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102 SCHOOL ST - BUILDING INSPECTION (2) is . .. b The Commonwealth of Massachusetts ' Board of Building Regulations and Standards CITY OF SALEM Massachusetts State Building ,Code 780 CMR Revised Mar 2011 if Building Permit Application To Construct, Repair, Renovate Or D molish a ,IAA One- or Two-Family Dwelling This Section For Official Use Only 111✓✓✓ Building Permit Number: - D Applied: r / Building Official(Print Name) Signatu Date SECTION 1: SITE INFORMATION 1.1 Pro ert d ess: I �r it. 1.2 As)ely rs Map& Parcel Numb�� 1.I a Is this an accepted street?yes_X no Map Number Parcel Number 1.3 ZAning Informat1 1.4 Property Di sions: Zon> District Proposed Use VY) Lot (sq R) Frontage 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required vided EIRred Provided Required ovided 1.6 Wa[ apply:(M.G.L c.40,§54) IJ F d Zone Information: 1.8 S ge Disposal System: Z _ Outside Flood Zone9 wiici al ❑ On site disposal system ❑ P c❑ Private ❑ Check if yes❑ P p y �Cr7,r,1 SECTION 2: PROPERTY OWNERSHIP' 2.1 /�er'ofRV •rL'1QS 521em MOO — 019 -71 y Name(Print) I City,State,ZIP 109 Sc YI C)o 1 S�` 9V.744•Szo No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORW(check all that apply) New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: ( ,ef Description of Ewposed Wo V: / ttz n l t SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1. Building $ 3 ,. Building Permit Fee: $ indicate how fee is determined: ❑Standard City/Town Application Fee 2. Electrical $ 11 — ❑Total Project Costs(Item 6)x multiplier x 3. Plumbing $ �— 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees:$ eck No. - Check Amount Cash Amount: '�] 6.Total Project Cost: $ ' 7 ,� r 3 ❑ Paid in Full ❑Outstanding Balance Due: - _ I SECTION 5: CONSTRUCTION SERVICES 5.1 Co struction S pervisor License(CSL) L' 7S / 1 OS 31 1 a V(? _ S License Number Exp ration ate Name of CSL Flol er ^V List CSL Type(see below) I'Y1�VN) /` Type Description No.an Street �n/1 Vn/DZ7- U Unrestricted(Buildings u to 35,000 cu. ft.) �M/Z t!♦ �i C-F — R Restricted 1&2 Family Dwelling City/Town,Sta e,ZIP M Masonry RC Roofing Coverin WS Window and Siding g6� I SF Solid Fuel Burning Appliances 7530ASZ l SVECGDZG@C6f1 erne I Insulation Iele hone Email address D Demolition .2 Register d Home Im�roveme t C tract r(HIC) r I /1 Q —7 /� �� !2t HIC Registration Number Exp' ation Date HIC Com an ,�n e or UIC Reg st lit Nan ti%12 Z , F C_ en 2 - �Sf2Z� ,lz o.and Street Email address nCI tA700 �F L3275U 8>50 Z53 oas"Z Cit /To4 n,State,ZIP Telephone SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes .......... No...........❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT r _—r—, l � n I,as Owner of the subject property,hereby authorize /I hQ to act on my behalf, in all matters re tive to work as horize b this b Iding pe it appli ton. ll�w !ram Print Owner's Name(E ronic Signature) Date SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contain din this application is ue an cu to the best my know dge and understanding. lali� ao1/ Print Owner's or Authorized Uate NOTES: I. An Owner who obtains a bung petann to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www mass.eov/oca Information on the Construction Supervisor License can be found at www.mass.sov/dos 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.I (including garage,finished basement/attics,decks or porch) Gross living area(sq. ft.) - Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" CITY OF SALIED4. N'WSACHUSETTS BUILDING DEPARTMENT • #• 130 WASHNGTON STREET, 3'0 FLOOR TPI- (978) 745-9595 FAx(978) 740-9846 (<I\C3ERr EY DRISCOLL THomAs ST.PIBRRE MAYOR DIRECTOR OF PUBLIC PROPERTY/BUI DNG CON