39 PRINCE ST - BUILDING INSPECTION (3) • "This
ommonwealth of Massachusetts
CITY
��1 Building Regulations and Standards pisSALEM
tate Building Code,780 CMR,T" edition RevisedJanuary
ion To Construct, Repair, Renovate Or Demolish a 1, 2008
ne-or Two-Family Dwelling
This Section For Official Use Only
Building Pe it Nu c Date Applied:
Signature: ! j ' /p
B ' ing Commissioner/ p r ildings Date:SITE INFORMATION
];ropq�tn, r s 1.2 Assessors Map&Parcel Numbers
1.1 aI Is this an accepted street?yes_ no. Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone? Municipal ❑ On site disposal system ❑
Public❑ Private❑ Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
l2 Owner'of R cor,¢:�
N e Address for►Sery
Si ure Telephone
SECTION3: DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ erattioon(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units_ Other pecify: Za2rl�T �a
Brief De cript n o roposed World: —
'OL 'II C
SECTION 4: ESTIMAT D CONSTRUCTION COSTS
Estimated Costs: Official Use Only
Item Labor and Materials
1. Building $ SID.
1. Building Permit Fee: $ _ Indicate how fee is determined:
❑Standard: City/Town Application Fee
2.Electrical $ ❑Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ L.ist: .
W
5.Mechanical (Fire $ Total All Fees:.$
Su ression
��, Check No. Check Amount: Cash Amoum:
6.Total Project Cost: $ d / 0 Paid in Full ❑Outstanding Balance Due:
SI&
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL) �) Mb3 5J �l -fit`
' Sly 6'��"-o License Number ExpiraVon Da�Fj�
Name,o SL-Holder
t 1 L r ykk ont> �� .. ® List CSL Type(see below)
Address g' Type Description
_�^ O� � U Unrestricted u [0 35,000 Ca Ft.
Si natur� R Restricted 1&2 FamilyDwellin
M Masonry Only
oO J Z� RC Residential Roofing Covering
Telephone WS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5.2 Registered Homt;g� r !n nt�CgQtractor(HIC)
1 mn Name oorr�C a isV % a 1� `3 Registration Number
Add res n M pp 4tt/,, ctl 11gl ao) c)C 9�p�w� p w Expiratio Date
e
SigrAtuW ITelephone
SECTION 6:.WORKERS'COMPENSATION INSURANCE AFFIDAVIT.(M.G.L.c.152.§ 25C(6))
Workers Compensation Insurance affidavit must be co pleted and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuanc f the building permit.
Signed Affidavit Attached? Yes .......... V No...........❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner of the subject property hereby
authorize 2p—IFJ' to act on my behalf, in all matters
relative to authorized by this building permit application.
71 -S-09
Sig *re of Owner Date
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and
behalf.
Print ame
Signature of Owner or Authorized Agent Date
(Signed under the pains and penalties of au
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A. Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.R6 and 110.R5,respectively.
2. When substantial work is planned,provide the information below:
Total floors area(Sq. Ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(Sq. Ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
0
c n sk'
r�t'8
877—MrRaofs
01.
Nancy Moore October 17, 2009
39 Prince St
Salem, Ma
781-258-6845
Hbllc2005@aol.com
RUBBER ROOF ESTIMATE
1. Details of work area: Complete Main Building & Roof over existing rear porch
2. Spread and level existing gravel
3. Remove existing steel structures on the roof
4. Install a 1" ISO Board to the entire deck
5. Insulation will be mechanically fastened using specialty coated plates and 2 1/4 " screws
6. Apply a bonding adhesive to the ISO board to give a fully adhered system
7. Install a Firestone .060 Rubber membrane to entire decking surface.
8. Install a pressure treated decking to the perimeter of the work area.
9. Install a 032 Edge Metal around the outside roof perimeter to match the window trim
10. Install a new OMG drain with a basket cover
11. Wash all lap and splice areas with splice cleaner.
12. Install uncured cover tape at all lap and spliced areas.
13. Install a cover tape over all metal
14. Reflash all pipe protrusions as needed
15. Install a B-RHG Steel Roof Hatch 30" x 36" in the upper hallway (Hatch Only) ,
16. Remove existing hatch in apartment and install a plywood over the existing hole (Building
Owner is responsible for any all interior work)
I
17. Mr. Roofs Corp will connect the existing drain with a 4" PVC pipe that will go thru the
Roofline
18. Mr. Roofs Corp Inc. will supply the customer with any and all permits pertaining to the job.
19. Mr. Roofs Corp Inc will supply the customer with a liability ($2,000,000.00) and workers'
compensation ($1,000,000.00) insurance certificate. (All workers are employees, not
subcontractors.)
