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HomeMy WebLinkAboutBuilding Permit #059-13 - 58 EVERGREEN DRIVE 7/17/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: "5-5 Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page Pnnt PROPER �Y OWNER, C h Print 100 Year•Old Structure R yeno I MAP NO S PARCEL: �� . ZONING DISyTtRICT _. Historic Distract, y e: y -- — - Machine Shop Villag j , TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building N60ne family ❑Addition ❑Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic r ❑1Nell' ❑ Floodplain f p 1%Vetlands� q V1,bt6rs`.hed District- , _ _ r .❑Water/Sewer - _ DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: ,[ VA-�i,G Phone: �- Address: V� l�-v CONTRACTOR 'Name. 1 ,� _l�r N aZh'Z$r it PhoneL �/77 _ .tl Address: j S ervlsor's _onstruction'Licgnse �l up p y - II Wome Improvement'Lice nse Exp, 'JARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.0, OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. ' � OS yq Total Project Cost. $ > FEE: $ ��11 7 Check No.: -7-7 .)-7 Receipt No.:(467 /. NOTE: Persons contracting wit unregistered contractors do not have access to a uaranty fund Signature of4Agent/Owner,` _ a Sig ature of cbnt.as t Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Location 7 �"Y,C•► (� — No. S ^' Date C_ 0 . TOWN OF NORTH ANDOVER on `Ad ' • m - Certificate of Occupancy $ Building/Frame Permit Fee ,a Foundation Permit Fee $ Other Permit Fee $ TOTAL Check# Yy 26631 Building Inspector Plans Submitted ❑ Plans Waived❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF.SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBodyArt ❑ Swimming Pools ❑ well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. ❑ Permanent Dum ster on Site p ❑ . I 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 1 COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Conn ection/Siqnature& Date Driveway Permit DPW Tovv;! Engineer: Signature: Located 384 Osgood Street SIRE DEPARTMENT =Temp Dumpster on site yes.. no � Located at 1124,Mair, Street �. Fire Depa nature/tlate`'�. . C010MENTS } ti Dimension f 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 'i If , I i I 4 14 El Notified for pickup - Date E I - f Doc.Building Permit Revised 2010 { Building Department The folkawing is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofiv,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 o 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) o 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 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.tted with the building application Doc: Doc.Buiiding Permit Revised 2012 _ I Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost y 549 bb m $ ........ d - $ 366.59 Plumbing Fee $ 45.82 Gas Fee 100 comm. $ 100 00 Electrical Fee $ 45.82 Total fees collected $ 558.24 58 Evergreen Drive 059-12 on 7/17/13 Kitchen Remodel Massachusetts -Department of Public Safety Board o - f Building Regulations and Standards Construction Supervisor License: CS-097650 PETER M CIARA01 9 OLDE WOODS-'RD SALEM NH 0301- fa;l �A Expiration Commissioner 07/03/2015 } ' Office n C, MENT CONTRACTOR onsumer Affalr�s&E(�sine��egulatle�u& ` HOME IMPROVE �i Ty.P�' I Registration:;�*170870 ' E Expiration 1/10/2014 DBA PROFESS IONAL`BUILDING SERVLCES INC. 41 r PETER CIARALDI-�1 "t -!_ o OLDS WOODS RD � �4SALEM,NH 0307..a Un&rsecretarY�,_.. r -I NORTFt _ t E � L �. .0 . . ver o No. T �O lAM• h ," ver, Mass, w coc"Ic Ntwm" Id AD�ATED BOARD OF HEALTH PE RMIT - Food/Kitchen Septic System THIS CERTIFIES THATUBUILDING INSPECTOR Foundation has permission to erect ............�%w ....... buildings on ..G.�.....��. .��� ...... ....r........ Rough ..to be occupied as .......... 4. ........ruort.,10. &�.L............................................................ Chimney 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 3�s PERMIT EXPIRES IN 6 MONTH§ ELECTRICAL INSPECTOR UNLESS CONSTRUCT TA 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 Professional Building Services by PMC, LLC Professional Building Services by PMC,LLC Estimate 9 Olde Woode Road Salem,NH 03079-1863 Date ``r Eslr�rate#;. (603)898-2977 07/12/2013 1567 ----- `" pete@professionalbuildingservices.com E— www.professionalbuildingservices.com -X 07/20/2013 Rich&Beverly Valle 58 Evergreen Drive North Andover,MA 01845 — PMC -r i n p:y A n .? ` _ r.n a Mt131t7f n �l�Gl .. ". E d�,Il1QLClIt _.L... �.... �..._. •Building Permit-Administration Fee 1 300.00 300.00 j Home owner can pull building permit themselves. i i If customer wishes Professional Building Services to pull permit,please add I $300. i ** Customer to reimburse Professional Building Services cost of permit fee paid to Town/City.** •Building Permit Fee paid to Town/City-TB) 0 0.00 0.00 � I This fee to be reimbursed to Professional Building Services or customer can pay i directly to municipality i • 15 yard dumpster with 2 tons.If additional dumpster needed,customer agrees to 1 425.00 '425.00 pay for additional dumpster or dumping fee. •Prep construction area.Apply 4mil poly sheets on all door openings to contain dust 1 150.00 150.00 and debris.Tarp entry and exit entries •Removal of all kitchen cabinets,backsplash and counter tops.Appliances to be 1 !. 