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Home My WebLink AboutBuilding Permit # 6/14/2016 BUILDINGPERMIT0. �,o��, TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION ® ', Permit No#: Date Received ��A�RaTEn PPa �5 �SS•ac�ous�R Date Issued: EVIP I2TANT: Applicant must complete all items on this page LOCATION s .5(— Print PROPERTY OWNER ICS Print 100 Year Structure yeso MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no n TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New BuildingOne family ❑Addition Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other u-❑'Se tic `❑,Well a ❑ Floodplain ' ❑'Wetlands , �' ❑ Watershed Distrrct ; 5p r 3 l4 i'. r i r- '�/ .-'i r p i ,.,' r1✓ :.t s p rK rrr ai/j fes;y°fir r� 4l N +E r L DESCRIPTION OX WORK TO BE PERFORMED: ® &j i A.,0-64, Identification- Please Type or Print Clearly OWNER: Name: 3iPhone: z_7 Address: t Contractor Name: Phone: `7 V- , Email Ail Address: Supervisor's Construction License: `� Exp. Date Home Improvement License: �% -� Exp. Date: _ ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. 17 Total Project Cost: $ W m FEE: $ Check No.: ' Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund r txORTH Town ofI � �� 0Andover �' -N' • Y" t 0 ® 4 t _ _ L iL �i C, �AKe ver, ass, J(A tJ Q., cocwicMewocn ll BOARD OF HEALTH Food/Kitchen PERMI L D Septic System THIS CERTIFIES THAT .. . ... ................ BUILDING INSPECTOR . ... . .... . ... ... ... ..... ...... has permission to erect ....... buildings on Foundation ................... ................ .............................. .. .. . . ............. .................................... Rough to be occupied as .....�. ....... . . .. .............� . ........ .......... Chimney provided that the person accepting ti permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONST TIO Rough Service _ .. .......... .. .... .... ................ ............. Final ILDING I PECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy BuRough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing r Dry Wall To Be ®one FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. Contract - Detailed Pella Window and Door Showroom of Haverhill Sales Rep Name: Gless, Benjamin 45 Fondi Rd Sales Rep Phone: 978-360-0818 Haverhill, MA 01832 Sales Rep Fax: Phone: (978) 373-2500 Fax: (978) 373-7274 Sales Rep E-Mail: glessba@pellaboston.com Customer Information ProjectlDelivery Address Order Information Jim Keefe 19 250 Series Windows Keefe,Jim,1719058 Quote Name: Keefe,Jim,North Andover 1719058 1353 Salem St 1353 Salem St Order Number: 741BG0112 NORTH ANDOVER,MA 01845-4915 Lot# Quote Number: 7855336 Primary Phone: (978)8212720 NORTH ANDOVER, MA 018454915 Order Type: Installed Sales Mobile Phone: County: ESSEX Payment Terms: WF4115-60 Month no Interest Fax Number: Tax Code: MA TAX 6.25 E-Mail: keefe1982@gmail.com Quoted Date: 5/13/2016 Great Plains#: 10636505 Customer Number: 1007889099 Customer Account: 1003766570 Line,#: Location:' Attributes, 10 Delivery/Setup- Delivery/Setup Item Price Qty Exrd Price $235.00 1 $235.00 For more information regarding the finishing, maintenance, service and warranty of all Pella®products,visit the Pella®website at www.pelia.com Printed on 5/14/2016 Contract-Detailed Page 1 of 9 Customer:Jim Keefe Project Name: 19 250 Series Windows Keefe,Jim,1719058 Order Number: 741BG0112 Quote Number: 7855336 Line# Location: 'Atttibbtes . 15 Office FOH Pella 250 Series, Double Hung,22 X 49.25,White Item Price Qty ExVd Price $718.80 4 $2,875.20 1 1:Non-Standard SizeNonStandard Size Double Hung,Equal PK# Frame Size: 22 X 49 1/4 99 9 787 General Information: Standard,Vinyl,Block,Foam Insulated,3 1/4",3 1/4",Sill Adapter Included,Head Expander Included Exterior Color/Finish: White i ft Interior Color/Finish: White Glass: Insulated Dual Low-E Advanced Low-E Insulating Glass Argon Non High Altitude - Hardware Options: Cam-Action Lock,White,Standard Vent Stop,No Limited Opening Hardware Viewed From Exterior Screen: Half Screen Frame Size:22"X 49.25" Grille: No Grille, Wrapping Information: No Interior Trim,Pella Recommended Clearance,Perimeter Length=143",Glazing Pressure=155. Lead Safe Install-Lead Safe Install Qty 1 PI_Express-Express Pocket Qty 1 Line# Locations Attributes 20 Living Room FOH Pella 250 Series, Double