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HomeMy WebLinkAboutBuilding Permit #270 - 57 GREEN HILL AVENUE 9/24/2013 TOWN OF NORTH ANDOVER i APPLICATION FOR PLAN EXAMINATION Permit NO: Q-�-vDate Received Date Issued: qbtd� IMPORTANT: Applicant must complete all items on this page .: .'� {� ,�: �;• /7t r�'P'/y///]]]]]��-�- ��/�` �. a` � 9` '# ,, a fik y LOCATION PROPERTtY OWNER t ccQ � AL t r ,Pant .1-00 Y-e'a d�Structure yes," nn 'MAP NO'lJZ _PARCEL. (� ZONLNG�DIS�TRICT yesr" chineShop Villa TYPE OF IMPROVEMENT. PROPOSED USE f Residential Non- Residential ❑ New Building ,A-One family ❑Addition ❑Two or more family ❑ Industrial .*Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ;Septic ❑`,1Nell ❑ Flog plain« 1Netlands ❑ Watershed Dist�ict� 1 =p Water/Sewer - - -._ D SCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR``Name ,(s( =� sc R 0kdi'- . c�t�` Phone -Address. o Aj x Sup" iso_f's Constructi WL cense t Co79 `Exp Date. i Home Improvement License._ 133 2 �:- 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: $ - 0 FEE: $ - - Check No.: ; Receipt No.: NOTE: .Persons contracting with unregistered contractors do not have accessto the arantynd S ni ature of A-end w0 ner - $� j� giature.of contractor � a Plans Submitted Pi Plans Waived ❑ Certified Plot Plan ❑ Stamped lans ❑ g ui i�n -De artment � The Eowing is-a-list of the required forms to be filled out for tA�avpr , riate permit to be obtained. i oofirg, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit i ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ loor Plan Or Proposed Interior Work ❑ En " ring Affidavits for Engineered product NOTE: All dumpster pe its-re .quire sign off from Fire D ment prior to issuance of Bldg Permit Addition Or Decks _— i ❑ 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 ConstructionSin le and Two Family) � 9 Y) ❑ Building Permit Application i ❑ 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 apw-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.+.ted with the building application Doc: Doc.Building Permit Revised 2012 i i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE_OF°:SEWERAGE DISPOSAL El Public Sewer ElTanning/Massage/Body Art ❑ Swimming Pools Well ❑ Tobacco.Sales ❑ Food Packaging/Sales El 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 HEALTH Reviewed on Signature COMMENTS .A Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes . Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer ConnectioniSignature& Date Driveway Permit DPW Tow2 Engineer: Signature: - Located 384 Osgood Street FARE-DEPARTMfeli9T Temp Dempster on site yes no Located at 124 Mair. Street Fire'Depart`riie►it.signature/date " COMMENTS t i f Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions._ Total land area, sq. ft.: ELECTRICAL: Movement of Dieter location mast or service drop q pp 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 rase j I D Notified for pickup - Date i 2 Doc.Building Permit Revised 2010 I Location No. a Date— — 1 • • TOWN OF NORTH ANDOVER � Certificate of Occupancy $ In Building/Frame Permit Fee . $. Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 2689 Building Inspector BONEMA1 OP ID:SH Ate-'=- CERTIFICATE OF LIABILITY INSURANCE DATE 101301D0lYYYY) 10!30/2013 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 POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed, If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s), PRODUCER CONTACT Whittemore Insurance NAME: 172 Rockingham Road LLc_Ma,5><t1:,603-432-2577 LIC,No); 603-432-4700 Londonderry,NH 03053 E-MAIL - ADDRE88; INSURERU ARFORDtNO COVERAGE NAIC d __. _ __,••INSURERA:NGM Insurance Company, _ 14788 INSURED MJB COnStruCtlOn INSURER M:Liberty Mutual Marco Bonenfant dba - - - 11 Cove Street INSURER 0: Derry, NH 03038 INSURER O; INSURER e: _ INBURER F*.'"' COVERAGES CERTIFICATE NUMBER. REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. )NSR TYPE OF INSURANCE - LILY EFF P Lley gxp POLICY NUMBER MMD YYY MMIDDIY LIMITS GENERAL LIA9ILITY EACH OCCURRENCE S 1,DOO,000 A X COMMERCIAL GENERAL LIABILITY MPK0313N 04130/2013 04/30/2014 UAMAG�TORFc1trrDence x 50,000 PRIEMISCI.AIMS-MADE L 