Loading...
B-19-769 - 0035 BELLEAU ROAD - Building Permit 1 ' The Commonwealth of Massachusetts J3 Board of Building Regulations and Standards Massachusetts State Building Code,780 CD& ar Revase Mar 201 1 y Building Permit Application To Construct,Repair,Renovate Or Demolis�a=z" One-or Two-Family Dwelling7. Sewn Fcr txa1 irse Only llutldnig Perttut Nnl�r Date AppFrd �.. ✓ems� ? L��� s > hlWg Oflgc�al(Prue#Naaxe) Srgriat a hotg 1.1 P � p e A dress; 1.2 Assessors Ma &Parcel plumbers 1.1a 1s this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property]Dimensions: Zoning]District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 lBuAding Setbacks(ft) Front Yard Side Yards Rear Yard Required 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: Public 0 Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ SE�2t P1201@3 �`�� �1Ld� P1 . 2.1 Owner'of Record: Name(Print) City,State,ZIP No.and Street Telephone Email.Address SEC 11< 1+13f 1Dl�SCRIPI I�I�O)F I'R 1P®S1-D i3 ORKt(ph6ck afl drat al►ply) New Construction-I] Existing Building❑' Owner-Occupied ❑ Repairs(s)K I Altbidtidn(sJ ❑ Addition..u... Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify: Brief Description of Proposed Worle: Lam' ,V 0 u 5 CTTON 4:ESTEVIATIED CoNsTRtUCTIQN COSTS =, Estimated Costs: Item Official Use onll . (Labor and Materials l.Building $ 1• Btul&g wit Fee:$ Indicate"fee is deter-nmeu: �00 2.Electrical $ O Standard City/Town own Application Fee 'Total Project Gosh Gum 5)x multiplier x 3.Plumbing $ 2. Other Fees: $List: 0 . 4.Mechanical (HVAC) $ 5.Mechocal (Fire $ Su ression Total All Fees:$ Cheok No. Check Amount:_Cash Amount: 6.Total Project Cost: $,'IIIe� — El Paid in Full 0 Outstanding Balance Due: . ILPd C 'STRULiIC 5.1 Construction Supervisor License(CSL) 6. 2� License Number Expiration Date Name of _ older`r List CSL Type(see below) go.and Street 19�... .:. hon... UJ I Unrestricted OBuildings up to 35,000 cu.ft. Cr State d' Restricted 1&2 Farm] Dwelling M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5. a al ome Improvement Contractor(EUC) W S� MC Registration Number Expiration Date HIC Com an ame or HIC Registrant Name �cl Street g, y`� AM, 02- El' _7 Email address Ci 'Town,State,-4 Tele hone SKC'MN G:MAPAU"C0Ili(I'E111'9AU4PN I STI I Al ,AST(VI, Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes.......... No...........❑ CTffDi?d'las O IZ I I �')C 1 T�$E fib'" N 0 �D J'A .1.T 0-Cab I,as Owner of the subject property,hereby authorize t, to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Date EC'ITION fib:dWi&W OR ATJT> ' 1GEI� Ik L�1ItA IO3 i : :. . .. . 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. Print Owner's or Authorized Agent's Name(Electronic Signature) Date •1��'ESz - 1. 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 M.G.L.c. 142A.Other important information on the HIC Program can be found at wlvw.mass.gov;oca Information on the Construction Supervisor License can be found at wxviv.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (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"maybe substituted for"Total Project Cost" .. _.. 7'Iie�Comirion�eultla ref�Yftcssircliusetts z _ Pefad east f Pitclacstrial;4ccrrlenis; . Cris%r a'ss Street;'Sacrte,00., 3ostM;-MA 0.211� 2Q l T W3fl IllasS O,Y lIIlt ��ockers'compensation Tnsirrance ALfida�>it $ti'ilcl�rs/Contfsctors/Electricians/M it fs:; TO Bh.FILED WITH THE:ITIUVII 1 2Al2th iif.informs#ioii 'Please Print U ilily: Na;illf� {Pius nzSs Or ani�alionlTnrin i;%ual).' 19CIM gA R�A o ADD City rStateZa :.. 'hone k Are:vuu an.crujtlorer-Chccl.the.approprtite[ioz T} 0 of ga 2Ct P. Ye utref`.P 1 � .9 3 l tta.emplov�n.t [li. omploj,ees:�ruli,tutd'nrparifi�ne)* 7: ElNeW-Cotlstructrbii ?,�'1 am a stile proprietor ompanriershcp aril ltavc qo empio}ers tiYurk}nformz it $, ReliiOdelittg ;an} c 7o+};nrkers ,cump msuranc.e reguret3.j 4 DentalitW a:ltonao�viter.otn all trod ntyscl� \n vvorkev� camp insuraitcc requiret3 i IQ. Bulldin addlttfln -- A. t a a ho r and W l g�ht i contractors io conduct all;c ork qn m}'property ensure ilaatall contractors 64,e hake v}nrl.