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HomeMy WebLinkAboutBuilding Permit #281-14 - 171 WEYLAND CIRCLE 9/27/2013 NORT{i P � 064t�e°na�ti0 BUILDING PERMIT ,�? b,,::�. ._ ,. 6 0� TOWN OF NORTH ANDOVER - o APPLICATION FOR PLAN EXAMINATIO Permit NO: Date Received 6AATOP <a �-<•� �' �9SS�CHUS'( Date Issued: 11 I RTANT:Applicant must complete all items on this page LOCATION 1-7Weyl(2nd (! ; Mle— I PROPERTY OWNER ZQ.Y11 e- CL Print Z accr) rd Print MAP NO: 6.5 PARCELZG4 ZONING DISTRICTR2 Historic District yesrno Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer zrin siL 1 I 4 Pe la e-meyii nJo me- S^i eei Ajor) -Efru.ctc ra. 1 . u- Ra.cio r- o 0. 30 L n A Doe Rami ' eottn o Identification Please Type or Print Clearly) OWNER: Name: Dan 1' e I cLr Phone:978•?2 S. *16 3 Address: I'll W e 1 Q l��?i're I NorA Andover-, MCX~0134S- CONTRACTOR Name: Phone- 860,-7 G 3-6452- SeurowiP --v"n- �t.l L25 v&C- eorrs �en Address:82.7 7- Yom ,5 p n f'� t'C tAomP S OY1 CT d 6 Z 77 Supervisor's Construction License: Exp. Date: �., q'1 S l q 8/31 ?-014- Home Improvement License: 148 G() -7 Exp. Date: �D / 1 ZO/3 ARCHITECT/ENGINEER N A Phone: Address: Reg. No. FEE SCHEDULE.BULDINGG�PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. `'t' Total Project Cost: $ e 3 O — FEE: $ V54 ` �- -o 4, Check No.: — Receipt No.: NOTE: Persons contrae ing with unregistered contractors do not have ae ess to I e g aranty f nd .,t Signature of Agent/Own Signature of contractor j y � * F 1! Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ STYPE OP--SEW-ERAGEDiSPOSAL Public Sewer ❑ Swimming Pools El Art ❑ _ . 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:APPR-OVED 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 f DPW'To` ;2 Engineer: Signature: Located 384 Osgood Street FIRE-DEPARTMENT Temp Dumpster on site yes no Located-at 124 Mair, Street -Fire Department signature/date`' 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 t Doo.Building Permit Revised 2010 Building Department The following i6 a list of the required.forms to be filled out for the appropriate.permit to'be obtained. Roofing, Siding, Interior Rehabilitation Permits u Building Permit Application u Workers Comp Affidavit u Photo Copy Of H.I.C. And/Or C.S.L. Licenses u Copy of Contract L3 Floor Plan Or Proposed Interior Work u Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks u Building Permit Application • Certified Surveyed Plot Plan Li Workers Comp Affidavit Li Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract u Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) Li Mass check Energy Compliance Report (If Applicable) u 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) o Building Permit Application i o Certified Proposed Plot Plan Li Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) L3 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 apw al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.tted with the building application Doc: Doc.Building permit Revised 2012 Location + +"�i Cide— No. ~ Date • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 94,&D Foundation Permit Fee $ Other Permit Fee $ TOTAL $ • Check# e-Ak-- � �' v 1 Building Inspector NORTly Town of EAndover No. � I- 14:�ver, Mass, COC NIC Nl WICK y1. ��AERATED Pp��,�y S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT �� �0rCC��. BUILDING INSPECTOR has permission to erect .......................... buildings on 11.1.......W.C... ..............�N.. .� < Foundation ..... .... ... � ....... ..`........ Rough to be occupied as ...4......RIC .. .�, li� ... � J�I.'.-M+�......................................... Chimney provided that the person accepting t is permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIT TS Rough 90'. Service .................. .. I........ ............................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. SEE REVERSE SIDE The Commonwealth of Massachusetts ! Department of Industrial Accidents Office of Investigations UT 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly. Name (Business/Organization/Individual): Sears Home Improvement Products Incorporated Address: 1024 Florida Central Parkway City/State/Zip: Longwood, FL 32750 Phone #: 860-753-0452 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 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 8. ❑ Demolition working forme in any capacity, workers' comp. insurance. 