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HomeMy WebLinkAboutMiscellaneous - 9 ROCK ROAD 4/30/20189372 Date . .. q. �'<".� " �tio TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ACNusE This certifies that has permission to perform plumbing in the buildings of ........ ................... at ..... .z.-.. �.cn!�„ , , c4No,,h Ando et, Mass. Fee.t.V.�..Lic. No....��p. PLUMBING INOECTOR Check # MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT' TO PERIFORM PLUMBING WORK '111;01_6 CITY MA DATE �1 1 PI=�r�IT � . J05SITEADDRESS �/ 5 Z S lF� � f OWNER'S NAME FOS S jr OWNERADDRESSl TEL IFAXI TYPEOk OCCUPANCYTYPE COMMERGIAL1 1 EDUCATIONAL l I RESIDENTIAL PRINT IGL,EARLY NEMIA RENOVATION: I REPLACEMENT f PLANS :$URMITTED: YES( 1 N01 i FIXTURES T FLOOR-* 13sk 1 2 s 4 5 s 7 n s 10- 1t 12 13 14 BATHTUB _I,......_ I..., --- CROSS CONNECTION DEVICE OEOICATEO8POIALWASTESYSTEM :� ...:.., _ .:. _, . _ .., ._ .:........-, -_)j.... .._. .;......_ I -.... j _,.... DEDICATED GAS101USAND SYSTEM 1 DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM17 ! DEDICATED WATER RECYCLE SYSTEM . DISHWASHER DRINKING FOUNTAIN ...... i i � FOOD DISPOSER I . . � _ f .... i :. s . )' ... i ...... ! ;. . e .. • � - FL09R/AREADRAIN is --- -- INTERCEPTOR (INTERIOR) I . KITCHEN SINK LAVATORY i ...... ROOF DRAIN __. SHOWER STALL ) � SERVIOEIMOPSINi< TOILET URINAL -- WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING .OTHER i INSURANCE COVERAGE: have a ctirrdnt liabilit iiistlraljce policy.or its sufistantial equivalent which meets the fegt irenients of MGL Ch. 142. YES NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVFRAGEBY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY I , BOND �• OWNER'S INSURANCE:WAIVER, f am aware that the licensee.does not have the insurance coverage required by Cfiapter"142 of the Massachusetts General laws, and that my signature on this permit. application waives this reduiretiient. - . OHECK-ONEUNLY:. OWNER 1 1 AGENT 1 .1 SIGNATURE OF OWNER OR AGENT I hereby certify chat all of the details and infonnallon I have submitted or entered recdardin91bis application are I nd accurate to th best ofAy knoerlddge and that all plumbing work and Installations performed under the permit issued for this application toil[ tie f nip' nce 'lh all Perls t pro on oflhe Massachusolts State'Plumbincd Code and Ohapter of the General Laws. -17 y142 y/,d PLUMBER'S NAME �`� k/ ' f7 ILICENSE # 1 fl) 3 t' , Sl/QATU MPI I JPI CORPORATIONI �I iJJ V S 1PARTNERSHIPf, LLC 1' 10 COMPANY NAME (��� S /��tl J ADDRESS I CITY1 ') ld (}'v✓� U te, STATE /`% I ZIP o ��!EL. FAX CELL I i EMAIL 2 K. � \ § \ w� � ' . . OD ;! � . . e . m 2 ¥ E Q k \ « � , § � / # � k � k 2 ...16 � --\..\�..\�.. . . � . / / C. k � �_. & » � . d \ The Commonwealth of Massachusetts Department oflndustrialAccidents Office of Investigations to 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/fndividual): Address: City/State/Zip: Phone #: 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. ❑ I am a sole proprietor or partner- listed on the attached sheet. t ship andhave no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] employees. [No workers' comp, insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.0 Plumbing repairs or additions 12. El Roof repairs 13.❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. 7 Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that check this box must attached anadditional sheet showing the name of the sub -contractors and their workers' comp, policy information. lam an employer that is providing workers' compensation insurance for my employees Below is the policy and job site information. Insurance Company N 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 requiredunder Section 25A of MGL o. 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 certify under the pains and penalties ofperjury that the information provided above is true and correct. Signature: Date: 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 S. Plumbing Inspector 6. Other - - - Contact Person: Phone #: C 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 defrred 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' 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 may be 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 permit/license applications in any given year, need only submit one affidavit indicating current policy information (ifnecessary) and under "Job Site Address" the applicant should write "all locations in (city or town)" A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license orpermit 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 oyt 406 on 1-877�,MASS.AF Revised 5-26-05 Fax # 617727-7749 wWW.Mass,8oV1CRa MASSACHUSETTS UNIFORM APPLICATION FOR A PIERMIt TO PERFORM PLUMBING WORK TYf'E-011 PRINT CLEARLY 'CITY 1 .... MA DATE] f/ � � / J.Z I PERMIT tl JOBSITEADDRESS y 5 Z SOWNER'S. NAME FO s S OWNERADDRESS I 1 TELT IFAXI I OCCUPANCY TYPE COMMERCIAL I i EDUCATIONAL ( j RESIDENTIAL J NEW: I A REN4VAT1914: { REPLACEMENT: f PLANS .SUBMITTED: YES NO] 1 Axi-ORES - FLOOR- BSM 1 2 3 4 5 6 7 8 9 10. 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE ` DEDICATED SPECIALWASTE•SYSTEM : . . ; :.. ----, - ... _ •� :... DEDICATED GASIOIUSAND SYSTEM . _ . . __ .. . _ .: . _ _. .......... :. ..... _ .. — - --- DEDICATED GREASE SYSTEM I, ' DEDICATED GRAY WATER SYSTEM i ... ..... ......... a . :::. .. .... i :.......... DEDICATED WATER RECYCLE SYSTEM —= =- - DISHWASHER :.., .. :_ ..: . is DRINKING FOUNTAIN l FOOD DISPOSER FLOOR !AREA DRAIN INTERCEPTOR (INTERIOR} —' i .� -• .:.--, ... , , ; .. ; . 1 .....I .. i;"``' ..i . KITCHEN SINK ..... ... : ; .. i --•I -- _.._. ' . -. LAVATORY .I --. ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET •� -- --- ------I - '-- - . - �.:• URINAL _ ... ., ---- -... _.i .