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2 LOGAN ST - BUILDING INSPECTION (3) Ik7 5—O G - r, The Commonwealth of Massachusetts � Board of Building Regulations and Standards CITY OF Massachusetts State Building Code, 730 CMR SALEM : ( ., I Revised Alar 201/ Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Tivo-Family D-velling , '1` ' fhis Section Fbr OfRcial Usa 0nl . Building Permit Number. Dafe Applied Building Official(Print Ntime) $r motors, ate SECTION I:SITE INFORMATIOCI. 1.1 Property Address. 1.2 Assessors Map Parcel Numbers _ '5/— L Ia Is this an acce to street?yes no Map Number Parcel Number 1.3 Zoning Information- 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq R) Frontage(R) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.O.I.c.40,§54) 1.1 Flood Zone Informations 1.3 Sewage Disposal Systems Public❑ Private❑ Zone: _ Outside Flood Zone? biunlci et❑ On site disposal stem ❑ Check if es❑ P P Y S$GTION Z;' PROPERT$'MV. $ERStIjE!f 1: 2.1 Owne tofRcca d. Name(Print) S ` Cuy,State,Zip T 3Yf�- No,and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSEO.WORKs'(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ I Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Dcscrtptton of Proposed Work Sr 7 lew e--e ( C -;i-e / . 3 SECTION4: ESTINLAfED CONSTRUCTION COSTS- ftcm Estimated Costs: OfRelal Use Only. Libor and Materials 1. Building g I. Building Permit Fee:S Indicate haw fee is determined: t. rlectrical QStandaid.City/town Application Fee,. ❑'rotif Froject Costs(Item 6)s multiplier x 1. Plumbing i J_ Other Faes: .S 1 .M-ehanical (IIV.\t.:) i List:. i. .\laclt.w ic.tl (Pin: iup�c=iuiion) l'hack +`!o. Chcc!cr\utunut: ('.ish :\mount � trial Nrnjrct ( 'nit S o2(b0- d ---- --- U I'.lid in Pnll Q t)ut;fm+lin;; Ii;ilanec I!n+:� _ i 5rcrION 5: CONs'fltUCTION SERVICES 5.1 Construction Supervisor License(CS[.) — License Number Expiration Date l:tmu ot•CSL I folder 3 H1(> $tIfR[ List CSL rype(sue below) U rype Description No. and Street U Unrestricted Duildin s u to 33AUU cu. R. It Restricted Ida2 Famil Dwcllin city/rown,State, YIP II Rout nr RC Ruutin Cuverin WS Window and Sidin SF Solid Fuel Burning Appliances q-2 �r y-V y 3 ( insulation Email address U Demolition fete hone /Y 5.2 Registered Horne eI�m.p„.r�ovement.Contnctor(H(C) yo 3 �a Ll i.w� 'M LLC IIIC Registration Number Expiration Date I I IC Company Name ur HIC $39'it Ii:J �.PIC Email address No.and Street _S-1y7 City/Town, State ZIP Telephone SECTION 6: WORKERS'CODIPENSAXION INSURANCE AFFIDAVIT(NI.G.L.c. 152. 1 2SC(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 a building permit. Signed AffidavitAttached7 Yes......... No...........1 SECTION la: OWNER AUTHORIZATIONTo BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT (, as owner of the subject property,hereby authorize ermit application. to act on my behalf, in all mutters relative to work authorized by this building p pp ULA / Date Print Ownur's Name(Eieetrante Signature) SF.CT(OIt 7h: OWNER t OR AUTHORIZED AGENT DECLARATION By entering my name below, 1 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. rate Print Uwoncr's ur.\uUtunc Signaauo) NOTES: I. ;\n Owner who obtains a building permit to do hisiher own work,or an owner who hires an unregistered contractor (nut registered in thu Home improvement Contractor(HIC) Program), will Ern have access to the arbitration progr:un or guaranty rand under M.O.L. c. ILL\• Other important information on the H(C Program can be found at w ww m•u+ etrv%era Information on the Construction Supervisor License can be round at uwvw.wass.�, L.l 2. When sub,tantini work is Planned,Pruvi.(u To information belu"'a a finished bnselnenVattic;, dcu,ls or porch) total tloonuca(oi. 11.) ._----- —lincludingg g . f hbitable room count _ rw; liviny :n'ca(;,Ltt.l -- ,lumber ofbalrnonas _--_-- ----- --"--- ,lumperofh.tleb,uhs yuwMrro(b.uhronms — -. ._.-- I' Ile "t 11..ui111; ;y;lc111 — Puclo;al Pen s,lu ir.