IISSIONER Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 CMR section 11 L5 Debris, and the provisions of MGL c 40, S 54; Building Permit # is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c 1 11, S 150A. The debris will be transported by: -TrCnC lK i n 4 (name of hauler) The debris will be disposed of in (name of facdityZ S (�f n l ve cS 1 � Ave n u e— Y -azo01v addre�cility� C t�ui an[ V 7 '?, 'yo � date JcbrisWrdk: CITY OF S.UI F_ Is ANSSACHUSETTS • BUU.DI2NG DEP ART\MNT Ly 120 WASHINGTON STREET,3ao FLOOR TEL (978) 745-9595 F.Ut(978) 740-9846 ICI\(BERLEY DR(SCOLL THOMAS ST.PW RRE MAYOR DIRECTOR OF PUBLIC PROPERTY/Bl.'IL.DL\G CONMRSS[ONER Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Anplicant Information Please Print Le ibi Name iBusims OrganizatioNlndividuaq: wQrnue Address: 7, HD- Irk LA)CA_ R�t2_ City/State/Zip Phone #: ZS6D ' G S 3- Are you as employer"Check the appropriate hex:- - Type o;project(require&,:" 1.❑ 1 am a employer with 4..❑ 1 am a general contractor and 1 6. ❑New construction employees(full and/or part-time).' have hired the sub-contractors 2.❑ I am a sole proprietor or partner- - listed on the attached sheet. �- ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition workingfor me in an capacity. workers'comp.insurance. 9 y ❑ building addition (No workers*comp. insurance 5.( We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL I L❑ Plumbing repairs or additions myself. (No workers'comp. C. 152,§1(4),and we have no 12.❑ Roof repairs insurance required.]t employees. LAto workers' 13. Other /�h - comp. insurance required.] •Anv applicant that checks box xI most also rill out the section blowshowing their workers'compensasion policy information. /�77 U 't hwsxowners who suhmil this affidavit indicating they are doing all work and then hire outside cm i�ctors must submit anew affidavit i icming sdc, -Cumrxtors,hat check this box must anached an additiowal,hms showing the name of the sub-eontmciars and thew woda ts'carp.policy information. l am an employer that is providing workers'compensation insurance jar my employees. Below Is the policy and jab site information. /� Insurance Company Name: Ace Awe,,-,t Policy 4 or Self-ins.Lie, R I Expiration Date6 A Iqq�/�,� � -- �� r Job Sire Address: City/StateJZtiQ l Iq-7D 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 S1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator. lie advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. /do hereby cerl h r thr pain xd pence/Iles ojperjury th t the info mutlorr provided above is/true and correct 'ism;t tr 5 Date: �l Phone 9: _ r Official use mdy. Do not write in this area,to be completed by city or town officiaL City or'rown: Permit/Llcense g.— Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.Cityrfown Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other ,,-- Contact Person: _�......__.._.._.._._... Phone H: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 ww%umass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Orgattizatiord[ndividu d):_ 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: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction e-mpfoyees(full and/or part-time).* have hired the sub-contractors 2.❑ I am 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 in any 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 r`cpaa s insurance required.] t employees. [No workers' 13.� Other V 1h Si fY1 comp. insurance required.] I— "My applicant that chedcs box#1 must also fill out the section below showing their workers'compensation policy information. n T t Homeowners who submit this affidavit indicating they are doing.all work and then hire outside contractors must submit a new atri vt m Icanng[contractors that check this box must attached an additional sheet showing the name ofthe sub-contractors and their workers'comp.policy information. 