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Building Permit #023-2017 - 36 ALCOTT WAY 7/7/2016
BUILDING PERMIT 4 %aorarH u R o��T L6C ,b qaO � I� � T®11VN ®� N®RTH ANDOVER �� y�;:�'._ �_•.. aIN APPLICATION FOR PLAN EXAMINATION �2,/J7 ^ ! Date Received r�� �� SpA Permit NO�: ( °ja�re°Pea`,Z9 �SSACHS�� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION QA-q Print PROPERTY OWNER dVl6�LtlWtl� ��2r2cscJ Print 100 Year Structure yes 0 MAP PARCEL:_ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New BuildingCo One family ❑Addition ❑ wo or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial oi�Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition 0 Other ❑ Septic p Well'; ❑floodplain p Wetfantls ❑ Watershed Distract a ❑',1Nater/Sewer _ - - -- - --- DESCRIPTION OF ORK TO BE PERFORMED: xjo cv Identification- Please Type or Print Clearly OWNER: Name: 0 Ly^ro LJ Phone: g713 9 Zy Address: 4-L_c.oT-f- LLJ Contractor Phone: �2),2r zL5 -74ds- Email: Address: -/S' r—Dnlor_ A, e'5--3 Supervisor's Construction License. p. Date.- Ex Home Improvement License: Exp. Date: 7"Lf'1 ARCH ITECTIENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST B7 - Check D D�$1 00 PER S.F. Total Project Cost: $ GDS FEE: $ //�j/J No.: ( Z4 _�o Receipt No.: vol NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund of t4ORTH q BUILDING PERMIT ��t�Ep "o TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION Permit No#: l � � Date Received CI-?- Z41416'� R""pArEp " c5 �SS 9cHtu) Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION 3G 4LzorT- Print PROPERTY OWNER A411-' 11HW-e fs r Print 100 Year Structure yes o MAP G- PARCEL: ZONING DISTRICT:-Historic District yesi no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building Co One family ❑Addition ❑ wo or more family El Industrial ❑Alteration No. of units: ❑ Commercial IZ_Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Se=tic Well - fl Rood lapin. ®1`I;Vetla�nod ] UUate 'ed ®strict - s� 10ater Sewe DESCRIPTION OF AORK TO BE PERFORMED: �w.mss dt 1�t1 t.' }j�v S SL,oe"S b6-Dk- No S Identification- Please Type or Print Clearly OWNER: Name: Phone: �Z�Zy'- s Address: 3<a A-L_C Contractor Name:�J� l Arra Phone' 716x- Email: Address: L-/.1�_ FMni4 Supervisor's Construction License: QF7 �'� 3 Exp. Date: ts- Home Improvement License: ����'� Exp. Date: "_7.'LV.-1 2 ARCHITECT/ENGINEER 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: $ FEE: $ � CJ Receipt No.: Check No.:— NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ;� x � �'c-dei 'C? r- •?'*,w?a ': da ,. ithe>': X - 4,. Ingr x rt v? `.s`�,., N Location 5,1, r/ No.n-7 Dateev 4 ams • • TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee $ .�.- Foundation Permit Fee $� Other Permit Fee $ TOTAL $� Check# 23� �1 f/ Building Inspector 1 f Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBody Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dwnpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF a U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIREJDEPARf,MEfirf! T�empiDumpster onsite. lyes�.� s Locat�ediat f,N-004 eet Fire_©e�artrnent�sigrtat�sre/date COMMENTS j Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Deter location, avast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$10041000 fine NOTES and DATA—(For department cruse) I I El Notified for pickup Call Email F Date Time Contact Name Doe.Building Permit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits Building Permit Application Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract Floor Plan Or Proposed Interior Work Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Building Permit Application Certified Surveyed Plot Plan Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) Mass check Energy Compliance Report (If Applicable) Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) Building Permit Application Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses Workers Comp Affidavit Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) l Copy of Contract 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 � NORTH Town of No. ver, Mass, 07y 09: cocHcHewcw 'l' L9 QDR�TED s V BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT BUILDING INSPECTOR . Foundation has permission to erect .......................... buildings on ..... .��►.... !01 Rough to be occupied as Q49.444........ Chimney provided that the person accepting this permit shall in every respect conform to Me ferms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR. . UNLESS CONST ION S Rough Service .. ... ... .......... ........ . Fina BUILDING I ECTOR GAS INSPECTOR Occupancy Permit Reguired to Occupy Buildingu 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. Contract - Detailed Pella Window and Door Showroom of Haverhill Sales Rep Name: Griseto, Anthony 45 Fondi Rd f 'r�I Z Sales Rep Phone: 978-490-9666 Haverhill, MA 01832 Sales Rep Fax: Phone: (978)373-2500 Fax: (978) 373-7274 Sales Rep E-Mail: GRISETOAC@pellaboston.com Customer Information _ Project/Delivery Address Order Information Marianne Corrou Corrou,Mariann e,NorthAndover,MA,742489 Quote Name: 1 Patio Door 2 sets of Casement Windows 36 Alcott Way 36 Alcott Way Order Number: 741AGO648 NORTH ANDOVER,MA 01845-5819 Lot# Quote Number: 7974113 Primary Phone:(978)9749380 NORTH ANDOVER,MA 01845-5819 Order Type: Installed Sales Mobile Phone: County: ESSEX Payment Terms: Deposit/C.O.D. Fax Number: Tax Code: MA TAX 6.25 E-Mail: mcorrou@gmail.com Quoted Date: 6/20/2016 Great Plains#: 10794382 Customer Number: 1007952502 Customer Account: 1003836191 Line# Location: Attributes 10 Delivery Delivery/Setup- Delivery/Setup Item Price Qty Ext'd Price $204.45 1 $204.45 For more information regarding the finishing, maintenance, service and warranty of all Pella@ products,visit the Pella®website at www.pelia.com Printed on 6/21/2016 Contract-Detailed Page 1 of 5 Customer: Marianne Corrou Project Name: Corrou,Marian ne,NorthAndover,MA,742489 Order Number: 741AGO648 Quote Number: 7974113 Line# Location: Attributes 15 Patio Door Proline, Double Sliding Door, Contemporary, Fixed/Vent Left, Poplar White Item Price Qty Ext'd Price $3,657.65 1 $3,657.65 1:Fixed/Vent Left Double Sliding Door PK# General Information: Clad,5718",49Y16" `;- 798 Exterior Color!Finish: Standard Enduraclad,Poplar White Interior Color/Finish: Bright White Interior Glass: Insulated Tempered Low-E AdvancedComfort Low-E Insulating Glass Argon Non High Altitude Hardware Options: Black,White,Handle Included,Handle Included Screen: Sliding Screen,Wood Interior Color Matched Exterior,Champagne,Bright White,InViewTM Viewed From Exterior Performance Information: U-Factor 0.26,SHGC 0.27,VLT 0.50,CPD PEL-N-4-0031 1-00001,Performance Class R,PG 30,Calculated Positive DP Rating 30,Calculated Negative DP Rating 30 Grille: No Grille, Finish Patio Trim-Finish Paint/Stain Patio Door Interior Trim Only Qty 1 PD-2 Wide-Install 2-Wide Sliding Patio Door Qty 1 Paint Ext-Trim-Paint Exterior Trim(pine only) Qty 1 Remove/Reinstall Blinds-Remove/Reinstall Blinds Qty 1 Line# Location: Attributes 20 DR ProLine, 2-Wide Casement, Poplar White Item Price Qty Ext'd Price $2,832.72 2 $5,665.44 1:Left Casement PK# General Information: Clad,5",311/16" f 798 Exterior Color/Finish: Standard Enduraclad,Poplar White Interior Color/Finish: Bright White Interior Glass: Insulated Tempered Low-E AdvancedComfort Low-E Insulating Glass Argon Non High Attitude Hardware Options: Fold-Away Crank,White,No Limited Opening Hardware Screen: Full Screen,Bright White,InViewTM Viewed From Exterior Performance Information: U-Factor 0.25,SHGC 0.27,VLT 0.50,CPD PEL-N-14-00458-00001,Performance Class R,PG 30,Calculated Positive DP Rating 30,Calculated Negative DP Rating 30 Grille: No Grille, Vertical Mull 1: FactoryMull, 1"x 4 3/8"Wood,Mull Design Pressure-20 2:Right Casement General Information: Clad,5",3 11/16" Exterior Color/Finish: Standard Enduraclad,Poplar White Interior Color/Finish: Bright White Interior Glass: Insulated Tempered Low-E AdvancedComfort Low-E Insulating Glass Argon Non High Altitude Hardware Options: Fold-Away Crank,White,No Limited Opening Hardware Screen: Full Screen,Bright White,InViewTM Performance Information: U-Factor 0.25,SHGC 0.27,VLT 0.50,CPD PEL-N-14-00458-00001,Performance Class R,PG 30,Calculated Positive DP Rating 30,Calculated Negative DP Rating 30 Grille: No Grille, Vertical Mull 1: FactoryMull, 1"x 4 3/8"Wood,Mull Design Pressure-20 For more information regarding the finishing, maintenance, service and warranty of all Pella®products,visit the Pella®website at www.pelia.com Printed on 6/2112016 Contract-Detailed Page 2 of 5 Customer:Marianne Corrou Project Name: Corrou,Marianne,NorthAndover,MA,742489 Order Number: 741AGO648 Quote Number: 7974113 Trim—Stool and Apron-Add Stool and Apron Trim to Picture Frame Qty 1 Finish FF Trim-Finish Paint/Stain FF Interior Trim Only Qty 1 FF>60 Height-Install Full Frame Window>60 inches Unit/Composite Height Qty 1 FF<48 wide-Install Full Frame Window 48 inches or less wide Qty 1 Paint