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Building Permit # 8/20/2015
BUILDING R IT of OORORT(i TOWN OF NORTHA a1 APPLICATION FOR PLAN EXAMINATION ® A Permit No#: Date Received rEPPQp"°5 ., gsSACHUS�a� Date Issued: IMP RTANT:Applicant must complete all items on this page LOCATION 1Q,1)Q Print PROPERTY OWNER ' V Print 100 Year Structure yes rio MAP " PARCEL: _ZONING DISTRICT- ' " Historic District yes no /6'7 � Machine Shop Village yes o 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 / ❑oi/� olkN 1,Ii,iyff o,r/1//d1irrr//p/„,..l.//aI!,/,�t/In/,,IlJ/iil/„////��tI/./,i/...,il..r/f..i�i,l/IU,l/ea/%ir�.f.l/,,.airi//,�cn;,I fd1,/.,/fl./.f//////,f,I,,1 rt///��//i I/,..N�,�l�,/r,❑J.r,.„.//��'rW,ii.,,,.,a(rI.�,t Iyt e/Nl„l.lNr.,1I',U,.JJf��1,i I/e i 00/1M DESCRIPTION O WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: e37v . Address: Contractor Name: �&Oeh.L, • ` W,*hone• 577 fi ,4LC, 74 Email: Address: Supervisor's Construction License: s” Exp. Date: Home Improvement License: L-7 : '.3 Exp. Date: I/ ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BAS ON$125.00 PER S.F. Total Project Cost: $ c KK' FEE: $ Check No.: Receipt . t No f' 61 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund /�, Town oll Andover V% No. 2.t `'o �.K. h verMass COC "ICt4tw.cx y1. QORgTED S U BOARD OF HEALTH PERM Food/Kitchen Septic System A D THIS CERTIFIES THAT .. BUILDING INSPECTOR ............... !... .. . .. ........ .. .. ...................................... has permission to erect.......................... buildings on . .. . . . ..... .. 0. .....&r............ Foundation ................ Rough tobe occupied as ........ ..... .... ..... ..®....... .. ..... .............................. Chimney provided that the person accepting this 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMITE S ELECTRICAL INSPECTOR LESSIRough Service .........................JIMRX ............................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® 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 bv the Building Inspector. Burner Street No. Smoke Det. Contract - Detailed Pella Window and Door Showroom of Haverhill Sales Rep Name: Makos, Alex m 45 Fondi Road Haverhill, MA 01832 9 1 4^ Sales Rep Phone: 978-423-7156 � Phone: (978) 373-2500 Fax: (978) 373-7274 Sales Rep Fax:( Sales Rep E-Mail: MakosAM@pellaboston.com Customer Information Project/Delivery Address Order Information Anthony Fragala Anthony Fragala Quote Name: Anthony Fragala 1000 Johnson St 1000 Johnson St Order Number: 741AM0177 NORTH ANDOVER, MA 01845-5525 Lot# Quote Number: 7029450 Primary Phone: (978)6865533 NORTH ANDOVER,MA 01845-5525 Order Type: Installed Sales Mobile Phone: County: ESSEX Payment Terms: Deposit/C.O.D. Fax Number: Tax Code: MA TAX 6.25 E-Mail: tonyfragala@comcast.net Quoted Date: 8/6/2015 Great Plains#: 9574824 Customer Number: 1007293934 Customer Account: 1003003171 Line# Location: Attributes 10 None Assigned Delivery/Setup- Delivery/Setup 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 8/6/2015 Contract-Detailed Page 1 of 8 Customer: Anthony Fragala Project Name: Anthony Fragala Order Number: 741AM0177 Quote Number: 7029450 Line# Location: Attributes 15 None Assigned Minimum Unit Value Add - Min. Order Setup VA 3 or Less Windows Qty 1 Line# Location: Attributes 20 Front side door Encompass By Pella, Inswing Entry Door Left, 33.5 X 81.5 Qty 1 � 1:3280 Left Inswing Entry Door +' PK# Frame Size: 33 1/2 X 81 1/2 General Information: No Fire Rating,Wood,Wood, Pine,Standard Sill,Mill Finish Sill,Composite Threshold 718 Entry Door Panel: Glazed, Fiberglass,Smooth,Smooth, 1/2 Light Exterior Color/Finish: Unfinished,Primed : Interior Color/Finish: Unfinished, Primed Glass: Tempered Low-E Viewed From Exterior Hardware Options: Latch Bore,2 3/8",Standard Steel,Satin Nickel Frame Size:33.5"X 81.5" Grilles: Grilles Between Glass,3/4"Contour,White,White,Traditional,3,3 Wrapping Information: 2"Brickmould,No Interior Trim,4 9/16",4 9/16", Pella Recommended Clearance,Perimeter Length=230". Comp Trim>48-Composite Trim Upgrade>Greater