9. ❑Building addition [No workers' comp. insurance 5. We are a corporation and its required.] officers have exercised their I0.EJ Electrical repairs or additions 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.❑Roofrepairs � ua insurance required.] t employees. o'workers' 13.� Other " R �n comp. insurance required.] *Any applicant that checks box#1 must also fill 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. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site information. Insurance Company Name: Ace American Insurance Company / Phone:866-283-7122 Policy#or Self-ins. Lic. # WLRC47322534 Expiration Date: 08/01/2014 iir r MCL Job Site Address: I JL, / e City/State/Zip C�r" Attach a copy of the workers'compensation.policy declaration page(showing the policy number and expiration date).0184S7 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. 1 do hereby cerhf nde a pains an nalties of perjury that the information provided above is true and correct. Si nature (Sears Auth.Agent) Date: Z7 Phone#: Home—Fax: 860-935- 46 / Cell: 860-753-0452 Official use only. Do..not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone M Y A CERTIFICATE OF LIABILITY INSURANCE FATE07M9/20 3YYY) 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 00 BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. 0 J IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the w certificate holder in lieu of such endorsement(s). m PRODUCER CONTACT Aon Risk Services Central, Inc. NAME: Chicago IL Office (A1C Mo.Ext): (866) 283-7122 F�No : (800) 363-0105 d 0 200 East Randolph E-MAIL c Chicago IL 60601 USA ADDRESS: _ INSURER(S)AFFORDING COVERAGE NAIC p INSURED INSURER A: ACE American Insurance Company 22667 Sears Holdings Corporation INSURERS: Indemnity Insurance Co of North America 43575 dba Sears Home Improvement Products, Inc Attn: Risk Management E3-219A INSURER C: 3333 Beverly Road INSURER D: Hoffman Estates IL 60179 USA INSURER E: INSURER F; COVERAGES CERTIFICATE NUMBER:570050796993 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested INSIR LTR TYPE OF INSURANCE INSR WAID POLICY NUMBERMMIDD/YYYY MMIDDIYYYY LIMITS A GENERAL LIABILITY HDOG 1 EACH OCCURRENCE $5,000,000' X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence) $5,000,000 CLAIMS-MADE X❑OCCUR MED EXP(Any one person) EXCI uded PERSONAL&ADV INJURY $S10001000 rn GENERAL AGGREGATE $5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S5,000,000 w 0 X POLICY PRO- LOCJECT p t` A AUTOMOBILE LIABILITY ISAH08719780 08/01/2013 08/01/2014 COMBINED SINGLE LIMIT $5,000,000 N A ISAH08719792 08/01/2013 08/01/2014 Ea accident A ANY AUTO ISAH08719809 08/01/2013 08/01/2014 BODILY INJURY(Per person) O Z X ALL OWNEDSCHEDULED BODILY INJURY(Per accident) y AUTOS AUTOS +.. X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE V AUTOS Per accident d UMBRELLA LIABLl OCCUR EACH OCCURRENCE V EXCESS LIAB CLAIMS-MADE AGGREGATE DED I RETENTION A WORKEEMPLORS COMAPEEIN YTION AND WLRC47322534 08/01/2013 08/01/2014 X TORY LIMITS ETH YIN CA MA AZ BANY PROPRIETOR I PARTNER I EXECUTIVE E.L.EACH ACCIDENT $2,000,000 OFFICER/MEMBER EXCLUDED? NIA WLRC47319122 08/01/2013 08/01/2014 (Mandatory in NH) All other States E.L.DISEASE-EA EMPLOYEE $2,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $2,000,000 li• DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,H more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WALL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Sears Home Improvement Products, Inc. AUTHORIZED REPRESENTATIVE 1540 American way Longwood FL 32750 USA ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD ........ .......... ........ .... d rax s� Office of Consumer Aff°ai aiXus=es/ u�atir�>i� 0 Park Plaza - Suite 5170 Boston, Massachusetts 0211 Home tmprovembnt Contractor Registration # egistratioh: 148607 Type: Supplement Card. Expiration: 10/1W013 SEALS HOME IMPROVEMENT PRODUCT LU OS SVEG 1024 FLORIDA CENTRAL AL PKWY LONGWOOD, FL 3275 Update 'tddress anti return card Murk reason for cb anft, Address Renewal .`; EmploYme"t Lost(;crit ;`f"v:,•°. &:Z-x2_ Yz-F;:�rrx S�b1J - ..,,.. ..., Offict of('omuaner Affairs Rcgubitioo License or registration solid frar irrriir tlu#use only HOME IMPROVEMENT CONTRACTOR before the expiration date. if found return to, Office of Consumer Affairs and Business*gulation Registration. 10307 Type: 10 Puri.Plaza«.Shite 5170 E.xpiration,, 1 iii it2p13 Supplement Gard tftrsttau, 41A 02116 SEARS FSOWE IMPROVEMENT PRODUCTS INC. LUBOS SVEC C2x�FLORIDA CENTRAL PKWY :a„ .,_..... LO vafirOOD.it_32750 1'ndersecrrifar. Not valid s+itlaorat Sig attire {{ i ,: -�-- .