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Building Permit #084-2016 - 40 MILK STREET 7/2/2015
BUILDING PERMIT of NLE,,eO q TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION * ,� Permit No#: ® i 7 Date Received SACH►15 Date Issued: JVk\X , IMPORTANT: Applicant must complete all items on this page LOCATION 4{b Jk j,L k �� Print " PROPERTY OWNER �.x? S&4 , 'L ���'r� A,"4 1 1,� Print 100 Year Structure yes o MAP PARCEL: ` ZONING DISTRICT: Historic District yes 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 ❑ Septic p Well ❑ Floodplain ❑Wetlands 11 Watershed District 0 Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: IV 0 Identification- Please Type or Print Clearly OWNER: Name: CA-r-&- Sja Phone1*-2zS-631'" Address: YOAftr, j fle-lC' Sr- Contractor NameUUrxcnr-,,,5/,.,.►" p4sL(hone: Email: Address: d{5_ nrat- 4,0 Cir ri h/Sr� Supervisor's Construction License: OcC5 c,-s''� Exp. Date: G6. 24-r4 Home Improvement License: 1 -7 rr 3 9- 3 Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING P eMIT.$12.00 PER$1000.000 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 7aa C 6 5 FEE: $ Check No.: to 3 '� Receipt No.: c� NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Ni 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 rP 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 4. Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) 4. 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 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 m U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Siqnature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Hanning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRED PAR+ ENT 10 rnp D;urnpster on site lyes__ nog FreDepartmen ,s'gr�ature/date 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 rnin.$100-$1000 fine NOTES and DATA— (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 Location No. L o( Date . - TOWN OF NORTH ANDOVER . rTrn, s .: Certificate of Occupancy $ Building/Frame Permit Fee $fig Foundation Permit Fee $ Other Permit Fee $ 0 TOTAL $ Check# Building Inspector NORTH Town of 2 EAndover 0 46�� No. Z er, Mass of S c OCH1c Nt Wlck y1' �d RATED S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System t THIS CERTIFIES THAT ............ r !l.... ..... .�e. Mr.l� BUILDING INSPECTOR ��... . L t.�. Foundation has permission to erect .......................... buildings on .......... . �. . ............... � Rough to be occupied as ....2) ...2z.�tx�N.M.6l*....51� �. .. ... '. ..................... Chimney provided that the person accepting this permit shall in every respect cdtffeft to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO TA Rough Service ................................................................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. - Burner Street No. Smoke Det. Contract - Detailed Pella Window and Door Showroom of Haverhill Sales Rep Name: Hanscom, Luke ® 45 Fondi Road Sales Rep Phone: 978-490-6934 Haverhill, MA 01832 Sales Rep Fax: Phone: (978) 373-2500 Fax: (978) 373-7274 -1 '.5 Sales Rep E-Mail: hanscomlf@pellaboston.com Customer Information Project/Delivery Address Order Information Craig Schumann Schumann,Craig,1581276 Quote Name: Schumann,Craig,1581276 40 Milk St 40 Milk St Order Number: 741 NORTH ANDOVE'2, MA 01845-4518 Lot# Quote Number: 6855561 Primary Phone: (978)2250375 North Andover, MA 01845-4518 Order Type: Installed Sales Mobile Phone: County: Payment Terms: WF4091 -36 Month no Interest Fax Number: Tax Code: MA TAX 6.25 E-Mail: Quoted Date: 6/14/2015 Great Plains#: Customer Number: 1007238465 Customer Account: 1002936932 Line# Location: Attributes 10 None A-signed Delivery/Setup- Delivery/Setup Item Price Qty Ext'd Price $222.99 1 $222.99 For more information regarding the finishing, maintenance, service and warranty of all Pella®products, visit the Pella®website at www.pella.com Printed on 6/15/2015 Contract-Detailed Page 1 of 6 1 Customer: Craig Schumann Project Name: Schumann,Craig,1581276 Order Number: 741 Quote Number: 6855561 Line# Location: Attributes 20 front door Designer, Double Inswing Door Active/Fixed, 66.25 X 79.5. Brick Red Item Price Qty Ext'd Price $7,610.13 1 $7,610.13 1: 6780 Active/Fixed Double Inswing Door PK# Frame Size: 66 1/4 X 79 1/2 714 General Information: Standard,Clad,5 7/8",4 9/16", No Certification,Standard Sill,Brown Finish Sill ti Exterior Color/Finish: Standard Enduraclad,Brick Red J r` Interior Color/Finish: Prefinished White Interior