HomeMy WebLinkAboutBuilding Permit #288-1 - 4 HOLBROOK ROAD 9/4/2015 %AORTH
BUILDING PERMIT O�tijeD bq�o
TOWN OF NORTH ANDOVER �,a h` ,'- .._..,.46
APPLICATION FOR PLAN EXAMINATION -
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Permit No#: �l Date Received �yA�RATEO
SSACHU`��
Date Issued:
MPORTANT: Applicant must complete all items on this page
LOCATION
Print
PROPERTY OWNER S,+M,F—S h>, sk&A
Print 100 Year Structure yes Ono MAP �i17 PARCEL:®/' ZONING DISTRICT:X3 k Historic District yes
Machine Shop Village yes
TYPE O IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ALOne family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
Se tie ❑Wel.l. a ❑ Flood lain p Wetlands J
p Ty p ; D 'Watersheds Dastnct,
p°Water:-/Sewer,_ 'i
DESCRIPTION OF WORK TO BE PERFORMED:
/V,,
Identification- Please Type or Print Clearly
OWNER: Name: Af,•c&s sG�l-e_�. Phone:27�.&q, 3pyl
Address: ko
x�,�/s
Contractor Name: eUA- t�l�I\,v1F,..,` �,�(.C, _. Phone: z�-•Z�� ���s�
Email:
Address: &J15— !C-oichy-- g-) Q1f3 L ;<
Supervisor's Construction License- Exp. Dater fC�az6 ��� �•]
Home Improvement License: j Z Y- 35, Exp. Date:
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.
Total Project Cost: $ 720c o FEE: $ 9 -0
Check No.: 0yJ 4 Receipt No.: 09 50�
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑
Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑
Private(septic tank, etc. ❑ Permanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT Reviewed On Signature_
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
i
HEALTH Reviewed on Signature
COMMENTS
Zdhing Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Wafter & Sewer Connection/Signature& Date Driveway Permit
DPW'Town Engineer-`*- nature:
Located 384 Osgood Street
�,FIRE DEPAR TMEfd =Temp D psteon situy s
(L ed at 124 Main'Street... ,_, K�'I 4° '�� �h -�, .� ,. a •.R „�
�a.� 6 t.�� � 4�.zK: +.star.�4�' �r Nj��-�'°rt .x, �r'�*. .ni r�t,
Mia signature/date
: z ;? ..e:.�svy►._. k .c, , '; ' . r �}
't.'^ &
//��' �,,.Q ,, t *_ `�1d.. c �'�$":' `,...w aX,,,•�r�' tf R� ��e i- u. ,Atpj�
'Dimension l
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
DANCER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
NOTES and DATA— (For department ease)
® Notified for pickup Call Email
Date Time Contact Name
Doc.Building Pen-nit Revised 2014
r
r
Building Department
The following is a list of the required forms to be filled out for the appropriate permit to be obtained.
Roofing, Siding, Interior Rehabilitation Permits
Building Permit Application
Workers Comp Affidavit
Photo Copy Of H.I.C. And/Or C.S.L. Licenses
Copy of Contract
Floor Plan Or Proposed Interior Work l
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 ConstructionSin le and Two Family)
� 9 Y)
Building Permit Application
Certified Proposed Plot Plan
Photo of H.I.C. And C.S.L. Licenses
Workers Comp Affidavit
Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
Copy of Contract
2012 IECC Energy code
Engineering Affidavits for Engineered products
OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit
In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be submitted with the building application
Doc:Building Permit Revised 2014
LocationG J
No. "�4e_ fDate
v
. - TOWN OF NORTH ANDOVER
AXI)
Certificate of Occupancy $_ +_
. .