>- WASHING MACHINE CONNECTION _ WATER. HEATER ALL TYPES. WATER PIPING .OTHER J INSURANCE COVERAGE: -- - - 1 have a ctirront liabilit iilsitraljce poligor its sulistontial equfValentwliicii meets the requirements of MGL*Cfi.142. YES J1--f NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY J OTHER TYPE OF INDEMNITY I i BOND (• j OWNER`S INSURANCE: WAIVER: I am aware that the licensee.does not have the ftisarance coverage required by Cfiapl6142 of the Massachusetts General Laws, and that:my signature on this permit application waives this requfre(nent. tHtCK-ONEONLY:. OWNER AGENT - SIGNATURE OF OWNER OR AGENT I hereby certify that 811 of [tie delails and infonnation I have-66 tilled of enlered recdardingthis application are t nd accutate la lh 6est of y knoeriedg'e and that all plumbing work and Installations performed under the permit issued for (his application Wlt be in mp' nce 'lh all Pero 1 pro on OT (ho &1assacliusel(s State Plumbing Code and Chapter 142 of die General Laws. 1,v�, PLUMBER'S NAME �%�� �` ILICENSE11I fT3& - SI ATU MPS I .1PJ J CORPORATIONS . ,33YS JPARTNERSRIPj Jill JLLCJ Jill J COMPANY NAME 1 ��� S t`�i �`� H 1 ADDRESS 1 I CITY I �'/U STATE 1'l� I ZIP I o/,% 1 TEL FAX I CELL I 1 EMAIL 1 J ry_CXThe Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: Phone #• Are you an employer? Check the appropriate box: Type of project (required): 1. ❑ I am a employer with 4. [:11 am a general contractor and I 6. ❑ New construction employees (full and/or part-time).* 2. El am a sole proprietor or partner- have hired the sub -contractors listed on the attached sheet. 7• ❑Remodeling ship and'have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their 3. ❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, § 1(4), and we have no 12. ❑ Roof repairs insurance required.] t employees. [No workers' 13.[j Other comp. insurance required.] 'Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. I Homeowners who submit this affidavit indicating they aie doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. 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 requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certiq under the pains and penalties ofperjury that the information provided above is true and correct. Signature: Date: Official use only. Do not write in this area, to he 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 #: I 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 ofhire,. 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' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) 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 confiumation 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 permit/license applications in any given year, need only submit one affidavit indicating current Policy information (ifnecessary) and under "Job Site Address" the applicant should write "all locations in (city or town)" A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each year. Where a 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 Commonmazth ofMossachuse is Department ofIndustrial A.ccideuts Office of Investigations 600 Washington Stroot Basion? SIA. 021 X 1 Tel, # 617-727-4900 ext 406 or 1-877 MASSAFB Revised 5-26-05 Fax # 617^727-7749 www.z>aass,gev(daia Qlf�e (gammouturaffff ufAassarhussffs HOUSE OF REPRESENTATIVES 16TH ESSEX DISTRICT MARCOS A. DEVERS STATE REPRESENTATIVE STATE HOUSE, ROOM 146 TEL: (617) 722-2011 BOSTON, MA 02133-1054 FAX: (617) 722-2238 MarcosDevers@MAhouse.gov V Joint Committees: • Economic Development a Emerging Technologies, *� • Education • Transportation • Redistricting House Committees: • Steering Policy a Scheduling J e � . � �, aQ g��e&t 69� Q ♦ogSoo� ie aoa y�e ®§ Pe`edp a\k Ce\ p cia @ 0 9G ds �e �- Ptes�de ooh\a��PO�g�a\�d� �a� cAsd �a� COMMONWEALTH OF MASSACHUSETTS OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATION Ten Park Plaza, Suite 5170 Boston, Massachusetts 02116 W Phone (617) 973-8700 M Fax: (617) 973-8799 d Home Improvement Contractor L7M SveJ Complaint Form �\ M.G.L. CHAPTER 142A & 201 CMR 18 To file a complaint against a home improvement contractor, you must fill out this form completely and submit it to the Office of Consumer Affairs and Business Regulation ("OCABR"). OCABR will review all complaints. The submission of a complaint will not automatically result in a hearing against a contractor. If OCABR determines that your complaint is appropriate for a hearing, your complaint may result in disciplinary action against the contractor's registration and/or administrative fines. You will be notified in writing if a hearing is scheduled to address your complaint. You will be asked to testify at that hearing. Please refer to the OCABR website (www.mass.gov/oca) for additional information about OCABR's home improvement contractor complaint process. FILING A COMPLAINT WITH OCABR WILL NOT RESULT IN A MONETARY AWARD FOR YOU. IF YOU SEEK A MONETARY AWARD, CONTACT OCABR'S ARBITRATION & GUARANTY FUND PROGRAMS. 1. Your information: (Please type or print neatly) Name: n Current address: /�� ��� /' �7/�If/lr� N/ �1 �J9 Address of building at issue: % �vclG / , fl�IG�BG��Gi r Ar � U/w Number of dwelling units in the building at issue: / Is it a residential property? (circle) Yes No Is the building at issue your primary residence or did you intend for it to become your primary residence? (circle) Yes No Day phone: (qW) (?11i1 902o Fax: (%%A .3 3/. E-mail 161✓U,71- I Use 0 iA/lots. 2. Contractor Information: Contractor name: Lle VAs Business name (if any): E/��/1 S /ai✓IGtd2M(17 Business address: vZ i U f3A i f ep[/ 15+.L�tGJ-a l VICC �I� fJ i 3 Phone: Date contract signed: // / /C l -11) / Amount of contract: $ s e-0 e Home Improvement Contractor Registration (HIC) # 1 -2 - : To the best of your knowledge, has the contractor filed for bankruptcy? (circle) Yes No 3. Other Information: If you have included photographs with your complaint, do you want OCABR to return them to you later? (circle) Yes f 0 N/A 1 4. Complaint Information: Please circle the number of any of the following acts that you allege took place in your dealings with the contractor. You must circle at least one allegation. 