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Home My WebLink AboutBuilding Permit #1211-16 - 149 SUMMER STREET 5/1/2018 L NORTH q BUILDING PERMIT 0 .1 X64 4.0 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: �/ . 16 Date Received 7qA°RATED�Pa��g SUS ACH Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER PA-t1L �L-c Print 100 Year Structure yes no MAP 3Q_PARCEL: S_ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family [I Addition ❑ wo or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial 2epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION 9,F WORK TO BE PERFORMED: r Identification- Please Type or Print Clearly Y Phone: g OWNER: Name: � 1-�Zl-�S 7.Z Address: St— Contractor Name: r 41A r one: -2 ` 4-� ` Email: Address: Supervisor's Construction License: -Exp. Date: 6-26 -�.. Home Improvement License:_ 1 f Z? 3 Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. i FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. ^f Total Project Cost: $ S.�O ' FEE: $ -&0 Check No.: l-�3�2 Receipt No.: 712 9 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund I J Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ I TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - H FORINT � PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes i Planning Board Decision: Comments .-Conservation Decision: Comments Water& Sewer Connection/snature Date Drivewav Permit I DPW Town ]Engineer: Signature: RE DEPA FRIT - z - Located 384 Osgood Street F� �TrM .T mrnp�steronsite^yes �; .n,o {Located.at,1r24.11/Iain�St'reetf �•- �- "� - �—� FireDepartmentsignatur�e ate __,_ µ ,e �C.®MMEN�T 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 A 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) i El Notified for pickup Call Email r _ Date Time Contact Name Doc.Building Pennit Revised 2014 . r 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 Pp 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) 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 Doe:Building Permit Revised 2014 Location No. '� f r ,r Date S-/ • TOWN OF NORTH ANDOVER f Certificate of Occupancy $ Building/Frame Permit Fee $ G '� Foundation Permit Fee $ �_ Other Permit Fee $ TOTAL $ , Check#�, ? Cj Building Inspector r1 NORTH _ : ver O •-tiw y`' to No. z - � o ver, Mass, 4ATEo U BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System � BUILDING INSPECTOR THIS CERTIFIES THAT ........ 11945 2..1....!.`.J. �.�............................................................................. has permission to erect g ... �i�f, 50,W1� ��' �� Foundation .......................... buildings ....... .......................................................... Rough tobe occupied as ............................... .. ............................ ... ............................................................. Chimney provided that the person accepting this permit shall in every respect conform to the'terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION TS 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 by the Building Inspector. Burner Street No. Smoke Det. L Contract - Detailed Pella Window and Door Showroom of Haverhill Sales Rep Name: Griseto, Anthony ® 45 Fondi Rd Sales Rep Phone: 978-490-9666 Haverhill, MA 01832 Phone: (978) 373-2500 Fax: (978) 373-7274 Sales Rep Fax: Sales Rep E-Mail: GRISETOAC@pellaboston.com Customer Information Project/Delivery Address Order Information Paul Tanglis Tanglis,Paul,NorthAndover,MA,1714461 Quote Name: 2 Encompass Doors 2 Storm Doors 149 Summer St 149 Summer St Order Number: 741AGO623 NORTH ANDOVER, MA 01845-4816 Lot# Quote Number: 7790574 Primary Phone:(978)7715573 NORTH ANDOVER, MA 01845-4816 Order Type: Installed Sales Mobile Phone: County: ESSEX Payment Terms: Deposit/C.O.D. Fax Number: Tax Code: MA TAX 6.25 E-Mail: pltanglis@yahoo.com Quoted Date: 4/26/2016 Great Plains#: 10616400 Customer Number: 1007880725 Customer Account: 1003740108 Line# Location: Attributes 10 Delivery Delivery/Setup-Delivery/Setup Item Price Qty Ext'd Price $197.40 1 $197.40 For more information regarding the finishing,maintenance, service and warranty of all Pella®products,visit the Pella®website at vwwv.pella.com Printed