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Home My WebLink AboutBuilding Permit #540 - 1 FOREST STREET 4/14/2009 BUILDING PERMIT OtNORTIy TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION #- 0 4L Permit NO: ` Date Received — SSACHUS Date Issued: Vi—o IMPORTANT: Applicant must complete all items on this page LOCATION P=unt PROPERTY OWNER,4 A"4 My JV int 11/lAPIt7PAFtC.EI.: ZONII DISTRI=CT: v Hrs#oric:lJlstrict yes Marchi a Shop UIIFage n TYPE OF IMPROVEMENT PROPOSED USE Resi Non- Residential New Building - ne family Addition Two or more family Industrial Alteration No. of units: Commercial air re lacem Assessory Bldg Others: Demolition Other Septic. Kell Floodplain Wetlands Watershed District, Wato lSewer DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: )cW/a Phone: •2 -•7 Address: ! /orzEsT ST CONTRACTOIae: ' t Phone.: k L 7J S Address: -,b 1= Sultieruisar's Construction License... AS Exp.n FDate: Home.provement Licenses oeP• .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. Total Project Cost: $ "01aL T3 7 FEE: $ Check No.: &/� g Receipt No.: 0 15q NOTE: Persons contracting with unregistered contractors do not have access to the duarantyfund 5igr}ature of Agent/Qwrrer, ,c. — --�'"� Signature of contraeto ----- r Locatio s No. ��"� Date �ORTM TOWN OF NORTH ANDOVE� Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ L TOTAL $ Check # G � Building Inspector Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales Private(septic tank,etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature &Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT' Temp Du,mpster on site yes no Located,at 1-24 Main Street ,Fire Departme-nt sigrraturel ate COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— For department use ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application o Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work Li Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:INSPECTIONAL SERVICES DEPARTMENTMFORM07 Revised 2.2008 tIORTFI Town of Andover 0 No. sy/ dover, Mass., 0 LAKE /� COCKICMEWICK C2 7,9 0"�ATED S E BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR .10A.................................................................... THIS CERTIFIES THAT.............. .............iF4./ Foundation has permission to erect........................................ buildings on ../ ....................... . ................................. Rough Chimney .............. to be occupied as 77-0.....49t)-640000.............................................................. provided that the person accepilng�-ihio.-I!e-imit shall in every respect conform to the terms of the application an file in Final 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 3� ' UNLESS CONSTRU S ELECTRICAL INSPECTOR �IET7 Rough ST Service ......... ..................... ...................... .......... BUILDING INS TOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display 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 Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. The Commonwealth of Massachuseits Department of Industrial Accidents Office of lnvestigadons IF 600 Washington Street Boston.,1MM02111 www.massgov/dia Workers' Compensation Insurance Affidavit: BuiIlders/Contractors/Blectricians/Plum hers A�mlicant IInfoXmation Please Print]Lel oIlv Name(Businesslorganhation/Individual): Pe l k (J,A_A-ow.5 q t4 T>v.-oo d-s 'he Address: q S, FDt^4'1 U City/State/Zip: kyer l►i�� M,4 01232 Are you an employer?Check the appropriate bog: Type of project(required): 1. I am a employer with 2.T 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.t 7. ❑Remodeling ship and have no employees These sub-contractors have S. ❑Demolition working for me in any capacity. workers'comp.insurance. ' 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its 10.❑Electrical re airs or additions required.] officers have exercised their p 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers'comp. c.152,§1(4),and we have no 12.[]Roof repairs insurance required.]t employees. [No workers' comp.insurance required.] ME]Other *Any applicant that checks box#1 must also fill out the section below showing thei Ncr` el isl compensation policy information. f Homeowners who submit this affidavit indicating they are doing allwork and then hire outside contractors must submit anew affidavit indicating such. =Contractors that check this box must attached an additional sheet showing the name ofthe sub-contractors and their workers'comp.policy information. I am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy andjob site Information. +� �" Insurance Company Name: i�—U��0� 1di'�a�1 Policy#or Self-ins.Lie.#;_02 W GAIL 57&/?. Expiration Date: = 09 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 6f this"statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the iq formation provided above is true and correct. Sienature• Date: L/—/ Phone#: N 79" Officlal use only. Do not write in this area,to be completed by city or town offWaL. City or Town: Permit/License# Issuing Authority(circle(Me): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector •5.Plumbing IImspector b.Other Contact Person: .; Phone M. DATE(MMfOD1YYYY) ACORD ' p � 7 � 14 PRODUCER .