� F����Li�;r"urry he nib,ntia:,l - - . Rightfax C3-2 3/11/2013 4 : 45 : 54 AM PAGE 2/'002 Fax Server =� CERTIFICATE OF LIABILITY INSURANCE DATEIMM/DD03/1 120/YYYY) T IFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICAT O DER. IS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED SY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATNE 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 and endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT NAME: EASTERN INS GROUP LLC PHONE FAX 233 WEST CENTRAL ST (A/C,No,Ext): (A/C,No): E-MAIL NATICK, MA 01760 ADDRESS: 22MLW INSURER(S)AFFORDING COVERAGE NAIC p INSURED INSURERA: AMERICAN ZURICH 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: IS IS TO CERTIFY STED BELOW HAVEBEEN ISSUEDTO 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 ISSUEDOR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONSAND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD SUB POLICY EFF DATE POLICY EXP DATE 'S LTR TYPE OF INSURANCE L R POLICY NUMBER (MMTDDIYYYY) (MMTDDIYYYY) LIMITS GENERAL LIABILITY -ACH OCCURRENCE COMMERCIAL GENERAL LIABILITY 8 CLAIMS MADE =OCCUR. DAMAGE TO RENTED SREMISES(Ea occurrence) VIED EXP(Arty one person) $ GEN'L AGGREGATE LIMIT APPLIES PER: RSONAL&ACV INJURY Is ENERAL AGGREGATE $ POLICY PROJECT LOC RODUCTS-COMP/OP AG S AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY 8 SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTYDAMAGE $ (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND X WC STATUTORY OTHER EMPLOYER'S LIABILITY YIN UB-58270121.13 03202013 03202014 LIMITS ANY PRCPERITOR/PARTNER/EXECUTNE N N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDEDo 500,000 (ManCatoryln NH) E.L. DISEASE-EA EMPLOYEE $ 500,000 Byes.describe under DESCRIPTION OF OPERATIONS below E.L..DISEASE-POLICY LIMIT Is 500,000 DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUBD TO THE CBRTIBICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION CITY OF SALEM SHOULD ANY OF THEABOVE DESCRIBED POLICIES BE CANCELLED 93 WASHINTON ST BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. SALEM,MA 01970 AUTHORIZED REPft Tj AVEy _.._ /�la..r, CC `^ �... Y ACORD 25(2010/05) The ACORD name and logo are registered marks of ACOR 1988-2010 ACORD CORPORATION. All rights reserved. `'1✓°® CERTIFICATE OF LIABILITY INSURANCE °A'�`M""013 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 e certificate holder in lieu of such endorsement(s). ndorsed. If SUBROGATION IS WAIVED, sub)ect to the terms a conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the PRODUCER CON . T Construction Eastern Insurance Group LLC PHONE (SOB)651-7700 F 233 West Central Street E- n. Wc No) ADDRESS- INSURE S AFFORDING"Co. 1360 Natick MA 01760 INSURERA:Arbella ProtectiINSURED - INSURERB'Arbella IndemnitAtlantic Weatherization INSURERCNautilus Insuran 61 Rear Jefferson Avenue INSURER D: NSURER E: Salem MA 01970 INSURER F: COVERAGES CERTIFICATE NUMBERMSTER 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 POUCYNU BER PwpD EFF MwD POLICY LIMITS tGEN'L IABILITY EACH OCCURRENCE E 1,000,000 ERCIAL GENERAL UABILITY P MI Ea tune b 50,000 ALAIMS-MADEOCCUR 500042816 /20/2013 /20/2014 MEDEXP Anyone person E 5,000 PERSONAL&AOVINJURY S 1,000,000 GENERAL AGGREGATE E 2,000,000 REGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG E 2 000,000 Y X PRO- LOC E AUTOMOBILE LIAMUTY COMBI SIN LE LIMI Ea accident 1,000 000 ANY AUTO H BODILY INJURY(Per person) E ALL OWNED SCHEDULED _ AUTOS X AUTOS 020015871 /20/2013 /20/2014 BODILY INJURY(Per accident) S X HIRED AUTOS X NON_O NED ALTOS POP«RN DAMAGE E PIP-Basic e E X UMBRELLA UAB X OCCUR EACH OCCURRENCE E 1,000,000 A EXCESS LUtB CLAIMS-MADE AGGREGATE E 1,000,000 CEO RETENTIONS 4600047820 /20/2013 /20/2014 WORKERS COMPENSATION E ANDEMPLOYERS'LIABILITY WC STATU- OTH- ANY.PROPRIETORIPARTNERIEXECUTIVE Y I N OFFICER/MEMBER EXCLUDED? NIA E.L.EACH ACCIDENT E (Mandatory In NH) If yes,describe under E.L DISEASE-EA EMPLOYE E DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT S C POLLUTION LIABILITY PL2003786001 0/1/2012 10/1/2013 GENERALAGGREGATE $1,000,000 EA POLLUTION CONDITION $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more apace is re iulmd) 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 �«•�--a�,l'�< ACORD 26(2010/05)IN5025 rim M9M 01988-2010 ACORD CORPORATION. All rights reserved. The nRf1Rr1 namn and Inns nro ron:nb.oA ma.4v nF p(!