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HomeMy WebLinkAboutBuilding Permit # 11/16/2016 S tsory . BUILDING PERMIT f'/ Q �LED !6 TOWN OF NORTH ANDOVER $ y APPLICATION FOR.PLAN EXAMINATION ', Permit Nod: Date Received 1 1(® Ol • SSACIius� Date Issued: I I - i i ENRORTANT:Applicant must compIcte all iteins on this"page LOCATION -- __ Pnnt PROPIvRTY OWNER ' - Pnnt' 1 aQ Year Structr�i� yes no MAP ._ __ _ PARCEL. Z N]NO' DISTRI6T Histaib Distriat yes rio Mil:Chirie_Sliop;Vi age yes n.o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑Addition U Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ,"Repair, replacement OAssessoryBldg . ❑ Others: ❑�jemo[ition ❑ Other C] Sepik ❑ Weli m ❑ Floodplain lij Wet[arids l7 Ulla.,rshec! District DESCRIPTION OF WORK TO BE PERFORMED: 2)6_1 OlVi-i S Identification- Please Type or Prim Clearly OWNER: Name: Phone 7-6 3 - - Address: -..Zs-. �.. ... Contractor Name- � � _.r�'.• Phc�irie_. . - Address: 5tpervisor's Construction: License ._ E?(p"" Date: _ r Norm Improvement License:. Exp; Date _ - ARCHITECTIENG[NEER Phone: Address: Reg, No. FEE SCHEDULE.BULDING PERMIT'$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$12500 PER S.F. ,I otal Projeot Cost: $_ 0 -� FEE: $ Check No.: I Receipt No_: �� � � NOTE: Persons contracting with unregistered contractors do not have:access to the guaar aH y fund 5igaafiure bf_A�enlC�:wer ,(- Simi a� contractor �.,__ %QRTH '4 own of . 'N' a ndover O + No. 41 , h ver, Mass, it fa1 dl coc,uc„ewrcw 1' ATED C7 S U BOARD OF HEALTH Food/Kitchen PERMIT / T Septic System THIS CERTIFIES THAT . 1LA...W*VbkQw .. ............�.44 M.10 BUILDING INSPECTOR has permission to erect .......................... buildings on .-..... .........4 V.M.@. .........................• Foundation Rough tobe occupied as ..........7......... ..................................................... Chimney provided that the person accepting this 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 VIOLATION of the Zoning or Building Regulations Voids this Permit, Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIONARTS Rough ................. . ... .... Fi/4Service al Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required- to Occupy Buxld,inRough Display in a Conspicuous Place on the Premises — Do Not Remove Final YY No Lathing or Dry all To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Contract - Detailed Pella Window and Door Showroom of Haverhiu ® 45 Fondi Rd sales Rep Name: Duff, Ste he Haverhill,MA 01832 Bales Re phone. n Phare: (97S)373-2500 Fax.. (97,S)373-7274 fi li p : 978-373-2500 Sales Rep Fax: sales Rep E-Mail: DutfS ftellaboston.c om -Custortrei Tiforiiiafic#i - <�. _,: �r:.:;.:.;•::�- eLDelfli-. Bill Callahan .. •.- ,. "Order - - _2 L Callahan,3114NorthAndover trtforin io f;3 yman fid 23 Lyman Rd Quote Nance: WINDOWS PROJECTN©RTH ANDOVf MA 018455~3709Lot# Number: 741 Sf1M Primary Phone:(617)8332308 Quote Number: gmvea 1Nobiie Phone: NO*Andover,MA 01845-3?fl9 Order Type.-YAe.- Installed Safes Fax Number. E-Mad: bMl9 Payment Teens: C.O.D. 2@gmaif eorrr Tax Code: MA TRX 625 Great Plains : 11186299 Quoted Date: 101MO16 CusWler Number. w81F74go Cusldmer Account: 1004039673 L Local ".r 10 NaleAssigned `,:,:`` Attriti€ites ,:•::.