16 SUNSET - BUILDING INSPECTION �Z The Conunonweslth of Massachusetts
i Board of Building Regulations and Standards I't Ht
11l'NI<'ll'.\I.I'I1
4 'tlj Massachusetts State Building Code. 73l)('MR. 7"' edition I BSI:
Building Permit Application To RrI oed.himw)r
ConsuucL Repair. Renocatr Or Demolish a
One-or Tit un ' r Duelling 1. 'un,)'
This S ction For I'icial Use Only
Building Permit Nur er: 9wte Applied:��
Signature: —) y�0 -- —
Building onunissiui r/ Inspecturut ui III Dal[
SEC I: SITE INFORm,%TION
LI Property Address: 1.2 :assessors Nlap & Parcel Numbers
��SVNS�r
I.la Is this an accepted street? yes ✓ no___ Map Nun.her Parcel Niimher
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area Isq to Frontage uU
1.5 Building Setbacks (ft)
Front Yard Side Yards Rem Yard
Required Provided Required Provided Required Pruv ided
1.6 Water Supply: (M.f).L c. 40. §54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone'' Municipal ❑ On site disposal s +tcIn ❑
Public ❑ Private ❑ Check if yes❑ P I y
SECTION 2: PROPERTY OWNERSHIP[
2. Ownerl of Record:
�ON SEEEM Y �� �toi✓S¢�
Name(Print) / Address for Service:
(rm zY n /Af -7Sid-(-7.50.� _
Signature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction ❑ Existing Building ❑ Owner-Occupied ❑ Repairs(s)sls) Alteration(s) ❑ :Wdi:inn ❑
Demolition ❑ Accessory Bldg. ❑ 1 Number of Units__ Other ❑ Specily:
Brief Description of Proposed Work':---
SECT ION 4: ESTIMATED CONSTRUCTION COSTS` �-
Item Estimated Costs: Official Use Only
(Labor and Materials) _
I. Building - L Building Permit Fee: $ Indicate how tee is determined:
- ❑Standard City/Town Application Fee
2. Electrical $ "— ❑Total Project Cost' (Item 6) x multiplier x
3. Plumbing $ 3. Other Fees:
4. Mechanical (HVAC) $ List: l (J
5. Mechanical (Fire $ '�
Suppression) Turd All Fees: 5
Check No. Check Amount: Guh :\moune
j b. Total Project Cost: S _741fil ❑ Paid in Full ❑ Outstanding Balance Due:____-..
I
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor (CSL) coe7 ?J .3
rALhIlMn Alk /S License Number 6spii:ui"m Date -
Nantc of CSL- holder
10: a AtOr— k� J_ .� .fir ���� List CSL T%pc (see below) _
\ndrehl A�fV Description
L Unrestricted ut m 3a.000 Cu. Fl.r
R Restricted 1&2 Famil\ Dskellinfl
Signature _ y1 \lasonn Only
_RC Residential Rooline Co%crme
Telephone \\'S ReSI&IIIlal Windo'� end Siding _
SF Residential Solid Fuel 13urnntu \ >>lianee Instill:wall
U Resident):d Dentohoon
5.� R gistered )tome 1 tpro ement Cuntr ctor (IIIC)
FDIC Company Name or HIC�R},gistrmll N me Regtstrauun Numhcr
Address
Expiration Date
Signature --_- Telephone
SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152. § 2506))
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
I, _ e� �I�' as Owner of the subject property hereby
❑uthorize edi4 W"IV100-kj3 to act on my behalf, in :dl maaers
relative to work authorized by this buildvlg ^ermh application.
Signature of Owner . _ - Date _
SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION
rrff '- ---i
1, c LLa ,s as Owner or Authorized Agent hereby declare j
that the statements and information on the fofegoing application are true and accurate, to the best of my knowledge and
behalf.
Print game
Signature of Owner or Authorized Agent Date
(Signed under the pains and penalties of perjury)
NOTES:
I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an Limegislered contractor
(nut 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 and
Construction Supervisor Licensing (CSL)can be found in 730 CMR Regulations 1 IO.R6 and I IO.R5. respectively.
