Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Building Permit #23327 - 280 JOHNSON STREET 8/18/2010
NOFTp 6f f,5 / p 4,.ao y h0 3?ea.r, ..i._a• pL ° : % TOWN OF NORTH ANDOVER '.e . >•�.' APPLICATION FOR PLAN EXAMINATION 'SACH 51 y r Permit NO: / ";z Date Received: Date Issued: �l IMPORTANT: Applicant must complete all items on this page LOCATION U 0 ' "t ®h S 7— Print PROPERTY OWNER &' � i! Print MAP NO.:AI—PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑New Building , One family ❑ Addition ❑Two or more family ❑ Industrial ❑ Alteration No. of units: Repair, replacement ❑ Assessory Bldg ❑Commercial ❑ Demolition ❑ Movin (relocation) ❑ Other ❑ Others: ❑ Foundation only DESCRIPTION OF WORK TO BE PREFORMED Identification Please Type or Print Clearly) OWNER: Name: 0 Phone. 6 f-e'%Sl Address: � Y 0 Yl SLS c� J ( r An do CONTRACTOR Name: C Phone: Address: r % c.7;- Supervisor's Construction License: Exp. Date: Home Improvement License: / �/ 7 Exp. Date: a ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT.,810.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON.8'125.00 PER S.F. Total Project Cost :$ _ 12� 0 a o o o xlD K=-FEE:$ OJ Check No.:`D C�Receipt No.: Pare Iof4 TYPE OF SEWARGE DISPOSAL _ Tanning/Massage/Body Art II Swimming Pools iJ Public Sewer ❑ ,� Tobacco Sales Food Packaging/Sales ❑ Well I–i ❑ Permanent Dumpster on Site Private(septic tank,etc. Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of Contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM DATE REJECTED DATE APPROVED PLANNING &-DEVELOPMENT ❑ -- -❑ ❑Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS t DATE REJECTED DATE APPROVED HEALTH ❑ iEl 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 Temp Dumpster on site yes—no— Fire Department signature/date Building Permit Approved and Issued by: Page 2 of 4 i Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided DIMENSION Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area,sq.ft.: NOTES and DATA—(For department use) i Page 3 of 4 Doc:INSPECTIONAL SERVICES DEPARI'MENT:BPFORMQ5 Cmaled JNIC.Jan.20N, 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 Addition Or Decks ❑ Building Permit Application ❑ Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) New Construction(Single and Two Family) U ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:INSPECTIONAL SERVICES DEPARTMEN"rMFOR'1105 Page 4 ol'4 Location QO v .T(X) o Y%N.J b No. 13r:q- Date -!a NORTiy TOWN OF NORTH ANDOVER 3? � •' 0 4 10. p " Certificate of Occupancy $ Ty -TS •Eta' Building/Frame Permit Fee $ cHus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # l) Q 2 3 3 7 Building Inspector From: 08/1712010 16:11 #513 P.002/004 CERTIFICATE 7REPRESENTATIVE CERTIFlCATE IS ISSUED AS A MATTERCAT11 DE OF LIABILITY INSURANCE °" cDDIYYYY) IFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND 8/11/2010 6 111 11 1 ��)111 11111111 lc�111 AND CONFERS NO RIGHT8 UPON 7HE CERTIFICATE HOLDEA.THIS W. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZtiD OR PRODUCER,AND THE CERTIFICATE HOLDER EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES IMPORTANT: c the cartlf Of holder(s er ADDITIONAL INSURED,the policy((ss)must be endorsed. B SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies play require an endorsement A ata certificate holder In lieu of such andorsement(s). terneM on this certificate does not confer rights to the PRODUCE" (916)459-2101 Albert A. Daigle Ins A CONI ACT Agency, Inc PHONE313 1111 lard Street E-MAIL Dracut, m 01828-5099 DD PRODUCER INSURED INSURER S AFFpRDOta jWRA119Oeorgoulis Construction Inc. aauRERA:American Home A ""100 98 Arlington Ave. Dracut, MA 01826 INSURER D: INSURER E., COVERAGES CERTIFICATE NUMBER: REVISION IN IIIA'I I INSURER F: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTEDBELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITHES RPECT 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 OLAIMe. AM!Rrg— INSURANCEPOUC NUMBERUMIri GENERA�TYPIE: EACH OCCURRENCE COMMERCIAL GENERAL LIABILITY CI AIMS MAGE OCCUR MED EXP(Any am parson) tf PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN1 AGGREGATE LIMIT APPLIES PER: POLICY PRO PRODUCTS•COMP/OP AGG $ LOC $ AUTOMOBILE UABILI COMBINED SINGLE LI $ ANY AUTO (Es accident) ALL OWNED AUTOS BODILY INJURY(Per person) $ SCHEDULED AUTOS BODILY INJURY(Per aoeidsM) $ HIRED AUTOS PROPERTY DAMAGE _ (Peraccidem) I NON-ONNEDAUTOS $ UMBRELLA UAB OCCUR EXCESS UAB EACH OCCURRENCE $ �CLAWS-MADEEACH $ DEDUCTIBLE RETENTION WORKERS COMPENSATION $ AANY PROPRNDEMPLOYERS'LIAMUTY WCSTATU• ATH• R:TOR/PARTNER/EXECtJTIVE I" $ 100,000.00 O(MandatoryKIME ONH)EXCLUDED? N/A WC009-75-2868 09/25/09 09/25/10 E.L.ELEACH ACCIDENT II yesdescnU under E.L.DISEASE-EA EMPLOYE $ 10U 000.00 DESCRIPTION OF OPERATIONS 6etow E.L.DI-EASE-POLICY uMlr s 500 000.