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Home My WebLink AboutBuilding Permit #311-13 - 57 BOXFORD STREET 10/16/2012 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: s Date Received Date Issued: " IMPORTANT:Applicant must complete all items on this page LOCATION— Print PROPERTY OWNER_ grab Iti CiYal�/C.yl__ Print 100 Year Old Structure yesno MAP NO��6 _PARCEL: ZONING DISTRICT: Historic District yes no Machine.Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 06ne family ❑Addition ❑Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: Demolition ❑.Other ❑ Septic ❑Well D Floodplain ❑Wetlands ❑ Watershed District D Water/Sewer DESCRIPTION OF W RK TO BE RFORMED: Identification Please Type or Print Clearly) OWNER: Name: Ro i✓Y 4 xivi ati1 Phone: 9�h' f 9'e6 Address: CONTRACTOR Name: �pIQA,-Rst,��o L_ o Phone: Address: Supervisor's Construction License: �S _ >bti VExp: Date: Home Improvement License: Exp. Date: 6,!5- ARCH ITECT/ENG I NEER 5-ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE T TAL ESTIMA D TB7 OYD N$125.00 PER S.F. Total Project Cost: $ FEE: $_ '6 Check No.: Receipt No.: NOTE: Persons contracting w' unegl tered contractors do not have access to the guaranty fund Signature of Agent/OOwner. �!�/l Signature of contractor Plans Submitted ❑ Pla s W ive ❑ Certified Plot Plan 11 Stamped Plans ❑ { N ),- Date TOWN OF NORTH ANDOVER � 7 Certificate of Occupancy $ Building/Frame Permit Fee i Foundation Permit Fee $ Other Permit Fee $ at,,n TOTAL $ Checkytd,� 25841 Building Inspector Plans Submitted'd Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL ' L Public Sewer ❑ Swimming Pools El Art ❑ 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 r I HEALTH Reviewed on Signature � Y L 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: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 MainStreet Fire Departinenfsignature/date ° COMMENTS h l I 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, 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.$10041000 fine NOTES and DATA— (For department use ® Notified for pickup - Date i Doc.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. Roofing, Siding, Interior Rehabilitation Permits b/ Building Permit Application U/ Workers Comp Affidavit 4,' Photo Copy Of H.I.C. And/Or C.S.L. Licenses b/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) o 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 appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: Doc.Building Permit Revised 2012 Enter construction cost for fee cal - North Andover Fee Cakulatlon Construction Cost $ 46,000.00 m $ - $ 552.00 Plumbing Fee $ 69.00 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 69.00 Total fees collected $ 790.00 57 Boxford Street 311-13 on 10/16/2012 Remodel master bath, add new bath NORTH -own of : E : ,, sAndover No. t - h ver, Mass, d • �, �O COC It"WICK y.1 �- ADTED S V BOARD OF HEALTH Food/Kitchen PER IT D Septic System • THIS CERTIFIES THAT .. AVOW.... ... .. .�. .�. BUILDING INSPECTOR . .......... .... ... .. ......... .......... .................. has permission to ere c ........... buildings on .. ..o Foundation ., � Rough 1► to be occupied as .... ......... .... 1�I........... .... ... ..... chimney provided that the person accepting this permit shall in every respect conform o the erms 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 ONTH ELECTRICAL INSPECTOR UNLESS CONSTRUC I ST 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. SEE REVERSE SIDE NORTy T.ownoft E ., 6Andover 0 . � 0% h ver, Mass, �p COCNIC Nl WICK y1. A04ATED s � BOARD OF HEALTH Food/Kitchen PERIT LD Septic System THIS CERTIFIES THAT ........ 