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HomeMy WebLinkAboutBuilding Permit #261 - 76 BUCKINGHAM ROAD 10/1/2009 BUILDING PERMIT tIORTFI o�� �ED ,°gtio TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received pDRATED "'`�y 7 �SSACHU`��� Date Issued: IMPORTANT: Applicant must complete all items on this page zX LOCATION �L.J µ PROPERTY OWNER n �- MAP NO ciao PARCEL `? ( ZONING.DISTR[CT = f HISTORIC DISTRICT , yes y, no m, , TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building AOne family ❑ Addition ❑ Two or more family ❑ Indu al ❑ Alteration No. of units: ❑ mercial Repair, replacement ❑ Assessory Bldg ❑ Other .. ❑ Demolition ❑ Other ❑`Septic` ❑ Well ; ❑ Floodplain CI Wet(andsa ❑ Watershed Des#rtcty DESCRIPTION F ORK O BE REFORMED: 3 vYr 1r c --t&n1offication Please Type or Print Clearly) OWNER: Names II II� *I, Phone978 .6`7/- S714- Address: 6 U-CK n3 ;, r zF,, y s n s t t%b fid' CONTRACTOR Name 'Phone.'S=, ,r . ✓y P r. Lr n�� v v x � �/ [. ` Pr x��, z R� Y � q.....f'�` Address _L #a 3 Supervisor's Construction.License q :�� a Expbate"�j g r `c�U t [� S Home Imp rovementL�cerise ARCHITECT/ENGINEER �� Phone:-/-- Address: hone: /--Address: Reg. No. �— FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER F. Total Project Cost: $ 3 Q4 0 FEE: $ Check No.: Receipt No.: 01 NOTE: Persons contracting with unregiste ed contractors do not have access to g aranty fund Signature of Agent%Owner Signature of contract;"3 � � Location No. Date NORTH TOWN OF NORTH ANDOVER .�� F � 2 ' Certificate of Occupancy $ ;,SSACNUSEt� Building/Frame Permit Fee $ Foundation Permit Fee $ _ Other Permit Fee $ TOTAL $ Check # l 224 %7 Building inspector 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ s COMMENTS i . Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt-submitted yes Planning Board Decision; Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit Located at 384 Osgood Street :FIRE DEPARTMENT ","'1401p,Dumpster on site' yes no ,, Located at 124 Main Street F" x Ire:Department signature/elate 1 z s � T 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 min.s100-s1000 fine NOTES and DATA— (For department use) ❑ Notified for pickup - Date Doc.Building Permit Revised 2007 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 .r/ 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 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 Li Copy Of Contract o Floor/Crossection/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 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 a Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit o 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 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 tAORT1 f ® o : 4 over TO / 4 -== A K E = dover, Mass., ' Co C MIC ME WICK ��. ADRATED PPa\ -`2 S BOARD OF HEALTH Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.. .. &A.rITC� .r....... ............. """ """ Foundation has permission to erect................................ .... buildings on�4....... C� ��r........*4 Rough to be occupied as .....�i� t. .w� y Chimne provided that the person accepting this perspect conformto the terms of the application on file in Final 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 CONS TR TARTS Rough Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. DEBRA L.SVEC 8� 13 sass/221 t3 LUBOS SVEC '153• e}Sa— 827 THOMPSON RD THOMPSON,CT 08277 QDate /�f� Pay to the n Order of a,v h� oars � os k cWEBSTEI3 PEDERAL TCREDIT GF(( S UNION •�-� � j�Webster,MA 01570 . ..r` IVP 4, 211386S971: 23 7833831�' L Harland Clarke 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 #: 407-551-5402 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ Iam a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ lam a.sole proprietor or partner- listed on the attached sheet. t 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working forme 'many capacity. workers' comp. insurance. 