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HomeMy WebLinkAboutBuilding Permit #153-14 - 32 BANNAN DRIVE 8/15/2013 Q OORTH BUILDING PERMIT �� �r�`" �, °A�°0 TOWN OF NORTH ANDOVER ° ; APPLICATION FOR PLAN EXAMINATIO Permit NO: Date Received �jY � �gATlO♦TP`�� Date Issued: U � 9SSgCHU`��� IMPORTANT: Applicant must complete all items on this page t 1 ¢e Y ON \ I RfJPERN Y !WA E r IAPI�I® F ,'F [ ZC)Nl GDST�RIT \Istorr�lrsct � y� ©', �\ 3..: ,: � \ \3 ��i'�_� "C �J� .,,, � � � C �G ill +✓ .,.�e �S:/'. D TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building )(One family 0 Addition ❑Two or more family C Industrial Alteration No. of units: [I Co rc _ ia 0 Repair, replacement 0 Assessory Bldg ❑ hers: 0 Demolition 0 Ot}hner 3iN ltp darn 1�etl .:d \ f��d„ d ©1St V-1'n I hQ 6. 17am Zwa I h na r 4 - Ap# ro x e S� Ide tification Please Ty a or Print Clearly) 9 78 OWNER: Name: Phone: (38e- 93 13 Address: 32 nn r—t V e_ UNTR�A TOI Ntti� 3 s + n c.f a �AOS4l \ Address ���� Z �Z W-01 rsIul'b onstructr nse � x [ ate vWw � -e lrnp-(JVeA` n Lrcens 3� F x ARCHITECT/ENGINEER AJ A Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ '7, ,391 FEE: $ .2..v q �9 I. Check No.: Zrjg Receipt No.: ZtoI457 NOTE: Persons contracting with unregistered contractors do not have access to he uarantVfiund S� natureAgenll�r So6rgn�ire nf.. n> �t ' 9 «: "" S ✓ 1�� ' , ��� t 11 �/�—"—° 6 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION Print, PROPERTY OWNER Print •100 Year Old Structure yes no MAP NO: PARCEL: ZONING DISTRICT: ,Historic District, yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 0 Septic ❑Well 0 Floodplain ❑Wetlands ❑ Watershed District o Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) Y OWNER: Name: Phone: Address: __ : CONTRACTOR Name: Phone: . Address: Supervisor's ConstructionLicense: _'.. Exp. Date: _ rt Y Home Improvement License: Exp. Date: I ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. j Total Project Cost: $ FEE: $ + Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of.Agent/Owner' .� _ 81gat0rex0f contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Location No. 1��— Date��IS��3 • • TOWN OF NORTH ANDOVER) . D 1- Certificate of Occupancy $ Building/Frame Permit Fee $day""•` Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check#2�7l f f 26745 1366ing Inspector A x, Plans Submitted ❑ C Plans Waived ❑ Certified Plot Plan❑ Stamped Plans ❑ TYPE-OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBodyArt ❑ Swimming Pools ❑ Well ❑ Tobacco.Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ I THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED - DATE APPROVED i PLANNING & DEVELOPMENT' ❑ ❑ COMMENTS CONSERVATION Reviewed on Siqnature COMMENTS HEALTH Reviewed on Signature COMMENTS e Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes I Planning Board Decision: Comments Conservation Decision: Comments j I Water & Sewer Connection/Signature& Date Driveway Permit DPW Tuvv� Engineer: Signature: Located 384 Osgood Street FIRE DEPART 'NT - Temp Dumpster on site yes no i Located at 124 Mair, Street_. Fire Departmerit 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 Doc.Building Permit Revised 2010 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Pidinglnterior Rehabilitation Permits Building Permit Application 4orkers Comp Affidavit 'hoto Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract NA- .0 Floor Plan Or Proposed Interior Work NA--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 ❑ Building Permit Application ❑ Certified Surveye PPlan ❑ Workers Comp d vlt ❑ Photo Copy of .I. C.S.L. Licenses ❑ Copy Of C act ❑ Floor/ ossection/Elevation Plan Of Proposed Work With Sprinkler Plan And H raulic Calculations (If Applicable) ❑ ass check Energy Compliance Report (If Applicable) Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Applica 