Glass: Insulated Tempered Low-E Advanced Low-E Insulating Glass Argon Non High Altitude + .t9 Hinge Panel: Clear,Tempered Viewed From Exterior Hardware Options: Oil Rubbed Bronze,Order Handle Set, Multipoint Lock Frame Size:66.25"X 79.5' Screen: Sliding Screen,Brick Red,Brown, InViewTM Unit Accessories: Snap-In Between-The-Glass Fabric Shade Bottom-Up,Linen, Manual Grille: No Grille, Wrapping Information: Foldout Fins, Factory Applied, No Exterior Trim, No Interior Trim,4 9/16",5 7/8", Factory Applied, Pella Recommended Clearance, Perimeter Length=292",Glazing Pressure=205. PD-2 Wide Hinged-Install 2-Wide Hinged Patio Door Qty 1 Finish Patio Trim-Finish Paint/Stain Patio Door Interior Trim Only Qty 1 Comp Trim>48-Composite Trim Upgrade>Greater than 48 inches wide Qty 1 Line# Location: Attributes 30 living ro,)m Impervia, Single Sliding Door, Impervia, Double Sliding Do,�r, 104.312 X 79.5,White Item Price Qty Ext'd Price $4,918.43 1 $4,918.43 1:3280 Fixed Single Sliding Door PK# Frame Size: 31 5/16 X 79 1/2 ` 714 General Information: Standard, Duracast®,Block,Foam Insulated,4 3/4", 1 5/16",3 7/16" Exterior Color/Finish: White Interior Color/Finish: White 7T Glass: Insulated Tempered Low-E Advanced Low-E Insulating Glass Argon Non High Altitude Grille: No Grille, Viewed From Extr;rior Vertical Mull 1: FieldMull, 1"x 3"Tube Mullion, Frame To Frame Width: 1.5" 2:7280 Vent Right/Fixed Double Sliding Door Frame Size: Frame Size: 71 1/2 X 79 1/2 General Information: Standard,Duracast®, Block,Foam Insulated,4 3/4",1 5/16",3 7/16" Exterior Color/Finish: White Interior Color/Finish: White Glass: Insulated Tempered Low-E Advanced Low-E Insulating Glass Argon Non High Altitude Hardware Options: Footbolt Included,Oil Rubbed Bronze Screen: Sliding Screen,InViewTM Grille: No Grille, Wrapping Information: Standard Fin,No Exterior Trim,No Interior Trim, Pella Recommended Clearance,Perimeter Length=368",Glazing Pressure =170. Comp Trim>48-Composite Trim Upgrade>Greater than 48 inches wide Qty 1 Finish Patio Trim-Finish Paint/Stain Patio Door Interior Trim Only Qty 1 PD-3-Wide-Install 3-wide Patio Door Qty 1 Bench Mull-Bench Mull 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 6/15/2015 Contract-Detailed Page 2 of 6 Customer: Craig Schumann Project Name: Schuman n,Craig,1581276 Order Number: 741 Quote Number: 6855561 Line# Location: Attributes 35 back Impervia, Single Sliding Door, Impervia, Double Sliding Door, 104.312 X 79.5,White Item Price Qty Ext'd Price $4,918.43 1 $4,918.43 1:3280 Fixed Single Sliding Door PK# Frame Size: 31 5/16 X 79 1/2 714 General Information: Standard, Duracast®, Block, Foam Insulated,4 3/4", 1 5/16", 3 7/16" Exterior Color/Finish: White Interior Color/Finish: White �.31ta Glass: Insulated Tempered Low-E Advanced Low-E Insulating Glass Argon Non High Altitude Grille: No Grille, Viewed From Exf•)rior Vertical Mull 1: FieldMull, 1"x 3"Tube Mullion, Frame To Frame Width: 1.5" Frame Size: 2: 7280 Vent Right/Fixed Double Sliding Door Frame Size: 71 1/2 X 79 1/2 General Information: Standard,Duracast®, Block, Foam Insulated,4 3/4",1 5/16",3 7/16" Exterior Color/Finish: White Interior Color/Finish: White Glass: Insulated Tempered Low-E Advanced Low-E Insulating Glass Argon Non High Altitude Hardware Options: Footbolt Included,Oil Rubbed Bronze Screen: Sliding Screen,InViewT9 Grille: No Grille, Wrapping Information: Standard Fin,No Exterior Trim,No Interior Trim,Pella Recommended Clearance,Perimeter Length=368",Glazing Pressure =170. Comp Trim>48-Composite Trim Upgrade>Greater than 48 inches wide Qty 1 Finish Patio Trim-Finish Paint/Stain Patio Door Interior Trim Only Qty 1 PD-3-Wide-Install 3-wide Patio Door Qty 1 Bench Mull-Bench Mull Qty 1 Thank You For Purchasing Pel�a® 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 apart of this contract. Please see the warranties for complete details,taking special note of the two important notice sections re,garding 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(eg•ess)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. Per the manufacto-er'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 PKODUCTS: 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 Agreemr;nt and Privacy Policy are part of the terms of sale. For more information regarding the finishing, maintenance, service and warranty of all Pella®products, visit the Pella®website at www.pella.com Printed on 6/15/2015 Contract-Detailed Page 3 of 6 Customer: Craig Schumann Project Name: Schumann,Craig,1581276 