945.001 945.00 moved out of work area in place to be determined. I � � Removal of kitchen wall per plan. i **Any removal of plumbing,electrical,structural bearing member or any other j unforeseen issues in the wall to be removed will be handled on a change order basis after consulting and agreement with home owner** I I I i Continue to the next page I Page 2 of 4 t -- t Activity Quanfity 1 Rate Amount_ xx _ _ - . •Framing: 1 1200.001 1200.00 Remove wall between kitchen and hall. Bearing wall will need to inspect existing internal structure to design beam to accommodate. Engineering of beam included •Kitchen Cabinets(allowance)CABINETS TO BE PROVIDED BY CUSTOMER 1 0.001 0.00 •Kitchen Counters(allowance)COUNTERS TO BE PROVIDED BY CUSTOMER 1 0.00. 0.00 •Kitchen cabinet installation per Janet Maglia plan dated 1 2,800.00, 2,800.00 •Additional bracing of counter I 400.001 400.00 •Countertop Installation- to be supplied by customer&installed by granite(or 1 0.001 0.00 alike) subcontractor •Soffit installation-soffit materials will be supplied by customer.To be large crown 1 1,480.00! 1,480.00 molding.Labor only •Kitchen cabinet knob installation 1 125.00! 125.00 •Plumbing Allowance 1 747.50 747.50 Install new kitchen sink and dishwasher. Add ice maker line for refrigerator. If plumbing is discovered in the wall that is to be removed between kitchen and dining room,will write up on a T&M basis. •Install vented hood vent fan-unit to be supplied by customer.New code requires 0 325.00 0.00 this to be completed by licensed sheet metal staff- NON-VENTED UNIT.NO WORK NECESSARY i i I a Continue to the next page I i i i i I I I i Page 3 of 4 ------ # Activity Quantity` Rate Amount •The proposed electrical work is limited to the following: 1 5,961.60 a 5,961.60 Select electrical demolition and re work in conjunction with cabinet removal.Install three new counter outlets. Install three new GFCI counter outlet One new dedicated counter circuit. Install one new dedicated circuit for microwave. Install two new dimmer switches. Supply and install five 5 recessed can fixtures(old work style). Install and wire two customer supplied pendant fixtures. Supply and LED under cabinet lighting under upper cabinets and in glass cabinet. Supply and install one 120 volt electric kick toe heater with wall mounted thermostat.All existing circuits to be re used. Replace four existing kitchen devices with new to match new devices. Note: Some of the above outlets are included to satisfy current code.Patching ceiling where; existing fixtures are removed,by others.Electrical permit will be invoiced accordingly without markup. This estimate does not allow for repair or correction of any unknown or unseen circumstances,which may be exposed during demolition. Smoke and Carbon Monoxide detectors are not included in this estimate,it is recommended the owners check with North Andover Fire Prevention to determine if any additional detectors will be required.Any such work so ordered by Fire Prevention shall be considered extra work. •Flooring Allowance: l 0.001 0.00 Material+labor Kitchen(300 sq.ft.)floor with customer pick of Armstrong vinyl tile w/grout,that includes removing existing sheetvinyl+ 1/4" plywood underlayment.Replacing with new 1/4" underlayment,complete.$5,100.00. Kitchen backsplash installed on diamond$850.00 labor only(35 sq.ft) I NO FLOORING INCLUDED-TO BE SUPPLIED BY AND INSTALLED BY HOMEOWNERS REP. IF ADDITIONAL TIME NEEDED OR DELAYS INCURRED BY HOME OWNERS SUBCONTRACTOR,HOMEOWNER AGREES TO PAY ANY ADDITIONAL COSTS. SUBCONTRACTOR WILL NOT BE COVERED BY PBS INSURANCE NOR LICENSES l �I I I Continue to the next page i Page 4 of 4 • , Activi Quanfi Rate Amount '1 _: •FLOOR PROTECTANTS TO BE SUPPLIED,INSTALLED AND LATER 1 0.001, 0.00 REMOVED BY HOMEOWNERS SUBCONTRACTOR-SUBCONTRACTOR WILL NOT BE COVERED BY PBS INSURANCE NOR LICENSES PBS TO BILL FOR T&M FOR ANY ADDITIONAL COSTS INCURRED. •Drywall patch and repair 1 700.00i 700.00 •Install new window trim 1 150.001 150.00 2 1/2 colonial trim-primed&painted •Strip wallpaper Allowance 0 1,700.00. 0.00 CUSTOMER TO REMOVE ALL WALLPAPER •Primer,2 coats of paint on walls 0 400.001 0.00 CUSTOMER WILL PRIME AND PAINT I •Cleanup&Restoration 6 45.001 270.00 •CONCEALED CONDITIONS:This Agreement is based solely on the observations 1 0.00 Contractor was able to make with the structure in its current condition at the time this Agreement was bid.If additional concealed conditions are discovered once work has commenced which were not visible at the time the proposal was bid,Contractor will stop work and point out these unforeseen concealed conditions to Owner so that Owner and Contractor can execute a Change Order for any Additional Work. i i •i i I i ,I II i i i .. THANK YOU ! We appreciate the opportunity and look forward to working ' Total $15M410,1 with you on your upcoming project. Accepted By Accepted Date The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print lLegibly Name(Business/Organization/Individual): Frd I-E V Itr b L,- �,) z y f Address: City/State/Zip: Alfk 002 Phone#: T Are you an employer?Check t e appropriate box: Type of project(required): 1.to I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-tune).