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t Massachusetts Home Improvement Sample Contract
This form satisfies all basic requirements ofthe state's Home Itvprovemen[Contractor Law(MGL chapter 142A),but does not include standard
language to protect homeowners. Seek legal advice if necea+ary. Any person planning home improvements should first obtain a copy of"a
Massachusetts consumer guide to home improvement"before agreeing to any work on your residence.You may obtain a free copy by calling the
Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617-973-8787 or 1488-283-3757.
Homeowner Information Contractor Information
erne Cop,uny Marc -. - -
-
- So-cet Address(do nor uuaP ice aux address) onaacmr/SalerpersoN 0.Name
c#I
city/Town V Sam Zip Code mivvs Address(mutt include strecadancs)
—r)Y� `� 2
a,mrs Phone Evening Phvee irylfown State Zip Code
!ori/o
Mailing Address(It diff t from above) ss Phone Waal EmPloyer m or S S. mober
IvurregwmlMnrten Mnm int Home mpmvnmm Cmuu'Ia Rab NunM FgenOondnR
rs rvrtp lemuu]mluve.
war m®weo"mmrx.The Contractor agrees to do the following work for the Hos.
om ver:
(Viscarwar. it e war o courpreran,rpro,yurs Me tysi,turna,m e o ma a s o us
Required Permits-The following building permits are required Proposed Start and Completion Schedule-The following schedule will
and will be secured by the contractor as the homeowner's agent, be adhered to unless circumstances beyond the wvtracml's control mise
(Owners who secure their own permits will be f�jj
excluded from the Guaranty Fund provisions of _�_al2hen contactor will begin contracted work.
MGL chapter 142A.) o
g�p'OIPc when contracted work will be substantially completed.
Total Contract Price and Payment Schedule
The Contractor agrees to P4.".the work,famish the material and labor specified above for the total sum of. zapA
- "40"
Payments will be made according to the following schedule:
$ upon signing contract(not to ecceed 1/3 ofthe total compact prim or the cost of special order items,whichever is greater)
$ by /_/ or upon completion of
$ by _/_/_m upon completion of
$ tV p �aupgb completion ofthe comma. (law forbids demanding CWI payment until contract is completed in both party's satisfaction)
The following matentruNuipmmu must be specialS robe paid for
ordered before the contracted work begin in order E m be paid for
m meet the compUrni scbdule(")
NOTES:(')Including all burns,charges('e)law requires that any deposit or down-payment requtrd by the contractor before work betgns may
not arced the restar of(a)onsul ird of the total contract prim or(b)the actual cost of any special equipment in casrmn made materiel
which most be special orchil in advance to meet the completive schedule.
E W bets, idd by thsaamN N V f 11 runs or the warrant,must he stmrkd to the contract)
Subcontractors-The contractor agrees to be solely responsible for completion of the work described regardless of the actions ofany third
parry/subcontusaar uulised by the contactor. The contocmr father agrees to be solely responsible for all payments to all subcontractors for
Mannish d labor undm this agreement
Contract Acceptance-Upon signing,this document becomes a binding contract under law. Unless otherwise noted within this document,the
contract shall not imply that any lien or other security interest has bcrn placed on the residence. Review the following cautions and notices
carefully before signing this contract.
a Don't be pressured into signing the contract Take time to read and idly understand it. Ask questions if something is unclear.
Make samosetact h fd Home Ira rovemem Contructm Registration. The law requires most home improvement contractors and
subcontractors to he registered with the Director of Home Improvement Conbmotor Registration. You may inquire about contractor
registration by writing to the Director at One Ashburton Place,Room 1301,Boston,MA 02108 or by calling 617-727-3200 or
1-800-223-0933.
a Does the contractor have insusnce? Check to ser that your contractor is properly insured.
a Know you rights and responsibdities. Read the Important Information on the reverse side of dais form and get a copy ofthe Consumer
Guide to the Home Improvement Contractor Law.
You may cancel this agreement if it has been signed at a place oiler than the commences normal place ofbusivess,provided you notify the
contractor in writing at his/her main office or branch office by ordinary mail posted,by telegram sent or by delivery,not leder than midnight of the
third business day following the signing of this agreement See the attached notice of cancellation form form explanation of this right
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES!!!
Two idmaW copies ofNc convect awl h wmpleadeM sigvd.One entry tlmuM go m rhe hammwmx.The o0awpy shnWd m kept try Ne cannvcmr.
