34 VALIANT WAY - BUILDING INSPECTION l '
The Commonwealth of Massachusetts EC IONALT VICE
Board of Building Regulations and Standards SALEM
j Massachusetts State Building Code, 780 CMR 1014 S Abeu�ur9fl(
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date A ied: _
Building Otlicial(Print Name). Signature Date
SECTION 1:SITE INFORMATION`
1.1 Property Address: 1.2 Assessors blap&Parcel Numbers
114l�i A�.r i- kI kt�
I.I a Is this an accepted street?yes ---no Map Number Parcel Number
1.3 Zoning Information: 1.4 Properly Dimensions:
Zoning District Proposed Use Lot Area(sq 11) Frontage(It)
1.5 Building Setbacks(R)
Front Yard Side Yards Rear Yard
Requimd Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Public❑ Private❑ Check if es❑ p Po y
SECTION2: PROPERTY OWNERSHIP!
2.1 Ownert of Record:
MA�2C. �F�zEr ttf rz�Ivest S4694"
N me(Print) City,State,ZIP
No.and Slrecl Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORKS(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Specify:
Brier Description of Proposed\York': fylPa
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials)
I. Building S ,SDov— 1. Building Permit Fee:S Indicate how fee is determined:
❑Standard City/Town Application Fee
2. Electrical S ❑Total Project Cost'(item 6)x multiplier x
J. Plumbing S P Other Fees: .S
4.Mcchvtical (FIV;\C) S
List:
5. Mechanical (Fire S Total All Fees:S
Su mssiun)
Check No._Check Amount: Cash Amount:_
6.Total Project Cost: S �9000 ❑Paid in Full ❑Outstanding Balance Due:
MPq Ll(-:;o a/zz
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 061 t, 3 0"26^)
r 17 11ii l S License Number Expiration Dale
—
u'.une of 'SL Holder List CSI.Type(see below) L)
Sueet
N 4L `� T Description
Nu.;mJ s
``��
Unrestricted(Buildings u l0 35,000 cu. R.)
,-a0J C,44r QJE 3 z R Restricted 1&2 Famil Dwelling
Cityflbwn,State,ZIP M Masonry
RC RootingCovering
WS Window and Siding
SF Solid Fuel Buming Appliances
./JA' y,• .7�c I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) l !% V-3
HIC Registration Number Expiration Date
IIC ontp;my Name or IIIC Registrant Nmne
4ri� Igo. t to kJA4-Qlb'1-
No. and Street Email address
�7F tt,.s.7a�'
Cit /Town,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 Iskuance of the building permit.
Signed Affidavit Attached? Yes.........4nN, No........... ❑
SECTION 7a.OWNER AUTHORIZATION.TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT"
I,as Owner of the subject property,hereby authorize P-61A- kJ jn/4DwS
t9 act on my behalf,in all matters relative to work authorized by this building permit application.
,
are(- W•JPz•U tJni
Print wner's Nmne(Electronic Si at ) Date
SECTION 7b:OWNEW ORAUTHORIZED AGENT DECLARATION
By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
1'rin owner's or Authorized Agent's Name(Electronic Signature) Dale
NOTES:
I. An Owner who obtains a building permit 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 bI.G.L.c. 142A.Other important information on the HIC Program can be found at
www.mass.eov'oea information on the Construction Supervisor License can be found at www.nlas.eov:'dns
2. When substantial work is planned,provide the information below:
Total floor area(sq. R.) (including garage, finished basement/attics,decks or porch)
Gross living area(sq. 11.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
type of heating system Number of decks/porches
'I`ypeofcoolingsystem Enclosed Open
3. "ii'olal Project Square Footage"may be.substiluted for"rotal Project Cost"
i
CITY OF SALEM, MASSACHUSEM
ft �� BUILDING DEPARTMENT
120 WASHINGTON STREET,311D FLOOR
�+ T!EL. (978)745-9595
KIMBERLEY DRISCOLL FAX(978)740-9846
MAYOR THomAS ST.PIERRE
DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER
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 111.5 Debris,
and the provisions of MGL c40, 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 deposit facility as defined by MGL c 111, S 150A.
