HomeMy WebLinkAboutBuilding Permit #219-16 - 1000 JOHNSON STREET 8/20/2015 BUILDING PERMIT NORTH q
,ct�e°. 6� ti0
TOWN OF NORTH ANDOVER o� y` '` TN
-
APPLICATION FOR PLAN EXAMINATION
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Permit No#: I Date Received °�RAre°
� gSSACNU5�4
Date Issued:
IMP RTANT: Applicant must complete all items on this page
LOCATION Sr—
Print
PROPERTY OWNER AAn *OAd� fir/ 11-*4_ -
Print 100 Year Structure yesno
MAP PARCELS ZONING DISTRIC�Historic District yes no
167 6 3,zG �- Machine Shop Village yes n
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building AOne family
❑Addition ❑ Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
.6_Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
❑ Septic D Well ❑ Floodplain ❑Wetlands ❑ Watershed District
❑Water/Sewer
DESCRIPTION O WORK TO BE PERFORMED:
C�'�GGwce irj,7 0
Identification- Please Type or Print Clearly
OWNER: Name: Phone: vli -5, -9-.3
Address: -r—
t
Contractor Name:R���f t,uoe•�-S 1,,,4,4 iJAhone: ?fir
Email: 6
Address:- Ir
Supervisor's Construction License:_ Exp. Date:
-Home Improvement License: 3Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.,BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BAS ON$125.00 PER S.F.
Total Project Cost: $ _ 0,:�o FEE:
Check No.: (U-S,-� Receipt No.: �C� 3-3
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
V
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
PLANNING & DEVELOPMENT Reviewed On Signature_
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
r
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
i
Conservation Decision: Comments
Water & Sewer Connection/Signature & Date Driveway Permit
i
DPW Town Engineer:,Signature:
Located 384 Osgood Street
FIRE yDEPARaTMENT Tem .tQumpster onijitp iy�esw__ ;nog
+ Located�at 124�iMain�Stree_"t• , A� � �
Fire�DepartmentigrAature/date
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 Call Email
Date Time Contact Name
Doc.Building Permit Revised 2014
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
:,. Workers Comp Affidavit
Photo Copy Of H.I.C. And/Or C.S.L. Licenses
Copy of Contract
Floor Plan Or Proposed Interior Work
Engineering Affidavits for Engineered products
OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
Building Permit Application
Certified Surveyed Plot Plan
Workers Comp Affidavit
Photo Copy of H.I.C. And C.S.L. Licenses
Copy Of Contract
Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
Mass check Energy Compliance Report (If Applicable)
Engineering Affidavits for Engineered products
OTE: 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)
:ra Copy of Contract
2012 IECC Energy code
Engineering Affidavits for Engineered products
OTE: 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:Building Permit Revised 2014
Location/W0
No. Date t ,
• - TOWN OF NORTH ANDOVER
� T QED js��` .
i. Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $ g
TOTAL $
Check# �
Building Inspector
NORTH
Town of 1.. , adover
O
2.A
ver, Mass 0
0 L 1 7
COCHIC041WICK �01
V BOARD OF HEALTH
PERM D Food/Kitchen
Septic System
THIS CERTIFIES THATA.n . . .... ......... /.... ............... BUILDING INSPECTOR
i '
Foundation
has permission to erect .......................... buildings on .�(�.Q�.C.�.....`.�. !�..... �..............
I � Rough
�"1.�:..... .�1 ..�.......C�► ..... .................................... Chimney
j to be occupied as ........
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
Rough
VIOLATION of the Zoning or Building Regulations Voids this Permit.
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCTIONR Rough
Service
............................ .................................................. Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Building 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 U the Building Inspector. Burner
Street No.
Smoke Det.
Contract - Detailed
Pella Window and Door Showroom of Haverhill Sales Rep Name: Makos, Alex
® 45 Fondi Road C �_ Sales Rep Phone: 978-423-7156
Haverhill, MA 01832 Sales Rep Fax:
Phone: (978) 373-2500 Fax: (978) 373-7274 (� Sales Rep E-Mail: MakosAM@pellaboston.com
Customer Information Project/Delivery Address Order Information
Anthony Fragala Anthony Fragala Quote Name: Anthony Fragala
1000 Johnson St 1000 Johnson St
Order Number: 741AM0177
NORTH ANDOVER, MA 01845-5525 Lot# Quote Number: 7029450
Primary Phone: (978)6865533 NORTH ANDOVER, MA 01845-5525 Order Type: Installed Sales
Mobile Phone: County: ESSEX Payment Terms: Deposit/C.O.D.