Hung,22 X 49.25,White Item Price Qty Ext'd Price _. $718.80 4 $2,875.20 1:Non-Standard SizeNonStandard Size Double Hung,Equal PK# Frame Size: 22 X 49 1/4 787 General Information: Standard,Vinyl,Block,Foam Insulated,3 1/4",3 1/4",Sill Adapter Included,Head Expander Included Exterior Color/Finish: White Interior Color/Finish: White Glass: Insulated Dual Low-E Advanced Low-E Insulating Glass Argon Non High Altitude Hardware Options: Cam-Action Lock,White,Standard Vent Stop,No Limited Opening Hardware Viewed From Exterior Screen: Full Screen Frame Size:22"X 49.25" Grille: No Grille, Wrapping Information: No Interior Trim,Pella Recommended Clearance,Perimeter Length=143",Glazing Pressure=155. Lead Safe Install-Lead Safe Install Qty 1 PI_Express-Express Pocket Qty 1 For more information regarding the finishing, maintenance,service and warranty of all Pella®products,visit the Pella®website at www.pelia.com Printed on 5/14/2016 Contract-Detailed Page 2 of 9 Customer:Jim Keefe Project Name: 19 250 Series Windows Keefe,Jim,1719058 Order Number: 741 BG0112 Quote Number: 7855336 Line# Location: Attributes, 25 Downstairs Bath Pella 250 Series, Double Hung, 38 X 49.25,White Item Price Qty Ext'd Price $778.49 1 $778.49 1:Non-Standard SizeNon-Standard Size Double Hung,Equal PK# Frame Size: 38 X 49 1/4 787 General Information: Standard,Vinyl,Block,Foam Insulated,3 1/4",3 1/4",Sill Adapter Included,Head Expander Included Exterior Color/Finish: White I Interior Color/Finish: White Glass: Insulated Dual Low-E Advanced Low-E Insulating Glass Argon Non High Altitude Hardware Options: Cam-Action Lock,White,Standard Vent Stop,No Limited Opening Hardware Viewed From Exterior Screen: Full Screen Frame Size:38"X 49.25" Grille: No Grille, Wrapping Information: No Interior Trim,Pella Recommended Clearance,Perimeter Length=175",Glazing Pressure=90. Lead Safe Install-Lead Safe Install Qty 1 PI_Express-Express Pocket Qty 1 Line# Locations Attributes 30 Master Bed Pella 250 Series, Double Hung,41.75 X 49.5,White Item Price Qty Ext'd Price _ $1,408.41 3 $4,225.23 1:Nonstandard SizeNonStandard Size Double Hung,Equal PK# Frame Size: 41 3/4 X 49 1/2 787 General Information: Standard,Vinyl,Block,Foam Insulated,3 1/4",3 1/4",Sill Adapter Included,Head Expander Included Exterior Color/Finish: White Interior Color/Finish: White Glass: Insulated Dual Low-E Advanced Low-E Insulating Glass Argon Non High Altitude 1:75 Hardware Options: Cam-Action Lock,White,Standard Vent Stop,No Limited Opening Hardware Viewed From Exterior Screen: Half Screen Frame Size:41.75"X 49.5" Grille: No Grille, Wrapping Information: No Interior Trim,Pella Recommended Clearance,Perimeter Length=183",Glazing Pressure=80. PVC Upgrade<48 -PVC Upgrade less than 48 inches Qty 1 Lead Safe Install-Lead Safe Install Qty 1 FF<48 wide-Install Full Frame Window 48 inches or less wide Qty 1 Finish FF Trim-Finish Paint/Stain FF Interior Trim Only Qty 1 Trim—Stool and Apron-Add Stool and Apron Trim to Picture Frame Qty 1 For more information regarding the finishing, maintenance, service and warranty of all Pella®products,visit the Pella®website at www.pella.com Printed on 5/14/2016 Contract-Detailed Page 3 of 9 Customer:Jim Keefe Project Name: 19 250 Series Windows Keefe,Jim,1719058 Order Number: 741BG0112 Quote Number: 7855336 Line#, �Locatioh: Attributes , 35 Kids Room Pella 250 Series, Double Hung, 38 X 49.25,White Item Price Qty Ext'd Price $826.49 5 $4,132.45 1:Non-Standard SizeNonStandard Size Double Hung,Equal PK# Frame Size: 38 X 49 1/4 787 General Information: Standard,Vinyl,Block,Foam Insulated,3 1/4",3 1/4",Sill Adapter Included,Head Expander Included Exterior Color/Finish: White I Interior Color/Finish: White Glass: Insulated Dual Low-E Advanced Low-E Insulating Glass Argon Non High Altitude Hardware Options: Cam-Action Lock,White,Standard Vent Stop,No Limited Opening Hardware Viewed From Exterior Screen: Half Screen Frame Size:38"X 49.25" Grille: No Grille, Wrapping Information: No Interior Trim,Pella Recommended Clearance,Perimeter Length=175",Glazing Pressure=90. PI_Express-Express Pocket Qty 1 Lead Safe Install-Lead Safe Install Oty 1 Replace Exterior Sill -Replace Exterior Sill Nose(Pine) Qty 1 Line,# Location': Attributes: 40 Upstairs Bath Pella 250 Series, Double Hung,28 X 37.25,White Item Price Qty