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09-008 To Whom It May Concern: I, --1- (r ' e l / , as property owner, give permission to our contractor, Pella Products, Inc., to obtain a building permit for the installation of windows or doors in my home, located at 2 KPilf7cd . Please accept this letter in place of my signature on the permit application. Thank you, Please Print Name Homeowner's Signature,/ Date rCh (ix _ 4 $ Pella' Windows & Doors OXXO Awareness For My sale representative has reviewed with me the reason Pella Products, Inc. requests that customers purchasing this door sign this form. This form is used to educate customers about the four panel sliding door. I understand that while the four panel sliding door that I am purchasing does perform well, because of the design it does not perform as well as a standard two panel sliding door. The four panel sliding door has two moving panels that close into each other as opposed to a fixed jam on a two panel sliding door. The seal of the four panel door does not have an equivalent design pressure rating when compared to the conventional two panel sliding door. I also understand that the door requires more care during installation and requires sufficent framing to carry the large span above the door. I have been informed by the sales representative that this door may require adjustment and maintenance in the future. Great care will be taken by myself and my installer to follow the installation instructions. Date: / ._ . 7 -7 ; 7 ..... Cu stomer Name: P (7/2., it/ LL ...L_ tip ( Order Number: j 3 L = w - �J 111 X r sir ! A to 11111 II OXXO XO MEETING MEETING STILE STILE Four Panel Standard Two Door Panel Door �����K���) ��������� ����^����J� ^���� ��d���� ' ---~~^ ~~ ~~~~^^^ " " ~° " "^�^ ^������o~~. . Form ... l this be used by renovation Tunis to docunient compliance with 8m ede I pre-renovation education [-Ind renovation, weir, and painting regulations. Occupant Confirmation 11v. pf / have .ero"woa copy ro the |eao hazard information pamphlet 'momvnAmacvthe |`o|rmia| nr the load huzo,d exposure ymnn renovation activity tobyoerfnnnedin thy dwelling unit. |/eomv*1 this pamphlet before the work begon. Owner-occupant Opt-out Ackno |ouQment (A) I oonm'n that / wwn and nvein ihiu ybperty, that no child under the ugeo| O ,rsmeohere. that no pregnant woman resides here, and that this properly is not s mvm-occupied bd|i�p � Note:.ad`uuak:lns in the residence i his or her uumodig Parw�a.�0� guardians foster parents, or informal c.;aretakor it the child lives and sleeps most ot tho tune a\ the caretaker's residence. • No�:�oN|U'ocr;�ygloo�ty/u^pn1g78JNdx�) u�dyby the smile ' �'�. u��0��� �oo��o d��d�on���ywo�'�� |�� ec=tt /-� J novu aadh day, pn*ideU UhatNov/o�ukda ut|+u� 0] hnommnnuuU� ' - k BoxAiu checked, chock either 8oxBo, Box C. but riot both. • / fri /�� x�� f Q <8)|re1uex| that the rermvmion1ixnuse Ul* lead-safe vvorkpr� required I ' �� � [�Reno,oio'\ Rap*x and Painting Rule; o, ^ 3Uundouu»n0Una the me/enovsNnn not be required /ou the |*sc work u*mioeurequired byL.FY\oRenovation, Repair, unc Painting Rule ' - I. "" j- i2gLi 2- . ' ; I724 o(0 �� `' �� Signntu Renovmvor'sGuneCeutfica1imn tmnant-onnvpied dwellings only) � |. u/u x xk/xuioRenovator: IfUha lead |azard information pamphlet was de|kmsN hut ( SignatumWtThumOt. Olatainable, you nay check the appropriate box below, Lk uacUred - |cn/ d faith effort to deliver the lead nazarJ information pamphlet to the rental dwelling unit listed below at the date and time mmvamoa^1thazmencoupan|Jeo||oeuiosionthoconikmutionu[receip|.|kVher Lelik That I ave IcR a copy ci the pan phtet at Ihe unit witli the occupant Ii Unavailable ion signature •- I car Lity that I have made a cjood taith effort to deliver the lead haluud information part iphlet 1othe rental dwelling unit listed below and that ikeuco /pmntwau unavailable to sign he oontioU nbono| necmipi | tUrthor certify that \ have leuu copy of the pITlphIet at the unit by sliding it undel the door or by full In how ;Jan1)18a\ was |etd. Pm'it(C1Nomeo( Certifying Da|ivwY Attempted Delivery Date -- �-� ', Person Codifying Leud Pal phlp Delivery Uoi( Address Note Regarding Mailing Option Ax an alternative to cletioci in parson you nay nail t least sawn , :luyo before rwmwa\ku` Mailing must be documented by ouerUDna^an\ n un rho post chico, Note: This turin is nut eiftuc: vii intl April 20 it) Customer: Fred Grinnell Project Name: Grinnell Fred 562 Kennedy Rd Leeds MA 01053 Order Number: 739 Quote Number: 3679107 may be declared due and payable because the holder deems himself to be insecure. However, where the contractor deems himself to be insecure he may require as a prerequisite to continuing said work that the balance funds due under the contract, which are in possession of the owner, shall be placed in a joint escrow account requiring the signatures of the home improvement contractor and the owner for withdrawal. 13. No work shall begin prior to the signing of the contract and transmittal to the owner of a copy of such contract. 14. Arbitration: If the contractor determines that in the event of a dispute, the contractor wishes the dispute to be settled by arbitration, this fact must be signified on the contract and both the contractor and owner shall sign this clause separately. The contractor and the homeowner hereby mutually agree in advance that in the event that the contractor has a dispute concerning this contract, the contractor may submit such dispute to a private arbitration service which has been approved by the Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided in MGL c 142A jam � Owner: Contractor: Notice: The signatures of the parties above apply only to the agreement of the parties to alternate dispute resolution initiated by the contractor. The owner may initiate alternative dispute resolution even where this section is not signed separately by the parties. Site Responsibilities 1. 