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Building Permit # 3/1/2017
BUILDING PERMIT 0 V0 R1TFJ � TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION - peIrCIi �(7 Date Received �aareo rvN q. C HU'S� Date Issued. 47 t PCDWI 'I'. Applicant must complete all items ate this page Print PROPERTY OWNER �� Print, f C1a,Year Structire yes " no MAF' ' . . PAFGEL� ZEE NINA D1ST11 aT:, Historic District yes no Machine Shap Village yes, n°. TYPE OF IMPROVEMENT PROPOSED USE Residential Non-- Residential ❑ New Building One family ❑Addition ❑Two or more family ❑ Industrial 11 Alteration No. of units: ❑ Commercial ,,QJ, ppair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other b Septic P Well ❑ FP6odplain ❑Wetlands CJ WatershedDistrict Watgr/s6wer DESCRIPTION OF WORK TO BE PERFORMED: V & a,2 :,J Identification- PleaseType or Print Clearly' OVVNER: Name i ° ,: r, . . Phone L L Address:- �.�t for a.,.,cz e Contractor Dame: i ,w�„ , Address: Supervisor's nstructiar Lic rise:_.. . _._,.... . Exp. date °wY Norrie Improvement License: �' W Exp. Date ` 2,,q_-J ,-7_ LL ARCHITECT/ENGINEER Phone: Address- _ Reg. No. - FEE SCHEDULE:9ULD1NG P,_ERM/r:$12.00 PER$'1000.0 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. otal Project Cost: $ r � m FEE. Check No.: Receipt No.: I NOTE: Persons contracting with unregistered contractors clo not have-access to the gucartinty fund e...... r Signature r� cloi raclor. _g __ _ ®R f ij "Tn o fnduver ,..5 0 5bl- h ver, Massgot M7 • t o[ [.wE w7C� �p0 �a`V ATE D S U BOARD OF HEALTH Food/Kitchen R I T T LD Septic System FIES THAT ...... �.�"®� .�............................................................. BUILDING INSPECTOR .. . Foundation ,ion to erect .......................... buildings on ....... .........14 a(..�.��.a. ..... �. 1. Rough ledas ...... ... ........... ........... ... . . 04. .............................................. Chimney it the person accepting this permit shall in every respect conform to the terms of the application Final s office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and n of Buildings in the Town of North Andover. PLUMBING INSPECTOR of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRESIN 6 MONTHS ELECTRICAL INSPECTOR .. UNLESS1 T Rough ""... Service ....,. .. . ... . . . .. ... ................. Final BUILDING INSPECTOR GAS INSPECTOR ccu ancy Permit Required to Occupy Budding Rough flay in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the wilding Inspector. Burner Street No. Smoke Det. Contract - Detailed 441- Pella Window and Door Showroom of Haverhill Sales Rep Name: Clancy, Ryan 45 Fondi Rd Sales Rep Phone: 978-373-2500 Haverhill, MA 01832 Sales Rep Fax: Sales Rep E-Mail: clancyrp@pellaboston.com Customer Information Project/Delivery Address Order Information James Hashem Hashem,James,NorthAndover,MA,1844144 Quote Name: 2 Doors,1 Window 4 Holbrook Rd 4 Holbrook Rd Order Number: 741 RC0410 NORTH ANDOVER,MA 01845-3706 Lot# Quote Number: 8694592 Primary Phone:{978}3143051 NORTH ANDOVER,MA 01845-3706 Order Type: Installed Sales Mobile Phone: County: ESSEX Payment Terms: Deposit/C.O.D. Fax Number: Tax Code: MA TAX 6.25 E-Mail: jdhashem@gmail.com Quoted Date: 2/20/2017 Great Plains#: 9535605 Customer Number. 1007279706 Customer Account: 1002991683 Attributes Line# Location: 10 None Assigned Item Price Qty Ext'd Price s Delivery/Setup-Delivery/Setup $190.74 1 $190.74 For more information regarding the finishing, maintenance,service and warranty of all Pella@ products,visit the Pella@ website at www.pelia.com Printed on 2121(2017 Contract-Detailed Page 1 of 8 Customer:James Hashem Project Name: Hash em,James,NorthAndover,MA,1844144 Order Number: 741RC0410 Quote Number: 8694592 ..'Location." Attributes 15 Garage window Vinyl Windows!Doors By Pella, Double Hung,31.5 X 54.5,White Item