20. Mr. Roofs Corp Inc will furnish a 10 year manufacturers warranty and 10 year workmanship
warranty that covers labor.
21. Any alteration or deviation from the above specifications involving extra costs will be executed
only upon written orders and will become an extra charge over and above the estimate.
22. Payment to be made as follows: 1/3 deposit due upon signing, 1/3 due halfway through the job and
the balance due upon completion of the job.
All Jobs to be started approximately 7 days after contract is signed& deposit is paid
(Pending Weather)
Cost: $ 12,800.00 Complete Roofing System & Hatch System
$ 12,800.00 Total Investment
QUOTE GOOD FOR 14 DAYS ONLY!
COMMENTS: If you have any questions please call Sean Green @ 978-265-8300
75 Lancelot Lane, Bristol, NH 03222
28 Westford Rd, Tyngsboro, MA 01879
www.MrRoofs.com - info mrroofs.com
877-MRROOFS
2
o:
f MR�ROOFS
M.. 8�+=7-MrRooTs
CONTRACT /
Sale Rep: Jr24/7 C"/,lfi7
This Contract between the contractor(the"Contractor")and the owner(the"Owner")named below
OWNERnrn� //� /� i7 CONTRACTOR
Mr Roos Corp Inc.
Name: G� / ..c✓
Address: Jp 001-'AC.l o- 28 Westford Rd
City: .!(o(L./79 Tyngsboro, MA 01879
State: ELA Zip: 877-Mr Roofs ext
Mailing Address(if
different): 1� �^ 978-265-8300 Cell Number
Address:
City: I.LJJ�1Qf�{f
State: IV A' Zip: Mal
Day: 7S/ -d,,57' (m 9lfr Evening: Alternate:
We propose hereby to furnish material and labor-complete in accordance with specifications below.,
Existing Roof consists of#of Comp layers: #of Wood layers: '— Ridge to install —
Roof to Install: Manufacture LraJ hr c Type: 0(iD Color: 91a u
Drip Edge_ Vented Drip Edge(Color) Re-lead Chimney Soffit Vents(Qty)
This contract is dated IC-Jt-d rj (Month/Day/Year).The work under the Contract is scheduled to begin
on or about (Month/Day/Year)and is scheduled to be substantially completed on or
about i I-" -0 e/ (Month/DayNear); provided, however(1)such scheduled dates of beginning an
completion are subject to change due to unforeseen circumstances,and(ii)the Contractor shall have no obligation to begin work
until the Owner has paid the Initial Advance(as hereinafter defined).The scheduled dates for beginning and completion are
estimates only,and the Contractor shall have no responsibility or liability for reasonable delays in the beginning and completing the
work hereunder.In addition,the Contractor shall have no responsibility or liability for any delays arising from permitting
requirements,the Owner's loan approval and funding,loan disbursement,acts of God,weather,strikes, lockouts, boycotts,or other
local labor union activities,job changes requested by the Owner, inability to secure materials, labor shortages,failure of the Owner
to make payments when due,delays caused by inspections,changes caused by inspectors,delays by the Owner in making
selections,or any other cause beyond the Contractor's control. -
The work described below is to be performed at the following property: .3 ej 116A-G, d'r ✓Q(C+>1
The following is a detailed description of the work to be performed and the materials to be used in the performance of this Contract:
Refer to attached estimate.
Such work and materials are hereinafter referred to as the"Work".This Contract shall be construed as requiring the Contractor to
perform any work or to install any items or materials except expressly set forth above.In the event the Contractor determines that
certain materials are not readily available,the Contractor reserves the right to substitute materials of equal or greater value.
Prior to the Contractor beginning the Work,the Owner shall pay the Contractor the sum of$ 0. BrJel,H O y0 / y "ff AA.Ad
(the"Initial Payment")in advance,which amount(if this Contract is for Residential Contracting)shall not exc6ed 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 the Work.Thereafter,the Owner shall make progress payments to the
Contractor as follows: 113 Deposit-113 Middle Payment-113 Final Payment
The owner is signing below to acknowledge that the Owner has been advised of this cancellation right described in detail
on the back of this Contract and also on the notice of cancellation form.