than 48 inches wide Qty 1 ES—Single-Install Single Entry Door Qty 1 Schlage Knob Only-Satin-Schlage Knob Only-Satin Qty 1 Line# Location: Attributes 25 Bsck side door Encompass By Pella, Inswing Entry Door Right, 33.5 X 81.5 Qty i b 1:3280 Right Inswing Entry Door PK# Frame Size: 33 1/2 X 81 1/2 General Information: No Fire Rating,Wood,Wood,Pine,Standard Sill,Mill Finish Sill,Composite Threshold 718 Ent Door Panel: Glazed,Fiberglass,Smooth,Smooth, 1/2 Light Entry 9 9 Exterior Color/Finish: Unfinished,Primed E` Interior Color/Finish: Unfinished,Primed =� Glass: Tempered Low-E Viewed From Exterior Hardware Options: Latch Bore,2 3/8",Standard Steel,Satin Nickel Frame Size:33.5'X 81.5" Grilles: Grilles Between Glass,3/4"Contour,White,White,Traditional,3,3 Wrapping Information: 2"Brickmould,No Interior Trim,4 9/16",4 9/16",Pella Recommended Clearance,Perimeter Length=230". For more information regarding the finishing, maintenance, service and warranty of all Pella®products,visit the Pella@ website at www.pelia.com Printed on 8/6/2015 Contract-Detailed Page 2 of 8 Customer: Anthony Fragala Project Name: Anthony Fragala Order Number: 741AM0177 Quote Number: 7029450 Comp Trim>48-Composite Trim Upgrade>Greater than 48 inches wide Qty 1 ES—Single-Install Single Entry Door Qty 1 Schlage Knob Only-Satin-Schlage Knob Only-Satin Qty 1 Line# Location: Attributes 30r kitchen window Vinyl Windows/Doors By Pella, Sliding Window Vent Right/Fixed, 38 X 39.25,White Qty 1:Non-Standard SizeNon-Standard Size Vent Right/Fixed Double Slider 1 r PK# Frame Size: 38 X 39 1/4 + 718 General Information: Standard,Vinyl, Block,2 11/16",2 11/16" Exterior Color/Finish: White Interior Color/Finish: White - Glass: Insulated Low-E Advanced Low-E Insulating Glass Argon Non High Altitude Hardware Options: Cam-Action Lock,White Viewed From Exterior Screen: Half Screen Frame Size:38"X 39.25' Grille: No Grille, Wrapping Information: No Exterior Trim, No Interior Trim,Pella Recommended Clearance, Perimeter Length=155",Glazing Pressure=80. Venting Width: Equal PI—Ext Trim-Pocket w/Exterior Trim Qty 1 No Ext.Wrap/Cap-No Exterior Wrap/Cap Qty 1 PI—Insulate Pockets-Insulate Weight Pockets Qty 1 Comp Trim<48-Composite Upgrade-48 Inches or Less Wide Qty 1 Line#; Location: Attributes 35 Family room front Vinyl Windows/Doors By Pella, Double Hung, 36 X 53.5,White Qty 1 1:Nonstandard SizeNonStandard Size Double Hung,Equal PK# Frame Size: 36 X 53 1/2 718 General Information: Standard,Vinyl, Block Frame With Mull Groove,3 1/4",3 1/4",Sill Adapter Included,No Head Expander Exterior Color/Finish: White Interior Color/Finish: White Glass: Insulated Low-E Advanced Low-E Insulating Glass Argon Non High Altitude Hardware Options: White,Standard Vent Stop Viewed From Exterior Screen: Full Screen Frame Size:36"X 53.5° Grille: GBG,No Custom Grille,3/4"Contour,Traditional(3W2H/3W2H) Wrapping Information: No Exterior Trim, No Interior Trim,Pella Recommended Clearance,Perimeter Length=179",Glazing Pressure=90. PI_FF-Full Frame Pocket 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 8/6/2015 Contract-Detailed Page 3 of 8 Customer: Anthony Fragala Project Name: Anthony Fragala Order Number: 741AM0177 Quote Number: 7029450 Line# Location: Attributes 40 Family room back Vinyl Windows/Doors By Pella, Double Hung, 36 X 53.5,White Qty 2 1:Non-Standard SizeNon-Standard Size Double Hung,Equal Y PK# Frame Size: 36 X 53 1/2 -r; — — 718 General Information: Standard,Vinyl, Block Frame With Mull Groove,3 1/4",3 1/4",Sill Adapter Included,No Head Expander Exterior Color/Finish: White Interior Color/Finish: White I.' Glass: Insulated Low-E Advanced Low-E Insulating Glass Argon Non High Altitude Ts Hardware Options: White,Standard Vent Stop Viewed From Exterior Screen: Full Screen Frame Size:36"X 53.5° Grille: GBG,No Custom Grille,3/4"Contour,Traditional(3W2H/3W2H) Wrapping Information: No Exterior Trim, No Interior Trim, Pella Recommended Clearance,Perimeter Length=179",Glazing Pressure=90. PI_FF-Full Frame Pocket 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. 