50% Deposit required at time of order. 2. Final payment is to be made to installation team on the morning of the last day of installation. 3. If the customer will not be present at time of install, payment is to be made prior. 4. Checks returned NSF will be assessed a fee of $50.00 to cover fees incurred by Pella. Failure to pay your final bill will result in finance charges of 1 -1/2% per month (18% Annual) and legal fees associated in the collection of owed monies. 5. Due to inclement weather or site conditions, it may be necessary to reschedule. 6. We cannot and will not guarantee specific dates or days of the week for installation. 7. Time given to complete a job is an estimate, extension of time is possible. 8. An install appointment will be confirmed at Verification. A courtesy reminder cal will be placed 1 week prior. 9. Unforeseen rot repair will be quoted on site as additional work via a Change Order. 10. Substantial completion is achieved when all available products have been installed and are operational. Items such as missing or broken parts and service adjustments are covered by Warranty and do not affect the status of a project from being Substantially Complete. 11. In the even that any products are unable to be installed, the final payment will be recalculated. The cost of the products not installed will be subtracted from the balance due. A subsequent and final payment equal to the cost of products not installed as scheduled will be due upon final completion. 12. Order is not binding until approved by Pella Products management. 13. Pella will secure all necessary Building Permits. Type of Installation: New Construction: (tear out installation - existing frame is disposed of) Remove interior and exterior Trim, remove existing window frame, install new window in rough opening, trim both interior and exterior of window / door. Pocket Install: (sash replacement, existing frame remains) For more information regarding the finishing, maintenance, service and warranty of all Pella® products, visit the Pella® website at www.pella.com A v17 in n4 n a i 1l F :I J n n n Customer: Fred Grinnell Project Name: Grinnell Fred 562 Kennedy Rd Leeds MA 01053 Order Number: 739 Quote Number: 3679107 Remove interior or exterior stops, install new window in existing sash opening, re -use existing or replace window stops (interior or exterior). Glass loss will occur. Lead Paint Discloser: 1. Home was built prior to 1978, Pre Renovation Form signed and "Protecting Your Family From Lead in Your Home" brochure has been given to the Home Owner. 2. Are there children under the age of 6 or women who are pregnant? Pella Will Owner Will Authorize install of Yard Sign on 1st day of installation and remove 7 days afterward Finish (paint or stain) product purchased: Trim will be painted by customer _X_ Ensure someone over age 18 is present at all times while Pella Employees are in the home _X_ Cut -back or tie trees, bushes, shrubs from exterior wall _X_ Arrange to have alarm system disconnected and reconnected - Pella Products can re -route alarm wires but can not reconnect contacts _X_ Arrange to have any plumbing or electrical repairs or changes by appropriate licensed contractor - $500 charge for site unprepared on 1 day job _X_ Remove and reinstall existing window treatments, wall hangings and air conditioning units - 4 -5 feet in front /1 foot to side with clear path _X_ Remove and reposition furniture in work area _X_ Secure pets in a safe manner X Remove valuable / breakable items from work area _X_ Remove snow from area of worksite if necessary _X_ Deliver and unload products _X_ Place drop cloths in work areas _X_ Remove and reinstall interior and exterior trim if applicable _X_ Remove and reinstall existing shutters and awnings by contract _X_ Remove existing product and adjust or modify opening as needed _X_ Provide all equipment necessary to install products X Cut all wood and other materials outside of home _X_ Install all products purchased _X_ Insulate and caulk around products X_ Remove stickers and perform initial cleaning of all glass surfaces _X_ Demonstrate proper operation of products _X_ Confirm that all products are in working order _X_ Remove drop cloths, vacuum and remove all old products from premises Signature: .% For more information regarding the finishing, maintenance, service and warranty of all Pella i® products, visit the Pella® website at www.pella.com rl -:..4 ..J .... A In 1n!\4 n 1 - ..-.1 r,, 4..:I...J Customer: Fred Grinnell Project Name: Grinnell Fred 562 Kennedy Rd Leeds MA 01053 Order Number: 739 Quote Number: 3679107 Line # Location: Attributes 60 Site Responsibilities Item Price Qty Ext'd Price $0.00 1 $0.00 Customer Notes: HOMEOWNER - FOR YOUR INFORMATION LEGAL CONTRACT REQUIREMENTS FOR HOME IMPROVEMENT CONTRACTORS IS DETAILED BELOW THIS SITE RESPONSIBILITIES FORM IS PART OF YOUR CONTRACT WITH PELLA PRODUCTS INC. 155 MAIN STREET, GREENFIELD, MA 01301 HOME IMPROVEMENT CONTRACTOR REGISTRATION # 142279 EXP. 3 -24 -12 FEDERAL TAX ID #: 04- 2303271 The law requires the following fourteen items to be included in any contract between the homeowner and a registered home improvement contractor in all contracts for home improvement work subject to MGL c 142A 1. The complete agreement between the owner and a clear description of any other documents which are part of the agreement. 2. The full names, federal ID, addresses (not PO box #'s) of the parties, the contractor's registration number, the names(s) of the sales person(s)) involved, if any and the date the contract was executed by the parties 3. The date on which the work is scheduled to begin and the date the work is scheduled to be substantially complete. 4. A detailed description of the work to be done and the materials to be used. 5. The total amount agreed to be paid for the work to be performed under the contract. 