Price Qty Exed Price $609.87 1 $609.87 c 1:Non-Standard SizeNon-Standard Size Double Hung,Equal PK# Frame Size: 31 112 X 54 112 General information: Standard,Vinyl,Block Frame With Muli Groove,3 114",3 114",Sill Adapter Included,Head Expander Included ' 1979 Exterior Color/Finish: White Interior Color/Finish: White Glass: Insulated Low-E Advanced Low E Insulating Glass Argon Non High Altitude — ^t_• — Hardware Options: White,Standard Vent Stop,No Limited Opening Hardware Viewed From Exterior Screen: Full Screen Performance Information: U-Factor 0.30,SHGC 0.28,VLT 0.53,CPD PEL-N-1 08-00116-0000 1,Performance Class LC,PG 35,Calculated Positive DP Rating 35,Calculated Negative DP Rating 35,Year Rated 0811 Grille: No Grille, Wrapping Information: No Exterior Trim,No Interior Trim,Pella Recommended Clearance,Perimeter length=172". Overall Rough Opening Dimensions: 32 X 55 Frame Size:31.5`X 54.5" Material—Pocket WlWrap-Upgrade Pocket WlWrap Qty 1 Pocket Installation-Pocket Installation Qty 1 Lead Safe Install-Lead Safe Install Qty 1 Line#: Location: Attributes;' 20 Interior Garage Encompass By Pella, Entry Door lnsWng,33,5 X 81.5,4 9116" Item Price Qty Exrd Price $1,952.53 1 $1,952.53 l 1:3280 Entry Door PK# Frame Size: 33 112 X 81 112 1979 Unit Type: Right Inswing,Standard Sill,No Fire Rating Panel Style: 112 Light 5 Glass: Tempered Low-E Air-Filled Grilles: No Grille Panel Selection: Smooth,Painted,White,Painted,White Viewed From Exterior Frame Selection: Wood,Pine,Composite Threshold,Primed,Wood,Primed Hardware Options: Latch Bore,2 318",Standard Steel,Brasstone Zinc dichromate,Bronze Anodized Performance Information: U-Factor 0.23,SHGC 0.11,VLT 0.17,CPD PEL-M-174-01811-00001 Wrapping Information: Without Brickniould,No Exterior Trim,No Interior Trim,4 9116",4 9116",Factory Applied,Pella Recommended Clearance, Perimeter Length=230". Overall Rough Opening Dimensions: 34 114 X 82 Frame Size:33.5"X 81.5' Lead Safe Install-Lead Safe Install Qty 1 ES—Single-Install Single Entry Door Qty 1 Entry Trim Finish-Finish PainNStain Entry Interior Trim Only Qty 1 Misc.Labor-Miscellaneous Labor. Qty 1 For more information regarding the finishing,maintenance,service and warranty of all Pella®products,visit the Pelta®website at www.pella.com Printed on 2/2912017 Contract-Detailed Page 2 of 8 ... ....................... Customer: James Hashem Project Name: Hashem,James,NorthAndover,MA,1844144 Order Number: 741RC0410 Quote Number: 8694592 Line# Location: Attributes 26 Exterior Garage Moor Encompass By Pella, Entry Door Inswing, 37.5 X 81,5,4 9116" Item Price Qty Exfd Price $1,807.84 1 $1,807.$4 z M 1:3680 Entry Door �—, PK# Frame Size: 37 112 X 81 1/2 [z Unit Type: Right Inswing,Standard Sill,No Fire Rating m a f 1979 Panel Style: Turin Colonial Light In ' Glass: Tempered Low Air Filled 21"Mil Grilles: No Grille s.:. - Panel Selection. Smooth,Painted,Real Red,Painted,Real Red Viewed From Exterior Frame Selection: Wood,Pine,Composite Threshold,Primed,Wood,Primed Hardware Options: Latch Bore with Deadbolt,2 318",Standard Steel,Brasstone Zinc Dichromate,Bronze Anodized Performance Information: U-Factor 0.19,SHGC 0.05,VLT 0.08,CPD PEL-M-174-01757-00001,Calculated Positive DP Rating 40,Calculated Negative DP Rating 40 Wrapping Information: W€thout Brickmould,No Exterior Trim,No Interior Trim,4 9116",4 9116",Factory Applied,Pella Recommended Clearance, Perimeter Length=238". Overall Rough Opening Dimensions. 38 114 X 82 Frame Size.37.5"X 815' PVC Upgrade>48-PVC Upgrade greater than 48 inches Qty 1 Lead Safe Install-Lead Safe Install Qty 1 ES—Single-Install Single Entry Door 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 inaddition to or obligations which are inconsistent with Pella written warranties. Clear opening(egress)information does not take into consideration the addition of a Ro[screen[or any other accessory]to the product.You should consult your local building code to ensure your Pella products meet local egress requirements. 