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 For more information regarding the finishing, maintenance, service and warranty of all Pella®products,visit the Pella®website at www.pella.com Printed on 8/6/2015 Contract-Detailed Page 4 of 8 Customer: Anthony Fragala Project Name: Anthony Fragala Order Number: 741AM0177 Quote Number: 7029450 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 followinq: Keep pets safely away from work area Keep children safely away from work area Allow Pella Installer room to work safely within your home During the Installation Pella agrees to do the following: Deliver and unload products purchased per contract Place and remove drop cloths in work area then vacuum, and remove all debris at end of day Remove existing product, including storm windows, and dispose of it unless otherwise specified Install all products using method specified in contract per Pella Installation Instructions Replace interior and/or exterior trim only if purchased If Purchased, install exterior primed pine wood trim or Composite. Composite will be unfinished. If Purchased, install interior trim matching wood window finish or White trim for Impervia and Encompass Install non-Pella entry door lockset provided by you. Pella is not responsible for it's quality or performance After the Installation the Homeowner agrees to do the followinq: Be available for completion and sign off to verify all products purchased are in working order Reinstall existing shutters and awnings Re-install existing shades, drapes, window treatments, wall hangings, and reposition furniture Arrange to have alarm system and doorbells reinstalled Reinstall air conditioners Remove stickers from product and save for energy rebate and tax purposes Wash all interior& exterior glass surfaces Fill nail holes and joints on interior trim if windows are to be stained (after staining) Cl5"exteri�g issues due to storm window removal if full wrap or new exterior trim is not purchased c2l 2/21 �P oject Checklist has been reviewed Custo ur nitial Product Only Addendum has been reviewed Customer initial 0377 Credit Card Account#: Last 4 Digits For more information regarding the finishing, maintenance, service and warranty of all Pella®products,visit the Pella®website at www.pella.com Printed on 8/6/2015 Contract-Detailed Page 5 of 8 Customer: Anthony Fragala Project Name: Anthony Fragala Order Number: 741AM0177 Quote Number: 7029450 Expiration Date: 04/2017 / Charge final payment to same accou (Upon substantial completion) Customer initial ❑Project Checklist has been reviewed Anthony R Fragala Alex Makos Customer Na (Please print) Pella Sales Rep Name (Please print) Order Totals Ge,�Mahos Taxable Subtotal $3,148.95 Customer Signatr � Pella Sales Rep Signature Sales Tax @ 6.25% $196.81 8/6/15 8/6/15 Non-taxable Subtotal $3,905.66 Date Date Total $7,251.42 Deposit Received $3,625.71 The cardholder authorizes Pella Windows&Doors to charge the(circle one)VISA, MASTERCARD, Amount Due $3,625.71 DISCOVER,or AMERICAN EXPRESS for the full amount of this order. The cardholder agrees to the card issuer's terms and conditions and is legally authorized to use this card.The cardholder can request an electronic receipt of this transaction.The cardholder's signature further acknowledges use of this card for this purchase and gives permission to have this card used for transactions associated with this order. 0377 Last 4 Digits of Credit Card 04/2017 Card Expiration Date(MM/YYYY) Card Holde at r Date of Signature For more information regarding the finishing, maintenance, service and warranty of all Pella®products, visit the Pella®website at www.pella.com Printed on 8/6/2015 Contract-Detailed Page 6 of 8 Customer: Anthony Fragala Project Name: Anthony Fragala Order Number: 741AM0177 Quote Number: 7029450 Lead Safe Installation Customer Performance Expectations In order to ensure a proper Lead Safe Installation, it is essential that we have you complete the below tasks prior to your installation: ❑ ALL furniture needs to be moved at least 8 feet away from any window or door