50 OSGOOD ST - BUILDING INSPECTION (2) The Commonwealth of Massachusetts
\ }yam Board of Building Regulations and Standards CffY OF
Il( tb(assachusetts State Building Code, 730 CMR SALENI
. ;, Revised Ahir 2011
Building Permit Application To Construct, Repair, Renovate Or:Damolish a
One-or Tw Y Dwellino-Famil 8 ., . . ,
This Sect(aQ For Official UsaOnl�:-
Building Permit Number Datd,ApplietL,
Building Oft(cial(Print Name) $tgna( Date
Ut
SECTION I:SITE iNFORNEATION
1.1 Property AJJress: .2 Assessors Map Parcel Numbers
SO 05gon cf 5tk-
1.1a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Informatlant 1.4 Property Dlmenslonb: , t
Zoning District Proposed Use Lot Are&(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Prov4 ided Required Provided Required Provided
1.6 Water Supply: (IM.O.L C.40,§54) 1.7 Flood Zone Information: 1.3 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal
Check If eA3 P p system ❑
SECTION 2-' PROPERTV'OWiVERSHD !'? '
2.1 Owapa^ofRceord:CA WLl ( C
S/� �r�✓1 6�//3
Name(Print) City,State,ZIP
9 C>Sm�sn f 9?fr 7yy-Vy--
No.and Street ( Telephone Email Address
SECTION 3: DESCRIPTION OF.PROPOSED WORIe-6heck all that apply)
New Construction❑ Existing Building❑ Owner-Occupied Q Repairs(s) ❑ ,4lteration(a) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ NumherafUnita� Other ❑ Specify:
Brief Description of Proposedd%Vork : ,I�,&w17 G�tirl, L LIt5 _ (S
dff, C�- 2
e_A we- n Q f o -
SECTIOt`f 4: ESTINIATED CONSTRUCTION COSTS-
(tom Estimated Costs: Official Use Only'.
L tbor and �raterials y'
I. Building g I. Building Permit Fee.S frttlicara how fee is determined:
2. rlectrical ❑Standard.City(fown.Application Feer
O Total Project Cost'(Item.6)IVmultipl(er
). PlumbingS ?. Other Fees .$
t. M-ehanical (IIV.\t_) S List:_
i .\lach.mieal (Fir:
1'o1.71 All Pecs' i
-����AA --- t'hec.l' Nu. (:hce!e,luwunt: __(',ish auiuunt
� ftall'rnjci: ( 'uit $ �l/Q-�� ❑thit;tawlin;; lhi(utealua:
f !] I'.iid in Pull t
SFC'I'MN 5: CONs,rRUCTION SERVICES
5.t Construction Supervisor License(CSL) 0?�) ;i—Y
License Number Cxpiratimr Dato
mime of CSL holder 31 Street List CSL rype(see below)
+} -
r Description
.pew
,No. and Street U Unrestricted Duildin s u to l5,UUu eu. it.
R Restricted I:a2 Fanul U%!2aU
RI M
6tyr�own,Stute, ZIP ofill
RC RoutLt ICuvcrin
WS Window and Sidin
SF Solid Fuel Bunting Appliances
Insulation
Pule home
7 Email address U Demolition
5.2 Registered Hume Improvement Contrnctor(111C)
LLC fliC liegistrndon Number Expiration Dale
I Ilc Company Nnme or I(IC Reg trm+lytiansx rrr% W�iic
v Email address
No.and Street 51Ss 71/Y �7
Ci /Town State ZIP Tate hone
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L,c. 152. 1 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuance of the building'permit.