`mow" .,,z�,-`'�`" •"acs �,w� Massachusetts«Department of Panic Safety Board of Building Regulations and Standards Construction Super,iisol- Li nse CS-097519 LUBOS SVEC 827 THOMPSON,'ROA6 Thompson CT 06-277 f a� Expiration commissioner 08/3112014 r� •' ���������������� Office Location:BOSTON Proposal Date 08/07/2013 Job Number 16024452 Sears Home Improvement Products,Inc. Customer Name /�'� P.O.Box 522290 DANIELA DACCORD 1 95 e.. �1�� 1024 Florida Central Parkway Customer's Home Phone Customer's Work Phone Longwood,FL 32750-7579 (978) 725-4963 (978) 807-1379 Home Improvement Products phone 800 469-4663 Street Address ESTIMATE AND PROPOSAL Contractor License/Registration Number 171 WEYLAND CIR MA(148607) City State Zip Code wlndOWS All plumbing and electrical services performed by NORTH ANDOVER MA 01845 Is installation within city limits? licensed subcontractors Installation Address County MIDDLESEX (Yes/No): NO FEIN 25-1698591 Billing Address(if different from above) City State Zip Code Project Consultant Name 8 License No.(if applicable) LEONARD 3 ZAVALICK 30409 � Description of the Project and Description of the Significant Materials to be Used and Equipment to be installed 1. Remove existing units to be replaced.(PLEASE NOTE:The removed units are likely to be damaged.) 2. Prepare openings as necessary to receive replacement units.(No finish work other than normal installation is to be done unless otherwise noted below.) 3. Installation includes the clean-up of all job-related debris upon completion of the job. 4. (If applicable)After the completion of the project,the customer will be responsible for the application and removal(storage)of shutter panels. In the event that the project requires the installation of storm shutters or egress windows, Sears Home Improvement Products, Inc. ("Sears') will not re-install any affected security bars. 5. (If applicable)In the event Sears is unable for whatever reason to obtain the proper permits prior to the commencement of any work,Sears will refund any previous payment and this contract will be automatically cancelled. Summary of Window Order Addendum(see detailed Window Order Addendum for more information): Type: WB PLUS (WINCORE) Quantity: 4 Type: Quantity: Type: Quantity: Type: Quantity: Type: Quantity: The Window Order Addendum is made a part of and incorporated into this contract by Customer(s)initials reference. Additional work to be done:NONE Work NOT to be done: NONE SPECIAL INSTRUCTIONS:NONE All of the above check boxes, "Work NOT to be done," "Additional work to be done," and Customer(s)initials "Special Instructions"sections have been reviewed and explained to me. SM-MA (Dig.) Rev 08/13/12 Page 1 of 3 Yy " II III III I I III III • 16024452 Job Number. APPROXIMATE START DATE and APPROXIMATE COMPLETION DATE: The work will start approximately 2-4 WEEKS (Approximate Start Date) It will be substantially completed by approximately 4-6 WEEKS (Approximate Completion Date) These dates are subject to change at the time the contract is accepted by Sears Home Improvement Products, Inc.("Sears")or at any other time by mutual written agreement.Customer understands that the Approximate Start Date is only an estimated date and the Customer will be contacted prior to this date to schedule the actual start date. ASBESTOS ABATEMENT: This Estimate and Proposal assumes that there are no asbestos containing materials ("ACMs")that would be disturbed in the performance of the installation work. If upon further inspection by the contractor or others it is learned that ACMs have to be disturbed to perform work,then Customer must arrange and pay for abatement of asbestos by a qualified person prior to the start or continuation of work. If Customer fails to arrange for necessary asbestos abatement within thirty (30) days, Sears may cancel this contract upon -IF-! written notice to Customer. Customer(s)initials cL The TOTAL PRICE including all labor,material,taxes and any applicable discount is$ 4,530.89 Contract Price $4,530.89 Initial Payment(not to exceed 30%of Total Price unless Special Order)$ 1,359-27 State Sales Tax( 0.00 %o) $o.oo Final Payment(balance payable upon completion of job)$ 3,171.62 Local Sales Tax( 0.00 %) $o.oo The Initial Payment is due prior to Sears ordering products. I Total Amount