(tRra The Commonwealth of Massachusetts Print Form Department of Industrial Accidents �* Office of Investigations ' .4 I 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 (Business/Organization/individual): ATLANTIC WEATHERIZAT10N LLC 61RJEFFERSON AVENUE Address: SALEM. MA 01970 FAX(978) 745-2200 City/State ip: Phone#: Are yo n employer?Check the appropriate box: Type of project(required): 1. am a employer with a S 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' 9 ❑ Building addition [No workers' comp. insurance comp. insurance.! required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their I I.❑ 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 employees. [No workers' 11M Other comp. insurance required.] *Any applicant that checks box#1 must also till out the section below showing their workers'compensation policy information. f Homeowners who submit this affidavit indicating they are doing all work and then him outside contractors must submit anew affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the subcontractors 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 and Job site information. In Insurance Company Name: L Policy#or Self-ins. Lic.#: S 9?0 f e21 Expiration Date: // 7 0 Job Site Address: ✓t S � City/State/Zip:_5 �U_ � 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 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 c!E4 ti er the pains and enalties of perturythat the in ormatlon provided above is true and correct Si azure: Date Phone# 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. Other Contact Person: Phone#: CITY OF S:1.CZNf iti1;15S.1CHLSE t l TTS ©L'IL"gr1DEP.1MLENT 130 CU.13HC4rTONRE STET,3"FLOOR T�-;L (978) 745-9595 KJ.NtoERr Y DRISCOLL FAX(973) 7.10-9344 �UYO,i TFI01t�3 sr.FIERM DIRECTOR OF pL'8LlC pROFERTy/81:MDLY(3 CONWISSIO,NER Catlstruction Debris Disposal Aftldavit (required for all demolition mid renovation work) In accordance with the sixth edition orthe State Building Cade, 730 Chin Debris, and the provisions of MGL e 40, S 54; section l l L5 Building permit i> is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed wasta disposal Facility as defined by��IGL c III, S 150A. The debris will be transported by: (name of hauler) The debris will be disposed of in - (namc or racdily) - tal�reS.S Ur taJlh{y) - siynamra ufpermit applicant J t 4, CITY OF S.U,Eli, �/IASS.-1 -HUSET'TS BUILDING•DEPART1tENT - 120 WASHINGTON STREET,3"FLOOR "+ TEt. (978)74s 9595, nix:(918) '74Q-9ft 6 KIMBERLFY DRI4COLL ONIAS ST.PIERRE MAYOR DIRECTOR OF PUBLIC PROPERTY/BUILDING CONMIMIONER' Workers' Compensation insurance Affidavit: Builders/Contractors?EJeetrfelans/Pturtiber9 annlicant inftirtnation Please Print Legibly Narne (ousitxss/Otganizatio dindividual): Atlantic Tot -rizationr.I I C 61 R Jefferson Avenue Address: S e>ll City/State/Zlp. Phone.#: Are you an employer?Check the appropriate box: Type of project(required): 4. ❑ 1 am a general contractor and 1 1.❑ I am a'cmploycr with 6. New construction employees(full and/or part-time):' have hired the sub-contractors 1. listed on the attached sheet • 7• ❑Remodeling 2.[] i am a sold proprictoror partner - ship and have no employees. These sub-contactors havo it. ❑ Demolition - working for me in-any capacity.. workers'comp. instuance ' 9, Building addition (No workers!comp. insurance:: 5• We are scorporation anslit i !0.❑Electrical repairs or additions required.) oiTcers have exercisdd their, 3. 1 am a homeownei doing all work right of exemption pee MGL.,,- 1 I.❑ Plumbing repairs or additions myself:[No,workers'comp. c. 152,§1(4),and we have no 12.0 Roof repairs. insurance requtred,J t umpidyeey.[Na t'varkers 13.