1. Operating without a certificate of registration; DAbandoning or failing to perform, without justification, any contract or project engaged in or undertaken by a registered contractor or subcontractor, or deviating from or disregarding plans or specifications in any material respect without the consent of the owner; 3�Failing to credit to the owner any payment they have made to the contractor or his salesperson in connection with a residential contracting transaction; E_�4aking any material misrepresentation in the procurement of a contract or making any false promise of a character likely to influence, persuade or induce the procurement of a contract; 5. Knowingly contracting beyond the scope of the registration as a contractor or subcontractor; 6. Acting directly, regardless of the receipt or the expectation of receipt of compensation or gain from the mortgage lender, in connection with a residential contracting transaction by preparing, offering or negotiating; or attempting to or agreeing to prepare, arrange, offer or negotiate a mortgage loan on behalf of a mortgage lender; 7. Acting as a mortgage broker or agent for any mortgage lender; 8. Publishing, directly or indirectly, any advertisement relating to home construction or home improvements which does not contain the contractor's or subcontractor's certificate of registration number or which does contain an assertion, representation or statement of fact which is false, deceptive, or misleading; 9. Advertising in any manner that a registrant is registered under this chapter unless the advertisement includes an accurate reference to the contractor's or subcontractor's certificate of registration; 10. Violation of the building laws of the commonwealth or of any political subdivision thereof, If your complaint alleges structural violations of Massachusetts State Building Code, those allegations will be referred to the Board of Building Regulations and Standards(BBRS), within the Department of Public Safety (DPS), for possible action against the contractor's construction supervisor license or you may proceed by filing your own separate complaint to DPS/BBRS 11. Misrepresenting a material fact in obtaining a certificate of registration; 12. Failing to notify the OCABR of any change of trade name or address as required by section thirteen; 13. Conducting a residential contracting business in any name other than the one in which the contractor or subcontractor is registered; DFailing to pay for materials or services: rendered in connection with his operating as a contractor or subcontractor where he has ived sufficient funds as payment for the particular construction work, project or operation for which the services or materials were rendered or purchased; 15. Failing to comply with any order, demand or requirement lawfully made by the administrator or fund administrator under and within the authority of this chapter; 16. Demanding or receiving payment in violation of clause (6) of paragraph (a) of section (2), which states: "Any deposit required under the contract to be paid in advance of the commencement of work under said contract shall not exceed the greater of one-third of the total contract price or the actual cost of any materials or equipment of a special order or custom made nature, which must be ordered in advance of the commencement of work, in order to assure that the project will proceed on schedule. No final payment shall be demanded until the contract is completed to the satisfaction of the parties thereto;" 17. Violating any other provision of Chapter 142A. (Please specify below) a. Failing to present the homeowner with a written contract for residential contracting work exceeding $1,000 as required by section 2 b. Failing to include required terms in a written contract.for residential contracting work exceeding $1,000 as required by section 2 c Other provisions of Chapter 142A (please specify in your detailed narrative in Section 5 of this form) 5. Pledse provide a detailed narrative of the acts or omissions committed by the contractor that lead you to file this complaint. If necessary, please attach any additional pages. Your complaint will not be processed without a detailed narrative. t)g &) At CL1eVl S t/En f/dynl�,� iY wt l /%Df r2��/a�L yr/e:> o✓l ��o . /% �/ �; r��( t i,Nc/yde "S,r4o drop edge, Ge/J2f��/r�i Ku %S / ie��al�a3 redo SlC��9Ie S F++ ioof /e/%/GtLt'9//G�fl `ob fW q %7"I/E ad. /2 <*VM itiDLaeo/ A ffo& J '.y 17FeWS. 7o buy ~1 raP/ieW ur ll% -Of e &'4 4e"ded'). 5;i'a AI" exel''%'lew G%U/ Fl 44V� /0'y 4 Mfr A -0 61 Puf fe/t �aPer ew 7,5111 I -v f a( o ue Pard y� s�dP �f 9� , r��: /e fle� we9� s- A?eJ ifs, q 7i'ALM S�'�dY Caut�aYfL�<' fvr ct �v /jer9,1%f �CL1�lrLo�l ��2J2.7 �� �2 i)2%n1 Gyv1G� c7v�lc�c% •{vy �ZJm �?aurs Oyy V4 y„/d;-WV4e A1,17'/447 �Zr9LTrlCQlg er'(e�r-o"!W�ralccGi 1"ms'vs/N"”' erte fuf/ SLrweel% evr of.s, jc�rnvf's, �%G>;aio>c 1�wf 6�/ r'c'r ua�Gi h2fn'e he o,--;( rao f's d 4e/v6d`� rs ylo z /9;zfPirio>7a! --4e e/j/EPSP SPP f4e �i�cfu!'Ps a�au�iJ. Gr)e G�2/'Q cJ-1re�' �cbac� ovBrulf f�.� gGtal�y czr,ol �E`,�.'�Sn,�� 6�I/y t<�o �uys slocve� Gc4ti� •fUU�i�'� Ae;,z - �lyP . if�(/Z/7 SLyared ow A-lv-:-4Irnen/e/rf <'4e lyv&,,ked � f���J aixc� 4/E WA,1146 #12e Pee4 W74 -/ke ;2� >uD?6rGd' nLa7 i�fs -L Yi7 � �i�De. Gie ,t /W ne 7W /1e Aff Cee- yofe •4fe rgfkew . &, vaii 5'4(M;1*W . CO/�s1C GLi %1PX7 Gird/ '�v Yd'fu�l I2�ff �f 9esa7`c'�<< `2 %aoD} �^ carr dJacn ry4M , AW we nz -2'�, �te-ve��lle�p�%A/or+re / 4)'z�J A, w D�q'd /`�'!'-G, '--y CGcI 0� 6`',!/ �� ��o'• �)Oh2�LlIG/ (,17 f� /"'dls/e //e�%D � GYFY�Y 1�'/�%, e°Cl �he C`6ls�Q � eiti�I% ✓K �KOY7!'i 1�� DQ.vo a.zu� 0/L�/��/G �{�e y%��,y12��/C e{itrli incl %�/�SOYPi^�JL/ Gt�2i` Jrv`Q�} (p/15Ver9 7'�Yt �i� FS A 10-449/ Xe �IG fig 9treylc't/ � n+�r��i+r,1Zr44-r. Ile 61 e Gv a3 i Aly rr>^ot /�t�led� �l ,r iQ/!q 1 t�erv/L tw•c( /� �/ 72CG11� f%, /f/�J c e/• f/i�+t- ": �4� 2dlcr> Z C /a rsvt Guc��� s y�fe✓�c� �%4nd Ztae7q r D > y� 7u�o/P rc(/ rdloG�P� • 7xc< �{ �/�'�/, oc�} t�rlG7 ��rlr0 7Va.'V2 T`igre is Ifo c-.ft�%cf�r ��, armrr><cnad Fives -- &-w e"Z1 6. I hereby affirm that the information contained in this complaint package is true and accurate to the best of my knowledge and belief. Signed under pains and penalties of perjury: Signature Date 7. Please submit the complaint application, and all supporting documentation, e.g., building application, court judgments, contract, photographs (limited to 5 photographs), and the like (the documents or photographs should NOT be stapled) to: Office of Consumer Affairs and Business Regulation Program Coordinator HIC Complaint Program 10 Park Plaza, Suite 5170. Boston, MA 02116 3 PROPOSAL PROPOSAL N0. J_ TZ 1 el T SHEET NO. JG DATE / PROPOSAL SUBMITTED TO: WORK TO BE PERFORMED AT: NAME i -r' ADDRESS ADDRESS A /y DATE OF PLANS PHONE NO. ARCHITECT � � tL' d9j 9C U fi We hereby propose to furnish the materials and perform the labor necessary for the completion of _ — -- CIA - ALC -1 1 ti t r 'k)'rl e cr 4 .— ,�r / r L 1 t iL_ �A / 1 1} tt �i �� % ! (, — --- _ � u ._.lit _. :1 00 kvr .�-^� --- _- --� _- 4071* -------•---P � -.---- - -.