Ext-Trim-Paint Exterior Trim(pine only) Qty 1 Remove/Reinstall Blinds-Remove/Reinstall Blinds Qty 1 Thank You For Purchasing Pella® Products PELLA WARRANTY: Pella products are covered by Pella's limited warranties in effect at the time of sale.All applicable product warranties are incorporated into and become a part of this contract. Please see the warranties for complete details,taking special note of the two important notice sections regarding installation of Pella products and proper management of moisture within the wall system.Neither Pella Corporation nor Pella Windows&Doors will be bound by any other warranty unless specifically set out in this contract. However,Pella Corporation will not be liable for branch warranties which create obligations in addition to or obligations which are inconsistent with Pella written warranties. Clear opening(egress)information does not take into consideration the addition of a Rolscreen [or any other accessory]to the product.You should consult your local building code to ensure your Pel]a products meet local egress requirements. Per the manufacturer's limited warranty,unfinished mahogany exterior windows and doors must be finished upon receipt prior to installing and refinished annually,thereafter. Variations in wood grain,color,texture or natural characteristics are not covered under the limited warranty. INSYNCTIVE PRODUCTS:In addition,Pella Insynctive Products are covered by the Pella Insynctive Products Software License Agreement and Pella Insynctive Products Privacy Policy in effect at the time of sale,which can be found at Insynctive.pella.com. By installing or using Your Insynctive Products you are acknowledging the Insynctive Software Agreement and Privacy Policy are part of the terms of sale. Product Performance Information: U-Factor,Solar Heat Gain Coefficient(SHGC),and Visible Light Transmittance(VLT)are certified by the National Fenestration Rating Council(NFRC).Manufacturer stipulates that these ratings conform to applicable NFRC procedures for determining whole product performance.NFRC ratings are determined for a fixed set of environmental conditions and a specific product size.NFRC does not recommend any products and does not warrant the suitability of any product for any specific use. Design Pressure(DP),Performance Class,and Performance Grade(PG)are certified by a third party organization,in many cases the Window and Door Manufacturers Association (WDMA).The certification requires the performance of at least one product of the product line to be tested in accordance with the applicable performance standards and verified by an independent party.The certification indicates that the product(s)of the product line passed the applicable tests.The certification does not apply to mulled and/or product combinations unless noted.Actual product results will vary and change over the products life. For more performance information along with information on Florida Product Approval System(FPAS)Number and Texas Dept.of Insurance(TDI)number go to www.yella.com /performance. Project Checklist Review (Installed Orders Only) Before the Installation the Homeowner agrees to do the following: For more information regarding the finishing,maintenance, service and warranty of all Pella®products, visit the Pella®website at www.pella.com Printed on 6/21/2016 Contract-Detailed Page 3 of 5 Customer: Marianne Corrou Project Name: Corrou,Marianne,NorthAndover,MA,742489 Order Number: 741AGO648 Quote Number: 7974113 Obtain Condo Association Approval Obtain Historic Approval Remove existing shutters and awnings Remove air conditioners Remove existing shades, drapes,window treatments, wall hangings, and personal belongings Move;furniture atleast'3 feet away from work area4 Tie or cuf back trees, bushes and shrubs in the work area Arrange to have alarm system and doorbells disconnected Arrange to have any plumbing and electrical repairs or changes made by appropriate licensed contractor Provide a door handle and lockset for entry door if Pella handle and lockset is not purchased. Before the Installation Pella agrees to do the following: Obtain Building Permit (When required)) Prefinish products whempurchased in contract) During the Installation the Homeowner agrees to do the following: Keep pets safely away from work area Keep children safely away from work area Allow Pella Installer room to work safely within your home During the Installation Pella agrees to do the following: Deliver and unload products purchased per