�rs compgnsatW,msuranq ar aiesule l l E[c G riCa1 iep3irS or 3dd11tOns mo netots with no:em to ees .P p P ); T Pturnbmorepairs.c?r addrti:�ns 0 1 am a gzneral contractor sriil l have hred the sub con;acigcs lzsted on the attached sheii, Raol'repairs These,sub-contrartoahatzremplo}rem;andhat,e tntkers:.cucnp,mst�rn�e-v 6 D Llte are acoTppratioh attdttso�ficzrslta2 e3erctsedtlteirAltt oteYenption per 11G1 c: Q O?heF l i'.,§1(l) anc#,}te{iaveno empld}ees[�To vtiorkers comp:mstirmtce:;required] � nt:appbcantthat'che�l s box rt:i musl also frll,ouc ih scnon belo}v shoving theircvor[e,s compansan6n;po[icS nCorm3uon,: T.. bmeotiners.,v o Su6nit US affdaln;:ln.&caina,,the�ll are dmn;:illl work.audt7ten hire outside;:contiactors must-:submit a nztir'•;afii8avnt.is3dicatin;,*;:stich: CUtitcactors thar:c,heek thts:bo,,ntusfi:attaclt�dan add.cicitial sheersfiov+�n rti�mama cil�:the suii��ntrluors and slate�hether or'nor tlio_e enutte�fiav - a entploye�s [ftliesubcontractorsttaveempl'a;ees cue :tnustpcovrcletheircoilers. camp pghc number. I at�r art enrplot er.(lrut rs prowcrtan si �rhers':eomperisutr�n resrrranc for nil;=;errtplr : es Beloit rs.2lre potcc}€anr7/Fih SOL, i''ri•furrfiaturr:: Insurance Ct�mp�n ;Name,= � - [ �.® Polics"T or.Selflns Zis :..._G . ..�. .. ............ .......__..... .. 3aIi Site tlddress° —RA,copy of the::► orl.ers' compensation polio:.cleclatagaon page(sli"' tt i DO .number>antl Failiire,fa secure coverage:as r�qutrecf under l\�GL c 15� � A is a cnminat violation:punishable by a fitrie up:to SI :OQ 00: .. andsror one year iniprisolinient as. I as cir51 penalties in fhe form of s STOP AMORK ORD'E-R and a fine of up 1fl, Q QQ a day a amst the violatUr ' op� aftli s statement nla}_be for4.arded to the Office atli vestigat ons ofthe DIA far insurance'• cor�erae tiertficattou: I rialiere4 eedrfj un,.& �li:e:pnirzs rrnrI per a'lties o.perWix dzot the rrrforrrrail, ravro.,i.irlerl`above rs;true and earreek `7 Sc�nafrare � 'D�te;- z- 4f�rrcrl rise unl}' I10 arot;-ivrde lrttlzrs ureic,to:•fieeor#pleteci btu cltt yr tq.wsr offcicaT thy-or Tobvn :.. Permit/U;Cense, Is§.;i�in�Authorita;(ciq cfle one),: 1.Boarel of fel.ti 2, 3ueldingepartaant 3. ptylToasn �erli $ I leetrccai.;1<nspeztir S P1um pec ti Itistcar. Other contact Persoiii.; Phone#: CERTIFICATE OF LIABILITY INSURANCE DATE(MM,DD/YYYY) �./ 4/16/2019 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 ce%ificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or 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 - - - - CONTACT - 'Fred C. Church Insurance NAME: Jac ueline Normandin PHONE . 41 Wellman Street y oE :g00-225-1865 aC No:978-454-1865 Lowell MA 01851 ADDRESS: inormandin fredcchurch.com INSURERS AFFORDING COVERAGE NAIL# INSURER A:Hanover.Insurance Company 22292 INSURED BOSTWIN-01 INSURERB:A.I.M.Mutual Insurance Co 33758 Boston Window&Door, LLC DBA Pella Boston Windows&Doors INSURERC: 45 Fondi Road INSURER D: Haverhill MA 01832 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER:1603875097 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 18 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE %D.L SUBR POLICY EFF POLICY EXP - LIMITS INSD D POLICYNUMBER MM/DD MM/DDIYYYY A X COMMERCIALGENER/tILLABILITY ZBND79634 1/1/2019 1/1/2026 EACH OCCURRENCE $1,000,000 CLAIMS-MADE [�OCCUR DAMAGETORENTED PREMISES Ea occurrence $100,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $2,000,000 POLICY ECT F LOC PRODUCTS-COMP/OPAGG $2,000,000 OTHER: Is A AUTOMOBILE LIABILITY AWND796284 1/1/2019 1/1/2020 COMBINED SINGLE LIMIT $1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ OWNED [X] SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED I X I NON-OWNED PROPERT.YDAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ A )( UMBRELLALIAB 1 X 1 OCCUR UHND797278 1/1/2019 1/1/2026 1 EACH OCCURRENCE $9,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $9,060,000 DED I X I RETENTION$n $ B WORKERS COMPENSATION- 8007414 1/1/2019 1/1/2020 X PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER MA&ME ANYPROPRIETOR/PARTNER/EXECUTIVE FN] E.L.EACH ACCIDENT $500,000 OFFICERIMEMBEREXCLUDED? NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Pella Boston Window&Doors ACCORDANCE WITH THE POLICY PROVISIONS. 