- - All material is guaranteed to be as specified, nd the above work to be performed in accordance with the drawings and specifi•• cations submitted for above work and competed in a_ substantial workmanlike manner for the sum of �� Dollars ($ 767 00 � with payments to be made as follows. ri';10o - Rb9pectfuTiy submitted Q J &Q W 0 L-) 'j g Any alteration or deviation from above specifications involving extra costs _ will be executed only upon written order, and will become an extra charge ) over and above the estimate. All agreements contingent upon strikes, ac- cidents,Per or delays beyond our control. Mote—This proposal may be withdrawn by us if not accepted within _ ! % days. ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby, as specified. Payments will be made as outlined above. Signature 4pv Date /,/0 / f'C� �/ Signature CV,mms NU J?J1b-bU PROPOSAL You are authorized to do the work f31 A W N O 'm ', W N Qf C71 A 4) N m J r L 0 j h < lox a N H \ f�J J r L O iU O w L.. � u ,'buy 00 C aq u 1 O N i C_ 2 �, 2 36 f O C` s s J ✓: U. o M U y' v cl?C) LrA M 0 Ld > v ti AcG p r M U > y all41 U .. ,lz • • .r Q �., plz - J r O r .O TYPE.PA(5-.::SOR-ISSUINC-SWc PASAPORTE NP-PASSPORTK• . 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CLQ. i i IV-cc'k- 5T-- MAI, i M DJ & Steven Cuevas Handyman Owner: Scott Deas Address: 9 Rock Street North Andover, MA 01845 1. Roof a. Strip one layer of shingle roof b. Install new shingle roof MDJ Engineering & Construction Marcos A. Devers, P.E. R.P.E.L.#: 33848 C.S.L.#: 47056 H.LC.L.# 106698 Building Repair Proposal 16 Woodland St Lawrence Ma. 01841 T: 978-804-1588 978-685-5691 E-mail: marcosdevers@gmail.com 11/16/2011 Job Site: 9 Rock Street North Andover, MA 01845 Use: Residential Construction Type: Wood -Framed Structure Job Breakdown and Cost: 2. Clean Up a. Removal and disposal of demolition and construction debris 3.Miscellanous a. Permit b. Overhead Totals All home improvement contractors and subcontractors shall be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to: Office of Consumer Affairs and Business Regulation Ten Park Plaza, Suite 5170 Boston, MA 012116 Phone: (617)973-8700 The homeowner is entitled to his/her) three-day cancellation period under MGL c 93 s48, MGL c140D or 255D s14 as may be applicable. The owner has all warranties on the owner's rights under the Materials Labor Subtotal & Equipment $ 2,700.00 $ 2,902.63 $ 5,602.63 $ 600.00 $ 300.00 $ 900.00 $ 379.53 $ 117.84 $3,300.00 $3,202.63 $7,000.00 •:A' proavisions of and MGL c. 142A. Total Amount to be paid for the work to be performed under the contract is $7,000.00 The Job will be completed within 30 business days. Beginning within 5 business days after the closing date and completed within 30 business days thereafter The contractor will obtain all necessary construction permits. Owners who secure their own construction -related permits or deal with unregistered contractors shall be excluded from access to the Guarantee Fund Schedule of Payment According to the following: 50% of Documented Renovation Hard Costs for Initial Disbursement of Funds 50% of Documented Renovation Hard Costs & Labor for Final Disbursement of Funds Upon Completion DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES The contractor and the owner hereby mutually agree in advance that in the event that the contractor has a dispute concerning this contract, the contractor may submit such dispute to a private arbitration service which has been approved by the Office of Consumer affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided in MGL c. 142A Owners: Young Contractor: MDJ Incoi Date: dl, //1 ?� w The Commonwealth of Massachusetts Pnnt Form Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(BusinesslOrganizatiotvindividual): MDJ Incorporated Address: 16 Woodland Street Lawterlae, IVIH U ID4 I Phone #: 1dtu-LSU4-r0t5t5 Are you an employer? Check the appropriate box: Type of project (required): 1. I am a employer with 3 4. ❑ 1 am a general contractor and I 6. ❑New construction employees (full and/or part-time).* have hired the sub -contractors 2. ❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers 9. ❑ Building addition [No workers' comp. insurance required.] comp. insurance.+ 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their 11. E] Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, § 1(4), and we have no 13.❑ Other employees. [No workers' comp. insurance required.] 'Any applicant that checks boa I:1 must also fill out the section below showing their workers' compensation policy information. Homeowtim 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 or 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 andjob site information. Insurance Company Name: Continental Casualty insurance Co. Policy # or Self -ins. Lic. #: 0417N57511 Expiration Date: 4/24/2012 Job Site Address: _ City/State/Zip: A(Jp0_L4 _L lq4— 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 i.n the form of a STOP WORK ORDER and a fine of up to $250.00 a day agami thi violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of I do 978-804-7588 provided above is true and correct. Of 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 #: COMMONWEALTH OF MASSACHUSETTS OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATION Ten Park Plaza, Suite 5170 �� Boston, Massachusetts 02116 Ad Phone (617) 973-8700 w Fax: (617) 973-8799 Home Improvement Contractor 0� Complaint Form �M svev` M.G.L. CHAPTER 142A & 201 CMR 18 To file a complaint against a home improvement contractor, you must fill out this form completely and submit it to the Office of Consumer Affairs and Business Regulation ("OCABR"). OCABR will review all complaints. The submission of a complaint will not automatically result in a hearing against a contractor. If OCABR determines that your complaint is appropriate for a hearing, your complaint may result in disciplinary action against the contractor's registration and/or administrative fines. You will be notified in writing if a hearing is scheduled to address your complaint. You will be asked to testify at that hearing. Please refer to the OCABR website (www.mass.gov/oca) for additional information about OCABR's home improvement contractor complaint process. FILING A COMPLAINT WITH OCABR WILL NOT RESULT IN A MONETARY AWARD FOR YOU. IF YOU SEEK A MONETARY AWARD, CONTACT OCABR'S ARBITRATION & GUARANTY FUND PROGRAMS. 1. Your information: (Please -type or print neatly) Name: V _ _ - �,�' Current address: . ®t%`, Address of building at issue: 9 1110yo•/G /U,.Awey r , 1/m e%l�1144-p Number of dwelling units in the building at issue: f Is it a residential property? (circle) Yes No Is the building at issue your primary residence or did you intend for it to become your primary residence? (circle) Yes No Day phone: ��%U Fax: (%%A�f>)o E-mail YOGI1l,q , i &d li 2. Contractor Information: Contractor name: �..