HomeMy WebLinkAboutBuilding Permit #489 - 65 MARBLEHEAD STREET 2/21/2007BUILDING PERMIT
TOWN OF NORTH ANDOVER
(,% �j APPLICATION FOR PLAN EXAMINATION
Permit NO: 1 p 1 Date Received
Date Issued:_ t • b Y
IMPORTANT: Applicant must complete all items on this page
1 t_-) %,, . l t t A n
LOCATION�,
Print
PROPERTY OWNER,Q�C`(�,t�
int
MAP NO;yPARCEI� ZONING DISTRICT: Historic District
Machine Shop
V'tt \.EC 16�•ryO\
1
7a p�RA7E0 'PP���
SSgCHUS
yes no
ves no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
New Buildingnefamily
Addition
wo or more family
Industrial
Alteration
No. of units:
Commercial
e air, replacement"
Assessory Bldg
Others:
Demo i i
Other
Septic Well
Floodplain Wetlands
Watershed District
Water/Sewer
PTION OF WORK TO BE PREFORMED:.
ARCHITECT/ENGINEER Phon
Address: Reg. No.
FEE SCHEDULE: BULDING P T:$1 00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ FEE: $
Check No.: c 3 Receipt No.: Q 0
NOTE: Persons contracting with unregistered contractors do not hSyx-arcess#the guaranty, fund
of c � frac
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
❑ 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)
❑ 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 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: INSPECTIONAL SERVICES DEPARTMENTMFORM07
Revised 2.2007
Plans Submitted Plans Waived Certified Plot Plan Stamped Plans
TYPE OF SEWERAGE DISPOSAL
Public Sewer
Tanning/Massage/Body Art
Swimming Pools Es )'j
Well
Tobacco Sales
Food Packaging/Sai'eg J
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
DATE REJECTED DATE APPROVED
CONSERVATION
I - COMMENTS
DATE REJECTED DATE APPROVED
HEALTH
COMMENTS
Zonip Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
Comments
Comments
Water & Sewer Connection/Si nature & Date Drivewa _Permit
Located at 384 Osgood Street ,y
FIRE DEPARTMENT - Temp'Dumpster on site yes no'),, _ '`
Located at 124 Main -Street
Fire Department signature/date
COMMENTS
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
ELECTRICAL: Movement of Meter location, mast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine
Doc.Building Permit Revised 2007
Location 65 d
No. q99. Date ) . a
MaRTM
TOWN OF NORTH ANDOVER
O
9
�
r
Certificate
} , ,; +
of Occupancy $
CMU,t<'�'
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
20957
Building Inspector
e
Date... ...............................
O't��ac e 'ry
TOWN OF NORTH ANDOVER
p PERMIT FOR WIRING
This certifies that/ L .........�................... ....
has permission to perform ...... . �*?Zgep
wiring in the building of ..........................................
at ........6....n'!!4!Z.���€h? ...... -;; 7 ..... :.-i...... , North Andover, Mass.
Fee ..- ........... Lic. No. l IG�i�........................ .........
ELECTRICAL INSPECTOR
Check #
4 � f
14� Commonwealth of Massachusetts Official use only
- -
Department of ire Services Permit No.
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
[Rev. 11/991 (leaveblank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00
(PLEASE PRINTW INK OR TYPE ALL INFORMATIOAP Date:
Cpiy or Towo of IV ry 7-W A Ajmave,42 To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street & Number) Map: Lot-
Owner
orOwner or TenantTelephone No.
Owner's Address `�/%% �✓ �i/tJ�PGe/L i"!
Is this permit in conjunction with a building permit? Yes No ❑ Building Permit#
Purpose of Building Utility Authorization No.
Existing Service Amps / Vohs Overhead ❑ Undgrd ❑
New Service Amps / Volts Overhead ❑ Undgrd ❑
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
No. of Meters
No. of Meters
Com let. o the follmvin table may be waived by the Inspector of litres.
