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HomeMy WebLinkAboutMiscellaneous - 565 TURNPIKE STREET 4/30/2018 (6)�. �}aq'; a�;.'. m � ,�.. .�V' TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: i \ Date Received Date Issued:\ l A 'IMPjORTANT: Applicant must complete all item�sf on /this image` LOCATIONS � __ ,a � - z ��IZ z C PROPERTY OUVNER / ,/t� -_ - z Print 100 Year Old 8,tructc +MAP►NO:'� ARCEL ZONING DISTRICT 'Historic Dlstr;et lP �_ imach n a$' '6p V_i .TYPE OF IMPROVEMENT- PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family -- yeS,�, ❑ Industrial .TYPE OF IMPROVEMENT- PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: N,"Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other �} ❑:Septicx ❑ 1Nell - lain .'Wetlands O'Floodp -❑ Watershed ®istnct� 4r 7' OWNER: Name: Ari(irPgs: (/ ,k DESCRIPTION OF WORK BE Pf �d/e.(—e' o,(, W 6& Coe PleaseT e or l 40'e-7 Co Pi CQNTRAOT, OR'Name '�/�?� r� __ t`� Phone(i/, d _ Address is X, License_.FExp� }Date. cHomeImprovementrLicense �_m_ sExp 'Date 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. C Total Project Cost: $ JFEE: $ Check No.: W Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to th$ g77. nth nd1 / - - I % /- r�,l/ /1 %/�' Y// Signature=ofxAg'ent/Owner�{� _. ., `{_ _ "Ig�ature_ot contractorA: _ �i*' Plans Submitted LJ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Plans Submitted ❑ PlansWaived-11 ..Certified Plot Plan ❑ Stamped Plans ❑ "TYPE -OF' -SEWERAGE DISPOSAL" Located 384 Osgood Street Public Sewer ❑ Tanning/Massage/Body Art ❑ .. .Swimming Pools ❑ Well Tobacco.Sales •FoodPackaging/Sales ❑ Private (septic tank, etc:_ ❑ -- _ . -permanent Dumpster on Site ❑ - THE. FOLLOWING SECTIONS FOR OFFICE ,USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM . -DATE REJECTED - PLANNING & DEVELOPMENT" ❑ DATE:APPR.OVED ' i 1. •L 4 ' COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature s COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes . Planning Board Decision: Conservation Decision: Comments :Comm Water & Sewer Connectionlsignature & Date Driveway Permit DPW To` O Engineer: Signature: Located 384 Osgood Street FIRE DEPAk'tMr NT Temp Dumpster on site yes no 51 Y i Fire'Departme►it signatureldate `' S � 4'P:.�" Y„.:'4 y� 1^ • <�'t ��ti 1 � 3 3r +, v,�.. r: S # w n f w COMMENTS ,..A :�;k,.•f..s�° .. . . -. Dimemsi.on 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 DANGERZONE LITERATURE: Yes No MGL -.Chapter -166 Section 21A -F and G min.$10041000.fine NOTES and DATA — (For de LJ Notified for pickup - Date Doc.Building Permit Revised 2010 ent use Building Department =The fo0l)wing 18`41ist of the retluired.forms to be filled out for the appropriate. permit to`be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Rtailding Permit Application 0 Workers Comp Affidavit ❑ Photo Copy Of H.1.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ 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 o 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) 0 ❑ Building Permit Application o 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) o Copy of Contract o 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 thi 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 subm.?ted with the building application Doc: Doc.Buihing permit Revised 2012 Location 5k:9— 7'l iLvz{e t �A, S No. L Date TOWN OF NORTH ANDOVER • Certificate of Occupancy $ Building/Frame Permit Fee $ a Foundation Permit Fee $ Other Permit Fee $ 4TEli X _. TOTAL $ Check # _. � 1_ 27288 Building Inspector MM 3 0 H 0 as H J .mAn � L N o - O -a > N wQ c N -�� o �•Eoo T iv - 4 N 0 C O '> `c o � 'a : Qom°' m C m w CO) 0 . o c c _ O vi 2co m W = O O w LL '� 41 N C C E- .E��.2 Z CJ •a r 0 O W L d L •�y.. _ N -� o O c - CLov > 2 z G z W w CLx LU CH G W CL cr o a "z CD Z_ J m El I I E _ f+ O d ZCD y I C c N O �+ + O Vca O CL a. CL a� Q Cc ,v Q O {; C Z V tU 0 O O H V U LU OLLJ Q Y.I d C _Z Z Z a u. J H Q z c Z Z U w O O u Q w l7 �_ CO JJ L1. C m N N C d W u:!2 O O O z \ U -6 r C r r Uto 41 cu "O '�..