- Delive {Seth D n+ �- eliveryl5etup i Lead fest-Lead Test QtY 1 For more lnfarmation regarding the finishing,rreainterrance,service and warran€y of a8 Pe0a0 products,visit t11e PelfaC�website at wuvw.peifa.crnn l'rirAed on 1611712016 . Contract-Detaled Pme 1 of 8 Customer Big CWWhi3a Calltlan.BilfNOrthAndoverMAISO1779 I Number 741 SDO496 te Number 8M760 dauqF�M MOM Vinyl windows f boom By pe 'Alit 'Double Hung,30.5 X 52.25,Wfthibte PK# %zeMm4WWWO_-jae Dub), Qty 819 30 M X 5,2 114 Hung,equal 2 Ederlor COtW I Finish: White "riertOrCOlOr/Finkh; White 'Me""Mugr-MW'P'3114`.3 914",'W Adapter Included,Heid Expander Included C'"rel lnlo�on- StniW`V"y1'ac-k Fr' Mass: Insulated Low-rz AdnncadLOW-ElrWatingaass From or P"Owaf*Options: Wl*e,Standard Vent ftpNo Argon Non HighAftitude reen: Half ScMn Liffited Openinattar: Lt Factor 0.3ti, gwmffOnnafte Infam 8HGC 0.26 VLTO,47,CPDPEL-N-j0"0jj Year %ocnal pWH 8-0000Z PeftC 0W nnance Class p, Frame S'Zs-30,5-X,522V Jntedor Trim,Pella Recommended Clearance,perimeterLengM JW. PG K Cskldlfed Positive DID Material Pocket WAVrap.UPgrade,Pocket WjWrap Pocket Installation-Pocket h7stallation My I Lead Safe install-Lead Safe lnstan city I e# :7 PI Insulate Pockets Insulate Wejqjt PlIets 20 VI "nyl Windows I Doos 77-7 BY Peffa,Double fjUng,30.5 X SU5, Whb . .. .. 1:Non-standard PK $me.. StMNQn-St2M1ard$jw equal 30 1/2 X 521114 General InftrMation: 2 F3*d*rCQkr/Fjnj3h- Wflte frIA,Sleek Frame With Mua Groom.3 114n tnt&dor Color/FbTjsh.- VMlb 3 1141,811 Adapter incudal Head aprdL, i f— W's Glass' InsuIated Lowv..E Included Welded "ardw2re.Optio., Advanced LOw-E'"Aa#,,g Glass Argon Non ft Altkude adedor Screen: Half SQr1en White.Standard Vent Stop.No UMRed OPOnIn Performance Inramatioh: "actor OV,SHGO 0.25 VL 0.47, .9 Hwd� Ra'�V 35-C40Ldeted Negafive DP R�� I T CPD PEL_N_j08.00jj6_WW2.par,� Grille: GBG,No Custom 35 Year Rated 08 Wrapping Inkrotaffon, Contour,Traditional C11M R PG W,Ctlulld PosMve OWMIDWOF9 Frage Saxe:30.5. Tnm'N*interiorTrkl,Pella R,111nded Clearance,perimeter Length PUMula*Pockets-Insulate Weight pockets Lead Safe install.,LP-ad Safe irkstaj, Pocket frtvtalfatjon.pocket kstaliatIon Qty I Mat"14-Pocket Qty I W/Wrap-Lhxyude Pocket WlWrqp Oty I prhWon I(MVI 16 regarding lite finishing,Maintenanoe,service and warranty of all pellao City I COnkW-DeWed Products,visit the pellaD Website at WWW-Pella.corn page 2 of Customer.But Callahan pName; Galtaba►t,Bill,N�q�yer�At80 nD 1779 Alm roarrthtlnirtg ;w:: - OrderNear 741St?0496 Quaff N Vllyj Windows l Doors ByNFe#�a`p `Ater, . i.���� r oubi�Hung,$�,ar� SIR Geer Sbe si on Standard ral Inforrnatlrd on S a Size ilocffe Flung.84uai e4erforCotorlFlntsh: •gtcck Frame InreriarCotorlF►ntsh; y��, �Mulf�aov-,8 1I4; . V161ved Ftflnt r SS: It1s[Itated wsk- ftB 3 7I4:SOI Adapter Ind ire moons; �d 1 orov�1 udK Head under Irtcltided P@oreen: Malf$ween .StIn Vent OWassArAM gon Non H °►rrranca lntformattarr: noted Opel I:l 1wa ude Gryf%une 9a6vei pp°Ra5n8 35 Y GC 0 25 LTO,47,CPD AEL.N g08-t1b l7 Wr VP6,q Mformat<�o�No�COntauy Trad�naf PAV 2HIOW0 Pe Ce Cf R.PGA Frame 30.5"X S6° �No frrterior 7itrn,Pella Reca,;ermed Cf-arance,PW.efer Calc Lated Posdive nF Size; ��=173'. Pocket,�Insular-Weight PCFckets Lead Safe I nsrall-dead Safe Inst Packer Instaltaflan.Pocket InstaBarion OtY i tdat-tial Pocket W/W Ofy i �`�l�gtade PackerWltlY P�LLA WAi�{�'AryTY: rap Qty 1 a Thank You Fpr P�rchasin9 Pe�taC Pr i Pella _ Please see the a'arranfies for Pella's limited warrantes` Q�l#Ct5 within the wall system.Neither�telta deter, efitect at the time of sale. efPella CoFparatia p�ial note of the n imP�t All aPP cable Product warranties are CaTPoration will not be liable for brb wpb whteh cnoureate he 8c DaaFs wr�l beftuct Ce motions regardin naC°�°m into and by au ffi installation L of Pella Fart of this con teat-abiigaizons in and Ration become a motion to or obligation,Yowan_ ,, ess specifcal�ucus and proms m� ement of moisture, to op Y Pel groduc sect l ess into cnnsidcra wlfich are iuconsistenr With Y aet out in tLis contract two rhe additaou Of Ro tli Pella writteq However,Pella Per the rnanufacqments. lin[or any other wan, Yariations in rorer'3Ifinited accessory,to the o wood gtn�color,tw D ,al ch Unfinisbed ahoINSYNgany �.