Signed Affidavit Attached7 Yes.......... No...........❑
SECTION 7o:01VNERAUTHORIZATIONTO OE Conut—TED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, as Owner of the subject property,hereby authorize L
to
act on my behalf, in all matters relative to work
authorized by ht building permit application.
txScj c a
Print owner's Name(Electronic Signature)
SECTION 7h: OWNEW OR AUTHORIZED AGENT DECLARATION
By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding. 3
Z-. C Gam& Data
14int Uwnarb or Autlturized Aient's Name(Clectrunle Signature)
NOTES:
i. An Owner who obtains a building permit to do higher own work,Dian owner who hires an unregistered cuntrectur
(nut registerod in dw Rout¢ Onpravament cuntractur(HIC) Pmgr:un), will nn have access to the arbitration
progr:un ur guaranty land under ALCi.L. c. 1�2A. ether important information un the HIC Program can be found at
I�ww ma;t �tuv%ort fnfunnotion on the l.'unstnlction Supervisor License can ba found at ww.mass-" ��ILt
r 1b'hen substautini work is planneJ,provide the information below:
I-��altluur.vea(t,l. It.) ._____. —(including garage, tinisltaJbasemenVattics, decks urporch)
f fabitable room count __
ro;tlivin,arca(;y. tt.l -- Nuutberofbcdrn,ans
�hanilcr of b.ultn,oul.;
I••iIe„th;.uin,; ;y�lem — _ _ `:umhcrnf,lce6:; lorrltet _.- - ---
Puclo;ed then%PQ „f C,I,,lina
_ . ---"�� an•� P „t r;t" I n.rvha nlbdltnt,,I r:,r I,•r.11 I'r,q,�.l l'„d"
The Commonwealth of Massachusetts
Department ofln4ustrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.n:assgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Let=rbly
Name(Basiness/Organizatior✓lndividual): ATLANTIC WEATHERIZATION, LLC
Address: 61 SALEM, MA 01970 u
City/State/Zip: FAX(978) 745-2200
Phone#:
t
Fr:n
au employer? Check the appropriate box:
a em to erwith a 4. Type of project(required):P Y ❑ I am a general contractor and Iloyees(full and/or part-time).* have hired the sub-contractors 6 ❑New construction a sole proprietor or partner- listed on the attached sheet. t 7• ❑Remodeling
ship and have no employees These sub-contractors have 8. Demolition
working for me in any capacity. workers'comp. insurance.
[No workers coin .insurance 5. 9. ❑Building additioa
p ❑ We are a corporation and its
required.] officers have exercised their 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL I LEI 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'
comp. insurance required.] 13.0 Other
'Any applicant that checks box#I most also fill out the section below showing their workers compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such,
tContractors that check this box must attached an additional sheet showing the name of the subcontractors and their workers'wmp policy information
!am an employer that is providing workers compensation in
information, surance for my employees. Below is the policy and job site
insurance Company Name: <1, lk i',
Policy#or Self-ins.Lic. �O
/ Expiration Date: '� /•y
Job Site Address: 5C7 05 c S City/State/Zip:s�/_/w mv
Attach a copy of the workers' comp nation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
investigations of the DIA for insurance coverage verification.
I do hereby certi der the pains d penalties of er'a?y that the Information provided above is true and correct
Signature: / G ��" Date RZ9
Phone#: Y
Official use only. Do not write in this area, to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Othcr
Contact Person; Phone#: "`
Rightfax C3-2 3/11/2013 4 : 45 : 54 AM PAGE 2/'002 Fax Server
I
CERTIFICATE OF LIABILITY INSURA NCE DATE IMM/DD/YYYY)
T TIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE: HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,
THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER.
IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(tes) must be endorsed, If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy,certain policies may require and endorsement. A statement on this certificate does not confer rights to
the certificate holder In lieu of such endorsements .