Ext'd Price i $696.42 2 $1,392.84 I' 1:Nonstandard SizeNonStandard Size Double Hung,Equal k PK# Frame Size: 28 X 37 1/4 787 General Information: Standard,Vinyl,Block,Foam Insulated,3 1/4",3 1/4",Sill Adapter Included,Head Expander Included Exterior Color/Finish: White Interior Color/Finish: White Glass: Insulated Dual Low-E Advanced Low-E Insulating Glass Argon Non High Altitude Hardware Options: Cam-Action Lock,White,Standard Vent Stop,No Limited Opening Hardware Viewed From Exterior Screen: Full Screen Frame Size:28"X 37.25" Grille: No Grille, Wrapping Information: No Interior Trim,Pella Recommended Clearance,Perimeter Length=131",Glazing Pressure=150. Lead Safe Install-Lead Safe Install (Qty 1 PI—Express-Express Pocket Qty 1 Thank You For Purchasing Pella® Products PELLA WARRANTY: Pella products are covered by Pella's limited warranties in effect at the time of sale.All applicable product warranties are incorporated into and become a part of this contract. Please see the warranties for complete details,taking special note of the two important notice sections regarding installation of Pella products and proper management of moisture within the wall system.Neither Pella Corporation nor Pella Windows&Doors will be bound by any other warranty unless specifically set out in this contract. However,Pella Corporation will not be liable for branch warranties which create obligations in addition to or obligations which are inconsistent with Pella written warranties. Clear opening(egress)information does not take into consideration the addition of a Rolscreen[or any other accessory]to the product.You should consult your local building code to ensure your Pella products meet local egress requirements. For more information regarding the finishing, maintenance,service and warranty of all Pella®products,visit the Pella®website at www.pella.com Printed on 5/14/2016 Contract-Detailed Page 4 of 9 Customer:Jim Keefe Project Name: 19 250 Series Windows Keefe,Jim,1719058 Order Number: 741BG0112 Quote Number: 7855336 Per the manufacturer's limited warranty,unfinished mahogany exterior windows and doors must be finished upon receipt prior to installing and refinished annually,thereafter. Variations in wood grain,color,texture or natural characteristics are not covered under the limited warranty. INSYNCTIVE PRODUCTS:In addition,Pella Insynctive Products are covered by the Pella Insynctive Products Software License Agreement and Pella Insynctive Products Privacy Policy in effect at the time of sale,which can be found at Insynctive.pella.com. By installing or using Your Insynctive Products you are acknowledging the Insynctive Software Agreement and Privacy Policy are part of the terms of sale. Product Performance Information: U-Factor,Solar Heat Gain Coefficient(SHGC),and Visible Light Transmittance(VLT)are certified by the National Fenestration Rating Council(NFRC).Manufacturer stipulates that these ratings conform to applicable NFRC procedures for determining whole product performance.NFRC ratings are determined for a fixed set of environmental conditions and a specific product size.NFRC does not recommend any products and does not warrant the suitability of any product for any specific use. Design Pressure(DP),Performance Class,and Performance Grade(PG)are certified by a third party organization,in many cases the Window and Door Manufacturers Association (WDMA).The certification requires the performance of at least one product of the product line to be tested in accordance with the applicable performance standards and verified by an independent party.The certification indicates that the product(s)of the product line passed the applicable tests.The certification does not apply to mulled and/or product combinations unless noted.Actual product results will vary and change over the products life. For more performance information along with information on Florida Product Approval System(FPAS)Number and Texas Dept.of Insurance(TDI)number go to w��v.pel la.com. /performance. Project Checklist Review (Installed Orders Only) Before the Installation the Homeowner agrees to do the following: Obtain Condo Association Approval Obtain Historic Approval Remove existing shutters and awnings Remove air conditioners Remove existing shades, drapes, window treatments, wall