�/gmOWNER
�!
Prin Name: 7 hori„q3 Jh-I-uc.�<yl.r,a�-T Print Name:
ALTERNATIVE DISPUTE RESOLUTION
(SEE BACKSIDE OFCONTRACT FOR DETAILED DESCRIPTION)
THE CONTRACTOR AND THE HOMEOWNER MUTUALLY AGREE THAT IN THE EVENT THE CONTRACTOR HAS A DISPUTE CONCERNING THIS CONTRACT,THE CONTRACTOR MY INRIATE
ALTERNATIVE DISPUTE RESOLUTION THROUGH ANY PRIVATE ARBITRATION SERVICES APPROVED BY THE DIRECTOR OF CONSUMER AFFAIRS AND BUSINESS REGULATION.UNDER PARAGRAPHS
(a)TO(a),INCLUSIVE,OF SECTION FOUR OF THE HOME IMPRVOEMEN]CONTRACTOR lAw
CONTRACTOR:Mr RoofsCorp In ', By: / Date:
3 OWNER: Print Name: /f o -1-3 5kaC k� ,. Date: /r7-2c-2eCt_
OWNER: '�i I `� ) Print Name: Date: L
BY SIGNING THIS CONTRACT YOU ARE ACCEPTING ALL TERMS AND CONDITIONS
DO NO GN THIS CONTRACT IF THERE ANY BLANK SPACES
CONTRACTOR:Mr Roofs Corp Inc Br y: .�.! Date:. .,,)Z-d c/
�WNER: � V Print Name: Y b en.a-) d'iL Ark an Date: !d-2e -26.9-g
OWNER: Print Name: Date:
This Propassl pertains to services provided by Roofs Corp Inc.
2 After acceptance of this Proposal by the cusbmeo Mr Roofs Corp Inc has the option to withdraw based on management approved.
3. Unless rejected by-Management Approval'Its Proposal consUNtes the entire contract between the parties and may be changed my by mutual wonted agreement of the partes.
•4. All of the customers listed on the face of this Proposal must accept this Proposal,
5. Payment is due upon comple4on at our Tyngsboro office.Payment not recerved upon compledon may be deemed in default.In the event of a default,interest shall moral from the data of default at me
lesser of a tale of 1.6%per month(1 BOA PER ANNUMI or the maximum allowed by law,win a minimum charge of five dollars($5 00)per month.Customer agrees to pay all necessary,costs,expenses,
legal fees,and amounts due If Nis account a tendered for collection.
'o. Proper Momentum of the rwf system may require replacement of the flashing.During such replacement,siding adjacent IS this flashing,which has deteriorated,may crack,break or tear,Mr Roofs Corp
Inc MI make every reasonable effort to avoid damage,but will not be had responsible for any consequential damage to siding.
7. During application of the mof system,vibabon from the roof may be transmitted throughout the building.The customer assumes responsibility for all objects hung Gam exterior and interior walls and
Mom ceilings and Saba.These have been known to fall during installation and Mr Rash Corp Inc.will not be responsible for these Ocounexi
0. Mr Roofs Corp Inc.is considerate of the customers gardening,lower beds and landscaping,but due the nature of roof system iirmandion,some damage may occur.We attempt 0 minimize any
damage,and will not be held responsible If any damage occurs. - -
9. Customers shall not walk under the work area while roof wore is in progress.Construction site is a danger to person(s)on the ground Mom falling debris.
10. In the event Nat Mr Roofs Corp Inc.removes a smalie den or antenna Mom said roof in order to complete work,be homeowner shall be coley responsible for hiring a qualified technician W reinstall
align such Squirmed.Any cost arising from such work shall be the sale responsibility of the homeowner.
11. Mr Roofs Cory Inc.shall not be liable for preexisting structural deficiences.We will make every effort 0 infamn the customer of any defidency of which we become aware.We are not responsible for
cocoucang an inspection of any such confidential The installation of the new roof system may intensity the appearance of any befidenty.Mr Roofs Carp Inc volt not take responsibiliy for solving
prsexislhg deficiencies or the appearance of those deft tendes.