Fax Number: Tax Code: MA TAX 6.25
E-Mail: tonyfragala@comcast.net Quoted Date: 8/6/2015
Great Plains#: 9574824
Customer Number: 1007293934
Customer Account: 1003003171
Line# Location: Attributes
10 None Assigned Delivery/Setup- Delivery/Setup 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 8/6/2015 Contract-Detailed Page 1 of 8
Customer: Anthony Fragala Project Name: Anthony Fragala Order Number: 741AM0177 Quote Number: 7029450
Line# Location: Attributes
15 None Assigned Minimum Unit Value Add - Min. Order Setup VA 3 or Less Windows Qty
1
i
Line# Location: Attributes
20 Front side door Encompass By Pella, Inswing Entry Door Left, 33.5 X 81.5 Qty
a 1
1:3280 Left Inswing Entry Door
vas`° PK# Frame Size: 33 1/2 X 81 1/2
718 General Information: No Fire Rating,Wood,Wood, Pine,Standard Sill,Mill Finish Sill,Composite Threshold
Entry Door Panel: Glazed,Fiberglass,Smooth,Smooth, 1/2 Light
I�'-+.. Exterior Color/Finish: Unfinished, Primed
6. Interior Color/Finish: Unfinished,Primed
335 • Glass: Tempered Low-E
Viewed From Exterior Hardware Options: Latch Bore,2 3/8",Standard Steel,Satin Nickel
Frame Size:33.5"X 81.5' Grilles: Grilles Between Glass,3/4"Contour,White,White,Traditional,3,3
Wrapping Information: 2"Brickmould,No Interior Trim,4 9/16",4 9/16", Pella Recommended Clearance,Perimeter Length=230".
Comp Trim>48-Composite Trim Upgrade>Greater than 48 inches wide Qty 1
ES_Single-Install Single Entry Door Qty 1
Schlage Knob Only-Satin-Schlage Knob Only-Satin Qty 1
Line# Location: Attributes
25 Bsck side door Encompass By Pella, Inswing Entry Door Right, 33.5 X 81.5 Qty
1
` '•, i 1:3280 Right Inswing Entry Door
PK# Frame Size: 33 1/2 X 81 1/2
718 General Information: No Fire Rating,Wood,Wood,Pine,Standard Sill,Mill Finish Sill,Composite Threshold
Entry Door Panel: Glazed,Fiberglass,Smooth,Smooth, 1/2 Light
Exterior Color/Finish: Unfinished, Primed
Interior Color/Finish: Unfinished, Primed
Glass: Tempered Low-E
Viewed From Exterior Hardware Options: Latch Bore,2 3/8",Standard Steel, Satin Nickel
Frame Size:33.5"X 81.5" Grilles: Grilles Between Glass,3/4"Contour,White,White,Traditional,3,3 I
Wrapping Information: 2"Brickmould,No Interior Trim,4 9/16",4 9/16", Pella Recommended Clearance,Perimeter Length=230".
I
For more information regarding the finishing, maintenance, service and warranty of all Pella®products,visit the Pella®website at www.pella.com
Printed on 8/6/2015 Contract-Detailed Page 2 of 8
Customer: Anthony Fragala Project Name: Anthony Fragala Order Number: 741AM0177 Quote Number: 7029450
Comp Trim>48-Composite Trim Upgrade>Greater than 48 inches wide Qty 1
ES–Single-Install Single Entry Door Qty 1
Schlage Knob Only-Satin-Schlage Knob Only-Satin Qty 1
Line# Location: Attributes
30 kitchen window Vinyl Windows/Doors By Pella, Sliding Window Vent Right/Fixed, 38 X 39.25,White Qty
r 1
I 1: Non-Standard SizeNonStandard Size Vent Right/Fixed Double Slider
t PK# Frame Size: 38 X 39 1/4
718 General Information: Standard,Vinyl,Block,2 11/16",2 11/16"
Exterior Color/Finish: White
Interior Color/Finish: White
Glass: Insulated Low-E Advanced Low-E Insulating Glass Argon Non High Altitude
zio —~ Hardware Options: Cam-Action Lock,White
Viewed From Exterior Screen: Half Screen
Frame Size:38"X 39.25" Grille: No Grille,
Wrapping Information: No Exterior Trim, No Interior Trim,Pella Recommended Clearance,Perimeter Length=155",Glazing Pressure=80.