'on ❑ Certified Proposed P t ❑ Photo of H.I.C. An S. enses LiWorkers Com Vit ❑ Two S of Building Plans (One To Be Returned) to Include Sprinkler Plan And H raulic Calculations (If Applicable) Elopy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doe:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 Building Department The foEowing is-a list of the required forms to be filled out for the appropriate permit to be obtained. Roofivg, Siding, Interior Rehabilitation Permits o-' Building Permit Application ❑ Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks I i ❑ Building Permit Application Li Certified Surveyed Plot Plan 1 ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses I o Copy Of Contract a Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) La 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) i o Building Permit Application ' o Certified Proposed Plot Plan a Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit r o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract a 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 ap►ral 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.Bui?,ding permit Revised 2012 f F "'iY E � I ks`_ r � a • 1 ' � � •r ,_ c� � r .. .� 4 R it:,i,< �. �^ A 1 I'I i I I 1 J +I �r NORTH own of EAndover T Z b oh , ver, Mass, Af cocHic."t6. *I%. AOR^TED S V B ARD OF HEALTH Food/Kitchen Septic System THIS CERTIFIES THAT PERM- IT f-07 V .,.. BUILDING INSPECTOR ...................... . ............................... ................................r.................... . . � Foundation has permission to erect .......................... buildings on .�� .. .r. �. ...1 �!6.................... --�- ,� / Rough to be occupied as ........�/,..�K. ..... �/.1,f. ....... `. !.�. .:.................................... Chimney provided that the person accepting this permit shall in eve respect conform to# e 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 CONSTRUCTION STARTS Rough Service ........ .. .. ... .... ......... 4­6__Ib .............. Final iSPECTOR 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. SEE REVERSE SIDE Y The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600`Washington Street Boston;,MA 0211.1 mn440,1nass.gov/did Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information` Please Print Leg.My Name (Business/Oigarization/fndividual): Sears Home Improvement Products Incorporated Address: 1024 Florida Central Parkway City/State/Zip: Longwood, FL 32750 Photie #: 860-753-0452 Are you an employer?Check the appropriate boxi Type of project(required): .1:❑ I am a employer with 4. ❑ I am a•general contractor and I 6. ❑New construction employees(full an&orpa t-time).*- have hired..the sub-contractors 2.❑ I am a sole proprietor or partner listed on the::atwched sheet:# 7. ❑Remodeling ship.and have no employees These sub-contractors have 8. ❑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.❑ L 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,epairs insurance required.]t employees.[No workers' 1.3.0 OtherVI' comp.insurance required.j l *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. lContractors that check this bok must attached an additional'sheet showing the name of the'sub-contractors and their workerscomp.policy information. I am an employer that is.providtng workers'compensation insurance.for my employees:.Below is the policy-and job site information. Insurance Company Name: Ace American Insurance Company / Phone 866-283-1122 Policy#or Self=ins. Lic.#.: WLRC47322534 Expiration:Date,; 08/ 1/2014 or_ Job Site Address;3a R n n V(0 City/State/Zip -M0-- Attach 0—Attach a.copy of the workers'.compensation policy declaration pagp_(showingthe policy:number and expiration date). O 1849— Failure to secure coverage as required under Secti x:25A.of MGL c. 152 can lead to the imposition of"crii7 final penalties of a fine up to$1,500:00 and/or one-year imprisonment,:as well.as.civil penalties in theform of a STOP WORK ORDER and a fine of up to$250.00 a.day,against the violator. Be Advised-that a copy.