No. of Recessed. Fixtures
No. of Ceff Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Lighting Outlets
No. of Hot Tubs
Generators KVA
No. of Lighting FixturesSwimming
Pool Above ❑ In- ❑
rod. grod.
o. o Emergency Lighting
Battery Units
No. of Receptacle Outlets J-7
No. of OR Burners
FIRE ALARMS
No. of Zones
No. of Switches
No. of Gas Burners
No. of Detection andInitiating Devices
No. of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
Totals:
Number Tous JKW
No. of Sel€Contained
Detection/Alertine Devices
No. of Dishwashers
Space/Area Heating KW
Local Q Municipal Q Other
Connection
No. of Dryers
HeatingAppliances KW Pp
Security Systems:No. of Devices or Equivalent
No. of Water KW
Heaters
No. of No. of
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or Equivalent
OTHER:
Attach additional detail if desired, or as required by the bupector of Ii,ires.
.a INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee
provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such
coverage is in force, and has exhibited proof of same to the permit issuing office
CHECK ONE: INSURANCE Imo. BOND I]OTHER ❑ (Specify:) 7o h lei
(Expiration Date)
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion.
I certify, under the pains and penalties ofperjury, that the information on this application is true and complete
FIRM NAME: _,7,1V- e -.G r LIC. NO. - _A
Licensee: a;467@ f eaei!.. a sign atn LIC NO.: a 6 `7
(Ifapplicable, enter "exempt" in the license ,trymberline) Bus. Tel. No.: !2750-3,")/
Address: G f tJ�lk Tel. No.:
OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee does not have the liability insurance coverage normally required by law.
By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE: &-S Y, 0_8
" ✓1e 1°omrmzom.�aetx�/ a�✓�iaoacu/u�aekG
Board of Building Regulations and Standards 1
HOME IMPROVEMENT CONTRACTOR
_ Registration: 138294 -
Expiration: 3/19/2009 Tr# 128086
Type: DBA
R
ADAM'S SCREEN ENCLOSURES !
ROBERT ADAM
31 R. BOSTON ST.
SALEM, MA 01970 Administrator
_..� j .J%e Vo�nonaxu�caf./IE o�J��r�6ac/u7ael� {
Board of Building Regulations and Standards
Construction Supervisor License j11
l License: CS 60152• I
Birthdate: 3/20/1954
-.) Expiration: 3/20/2009 Tr# 11214
r
Restriction: 00
ROBERT W ADAM
2 PENNY LN �"...
PEABODY, MA 01960 Commissioner
a
N
m
m
e
X
m
m
C;
y
'v
C `C
•— CD
CifCD
C'7
n Z CO)
CCD O 'v
CL r c
� � c
CL H
nco -v
o v CD
CD O
CLQ
M CD
CD o CD
C O VaCDg
O co)
co I
CD
F v
CO O
� Z
CD
O CD
O
CCD
cn
VJ
n
0cn
.V I
O
cn
Z
o•
CD
0
Ca
0
c
a
F
m
0
0
CLW
N
Z
O y C7
CL
Cl) CD N
��
CDCD
d y
a a Q o
CL
CD. y
y '• _
Co CO2
CD ;V
=
'1
�h:
0 0
CD 0:
� o
CD _P:
.� CA
CD
o CD
_
m w
C-3
CA
coo:
cn
a
cn
w
G
m�m�
�
m
n
"r7
;
= D1
y
•T1
.dr O
=r CL
"ti
ro
m
CD MC
CD
x
CWA#O*
CA
`O
F,-
O
0-1-
� CD
a
0
Z
O y C7
CL
Cl) CD N
��
CDCD
d y
a a Q o
CL
CD. y
y '• _
Co CO2
CD ;V
=
'1
�h:
0 0
CD 0:
� o
CD _P:
.� CA
CD
o CD
_
m w
C-3
CA
coo:
cn
a
cn
w
G
qn
?7
y
;U
x
C7
"r7
;
Poo
a�
tom"
a
?i
w
�d
G
"ti
ro
Irl
w
x
C
a
07
`O
F,-
O
0-1-
rta o
N
IV
CL
ol
C
CD
►s
0O
`-.c�
Z L.
>
h o
e -r
0gmO
>
rD
�3
'+ 4'g 4.