1 OCCUR MEDEXP(Any ana person) S _ 51000 kOEN'L PERSONAL B ADV INJURY S 1,000,000 GFNERALAGGREGATE $ 2,000,000 AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGO S 2,000,000 PRO- r- _ POLICY LOC $ AUTOMOBILE LIABILITY I COM13INP-D$IN(JLE LIMIT �.A eccJ.aenO R_;, ANY AUTO BODILY INJURY(Per parson) $ ALL Or I SCHEDULED AUTOS AUTOS BODILY INJURY Peroccidnnl) $ _ .. HIREDAUTOS NON-OWNED PROPER DAMAGE '-- _. _ AUTOS (EER ACCIDENT) _ S UMBRELLA LIAR OCCUREACH OCCURRENCE $ _ EXCESS LIAR - CLAIMS-MADE AGGREGATE DED RETENTION$ S WORKERS COMPENSATION WC ST TU- OTH- AND EMPLOYERS'LIA6ILITY TORY-LI R—__. B ANY PROPRIETOR/PARTNER/BXECUTIVE YIN WCS-31 S-391795.013 09/18/2013 09/18/2014 E.L.EAC14 AOCIDP.NT $ 100,000 OFFICER/MF-MBER EXCLUDED? NIA (Mandatory In NH) E.L DISEASE-EA EMPLOYEE $ 100,000 If Yy�o- dagcribo under DGSCRIpT10N OF OPERATIONS below L.DISEASE-POLICY LIMIT •a 500,000 I DESCRIPTION OF OPERATIONS/LOCATIONS.!vEHICLES (Atlaoh ACORD 1011 Additional It marks SeAodulo,H mora spr,eo le roqulrod) Project location 57 Green H111 Ave in North Andover MA CERTIFICATE HOLDER CANCELLATION TOWNOFN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood St ACCORDANCE WITH THE POLICY PROVISIONS, North Andover, MA 01845 AUTHORIZEDREPRESENTA'nvE 10 e ©1988-2010 ACORD CORPORATION. All rlght9 reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost 32,000.00 m $ - $ 384.00 Plumbing Fee $ 48.00 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 48.00 Total fees collected $ 580.00 57 Green Hill Avenue 270-14 on 9/24/2013 Kitchen Remodel MJB Construction Design. Build. Remodel 978.360.0937 Date:9/12/2013 Steve and Kim 52 Green Hill Ave North Andover Ma Demo. • Kitchen cabinets and tops • I interior wall and 1 knee wall upon side entrance • Main bathroom shower stall tile and file floor • Block boxes side of chimney • Removal of trim for windows and doors in common areas • Removal of triple window separate units 2 being reused Bathroom • Remove wallpaper prep for paint • Tile shower stall and floor(owner to supply tile&grout) • Reinstall original toilet and white vanity Kitchen • Frame for 2 windows and install casement windows from demo • Install kitchen cabinets supplied by owner • Install center island supplied by owner Living room • Block and drywall for chimney • Build 2 plywood built-ins popular faced nonadjustable shelves Trim • Install new colonial casing for all common areas.nothing inside bedrooms and 2na bath Paint • Paint all ceilings flat white • All trim to be sanded and oil primed then painted with latex pearl finish • All rooms of house 1't floor to be painted with owners color choice • All paints to be used are from Benjamin Moore products Contractor will supply all materials,labor and permits for the upper described project except where noted. Home owner will supply all cabinets and counter tops estimated$13,000.00 Estimated price for contractor work as described above$19,000.00 Total Price of Project$32,000.00 Deposit of$6,333.00 upon acceptance of contract 2nd payment$6333.00 TBD Final payment$6,333.00 when job is complete. If everything is in order and satisfactory please sign and date below to proceed with project. Owner: Signature: Date: �.�> Contractor: Signature: Date: 07 Project Start Date: Any deviations or changes to above contract will be discussed and accompanied with signatures of both parties prior to proceeding.A change order will be drafted and payment will be due as work is completed. Marco Bonenfant 11 Cove Dr. Deny NH 03038 Construction Supervisor#CS-106799 Home improvement Contractor# 132426 r , NORTH c . . ver 0 No. to— _ - 14Z I� o - ��K. h , ver, Mass, coc LIC a C. TE� fkf' �S s � BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System THIS CERTIFIES THAT O C­04.4;�L.q* ........................................... BUILDING INSPECTOR ................ ....................... has permission to erect ...... buildings on .. ,�.C?�!�ti.�'�.(.1. ,�.�,.,.. Foundation .................... ........ ..... Rough to be occupied as ............... 1w.. .. ..... ...........� .