45 Fondi Road Haverhill MA 01830 AUTHORIZED REPRESENTATIVE --%f- T ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD a ^,'! a, `� '�, mniohWa=altta oF�Vlatsachaasei;ts;,. . D' - 5 ' '""'a•: Soard.of'[3uilding t�egaalataons:.ano1 StarortV�rds 3iF ryr7 r P N. N d: o Cons#rturhl } �rvisou I w o �. CS'089853 f c •c _ RAY, ' } tiL�arEs 9�/26/Z02fl v v um: ;g- T'.7 N f rt�•¢ o al 'J � � � 1 t'�,'t`� ��'��'"� �k gs_yr5��{r L a V 0 y w O, m •say ($: e i a 1IVYLLiPiM'RNtll.P-BCDd:V^ fif(- tt 'Cl , N b t eM G 18 CARTER AU NUE-Q rl u„ _ v' v c aoi w' NCno f�, , � �14F r yCE GLo� E. o .arm uDx 'r SALISi URY MAr®�`9624� N t z$ p; ¶,Llt, , t: � U 1p:0 fL3 ,a+: 7 p: �}' rr' QI:V C t:�, Ink�(! ' 7.HF�'6tP.•' .d!ad+z:.-."°" _� :.C m V. . a•0.0 y' `p C y J r 1^1,a1 rl:C9rnY619sSIC1Y9L'r' O O O: C N C °`iNIEr� �' ( tt�Ie __._._. 3 N v rn `- p:o'.o. y •- ?crg rn�- m o ,E N ,t fineldi pu Nto y 5 t jd% " f4 A`�r Ic O.� m.v + + d J t J¢ o N V G A y l: t� r ,tol D�(tlxrN,ah a t .�q�s IL VM ,:,!• , .::;� ".f�J r V & ::?:'� _� :.<t GJ' 1('J. �p.�.,-;u 3.�'.: ':.::r 3 .,.a,, ,....,,.ix z,=r'_ a X: N :. � .: y ..,,r :>a; -,s Y i 45,..:. '� „�' = } . :.,:,.+`� ,:�aa fr .fud��.'(90,/7?'. .,- .-Fr�- et w^i V• L.•r.,i♦•• a t s �'� r �F �� � `� !N:::m � � .G).-1: r '.r;.XfrEC�i'. �_ i�.�,i..� o�yt,�.....��. tC)2Q,2CUG'Clr�� }���CLJJlL�GGlr9 J�'1: �G'.s, �iJ `�,m �.,,.� •'G1 ,s. ,�.:m:. 5': . :�;, .!x s., �. lu�vgt.) lji , t- •rt'S :j 3`Y`- :.-,u:, �a� � J dt.�l �•:,'6z<F '� �,iY 'S f��;; '>t,i. 'W. "�, ,r. u r?,x t•. r yrr�r =-4 Yr `1 L .:� ,� > � x ,� .5��,: � � V3. 1.r._(�,'k G d` e u s,t t;aP.1,-�• %s• .C.. — lt�ti,?.t, 4 -, af:, o, C)ffleexof�Co�fsumer Affa rs$ Sm SS Re ut i U .., 9..., ✓'{, .,.. ,tiw j�. ,'/ (Y :, T d p.. !`% 4 ,. ,. a l F .-.:j. , ! rte� d4 4 J 5 u. .. ..5;.. t. , 'u s J, 4rtr j ; :,,, n LL t a t H0 iEIMPR.QUEIN : WUL � f �. ..v "., Y f µ'.•^ ....::... :SL 'r .. Cv4' 4,•4,'m ....a,.m.S ,•e �, .._... -i.¢u.. .... ., 'tom �..r .. '...� i3 n::.. -�Y '..-: i .- '.. �' -:7 ..-...._ sY v.. ,., :, ... s. .. .. •v,.W,... ... ,... �.- ;,:.: :.-,, .. 4 ,. �.f�¢ •.,, 1 .s s �f , t ':.:7I1' v a� ,.�3 '.,• ., ,- ,�: :..„,- dae" _:.... __s � ., _. r.. ..,> ,. _... .. �.^�.. ,:. , ::fYP„��. ..�: : tom•;_ a �,. _. ,. .�. _ , ,�r` r ... ._ ern nt•,.Card x � �s G •r � ,� .,_ ., .. ._. _ .rit, .._ ... .:, ... _�,t,,. .._ -.�..,4 �-t ... F-._ , ,.. __r�.S } .;.._ r +�.. .r l.,�., .-n- a ...;-. ..us�,.o,�� u• .'§.. �' :C:. `�� ^r,,,2 . �mv Y...vA •, � i t (,, _. R0 1 tG ::.,..:. ,.,.. .,:.., '_....: -:.... ... :,. :: :,. ,; :o , .r:,x v �• 1., e.,i _.. t _ i f'. .f3•'.. ::T ( 4: N f :�, .. ..... ..t':..,,. 3- ,,: .4 ., i ., ,::.;, f. y ;• vt ��:, ,. .�5 __. .. ,,,.. C f, W- T -.__ .. _.._. 3 __.v,a t ,�.:,:..yy .'iE .. -�:.:> ., .-:...,. o....'k. _ 5..% ,4 , _.. •�- _ �.,. _4._.�. Y. .Y N:,. .4:. {jy r•.I 't TN- ,z 5. � ., ,,..�� .. � ''t:� tir• ;1J'� .,�.., r �,;i; ;` .,, ;..n ..,., _. _:.:. :'y' � � .u.•.p: IYG�L,A !.'_ t .,, x. ,. , 's .F-vs`.: 1, a:,.,. 'rr:: .:.,: .. ,-._. -.. .-,., _.,... t.. xy?� -r!, +, ,xr•S ,.sz--"_I r,.[..._ 1• f x.>_ .r.. #, 5f ,.:.,:.:. .r r.., ..•,. : ,.;, ,. .. '.,,.... -_>. �, c��•,�- t T�n._ ... a; .,•, .. Rt' S* .sz- Y4f � _• ,,, ..:,. . --:.,.. ._.. ,._. ,.. -� 1,. 4.� t,x. is .,. ..��,.� ,. , ., r'� _..,:r -."� ,.ri ..t... ....... ,.�,,. rw:-.. , _.,..., ...; .:....•_. ., se::._, -.: t, .1. 'S f,,...,. rf�.rur._. ... t1., ..... ..,.., ,s,... J..� .,. f.<t. f its IP,: j AMVNIC.HbLS..�--.,.. 4 ).a J a� r . z.. ... e r >. .., .� :.>,..,- -.;_, ,_.,, ..:: ,:,_. ....• ...,:.� -„ ::� _ e _ m 1 !1t1 45 FONDI R ..n.-. J.. -,-. -.1 i�...., .:;. .': .. : l a la".s,,: -v,; f :a /. �r ,TJ;..f. ♦!f� - 3 .} 7�..�i •'r=..r.. ,_a,, ..._ _:, ,. - <. !:,,.�/�:,_,i•ti� tr >:-a(%„�..: _ ,W�s'._:rs�z»_..,�_��„t�t.n .F` �- - 1. ,f , � .,., . F:•: � r F.,.rz~HA�/.ERf�IL�L.. f.... ... .,.: ..: ,� ., ....,..:_ffl f. { t '°J .r.. 2 ,ti-x �:::.. 