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HomeMy WebLinkAboutBuilding Permit #742-14 - 67 MEADOW LANE 4/23/2014� Replace -moot Wlnolows Permit NO: Date Issued: TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received IMPORTANT: Applicant must complete all items on this page LOCATION _ ' Print. PROPERTY OWNER _ Print 100 Year Old 8iructure yes no MAP NO: _ PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT- PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic ❑ Well - ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address - CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Exp. Date: _ Home Improvement License: . 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: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Ageot/Owner Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ FJ • . - Plans Submitted ❑ Plans Waived ❑. ; _Certified Plot Plan ❑ Stamped Plans ❑ r -TYPE:OYSEWERAGEDiSROSAL - Public Sewer ❑ Tanning/Massage/BodyArt ❑ Swimming Pools ❑ Well ❑ Tobacco.Sales Food Packaging/Sales ❑ Private(septic tank, etc:_ ❑ - - � -_ � permanent Doumpster n:Site ❑ THE -..FOLLOWING SECTIONS FOR 'OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM -:-:-.-DATE REJECTED DATEAPPR=OVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS ,CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature . COMMENTS -Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes . Planning Board Decision: Comments Conservation Decision: :Comments Water & Sewer Con nectionisignature & Date Driveway Permit DPW Tovvo Engineer: Signature: Located 384 `FIRE DEPAKTM:L-NT =Temp Dump'ster on site yes.... no Located -at 124.Mair Street 3 . "Fire Department signature/date • - -. f. COMMENTS Street Dimensi n 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 DANGERZONE LITERATURE: =Yes No MGL.Chapter. 166. Section 21A -F and G min.$100=$1000:fine NOTES and DATA — (For department use El Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department ', rhe folkpwirng-is—a- list of:the required.forms to be filled outfor:the appropriate. permit to .be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ ` Building Permit Application o Workers Comp Affidavit o Photo Copy Of H.I.C. And/O'r G. S. L- Licenses ❑ Copy of Contract o Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster. permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) Li Mass check Energy Compliance Report (If Applicable) Li Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses Li Workers Comp Affidavit E, Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cas<s if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apo•-�al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.tted with the building application Doc: Doc.Buhding Permit Revised 2012 Location � 7 No. \ Date Check # TOWN OF NORTH ANDOVER Certificate of Occupancy $_T Building/Frame Permit Fee $�,! Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Building Inspector F,441NII 0 a 0 Z O CD N O O O CQ O W a to CD ca 0 H C 0. U) S N 'GCD o= "o z N _ < O N CD • CD n CD C) 0 rL cm m O 3 y. y CD' TI � fu h �. N W VJ o CD CD = Q O CO Q OO rt _U) O O = C�� C CD = 0 CDmo O < cO N X CD o o,r c � CD S Q O 0 Q O O (M O Q — Nfm < N O 77 = C CD W r N :CL c. D U) � C) .d O o O rtC :3 CD CD . U) CD D CD ' D-0 0 c� o CL O J N N 0 O ((D � • NW rt (D M Z O v m m m v D m T D1 :CD C OU S G7 H m i O T v V7 (D � (D Z7 C Dq S m C m f7 z M m T D) .Z7 C 00 S , T 61 n S 7 m A C ao S T 7 O_ v 0 :3 Go 0 z In z m 0 N 'O rt. ff N m 3 T O O_ \ n m :3 CA O D O T a S C � 0 NCD O e� 0 Z N A C '"'O� � Z-0 r- m �o cn- co•�' n �_ M ovCD �� C<D o Q :3�• C V+ Cl^ cr 2)CD " c CD0� O CD Q CD = O cm CD cn O N ao Z 0. Z 0 CD z < 0 CD 0 0 a 0 Z O CD N O O O CQ O W a to CD ca 0 H C 0. U) S N 'GCD o= "o z N _ < O N CD • CD n CD C) 0 rL cm m O 3 y. y CD' TI � fu h �. N W VJ o CD CD = Q O CO Q OO rt _U) O O = C�� C CD = 0 CDmo O < cO N X CD o o,r c � CD S Q O 0 Q O O (M O Q — Nfm < N O 77 = C CD W r N :CL c. D U) � C) .d O o O rtC :3 CD CD . U) CD D CD ' D-0 0 c� o CL O J N N 0 O ((D � • NW rt (D M Z O C I m m m v D m T D1 :CD C OU S G7 H m i O T v V7 (D � (D Z7 C Dq S m C m f7 z M m T D) .Z7 C 00 S C W Z m m T 61 n S 7 m A C ao S T 7 O_ v 0 :3 Go 0 z In z m 0 N 'O rt. ff N m 3 T O O_ \ n m :3 CA O D O T a S The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Sears Home Improvement Products Incorporated Address: 1024 Florida Central Parkway City/State/Zip: Longwood, FL 32750 Phone #: 860-753-0452 Are you an employer? Check the appropriate box: ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).' have hired the sub -contractors ❑ 1 am a sole proprietor or partner- listed on the attached sheet. t ship and have no employees working forme in any capacity. [No workers' comp. insurance required.] ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t These sub -contractors have workers' comp. insurance. We are a corporation and its officers have exercised their right of exemption per MGL c. 152, §1(4), and we have no employees. [No workers' insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 1 l . ❑ Plumbing repairs or additions 12. ❑ Roof repairs 13.0 Other 6' Rep lace V1 (nl+ *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. W I rt UV W -:b, t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew attidavrt indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that isproviding workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Ace American Insurance Company / Phone: 866-283-7122 Policy # or Self -ins. Lic. #: WLRC47322534 Expiration Dater 08/01/2014 /� OI - Job Site Address: 6? I �/ ea_ ( n _ City/State/Zip: -01945' 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 trim final 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. 1 do hereby cert�ondet�the pains and pepflldes ofperjury that the information providid above ,;s true and correct. Home — Fax: (Sears Auth. Agent) Cell: 860-753-0452 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 #: A o CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYYY) 07/19/2013 I 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 Aon Risk Services Central, Inc. Chicago IL Office CONTACT NAME: PHONE (866) 283-7122 FAX (800) 363-0105 (A/C. No. Ext): A1C. No.: EMAIL ADDRESS: 200 East Randolph Chicago IL 60601 USA INSURER(S) AFFORDING COVERAGE NAIC p LIMITS INSURED INSURER A: ACE American Insurance Company 22667 Sears Holdings Corporation dba Sears Home Improvement Products, Inc INSURER B: Indemnity Insurance CO of North America 43575 INSURER C: Attn: Risk Management E3 -219A 3333 Beverly Road Hoffman Estates IL 60179 USA INSURERD: INSURER E: INSURER F: X COMMERCIAL GENERAL LIABILITY COVERAGES CERTIFICATE NUMBER: 5/UUbU19b993 REVISION NUMBER: v 0 0 a 0 J d w :r c to a d a 0 2 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested INSR LTR TYPE OF INSURANCE A INSR WVD POLICY NUMBER MMIDDlYYYY POLICY EXP MMADDIYYYY LIMITS A GENERAL LIABILITY HDOG08/01/2014EACH OCCURRENCE $S'000'000 X COMMERCIAL GENERAL LIABILITY DAMAGE To PREMISES I=nce $S'000'000 CLAIMS -MADE X❑ OCCUR MED EXP (Any one person) EXCI uded PERSONAL B ADV INJURY $5,000,000 rn GENERAL AGGREGATE $5,000,000 0 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $5,000,000 X POLICY PRO LOC n A AUTOMOBILE LIABILITY ISAH08719780 08/01/70-1-3 08/01/2014 COMBINED SINGLE LIMIT Ea accident)$5,000,000 A ISAH08719792 08/01/2013 08/01/2014 BODILY INJURY ( Per person) A ANY AUTO ISAH08719809 08/01/2013 08/01/2014 ZO BODILY INJURY (Per accident) X ALL OWNED SCHEDULED N AUTOS AUTOS NON -OWNED V PROX TY DAMAGE HIRED AUTOS X AUTOS (Per Per accident d UMBRELLA LIAR EACH OCCURRENCE