12. Mr Roofs Corp Inc.warrants its roof system to be Mee from leaks for Me duration specified.Mr Roofs Corp Inc.assumes liabifiry for repair of any installation workmanship Wood causing leakage,
Homeowner agrees to hold Mr Roofs Cory Inc harmless for any interior or examor damage,to include enMmnmanW damage including'pro a resulting Mom water leakage.Mr Roofs Corp Inc.shall
have no liability beyond repair ofsab roof.Roofing material a mumbled by the manufacturer under a separate warranty,which is moved 0 the customer upon payment in full.
13, It is the responsibility of the homeowner to Poorly Mr Roofs Cory Inc within seventy-tyro(72)hours of discovery of a leak.It is the responsibility of the customer IS aka reasonable immediate action to
avoid funkier damage.
14. Wit regard to competed mi work,Mr Roofs Corp Inc shall have no warahty liability except for roof areas)that Mr Roofs Corp Inc performed work to as agreed upon in this contract
15. Or Roofs Carp Inc will send a represen a ve to inspect and investigate my reported leak.More Nan one inspecton may be necessary to broke the cause.it is the responsibility of the customer to
provide acceptable times and dates for such inspections and access.
16. Contractor and material disthbutord)shall require dmeway access with heavy maenals and equipment Contractor will not be responsible for subsequent damage M homeowners driveway or burns.
17. If maternal(s)he delNered and must be restocked or reordered due to customers cancellation,a return fee equal to twenty percent(20%)of the maedal(s)cost will be due no later Nan thirty(30)days
after contract camon latlon.The fee is charged by the roofing material distributer and a in addition to he cancellation fee imposed by Mr Roofs Cop Inc as described above.
18. Acceptance of the Proposal cannot be vdthdrawn after Mr Roofs Corp Inc personnel appear on the site ready 0 perform except by mutual written agreement of the paNes.
19, Any statements,communications or representations not omen on this Proposal are agreed to be immaterial and not relied upon by either party and do not survive the acceptance of this Proposal.
20. Roofing on cause dust debris,and small particles farm the raof'hnstallation to enter the building and attic.Use caution the lrst more in the attic access is used and do not look up the amss hard
immsdialey after opening as small particles may filter down.
21. All wannorms are transferable after payment in full.
22. Airy and all additional cerpmby work needed war not performed until the roof is complete and paid in for.
23, COMPLETE AGREEMENT The Contrail is the complete agreemem between the Conbzdor and the Omer,Re following is a description of all other documents,if any,which are incorporated into his
Contract
a) Proposal
b) Right of Cancellation Notice
M Comprehensive Evaluation
24. RIGHT OF CANCELLATION.If and only Ifthe Work(as herelafter deembed)conadmare"Residential Contracting'as defined M MassachuSats General Laws chapter 1420(the'Home Improvemem
Contractor Law)the Owner may canal the agreement If it has been sgned by a parry thereto at a place other than an address of the Contractor,which may be the Cortrednrs main office or band
thereof,provided that the Owner notified the Contractor in mong at the Contractors main ofice or branch by ordinary mail posed,by telegram sent or by mall not later than the him business day
following the signing of this agreement
25, The right 0 cancel only applies to Tesidential Contracting'which is defined in the Home Improvement Contractor law,as the reconstruction,atenal renovation,repair,modernization,conversion
improvement removal or demolition,or the construction of an addition to any pre-existing owner Occupied building containing at least one but not more Man bur dwelling units,which building or pwtior
thereof is used or designed to be used we a residence or dwelling not,of to smUcbms which are adjacent to such residence or building,An references in the Confined to'residemtial
Contracting'shall mean Residential Contracting as defined in the Home Improvement Contractor law,and shaft not be deemed to include any other work or services;performed by the Contractor or its
subcontractors.
26. If the owner fails 0 make timely,payments as set fort in this Contrail,the Contractor may suspend performance of the Work wti1 all delinquent payments are made.With respect to Residential
Contracting,no residential home improvement contract may contain an acceleration clause under which any pert Oran of the balance not yet due may be declared due and payable because the hotel
deems ffset to be insecure.However,min rasped 0 Resdential Contracting,If the Contractor deems itself to be insecure,the Contractor may reform as a prerequisite M commuing the Work,
hatthe averse of the funds due under this Contract which are h the possession of the Owner,be placed in a joht escrow account requiring the signature of the Contro for and the Ownerfor
withdrawal.The Contractors nights under this Contract are in addition to any and an other rights and remedies available to the Contractor at law and in equity.tide Work consAutes Residential
Contracting ony,the Cordector shall nor demand final payment until the Work is completed M the Satisfaction of tie parties hereto.