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. ARBITRATION AND CLASS ACTION WAIVER("ARBITRATION AGREEMENT") YOU and Pella and its subsidiaries and the Pella Branded Distributor AGREE TO ARBITRATE DISPUTES ARISING OUT OF OR RELATING TO YOUR PELLA PRODUCTS(INCLUDES PELLA GOODS AND PELLA SERVICES)AND WAIVE THE RIGHT TO HAVE A COURT OR JURY DECIDE DISPUTES.YOU For more information regarding the finishing, maintenance,service and warranty of all Pella®products,visit the Pella®website at www.pelia.com Printed on 2/2112017 Contract-Detailed Page 3 of 8 Customer:James Hashem Project Name: Hashem,James,NorthAndover,MA,1844144 Order Number. 741RC0410 Quote Number: 8694592 WAIVE ALL RIGHTS TO PROCEED AS A MEMBER OR REPRESENTATIVE OF A CLASS ACTION,INCLUDING CLASS ARBITRATION,REGARDING DISPUTES ARISING OUT OF OR RELATING TO YOUR PELLA PRODUCTS.You may opt out of this Arbitration Agreement by providing notice to Pella no later than ninety(90)calendar days from the date You purchased or otherwise took ownership of Your Pella Goods.To opt out,You must send notice by e-mail to pellawebsupportgpella,c om,with the subject line:"Arbitration Opt Out"or by calling(877)473-5527.Opting out of the Arbitration Agreement will not affect the coverage provided by any applicable limited warranty pertaining to Your Pella Products.For complete information,including the full terms and conditions of this Arbitration Agreement,which are incorporated herein by reference,please visit www.pella.com/arbitration or e-mail to pellawebsupport(or pella.com,with the subject line:"Arbitration Details"or call(877)473-5527.D'ARBITRAGE ET RENONCIATION AU RECOURS COLLECTIF("convention d'arbitrage")EN FRAN(CAIS SEE PELLA.COM/ARBITRATION.DE ARBITRAJE Y RENUNCIA COLECTIVA("acuerdo de arbitraje")EN ESPANOL VER PELLA.COMIARBITRATION. 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 parry.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 www.pelia.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 out 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) Prefnish products when purchased in contract During the Installation the Homeowner agrees to do the following: For more information regarding the finishing, maintenance, service and warranty of all Pella®products,visit the Pella®website at www.pella.com Printed on 2/21/2017 Contract-Detailed Page 4 of 8 Customer:James Hashem Project Name: Hashem,James,NorthAndover,MA,1844144 Order Number. 741 RC0410 Quote Number: 8694592 Keep pets safely away from work area Keep children safely away from work area Allow Pella Installer room to work safely within your home 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) AUstomerGap exterior casing issues due to storm window removal if full wrap or new exterior trim is not purchased roject Checklist has been reviewed nitial Product Only Addendum has been reviewed Customer initial Credit Card Account 4: Last 4 Digits Expiration Date: / Charge final payment to same account (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.pella.com Printed on 2/21/2017 Contract-Detailed Page 5 of 8 Customer:James Hashem Project Name: Hash em,James,NorthAndover,MA,1844144 Order Number: 741RC0410 Quote Number. 8694592 James Hashem Ryan Clancy OrderTotalis Customer Name (Please print) Pella ep N (Please print) Taxable Subtotal $2,004.28 Sales Tax @ 6.25% $125.27 stomer Signature P es R na e Non-taxable Subtotal $2,556.70 2121117 21117 Total $4,686.25 Date Date Deposit Received $4,686.25 Amount Due $0.00 Credit Card Approval Signature For more information regarding the finishing,maintenance,service and warranty of all Pella®products,visit the Pella®website at www.pella.com Printed on 2/21/2017 Contract-Detailed Page 6 of 8 Customer:James Hashem Project Name: Hashem,James,NorthAndover,MA,1844144 Order Number: 741RC0410 Quote Number. 