CV 0 -. 0
C5 I z y
J
6m+N
O
O
/^ n o N
O O
0
(n E
rD Vi
W
Q.
NN
A
�.
-IZ
20
°
m
gD
Or
-ngr)
CDA
?1w
00
cru
I
10z00 x�
m��
OC
-n
Om0
mm
r
•{mr
�rm-�
moo
all
=m.Z
°O
� K .
K
�wm
DO_I
D�
=D
>0
xmn
-1zA
UCiD
D {
(
CD 0
m
n
ADWm
Z D
°tnaCo
W
D
Www
ro ZCl)
� C
m 0
O
C
crpo rn
AK
0
?O�
m
O10D
-0m
0°
0Q
��
pCtr�ni
rmA
O d A.
<
r�
«t
Go
X
p
cr
O
ay H
r-
.�
z
0
O
XZ
CL
b
�d
N
a)0
mm
�.
a
0W
d
i
c�
... a
m
mD
0
aq
rZCCn
N N
=
o
.�
II
000 00
127'
WEC1231 W3636 W3018 W1836RDW362424SL
t
LB;24FHJ1 - BCFW42R \
m_
W
c -0 m N
a 0
!(n
00
� to
2
J m
BP4834.5VG G)�_ i !1
co
cn
7q T
� V
QI
m I
.mi Uy \BTCI2LR
o D
m _ _ � --
o t'Z069£l.d
VZ919£M
A
(n E
A>Z
_r0
W
Q! iGt
DOy
NN
A
D"n-.
r ->m
-IZ
20
°
m
gD
Or
-ngr)
CDA
?1w
00
=+
I
°_Om
ch
m��
OC
-n
Om0
mm
r
•{mr
�rm-�
moo
=m.Z
°O
Ox <
�wm
DO_I
D�
=D
>0
xmn
-1zA
UCiD
D {
(
CD 0
m
n
ADWm
Z D
°tnaCo
W
D
Www
ro ZCl)
� C
m 0
-q
C
-4
AK
0
?O�
m
O10D
-0m
0°
m
��
pCtr�ni
rmA
(�
<
r�
��D
X
p
°0
ov
r-
r
Qom
�O
r --u
ZPD
XZ
o0m
C0
v
a)0
mm
Drz
0W
i
�a'�
mo
mD
0
�Dn
rZCCn
k
=
°
II
<xm
m
0
z�
-u
°
>ovmi
�z>
m
O
w
°
-<
6) r
C
�
�
?K
w>
Cm
O
0,m
h,
A
m0
1
�r
x
��-<
m
O
°
m
vo
m=oM -n Fn
-
A
-
mp
O
_
rm-DO
A
A
°wC
-4
M
zz
r
r
m
v
e
0
:3
o
0
0 rA
0
O �
o
J
C
r.
N
O
A N
O
th. i
00 ' o *
rQM
c
� N
000
00
0
iml
fl
J
N a
(D�
A
N
k
A N
� O
!-h
�. m
a
�c
�d
N�
�
O
N
000
00,
iml
N
ON
4
i
9
O
z
ol
rA
rm
w
0
Z
z
u
U)
LQW
9
9
t
U
O
O
co
0
CD L
0
co
Z a
0 y
0 C
cm
CO)
O
0
h 0 �0
CO m
0
0 ® OL
0 0 Q
c
CO2
� c
0
COD
.0 Z
CD
CD CL
L.3 to
0 C
C C
c
CL
H
D
LLI
0
U)
LU
U)
19
LUW
C4
u
h
O
Q
G
�
w°
r�
v
U
w
O
74
a�'
w
O
W
w
w2'
c1
c°
w
H
7�
C2
ri
W
A
w
00
z
cin
Q
o
cn
0
Z
z
u
U)
LQW
9
9
t
U
O
O
co
0
CD L
0
co
Z a
0 y
0 C
cm
CO)
O
0
h 0 �0
CO m
0
0 ® OL
0 0 Q
c
CO2
� c
0
COD
.0 Z
CD
CD CL
L.3 to
0 C
C C
c
CL
H
D
LLI
0
U)
LU
U)
19
LUW
C4
c o
' ® c
c w
o `
C H
O
r.+ C
O
C.3 V
.•nom
CLC
ev cc
m C
C
O Cc
C
_ is
CL
to
�
_
' O Q
:w$
� cm
rA
o o
�
f
O
�: �y
z
cm
:�3
m �
H
V/
O
7.f
m
a
GO A
O
O
'a
W
Ey
CD
:mo
:c.vL
m
=
L O
Cf
�:
CD
cw.2=o
Z
0
coo
n
c
m
y
n
O
C, m
iyy
_
C Ame
w
H
HM
n
Z
oc
E
v CCD3 y
co
CD
o
Q
1
N�
n
m:2 OS
A
=
F-
W
r
0 n$m
0
Z
z
u
U)
LQW
9
9
t
U
O
O
co
0
CD L
0
co
Z a
0 y
0 C
cm
CO)
O
0
h 0 �0
CO m
0
0 ® OL
0 0 Q
c
CO2
� c
0
COD
.0 Z
CD
CD CL
L.3 to
0 C
C C
c
CL
H
D
LLI
0
U)
LU
U)
19
LUW
C4
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
` Boston, MA 02111 r:
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricans/Plumbers
Name (Business/Organization/Individual):
City/State/Zip:
Phone.#: 9,9M5zg --j-t-�Lk
Type of project (required)`
6. ❑ New construction
7. ?1emodeling
8. E] Demolition
9. [] Building. addition
10.❑ Electrical repairs or additions
11.❑ Plumbing repairs or additions
12.0 Roof repairs
13. ❑ Other
*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 or not those entities have
employees. If the sub-contractorshave employees, they must provide their workers' comp; policy number.