2T REQUIRED DISCLOSURES.The disdasmes sal forth the paragraph are required if the Work confidence Residential Contracting.The Owner
Acknowledges having the opportunity to read the folbwing disclosures prior to signing this Contract
ALL CONTRACTORS AND SUBCONTRACTORS MUST BE REGIATERED BY THE CHIEF ADMINISTRATOR OF THE BOARD OF BUILDING REGULATIONS AND STANDARDS,AN AGENCY
WITHIN THE EXECUTIVE OFFICE OF THE PUBLIC SAFETY,AND INQIRES ABOUT A CONTRACTOR OR SUBCONTRACTOR SHOULD BE DIRECTED TO SUCH CHIEF ADMINISTRATOR,THE
REGISTRATION NUMBER OF THE CONTRACTOR,IF THE WORK CONSTITUTES RESIOENTAIL CONTRACTING,THE CONTRACTOR SHALL MAKE AVAILABLE THE REGISTRATIOD
NUMBER OF ANY SUBCONTRACTORS PERFORMING THE WORK UPON THE OWNERS WRITTEN REQUEST.IF THE WORK CONSTITUTES RESIDENTAIL CONTRACTING,THE OWNEF
MAY HAVE THREE-DAY CANCELLATION RIGHTS UNDER SECTION FORTY-EIGHT OF MASSACHUSETTS GENERAL LAWS CHAPTER NINETY-THREE,SECTION FOURTEEN OF CHAPTEF
TWO HUNDRED FIFTY-FIVE D,SECTION TEN OF CHAPTER ONE HUNDRED FORTY D AS MAY BE APPLICABLE.THE OWNER HAS NO WARRANTIES UNDER THIS CONTRACT EXCEPT AE
EXPRESSLY SET FORTH HEREIN OR AS MAY ARISE UNDER APPLICABLE LAW.IF THE WORK CONSTITUTES RESIDENTIAL CONTRACTING,THE OWNER HAS RIGHTS UNDER THE
HOME IMPROVEMENT CONTRECTOR LAW AND UNDER 780 CMR RE,INCLUDING,WITHOUT LIMITATION,THE RIGHT TO ENFORCE THIS CONTRACT IN A COURT OF LAW OR TO SUSMO
DIPUTES TO PRIVATE ARBITRATION UNDER A PRIVATE ARBITRATION PROGRAM APPROVED BY THE DIRECTOR OF CONSUMER AFFAIRS AND BUSINESS REGULATION.THI:
CONTRACT DOES NOT CREATE A MORTGAGE OR SECURITY INTEREST IN THE PROPERTY,HOWEVER,THE CONTRACTOR AND OTHERS PROVIDING LABOR OR AMTERNL TO THE
PROPERTY HAVE THE RIGHT UNDER MASSACHUSE17S GENERAL LAWS CHAPTER TWO HUNDRED FIFTY-FOUR TO RECORD A NOTICE OF CONTRACT AS TO THE PROPERTY AND TC
OBTAIN A LIEN ON THE PROPERTY TO SECURE PAYMENT OF AMOUNTS OWED TO SUCH PERSONS AS A CONSEQUENCE OF THIS CONTRACT.
28. PERMITS.This paragraph applies only A the Work constimths Residential Contradng.The Contactor shall inform the Owner of any and all necessary permts("a Work.It shall be the oblgaam o
the Contractor to obain said permits.Homeowners who sealer their awn permits shall be excluded Mom the guaranty provisions of the Home Improvement Contractor law.
29. ALTERNATIVE DISPUTE RESOLUTION.This paragraph applies only t the Work consfiutes Residental Contracting,The Nome Improvement Contractor law provides aameove ers with the right V
in@ate an arbitration action(as an atemadver to court action)it they have a depute with tie contra don The Same right is not aubmatialy afforded the conbacra.however,The Contractor would haw
M resolve any dispute the Com mobs has wlth the homeowner to court unless both parties agree the optional clause provided on the front of firs Contract The clause would give the
contractor the same night SO amitafion as afforded to the homeowner by the Home Improvement Contractor Law.