8694592 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: ❑ ALL furniture needs to be moved at least 8 feet away from any window or door being replaced ❑ ALL personal items,wall hangings, and collectibles must be removed prior to your installation date ❑ 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 1 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 1 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. 2121117 stomer Signature Date For more information regarding the finishing, maintenance,service and warranty of all Pella®products, visit the Pella®website at www.pelia.com Printed on 2/21/2017 Contract-Detailed Page 7 of 8 Customer:James Hashem Project Name: Hashem,James,NorthAndover,MA,1844144 Order Number: 741RC0410 Quote Number: 8694592 Pre-Renovation Form Occupant Confirmation Pamphlet Receipt have received a copy of the lead hazard information pamphlet informing me of the potential risk of lead hazard exposure from renovation activity to be performed in my dwelling unit. I received this pamphlet before the work began. James Hashem Printed ame of Owner-occupant 2f21/17 gnature of Owner-occupant Signature Date Renovator's Self Certification Option (for tenant-occupied dwellings only) Instructions to Renovator,if the lead hazard information pamphlet was delivered but a tenant signature was not obtainable,you may check the appropriate box below. Declined -I certify that I have made a good faith effort to deliver the lead hazard information pamphlet to the rental dwelling unit listed below at the date and time indicated and that the occupant declined to sign the confirmation of receipt. I further certify that I have left a copy of the pamphlet at the unit with the occupant. Unavailable for signature-I certify that I have made a good faith effort to deliver the lead hazard information pamphlet to the rental dwelling unit listed below and that the occupant was unavailable to sign the confirmation of receipt. I further certify that I have left a copy of the pamphlet at the unit by sliding it under the door or by: (Fill in how pamphlet was left Printed Name of Person Certifying Delivery Attempted Delivery Date Signature of Person Certifying Delivery Unit Address Note Regarding Mailing Option --As an alternative to delivery in person,you may mail the lead hazard information pamphlet to the owner and/or tenant. Pamphlet must be mailed at least 7 days before renovation. Mailing must be documented by a certificate of mailing from the post office. For more information regarding the finishing, maintenance,service and warranty of all Pella®products,visit the Pella@ website at www.pelia.com Printed on 2121/2017 Contract-Detailed Page 8 of 8 PELLA WINDOWS AND DOORS CONTRACT 7 PAYMENTS 1. 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 New 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 8 CORRECTION 1"CON OC WORK the 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,ifearlier,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 detective 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 work site between the hours Windows&Doors Limited Warranty.THIS LIMI'T'ED 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 TILE 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 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 CIRCUMS'T'ANCES 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. other facilities and services necessary for the proper execution and completion ofthe Work. It, HOME IMPROVEMENT CONTRACTORS The materials and equipment furnished under the Contract will be goad quality All home improvement contractors and subcontractors shall be registered with the director of the