L) AGGREGATE EXCESS LIAR HOCCUR CLAIMS -MADE DEC) I RETENTION A WORKERS COMPENSATION AND WLRC47322534 08/01/2013 08/01/2014 X WC srnru- OTH- TORY LIMITS ER EMPLOYERS' LIABILITY YIN CA MA AZ E.L. EACH ACCIDENT $2,000,000 B ANY PROPRIETOR / PARTNER / EXECUTIVE FN NIA wLRc47319122 08/01/2013 08/01/2014 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) All other States E.L. DISEASE -EA EMPLOYEE $2,000,000 If es, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $2,000,000 lei DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Y 5' CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WALL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Sears Home Improvement Products, Inc. AUTHORIZED REPRESENTATIVE 1540 American way Longwood FL 32750 USA ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD ��ti �/` 7 L L� i"; '• � �s�`t���t�i%ii� �� 1���t+`�Z�I`!�' t'1 ��i�'l:){.�itrif l' /tl�i.J t``�l/t..�� .. Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 0211.6 Home Improvement Contractor Registration Registration; 148607 Type: Supplement Card Expiration: 10111/2015 SEARS HOME IMPROVEMENT PRODUCT LUBOS SVEC 1024 FLORIDA CENTRAL PKWY LONGWOOD, FL 32750 SCA 1 C 2i)M-0- : z 1 '? �itfice of Consumer 41fam X Business Regulation ' "�OME IMPROVEMENT CONTRACTOR `Registration: 148607 Type: Expiration: 10/11f2015 Supplement Card SEARS HOME IMPROVEMENT PRODUCTS INC. LUBOS SVEC 1024 FLORIDA CENTRALPKWY r=-- LONGWOOD, FL 32750 Undersecrctary Update Address and return card. Mark reason for change. _i Address Renewal f Employment (Lost Card License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business. Regulation 10 Park Plaza - Suite 5170 Boston, NIA 02116 va r wit Lout sig'' ,"" -a ur $ gam_ } �.} ¢v _ ..' ?xiCassai huaetts OepiwlrnY?il of Pubfic `1i`ety _ Sward of Eu0di , and Standards �; �1g ifi '2 is k 4ttt-:��'-'cx>;� �•-_ Lm ease_ CS i19 5i9 s LUBOS SIVEIC r " 827 THOMPSON '1?OAi? µ Thompson CT 06271 arrlis r€er 08(3112014 is Office Location: BOSTON Proposal Date 04/16/2014 Job Number 17037737 S Sears Home Improvement Products, Inc. Customer Name/�V9 P.O. Box 522290 PHYLLIS MUTUNGA a8wo I'51024 Home Improvement Products Florida Central Parkway Longwood, FL 32750-7579 Customer's Home Phone Customer's Work Phone (978) 208-8598 Phone (800)469-4663 Street Address ESTIMATE AND PROPOSAL Contractor License/Registration Number 67 MEADOW LN Windows MA (148607) City State Zip code All plumbing and electrical services performed by NORTH ANDOVER MA 01845 licensed subcontractors Is installation within city limits? (Yes/No): YES FEIN 25-1698591 Installation Address County ESSEX Billing Address (if different from above) City State Zip Code Project Consultant Name 8 License No. (if applicable) MUHAMMAD NAEEM 32130 Description of the Project and Description of the Significant Materials to be Used and Equipment to be installed 1. Remove existing units to be replaced. (PLEASE NOTE: The removed units are likely to be damaged.) 2. Prepare openings as necessary to receive replacement units. (No finish work other than normal installation is to be done unless otherwise noted below.) 3. Installation includes the clean-up of all job-related debris upon completion of the job. 4. (If applicable) After the completion of the project, the customer will be responsible for the application and removal (storage) of shutter panels. In the event that the project requires the installation of storm shutters or egress windows, Sears Home Improvement Products, Inc. ("Sears") will not re -install any affected security bars. 5. (If applicable) In the event Sears is unable for whatever reason to obtain the proper permits prior to the commencement of any work, Sears will refund any previous payment and this contract will be automatically cancelled. Summary of Window Order Addendum (see detailed