�do+ys Product.You should consult Your CTS PRQD not�v and doo,must be finis �I building code PrivacyPolicy CICIS:In adds flan,A-Ila In Sofiwafacs are ered under the li Mited 0n receipt Prior #o ins itlg and re in aPrivac time��sale,which can be f� am c00vc'ed by the Pella I fished a �, Agreement a Product Perk cY are part of the tei7ns of sale etive. Ilay om the. By r ?Products Some Liceme U F t ce Infotmadon: g Your Iu Agree,M and Pe actor,Solar H fictive Produce you are Pella ilasynct;ye Products Ow these �'t114 Coefficient attd a spew sO°�arm to applicable SNFR >and Visible Light a cnowled�g the fnsynctive Product size NERC docs not r uses a fight �� le p ad��rem fed by flee�r tonal Fenestration Prk9ed an iNiTFor more inform on latft regarding tFar finis products and does not war"am the°sWtabi —P'C lity of ratmgs Ire eewor any ed f Saco ciseMRenv'��nfacturer stipta 9,rnairrterranee,service and specific use. lrO ental conditions contract-©etwed �of aN l'elE a Products,Vkh the w ebsile 2t Wwyy Peila.con, __ Pace a Customer:Bin Callahan Nect Name. Callahan,Bill,North Andover,MA1801779 Order Number: 7418DOM Quote Number:8333760 Design Pressure(DP),Performance Class,and Performance Grade(PG)are certified by a third party organization,in mny cases the Window and Door Manufacturers Association (WDMA).The cert iication requires the performance of at least one product:of the product line to be tested in accordance with the applicableperfnrmance standards and verified by an independent party.The certification indicates that the product(s)of the product lute 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 pedbrmance in€onnation along with information on Florida Product Approval System(1?PAS)Number and Texas Dept of fnsnrance(TDI)number go to www.pella.com wonnance. Pr ect Checklist Review (Installed Orders Only) Befcirethe 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,bustles and shnibs in the work area Arrange to have alarm system and doorbells disconnected Arrange to have any plurnbing 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 During the Instaliatlon the Homeowner attrees to dn„the following: Keep pets safely away from worts area Keep children safely away from work area Atiow Pella Installer room to work safely within your home During the Installation Pefla 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 and 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 printed pine woad trim or Composite.Composite will be unfinished. If Purchased,install interior trite 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 its quality or performance After the Installation the Homeowner agrees to do the following: For more information regarding the finishing,mainte-mrnce,service and warranty of all Pelta®products,visit the Pelma website atwww.pellswom Printed on 10117/2016 Contract-Wiled Page 4 of 8 Customer.Bill Callahan Project Name: CallahmBill,North Andow MR18(11779 Order Number: 741500496 Quote Number.8333760 'Be available for completion and sign off to verify ag products purchased are in working order 'Reinstall eA%dng shutters and awnings Reinstall existing shades,drapes,window treatments,wag hangings,and reposition furniture Arrange to have alarm system and doorbells reinstalled Reinstall air conditioners Remove stickers from product and save for enemy rebate and tax purposes Wash all interior&exterior glass surfaces FII nail moles and jo€nts on interior trim if windows are to be stained(atter staining) Clean up exterior