�/L 04 Business name (if any): �iL�/1 S �!'l irlGtd�il6i17 Business address: v2 f C) 0a 3 Phone: (�/Y) Date contract signed: // / /d l -Ac / Amount of contract: $ %i U o e) Home Improvement Contractor Registration (HIC) # To the best of your knowledge, has the contractor filed for bankruptcy? (circle) Yes No 3. Other Information: If you have included photographs with your complaint, do you want OCABR to return them to you later? (circle) Yes, N/A 4. Complaint Information: Please circle the number of any of the following acts that you allege took place in your dealings with the contractor. You must circle at least one allegation. 1. Operating without a certificate of registration; �)Abandoning or failing to perform, without justification, any contract or project engaged in or undertaken by a registered contractor or subcontractor, or deviating from or disregarding plans or specifications in any.material respect without the consent of the owner; �3.Failing to credit to the owner any payment they have made to the contractor or his salesperson in connection with a residential contracting transaction; 4 , laking any material misrepresentation in the procurement of a contract or making any false promise of a character likely to influence, persuade or induce the procurement. of a contract; 5. Knowingly contracting beyond the scope of the registration as a contractor or subcontractor; 6. Acting directly, regardless of the receipt or the expectation of receipt of compensation or gain from the mortgage lender, in connection with a residential contracting transaction by preparing, offering or negotiating; or attempting to or agreeing to prepare, arrange, offer or negotiate a mortgage loan on behalf of a mortgage lender; 7. Acting as a mortgage broker or agent for any mortgage lender; 8. Publishing, directly or indirectly, any advertisement relating to home construction or home improvements which does not contain the contractor's or subcontractor's certificate of registration number or which does contain an assertion, representation or statement of fact which is false, deceptive, or misleading; 9. Advertising in any manner that a registrant is registered under this chapter unless the advertisement includes an accurate reference to the contractor's or subcontractor's certificate of registration; 10. Violation of the building laws of the commonwealth or of any political subdivision thereof, If your complaint alleges structural violations of Massachusetts State Building Code, those allegations will be referred to the Board of Building Regulations and Standards(BBRS), within the Department of Public Safety (DPS), forpossible action against the contractor's construction supervisor license or you may proceed by filing your own separate complaint to DPS/BBRS 11. Misrepresenting a material fact in obtaining a certificate of registration; 12. Failing to notify the OCABR of any change of trade name or address as required by section thirteen; 13. Conducting a residential contracting business in any name other than the one in which the contractor or subcontractor is registered; 14. Failing to pay for materials or services rendered in connection with his operating as a contractor or subcontractor where he has eived sufficient funds as payment for the particular construction work, projector operation for which the services or materials were rendered or purchased; 15. Failing to comply with any order, demand or requirement lawfully made by the administrator or fund administrator under and within the authority of this chapter; 16. Demanding or receiving payment in violation of clause (6) of paragraph (a) of section (2), which states: "Any deposit required under the contract to be paid in advance of the commencement of work under said contract shall not exceed the greater of one-third of the total contract price or the actual cost of any materials or equipment of a special order or custom made nature, which must be ordered in advance of the commencement of work, in order to assure that the project will proceed on schedule. No final payment shall be demanded until the contract is completed to the satisfaction of the parties thereto;" 17. Violating any other provision of Chapter 142A. (Please specify below) a. Failing to present the homeowner with a written contract for residential contracting work exceeding $1,000 as required by section 2 b. Failing to include required terms in a written contract for residential contracting work exceeding $1,000 as required by section 2 c Other provisions of Chapter 142A (please specify in your detailed narrative in Section 5 of this form) 2 3 , 5. Please provide a detailed narrative of the acts or omissions committed by the contractor that lead you to file this complaint. If necessary, please attach any/additional pages. Your , complaint will not be processed without adetailed narrative. A/2ca�frcz�fed Wr-f,W Cuevas �*- I W &4dIV7141 ./�' y Foot' rr(,a olexyL.Q!% %/v. 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APO/ r -f,4 Ae"V /Naxleld e tlo- ,4eked a;nM=9,71) a'q<( �ic� �v�<�� tee pe/Nw- W71 W -to' "e—ml V19 a—a.:6191;( �a���/s '71- Y// W Z?, f 0 ;5:�Ree:. he X/W lie :4 -e le /ale YLfccvrl . &ndgdl SGcrj�fe�fPd Otte jxtcL/ y/e' Giu / o' l rtafr�c �2 , oot� a�^u� coYr dais%pi �� // n7p G wee //ems✓e 1!241 - / �i�' /LQ �c� d-o(✓la � e / Jl 16,ve l%P�>o / w)d n?,"h !eel he -T'-- .2/e �aeyW � C%�( c�zvo a.au) � Avk- ale VIM'<• P-42,4, c -d 1411— ayf �vr/x /%a ',--eyer" s., �eu? y��a�! iauu Ts A faG /fe l`iv/G xl'w'� , r 17i i� r� u�vas �le is �.