41IF40.... ... ... . . ....... �. .... BUILDING INSPECTOR Foundation has permission to ere c ....................... buildings on .. .. .... .......... .. .... .. .A............ .' Rough • to be occupied as .... .........�II4t.d l ...... . ..,�r.�.�. ,.... . ... .....�. . . . . ��t.�!r1t Chimney provided that the person accepting this permit shall in every respect conform o th erms 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 Ig60NTH§ ELECTRICAL INSPECTOR UNLESS CONSTRUCT 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. SEE REVERSE SIDE t Dali M Renovations Inc. Agreement wwALF � 2464 Massachusetts Avenuete 128 "� O Cambridge,idge,MA 02140 Date # Renovations Inc. Dalfiorrenovationsinc@gmaii.com 8/21/2012 581 Ro,,oclehn„k tic..rwesira rtion Phone# (617)661.2000 _ Name/Address Robin Savigni 57 Boxford St North Andover MA 01845 Payments Description First Second Third Total Second floor bathroom remodeling: -Remove all tile,plumbing fixtures,drywall and wall between closet and bedroom -Frame the new wall making the bathroom larger -Frame new opening for 3 casement or 3 double hung windows(homeowner will li pay for windows) -Re do all plumbing per code -Build stand up shower -Install a soak in tub -Install new windows -Apply durock -Install file to shower floor,wall and ceiling -Install the to bathroom floors -Build a new paneling chairrail 42'high along bathroom walls and to side of tub -Install new drywall and plaster -Install insulation to interior walls -Rewire entire bathroom per code Install all electrical and plumbing fixtures and accessories -Remove wall separating both bedrooms(If it isnot a barring wall) -Install single door matching master bedroom entrance -Patch hardwood floors a6,000.00 Patch walls and ceilings -Refinish the floor including stair area in darker color -Paint bathroom,bedrooms,hall and stairs "Homeowner will provide tiles,plumbing and electrical fixtures,bathroom accessories,grout,cabinets,glass and windows" (To add a standard bathroom next to the master bathroom=$5,000.00 �f Total price of labor and materials=$36,000.00 - Payment Schedule: $10,000.00 Deposit $10,000.00 Once rough inspection are passed Total jorneow'eesVinature and date Contractor's signature and date Page 1 J. NORTH own of 2 ndover Oma, y` to h ver, Mass, �p A_ COCMICHIWICK ��• 7�A04ArEO 0'P�`�.t5 S U BOARD OF HEALTH - T D Food/Kitchen Septic System THIS CERTIFIES THAT .....PER1.1 .4IN40.... ... .. .I. .�Smt .......... .......... .................. BUILDING INSPECTOR Foundation has permission to ere c ....................... buildings on .. .. .... ......... .. .... .. .............. .. Rough to be occupied as nlht. �1.�� .... ... ..... .kroon'l Chimney provided that the person accepting this permit shall in every respect conform o the erms 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 6110 4THELECTRICAL INSPECTOR UNLESS CONSTRUC I ST 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. SEE REVERSE SIDE � NORTf-� 'T-own :of Andover O Y No. - C, h ti ver, Mass,0 �p . COCNICNl W.cKP�_ A°R�TEo ►' ,��Cy s U BOARD OF HEALTH - T Food/Kitchen PER I L D Septic System 41 THIS CERTIFIES THAT 411IM1110.... ... .. .�. �� .... BUILDING INSPECTOR . . .. .. . .. . Foundation has permission to ere c ....................... buildings on A..e .... .......... .. .... .. .�............ Rough to be occupied as �. .... ... ..... � 5 chimney provided that the person accepting this permit shall in every respect conform o th er 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 UAONTH4 ELECTRICAL INSPECTOR UNLESS CONSTRUC I ST 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. SEE REVERSE SIDE Dalf or enovations tRInc.fiE' 24164 Massachusetts Avenue Agreement 1 10 ite 128 ambdge,MA 024Dat #A llT O C Renovations ]nC. Dalflonenovationsinc@gmaii.com &212012 561 Rrmairlins;&Yr..