hangings, and personal belongings Move furniture at least 3 feet away from work area Tie or cut back trees, bushes and shrubs in the work area Arrange to have alarm system and doorbells disconnected Arrange to have any plumbing and electrical repairs or changes made by appropriate licensed contractor Provide a door handle and lockset for entry door if Pella handle and lockset is not purchased. Before the Installation Pella agrees to do the following: Obtain Building Permit(When required) Prefinish products when purchased in contract Durinq the Installation the Homeowner agrees to do the following: Keep pets safely away from work area Keep children safely away from work area Allow Pella Installer room to work safely within your home For more information regarding the finishing, maintenance,service and warranty of all Pella®products,visit the Pella®website at www.pella.com Printed on 5/14/2016 Contract-Detailed Page 5 of 9 Customer:Jim Keefe Project Name: 19 250 Series Windows Keefe,Jim,1719058 Order Number: 741 BG0112 Quote Number: 7855336 During the Installation Pella agrees to do the following: Deliver and unload products purchased per contract Place and remove drop cloths in work area then vacuum, and remove all debris at end of day Remove existing product, including storm windows, and dispose of it unless otherwise specified Install all products using method specified in contract per Pella Installation Instructions Replace interior and/or exterior trim only if purchased If Purchased, install exterior primed pine wood trim or Composite. Composite will be unfinished. If Purchased, install interior trim matching wood window finish or White trim for Impervia and Encompass Install non-Pella entry door lockset provided by you. Pella is not responsible for it's quality or performance After the Installation the Homeowner agrees to do the following: Be available for completion and sign off to verify all products purchased are in working order Reinstall existing shutters and awnings Re-install existing shades, drapes, window treatments,wall hangings, and reposition furniture Arrange to have alarm system and doorbells reinstalled Reinstall air conditioners Remove stickers from product and save for energy rebate and tax purposes Wash all interior&exterior glass surfaces Fill nail holes and joints on interior trim if windows are to be stained (after staining) Clean up exterior casing issues due to storm window removal if full wrap or new exterior trim is not purchased Project Checklist has been reviewed Customer initial Product Only Addendum has been reviewed Customer initial Credit Card Account#: Last 4 Digits 0308 Expiration Date: / 052020 Charge final payment to same account E (Upon substantial completion) Customer initial For more information regarding the finishing, maintenance, service and warranty of all Pella®products,visit the Pella®website at www.pelia.com Printed on 5/14/2016 Contract-Detailed Page 6 of 9 Customer:Jim Keefe Project Name: 19 250 Series Windows Keefe,Jim,1719058 Order Number: 741BG0112 Quote Number: 7855336 Project Checklist has been reviewed Jim Keefe Benjamin Gless Cu r Nam a riot) Pella S Rep Name (Please print) QCf�e1'TOta�S Taxable Subtotal $8,969.41 .' ustomer ignature Pella Sales Op Signature Sales Tax @ 6.25% $560.59 5/14/2016 5/14/2016 Non-taxable Subtotal $7,545.00 Date Date Total $17,075.00 Deposit Received $8,537.50 Credit Card Approval Signature Amount Due $8,537.50 For more information regarding the finishing, maintenance,service and warranty of all Pella®products,visit the Pella®website at www.pella.com Printed on 5/14/2016 Contract-Detailed Page 7 of 9 Customer:Jim Keefe Project Name: 19 250 Series Windows Keefe,Jim,1719058 Order Number: 741BG0112 Quote Number: 7855336 Lead Safe Installation Customer Performance Expectations In order to ensure a proper Lead Safe Installation, it is essential that we have you complete the below tasks prior to your installation: OVALL furniture needs to be moved at least 8 feet away from any window or door being replaced 01( ALL personal items, wall hangings, and collectibles must be removed prior to your installation date 0< All blinds and any interior window treatments need to be removed prior to your installation date Any non-movable furniture(for example: pianos, entertainment