1 am an employer that is providing 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.y#: LRC46482815 Expiration.Date: 08/01/2012 Job Site Address:10 L (tee City/State/Zi OIq '70 Attach a copy of the workers'-compensation policy declaration page(showing the policy number an 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 ORnF_.R and a fine , of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi 'nd the pains andlpenaldes ofperjury that the information provided above is true and correct. Si nature: (Sears Auth. Agent) Date: Phone #: Home—Fax : 860-315- 468 / 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#: J� DATE(MMIODNYW) "✓o CERTIFICATE OF LIABILITY INSURANCE 0711912D11 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 A? certificate holder in lieu of such endorsement(s). CONTACT V PRODUCER NAME: Aon Risk services Central, Inc. DC (966) 283-7122 FAX C No : (847) 953-8390 E Chicago IL office (AI .No.Extl: AI , . 200 East Randolph EMAIL O Chicago IL 60601 USA ADDRESS: 2 INSURER(S)AFFORDING COVERAGE NAIC A INSURED INSURER A: Indemnity Insurance CO Of North America 43575 Sears Holdings Corporation INSURER B: ACE American insurance Company 22667 dba Sears, Roebuck and Co. Attn: Risk Management E3-219A INSURER C: 3333 Beverly Road INSURER D: Hoffman Estates IL 60179 USA INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:570043294986 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. Limits shown are as requested AD POLICY EFF POUCYLXP SUER LTR TYPE OF INSURANCE INSR W VD POLICY NUMBER MWDDPPv1` MWDDIYYYY LIMITS GENERAL LIABILITY HGOG EACH OCCURRENCE 15,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurred SS,000,000 ¢ CLAIMS-MADE ❑% OCCUR NED EXP(Any one person) Excluded PERSONAL S AOV INJURY 15,000,000 m GENERAL AGGREGATE $5,000,000 m GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS.COMP/OP AGO 15,000,000 e 0 X POLICY PRO. LOG N B POMOBIUE LIABILITY ISAH08696637 08/01/2011 09 Ol 2012 COMBINED SINGLE LIMIT 55,000,000 B ISAH08690649 08/01/2011 08/01/2012 Ea maem ANY AUTO BODILY INJURY(Per person) 2 ALL OWNED SCHEDULED BODILY INJURY(Per acritlenll 01 AUTOS AUTOSHIRED AUTOS X NON-OWNED Per actitlenl AUTOS N UMBRELLALIAB OCCUR EACH OCCURRENCE U EXCESS LUIB CLAIMS-MADE AGGREGATE DEDI RETENTION A WORKERS COMPENSATION AND WLRC4648281S 08/01/2011 08/O1/2012 X TORYLIMITS DRTµ B EMPLOYERS'UABIUTY YIN WLRC46482803 08/O1/2011 OB/O1/2012 ANY PROPRIETOR I PARTNER I EXECUTIVE SCFC46482827 08/01/2011 08/01/2012 EL EACH ACCIDENT E2,000,000 A OFFICERAEMBER EXCLUDED? NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $2,000,000 _ U11y desuibe under E.L.DISEASE-POLICY LIMIT 52,000,000— DESCRIPTION OF OPERATIONS below0000000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(Anach ACORD 101,Additional Remarks Schedule,a mere space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOFDESCRIBEDOLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, DELIVERED IN ACCORDANCE NATH THE POLICY PROVISIONS. Sears Home Improvement Products, Inc. AUTHORIZED REPRESENTATIVE 1024 Florida Central Parkway Longwood FL 32750 USA (�y/,J /��/ W o yL set ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston,Massachusetts 02116 Home Improvementa;aA* tor Registration Rephstration: 14860F TYPe. Public Corporal= Expiration: 10/1 V2013 real 217797 SEARS HOME MNROVEMENT P ALFRED NYUA+4J`R. ._9 1024 FLORIDA CENTRAL PM(VY - 0 LONGWOOD, FL 32750 T Update Address and return card.Mark resent for change. ca"S�l a Address 0 Renewal Fj Employment 0 Lost Card Cift- asum�rAln Beilads et�Jna L.,int..,regursitut.valid for indwidul use only qV,,HOME IMPROVIEIIIIENTCONTI�CTOR b,[.r,the itpimu.d.m. Iff..d return w V, Reglwrinticrt.111486()7 Type: Olsen of Consumer Affairs and Business Regulation Expiration; 0/U112013 Public Ca(Nnnio, 10 Park Pisa-Suit.5 170 Boston,MA 02116 OME IMl?9?dVgME,(9T.PWDUCTS INC ALFREO 4YMA A-1 LONGWOOD,FL 32)%- lf.de.