9. ❑Building addition [No workers' comp. insurance 5. We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof rcpairs insurance required.]t employees. [No workers' 13.M Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors 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 thepolicy andjob site information. Insurance Company Name: Aon Risk Services Central,Inc. / Phone: (866)283-7122 Policy#or Self-ins.Lic. #: WLRC45701207 Expiration Date: 08/01/2010 +y. l 0 Job Site Address: 6 D City/State/Zip: h Q 1 F 4- Attach a copy of the workers'coml ns&i1n 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 herebyerci�unrthepaznscd penalties of perjury that the information provided above is true and correct. Si ature' (Sears Auth.Agent) Date: Phone#: Home:860-315-7468 / Cell:860-753-0452 Oficial 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 ® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 07/17/2009 1 PRODUCER Aon Risk Services Central, Inc. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY Chicago IL office AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS 200 East Randolph CERTI.FICATE DOES NOT AMEND,EXTEND OR ALTER THE Chicago IL 60601 USA COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC IY PxoNE•(866 283-7122 FAx- 847 953-5390 INSURED INSURER A: ACE American Insurance Company 22667 •• Sears Holdings Corporation INSURERB: Indemnity Insurance Co of North America 43575 dba Sears Home Improvement Products, Inc Attn: Risk Management E3-219A INSURER C: 3333 Beverly Road Hoffman Estates IL 60179 USA INSURER D: b INSURER E: p COVERAGES SIR applies per terms and conditions of the policy x 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIMITS SHOWN ARE AS REQUESTED INSR ADD' LTR INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS ATE(MM/DD DATE(MM/DD A GENERAL LIABILITY HDOG24933398 08/01/2009 08/01/2010 EACH OCCURRENCE $5,000,000 X COMMERCIAL GENERAL LIABILITY - DAMAGE TO RENTED $5,000,000 PREMISES(Ea occurrence) CLAIMS MADE © OCCUR MED FXP(Arw one Person EXCluded O PERSONAL&ADV INJURY $5,000,000El n GENERAL AGGREGATE $5,Q00,000 � GEN'L AGGREGATE LIMIT APPLIES PER: m PRODUCTS-COMP/OPAGG $5,000,000 ❑X POLICY 11PRO- F-1LOC O JECT A AUTOMOBILE LIABILITY ISAH0857957A 08/01/2009 08/01/2010 COMBINED SINGLE LIMIT C A ANY AUTO ISAH08579568 08/01/2009 08/01/2010 (Ea accident) $5,000,000 Z «: ALL OWNED AUTOS BODILY INJURY u SCHEDULED AUTOS (Per person) a.. X HIRED AUTOS m BODILY INJURY (.7 X NON OWNED AUTOS (Per accident) PROPERTY DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT ANY AUTO OTHER THAN EA ACC AUTO ONLY: AGO EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE ❑OCCUR ❑ CLAIMS MADE AGGREGATE BDEDUCTIBLE RETENTION A WLRC X C STATU- OTH- WORKERS COMPENSATION AND TORY LIMIT ER EMPLOYERS'LIABILITY Y N CA A � scFc45701220 0$/01/2009 08/01/2010 E.L.EACH AcclDErrr $1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE LLLJJJ OFFICER/MEMBER EXCLUDED? WI E.L.DISEASE-EA EMPLOYEE $1,000,000 B (Mandatory in NH) WLRc45701207 08/01/2009 08/01/2010 Yves,describe under SPECIAL PROVISIONS below All Other States E.L.DISEASE-POLICY LIMIT $1,000,000 J OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS — CERTIFICATE HOLDER CANCELLATION Sears Home Improvement Products, Inc SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 1024 Florida central Parkway DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL Longwood FL 32750 USA 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2009/01) 01988-2009 ACORD CORPORATION.All rights reserved= The ACORD name and logo are registered marls of ACORD Board of Building Regulations and Standards One Ashburton Place.- Room 1301 v Boston. Massachusetts 02108 -- Construction Supervisor License License CS: 97519 Restriction: 00 Birthdate: 8/31/1963 Expiration: 8/31/2010 Tri/ 97519 LOBOS SVEC 827 THOMPSON ROAD _-- THOMPSON, CT 06277 Update Address and return card.Mark reason for change. DPS-CAI i5 50M-O5/O6•PC8490 t_ Addres//s,, �_ ! Renewal/ 1- Lost Card ��3ei44rt� � �- ✓�V�(t4)ti)1LMLUlEfxU�l�./��•tzditzCtruJP,��G Board of Building Regulations and Standards �• .t" Construction Supervisor License JIM License: CS 97519 ma",d R'estrB Endwe'M Birthdate: 8/31/1963 Ler M 04 6-02 Eyes:HAZ :011-29.2007 i 1;• SVEC (. V. Expiration;- 8/3112010 Tr# 97519 ------n--» r Restriction: 00 _ 27UBDS Ti�?BN`I��..r— - q1r OMPSON CT OOM 100 LUBOS SVEC 827 THOMPSON ROAD ��- - �✓�� THOMPSON,CT 06277 Commissioner XjQ'a1*rr(9'foYff8'T'(' g eguala, ons anan a s One Ashburton Place - Room 1301 Boston, Mass husettts 021.0'8 Home Improvenaen� 1 ractoir Registration Registration: 148roO i Type: Public Corporation � Expiration: 10111/2009 Tri° 259352 i SEARS HOME IMPROVEMENT .