1 rJ vstin�,E;S,uZ��:w�.rt,F'..�-Y a, I :,�, 14 ..^w -.tkJ iY..t•,at� ,.. ,,, ..:.... .. .. :. .� ..: - .... -`i 2r )k h, :". _: •y V n3 a.,_;: ',';'t erse�t t...rly�tftrrt irk: i,, r ri� '1 y-..:1'{a,fr f3 �� �r7tw t�•��z a k{ � V .s. .¢, }t u x a A r'S ado �� � � �. �r__....�.. T .1-c�1,�..,�;+�.um Y,•_.ww.�.,.�,_.:,._,�=`r��a..---mod,-v"Ai�`�„-,—.'�..�.:,"` ��u'1,21�. L , , d r„t L:t , J J i _ Contract - Detailed �� o'1a --71a Pella Windows and Doors Sales Rep Name: McLoughlin, Daniel ® HIC# 183279/Tax ID#26-1413183 45 Fondi Road Sales Rep Phone: 978-373-2500 Haverhill, MA 01832 Sales Rep Fax: Phone: (978) 373-2500 Fax: Sales Rep E-Mail: mcloughlindv@pellaboston.com Customer lnforrnat�onoject/Dellvery Address . Order Information Helen Brown Brown,Helen,Salem,MA,2306123 Quote Name: 17 Windows 35 Belleau Rd 35 Belleau Rd Order Number: 741 DVO495 SALEM,MA 01970-5443 Lot# Quote Number: 11407935 Primary Phone:(978)2230366 Salem,MA 01970-5443 Order Type: Installed Sales Mobile Phone: County: Payment Terms: Deposit/C.O.D. Fax Number: Tax Code: MA TAX 6.25 E-Mail: Quoted Date: 5/27/2019 Great Plains#: Customer Number: 1009161498 Customer Account: 1005237553 Customer Notes: Deposit of$2,000 on check number 256 Remaining deposit amount of$15,370 due prior to ordering Line# Location ` s Attributes w 10 None Assigned Delivery/Setup- Delivery/Setup Item Price Qty Ext'd Price $214.39 1 $214.39 For more information regarding the finishing, maintenance, service and warranty of all Pella®products, visit the Pella®website at www.pella.com Printed on 5/28/2019 Contract-Detailed Page 1 of 8 Customer: Helen Brown Project Name: Brown,Helen,Salem,MA,2306123 Order Number: 741DVO495 Quote Number: 11407935 Line# Location - :, . Attributes 15 Kitchen Impervia, 3-Wide Casement, 79.5 X 34, Brown Item Price Qty Ext'd Price $4,078.88 1 $4,078.88 1:Non-Standard SizeNon-Standard Size Left Casement PK# Frame Size: 26 1/2 X 34 2037 General Information: Standard,Duracast@,Block,Foam Insulated,3 1/4", 1 5/16", 1 15/16" Exterior Color/Finish: Brown Interior Color/Finish: White,Two Color Glass: Insulated Low-E AdvancedComfort Low-E Insulating Glass Argon Non High Altitude Hardware Options: Standard,Wash Hinge Hardware,Fold-Away Crank,White,No Window Opening Control Device,No Limited Opening Hardware Viewed From Exterior Screen: Full Screen,InViewTm Performance Information: U-Factor 0.24,SHGC 0.26,VLT 0.48,CPD PEL-N-150-00704-00001,Performance Class LC,PG 50,Calculated Positive DP Rating 50,Calculated Negative DP Rating 50,Year Rated 11,Egress Does not meet typical United States egress,but may comply with local code requirements Grille: No Grille, Vertical Mull 1: FactoryMull,Standard Joining Mullion,Frame To Frame Width-0",Mull Design Pressure-20 2:Non-Standard SizeNon-Standard Size Left Casement Frame Size: 26 1/2 X 34 General Information: Standard,Duracast@,Block,Foam Insulated,3 1/4",1 5/16",1 15/16" Exterior Color/Finish: Brown Interior Color/Finish: White,Two Color Glass: Insulated Low-E AdvancedComfort Low-E Insulating Glass Argon Non High Altitude Hardware Options: Standard,Wash Hinge Hardware,Fold-Away Crank,White,No Window Opening Control Device,No Limited Opening Hardware Screen: Full Screen, InViewTm Performance Information: U-Factor 0.24,SHGC 0.26,VLT 0.48,CPD PEL-N-150-00704-00001,Performance Class LC,PG 50,Calculated Positive DP Rating 50,Calculated Negative DP Rating 50,Year Rated 11,Egress Does not meet typical United States egress,but may comply with local code requirements Grille: No Grille, Vertical Mull 2: FactoryMull,Standard Joining Mullion,Frame To Frame Width-0",Mull Design Pressure-20 3:Non-Standard SizeNonStandard Size Left Casement Frame Size: 26 1/2 X 34 General Information: Standard,Duracast®,Block,Foam Insulated,3 1/4",1 5/16",1 15/16" Exterior Color/Finish: Brown Interior Color/Finish: White,Two Color Glass: Insulated Low-E AdvancedComfort Low-E Insulating Glass Argon Non High Altitude Hardware Options: Standard,Wash