2. When substantial work is planned, provide the information below:
Total floors area(Sq. Ft.) (including garage, finished base ment/an is s. decks or porchi
Gross living area tSq. 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 SALEM
y 'S
PUBLIC PROPRERTY
DEPAR"I•�IENT
Construction Debris Disposal Affidavit
(rciluired lbr all demolition and ratovation work)
In accordance ith the sixth edition of the State Building Code, 780 CNIR section 1 1 1.5
Debris, and the provisions of N1GL c 40, S 54;
Building Permit it is issued with the condition that the debris resulting front
this work shall he disposed of in a pruperly licensed waste disposal facility as defined by MGL c
l 11. S 150A.
The dchiis will be transported by:
Lf/l7FMRNge airy-/
( me (it hauler)
The debris will be disposed of in : a
a
l iamr ul facility)
I:Iddtct<of Iacllit_V) _
'Igualu)c of p:mlit .p)phcant
�latc
The Commonwealth ofMassaehasetts
Department oflndrtstriol Accidents
Office ojlnvestigadons . .
600 Washington-Street
Boston,MA 02111
wwry MaSsgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plambers
Applicant Information f c Please Print IJeaibly
Name(Business/orgaab tion/(naividaal): W.AA-ow S Auld V h OOt'3 l nC
Address:�15ohd; fLa� .
City/State/Zip:_}}+0. �1i�� M� DIQ32 ,IPid&1it;t R�B-,f�ZAV•725S
Are you an employers Check the appropriate
60=: • ,
Type'ot pro]cct(required).
1. I am-a employer with Z'S • 4. ❑ I am a eral contractor and I
employees fun and%a • have h tik:.� 6. ❑New construction
( pattrfime). hued sub-cofactors
2. I am a sole 7."
❑ 'e t Remodeling Proprietor or partner- listed on the�attac)'ied sheet. ❑ . �g
ship and have no employees. These sub•conhactors have 8: .0 Demolition • .
working for me is any capacity. workers'comp. insurance. '
(No workers'camp. 5. We are a co 9: Building addition
insurance. tionand'
tµs ❑ rpota tts
aired 10. Electrical to required.] officers have exercised their ❑ Paps or-additions
3.❑ I ant.a.homeowner doing all.work . right of exemption per MOL 1.1-11 Plumbing repairs or additions
myself. (N rkers'ovvo
3's comp: -c► 1$2, §1(4), and we have no 12.❑Roof repairs
insurance t ,
• o
-_ required.] employees. [N workers.
1 3.
• comp.insurance regttiied:]
❑Other
Any applwct Wet chests bo,t al m cot su me t. �. putt lediatbdowahowiog ., ;°o'mPco7eu4nPulicY.iq�b ,
t Homecwntas who aehigt this Wldavlt_mAkating tliEj.ae dojo;all wod:and gm biKCSW de eoatrtit tm>t.tnmt avMpit i'sew iiidivitisocatin6 v=L.
Conttiiam that check this box must.atticj ed as additiaoal died showing the name dfoe sob oeatractoo.md their wotbets`ono- - information.
I ass an e44�h►yer a wt.is providbW x+vrkas'conlpemadon bourn ct for nw employees relaiv it thepolicy
'.infornsation. .. .. :artQjob sPte
Insurance Company Name: G, ".t�kVre•t�
Policy#or Self-ins.Lis:#:0$'W SAIL. 5*7 y 2 Expiration Date: 7 ZOO
JbSite Address
Attach a copy ofthe workers' compemaadon policy declaration pago.(showing the po4cyaitmber and expiration-date).
Failure to sequrccovetage as'requlrad under Sectidn 25A of MGL e.�152 can lead:to the imposition of criminal penalties of a
fine up to 51,500.00 and/or one-year imprisonment,'as well as clvtil penalties in-the form of a STOP WORK.ORDEtt;an8 a fir
of up to$250.00 a day against the violator. Be advised that a copy�;jiis statement itiay be fosvyerded to the Office of
Investigations of the DTA for 9*urdnce coverage verification
!do hereby certify rordw due paasr acid ptnaiNes of perjury drat the lnjorniadoa provided above b;due and correct
Signature: Date:
Phone#: 79-
t7J kid Use ow Do irot Write.in this area,to be compbited by or lownoflMaL
City or Town: PermiNLicemse#
Isauin A¢thori •, ; .k BwrdotHealth..2.8niidiat Ipartment 3.City/Town Clerk '4.IUectrical Inspector 5,.Plbmbing Inspector
6.Other
. CERTIFICATE OF LIABILITY INSURANCE 07/02"8`" 1 1 2""
g"R .