6. A time schedule of payments to be made under the contract and the amount of each payment stated in dollars, including all finance charges, if any. Any deposit required to be paid in advance of the start of the work shall not exceed one -third of the total contract price or the actual cost of any material or equipment of a special order or custom made nature, which must be ordered in advance of the start of the work to assure that the project will proceed on schedule. No final payment shall be demanded until the contract is completed to the satisfaction of all parties. 7. All parties must sign the contract. 8. There shall be a clear and conspicuous notice stating; a. That all Home Improvement Contractors shall be registered and that any inquiries about a contractor or subcontractor relating to a registration should be directed to; Registration Division, Program Coordinator One Ashburton Place - Room 1301 Boston, MA 02108 617 - 727 -3200 x 25239 b. The contractors registration number must be on the first page of the contract. c. The homeowners three day cancellation rights under MGL c93s48; NGK c 140D s 10or MGL c255D s 14 as may be applicable. d. All warranties on the owners rights under the provisions of 780 CMRR6 and MGL c 142A e. In ten point bold type or larger, directly above the space provided for the signature, the following statement; DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES f. Whether any lien or security interest is on the residence as a consequence of the contract 9. An enumeration of such other matters upon which the owner and contractor may lawfully agree. 10. Any other provisions otherwise required by the applicable laws of the Commonwealth 11. Permit Notice: Every contract shall contain a clause informing the owner of the following; a. and all necessary construction related permits b. that it shall be the obligation of the contractor to obtain such permits as the owner's agent c. that the owner's who secure their own construction related permits or deal with unregistered contractors shall be excluded from access to the Guarantee Fund. 12. Acceleration of payment: No contract shall contain an acceleration clause under which any part or all of the balance not yet due For more information regarding the finishing, maintenance, service and warranty of all Pella® products, visit the Pella® website at www.pella.com n., a ein7innen i + rl F :1 J n o s .in Customer: Fred Grinnell Project Name: Grinnell Fred 562 Kennedy Rd Leeds MA 01053 Order Number: 739L3EL111 Quote Number: 3679107 delivery time will be subject to a storage and handling fee of 1% of the net amount of the order ($25.00 minimum charge). The Buyer agrees that the product can be delivered without the Buyer present and agrees to accept the shipping documents as proof of delivery. The Buyer agrees not to hold the Seller responsible for any damage to driveways, sidewalks, trees and overhead wires caused by the Seller's delivery vehicles. The Buyer agrees to examine the product(s) upon delivery and within 7 DAYS OF DELIVERY provide the Seller notice of any discrepancy between the product(s) ordered and the products(s) delivered, including hardware. If the Buyer does not provide notice within 7 days the Buyer accepts the product(s) as is. Project Checklist has been reviewed _ Order Totals Taxable Subtotal $30,363.44 Credit Card Approval Signature Sales Tax @ 6.25% $1,897.72.; } Non - taxable Subtotal $9,581.00'1 1 5 . el e'v'aJL L 1 Sly /0(04 Lcdkhot4, Pi t Total $41,842.16 Customer Name (Please print) Pella Sales Rep Name (Plea - print) Deposit Received $20,921.08 .lsoilI l . _ _r . .4 Amount Due $20,921.08 Cu Omer Si na ales Rep Si ature 9 / Sig ((l A tr1 - r2 1 -1 - 1 a'77%02_ Date Date I For more information regarding the finishing, maintenance, service and warranty of all Pella® products, visit the Pella® website at www.pella.com Dr +o,+ r.r, ni'nJnn1n r ,,,i,—,-+ n,,t,ao,+ D.,,,,, 1') „+ 1') Customer: Fred Grinnell Quote Description: 739 Architect Designer 413 - 586 -0047 Order Number: 739L3EL111 Order Pricing Totals Total List Price $39,944.44 Discountable Amount $51,498.44 Discount @ 0.000% $0.00 Non - Discountable Amount ($11,554.00) Net Before Payment Discount $39,944.44 Payment Discount Amount $0.00 Net After Payment Discount $39,944.44 Taxable Subtotal $30,363.44 Sales Tax @ 6.25% $1,897.72 Non - taxable Subtotal $9,581.00 Total (Total Net + Taxes) $41,842.16 Deposit Received $20,921.08 Amount Due $20,921.08 Printed on 5/2/2012 Office Order Copy Page 15 of 15 Customer: Fred Grinnell Quote Description: 739 Architect Designer 413 - 586 -0047 Order Number: 739L3EL11 I Line # Quote Qty PO Qty Description Item Price Ext'd Price 90 0 2 01 HM0000 - 3" Pella Installation Tape, 150 ft (1) List Price: $50.83 Location: None Assigned Rough Opening: Discount %: 0.00 % Frame Size: Discount $: $0.00 $0.00 Final Wall Depth: Frame Perimeter (inches): Assembly Type: Pella Catalog Net Price: $50.83 $0.00 Last Revision Date: Outside View Line # Quote Qty PO Qty Description Item Price Ext'd Price 95 0 2 24" wide Aluminum Coil, Length: 600, Brown List Price: $303.73 Location: None Assigned Rough Opening: 1: 24" wide Aluminum Coil Discount %: 0.00 % Length: 600Exterior Color / Finish: Standard EnduraClad, Brown Discount $: $0.00 $0.00 Frame Size: 0 X 0 Final Wall Depth: Frame Perimeter (inches): Assembly Type: Pella Assembled Net Price: $303.73 $0.00 Last Revision Date: Line # Quote Qty PO Qty Description Item Price Ext'd Price 100 0 1 OCAW4000 - Touch -Up Paint, Brown - .6 oz. (2) List Price: $56.28 Location: None Assigned Rough Opening: Discount %: 0.00 % Frame Size: Discount $: $0.00 $0.00 Final Wall Depth: Frame Perimeter (inches): Assembly Type: Pella Catalog Net Price: $56.28 $0.00 Last Revision Date: Printed on 5/2/2012 Office Order Copy Page 14 of 15 Customer: Fred Grinnell Quote