centers, built in cabinets, etc) must be cleared of items and be surface dusted prior to installation You will be responsible for replacing all furniture and personal items after your installation ❑ Other items: What to Expect the Containment/Work Area to Look Like In order to ensure your safety, we will be taking measures to minimize dust/debris does not spread beyond our work area. This may include the use of plastic sheeting on the floors and/or walls, caution signs, sealing of heating and cooling air vents, and asking that you turn off your HVAC system during our work. During your Lead Safe Installation, you may also see your installation professional wearing Personal Protection Equipment. For your own safety,we are not permitted to allow you inside the work area during the removal of your current product or the installation of your new windows/doors. By signing the form below, I am affirming that I understand all the expectations noted above and that I have agreed to have all items completed prior to my installation commencing. I understand that failure to have these items completed will result in the re-scheduling of my installation and that my installation date will be scheduled for the next available date. .Z ?'�4 5/14/2016 Customer Signature Date For more information regarding the finishing, maintenance, service and warranty of all Pella®products,visit the Pella®website at www.pella.com Printed on 5/14/2016 Contract-Detailed Page 8 of 9 Customer:Jim Keefe Project Name: 19 250 Series Windows Keefe,Jim,1719058 Order Number: 741BG0112 Quote Number: 7855336 Pre-Renovation Form Occupant Confirmation Pamphlet Receipt I have received a co the lea azard information pamphlet infor me of t potential risk of lead hazard expo renovation activity to be performed in my elling unit. I ceived this pamphlet before th ork began Z0, Printed Namewner-occupan Z Sign re of Owner-occup Signature Date '04enovator's Self Certi ' ation Option (fo nant-occupied d lings only) Instructions to Renoor.•If the lead and information pa let was delivered b a tenant sign re was not obtainable,you may th propriate box below. Decli d- I certi at I have made a goo aith effort to deliv a lead hazard' lormation pamphlet to the al dwellin it listed below at the date an me indic d and that the occupa eclined to sign confirmation of eipt. I further certify that ve left a co of the pamphlet at the unit with t occupa . Un ailable for signature- I c ify that I have ade a good faith e rt to deliver the lea zard informatio amphlet to the rental dwelling ' listed low and that the occupan as unavaila o sign the confir on of receipt. I fu r certify that I ha eft a copy of the pamphlet a nit by sliding it under the door o y: (Fill ' ow pamphlet was le '00000/ Printed Name of P on Ce ing Delivery ttempted Delivery Da Signature o er Certifying Delivery Ore Unit Address Note Regarding Maili Op ' --As an alternative to d ' ery in p n,you may m ' e lead hazard' rmation pamphlet to the owner and/or tenant. Pamphlet must be ma' d a st 7 days before renovati . Mailin ust be documen by a certific of mailing from the post office. For more information regarding ' ng, maintenance, se ' an rranty of all Pella®products,visit the Pella®website at www.pella.com Printed on 5/14/2016 finCo act- ailed Page 9 of 9 PELLA WINDOWS AND DOORS CONTRACT 7 PAYMENTS 9. TERMS AND CONDITIONS Pella shall be entitled to stop the Work upon written notice to Owner for any material default or failure by Owner,including but not limited to,the Owner's These Terms and Conditions are an integral part of the contract set forth on the failure to pay Pella the amount due within seven days after the date payment is Product Order(the"Contract")between Now England Window and Door LLC due. dba Pella Windows&Doors,Inc.