contract) ,Place and remove drop cloths in work area then vacuum, and_remove alldebris at'end'of day, Remove existing product, including storm windows, and dispose of it unless otherwise specified) Install all products using method specified in contract per Pella Installation Instructions'_ Replace interior and/or exterior trim only if purchased' If Purchased, install exterior primed pine wood trim or Composite. Composite will be unfinished.', If Purchased, install interior trim matching wood window finish or White trim for Impervia and Encompass Install non-Pella entry door lockset provided by you. Pella is not responsible for it's quality or performance After the Installation the Homeowner agrees to do the following: Be available for completion and sign off to verify all products purchased a`re in working-order, Reinstall existing shutters and awnings Re-install existing shades, drapes, window treatments,wall hangings, and reposition furniture Arrange to have alarm system and doorbells reinstalled Reinstall air conditioners Remove stickers from product and save for energy rebate and-tax purposes Wash all interior&exterior glass surfaces Fill nail holes and joints on interior trim if windows are to be stained (after staining) Clean up exterior casing issues due to storm window removal if full wrap or new exterior trim is not purchased m ` w"'u'Af' iec list has been reviewed Customer initial Product Only Addendum has been reviewed For more information regarding the finishing, maintenance,service and warranty of all Pella@ products,visit the Pella@ website at www.pella.com Printed on 6121/2016 Contract-Detailed Page 4 of 5 Customer: Marianne Corrou Project Name: Corrou,Marianne,NorthAndover,MA,742489 Order Number: 741AGO648 Quote Number: 7974113 Customer initial Credit Card.Account#: Last 4 Digits 1 8 5 1 Expiration Date: 0 5 / 1 9 Charge final payment to same account (Upon substantial completion) Customer initial Project Checklist has been reviewed Marianne Corrou Anthony Griseto 12 Customer Name (Please print) Pella Sales Rep ame (Plea pri Order Totals " I ,�,�UA-1l� � Taxable Subtotal $6,620.00 Customer Signature Pella Sales Rep Sig4fiturekj Sales Tax @ 6.25% $413.75 6/21/2016 6/21/2016 Non-taxable Subtotal $2,907.54 1I Daa�te Date Total $9,941.29 W) `,U UAA t Ca� Deposit Received $4,970.65 Credit Card Approval Signature Amount Due $4,970.64 For more information regarding the finishing, maintenance,service and warranty of all Pella®products,visit the Pella®website at www.pelia.com Printed on 6/21/2016 Contract-Detailed Page 5 of 5 PELLA WINDOWS AND DOORS CONTRACT , PAYMENTS 1. TERMS AND CONDITIONS Pella shall be entitled to stop the Work upon written notice to Owner for any material default or failure by Owner,including but not limited to,the Owner's These Terms and Conditions are an integral part ofthe 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. ofthe 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 ofthe 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 ofthe 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 ofwaste materials or rubbish caused by performance ofthe 12. PERMITS(MA customers only) Work. Pella is obligated to and will obtain the following permits for this project: 4. CHANGES BUI ing . Homeowners who secure their own permits will be excluded from the guaranty fund provisions of Massachusetts General Laws, The Owner may order in writing changes in the Work consisting of additions, chapter 142A. deletions,or modifications("Change Order"). Any Change Order shall include an adjustment to the Price and the Substantial Completion Date,as In addition to the rights and warranties enumerated in this agreement,you may determined by Pella. Pella reserves the right to approve or disapprove any have additional rights under Massachusetts General Laws,chapter 142A and Change Order and any such Change Order must be signed by both Owner and 780 Code of Massachusetts Regulations R6. Pella to be effective. 13. NOTICE OF CANCELLATION 5. SUBSTANTIAL COMPLETION You may cancel this agreement if it has been signed by a party Owner understands and agrees that the Substantial Completion Date is an thereto at a place other than an address of the seller,which estimate only and that the actual date on which the Work is completed may be may be his main office or branch thereof,provided you notify extended to allow for Change Orders requested by Owner or if the time to complete the Work is affected by conduct of the Owner,weather,labor the seller in writing at his main office or branch by ordinary disputes,availability of subcontractors,acts of God,fire or other causes mail posted,by telegram sent or by delivery,not later than reasonably beyond Pella's control.If for any reason the Work is not fully midnight ofthe 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 ofthe completion costs or 10%ofthe remaining unpaid balance ofthe Price,whichever is less. Do not sign this contract if there are any blank spaces. 