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Home My WebLink AboutBuilding Permit #1130-2016 - 58 EVERGREEN DRIVE 4/21/2016 L f �` NORTH 1 ,f --YD BUILDING PERMIT14. O�tz`ED -b�tio � TOWN OF NORTH ANDOVER �� 5 ,.``- .:....46IN APPLICATION FOR PLAN EXAMINATION _ Permit No#: A6 Date Received p°RHrEo^PP R5 / gSSAC HV 5�4 Date Issued: I PORTANT: Applicant must complete all items on this page LOCATION eVEzGk,-e_,\f � - Print PROPERTY OWNER IQ,c�� Vhf_f / Print 100 Year Structure yes o MAP / PARCEL:Qd4�T ZONING DISTRICT:_ Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ®-erne family ❑ Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial P-R pair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other p`Septic ❑'1Nell Floodplain [I Wetlands 0 Watershed'District ❑'Water/S'ewer, DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: �, rr�--��( . f Phone:�l��Z� C� Address: F_ Contractor Name:PeUA-Ldw ji, Q hone: Email: Address: tiE s v f ^e5 �1��2 Supervisor's Construction License: /D% i reS Exp. Date: Home Improvement License; 7 9-3 a Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. a FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ �1� FEE: $ � I� '1 ZZSZ t No.:Receipt Check No.: p NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund iqG� r Location `�c' y 'vi `? � >vC— l V { No. ps � Date f' s • ' TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ --! Foundation Permit Fee $ Other Permit Fee $ TOTAL $ ! Check# ' / f 30301 Building Irispector J 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 e U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENT'S I CONSERVATION Reviewed on Signature I 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 tWater& Sewer Connection/Signature & Date Driveway Permit i DPW Town ]Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT �" � Temp Durnpster onsiteyes Lo tac ed a. . Main Street 777777, e ®L' alrt111ent a "' h ? h :a z e y:t � . py n �t 4 4 F$ r}. F�r � S �1ui�S� 6r f .e a r r. wide. rsr•�` t%r•o-k + F r w� i+7y st ;t yl.iOlVl � u + '• '� '� ""rt+ ry sr �' .fir �. Yet,1"�'.�7 v;.P9 'q'��t- aw?. S� s� t�' � t �` �` r•* C R+ �} 1 '-i a� "•, rr 4; . , W�,tf,.t I f`.: x �'. .. ri f f�4.•` "*'� r";'+ +..»st.a.4�...� --"—�....�.:..,...-.�-„_—�.aa.., .—rzii�.�«..» .4{.....?:•.:... .-'..yy..+ft�...��'r'•�i.�t.5abi� s'�' s f 1'�^-'r��#* r?��i .��,� i Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL. Movement of Meter location, wast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: lies No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department apse) f ! i i ® Notified for pickup Call Email Date Time Contact Name Doc.Buildinb Pennit Revised 2014 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 Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit i 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) 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 7 F_ 7 NORTFI 0 I No. P: - 2i o ANE h ver, Mas COCNICHEWICK �.95 RAreo U BOARD OF HEALTH PER IT TL D Food/Kitchen Septic System P BUILDING INSPECTOR THISCERTIFIES THAT ..........................SQL. @ ....J910................................... ............................ � � Foundation has permission to erect .......................... buildings on .... ......... .... .................. ...... ................. 1 � �• Rough to be occupied as ........a....... .��C�.` ....�L.!