�' ALFRED NYMAN JR. 1024 FLORIDA CENTRAL PKWY LONGWOOD, FL 32754 Update Addrem and return card Ittaric reason forchooge.. Addre s Reiseie apt I i Employment C LostCard DPE-CAI r'I 391a)_7t07_PC6$9D ✓lxF�iommta�tu�eel�ea���atsa�us�Ard Board al Ruiading likegnigtio and Standards Lkeese or registration valid for individul use tia h, HOME IMPROVEMENT CONTRACTOR before ft expiratlon date. If found return to: jg� .4% Board of Building Regulatiow and Standards >ReOaatr.010��148007 One Ashbtulon Place lit w 1301 E5�@iC#attsOtl till 000 7r# 25 62 ra-E" ,, Bostu moo.t121b8 iF �+pv.xtlV� SEARS HOME I DUCTS INC. Af�FRBD tdYIUTAN 1024 FLORIDA CEf��k� — ra,r _ 1•iot Yallt /FiAQ 5 at¢r. LONIaWOOd.F4 3275tT Adminfi,tramtor i r 13aa7r , uTim gal#egg 1aons an an ar s j - < One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Horne Improvement Contractor Registration Registration: 148607 'type: Supplement Card Expiration: 10/1112009 SEARS HOME IMPROVEMENT PRODUCT Sears A.at6oAzeed.Agent LUBOS SVEC Ho _ma 860-792-8106 1024 FLORIDA CENTRAL PKWY tell- 860-753-0452 LONGWUOD, FL 32750 Update Address and return card,h1ark reason for change. I I Address Ij Renewal F Employment Lost Card ri "r!Y13?9 hFf�21lN:'lldt�,/L C�r.:'�/tFi3txtfGC.1t'lYd ' \ Board of Ruildin Regulations and Standards License or registration valid for individul use only ' HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: r Board of Building Regulations and Standards {� l Registration: 148607 Expiration: 10/11/2009 One Ashburton Place Rai 1301 Boston,Alla.02108 Type: Supplement Gard SEARS HOME IMPROVEMENT PR 1024 FLORIDA CENTRAL PKWY LUNG'ti'UUD,FL 32750 Administrator 4otalid without signatiYte�_ 1�oa� o a. on ah n r One Asl n Place M Room 1301 Bostom Masswhueds 0210$ Home ImMvementC-bqtractor Registration �.... .- Rewsbltion: 148607 +� Tyres: Public Corlxoralion ;- _ lraiti�ti: 1I?t11720t� 1't � �rsr:- SEARS HOME IMPROVEMENT ALFRED NYMAN JR. 1024 FLORIDA CENTRAL PKIwY":;k, LCNGWOOD, FL 32750 UpdW.Adetews smd rMam yard.Mirk am tier ctta[t};a. F1 AddrW 0111;et 0"Oft F. Empleywair C Lost Card Qnry,.�4� ti ;�a.�atnr-rte - s tanasretr,��i�q�.nlsase� , it+Aar,# f ttrXit+g Regatgeoffi►.��and 8t<aradard� l[iet ar ce#ratiau vand for indivuida]Lase maty NODE IMPROVEME"r C6,k1' MCTOR Wmv Ow tVrzfien date: It fonod rehire tra: Board of Rnadi>oig>Ewwations retttl stirodarrtt tteqiRat�� 14MT 04c Asbbatrton IPlAec Rax 1301 IE -11rs t t1 ll2DQ9 1`efr ;�iria:Q21o8 t= - CLrri90r�tit�l "m4rn-2-1� SI=Ai?5HO 11r 4 ODUMS INC. ALFREDWIVIIA ';"'1024 FLORIDA CEP� �!`� _ - LClNGWOOD,FL 327 Adrninhi ntur I tit vaol'sd tit i tttarae O ' s lxqoyi National Fenestration 1151" Rating C±4tincll$ a a.7.°+.' 'W�,�...f.CILu I x.53Caj if 3 ;3 � ENERGY PERFORMANCE RATING EVALUACION OE RENDIMIENT-0ERGET1 U-Factor Solar bleat Gain Coefficient- Factor-U Coefnciente:Ganancia de Energia Solar 0 . 32 . 3, ' (U.s:Fl-P) (Met(cofsi) ADDITIONAL PERFORMANCE RATINGS EVALU ACTON SUPL1=MENTARIA DE'RENDIMfIlENTO Visible Transmittance Transmision de luzVisible -,3 8 Manufacturer stipulates that these ratings conform to applicable iNFRC procedures for determining whole product performance,NFRC ratings are determined for a fixed set of environmental conditions and a speciftc product size.NFRC does not recommend any product and does not warrant the suitability of any product for any specific use.Consult manufacturer's literature for other product performance information.awAy.nfrc.org - - - - - - - - -- - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - Este fabricante estipula que estos valores cumpien con los procedimientos aplicables de NFRC para determinar el rendimiento total del producto.Los valores usados par NERC son del€rminados por un conjunto filo de condiciones arnbientales y un tamano de producto especifico.NFRC no recomienda ningun producto y no garantiza quo el pmducto sea adecuado para un use especifico.Consulte corn el folieto del fabricante para el use apropiado de este producto.vmw.nfre org :r � ���4&�..h� �.. f:iWA R 5 � � as tl ,< �F� - ��'��'.:. f`��;�•��^��.