Building/Frame Permit Fee $
,_. Foundation Permit Fee $
Other Permit Fee $ "
TOTAL $
4
Check Ids
Building Inspector
-Town of
NORTH
Ddover
0 �• "�
No. LAKI* _
' h ." ver, Mass,
A- COC NIC Nl WICK y1'
S U
BOARD OF HEALTH
Food/Kitchen
PERMIT T LD Septic System
THIS CERTIFIES THATi�...s.. �t.��.�.�.... ...,..... BUILDING INSPECTOR
�.� � ...... Foundation
has permission to erect.......................... buildings on ..... ........ ...: ..........
Rough
to be occupied as ................ . .......... ....... ...14010400W. .S.Ifr......... ............................. Chimney
provided that the person accep ing this permi shall in every respect conform to the terms of the application Final
on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and
Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 NTH ELECTRICAL INSPECTOR
UNLESS CONSTRUCT I A Rough
Service
............. ....... ....... ..... ........ ........................ Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Building Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
Smoke Det.
Contract - Detailed f
Pella Window and Door Showroom of Haverhill �1
Sales Rep Name: Clancy, Ryan
® 45 Fondi Road Sales Rep Phone: 978-373-2500
Haverhill, MA 01832
Sales Rep Fax:
"( Sales Rep E-Mail: clancyrp@pellaboston.com
Or IV
Customer Information , Project/Delivery Address Order Information
James Hashem Has hem,James,NorthAndover,MA,1600048 Quote Name: 4 Windows
4 Holbrook Rd 4 Holbrook Rd
Order Number: 741 RCO203
NORTH ANDOVER, MA 01845-3706 Lot# Quote Number: 6999920
Primary Phone:(978)3143051 NORTH ANDOVER,MA 01845-3706 Order Type: Installed Sales
Mobile Phone: County: ESSEX Payment Terms: Deposit/C.O.D.
Fax Number: Tax Code: MA TAX 6.25
E-Mail: jdhashem@gmail.com Quoted Date: 7/29/2015
Great Plains#: 9535605
Customer Number: 1007279706
Customer Account: 1002991683
Customer Notes: Permit fee of$108 paid on 7/30/15
Line# Location: Attributes
10 None Assigned Delivery/Setup- Delivery/Setup Item Price Qty Ext'd Price
$180.76 1 $180.76
For more information regarding the finishing, maintenance, service and warranty of all Pella®products,visit the Pella®website at www.pella.com
Printed on 7/30/2015 Contract-Detailed Page 1 of 10
Customer:James Hashem Project Name: Hash em,James,NorthAndover,MA,160 0048 Order Number: 741RCO203 Quote Number: 6999920
Line# Location: Attributes
15 Kitchen Vinyl Windows 1 Doors By Pella, 3-Wide Double Hung, 99 X 40,White Item Price Qty Ext'd Price
$1,887.53 1 $1,887.53
1:Non-Standard SizeNon-Standard Size Double Hung,Equal
,y s PK# Frame Size: 19 1/2 X 40
- General Information: Standard,Vinyl,Nail Fin,4 3/16", 1 5/8",2 9/16"
m (p 718 Exterior Color/Finish: White
=' Interior Color/Finish: White
Glass: Insulated Low-E Advanced Low-E Insulating Glass Argon Non High Altitude
Hardware Options: White,Standard Vent Stop
Viewed From Exterior Screen: Full Screen
Frame Size:99"X 40" Grille: No Grille,
Vertical Mull 1: FactoryMull,1/2"Standard Mullion,Frame To Frame Width: 0.5"
2:Non-Standard Size Non-Stand ard Size Fixed Direct Set
Frame Size: 59 X 40
General Information: Standard,Vinyl,Nail Fin,4 3/16",1 5/8",2 9/16"
Exterior Color/Finish: White
Interior Color/Finish: White
Glass: Insulated Low-E Advanced Low-E Insulating Glass Argon Non High Altitude
Grille: No Grille,
Vertical Mull 2: FactoryMull,1/2"Standard Mullion,Frame To Frame Width: 0.5"
3:Non-Standard SizeNon-Standard Size Double Hung,Equal
Frame Size: 19 1/2 X 40
General Information: Standard,Vinyl,Nail Fin,4 3/16", 1 5/8",2 9/16"
Exterior Color/Finish: White
Interior Color/Finish: White
Glass: Insulated Low-E Advanced Low-E Insulating Glass Argon Non High Altitude
Hardware Options: White,Standard Vent Stop
Screen: Full Screen
Grille: No Grille,
Vertical Mull 1: FactoryMull, 1/2"Standard Mullion,Frame To Frame Width: 0.5"
Wrapping Information: No Exterior Trim,No Interior Trim,Pella Recommended Clearance,Perimeter Length=278",Glazing Pressure=55.