* 1.. . ................................. Chimney provided that the person accepting t is permit 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. pp y �A Final PERMIT EXPIRES IN-,6 MONTHS - ELECTRICAL INSPECTOR s UNLESS CONSTRUCT START 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 l 2,0 Pella Window and Door Showroom of Haverhill Sales Rep Name: Gless, Benjamin ® 45 Fondi Rd Sales Rep Phone: 978-360-0818 Haverhill, MA 01832 Sales Rep Fax: Phone: (978)373-2500 Fax: (978) 373-7274 Sales Rep E-Mail: glessba@pellaboston.com ri Customer,lnformat�on ', x ; x : Pro�ect/Delivery Address Pro(I* ( _ -. v x Richard Valle Valle,Richard,1705973 Quote Name: 350 Series FULL FRAME 58 Evergreen Dr 58 Evergreen Dr Order Number: 741BG0105 NORTH ANDOVER,MA 01845-6002 Lot# Quote Number: 7736338 Primary Phone:(978)6851022 NORTH ANDOVER,MA 01845-6002 Order Type: Installed Sales Mobile Phone: County: ESSEX Payment Terms: Deposit/C.O.D. Fax Number: Tax Code: MA TAX 6.25 E-Mail: valle.r@vedzon.net Quoted Date: 4/10/2016 Great Plains#: 10571750 Customer Number: 1007863449 Customer Account: 1003713493 Customer Notes: Predeliver all interior trim to H/O to be stained. 21/2 colonial for casings and apro 1 x4 flat for extension jambs. 1 x6 round over stool. 5/4 x 5 flat for field mull in David's BR. ALL EXTERIOR CASINGS TO BE CAPPED in POPLAR WHITE. 4,..e l T s `w. h ly. .,..; ,�,.;k. -;'..R:,n'"z^.: .-A, r:,„*.;, xi: A x s...• :..�.- a�.i. ,mss- 1�. Line4l r'„ _' x a - # s #ArlblltBS w _as a. a ' a 10 None Assigned Delivery/Setup- Delivery/Setup Item Price Qty Ext'd Price $176.25 1 $176.25 For more information regarding the finishing, maintenance,service and warranty of all Pella®products,visit the Pella®website at www.pelia.com Printed on 4/14/2016 Contract-Detailed Page 1 of 10 Customer: Richard Valle Project Name: Valle,Richard,1705973 Order Number. 741BG0105 Quote Number: 7736338 N Line# Location: r v rl U $ 30 Dining Room Back Pella 350 Series, Double Hung, 33.75 X 47.5,Almond Item Price Qty Exrd Price _ $1,266.22 1 $1,266.22 1:33.7547.5 Double Hung,Equal a PK# Frame Size: 33 3/4 X 47 1/2 779 General Information: Yes,Standard,Vinyl,Nail Fin,Foam Insulated,4 1/2", 1 3/8",3 Exterior Color/Finish: Almond J , Interior Color/Finish: Almond ;! Glass: Insulated Dual Low-E Advanced Low-E Insulating Glass Argon Non High Altitude Hardware Options: Cam-Action Lock,Almond,Standard Vent Stop,No Limited Opening Hardware,No Maximum Opening Hardware,Integrated Vinyl Viewed From Exterior Sash Lift Frame Size:33.75"X 47.5" Screen: Full Screen,InViewTm Grille: GBG,No Custom Grille,3/4"Contour,Traditional(3W2H/3W2H),Almond,Almond Wrapping Information: No Interior Trim,Pella Recommended Clearance,Perimeter Length=163",Glazing Pressure= 105. Customer Notes: Try and keep the interior stool intact. Trim—Stool and Apron-Add Stool and Apron Trim to Picture Frame Qty 1 Wrap Coil Stock-Full Capping per unit Qty 1 FF<48 wide-Install Full Frame Window 48 inches or less wide Qty 1 Lead Safe Install-Lead Safe Install Qty 1 _ _ InP * Location .� r + 3 butes t' A 31 bath back Pella 350 Series, Double Hung, 33.75 X 39.5,Almond Item Price Qty Ext'd Price { $1,243.83 1 $1,243.83 1:33.7539.5 Double Hung,Equal PK# Frame Size: 33 3/4 X 39 1/2 779 General Information: Yes,Standard,Vinyl,Nail Fin,Foam Insulated,4 1/2", 1 3/8",3 1/8" E - Exterior Color/Finish: Almond 5 Interior Color/Finish: Almond Glass: Insulated Dual Low-E Advanced Low-E Insulating Glass Argon Non High Attitude Hardware Options: Cam-Action Lock,Almond,Standard Vent Stop,No Limited Opening Hardware,No Maximum Opening Hardware,Integrated