Venting Width: Equal
PI–Ext Trim-Pocket wl Exterior Trim Qty 1
No Ext.Wrap/Cap-No Exterior Wrap/Cap Qty 1
PI–Insulate Pockets-Insulate Weight Pockets Qty 1
Comp Trim<48-Composite Upgrade-48 Inches or Less Wide Qty 1
Line# Location: Attributes
35 Family room front Vinyl Windows/Doors By Pella, Double Hung, 36 X 53.5, White Qty
I 1:Non-Standard SizeNon-Standard Size Double Hung,Equal
PK# Frame Size: 36 X 53 1/2
{J 718 General Information: Standard,Vinyl, Block Frame With Mull Groove,3 1/4",3 1/4",Sill Adapter Included, No Head Expander
Exterior Color/Finish: White
Interior Color/Finish: White i
Glass: Insulated Low-E Advanced Low-E Insulating Glass Argon Non High Altitude
Hardware Options: White,Standard Vent Stop `
Viewed From Exterior Screen: Full Screen
Frame Size:36"X 53.5" Grille: GBG,No Custom Grille,3/4"Contour,Traditional(3W2H/3W2H)
Wrapping Information: No Exterior Trim, No Interior Trim, Pella Recommended Clearance,Perimeter Length=179",Glazing Pressure=90.
PI_FF-Full Frame Pocket 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 8/6/2015 Contract-Detailed Page 3 of 8
Customer: Anthony Fragala Project Name: Anthony Fragala Order Number: 741AM0177 Quote Number: 7029450
Line# Location: Attributes
40 Family room back Vinyl Windows/Doors By Pella, Double Hung, 36 X 53.5, White Qty
EM
2
1: Non-Standard SizeNon-Standard Size Double Hung,Equal
Ln PK# Frame Size: 36 X 53 1/2
718 General Information: Standard,Vinyl,Block Frame With Mull Groove,3 1/4",3 1/4",Sill Adapter Included, No Head Expander
Exterior Color/Finish: White
Interior Color/Finish: White
Glass: Insulated Low-E Advanced Low-E Insulating Glass Argon Non High Altitude
-' Hardware Options: White,Standard Vent Stop
Viewed From Exterior Screen: Full Screen
Frame Size:36"X 53.5" Grille: GBG,No Custom Grille,3/4"Contour,Traditional(3W2H/3W2H)
Wrapping Information: No Exterior Trim, No Interior Trim, Pella Recommended Clearance, Perimeter Length=179",Glazing Pressure=90.
PI_FF-Full Frame Pocket Qty 1
Thank You For Purchasing Pella® Products I
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.
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.
I
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
For more information regarding the finishing, maintenance, service and warranty of all Pella®products,visit the Pella®website at www.pella.com
Printed on 8/6/2015 Contract-Detailed Page 4 of 8
Customer: Anthony Fragala Project Name: Anthony Fragala Order Number: 741AM0177 Quote Number: 7029450
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
During 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
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
i
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)
CIS exterior ca�g issues due to storm window removal if full wrap or new exterior trim is not purchased
_ oject Checklist has been reviewed
Custo'irteE4nitial
Product Only Addendum has been reviewed
Customer initial
0377
Credit Card Account#: Last 4 Digits r
For more information regarding the finishing, maintenance, service and warranty of all Pella@ products, visit the Pella®website at www.pella.com
Printed on 8/6/2015 Contract-Detailed Page 5 of 8
Customer: Anthony Fragala Project Name: Anthony Fragala Order Number: 741AM0177 Quote Number: 7029450
Expiration Date: 04/2017
Charge final payment to same accou
(Upon substantial completion) Customer initial
❑Project Checklist has been reviewed
Anthony R Fragala Alex Makos
Customer Na (Please print) Pella Sales Rep Name (Please print) Order Totals
*x Maros Taxable Subtotal $3,148.95
Customer Sign 8/6/15 Pella Sales Rep Signature Sales Tax @ 6.25% $196.81
8/6/15 Non-taxable Subtotal $3,905.66 f
Date Date Total $7,251.42
Deposit Received $3,625.71
The cardholder authorizes Pella Windows&Doors to charge the(circle one)VISA, MASTERCARD, Amount Due $3,625.71
DISCOVER,or AMERICAN EXPRESS for the full amount of this order. The cardholder agrees to the card
issuer's terms and conditions and is legally authorized to use this card.The cardholder can request an
electronic receipt of this transaction.The cardholder's signature further acknowledges use of this card for this
purchase and gives permission to have this card used for transactions associated with this order.