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Misch ACORO 101,Additional Remarks SchedMa,B more spew Is raauked) CERTIFICATE HOLDER CANCELLATION Polly Pyle 280 Johnson St. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN North Andover MA 01845 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESMATIVE ACORD 25 2008/09 ®1988- CORD C R ON. All rights reserved. ( ) The ACORD name and logo are registered rnarks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations i U i` d i 600 Washington Street w s Boston,MA 02111 Mdwww.mass.g ov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):_.& cf Jtt; C t Address: 111n4 City/State/Zip: VO/_C L /W4 Phone #: Are you an employer?Check the appropriate box: Type of project(required): 1.�I am a employer with /b 4. El am a general contractor and I 6. E]New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. # 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. F-1Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' cotnp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.E] 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.❑ Roof repairs insurance required.] t employees. [No workers' 13.❑ Other 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. TContractors that check this box must attached an additional sheet showing the name of the sub-contractors acid their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: k C ce.7 A/11 0 Policy#or Self-ins. Lic. (?66 Expiration Date: —0- Job 0 Job Site Address: e? o �_J N-C)��o� City/State/Zip: _,h �G /�e G✓ill�Q 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 Y P P 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 certify unde the pains anddppen'aallties of peijury that the information provided above `is�ptrue and correct. Signature: (1-`v '� Date: Phone#: 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." i MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confinnation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax#617-727-7749 www.mass.gov/dia ORTFI Tovm ofo . Andover 'Y. No. ..4w 1 LAKE -O dover, Mass., w COCHICHEMCK y^ AD RATED SS ` BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT........ Foundation ... Rough has permission to erect.................:...................... uildi gs on .............��......�....peappilication ......:. s to be occu ied.as a s Chimney provided that the person accep g this permit shall in every res t conform to the terms o on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations''Voids this Permit. Rough Final PERMIT EXPIRES e6ANTHS UNLESS CONSTRUT TS ELECTRICAL INSPECTOR Rough NONNI.. ....................................................... ................ Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE / Smoke Det. 91te AWWOMINgaddegulo/iolni-s antandar s One Ashburton-Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration -_ Registration: 117870 E ;: Type: Private Corporation +== Expiration: 12/1212010 Tr# 278798 GEORGOULIS CONSTRUCTION- ,,-INC.,- SCOTT , INC.SCOTT GEORGOULIS 96 ARLINGTON AVE DRACUT, MA 01826 Update Address and return card.Mark reason for change. Address Renewal [j Employment ❑ Lost Card DPS-CAI G 5OM-07/07-PCMO Massachusetts- Department of Public safety Board of Building Regulations and Standards Construction Supervisor License License: CS 58498 _ Restricted to: 00 _ 7 SCOTT C GEORGOULIS 96 ARLINGTON AVE DRACUT, MA 01826 c— �''�`�-y—--f-` Expiration: 10/21/2011 Commissioner Tr#: 5031 GEORGMUS ROOFING & CONSTRIUC ION, INC. 96 Arlington Ave. Dracut,MA 01826 Al Greene-.Estimator 1-9784534242 Office 1-978-888-1700 Cell georgoul is i 4@aot.com PROPOSAL Polly Pyle 08/05/10 280 Johnson St N.Andover,MA 1-978-685-8451 ole 1JYi'onetravel0comcast