PRODUCER CONTACT
NAME:
EASTERN INS GROUP LLC PHONE FAx
233 WEST CENTRAL ST (A/C,No,Ext):
E-MAIL
NATICK,MA 01760 ADDRESS:
22MLW INSURER(S)AFFORDING COVERAGE NAIC#
INSURED INSURERA: AMERICANZURICH INSURANCE COMPANY
ATLANTIC WEATHERIZATION LLC INSURER B:
INSURER C:
INSURER D:
61 REAR JEFFERSON AVE INSURER E:
SALEM,MA 01970 INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THISISTOCERTI THAT Tr9V6rMFr5rMMNC50 13ELOW HAVE BEENISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,
NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY
PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITSSHOWNMAY
HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADD SUB POLICY EFF DATE POLICY EXP DATE
LTR TYPE OF INSURANCE L R POLICY NUMBER (MMDD\YYYY) (M"DmYYYY) LHATS
GENERAL LIABILITY =ACH OCCURRENCE Is
COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED $
CLAIMS MADE OCCUR. REMISES(Ea occurrence)
ED EXP(Arty one person) $
ERSONAL&ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: ENE RAL AGGREGATE $
POLICY a PROJECT =LOC
RODUCTS-COMP/OPAGG S
AUTOMOBILE LIABILITY
COMBINED SINGLE $
ANY AUTO LIMIT(Ea accident)
ALL OWNED AUTOS BODILY INJURY $
SCHEDULE AUTOS (Per person)
HIRED AUTOS BODILY INJURY S
NON-OWNED AUTOS (Per accident)
PROPERTYDAMAGE $
(Per accident)
UMBRELLA LIAB OCCUR EACHOCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DEDUCTIBLE S
RETENTION $ $
A WORKER'S COMPENSATION AND WC STATUTORY OTHER
EMPLOYER'S LIABILITY YIN UB-5B270121-13 03202013 03/20201A X LIM
IEX ITS
ANY PRCPERITOR/PARTNERECUTIVE N N/A E. L.EACH ACCIDENT $
OFFICERIME M8ER EXCLUDED' 500,000
(Mandworyin NH) E.L.DISEASE-EA EMPLOYEE 3 500,000
7Yes,descntoe wIdel
DESCRIPTION OF OPERATIONS Wew E.L_DISEASE-POLICY LIMIT $ 500,000
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/RESTRICTIONS/SPECIAL ITEMS
THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE.
CERTIFICATE HOLDER CANCELLATION
CITY OF SALEM SHOULD ANY OF THEABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED
93 WASHINTON ST IN ACCORDANCE WITH THE POLICY PROVISIONS,
AUTHORIZED REPR
SALEM,MA 01970
rJ
ACORD 25(2010/05) The ACORD name and logo are registered marks of;'CU-RD 1988-2010 ACORD CORPORATION. All rights reserved.
CERTIFICATE OF LIABILITY INSURANCE 11/2013
3/11/2013
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER ON ACT COnBtrUCtlOn
AME•
Eastern Insurance GroupLLC PHONE FAX
(508)651-7700
233 West Central Street 'a IL
INSURERS AFFORDING COVERAGE NAIL C
Natick MA 01760 INSURER(S)
Protection Ins. Co. 1360
INsua3o INSURER B Arbella IndermItX Ins Co. 10017
Atlantic Weatherization INSURER C Nautilus Insurance Co
61 Rear Jefferson Avenue INSURER O:
INSURER E
Salem MA 01970 INSURER F:
COVERAGES CERTIFICATENUMBERR—WTER 2013 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ILTR TYPE OF INSURANCE POLICY NUMBER POLICDY EFF NYYY1MOLICY EXP LIMITS
GENERAL LIABILITY
EACH OCCURRENCE § 1,000,000
X COMMERCIAL GENERAL UABILITY EREMISES Meo $ 50,000
A CLAIMS-MADE 5x-1 OCCUR 8500042816 /20/2013 /20/2014 MED EXP(Any one arson) § 5,000
PERSONAL S ADV INJURY S 11000,000'
GENERAL AGGREGATE $ 2,000,000'
GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000.