Order Number: 741 Quote Number: 6855561 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 spfely away from work area Allow Pella Installer room to work safely within your home During the Installation Pella agrees to do the followinq: 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 produc:s 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.;ompletion and sign off to verify all products purchased are in working order Reinstall existing shutters and awnings Re-install existir g shades, drapes, window treatments, wall hangings, and reposition furniture Arrange to have alarm system and doorbells reinstalled Reinstall air conditioners Remove stickerF 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 exteric,casing issues due to storm window removal if full wrap or new exterior trim is not purchased For more information regarding the finishing, maintenance, service and warranty of all Pella®products, visit the Pella®website at www.pella.com Printed on 6/15/2015 Contract-Detailed Page 4 of 6 C�usstomer: Craig Schumann Project Name: Schumann,Craig,1581276 Order Number: 741 Quote Number: 6855561 T Project Checklist has been reviewed Customer initial Product Only Addendum has been reviewed Customer initial Credit Card Account#: Last 4 Digits `� O Expiration Date: I C) / 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 6/15,12015 Contract-Detailed Page 5 of 6 Custom Craig Schumann Project Name: Schumann,Craig,1581276 Order Number: 741 Quote Number: 6855561 lloplrloo'ject Checklist has been reviewed Craig Schumann Lukq Hanscom Customer Name (Please print) Pe es Rep Nam (Please rint) Order Totals Taxable Subtotal $13,461.65 stome Signs ture ow 36 0 a e Signature Sales Tax @ 6.25% $841.35 6/15/15 6/15/15 Non-taxable Subtotal $4,208.33 Dat Date Total $18,511.33 Deposit Received X $5,000.00 r royal Signature Amount Due $13,511.33 For more information regarding the finishing, maintenance, service and warranty of all PellaO products, visit the Pella@ website at www.pella.com Printed on 6/15/2015 Contract-Detailed Page 6 of 6 NOTICE OF CANCELLATION Date of transaction: 6/15/15 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 yo!, 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 6/18/15 (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 Pella shall be entitled to stop the Work upon written notice to Owner for any 1. TERMS AND CONDITIONS material default or failure by Owner,including but not limited to,the Owner's These Terms and Conditions are an integral part of the contract set forth on the failure to pay Pella the amount due within seven days after the date payment is Product Order(the"Contract")between New England Window and Door LLC due. dba Pella Windows&Doors,Inc.("Pella")and the person(s)identified on the Product Order("Owner")to supply the products(the"Products"),and perform 8. CORRECTION OF WORK the work(the"Work")described or referred to in such Contract. For Product Pella shall correct installation Work not in conformance with the requirements of Only purchases,a signed"Product Only Addendum"is a required part of the the Contract,if notified in writing by the Owner within two years after the contract. Completion Date or,if earlier,the date on which the Work is substantially completed and payment of the Purchase Price made subject to a holdback as 2. OWNER 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 all remedy for defective workmanship,and is provided in lieu of any and all other shades;verticals,blinds,curtains,drapes or window mounted air conditioners, remedies.Pella's obligation to correct Work is conditioned on Pella's prior prior to the installation of the Products.Pella's installers are not responsible for receipt of all payments then due. the removal or installation of these types of items. Pella is not responsible for pre-existing window coverings fitting on newly installed Pella windows. 9. LIMITED PRODUCT WARRANTY The Owner shall provide complete access to the work site between the hours of Pella shall warrant all Pella products,but only in accordance with the Pella 7:00 a.m.and 6:00 p.m.