HomeMy WebLinkAboutBuilding Permit #607 - 7 LACONIA CIRCLE 3/19/2013TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit N0: 6Date Received�gi
Date Issued: S 11 J, I l
IMPORTANT: Applicant must complete all items on this pad
LOCATION I L to,., -AA
Print
PROPERTY OWNER
Print 100 Year Old Stru
MAP NO:PARCEL:( I ZO ZONING DISTRICT: Historic District
Machine Shop
yes no
ye no
ves no
TYPE OF IMPROVEMENT
RRQ4zQSED USE
al
Non- Residential
El New Building
AOne family
❑ Addition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Commercial
❑ Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
❑ Septic ❑ Well
❑ Floodplain ❑Wetlands
El Watershed District
❑ Water/Sewer
OWNER: Name:
Address:
DESCRIPTION OF WORK TU tit NtKrUKmtu:
ratification Please Type or Print Clearly)
` el Phone: X13441 145c
a q�,
Phone:
CONTRACTOR Name:
Address:3
�.Z�20x3
Supervisor's Construction Licensee 5Z`sl'1S Exp. Date:. _
Home Improvement License: Exp. Date: l
ARCHITECT/ENGINEER Phone:
Address: Reg. No
FEE SCHEDULE: BOLDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ , w s— FEE: $ .-4-6
Check No.: �—Z Receipt No.: Y L-4 0
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
�.
Signature of Agent/Owner Sign ture of contracto
--- ---
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑tamped Plans 11
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑
Tanning/Massage/Body Art ❑
Swimming Pools ❑
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
PLANNING & DEVELOPMENT11
COMMENTS
CONSERVATION
COMMENTS
HEALTH
COMMENTS
®�a
DATE REJECTED
DATE APPROVED
❑1
Reviewed on Signature
Reviewed on Signature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Comments
Conservation Decision: Comm
Water & Sewer Connection/Signature & Date Driveway Permit
DPW 'Town Engineer: Signature:
Locateo 3M Us 000 Street
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
NOTES and DATA — (For department use
U Notified for pickup - Date
Doc.Building Permit Revised 2010
Building Department
The foli'gwing is a list of the required forms to be filled out for the appropriate permit to be obtained.
Roofing, Siding, Interior Rehabilitation Permits
u Building Permit Application
u Workers Comp Affidavit
u Photo Copy Of H.I.C. And/Or C.S.L. Licenses
u Copy of Contract
o Floor Plan Or Proposed Interior Work
u Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
o Building Permit Application
o Certified Surveyed Plot Plan
u Workers Comp Affidavit
u Photo Copy of H.I.C. And C.S.L. Licenses
o Copy Of Contract
u Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o Mass check Energy Compliance Report (If Applicable)
o 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)
Li Building Permit Application
Li Certified Proposed Plot Plan
u Photo of H.I.C. And C.S.L. Licenses
o Workers Comp Affidavit
u Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o Copy of Contract
Li Mass check Energy Compliance Report
E3 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 app. -al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be submAted with the building application
Doc: Doc.Building Permit Revised 2012
Location e.— �f / /L—
No.lk Dat%
Checl<4�eZ P -v
26210
TOWN OF NORTH ANDOVER
Certificate of Occupancy $—
Building/Frame Permit Fee $,500
Foundation Permit Fee 4*v'r!�-
Other Permit Fee $—
Av*
TOTAL $
G-7���
Building Inspector
Enter construction cost for fee cal -
North Andover Fee Calculation
Construction Cost
$ 129000.00
m
$ -
$
144.00
Plumbing Fee
$
18.00
Gas Fee 100 comm.
$
100.00
Electrical Fee
$
18.00
Total fees collected
$
280.00
66 Settlers Ridge Road
606-13 on 316/2013
Water damage from frozen water
sprinklers
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In
1 6.