Viewed From Exterior Sash Lift P p 9 p 9 gVinyl Frame Size:33.75"X 39.5" Screen: Full Screen,InViewTm Grille: GBG,No Custom Grille,3/4"Contour,Traditional(3W2H/3W2H),Almond,Almond Wrapping Information: No Interior Trim,Pella Recommended Clearance,Perimeter Length= 147",Glazing Pressure=110. Trim—Stool and Apron-Add Stool and Apron Trim to Picture Frame Qty 1 Wrap Coil Stock-Full Capping per unit Qty 1 FF<48 wide-Install Full Frame Window 48 inches or less wide Qty 1 Lead Safe Install-Lead Safe Install 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 4/14/2016 Contract-Detailed Page 2 of 10 Customer:Richard Valle Project Name: Valle,Richard,1705973 Order Number. 741BG0105 Quote Number: 7736338 m u ��• � "� �►ttnbutes � °"" .x. --. 7— ,z ..s M..-x s wi�'. •_n �' ,b .. - A 35 David's BR front Pella 350 Series, 2-Wide Double Hung, 69.5 X 47.5,Almond Item Price Qty Exrd Price $2,284.93 1 $2,284.93 1:33.7547.5 Double Hung,Equal T PK# Frame Size: 33 3/4 X 47 1/2 779 General Information: Yes,Standard,Vinyl,Nail Fin,Foam Insulated,4 1/2",1 3/8",3 1/8" Exterior Color/Finish: Almond Interior Color/Finish: Almond Glass: Insulated Dual Low-E Advanced Low-E Insulating Glass Argon Non High Attitude Hardware Options: Cam-Action Lock,Almond,Standard Vent Stop,No Limited Opening Hardware,No Maximum Opening Hardware,Integrated Vinyl Viewed From Exterior Sash Lift Frame Size:69.5"X 47.5" Screen: Full Screen,InviewTm Grille: GBG,No Custom Grille,3/4"Contour,Traditional(3W2H/3W2H),Almond,Almond Vertical Mull 1: AlignedWith,2" 2:33.7547.5 Double Hung,Equal Frame Size: 33 3/4 X 47 1/2 General Information: Yes,Standard,Vinyl,Nail Fin,Foam Insulated,4 1/2", 1 3/8",3 1/8" Exterior Color/Finish: Almond Interior Color/Finish: Almond Glass: Insulated Dual Low-E Advanced Low-E Insulating Glass Argon Non High Attitude Hardware Options: Cam-Action Lock,Almond,Standard Vent Stop,No Limited Opening Hardware,No Maximum Opening Hardware,Integrated Vinyl Sash Lift Screen: Full Screen,InViewTm Grille: GBG,No Custom Grille,3/4"Contour,Traditional(3W2H/3W2H),Almond,Almond Vertical Mull 1: AlignedWith,2" Wrapping Information: No Interior Trim,Pella Recommended Clearance,Perimeter Length=234",Glazing Pressure= 105. Customer Notes: Add field mull on site to match existing. Trim—Stool and Apron-Add Stool and Apron Trim to Picture Frame Qty 1 Wrap Coil Stock-Full Capping per unit Qty 1 FF-48-96 wide-Install Full Frame Window_48-96 inches wide Qty 1 Lead Safe Install-Lead Safe Install Qty 1 Field Mull Win/Dr-Mull Window or Door in Field 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 4/14/2016 Contract-Detailed Page 3 of 10 Customer: Richard Valle Project Name: Valle,Richard,1705973 Order Number. 741BG0105 Quote Number: 7736338 t 40 Susan's BR front1sid Pella 350 Series, Double Hung,33.75 X 47.5,Almond Item Price city Ext'd Price $1,266.22 2 $2,532.44 1:33.7547.5 Double Hung,Equal �rA4 rrPK# Frame Size: 33 3/4 X 47 1/2 General Information: Yes,Standard,Vinyl,Nail Fin,Foam Insulated,4 1/2", 1 3/8",3 1/8" 779 Exterior Color/Finish: Almond • Interior Color/Finish: Almond Glass: Insulated Dual Low-E Advanced Low-E Insulating Glass Argon Non High Altitude Hardware Options: Cam-Action Lock,Almond,Standard Vent Stop,No Limited Opening Hardware,No Maximum Opening Hardware,Integrated Vinyl Viewed From Exterior Sash Lift Frame Size:33.75"X 47.5" Screen: Full Screen,InVewTm Grille: GBG,No Custom Grille,3/4"Contour,Traditional(3W2H/3W2H),Almond,Almond Wrapping Information: No Interior Trim,Pella Recommended Clearance,Perimeter Length=163",Glazing Pressure=105. Trim—Stool and Apron-Add Stool and Apron Trim to Picture Frame Qty I Wrap Coll Stock-Full Capping per unit Qty 1 FF<48 wide-Install Full Frame Window 48 inches or less wide Qty 1 Lead Safe Install-Lead Safe Install Qty 1 71 4- 2is pu� 45 master side/back Pella 350 Series, Double Hung, 33.75 X 47.5,Almond Item Price Qty Exrd Price $1,266.22 2 $2,532.44 1:33.7547.5 Double Hung,Equal PK# Frame Size: 33 3/4 X 47 1/2 779 General Information: Yes,Standard,Vinyl,Nail Fin,Foam Insulated,4 1/2", 1 3/8",3 1/8" Exterior Color/Finish: Almond Interior Color/Finish: Almond As Glass: Insulated Dual Low-E Advanced Low-E Insulating Glass Argon Non High Altitude Hardware Options: Cam-Action Lock,Almond,Standard Vent Stop,No Limited Opening Hardware,No Maximum Opening Hardware,Integrated Vinyl Viewed From Exterior Sash Lift Frame Size:33.75"X 47.5" Screen: Full Screen,InVewTm Grille: GBG,No Custom Grille,3/4"Contour,Traditional(3W2H/3W2H),Almond,Almond Wrapping Information: No Interior Trim,Pella Recommended Clearance,Perimeter Length=163",Glazing Pressure=105. Trim—Stool and Apron-Add Stool and Apron Trim to Picture Frame Qty 1 Wrap Coil Stock-Full Capping per unit Qty I FF<48 wide-Install Full Frame Window 48 inches or less wide Qty 1 Lead Safe Install-Lead Safe Install 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 4/14/2016 Contract-Detailed Page 4 of 10 Customer: Richard Valle Project Name: Valle,Richard,1705973 Order Number: 741BG0105 Quote Number: 7736338 Lme# Location: sAnbutes ro a 50 master bath back Pella 350 Series, Double Hung, 33.75 X 39.5,Almond Item Price city Exrd Price $1,243.83 1 $1,243.83 1:33.7539.5 Double Hung,Equal PK# Frame Size: 33 3/4 X 39 1/2 General Information: Yes,Standard,Vinyl,Nail Fin,Foam Insulated,4 1/2",1 3/8",3 1/8" 779 > Exterior Color/Finish: Almond Interior Color/Finish: Almond Glass: Insulated Dual Low-E Advanced Low-E Insulating Glass Argon Non High Attitude ,._ Hardware Options: Cam-Action Lock,Almond,Standard Vent Stop,No Limited Opening Hardware,No Maximum Opening Hardware,Integrated Vinyl Viewed From Exter'iof Sash Lift Frame Size:33.75"X 39.5" Screen: Full Screen,Inview'"' Grille: GBG,No Custom Grille,3/4"Contour,Traditional(3W2H/3w2H),Almond,Almond Wrapping Information: No Interior Trim,Pella Recommended Clearance,Perimeter Length= 147",Glazing Pressure= 110. Trim—Stool and Apron-Add Stool and Apron Trim to Picture Frame Qty 1 Wrap Coil Stock-Full Capping per unit Qty 1 FF<48 wide-Install Full Frame Window 48 inches or less wide Qty 1 Lead Safe Install-Lead Safe Install 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. 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' For more information regarding the finishing,maintenance,service and warranty of all Pella®products,visit the Pella®website at www.pella.com Printed on 4/14/2016 Contract-Detailed Page 5 of 10 Customer: Richard Valle Project Name: Valle,Richard,1705973 Order Number: 741BG0105 Quote Number: 7736338 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.pella.com /performance. 