being replaced ❑ ALL personal items, wall hangings, and collectibles must be removed prior to your installation date ❑ All blinds and any interior window treatments need to be removed prior to your installation date ❑ Any non-movable furniture (for example: pianos, entertainment centers, built in cabinets, etc) must be cleared of items and be surface dusted prior to installation ❑ You will be responsible for replacing all furniture and personal items after your installation ❑ Other items: What to Expect the Containment/Work Area to Look Like ❑ In order to ensure your safety, we will be taking measures to minimize dust/debris does not spread beyond our work area. This may include the use of plastic sheeting on the floors and/or walls, caution signs, sealing of heating and cooling air vents, and asking that you turn off your HVAC system during our work. ❑ During your Lead Safe Installation, you may also see your installation professional wearing Personal Protection Equipment. ❑ For your own safety, we are not permitted to allow you inside the work area during the removal of your current product or the installation of your new windows/doors. By signing the form below, I am affirming that I understand all the expectations noted above and that I have agreed to have all items completed prior to my installation commencing. I understand that failure to have these items completed will result in the re-scheduling of my installation and that my installation date will be scheduled for the next available date. Customer Si ature Date For more information regarding the finishing, maintenance, service and warranty of all Pella®products, visit the Pella@ website at www.pelia.com Printed on 8/6/2015 Contract-Detailed Page 7 of 8 Customer: Anthony Fragala Project Name: Anthony Fragala Order Number: 741AM0177 Quote Number: 7029450 Pre-Renovation Form Occupant Confirmation Pamphlet Receipt I have received a copy of the lead hazard information pamphlet informing me of the potential risk of lead hazard exposure from renovation activity to be performed in my dwelling unit. I received this pamphlet before the work began. Printed Name of Owner-occupant Sig natur _ r ant Signature Date Renovator's Self Certification Option (for tenant-occupied dwellings only) Instructions to Renovator.*If the lead hazard information pamphlet was delivered but a tenant signature was not obtainable, you may check the appropriate box below. Declined - I certify that I have made a good faith effort to deliver the lead hazard information pamphlet to the rental dwelling unit listed below at the date and time indicated and that the occupant declined to sign the confirmation of receipt. I further certify that I have left a copy of the pamphlet at the unit with the occupant. Unavailable for signature - I certify that I have made a good faith effort to deliver the lead hazard information pamphlet to the rental dwelling unit listed below and that the occupant was unavailable to sign the confirmation of receipt. I further certify that I have left a copy of the pamphlet at the unit by sliding it under the door or by: (Fill in how pamphlet was left Printed Name of Person Certifying Delivery Attempted Delivery Date Signature of Person Certifying Delivery Unit Address Note Regarding Mailing Option --As an alternative to delivery in person, you may mail the lead hazard information pamphlet to the owner and/or tenant. Pamphlet must be mailed at least 7 days before renovation. Mailing must be documented by a certificate of mailing from the post office. For more information regarding the finishing, maintenance, service and warranty of all Pella®products,visit the Pella@ website at www.pella.com Printed on 8/6/2015 Contract-Detailed Page 8 of 8 NOTICE OF CANCELLATION Date of transaction: 8/6/15 You may cancel this transaction, without any penalty or obligation, within three business days from the above date. If you cancel, any property traded in, any payments made by you under the agreement, and any negotiable instrument executed by you will be returned within ten business