Hinge Hardware,Fold-Away Crank,White,No Window Opening Control Device,No Limited Opening Hardware Screen: Full Screen,InViewTm Performance Information: U-Factor 0.24,SHGC 0.26,VLT 0.48,CPD PEL-N-150-00704-00001,Performance Class LC,PG 50,Calculated Positive DP Rating 50,Calculated Negative DP Rating 50,Year Rated 11,Egress Does not meet typical United States egress,but may comply with local code requirements Grille: No Grille, Wrapping Information: Standard Fin,No Exterior Trim,Pella Recommended Clearance,Perimeter Length=227". Frame Size:79.5 X 34" Paint/Stain Int Trim Wood-Paint/Stain Interior Trim Only(Wood) Qty 1 FF ag_a6 wino_I.Stall.Full c per. .a 48•-96;n s ..:de- n... , Trim_Stool and Apron-Add Stool and Apron Qty 1 Coil-Coil Wrap/Cap Exterior Trim 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 5/28/2019 Contract-Detailed Page 2 of 8 Customer: Helen Brown Project Name: Brown,Helen,Salem,MA,2306123 Order Number: 741 DVO495 Quote Number: 11407935 Llne# location: .. Attrikutes. 20 LR Side and Back Impervia, 3-Wide Casement, 87 X 73, Brown Item Price City Ext'd Price $6,180.91 4 $24,723.64 1:Non-Standard SizeNon-Standard Size Left Casement PK# Frame Size: 29 X 73 2037 General Information: Standard,Duracast®,Block,Foam Insulated,3 1/4", 1 5/16",1 15/16" Exterior Color/Finish: Brown Interior Color/Finish: White,Two Color Glass: Insulated Tempered Low-E AdvancedComfort Low-E Insulating Glass Argon Non High Altitude Hardware Options: Standard,Wash Hinge Hardware,Fold-Away Crank,White,No Window Opening Control Device,No Limited Opening Hardware Viewed From Exterior Screen: Full Screen,InViewTm Performance Information: U-Factor 0.24,SHGC 0.26,VLT 0.48,CPD PEL-N-150-00704-00003,Performance Class LC,PG 50,Calculated Positive DP Rating 50,Calculated Negative DP Rating 50,Year Rated 11,Egress Does not meet typical United States egress,but may comply with local code requirements Grille: No Grille, Vertical Mull 1: FactoryMull,Standard Joining Mullion,Frame To Frame Width-0",Mull Design Pressure-20 2:Non-Standard SizeNon-Standard Size Left Casement Frame Size: 29 X 73 General Information: Standard,Duracast(D,Block,Foam Insulated,3 1/4", 1 5/16", 1 15/16" Exterior Color/Finish: Brown Interior Color/Finish: White,Two Color Glass: Insulated Tempered Low-E AdvancedComfort Low-E Insulating Glass Argon Non High Altitude Hardware Options: Standard,Wash Hinge Hardware,Fold-Away Crank,White,No Window Opening Control Device,No Limited Opening Hardware Screen: Full Screen,InViewTm Performance Information: U-Factor 0.24,SHGC 0.26,VLT 0.48,CPD PEL-N-150-00704-00003,Performance Class LC,PG 50,Calculated Positive DP Rating 50,Calculated Negative DP Rating 50,Year Rated 11,Egress Does not meet typical United States egress,but may comply with local code requirements Grille: No Grille, Vertical Mull 2: FactoryMull,Standard Joining Mullion,Frame To Frame Width-0",Mull Design Pressure-20 3:Non-Standard SizeNon-Standard Size Left Casement Frame Size: 29 X 73 General Information: Standard,Duracast®,Block,Foam Insulated,3 1/4", 1 5/16", 1 15/16" Exterior Color/Finish: Brown Interior Color/Finish: White,Two Color Glass: Insulated Tempered Low-E AdvancedComfort Low-E Insulating Glass Argon Non High Altitude Hardware Options: Standard,Wash Hinge Hardware,Fold-Away Crank,White,No Window Opening Control Device,No Limited Opening Hardware Screen: Full Screen,InViewTm Performance Information: U-Factor 0.24,SHGC 0.26,VLT 0.48,CPD PEL-N-150-00704-00003,Performance Class LC,PG 50,Calculated Positive DP Rating 50,Calculated Negative DP Rating 50,Year Rated 11,Egress Does not meet typical United States egress,but may comply with local code requirements Grille: No Grille, Wrapping Information: Standard Fin,No Exterior Trim,Pella Recommended Clearance,Perimeter Length=320". Frame Size:87"X 73" Trim—Stool and Apron-Add Stool and Apron Qty 1 Foil-Coil WraplCap.Exterior Trim_ O i ?. FF_48-96 wide-Install Full Frame Window_48-96 inches wide Qty 1 Paint/Stain Int Trim Wood-Paint/Stain Interior Trim Only(Wood) Qty 1 FF>60 