POLICY X PRO- LOC §
AUTOMOBILE LU§BIUTY EaemIdE01 SI ELIMIT 11000,000
B ANY AUTO BODILY INJURY(Per person) $
ALL OWNED X SCHEDULED 020015871 /20/2013 /20/2014 ( )
AUTOS AUTOS BODILY INJURY Per eccitlem S
X HIRED AUTOS X NON-OWNED PR PERTY DAMAGE
AUTOS PeracGdent $
PIP-Basic S
X UMBRELLA LIAS X OCCUR EACH OCCURRENCE $ 1,000,000
A EXCESS LIAS CLAIMS-MADE AGGREGATE S 1,000,000
DED I I RETENTION 600047820 /20/2013 /20/2014 §
WORKERS COMPENSATION I WC STATU- OTH-
AND EMPLOYERS'LIABILITY YINFR
ANY.PROPRIETORRARTNERIFJCECUTNE E.L.EACH ACCIDENT $
OFFICERIMEMBER EXCLUDED? NIA
(Mdnddtoryesc in NH)and If E.L DISEASE-EA EMPLOYE $
yes,DESCRIPTION
OFO
DESCRIPTION OF OPERATIONS Below E.L.DISEASE-POLICY LIMIT 1 E
C POLLUTION LIABILITY PL2003786001 0/1/2012 0/1/2013 GENERALAGGREGATE $1,000,000
EA POLLUTION CONDITION $1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES (Atlech ACORD 101,Additional Remarks,Schedule,11 more apace Is required)
t
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
CITY OF SALEM ACCORDANCE WITH THE POLICY PROVISIONS.
93 WASHINGTON STREET
SALEM, MA 01970 AUTHORIZED REPRESENTATIVE
Rosemary Fulham/PMA
ACORD 25(2010105) 01988.2010 ACORD CORPORATION. All rights reserved.
INSn25 nmmc,si Tho aRlTRrY nvmo and Innn am ronimnmd mnr4a of AY:fhRrl
MassachIuseUs Home Improvement Sample Contract
This form smisfics all basic mquGEmeads of the sam-s Rome Improvement Contractor Law chapter 142A),butdocsnotin.iudeslundarcl '
Ilanguage to protect homeowners!ISecklegal advice if necessary. Anypersonplan^�home improvements should fast obtainae-.py of"A
MessaofCom Consumer GuideByJJ ome Improvement'before agreeing to my work on your residence.You may obtain a free copyby callingthe h.
06rce of Consumer Affairs and Hkness Regulation's Connate Information Hotlineat 617 973 8787 o 1 888 283 3757 or our rwhsite.
Homeowner Information Contractor Information
Tlun�� Company Name
JC SS; C a.
„sdo not use aeon OIDcb ax address) Cotmacuntsalespers
S o 61 R k2eesan Aventle
CityflOVen Stair Zip Coda Business Aridness(mus[include SUYe tract 4va etltlr —'
N$A 01970
Daytime Phone Evening Phone Ciry/1'own sm[e 2lp Code --
q� Fr -
Mailing Addmsa(a diBment form ebo5 Business Phone PcdcrN EmploYMMOTS.S.Numnber
! .. r.•..Ra•w,eoe men eom. ha r„wAr<mv w=w.mraq.nwro.r amm�dw
i 1114•ormre....M n:6- JyZL
The Contractor agrees to do the following work for the Homeowner:
(Describe in detail the work to completed,specifying the type,brand,and grade of materiels m be used, sde't/onel h =fir.r tnecp�_)
e- f� {�l-Ere �r�5 e�ilnry lea �-3 �
RequiredPermite-'Ihefollowing'Iauildingpermit mere d Proposed Start and Completion Schedule-The following seta/dole will
and will be secured by the contractoi as the homeowners Cut. be adhered to unless circumstances beyond the contractor's conaol arise
(Owners who secure their own permits will be
occluded from the Guaranty Fund provistoes of Vx'
Dam when contractor will begin contracted woreMGL chapter 142A.)
.3 DatewhmcontractedworlcmdUbesubstantiallycompleted.