days following receipt by the seller of your cancellation notice, and any security interest arising out of the transaction will be cancelled. If you cancel, you must make available to the seller at your residence, in substantially as good condition as when received, any goods delivered to you under this agreement; or you may if you wish, comply with the instructions of the seller regarding the return shipment of the goods at the seller's expense and risk. If you do make the goods available to the seller and the seller does not pick them up within twenty days of the date of your notice of cancellation, you may retain or dispose of the goods without any further obligation. If you fail to make the goods available to the seller, or if you agree to return the goods to the seller and fail to do so, then you remain liable for performance of all obligations under the contract. To cancel this transaction, mail or deliver a signed and dated copy of this cancellation notice or any other written notice, or send a telegram to Pella Windows and Doors, at 45 Fondi Rd., Haverhill MA 01832 not later than midnight of 8/10/15 (three business days from the date of transaction above). I hereby cancel this transaction. (Date) (Buyer's signature) PELLA WINDOWS AND DOORS CONTRACT 7. PAYMENTS 1. TERMS AND CONDITIONS Pella shall be entitled to stop the Work upon written notice to Owner for any material default or failure by Owner,including but not limited to,the Owner's These Terms and Conditions are an integral part 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 Only purchases,a signed"Product Only Addendum"is a required part of the Pella shall correct installation Work not in conformance with the requirements contract. of the Contract,if notified in writing by the Owner within two years after the Completion Date or,if earlier,the date on which the Work is substantially 2. OWNER completed and payment of the Purchase Price made subject to a holdback as provided above.Correction of Work as herein provided shall be Owner's sole Pella is not responsible for any existing security systems.Owner shall remove remedy for defective workmanship,and is provided in lieu of any and all other all shades;verticals,blinds,curtains,drapes or window mounted air remedies.Pella's obligation to correct Work is conditioned on Pella's prior conditioners,prior to the installation of the Products.Pella's installers are not receipt of all payments then due. responsible for the removal or installation of these types of items. Pella is not responsible for pre-existing window coverings fitting on newly installed Pella 9. LIMITED PRODUCT WARRANTY windows. Pella shall warrant all Pella products,but only in accordance with the Pella The Owner shall provide complete access to the work site between the hours Windows&Doors Limited Warranty.THIS LIMITED WARRANTY SHALL of 7:00 a.m.and 6:00 p.m.(Monday through Friday)for Pella's installers to BE THE SOLE WARRANTY WITH RESPECT TO THE PRODUCTS AND deliver the Products and perform the Work. PELLA SPECIFICALLY DISCLAIMS ALL OTHER WARRANTIES, EXPRESS OR IMPLIED, WRITTEN OR ORAL(INCLUDING WITHOUT 3. PELLA LIMITATION ANY WARRANTY OF MERCHANTABILITY OR FITNESS Pella will be responsible for and have control over construction means, FOR A PARTICULAR PURPOSE). methods,techniques,sequences and procedures and for coordinating all portions of the Work.Pella will be responsible for the Work of its Pella 10. NO CONSEQUENTIAL DAMAGES Contractors who will install the Products. UNDER NO CIRCUMSTANCES SHALL PELLA BE LIABLE FOR Unless provided otherwise in the Work description,Pella will provide and pay CONSEQUENTIAL,INCIDENTAL,INDIRECT,OR SPECIAL DAMAGES, for all labor,materials,equipment,tools and machinery,transportation,and WHETHER FORESEEN OR UNFORESEEN. other facilities and services necessary for the proper execution and completion of the Work. 11. HOME IMPROVEMENT CONTRACTORS The materials and equipment famished Linder the Contract will be good quality All home improvement contractors and subcontractors shall be registered with