� C c CU Y O CL 3 7 t6 7 m i c6 7 N - w O j 0 a) O O s O = O v s O O � -' LL N LL M U LL K LL CC N LL IL CO {n to 3 0 H 0 as H J .mAn � L N o - O -a > N wQ c N -�� o �•Eoo T iv - 4 N 0 C O '> `c o � 'a : Qom°' m C m w CO) 0 . o c c _ O vi 2co m W = O O w LL '� 41 N C C E- .E��.2 Z CJ •a r 0 O W L d L •�y.. _ N -� o O c - CLov > 2 z G z W w CLx LU CH G W CL cr o a "z CD Z_ J m El I I E _ f+ O d ZCD y I C c N O �+ + O Vca O CL a. CL a� Q Cc ,v Q O {; C Z V tU 0 The Commonwealth of Massachusetts - Department of Indushigl Accidents Office of Invesfigations 600 Washington. Street Boston, MA 02111 www.mass gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name Mr-L2dta CJ©/ -g 4 Ike l Address: 12 /qA r v in City/State/Zip: / V _V w � o w -/ 0 t'2 Y P%hane #• � � <<C� 33 Are you an employer? Check the appropriate box: Type of project (required): 1. I am a employer with 4• ❑ I am a general contractor and I 6.. [] New construction _ /employees (full and/or part-time).* have hiredthe sub -contractors listed on the attached sheet. 7• F1 Remodeling 2. I am a sole proprietor or partner- ship and'have no employees These sub -contractors have 8. ❑ Demolition working for me in. any capacity. workers' comp. insurance. g. E] Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10. F1 Electrical repairs or additions required.] 3. ❑ I am a homeowner doing all work officers have exercised their right of exemption per MGL I L ] Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12. ❑ Roof repairs insurance . re uired required.] employees. [No workers' 13.❑ Other comp. insurance required.] x4ny applicant hat checks box#1 must also fill out the section below showingtheirworkers' compensation policy information. 'Homeowners who submit this affidavit indicating they Ate doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that checktI6 box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. X am an employer that isproviding workers' compensation insurance for my employees. Below is thepolicy and job site information. rl �7 Insurance Company Policy # or Self ins. Lic. #: 3 3 �1_2 Expiration Date: Job Site Address: Cel. Hy`l e/Zip: % 7o VP fV//�/0 Attach a copy of the workers' compensation -policy declaration page (showing the policy number and expiration date). Failure to secure coverage as kequired.under Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a fore 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. / /YU #(I, a ��14 (® r°'-? X do Izereby certi undpaIZ .4tiQnafiTra.� L// Phone #• (7919 6�®-3312 that the information provided above is true and correct nate. 211alpal �, . Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (turtle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - - - Contact Person: Phone #: 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.,, An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a.- deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold 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' compensaiion 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 may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. AIso 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 aworkers' 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 foryou 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 m any given year, need only submit one affidavit indicating current PORGY 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 maybe 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: `rho Commonwealth ofMassa..chusPits. Department ofzndustdal .Accidents (free ofluvestigations 600 Was apa Street Boston} MA 02111 `A, # 617-7-2.7-4900 -4900 o 406 or 1-877M.ASS.AFE Revised 5-26-05 Fax # 617-727-7749 ww.Mass.govaa proposal to: Michael Grossman M.D. 4e-a5S 11)'9 -- 565 turnpike street ,suite 74 North Andover MA Stage A work to be conducted over weekend , Cost of the materials will be paid by the owner after receipt is provided by the contractor. Materials will be delivered by the contractor to the site. All the debris will be removed from the site by the contractor. 