� i l Xe cv L -e 7i, !1/f /)ay X46 n'?te y' Ar L C/ai'l Ca aVv"-s liesfole 7Ky weaeV 1" aPS-D'� 2,4-rrea/ A�l-' // /` eEnt e'y/, 6. I hereby affirm that the information contained in this complaint package is true and accurate to the best of my knowledge and belief. Signed under pains and penalties of perjury: 's 1 -2 - Signa re Si nature Date 7. Please submit the complaint application, and all supporting documentation, e.g., building application, court judgments, contract, photographs (limited to 5 photographs), and the like (the documents or photographs should NOT be stapled) to: Office of Consumer Affairs and Business Regulation Program Coordinator HIC Complaint Program 10 Park Plaza, Suite 5170 Boston., MA 02116 3 PROPOSAL - - ---- - - - �7 .3 9 f "S PROPOSAL SUBMITTED TO: NAME �i c �� q ADDRESS �i f 7/11 1,� >� �, PHONE NO. e' PROPOSAL N0. y _ 2 SHEET Na. DATE j WORK TO BE PERFORMED AT: ADDRESS �� q 7/11 DATE OF PLANS / C ARCHITECT We hereby propose to furnish the materials and perform the labor necessary for the completion of W _J tete' A it (I t /U A16 ' t AJ r11 L+ t CA ,f �trt' t,1IE t 1 pC '�' o C11 1 _.111 tf .it- !f –�c�1—f f O kst`� 'T 4 r %:r' j• ,'-- --- .P �r'°� ,I i �� i2 (--� __ `F�'�,ti � f r�� 6P' v tff � !.. ,r., fir`• —� f � i -- i —------------ - All material is guaranteed to be as specified, the above work to be performed in accordance with the drawings n g p �. p gs a d specifi- cations submitted for above work and completed in a substantial workmanlike manner for the sum of `�C� �.f!, . 1 t 4 1 .. t c f Ir. t - •M .�_._._ ...� .__..__ ..,..__ Dollars ($ with payments to be made as follows. Respectfiiilly submitted i t:.' J �`�}:::: Any alteration or deviation from above specifications involving extra costs will be executed only upon written order, and will become an extra charge r ( Per over and above the estimate. All agreements contingent upon strikes, ac- � - cidents, or delays beyond our control. Note —This proposal may be withdrawn by us if not accepted within._ ;__.'days. . y ._ �,-.1_ .may,; �.�. _--�•3F�rti:-.+, :...r--- . -"._a ,r TrK:*a-aa� --�-ti--,r.'z•:: - ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are herebyepted. You are authorized to do the work as specified. Payments will be made as outlined above. 1Z ; Signatures Date/` i ;�/! Signature ed ­c Nr, r1Qi 4_Cn r,=A tel, /� ffi1 A F7 , ItrtC���JI��1l�li�\L cn J 0 " C4 to � yam h }� I/CUO 00 V1 U an .f •s"' o y O N _ SSJ LL U` 4 ! /. pod C�.,1 nP'Ple 6 ' -.-- x A 0 C4 0- Z; 6 0 C) 74F: 2 6 co G > c) > 0 • 0% 2 0 ' c F5 E5 Q CL c� c'. 6 c;i 0 cz: ti o o > 7V 8 C4 RF—PPAIS -�::SOR ISSUING Sl*-- PASAPORTE N.* - PASSPORTIC �(JJBI-IUCA D01MINICANIA AP— REGULARE DOM BsO207594- DOS-SURNAM C 1, 'E V A S C'ANDELARIO momeEES - GAIEN WfES MARTIRES ESTEBANM XA--: CNAUMAD - RAIMMA LITY DOCUME4fO DE IDENTMAD N.- La PV 2 Z,:OIQ 9, U3 I DOMINICANA -'sx� -0 - LUGAR DE 'r'-rAT-FS!R"4 03 FEB./FEB 1977 SANTO DOMINGO RD f FEV, -:A DEE N - DATE OF ISSUE FECHA EVENCIMIUM SIPRY 25 FEB/F2011 25 F EIL,/FEB 2017 CONS. GEN. 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NOIsva OZ abed sr j uo suzalt IIp alaiduzoo Isnut;ueoil V :yNVydpawI _ , :penssi a}ea panlaoaU a}ea :ON 41wlad NOIIVNIV4VX3 N'ld UOJ N0Il`d0llddV N3AOQNV H1210N dO NM01 CA m m rn m v y C � "0. O CD n CO) o. o 0. r CL c � CO) O 0 o p CD CD o CL cr co CD ® C W W C C® y' CDCL CO2 C CO C CSD n CD P-* O CD CD n (0A cn n J C ® z cn _C O 0 o„ CD 0 O co 0 CL: _' co CD CM r�•1• O H O CL CO) dp �•m � y O m O m c) moao -, m p d d = N• 9 c o' m m _ S o, coo mm _ O �Sm: m a O m CO) - Z�•cm, O H C- m SO.O CL , . O CD co m : H 01 CO O S . O. W d C C• C H m .'O O co U2 .•� Q!! S /�� CD o J 0 L1p: b CD .r m CD v CDCD : Q o S: = .m oil m m' -o a •o n C' Cm = O O � 1 C O cm O . t v v0 CD '�-•- :- sachutcits - Depal'hllent f,1• Public Salm llr3.0 d uf' Bvildill f Rc� ulutinn�'Jilt] stand.lrtls Construction Supervisor License License-, CS 47056 MARCOS A DEVERS 16 WOODLAND ST LAWRENCE, MA 01841 ! Expiration: 10125/2013 C +"Iuni.�luncr Tr=: 5685 `T .h ��/tf C�R)ff 7J7l9ttlKClll� C� ��(],fJC(CfItfSC'�i�1�1� ERF- — 1 Office ofC'onsumcrAffalrs R Business Rcgulanon HOME IMPROVEMENT CONTRACTOR I Registration: .106698 Type: x"' Expiration: 7/24!2012 Private Corporatiot' . ``; - i MDTINC. Marcos Devers i 61 WOOD LAND STREET � _ i LAWRENCE, MA 01841 Undenwretary 1 G MM Jid11l€ASN C? h1ASSA6E10 E'Ti REd)tiX6 CIVIL ENGINEER Z . 1 t 1'3SVE_ "Tt-iE RH:Ji%ELtCfNfiE I U MARCOS A DEVERS 16 WOODLAND ST LAWRENCE MA 01841-2315 33848 06/30/12 791763 0 i2..cic,k S -T- N A. r & Steven Cuevas Handyman Owner: Scott Deas Address: 9 Rock Street North Andover, MA 01845 1. Roof a. Strip one layer of shingle roof b. Install new shingle roof MDJ Engineering & Construction Marcos A. Devers, P.E. R.P.E.Uh 33848 C.S.L.#: 47056 H.I.C.L.# 106698 16 Woodland St Lawrence Ma. 01841 T: 978-804-7588 978-685-5691 E-mail: marcosdevers@gmail.com 11/16/2011 Building Repair Proposal Job Site: 9 Rock Street North Andover, MA 01845 Use: Residential Construction Type: Wood -Framed Structure Job Breakdown and Cost: 2. Clean Up a. Removal and disposal of demolition and construction debris 3.Miscellanous a. Permit b. Overhead Totals All home improvement contractors and subcontractors shall be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to: Office of Consumer Affairs and Business Regulation Ten Park Plaza, Suite 5170 Boston, MA 012116 Phone: (617)973-8700 The homeowner is entitled to his/her) three-day cancellation period under MGL c 93 s48, MGL c140D or 255D s14 as may be applicable. The owner has all warranties on the owner's rights under the Materials Labor Subtotal & Equipment $ 2,700.00 $ 2,902.63 $ 5,602.63 $ 600.00 $ 300.00 $ 900.00 $ 379.53 $ 117.84 $3,300.00 $3,202.63' $7,000.00 j p ovisions of and MGL c. 142A. Total Amount to be paid for the work to be performed under the contract is $7,000.00 The Job will be completed within 30 business days. Beginning within 5 business days after the closing date and completed within 30 business days thereafter The contractor will obtain all necessary construction permits. Owners who secure their own construction -related permits or deal with unregistered contractors shall be excluded from access to the Guarantee Fund Schedule of Payment According to the following: 50% of Documented Renovation Hard Costs for Initial Disbursement of Funds. 50% of Documented Renovation Hard Costs & Labor for Final Disbursement of Funds Upon Completion DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES The contractor and the owner hereby mutually agree in advance that in the event that the contractor has a dispute concerning this contract, the contractor may submit such dispute to a private arbitration service which has been approved by the Office of Consumer affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided in MGL c. 142A Owners: Young Contractor: MDJ Incoi Date: Date: d' y' t �„a ' The Commonwealth of Massachusetts Print Form Name (Business/Organization,7ndividual): MDJ Incorporated Address: 16 Woodland Street Department of Industrial Accidents City/State/Zip:Lawrence, MA 01841 Office of Investigations 1 Congress Street, Suite 100 r Boston MA 02114-2017 Fs° www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization,7ndividual): MDJ Incorporated Address: 16 Woodland Street City/State/Zip:Lawrence, MA 01841 Phone #: 978`804-7588 Are you an employer? Check the appropriate box: Type of project (required): 1. ❑✓ 1 am a employer with 3 4. ❑ 1 am a general contractor and I 6. E] New construction employees (full and/or part-time).