(800)225-1865 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION FSC.Church.lnc, _ __ ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE man 41 WellStreet - —fIM0ER.7HISCERTIFICATE—DOD—OR Lowell,MA 01851 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 800-225-1865 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Citizens lim mee Company of America New England Wmdow&Door LLC 45 Fondi Road INSURER B: Hanover hmrance Company Haverhill,MA 01832-1302 INSURER C Massachusetts Bay Insurance INSURER D: Twin City Fire hrsurance CO. 129459 INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DIL TYPE OF INSURANCE POLICYNUMBER POLICY EFFECTIVE POLICYEXPIRATION LIMITS GENERAL LIABILITYEACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Eaoccu nce $500,000 CLAIMS MADE FRK OCCUR MED EXP(Any one arson $10,000 A ZBN8161407 7/1/2008 7/1/2009 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $2,000,000 POLICYF_j PRO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 X ANY AUTO (Es accident) ALL OWNED AUTOS BODILY INJURY SCHEDULEDAUTOS (Per parson) $ C ADN8162169 7/1/2008 7/1/2009 X HIRED AUTOS BODILY INJURY $ (Per accident) X NON-OWNED AUTOS PROPERTY DAMAGE. $ (Per accident) GARAGELIABILITY AUTO ONLY-EAACCIDENT $ ANYAUTO OTHER THAN EAACC $ AUTO ONLY: • AGG •$ EXCESSIUMBRELLALIABILITY EACH OCCURRENCE $9,000,000 X OCCUR CLAIMS MADE AGGREGATE $9,000,000 B LTHN8167305 7/1/2008 7/1/2009 $ DEDUCTIBLE $ X RETENTION $ $ WORKERS COMPENSATION AND X WC STATU- 09, EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $500,000 D OFFICERWE BEREXCLUDED?ECUTIVE 0$WBNL5742 7/1/2008 7/1/2009 E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under E.L.DISEASE-POLICY LIMIT $ 500,000 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Proof of hisumnce CERTIFICATE HOLDER CANCELLATION New England Window&Door LLC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 5 Fondi Road DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN averhill,MA 01830 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE 08-09 GL,UMB,WC, ©ACORD CORPORATION 1988 Au ACORD 25(2001108) Client# 2960 Mst# m Cert# ,l�F.' lnam77zo-7tilJra,�,[It n� lla"Zd'fz� Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 129774 Expiration: 11/2/2009 Type: Supplement Card PELLA WINDOWS AND DOORS WILLIAM NICHOLS 45 FONDI RD. „�� HAVERHILL,MA 01832 Administrator Massachusetts - Dcpar-tnuvit rif Public SafetN Board of Builtlin{ Rc-ulatiun�:uad stantlartls Construction Supervisor, License License: CS 89853 Restricted to: 00nHui WILLIAM R NICHOLS " 57 PEARTREE RD HAVERHILL, MA 01830 Expiration: 10/26/2010 C uumi.�iuiu'r' Tr#: 5196 Proposal - Detailed Sales Rep Name: Gould, Rich / Sales Rep phone: (478)423-7156 Sales Rep E-Mail: GouldRM@PellaBoston.com Phone: Pax: Sales Rep Parc: mer Ir� ols_ -- raj# l3lirreAdtlr �rdl-Itforrrlattfsn I' __ Bryan Fallon Fallon Bryan,Nopdh andover Quote Name: Entry door Order Number: 741 RGO014 Cust Delivery Date: Nene Quote Number: 309570 Quoted Date: 3112/2009 1 FOREST ST Order Type: Installed Sales Contracted Date: NORTH ANDOVER,MA 01845 Lot# Wall Depth: Boolted Date: Payment Terms: Deposit/C,n.17. Customer PO#: Dalt Phone: Tax Code: MA TAXABLE - Mobile Phone: pries(unaged Air bill vely ue Fax Number: Owner!dame: E-Mail: Bryan Fallon Contact Name: Owner Phone: Great Plains#: 3273105 Customer Notes: TI:25.14.13.183 HIC: 129774 1�inli# 10 syr Entry Systems,InsvAng Door Left,37.5 X 81.5,White,44116" Item,Price -;jk___ Ext'd Price $3,048.08 1 $3,048.08 1:X80 Left Inswing Dow France Size:371/2X81 1/2 r General Information: Clad,Standard Sill,Nickel Anodized,Glazed,Grafteman,Crattsnran4rain Fiberghms Eiderior Colas'/Finish, Standard EMuraClad,White,Stained,Special Walnut Stain . LC c Interior Color/Finishs Stained,Special Walnut Stain,Match Interior Panel Irbriar � 1 i � Sash/Panel., Include panel Prote0w Face Sheet i r� `� A��;� Glass:Low S Argon Gas j Vieuds�rrni1 x eritx Hardware ins: tach Sore with Deadbolt,2-30,Nam,Standard Hinge;Satin Ni" Rough Opening: 381/4"X 82' Unit Accessoriest: No Options,None Grilles:Simulated Divided Ute(SCL),1.1t8 ?raditionsl,3,2. Final Wall Depth:440/16* Wrapping Inforrrsation: 8u Installation Clips,449/101 Factory Applied,Perimeter Length=238". For more information regarding the finishing, maintenance,service and warranty of all Pella4b products,visit the Pella®website at www.pelia.com Printed on 3/19/2009 Detailed Proposal Page 1 of 3 Customer.Bryan Fallon Project Name: fallon Bryan,Noprth andover Quote Number:309570 f consult your local building code to ensure you Pelle products meet local egress requirements Per the manufacturer's 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 TOMS&CONDITIONS: QUOTE=S ARE VALID FOR 30 DAYS �0,V �rder'�c�tais Customer Name (Phase pHnt) Della Salestrte (Plea ent) Taxable Subtotal. - $2,009.84 AI, _ --�-- SalesTaxV% $100.49 Customer S.. re Della Salsa Rep Signature Non=taxable Subtotal $824,00 Total $2,934.3 Date nate atepq it Received $1,467.1__ Amount