1. Installation of the wall with the solid wood door and frame ( match the existing doors )(25"- 30") in the existing room in order to create two connecting rooms. 2. New Door to have ability to be locked on both sides (side of the lock and deadbolt need to be discussed prior installation ) 3. new wall , the new door , frame and the ceiling above on both side of the wall to have soundproofing. Existing door to the waiting room to have a new door handle with a lock from inside the room installed, also installation of the door sweep, weatherstripping , etc to soundproof , ceiling on both side of the door and the existing wall need to be soundproofed to extent possible . 4. installation of the baseboards on both side of the new wall (to match the existing ) 5. ceiling to be restored to match the existing 6. installation of the 2 door sweeps (to the new door and to the door leading to the waiting room) 7. paint all to match the existing paint including wall, new door, baseboards, door frame, chair rail. 8. Move and arrange the existing desk and credenza in doctor room, so he can work , 9. move existing furniture, rearrange existing furniture as needed , clean the debris and residuals of the construction. 10. (installation of the ceiling rail for privacy curtain. Need to be discussed. Most likely to be done during second stage of the work ). 11. Installation of the support hardware under the reception counter on both side of the window. 12. Installation of the vinyl Mural ( similar to photo wall paper) on the new wall. Mural, installation kit and the paste to be provided by the owner. 13. Installation of the 6' chairail ( from hard and durable material ) on the one wall ( to protect the wall against the ultrasound machine) 14. Contractor will receive the construction permit from town of North Andover building department . proposed estimate including price of the permit :.X'./_ST-O /'1- 10 "Yel S R-49 a �f 6 5 7 y IY4 FS AJ rE R e eq &ig AVOW IUI oft Cal,'nL&F u.,,th t44 5; n x rI7 13 i El F- ............ -� "9/0 ig Conditions Floor Plon co n.ucrOw 1/5"=1'-0') "Olv ............. . .. "SV(77,tZ DATE (MMIDDIYYYY) ACaRV CERTIFICATE 4F LIABILITY INSURANCE 09/0312013 TH�RTIFICATE IS ISSUED AS A MATTER ONEGATNE Y AMENDYEXTEND,AND NORRALTER THE COVERAGE AFFORDED BY THE POLICIES NO RIGHTS UPON THE CERTIFICATE HOLDER. S CERTIFICATE DOES NOT AFFIRMATIVELY OR AUTHORIZED BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. ect to IMPORTANT: if the certificate ons of the policy, certai npoticOies mayNAL equINSURED, an ethe ndorsement. A statement o this certiust be endorsed. if ficcate does noOGATION ISt confer rrightslto the the term certificate holder in lieu of such endorsement(s). NRtCT Stewart PRODUCER 01984-001pp �1Sit0. Ext: (617)6274400 FA/C. No Segal Insurance Agency �Siss: 424 Langleyy Road Newton, MA 02169 A.I.M. Mutual Insurance Company 33768 INSURED V & F Contractors Inc 12 Marvin Lane Newton, MA 02469 COVERAGES CERTIFICATE NUMBER: :LUSIONS ANU WNW INnv� W, TYPE OF INSURANCE GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 0 OCCUR AGGREGATE LIMIT APPLIES PER: AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS REVISION NUMBER: HAVE BEEN ISSUED 70 THE )N OF -ANY CONTRACT—OR OTHE.R..DOCUMENT WITH RESPECT.TO WHICH THIS... RDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, F BEEN REDUCED BY PAID CLAIMS. POLICY NUMBER UMBRELLA LIAR OCCUR EXCESS LIAB CLAIMS MADE y�pRKDEERDg cpMPRETENTION $ AND EMPLOYERS1i'Isa33l% ECUTIVE N A a�l�n��jd�5WRt FN NIA VWC-100-6008670-2013A 6111/2013 6111!2014 (Mandatory In NH) , If more space is required) DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101, Addttlonal Remarks Schedule LIMITS. EACH OCCURRENCE $ DA AG EN ED PREMISES (Ea ocourren $ MED EXP (Any one person) $ PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ coMnlNtu 5irvv�� U $ ui ent BODILY INJURY (Per person) $ BODILY INJURY'(Per accident) $ R?