FF>96 wide-Install Full Frame Window>96 inches wide Qty 1
Finish FF Trim-Finish Paint/Stain FF Interior Trim Only Qty 1
Comp Trim>48-Composite Trim Upgrade>Greater than 48 inches wide Qty 1
Trim—Stool and Apron-Add Stool and Apron Trim to Picture Frame 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 7/30/2015 Contract-Detailed Page 2 of 10
Customer: James Hashem Project Name: Hash em,J ames,NorthAndover,MA,1600048 Order Number: 741RCO203 Quote Number: 6999920
Line# g Location: Attributes
20 Master Bedroom Vinyl Windows/Doors By Pella, 3-Wide Double Hung, 99 X 64,White Item Price Qty Ext'd Price
$2,193.88 1 $2,193.88
1:Non-Standard SizeNon-Standard Size Double Hung,Equal
v PK# Frame Size: 19 1/2 X 64
718 General Information: Standard,Vinyl,Nail Fin,4 3/16", 1 5/8",2 9/16"
g, q' Exterior Color/Finish: White
Interior Color/Finish: White
Glass: Insulated Low-E Advanced Low-E Insulating Glass Argon Non High Altitude
Hardware Options: White,Standard Vent Stop
Viewed From Exterior Screen: Full Screen
Frame Size:99"X 64" Grille: No Grille,
Vertical Mull 1: FactoryMull,1/2"Standard Mullion,Frame To Frame Width: 0.5"
2:Non-Standard Size Non-Stand ard Size Fixed Direct Set
Frame Size: 59 X 64
General Information: Standard,Vinyl,Nail Fin,4 3/16",1 5/8",2 9/16"
Exterior Color/Finish: White
Interior Color/Finish:.White
Glass: Insulated Low-E Advanced Low-E Insulating Glass Argon Non High Altitude
Grille: No Grille,
Vertical Mull 2: FactoryMull,1/2"Standard Mullion,Frame To Frame Width: 0.5'
3:Non-Standard SizeNon-Standard Size Double Hung,Equal
Frame Size: 19 1/2 X 64
General Information: Standard,Vinyl,Nail Fin,4 3/16", 1 5/8",2 9/16"
Exterior Color/Finish: White
Interior Color/Finish: White
Glass: Insulated Low-E Advanced Low-E Insulating Glass Argon Non High Altitude
Hardware Options: White,Standard Vent Stop
Screen: Full Screen
Grille: No Grille,
Vertical Mull 1: FactoryMull, 1/2"Standard Mullion,Frame To Frame Width: 0.5"
Wrapping Information: No Exterior Trim,No Interior Trim,Pella Recommended Clearance,Perimeter Length=326",Glazing Pressure=65.