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 # or Self -ins. Lic. #:'
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 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.
Ido l;e eby cgrtify i er the pains and penalties of perjury that the information provided above is true and correct
( X 1 -� �', (�
C n� _Sr�1.1k1 Iv —
not write in this area, to
City or Town:
Issuint, Authority (circle one):
L Board of Health 2. Building Department
6,., Other
Contact Person:
or town official.
Permit/License #
3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
Phone #:
%U(VA
Are you an employer? Check the appropriate box:
1. ❑ I am a employer with
4. I am a general contractor and I
employees (full and/or part-time).*
have hired the sub -contractors
2.,-1 am a sole proprietor or partner-
listed on the attached sheet.
ship and have no employees
These sub -contractors have
working for me in any capacity.
employees and have workers'
[No workers' comp. insurance
comp• insurance.t
required.]5.
E]We are a corporation and its
3. ElI am a homeowner doing all work
officers have exercised. their .
myself. [No workers' comp.
right of exemption per MGL
insurance required.] t
c. 152, §1(4), and we have no
employees. [No workers'
comp. insurance required.l
Type of project (required)`
6. ❑ New construction
7. ?1emodeling
8. E] Demolition
9. [] Building. addition
10.❑ Electrical repairs or additions
11.❑ Plumbing repairs or additions
12.0 Roof repairs
13. ❑ Other
*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 or not those entities have
employees. If the sub-contractorshave employees, they must provide their workers' comp; policy number.
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 # or Self -ins. Lic. #:'
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 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.
Ido l;e eby cgrtify i er the pains and penalties of perjury that the information provided above is true and correct
( X 1 -� �', (�
C n� _Sr�1.1k1 Iv —
not write in this area, to
City or Town:
Issuint, Authority (circle one):
L Board of Health 2. Building Department
6,., Other
Contact Person:
or town official.
Permit/License #
3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
Phone #:
%U(VA
Information and Instructions
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 of hire,
express or implied, oral or written."
i
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 bf such employment be deemed to be an employer."
MGL chapter 152, §25C(6) also states that "ever state or local licensing agency shall withhold the issuance or
renewal of a Iicense or permit to,opera'te�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 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 permiVhcense 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 Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street.