30. THE SIGNATURES OF THE PARTIES ON THE FRONT OF THIS CONTRACT UNDER ALTERNATIVE DISPUTE RESOLUTION APPLY ONLY TO THE AGREEMENT OF THE PARTIES TIC
ALTERNATIVE DISPUTE RESOLUTION INITIATED BY THE CONTRACTOR.THE OWNER MAY INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THIS SECTION IS Ni
SEPARATELY SIGNED BY THE PARTIES,IN ADDITION,THE OWNER ACKNOWLEDGES THE CONTRACTOR'S RIGHTS TO ALIEN UNDER MASSACHUSETTES GENERAL LAWS CHAPTEF
TWO HUNDRED FIFTY-FOUR AND THE CONTRACTOR'S RIGHT TO AKE ANY AND ALL ACTION NECESSARY TO ENFORECE AND/OR PRESERVE SUCH LIEN,INCLUDING,WTHOUI
LIMITATION,THE RIGHT TO FILE A COMPLAINT WITH THE APPROPRIATE COURT,NOTWITHSTANDING THE PARTIES'AGREEMENT TO ALTERNATIVE DIPSUTE RESOLUTION.
31, OWNERS RIGHTS.This paragraph applies only If the Work cc mounks Residential Contracting.A homeowners rights under the Home Improvement Contractor Law(Massachuseter General Lewh
chatter 142A)and other consumer protection laws(such as Massim usees General laws chapter 93A)may not be waived in any way,even by agreement.However,homeowners may be excluder
him certain rights if the contractor they choose a not properly registered as prescribed by law.Homeowners who secure their awn building permits are automatically excluded Mom all Guaranty Funk
provisions of Me Home Improvement Contractor Lax,The Contractor is responsible for completing work as deserted,in a limey,and workmanlike manner.Homeowners may be added to othe
Spedfic legal rights ff the Contractor guarantees or provides an express moral fix workmanship or materials.In addition to guarantees or wartantes provided by the Control an goods sold e
Masaduseds carry an implied warranty of merchad itiy and Save for a pull purpose.An enumerrom of other madam an which to homeowner and contractor exhi agree may be Sol
0 the terms of the contrail as long as May do not restrict a homeowners basic consumer rights.If you have questions about your consumed homeowner ribs,contact the Consumer Informal
Hotline Oieted below)
32. ADDITIONAL INFORMATION This paragraph only applies if Me Work constibes Residential Contracting.If the Owner has general questions or needs additional information about Me Hoorn
Improvement Contractor Law or other consumer fights,or to the Owner wishes to obtain a Mee copy of'A Consumer Guide b the Home Improvement Contractor Law.Then before entering into thi:
Contract Me Omer should contact Consumer Information Hotline,Commonwealth of Massach errs,Executive Office of Consumer Affairs and Business Regulation,10 Fork Plaza,Room 5170
Boston,MA 02116,617-973 8787
All home improvement contractors and subcontracts are required to be registered with the Director of Home Improvement ftegishation.If the Owner wants to verify the registration of a contractor Or i
the Owner has questions or needs additional information specRically about the contractor registration component of the Home Improvement Contractor law,contact:Director of Home Improvement
Contractor Registration,Bureau of Suilding Regulations and Standards,One Ashburton Place,Room 1301,Boston,MA 02108,617-727-3200,eM 25205.
For assistance wNh Informal mmmon ofdeputes or to registerfornal complaints against a business calk.Consumer Compliant Sector,Office of the Attsmry Ge Sent,817-727 MO.
33. This Contract Satisfies all basic requirements of the Home Improvement Contractor Law,but does not preclude Fames Mom agreeing to add language 0 protect their specific interests.THE OWNEF
SHOULD SEEK LEGAL ADVICE IF NECESSARY.
34, EXECUTION The Owner and the Contractor are executing this Contract as of the data set fort on the mount of Nis Contract This Contract shall eke effect as an instrument under seal.This Contra:
must be executed in duplicate and should not be signed until a copy of all exhibits and referenced document have been attached.One original signed copy of this Contract with attachments is to bra
given 0 the Owner and the other kept by the Contractor.By signing the hoot of the Contract the Owner acknowledges hating received a copy of this Contract signed by both the Contractor and thr
Owner,with attechmente Any mci ificOons to this Contract must be to ming and agreed to by both parties.Contracted work may not begin until both parties have recerved.a idly executed copy of the
Contract and the three-day rescission period has expired.