FF>96 wide-Install Full Frame Window>96 inches wide Qty 1
FF>60 Height-Install Full Frame Window>60 inches Unit/Composite Height Qty 1
Finish FF Trim-Finish Paint/Stain FF Interior Trim Only Qty 1
Comp Trim>48-Composite Trim Upgrade>Greater than 48 inches wide Qty 1
Trim—Stool and Apron-Add Stool and Apron Trim to Picture Frame Qty 1
For more information regarding the finishing, maintenance, service and warranty of all Pella®products,visit the Pella®website at vwvw.pella.com
Printed on 7/30/2015 Contract-Detailed Page 3 of 10
Customer:James Hashem Project Name: Hash em,James,NorthAndove r,MA,160 0048 Order Number: 741RCO203 Quote Number: 6999920
Line#t Location: Attributes,
25 Living Room Front Vinyl Windows/Doors By Pella, 3-Wide Double Hung, 80 X 64,White Item Price Qty Ext'd Price
$2,042.07 1 $2,042.07
1:Non-Standard SizeNon-Standard Size Double Hung,Equal
8' PK# Frame Size: 19 1/2 X 64
718 General Information: Standard,Vinyl,Nail Fin,4 3/16", 1 5/8",2 9/16"
0 Exterior Color/Finish: White
Interior Color/Finish: White
r j
-'j.qt Glass: Insulated Low-E Advanced Low-E Insulating Glass Argon Non High Altitude
Hardware Options: White,Standard Vent Stop
Viewed From Exterior Screen: Full Screen
Frame Size:80"X 64" Grille: No Grille,
Vertical Mull 1: FactoryMull,1/2"Standard Mullion,Frame To Frame Width: 0.5"
2:Non-Standard Size Non-Stand ard Size Fixed Direct Set
Frame Size: 40 X 64
General Information: Standard,Vinyl,Nail Fin,4 3/16",1 5/8",2 9/16"
Exterior Color/Finish: White
Interior Color/Finish: White
Glass: Insulated Low-E Advanced Low-E Insulating Glass Argon Non High Altitude
Grille: No Grille,
Vertical Mull 2: FactoryMull,1/2"Standard Mullion,Frame To Frame Width: 0.5"
3:Non-Standard SizeNon-Standard Size Double Hung,Equal
Frame Size: 19 1/2 X 64
General Information: Standard,Vinyl,Nail Fin,4 3/16", 1 5/8",2 9/16"
Exterior Color/Finish: White
Interior Color/Finish: White
Glass: Insulated Low-E Advanced Low-E Insulating Glass Argon Non High Altitude
Hardware Options: White,Standard Vent Stop
Screen: Full Screen
Grille: No Grille,
Vertical Mull 1: FactoryMull,1/2"Standard Mullion,Frame To Frame Vvidth: 0.5"
Wrapping Information: No Exterior Trim,No Interior Trim,Pella Recommended Clearance,Perimeter Length=288",Glazing Pressure=50.
FF>60 Height-Install Full Frame Window>60 inches Unit/Composite Height Qty 1
FF-48-96 wide-Install Full Frame Window_48-96 inches wide Qty 1
Finish FF Trim-Finish Paint/Stain FF Interior Trim Only Qty 1
Comp Trim>48-Composite Trim Upgrade>Greater than 48 inches wide Qty 1
Trim—Stool and Apron-Add Stool and Apron Trim to Picture Frame Qty 1
For more information regarding the finishing, maintenance, service and warranty of all Pella®products, visit the Pella®website at www.pella.com
Printed on 7/30/2015 Contract-Detailed Page 4 of 10
Customer:James Hashem Project Name: Hashem,James,NorthAndover,MA,1600048 Order Number: 741RCO203 Quote Number: 6999920
Line# Location: Attributes
