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Home My WebLink AboutBuilding Permit #224-14 - 99 SECOND STREET 9/10/2013 .. BUILDING PERMIT 3?° � � a�°` TOWN OF NORTH ANDOVER ° 'A APPLICATION FOR PLAN EXAMINATION ,Z�Jermit NO: � ' I Date ReceivedArMD (� ACH Date Issued: -I 4 US ORTANT: Applicant must complete all items on this page LOCATIOO— y j hl Print PROPERTY OWNER m Print MAP NO:01q- 0 PARCEL:QQc ZONING DISTRICT: Historic District yesno Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial Repair, lacem Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer Identification Please Type or Print Clearly) OWNER: Name: _A) V L O�ni bg,-,' Phone: 509 - X 65 y�y3 Address: I'DGvvv�� CONTRACTOR Na °/-7k(db -/Phone: Address: PU 1 �� o j ktl, Supervisor's Construction License: �Syy3 Exp. Date: /J//o/t 3 Home Improvement License: 33, Exp. Date: Zz 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 Co M0 FEE: $ Check No.: Receipt No.: OTE: Persons contractin ithn unre istered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE-OF:SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/BodyArt ❑. . 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 DATE REJECTED. DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS ,CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes . i I Planning Board Decision: Comments � Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW T ovv . &engineer: Signature: Located 384 Osgood Street FIRE-DEPARTMENT - Temp Dumpster on site yes no Located at 124 Mair Street Fire Department signatureldate- COMMENTS a 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 I B Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department The foltoswing 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 o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses a Copy of Contract Li Floor Plan Or Proposed Interior Work o 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 o Workers Comp Affidavit a Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract a Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) Li Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) o Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses Li Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Li Copy of Contract o Mass check Energy Compliance Report a 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 apo,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.Bui?ding Permit Revised 2012 Location No. L1 ' Date 1 . - TOWN OF NORTH ANDOVER • gLLED t646 • Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# Building Inspector NORTFl Town of t E ndover No. 1--w14 - �oAh ver, Mass,L..,. I o 2a 3 COCN1c"t—ck V^ S V BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT �•�/ BUILDING INSPECTOR .................... ...... ..............................................ji� . ......... . has permission to erect .................... buildings on %:.7 'a1 — rpG Foundation ...... .. ................................................................ Rough tobe occupied as ........ .... ...cc ......................................................................... 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough AT-1 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 Rightfax N2-2 9/11/2013 5 : 47 : 56 AM PAGE 2/002 Fax Server " CERTIFICATE OF LIABILITY INSURANCE DATE(M11/9n YYYY) 13 T TIFICATE 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 and endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: GILBERT INS AGCY PHONE FAX 137 MAIN ST (A/C,No,Ext): (A/C,No): E-MAIL READING,MA 01867 ADDRESS: 73MCG INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA DUVAL ROOFING LLC INSURER B: INSURER C: INSURER D: P O BOX 637 INSURER E: NORTH READING,MA 01864 INSURER 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. INSR ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MMDD\YYYY) (MMDD\YYYY) LIMITS GENERAL LIABILITY zACH OCCURRENCE $ H� COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE [—]OCCUR. DREMISES(Ea occurrence) ED EXP(Arty one person) $ ERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: ENERAL AGGREGATE $ POLICY a PROJECT LOC RODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND X WC STATUTORY OTHER EMPLOYER'S LIABILITY Y/N UB-0230N919-13 03/11/2013 03/11/2014 LIMITS ANY PROPERITOR/PARTNER/EXECUTIVEN/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? � 100,000 N (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDO VER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 1600 OSGOOD STREET BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTgy,�YVE Z r NORTH ANDOVER,MA 01845 ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved. 09/10/2013 09:19 FAX 781 942 2226 GILBERT Q001 V:HISCERTIFICATE OF LIABILITY INSURANCE � D/10//DD/Y3i 9/10/2013ERTIFICATE 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(ie5) must be endorsed. If SUBROGATION IS WANED,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 COINuI�ACT Barbara McDonough Gilbert Insurance Agency, Inc. PNONa (781)942-2225 FAC No 1 (7111)942-2226 137 Main Street E-MAIL .bmadonough@gilbertinsurance.cam1 INSURERJSI AFFORDING COVERAGE I NAIL A Reading MA 01867-3922 INSURERA;HARLEYSVILTM ORCESTER INS CO. 26182 INSURED INSURER g:Travel era Ins. Co. 0031 I Duval Roofing, LLC. INSURER C P.O. Box 637 INSURER D., INSURER F: North Reading MA 01864 INSURER F: I COVERAGES CERTIFICATE NUMBER:CL1331300142 REVISION NUMBER: I 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. rLTR TYPE OF INSURANCE ADDL R POLICY EFF POLICY EXP POLICY NUMBER MMIDD LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMI ES TED S 100,000 CLAIMS-MADE Q OCCUR Lfi4158G 10/23/2012 0/23/2013 MED EXP(Any one orson) S 5,000 PERSONAL&ADV INJURY s 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER; PRODUCTS-COMPIOP AGG 3 2,000,000 X POLICY PRO LOC S AUTOMOBILE LIABILITY 0 91NED SINGLE LIMIT 500,000 ANY AUTO BODILY INJURY(Per pelsor') $ A ALL OWNEDSCHEDULED 64456G 10/23/2012 10/23/2013 AUTOS X AUTOS BODILY INJURY(Per eccltlenq S X HIRED AUTOS X NON-OWNED PROPS IRC DAMAGE g AUTOS Uninsured motarlsl Bt s lit limit S 100,0 UMBRHLLA LIAR OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTIONS I $ $ WORKERS COMPENSATION To be provided diesotly WC STATU- 0TH. AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVEiA Travelers Insurance E.L.EACH ACCIDENT 5 100 000 OFFICERfMN/A EMBER EXCLUDED? /11/2023 /11/2014 (Mandatory In NN) E,L DISEASE-EA EMPLOYE S 100,000 Ifyea,describe under DESCRIPTION OF OPERATIONS bolpw E.L.DISEASE-POLICY LIMIT 5 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,AddlUonal Ramarks Schedule,If more space Is roQulrad) Evidance of Coverage i CERTIFICATE HOLDER CANCELLATION (978) 686-9542 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL I BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Oagood Street North Andover, Masi AUTHORIZED REPRESENTATIVE M Gilbert, CSC/BF.RBAR I ACORD 25(2010/06) ®1988-2010 ACORD CORPORATION.; All rights reserved. INS025(20100401 The ACORD name and logo are registered marks of ACORD l Page No. of Pages r Builders License # 58443 Home Construction Reg. # 167338 D u w. Iva JA L mrm R,OF o fin Am LLC (781)944-1994 (978)664-2557 READING NORTH READING P.O. Box 637, North Reading, MA 01864 Please visit us at www.duvalroofing.com PROPOSAL SUBMITTED TO PHONE DATE ST ET •ri.