("Pella")and the person(s)identified on the Product Order("Owner")to supply the products(the"Products"),and perform S. CORRECTION OF WORK work(the"Work")described or referred to in such Contract. For Product Only purchases,a signed"Product Only Addendum"is a required part of the Pella shall correct installation Work not in conformance with the requirements contract. of the Contract,if notified in writing by the Owner within two years after the Completion Date or,if earlier,the date on which the Work is substantially 2 OWNER completed and payment of the Purchase Price made subject to a holdback as provided above.Correction of Work as herein provided shall be Owner's sole Pella is not responsible for any existing security systems.Owner shall remove remedy for defective workmanship,and is provided in lieu of any and all other all shades;verticals,blinds,curtains,drapes or window mounted air remedies.Pella's obligation to correct Work is conditioned on Pella's prior conditioners,prior to the installation of the Products.Pella's installers are not receipt of all payments then due. responsible for the removal or installation of these types of items. Pella is not responsible for pre-existing window coverings fitting on newly installed Pella 9. LIMITED PRODUCT WARRANTY windows. Pella shall warrant all Pella products,but only in accordance with the Pella The Owner shall provide complete access to the worksite between the hours Windows&Doors Limited Warranty.THIS LIMITED WARRANTY SHALL of 7:00 a.m.and 6:00 p.m.(Monday through Friday)for Pella's installers to BE THE SOLE WARRANTY WITH RESPECT TO THE PRODUCTS AND deliver the Products and perform the Work. PELLA SPECIFICALLY DISCLAIMS ALL OTHER WARRANTIES, EXPRESS OR IMPLIED, WRITTEN OR ORAL(INCLUDING WITHOUT 3. PELLA LIMITATION ANY WARRANTY OF MERCHANTABILITY OR FITNESS Pella will be responsible for and have control over construction means, FOR A PARTICULAR PURPOSE). methods,techniques,sequences and procedures and for coordinating all 20/lifetime/10 portions of the Work.Pella will be responsible for the Work of its Pella 10. NO CONSEQUENTIAL DAMAGES Contractors who will install the Products. UNDER NO CIRCUMSTANCES SHALL PELLA BE LIABLE FOR Unless provided otherwise in the Work description,Pella will provide and pay CONSEQUENTIAL,INCIDENTAL,INDIRECT,OR SPECIAL DAMAGES, for all labor,materials,equipment,tools and machinery,transportation,and WHETHER FORESEEN OR UNFORESEEN, i other facilities and services necessary for the proper execution and completion of the Work. 11. ROME IMPROVEMENT CONTRACTORS The materials and equipment famished under the Contract wilt be good quality All home improvement contractors and subcontractors shall be registered with and new unless otherwise required or permitted,the Work will be free from the director of the Home Improvement Contractor Registration Program defects not inherent in the quality required or permitted,and the Work administered by the Board of Building Regulations and Standards. Pella and conform with the requirements of this Contract.Pella shall not be responsible any of its subcontractors identified in this agreement have been registered. I for damages or defects caused by abuse,modifications not executed by Pella, Any inquires about Pella or any o£its subcontractors relating to registration improper or insufficient maintenance,improper operation or normal wear and should be directed to:Director,Home Improvement Contractor Registration, tear. Pella will keep the premises and surrounding area free from 10 Park Plaza,Room 5170,Boston,MA 02116,617-973-8787,888-283-3757 accumulation of waste materials or rubbish caused by performance of the or visit the HIC website at http://ivww.mass.gov/ocabr/ Work. 12. PERMITS(MA customers only) 4 CHANGES ell �i obligated to and will obtain the following permits for this project: 1�U(�Q I(1g . Homeowners who secure their own permits will be The Owner may order in writing changes in the Work consisting of additions, excluded from the guaranty fund provisions of Massachusetts General Laws, deletions,or modifications("Change Order"). Any Change Order shall chapter 142A, include an adjustment to the Price and the Substantial Completion Date,as determined by Pella. Pella reserves the right to approve or disapprove any In addition to the rights and warranties enumerated in this agreemratt,you may Change Order and any such Change Order must be signed by both Owner and have additional rights under Massachusetts General Laws,chapter 142A and Pella to be effective. 