❑Other comp.inwrance mquir d] •AnY applldtm dial chwks bar p l must alit fill out the section below showing thou wwkets'.compensation polity information. PI hnmeowtxtnwho submit this Affidavit indicating they am doing all work and then him outside"am hors must submit new aMdavit indicating such. :Cutumion that chwk this box must anached an additional sheet showing the name of the sub•eontractois and their wo*om'camp.policy infonmatioo. . um air employer that Is'Provlding workers'conrpensedom insurance for piny,employees. Below Is the policy and Job site Insurance Company Name, Policy#yr Self-ins.Lic.H: �� 2--10 Expiration Date:_ Job Site Address:- 2 LO 4 �-vi ., City/State/Zip:' /�A Attach a copy of tbe,iv'orkers'compensation policy,declaration page(showing the policy nurot or and expiration date). Failure to secure coverage as required under Suction 25A of MGL c. 152 can lead to the imposition'of criminal penalties of a. fine up to SI,500,00 and/or one-year imprisonment as well as civil penalties in the Conn of a STOP WORK ORDER and a fine of up to$230.00 a day against the violator. 13e advised that copy of this statement_may be forwarded to the Office of Investigutimiabf the DIA for itisuraice covcmge vcrftication, I do hereby cerrlfy aederthepains and penal)fieesss o/fperfary rhur the inforinudon provided above it rr/uetee and correct Official use wily, Do nor write in this area,to be caahplered by city arfawn Official' City or,rownt PermitilAccnse#.:_ Issuing Authority(circle one): 1.Board of health 2.Building Department 3.City/town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Ott)cr- __—.-- Contact Person: __._----- Phone#: MassacZ !setts Home Improvement Sample Contract - n :his term satisfies all basic requu ea is of the Aws Home Improvement Contractor Lmy(MGI;chapter 342A),but does not include swndartl language a is Con homeowners J��,�Sceels legal advice d'neecssary. Any person Pluenmghomc Improvements should Brat obtain-a c-py of"A Messechusetls Coasmm($tide.�vJ,tlOme Improvemeat"before agreab(g m My work on yomresidenee.You may obtain a free copybycsil!ng the Office of ConaumerAffairs and)3dfinces Regulntim"s Censors WmInAti Hotline et 617 973-8787 or 1 88g283 3757 or on oor twFsir.. Homeowner 1111 r ation Contractor Information" rTe 11 Company Name ..,,.:'.dSI,C.e-mauve A Pent Omeb 8oz add=) Contractor/Sol TZe a --- n a 5 eft /.1 61 R7e bm. lAvcnite Cirylfown I tip Cade Hominess Address(must include tad , - dlcill'"FRA 01970 Daytime Phone - Evbt)tog?hem Chy/fown State Zip Code F? S� hleOing Addrtsi(adiffemtfram eb ' Bvaivea Phone Fcdaat Pmplg IDwa.a.Numb .. .. rm,[s.lm[wemma.m. m®t•v�o.[�a®ec„s[a a,om[e a,P;,[n edw ',� �mPm,tmat[ootRnm•ppp t -' mid[Reea9annvmae. , y1-G�+,"�. 7 �/� The Contractor agroa m do the fa owingwurkmr the Homeowner. cJ (Describe,to dereil me worktocemPlet✓a�specifyingthOMrbmnd,Mdiada of matrolsto bbowed- _dmo"el[n fnewan .) . C ,,-�, 5 �7 �_ T JS? At 5c 1 { t4 C� �c(w-} ,}cz t sy n', r7c6r 7 3 �o'l ue� �S =ZI ts-The mllowmetiuHdiug permits are Proposed Start and Completion Schedule-The following sd:adule will by the �ame of as the homeownef3 SgmIt be adhered m uWess circumstances beyond the conbactofs mnr'd arise secure their o' permits will be //the G¢arnniy F¢nd provisions of '7 p/jData when conhamorw!ll Begin contracted vrorc 142A.) $/ Date when contracted work will be substantially convicted Total Contract Price and PaymedgSchedule The Contractor agrees to perform t4d work,fumishthe material and labor specified above for the total stun of Payments will be msde aOcmtiug tepee following schedule: �.. ._ dl>ots®ung coie'M"(nbtfoEtFceedl'3'bYth'e tbretcentieU"pnw`Q the c6s[ofspeciei order iume,vmienever is greazvj_. S by /_'� W up-completion of by -up_completion of - S upon completion the contract (yaw forbids demanding a 1. . _ _ g full P ymemardil contact is completed to both party's mtisfartion). 