30 Living Room Side Vinyl Windows/Doors By Pella, 3-Wide Double Hung, 99 X 64, White Item Price Qty Ext'd Price
$2,193.88 1 $2,193.88
- - 1:Non-Standard SizeNon-Standard Size Double Hung,Equal
LPK# Frame Size: 19 1/2 X 64
General Information: Standard,Vinyl,Nail Fin,4 3/16", 1 5/8",2 9/16"
718
Exterior Color/Finish: White
Interior Color/Finish: White
Glass: Insulated Low-E Advanced Low-E Insulating Glass Argon Non High Altitude
Hardware Options: White,Standard Vent Stop
Viewed From Exterior Screen: Full Screen
Frame Size:99"X 64" Grille: No Grille,
Vertical Mull 1: FactoryMull, 1/2"Standard Mullion,Frame To Frame Width: 0.5"
2:Non-Standard SizeNon-Standard Size Fixed Direct Set
Frame Size: 59 X 64
General Information: Standard,Vinyl,Nail Fin,4 3/16",1 5/8",2 9/16"
Exterior Color/Finish: White
Interior Color/Finish: White
Glass: Insulated Low-E Advanced Low-E Insulating Glass Argon Non High Altitude
Grille: No Grille,
Vertical Mull 2: FactoryMull,1/2"Standard Mullion,Frame To Frame Width: 0.5'
3:Non-Standard SizeNon-Standard Size Double Hung,Equal
Frame Size: 19 1/2 X 64
General Information: Standard,Vinyl,Nail Fin,4 3/16", 1 5/8",2 9/16"
Exterior Color/Finish: White
Interior Color/Finish: White
Glass: Insulated Low-E Advanced Low-E Insulating Glass Argon Non High Altitude
Hardware Options: White,Standard Vent Stop
Screen: Full Screen
Grille: No Grille,
Vertical Mull 1: FactoryMull, 1/2"Standard Mullion,Frame To Frame Width: 0.5"
Wrapping Information: No Exterior Trim,No Interior Trim,Pella Recommended Clearance,Perimeter Length=326",Glazing Pressure=65.
FF>96 wide-Install Full Frame Window>96 inches wide Qty 1
FF>60 Height-Install Full Frame Window>60 inches Unit/Composite Height Qty 1
Finish FF Trim-Finish Paint/Stain FF Interior Trim Only Qty 1
Comp Trim>48-Composite Trim Upgrade>Greater than 48 inches wide Qty 1
Trim—Stool and Apron-Add Stool and Apron Trim to Picture Frame 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 Pella products meet local egress requirements.
For more information regarding the finishing, maintenance, service and warranty of all Pella®products,visit the Pella®website at www.pella.com
Printed on 7/30/2015 Contract-Detailed Page 5 of 10
Customer: James Hashem Project Name: Hash em,James,NorthAndover,MA,1600048 Order Number: 741RCO203 Quote Number: 6999920
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.
Project Checklist Review (Installed Orders Only)
Before the Installation the Homeowner agrees to do the following:
Obtain Condo Association Approval
Obtain Historic Approval
Remove existing shutters and awnings
Remove air conditioners
Remove existing shades, drapes, window treatments, wall hangings, and personal belongings
Move furniture at least 3 feet away from work area
Tie or cut back trees, bushes and shrubs in the work area
Arrange to have alarm system and doorbells disconnected
Arrange to have any plumbing and electrical repairs or changes made by appropriate licensed contractor
Provide a door handle and lockset for entry door if Pella handle and lockset is not purchased.