0377
Last 4 Digits of Credit Card
04/2017
Card Expiration Date(MMNYYY)
Card Holde at r
i
Date of Signature
For more information regarding the finishing, maintenance, service and warranty of all Pella®products, visit the Pella@ website at www.pella.com
i
Printed on 8/6/2015 Contract-Detailed Page 6 of 8
CUsxomer: Anthony Fragala Project Name: Anthony Fragala Order Number: 741AM0177 Quote Number: 7029450
Lead Safe Installation Customer Performance Expectations
i
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/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.
Customer Si ature Date
IIS
For more information regarding the finishing, maintenance, service and warranty of all Pella@ products, visit the Pella@ website at www.pella.com
Printed on 8/6/2015 Contract-Detailed Page 7 of 8
Customer: Anthony Fragala Project Name: Anthony Fragala Order Number: 741AM0177 Quote Number: 7029450
Pre-Renovation Form
Occupant Confirmation
i
Pamphlet Receipt
I 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.
Printed Name of Owner-occupant
Signatur r ant 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 8/6/2015 Contract-Detailed Page 8 of 8
NOTICE OF CANCELLATION
Date of transaction:
8/6/15
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 8/10/15 (three business days from the date of
transaction above).
I
I herebycancel this transaction.
(Date) (Buyer's signature)
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 OF 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,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 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
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.
other facilities and services necessary for the proper execution and completion
of the Work. IL HOME IMPROVEMENT CONTRACTORS
The materials and equipment furnished under the Contract will 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.
for damages or defects caused by abuse,modifications not executed by Pella, Any inquires about Pella or any of 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 One Ashburton Place,Boston,MA 02108,617-727-8598
accumulation of waste materials or rubbish caused by performance of the 12. PERMITS(MA customers only)
Work.
Pella is obligated to and will obtain the following permits for this project:
4. CHANGES B . Homeowners who secure their own permits will be
exclude from the guaranty fund provisions of Massachusetts General Laws,
The Owner may order in writing changes in the Work consisting of additions, chapter 142A.
deletions,or modifications("Change Order"). Any Change Order shall
include an adjustment to the Price and the Substantial Completion Date,as In addition to the rights and warranties enumerated in this agreement,you may
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
complete the Work is affected by conduct of the Owner,weather,labor the seller in writing at his main office or branch by ordinary
disputes,availability of subcontractors,acts of God,fire or other causes mail posted,by telegram sent or by delivery,not later than
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
parts or work to be completed is acceptable.However,the holdback will not this right.
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
requisite approvals and authorizations for the full amount of the requested
financing shall have been received from the financial institution. Customer signature 8/6/15
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
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.
The Coameaonwealth of Massachusetts �K�tr�t�Fsorrrr
Department of Industrial Accidents
= Office of hmestigations
I Congress Street, Suite 100
Boston,MA 021142017
www mass,gor/dia
Workers' Compensation Insurance Affidavit: builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): )PEZ/
Address: 4.11_)
City/State/Zip: `r&t (A72- Phone#: c 76-Z6,S'_y7_ .;j, '
Are you an employer? Check the appropriate box: 'Type of project(required):
1.[&l am a employer with J 4. ❑ I am a general contractor and I
have hired the sub-contractors 6. F]New construction
employees(full and/orpart-time).+
2.❑ I am a sole proprietor•or partner- listed on the attached sheet. 7. Z&�emodeling
ship and have no employees These sub-contractors have o, ❑ Demolition
working for me in any capacity. employees and have workers' 9. E]Building addition
[No workers'comp. insurance comp. insurance.
required.] 5• E] We are a corporation and its 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their l l.❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL l 7,❑ Roof repairs
insurance required.] t c. 152, §1(4),and we have no 13F1 Other
employees. [No workers'
comp.insurance required.]