� CITY,STATE AND ZIP CODE We hereby submit specifications and estimates for: Rip& Remove all existing roof related debris from roof as well as job site with our own disposal truck. NO DRIVEWAY DUMPSTERS �-,,,,��❑ 1 layer of existing roof shingles 62 Layers of existing roof shingles LJ3 layers or more of existing roof shingles �,ri-►eplace any damaged roof decking; not to exceed 32sq.ft. (additional at$1.70 per sq.ft.) nstall 8"Aluminum Drip-edge/Rake-edge along entire perimeter(Choice of White) Brown or Mill) 21onstall ICE&WATER UNDERLAYMENT on all horizontal eaves, sidewalls, skylights and chimney flashing Install a premium base sheet underlayment(felt)that is in compliance with the asphalt shingle manufacturer chosen by the homeowner oe Install The Homeowner's Choice of the selected Tamko/IKO or GAF Limited Lifetime Architectural Roof Shingles See individual manufacturer's warranty for specific details �eplace all existing bathroom louver and/or exhaust pipe(s)with new aluminum flanges Chimney(s) -counter-flash and re-step existing flashing ❑Cut& Install new lead flashing nstall a continuous low profile Ridge-Vent'on all ridge lines ❑Soffit-Vents J ❑Roof Louver-Vents ❑Seamless Aluminum Gutters-Custom fabricated on site with our own gutter machine ❑ Downspouts at additional ❑Leaf Guards Other r iI i I 'Please Note:All items in roof attic should be removed or covered due to falling roof particles, at time of roof tear-off Price includes all items above that are checked only/others may be priced separately upon request. We ]Jropase hereby to furnish material and labor-complete in accordance with above specifications,for the sum of: C�UO Total price not including options. dollars($ 11'S 7o ). j Payment to be made as follows: 30%deposit required before ordering materials.Balance due in full upon day of completion. Please make all payments out to Kenneth Duval, mailed to: P.O. Box 637, No. Reading, MA 01864 Final Payment is due upon day of completion and is subject to the Authorized supplemented Terms&Condition sheet when scheduling. Signature THIS PROPOSAL IS VALID FOR = (.. DAYS DUE TO CES. FLUCTUATIONS IN MATERIAL&DISPOSAL PRI c ` Massachusetts Home Improvement Sample Contract c 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 or on our website. Homeowner Information Contractor Information y Name 1 Iry d— rr%6 — U Q__ �A S¢get Address(do not use aPosRffi�x�dress) Conhactor/Sale son/Ovmer Name (`'!�1/Town j``\7•J State L� e mess Address(m . Ind eta ss) 91 )OQY Daytime Phone Evenin Phone C /C State Zip Code a s �►-� -A 1�6 y Maifing Address(It different from above) Business Phone lFederal Employer ID or S.S.Number Home lmpmvement C.Nmclor Reg.Numbs P.�imcon r..rw yIre.tbm men nerve Improv went c"ntraelon b.ve Al ..wa regtm.¢a•member Q / !/V The Contractor agrees to do the following work for the Homeowner: (Describe in detail th<` completed,specifying the lype�d grade of materials to be used,use additional sheets if necessary.) ec- /A Required Permits-The following building permits are required Proposed Start and Completion Schedule-The following schedule will and will be secured by the contractor as the homeowner's agent: be adhered to unless circumstances beyond the contractor's control arise (Owners who secure their own permits will be w�•�—`R' excluded from the Guaranty Fund provisions of �--'Date when contr or will begi ontrac work. MGL chapter 142A.) I' ( I:t7� Date when contracted work will be subs tially 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: 70+ R_ (•) Payments}will be made ac g to the following schedule: V��+ upon signing contract(not to exceed 1/3 of the total contract price yI the cost of special order items,whichever is greater) $ by_/_/ or upon completion of $ by_/ /_or upon completion of $ + upon of the contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction) The following rnsterial/equipment most be special $ to be paid for ordered before the contracted work begins in order to meet the completion schedule.