- _ The Commonwealth of Massachusetts
FOR
UBoard of Building Regulations and Standards
iX
MUNICIPALITY
Massachusetts State Building Code, 780 CMR, 7'h edition
USE
Revised
Building Permit Application
August, 2012
This Section For Official Use Only
Building Permit Number:
Date Applied:
(Z-1 g /I � / 13
Signature:
Building Inspector Date
SECTION 1: SITE INFORMATION
Residential ❑ Commercial ❑ Other Description:
1.1 Property Address:
1.2 Assessors Map &Parcel Numbers
7Z Lit-ea��A C111-CL-6
Lla Is this an accepted street? yes no
Map Number Parcel Number
1.3 Zoning Information:
1.4 Property Dimensions:
Zoning District Proposed Use
Lot Area (sq 11) Frontage (ft)
1.5 Building Setbacks (ft)
Front Yard
Side Yards
Rear Yard
Required
Provided
Required
Provided
Required
Provided
1.6 Water Supply: (M.G.L c. 40, §54)
1.7 Flood Zone Information:
1.8 Sewage Disposal System:
Public ❑ Private ❑
Zone: Outside Flood Zone?
Municipal ❑ On site disposal system ❑
Commercial- Service Size
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner' of Record:.�,� «�
� �
UI% V� N 1,3- ! LA-CO►IJ kA G ° --( LIE �1 %I>0-J tZ.
Name (Print) Address for Service:
SAA= ,mm--ccs, 4 t 3 -A*4 t - i45'0
—�
Signature Telephone E-Mail Address
SECTION 3: DESCRIPTION OF PROPOSED WORK (check all that apply)
New Construction ❑
Existing Building ❑
Owner-Occupied ❑
Repairs(s) X
Alteration(s) ❑
Addition ❑
Demolition ❑
Accessory Bldg. ❑
Number of Units
Other ❑ Specify:
Brief Description of Proposed Work: V t N
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item -32 S�f�
Estimated Costs:
Official Use Only
9 A 2-o
(Labor and Materials)
1. Building �{ I `Z U_15
$ '1(� g
1. Building Permit Fee: $
2. Indicate how fee is determined:
2. Electrical
$
❑ Standard City/Town Application Fee
3. Plumbing
$
❑ Total Project Costa (Item 6) x multiplier x
3. Other Fees: $
4. Mechanical (HVAC)
$
List:
5. Mechanical
$
(Fire Suppression)
Total All Fees: $
6. Total Project Cost:
$ At 0 !�-
Check No. Check Amount: Cash Amount
1U/z4/ZU12 15:34 FAX 603 772 3246 FOy Ins.GrOUP Exeter
Q0001/0001
CERTIFICATE OF LIABILITY INSURANCEDATE( DI 2'
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 POIIcY(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terns 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 endorsoment(a).
PRODUCER . c Nancy Bird CISR ACSR CIC
Foy Insurance — Exeter PHONE (603)772-4781 (603)772-3245
L46 0, ftfi,
64 Portsmouth Ave L .nancy.bird@foyinsurance.com
PO Box 1030 INBU S AFFORDING COVERAGE NAIC /
Exeter NH 03833 INSURERA:Csntral Mutual Insurance 20230
INSURM
INSU B:
ADVANCED METAL ROOFING LLC INSURERC:
Advanced Siding & Window Inc. INSURMD:
335 Route 125 INSu E:
BRENTWOOD NH 03833
CAVr-Rdr:CQ ung _� _----- --
�W l vwm 1wm1j¢r%:
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.