Height-Install Full Frame Window>60 inches Unit/Composite Height 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 5/28/2019 Contract-Detailed Page 3 of 8 Customer: Helen Brown Project Name: Brown,Helen,Salem,MA,2306123 Order Number: 741DVO495 Quote Number: 11407935 a. •;E .Attrib tes. Location , 25 LR Side Impervia,2-Wide Casement, 58 X 73, Brown Item Price Qty Ext'd Price $4,070.96 f $4,070.96 1:Non-Standard SizeNon-Standard Size Fixed Casement PK# Frame Size: 29 X 73 2037 General Information: Standard,Duracast®,Block,Foam Insulated,3 1/4",1 5/16", 1 15/16" Exterior Color/Finish: Brown Interior Color/Finish: White,Two Color �a 3 Glass: insulated Tempered Low-E AdvancedComfort Low-E Insulating Glass Argon Non High Altitude Performance Information: U-Factor 0.22,SHGC 0.30,VLT 0.55,CPD PEL-N-152-01338-00003,Performance Class LC,PG 50,Calculated Positive DP Viewed From Exterior Rating 50,Calculated Negative DP Rating 50,Year Rated 11 Grille: No Grille, Vertical Mull 1: FactoryMull,Standard Joining Mullion,Frame To Frame Width-0",Mull Design Pressure-20 2:Non-Standard SizeNon-Standard Size Left Casement Frame Size: 29 X 73 General Information: Standard,Duracast®,Block,Foam Insulated,3 1/4", 1 5/16", 1 15/16" Exterior Color/Finish: Brown Interior Color/Finish: White,Two Color Glass: Insulated Tempered Low-E AdvancedComfort Low-E Insulating Glass Argon Non High Altitude Hardware Options: Standard,Wash Hinge Hardware,Fold-Away Crank,White,No Window Opening Control Device,No Limited Opening Hardware Screen: Full Screen,InViewT^" Performance Information: U-Factor 0.24,SHGC 0.26,VLT 0.48,CPD PEL-N-150-00704-00003,Performance Class LC,PG 50,Calculated Positive DP Rating 50,Calculated Negative DP Rating 50,Year Rated 11,Egress Does not meet typical United States egress,but may comply with local code requirements Grille: No Grille, Wrapping Information: Standard Fin,No Exterior Trim,Pella Recommended Clearance,Perimeter Length=262". Frame Size:58"X 73" Paint/Stain Int Trim Wood-Paint/Stain Interior Trim Only(Wood) Qty 1 FF>60 Height-Install Full Frame Window>60 inches Unit/Composite Height Qty 1 FF_<48 wide-Install Full Frame<48 inches wide Qty 1 Trim—Stool and Apron-Add Stool and Apron Qty 1 Coil-Coil Wrap/Cap Exterior Trim Qty 1 Thank You For Purchasing Pella® Products For more information regarding the finishing, maintenance, service and warranty of all Pella®products,visit the Pella®website at www.pella.com Printed on 5/28/2019 Contract-Detailed Page 4 of 8 Customer: Helen Brown Project Name: Brown,Helen,Salem,MA,2306123 Order Number: 741 DVO495 Quote Number: 11407935 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 apart 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 the Seller 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 terns of sale. ARBITRATION AND CLASS ACTION WAIVER("ARBITRATION AGREEMENT") YOU and Pella and its subsidiaries and the Pella Branded Distributor AGREE TO ARBITRATE DISPUTES ARISING OUT OF OR RELATING TO YOUR PELLA PRODUCTS(INCLUDES PELLA GOODS AND PELLA SERVICES)AND WAIVE THE RIGHT TO HAVE A COURT OR JURY DECIDE DISPUTES.YOU WAIVE ALL RIGHTS TO PROCEED AS A MEMBER OR REPRESENTATIVE OF A CLASS ACTION,INCLUDING CLASS ARBITRATION,REGARDING DISPUTES ARISING OUT OF OR RELATING TO YOUR PELLA PRODUCTS.You may opt out of this Arbitration Agreement by providing notice to Pella no later than ninety(90)calendar days from the date You purchased or otherwise took ownership of Your Pella Goods.To opt out,You must send notice by e-mail to pellawebsupport@i)ella.com,with the subject line:"Arbitration Opt Out"or by calling(877)473-5527.Opting out of the Arbitration Agreement will not affect the coverage provided by any applicable limited warranty pertaining to Your Pella Products.For complete information,including the full terms and conditions of this Arbitration Agreement, which are incorporated herein by reference,please visit www.pella.com/arbitration or e-mail to pellawebsupport@pella.com,with the subject line:"Arbitration Details"or call (877)473-5527.D'ARBITRAGE