Before the Installation Pella agrees to do the following:
Obtain Building Permit (When required)
Prefinish products when purchased in contract
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 all debris at end of day
Remove existing product, including storm windows, and dispose of it unless otherwise specified
Install all products using method specified in contract per Pella Installation Instructions
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:
For more information regarding the finishing, maintenance, service and warranty of all Pella®products, visit the Pella®website at www.pelia.com
Printed on 7/30/2015 Contract-Detailed Page 6 of 10
Customer:James Hashem Project Name: Hashem,James,NorthAndover,MA,1600048 Order Number: 741 RCO203 Quote Number: 6999920
Be available for completion and sign off to verify all products purchased are in working order
Reinstall existing shutters and awnings
Re-install existing shades, drapes, window treatments, wall hangings, and reposition furniture
Arrange to have alarm system and doorbells reinstalled
Reinstall air conditioners
Remove stickers from product and save for energy rebate and tax purposes
Wash II interior&exterior glass surfaces
Fill holes nd joints on interior trim if windows are to be stained (after staining)
t i casing issues due to storm window removal if full wrap or new exterior trim is not purchased
oject Checklist has been reviewed
Customer initial
Product Only Addendum has been reviewed
Customer initial
Credit Card Account#: Last 4 Digits
Expiration Date: /
Charge final payment to same account
(Upon substantial completion) Customer initial
For more information regarding the finishing, maintenance, service and warranty of all Pella®products,visit the Pella®website at www.pella.com
Printed on 7/30/2015 Contract-Detailed Page 7 of 10
Customer:James Hashem Project Name: Hashem,James,NorthAndover,MA,1600048 Order Number: 741 RCO203 Quote Number: 6999920
roject Checklist has been reviewed
Ja es Hashem VRyanI ncy
omer N e (Please print) e ep Name (Please print) Order Totals
Taxable Subtotal $4,201.49
Customer Signature es Rep Signature Sales Tax @ 6.25% $262.59
7/30/15 7/30/15 Non-taxable Subtotal $4,296.63
Date Date Total $8,760.71
Deposit Received $8,760.71
Credit Card Approval Signature Amount Due $0.00
For more information regarding the finishing, maintenance, service and warranty of all Pella®products,visit the Pella®website at www.pella.com
Printed on 7/30/2015 Contract-Detailed Page 8 of 10
NOTICE OF CANCELLATION
Date of transaction: 7/30/15
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 8/3/15 (three business days from the date of
transaction above).
I hereby cancel this transaction.
(Date) (Buyer's signature)
PELLA WINDOWS AND DOORS CONTRACT
7. PAYMENTS
1. TERMS AND CONDITIONS Pella shall be entitled to stop the Work upon written notice to Owner for any
material default or failure by Owner,including but not limited to,the Owner's
These Terms and Conditions are an integral part 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 ofthe 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 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 ofthe 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
ofthe 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 ofthe 12. PERMITS(MA customers only)
Work.
Pella is obligated to and will obtain the following permits for this project:
Building . Homeowners who secure their own permits will be
4. CHANGES 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 ofthe 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 of the 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 of this Contract and the
requisite approvals and authorizations for the full amount ofthe requested
financing shall have been received from the financial institution. Customer signature
7/30/15
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 and Doors
Contractor
omeowner
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.
The Commonwealth of Massachusetts r l in t Fpx)n
— Department of Industrial Accidents
Office of Investigations
1 Congress Street, Suite 100
+ Hoston, MA 02114-2017
www mass.gov/ilia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): AyI
Address: 4S_ [-7o,ra r— P3,10
City/State/Zip: 14 ep,&tj Z Phone#:
Are you an employer? Check the appropriate box: Type of project(required):
1.UkI am a employer with --,75- 4. ❑ I am a general contractor and 1 6. ❑ 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 g• ❑ Demolition
working for me in any capacity. employees and have workers' 9. ❑ Building addition
[No workers' comp. insurance comp. insurance.'+
5. We are a corporation and its 10.❑ Electrical .repairs or additions
required.] ❑ P
3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions
myself. No workers' coin right of exemption per MGL
y [ P• 12.0 Roof repairs
insurance required.] t c. .152, §1(4),and we have no
employees. [No workers' 13.0 Other
comp. insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
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(his box must attached an additional sheet showing the name 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.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information. j
Insurance Company Name: �-t ®Ltil iN
Policy#or Self-ins.Lic.#: (_M 30 L4 C; I o ( Expiration Date:
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 tinder Section 25A of MGL c. 152 can lead to the nnposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certLunder thepains andpenalties of e!jury that the information provided above is true and correct.