Due $1,467.16 For more information regarding the finishing, maintenance,service and warranty of all Pella*products,visit the PellaO website at www.pells.com Printed on 3119/2009 Detailed Proposal Page 3 of 3 ■ PELLA WINDOWS AND DOORS CONTRACT 7 PAYMENTS . Pella shall be entitled to stop the Work upon written notice to Owner for any 1 TERMS AND CONDITIONS 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 OF WORK the work(the"Work")described or referred to in such Contract. For Product Pella shall correct installation Work not in conformance with the requirements Only purchases,a signed"Product Only Addendum"is a required part of the of the Contract,if notified in writing by the Owner within two years after the j contract. Completion Date or,if earlier,the date on which the Work is substantially completed and payment of the Purchase Price made subject to a holdback as 2. OWNER 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 work site 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 10. NO CONSEQUENTIAL DAMAGES portions of the Work.Pella will be responsible for the Work of its Pella Contractors who will install the Products. UNDER NO CIRCUMSTANCES SHALL PELLA BE LIABLE FOR CONSEQUENTIAL,INCIDENTAL,INDIRECT,OR SPECIAL DAMAGES, Unless provided otherwise in the Work description,Pella will provide and pay WHETHER FORESEEN OR UNFORESEEN. for all labor,materials,equipment,tools and machinery,transportation,and other facilities and services necessary for the proper execution and completion 11. HOME IMPROVEMENT CONTRACTORS of the Work. All home improvement contractors and subcontractors shall be registered with The materials and equipment furnished under the Contract will be good quality the director of the Home Improvement Contractor Registration Program and new unless otherwise required or permitted,the Work will be free from administered by the Board of Building Regulations and Standards. Pella and defects not inherent in the quality required or permitted,and the Work 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 One Ashburton Place,Boston,MA 02108,617-727-85.98 tear. Pella will keep the premises and surrounding area free from accumulation of waste materials or rubbish caused by performance of the 12. PERMITS(MA customers only) Work. Pel is i�gated to and will obtain the following permits for this project: j_ r Homeowners who secure their own permits will be 4. CHANGES �y 1!! excluded from re guaranty fund provisions of Massachusetts General Laws, The Owner may order in writing changes in the Work consisting of additiott';, chapter 142A. deletions,or modifications("Change Order"). Any Change Order shall In addition to the rights and warranties enumerated in this agreement,you may include an adjustment to the Price and the Substantial Completion Date,as determined by Pella. Pella reserves the right to approve or disapprove any have additional rights under Massachusetts General Laws,chapter 142A and Change Order and any such Change Order must be signed by both Owner and 780 Code of Massachusetts Regulations R6. Pella to be effective. 13. NOTICE OF CANCELLATION 5. SUBSTANTIAL COMPLETION You may cancel this agreement if it has been signed by a party Owner understands and agrees that the Substantial Completion Date is an thereto at a place other than an address of the seller,which estimate only and that the actual date on which the Work is completed may be may be his main office or branch thereof,provided you notify extended to allow for Change Orders requested by Owner or if the time to the seller in writing at his main office or branch by ordinary complete the Work is affected by conduct of the Owner,weather,labor mailoSted,p 'by telegram sent or by delivery,not later than disputes,availability of subcontractors,acts of God,fire or other causes reasonably beyond Pella's control.If for any reason the Work is not fully midnight of the third business day following the signing of this completed by the Substantial Completion Date(including any extensions agreement. contemplated above),but is substantially completed by such date,i.e.,the Product has been installed,but minor parts or components are missing or need See the attached Notice of Cancellation for an explanation of to be replaced or repaired,a hold back proportionate to the cost of remaining this right. 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 balance of the Price,whichever is less. Do not sign this contract if there are any blank spaces. 6. FINANCING 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 'Sir, _ requisite approvals and authorizations for the full amount of the requested financing shall have been received from the financial institution. Custom signature D Date i DISPUTES Job Name p �o Date 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 Contractor 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 Customer Name: _, I tV� �N (PI ase print) Date of transaction: 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 3'Z Gree business days from the date of transaction above). I hereby cancel this transaction. (Date) (Buyer's signature)