on 5/1012016 Contract-Detailed Page 1 of 8 Customer: Paul Tanglis Project Name: Tan glis,Paul,NorthAndover,MA,1714461 Order Number: 741AGO623 Quote Number: 7790574 Line# Location: Attributes 15 Back Door Encompass By Pella, Entry Door Inswing, White Item Price Qty Ext'd Price $2,643.08 1 $2,643.08 1: Entry Door PK# Unit Type: Right Inswing,Standard Sill,No Fire Rating 787 Panel Style: 1/2 Light Glass: Tempered Low-E Air Filled Grilles: No Grille Panel Selection: Oak,Painted,White,Stained,Early American Frame Selection: Wood,Pine,Composite Threshold,Primed,Wood,Primed Viewed From Exterior Hardware Options: Latch Bore with Deadbolt,2 3/8",Steel Spring,Satin Nickel, Bronze Anodized ES—Single-Install Single Entry Door ( Qty 1 PVC Upgrade>48-PVC Upgrade greater than 48 inches Qty 1 Paint ED Frame-Paint Encompass ED Frame Only I Qty 1 Schlage Lever&Db-Satin-Schlage Lever&Deadbolt-Satin Qty 1 Entry Trim Finish-Finish Paint/Stain Entry Interior Trim Only Qty 1 Line# Location: Attributes 20 Front Door Encompass By Pella, Entry Door Inswing, White Item Price Qty Ext'd Price $2,433.86 1 $2,433.86 -'; 1: Entry Door PK# Unit Type: Right Inswing,Standard Sill, No Fire Rating Panel Style: 6 Panel e' 787 Panel Selection: Oak,Painted,White,Stained,Early American Frame Selection: Wood,Pine,Composite Threshold,Primed,Wood,Primed Hardware Options: Latch Bore with Deadbolt,2 3/8",Standard Steel,Black,Bronze Anodized Viewed From Exterior Schlage Lever&Db-ORB-Schlage Lever&Deadbolt-Oil Rubbed Bronze Qty 1 Entry Trim Finish-Finish Paint/Stain Entry Interior Trim Only Qty 1 ES Single-Install Single Entry Door Qty 1 PVC Upgrade>48-PVC Upgrade greater than 48 inches Qty 1 Paint ED Frame-Paint Encompass ED Frame Only � Qty 1 For more information regarding the finishing, maintenance,service and warranty of all Pella®products,visit the Pella®website at www.pella.com Printed on 5/10/2016 Contract-Detailed Page 2 of 8 Customer: Paul Tanglis Project Name: Tanglis,Paul,NorthAndover,MA,1714461 Order Number: 741AGO623 Quote Number: 7790574 LLine# Location: Attributes 25 None Assigned Entry Systems, Storm Door Fullview Interchangeable Unhanded, White(91025) Item Price qty Ext'd Price $668.64 1 $668.64 i 1:to 81 Unhanded Storm Door PK# General Information: Clad 787 Exterior Color/Finish: Standard Enduraclad,White Sash/Panel: 1 5/8"Extruded Glass: Clear Hardware Options: Standard,Oil Rubbed Bronze Model: 4601 Viewed From Exterior ES—Storm Door Express-Install Storm Door Express(4601,4602,3900,3010,3020) Qty 1 Line# Location: Attributes 30 None Assigned Entry Systems, Storm Door Fullview Rolscreen Unhanded, White (P390052331) Item Price Qty Ext'd Price $701.53 1 $701.53 1:to 81 Unhanded Storm Door PK# General Information: Clad Exterior Color/Finish: Standard Enduraclad,White I 787 Sash/Panel: 1 3/8"Extruded Glass: Clear Hardware Options: Standard,Satin Nickel r Model: 3900 Viewed From Exterior ES—Storm Door Express-Install Storm Door Express(4601,4602,39D0,3010,3020) 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 apart 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. For more information regarding the finishing, maintenance, service and warranty of all Pella@ products,visit the Pella®website at www.pella.com Printed on 5/10/2016 Contract-Detailed Page 3 of 8 Customer: Paul Tanglis Project Name: Tanglis,Paul,NorthAndover,MA,1714461 Order Number: 741AGO623 Quote Number: 7790574 Product Performance Information: U-Factor,Solar Heat Gain Coefficient(SHGC),and Visible Light Transmittance(VLT)are certified by the National Fenestration Rating Council(NFRC).Manufacturer stipulates that these ratings conform to applicable NFRC procedures for determining whole product performance.NFRC ratings are determined for a fixed set of environmental conditions and a specific product size.NFRC does not recommend any products and does not warrant the suitability of any product for any specific use. Design Pressure(DP),Performance Class,and Performance Grade(PG)are certified by a third party organization,in many cases the Window and Door Manufacturers Association (WDMA).The certification requires the performance of at least one product of the product line to be tested in accordance