Window Order Addendum for more information): Type: WB PLUS (WINCORE) Quantity: 6 Type: Quantity: Type: Quantity: Type: Quantity: Type: Quantity: The Window Order Addendum is made a part of and incorporated into this contract by Customer(s) initials reference. Additional work to be done: NA Work NOT to be done: NA SPECIAL INSTRUCTIONS: NA All of the above check boxes, "Work NOT to be done," "Additional work to be done," and Customer(s) initials "Special Instructions" sections have been reviewed and explained to me. SWI -MA (Dig.) Rev 08/13/12 Page 1 of 3 lob Number: 17037737 APPROXIMATE START DATE and APPROXIMATE COMPLETION DATE: The work will start approximately 6-8 WEEKS (Approximate Start Date) It will be substantially completed by approximately 1-2 WEEKS (Approximate Completion Date) These dates are subject to change at the time the contract is accepted by Sears Home Improvement Products, Inc. ("Sears") or at any other time by mutual written agreement. Customer understands that the Approximate Start Date is only an estimated date and the Customer will be contacted prior to this date to schedule the actual start date. ASBESTOS ABATEMENT: This Estimate and Proposal assumes that there are no asbestos containing materials ("ACMs") that would be disturbed in the performance of the installation work. If upon further inspection by the contractor or others it is learned that ACMs have to be disturbed to perform work, then Customer must arrange and pay for abatement of asbestos by a qualified person prior to the start or continuation of work. If Customer fails to arrange for necessary asbestos abatement within thirty (30) days, Sears may cancel this contract upon Customer(s) initials IIF_ written notice to Customer. W The TOTAL PRICE including all labor, material, taxes and any applicable discount is $ 6,372.47 Contract Price $6,372.47 Initial Payment (not to exceed 30% of Total Price unless Special Order) $ 1,911.74 State Sales Tax ( 0.00 %) $ 0.00 Final Payment (balance payable upon completion of job) $ 4,460.73 Local Sales Tax ( 0.00 %) $ 0.00 The Initial Payment is due prior to Sears ordering products. I Total Amount Due $6,372.47 The form and method by which the Customer(s) will pay is described in a separate Cash/Credit Customer(s) initials LCard 11 Payment Addendum made a part of and incorporated into this contract by reference. NOTICE TO BUYER: YOU, THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY (FIFTH BUSINESS DAY IN ALASKA, FIFTEENTH BUSINESS DAY IN NORTH DAKOTA IF YOU ARE AGE 65 OR OLDER) AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. ADDITIONAL PROVISIONS Proposal and AWroval. Sears offers to furnish the materials and arrange for their delivery and installation as specified on the first page and/or the attached sketches and specification sheets for the TOTAL PRICE shown. This offer must be approved by the Installation Department. If this is a credit sale or a payment on completion sale, it must be approved by the Credit Sales Department. If this proposal is not approved or the installation cannot be made in accordance with the law, this offer will be withdrawn and any payments you have made will be refunded to you. Any materials left over after the installation has been completed are Sears property and will be removed by Sears. Installation. I understand that Sears will not install the materials but will arrange for the installation. Sears is not responsible for materials or installation NOT furnished or arranged by Sears. Sears' installation contractor(s) will obtain all building permits required by local law. For homes located in historic or landmark zoning districts, Customer will be responsible for obtaining required approvals and related permits prior to the commencement of work on this contract. Authorization. I