7Lefell6wing=UdaVegmpm.l.tbespeeid $ " ' tobe paidfor ".. ordered bdbm the cdntmcled begiminamer tomeetthceomplotlM schedW •`) S tobepaid for NOTES:(•)Including all r(nam charges C")Iaw requires teat any deposit or down-payment required by the connector before woe:begins may not aueed the greater od6)anathmt efthe tend consent price or the acnW cost-tarry specW equiPmmt or comm made whc iar ' which mustbe spedd ordered in advance to wear tho w api flo.seheduh, Emrm Wnrrnnw•tt an emrex.vnin6 Nbei rovldN loan h 4 ❑N ❑Y Subcontractors-The contractor Agrees to be solely responsible for completion of the work desmbed regardless of the actions of My third party/submnuactorut iznd by the ddaireemr.The conRacmc further agora m be solelyresponn-ble for all payments to all subwntrncfors for materials dhy Ant ContraetAc"Prance-Upoasrgai*tbbdowmentbecamesabmdmgwntmct[mdalew. Unl=otherwisenoredwithintbisdoeumcnt,etc warrant shall not imply that my lietbr other security interest has been placedon the residence. Reviewthemllowingenationa Mdnoticcs carefully before signing this conhaU, DMI be pressured into signing the conheet Take than to read pndbilyvnderstandit Askquestions!fsometbingisundeer. M.h.;,..th trnetm•h of-ddN mCoatmdorlicjdon ThelawrequirammthomeimprovementcontmMmmd subwatracamato be rellUtered-Tth the Director of Home Improvement ContractorRegutation. You may inquire about contractor registration by writing the TYirecmr m 10 PArkPlam,Room 5170,Boston,MA 02116 or by calling 617-973-8787 or 888-283-to • Dos the cons actorhave inson etee7 Ask the Contractor forbis insurance company Information so that you cen confirm coverage,or ask to not a copy oft"proofofinsm8dce^document _ • Rnowyom rights and responsibilities. Read the Important Information on the reverse ride ofthis form and get a copy ofth Consumer Oxide to the Home lmprodc pen}Contractor Law. runway cancel this a®ermeat ifit hie,been signed a spinet,offer than the contrectoPs Mrmnlpleee ofbosiness,provided yeti notify the contractor' waiting at his/her mamiciffice or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight ofher thud basiam day following the similg ofthis agreement See the atrnehed notice ofcencesatirm form fen an explanation ofthis tight DO NOT SIGb,V Tffi CONTRACT IF THERE ARE ANy BLANK SPACES!!! Ten¢Indwraaptu Oran miuF.m msttx[anymm had[yo<a,oar[wpy[n•wd s=a um eooso.msc m[otw w?y nwwd m a[pi ard'a e!!! HomeovmeP Contra ZZI Da a Date Contractor Arbitration ' The Home Iin alternative to rov p. ementContractor Lawprovides homeowners with the right to initiate an arbitration action(as an court action)if they have a dispute with a contractor. The same right rs i1St auiWmaticali contactor,however. The contractor would have to resolve an dis both parties agree'to the o ho 1 Y Pute he/she has with a ho m Y afforded to a arbitration ar,i P na clause provided below. This clause would weer in court unless afforded to the homeowner by the Home improvement give the coat, or the,same right to P Contractor Law.' _ The contractor and the homeowner hereby m - concerning this. Y utoally agree in advance that in the even coAd'@.ctr"thae°atritotOn maysubmit the dispute to a ri the contractor has a dispute edit to s c theFxecuiive Office o Consumer Affairs P vate arbitration firm! hich has been approved to submit to suck atlirtsgh6a as provided in Massachusetts and Business Re b)' Ivlassachusetts General Laws,cha�p[ehron and then°nsumer shall be required Homeowner's a oiBnanire . .. - NOTICE;The signatures of the parties above mraotors Signature resolution initiated b the aPP1Y Only to the agreement of the parties t section is not se Y contractor. The homeowner may initiate alt q oltorneven dispute arately signed by the parties. ernative dispute resdljition even where this " Homeowner's-Rlghts !! A homeowners rights under the Home Improvement Contractor Law protection laws(i.e.MGL he 93A may (Milt chapter 142A�' d other cons may be excluded from certain right ) Y not be waived in anyway even by agreemeal. However, inner, if the contractor they choose is not re homeowners Homeowners who secure their own building properly registere the Home Improvement