PRODUCER '•.(800)225-1965 THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION
Fred G ChuLd.Inc. ONLY AND CONFERS NO R16HTS UPON THE CERTIFICATE
m
HOLDER. THIS CERTIFICATE DOES..NOT-AMEND, EXTEND OR
41 Wellman
l an Sheet 0185i ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
800.225-1865 S NAIL B'.
INSURER AFFORDING COVERAGE-
INSURED INSURERA: Cffi=wmanm CampaDy of AmO:i .
Now EwjandWmdow&D=LLC >'I�INSURERS. 'erlImu DmcOIvaIY
45 Fondi Road
Havetfiill,MA 01832-1302 INSURER C: MaNVAUNO BEY losunRoa 29459
INwRER n Twm city Five IDsunace Co.
INSURER E
COVERAGES
THE POUCIES 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 WITFI 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.
INSR POLIOYNUMBER POLICYEFFEC7/VE POLICYF1�N1Ati0N LIMITS
um TYPEOFINWIRANCEEACH OCCURRENCE 51.�.�GENERAL LL400JN :500,000
X COMMERCUILGENERALLIABILIIY
0.AIMSMADE 0 OCCUR MEDEW An om adm $10.000
p ZBN8161407 7/12008 7/12009 PERSONAL&AOV INJURY $I,000.000
GENERALAGGREGATE S 2,000.000
GENLAOGREGg7E UMRAPRJES PER pRODUCTS-COMPIOPAW $ 2,000.000
POLICY PRO- LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000
X ANY AUTO (Ea maddmI)
ALL OWNED AUTOS BODILY INJURY S
(PW Pa )
C SCNEDULEDAVTOS ADMI62169 - 7/12008 7/12009
X wREOAuros INJURY $
— -----
PROPERr
sad. �D.AMAGE,+ -
.. OARAGELIABILTTY;:' ,. AUTOa -EAACCIOENT S
ANY AUTO OTHER THAN EAACc $
AUTO ONLY: . - AGO s
EXCEssnIMaREuwLNA9ILlry EACIIOCCURRENCE $9000000
.X OCCUR ❑-CLAMS MADE AGGREGATE :9,000 U00
B UBMI67305 7/12008 711i2009
DEDUCTIBLE
s
S
' X RETENTION S A
WORKERSCWPEWAiION AND —_
D AnrPROPaEtoRmWEIVEXECurrvE 08WBN45742 7/12008 7/12009 EL DISEASE'EA EMpL S 500A00
OFFICERMEMBERExCLwBOT
E aaMAM uliaar • , ... .. E.L DISEASE'-POIICYUMIT IS 500,000
yypp,
SPECMLPROVISIONS below
OTHER
DESCRIPTION OF OPERATONS I LOCATIONS I VEHICLES I EXCLUSIONS AVOW BY ENDORSEMENT/SPECSLL PROVISIONS
Ptaof of Ilmum oe -
CERTIFICATE HOLDER CANCELLATION
New England Window&Door ALL' sNooLR AxroFT+EABovEOEscRmELipbuaESRE cANOELLEo 9EFORE T'E°w'R"T°"
5 Fondi Road DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
averhilL MA 01830 NOTICE TS THE CERTIFICATE HOLDER NAMED TO LEFT.BUT FAILURE TO Do 80 eNIAIA
IMPOSE NO OBU7AT10N OR LIABILITY OF ANY Im10,UPGN THE NSUREA.ITS AGENTS OR
REPRESENTATIVES.
AVTNORQEOREPRESE. E�.•: •... ..