��/.!:Fr� .. .. ............................... C imney n provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. - PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES tINMONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU TSRough 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 lcx The Commonwealth of Massachusetts Department of IndustriglAccidents Office of Investigations 600 Washington.Street Boston,MA.02111 U9 www.massgov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers ,Applicant Information Please Print Legibly Name(Business/Organization/Individual): r SJ?1Q"Z1C) Address: r - City/State/Zip: e> a Phone#: 0/7 ZC (�C��fi?-):Z Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have Hired the sub-contractors 2.(� I am a sole proprietor or partner- listed on the attached sheet. 'l• ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its 10.[1 Electrical repairs or additions required.] officers have exercised their 3111 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance .re uiredemployees.[No workers' required.] 13.F1 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 checkthis box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the,policy and job site information. Insurance Company Name:. Policy 0 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 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. Ido I re by cert un r ae pain dpenalties ofperjury that the information provided above is ff a and correct. Si atur a Date: Phone#: Ofjlei l use only. Do not write in this area,to be completed by city or town official. City 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 - !t - C'nn+a PfpPYcnn• � Phone 4: __-_ 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"he 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-contractors)name(s),address(es)and phonenumber(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 notrequired to cavy workers'compensation insurance. If an LLC or LLP 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. 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,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(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 future permits or licenses. A new 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 and fax number: The Goxnmo woa t o iassachusPt Depart went of WuMal.Accidents Office ofInayestigations. 600 Washington Stroet BwfQ-nMA021T1 TQL#617-72.7-4900 eYt 406 or 1.-877-MASSAFF, Revised 5-26-05 Faze#617-727-7749 --- �Cr�aacfu�eGld ze o f Consumer Affairs , office oCONTRACTOR ess Regulation 1 _ Type; OMEIMPROVEMENT registration: 132426 Individual` Expiration ?1512015'` Marco Bonenfant l M o Marco Bonenfant I ' 11 COVE GR undersecreta.Y NH 03038 rx. DERRY, - Massachusetts-Department of Public Safety. lug Board of Building Regulations and Standards Construction Supervisor AIM, I License: CS-106799 MARCO BONENFA—NT 11 COVER DRIVE fl Derry NH 03038= h 'i Expiration Commissioner 03/311 016 M >lnoe.40 Rome Tain -,rnyP -aant sam ]P- (rn-nfx' 'a ct This farm satisfies all basic re language to protect hoquirements of the state's Home Improvement:Contractor Law(MGI.:chapter 142A),but does not include standard meowners. Seek legal advice if necessary. Any person planning home iinprovementS should first obtain a copy af'!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 lt,eguiation's Consumer InfoaanationHatliiae at 617-973-877 or 1-888-283-3757 ox on our website. ' ®ffieO�PI]e1t' ® �1�i®III n Contractor Iniformat on Name r— n Company Name Street Address((do aiotuse aPost Office Box address) J N LCon=taotor/Salesperson OwnerName '` 0°m Snrte ApCode Bpsiness Address(tmTst include.a street address) Tr7r3�� r70 D�' Daytime Phone EveningPhonewn • City/Town �r State Zip C°dc Mailing Address(It different from above) O 30 Business Phone federal Bmployer ID or S.S.Number HomeImpmvemertContmcrorlteg:Number Expiration date ' Law rcgttires tbatmost home improvement contractors itnve a wild registration number The Contractor agrees to do the following work for the Homeowner: (Describe in detailthe worlcto completed,specifyingthe type,brand,and grade.of materials to be used,tise additionai_sheets ifnecessa,v) NI N U LC 4N4*AJ b' s -� Require'Permits-The foJlowmg building