authorize Sears to: (1) arrange for a contractor (licensed where required by law) to make the installation of materials; (2) issue a work order for this installation to a contractor; (3) inspect the installation; and (4) pay the contractor when the installation is complete if I have signed a certificate that the installation has been completed to my satisfaction. Delays in Installation. I agree that Sears is not responsible for delays in delivery or installation due to weather, fire, strikes, war, government regulations or any causes beyond Sears' control. Oral Agreements and Changes in Contract. I understand that there are no oral agreements between Sears and me. Everything I expect Sears to do has been included in writing in this contract. Nothing can be changed in this contract unless it is in writing on a separate form accepted by me and Sears. Responsibility of Buyer. I agree that any information or measurements that I give to Sears are correct and complete. I am responsible for any special work described in this contract. Electrical & Plumbing Service. I will provide adequate electrical and/or plumbing service(s) to run any newly installed appliances or other furnishings. If the electrical and/or plumbing service(s) do not meet the standards of the utility company or electrical and/or plumbing codes, I will make the necessary changes at my expense unless Sears has agreed in this contract to make the changes. Payment. I will pay Sears the cash price that covers the price of material and installation as shown on the first page. Warranty Information. Appropriate product warranty documents will be given to me by Sears. Sears' Warranty on Installation is: SEARS' LIMITED WARRANTY ON INSTALLATION In addition to any manufacturer warranty extended to you on the product(s) used (which warranty becomes effective the date the merchandise is installed), if the workmanship (or application) of any Sears' arranged installation proves faulty within (i) one year for Weatherbeater Value Line, (ii) two years for Weatherbeater Plus, or (iii) three years for Weatherbeater Max, and Weatherbeater Stormbeater, then upon notice from you Sears will cause such faults to be corrected by repair at no additional cost to you. If Sears determines that repair is not commercially practicable or cannot be timely made, then, at Sears' sole discretion, Sears may elect to provide replacement or refund. Service under this Limited Warranty is available by calling Sears Home Improvement Products at 1-800-222-5030, Option 4. This warranty gives you specific legal rights, and you may also have other rights that vary from State to State. SWI -MA (Dig.) Rev 08/13/12 Page 2 of 3 Job Number: 17037737 NOTICE TO BUYER 1. DO NOT SIGN THEAGREEMENT IFANY OF THE SPACES INTENDED FOR THEAGREEDTERMS TO THE EXTENTOF THEAVAILABLE INFORMATION ARE LEFT BLANK. 2. YOU ARE ENTITLED TO A COPY OF THIS AGREEMENT AT THE TIME YOU SIGN IT. KEEP IT TO PROTECT YOUR LEGAL RIGHTS. 3. YOU MAY PAY OFF THE FULL UNPAID BALANCE DUE UNDER THE AGREEMENT AT ANY TIME, AND IN SO DOING YOU SHALL BE ENTITLED TO A FULL REBATE OF THE UNEARNED FINANCE AND INSURANCE CHARGES. 4. YOU MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY [FIFTH BUSINESS DAY IN ALASKA, FIFTEENTH BUSINESS DAY IN NORTH DAKOTA IF YOU ARE AGE 65 OR OLDER] AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. FAILURE TO EXERCISE THIS OPTION, HOWEVER, WILL NOT INTERFERE WITH ANY OTHER REMEDIES AGAINST THE RETAIL SELLER YOU MAY POSSESS. IF YOU WISH, YOU MAY USE THIS PAGE AS NOTIFICATION BY WRITING "I HEREBY RESCIND" AND ADDING YOUR NAME AND ADDRESS. A DUPLICATE OF THIS RECEIPT IS PROVIDED BY THE SELLER FOR YOUR RECORDS. 