The debris will be transported by:
�L k ••tea c C1-1 r
(name of hauler)
The debris will be disposed of in:
OL9dL&&iz:FeeLa er
(name o facility)
Fo^ro /4n--,e tl�,lI a�a 0ir 3 L
(address of facility)
Signature of applicant
Al -14
Date
CITY OF SiU EM, NLL SSACHUSETTS
i
BUILDING DEPARTMEINT i
120 WASHLNGTON STREET, 3w FLooR
aa=a� TEL (978) 745-9595
Rla(978) 740-9846
KINIBERLEY DRISCOLL
"'AAYOR THOntA.s ST.PIERm
DIRECTOR OF PUBLIC PROPERTY/0D¢.DING CONNISSIONER
Yorkers' Compensation Insurance Affidavit: Builders/Contractors/Electrfeians/Plumbers
Appiicant_Information- Please Print t e iblY
VaitlC (flusiness Organiratioro'Individual):�G I'aq-- 'L�(f� /1Oy/S
Address: q.�;-
City/State/Zip: RNA&e,04d1 MW 0f87--Phone #:_'� Y Zfo� 7r➢
Are you an employer?Check the appropriate box: Type of project(required):
1�&l am a empioycr with � 4. ❑ I am a general contractor and 1 6. ❑New construction -
employees(full and/or part-time).* have hired the sub-contractors
2.❑ lain a sole proprietor or partner. listed on the attached sheet. t 7•.-(Remodeling
ship and have no employees These sub-contractors have S. ❑ Demolition
working Misr me in any capacity. workers'camp.insurance. 9. ❑ Building addition
(No workers*comp. insurance 5. ❑ We are a corporation and its
required.) officers have exercised their 10.❑Electrical repairs or additions
J.❑ 1 am a homeowner doing all work right of exemption per MGL I I.❑ Plumbing repairs or additions
myself. (No workers'comp, c. 152, g 1(4),and we have no 12.❑ Roof repairs
insurance required.) t employees. tNo workers' I3.❑ Other
comp. insurance required.)
•Any uppliumn Ilw1 checks bee s t must alsu rill out arc secliun bcluw showing their woden'eompenudun pulicy inlilnnudon.
'I lomanwrwns who whn,it this of icinvit indicating they are doing ill work and then hire outride cmllncton must nhmit anew air.daviI indicating such.
f'nnmcwn Ihot clack this box must a tachal an:ddiliuwl shun showing the name of then b4onaractom and their workcn'camp,pulley information,.
f um an employer that Is praviding workers'conspeasadan insurrnrcefor my employees. Below Is the pulley and job site
iafirrmalinn.
Insurance Company Name:
Policy it or Self-ins. Lie.0: (in 00 U L.B
.�_.._ Expiration Date:
Job Site Address: City/Stale/Zip;
Altach a copy of the workers'compensatlon pulley declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of,%IGL c. 152 can lead to the imposition ofcriminal penalties of a
tine up to S 1,500.00 and/or one-year imprisnnmcnt,as well as civil penalties in the farm of a STOP WORK ORDER and a line
of up to S250.00 a day against the violator. Ile advised that a copy of this statement may be forwarded to the Ol'lice of
Inv"ligrtiuns ol'the OIA for insurance coverage verification. -
/do hereby certify under the pubis and penuf leo'of perjury that the b furantah t provided abuve r:r true and correct.
Phone t I Z �- • 7iSC— _
OfIf-AIJ we only. Do not write he this area, to be completed by city or to ova ojjlrfaC
Ciry nr hen: _ PermitiLleense q
Issuing Authority (circle one): -- _ _-- --
1. hoard of health Z. Iluildlm„Departuu'nt I.fityfrima f_'lerk J. Flectrical Lslpectur 5. Plunlblog Inspector
6.)hher
j CgnOcl person:
l Phone!!:__.. __ �
Contract - Detailed
Pella Window and Door Showroom of Haverhill Sales Rep Name: Duff, Stephen
45 Fondi Road I✓ / �{ Sales Rep Phone: 978-373-2500
Haverhill, MA 01832 V 3I'Z
Sales Rep Fax:
Phone: 9783732500 Fax: 9783737274 Sales Rep E-Mail: DuffS@pellaboston.com
Customer formation Project/Delivery Address Order Information
Margaret Wrynn Wrynn,Margaret,Salem,MA 1448404 Quote Name: 350 Series Sliders
34 Valiant Way 34 Valiant Way
Order Number: 741
SALEM,MA 01970-6609 Lot# Quote Number: 6025377
Primary Phone: (978)7458993 Salem, MA 01970-6609 Order Type: ` Installed Sales
Mobile Phone: County: Payment Terms: Deposit/C.O.D,
Fax Number: Tax Code: MA TAX 6.25
E-Mail: mwrynn@msn.com Quoted Date: 8/22/2014
Great Plains#: -
Customer Number: 1006969892
Customer Account: 1002449867
Customer Notes: PERMIT FEE=$25
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.pella.com
Printed on 8/26/2014 Contract-Detailed Page 1 of 5
Customer: Margaret Wrynn Project Name: Wrynn,Margaret,Salem,MA 1448404 Order Number: 741 Quote Number: 6025377
Line# Location: Attributes
15 f UPSTAIRS Pella 350 Series, Double Sliding Door Fixed/Vent Left, 71.5 X 79.5, White Qty
1
I t:7280 Fixed I Vent Left Double Sliding Door
PK# Frame Size: 711/2X 791/2
657 General Information: Yes,R,Standard,+/-50,+/-50,Vinyl,Nail Fin,No Foam Insulated,6", 1 3/8",4 5/8",No Sill Riser
Exterior Color/Finish: White
.I Interior Color/Finish: White
Glass: Insulated Dual Tempered Low-E Advanced Low-E Insulating Glass Argon Non High Altitude
Hardware Options: Yes,White,White, Steel
Viewed From Exterior Screen: Sliding Screen,White,Premium,Conventional Fiberglass
Grille: No Grille,
Frame Size:71.5"X 79.5" Wrapping Information: No Interior Trim, Pella Recommended Clearance,Perimeter Length=302",Glazing Pressure=175.