casing issues due to storm window removal tf fug wrap or new exterior trim is not purchased ZAtPkaject Checklist has been reviewed �stc�r initial �✓�' Product Only Addendum has been reviewed Credit Card Account#: Last 4 Dzgi-ts � 3098 Expiration Date: 0812020 i Charge final payment to same account (U. n substantial completion) CLIAOMWin LW For more infonragon regarding the finGstairig,maintenance,service and warranty of alt Pellab products.viisit the Petla47 website atwww.pella.corn Printed on 10117/2016 Contract-Detailed Page 5 dl 8 Gomer:Rill Callahan Project Narne; Callaahhan,BIII,Norih Andomr.MA1801779 Order Number: 7418DD06 Quote Nunter;8333760 []Project Checklist has been reviewed Bill Callahan Steve Duff Customer Name tp MOO Pelta Sales Rep Name &Flem d Taxable Subtotal N $2,455.f X WLR ales Tax @ 6.26% $153.45 customer Snature PeNa Sales Rep siqnatU4 Non-taxable Subtotal $2,728.00 011X1 __ _ Total DOW Date ti[/� �'1'LAmount Received $2,668.31 Dote $2,668.3 cicdit Card Approval SWatUM �tl For more information regarding the finishing.maintenance,service and warranty of all Pelta®products,visit the Pella®website at www.peHa.com Primed on 10/17IM16 Contact-Detailed Page 6 of 8 i PELL.A WINDOWS AND DOORS CONTRACT - x PAYt1'I1LIITS 9,. ,,1BMA1yncoma= PellashallbccWtledtoatoptheWork upon wittonmotimtoOwntrforagy material default ar fitilmm"wner,hebriingbutnothnitcd to,the Owner's These Tam aad Conditions are an Integratpart ofthe contract set tbrth on the failure to pey Pella the amount duo within seven days afterthedale paymeat]s Product Order(the"Contraof)between Now BnWand Window and Door LLC duo, dba Pella Windows&Doors,Inc.("Pella')and theperson(s)identified on din Product Order Mwnee)tosuppiyibeproducts(tha"Pmducls!),cod polome COkt CTiOPI4FWORK the work(iha"Work")described orret�tt;dtoiasuch Contract. ForProduct S' Only purchases,a ssgood`TroductOnly Addendum"Is amquiredpart ofthe Pella shall correct Installation Work riot Ineontbrmanoewith the roquiremeats ; 001ktreot oftheContraer,Ifnodffedinwriftbythe Ownerwithin two yew 4ftertbo 1 Completion Date or,if earifer,the date on which the Work is substaWlal(y 3. camplatedand paymeatorthePurchasoNice made iubjtdtoaholdbachas. ' Povided aboeC(aectionnfWorkasharolapmvfdedthaltbeOwners sole Pella Is notpaasiblefr any 8securty systems.Owner shall remove remedy for defective wmtostanaMp,and is provided in Ileu of any and all other all shades,vatifoafs,blinds,curtains,dmpos or window mounted air remedies,Polles obligatlon to correct Work is conditioned oa Palla'aprior ` eondltlotters,prior to the Installation of the Products.Feltz's installers ate not receipt ofall payma u then due, i responsiblefort6creurovatorfaeta!]aEEonofthesa pas ofheam Pollafsoot mponsiblo lbrpro-ardating window coverings flulngonnewLy Installed Polls 9. LMUMD PRODUCr WAItltAirFTY windows. Polls shall lle The Owner shall provide complete suets to the work'sita between the hours Windows&Dors T.imitcd W rrentyducA.�t,1,IV,Ciaccordance 7'f3uUr WARRAARV SHALL of 7:00 a.m.and 6:00 pan.(Mondoy tbrou&&alloy)farPolla's Installers to BE THE SOLE WARRANTY WI71HF- BCT TO THE PRODUM AND deliver The Products and perflsmt the Mork. VULLA SPECIFICALLYDISCLAID/IS ALL OTI1);R WARRANM, SXPRUM OR livil'UED, WRY]"I 3N OR ORAL(INCLUDING WTTHOUC 1 3. PU LA LIMITATION ANY WAft12AlM OF MRCHAANTABII,ITY OR FITNESS Pella Will beresponsiblefor and have coatralover constructloni am, FORAPARTIC(XARPMOSR). ; medmds,teehniquos,soquenees and procedures and for coordinating all portions of this W4rk1 Pellet writ be responsible for the Work of its Pella 10. NO CONSEQUENT"DAMAGES g Contractors who will Install the l'mducfs. UNDERNO CIRCUMSTANCES SHALL PELLA.BB.L1ABLEFOR ' Unless provided otherwise in this Work description,Pella will provide and pay CO111SEQUEN77AL,INCIDENTAL,INDIRECT,01i 1112CM DAMAGES, fur all labor,matadafs,agolpment,tools andmarhlacty,ttsusportation,and W11:11M 1PORl SEM O1tMORt3 EN. other hallities and satAmnacessary for thaprWer execution and completion oftheWont: III HOME 1.