�.Irkt.q .....re \111,,,Ichljwll> 1),p'll till,III d Pilblic Biard lit Buildiii--, Ri.�itj I'll i"ll, '[till Constriction Supervisor License License: CS 97519 LUBOS SVEC 827 THOMPSON F ')AD THOMPSON, CT 06277 1�7_--�— — Expiration: 8/31/2012 ........ Tr= 2442 Office Location: BOSTON Preposaloate 10/13/2011 dm# 12771067 Sears Home Improvement Products,Inc. Custom G VA S 102P.O Box 290 CenTINA G vARGAs 1024 Floridaida Central Parkway CLstorer s Horne Phone Custcrrers Wak Phone Longwood,FL 32750-7579 (978) -44-5205 - Home improvement Products Phone 800 469d663 sired Address ESTIMATE AND PROPOSAL Contractor Licanse�Registrabon Nunber 102 SCHOOL ST MA(148607) Siding Cty State Zip Code plumbing All lumbin and electrical services performed SALEM MA 1910 Is—installation within city limits? by licensed subcontractors Installation Address Coun EssEx Yes/N0: YES FEIN 25.1696591 &fling Address(t d'J!"tfmmahove) City State LP Code Project Cmsultanl Name&License No(6 applicable) SETH WILLIAMS Description of the Project and Description of the Significant Materials to be Used and 1Eq ul ment to be installed The work to be done under this contract includes the following(where checked): Specifications(0=Included❑ =Not Included) Preparation: 1. 0 Obtain all necessary permits and insurance. 2 0 Inspect surfaces in workarea,re-nail loose wood,and replace rotten surface wood where necessary in work area(excluding roof,decking,rafters and structural members). 3. ❑ Remove existing siding. Type: 4. ❑ Fir out walls on brick,black,metal or stucco areas. Location: 5. ® Caulk and seal around all windows and doors in the work area as necessary. 6. ® install approved non-corrosive starter strip. Insulation: T 53 Install insulation of ftatwall areas that are to be sided with (3/4"or 114"): 3/4" extruded polystyrene insulation. Custom Trim: 8. 62 Install custom Vyna-Klad aluminum fascia system. Color: GLACIER WHITE 9. ® Remove existing guttering.Alter removal,exi56ng guttering will be: (re-attachedldlsposed Of): RE-ATTACHED 10. ❑ Install new guttering and downspouts. 11. ❑ Cover soffit areas of hone with vinyl soffitsystem(except where noted below in"Work NOT to be done")using: (WB Max/WB Plus/Weatherbeater/Value Line/Other): Color: Pattern: 12. ❑ Install custom Vyna-Klad aluminum frieze boards. Size: Location: Color 13, 0 Wildow brim: (Jump/butt): JUMP Location: WINDOWS AND DOORS Color: GLACIER WHITE 14. 10 Custom wrapwindm,sills,mulls,headers with Vyna•Kladalumbum. Color: GLACIER WHITE 15. ® Remove and re-install existing: (storm windows/awnings I shutters): SHUTTERS 16. ❑ Install new shutters: (Panel I Lower): Color: 17. ® Custom wrap doorfacings with Vyna-Kladaluminum. Color: GLACIER WHITE 18. ❑ Custom wrap garage doorfacings with Vyna-Klad aluminum(single l double): Color: 19. ❑ Remove and re-install storm doors. 20. 10 Install deluxe corner posts. Color: GLACIER WHITE Siding: 21. ® Install: (WB Max/WB Plus 1 Weatherbeater/Value Line I Other):We PLUS Solid vinyl siding. TYPE:(HoriZontal/Vertical): HORIZONTAL Color: ANTIQUE PARCHMENT Porch Systems: 22. ❑ Porch ceilings: Location: Color: 23. ❑ Porch posts: Color: 24. ❑ Porch beams: Color: Clean up: 25. 0 Clean up and removal of all job-related debris. 26. 