ET RENONCIATION AU RECOURS COLLECTIF("convention d'arbitrage")EN FRAN(�AIS SEE PELLA.COM/ARBITRATION. DE ARBITRAJE Y RENUNCIA COLECTIVA("acuerdo de arbitraje")EN ESPANOL VER PELLA.COM/ARBITRATION. Product Performance Information: U-Factor,Solar Heat Gain Coefficient(SHGC),and Visible Light Transmittance(VLT)are certified by the National Fenestration Rating Council(NFRC).Manufacturer stipulates that these ratings conform to applicable NFRC procedures for determining whole product performance.NFRC ratings are determined for a fixed set of environmental conditions and a specific product size.NFRC does not recommend any products and does not warrant the suitability of any product for any specific use. Design Pressure(DP),Performance Class,and Performance Grade(PG)are certified by a third party organization,in many cases the Window and Door Manufacturers Association (WDMA).The certification requires the performance of at least one product of the product line to be tested in accordance with the applicable performance standards and verified by an independent party.The certification indicates that the product(s)of the product line passed the applicable tests.The certification does not apply to mulled and/or product combinations unless noted.Actual product results will vary and change over the products life. For more performance information along with information on Florida Product Approval System(FPAS)Number and Texas Dept.of Insurance(TDI)number go to www.pelia.com/verformance. 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 5/28/2019 Contract-Detailed Page 5 of 8 Customer: Helen Brown Project Name: Brown,Helen,Salem,MA,2306123 Order Number: 741DVO495 Quote Number: 11407935 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. 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 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 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,Prod,ict and.save for energy rebate? n.',a--p,,rposes. 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 For more information regarding the finishing, maintenance, service and warranty of all Pella®products,visit the Pella®website at www.pella.com Printed on 5/28/2019 Contract-Detailed Page 6 of 8 Customer: Helen Brown Project Name: Brown,Helen,Salem,MA,2306123 Order Number: 741 DVO495 Quote Number: 11407935 • Project Checklist has been reviewed Custome nitial Product Only Addendum has been reviewed Customer initial • 10%0 Final payment is due upon Substantial Completion per the Terms and Conditions Customer Initial 02• Removal and reinstallation of blinds are the responsibility of the homeowner. If for any reason blinds are not removed,you will be charged to remove the blinds and we are not responsible for any damage that might occur to the existing blinds. Pella will not reinstall blinds and does not guaranty existing blinds will fit in to the new windows. Customer Initial A 1.5%FINANCE CHARGE PER MONTH WILL BE ASSESSED TO ALL BALANCES OLDER THAN 30 DAYS Credit Card Account#: Last 4 Digits Expiration Date: / Charge final payment to same account (Upon substantial completion) Customer initial For more information regarding the finishing, maintenance,service and warranty of all Pella®products,visit the Pella®website at www.pella.com Printed on 5/28/2019 Contract-Detailed Page 7 of 8 Customer: Helen Brown Project Name: Brown,Helen,Salem,MA,2306123 Order Number: 741DVO495 Quote Number: 11407935 ❑Project Checklist has been reviewed Helen Brown Dan McLoughlin Order Totals e Customer ame (Please print) Pella Sales Rep Name ase print) • Taxable Subtotal $26,434.04 Sales Tax @ 6.25% $1,652.13 Cuglbriier Signature V7a es Rep Signature 5/28/19 5/28/19 Non-taxable Subtotal $6,653.83 Total $34,740.00 Date Date Deposit Received $2,000.00 • Amount Due $32,740.00 Credit Card Approval Signature Deposit of $2,000 on check number 256 Remaining deposit amount of $15,370 due prior to ordering For more information regarding the finishing, maintenance, service and warranty of all Pella®products,visit the Pella®website at www.pella.com Printed on 5/28/2019 Contract-Detailed Page 8 of 8 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. 