* have Hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.z 7. Remodeling ship and'have no employees These sub-contractors have 8. Demolition working for me in any capacity. workers' comp,insurance. g, ❑Building addition [No workers'comp.insurance 5. F1 We are a corporation and its required.] officers have exercised their ME]Electrical repairs or additions 3.❑ I 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.❑Roofrepairs insurance required.)i employees.[No workers' 13.[i 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 Ee doing all work and then hire outside contractors must submit anew 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 the policy and job site information. Insurance Company Name:. A9_�7 Policy#or Self-ins.Lic.#:_ J C / 49C/ Expiration Date: Job Site Address:_ zfV ey,i'/�2 Pity/state/Zip:- �` �J 4-1[06V qZ. /td A- 01P;0T 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 maybe forwarded to the Office of Investigations of the DTA for insurance coverage verification. !1do rti u r thepains anrdpenalties ofperjury thatthe information provided above is true andcorrect. Si:ature: Date: Llzz� Phone Official 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): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.PIumbing Inspector 6.Other Contact Person• Phone#: Informadon and bstrj111e lon'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 employeils defined as"an individual,partnership,association,corporation or other legal entity,or any two or more ofthe 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-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry 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 rinted legiblY. TheD epatfinent lis provided a qiace— atthebotfom 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. Anew affidavit must be filled out each year.Where a homeowner or citizen is obtaining a license or'-permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The CoMjAonwe'atth off-assac usetts Department ofJadustdal,Accidents Office of Investigatitons 600 Washiugtou Street Boston,MA 02111 Tel.,#617-727-4900 at 406 or 1-8777 ASSAFF, Revised 5-26-05 Fax#617-7277749 wwwmass..gov/dia A CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 7/8/2013 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 Patricia Blais Financial Insurance Services Inc PHONE (603)432-6414 A 'AC. IC No:(603)432-3852 PO Box 950 E-MAIL ADDRESS:Pblais@fisins.com INSURERS)AFFORDING COVERAGE NAIC# Derry NH 03038 INSURER ANational Grange Insurance Cc INSURED INSURER B:Hartford Insurance Company Professional Building Services, LLC INSURER C: 9 Olde Woode Road INSURER D: INSURER E: Salem NH 03079 INSURER F: COVERAGES CERTIFICATE NUMBERCL1321104523 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. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DDIYYY Y LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED }� COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 300,000 A CLAIMS-MADE a OCCUR T1630H /5/2013 /5/2014 MED EXP(Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO-.IFQT F1 LOC $ AUTOMOBILE LIABILITY EOM�BIINdEeDtSINGLE LIMIT 1,000,000 A ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED B1T1630H /5/2013 /5/2014 BODILY INJURY(Per accident) $ AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ Medical payments $ 5,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATIONWC STA _T OT ANDEMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 100,000 OFFICERIMEMBER EXCLUDED? N/A (Mandatory in NH) 4WECLB1809 /5/2012 /5/2013 E.L.DISEASE-EA EMPLOYE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) I I CERTIFICATE HOLDER CANCELLATION valle.r@verizon.net SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Richard 6 Beverly Valle ACCORDANCE WITH THE POLICY PROVISIONS. 58 Evergreen St North Andover, MA 01845 AUTHORIZED REPRESENTATIVE j Sam Fragala/DEBRA 4 ,-z- ACORD -z ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025l9Mnn51 n1 Tho Ar non n2mo 2nrl Inn^oro rnnic4orarl mnrtr¢^f Ar'non 1 t' Massachusetts Home Improvement Contract This form satisfies all basic requirements of the state's Home Improvement Contractor Law(MGL chapter 142A), but does not include standard language to protect homeowners.Seek legal advice 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. Homeowner Information Contractor Information Name Richard and Beverly Valle Company Name __ __ PRU}!'iS51C)N/11.:131A1,1.)INCi S[iRV10ES/Y(.