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 See HO about Storm windows 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 are in working order Reinstall existing shutters and awnings Re-install existing shades, drapes, window treatments, wall hangings, and reposition furniture For more information regarding the finishing, maintenance,service and warranty of all Pella®products,visit the Pella®website at www.pelia.com Printed on 4/14/2016 Contract-Detailed Page 6 of 10 Customer: Richard Valle Project Name: Valle,Richard,1705973 Order Number: 741BG0105 Quote Number: 7736338 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) a�r-rproirect casing issues due to storm window removal if full wrap or new exterior trim is not purchased Checklist has been reviewed Customer initial Product Only Addendum has been reviewed Customer initial 1061 Credit Card Account#: Last 4 Digits Expiration Date: 9/2017 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.pelia.com Printed on 4/1412016 Contract-Detailed Page 7 of 10 Customer: Richard Valle Project Name: Valle,Richard,1705973 Order Number. 741BG0105 Quote Number: 7736338 roject Checklist has been reviewed Richard Valle Benjamin Gless w- Customer N me ease print) Pella S Rep Na a (Please print) Taxable Subtotal $5,681.19 Customer Signature Pella ales Nep Signature Sales Tax @ 6.25% $355.07 Date 4/14/2016 4/14/9(11 F Non-taxable Subtotal $5,598.75 Date Total $11,635.01 Deposit Received $5,817.51 Credit Card Approval Signature Amount Due $5,817.50 r For more information regarding the finishing,maintenance, service and warranty of all Pella®products,visit the Pella®website at www.pella.com Printed on 4/14/2016 Contract-Detailed Page 8 of 10 i I7re Conti OMvealtls of Massachusetts _ Department of Industrial.Accidents Office of Inveshkadons 1 Congress Street,Suite 100 - Boston,AL4 02114-2017 MM mass.govldia Workers' CoMpeusati®n Insurance Affidavit: builders/Contractors/Electricians/Plumbers ApRhLeant Information Please Print Legibly Name(Business/Organizatiort/Individual): J CIIA Address:A—�) r— rg� City/State/Zip: sv d.C i one#: Are you an employer?Check the appropriate box; 1. [3,1 am a employer with Z� 4. El am a general.contractor and I Type°i project(required): employees(full and/or part-time).* have hued the sub-contractors 6. ❑New constiuction 2.❑ I am a sole proprietor-or partner.- listed on the attached sheet. 7. 04emodeling ship and have no employees These sub-contractors have g ❑Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp. insurance.l 9. ❑Building addition required.] 5. ❑ We are a corporation and its 10.El Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LEI Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL insurance required.] C. 152, §1(4),and we have no 12.❑Roof repairs employees. [No workers' 13.0 Other comp.insurance required.] *Any applicant that check box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who subulit 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 arra an employer that is providing workers'compensation insurance for my employees. Below is the policy and joh site information. Insurance Company Name: �-r� �' ��. Policy#or Self-ins.Lie.#: ( L4 A, ( 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 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 certify under the pains and penalties ofperiury that the information provided above is true and correct. Sianattue: — - �� `—'-"� I _.__._ ___.