichever is grea e�iNe�a 30�o v �------=— by 3 / 3 / 40 upon, completion of D-000 ie .1� $' ¢ (�6 �J9 C#v�Ne7-f' irrg,vir� $---- p ° by¢or upon coin Teflon of _� M d -d r' p1 P%b14;JU1�"�� ���j "i1�R X006 upon completion of the contract. (Law forbids demanding� rr*r� full payment until contract is completed to both ' Thefollowingmateriallequipmentmustbespecial t-407 �(O plyssatisfaction). Ordered before the contractedworkbegins inorder =;:= -- . tobepaidfox o wNe l� to meet -the completion schedule.o�-*) to be paid for Including all finance charges (*'j°) Law requires that any deposit or down payment required by the contractor b for orjc not exceed the greater of er one) of the total contract price or (b) the actual cost of any special equipment or ew custombegin material which must Ue special ordered in advaude to meet the completion Behedule. made Subcontr actors -'The contractor agrees to be solelyxesponsible forreompletl0 o f 0 work d scriOf thezamInn-il—MMITst be, bed regardless o£ihe actions of cT JO theconontrael:' party/subcontractor of zedbythe contractor. The contractor furthex agrees to be solely responsible for all a ate ials and aborundertlus a eement payments to all subcontractors for c o tract shall nOt im imply Upon signing, this document becomes a bin ding comtract under law. Unless Otherwise noted withi-a:EE- documen the contract shall rot i ring this cony Tien or other security interest has been, placed on.the residence- Review tine following cautions and notices carefully before signing this contract. � ° Don't be pressured into signing the contract. Take time to read and fully understand it. Ask questions if something is unclear., Make sure the contractor has a valid I�orn e im xovement Contractor Re MT "On. subcontractors to bele with the Director of:I3ome Improvement Contractor Registration. You may inquire about contractor The law requires most home improvement contractors and registration by writingto the Director at 10 ParkPlaza, Room, 5170,130ston, MA .02116 or by calling.617-973 8787 or 888 283-37 7. Does the contractor have insurance? Ask the Contractor fox his insurance company information so that ybu can cvnfu r coverage, or . to sees copy of a "proof of insurance" document. ° Ian ow our rights and xes onsibilities. Read the Im ortaut Information on the reverse side of this form and et a Y gh p p Guide to the I-1omc Improvement Contractor Law: g copy of the Consumer c ou may cancel this at m in O been signed at a place other than. the contractor's normal place of business, provided contractor in writing at 7us/hex mann office or branch office by ordinary mail posted, by telegram sent or by deiiveiy, not later than midni t o third business clay followia the sq p you r.otifythe g b'uing ofthis agreement. Seethe attached notice of caucellation :20121001' an explanation ofthis right, fthe �®1\Tpies CIdT'J[' [I[ (C T�RA,C�' IV 7CII o idenh copies oft, contract must be completed and signed, One copy should go to the homeowner. ERE APX AN' 3'� g CE'S oairaceor, Ivmeow er's z ' Jure Contractor's Signature 'Date � /O �oZ a / Date ConfXactor Arlan-.tiou The Home 7n1p%ovem--nt Contractor Law provides homeowners with the right to initiate an arbitration action (as an 'altermative to court action) if they have a dispute with a eoniTaetor. contractor, however. The contractor would have to The Bayne right is not automatically afCordedto a both parties agree to the optional[ clause resolve any dispute he/she has With a home owner.in court unless provided below. This clause would give the contractor the same o t un arbitration as is afforded to the homeowner by the Home Improvement Contractor Law. gto The contractor and the homeowner hereby inutaally agree in advance that in the event the contractor has a dispute concexniug this contract; tale contractor may submit the dispute to a private arbitration ;C m which has been approved by the Secretary of the Executive OfEce of Consumer Affairs and Business Regtirlation and the consumer shall be required to sttb 't to s h axbitraixon as -provided In Massachusetts General. Laws, chapter 14.2 Romeo or ' Signattitte ®�� Contractors Signature he signatatres of the parties above apply onlyto the agreement of parties to alternative dispute xesolut"On initiated by the contractor: The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the joarties. Homeowner's Rights A homeowner's rights under the Home Improvement Contractor LM (MGL chapter 142A) and other consumer protection. laws (i.e. MGL chapter 93A) may not be waived iaa. any way, even. by agreement. Ilowever, homeowners may be excluded from cextaan rights if tli e contractor they choose is not properly registered as prescribed by law, Hoxneown ens who secure their own buildi7a g p ermits are automatically excluded :0; om all Gttaxauty Fund provisions of the dome Improvement Contractor -Law. The contractor isf responsible for completing the work as described, in a timely anal woxl=anlike manner. Homeowmrs may be entitled to other specific legal rights if the contractor gr Provided b or e, coprovntrades t express warranty for woxlmnanship or materials, k addition to provided by the contractor, all goods sold -in Massachusetts cagy an implied warranty of merchantability and tion s for a paaticular purpose. An enumeration of other matters on which the homeowner and contractor lavduny agree may tae added to the terms of the contract as long as they do not xesl,Tict a homeowner's basic consumer rights. Tf yott have questions about your eonsumer/ho=eowmer rights, contact the Consumer 111f01rnation xlotline (listed below). 