—n-1 MAGE $ P cadent EACH OCCURRENCE $ AGGREGATE $ E.L. EACH ACCIDENT $ 1,000,000.1 E.L. DISEASE . EA EMPLOYEE $ 1,000,000: E.L. DISEASE - POLICY LIMIT $ 1,000,000. SHOULD ANY OF THE.ABOVE DESCRIBED POLICIES BE CANCELLED BEFOR THE EXPIRATION ATE THEREOF, WILL BE DELIVERED II ACCORDANCE WITHHE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE � O� Q 1988-2010 ACORD CORPORATION. All rights resery Ind logo are registered marks of ACORD i ��1��z�yyul�zct�(zz/ s:- Office of Consumer Affairs and Business Regulation - = 10 Park Plaza.- Suite 5170 '�<'--�=•=' Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 126637 Type: Individual T. r, n,2 VLADIMIR PROKUPETS VLADIMIR PROKUPETS 20 MARVIN LANE NEWTON, MA 02459 SCA 1 C; 2OM•05/11 _ L .... r'��t; (Lu71�7itod�tt�:�z�/� �� C�•F't rr3Jric�C�3c�i '}y Office of Consumer Affairs & Busi�ss Regulation HOME -- egistration: 126637 Type: expiration 6!29/2014 Individual VLAD AIR PROKUPET$ VLADIMIR PROKUPETS' 20 MARVIN LANE NEWTON, MA 02459 Undersecretary License or registration valid for individul use only before the expiration date. 1f found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, MA 02116 --&td without s gnature WMassachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supervisor, License; CS -076M ; VLADIMIR PROI�i 12 MARVIN LANE Newton Center Nle )1'0%`' Expiration Commissioner 01/19/2016 Sample C This io17n satisfies alt basic requirements of the skate's Home Improvement Contractor Law (MGL chapter 142A), but does not include standard language to protect homeowners. Seely Iegal advice if necessary. Any person planning home itnpxovement5 should first obtain a copy of da Massachusetts Consumer Guide to p, Home Improvement" before agreeingto any woric on your residence. You may obtain; afree copy by callitig•tbe Office of Consumer Affairs and Business R,egulation's Consumer TnfolsnationHotline at 617-973-8787 or 1-888-283-3757 ox on ourwebsite. �oMeo'� nel'hfol(t71���7lom 'Contractor J>rnf®n•Mjjxoxt � company Name S/trect,A•ddress (do notuseaPo 0 ce Box address) Contractor/ Salesperson/ OwmrName City/Town State Zip Code Address (must include.a street address) Daytime Phone EvemngPhone City/Town 91?��0 —3 f 6'® State Zip Code 1 ��'� i�7�'f6�'C� ,f/eev �� Mailing Address (it different from above) Business Phone eralEmployerlDorS.S. ,/�`� O /jp � /y/ %fi �y n /� X'+eW re[IlIiYCS t�let$aStllaIije �omeImprovementi ContmcrorReg:Namber improvemI contrnctershave n valid reg'stmfian manner /az, V / % 2 The Contractor agrees to do the following work for the Homeowner: (Describe in detaibthe worleto completed, specifyingtbe type, brand, and grade of materials to be used, use additional sheets ifnecessa M 51�4�CL 7�i •(i til �� �C.e iC/ll,(� c!/� 7jj9 ��'C-� f�[L/��G„/.� , _ . •) Izequired Permits - The following building permits are required Will be secured by the contractor asthe homeowner's agent: (Owners Who Secure their own Pelrmits:wMbe excluded from iSie Guaraniy 7=d provisions of :KGG chapter 142,A.) date o' -/a 9IA,,5�7/ Proposed Start and Completioa iSCheclule - The following schedule will be adhered to unless circumstances beyond the contractor's control arise ©2 ata when contractor will begin cont7ractedwozlc. 