Due $4,530.89 The form and method by which the Customer(s)will pay is described in a separate Cash/Credit Card Payment Addendum made a part of and incorporated into this contract by reference. Customer(s)initials NOTICE TO BUYER: YOU, THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY (FIFTH BUSINESS DAY IN ALASKA, FIFTEENTH BUSINESS DAY IN NORTH DAKOTA IF YOU ARE AGE 65 OR OLDER)AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. ADDITIONAL PROVISIONS Proposal and Approval.Sears offers to furnish the materials and arrange for their delivery and installation as specified on the first page and/or the attached sketches and specification sheets for the TOTAL PRICE shown.This offer must be approved by the Installation Department. If this is a credit sale or a payment on completion sale,it must be approved by the Credit Sales Department. If this proposal is not approved or the installation cannot be made in accordance with the law,this offer will be withdrawn and any payments you have made will be refunded to you.Any materials left over after the installation has been completed are Sears property and will be removed by Sears. Installation. I understand that Sears will not install the materials but will arrange for the installation.Sears is not responsible for materials or installation NOT furnished or arranged by Sears.Sears'installation contractor(s)will obtain all building permits required by local law. For homes located in historic or landmark zoning districts,Customer will be responsible for obtaining required approvals and related permits prior to the commencement of work on this contract. Authorization. I authorize Sears to: (1)arrange for a contractor(licensed where required by law)to make the installation of materials; (2)issue a work order for this installation to a contractor; (3)inspect the installation; and(4)pay the contractor when the installation is complete if I have signed a certificate that the installation has been completed to my satisfaction. Delays in Installation.I agree that Sears is not responsible for delays in delivery or installation due to weather,fire,strikes,war,government regulations or any causes beyond Sears'control. Oral Agreements and Changes in Contract.I understand that there are no oral agreements between Sears and me.Everything I expect Sears to do has been included in writing in this contract. Nothing can be changed in this contract unless it is in writing on a separate form accepted by me and Sears. Responsibility of Buyer. I agree that any information or measurements that I give to Sears are correct and complete. I am responsible for any special work described in this contract. Electrical&Plumbing Service. I will provide adequate electrical and/or plumbing service(s)to run any newly installed appliances or other furnishings. If the electrical and/or plumbing service(s)do not meet the standards of the utility company or electrical and/or plumbing codes, I will make the necessary changes at my expense unless Sears has agreed in this contract to make the changes. Payment.I will pay Sears the cash price that covers the price of material and installation as shown on the first page. Warranty Information.Appropriate product warranty documents will be given to me by Sears.Sears'Warranty on Installation is: SEARS'LIMITED WARRANTY ON INSTALLATION In addition to any manufacturer warranty extended to you on the product(s)used(which warranty becomes effective the date the merchandise is installed),if the workmanship(or application)of any Sears'arranged installation proves faulty within(i)one year for Weatherbeater Value Line,(ii)two years for Weatherbeater Plus,or(iii)three years for Weatherbeater Max,and Weatherbeater Stormbeater,then upon notice from you Sears will cause such faults to be corrected by repair at no additional cost to you. If Sears determines that repair is not commercially practicable or cannot be timely made,then,at Sears'sole discretion,Sears may elect to provide replacement or refund.Service under this Limited Warranty is available by calling Sears Home Improvement Products at 1-800-222-5030, Option 4.This warranty gives you specific legal rights,and you may also have other rights that vary from State to State. SW1-MA (Dig.) Rev 08/13/12 Page 2 of 3 ra Job Number: 16024452 NOTICE TO BUYER 1. DO NOT SIGN THE AGREEMENT IF ANYOF THE SPACES INTENDED FOR THE AGREED TERMS TOTHE EXTENT OF THEAVAILABLE INFORMATION ARE LEFT BLANK. 