ACORD 25(2001/O8) CHmt N 2960 Mat 111 0 GI,LIM,WC, Celt q ®ACORD CORPORATION 1988
Liven r CTiI
t....�yri
tv:
rK nk� 4
? Y
�- __ _ Gf/ee �om�mzane�ealNc a�./fr!anagr/mella 1
Board of Building Regulations and Standards j
HOME IMPROVEMENT CONTRACTOR
Registrafion.: 129774 j
EXPrrahon- 11/2/2009
T a Su[[
lament Card
PELLA WINDOWS AND,DOORSI-�'
WILLIAM NICHOLS
45 FONDI RD.
t HAVERHILL,MA 01832
Administrator
Contract
Pella Windows&Doors, Inc.
45 FONDI ROAD
® HAVERHILL
MA 01832
- l .
Phone: 800-866-9886 Fax: 978-373-7274
Customer Project/Ship-To Order
DON JEFFREY JEFFREY-SALEM2 Date 00/00/00
Quote No. JEFFREY2
16 SUNSET 16 SUNSET Order No.
Need Date 00/00%00
SALEM, MA 01970 SALEM,MA 01970 Sales Rep.Name Gould,Rick/WME
ESSEX ESSEX Prepared by
Payment Terms Deposit/C.O.D.
Owner: DON JEFFREY Architect
Bus. Phone: ( ) - Bus. Phone: Jamb Depth
Bus. Fax: ( ) - Home Phone: (978)744-7505 P.O. No.
Cellular: ( ) - Branch Order No.
Home Phone: ( ) - Order Type Installed Sales Order
Glazing Design 20.00 psf.
Pressure
Branch Name Pella Windows&Doors, Inc. Branch Address 45 FONDI ROAD
Phone 800-866-9886 City HAVERHILL
Fax 978-373-7274 State MA 01832
Comments: Customer has paid$3,743.32deposit(50%of contract Total)
Customer has paid using a(credit Card)
The Remaining$3,743.32(Final 50%)will be paid upon substantial Completion of installation.
Customer will be paying balance with(credit Card
For information regarding the finishing, maintenance, service, and warranty for all Pella products,visit the Pella Website at
www.yelia.com.
Printed 08/13/08 Contract-Page I of 3
Contract for Customer DON JEFFREY Project: JEFFREY-SALEM2 Order No.:
Outside View Item No. Otv. Summary Description unit Price Extended Price
Item#10 Qty: 3 Vent-DR Luxury Edition Precision Fit Window,Make Size:30- 934.36 2,803.08
Location: Daughters Guest rrn 3/4 X 52-1/2: Architect Series,Clad,Model 3, White,Half Vent
RO: 2'7-1/4" X 4'S" /match Half Vent, 5/8" InsuIShld IG Glazing,Full Screen,White
Hardware,3/4"REM Traditional Grille(Grille Lites Wide=03,Grille
Lites High Upper Sash=02, Grille Lites High Lower Sash=02),White,
White,PreFinished White
Value Added Items: Disposal per Unit-Qty I
Standard P-Fit Install-Qty I
Notes:
Outside View Item No. Oty, Summary Description Unit Price Extended Price
Item# 15 Qty: 4 Vent-DR Luxury Edition Precision Fit Window,Make Size:30- 891.62 3,566.48
Location: study 3/4 X 44-1/2: Architect Series,Clad,Model 3, White,Half Vent
RO: 2'7-1/4" X 3'9" /match Half Vent, 5/8" InsulShld IG Glazing,Full Screen,White
Hardware,3/4"REM Traditional Grille(Grille Lites Wide--03,Grille
Lites High Upper Sash=02, Grille Lites High Lower Sash=02),White,
White,PreFinished White
Value Added Items: Disposal per Unit-Qty I
Standard P-Fit Install-Qty 1
Notes:
Outside View Item No. Oty- Summary Descrintion Unit Price Extended Price
Item#20 Qty: 1 Vent-DR Luxury Edition Precision Fit Window,Make Size:28- 838.09 838.09
Location: Bath 3/4 X 36-1/2:Architect Series, Clad,Model 3, White,Half Vent
RO: 2'S-1/4" X 3' 1" /match Half Vent,5/8" InsulShld IG Glazing,Full Screen, White
Hardware, 3/4"REM Traditional Grille(Grille Lites Wide=03, Grille
Lites High Upper Sash=02, Grille Lites High Lower Sash=02),White,
White,PreFinished White
Value Added Items: Disposal per Unit-Qty 1
Standard P-Fit Install -Qty I
For information regarding the finishing, maintenance, service, and warranty for all Pella products, visit the Pella Website at
www.t)ella.com.