(Monday through Friday)for Pella's installers to deliver Windows&Doors Limited Warranty.THIS LIMITED WARRANTY SHALL the Products and perform the Work. BE THE SOLE WARRANTY WITH RESPECT TO THE PRODUCTS AND PELLA SPECIFICALLY DISCLAIMS ALL OTHER WARRANTIES, 3. PELLA EXPRESS OR IMPLIED, WRITTEN OR ORAL(INCLUDING WITHOUT LIMITATION ANY WARRANTY OF MERCHANTABILITY OR FITNESS Pella will be responsible for and have control over construction means,methods, FOR A PARTICULAR PURPOSE). techniques,sequences and procedures and for coordinating all portions of the Work.Pella will be responsible for the Work of its Pella Contractors who will 10. NO CONSEQUENTIAL DAMAGES UNDER NO install the Products. CIRCUMSTANCES SHALL PELLA BE LIABLE FOR CONSEQUENTIAL, Unless provided otherwise in the Work description,Pella will provide and pay for INCIDENTAL,INDIRECT,OR SPECIAL DAMAGES,WHETHER all labor,materials,equipment,tools and machinery,transportation,and other FORESEEN OR UNFORESEEN. facilities and services necessary for the proper execution and completion of the Work. 11. HOME IMPROVEMENT CONTRACTORS All home improvement contractors and subcontractors shall be registered with The materials and equipment furnished under the Contract will be good quality the director of the Home Improvement Contractor Registration Program and new unless otherwise required or permitted,the Work will be free from administered by the Board of Building Regulations and Standards. Pella and any defects not inherent in the quality required or permitted,and the Work conform of its subcontractors identified in this agreement have been registered. Any with the requirements of this Contract.Pella shall not be responsible for inquires about Pella or any of its subcontractors relating to registration should be damages or defects caused by abuse,modifications not executed by Pella, directed to:Director,Home Improvement Contractor Registration,One improper or insufficient maintenance,improper operation or normal wear and Ashburton Place,Boston,MA 02108,617-727-8598 tear. Pella will keep the premises and surrounding area free from accumulation of waste materials or rubbish caused by performance of the Work. 12. PERMITS(MA customers only) Pella is obligated to and will obtain the following permits for this project: 4. CHANGES R iilrlinn . Homeowners who secure their own permits will be The Owner may order in writing changes in the Work consisting of additions, excludedfrom the guaranty fund provisions of Massachusetts General Laws, deletions,or modifications("Change Order"). Any Change Order shall include chapter 142A. an adjustment to the Price and the Substantial Completion Date,as determined by Pella. Pella reserves the right to approve or disapprove any Change Order In addition to the rights and warranties enumerated in this agreement,you may and any such Change Order must be signed by both Owner and Pella to be have additional rights under Massachusetts General Laws,chapter 142A and 780 effective. Code of Massachusetts Regulations R6. 5. SUBSTANTIAL COMPLETION 13. NOTICE OF CANCELLATION Owner understands and agrees that the Substantial Completion Date is an You may cancel this agreement if it has been signed by a party estimate only and that the actual date on which the Work is completed may be thereto at a place other than an address of the seller,which may extended to allow for Change Orders requested by Owner or if the time to be his main office or branch thereof,provided you notify the complete the Work is affected by conduct of the Owner,weather,labor disputes, availability of subcontractors,acts of God,fire or other causes reasonably beyond seller in writing at his main office or branch by ordinary mail Pella's control.If for any reason the Work is not fully completed by the posted,by telegram sent or by delivery,not later than midnight of Substantial Completion Date(including any extensions contemplated above),but the third business day following the signing of this agreement. is substantially completed by such date,i.e.,the Product has been installed,but minor parts or components are missing or need to be replaced or repaired,a hold See the attached Notice of Cancellation for an explanation of this back proportionate to the cost of remaining parts or work to be completed is right. acceptable.However,the holdback will not exceed the amount of the completion costs or 10%of the remaining unpaid balance of the Price,whichever is less. Do not sign this contract if there are any blank spaces. 6. FINANCING If payment of the Price is financed with a financial institution through Pella,all rinancing paperworK must be completed upon signing of this Contract and the requisite approvals and authorizations for the full amount of the requested financing shall have been received from the financial institution. 