Boston, MA 02111
Tel. # 617-727-4900 ext.406 or 1-877-MASSAFE
` Fax # 617-727-7749
Revised 11-X22-06
www.mass_gov(dia
Robert Adam�"d/b/a
Ar%AIIAFQ ennrrw•I ICBI^I A@IInv,&
r
Page No..— of .
Reg# 138294 PROPOSAL"
31 R. Boston St.
SALEM, MA 01970= -,8,11-,home improvement contractors and subcontractors_
(978) 741-0379 FAX (978)-535-3967 engaged in home improvement contracting, unless
1800-339-0379 _ specifically exempt frorri,regist�ation by Provisions of
�\ "O
I Chapter 1-42A of the general laws, must be registered with
Submitted \ , I
To: _ 1 ` �C " O l �� the Commonwealth of°Massachusetts: Inquiries about
= registration and status should be made to the Director,
Home Improvement Contract Registration, One Ashburton
Place, Room 1301, Boston, MA 02108 (617)7-27-8598.
l Owners who secure their- own construction related
}�}T_�{��i permits or deal with unregistered contractors will
be excluded from the Guaranty Fund Provision,of
MGL c. 142A. A
PHONE rN f_ n, ( DATE REGISTRATION NO.
{ (j 6, — � ` - l'1 i 138294 LICA 60152
h JOB.NAME/NO JOB LOCATION
We hereby submit specificatipns a d estimates for work to a performed and\materials to be used:
C
"---•�'-,r' J � C, _ __J ` �.•�- ` �. } � `�� �, t \ 0 �� i�i.lt� � \l � f �i \ lli � ih l\ � � i(1.h( i
A,
1 `r V% ;�__� ,.rte 1 `(
�^�1."V
��\ 1\�cr,�� i \.�t"J �,�i'.t`�.�'! —tJ� t ✓`i2t�\� / \S L'u\1ti1.'`.`
-} -
Construction related permits:
WORK SCHEDULE
Contractor will not begin the work or order the materials before the third day -following the signing of this Agreement, unless specified herein writing. Contractor will begin the work on or
about (date). Barring delay caused by circumstances beyond Contractor's control, the work will be completed by (date). The Owner hereby
acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the contractor shall not be considered as violations of this Agreement.
WARRANTY
The Contractor warrants that the work furnished hereunder shall be free from defects in material and workmanship for a period of following completion and shall
comply with the requirements of this Agreement. In the event any defect ih'-workmanship or materials, or damage caused by the Contractor, his subcontractors, employees or
agents, is discovered within one year after completion of any job, including clean up, the Contractor shall, at his own expense, forthwith remedy, repair, correct, replace, or cause to
be remedied, repaired, or replaced, such damage or such defect in materialsC workmanship. The foregoing warranties shall survive any inspection performed in connection with
the agreed-upon work.
We Propose hereby to furnish material and labor — complete in accordance with above specifications, fp . e sum,of: °
Payment to be made as follows: dollars( _J
�
•--
4. / fJ
/' ($ � t 1�..) upon signing Contract; Robert W. Adam
' # Name of Contractor/ Designated Registrant
T
($ ) upon completion of 31 R Boston St.
ti ! Street Address��
($ e,� 0) upon completion of Salem Mk6l!970.
City/State Phone
($ ii _shall be made forewith upon 978 74.1-0379 04-3086159
BAL. %
completion of work under this contract. �- Phone �.) Federal ID No.
Notice: No agreement for home improvement contracting work shall require a down 1 Ntme df Salesman �\ I
payment (advance deposit) of more than one-third of the total contract price or the total 1 1 i
amount of all deposits or payments which the contractor must make, in advance, to order, — _J �� it
and/or otherwise obtain delivery of special order materials and equipment, whichever
Authorized Signature '
amount is greater.
Note: This proposal may be withdrawn by us if not accepted within days.
Acceptance of Nroposal I have read both sides of this document and accept the prices, specifications and conditions stated. I understand
that upon signing, this proposal becomes a binding contract. You are authorized to do. the work as specified. Payment will be made as outlined above.
You, the Buyer, may cancel this transaction at any time prior to midnight of the`third'business day after
the date of this transaction. Cancellation must be done in writing.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
Signature Date Signature Date
r