* have hired the sub -contractors 2. ❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub -contractors have g, ❑ Demolition workingfor me in an capacity. y p �`• employees and have workers' comp. insurance.¢ 9. E] Building addition [No workers' comp. insurance required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] fi c. 152, § 1(4), and we have no 13.❑ Other employees. [No workers' coma. insurance required.] *Any applicant that checks box Nl 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 anew 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 fire sub -contractors have employees, they must provide their workers' comp. policy number. lain an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Continental Casualty Insurance Co. Policy # or Self -ins. Lic. #: 0417N57511 Expiration Date: 4/24/2012 Job Site Address: 1 & 't—t— City/State/Zip: AUD011 FwL X/4– Attach /4 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 imprisotunent, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day again t th violator. Be advised that a copy of this statement may be fonvarded to the Office of Investigations of the�+catjon. I do 978-804-7588 provided above is true and correct. . . Official case 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 6. Other Contact Person: 4. Electrical Inspector 5. Plumbing Inspector Phone e MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO 00 GASFt ING (Print or Type) l NORTH ANDOVER , _ Mass. Date - I� building New .7 Location Renovation Ej Permit # Own s Name Replacement Plans Submitted D (Print or Type) Installing Company Name Check e: Certificate Corp. Address G U Partner. Alln r 0% Firm/Co. Business Telephone:_ ke e Name of Licensed Plumber or Gas Fitter �('j vt� Insurance Coverage: Indicate th stype of insurance coverage VY checking the appropriate box: Liability insurance policy Other type of indemnity 0 Bond NEE No ME EMIN ME 0 9; NEMENEEMENNNAMMEMME MEN MEE ��MEEEMEN ONES ONEMEMEMEMEMSE, (Print or Type) Installing Company Name Check e: Certificate Corp. Address G U Partner. Alln r 0% Firm/Co. Business Telephone:_ ke e Name of Licensed Plumber or Gas Fitter �('j vt� Insurance Coverage: Indicate th stype of insurance coverage VY checking the appropriate box: Liability insurance policy Other type of indemnity 0 Bond Insurance Waiver: 1, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner 17 Agent 11 I hcteby certify that all of the details and information 1 have submitted (or entered) in above application are true and accurate to the best of my knowlcdge and that all plumbing work and installations performed under Permit ksced fo: this application will -be in compliance with all peatlnent provisions of tho Massachusetts State Cas Code and Chapter 142 of tho Genual Laws. %/ By Title City/Town: APPROVED (OFFICE USE ONLY) TYPE LICENSE: P1 ber sf itter. Master Journeyman VSif nature of L' ensed P1rber or Ga fitter l07 �/ License limber CPHONE C�►L.L +FOR �/ DATE a TIME P. M 0 o e-, _ r NOTESR 4 r , e r, Date ..... . 1 !.... _ r TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION O -r LL This certifies that ......................... r has permission for gas installation ... :.'.............:` in the buildings of-,. . . .11.111.41!. ......................... . at .. ` .... ' :`+-... �� ��. , ... , North Andover, Mass. Fee.. ? %!... ic. No. / ��. �. ....................... . GAS INSPECTOR WHITE: Applicant _ ANARY: Building Dept. PINK: Treasurer GOLD: File -.> -1 v > C y. �>•. k �.M., ti t`f a 7 '•7- :i' > r'.ry l� ` �t t 1 \ n. \ iri• >,-it" 3 "C > >;,-1-MW 4a.-1 '. � { �' r 7. � �;; 7 � � �t .• yx '�tit1,��Yt�` ":','A. \'• ;, `i�� +�.��>, :''�., L? `� 1� �s�.ti�i:`; �it'1 -+r \ .� ` N to t i \ r V�.' t -�\ .,t\1 't�tli ti�?�\�\>�1 v>>,. �`•�t �kA.l�� �`k.i�� �'�,��:ni\'�5\��`.bsy>.,31<'�+'�,�i�,��f-ti����'fiij\5':i.-`v o n own . , ..:� � ,�{ r ', . x , �,,iR\ � �.� '` �„ � a..c ..�\��i . �� 11 � +ry t L •� � t � t� >, 1 ,.� 7Z} ' ' .`. Von,�,; tl�- r r t�{ t•` `` e� wa� Z� `� 7{+ t, :r sv s. aY t -t --1 -fk Deval L. Patrick Governor Timothv P. Murrav Lieutenant Governor Gerald Brown COMMONWEALTH OF MASSACHUSETTS OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATION 1600 Osgood Street North Andover MA 01845 10 Park Plaza, Suite 5170 Boston, Massachusetts 02116 www.mass.gov/consumer Phone (617) 973-8700 Fax (617) 973-8799 Contractor's name: CUEVAS CANDELARIO HIC #: 0 Property Address: 9 Rock Road North Andover MA Complainant: Young Woo Jeon Complaint Number: 2012-013 Gregory Bialccki Secretary of housing and Economic Development Barbara Anthony Undersecretary Wednesday, February 01, 2012 Dear Gerald Brown: Please be advised that the Office of Consumer Affairs & Business Regulation has received a complaint against the above -listed registrant. Your immediate attention to this matter is requested. In order to assist the Office of Consumer Affairs & Business Regulation in its investigation of the complaint, kindly forward any documentation relative to the above -listed property that you have in your possession to us. Please reference the complaint number and registrant in your reply. Thank you in advance for your invaluable assistance. Very truly yours, Office of Consumer Affairs & Business Regulation COMMONWEALTH OF MASSACHUSETTS OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATION Ten Park Plaza, Suite 5170 ...� Boston, Massachusetts 02116 Phone 617 973-8700 �� 3 Fax: (617) 973-8799 JAN 2 4 2011 m d W Home Improvement Contractor OFFICE �� �a�SUMER Complaint Form AFFAIRS 01M 2 nn r I . CHAPTER 142A & 201 CMR 18 To file a complaint against a I m completely and submit it to the Office of Consumer Affai2012-013review all complaints. The submission of a complaint wi ;tor. If OCABR determines that your complaint is appropriate y action against the contractor's registration and/or administm _ . _ s scheduled to address your complaint. You will be asked to testify at that hearing. rieunu website (www.mass.gov/oca) for additional information about OCABR's home improvement contractor complaint process. FILING A COMPLAINT WITH OCABR WILL NOT RESULT IN A MONETARY AWARD FOR YOU. IF YOU SEEK A MONETARY AWARD, CONTACT OCABR'S ARBITRATION & GUARANTY FUND PROGRAMS. 