net Job Location:280 Johnson St.N.Andover,MA Scope of Work: Remove all layers of roofing down to wood deck on all roofs of the house. Install 6'of GAF Weatherwatch Ice/Water Shield underlayment on all roof eaves,around chimneys, around stack pipes,in all valleys,and up rakes at all roof to wall locations. Install 15#felt paper over remaining exposed roof deck. Install 8".025 gauge heavy duty white aluminum drip edge on entire roof perimeters. Install GAF Timberline Prestique high definition 30 yr.Architectural shingles with 3-Tab caps on roof. Install new stack pipe boots on plumbing pipes. Install new Coravent V-400 ridgevent on all main house ridges. Install new lead flashings on both existing chimneys. Remove all job related debris from property on a daily basis and at jobs completion. $55.00 Per Sheet Extra Cost to replace any damaged plywood(if needed). $2.50 Per lineal Foot Extra Cost to replace any damaged roof boards(if needed). WE PROPOSE hereby to furnish material and labor complete in accordance with above specifications, for the stun of tet. Twelve Thousand Dollars CK U $12,000.00 PAY110PN 'TO 13E MADE AS FOLLOWS: 000.00 PAID M ADVANCE FOR MATERIA; COST UUMrLETELY FIlVISHEALP ACCORDING TO THE ABOVE PAW IN pSAL. WHEN JOB is All material is guaranteed to be as specified.All work to be completed in a substantial workman like in according O `O to specifications submitted per standard practices.Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate. All agreements contingent upon strikes,accidents or delays beyond our control.Owner to necessary insurance.Our workers are fully covered by workers compensation insurance, fire,tomado and other C�na r C oa.. Authorized Signature This proposal may be withdrawn by us if not accepted within 30 days. Acceptance of Proposal-The above prices,specifications are satisfactory and are hereby accepted. You are authorized to do Payment will be made as outlined above. the work as specified. Signature y,� ' signature c �- P VI of acceptance s r al The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ky 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affldavit: Builders/Conttractors/Electricians/Flumbers Atnp➢icant Information Please Print]LelfiiiIly Name(Business/organization/individual): Pe l k (J,Aa-o W 3 Qr 4 'Dbo d'S 1 AC . Address: qSa pC0,4,, City/State/Zip: kye'b4tll MA M232 �/.Fli�����:•► �78'�2��.'��5� Are you an employer?Check the appropriate box: Type of project(required): 1.M 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.El am a sole proprietor or partner- listed on the'attached sheet.t �• Remodeling ship and have no employees These sub-contractors have S. ❑Demolition working for me in any capacity. workers'comp.insurance. ' 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.[]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.❑Roof repairs insurance required.]t employees. [No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box A must also fill out the section below showing thehr:�ior. "rs'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 oftie 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 and job site information. Insurance Company Name: Fr`e4 C. Vr e-k Policy#or Self-ins.Lic.#: 09 W SAIL.TWO. Expiration D: =J=' •'.rc.:�:!.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 6f's statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penakles of perjury that the information provided above is true and correct: Siunature: —— Date: —o Phone#: ?79, 16S°—�ISS Official nese only. Do not write in this area,to be completed by city or town offuial City or Town: Permit(License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.