Signature: _. _ ___-- ._ __.._..__ :_ .__�.__ __...____ __ ._. I -
Date
Phone#:
Official use only. Do not write in this area, to be completed by ci4,or town official
City or Town: Permit/License#
Issuing Authority(circle one):
L Board of Health 2.Building Department 3.City/Town Clerk 4—Electrical Inspector 5.Plumbing Inspector
6.Other
Contact.Person: Phone#:
� RD� DATE� °°YY� IFICATE OF LIABILITY INSURANCE 06/ ,2I
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER
Fred C.Church,inc. HANE NTA T pommy A.Corlett,CIC,RPLU
41 Wellman Street PHONE 9783227231 1 FAX (978)454-1065
Lowell,MA 01851 o A1C No):
(800)225-1865A L S: dcorteU@hadcchurch.cwm
INSURER(S1 AFFORDING COVERAGE NAIC#
INSURER A: Cilaens Insurance Company of America 31534
INSURED INSURER 8: New Hampshire Employers Insurance Company 13083
New England Window$Door LLC
45 Fondl Road INSURERC:
Haverhill.MA 01832-1302 INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:54457 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 REDUCEDBYPAID CLAIMS.
INSR ADDL SUBR POLIC
LTR TYPE OF INSURANCE POLICY NUMBER Y EXP
DOGEY EFF POLICY
LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABIUTY DAMAGE TO RENTED $ 100,000
PREMISES Ea occurrence
CLAIMS-MADE a OCCUR MED E(P(Any one person) $ 10,000
A X CG0001 ZBN8161407 71112015711@016 1,00°,000
PERSONAL SADVINJURY $
GENERAL AGGREGATE $ 2.000,000
GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ 2,000,000
POLICY X PRO- X LOC $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
Ea accldenl
ANY AUTO BODILY INJURY(Per person) $
ALL OWNED SCHEDULED
ALTOS AUTOS BODILY INJURY(Per accident) $
HIRED AUTOS AUTOS�� PROPERTY DAMAGE $
Per accident
$
UMBRELLA LIAB OCCUR
EXCESS LIAR EACH OCCURRENCE $
CLAIMS-MADE AGGREGATE 8
DED RETENTION$ $
WORKERS COMPENSATION X I VIC STAID- OTH-
AND EMPLOYERS'UAaIUTY YINLIMITS I I ER
CRYB ANY PROPRIETORIPARTNERIEXECUTIVEE.L.EACH ACCIDENT $ 500,000
OFFICERIMEMBER EXCLUDED? N 1 A 400040101 7112015 71112016
(Mandatory In NH) 500000
If yes,describe under E.L.DISEASE-FA EMPLOYE $ ,
DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 500,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required)
CERTIFICATEAOLDER 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.
AUTHORIZED REPRESENTATIVE
Client ik - Mat 9 Cert Holder# 38407
01988-2010 ACORD CORPORATION. All rights reserved.
ACORD?S(2010/®S) The ACORD name and loco are reoistered mance rnf A(`nRn
h B
.. v�'`�• . <.,,I N
_,(,U." f•!;` i Cl 5 a n .f !
It ISO ISOJ- - ❑r, y•_, _
._ . CS-089853
WILLIAM R 1NICROLS ,s
57 PEARTREE RD'
RAVERMLL MIA 01830'
. - :�� � .[j,t,�_ . i tib.ai'�t1<3•? `.
ti
___._..............._.._...... ..
__.
cJ cnrrrricn�atuctrlt/n��la��ncdrr�c/Y; License or regSstration�Calid for individul use only
,.\ Office:af Consumer Affairs&$usiness Regulation before the expiration date. If found return to:
ME IMPROVEMENT CONTRACTOR Office.of Consumer Affairs and Business Regulation ..
egistration 178383 Type:
10 Park Plaza-Suite.5170
xpiration 4/1612016.: Corporation Boston,MIA 02115
PELLA WINDOWS AND DOOR
WILLIAM NICHOLS
45 FONDE RD
HAVERHILL,MA 01832 Undersecretary Not valid without signature