•ePhone# (617)661-2000 _ Name 1 Address Robin Savigni 57 Boxford St North Andover MA 01 845 Payments Description First Second Third Total $10,000.00 Once drywall,windows and tile are done $6,000.00 Once final inspection is passed Total $36,000.00 Honleo ees Ignature and date Contractor's si nature and date Page 2 n Sc,v ► �n� . S cl Flcooc Remo e-X x ki n Ll o aa x w � i i U S cxoe, ' - of 6'\ n J �= r �r� �c��c►v_�r, M� _t_oma. � [ �� i i r,.. i i a _ 1 S � 177/1 b d Io �s a i � _ i - ' i i � I r i � .• To:Building department Page 2 of 2 2012-09-25 16:44:05(GMT) 16178122425 From:Fernando Dalfior ........ ... 9/19/2012 6:12:05 AM PST (GMT-8) FROM: 1.00005-TO- 150S58_37744 Page: 2 of 2 ATE(WWOD/YYYYj CERTIFICATE OF LIABILITY 4USURANCE Sjj&20112 THIS CERTIFICATE 16 ISSUED ASA MATTER OF INFORMATION ONLY:AND•PONFFRS.NO RIGHTS UPON.THE CERTIFICATE HOLDER,THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR.NgGA AMEND, EXTEND.OR;-ALTER.. THE COVER, E AFFORDED BY .T[VELYAr? P .THE POLICIES BELOW. THIS CERTIFICATE OF:14$URANCE DOES M07 CONSTITUTE.A CONTRACT 1BETWEEN THE ISSUING INS-URER(S). AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:. if the certificate holderls an ADDITIQNAIL.INSURED,Ahe'poli do USURROGATION I y Ie ).musb e:en ,rsed. I S WAIVED, Subject to the team and can.ditions offho.policy,cartain.pplicies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu ofsuch endorsements. PRODUCER SYLVIA F.COSTA IN. AGCY CONTACT NAME: s�L�lx F dwx 15 MONTELLO ST* 10. BROCKTON, MA 02301 �11E 2 E-MAIL ADDRESS: INSURE R(S)AFFOROW6 COVERAGE MAIC If I NSURERA I ihprfV ut6al Insurariep INSURED INSURER.0 DALFIOR RENOVATIONS INC 2464 M,.SSAVENUE SUITE 1128INSURERC:. CAMBRIDGE MA 02140 INSURERO: INSURER I- WSURERF COVERAGES CERTIFICATE NUMBER. 114i25632 REVISION NUMBER: THIS 15 TO CERTIFY THATTHE:Pnl It IFS F-LISTEDEIELOW:H.. E J3EFWISS.IjIFD.*TO THE:INSURED.NAMED-.A8.bvE AN(7 FOR THE.,POLICY PERIOD, INDICATED. NOTWITHSTANDING AN.Y,.REQUIREMENT,TERM OR CONDITION PFANY CONTRACT OR OTHER-POCUMENT WITH RESPECT TO WHICH THIS. CERTIFICATE.MAY..5E.'ISSUEO::09*.M^Y.i!�ERTA II*4.THE IN3URANCE.-�kFFO!tDEP-BYTIIE.F;OLii�iE!:DEOQk.iS.�p, ]IPRpN is suejEcT To.ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE PIKN...REDUCED:PY PAID CLAIMS.: TYPE OF INSURANCE A001 SUER POLICYErr: POLICY EXP' LIMITS LTR INSR.= POLICY NUM.8.ER 77 GENERAL LtAH16TY EAGH OCCURRENGE 5 COMMERCIAL GENERALLIAWLITY 0REA 'ISE .De TO R INcT.ED S� Pon. ...... CLAIMS-MACE OCCUR MED EXP(Any one pemon) PERSONALA ADV.INJQRY $ GGNERALAdGREGATE $ CPNI.A(,CRFGATF.,I.IMIT.AP—PL IES PER:_. PRODUCTS.COMPIOP AGO S PRO LOG POLICY AUTOMOBILE LIABILITY a eaci SOjyNGLE LIMIT % ANY AUTO BODILY INJURY(Per pe—al 5 ALL OWNED SCHEDULED BODILYINJURY(Per accidefd) AUTOS- AUTOS NOWOWNED P1.1PROPERTY AhTACE HIRED AUTOS AUTOS Per UMBRELLA LIALS OCCUR .. EACHOCCuRprNCE. EXCESS UAB CLAIMS-MADE AGGREGATE DED RETENTIONS AWORKERS COMPENSATION YIN WC5-31S-354447-022 5412013 W CSTATU ANO eMPLOYERS-UAWLITY / TORY- IMITiI &,I ANY PROPRIETORWARTNER/EXECUTVIEE.L.EACH ACCIOErrr OFFICGB R/MEM ER.E:KCLUDrzG7 F_N_j NIA 500000 JM.Aciploq;n,N14) E-L DISEASE,EA EMPLOYEES 500000 If y",da.aiba under DESCRPTION Or OPERATIONS bete. E.L.DISEASE-POLIGY LIMIT S. 500000 DESCKIPTIONOI-OPEKXrIONS/LOCATIONS IVEHICLES(AWchACCRO 101,AQQitlon3l,RemlJRs Schedule,Ii!nvorp.space IS.'equirod) Workers corrIpenSation inSUrOnCo CoveraCle poplipS o .Ihe workOM Com pon5ation lawn of the stato MA. CERTIFICATE HOLDER CANCELLATION SHOULD ANY:OF'THE ABOVE ixescRiBiEDPOLICIES BE CANCELLED BEFORE THE EXPIRATION 'DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE A 16- 44 dridge . I Ia'19118.20110.41CORD,CORPORATION, All