("•) $ to be paid for 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)ane-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 beine 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 amyement 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 Us contract. • 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 registration by writing to the Director at 10 Park Plaza,Room 5170,Boston,MA 02116 or by calling 617-973-8787 or 888-283-3757. • Does the contractor have insurance? Ask the Contractor for his insurance company information so that you can confirm coverage,or ask to see a copy of a"proof of insurance"document. • 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 aplace 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. Seethe attached notice of cancellation form for an explanation of this right. O NOT SIGN T CONTRACT IF THERE ARE ANY BLANK SPACES!!! Two i 'cal copies the contract V64c complqed and OWd.One copy should go to the homem other copy should be kept by the co m ctcn G� PZ Home_ is Sign re __tractor's Signature — q 4 / � /3 3 Date ate Vo YL4L-) 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 t such arbitr ion as provid In Massachusetts General Laws, ha ter 142A. Horn er's na a 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 maybe 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 Massachusetts Consumer Guide to Home Improvement" contact: Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787,888-283-3757 or visit the OCABR website at http://www.mass.Poy/ocabr/ If you want to verify the registration of a contractor or if you have questions or need additional information specifically about the contractor registration component of the Home Improvement Contractor Law,contact: Director of Home Improvement Contractor Registration Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787,888-283-3757 or visit the HIC website at http://www.mass.gov/ocabr/ Go online to view the status of a Home Improvement Contractor's Registration: http://db.state.ma.us/homeimprovement/licenseelist.asp For assistance with informal mediation of disputes or to register formal complaints against a business,call: Consumer Complaint Section Office of the Attorney General 617-727-8400 AND/OR Better Business Bureau 508-652-4800,508-755-2548 or 413-734-3114 Version 2.1-11/22/2010 NOTICE OF CANCELLATION YOU MAY CANCEL THIS TRANSACTION, WITHOUT PENALTY OR OBLIGATION,WITHIN THREE BUSINESS DAYS FROM THE ABOVE DATE. IF YOU CANCEL,ANY PROPERTY TRADED IN,ANY PAYMENTS MADE BY YOU UNDER THE CONTRACT OR SALE,AND ANY NEGOTIABLE INSTRUMENTS EXECUTED BY YOU WILL BE RETURNED WITHIN TEN BUSINESS DAYS FOLLOWING RECEIPT BY THE SELLER OF YOU CANCELLATION NOTICE,AND ANY SECURITY INTEREST ARISING OUT OF THE TRANSACTION WILL BE CANCELLED. IF YOU CANCEL,YOU MUST MAKE AVAILABLE TO THE SELLER AT YOUR RESIDENCE,IN SUBSTANTIALLY AS GOOD CONDITION AS WHEN RECEIVED,ANY GOODS DELIVERED TO YOU UNDER THIS CONTRACT OR SALE; OR YOU MAY, IF YOU WISH,COMPLY WITH THE INSTRUCTIONS OF THE SELLER REGARDING THE RETURN SHIPMENT OF THE GOODS AT THE SELLER'S EXPENSE AND RISK. IF YOU DO MAKE THE GOODS AVAILABLE TO THE SELLER AND THE SELLER DOES NOT PICK THEM UP WITHIN TWENTY DAYS OF THE DATE OF CANCELLATION,YOU MAY RETAIN OR DESPOSE OF THE GOODS WITHOUT ANY FURTHER OBLIGATION. IF YOU FAIL TO MAKE THE GOODS AVAILABLE TO THE SELLER, OR IF YOU AGREE TO RETURN THE GOODS TO THE SELLER AND FAIL TO DO SO,THEN YOU REMAIN LIABLE FOR PERFORMANCE OF ALL OBLIGATIONS UNDER THE CONTRACT. TO CANCEL THIS TRANSACTION, MAIL OR DELIVER A SIGNED AND DATED COPY OF THIS CANCELLATION NOTICE OR ANY OTHER WRITTEN NOTICE,OR SEND A TELEGRAM TO [Name of Seller],AT [Address of Seller's Place of Business]NOT LATER THAN MIDNIGHT OF (date). I HEREBY CANCEL THIS TRANSACTION. Date: Buyer's Signature: t kk om1 4y1��G'O�5 ygoP� Or- \\.\S\ \\.