•oftstatementmay be forwarded to the:Office of Investigations of the DIA for insurance coverage verification. 1 do hereby cerhf 7nder a pains and p nalties of perjury that the information pro id d above is true and correct. Si nature: (Sears Auth.Agent) Date: Phone-#: Home—Fax: 860-93 --0346 / Cell: 860-753-0452 Official use only. Do notwrite in,this area, to be completed by city or town official. City or Towns Permit/License# Issuing Authority(circle:one): 1.Board of Health 2.Building Departm ent J.City/Town Clerk 4.-,E lectricai Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: v I ACORO® DATE(MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE07119/2013 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 °o BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED m REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. o IMPORTANT: If the certificate holder is an ADDITIONAL INSURED;the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to ': the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the 2 certificate holder in lieu of such endorsement(s). PRODUCER CONTACT d Aon Risk Services Central, Inc. NAME: 0 Chicago IL Office (ac.No.Ext): (866) 283-7122 F�No : (800) 363-0105 y 200 East Randolph E-MAIL a Chicago IL 60601 USA ADDRESS: G INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: ACE American insurance company 22667 Sears Holdings Corporation dba Sears Home Improvement Products, Inc INSURERB: Indemnity insurance Co Of North America 43575 Attn: Risk Management E3-219A INSURER C: 3333 Beverly Road Hoffman Estates IL 60179 USA INSURER D: 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 LICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMIDDIYYYY LIMITS A GENERAL LIABILITY HDOG MMID19 IYYYY 08/01/2014 EACH OCCURRENCE S5,000,005 X COMMERCIAL GENERAL LIABILITY DAMAGE TO REN PREMISES Ea occurrence $5,000,000 CLAIMS-MADE X❑OCCUR MED EXP(Any one person) Excluded PERSONAL B ADV INJURY $5,000,000 GENERAL AGGREGATE $5,000,000 rn GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $5,000,000 X LO POLICY PRO- LOC o JECT0 A AUTOMOBILE LIABILITY ISAH08719780 08/01/2013 08/01/2014 COMBINED SINGLE LIMIT LO$5,000,000 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 ALL OWNED SCHEDULED Z X AUTOS AUTOS BODILY INJURY(Per accident) d X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE v AUTOS Per accident li. t: d UMBRELLA LIAB OCCUR EACH OCCURRENCE 0 EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION A WORKERS COMPENSATION AND WLRc47322534 08/01/2013 08/01/2014WC STATU- OTH- EMPLOYERS'LIABILITY Y 1 N - CA MA AZ X TORY LIMITS ER ANY PROPRIETOR I PARTNER I EXECUTIVE B OFFICERIMEMBEREXCLUDED? NIA WLRc47319122 08/01/2013 08/01/2014 E.L.EACH ACCIDENT $2,000,.000 (Mandatory in NH) All Other States E.L.DISEASE-EA EMPLOYEE $2,000,000 I(yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S2,000:000' DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Y CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Sears Home Improvement Products, Inc. AUTHORIZED REPRESENTATIVE 1540 American way Longwood FL 32750 USA c-.X1o� i��ldb/G�iL�.4L'1:td (�dlla6 e./�7Q ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD rF f a t f cC Aff ii andBasine ' Regulation az - -Suite 51.70 Ot �� Mai" cutis 01.16 s .. Re istr�tion: '148607 Type: SupplenneWGarti �s Expiration-, .10111IPO Ia SEARS NOME IMPROVEMENT' LUBOS SY.EC 1024 FLORDA CEr TRA . KW( LONGWOOD, FL 3275 C.'. iiaatc d lr4moi avd return card.NI'ark reason for chant e.. ictcire4 12eaiemaal E:mployrrrent Lo8t Carrs` rs �'.�� .9s ,r}���Pne1�Y��Gr fa� ✓a`t��Z�uata��r�`(e€¢f.