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 ofthis 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 10 Park Plaza,Room 5170,Boston,MA,02116,617-973-8787,888-283-3757 accumulation of waste materials or rubbish caused by performance of the or visit the HIC website at http://ww,,v.mass.gov/ocabar/ Work. 12. PERMITS(MA customers only) 4. CHANGES Pella is obligated to and will obtain the following permits for this project: Buildin . Homeowners who secure their own permits will be The Owner may order in writing changes in the Work consisting of additions, excluded from the guaranty fund provisions of Massachusetts General Laws, deletions,or modifications("Change Order"). Any Change Order shall chapter 142A. include an adjustnient to the Price and the Substantial Completion Date,as determined by Pella. Pella reserves the right to approve or disapprove any In addition to the rights and warranties enumerated in this agreement,you may Change Order and any such Change Order must be signed by both Owner and have additional rights under Massachusetts General Laws,chapter 142A and Pella to be effective. 780 Code of Massachusetts Regulations R6. 5. SUBSTANTIAL COMPLETION 13. NOTICE OF CANCELLATION Owner understands and agrees that the Substantial Completion Date is an You may cancel this agreement if it has been signed by a party estimate only and that the actual date on which the Work is completed may be thereto at a place other than an address of the seller,which extended to allow for Change Orders requested by Owner or if the time to may be his main office or branch thereof,provided you notify complete the Work is affected by conduct of the Owner,weather,labor disputes,availability of subcontractors,acts of God,fire or other causes the seller in writing at his main office or branch by ordinary reasonably beyond Pella's control.If for any reason the Work is not fully mail posted,by telegram sent or by delivery,not later than completed by the Substantial Completion Date(including any extensions midnight of the third business day following the signing of this contemplated above),but is substantially completed by such date,i.e.,the agreement. Product has been installed,but minor parts or components are missing or need to be replaced or repaired,a hold back proportionate to the cost of remaining See the attached Notice of Cancellation for an explanation of parts or work to be completed is acceptable.However,the holdback will not exceed the amount of the completion costs or 10%of the remaining unpaid this right. balance of the Price,whichever is less. 6. FINANCING Do not sign this coltract if there ar ny blank spaces. If payment of the price is financed with a financial institution through Pella,all V� 0 financing paperwork must be completed upon signing of this Contract and the WAA requisite approvals and authorizations for the full amount of the requested Customer signature financing shall have been received from the financial institution. 5/28/1 9 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 & Doors Contractor (?A4Uf6,a • 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 ALLTERNATIVE DISPUTE RESOLUTION EVEN WHERE THIS SECTION IS NOT SEPARATELY SIGNED BY THE PARTIES. CITY OF SALEM MASSA GiUSE T75 { { BUILDING DEPARTMNT 120 WASHINGTONSTREET,3'®FLOOR 'ILL.(978)745-9595 KRaERLEYDRISOOLL FAX(978)740-9846 MAYOR THOMM ST.PIERRE DIRECTOR OF PUBLIC PROPERTY/BUILDING 001,WSSIOMR Construction Debris Disposal Affidavit (required for all demolition & 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,S54;Building Permit# is issued with the condition that the debris resulting from this work shall be disposed of in a properly licenses waste deposit facility as defined by MGL c 111,5150A. The debris will be transported by: (name of ha r) The debris will be disposed of in: (name of facility) (address of facility) Vj4p L Signature of applicant (today's date)