6/15/15 Date OL Custom signature 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 Cie, Homeow er NOTICE: THE SIGNATURE OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNA T iVE 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 F'K[ttt pQrm` Department of Industrial Accident. Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-20.17 nww.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibly Name (Business/Organizatiort/Individual): 11A 4- M1)ct r2 Address: 4 S [-7L City/State/Zip: 4&vead,( I cA 6632- Phone MA 7�)-Z6,-7�.5—' Are you an employer? Check the appropriate box: Type of project(required): 1.[,l am a employer with �.5 4. ❑ 1 am a general contractor and 1 employees(full and/or part-time). have hired the sub-contractors 6. ❑New construction 2.❑ l am a sole proprietor or partner- listed on the attached sheet. 7. 1&gemodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me.in any capacity. employees and have workers' 9. E] Building addition [No workers' comp. insurance comp. insurance.' required.] 5. ❑ We are a corporation and its 1.0.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself:. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] ' c. 152, §1(4),and we have no 13T] Other employees. [No workers' comp. insurance required.] $Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeo..ners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. *Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and 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. Beloit,is the policy and job site information. Insurance Company Name: l4 1-7 t1A J)Lcq.,e,2 Policy#or Self-ins. Lie.#: i-�(� t;�-1 Cs t� �, 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 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 itriprisoninent, 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 certi2 under the gains and penalties o perjury that the information provided above is true and correct. Signature: -_.. --_ ____ ___.. .__ ___ _---._____ Date: _ _. -_-Z1.`� _.___ 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#: ATE .alb bP CERTIFICATE OF LIABILITY INSURANCE 06/9/2015MM /DDIYYYY) 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(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 certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Dorothy A.Corlett,CIC,RPLU Fred C.Church,Inc. NAME:PHONE 978 3227231 FAX (978)454-1865 41 Wellman Street Lowell,MA 01851 o AIC No (800)225.1865 E-MAIL No dcodett@fredcchurch.com INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: Citizens Insurance Company of America 31534 INSURED INSURERS: New Hampshire Employers Insurance Company 13083 New England Window&Door LLC INSURER C: 45 Fondi Road Haverhill,MA 01832-1302 INSURER D: INSURER E: INSURERF: 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 REDUCED BY PAID CLAIMS. INSR I TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD MMIDD GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X DAMAGE TO COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 100,000 CLAIMS-MADE Pil OCCUR MED EXP(Any one person) $ 10,000 A X CG0001 ZBN8161407 7/1/2015 7/1/2016 1,000,000 PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ 2.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2.000,000 POLICY X PRO- X LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ F F I $ HIRED AUTOS AUTOS Per accident UMBRELLA UAB H OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X NC STATU- OTH- AND EMPLOYERS'LIABILITY YIN N DRY LIMITS 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ B OFFICERIMEMBER EXCLUDED? N/A 400040101 7/112015 71112016 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) 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. AUTHORIZED REPRESENTATIVE Client# Met# Cert Holder# 31:1481 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD art ,e;• c t Pub1;c 5afety ,cg Re�uiations and gtariaa ds r . iIsIrJ.tIon SV;U,rNi.ui- a ,...cense. CS-089853 WILLIAM R NICHOLS 57 PEARTREE RD' HAVERHILL MA; 01830 orr;rre,ss o:�er 10/28/2096 n.%1P (('Q J/t JJ1Q77lOP,R:f�f1 Q,/C��CCCJJCICItLCJC�1 �• . .•. a Office.of Consumer Affairs&,$usiness Regulation License or registration X'alid for indvidul use only; ME IMPROVEMENT CONTRACTOR before the expiration date.:If fofind return to: egistration: 178383 -Type: Office of Consumer Affairs and Business.Regulation xpiration. 4/.10/2016 Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 PELLA WINDOWS AND DOOR. WILLIAM NICHOLS 45 FONDE RD g _ HAVERHILL,MA 01832 a —r'���' °_ –b 1 C'"' Undersecretary Not valid without signature