Hommwner,',a Sit, azMc untractor's Signature
—T >� Dare /3 —o
Contractor Arbitration
The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action(as an
alternative to court action)if they have a dispute with a contractor. The same right is not automatically afforded to a
contractor,however. The contractor would have to resolve any dispute be/she has with a homeowner in court unless
both parties agree to the optional clause provided below. This clause would give the contractor the same right to
arbitration as is afforded to the homeowner by the Home Improvement Contractor Law.
The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute
concerning this contract,the contractor may submit the dispute to a private arbitration firm which has been approved by
the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required
\ to su mit to such arbitration
asass pprovid�ed In Massachusetts General Laws,chapter 142A.
c /�J Homeowner's Signature ctor's Signature
NOTICE:The signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution
initiated by the contractor. The homeowner may initiate alternative dispute resolution even where this section is not
separately signed by the parties.
Homeowner's Rights
A homeowner's rights under the Home Improvement Contractor Law(MGL chapter 142A)and other consumer
protection laws(i.e.MGL chapter 93A)may not be waived in any way,even by agreement. However,homeowners
may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law.
Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of
the Home Improvement Contractor Law. The contractor is responsible for completing the work as described,in a
timely and workmanlike mariner. Homeowners may be entitled to other specific legal rights if the contractor guarantees
or provides an express warranty for workmanship or materials. In addition to guarantees or warranties provided by the
contractor,all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for a particular
purpose. An enumeration of other matters on which the homeowner and contractor lawfully agree may be added to the
terms of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have questions about
your consumer/homeowner rights,contact the Consumer Information Hotline(listed below).
Execution of Contract
The contract most be executed in duplicate and should not be signed until a copy of all exhibits and referenced
documents have been attached. Parties are also advised not to sign the document until all blank sections have been
filled in or marked as void,deleted,or not applicable. One original signed copy of the contract with attachments is to
be given to the owner and the other kept by the contractor. Any modification to the original contract must be in writing
and agreed to by both parties.Contracted work may not begin until both partes have received a fully executed copy of
the contract,and the three day recission period has expired.
Accelerated Payments
A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the
homeowner deems him/herselfto be financially insecure. However,in instances where a contractor deems him/herself
to be financially insecure,the contractor may require that the balance of funds not yet due be placed in ajoint escrow
account as a prerequisite to continuing the contracted work. Withdrawal of fords from said account would require the
signatures of both parties.
Additional Information
If you have general questions or need additional information about the Home Improvement Contractor Law or other
consumer rights,or if you wish to obtain a free copy of"A Consumer Guide to the Home Improvement Contractor
Law,"contact:
Consumer Information Hotline
Office of Consumer Affairs and Business Regulation
10 Park Plaza,Room 5170,Boston,MA 02116
(617)973-8787 or 1-(888)2833757
If you want to verify the registration of a contractor or if you have questions or need additional information specifically
about the contractor registration component of the Home Improvement Contractor Law,contact:
Director of Home Improvement Contractor Registration
Bureau of Building Regulations and Standards
One Ashburton Place,Room 1301,Boston,MA 02108
(617)727-3200 or 1-800-223-0933
For assistance with informal mediation of disputes or to register formal complaints against a business,call:
Consumer Complaint Section
Office of the Attorney General
(617)727-8400
AND/OR
Better Business Bureau
(508)652-4800
(508)755-2548
(413)734-3114
CITY OF SM.EM, N'IASSACHUSEM .
BLBDLNG DEPARTJIE2 T
• 120 W.ISHINGTON STREET,Yin FLOOR
TEL (978)745-9595
FAx(978) 740.9846 _
KI-
,IBF_RLEY DRISCOLL THOMAS ST.PtERR6 - - — -
MAYOR
- DIRECTOR OF PI:HLIC PROPERTY/HL'IIDLNG COMMISSIONER
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbera
Applicant Information Please Print Leeibly
Name(Busies: sOrganizationllndividusl): eQAc,>P!✓ C�O.✓J l
Address: 10-57- e# re_eo O /
City/State/Zip: 4qaWjv�/rf�t� Phone li:!OE�?
ArreF au employer?Check the appropriate box: Type of project(required):
1.U 1 am a employer with _ 4. ❑ I am a general contractor and 1 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.: 2. E Reeling
ship and have no employees These sub-contractors have 8. ❑Demolition
workingfor me in an capacity. workers'comp.insurance. q
y p ry. E]Building addition
[No workers'comp.insurance 5. ❑ We are a corporation and its
required.] officers have exercised their 10.El Electrical repairs or additions
3.❑ 1 am a homeowner doing all work right of exemption per MGL I I.[]Plumbing repairs or additions
myself.[No workers'comp. C. 152,§1(4),and we have no 12.❑Roof repairs
insurance required.)t employees.[Noworkers' 13 ❑Other
comp. instaance required.]