�I'LR CaARA1.:Dl Street Address(do not use a Post Office Box address) Contractor/Salesperson/Owner Name 58 Evergreen St t}01.1x:.WOOD[.RD City/Town State Zip Code usiness Address(must include a street address) North Andover MA —SALEM Nil 03079 Daytime Phone Evening Phone ity/Town State Zip Code i 978-685-1022 i Mailing Address(It different from above) Business Phone Federal Employer ID or S.S.Number 603-898-2977 20-5303576 Law requires that most home Home Improvement Contractor Expiration Date Improvement contractors have a valid reg.number Registration number CS97oSi1 7/14 The Contractor agrees to do the followi g work for the Homeown r: (Describe in detail the work to completed,spe 'tying the type,brand,and gra#of materials to be used,us( additional sheets if necessary.) Reference Professional Building Services Estimate#1567 Required Permits-The following building permits are required Proposed Start and Completion Schedule-The following and will be secured by the contractor as the homeowner's agent, schedule will be adhered to unless circumstances beyond Owners who secure their own permits will be the contractors control arise excluded from the Guaranty Fund provisions of Week of 711'2 i/13_Date when contractor will begin contracted work. MGL chapter 142A.) 8/26/13—Date when contracted work will be substantially completed. Total Contract Price and Payment Schedule The Contractor agrees to perform the work,furnish the material and labor specified above for the total sum of: $1 5,654.10 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) s-5,2 18 upon signing contract(not to exceed 1/3 of the total contract price or the cost of special order items,whichever is greater) $_5,218 by_/_/_orupon completion of_Cabinets Installed $_remainder upon completion of the contract.(Law forbids demanding full payment until contract is completed to both party's satisfaction) The following material/equipment must be special$_N/A to be paid for N/A ordered before the contracted work begins in order$_N/A to be paid for N/A to meet the completion schedule.(**) NOTES:(*)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 warranty being provided by the contractor? No Yes (all terms of the warranty must be attached to the contract) Subcontractors-The contractor agrees to be 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 agreement. 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. i • 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 Home Improvement Contractor Registration.The law requires most home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration.You may inquire about contractor registratiomby writing to the Director at One Ashburton Place,Room 1301,Boston,MA 02108 or by calling 617-727-3200 or 1-800-223-0933. • Does the contractor have insurance?Check to see that your contractor is properly insured. • Know 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 of the third business day following the signing of this agreement.See the attached notice of cancellation form for an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES!!! Two identical copies of the contract must be completed and signed.One copy should go to the homeowner.The other copy should be kept by the contractor. Homeowner's Signature Contractor's Signature 7/13/2013 Date Date i i i i i i 'd Contractor Arbitration The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action(as an alternative to court action) if they have a dispute with a contractor.The same right is not automatically afforded to a contractor,however.The contractor would have to resolve any dispute he/she has with a 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 mutually agree in advance that in the event the contractor has a dispute concerning this contract,the contractor may submit the dispute to a private arbitration firm which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided In Massachusetts General Laws,chapter 142A. G� 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 workmanlike 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 the original contract must be in writing and agreed to by both parties.Contracted work may not begin until both parties have received a fully executed copy of the contract,and the three day 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 be financially insecure,the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work.Withdrawal of funds from said account would require the signatures of both parties. Additional Information If you have general questions or need additional information about the Home Improvement Contractor Law or other consumer rights,or if you wish to obtain a free copy of"A Consumer Guide to the Home Improvement Contractor Law,"contact: Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza, Room 5170, Boston, MA 02116 (617)973-8787 or 1-(888)2833757 If you want to verify the registration of a contractor or if you have questions or need additional information specifically about the contractor registration component of the Home Improvement Contractor Law, contact: Director of Home Improvement Contractor Registration Bureau of Building Regulations and Standards One Ashburton Place,Room 1301, Boston, MA 02108 (617)727-3200 or 1-800-223-0933 For assistance with informal mediation of disputes or to register formal complaints against a business,call: Consumer Complaint Section Office of the Attorney General (617)727-8400 AND/OR Better Business Bureau (508)652-4800 (508)755-2548 (413)734-3114