780 Code of Massachusetts Regulations R6, 13. NOTICE OF CANCELLATION S. SUBSTANTIAL COMPLETION Owner understands and agrees that the Substantial Completion Date is an You may cancel this agreement if it has been signed by a party estimate only and that the actual date on which the Work is completed may be thereto at a place other than an address of the seller,which I extended to allow for Change Orders requested by Owner or if the time to may be his main office or branch thereof,provided you notify complete the Work is affected by conduct of the Owner,weather,labor ' disputes,availability of subcontractors,acts of God,fire or other causes the seller in writing at his main office or branch by ordinary reasonably beyond Pella's control.If for any reason the Work is not fully mail posted,by telegram sent or by delivery,not later than completed by the Substantial Completion Date(including any extensions midnight of the third business day following the signing of this contemplated above),but is substantially completed by such date,i.e.,the agreement. Product has been installed,but minor parts or c 'need to be replaced or repaired,a hold ba r ionate to the cost of remain See the attached Notice of Cancellation for an explanation of parts or work to be complete ' ceptable.However,the holdback will not this right. exceed the amount of the pletion costs or 10%of the remaining unp ' balance of the Price,w ever is less. 6. FINANCING Do not sign this contract if there are any blank spaces. Ifpayment ofthe Price is financed with a financial institution through Pella,all ' financing paperwork must be completed upon signing of this Contract and the requisite approvals and authorizations for the full amount of the requested financing shall have been received from the financial institution. Customer signature 5/14/2016 Date DISPUTES THE CONTRACTOR AND THE HOMEOWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT PELLA HAS A DISPUTE CONCERNING THIS CONTRACT,PELLA MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUTIVE OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATIONS AND THE CONSUMER SHALL BE REQUIRED TO SUBMIT TO SUCH ARBITRATION AS PROVIDED IN M.G.L.c. 142A Pella Windows and Door NE Contractor s U Homeowner NOTICE: THE SIGNATURE OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE SETTLEMENT INITIATED BY THE CONTRACTOR. THE OWNER MAY INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THIS SECTION IS NOT SEPARATELY SIGNED BY THE PARTIES. NOTICE OF CANCELLATION Date of transaction: 5/14/2016 You may cancel this transaction, without any penalty or obligation, within three business days from the above date. If you cancel, any property traded in, any payments made by you under the agreement, and any negotiable instrument executed by you will be returned within ten business days following receipt by the seller of your cancellation notice, and any security interest arising out of the transaction will be cancelled. If you cancel, you must make available to the seller at your residence, in substantially as good condition as when received, any goods delivered to you under this agreement; or you may if you wish, comply with the instructions of the seller regarding the return shipment of the goods at the seller's expense and risk. If you do make the goods available to the seller and the seller does not pick them up within twenty days of the date of your notice of cancellation, you may retain or dispose of the goods without any further obligation. If you fail to make the goods available to the seller, or if you agree to return the goods to the seller and fail to do so,then you remain liable for performance of all obligations under the contract. To cancel this transaction, mail or deliver a signed and dated copy of this cancellation notice or any other written notice, or send a telegram to Pella Windows and Doors, at 45 Fondi Rd.. Haverhill, MA 01832 not later than midnight of 5/18/2016 (three business days from the date of transaction above). I hereby cancel this transaction. (Date) (Buyer's signature) �7 aPF� poi rra �BBe. Departgneni o,/fdaadasMal Accidetai Office of hivesdgaalions I Congress Sereei, Smile 100 r' Bosion,MA1 02114-2017 P6'PtJm PPm§s.govIdiad Workers' Compensaflon ffnsuw2nee Affid2-r. Bu!Rders/Conalscrolls/Electric0ons/P�umbers jpHca nt Information Muse Print Ledblly Name(Business/Organization/Individual): Address: c �� City/State/Zip: a v� 6)631 Phone#: 077 )-Z65_-721L Are you an employer?Check:the appropriate box: Type of project(required): 1.N,,1 am a employer with 4. ❑ I am a general contractor and 1 employees(full and/or part-time).