-Any apparam that d=ks boa 9l must atm fie out the section below stowing their workers'wmpensaiun policy infumudon.
t I lonuma els who submit this affidavit indicating+hey aro doing all work and thea hire outside contracts most submit a new,andavil indicating such
:Conimciors that cheek this box must snachod an additional short showing the none of the subK ntraetm and their workers•comp.policy infomotion.
I am an employer that is providing workers'compensodan insurance for my employees. Below is the policy and Job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.It, �Z7 u �5,?9 �.�Y 30^'��Exp'vation Date:
Job Site Address: f C, Eo ,2,,Z City/StaWZip:_Lfor
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration tate).
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$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 of perjury that the information provided above is true and correct
Sferruure•�i�./1�
Phone
OJrchef use on/j. 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 Ilealth 2.Building Department 3.Citylfown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other,
Contact Persoa: Phone#:
l
--
WORKERS COMPENSATION
ZURIAND
EMPLOYERS LIABILITY POLICY
TYPE AR INFORMATION PAGE WC 00 00 01 ( A)
- POLICY NUMBER: (6ZZUB-0245N30-6=09)
RENEWAL OF (6ZZUB-1361C38-5-08)
INSURER: AMERICAN ZURICH INSURANCE COMPANY NCCI CO CODE: 80012
1.
PRODUCER:
INSURED:
HARRIS MURTAGH INS
GONYEA, DARREL DBA 30 CENTRAL STREET
GONYEA CONSTRUCTION PEABODY MA 01960
p 0 BOX 504
ROWLEY MA 01969
Insured is AN INDIVIDUAL
Other work places and identification numbers are shown ni0nithe schaedluee( su attached.
address.
2. The policy period is from 03-13-09 to 03-13-10
3, A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers
Compensation Law of the state(s) listed here:
MA
B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each state listed in
item 3.A. The limits of our liability under Part Two are:
Bodily Injury by Accident: $ 100000 Each Accident
Bodily Injury by Disease: $ 500000 policy Limit
Bodily Injury by Disease: $
100000 Each Employee
C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, H any, listed here:
COVERAGE REPLACED BY ENDORSEMENT WC 20 03 0GA
o
D. This policy includes these endorsements and schedules:
SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE
Classif
ons, Rates
s of Rules,
4 Plans• All required in orlmat on s subject to verifIcationnand change by audit to'be' d Rating
will be deterined by our made ANNUALLY
ST ASSIGN: MA
DATE OF ISSUE: 03-09-09 WC g09
OFFICE: ZURICH-ORLAN 29HRD
PRODUCER: HARRIS MURTAGH INS
005322 ---_-
.__- - __ _-
O m
P.O. Box 504 -
Rowley, Ma 01969
Phone & Fax 978-948-6001
Proposal
Page 1 of 2
July 20, 2009
Mr. & Mrs. Richard Eagan
1 Ugo Road
Salem, Ma 01970
978-744-8242
Camentry
Remove existing wall and base cabinets.
Cut trench in wall behind base units for electric runway.
Patch ceiling as close as possible where old electrical work existed.
Patch electrical runway.
Install new owner supplied wall and base cabinets to layout sheet.
Install owner supplied trim work.
Supply and install 3 '/s" crown molding in basement to hide wires from electrician if needed.
No Permit.
Plumbing
Remove existing sink.
Move gas pipe to new location.
Supply and install water to refrigerator.
Supply and install toe kick heater.
Hook up new sink and faucet. (Owner supplied fixture.)
Permit included.
I
Page 2 of 2
Electrical By Owners Plan)
- Supply and install seven 4" can lights.
Move paddle fan.
Install five counter receptacles.
Install microwave feed.
Switch for sink light.
Switch for disposal.
Three switches for circuit A.
Move refrigerator plug.
Move stove plug.
Switches for other lights.
Wire toe kick.
Permit included.
Contractor will supply dump trailer.
Owner is responsible for dump fees.
No paint or stain work.