1. Your information: (Please type or print neatly) Name: r, 'Je4/7 Current address: PO G� ,�p� , /V 1SY l d rt1'er , /"/4 491 d,4--y— Address of building at issue: Dao% /u, /t/�&Gl'dt�i7�� Number of of dwelling units in the building at issue: / Ts it a residential property? (circleYes No Ts the building at issue your primary residence or did you intend for it to become your primary residence? (circle), Yes No Day phone: (9 ) off, G/: g0.2o Fax: (q%) E-mail tIp"/71, 169011 0-- oo. cern 2. Contractor Information: Contractor name: _ ill' A, S Co ld�Gi r-1ryrp Z Business name (if any): p/L'flSf �&,I 'l/7" :117 pp Business address: J i c) �j�Gi r t�ij Sf- Utw) �'r1CC ; PA b l F43 Phone: (/f;/ )� , S4 Date contract signed: /J / IC l / Amount of contract: s 2; /)-o �f Home Tmprovement Contractor Registration (HIC) # ,1 % -2 3,1% t1 Q To the best of your knowledge, has the contractor filed for bankruptcy? (circle) Yes No 3. Other information: If you have included photographs with your complaint, do you want OCABR to return them to you later? (circle) Yes j N/A I. 4. Complaint Information: Please circle the number of any of the following acts that you allege took place in your dealings with the contractor. You must circle at least one allegation. 1. Operating without a certificate of registration; Abandoning or failing to perform, without justification, any contract or project engaged in or undertaken by a registered contractor or subcontractor, or deviating from or disregarding plans. or specifications in any material respect without the consent of the owner; )3Failing to credit to the owner any payment they have made to the contractor or his salesperson in connection with a residential contracting transaction; E)4aking any material misrepresentation in the procurement of a contract or making any false promise of a character likely to influence, persuade or induce the procurement of a contract; 5. Knowingly contracting beyond the scope of the registration as a contractor or subcontractor; 6. Acting directly, regardless of the receipt or the expectation of receipt of compensation or gain from the mortgage lender, in connection with a residential contracting transaction by preparing, offering or negotiating; or attempting to or agreeing to prepare, arrange, offer or negotiate a mortgage loan on behalf of a mortgage lender; 7. Acting as a mortgage broker or agent for any mortgage lender; 8. Publishing, directly or indirectly, any advertisement relating to home construction or home improvements which does not contain the contractor's or subcontractor's certificate of registration number or which does contain an assertion, representation or statement of fact which is false, deceptive, or misleading; 9. Advertising in any manner that a registrant is registered under this chapter unless the advertisement includes an accurate reference to the contractor's or subcontractor's certificate of registration; 10. Violation of the building laws of the commonwealth or of any political subdivision thereof, If your complaint alleges structural violations of Massachusetts State Building Code, those allegations will be referred to the Board of Building Regulations and Standards(BBRS), within the Department of Public Safety (DPS), for possible action against the contractor's construction supervisor license or you may proceed by filing your own separate complaint to DPS/BBRS 11. Misrepresenting a material fact in obtaining a certificate of registration; 12. Failing to notify the OCABR of any change of trade name or address as required by section thirteen; 13. Conducting a residential contracting business in any name other than the one in which the contractor or subcontractor is registered; 514. Failing to pay for materials or services rendered in connection with his operating as a contractor or subcontractor where he has eived sufficient funds as payment for the particular construction work, project or operation for which the services or materials were rendered or purchased; 15. Failing to comply with any order, demand or requirement lawfully made by the administrator or fund administrator under and within the authority of this chapter; 16. Demanding or receiving payment in violation of clause (6) of paragraph (a) of section (2), which states: "Any deposit required under the contract to be paid in advance of the commencement of work under said contract shall not exceed the greater of one-third of the total contract price or the actual cost of any materials or equipment of a special order or custom made nature, which must be ordered in advance of the commencement of work, in order to assure that the project will proceed on schedule. No final payment shall be demanded until the contract is completed to the satisfaction of the parties thereto;" 17. Violating any other provision of Chapter 142A. (Please specify below) a. Failing to present the homeowner with a written contract for residential contracting work exceeding $1,000 as required by section 2 b. Failing to include required terms in a written contract for residential contracting work exceeding $1,000 as required by section 2 c. Other provisions of Chapter 142A (please seci in your detailed narrative in Section 5 of this form) N 5. Please provide a detailed narrative of the acts or omissions committed by the contractor that lead you to file this complaint. If necessary, please attach any additional pages. Your complaint will not be processed without a detailed narrative. 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AP c«C��iv� f r?encs z � y fZ7s'� a•/ )s2G%�1 ei` ,7iµ Z 9k,�G o/n�- ?�'' a� n% �$ /� %��_%j� /l�v'i� : S 7l0 Ccu1Ls%/�tfi�t't� ?cc��L'nod 7�` Els-a,./� 6. I hereby affirm that the information contained in this complaint package is true and accurate to the best of my knowledge and belief. Signed under pains and penalties of perjury: Signature Date 7. Please submit the complaint application, and all supporting documentation, e.g., building application, court judgments, contract, photographs (limited to 5 photographs), and the like (the documents or photographs should NOT be stapled) to: Office of Consumer Affairs and Business Regulation Program Coordinator HiC Complaint Program 10 Park Plaza, Suite 5170 Boston, MA 02116 3