with the applicable performance standards and verified by an independent party.The certification indicates that the product(s)of the product line passed the applicable tests.The certification does not apply to mulled and/or product combinations unless noted.Actual product results will vary and change over the products life. For more performance information along with information on Florida Product Approval System(FPAS)Number and Texas Dept.of Insurance(TDI)number go to www.pella.com /performance. Project Checklist Review (Installed Orders Only) Before the Installation the Homeowner agrees to do the following: Obtain Condo Association Approval Obtain Historic Approval Remove existing shutters and awnings Remove air conditioners Remove existing shades, drapes,window treatments,wall hangings, and personal belongings Move furniture at least 3 feet away from work area Tie or cut back trees, bushes and shrubs in the work area Arrange to have alarm system and doorbells disconnected Arrange to have any plumbing and electrical repairs or changes made by appropriate licensed contractor Provide a door handle and lockset for entry door if Pella handle and lockset is not purchased. Before the Installation Pella agrees to do the following; Obtain Building Permit(When required) Prefinish products when purchased in contract Durina 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 Durina 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 For more information regarding the finishing, maintenance,service and warranty of all Pella®products,visit the Pella®website at www.pelia.com Printed on 5/10/2016 Contract-Detailed Page 4 of 8 Customer: Paul Tanglis Project Name: Tanglis,Paul,NorthAndover,MA,1714461 Order Number: 741AGO623 Quote Number: 7790574 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 and joints on interior trim if windows are to be stained (after staining) 'I up exte ' r casing issues due to storm window removal if full wrap or new exterior trim is not purchased 1 - oject Checklist has been reviewed Customer ini Product Only Addendum has been reviewed Customer initial / Credit Card Account#: Last 4 Digits / Expiration Date: p Charge final payment to same account ' J (Upon substantial completion) Customer initia For more information regarding the finishing,maintenance,service and warranty of all Pella®products,visit the Pella®website at www.pella.com Printed on 5/10/2016 Contract-Detailed Page 5 of 8 Customer:Paul Tanglis Project Name: Tanglis,Paul,NorthAndover,MA,1714461 Order Number: 741AGO623 Quote Number: 7790574 Project Checklist has been reviewed Po u. ( 1 , 4 - Customer Name (Please print) Pella Sa s p N9Je (Please print Order Totals Taxable Subtotal $3,515.51 Customer Signature P Ill a Sales / S' ture Sales Tax @ 6.25% $219.72 Non-taxable Subtotal $3,129.00 Date Date Total $6,864.23 P � Deposit Received $0.00 Credit Card Approval Sign ure Amount Due $6,864.23 For more information regarding the finishing,maintenance, service and warranty of all PellaO products,visit the Pella@ website at www.pella.com Printed on 5/10/2016 Contract-Detailed Page 6 of 8 stomer:Paul Tanglis Project Name: Tang is,Paul,NorthAndover,MA,1714461 Order Number: 741AG0623 Quote Number: 7790574 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) st be cleared of items nd be s ace dusted r to installation ❑ You will be responsible for replacing all furniture and personal items after your inst ation ❑ Other items: What to Expect the C ntainment/Work Area to Look Like ❑ In order to ensure your safety, we will be taking meas es 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, tion 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 m also see your installation professional wearing Personal Protection Equipment. ❑ For your own safety, we are not per itted 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 a affirming that I understand all the expectations noted above and that I have agreed to have all items completed prior to my installation commencin . understand that failure to have these items completed will result in the re-scheduling of my installation and that my installation date will be eduled for the next available date. Customer