rights. ACORD 25(2010105). The ACORD name and logo are reolstered.marKsvfACORV CERT N 14125832 CLIENT CODE: 1475266 Anne Chandler 9119/2IV)012 6:09:57 -age.1.94.1. HIS Coei:cL 4C&te CanCeIS-and SuperaedeS ALL preVLoUsLy Issued CVA:tifLCat.5.. Building department Page 1 of 2 2012-09-25 16:44:05(GMT) 16178122425 From:Fernando Dalfior FAX COVER SHEET TO Building departrnent COMPANY FAX NUMBER 19786889542 FROM Fernando Dalfior DATE 2012-09-25 16:43:42 GMT RE Dalfior Renovations Inc COVER MESSAGE This is the workers comp certificate for the job on57 Boxford St, North Andover MA 01845. Please contact our office with any questions 617.661.2000. Hanna WWW.EFAX.COM sa, CJhn.Yer�7rc��aoaacuetiGC/o a�"C�iliLa�uic2ci�uu� Office of Consumer Affairs&Business Regulation #NOME IMPROVEMENT CONTRACTOR registration: 166284 Type: xpiration: 5/1.1/2014: Private Corporatic DALFIOR RENOVATIONS.;-INC FERNANDO DALFIOR ` 38 WEBBER ST - ga MALDEN,MA 02148 Undersecretary Massachusetts -Department of Public Safety ' Board of Building`Regulations and Standards Construction Supervisor License: CS-106404 FERNANDO DAL�1O 2464 MASS AVE 9128Ai' Cambridge MA 63140 4 Expiration Commissioner 04/14/2016 s The Commonwealth of Massachusetts Department of Industrial Accidents -- $ Office of Investigations I Congress Street,,S'uite 100 Boston, 0,114-2017 www mass,gov/dia r Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers f Applicant Information Please Print Legibly Naha(Business/Organization/Individual): L'(p Address: �y,��' fil 0.6 5 4 C L, y 7t 5 22 Vl � r av City/State/Zip: f&1W b , p Phone#: 02.od p 1 A!Zana n employer?Check th�eya�ppropHate box: Type of project(required): � 1. a employer with / // 4. E] I am a general contractor and I -Y--"- employees (full andlor part-time). have hired the sub-contractors 6• ❑ New construction 2.❑ I am-a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have S. ❑Demolition working for me in any capacity. employees and have workers' , [No workers'comp.insurance comp.insurance. # 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 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4), and we have no. employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether of not those entities have employees. If the subcontractors have employees,they must provide their work6rs'comp.policy number. I arra an employer that is providing workers'compensation insurance for my employees. Below is the policy andlob site information. Insurance Company Name: / ' & V-f-1,9 . Policy#or Self ins.Lie.#: L Ve- S _ 3 - 35- q y G - Expiration Date: Job Site Address:_ 7- Q3 c.4- City/State/ZipA-.,9_v Attach a copy of the 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$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. I do hereby certz der the p ains an d p enalties of EfYLUrY that the information provided above is true and coFree L Sign __Date Phone ff: L Official use oral,. Do not write in this area,to be completed by city or town official City or Towm: Permit/License# Issubg Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone# The Commonwealth ofMassachusetts Board of Building Regulations and Standards _._..... ..........._. -.Massachusetts-State-Building Code;780 .. CMR,7h--Edition ..... .. _ ...:............ _.__.._...