and new unless otherwise required or permitted,the Work will be free from the director of the Home Improvement Contractor Registration Program defects not inherent in the quality required or permitted,and the Work administered by the Board of Building Regulations and Standards. Pella and conform with the requirements of this Contract.Pella shall not be responsible any of its subcontractors identified in this agreement have been registered. for damages or defects caused by abuse,modifications not executed by Pella, Any inquires about Pella or any of its subcontractors relating tregistration improper or insufficient maintenance,improper operation or normal wear and should be directed to:Director,Home Improvement Contractorr Registration, tear. Pella will keep the premises and surrounding area free from One Ashburton Place,Boston,MA 02108,617-727-8598 accumulation of waste materials or rubbish caused by performance of the 12. PERMITS(MA customers only) Work. Pella is obligated to and will obtain the following permits for this project: 4. CHANGES B . Homeowners who secure their own permits will be exclude from the guaranty fund provisions of Massachusetts General Laws, The Owner may order in writing changes in the Work consisting of additions, chapter 142A. deletions,or modifications("Change Order"). Any Change Order shall include an adjustment to the Price and the Substantial Completion Date,as In addition to the rights and warranties enumerated in this agreement,you may determined by Pella. Pella reserves the right to approve or disapprove any have additional rights under Massachusetts General Laws,chapter 142A and Change Order and any such Change Order must be signed by both Owner and 780 Code of Massachusetts Regulations R6. Pella to be effective. 13. NOTICE OF CANCELLATION 5. SUBSTANTIAL CONIPLETION You may cancel this agreement if it has been signed by a party Owner understands and agrees that the Substantial Completion Date is an thereto at a place other than an address of the seller,which estimate only and that the actual date on which the Work is completed may be may be his main office or branch thereof,provided you notify extended to allow for Change Orders requested by Owner or if the time to complete the Work is affected by conduct of the Owner,weather,labor the seller in writing at his main office or branch by ordinary disputes,availability of subcontractors,acts of God,fire or other causes mail posted,by telegram sent or by delivery,not later than reasonably beyond Pella's control.If for any reason the Work is not fiilly midnight of the third business day following the signing of this completed by the Substantial Completion Date(including any extensions agreement. contemplated above),but is substantially completed by such date,i.e.,the Product has been installed,but minor parts or components are inissing or need See the attached Notice of Cancellation for an explanation of to be replaced or repaired,a hold back proportionate to the cost of remaining parts or work to be completed is acceptable.However,the holdback will not this right. exceed the amount of the completion costs or 10%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 financing paperwork must be completed upon signing of this Contract and the requisite approvals and authorizations for the fidl amount of the requested financing shall have been received from the financial institution. Customer signature 8/6/15 Date DISPUTES THE CONTRACTOR AND THE HOMEOWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT PELLA HAS A DISPUTE CONCERNING THIS CONTRACT, PELLA MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUTIVE OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATIONS AND THE CONSUMER SHALL BE REQUIRED TO SUBMIT TO SUCH ARBITRATION AS PROVIDED IN M.G.L.c. 142A Pella Windows and Door NE Contractor Homeowner NOTICE: THE SIGNATURE OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE SETTLEMENT INITIATED BY THE CONTRACTOR. THE OWNER MAY INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THIS SECTION IS NOT SEPARATELY SIGNED BY THE PARTIES. The Commonwealth of'Massaehiraseas flrt Fartti ' - Department ofIndustrial A ecidents _Office of Investigations 1 Congress Street, Suite 100 Boston, Mak 02114-2017 www.mass.gorIdia Workers' Compensation Insurance Affidavit: B uilders/Cont>ractors/Electlriclans/IDluanbelrs Applicant Information Please Print Legibly Name(Business/Organization/Individual): T//j Address: t{-.s RD City/State/Zip: w .