__ —Z ------ - -......._._ _.. =Date: Phone#: � _ -U-,5_—-7 5��9 - - — ------- Official use only. Do not write in this area,to be completed by city or toren official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Buildine Deavartnment CiN/'fi'rnwnn r,HPrRr at CERTIFICATE E OF LIABILITY INSURANCE 061Y9120155n01T,DIYY,n,T IFAS CERTIFICATE 15 ISSUE®A5 A MATTER OF I CERTIFICATE DOES NNFORflflATION 4]Nt-ll'AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, OT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLITHIS CIES BELOW. THIS CERTIFICATE.OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER{S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. the ORTAterms an I€the io sificate holder Is an ADDITIONAL INSURED,the policy{ies) Rust he endorsed If SUgR®GgTION 19 W(AIVEI�, subject the terns and conditions o of the ender o certainepolicies may regtdre an etldotsemeriL A statement on this c"ficate does not confer rights to the certificate holder In ii®u of such endor3etnenas). 1 � PRODUCER Fred C.Chump,me ONNT CT 41 Wellman Sheat NAOomery A Coded CIC,RPLU Lowell,MA 01851 PHONE 9183M23 FAA (BDO)225-1885 E MAIL AIC Na: (978)454-1065 DDRESS: d0*ff@hedmh lD1Lcom INSURER 81 AFFORDING COVERAGE NAIC S INSURED INSURERA: Ciramhrsuramwcompany efAmedca 31534 Now Enolend window ADoor LLC INSURER B.: New Haspsm Employers Insurance Company 13003 45 Fendi Road INSURER C: Havedrtt,MA 01032.1302 IN9URM D: INSURERE: COVERAGES CERTIFICATE NUMBER: INSURER F: 54457 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED 13ELDW HAVE BEEN ISSUE D TO THE INSURED NASMED ABOVE OR THE POLICY PERIOD ION NUMBER: INDICATED. Np7WBE S SUED G ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHETi DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY O ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIED HEREIN ISITHRESUBJECT EC ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED CES D CLAIMS. INSR ADO.S BR L TYPE OF INSURANCE Y EVPOLICY EFF POLICY GENERAL LIABILITY POLICYNUMBER MMIDD OLIO LIMITS 7( COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 1,DOD,000 0 AGE TOR CLAIM9•MAOE X OCCUR PREMISES Ea occurlencs 5 100,000 A >< Ce Doi MED EXP(Any ane Patsor,I $10,000 N816140f 7/1/2015 7/11201fi ------------ PERSONAL&ADV INJURY 5 1.000,000 GEM AGGREGATE LIMIT APPLIES PEFL• GENERAL AGGP,EGATE 5 2,0011,000 POLICY X J Ro X LOC PRODUCTS-COMP/OP AGO 5 2,0011,000 AUTOMOBILE LUIBR ITY $ ANY AUTO COMBINED SINGLE LIMIT Es accident ALL OWNED SCHEDULED BODILY INJURY(Perperson) s AUTOS AUTOS HIRED AUTOS NON--SINNED BODILY INJURY(Peraccidenll 5 AUTOPROPERTY DAMAGE 5 accldan[ UMBRELLA LIAR OCCUR 5 EXCESSUAB CLAIMS-MA13E EACH OCCURRENCE 5 DED RETENTIONS AGGREGATE 5 WORMS COMPENSATION AND EMPLOYERS,LIABILITY 5 ANYPRO PRIETORIPARTNEHIEIECUTIVE TIN TI WCSTIIMTU• OTN B DFFlCER/Mf3NBER EXCLUDED? ❑ 400040101 NIA E (Mandatory In NH) 7/1/2015 i/1L016 I11CH ACCIDENT $ 500,000 If yes,descn3s under 5500,000 DESCRIPTION OF OPERATIONS below ELL DISEASE-EA EMPLOY EL DISEASE-POUCY LIMIT 5DO.ODO 5 OESCR1p TION OF OPERATIONS f LOCATTON9I WR "LES(AUach ACORD 101,AddiOonal Remarlts Schedule,if more space hetgmserl( CERTIFICATE HOLDER C,4NCELLA-no" SHOUL®A"OF THE AmOVE tTESCRIBED POLOCIES BE CANCELLEU3 DEFo}RE TIRE ET(PIRATOON MATE TNFP.Fd1F aete�rr c snuos a me m-,., .�T ... T C d t{ 'sa�a"�4 r; CS-089853 �p W IILLUM R NICKPLS ` 1,7 P.EARTRLE RII]`` RAVERIULL MA p01830 , 10/26120'16 �coarr�ncrrrrerrlr/o/ aJlrrr%rtan// License or registration valid,for individul use only ice of Consumer Affairs&Business Regulationbefore the expiration date. If found return to:.. ' 1AE IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation Type 10 Park Plaza-Suite 5170 egistration 1:83279 9124/2017 Supp Expiration. lement C`;)rd Boston,MA 02116 NEW ENGLAND WINDOW&DOOR,LLC. PELLA WINDOWS&DOORS Wiliiam Nichols 45 FONDI ROAf? Not valid.without signature HAVERHILLL,MA 01832 Undersecretary