Description: 739 Architect Designer 413 - 586 -0047 Order Number: 739L3EL11 I Outside View Line # Quote Qty PO Qty Description Item Price Ext'd Price 75 0 5 Casements and Doors Mullion Covers, Length: 96, List Price: $25.58 Location: None Assigned Golden Oak Stain Rough Opening: 1: Casements and Doors Mullion Covers Discount %: 0.00 Length: 96 Discount $: $0.00 $0.00 Frame Size: 0" X 0" Interior Color / Finish: Golden Oak StainWood Type: Pine Final Wall Depth: Frame Perimeter (inches): Assembly Type: Pella Assembled Net Price: $25.58 $0.00 Last Revision Date: Outside View Line # Quote Qty PO Qty Description Item Price Ext'd Price 80 0 5 Casements and Doors Mullion Covers, Length: 96, Linen List Price: $25.58 White Location: None Assigned Discount %: 0.00 Rough Opening: 1: Casements and Doors Mullion Covers Length: 96 Discount $: $0.00 $0.00 Frame Size: 0" X 0" Interior Color / Finish: Linen WhiteWood Type: Pine Final Wall Depth: Frame Perimeter (inches): Assembly Type: Pella Assembled Net Price: $25.58 $0.00 Last Revision Date: Line # Quote Qty PO Qty Description Item Price Ext'd Price 85 0 5 OBLT2000 - Keylock, Stainless Steel, Keyed Alike List Price: $18.96 Location: None Assigned Discount %: 0.00 Rough Opening: Discount $: $0.00 $0.00 Frame Size: Final Wall Depth: Frame Perimeter (inches): Assembly Type: Pella Catalog Net Price: $18.96 $0.00 Last Revision Date: Printed on 5/2/2012 Office Order Copy Page 13 of 15 Customer: Fred Grinnell Quote Description: 739 Architect Designer 413 - 586 -0047 Order Number: 739L3EL111 Line # Quote Qty PO Qty Description Item Price Extd Price 65 1 0 Prefinish Disclaimer List Price: $0.00 Location: Rough Opening: 0" X 0" Discount %: Frame Size: Discount $: $0.00 $0.00 Final Wall Depth: Frame Perimeter (inches): Assembly Type: Manual Line Net Price: $0.00 $0.00 Last Revision Date: Customer Notes: PRE - FINISH DISCLAIMER Stained and paint color samples are produced as accurately as possible: however, actual colors may vary from batch. Because wood is a natural product, each window or door will display its own personality with regards to variation in color, texture and grain pattern. Natural wood variations include distinctive grain patterns or unusual shadings in color. Due to the nature of using natural products, Pella Windows and Doors cannot be responsible for the actual degree of variation that may occur in your purchase. Line # Quote Qty PO Qty Description Item Price Ext'd Price 70 1 0 Brown Aluminum Coil for Wrap List Price: $0.00 Location: Rough Opening: 0" X 0" Discount %: Frame Size: Discount $: $0.00 $0.00 Final Wall Depth: Frame Perimeter (inches): Assembly Type: Manual Line Net Price: $0.00 $0.00 Last Revision Date: Shop Notes: Please pull from stock and barcode: 8 - tubes of RTV Bronze caulking Printed on 5/2/2012 Office Order Copy Page 12 of 15 Customer: Fred Grinnell Quote Description: 739 Architect Designer 413 - 586 -0047 Order Number: 739L3EL111 New Construction: (tear out installation - existing frame is disposed of) Remove interior and exterior Trim, remove existing window frame, install new window in rough opening, trim both interior and exterior of window / door. Pocket Install: (sash replacement, existing frame remains) Remove interior or exterior stops, install new window in existing sash opening, re -use existing or replace window stops (interior or exterior). Glass loss will occur. Lead Paint Discloser: 1. Home was built prior to 1978, Pre Renovation Form signed and "Protecting Your Family From Lead in Your Home" brochure has been given to the Home Owner. 2. Are there children under the age of 6 or women who are pregnant? Pella Will Owner Will Authorize install of Yard Sign on 1st day of installation and remove 7 days afterward Finish (paint or stain) product purchased: Trim will be painted by customer _X_ Ensure someone over age 18 is present at all times while Pella Employees are in the home _X_ Cut -back or tie trees, bushes, shrubs from exterior wall _X_ Arrange to have alarm system disconnected and reconnected - Pella Products can re -route alarm wires but can not reconnect contacts _X_ Arrange to have any plumbing or electrical repairs or changes by appropriate licensed contractor - $500 charge for site unprepared on 1 day job _X_ Remove and reinstall existing window treatments, wall hangings and air conditioning units - 4 -5 feet in front / 1 foot to side with clear path _X_ Remove and reposition furniture in work area _X_ Secure pets in a safe manner _X_ Remove valuable / breakable items from work area _X_ Remove snow from area of worksite if necessary _X_ Deliver and unload products _X_ Place drop cloths in work areas _X_ Remove and reinstall interior and exterior trim if applicable _X_ Remove and reinstall existing shutters and awnings by contract _X_ Remove existing product and adjust or modify opening as needed _X_ Provide all equipment necessary to install products X Cut all wood and other materials outside of home _X_ Install all products purchased _X_ Insulate and caulk around products _X_ Remove stickers and perform initial cleaning of all glass surfaces _X_ Demonstrate proper operation of products _X_ Confirm that all products are in working order _X_ Remove drop cloths, vacuum and remove all old products from premises Signature: Printed on 5/2/2012 Office Order Copy Page 11 of 15 Customer: Fred Grinnell Quote Description: 739 Architect Designer 413 - 586 -0047 Order Number: 739L3EL11 I DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES f. Whether any lien or security interest is on the residence as a consequence of the contract 9. An enumeration of such other matters upon which the owner and contractor may lawfully agree. 