1Execution. of Contract. The contract mast be executed in clttplicate and should not be signed until a copy of all exhibits and referenced Med documents have been -attached. Patties are. also advised not to sign the documenttryaifil all blank sections have been ed in or marlted as void, deleted, or not applicable. One brigival signed copy of the contract with atL•achments is to be given to the owner and the other kept by the coniTactox. Any Mod" cation 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 fatty 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 deeally i eewe rself to be financially insecLlre. However, in instances where a conixactor deems him&erself to be financially insecure, the contractor May requite that the balance of funds not yet due be placed in a j oint escrow account as a pxeregttisite to comtintiting the contracted woxlt. �?,rxthclrawal of fLw ds Crow saidaccottut would require the SignatLtres of both parties. Additional Wormation .If you have general questions or need additional in-oxination about the Rome Improvement Contractor Law or other consumer rights, or if you. wish to obtain a free copy of "A Massachusetts Consumer Guide to Horne Ixmp�ovement" contact: Consumer Ihf- foz ation 11&ae Of. ce of Consumer Affairs and Business Regtitlation 10 617-973-8787,'888-28g-3757 ox�asitthe OCABR••webs , ROOM 5170, ie atl02116 pl �v vxnass: ' — �•ov/ocabi/ If you want to verify the registration of a contractor ox i f you have questions or need additional information speci;C"<cally about the contractor registration CO you of the Home Improvement Contractor Law, contact: DrTectox of Home improvement Contractor Regi st *anon. OfEce of Consumer .Affairs aud•Business Regulation 1b PaTkPlaza, ROOM:5170, BostonMA 617-973-8787, 888-283-3757 or visit the 1 -UC we bsite'at --17 02116 •//wtX�LVi11aSs Dov/nr��1/ Go online to view •the status of a Home Improvement Contractor's Registration: , h�.i. �://db s•Eate ma tee/t1o7neirnt�roveir�en•Ulicenseelist.as . For assistance with informal anediatxon of disputes or to register formal complaints against a business, call,; Consumex Complaint Sectio? OfEce of the AttoLacy eeneral 617-727-8400 AND/OR, Better Business Bureau 508-652-4-800,;508.7755-2548 or 413-734-31:14. RM,1 1 1 ; � BRAD POWERS CONSTRUCTION 22 Wymans Landing DANVILLE, NH 03819 (603) 642-6428 Page No. of Pages PROPOSAL S9r 7— / LJ yQ V PHONE I DATE 0?— / STREET / / ` a JOB NAME CITY, STATE and ZIP CODE JOB LOCATION / r--- Ve ARCHITECT DATE OF PLANS J B PHONE Pee --0710/.3 - 9�(ob'"9-�d�?7 We Pir0P0$P hereby to furnish material and labor— complete in accordance with specifications below, for the sum of: dollars$ / 6 00, DD ( ). Payment to be made as follows: y s7"�r7- ''�.3oov_ aOc'oMp, o -P trema, prep �' �9sQ. Cgk)Vers, 3. ©oo,Ca Cory . d 4' /'e1)fai,jiN C-iNeT,r T/c. C'Qu�i�t"T'�s ' 1 �. C°oL, a P'b All material is guaranteed to be as specified. All work to be completed in a workmanlike i manner according to standard practices. Any alteration or deviation from specifications be- Authorized low involving extra costs will be executed only upon written orders, and will become an Signature C extra charge over and above the estimate. All agreements contingent upon strikes, acci- dents or delays beyond our control. Owner to carry fire, tornado and other necessary Note: This proposal may be insurance. withdrawn by us if not accepted within .days. We hereby submit specifications and estimates for: + 5/rte- prep,-�'/bor 4 roF-ec-7'X'a/V -- Remove- v// c -Q N* T -s �/',�'� 4�vice s 6,-) iN9 %r TriC� I D'S. Ca!-1N-eCTRYPp -Fr- /VebvC-77S a i s� Pose_ a q // A-. r is iN AIM? 7Y-7; /-,-- r l -- re Whlls :F �/�sf'ef �C�;l�N� 147-1 avers;lv �TNs f`9 // /V e tN Cg ;Ne rs r `m/.)/4% -e- work -ror /le�-j Coco, icr 72�!'9N!Tg of /0-) - �Ns7- ?/� rer��,�►;NG �`�S�Ne rs ��a���„�I C Nt-er To? J- /Ns/gIle ��►rR;,,'r;e- IDcdf/r- - SNS Tei/ q c/4.� �'/� 9 r 7-- S T� e. s c -e- 4e�re r c/vd4e, Q) -- /� 7-06q %1 aa{c A'v r7 A4 UP le -r 644 %i yrs "�-Ove sC4 -- G� us r do o Tui clr9we-rs:” s-' 4vs /-;t?/ / f? q rgefrq re_. 0<"L'--r"P v//s� -- Pro -e iro11,e c 7 e -7 m*—, -r, t' -- tail Cov,vTP/��4;NJ1�v }7'i/eA/'ov� c3��o/i�Nc esu p-erml rs.) T9 l C o f r �ej c ri r Acceptance of Proposal— The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Date of Acceptance: I Signatur /j/�Znl____ Signature