&PROVIh4MCONTRACTORS Thematerla[s and equipment fitmishad under the Contract willhe god qualityAll bnma impmvamast aontraetoziand subcontractors$ball be reestated with the dima w of"Hama Improvement Contractor Roglettatian Program and now unless offienviaarequlred orporntIM4 the Work will balers Jim admWa daf0otynot(niterentfntltoquality recpilredarpermitted,andtheWork tr�dbythaHosrdofBuildiagRepW!ouasandStandunb.Pelinand conform with the requIntuantsofthls Contact.Peilashall not be rrsponsiblo any*?Its rm aboutsnbcortivPella identified is fids contractors nava bean registered. for damages or deftets caused by abuse,modifications not executed byPella, Any inquires about Pella cr any of its subcontractors trolstingto mgistra@nn i iropmperarinsufrlcfeatmalntetiartce,improperaperatinnnrnnrmslwaerand should be directed to.Director,Honic Improvement Contraelor ltcglstmtlon, ; tear Pella r innill keep the premien and Imprsmeoper op arae doss Aron 10'Parkl']ara,Room i 170,Boston,MA 02116,617-973.8787.888.2$3-3757 accumulation ofwasto materials orrubbish caused byporformanae of this or visit the Id1C weiulta at htgt l/www.tuassgavlocabr/ Wok 12. PERMITS(MA customers only) P la $gyh todtoand t lldtatntitotolhrwingpennitsfor this project 4. C1fANGE9 isia�laE Homeowaciawhow=mtheir ownpemilswill be lheOma may aderinwrltlatchangesIn.the Work canalstingofadditions, mrclnded&amtbegusraniyfemdpra4lontsofMasaechusetisGeneral Laws. deletions,armodifit tlona("Chaoge ardoe).Any Change Order shall olag W 142A. luck*an stvatnent to than price and 11110 Std AW041 pouipletlan Date,E9 detumined by Pdla Pella reserves the right to approve or disapprove am Its additioa to the rights and warrandas ontmaerated in this ag mmL you.may ChangeOrder and any such ChanpOrder mnetbeatguedbyboth Owner and have additional rightaunderMessaahuaetlsGeneralLaws,ehaptarNZAand Pallatoboet'fkativa. 780 Coda IMassachusetttRegitlaltonsR6. 51 T9FIBf3TANTIrLL COIVII'I.E7ZeylY I& NOTICE OF CANCELLATION i Owncr understands and agrees 0%utthe Subatpnrlal ComplerlonDate is an You may cancel this agreement if it has been signed by a party � ortitnate only and that the actual data on which the Work is completed may be #1 Veto at a plata other thein an address of this seller,which extcaded to allow ft change Ord=requested by Owner or ifth0 timo to may be his main of coo or branloh thereof,provided you notify complete the Work Is afecte d by conduct of the Owner,weather,labor the seller in writing at fele xtittiri office a?T branch by ordinary I disputes,availability of suboontraotors,acts of",fire or other rouses J reasonaoly beyond Pe]Ia'a oonttnl.)f fbr stew reason the Work is not fully mail posted,by telegraw sent or by delivery,not later than completodby aha SubelanUal Campletlon Stale(fnaludittgaay exteusioua midnight of the;third business day following the signing of this contemplated above:),but 1a au%wdalty completed by such data,I a.,the Product has been It ttellad,but m1norperts or components are missing or need a�Gaetlf' { to be replaoW or repaired,a hold back proportlonata to the cost of remaining Ut;the allehed Notice of Cancellation for an explatiat ion of '. parts or work to be aomplotod fir acceptable.However,the h0ldba0lc will not tlri8 rlgllt. oxoeetl the amount oftha ootnphdon oasts or 10%of the remaining unpaid i balanus of ftPriee,whlahever is less. 6. 