Home Improvement Contractor Registration Program and new unless otherwise required or permitted,the Work will be free from defects not inherent in the quality required or permitted,and the Work administered by the Board of Building Regulations and Standards. Pella and any of its subcontractors identified in this agreement have been registered. conform with the requirements of this Contract.Pella shall not be responsible Any inquires about Pella or any of its subcontractors relating to registration for damages or defects caused by abuse,modifications not executed by Pella, should be directed to:Director,Home Improvement Contractor Registration, improper or insufficient maintenance,improper operation or normal wear and 10 Park Plaza,Room 5170,Boston,MA,02116,617-973-8787,888-283-3757 tear. Pella will keep the premises and surrounding area free from or visit the HIC website at h_ttp:/hv rw.mass, ovg /ocabar/ accumulation of waste materials or rubbish caused by performance of the Work. 12. PERMITS(MA customers only) 4. CHANGES Pella is obligated to and will obtain the following permits for this project: Building __. 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 agreement,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 5. 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 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 components are missing or need to be replaced or repaired,a hold back proportionate to the cost of resnaining See the attached Notice of Cancellation for an explanation of parts or work to be completed is acceptable.However,the holdback will not exceed the amount of the completion costs or 10%of the remaining unpaid this right. balance of the Price,whichever is less, 6. FINANCING Do not sign this contract if there are any blank spaces. If payment of the 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 stonier signature financing shall have been received from the financial institution. 2121/17 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 & Doors Contractor lie 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: 2121117 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 2124117 (three business days from the date of transaction above). I hereby cancel this transaction. (Date) (Buyer's signature) The Commonjvealth of Afasvachusetts Depcarlrnent ofIndustrialAcc dents X Congress Street,Suite 100 x Boston,IWA 02114-2017 lVlm mass golv7dia Workers'Compensation Insurance Affidavit:Builders/Contractors/EIectricians/£'lumbers. To BE FILED WITH THE PERARTI'ING ACJMORITx'. Applicant Information Please Print Le ibl NaMe(Business/OrgauizaEon/tudividual)- _ old Address: '�°1 �m City/State/Zip: ti( / Phone#: Are you an employer?Check the appropriate box: "Type of project(required): I am a employer with employoes(fuA.and/orpart-time).* 7. F]New construction 2.Q I am a sole proprietor or partnership and have no employees working forme in S. Wernodeling any capacity.[No workers'comp.insurance required.] i9. El Demolition 3.01 am a homeowner doing all work myself No workers'comp.insurance required]t 10E]Building addition 4_E]I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have wormers'comps Ovation insurance or are sole- 11.0 Electrical repairs or additions proprietarswith no°employees. .12:0 Plumbing repairs or additions__,. 5.n I am a general contractor and I have hired the sub-cormactors listed onthe attached sberL 13. Roof repairs these sub-eoutraetors have employees and have workers'comp.iusuraneeJ 6.0 We are a corporation and its officers have exercised their right of exemption per MGL e. 14.[:]Other 152,§1(4),and we have no employers.