*Any applicant that checks box#1 must also till out the section below showing their workers'compensation 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.
Tonraactors 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. Ifthe sub-contractors have employees,they must provide their workers'comp.policy number.
I am an emplgt er that is proi,iding workers'compensation insurance for nzy employees. Below is the policy and job site
information.
Insurance Company Name: �Z_s .req S
Policy#or Self-ins. Lie.#: -4)60 L4 L 10 tt Expiration Date:
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
tine 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 tine
of up to$250.00 a day against the violator. Be advised that a copy of this staternent may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do Izereby ycer.ti •.under the pains andpenalties of erjtiry that the information provided above is true and correct.
Sit nat re: ...w/ ----' A._�-- _ - ----- -- - - Date l�S zc� "!� :1
Phone#:
Official use only. Do not write in this area,to be completed by city or town official
City or'Torun: Permit/License#
Issuing Authority(circle one):
1. Board of Health 2.Building Department 3.City/'.Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
i
6.Other
I
Cantnet Percaan^ 0e6....,,U.
A� ®® CERTIFICATE ®F LIA ILIT`� INSU NCS GWDATE 9/2D15MMIODnYYY,
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be 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 CONTACT Dorothy A.CodelL CIC,RPLU
Fred C.Church,Inc. NAME
41 Wellman Street PHONED 9783227231 Nn: (978)454-1865
Lowe(800) MA 01651 dcorlett@tredcchurch.com
(8110)225-1865 -MAIL
ADDRESS:
INSURER(S)AFFORDING COVERAGE NAIC 9
INSURER A: Citizens Insurance Company of America 31534
INSURED INSURER B: New Hampshire Employers Insurance Company 13083
New England Window&Door LLC
45 Fendi Road INSURER C:
Haverhill,MA 01832-1302 INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:54457 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 NTH 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 ADDL SUBR POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MWDO MWDD LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 100.000
PREMISES Ea occurrence $
CLAIMS-MADE OCCUR MED EXP(Any one person) $ 10,000
A X CG0001 ZBN8161407 7/112015 71112016 1,000,000
PERSONAL&ADV INJURY $
GENERAL AGGREGATE $ 2.000.900
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2.000,000
POLICY X PRO- I X LOC $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
Ea accident
ANY AUTO BODILY INJURY(Per person) $
ALL OWNED SCHEDULED BODILY INJURY(Per $
AUTOS AUTOS ( )
HIRED AUTOS NON-OWNED PROPERTYDAMAGE $
AUTOS Per accident
S
UMBRELLALJAB OCCUR
EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE
AGGREGATE $
HOED I r RETENTION$ $
WORKERS COMPENSATION X WC STATU- OTH-
AND EMPLOYERS'LIABILITY SOO,ODO
ANY PROPRIETOR/PARTNER/EXECtfiVE YIN
N MIA A 4DD040101 7/112015 7/112016
B ❑ E.L.EACH ACCIDENT S
OFFICER/MEMBER F.XCLUDE07
(Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 500,000
If yes,describe under 500,000
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,U 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 y�
Client s 29bu Msl u Cert Holder# 38497 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25(20.10/05) The ACORD name and logo are registered marks of ACORD
se"W, 1 tri ent.9f�-ubhc Safety
E;
ti r"nggiilattons ano § andarcis
. i i .ft�Cl UCrltl❑ 4,'As�fi`r.�Ik41' `w• �_:: '+
Licence: CS-089853
to
WILLIAM R NICFtOLS
57 PEARTREE RI)'
HAVERHILL MA 01830 MM'.
vJ--
Expiration `
Commissioner 10/26/2016
5
/� .. .. �._ , • ._�,. .-_, .......N .. -..�.firs _
Office-of Consumer Affairs&,$usin/ess Regulation ! License or registration�Calid for indiviaul use only,
ME IMPROVEMENT CONTRACTOR before the expiration date.'If fotlnd return to:
egistration: 178383 Type: Office of Consumer Affairs and Business.Regulation ..
xpiration: 4/10/2016: Corporation 10 Park Plaza-Suite.5170
Boston,MA 02116
PELLA WINDOWS AND DOOR f
WILLIAM NICHOLS
. 45 FONDE RD 4
HAVERHILL,MA 01832C--"—
Undersecretary Not valid without signature
I IL
i