\S\ �y1012p1� O 19G MPbN o10 vo p 4�Nocc C •V a<an�W��N 0L0 ... ......... OCf'c �MPRO 16T33 A \A00 5t<at�o�• � pi2p1 R t1on Seecetiac9 KENN��I TZN REpp�NG'M NO r——� NOTICEN NOTICE TO a TO EMPLOYEESW EMPLOYEES The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 Washington Street, Boston, Massachusetts 02111 617-727-4900 — http://www.mass.gov/dia As required by Massachusetts General Law, Chapter 152, Sections 21,22&30, this will give you notice that I (we) have provided for payment to our injured employees under the above mentioned chapter by insuring with: THE TRAVELERS INSURANCE COMPANIES NAME OF INSURANCE COMPANY P .O. BOX 1450 MIDDLEBORO MA 02344-1450 ADDRESS OF INSURANCE COMPANY (7PJUB-023ON91 -9-13) 03-11 -13 TO 03-11 -14 POLICY NUMBER EFFECTIVE DATES ^ GILBERT INS AGCY 137 MAIN ST READING MA 01867 NAME OF INSURANCE AGENT ADDRESS PHONE# o DUVAL ROOFING LLC 184 PARK STREET NORTH READING MA 01 864 EMPLOYER ADDRESS EMPLOYER'S WORKERS COMPENSATION OFFICER (IF ANY) DATE n MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers' Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the services provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention, employees are hereby notified that the insurer has arranged for such attention at the NAME OF HOSPITAL ADDRESS 001907 W20P1G02 TO BE POSTED BY EMPLOYER J. Z V I J J 1- Town of North Andover , No 0450 P. 1 It - - . The�vm�z¢�wea �of�rr�sachr�sefls pia iintn,frr0ust (d,4cc!dihft Office Q,f'ravesfigafions 600 Washington Streei ostvra,MA 02111 v mass.govldla Workers' CompeosationImuranceAffldavit:)3rdldersfContractor&fglectiiciawfflmnDero Applicant Inforin itiom Flease Prm lie h Name(Business/orgmhati nd-daia�; Duval Roofing, LLC ' X 631 Address: Np Headinq, MA 01864 - City/state/zip: Phone 0: 9 I Aare yeo an employer?Check tiLe propriatebox: Type of project(required) 1. Y am a em In erwith 4. ❑T am a general contractor t mdI p y 6. ]Ne constrcctian emplaYMS(fan O.d/or part�=) * have Bired the sub-conraators 2.Q 1 am a sole goprietar or pattex list` d ora t'4e attached sheet.# 7• Rsbo oMfug ship audyhave uo employees 'these sub-amtracun Lave 8. ❑Demolition vtorltmg for me in any capacity. workers'camp.sn$utauce. 9. [J Building additim [No-worlwe comp.knsurartce 5. Q We are a earporatigu and its [[� �� 1Q. kct�rlcex repairs or addi�orty mise ovJnrxere'rump. �W Y� a�. ullc rasa insurar�cc,�cquj�cdj i employes_[Eri wnrlcers' 13.M Other comp.inns oo x quired-] !hWappliomtthatchodobox#lmtistAso t!}1outthesectioabdowabmviagthtlrwot'k sation poliq irbzwotlon. t.uomeowwus vAo submitthis affidavit indicating thr y&'to drying oilvmxkond thentim outside eonactors mustoabm t a naw affcdniE h dicW0gsn0h. tCoaftotwsthat akeckthisbormastattachedansdditionatshretehowingthaname ofthosab-conit&CfOtBt>i+dtheir�¢ 'comg.policyintb�atinn. taunt employefthatfsprovidingworkets'cogn�er�ratlata$nsyurancefotrry t lrryee lelotv&sthepnlicytlnt7,�crhsite htfoI]nadon. _ 1murance Companyliame:_ o, isox ss lob site Afress' ` A �J �Giyltate/ zp: �U Attach a.copy of the markers'coorpertsartion policy cleeIarationpage(abovymg the policy xtaml?er and expiration date). VnIbrra to wir irf-r.nvi-mvi as rpxpire-0 nngt-r Sertirtn 25A ofMGL 0.152 cm lead to tho i=000A of Criminal penalties of a fino up to$1.,500.00 and/m cae-pat haprisonmcti na vallas oivilpemldec in the f_ostu of a STOP WORK€1RM and a fine of up to$250.00 a day agabst the violator. Bo advised that a copy of ffis stateunmt may be tbivarded to&o C31f'tce-of �Vestigations of thel7IA forinstzraraca eoveTage verification. I cryo hemby cgl�'t ratrdst#V;pacW and penalft ofpp-Iroy aat Me hIfbrmntidn1 wnvt o7.1ahapa is irate atzd Colvad 1 tee: bate 3 Phone 9: Of laial rata Only. Do riot 1pflta In 3%FS aroir,to bo ew?pyetad'ly CM.I or town aff efirl. City or Town: �'�tnitlLicenge# hsiftg Authority(elms ane): t.hnnrel nt tumth -r,.hutlfiingMpartmeat .i.t;tWITilwn Claris 6.Other - -