10. Any other provisions otherwise required by the applicable laws of the Commonwealth 11. Permit Notice: Every contract shall contain a clause informing the owner of the following; a. and all necessary construction related permits b. that it shall be the obligation of the contractor to obtain such permits as the owners agent c. that the owner's who secure their own construction related permits or deal with unregistered contractors shall be excluded from access to the Guarantee Fund. 12. Acceleration of payment: No contract shall contain an acceleration clause under which any part or all of the balance not yet due may be declared due and payable because the holder deems himself to be insecure. However, where the contractor deems himself to be insecure he may require as a prerequisite to continuing said work that the balance funds due under the contract, which are in possession of the owner, shall be placed in a joint escrow account requiring the signatures of the home improvement contractor and the owner for withdrawal. 13. No work shall begin prior to the signing of the contract and transmittal to the owner of a copy of such contract. 14. Arbitration: If the contractor determines that in the event of a dispute, the contractor wishes the dispute to be settled by arbitration, this fact must be signified on the contract and both the contractor and owner shall sign this clause separately. The contractor and the homeowner hereby mutually agree in advance that in the event that the contractor has a dispute concerning this contract, the contractor may submit such dispute to a private arbitration service which has been approved by the Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided in MGL c 142A Owner: Contractor: Notice: The signatures of the parties above apply only to the agreement of the parties to alternate dispute resolution initiated by the contractor. The owner may initiate alternative dispute resolution even where this section is not signed separately by the parties. Site Responsibilities 1. 50% Deposit required at time of order. 2. Final payment is to be made to installation team on the morning of the last day of installation. 3. If the customer will not be present at time of install, payment is to be made prior. 4. Checks returned NSF will be assessed a fee of $50.00 to cover fees incurred by Pella. Failure to pay your final bill will result in finance charges of 1 -1/2% per month (18% Annual) and legal fees associated in the collection of owed monies. 5. Due to inclement weather or site conditions, it may be necessary to reschedule. 6. We cannot and will not guarantee specific dates or days of the week for installation. 7. Time given to complete a job is an estimate, extension of time is possible. 8. An install appointment will be confirmed at Verification. A courtesy reminder cal will be placed 1 week prior. 9. Unforeseen rot repair will be quoted on site as additional work via a Change Order. 10. Substantial completion is achieved when all available products have been installed and are operational. Items such as missing or broken parts and service adjustments are covered by Warranty and do not affect the status of a project from being Substantially Complete. 11. In the even that any products are unable to be installed, the final payment will be recalculated. The cost of the products not installed will be subtracted from the balance due. A subsequent and final payment equal to the cost of products not installed as scheduled will be due upon final completion. 12. Order is not binding until approved by Pella Products management. 13. Pella will secure all necessary Building Permits. Type of Installation: Printed on 5/2/2012 Office Order Copy Page 10 of 15 Customer: Fred Grinnell Quote Description: 739 Architect Designer 413 - 586 -0047 Order Number: 739L3EL111 Line # Quote Qty PO Qty Description Item Price Ext'd Price 60 1 0 Site Responsibilities List Price: $0.00 Location: Rough Opening: 0" X 0" Discount %: Frame Size: Discount $: $0.00 $0.00 Final Wall Depth: Frame Perimeter (inches): Assembly Type: Manual Line Net Price: $0.00 $0.00 Last Revision Date: Customer Notes: HOMEOWNER - FOR YOUR INFORMATION LEGAL CONTRACT REQUIREMENTS FOR HOME IMPROVEMENT CONTRACTORS IS DETAILED BELOW THIS SITE RESPONSIBILITIES FORM IS PART OF YOUR CONTRACT WITH PELLA PRODUCTS INC. 155 MAIN STREET, GREENFIELD, MA 01301 HOME IMPROVEMENT CONTRACTOR REGISTRATION # 142279 EXP. 3 -24 -12 FEDERAL TAX ID #: 04- 2303271 The law requires the following fourteen items to be included in any contract between the homeowner and a registered home improvement contractor in all contracts for home improvement work subject to MGL c 142A 1. The complete agreement between the owner and a clear description of any other documents which are part of the agreement. 2. The full names, federal ID, addresses (not PO box #'s) of the parties, the contractor's registration number, the names(s) of the sales person(s)) involved, if any and the date the contract was executed by the parties 3. The date on which the work is scheduled to begin and the date the work is scheduled to be substantially complete. 4. A detailed description of the work to be done and the materials to be used. 5. The total amount agreed to be paid for the work to be performed under the contract. 6. A time schedule of payments to be made under the contract and the amount of each payment stated in dollars, including all finance charges, if any. Any deposit required to be paid in advance of the start of the work shall not exceed one -third of the total contract price or the actual cost of any material or equipment of a special order or custom made nature, which must be ordered in advance of the start of the work to assure that the project will proceed on schedule. No final payment shall be demanded until the contract is completed to the satisfaction of all parties. 7. All parties must sign the contract. 