1tEtiANC[NG Do not sign this contract If there are s blank spaces. ] Ifpayment afthe Frioo is financed with a fiaanolal institution through Pada,all :Gmanaing paperwork must be completer)upon signing of This Contract and the ,( requisite approvals and authorizations fortttufltflamountoftirex requested financing shall have beers received from the financial Insiltutlon. Cuetatuer atter° 1.0/17/16 Data ,1 DISPUTES THE CONTRACTOR AND THE HOMEOWNER HERESY 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 REQUIRE]TO SUBMIT TO SUCH ARBITRATION AS P OVIDED IN M.G.L.c. 142A Contractor X Homeowner NOTICE:THEI , O A =WABOVE APPLY ONLY TO THE AGREE ME DISPUTE SETTLEMENT INITIATED BY THE CONTRACTOR.. THE OWNER MAY INXTSA.TE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THIS SECTION IS NOT SEPARATELY SIGNED BY THE PARTIES. i I i i NOTICE OF CANCELLATION Date of transaction: 10/17/16 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 therm 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_ oors, at 4SFondh Itd., Iaverhill.MA 41832 not later than midnight of 1 0'20/ 6(three business days from the date of transaction above). I hereby cancel this transaction. (Date) (Buyer's signature) ne Cowtiwnwealth of Massachusetts Depari-mant of bidusiria(Accidears I Congress Street,Suite 100 ,goston . 02114.20. 7 Ur wwll:xtlas..gov1dhz Workers'Compensation Insurance Affidavit:)3uilders/Confraetorg/lller-triczansll'lumbers. TO BE AILED WrM TRE RSG AT3THO ITS'. Name licautlaformatlon Please Print Lep-ib Name(B siuesSIoTanizafionffitddividllal): Mb Q�J boon— Address: pity/S /Zzp= a I I M& 4r `� Phoue#: �p��i��� Axeyou an employer?Check the appropriate box: Type of project{required}: l an a empluyer v& ?r empIoyecs(imand/or part time).* I. ❑New constz-uciion 2.❑I am a sole proprietor or parfnmsbip and have no employees working icor me in may capacity.[No wozkers'comp.insurance required.] 8. remodeling 9• ❑Demolition 3.E]I am a homeowrmr doing all warkmyself[No workers'comp.ksura rp mquira]t 4. E am a homewruer and wr11 be canfraclDrs to conduct all w------------rk oa•.. 10❑Building addition �� myprope�Y..Zwrll .-.. _ _._- . ..._.._. . . . .,_. ease that all coruhactars either have wad='compensation insurmce or are sole_ 11.❑Bleclrical repairs or additions propri 5. ..I am a erei contractor and Ihave hirers the , . ._.. ...rs li tad__.---.. _...._....._,_ .. . . e rs •av em ees:..•. .._. I2:O plumbing repairs or additions [� gzru a sttb-caatractnrs listed on the attached sheet. 13Roof repairs Th=sub-co�aetm have employees and have wod='comp.fimummt .❑ 6. We are a co oration and its officer;have exercised their ri t of exe 14.❑Outer ❑ rp gkr mpiaaaperl4lGL c. 157.§1(4),and wehave no employees.[Aro vrurkars'comp,irmaaircerequued.] 4'Any applicautihat chec&s box#1 must also IM out the swtinabelaw showing their workers'compensation pz)icy iaf mnafiaa. t Homeowners who submit ibis affidavit indicating that'are doing all workand then Hire outside contractors must submit anewaMdavitk4catMgsm1 �Canhac[nrs that ncccktlu boxmust attached an additional sheet showing the zamze ofthe sob-contractors aud state whether or not these entities have employees. Ifthe sub-coat=tors have employees,they must provide their workers'comp.policy number. X am aro efrrployer that is proving workers'compensation insurance for W employees. Below>s&LPoUcy and job site informadom Insurance Compauy Narue: ,� Policy#or Self-ins.Lic_#: Expiration Date: ]bb Site Address: City/swzip: .Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required underMGL c.152,§25A is a criminal violation punishable by a fine up to$1,500.00 andlor one-year imprisonment,as well as civil penalties in the form of a STOP WORD ORDER and a fine of up to$250.00 a clay against the violator.A copy ofthis stafemont may be forwarded to the Office of Investigations of the DIA for instuzanee coverage verification. X do hereby certify fender the pains andpenaldes of pasFmry that the infornratiom provided above is true and correct . ature: - Date: 1 G Phone#: f Official use only. Do not write in this iweo,to be completed by city or town offuzal City or Town; PermitiLicense 9 l(ssuing Authority(circle one):. 1.Board of Health 2.Building Department 3.City/Tow n Clerk 4.'electrical[Inspector 5.Plumbing Inspector 6.Other r ® DATE lMWDDNYYY) A�© CERTIFICATE OF LIABILITY INSURANCE 07/0712018 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(les)frust be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER _ciJNTACT Dorothy A.Corlett.CIC,RPLU Fred C.Church,Inc. NAME: _ 41 Wellman Street PHONE Extl: 078 3227231 FAX No : (97S)454-1865 IAILowell,MA 01851 -MAIL deWeltAfredoGlurch.com (800)223-1865 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC 9 INSURER A: Chiiens Insurance Company of America 31534 INSURED _ INSURER B: New Hampshire Employers Insurance Company 13083 New England Window 8 Door LLC INSUAERC: 45 Fondi Roatl Haverhill,MA 01 8 3 2-1 302 INSURERD: INSURER E: €NSURERF COVERAGES CERTIFICATE NUMBER:56475 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 AFFOROED 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. INSR TYPE OF INSURANCE iNsR AODL Un POLICY NUMBER MM/DOYNYYY MMID YYY1 LIMITS LTR CE14ERAL LIABILITY EACH OCCURRENCE S 1,000,000 DAMAGE TO RENT O 100,040 X COMMERCIAL GENERAL LIABILITY PREMISES Fa occurrence S CLAIMS-MADE 71 OCCUR MEDEXP Any ane person) $ '0.000 A X CG0001 ZENS161401 711R016 71112017 PERSONAL S ALN INJURY $ 1000,000 GENERAL AGGREGATE $ 2,000.000 G@NL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMWOP AGG $ 2,000,000 POLICY X JECT PRO- X LOC $ AUTOMOBILE LIABILITY COMBINED SING$LIMIT Ea accfdeni ANY AUTO BODILY INJURY(Porperson) $ ALL OWNEDSCHEDULED BODILY INJURY(Peraccidenl) $ AUTOS N OWNED PROPERTYDAMAGE $ HIREDAUTOS AUTOS of 8[ddenl $ UMBRELrIA LIM, OCCUR EACH OCCURRENCE $ EXCESS L'AB CLAkMS•MADE AGGREGATE $ DEC I RETENTION$ $ WORKERS COMPENSATION X IMC STATU- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOWPARTNERIEXECUTiVE rR YIN 8807024 7MI2016 7!1!2017 E-L,EACH ACCIDENT $ 500,W0 B OFEICERIMEMBER EXCLUDED? NIA 500,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS f LOCATIONS IVEHICLES(AOach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION Town of North Andover 1600 Osgood Street,SAA 2043 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Nrth Andovar.MA 01845 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE / Client# Mst a 68475 Cert Holder# ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD tl q i I 3 Massachusetts Department of'Pubiic Safety _. Board of Building Regulations and Standards License: CS-089853 eF Construction Supervisor WILLIAM R NICHOLS 57 PEARTREE RD HAVERHILL MA 0183p. e CA— Expiration: c6rnmissioner 10/26/2018 iice of Consumer Affairs&business Regulation' License or registration valid for individul use only {V1E IMPROVEMENT CONTRACTOR before the expiration date. If found return to:.. Office of Consumer Affairs and Business Regulation egistratiort 183279" Type- 10Park Plaza-Suite•51'10 Expiration 9724120'17Supplement C'- rd Boston,MA 02116 NEW ENGLAND.,-WINDOW&DOOR, LLC. PELLA WINDOWS&DOORS William NichoJs 45 FONDI €OAI7 HAVERHII L,1LAA Q1 832 . Undersecretary Not validwithout signature