"TAU
TYPE OF INSURANCE
SUOR
R
LLY EFF
/7/2012
-POLICY EXPL
UNITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE 1z OCCUR
LP 9179244
/7/2013
EACH OCCURRENCE 3 1,000,000
ff-
f 300,000
MED EXP one Moon 3 5,000
PERSONAL &ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000 000
GEN'LAGGREGATE LIMIT APPLIES PER
X POLICY PRO- LOC
PRODUCTS-COMPK)P AGG 3 2,000,000
$
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNEDSCHEDULED
AUTOS AUTOS
HIRED AUTOSN'OWNED
AUTOS
COMIRED SINGLE Lima
BODILY INJURY (Per person) S
BODILY INJURY (Per accident) $
PROPERTY DAMAGE -
S
UMBRELLA UA8
EXCESS LIAB
HOCCUR
CLAiMS•MADE
EACH OCCURRENCE $
AGGREGATE S
DED RETENTION $
$
A
WORKERS COMPENSATION
S'
AND EMPLOYERLIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDEDT Q
(ManalatM In NH)
H 5. def l* Under
DESCRIPTION OF OPERATIONS below
NIA
RC9570029
A Stat* NS
ayn!> wilusz EXCLUDED
D6/08/2012
6 08/2013
X WC 877A - OTM-
LLl
E.L. EACH ACCIDENT $ 100,000
E.L. DISEASE - EA EMPLOYEE $ 100 ,000
E.L. DISEASE - POLICY LIMIT $ 500,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, AddIdcnalRamauka S" 'h"ula, H more apnea Is regWrad)
Operations usual i customary for a Building Material Dealer:
"FOR BID PURPOSES ONLY"
1(603)679-2844
Advanced Metal Roofing LLC
Advanced Siding & Window Inc
335 Route 125
Brentwood, NH 03833
ACORD 25
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Rohr, CIC/ENANCY
INS026 (201005)AI The ACORD name and logo are registered marks of ACORD
CORPORATION. All riehm raaarvad.
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
1 Congress Street, Suite 100
Boston, MA 02114-2017
Print Form
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Lezibly
Name (Business/Organization/Individual): Advanced Metal Roofing LLC _
Address: 335 Route 125
City/State/Zip: Brentwood, MA 03833 Phone #: (603) 679-2844
Are you an employer? Check the appropriate box: Type of project (required):
1. ❑✓ 1 am a employer with 4 4. E]I am a general contractor and I
empoyees (anr pa -me).
* have hired the sub -contractors 6. ❑New construction
lfull d/ortti
2. ❑ 1 am a sole proprietor or partner-
ship and have no employees
working for me in any capacity.
[No workers' comp. insurance
required.]
3. ❑ I am a homeowner doing all work
myself. [No workers' comp.
insurance required.]'
listed on the attached sheet.
These sub -contractors have
employees and have workers'
comp. insurance.+
5. ❑ We are a corporation and its
officers have exercised their
right of exemption per MGL
c. 152, § 1(4), and we have no
employees. [No workers'
comp. insurance required.]
7. ❑ Remodeling
8. ❑ Demolition
9. ❑ Building addition
10.❑ Electrical repairs or additions
11.❑ Plumbing repairs or additions
12. ❑✓ Roof repairs
13. ❑ Other
*Any applicant that checks box #I 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 -contractors have 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: Central Mutual Insurance
Policy # or Self -ins. Lic. #: WC9570019
Job Site Address:23 Wiles Rd.
Expiration Date:
06/08/2013
City/State/Zip:Sterling, MA 01564
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 certifyunder the pains and penalties ofperjury that the information provided above is true and correct.
Phone #: L C Ino ` `5 li - `L A =
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):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone #:
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https:Honlinebanking.tdbank.com/popup/checklmage.asp?index=l &chkNum=8278&acclndex= l ... 3/19/2013
Office of Amer A airs B in sRe"egu" X'o
HOME IMPROVEMENT CONTRACTOR
Registration: . 164363 Type:
Expiration: 1,0/1/2013 LLC
A' "LACED METAL ROOFING L.LC.
WAYNE WILUSZ.
335 RTE 125
BRENTWOOD, NH 03833"`
Undersecretary
License or registration valid for individul use only
before the expiration date. If found return to:
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, MA 02116
�a
ANotid without signature
llassachusetis - Department of Public SafetA
Board of Buildin- Re-lulations and Standards
Construction Supervisor License
License: CS 52975 �_ ---
SCOTT A'WOODMANSEE
17 BALL ROAD
KINGSTON, NH 03848
Expiration: 1/25/2013
(' unntissiunrr Tr#: 14319
--,AOMk IMPROVEMENT
SALE AGREEMENT
It
ADVANCED
SIDING & WINDOW CO. INC.