__..._... r: Building Permit Application To Construct,Repair,Renovate Or Demolish a One-or Two-Family Dwelling ' SECTION fie AI)I3MONAP,APPROVALS r - 1. Ballardvale Historic District Commission: Date: 2. Board of Health: Date: ' 3. Conservation Commission: Date: j 4. . Design Review Board: Date: S. Electrical Permit Number: Date: 6. Fire Prevention: Date: 7. Planning Board Lot Release: Date: 8. Preservation Commission: Date: 4 9... Zoning Board of Appeals: Date: } 1 - I R t Massachusetts Come Im rovement - p SamPle contract This form satisfies all basic requirements o£the slate's Home Improvement Contractor Law(MGL chapter 142A),but does not include standard language to protect homeowners. Seek Iegal advice if 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 obtain a free copy by calling the Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617-973-8787 or 1-888-283-3757 or on our website. j Homeowner Information Contractor Information Name clCompany Name 5 dA.- Lto tel/ StreetAddress(do notusearostOfficeBoxaddress) Contractor/Salesperson/Owner Name /v City/Town State Zi Code 5 V P Business Address(must include a street address) 17/7 fS7 t • 6 b / � Daytime Phone Evening Phone City/Town State Zip Code Mailing Address(It different from above) usmess Phone I Federal Employer ID or S.S.Number Home Improvement Contractor Reg:Number Expiration date Law rerprires that most home improvement contractors have n valid registration number O 7 The Contractor agrees to do the following work for the Homeowner: (Descn'be in Beta` the worlcto completed,specifyingthe type,brand,and grade of materials to be used,use additional sheets ifnecessarv.) 3��rm�� rle�v��-,..1�0�/.,, L�-oma(/` • •� Sa�� °� 01 f.�.t ar•';L�m�^'..'��-� �f�� i��t/�— e�•••s� �, r j / � i!/,,e�-,�• �r/.�-..sus iv> '� 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 their own permits will be excluded from.the Guaranty Fund provisions ofo-/�- L 2. Date when contractor will begin contracted work. MGL chapter 142A.) -Date when contracted work will be substantially completed. Total Contract Price and Payment Schedule _ The Contractor agrees to perform the work,furoish the material and labor specified above for the total sum of: 6f 0"00 , -ep Q (F) Payments will be made according to the following schedule: $ �upon signing contract(not to exceed 1/3 of the total contract price or the cost of special order items,whichever is greater) by / / or upon completion of i $ a by / / or upon completion of $ upon completion of the contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction) . The following material/equipment must be special $ to be paid for ordered before the contracted work begins in order to meet the completion schedule.(**)) $ to be paid for NOTES:('i')Including all finance charges(*!")Law requires that any deposit or down-payment required by the contractor before work begins may not exceed the greater of(a)one-third of the total contract price or(b)the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule. Express Warranty-Is an express wRrl aniy being provided by the contractor? No❑•'Yea(all terms of the wnrranty must be attached to the contractl Subcontractors-The contractor agrees to bre solely responsible for completion of the work described regardless of the actions of any third party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agriement Contract Acceptance-Upon signing,this document becomes a binding contract under law. Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this contract. C Don't be pressured into signing the contract.Take time to read and fully understand it. Ask questions if something is unclear, 0 Malce sure the contractor has a valid Home Improvement Contractor Registration. The law requires most home improvement contractors and . subcontractors to be registered with the Director ofHome Improvement Contractor Registration. You may inquire about contractor registration by writing to the Director at 10 Park Plaza,Room 5170,Boston,MA.02116 or by calling 617-973-8787 or 888-283-3757. Does the contractor have insurance? AsIc the Contractor for his insurance company information so that you can confirm coverage,or