Total Contract Price and Paymett Schedule
The Contractor agrees to performthd work,furnish the material and labor specified above for the total sum of M
Payments will be made according to lithe following schedule:
'6'act net w exceedl,3 ofice-medi donirnctprice-Qr`tie cost ofspcci order ifeids,whichever is gr off —"-
pen srgmng con,
$ / or upon completion of Q
$41061 _by—la�Y or upon completion of J-3 6
$ upon completou i fthe contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction)
TLefolfOwingmatenal/equipme t1mMbespecia1 S to be paid for
ordered before the contracted wo,k begins in abler
to meet the completion schedule.%••) $ to be paid for
NOTES:(•)Including all fimnce charges(••)Lawrequina that any deposit or dawn-payment required by the contractor before work begins may
act exceed the greater of(a)onathird of the Und contract price or(b)the actual cost of nrry special equipment or custom made matuial
which must be special ordered in advance to meat toe completion schaduln
E+xoress waame,is no morass ntmalikeina providedby the c t TON ❑YBf llt fth w b tt M1tlt ft t t1
Subcontractors-no Momenta agrees to be solely responsible for completion of the work described regardless of the actions of any third
party/suboontrector utilized by the ddntractor, The contractor further agrees to be solely responsible for all payments to all subcontractors for
materials and labor+ der this aeree' t
Contract Acceptance-Upon signing,this document becomes a binding contract under law. Unless otherwise noted within this document,the
con¢net shelf not imply that my he�br other security interest has been placed on the residence. Review the following cautious and notices
carefully before signing this wntmUl,
Dort be pressured into signing the contract Take time to read and fully understand it. Ask questions if something is unclear.
MaITjigg tb 22nnactor has 'alICL lm t(' trot R , The law requires mosthome improvement contractors and
subcontractors to be reghstered'Iwuh the Director ofllo m,Improvement Contractor Registration. You may inquire
ut contractor
registration by writing to the Director at 10 Park Plans,Room 5170,Boston,MA 02116 or by calling 617-973-87 oor 888-2833757.
• Does the contractor have nsurmce7 Asir the Contractor for his insurance company information so that you can confirm coverage,or ask to
see a copy of a"proof Ofinsmmce"document.
• Know your rights and responsibilities. Read the Important Information on the reverse side of this form and get a copy of the Consumer
Guide m the Home Improvamehl Contractor Law.
Yau may cancel this agreement ifit has been signed map lace other tom the controcures normal place of business,provided you notify the
contractor in writing at his/her mainjdffice or branch office by ordinmy mail posted,by telegram sent or by delivery,not later than midnight of the
third business day following the signing of this agreement Sea the allnched notice of cancellation form For an explanation of this right.
DO NOT SI IL THLS CONTRACT IF THERE ARE ANY BLANK SPACESM
1Woidentkal eoyic•afWe oonaactmmt be mmpkmd wdvlgncd.One eopy.M1•Wd gorothe lwvmoxn The other copy fioWd L<kept byche eonmcier.
scSS;Cud.
Homeowner's Signature / Co ctor's Signature .
Date Date
/I
Contractor Arbitration
The Home rovement Contractor Law
homeowners
alternative to court action)if they have a d'spu eewith a contractor.with
The sameright
to right initiate o automafically afforded to a
contractor,however. Tye contractor would have to resolve any dispute he/she has with a hutomatical in court unless
both parties agree to the optiongl clause provided below. This clause would give arbitration as is afforded to the homeowner by the Home Im
gi the .Ontr! ctor the same right to
provement Contractor Law.
s� The contractor and the homeowner hereby mutually agree in advance that in the event the
concemp>g this.
the Secret r C0o"G' tl the•comipetor maM aubmit the dispute to a private arbitration Contractor has a dispute
ary of the Executive Office of Consumer Affairs and Business Red kith has been approved by
to subaut to sucharbitLatr6d as F gutation and the�consumer shall be required
�} � ovided 7n Massachusetts General Laws,chapter 142A.
Ho N . . ��� /
w a oigriatine
NOTICE;The signatures of the parties above apply Lout actora Sr a
resolution initiated by the contractor. The homeowner may initiate alternative disput gresgIOterr even where this
PP Y only to the agreement of the parties tq�Iternative dispute
�60section is not separately signed by the parties.