Contract-Page 2 of 3
Contract for Customer DON JEFFREY Project: JEFFREY-SALEM2 Order No.:
Notes:
Thank You For Purcha ' g Pella Products
Taxable Subtotal $ 5,579.65
Cus m Signature Pella Sales Representative Signature Sales Tax at 5.0000% 278.98
(� Non-taxable Subtotal 1.628.00
'3_G� I__ 13 — r} Total $7,486.63
Date Date Deposit Received $ 3,74332
Deposit Received $3,743.32
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,Inc. 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.
For information regarding the finishing, maintenance, service, and warranty for all Pella products,visit the Pella Website at
www.nella.com.
Contract-Page 3 of 3
PELLA. WINDOWS AND DOORS CONTRACT m
7. PAYMENTS
1. TERMS AND CONDITIONS Pella.hall 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 falure to pay Pella the amount Chia within seven days after the date payment is
Product Order(the"Contract')between New Englund Window and Door LLC due.
dba Pella Windows&Doors.Inc.("Pella')and the persons)identified on the
Product Order(`Owner")to supply the products(the"Products'),and perform 8 CORRECTION OF WORK
the work(the"Work")dese,ibed 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
OWNER provided
and payment of the Purchase Price made subject to a holdback as
2. provided above.Correction of Work as herein provided shall be Owner's sole
Pella is not responsible for any existing security systems.Owner.hall 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 covenrlp fitting on newly installed Pella y LIMITED PRODUCT WARRANTY
windows.
Pella shall wnrt:vu all Pella produces,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.(Mondav 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 DISCLAINIS ALL OTHER WARRANTIES.
EXPRESS OR lx4PLIED, 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 IMPROVENIENT CONTRACTORS
The materials and equipment famished under the Contract will be good quality
All home improvement contractors and subcontractors shall be registered with
the director of the Home Improvement Contractor Registration Program
and new unless otherwise required or permitted,the Work will he Free fmm administered by the Board of Building Regulations and Standards. Pella and
defects not inherent in the quality required or permitted,and the Work
any of its subcontractors identified in this agreement have been registered.
conform with the requirements of this Contract Pella shall not be responsible
Any inquires about Pella or any of its.vubcontractors relating to registration
for tlamatges or defects caused by abuse,modifications not executed by Pella, should be directed to: Director,Home Improvement Contractor Registration,
improper or insufficient maintenance, improper operation or normal wear and One Ashburton Place.Boston.MA 02108,617-727-8198
tear. Pella will keep the premises and surrounding area free from
accumulation of waste materials or rubbish caused by performance of the 12. PERMFrs(MA customers only)
Work
Pella obliaz ed to and will obtain the following permits for this project:
4. CHANGES Homeowners who secure their own permits will be
excluded from the natality 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 Or(ler'). 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 anv 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. SHRSTANTIAL COMPLETION You may cancel this agreement if it has been signed by a party
Owner understands and agrees but 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 subcontracto¢,acts of God fire or other causes mail posted, by telegram sent or by delivery, not later than
reasonably bevond Pella's control.If for any reason the Work is not fully 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 pans or components are missing 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 90 of the remaining unpaid
balance of the Price,whichever is Tess.
Do not sign this contract if there are any blank spaces.
6. FINANCING
If payment of the Price¢financed with a financial institution through Pella,all
financing paperwork must be completed upon signing of this Contract and the t
requisite approvals and authorizations for the full amount of the requested L a
financing shall have been received from the financial institution. C Smnter sig_�alure / 7 �/
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
Contractor
meo �y
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.
NOTICE OF CANCELLATION
Date of transaction: 'S /z y
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/Flondi Rd., Haverhill, MA 01832
not later than midnight of (three business days from the date of
transaction above).
I hereby cancel this transaction.
(Date) (Buyer's signature)