$10,860.00
i CITY OF S.0 E,%VI, . LiSSACHUSETTS
• BUILDIING DEPs.RTNI&NT -
130 W.jmNGTON STREET,3"0 FLOOR
TEE- (978) 745-9595
FAX(978) 740-9846
Ki5{BFRt EY DRISCOLL
,MAYOR "IHoMas ST.PtERRs
DIRECTOR OF PUBLIC PROPERTY/BU DING CONMaSSIONER
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 111.5
Debris, and the provisions of MGL c 40, S 54;
Building Permit# 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)
The debris will be disposed of in :
s LTi
(name of facility)
(address of facility)
signature ofpen applicant
f3—ri 9 I'
date
Jcbrisalf:dce
s a a zn ` t " �ux ,zi S6C1'ION 5-'CONStFRUGTION-SER,,YICB.4 Ez� � ,irPt
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, �. ;+nRC. TR`es`iJth"itidltRoaM CUYen "TMa?+'+. +»
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r� ^. } F t ��. - ,` r ' -, y i, SF, � .Ru�ideliiiill;SuhJ.Fuei:Bdmm A IW11i�lnstallaJlm� h5 _
vD � Res,dentfdl DeaU3htaml.,.r t t tet`
t 3n -fit' .1
eMM66W., mpro"veriient-Cdnfcuctor.(f11C):"� .� ifi 1 - '' 3•-.
it , .,R� �t Name \ rK FF. Wt. +a t�RegtStraJan NlrinhlCY r.. .✓r '.L1
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.SECTION 6'W 'COMPFdNSATION INSURAIVlff
C�FAFFIDAVIT(M
- r r y . Yr'[Z "•. "5 'F-!4•G.r +�. YT.*'S •v+v :3:: i r T {
Virnrkws Compeasa on insumoce aMwi must be completed ami stibmllted W)th`Ihfs�applicauun Tnllure m pruvlde
+ this uffida5d Wdl�ul[iothefidennialiofbtha Isftinnce of trig pemur` ; r HIM 1z
1 Si° r iz 1 i •I d a. Yk,rtrt 5#�'Y awl` t's� 1' tl {J �1� Sr c._ t .
Signed At#ldaviE'Aieched?fies r Y�y{No 2 ,O , . t
t J*
o $ECT10MU OWNBRjAUTFIORiZA170N TO BE COMELB F®WREN rr
h _! r �, z -
ry OWNER'S'A°GENTOR�CONTR}ACTORAPI!�IESFOR�BIII[DINGPERMIT � j
+s r•- 1 atH ta4 7t 1m
.��
} M� s '+d;+ r`Y hi{�.r s x-t i aS dWrler,.Of f�$Ub,�eCtt foperty hereby t�,r -
..
amhorlu,t .� xy , r �' .S ` �' m aerolarmy+�6ehalf in alt metiers
Nl
gpermttapplicatlon s� r 'F
relnuve to Work authorfud by this 6uildl n
777
5.t i ta. zipCTFON 7b.OYi7VERr OR AUTFIOBiZED AGENT DECLARATION' x 4 " i
tw 1 - 7 1 Y � i a { l' tyF .•� vt� i aA e „
TO homs,
i of
� ��r,3,-.y.y � '' r os Owner orAuthariudAgenrherebydeclare
s cuFa[e m'$1e best ofm'Icnowled and '
the)tF1es`�atements andmformatton oa the foregomg�ppiication ore true and be Y ge
k1a w yu
P � ' - a.i .t h ' v
-7 behalf s sl z s -U L"t 4 1 1 1 i 3 - exp /y!
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' turrof6Wworz udl
SlgnaAgent.lt >*z 1 _ i EDa[er - . : -
Sf edunde'Mft -
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'l An Oma who abbuns a building permitto do his/her own work,or an owner w o lures analnregistered ivntro�for
Cmi reglefated in }1 Aomo]mprovement Cmttrector{FAC)-Program).wtli -navc aceess ioYhaarbttralnn
d ice.(._.::'�"�..C1-;I: _ h .arm t...
program or�uamnq�fund underM O L ca142A,Other�mpbrtant mformutionpn theEffiC Pm
- s` �'%� CJonSuvction' `�' suil�cens!ng(CSL}cnn 6e".fo'Jixi in 780CMR'Regulahcns 110 Rb and 1 LSO RS respeciiveiy
2 , When', ubsmndeXf works planned•provide the infartnnhon below ; Ix
' . , s" Toml floas.area($9 rE§c) (inclGding garnga fi tied basemendattka de�ksprpdn>hl
>, +n zt J
'Grass fiVIng aFea(Sq tL=) ' H mdableoroom count
,:N1lmh�e`roFfjrep
N Ger f bedrooms r `
Nr y Numberbfha{f/baths " '
Ni1mh�bf bnthrooms ,k
R+ '
1leatify ngsysrrd4ni:.k ' - j t +� s.'NumberofdeUcslporches- ^-`''
» Type of' tem, v � s
I ' 2•u t S FJi<h4%�d it -�4- QpCn a R to �''Pr
6fq)voYmg syem ri � � 3 , 1 _
r
Projcc Ua a Maga may lu subsutut2"dtfar"7 ofai Protect Cost , r , r
t
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