8. There shall be a clear and conspicuous notice stating; a. That all Home Improvement Contractors shall be registered and that any inquiries about a contractor or subcontractor relating to a registration should be directed to; Registration Division, Program Coordinator One Ashburton Place - Room 1301 Boston, MA 02108 617- 727 -3200 x 25239 • b. The contractor's registration number must be on the first page of the contract. c. The homeowners three day cancellation rights under MGL c93s48; NGK c 140D s 10or MGL c255D s 14 as may be applicable. d. All warranties on the owners rights under the provisions of 780 CMRR6 and MGL c 142A e. In ten point bold type or larger, directly above the space provided for the signature, the following statement; Printed on 5/2/2012 Office Order Copy Page 9 of 15 Customer: Fred Grinnell Quote Description: 739 Architect Designer 413 - 586 -0047 Order Number: 739L3EL11 I Line # Quote Qty PO Qty Description Item Price Ext'd Price 55 1 0 INSTALLATION - INSTALLATION List Price: $120.00 Location: None Assigned Rough Opening: Discount %: 0.00 % Frame Size: Discount $: $0.00 $0.00 Final Wall Depth: Frame Perimeter (inches): Assembly Type: Branch Catalog Net Price: $120.00 $120.00 Last Revision Date: Customer Notes: Permit Fee Printed on 5/2/2012 Office Order Copy Page 8 of 15 Customer: Fred Grinnell Quote Description: 739 Architect Designer 413 - 586 -0047 Order Number: 739L3EL11 I Line # Quote Qty PO Qty Description Item Price Ext'd Price 40 1 0 National Pella Promotion: 20% $2,461.00 off Expires: List Price: ($2,461.00) Location: 4/30112 Rough Opening: 0" X 0" Discount %: Frame Size: Discount $: $0.00 $0.00 Final Wall Depth: Frame Perimeter (inches): Assembly Type: Manual Line Net Price: ($2,461.00) ($2,461.00) Last Revision Date: Line # Quote Qty PO Qty Description Item Price Ext'd Price 45 1 0 Local Pella Promotion: 10% $3,551.00 off Expires: 4130/12 List Price: ($3,551.00) Location: Rough Opening: 0" X 0" Discount %: Frame Size: Discount $: $0.00 $0.00 Final Wall Depth: Frame Perimeter (inches): Assembly Type: Manual Line Net Price: ($3,551.00) ($3,551.00) Last Revision Date: Line # Quote Qty PO Qty Description Item Price Ext'd Price 50 1 0 Order Now Discount: 5% $1,597.00 off Expires: 4/30/12 List Price: ($1,597.00) Location: Rough Opening: 0" X 0" Discount %: Frame Size: Discount $: $0.00 $0.00 Final Wall Depth: Frame Perimeter (inches): Assembly Type: Manual Line Net Price: ($1,597.00) ($1,597.00) Last Revision Date: Printed on 5/2/2012 Office Order Copy Page 7 of 15 Customer: Fred Grinnell Quote Description: 739 Architect Designer 413 - 586 -0047 Order Number: 739L3EL111 Outside View Line # Quote Qty PO Qty Description Item Price Ext'd Price • 25 15 15 Wood Products 3 112 Craftsman 2, Length: 144, Golden List Price: $60.89 Location: kitchen /living Oak Stain Rough Opening: 1: - - Accessory Discount %: 0.00 % Frame Size: 0" X 0" Frame Size: -1 X -1 Discount $: $0.00 $0.00 General Information: Pine Final Wall Depth: Interior Color / Finish: Golden Oak Stain Interior Frame Perimeter (inches): Wrapping Information: Assembly Type: Pella Assembled Net Price: $60.89 $913.35 Last Revision Date: Outside View Line # Quote Qty PO Qty Description Item Price Ext'd Price 30 8 8 Wood Products 3 1/2 Craftsman 2, Length: 144, Linen List Price: $51.64 White Location: Dining Discount %: 0.00 Rough Opening: 1: -1 -1 Accessory Frame Size: 0" X 0" Frame Size: -1 X -1 Discount $: $0.00 $0.00 General Information: Pine Final Wall Depth: Interior Color / Finish: Linen White Interior Wrapping Information: Frame Perimeter (inches): Assembly Type: Pella Assembled Net Price: $51.64 $413.12 Last Revision Date: Line # Quote Qty PO Qty Description Item Price Ext'd Price 35 1 0 Project Volume Discount: 10% $3,945.00 off Expires: List Price: ($3,945.00) Location: 4/30/12 Rough Opening: 0" X 0" Discount %: Frame Size: Discount $: $0.00 $0.00 Final Wall Depth: Frame Perimeter (inches): Assembly Type: Manual Line Net Price: ($3,945.00) ($3,945.00) Last Revision Date: Printed on 5/2/2012 Office Order Copy Page 6 of 15 Customer: Fred Grinnell Quote Description: 739 Architect Designer 413 - 586 -0047 Order Number: 739L3EL111 * * * FF - 9A - Full Frame Tear Out Installation between Qty 1 141 - 150 UI * * * INTSTYLE3 - Interior style - square edged stool and Qty 1 apron * * * EAC -2 - Exterior Aluminum Capping (Coil Stock) Qty 1 Over 110 UI Outside View Line # Quote Qty PO Qty Description Item Price Ext'd Price 22 4 4 Wood Products Lattice 1, Length: 144, Linen White List Price: $51.64 Location: Hallway Discount %: 0.00 Rough Opening: 1: - 1 - 1 Accessory Frame Size: 0" X 0" Frame Size: -1 X -1 Discount $: $0.00 $0.00 General Information: Pine Final Wall Depth: Interior Color I Finish: Linen White Interior Frame Perimeter (inches): Wrapping Information: Assembly Type: Pella Assembled Net Price: $51.64 $206.56 Last Revision Date: Outside View Line # Quote Qty PO Qty Description Item Price Ext'd Price 23 1 1 Wood Products Lattice 2, Length: 144, Linen White List Price: $74.12 Location: Hallway Rough Opening: 1: -1 -1 Accessory Discount %: 0.00 % Frame Size: -1 X -1 Discount $: $0.00 $0.00 Frame Size: 0" X 0" General Information: Pine Final Wall Depth: Interior Color I Finish: Linen White Interior Frame Perimeter (inches): Wrapping Information: Assembly Type: Pella Assembled Net Price: $74.12 $74.12 Last Revision Date: Customer Notes: FOR SQUARE EDGE STOOL Printed on 5/2/2012 Office Order Copy Page 5 of 15 Customer: Fred Grinnell Quote Description: 739 Architect Designer 413 - 586 -0047 Order Number: 739L3EL11 I Outside View Line # Quote Qty PO Qty Description Item Price Ext'd Price 21 1 1 Designer, 4 -Wide Casement, 100 X 47, Brown, 6- 9116" List Price: $7,166.12 Location: Hallway rdi F h Rough Opening: 100.75 X 47.75" IZI grill 1: 2547 Left Casement Discount %: 0.00 Frame Size: 100" X 47" Frame Size: 25 X 47 Discount $: $0.00 $0.00 General Information: Standard, Clad Final Wall Depth: 6-9/16" Exterior Color / Finish: Standard EnduraClad, Brown Frame Perimeter (inches): 294 Interior Color / Finish: Linen White Interior Glass: Insulated Tempered Low E Advanced Argon Gas Assembly Type: Pella Assembled Hinge Panel: Clear, Tempered, Standard per design (3mm) Hardware Options: Standard Roto Operator, Satin Nickel Net Price: $7,166.12 $7,166.12 Last Revision Date: Screen: Full Screen, Champagne, InView Unit Accessories: Cellular Fabric Shade - Bottom Up, Capuccino Grille: Vertical Mull 1: FactoryMull, Standard (Vertical Factory) (0 ") 2: 2547 Left Casement Frame Size: 25 X 47 General Information: Standard, Clad Exterior Color / Finish: Standard EnduraClad, Brown Interior Color / Finish: Linen White Interior Glass: Insulated Tempered Low E Advanced Argon Gas Hinge Panel: Clear, Tempered, Standard per design (3mm) Hardware Options: Standard Roto Operator, Satin Nickel Screen: Full Screen, Champagne, InView Unit Accessories: Cellular Fabric Shade - Bottom Up, Capuccino Grille: Vertical Mull 2: FactoryMull, Standard (Vertical Factory) (0 ") 3: 2547 Right Casement Frame Size: 25 X 47 General Information: Standard, Clad Exterior Color / Finish: Standard EnduraClad, Brown Interior Color / Finish: Linen White Interior Glass: Insulated Tempered Low E Advanced Argon Gas Hinge Panel: Clear, Tempered, Standard per design (3mm) Hardware Options: Standard Roto Operator, Satin Nickel Screen: Full Screen, Champagne, InView Unit Accessories: Cellular Fabric Shade - Bottom Up, Capuccino Grille: Vertical Mull 3: FactoryMull, Standard (Vertical Factory) (0 ") 4: 2547 Right Casement Frame Size: 25 X 47 General Information: Standard, Clad Exterior Color / Finish: Standard EnduraClad, Brown Interior Color / Finish: Linen White Interior Glass: Insulated Tempered Low E Advanced Argon Gas Hinge Panel: Clear, Tempered, Standard per design (3mm) Hardware Options: Standard Roto Operator, Satin Nickel Screen: Full Screen, Champagne, InView Unit Accessories: Cellular Fabric Shade - Bottom Up, Capuccino Grille: Wrapping Information: Foldout Fins, Factory Applied, 6- 9/16" Standard 4- sided Jamb Extension, Factory Applied, Perimeter Length = 294 ", Glazing Pressure = 205. Printed on 5/2/2012 Office Order Copy Page 4 of 15 Customer: Fred Grinnell Quote Description: 739 Architect Designer 413 - 586 -0047 Order Number: 739L3EL11 I Outside View Line # Quote Qty PO Qty Description Item Price Ext'd Price 20 2 2 Architect, Sliding French Door Fixed / Vent / Fixed, 108 X List Price: $6,923.54 t' Location: Dining Room 80.125, Brown, 6 -9/16" iG` I Rough Opening: 108.75" X 80.625' 1: 10881 Fixed / Vent / Fixed Sliding French Door Discount %: 0.00 % Frame S ize: 108 X Discount $: $0.00 $0.00 B Frame Size: 108" X 80.125" Genera Information: 80 S tandard 1/8 , Clad, Pine I `" Final Wall Depth: 6- 9/16" Exterior Color / Finish: Standard EnduraClad, Brown Interior Color / Finish: Linen White Interior Frame Perimeter (inches): 377 Glass: Insulated Tempered Low E Advanced Argon Gas Assembly Type: Pella Assembled Hardware Options: Champagne, Handle Included, Handle Included, Satin Nickel Net Price: $6,923.54 $13,847.08 Last Revision Date: Screen: Sliding Screen, Wood Interior / Brown Exterior, InView Grille: Wrapping Information: Foldout Fins, Factory Applied, 6- 9/16" Factory Applied, Perimeter Length = 377 ", Glazing Pressure = 190. * * * PD -8 - 2nd Patio Door Installation Qty 1 * * * PD -6 - PD Exterior Aluminum Capping (Coil Stock) Qty 1 * * * AC -1 - Trim Jack Stud -1 RO Qty 1 * * * AC -9E - Patio Door UNF Oak transition strip at Qty 1 threshold Printed on 5/2/2012 Office Order Copy Page 3 of 15 Customer: Fred Grinnell Quote Description: 739 Architect Designer 413 - 586 -0047 Order Number: 739L3EL111 Outside View Line # Quote Qty PO Qty Description Item Price Ext'd Price - 10 1 1 Designer, Sliding French Door Fixed I Vent / Vent I Fixed, List Price: $13,476.77 Location: Kitchen 188.125 X 80.125, Brown, 4- 9/16" I� Rough Opening: 189.125" X 80.625" Frame Size: 188.125" X 80.125" 1: Fixed /Vent / Vent / Sliding French Door Frame Size: 188 1/8 X 80 1/8 Discount %: Discount $: 0.00 ® J $0.00 $0.00 General Information: Clad '"°"' Final Wall Depth: 6- 9/16" Exterior Color / Finish: Standard EnduraClad, Brown Frame Perimeter (inches): 537 Interior Color / Finish: Golden Oak Stain Interior Glass: Insulated Tempered Low E Advanced Argon Gas Assembly Type: Pella Assembled Hinge Panel: Clear, Tempered, Standard per design Hardware Options: Champagne, Handle Included, Handle Included, Satin Net Price: $13,476.77 $13,476.77 Last Revision Date: Nickel Screen: Sliding Screen, Wood Interior / Brown Exterior, InView Unit Accessories: Cellular Fabric Shade - Bottom Up, Capuccino Grille: Wrapping Information: Foldout Fins, Factory Applied, 6- 9/16" Applied by Branch, Perimeter Length = 537 ", Glazing Pressure = 180. * * * AC -9E - Patio Door UNF Oak transition strip at Qty 1 threshold * * * PD -6 - PD Exterior Aluminum Capping (Coil Stock) Qty 1 * * * PD -4 - 4-Wide Patio Door Install (Need OXXO Form) Qty 1 Outside View Line # Quote Qty PO Qty Description Item Price Ext'd Price 15 2 2 Architect, Sliding French Door Fixed / Vent / Fixed, 108 X List Price: $7,640.66 t i Location: Living Room 80.125, Brown, 6 -9/16" i Rough Opening: 108.75" X 80.625" 1: 10881 Fixed / Vent / Fixed Sliding French Door Discount %: 0.00 Frame Size: 108 X 80 1/8 Discount $: $0.00 $0.00 B ' Frame Size: 108" X 80.125" General Information: Standard, Clad, Pine i " - r∎ Final Wall Depth: 6- 9/16" Exterior Color / Finish: Standard EnduraClad, Brown 1; Interior Color / Finish: Golden Oak Stain Interior Frame Perimeter (inches): 377 Glass: Insulated Tempered Low E Advanced Argon Gas Assembly Type: Pella Assembled Hardware Options: Champagne, Handle Included, Handle Included, Satin Nickel Net Price: $7,640.66 $15,281.32 Last Revision Date: Screen: Sliding Screen, Wood Interior / Brown Exterior, InView Grille: Wrapping Information: Foldout Fins, Factory Applied, 6- 9/16" Factory Applied, Perimeter