0 Remove excess materials and re-stock(each job is over-shipped to avoid delays). Additional work to be done: INSTALL SMALL WINDOW IN SHED TO REPLACE EXISTING WITH SIMILAR SIZE. CUSTOMER UNDERSTANDS THAT WINDOW IS NOT CUSTOM AND WILL NOT HAVE A WARRANTEE AS A RESULT. Work NOT to be done: No drip edge covered;no paint applied.NO SOFFIT AND FACIA ON MAIN HOUSE. ONLY ON RIGHT SIDE OF CAR PORT. AND SMALL SECTION ON SHED. SPECIALINSTRUCTIONS:WRAP FACIA ON CARPORT AND SHED. R&fd GUTTERS ON THOSE TWO SECTIONS ONLY, DO NOT TOUCH S&F ON MAIN HOUSE. JUMP WINDOW TRIM WITH INSULATION AND WRAP OVER WITH CLADDING FOR WINDOWS AND DOORS. )-CHANNEL IS IN GLACIER WHITE. All of the above cf A boxes,'Work NOT to be done;'Additional work to be done;and"Special Customers)initials �. •7/• Instructions"sections have been reviewed and explained to me. Paoe 1 of 3 SS1-,,A(Dig)Rev 05/711 - Job Number 12771067 APPROXIMATE START DATE and APPROXIMATE COMPLETION DATE: The work will Start approximately 3-5 WEEKS (Approximate Start Date) It will be substantially completed by approximately 1 a DAYS (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. The TOTAL PRICE including all labor,material,taxes and any applicable discount is$ 12,1s4.33 Contract Price $ 12,184.33 Initial Payment(not to exceed 30%of Total Price unless Special Order)$ 0.00 State Sales Tax( 0.00 %) $ 0.00 Final Payment(balance payable upon completion of job)$ 12,184.33 Local Sales Tax( 0.00 %) $ 0.o0 Total Amount Due$ 12,184.33 The form and method by which the Customers)will pay is described in a separate Cash(Credit Customer(s)initials Card 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 Approval.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 credihsale 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 Chanaes 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. 1 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 charges at my expense unless Sears has agreed in thisoontract to make the changes. Payment.I will pay Sears the cash price thatcovers 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 produd(s)used(which warranty becomes effective the date the merchandise is installed),if the workmanship (or application) of any Seers' arranged installation proves faulty within (i)one year for Weatherbeater or other brand, (ii) two years for Weatherbeater Plus, or (III)three years for Weatherbeater Max, 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. SS 1-NLA(Dig)Rev 05I271l11 Page 2 of 3 Job Number 12771067 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,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 tome 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,MA02780-0871 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 CDOS") 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 10/13/2011 10/13/2011 Customer's signature Date Customers signature p1 Date Accepted by Sears Home Improvement Products,Inc.("Sears")on 10/13/2011 by: Date Management Representative SSNMA(Dig)Rev 05/27A 1 Page 3 of 3 Office Location: eOSTON Proposal Date 10/13/2011 IJobg 12.71067 Sears Home improvement Products,Inc. CLslo e P.O.Box 522290 TINA G VARGAs Seo9drs 1024 Florida Cen tralParkway CLslon-ers Horne Phone Customers Work Phone Home Improvement Products Longwood,FL 32750.7579 (978) 744-5205 P Phone 800 469-4663 Bred Address ESTIMATE AND PROPOSAL contractor LicensetRegistratlon Nurreer 102 SCHOOL. ST Windows MA(148607) Op, LP Code All plumbing and electrical services performed SALEM 1910 is installation within city limits? by licensed subcontractors installation Address County Yes/No: YEs FEIN 25-1698591 Billing Address(if different from above) City State Zip Code prclect wrisulta ng Nana&License No.(it applicable) SETH WILLIAMS Description of the Pro ect and Description of the Sf ntficant Matertals to be Used and Equipmeritto 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 rated below.) 