0 X Pate when contracted woxlc will be substantially completed. Total Contract Price and Payment Schedule The Contractor agrees to perform, the wozlc, :Ciarnisbtthe material and labor speoMed above for the totalsum of: � JPO ig Payments will bemade. according to the foliowing schedule: ( ) $570(9 upon signibg contract (sotto exceed 113 'of the total contractprice or the cost of special order items,-Which,ver is greater) ------ ` � by 1 I or upon completion of --�==--- by / 1 or upon completion of upon completion of the contract. (Law forbids demanding fu11 payment until contract is Comp feted to both Thefonowingznaterial/equipmentmustbespecial g P y'ssatisfaction). ordered before the contracted work begins in order -- to be paid fox to meetthe completion to be paid for NOTES- 01) Including all mance charges (*:M osit Or dOwil- not exceed the Speatercial cia or er on third of the total contrac pri a or (b) the actual cost of any aymont required pecial equipment ocontractor b r custom made material which must be special orderedin advaude to meet the completion schedule. Subcontractors - The contractor agrees to be solely responsibleforof e work described of thew' regaldless ofthe actions fe�y��dontract partylsubcontractox utilized by the contractor. The contractor farther agrees to be solely for all a materials and labor finder flus a eement payments to all subcontractors for Co tzact shall eptanee - Upon signing, this document becomes abinding contract under law. Unless othezwise noted withint contract shall not i ring th s con lien ox other security interest has been. placed on the residence. Review the following cautions and notices the carefully before signing this contract. b Don't be pressured into signing going the contract. Take io time to: read and hilly understand it. Ask questions if something is unclear.. sub Make sure the contractor has a valid Tome 7m xovement Contractor Re 'stration. The law requires most home improvement contractors and • subcontractors to be registered with,the Director ofl3ome Improvement Contractor :Registration. registration by writing to the -Director at 10 Park -Plaza, Room 5170,,toston, MA.02116 or by calling 617-973-8787 or 888-283-3757. gisiration. You maym u.7xa about contractor o Does the contractor have insurance? Aslc the Contractor for Itis insurance company information so that you can confam coverage, or aslcto see a copy of a "proof of insurance" document. o I�nowycurrights andresponsibilities. Read the importantTnfolma.•tion onereverse side of foam and et a co Guide to the Home improvement Contractor Law: g copy ofthe Consumer You may cancel this agreement if ail has been signed at a place other than thnla e contractor's normal place of business, provided you no ' the contractor in writing at his/Itex main office or branch O:Mce b ordin third business day following the sio ;rg oftbis agreement. Seethe attached notice f cancellaiaon f x an expTauationU posted, by telegram sent or by delivery, not tof thist of DO NOT'SIGN T�][� �CNTRACT IF 7C'I-CEIZE right. Two identical copies oftlte contract most be completed and ' �` A1�1Y ]�]f_+A1�I �� SPACEST T T c s go to the IiomeoWner. The o"' t)LereopyslwtlIdbeIceptbgflieconiracter. 01 :rTomeownex's Signature - . `'L_ Contractor's Signature �/� to ` CO3mir aior i rbn ra ion The Home 7xnpxovement Contractor Law provides homeowners with the right to initiate an arbitration action as an 'alternative to cotu•t actio") if they have a dispute with a contractor. The sane ri ht,is contractor., however. The contractor would have to resolve any dispixte he/she has with a homeoAt awneKlu tically coo. mess both parties agree to the optiona1 clause provided below. This clause would give the contractor the same xi ht to arbitration as is afforded to the homeowner by the Nome Tmpxotrement Contractor Law. g The contractor and the homeowner hereby inuta&UY agree in advance that in the event the contractor has a dispute concerniug this contact; the contractor may submit the dispute to a private arbitration f a -M which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the eonstmer shall be required to submit to such arbitration