(Electrical Inspector S.Plumbing Inspector 6.Other "Ti V;:;«;;.3.r. �,hae4oe4 Yrensonn: ]Phone M. i AC®R®,n, CERTIFICATE ®F LIABILITY INSURANCE D0/200ATE 9I16:20 In 06/30/200916:20 PRODUCER (800)225-1865 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Fred C.Church,Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 41 Wellman Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Lowell,MA 01851 800-225-1865 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA: Citizens Insurance Company of America New England Window&Door LLC INSURERS: Hanover Insurance Company 45 Fondi Road Massachusetts Ba Insurance Haverhill,MA 01832-1302 INSURER C: y INSURER D: Wausau Underwriters Insurance Company INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR D' iF INSURANCEPOLICYNUMBER POLICYEFFEp IVE POLICY EXPI EXPIRATION LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED 100 000 X COMMERCIAL GENERAL LIABILITY PREMISES Eaoccurence $ CLAIMS MADE FE OCCUR MED EXP(Any one person) $10,000 A ZBN8161407 7/1/2009 7/1/2010 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPlOP AGG $ 2,000,000 POLICY X PRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 X ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ (Per person) C SCHEDULED AUTOS ADN8162169 7/1/2009 7/1/2010 HIRED AUTOS BODILY INJURY $ (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) GARAGELIASILITY AUTO ONLY-EA ACCIDENT $ ANYAUTO OTHERTHAN EAACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLALIABILITY EACH OCCURRENCE $9,000,000 X OCCUR 0 CLAIMS MADE AGGREGATE $9,000,000 B UHN8167305 7/1/2009 7/1/2010 1 $ RDEDUCTIBLE $ X RETENTION $ $ )( WC STATU- 10TH $ W WORKER TH- WORKERS COMPENSATION AND —1O rp EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $500,000 D ANY PROPRIETORIPARTNERIEXECUTIVE BINDWC 7/1/2009 7/1/2010 500,000 OFFICERWEMBEREXCLUDED? E.L.DISEASE.EA EMPLOYEE $ If yes,descdba under E.L.DISEASE-POLICY LIMIT $ 500,000 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION New England Window&Door LLC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 45 Fondi Road DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN Haverhill,MA 01830 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001108) Client# )QAn Mst# 09-10 GL,WC,Auto, Cert# ©ACORD CORPORATION 1988 Umb Il+ ,r i'f� f IdJf ll�iJl•• 1.41 +•.;f,. 89853 00 WILLIAM R NICHOLS J 57 PEARTREE.RD . ' ' ' HAVERHIL'L, MA 01830 10%26/2010 5196 - .'��<.• f•aurivairrre<rll� n!!..- ll<r»u�1 rraelZS Office of Consumer Affairs&Business Regulation .�.(HOME IMPROVEMENT CONTRACTOR Registration: 129774 tion: p' Ex ira 11/2/2011 Type: Supplement Card PELLA WINDOWS AND DOORS WILLIAM NICHOLS 45 FONDI RD. HAVERHILL,MA 01832 Undersecretary Proposal - Detailed Pella Windows&Doors Sales Rep Name: Gould, Rich ® HIC#129774/Tax ID#26-1413183 45 Fondi Road Sales Rep Phone: (978)423-7156 Haverhill, MA 01832 Sales Rep E-Mail: GouldRM@PellaBoston.com Phone:(978)373-2500 Fax: (978)373-7274 Sales Rep Fax: Customer Information Project/Delivery:Ad,dress Order Information. DUNKIN PYLE DUNKIN PYLE Quote Name: architect series 280 JOHNSON ST 280 JOHNSON ST Order Number: 741 RG0130 NORTH ANDOVER,MA 01845 Lot# Quote Number: 905013 Day Phone: (978)685-8451 NORTH ANDOVER,MA 01845 Order Type: Installed Sales Mobile Phone: County: ESSEX Wall Depth: Fax Number: Owner Name: Payment Terms: Deposit/C.O.D. E-Mail: DUNKIN PYLE Tax Code: MA TAX 6.25 Contact Name: Owner Phone: (978)685-8451 Cust Delivery Date: None Quoted Date: 9/28/2009 Great Plains#: 3807616 Contracted Date: Booked Date: Customer PO#: �711ne# "Location: Attributes 10 None Assigned Architect, Precision Hung Double Hung, 31.5 X 50.5, White Item Price Qty Ext"d Price 1 1:31.550.5 Double Hung,Cottage Split $826.58 6 $4,959.48 Frame Size:31 1/2 X 50 1/2 General Information: Style Edition,Clad Exterior Color/Finish:Standard EnduraClad,White Interior Color/Finish:Unfinished Interior I Glass:Insulated Low E SunDefense Dual LowE Argon Gas Hardware Options:Standard Lock,White,OrderGas_ h�Lift J — Viewed From Exterior Screen:Half Screen,Standard Fiberglass Rough Opening: 32"X 51" Grille:RMB,No,3/4",Traditional(4W2H/4W3H),Unfinished Wood,Unfinished Wood,Shipped In Unit Wrapping Information:Perimeter Length=164",Glazing Pressure=90. Disposal-Disposal per Unit Qty 1 PF Standard-Install Standard P-fit Qty 1 UNFINISHED-No Finish-Ready to Stain Qty 1 No Exterior Wrap-No Wrap Qty 1 For more information regarding the finishing, maintenance, service and warranty of all Pella®products,visit the Pella@ website at www.pelia.com Printed on 10/27/2009 Detailed Proposal Page 1 of I Customer: DUNKIN PYLE Project Name: DUNKIN PYLE Quote Number: 905013 Line# Location: Attributes i 15 None Assigned Architect, Precision Hung Double Hung, 27.5 X 44.5,White Item Price Qty Ext'd Price 1:27.544.5 Double Hung,Cottage