Signature Date F�� more information regarding the finishing, maintenance, service-and of alI Pella®products,visit the Pella®website at www.pella.com Printed on 5/10/2016 Contract-Detailed Page 7 of 8 Customer: Paul Tanglis Project Name: Tang lis,Paul,NorthAndover,MA,1714461 Order Number: 741AGO623 Quote Number: 7790574 Pre-Renovation Form Occupant Confirmation Pamphlet Receipt I have received a copy of the lead hazard information pamphlet informing me of the potential risk of lead hazar xposure from renovation activity to be performed in my dwelling unit. I received this pamphlet before the work began. l Printed Name of Owner-occupant Signature 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 bu 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 t ead hazard information pamphlet to the rental dwelling unit listed below at the date and time indicated and that the occupant declined to sign the c irmation 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 ood faith effort to deliver the lead hazard information pamphlet to the rental dwelling unit listed below and that the occupant was unavailable to sig he 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 Delive Attempted Delivery Date i Signature of Person Certifyi�Diery 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.pella.com Printed on 5/10/2016 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 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 windows. 9 LIMITED PRODUCTWARRANTY 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. FELLA SPECIFICALLY DISCLAIMS ALL OTHER WARRANTIES, EXPRESS Olt 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. 11. 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 Pelta 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 02108,617-727-8>98 accumulation ofwaste materials or rubbish caused by performance of the 12. PERMITS(MA customers only) Work. Pella is obli aled to and will obtain the following permits for this project: Homeowners QUI o eowners wh secure 4. CHANGES o s cu c their own permits will be excluded 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 extended to allow for Change Orders requested by Owner or ifthe 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 the seller in writing at his main office or branch by ordinary disputes,availability of subcontractors,acts of God,faire 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 j to be replaced or repaired,a hold back proportionate to the cost of remaining See the attached Notice of Cancellation for an explanation of �I 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. 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 ofthis Contract and the C.�—� �CJ�/"`�_` requisite approvals and authorizations for the full amount of the requested financing shall have been received from the financial institution. Customer stn ure 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 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: 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 \� f not later than midnight of J f (three business days from the date of transaction above). I hereby cancel this transaction. (Date) (Buyer's signature) Do NOT sign here unless you wish to cancel ' The tCominaonwea th ofl�llea,sacist¢seiis ePrfnf} Orr i Depaari¢uent of Industrial Accidents - Office of Investigations }! I Congress Street, Suite 100 Boston,MA 02114-2017 nww.mass.gov1dia Workers' Compensation ffnsua-ance Affidavit. Builders/Coanrtractors/Electrisaans/PBumbelrs Ayulicant Information Please Print Legibly Name(Business/Organization/Individual): 4011 Address: 45 ,x, g City/State/Zip: t _a t( I Phone#: '735-Z6,'-7. Are you an employer`'Check the appropriate box: Type of project(required): 1.D.,,I am a employer with 7-S 4- ❑ I am a general contractor and.1 have hired the sub-contractors 6. []New construction employees(full and/or part-time).* 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp. insurance comp. insurance.' required.] . 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.E]Roof repairs insurance required.] c. 152, §1(4),and we have no 13.