$es
16 •.���
Siding, Window, Sunroom & Patio Enclosures • Serving New Hampshire, Maine & Massachusetts • Corporate Office, 335 Route 125, Brentwood, NH 03833
(603)-679-2466 • (800)-519-9944 • Fax (603)-679-2844 • E-mail: aswc@verizon.net • www.advancedsidingandwindow.com
THIS CONTRACT made the 5`1 / day of iE 1 20 between
of
AL
(Bus.
Lam' �0
(zip) V (E-mail)
hereinafter called the Owner and Advanced Siding, hereinafter called the Contractor. WITNESSETH:
The said Contractor hereby agrees that it will for the consideration hereinafter mentioned, furnish all labor and material necessary to install the fol-
lowing described work at premises located at
Sew, Z�p 1k4C,1 A �.� �� (C
(Job Address)
The words "I", "me" and "my" refer to each person who signs as Owner. The words "you" and 'your" refer to the Seller or holder of this agreement. If more
than one person signs below as Owner, each person is jointly and severally liable for the promises made in this agreement.
AGREEMENT. I agree that it is my decision to purchase the goods and/or services described below at the Total Cash
Price of $ 3,) , _f,d"- �� . I promise and agree as follows:
SPECIFICATIONS OF CONTRACT:
1. Cover flat wall area with A vanc d approved solid vinyl siding, except tbos�p areas noted below.
Type of material to be: v .-'Color to be:
Include all custom "J" channel trim for win o%nd door facings,
color to be: IR 12 All custom corner osts, color to be: _
2. Cover all walls with insulation. Type: Thickness to be: ll
�A ..
3. Custom wrap window sills: Color to be:
4. Custom wrap fascia areas of home except those noted below.
Color to be 7"-
5. Cover soffit areas of home with, Advanced approved solid vinyl soffit system, except those
noted below. Color to be:
6. Cover porch ceilings with Advanced approved solid vinyl ceiling material, except those noted
below. Color to be:
7. Provide and install pairs of Advanced approved polystyrene shutters.
Color to be:
8. Placement of dumpster on premises shall be located:
9. Mail customer warranty after completion and payment in full is received.
10. Additional
ALL AREAS AND WORK NOT TO BE COMPLETED:
CASH
PRICE
! 3 r
Permit Cost§8'
TOTAL
CASH
3, ��
PRICE
Deposit
with order
f
Additional
Deposit
b
Due Date:
Balance Due
on Substantial
Completion
L CiQ 6�
Job Sign OK
Advanced Siding & Windows does not do
any painting or staining and is not
responsible for conditions or circum-
stances beyond its control including con-
densation resulting from or due to pre-
existing conditions.
REPRESENTATIONS: Contractor is responsible only for work described in writing on this contract. This contract covers and supersedes all conversations, statements, and
agreements, expressed or implied, between the parties, their agents or representatives.
NOTE: Any changes(s) you may wish to the above specifications are subject to our approval and must be in writing and signed by both parties prior to commencement of work
relating to the change(s). An additional deposit may be required. Such written changes, upon being signed shall become a part of this agreement.
NEW HAMPSHIRE LAW, RSA 359G, Contains important requirements you must follow before you may file a lawsuit or other action for defective construction against the con-
tractor who constructed, remodeled, or repaired your home. Sixty days before you file your lawsuit or other action, you must serve on the contractor a written notice of any con -
D(� o
oma"
rvtvv MAMr-anlrtt LAW, mart Jaya, Uontams important requirements you must rouow oerore you may rue a rawswt or Littler action rot uerecave uunsuuuiun ayants..ne wrr-
tractor who crnstructed, remodeled, or repaired your home. Sixty days before you file your lawsuit or other action, you must serve on the contractor a written notice of any con-
struction co5itions you allege are defective. Under the law, a contractor has the opportunity to make an offer to repair and/or pay for the defects. There are strict deadlines
and procedures under state law, and failure to follow them may affect your ability to file a lawsuit or other action.