CITY OF S.U.E-M, NLuSACHUSETTS
BLII.DLNG DEPARTM&tiT
120 WASI-INGTON STREET, P FLOOR.
TE1- (978) 745-9595
P.a..c(978) 740-9M
KINIBERLEY DRISCOLL
MAYOR THosw ST.PtERRE
DIRECTOR OF PUBLIC PROPERTY/31211131IVG CONWISSIONER
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section 11 L5
Debris, and the provisions of MGL c 40, S 54;
Building Permit At is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
111, S 150A.
The debris will be transported by:
(name of hauler)
�v
The debris will be disposed of in
pdameo
� �
f facility)
�d _h �� HO DOW
(address of facility
signature of permit app tc
date
•.fcbri5a if.dw
CITY OF SM�E Y, NLkSSACHUSETTS
BuILDNG DEPARTNIENT
120 WASHNGTON STREET,Jao FLOOR
TEI_ (978) 745-9595
FA.Y(978) 740-9846
KI,NfBERLEY DRISCOLL
1TMAYoR THoNw ST.PtF3tRa3
DIRECTOR OF PUBLIC PROPERTY/B n.DNG CONMSSIONER
Workers' Compensation Insurance Affidavit: Builders/ContractorslElectricians/Plumbers
A i licant Information Please
�Print Legibly
Name tBusin ss,Organization indi��vidualal): ,-
Address: 01 �1y y�-t �-!"�—
City/StateiZio: w �`I_ St 0daaPhone #: a�77 6277-�ID�J1./ f�
A,re�y un employer?Chec t e appropriate box: Type of project(required):
1..� I am a employer with 4. ❑ 1 am a general contractor and I 6. ❑New construction
employees(full and/or part-time).' have hired the subcontractors
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet.t 7• ❑Remodeling
strip and have no employees These sub-contractors have S. ❑Demolition
working for me in any capacity, workers'comp. insurance. g, ❑ Building addition
[No workers'comp. insurance 5. ElWe are a corporation and its
required.] officers have exercised their 10.❑Electrical repairs or additions
3.❑ 1 am a homeowner doing all work right of exemption per MGL I I.El 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 ❑Other
comp. insurance required.]
'Any applicuni ilud checks box#i most alw fill out the section bclowshowing their workers'compensation policy information.
'I l.cowncrs who submit this affidavit indicating they arc doing all work and then him outside contractors mtat submit a new affidavit indicating such.
-Cuntracton tlwt chink door box most anached an a Witi.red.Inset showing the name of the sub-ttfmractore and their workers'comp.policy information.
I um un employer that is providing workers'eoarpensadon insurance jar my a layers. Below is the policy and fob site
hiforatation. p y� �� Q /� rtn
Insurance Company Name: 1 �1�Aa q) A,O v I 'fW Ale-r"l�e__C
Policy k or Self-ins.
�Liic..q�Cn(,, V} .(_ Expiration Date: )IC) 1 .
Job Site Address: '"71✓)C�.. �:, `e A'1 city/state/zip: ceJ5yP�1Lt Ml7' eM 70
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 S 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 S250.00 a day against the violator. He 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 of perfury that the itrforaration provided above is true and correct
Si i t re' A4 Date:
Phone N:
01rchd use only. Do nor write in this area,to be completed by city or town official
City or Town: PermitfLicense#
Issuing Authority(circle one):
I. Board of llealth 2.Building Department 3.Cityfrown Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other ,,,,
�I, Contact Person: Phone N:
Ult;�:i1 C/Z </ZU(Ju 1 : 44 : ZZ Pm PAO L ?/ouJ tear; t)erver
MRROOF
DATE uuiDD;wrn
v 3—aaIgo aao� a " va 1e_e a a e:wveXA--ILe mv 0 612 712 0 0 3
PRdaucEn THIS CERTIFICATE IS ISSUED AS A MA-TER OF!NFORMATION
USi ins SeeV Of n1A,inC I ONLY AND CONFERS NO R!GHT¢UPON THE Cc RTfnOATc
2 GIM st-ec.su:—a 5500 I HO'DER.THIS CERTIFICATE DOES NOTAM,END,EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
..O.Box 4093
Woburn KA 01888 I......___� ..