❑Other employees. [No workers' comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. r Homeoxvners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. [f the sub-contractors have employees,they must provide their workers'comp.policy number. I am an emplover that is providing Workers'compensation insurance for neap employees. Below is the policy and job site information. Insurance Company Name: Lc, • ip Zig,, Policy#or Self-ins.Lic.#: 0 L40 Expiration Date: :I Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under lite pains and penaldes ofperjury that the information provided above is true and correct &Matu e: - - - -- - -- - - — - 'Date' Phone#: ®fficial use only. Ido not Write in this area, to be completed by ciq,or town official. City or Town: Permit/License ff Issuing Authority(circle one): 1.Board oT l'Ieakh 2. wilding Department J.C'kyff wn fieri;, 4. 1L+Oectrica� Inspector 5. Muoubing Inspector 6. other 4Y„m,-.,.,,,. m,ft.... ,, u- RYIFOC o F LIABILITY INSURANCECIMB6I�Im,5�0DLrDAfYYYI "PHIS T CERTIFICATE E 15 ISSUED A fiiIATTER OF INFORINATIAN ONLY AND CONFERS N0 RIGHTS UPON THE L'ERTIFICATE HAI�EIT THIS DOOES NOT AFFIRR MATIVELY OR NEGATIVELY AMEND, UMND OR ALTER TELE COVERAGE AFFORDED BY THE IaOU�� BELOlR1. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE TEtACi®ETUiEEN THE ISSUING INSURER(S),AIUT$I®RILED REPRESENTATIVE OR PRODUCER,AND TETE CERTIFICATE A CANHOLDEEL IMPORTANT If the certificate holdee is an ADDITIONAL INSURED,am policy(ies'¢Raaf6e endorsed If SU6RAGATION IS VIIAIIlEE�,sBrf►Jecf the feMIS acid cONdiliDns of the p01Ecy;certain 1lolicies array ar e�9yrrd0iseRaeasL A sblsanent ora Ilds go certificate holder in heN Of such endow--emen . a 8ca6a dose aNyf�yd�dl to The PRODUCER Fmd t Ch Set h Loc 91 WermanShe0 ACF pV1hyA.CujKCIC,RPLU LGIVEA MA 01851 PHONE 0321231 IBpU)2Z5gB85 E�OAIL FAX Na (B7BI454-1065 OGRESS: �°hed OAIAiERI AFFDRDWG COVERAGE INSURED INSURERA- CM —®CTnPny9[Aml NAICiT 37539 NewEn9lendilifmdaw6pmu!!C INSURERS.: Neallimps aEmplayerslnsuren�Company 13003 45 ft&Road INSURER C: Haeedial,MA Olen-IM INSURERD: . INSURER E: COVERAGES CERTIFICATE NUM9ER INSURER F: THIS IS TO CERTIFY THAT TMEPOLICIES OF INSURANCE LISTm BELOW HAVE BEEN ISSUED TO THE INSURED NAMED AeOUSION MEDFOR THE POLICY PERIOD INDICATED. PIOIIMTHSTANDING ANY REQUIREMENT; CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLI Cr R OT"ER D HEREIN IS SUBJECT EC ALL THEH THIS TERMS, TEN OR I;QND►>lON 8F ANY CONTRACTOR OTHER DOCUMENT WITH RESPECTTO yU►.I(CH THIS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BYPI4ID CLAIMS. INSR L TYPEOFWSURANCE AOOLSUBR PO DYER POUCY G89ERALLLUUM POLICYNUMBER MMIDO ft00 Lem ft COMMERCIAL GENERAL UABiIfi Y MH OCCURRENCE g 1.100,008 DSES a�AG RID $100,000 CLAIMS•a6A0E It OCCUR A IT CGpOpi MED EV(Any a�re $Tgppo �N01619p7 7Ii12p15 1111F1116 PER50NAL&ADVINJURY 51.100,000 GENT-AGGREGATE LIMT APPLIES PER. GENERAL,AGGP,EGAIE $Z11W.1100 POLICY X PRO g J LOC PRODUCTS-COP 2=13.11110M lOPAGti $ AUTO MOBILE LUU31LfTY S MY AUTO COMBNEDSINGLEIIM ALL a e g TI AUTO; I� SCHEDULED 0000 Y Kmy(PerPelsanQ 5 ALITUS HOIEDAUTTTS A O � 0000-YW1JRY(PermxWanl) $ PROan E S UMBRELu UAB OCCLIR 9 amms LUTB CLAIMS MAGE EACH OCCURRENCE 5 DED RETENTIONS AGGREGATE 5 WOfl10EtS COMPENSATION AND EMPLOYm LIIIBaLTrY S e ANY PROPRIETORIpARTNEREMU-IjVE TIN H WCSTAMTU- OTH- OFFICEIUMGIABEREMCLUDED? ® NIA 900090101 IMandaamyinNfl) 7N1$D15 TIM015 �-EACHACCIDINT $fi00000 OES PlION OFOPERATIONS helnmr $SW,00p � EL DISEASE-EA F-LOISFASE-POUCYLRIIFF $�400f1 OESCRIPII aPERATRTNSILOCAT10MSiVEpCLE5(A"d'ACOR0iKAddLonaaRemafiSSc CERTIFICATE HOLDIER CA4NGIELLATION III,of Public Safe'q- •°'`-r-`r a o}ta1 r.tstiiin �aaa�.,r�israr a - � LiCenS`e: CS-089853 WILLIAM+R NICH®LS ' a€ s 7 PEARTREE RD w " _ VLRHILLMA'Q1830�`.�� Y « y n Expirati ` Cornmissioner 1b12612016 ' .nf/ze Cpa79177�n02cc�e�r�/!Ga�C��aJa¢c�r�JG//11 . 'cc of Consumer Affairs&Business Regulation License or registration valid.for individul use only 11,,X IAE IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation egistration 183279 Type: 10 Park Plaza-Suite 5170 Expiration g(24/2017 Supplement Curd Boston,MA 02116 NEW ENGLAND WINDOWA'DOOR; LLC. PELLA WINDOWS&DOORS William Nichols 45 FONDI ROAD HAVERHILL,AAA 0,18$2 . Undersecretary Not valid.without signature 'JL