permits are required Proposed Start and Completion Schedule- and will be secured by the.contractor as-the , P u e The followin schedule Will homeowners agent: be adhexedto unless circum tg ®�vmeys stances beyond the contractors co who secure their own ile>rm its:wW be control arse excluded frons.the Guaranty Emd provisions of MGL chapter 142.A,.) Date when contractor will begin contracted work. Date when contracted work will be substantially completed. Total Contract Price.and Payment Schedule The Contractor agrees to per form the work,furnish the material and labor specified above for the total sum of. Payments will be made according to the following schedule: _ upon signing contract(not to exceed 1/3 of the total contract price ox the cost of special order items,whichever is greater) by or upon completion of $ by / / or upon completion of upon completion of the contract. (Law forbids demanding full payment until contract is completed to both p party's satisfaction) . The following material/equipmentmust be special $ ordered before the contracted work begins in order to be paid for to meetthe completion ichedule.(*") $ to be paid for NOTES,(")Including all finance charges(.r..r.)Law requires that any deposit or down- payment not exceed the greater of(a)one-third of the total contract price or(b)the actual cost required f anb special pequipme contractor before custom may which must be special ordered in advande to meet the completion schedule. Yequipment or cusinm made material Bx Tess Warran -Xs an c. ress warren bein rovicied the contractor? Subcontractors-The contractor agrees to b.e solely responsible for completion of the work described regardless ofthe actions of any third ontract party/subcontractor utilized by the contractor. The contractor anther agrees to be solei responsible for all a Y Materials and labor under this a cement Y payments to all subcontractors for c Contract s all notaimplyt ori signing,eor other r security becomes ab inding contract under law. Unless otherwise noted within.this docume>�the contract before i ring this any ran or other security interest has been placed onthe residence. Review the following cautions and notices carefully before signing this contract. b Don't be pressured into signing the contract.Take time to read and fu]] o and al Y understand i ce sine t t. Ask questions be c es ontractor has a valid Tome Tin rovement q lacus if something is unclear, Contractor Re 'stration subcontractors to be registered with the Director ofl-Iome Improvement Contractor Registratio. The law n. You most may home �e bout c improvement contractors and cis registration by writingto the Director at 10 Parlc Y q about contractor Plat Room 5 x o Does the contractor have insurance? Ask the Contractor for his�70,Roston,MA or by calling.617-973 8787 or 888-283-3757. see a copy of a `proof of insurance"documentinsurance eo. m'pmy information so that you can confirm coverage,or ask to o X ow your rights and responsibilities. Read the Important Infonntation on,the reverse side of this fora.and get a copy of the Consumer Guide to the Rome Improvement Contractor Law. Youmay cancel this ogreement.ifithas been signed ataplace other than the contractor's normal place of business,provided you no' the contractor in writing at his/her main office o th branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business clay following the signing oftbis agzeement. Seethe attached notice of cancellation form for an explanation of this right, ®1copies o the c TSS CONTRACT IF TB ERF, Two identical copies of the con ct must be completed and signed. One c ARE �` ��AM<Sg.ACES 111 opy should go to the homeodmer. The other copy shouldbe kept by the contractor, CO Contractor's Signature 'Date Date The Home Improvexn ent Contractor Lawprovides homeowners with the right to initiate an arbitration action(as an 'alternative to court action)if they have a dispute Mtli a contractor. The setae right is no t automatically a�oxdedto a contractor,however. The contractor would have to resolve any dispute he/she has with a homeowner.in eotu unless both parties agree to the optional clause provided•below: This clausewould give the contractor the same xi arbitration as is afforded toht to .the homeowner by'the'Homa Improvement Contractor Law. g The contractor and the homeowner hereby inutaally concerning this contracagreein advance that in the event the contractor has a dispute t, he contractor may submit the dispute to a private arbitration,:am which has been approved.by the S ecretkT of the Executive Office Of.Consubi.er Affairs and Business Regulation and the coylsttm er shaT7 be re;„,ed to submit to 'such arbi•(raticn as-provided la Massachusetts General Laws, chapter 14.2A.. t 34ne iaeContractor's Signature OT The si tares ofthe pages above apply only to the agreement of the pal tie to alternative dispute resolution initiated by the contractor: The homeowner may initiate alternative dispute resolution even section isnot separately signed 3y the patties. where this I lomeowner's Rights A homeowner's rights under theIoyne Improvement Contractor Law(MGL chapter 142A)6ayd other consumer r-.- protection.laws (i.e.MGL chapter 93A)may not be waived in any way, even,by agreement. However,homeowners, maybe excluded from certain,rights if the contractor they choose is not properly y:egistered as prescribed by law. Homeowners who secure their own building permits are automatically excluded'From all GuarmtyFund provisions of the Home Improvement Contractor Law. The contractor is responsible for completing the woxlc as described,in a timely and worlumnlike manner. Homeowmrs may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty:for workmanship or materials. In addition to provided by the contractor, all goods sold•in Massachusetts cavy an implied #arranty of merchantability and fitness for a particular purpose. An enumeration of other matters on which the homeowner and contractor lav6 l.ly agree may be added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights. If yott have questions about your consumer/homeowner rights, contact the Consumer I-ofbimation Hotline(listed below). (Execution of Contract- The ontractThe contract must be executed in dtt licate and should not be signed until a copy of all exhibits and referenced documents have been attached. Panes are.also advised not to sign the document until all blank sections have been , filled in or marlwd as void,deleted, or not applicable. Ono orignal 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 fany 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.paymen-schedule incases where the homeowner deems 1�;mlherself to be financially insecure. However,in instances where a contractor deems him/herself to be:ruancially insecure,the contractor may require that the balance of funds not yet dii.e be placed in a j oint escrow account as a prerequisite to continuing the contracted work Withdrawal of fitnds signatures of both parties. from said account would require the :Additiond Wo:rm.ation 7f you have general,questions or need additional i -rorivation about the Home Improvement Contractor Law or other constuuer rights, or if you wish to obtain a free co of " AM copy Massachusetts Consumer onsumer Guide to Home Im rovemen,t Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plazai,ROOM 5 170,13 02116 617-973-8787;888-283-3757 or`vzisittthe OCA$Rwebs teat1 /Iwwtiv.mass: o ' If you want to verify the registration of a contractor or if you have questions or need additional information speci:C Bally about the contractor registration component of the Home Improvement Contractor Law,contact: Director of TIome Improvement Contractor Registration O:C-E'ice of Constuner Affairs and-Business Regulation 10 Park Plaza,Room 5170,Boston,MA.02116 617-973-8787, 888-283-3757 cr visit the I-UC website at 1.1ttn://wu�v mass aov/ocabil Go online to view the status of a Home Improvement.Contractor's Registration: 1t1.i.7�://db.state ma t2s/ho7neitnytovelnent/licettseelist.as For assistance with informal mediation of disputes or to regisi:er:Corxml complaints against a g busyness, call: Consumer Complaint Section O:ff'ice of the Attorney General 617-727-8400 AND/OR Better Business Bureau S08-6S2-4800,508-7755-2548 or413-734-31:14 version 2.1-11.L��i�nv n