3. Installation includes the clean-up of all job-related debris upon completion of the job. 4. Install Sears Weatherbeater PLUS Windows in the openings described below according to the following specifications: COLOR, (WhiterTanlClayMhite1LightWoodgraininterionWhitelDarkWoodgrainInterior): WHITE TYPE: ❑DH Qty ❑ PW Qty ❑Casement Qty Type ❑SH Oty ❑ PD Qty ❑Casement Qty Type ❑1-LR Qty ❑Garden Door Qty ❑Bay 10 Bow (3litel4litel5lite): 4 LITE ❑2-LR Qty ❑Garden Window ❑3-LR Qty ❑ Other oty GLASS: ❑Tempered' Qty ❑ OBS Half Qty SCREENS:Check if other than FIBERGLASS PLEASE NOTE:Tempered glass will be installed to ❑OBS Full Qty (on sashes only) ❑Aluminum meet building codes. ❑ Laminated Qty GRIDS: Type _____________Color --------Placement --------- Existing units NOT to be replaced: ❑Yes ❑Col Flat ❑White ❑Woodgram O Top ®No ❑Col SculplContour ❑Tan ❑Full ❑Other(Specify): ❑ Brass ❑Bottom ❑Clay ❑Flankers Only 5. (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. 6. (If applicable)In the event Sears is unable for whatever reason to obtain the proper pernits prior to the commencement of any work, Sears will refund any previous payment and this contract will be automatically cancelled. Additional work to be done:NONE Work NOTtobedone:gOW REPLACEMENT ONLY SPECIAL INSTRUCTIONS:WHITE TRIP! ON INSIDE. WRAP OUTSIDE TRIM ON WINDOW TO 8E REPLACED IN GLACIER WHITE. All of the above check boxes,'Work NOT to be done,•°Additional work to be done'and'Special Customers)initials S. Instructions'saloons have been reviewed and explained to me. SW 1-i14(Die)Rev 05"T'l 1 Page 1 of 3 +' IIIIIIIIIIIillil Job Number 12771067 APPROXIMATE START DATE and APPROXIMATE COMPLETION DATE The work will gtartapproximately 3-4 WEEKS (Approximate Start Date) it will be substantially completed by approximately 1-2 DAYS (Approximate Completion Date) These dates are subject to charge 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 Data is only an estimated date and the Customer will be contacted prior to this date to schedule the actual start date. The TOTAL PRICE including all labor,material,taxes and any applicable discount is$ 5,189.51 Contract Price $ 5,189.51 Initial Payment(not to exceed 30%of Total Price unless Special Order)$ 1,556.85 State Sales Tax( 0.00 %) $ 0.00 Final Payment(balance payable upon completion of job)$ 3.632.66 Local Sales Tax( 0.00 %) $ 0.00 The Initial Payment is due prior to Sears ordering products. Total Amount Due The form and method by which the Customer(s)will pay is described in a separate CaslJCredit Custortrer(s)initials Card 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 Approval.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 mysatisfaction. 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 Aareements and Chanaes 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. Sectrical &Plumbing Service.I will provide adequate electrical and/or plumbing service(s)to run any newly installed appliances or other furnishings.If the electrical aril/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(ill)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 1-800-22245030,Option 4.This warranty gives you specific legal rights,and you may also have other rights that vary from State to State. S«'1-M. A 00 Rev 05_711 Pace Z of 3 .Job Number 12771067 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,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,MA02780-0871 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 10/13/2011 10/13/2011 Customer'ssgnature Date Customer's signature ��((��((�� Date Accepted by Sears Home Improvement Products,Inc.('Sears")on 10/13/2011 by. _� \i" ? �~ Date Management Representative SW I-MA(Dig)Res 05fZT I1 Page 3 of 3 � i ti-.n-~.__�_ - ._f�� Lila '-' _-•�__ __iL NFRC -. 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