I.JVRERS AFFORDING LAVYCRAVC NAIV¢
D �INGURERA Gemini insUranLe CdRlisalny 10833
Mr,Roos Corporation Inc,dba Mr,Rools ____
l INSURER B: u'bel war rns T.OurHeu'
ioa l 65315
75 Lancelot Lane
inuuRER D: rnM
Bristol,NH 03222
I NSURER�•
vcRER
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATEO.NOTWITHSTANDING
ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERnFICATE MAYBE ISSUED OR
MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DE5CF.iBED HEREIN IS SUBJECT TO ALL THE r CRMS,EXCLUSIONS AND CONDITiONs OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
WSR lop,
POLN:YEFTECME POLpY IXPIMTgM
,ry R TYPE OF INSURANCE POLICY NU48ER _ unnryp LMAITB
A I'GENENERALLIABILI 5706541 08/20/09^ 08120/10 EACH OCCURRENCE s1.004.0n0
I nx I OOMMERGIAL GENERAL LIABILITY I pREuTF N� 5$0.000
CLNMSMADE OCCUR MFOIXPIMTon. .e ) 1 S nn8
PERSONALfl AM INJURY si000On0
x 2,500 Deductible I I I GENEIIALAGGREGATE g2,000,000
_LNL AGGREGAF LIMIT APPLJ7= I I PRODUCTS-COMPCP AGG I s2,000,000
I �J Xj POUCYECT �LOC l I I
AUTOMOBILE LIABILITY I I COMBINED SINGLE LIMIT e
ANYAUTO I I (Fe A¢dRra)
ALLO'NNEDA1705 I aDORYINJURY
WHEODUMAUTOS I Mier grsan} IS
HIRED AUTOS I IBOCILYINJURY IS I
NONOYMEDAUTOS I rY••��'•;}
PROPERTY DMAACC: �
GARAGEBfLRY I AUTO ON iO N LY-EAACCT
A y S
ALTO ONLY:
EA OCCU CH RRENCE
I EMr,R.._._ L;A°1LTru^aMs rAADE I AG�RE;a�—
ff DEDUCTIBLE
I~RETENrm S I S
B WORMERS COMPENSAT k"0 6KUB9797161816 06/23/09 106/23110 X sr�ru 0,
EMPLOYER171JAWLITY I 1
s100,0CC
ANY PROPPE OR"PAR NEPor"J(E;,JTr EL.EACH AccIDFirr I
OFRCERlMEMBEREX UJDEDT EL OISFASE-EAEMPLOYEE S500,000�
I( c ORraW u,Cer
BdEDut PROvbIONS CeL:N EL.DisFABE-POLICY IIMIT 1 5100000
OTHER
I I
DESC0.9';1NJ OF OPERATIONS I LOCATKMIS(VEHICLE!IXCLUSIONS AOCEO 8Y ENO!O�"NSEMENTI BPECILL PRCYISpNS I
CertiRN cote 1,V14art IAartrad as a4414V1ra1 ir.s IIC4 Wl T%L L1atpi for Iwo r1L Ne,rfW ed Vy
arricv insumd ori!
�.. it
Evidence--I coverags
I I
CERTIFICATE HO+DER CANCELLATION
(SHOULD ANY OF THE ABOVE BESCR18E0 POLCIFS BECANCELLED BEFORE THE�(..IRATIDNI
�r.Roofs Corporationlnc.dbB DaTryTn LOT`HE LwNOr-S EMwuL F EQ TO LWLDArC I£R
ofY0 no ti L j n T
Bristol,NH 03222 IMPOSE NO 06Lw,ZNORLiAOMrFf Or AvnhD UFONTHC FiSURZER,, SS AeEN ou-`L
AUTHOR2E0 REPRESERTATD'E 1
ACORD 25(2(1011051 1 of 1 #,40nn0771mn3Ga.A33 v GZGrn O ACORO CORFORA.TION 1988
s�.�llltikltotl��i1�
. �1rU,�U° yf tK` u1 rtrnec1alty LI°en.`y ',
11as,� Kuildu_ visor SP
Qo;1rd u1 0o S�Per
.. CpOStN�'s sl �p10�
�cease: w
RQSUicled t0 R:
EEN P D ROPD 1%�,
SEPN EC AGUE 46� 2p12
M
01 P ETON, P'' ExPi�ai�j f 51pipy3
Board of Building Regulations and Standards
License or registration valid for indie u use only
return
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found returr n to:
Registration 160840 Board of Building Regulations and Standards
Expira iqn 918/2010 Trk 274288 One Ashburton Place But 1301
;. Boston,Ma.02108
SCOTT CARPENTRY CONTRACTING �r
CARPENTER SCOFF' An YT�ASHBY,
398 SIMONDS ROS MA 01431 Administrator Novaliun tore