6. FINANCING If payment ofthe Price is financed with a financial institution through Pella,all financing paperwork must be completed upon signing ofthis Contract and the /u4 (2,,,,J7,- requisite approvals and authorizations for the full amount of the requested financing shall have been received from the financial institution. Customer signature 6/21/2016 Date DISPUTES THE CONTRACTOR AND THE HOMEOWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT PELLA HAS A DISPUTE CONCERNING THIS CONTRACT,PELLA MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUTIVE OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATIONS AND THE CONSUMER SHALL BE REQUIRED TO SUBMIT TO SUCH ARBITRATION AS PROVIDED IN M.G.L.c. 142A Pella Windows & Doors Contractor W1 U.A A, C,d aw- Homeowner NOTICE: THE SIGNATURE OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE SETTLEMENT INITIATED BY THE CONTRACTOR. THE OWNER MAY INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THIS SECTION IS NOT SEPARATELY SIGNED BY THE PARTIES. NOTICE OF CANCELLATION Date of transaction: 6/21/2016 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 6/24/2016 (three business days from the date of transaction above). I hereby cancel this transaction. (Date) (Buyer's signature) Do NOT sign here unless you wish to cancel The Commonwealth of Massachusetts Department of Industrial Accidents Office ofinvestigations investigations 600 Washington Street Boston,MA 02111 www z+ ass.govIdia Workers' Compensation Insurance davit:Buailde>rs/Coutraetto>rs/ERectricians/Fllumbeils ARE licant Information Please Print Le ibl Flame(Business/Organization/lndividual): IN (} 1� p p V.?— Address:- City/State/Zip: LAddress:City/State/Zip: 6lLd,d AM Q V3 -z- Phone#: 7 V:6: 72SE Are you in employer?Check the appropriate box: Type of project(required): 1.&,I am a employer with 2.� 4. ®1 am a general contractor and I employees(full and/or part-time). � have hared the sub-contractors 6. ®New construction 2.0 1 am a sole proprietor or partner- listed on the attached sheet. 7. -Remodeling ship and have no employees These sub-contractors have g• ❑Demolition workingfor me in an capacity. employees and have workers' y P tY 9. ❑Building addition [No workers'comp.insurance comp.insuranceJ required.] 5. ® We are a corporation and its 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their I L[J Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12.®Roof repairs . insurance required.],t c. 152,§1(4),and we have no employees.[No workers' 13.n Other comp.insurance required.] *Any applicant that checks box#1 rrsrst 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 subnrit a new affidavit indicating such- Icontractors that check this box must attached an additional sheet showing the natre of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have.employees,they must provide their workers'comp.policy number. T am an employer that is providing workers'compensation.insurance foe my employem Below is the policy Band job site information- Insurance Company Name: �c Cpl S Cl) Policy#or Self-ins.Lie..#: q(,J CJ Expiration Bate: -7-1 / Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby cert under the pains and penalties of perjury that the information provided above is true and correct Simature• n Date: 2 J 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#: Public:Secty x V1 LYfations anO,%,* B rtiWiun L,icens<e: CS-089853 _ t' V w WILLL4M R NICHOLS a V`PEA'RTREE RD` X d ' "i HAVERHILi Mfr 01830 a a Commissioner 1U/26/2Q'16 • ��fe.�n�ra�rr�ru�errl/�aJr'�f��rdJczr�n�c�li ce of Consumer Affairs&Business Regulation License or registration valid,for individul use only E IMPROVEMENT CONTRACTOR before the expiration date. ff found return to: s Office of Consumer Affairs and Business Regulation egistration 183279 Type 10 Park Plaza-Suite 5170 Expiration ,.9/$4/2017 Supplement C••rd Boston,MA 02116 NEW ENGLAND WINDOW&DOOR;LLC. PELLA WINDOWS&`DOORS William Nichols '45 FONDI ROAD HAVERHILL,MA 01832 Undersecretary Not valid.without signature