Composite Trim>48-Composite Trim Upgrade>Greater than 48 inches wide Qty 1
Finish Patio Trim-Finish Paint/Stain Patio Door Interior Trim Only Qty 1
PD_2 Wide-Install 2-Wide Patio Door City 1
Line# Location: Attributes - -
20 BASMENT Pella 350 Series, Double Sliding Door Fixed/Vent Left, 71.5 X 79.5, White Qty
� I 1
1:7280 Fixed/Vent Left Double Sliding Door
PK# Frame Size: 71 1/2 X 79 112
657 General Information: Yes,R,Standard,+/-50,+/-50,Vinyl,Nail Fin,No Foam Insulated,6", 1 3/8",4 5/8",No Sill Riser
Exterior Color/Finish: White
!, Interior Color/Finish: White
Glass: Insulated Dual Tempered Low-E Advanced Low-E Insulating Glass Argon Non High Altitude
7LZ Hardware Options: Yes,White,White,Steel
Viewed From Exterior Screen: Sliding Screen,White, Premium,Conventional Fiberglass
Frame Size:71.5"X 79.5" Grille: No Grille,
Wrapping Information: No Interior Trim,Pella Recommended Clearance,Perimeter Length=302",Glazing Pressure= 175.
Finish Patio Trim-Finish Paint/Stain Patio Door Interior Trim Only Qty 1
PD_2 Wide-Install 2-Wide Patio Door 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 8/26/2014 Contract-Detailed Page 2 of 5
Customer: Margaret Wrynn Project Name: Wrynn,Margaret,Salem,MA 1448404 Order Number: 741 Quote Number: 6025377
Line# Location: Attributes
25 None Assigned V615318- PD Keylock Qty
2
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.
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
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.
For more information regarding the finishing, maintenance, service and warranty of all Pella®products, visit the Pella®website at www.pelia.com
Printed on 8/26/2014 Contract-Detailed Page 3 of 5
Customer: Margaret Wrynn Project Name: Wrynn,Margaret,5alem,MA 1448404 Order Number: 741 Quote Number: 6025377
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 following:
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 followinq:
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 following:
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)
Clean up exterior casing issues due to storm window removal if full wrap or new exterior trim is not purchased
X Project Checklist has been reviewed
Customer initial
Product Only Addendum has been reviewed
Customer initial
Credit Card Account#: Last 4 Digits
Expiration Date: /
For more information regarding the finishing, maintenance, service and warranty of all Pella®products, visit the Pella®website at www.pella.com
Printed on 8/26/2014 Contract-Detailed Page 4 of 5
Customer: Margaret Wrynn Project Name: Wrynn,Margaret,Salem,MA 1448404 Order Number: 741 Quote Number: 6025377
Charge final payment to same account
(Upon Substantial completion) Customer initial
Project Checklist has been reviewed
Margaret Wrenn Steve Duff
Customer Name (Please print) Pella Sales Rep Name (Please print) Order Totals
M-'�2 f�h/N/ / \ , Taxable Subtotal $3,629.39
Customer Signature Pella Sales Rep'Signa a Sales Tax @ 6.25% $226.84
8/26/14 8/26/14 Non-taxable Subtotal $1,923.65
Date Date Total $5,779.88
Deposit Received $2,889.94
Credit Card Approval Signature JAmount Due $2,889.94
For more information regarding the finishing, maintenance, service and warranty of all Pella@ products, visit the Pella@ website at www.pella.com
Printed on 8/26/2014 Contract-Detailed Page 5 of 5
PELLA WINDOWS AND DOORS CONTRACT
7. PAYMENT'S
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.Pel la'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 in.(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. it. HOME IMPROVEMENT CONTRACTORS
The materials and equipment furnished under 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 to registration
improper or insufficient maintenance,improper operation or normal wear and should be directed to:Director,Home Improvement Contractor Registration,
tear. Pella will keep the premises and surrounding area free from One Ashburton Place,Boston,MA 02108,6)7-727-8598
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 BUM
IfI(] . Homeowners who secure their own permits will be
excluded 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 Omer and 780 Code of Massachusetts Regulations R6.
Pella to be effective.
13. NOTICE OF CANCELLATION
5. SUBSTANTIAL COMPLETION 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 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 dale,i.e.,the
Product has been installed,but minor parts 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%of the remaining unpaid
balance of the Price,whichever is less.
Do not sign this contract if there are any blank spaces.
6. FINANCING qq��
If paymentfinancing
pap theerwork
Price is financed with a financial institution of this
through Pella,all
financing paperwork must be completed upon signing of this Contract and the
requisite approvals and authorizations for the full amount of the requested
financing shall have been received from the financial institution. Customer signature 8/26/14
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
M�
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.
NOTICE OF CANCELLATION
8/26/14
Date of transaction:
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
8/29/14
not later than midnight of (three business days from the date of
transaction above).
I hereby cancel this transaction.
(Date) (Buyer's signature)