The Contractor represents that it carries Workmen's Compensation and Public Liability Insurance in amount equal to or greater than $500,000.
PROMISE TO PAY: Owner(s) agree to pay this balance in full to the Installation Mechanics on the date of substantial completion.
GOVERNING LAW: The terms of this agreement shall be governed by the laws of the state in which the work Is being performed. This
Contract may be rescinded by the Buyer until midnight of the third business day following the date hereof by giving written notice of recis-
sion to the Contractor at his place of business given in this Contract. IF after the recission period but prior to the time the Contractor starts perform-
ance of this Contract, Buyer fails or refuses to accept delivery of the goods or performance of the services covered hereby, Buyer agrees to pay to
Contractor as liquidated damages an amount equal to (50) percent of the Cash Prize stated herein. All promotions,and discounts have been applied.
IN WITNgj5S OF, the parties have hereunto signed their names this day of A k 20
Marketing alive
ACCEPTED:
BY:
OFFICER OF ADVANCED SIDING, INC.
AUTHORIZED SIGNATURE TITLE
SIGNED d V
OWNER
SIGNED
OWNER
NOTICE: The terms of this agreement are contained on both sides of this page.
9
ADVANCED
METAL ROOFING, LLC
—Metal Roofing Specialist—
HOME IMPROVEMENT SALE AGREEMENT
THIS CONTRACT made the ...........�........... day of ...
`C' �` l n f
...........................�......... .
..:
( wners)'
of ........... .......Lkc.P.M.o . ........ � G.� ..............
(Address
Corporate Offices • 335 Route 125 • Brentwood, NH 03833
(800) 519-9944
Email • aswc@myfairpoint.net
www.advancedsteelroofingandsiding.com
Offices in Maine, New Hampshire & Massachusetts
...k!3.....................................................................12d.3 ............ between
....................................�1.,,�.........Z1:....
........................................
(Home Phone) (Business Phone)
M.rth ....................AA...........ol..q..................
(State) (Zip Code)
hereinafter called the OWNER and Advanced Metal Roofing LLC, hereinafter called the CONTRACTOR. WITNESSETH:
The said Contractor hereby agrees that it will for the consideration hereinafter mentioned, furnish all labor and material necessary to install the
following described work at premises located at:
................................................... ..............
`' :...............................................................................................................................
(Job Address)
The words "I", "me" and "my" refer to each person who signs as OWNER. The words "you" and "your" refer to the SELLER or holder of this agree-
ment. If more than one person signs below as Owner, each person is jointly and severally liable for the promises made in this agreement.
AGREEMENT: I agree that is my decision to purchase the goods and/or services described below at the TOTAL CASH.
Price of $_ fz) r I promise and agree as follows:
TOTAL ORDER PURCHASED
YES
TOTAL
BRAND OLOR
ADDITIONAL
WORK
OR
NO
CASH
PRICE
FIC20
Strip Roof YES ONO
Drip Edge
Deposit with Order
7,9
Underlayment �� 'fry-
Ridge Cap
��
Additional Deposit on Delivery
MESA
Cut OutwQ
Balance
tanding Seam 1 " / 1.75" A)A
Screws
&5
Due on Completion
Galvalume / Aluminum A
Flash Chimney
of Work
Steel Shingle
A
Snow Stops
NA
IN
Asphalt N A
Remove Gutters
FM
ALL AREAS AND WORK NOT TO BE COMPLETED:
REPRESENTATIONS: contractor is responsible only for work described in writing on this contract. This contract covers and supersedes all conversations, statements, and agreements,
expressed or implied, between the parties, their agents or representatives.
NOTE: any changes(s) you may wish to the above specifications are subject to our approval and must be in writing and signed by both parties prior to commencement of work relating
to the change(s). An additional deposit may be required. Such written changes, upon being signed shall become a part of this agreement.