Split $777.64 2 $1,555.28 94 Frame Size:27 1/2 X 44 1/2 General Information: Style Edition,Clad Exterior Color/Finish:Standard EnduraCiad,White Interior Color/Finish:Unfinished Interior Glass:Insulated Low E SunDefense Dual LowE Argon Gas Zr j5 Hardware Options:Standard Lock,White,Order Sash Lift Viewed From Exterior Screen:Half Screen,Standard Fiberglass Rough Opening: 28"X45" Grille:RMB,No,3/4",Traditional(4W2H/4W3H),Unfinished Wood,Unfinished Wood,Shipped In Unit Wrapping Information:Perimeter Length=144",Glazing Pressure=115. UNFINISHED-No Finish-Ready to Stain Qty 1 Disposal-Disposal per Unit Qty 1 al PF Standard-Install Standard P-fit Qty 1 No Exterior Wrap-No Wrap Qty 1 Thank You For Your Interest In Pella® Products PELLA WARRANTY: Pella products are covered by Pella's limited warranties in effect at the time of sale.All applicable product warranties are incorporated into and become a part of this contract. Please see the warranties for complete details,taking special note of the two important notice sections regarding installation of Pella products and proper management of moisture within the wall system.Neither Pella Corporation nor Pella Windows&Doors will be bound by any other warranty unless specifically set out in this contract. However,Pella Corporation will not be liable for branch warranties which create obligations 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 cod 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. BRANCH WARRANTY: 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 and Doors of Boston 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 i 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 you Pella products meet local egress requirements Per the manufacturer's warranty,unfinished mahogany exterior windows and doors must be finished upon receipt prior to installing and refinished For more information regarding the finishing, maintenance, service and warranty of all Pella®products,visit the Pella®website at www.pelia.com Printed on 10/27/2009 Detailed Proposal Page 2 of - - Customer:DUNKIN PYLE Project Name: DUNKIN PYLE Quote Number; 905013 annually,thereafter. Variations in wood grain, color,texture or natural characteristics are not covered under the limited warranty TERMS&CONDITIONS: QUOTES ARE VALID FOR 30 DAYS i Order Totals Customer Name (P se print) Pella Sales Rep Name (Please t) ,(� Taxable Subtotal $4,792.52 `�Jy✓��GJ�. 5Q-'-e �y leSales Tax @ 6.25% $299.53 Customer Signature Pella°Sales Rep Signature Non-taxable Subtotal $1,722.24 Z Total $6,814.29 Date Date Deposit Received $3,407.15 Amount Due $3,407.14 i i I For more information regarding the finishing, maintenance, service and warranty of all Pella@ products, visit the Pella@ website at www.pelia.com Printed on 10712009 Detailed Proposal Page 3 of 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 td,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. 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 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. Al 1'91is OvIiiated to and will obtain the following permits for this project: 4. CHANGES 12 . Homeowners who secure their own permits will be excluded from tM 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 complee 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 signat6 Date Y � DISPUTES Job Name Lc ! P Date 10-- THE CONTRACTOR AND THE HOMEOWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT PELLA HAS A DISPUTE CONCERNING THIS CONTRACT, PELLA MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUTIVE OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATIONS AND THE CONSUMER SHALL BE REQUIRED TO SUBMIT TO SUCH ARBITRATION AS PROVIDED IN M.G.L.c. 142A Contractor Homeowner NOTICE: THE SIGNATURE OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE SETTLEMENT INITIATED BY THE CONTRACTOR. THE OWNER MAY INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THIS SECTION IS NOT SEPARATELY SIGNED BY THE PARTIES. NOTICE OF CANCELLATION Customer Name: D14a k,r n l 41 (Please print) Date of transaction: I D-Z 7—meq 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 lo-3o-61. (three business days from the date of transaction above). I hereby cancel this transaction. (Date) (Buyer's signature)