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also 511 out the section below showing their workers'cornpensaiion policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state wbetber or not those entities have j employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing tporlters'compensation insurance for my employees. Belvty is the policy andjob site informaiiFon. Insurance Company Name: mdt Policy#or Self-ins.Lic.#: Expiration Datc: — —/ 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 MGI.c.152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA.for insurance coverage verification. .I do hereby cera;f under the pains and penalties of perjury that the informadon provided above is true arid correct. rN, wm Si ature•b,° Date: 6 Phone#: Offacial use only. Do not write in this area,to be completed by city or town ofJWaL City or Town: PermitlLicense# Issuing Authority(circle one):. 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone##:__. __. 7 ® DATE(MMIPDIYYYI') A ►o CERTIFICATE OF LIABILITY INSURANCE 97Ie7201e 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 pollcy(les)must 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 NAME C Dorothy A.Code6,Ctr,RPLU Fred C.Church,Ina PHONE 878 3227231 FAX (978}454-1885 41 Wellman Street AI t: AIC No]: Lawell.MA 01855 E-MAILdcarieliMlredochurch.mat (600)225-1865 ADDRESS: INSURERS AFFORDING COVERAGE NAIC N INSURERA: CAEzens Insurance Company ofAmetica 31534 INSURED INSURER B- Nen Hampshire Employers insurance Company 13083 New England Wiedaw&Door LLC INSURER C 45 Fondl Road Haverhill,MA 01832-1302 INSURER D INSURER E INSURER F 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 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. INSR TYPEOFINSURANCE ADDL SUBft POLICYNUMBER MMlDgYlYY1'1' MM1DD EXP L€NITS LTR GENERAL LIABILITY EACH OCCURRENCE $ 1,000,900 X PREMISES Ea occu ence $ i 00,000 COMMERCIAL GENS=RAL kIABlLITY CLAIMS-MADE M OCCUR MED EXP(A0y nno person) $ 10,000 A X 000001 ZBN6181407 71112016 71112017 PERSONAL&ADV INJURY S 4,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PERPRODUCTS-COMPIOP AGG $ 2,000,000 POLECYX PRO- X LOC $ COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY a acddenf d aOGILY INJURY(Par pers(n) $ ° ANYAUTO ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS NO OWPIED AUTOS PROPERTY DAMAGE $ pp HIREDAUTOS AUTOS (Per acc+denl V S U�RETENTION EACH OCCURRENCE $ EAGGREGATE $ I. OX U4iC STATU- DTH- $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN 500,000 ANY PROPRILTOWPARTNERIEXECUTIVE❑ 8007024 711/2016 71112017 ELL EACH ACCIDENT $ B OFFICERItAEMBER EXCLUDED? NfA 500,000 (Mandatory in NH) E.L.DISEASE-FA EMPLOYEE $ ifyes,descdbe antler 60,0110L.D$ - DESCRIPTION OF OPERATIONS below L i' DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES(Attach ACORO 101,Additional Remarks Schedule,if more space is requiredl 9 r CERTIFICATE HOLDER CANCELLATION Town of Nodh Andaver 1800 Osgood Street,Suile 2043 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Nrth Andover,MA 01845 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORMED REPRESENTATIVE --�In`.-.t-•.�.--fes �S f �s-------- client ft Msttl Celt Holder# ©1488-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD iMassachusetts Depar+.ment.o -Puaiie.Safety Board of Fuiidina Regulations and.Stand@rds License: CS-089853 '-i L:1lSY?'i.iC.i1!7t1 ,',.upervisoS '4'. 4± " tt 1NlLUAM R NICHOLS 57 PEARTREE RD HAVERHILL MA 6830 �.., CA_ Expirax on: �csnmissioner 1012612018 ,� -;:��< �n»�rirr,irrur-crl� r���((r r'.t�rrr•:i��,u•Fli' . face of Consume Affairs&Business Regulation' License or registration valid$or individul use oniy before the expiration date. If found return to: E IMPROVEMENT CONTRACTOR p Office of Consumer Affairs and Business Regulation . , egistration: 183279 -Type- -Suite 5170 Expiration: 9/24/2017 Supp[ement C�:,trd Boston,MA 02116 NEW ENGLAND WINDOW&DOOR,LLC_ PELLA WINDOWS&DOORS William Nichols � 45 CONDI ROAD f iAVERI-i3LL,AAFj Q1832 Undersecretary Not valid without signature