Contractor Law a contractor is ex°hided from d Prescribed by law. timely and wor sPonsible for completing Guaranty 1•lmd provisions of r ovidesre manner. Homeowners may be entitled to other P ng the"York a described,in a guarantees b Or provides an express warrantyfor win specific legal rights if the contractor. . Provided by the contractor,all workmanship rr materials, la addition to tees or warn aP�cular - goods sold in Mdassachusetts carry m tin had i°m� antics' purposefAne enumeration of other matters on which the homeowner �on mercSantability and fitness for added to the terms of the contract as lot as thetrot tor'lawfully agree may be questions about our co 8 Y do not restrict a homeowner's basic consumer rights. If you have Y nsumer/homeowner rights,contact the Consumer Information Hotline(listed below)..Execution of Contra ct The contract mustbe executed in dui 1'cat and should not be signed until a copy of all bits and'refereaced documents in tr harkedve as attached. Parties are also advised not to sign the document until all blank,sections have been - filled is or marked as void,deleted,.or not applicable. One original signed copy of the,°grunt sect attachments is to be agree to th-bye owner and the other kept by the contractor. Any modification to the origincontact with contract muchmi is is to and contract and troth parties.ConttactedwOrl�aayy Wbegihliutitil botEpalties have rece'd d a fu$ .. the contract,and the three day rescission period has expired. !I F Y executed copy of .. .- Accelerated Payments - A contractor may t demand payments in advance of the dates specified on the aem schedule in cases where the homeowner ut - erself to be financially insecure. However,in instan P Ym s account nt as a Pre Prerequisite e;the contractor may re uirethat the balance of funds not where du o e°actor deems him/herself account as a prerequisite to cominiiin Y q Y eJi placed in a joint escrow signatures of both parties. _ g the contracted work, Withdrawal of funds from said account would require the Additional Information-_ - Ifyou have general questions or need additional information about the Home 7mproveme Contractor Law or other consumer rights,or if you wish to obtain a free copy of!'A Massachusetts Consumer Gvifid�to Home Improvement" contact- _ .. . Consumer Information Hotline _ Office of Consumer Affairs and Business Regulation i 10 Park Plaza,ROOM 5170,Boston,MA 02116 617-973-8787,888-28373757or visit the OCABRwebsiteatbM,//ww,. asA goy/ocnbrl 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 ' Office.of Consumer Affairs and Business Regulation . 10 Park Plaza,Room 5170,Boston,MA 02116 *-i i.. _ ' 617-973-8787,888-283-3757 or visit the HIC website at ://www,Mass¢ov/oca r/ Go online to view the status of a Home Improvement Contractor's Registration;h3N-//db.state m USMOM _ _ ___ ' ice 1 I i - For assistance with informal mediation of disputes or to register formal complaints . _. _ P. a business,call: Consumer Complaint Section Office of the Attorney General 617-727-8400 . AND/OR Better Business Bureau i 508-652-4800,508-755-2548 or 413-734-3114 Version 2.1-I IQ2r2010 ' ii Unrestricted-Buildings of any_use.group which carsa:CSM7977 - - contain less than 35,000 cubic feet(991 m')of _ enclosed space. EPJC W PAF.W'� _ 3HILTONST ;I';.,x,. ' SALEM MA-019703 :, e.t{..,- Failure to possess acurrent edition of the Massachusetts 04/23/2014 State Building Code is cause for revocation of this license. .. - for DPS Licensing information visit: v .Mass.Gov/DPS ,� -�6i'•i:�p w'['a cat:.nL53 ¢ L/QJ:a^ U�L`OnSaID¢l:lalr5tI51 F(gn tihotlp HOME IMPROVEMENT CONTRACTOR _ License or ration valid for individut use only 4 Re9151tationc .142089 Type: - regal before the espiration date. If foetid return to: `E:tpiratiore 31i212014 Ltd LiablityCotpor Office of Consumer Affairs and Business Regulation Ai&iinc WEATHERiZATtON L.L.C. SO Park Plaza-Suite 5170 .Boston,h2A 02116 ERIC PALM EiIR JEFFERSON AVE SALEM,MA 01970 Cudermcretery - - Not valid'wiihmrt signalnre