� �*�' ��1`�:�r Vii.: '�s. STV aM zr — F Keep this label for possible ENERGY STARe rebates.To leam more t#v+�Av.energystar gov Guarde este etiqueta_paro posibles reembolsos ENERGY START Para conoter mos acerca de esto,visite wAtenergystar.gov. ' p.2 c�t �IIIIII'1 lta�' Proposal dateG� qp# {7 &Mrs Sears Home Imprevemenl Prot aets,Inc. Customer llama P.O.Box 522290 �j� &1 Q.f\ 1024 Florida Central Parkway Customers Home Phone Cuswme'e Work Proea Longwood.FL 32752-2290 q-- Lo 15`1141 HomehtlprovementProducts Phone 8D0 4694663 Street Address ESTIMATE AND PRDPOSAL ComrxWr License/Re;isMion Number 9k .r-C r 'n n 1 Windows CT(HIC.0607669);OG(50006423); Girl state Zlp Cj!�!s MD(46542,87854);RI(27281); av'� Mk Gt nstallalion within city Imis? WV(Wy025882) Installation Address Cot Yes ❑No _ Billing Add,ns(If different frcm above) fJty State Tip Code Project Consultant Name&License No.of applicable) A3 n't C.A.. e Desrxiption of the Project and Description of the Si cold 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 now Maw.) 9. Installation includes the clean up of all job-related debris upon completion of the job. 4. install Sears Weatherbeater GO l UL Windows in the openings described below according to the following specifications; COLOR: 2thite ❑Tan ❑Clay ❑WhiWLight Woodgrain Interior 13WhherDark Woodgrain Interior TYPE H Gty-a— Q'PW Oty--L_ 11 Casement Gly— Type ❑SH Oty— ❑PD City_—_ ❑Bay j ❑t-LR Qty__,__ ❑Garden Door City_ ❑Boir. ❑3 lite ❑4 lire ❑5 the ❑`L-LH Qty_ ❑Garden Window ❑3-,R Qty— ❑Other City GLASS: ❑Tempered' Qry. -�� ❑DRS Half Qty_ SCREENS:Check'd other than FIBERGLASS 'PLEASE NOTE:Tempered plass will be installed to ❑OBS Full Qty. (an sashes only) C Aluminum meet building codes. ❑Laminated Oty._ GRIDS: Type Color: Placement Existing units NOT to be replaced. 19yes QCoI twat Whte ❑Woodgrdin Ed'op ❑No ❑Col SculpiContour ❑Tan ❑Full ❑Other(Specify:) ❑Brass O Bottom ❑Clay ❑Flankers On:y 5. (It 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 scatters or egress windows,Sears Home Improvement Products, Inc.('Sears')will not reinstall any affected security bars. B. (it applicable)In the event Sears is unable for whatever reason to obtain the proper permits prior to the commenoement of any work, Sears will refund any previous payment and this contract will be automatically cancelled. Additional work to be done: lump6,., kAtAtill tjrN 4T �n rcL% t L I'tLj(ifljow 9iC,A'kArw— h e, onLkA fp Q Ud ori Work NOT to be done: - t , Nt4 LL; SPECIALINSTRuc-noN5 �p\'nI („���- Gla S )1� � ��SGGfded , All of the above check boxes and the"Work NOT to be done"section have been reviewed and explained to me. Customer(s)initials APPROXIMATE START DATE and APPROXIMATE COMPLETION DATE:The work will start approximately i- 3 W*4A6(Approximate Start Date)and will be substantially Completed by approximately5k-�O x4(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 tme by mutual written agreement Customer understands that the Approximate Start Date is only an estimated dam and the Custcmer will be contacted prior to this date to schedule the achrat start date. The TOTAL PRICE Including all labor,materlal,taxes and arty applicable discount is$ C)Li l? Contract Price C)4 0 Initial Payment(riot to exceed 0A of Total Price unless Special Order $ 91 State Sales Tax Final Payment(balance payable upon completion of job) Local Sales Tax The Initial Payment is dire prior to Sears ordering products. Total Amount Due S () The form and method by which Ute Cusiomer(s)vr)ll pay is described in a Separate CasK edit Card Payment Addendum made a part of and incorporated into this contract by reference. -- __-- _ Customers)initiels?f 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 ADE 55 OR OLDER)AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHEO NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. vl Additional provisions of this contract are stalled on the pages foltowiag. Customer(s)initials ,.VG4 A-Over y P.10 °`s Nlglllllllll� ADDITIONAL PROVISIONS Proposal mW&ppfuval. Sears otters to lumish 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 thin is a credit sale or a payment on completion sale,it must be approved by the Credit Sales Department.H this proposal is not approved or chi: 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. Inslallatlon. I underst2od that Sears Ivill not install the materials but sdili arrange for the installation.Sears Is not responsible for materials or i..1stallation NOT furnished or arranged by Sears.Sears agrees to procure all permits required by local law. AutItorization. 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 Insballatio . 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 Seats'control. DW Agreements aBdChanceS In egg, 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 an a separate form accepted by me and Sears, Resgensib[tllyid h 1. I agree that any information.or measurements that I give to Sears are correct and complete.I am responsible foranle special work described in this contract. Electrical A Plumbing SEA. I will provide adequate electrical and/or plumbing service(s)to run any newly installed appliances or other furnishings.If the electrical andror plumbing service(s)do not meet tete standards of the utility company or electrical andlor plumbing codes, I will make the necessary changes at my expense unless Sears has agreed in this contract to make the changes - Paymenf. I will pay Sears the cash price That covers the price of material and installption as shown on the first page. WarrantyInformation. Appropriate productwarranty documents viill be given to me by Sears.Sears'Warranty on Installation is: SEARS'LIMITED WARRANTY ON INSTALLATION In addition to any manufacturer warramy extended to you on the product(s)used(which warranty becomes effective the date the merchandise is installed), f the workmanship(orapplicatlon)of any Sears'arranged installation proves taultywithin(i)oneyear for Weatherbeater Value Line,(ii) Nye years for Weatherbeater Plus,or(iii)three years for Weatherbeater Max,and Weatherbeatef Stormbeafer,then upon notice from you Sears vrill cause such fauns 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 1-800-222-5090,Option 4.This warranty Gives you specific legal rights,and you may also have other rights that vary from State to State. NOTICE TO BUYER 1. DO NOT SIGN THE AGREEMENT IF ANY OF THE SPACES INTENDED FOR THE AGREED TERMS TO THE EXTENT OF THE AVAILABLE 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,PALL 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, S. IT SHALL NOT BE LEGAL FOR THE SELLER TO ENTER YOUR PREMISES UNLAWFULLY DR COMMIT ANY BREACH OF THE PEACE TO REPOSSESS GOODS PURCHASED UNDER THIS AGREEMENT. NQTICETO MARYLAND RESIDENTS ONLY Notice:All home improvement contractors and subcontractors must be lioensed by the Maryland Home Improvement Commission.Inquiries regard- ing a contractor or subcontractor should be directed to the Home Improvement Commission,telephone:41 D-230-6309 or(in-state)1-888-21B-59n. NOTICE TD NEW HANEXHIRE CUSTOMERS NEW HAMPSHIRE LAW,RSA 359-G,CONTAINS IMPORTANT REOUIRt MENTS YOU MUST FOLLOW BEFORE YOU MAY FILE A LAWSUIT OR OTHER ACTION FOR DEFECTIVE CONSTRUCTION AGAINST THE CONTRACTOR WHO CONSTRUCTED,REMODELED,OR REPAIRED YOUR HOME.SIXTY DAYS BEFORE YOU FILE A LAWSUIT OR OTHER ACTION,YOU MUST SERVE ON THE CONTRACTOR A WRITTEN NOTICE OF ANY CONSTRUCTION CONDITIONS You ALLEGE ARE DEFECTIVE.UNDER THE LAW A CONTRACTOR HAS THE OPPORTUNITY TO REPAIR ANWOR PAY FOR THE DEFECTS_THERE ARE STRICT DEADLINES AND PROCEDURES UNDER STATE LAW,AND FAILURE TO FOLLOW THEM MAY AFFECT YOUR ABILITY TO FILE A LAWSUIT OR OTHER ACTION. 14- Customers s-gnalure Data Customer's signature �r Date Accepted by Sears Home Improvemam Products,Inn,.("Sears")on (j� yy_ Y,-) Date Management Representative SW Imo.{Rev CO Received on 9/27/2009 7:16:34 PM