ask to see a copy of a"proof of insurance"document. C Xn.ow your rights and responsibilities. Read the Important Information on the reverse side of this form and get a copy of the Consumer Guide to the Home Improvement:Contractor Law: You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business,provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight ofthe third business day following the signing of this agreement. See the attached notice of cancellation form for an explanation of this right. �----- D 'SIGN THIS CONTRACT IF THERE ARE ANX B LANd£SgACES!tr o identical opi of the contract must be completed and signed. One copy should go to the homeowner a other copy sltot11 kept by flee contractor. /� .. Romeo ner's rgna a�fontractor's Si atuxe Date %2 7 at- Date _ I I Contractor Arbitration The Home Impioyement 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 inutually 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 Rights A homeowner's rights under the Home Improvement Contractor Law(MGL chapter 142A) and other consumer protection laws (i.e.MGL chapter 93A)may not be waived in any way, even by agreement. However,homeowners may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law. Homeowners who secure their own building permits are automatically excluded'from all Guaranty Fund provisions of the Home Improvement Contractor Law. The contractor is responsible for completing the work as described,in a timely and worlananlike manner. Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for workmanship or materials. In addition to guarantees or warranties provided by the contractor, all goods sold-in Massachusetts carry an implied warranty of merchantability and fitness for a particular purpose. An enumeration of other matters on which the homeowner and contractor lawfully agree may be added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have questions about your consumer/homeowner rights, contact the Consumer Information 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 theoriginal contract must be in writing and agreed to by both parties. Contracted work may not begin until both parties have received a filly 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 im/herselfto be financially insecure,the contractor may require that the balance of funds not yet due be placed in a j oint escrow account as a prerequisite to continuing the contracted work. Withdrawal of fiends from said account would require the signatures of both parties. Additional Information .If you have general questions or need additional information about the Home Improvement Contractor Law or other consumer rights, or if you wish to obtain a free copy of "A Massachusetts Consumer Guide to Home Improvement" contact: Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza,Roam 5170,Boston,MA 02116 617-973-8787, 888-283-3757 or visit the OCABRwebsite atl2wvwv.mass.gov/ocabr/ If you want to verify the registration of a contractor or if you have questions or need additional information specifically about the contractor registration component of the Home Improvement Contractor Law,contact: Director of Home Improvement Contractor Registration Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787, 888-283-3757 or visit the H1C website at b=://www.inass-zov—/oc-,Lbr/ Go online to view the status of a Home Improvement Contractor's Registration: . 11t1-13://db.state.ma.us/homeimprovement/lice.seelist.asp For assistance with informal mediation of disputes or to register formal complaints against a business, call: Consumer Complaint Section Office of the Attorney General 617-727-8400 AND/OR Better Business Bureau 508-652-4800, 508-755-2548 or 413-734-3114• Version 2.1-11/22/2010