Homeowner's,Rights -
A homeowners rights imder the Home Improvement Contractor Law
Protection laws(Le.MGL chapter 93A)may not be waived in an (MGL chapter 142A'
may be excluded from certain rights ),and other consumer
if contractor they choose is not properly regeisimere t'aHowever,homeowners
Homeowners who secure their own building permits we out excluded from all Guaranty Fby law
the Home Improvement Contractor Law. The contractor is responsible for completing the ua rknty Fund prescribed provisions
si a
timely and workmanlike warmer. Homeowners maybe entitled to other specific legal ri Ty and provisions of
guarantees or provides an express warranty for workmanship ocmaterials. In addition to guarantees provided by the contractor,all goods sold in Massachusetts carry gu if the contractor
a particular of hates or warranties
Purpose. An enumeration of other matters on which the homeownernwarrand contra for lawfully agrdee May beor
added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights. L:you have
questions about your consumer/homeowner rlghts,contact the Consumer Information Hotlu,'ie(listed below).
Execution of Contract
The contract must be executed in d licate and should not be signed until a copy of all exlaybits and referenced
documents have been attached. Parkes aze also advised not to si
filled in or marked as void,deleted,or not applicable. One original signed copy of the cotitiact with been attachments n to
gn the document until all blank sections have in'
be given to the owner and the other kept by the contractor. Any modification to the on oral contract mu _
and agreed-to byboth:parties-.-Ooutmced woflrmay noYbegiri iuitri bot5parties have re�eyiied a fully exe sited copyruin
the contract,and the threeday rescission period has expired.
Accelerated Payments
A contractor ay t demand payments in advance cuthe dates specified on the payment schedule in cases where the
homeowner all arse contractor
ra forfin maybe insecure. However,in instances where a contractor deems
account
o financially equisit eto a contractor may require that the balance of fiords not yet duej be placed in ajoinhim/herself
t nesero ylf
account as a prerequisite. continuing the contracted work. Withdrawal of funds from sajd account would require the
signatures of both parties.
Additional Information
If you have general questions or need additional information about the Home 'Contractor Law or other
consumer rights,or if you wish to obtain a free copy of "A Massachusetts Consumer Guido to Home Improvement--
contact
Consumer
ation
Office of Consumer Affairs and Business Regulation i j
10 Park Plaza,Room 5170,Boston,MA 02116
617-973-8787,888-283-3757 or visit the OCABR website at http•//wvnv Ifl ss Rovlocahrl
If you want to verify g you the registration of a contractor or e ou have ent questions or need additional information specifically
about the contractor registration component of the Home Improvement Contractor Law,cbiitact:
Director of Home Improvement Contractor Registration '
Office of Consumer Affairs and Business Regulation
10 Park Plaza,ROOM 5170,Boston,MA 02116 .; 1 617-973-8787,888-283-3757 or visit the HIC website at htl�•//www maser
Go online to view the status of a Home Improvement Contractor's Registration:
htm.//db state.,
tate mausR'^^eimnro n• �I
t RSD
For assistance with informal mediation of disputes or to register formal complaints againsfila business,call:
Consumer Complaint Section
Office of the Attorney General
617-727-8400
AND/OR
- Better Business Bureau
508-652-000,508-755-2548 or 413-734-3114
vaeian 2.1-❑/22/2010
_ik-:ing
Unrestricted-Buildings of any use group which
r :CS 087977 contain less than 35,000 cubic feet(991 m')of
enclosed space.
ERIC W PALM
3 HILTON SF
SALEM MA=01970 ..f
Failure to possess a-current edition of the Massachusetts
-
' 04/23/2014 State Building Code is cause for revocation of this license. -
. . _. . for OPS Licensing information visit avww.Mass.Gov/DPS
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HOMEIMPROVEMENT CONTRACTOR _ License or registrrtionvalid for irdividul use only
y Regisaation: 142089 Type: before the expiration date. If found return to:
4 �4""Expiration: 971 212 01 4 Ltd liability Colpor Office of Consumer Affairs and Business Regulation
y`'•'' - '-- 10 Park Plaza-Suite 5170
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Boston,NLA 02116
ERIC PALM
G1R JEFFERSON AVE
SALEM MA 01970 tindcrsccmtary f 0-t�/'�y.�r
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