2. YOU ARE ENTITLED TO A COPY OF THIS AGREEMENT AT THE TIME YOU SIGN IT.KEEP IT TO PROTECT YOUR LEGAL RIGHTS. 3. YOU MAY PAY OFF THE FULL UNPAID BALANCE DUE UNDER THE AGREEMENT AT ANY TIME,AND IN SO DOING YOU SHALL BE ENTITLED TO A FULL REBATE OF THE UNEARNED FINANCE AND INSURANCE CHARGES. 4, YOU MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY[FIFTH BUSINESS DAY IN ALASKA, FIFTEENTH BUSINESS DAY IN NORTH DAKOTA IF YOU ARE AGE 65 OR OLDER]AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT, FAILURE TO EXERCISE THIS OPTION, HOWEVER, WILL NOT INTERFERE WITH ANY OTHER REMEDIES AGAINST THE RETAIL SELLER YOU MAY POSSESS. IF YOU WISH,YOU MAY USE THIS PAGE AS NOTIFICATION BY WRITING"I HEREBY RESCIND"AND ADDING YOUR NAME AND ADDRESS.A DUPLICATE OF THIS RECEIPT IS PROVIDED BY THE SELLER FOR YOUR RECORDS. 5. IT SHALL NOT BE LEGAL FOR THE SELLER TO ENTER YOUR PREMISES UNLAWFULLY OR COMMIT ANY BREACH OF THE PEACE TO REPOSSESS GOODS PURCHASED UNDER THIS AGREEMENT. NOTICE TO MASSACHUSETTS RESIDENTS ONLY In addition to the Notice to Buyer shown above, Massachusetts law requires that contracts for home improvement work state that all home improvement contractors and subcontractors shall be registered and that any inquiries about a contractor or subcontractor relating to a registration should be directed to: Director,Home Improvement Contractor Registration P.O.Box 871 Taunton,MA 02780-0871 Telephone:(508)821-9375 Please note that owners who secure their own construction-related permits or deal with unregistered contractors shall be excluded from access to the Guarantee Fund. Notwithstanding any other language in the contract or associated documents, Sears will not remove, replace, or install any heating or air conditioning system, or any portion thereof, if asbestos or asbestos-containing material is known or likely to be present in that heating or air conditioning system,or any portion thereof, If it is determined or reasonably suspected that asbestos is present,either before commencement or during performance of the work, it shall be the customer's responsibility to select, retain and pay all costs of a Division of Occupational Safety ("DOS") licensed Asbestos Contractor to remove all asbestos or verify that none is present in the components involved in the job. If the determination or reasonable suspicion of the presence of asbestos arises after Sears has started the work, Sears will immediately cease performing the work until a DOS licensed Asbestos Contractor,hired by the customer, removes all asbestos from the components scheduled for repair or replacement in accordance with 310 C.M.R.7.00 and 453 C.M.R. 6.00 or verifies that none is present. By signing the contract the customer agrees that it understands the above. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES n6wp 08/08/2013 n""""—' 08/08/2013 R DnCCORD oar+eu o¢coao Customer's signature Date Customer's signature Date Accepted by Sears Home Improvement Products,Inc.("Sears")on 08/08/2013 by: C4#�t_ Date Management Representative SW1-MA (Dig.) Rev 08/13/12 Page 3 of 3 9 JOB NUMBER: 16024452-0003 PROPOSAL DATE: 8/7/2013 WINDOW ORDER ADDENDUM d 1 WP-DOUBLE HUNG 3 27 W X 54 H WHITE ^— LOWE/ARGON/CLEAR GRID STYLE{COLONIAL CONTOURED= [1 V1 H]} MATCH PRODUCT FULL SCREEN TWO CAM LOCK 2 WP—DOUBLE HUNG 1 27 W X 62 H WHITE LOWE/ARGON/CLEAR GRID STYLE{COLONIAL CONTOURED= [1 V1 H]} MATCH PRODUCT FULL SCREEN TWO CAM LOCK TOTALS: 4 COMMENT: � C� 08/08/2013 � � 08/08/2013 Customer Signature Date Customer Signature Date 1 of 1 10!'10/2012 12:56 17814712978 BOSTON SALES PAGE 61101 � wcw Lis ;510QS aeries YRtd O0a61e Hang Window: Urrofow w* i Vilm fR.AFiF�:0erEikADON:'LFAR Rin�:wueeR41 r Vemul gilder 4lrndow 1 CPDttpGUJ—M---000— --— i ENERGY PERFORMANCE RATINGS Sg�r Pactor(Um—p) Hae!Ga(g Gaelficierit 0, 0 0.24 AOOITIONAL PERFORMANCE RATINGS Visible Tmismiltance 0.48 Ataepl7murb tllptllgrl ltA)ttlEaL taMAe epClerM m opff a4d NMC piacede7mfldd dt}pmllmp"kill prodptt pdNprfaanep,xfRAt tadAEt Ifo amunpFpd Im a I&!p ttiAt IndrpEAtaRlal ppedx�ap aAd.a ppdmRA fradatl 151.NFR6 d:Ep am neplelamAp 1Wf prmfam fatwbv pat xaRpm firm s.ta of (proem tm aAYEpfsVtk exCenlCl{AlaepluvmYplmttlttlm mhpr piApptlp6rlpratpncp lA'atlAmiOi, w'Mr+.A1'r..ary ENERGY STAR"� in All 50 States pim�a��t'pEaw•p Design Pressure:+35 t—35 Maximum Sim:40 x SS I'MNIone Testing Steodard:AAMANIOMAICSA 10711S2JA440-05 Tess teb:ARCNITECTURUTESTINO INC,