MMA/ WARADIZWIDC I AW DCA 110('_ nnn4oin imnn.44 .nn„i.cmnnAc ..n.. _+ 4nlln,u I.ef,— ,.n„ mm. 4;Ie o In,..c„if n. n41.n. oMinn 4... nnneln ,nlinn o..ainc4 Mho n..n4.oninr ,n.hn
- - - - - •� I". 19 — a ub wnuaci. i rns contract covers and supersedes all conversations, statements, and agreements,
expressed or implied, between the parties, their agents or representatives.
NOTE: any chanos(s) you may wish to the above specifications are subject to our approval and must be in writing and signed by both parties prior to commencement of work relating
to the change(s). An additional deposit may be required. Such written changes, upon being signed shall become a part of this agreement.
r
NEW HAMPSHIRE LAW, RSA 359G, contains important requirements you must follow before you may file a lawsuit or other action for defective construction against the contractor who
constructed, remodeled, or repaired your home. Sixty days before you fila; your lawsuit or other action, you ri iaot ier✓e on the contractor a written notice of any construction conditions
you allege are defective. Under the law, a contractor has the opportunity to make an offer to repair and/or pay for the defects. There are strict deadlines and procedures under state law,
and failure to follow them may affect your ability to file a lawsuit or other action.
The contractor represents that it carries workers compensation and public liability insurance in amount equal to or greater than $500,000.
PROMISE TO PAY: owner(s) agree to pay this balance in full to the installation mechanics on the date of substantial completion.
GOVERNING LAW: the terms of this agreement shall be governed by the laws of the state in which the work is being performed. This contract may be rescinded by the
buyer until midnight of the third business day following the date hereof by giving written notice of recission to the contractor at his place of business given in this contract.
IF after the recission period but prior to the time the contractor starts performance of this contract, buyer fails or refuses to accept delivery of the goods or performance of the services
covered hereby, buyer agrees to pay to contractor as liquidated damages an amount equal to (50) percent of the cash prize stated herein. All promotions and discounts have been ap-
plied.
IN WITNESS OF a parties have hereunto signed their names this day of� 20
Fy
MARKETING REPRE NTATIVE
ACCEPTED:
BY:
OFFICER OF ADVANCED METAL ROOFING LLC
AUTHORIZED SIGNATURE
TITLE
SIGNED
6 OWNER
SIGNED
OWNER
NOTICE: the terms of this agreement are contained on both sides of this page.
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor (CSL)
L.a -T Zg `? 1- 5-/ l4-
License Number xpiration Date
CSL Type below) y
Name of CSL- Holder
0 B A'tk—
List (see
Address
Type Description
U Unrestricted (u to 35,000 Cu. Ft.)
'K—k VJ J!5 `TO tJ )13 L.1\
Signature
R Restricted 1&2 FamilyDwelling
M Masonry Only
RC Residential RoofingCovering
Te epho e
WS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
AWO 1Q 5EE- �l� i ' I�E1
E-mail Address
D Residential Demolition
5.2 Registered Home Improvement Contractor (HIC)
//'I fb3t`o
Registration umber
J
l�I.Yy / % 3
HIC Company Name or HIC Registrant Name
Add es
�Qd— ' 7—gA�tYO
pir tion Date
Signature drTelephone
E-mail Address
SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152. § 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the issuance of the building permit.
Signed Affidavit Attached? Yes .......... ❑ No ...........
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, , as Owner of the subject property hereby
authorize to act on my behalf, in all matters
relative to work authorized by this building permit application.
Signature of Owner Date
SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION
I, as Owner or Authorized Agent hereby declare that
the statem nts and information on he foregoing application are true and accurate, to the best of my knowledge and behalf.
2d13
Si
Sig ture of wner or uthorized Agent Dat
ne d under the pains and penalties of perjury)
NOTES:
1. An Owner who obtains a building permit to do his/her own work, or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor (HIC) Program), will not have access to the arbitration program
or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program and Construction
Supervisor Licensing (CSL) can be found in 780 CMR Regulations 110.R6 and 110.R5, respectively.
2. When substantial work is planned, provide the information below:
Total floors area (Sq. Ft.) (including garage, finished basement/attics, decks or porch)
Gross living area (Sq. Ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/ porches
Type of cooling system Enclosed Open