* have hired the sub-contractors E] New construction 2.® 1 am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g• ❑Demolition working for me in any capacity. employees and have workers' 9. E]Building addition [No workers' comp.insurance comp. insurance.l required.] . 5 ® e are a corporation oration and its 10.E]Electrical repairs or additions • 3.❑ I am a homeowner doing all work officers have exercised their 1 I.E]Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12,❑Roof repairs insurance required.] c. 152, §1(4),and we have no employees.[No workers' 13.❑Other comp.insurance required.] =Any applicant that checks boat#1 must also fill out the section below showing their workeis'compensation policy information. ' Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. *Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. lam an emplgyer that is providing workers'compensation insurance for my employees. Below is the policy rand job site information. Insurance Company Name: N4a 3 C Policy#or Self-ins.Lic.#: 4000 d4 0 �0 Expiration Date: t' Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certify under the pains and penalties of peajaary that the inforrnadvn provided above is true and correct. Si Qnattue: Y Phone#: � '" —�7J Of•facial use onit: Do not write in this area,to be completed bk city or town official City or Town: Permit/License# dssuing Authority(circle otne): 0. Board of Health 2. Building M)ep:-,artmavaat 3,Cky/TDwn f'lea-lt 4, Ele0vic-al dta pector 5. Plit nalring lnspector 6.other CERTIFICATE OF LIABILITY I SU NCE 06/2912015DATE 8aNVOD/YVYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, E(TEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pol(Cy(ies)must be endorsed. If SUBROGATION IS WANED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT DoMhyA Codett.CIC,RPLU Fred C.Church,Inc. NAME: 41 Wellman Street Lowell,MA 01851 PHONE 978 3227231 FA)( C o Ext AIC No: (870)454-1865 (800)225-1865 E-MAIL ADDRESS: dcabll@fredcchurch.com INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA: Cilitenslnsurancecompany ofAmerica 31534 New England Window A Door LLC INSURERS: New Hampshire Employers Insurance Company 13003 45 Fondi Road INSURER C: Haverhill,MA 01832-1302 INSURER D: INSURER E: COVERAGE$ INSURER F. CERTIFICATE NUMBER:54457 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED REVISION AMED ABOVEBFOR THE POLICY PERIOD It 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, XCLUSIONS EAND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BYPAID CLAIMS. INSR ADDL SUER LTR TYPEOFINSURANCE POLICYNUMBER POLICY EFF POLICY EXP GENERAL LIABILITY MMIDD MMIDD LIMITS X EACH OCCURRENCEg2,000,000q COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES Ea occurrence A X CG0001 MED EXP(Any one person) ZBN8161407 7/1/2015 7/1/2016 PERSONAL✓�AI INJURY GENERAL AGGREGATE GEN'L AGGREGATE LIMIT APPLIES PER: PRO- X PRODUCTS-COMP/OPAGG $ 2,000,000 POLICY X CT LOC AUTOMOBILE LIABILITY $ COMBINED SINGLE LIMIT ANY AUTO Ea accident ALL OWNED SCHEDULED BODILY INJURY(Per person) S AUTOS AUTOS NON-OWNED BODILY INJURY(Peraccidenl) $ HIREDAUTOS AUTOS PROPERTYDAMAGE Per accldent $ UMBRELLA LIAR $ OCCUR EXCESS LIAR CLAIMS-MADE EACH OCCURRENCE $ $ DED RETENTION$ AGGREGATE WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY YIN IS X STATUOTH- B ANY PROPRIETOR/PARTNER/EXECUTIVE 500,000 OFFICER/MEMBER EXCLUDED? N/A 4000401017/1/2015 E.L.EACH ACCIDENT $ (Mandatory In NH) 7/1/2016 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-EA EMPLOYEE g 500,000 E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACO to 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Client ft Mst# Cert Holder# o arntarr ��ron.rnrne� _. _ _ O 1968.2010 ACORD CORPORATION_ All rin4aac;—.4 2 ',1;� _ ce of Consumer Affairs&business Regulation License or registration valid for individul use only ��111E IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation egistration: 183279 Type: 10 Park Plaza-Suite 5170 Expiration: 9/24/2017 Supplement C rd Boston,MA 02116 NEW ENGLAND WINDOW&DOOR., LLC. PELLA WINDOWS &DOORS William Nichols 45 FOIVDI ROAD HAVERHILL,KA,G'1832 Undersecretary Not validwithout signature OS-089853 v ,.�j7�7�7�g��gc7[.p q q�g� q V W u p'II+L.L'7 M R INIC OLS ..7 PEAItTREE RD HAVTEPJIM L NU, 01830 1012612016