�. Croce of C:iaaa mme'r,Mair5 w4 SoNiaess Rcgu)Ntloo likvise or,r+ valid or individcal tcse only s "Hflt�kR.IMPRQVENI)E>1T COWL RA T0R Wor°e tlae,e�,@irtariori date �1f�ftrurirl,refltlm to. a Ctllioe of cohsomer ffa rs aa&-OoOness Re ul;dob Registration, "48607 Type: 10S€' �6 Fire ? .Swire 51 sf? EXpiratrratc_'.1pl1, £fLio1.3 Sastatalernent'C,and 0ostcact,MA,02116 SEARS HOME fMPR,0V.UA5KT PRODUCTS,INC, LUB S SVF 1024 FLORIDA CENTRAL,PKWY Low-,'vi oob,Fl..3e r � Y'nc3ere':a•rdnri �+'�t�€al6riwat�tar:tsittatu3'e �""""`^�- , I � 2! >...Im . !< V4 sac a Y1s-Diffipadment of Puialic safety «... oard of. uilding Regulations and S1dl��3ard > a saracts a crirrra supers is .L`rcons�; cs:os�5as THOMPSON 120A Thompson CT 06 77 ExpiraVotl C ornmissloner 08/3112014 T E� IIIIIIIIII III III Office Location:BOSTON Proposal Date 07/10/2013 Job Number -4 Sears Home Improvement Products,Inc. Customer NameP.O.Box 522290 JOSEPH FORD S.,.arrs 1024 Florida Central Parkway Customer's Home Phone Customer's Work Phone Longwood,FL 32750-7579 (978) 685-9313 Home Improvement Products phone(800)469-4663 Street Address ESTIMATE AND PROPOSAL Contractor License/Registration Number 32 BANNON DRIVE MA(148607) city State Zip Code Siding All plumbing and electrical services performed by NO.ANDOVER MA 01845 Is installation within city limits? licensed subcontractors Installation Address County ESSEX (Yes/No): NO FEIN 25-1698591 Billing Address(if different from above) City State Zip Code Project Consultant Name&License No.(if applicable) ROBERT LOUIS MANSOUR 30408 Descri tion of the Pro'ect and Descri tion of the�Si nificant,Materials#o,b6 Used and E. u ment to be installed The work to be done under this contract includes the following(where checked): Specifications(0=Included❑=Not Included) Preparation: 1. 0 Obtain all necessary permits and insurance. 2. 0 Inspect surfaces in work area,re-nail loose wood,and replace rotten surface wood where necessary in work area(excluding j roof,decking,rafters,and structural members). 3. ❑ Remove existing siding. Type: 4. ❑ Fir out walls on brick,block,metal,or stucco areas. Location: 5. ❑ Caulk and seal around all windows and doors in the work area as necessary. 6. ❑ Install approved non-corrosive starter strip. Insulation: 7. ® Install insulation of flatwall areas that are to be sided with (3/4"or 1/4"): 3/4" extruded polystyrene insulation. Custom Trim: 8. ® Install custom Vyna-Klad aluminum fascia system. Color: MYSTIC BLUE 9. ❑ Remove existing guttering.After removal,existing guttering will be: (re-attached/disposed of): 10. ❑ Install new guttering and downspouts. 11. ® Cover soffit areas of home with vinyl soffit system(except where noted below in"Work NOT to be done")using: (WB Max 1 WB Plus/Weatherbeater/Value Line/Other): VALUE LINE Color: MYSTIC BLUE Pattern: VALUE LINE 12. ❑ Install custom Vyna-Klad aluminum frieze boards. Size: Location: Color: 13. ❑ Window trim: (jump/butt): Location: Color: 14. ® Custom wrap windows,sills,mulls,headers with Vyna-Klad aluminum. Color: GLACIER WHITE 15. ❑ Remove and re-install existing: (storm windows I awnings I shutters): 16. ❑ Install new shutters: (Panel I Louver): Color: 17. ® Custom wrap door facings with Vyna-Klad aluminum. Color: GLACIER WHITE 18. ® Custom wrap garage door facings with Vyna-Klad aluminum (single/double): SINGLE Color: GLACIER WHITE 19. ❑ Remove and re-install storm doors. 20. ❑ Install deluxe corner posts. Color: Siding: 21. ® Install: (WB Max 1 WB Plus/Weatherbeater/Value Line/Other): VALUE LINE Solid vinyl siding. TYPE:(Horizontal/Vertical): HORIZONTAL Color: MYSTIC BLUE Porch Systems: 22. ❑ Porch ceilings: Location: Color: 23. ❑ Porch posts: Color: 24. ❑ Porch beams: Color: Clean up: 25. 0 Clean up and removal of all job-related debris. 