5. IT SHALL NOT BE LEGAL FOR THE SELLER TO ENTER YOUR PREMISES UNLAWFULLY OR COMMIT ANY BREACH OF THE PEACE TO REPOSSESS GOODS PURCHASED UNDER THIS AGREEMENT. NOTICE TO MASSACHUSETTS RESIDENTS ONLY In addition to the Notice to Buyer shown above, Massachusetts law requires that contracts for home improvement work state that all home improvement contractors and subcontractors shall be registered and that any inquiries about a contractor or subcontractor relating to a registration should be directed to: Director, Home Improvement Contractor Registration P.O. Box 871 Taunton, MA 02780-0871 Telephone: (508) 821-9375 Please note that owners who secure their own construction -related permits or deal with unregistered contractors shall be excluded from access to the Guarantee Fund. Notwithstanding any other language in the contract or associated documents, Sears will not remove, replace, or install any heating or air conditioning system, or any portion thereof, if asbestos or asbestos -containing material is known or likely to be present in that heating or air conditioning system, or any portion thereof. If it is determined or reasonably suspected that asbestos is present, either before commencement or during performance of the work, it shall be the customer's responsibility to select, retain and pay all costs of a Division of Occupational Safety ("DOS") licensed Asbestos Contractor to remove all asbestos or verify that none is present in the components involved in the job. If the determination or reasonable suspicion of the presence of asbestos arises after Sears has started the work, Sears will immediately cease performing the work until a DOS licensed Asbestos Contractor, hired by the customer, removes all asbestos from the components scheduled for repair or replacement in accordance with 310 C.M.R. 7.00 and 453 C.M.R. 6.00 or verifies that none is present. By signing the contract the customer agrees that it understands the above. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES 04/16/2014 Customer's signature Date 04/16/2014 Customer's signature Date r Accepted by Sears Home Improvement Products, Inc. ("Sears") on 04/16/2014 by: Date Management Representative SW1-MA (Dig.) Rev 08/13/12 Page 3 of 3 JOB NUMBER: 17037737-0001-B PROPOSAL DATE: 4/16/2014 WINDOW ORDER ADDENDUM < 0 ) 0 F-7 . 1 WP - DOUBLE HUNG 2 36 W X 55 H WHITE LOWE/ARGON/CLEAR GRID STYLE{COLONIAL CONTOURED= [2V1 H]] MATCH PRODUCT j FULL SCREEN TWO CAM LOCK MAX CLEARANCE DIMENSIONS=[30.75 X 20.0625] I 2 WP - DOUBLE HUNG 2 20 W X 55 H WHITE LOWE/ARGON/CLEAR GRID STYLE{COLONIAL CONTOURED= [1 V1 H]] MATCH PRODUCT FULL SCREEN TWO CAM LOCK MAX CLEARANCE DIMENSIONS=[14.75 X 20.0625] 3 WP - DOUBLE HUNG 1 36 W X 37 H WHITE LOWE/ARGON/CLEAR FULL SCREEN TWO CAM LOCK MAX CLEARANCE DIMENSIONS=[30.75 X 11.0625] 4 WP - PICTURE WINDOW 1 52 W X 55 H WHITE LOWE/ARGON/CLEAR GRID STYLE(COLONIAL CONTOURED= [4V4H]) MATCH PRODUCT TOTALS: 6 COMMENT: 1 of 2 W� lw�j 04/16/2014 04/16/2014 Customer Signature Date Customer Signature Date 2of2 ENERGY STAR" Qualified "int.YSTAR In All 50 States Design Pressure:+351 —35 Maximum Sim:40 x HS FSC:None Testing 6lend1rd:AAMANIDMAICSA 1011IS2/A440-05 Test Lob: ARCHITECTURAL TESTING INC. wcw 51005SerieivfeI Double Nangwrnaow !Kant frnuP•H•• r NFM FP.PA16•:eWFraeeeNRIFPP Pref :wr,Y!m i ,. VartcerSltderPllPdov i . CPD: WCW—MtP7-0p020—DOOM F ENERGY PERFORMANCE- RATINGS factorN,SJI — P► fittHill Colo Coellklint . i 0.30`., a•2'4.'.::.. ADDITIONAL PERFO.R. MANCE PWINGS INible Trantmiltint, iEli-F d:Ia,nPmtipuPnhYidd>PMeE" i IeK kJnPl,earu MIdUWn lP,l !"apeklt P r•pappdetaPet"lmPOF,NfP!„ fnPp qdPPCFliPhilpnI ptrPtexImPP 1W 4wP1 hrPreliplee. IpMprrP,odteaN�I❑nCnPimrrturdPPePf;lV!!I,nYefnFli.rt, kPeFuFAP,CeC. "apt rww.P4reary ENERGY STAR" Qualified "int.YSTAR In All 50 States Design Pressure:+351 —35 Maximum Sim:40 x HS FSC:None Testing 6lend1rd:AAMANIDMAICSA 1011IS2/A440-05 Test Lob: ARCHITECTURAL TESTING INC.