• t i jI Phone#: Are you an employer? Check the appropriate box: Type of project(required): 1.NI am a employer with 4. ❑ I am a general contractor and I •r have hired the sub-contractors 6. ❑ New construction employees(full and/or part-time).•• 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ,Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers'comp. insurance comp. insurance.+ 5. We are a corporation and its 10.0 Electrical repairs or additions required,] ❑ `P 3.❑ I am a homeowner doing all work officers have exercised their I I.[] Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.E]Roof repairs insurance required,] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other COMP. insurance required.] Any applicant that checks box#1 must also till 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 contactors 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. Below is the policy and job site information. Insurance Company Name: - LU 1)LCQ. " � T'q S Policy#or Self-ins. Lie.M �:,66 ( 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 of periuiy that the information provided above is true and correct. Sitmahue. �� ", __-..___ . _ „- - - - - --- --- - Date• eft d Phone#: V• Z-&Y—z7 a , Of ficial use only. Do not write in this area,to be completed by citt,or town official City or Town: permit/.License# Issuing Authority(circle one): I. Board of Health 2.Building Department 3.City/Town Cleric 4.Electrical :Inspector S. Plumbing Inspector G. Other Contact Person: Phone#: A�EP,Fb' ����������� ®� ��� ���� 19 �6 6�� �� 06/29ADESMMIODIYYM THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER TAT Dorothy A.Corlett,CIC,RPLU Fred C.Church,Inc. NAME: 41 Wellman Street PHONED 9783227231 aC Noll: (978)454-1865 Lowell,(800)225-1865 5-01851 dcodett@fredcchurch.com (800)225-1665 -MAIL ADDRESS: .—INSURER(S)AFFORDING COVERAGE MAIC 9 INSURER A: Citizens Insurance Company of America 31534 INSURED INSURER B; New Hampshire Employers Insurance Company 13083 New England Window&Door LLC 45 Fondi Road INSURER C: Haverhill,MA 01832-1302 INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER:54457 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBft POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MWDD MWDD OMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 XDAMAGE TO RENTED 100,000 COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE 177_1 OCCUR MED EXP(Any one person) $ 11000 A X CG0001 ZBN8161407 7/112015 71112016 1,000,000 PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ 2.000,000 POLICY MPRO- X LOC S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Per $ AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE HIREOAUTOS AUTOS Peraccident $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATIONX WC 0TH- AND EMPLOYERS'LIABILITY YIN LI ITSTATU- ER 500,000 ANY PROPRIETOR/PARTNER(EXECUTIVE MIA A 400040101 7/112015 71112016 B ❑ E.L.EACH ACCIDENT $ (MandaOFFICEtory In H)EXCLUDED? 500,000 (Mandatory In and E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarl(s 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 Cgent Mst# Cert Holder# ©1960-2010 ACORD CORPORATION. All rights reserved. ACORD 25(20'10106) The ACORD name and logo are registered marks of ACORD a M " CS-089853 WILLIAM R NICHOLS 57 PEARTREE RD' HAVERHILL MA 01830 b, 10/26/2016 OF r%Xe (07177710JI1C��C91 O�C���CfJJfitGll.UJB�J - a, - _Office,of Consumer A=ffairs&a3iusiness Regulation License or registration xalid for individul use only, ME IMPROVEMENT CONTRACTOR before the expiration date.'If found 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 HAVERHILL,MA 01832 Undersecretary Not valid without signature