as.provided In. Massachusetts General. Laws, chapter 142A.. PTomeow.nei's SignatLue � Contractor's Signature NOT]CM The signatTes of the P'artie's above apply only -to the agreement of the pa7,-ties 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 loarties. Romeowner's Rights .A, homeowner's rights under the Home improvement Contractor Law (MGL chapter 142A) and other consumer protection laws (" MGL chapter 93A) may not be waived in any way, even, by eowners agreement. Izowevex, hom maybe excluded from certain rights if tlae contractor they choose is no E properly m egislaw, ment as prescribed m Homeowners who secure their own building permits are automatically excluded'b;omn all Guaranty Fund provisions of the Home lmnpxovement Contractor -Law. The contractor is•responsible for eompletingthe worlc as described, timely and worlcmaulikc mant.er. Homeowmrs may be entitled to other specific regal rights if the contractoin a r guarantees or provides an express warranty for workmanship or materials. In addition i provided by the contractor, all goods sold -in Massachusetts cavy as Implied waaraniy of meOgurchantability and '-'0s s for a palticular purpose. An enumeration of other maii;ers on which the homeowner and contractor Merchantability avf it t agree maybe added to the tenn.s of the contract as long as* they do not restrict a homeowner's basic consumer rights, if you have gtTe517Om1S ab0uty0ur consumner/homeownerTights, contact the Consume rxtiCoxmationZTotline (listedbelow). Execution. of Contract The contract must be, executed in cluPlicate and should not be signed until a copy of all exhibits and referenced documents have been'aitached. Pm ties axe. also advised not to sign the document until all blank sections have been filled in or marlced as void, deleted, or not applicable. One original signed copy of the contraot with attachments i.s to be given tc 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 tumid both parties have received a f m,Uy executed copy of ••the contract, and the three day rescission period has expired. Accelerated lPayna.euts A contractor may not demand payments in advance of the dates specified on, the•pa)7ment schedule in cases where the homeowner deems him/herself to be finateially insecure. However, in instances where a contractor deems him/herself to be aancially insectiue, the contractor may require that the balance of fan.ds not yet due be placed k a j oint escrow accouat as a prerequisite to continuing the contracted work. Withclawal of fLmds signatures of both parties. f= said account would require the Aadxtional I tfo:rmation. .If yotx have general gt2estions or need additional itlCorination about the Hoorne Tmpxovement Confractox Law or other con act: lights, or if you wish to obtain a free copy of "A Massachusetts Con.stimer Guide to Home knpiovemnent" contact: Consumer xnfonnationHotae Of'100 of Consumer Affairs and Business R.egLlation 10 Park Pl=� ROOM 5 170,13aston, 02116 617-973-8787,'888-283-3757 or vaasit the OCABRwebsxteatat /Iwwtiv.mass: ov/ ' ocabrl about the contractor want to n actor registration compverity the registration of a contractor or if you have questions or need additional. information speciC cally bout onent of the Homs Improvement Contractor Law; contact: - Director of Home T•raprovemnent Contractor Registration• Office of Consumer Affairs and -Business Regulation 10 ParkPl=a, Room 51.70, Boston, MA, 0211.6 617-973-8787, 888283-3757 orvisitthex-UC website at Go online to view the status of a Home Improvement Contractox's Registration: htL7�://db.state::ma.t2s/hotneimnrovexr�ent/IicenseeTis•t asn e Tbr assistance with inform, -l• mediation of disputes or to reg Sier Cormalcomplaints against a business, calx: Consumer Complaint Section Office of the Attorney General. 617-727-8400 AND/OR Better Business Bureau 508-652-4800, 508-755 254.8 or 413-7343114.