26. Z Remove excess materials and re-stock each job is over-shipped to avoid delays). Additional work to be done:REMOVE ALL BOARDS FORM FRONT STUCCO. Work NOT to be done: No drip edge covered;no paint applied. NONE SPECIAL INSTRUCTIONS:REPLACE ROTTEN WOOD AS REQUIRED 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. SS1-MA (Dig.) Rev 08/01/12 Page 1 of 3 Job Number: -4 APPROXIMATE START DATE and APPROXIMATE COMPLETION DATE: The work will start approximately 4-6 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 Customer(s)initials W Ir' written notice to Customer. The TOTAL PRICE including all labor,material,taxes and any applicable discount is$ 17,391.32 Contract Price w$17,391.32 Initial Payment(not to exceed 30%of Total Price unless Special Order)$ 5,217.40 State Sales Tax( 0.00 %) $0.00 Final Payment(balance payable upon completion of job)$ 12,173.92 Local Sales Tax( 0.00 %) $0.00 Total Amount Due $17,391.32 The form and method by which the Customer(s)will pay is described in a separate Cash/Credit p i Card Payment Addendum made a part of and incorporated into this contract by reference. Custom r(s)in'tia,s dY 11 1 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. Responsibilityofof 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 or other brand, (ii) two years for Weatherbeater Plus,or(iii)three years for Weatherbeater Max,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. SSI-MA (Dig.) Rev 08/01/12 Page 2 of 3 s . Job Number: -4 NOTICE TO BUYER 1. DO NOT SIGN THE AGREEMENT IF ANY OF THE SPACES INTENDED FOR THE AGREED TERMS TO THE EXTENT OF THE AVAILABLE 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 07/22/2013 07/22/2013 Customer's signature Date Customer's signature �o Date Accepted by Sears Home Improvement Products,Inc.("Sears")on 07/22/2013 by: Date Management Representative SSI-MA (Dig.) Rev 08/01/12 Page 3 of 3 TOWN OF NORTH ANDOVER AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c. 142 A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units...or to structures which are adjacent to such residence or building"be done by registered contractors, with certain exception, along with other requirem nts. Type of Work: S -1, ng, Est. Costa �q d Address of Work (a. Owner Name: Date of Permit Application: 4r 21-0/ 3 I hereby certify that: Registration is not required for the following reason(s): For office Use Only Work excluded by law Permit No. Job under$1,000 Date Building not owner-occupied Owner pulling own permit Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FIND LINER MGL c. 142A. Signed under penalties of perjury: I hereby apply for a permit as hu peUS �V�� h� 8 i 3 20 i3 �„ f' 14-8 GO Date Contractor Name Registration No. OR: Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date Owner Name %C R/.3 /2013 . Build Anx G I t PS+10)0S/ The following is a list of the required forms to be tl a III :d. —rha.o k -Y Q u-, Roofing, iding, nterior Rehabilitati ;vE?c Building Permit Application Porkers Comp Affidavit hoto Copy Of H.I.C. And/Or C. Copy of Contract r I T — '7^ Ct n YOU c r- CGS l NA—+� Floor Plan Or Proposed Interior ' eurh 1 h �� A—❑ Engineering Affidavits for Engin( ve WuCt Ct �C�" N 9 9 9 � �P NOTE: All dumpster permits require sign off frc _ Bldg Permit Addition Or Decks i ❑ Building Permit Application ❑ Certified Surveye PPlan ❑ Workers Comp d vit ❑ Photo Copy of P. C.S.L. Licenses ❑ Copy Of C act ❑ Floor/ ossection/Elevation Plan Of Proposed Work With Sprinkler Plan And n H raulic Calculations (If Applicable) ❑ ass check Energy Compliance Report (If Applicable) Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Applica 'on ❑ Certified Proposed P t ❑ Photo of H.I.C. An .S. enses ❑ Workers Com vlt ❑ Two S of Building Plans (One To Be Returned) to Include Sprinkler Plan And H -draulic Calculations (If Applicable) ❑ opy of Contract ❑ Mass check Energy Compliance Report Lo/Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 i i i I r it