Length = 377 ", Glazing Pressure = 190. * * * PD -6 - PD Exterior Aluminum Capping (Coil Stock) Qty 1 * * * AC -1- Trim Jack Stud - RO Qty 1 * * * PD -3 - 3 -Wide Patio Door Install Qty 1 * * * AC -9E - Patio Door UNF Oak transition strip at Qty 1 threshold Printed on 5/2/2012 Office Order Copy Page 2 of 15 s-z - 1 Office Order Copy ‘.11k Branch Number: 73900 Order Number: 739L3EL111 Window Store Name: Quote Number: 3679107 Quote Description: 739 Architect Designer 413 - 586 -0047 Project Name: Grinnell Fred 562 Kennedy Rd Leeds MA 01053 Customer Information Deliver To Address Order Information Fred Grinnell Lot # Sales Rep Name: Lukomski, Adam Cust Delivery Date: 6/11/2012 PO Box 535 Address: Business Segment: Retail Quoted Date: 4/24/2012 562 Kennedy Rd PO Box 535 Market Segment: Single Family Replacement Contract Date: 4/27/2012 562 Kennedy Rd Order Type: Installed Sales Booked Date: 4/27/2012 LEEDS, MA 01053 Effective Discount: 0.000% Earliest LRD: 5/14/2012 Contact Name: LEEDS, MA 01053 Commission Split: Lukomski, Adam - 100% Day Phone: 4135860111 County: HAMPSHIRE Tax Code: MASS Mobile Phone: Owner Name: Tax Exempt #: Fax Number: Fred Grinnell Payment Terms: C.O.D. Customer PO #: E -Mail: Order Verifier Name: DAVID RUFFNER Order Verification Date: 4/27/2012 Great Plains #: 53H0000454 Owner Phone: 4135860111 Customer Number: 2455478 Delivery Instructions: GPS, LONG DRIVEWAY THAT IS SHARED BY 3 OTHER HOUSES, HOME HAS BROWN SIDING AND BROWN TRIM, IT I STHE FIRST HOUSE ON THE LEFT AT THE TOP OF THE DRIVEWAY, #562 IS MARKED ON THE TREE ON THE ROAD AND AT THE END OF THE DRIVEWAY THAT LEADS TO THE HOUSE. Installation Notes: GPS, LONG DRIVEWAY THAT IS SHARED BY 3 OTHER HOUSES, HOME HAS BROWN SIDING AND BROWN TRIM, IT I STHE FIRST HOUSE ON THE LEFT AT THE TOP OF THE DRIVEWAY, #562 IS MARKED ON THE TREE ON THE ROAD AND AT THE END OF THE DRIVEWAY THAT LEADS TO THE HOUSE. Order Verification Notes: PM NOTES TO INSTALL: 4 3 -W AS FSLD, 1 4 -W DS FSLD, 1 4 -W DS CM ON MAIN FLOOR OF DWELLING. CEDAR 1/2 X 6 CEDAR CLAP FOR EXTERIOR WALL COVERING. INTERIOR TRIM COLOR VARRIES FROM OPENING TO OPENING. MOST INSTALL ON DECK WHICH SURROUND THE DWELLING AT THE SAME LEVEL, WITH DRIVEWAY ACCESS TO DECK, (NO STAIRS TO CLIMB). HARDWOOD FLOORING FOR INTERIOR FLOOR COVERINGS. 1 DOG. GOOD PARKING WITH TURN -A- ROUND. MAIN DRIVEWAY COMING IN IS SHARED BY 4 DWELLINGS. NEW PRODUCT IS REPLACING EXISTING PELLA CLAD FRAME PRODUCT INSTALLED IN THE MID 1980's. YOU WILL BE CUTTING BACK SIDING TO REMOVE EXISTING PRODUCT AND ADD PADDING TO WRAP TO. WRAP NEW PRODUCT WITH MATCHING COLOR WRAP. DR WILL BE ON 1ST DAY OF INSTALL. INSTALLATION DATE: 6- 11/15 -12, MONDAY -- FRIDAY MAN POWER: 4 MEN FOR 5 DAYS + MYSELF ON 1 ST DAY Printed on 5/2/2012 Office Order Copy Page 1 of 15 PELLA PRODUCTS INC 155 MAIN STREET GREENFIELD, MA 01301 2_ re i(4 Tb-ot, eels. Subject: Disposal of Debris The purpose of this letter is to certify that all the debris resulting from any project undertaken by Pella Products Inc. in your Town will be transported to a dumpster at our main facility at 155 Main Street, Greenfield, MA. Pella Products Inc.is under contract with Waste Management of Massachusetts for the disposal of the contents of this dumpster. Very Truly Yours, PELLA PRODUCTS INC. John P. Benjamin Accounting Manager The Commonwealth of Massachusetts w,; Department of Industrial Accidents - y Office of Investigations i 600 Washington Street } Boston, MA 02111 www.mass.gov /dia Workers' Compensation Insurance Affidavit: Builders /Contractors/Electricians /Plumbers Applicant Information f Please Print Legibly Name ( Business /Organization/Individual): 6 .0 Address: j 5 /K'eE 6 f City /State /Zip: f erg ?e /c/ Mg /30/ Phone #: -0/ Are you an employer? Check the appropriate box: Type of project (required): 1.N I am a employer with /j f 4 ❑ I am a general contractor and I 6. ❑ New construction employees (full and /or part- time).* have hired the sub - contractors 2. ❑ I am a sole proprietor or partner - • listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub - contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.: required.] 5. n We are a corporation and its 10.0 Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12. ❑ Roof repairs insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' 13.0 Other comp. insurance required.] *My applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. } Contractors that check this box must attached an additional sheet showing the name of the sub - contractors and state whether or not those entities have employees. If the sub - contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. �` Insurance Company Name: H el Oyer l S u rr7�J C l_. J /Y) &M r Policy # or Self -ins. Lic. #: C) H /�/ 9 , �� 76W -0 Q _ Expiration Date: 69,/- (V- /,3 Job Site Address: f<enfl eci �� City/State/Zip: L 2e Mit 0 ( ()v Attach a copy of the workers' compensatio olicy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and /or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and enalties of perjury that the information provided above is true and correct. Signature: / LA( Date: Phone #: 4(3-7 - 7 231 Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit /License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: SECTION d'- CONSTRUCTION SERVICES 8.1 Licensed Construction 6 Supervisor: Not Applicable ❑ / Name of License Holder : ,l AAA A k ), i 0 �/ 7 Q License Number 114. 0. . A/7 Pew Pq / <<� /� 7 c� /'3 Address n ) CIO / Expiration Date � . U C. j- J-/ 77 Z Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ Company Name n Registration Number X 4'0 AeOt / r l'� f� f�✓1 C 1301 ? q - 2 Cpl Address Expiration Date 3 w& C i�hJQ. Telephone 4. i- 77? -Q153 — SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the buil ing permit. Signed Affidavit Attached Yes No ❑ 11. - Home Owner Exemption tie current exemption ror nomeowners was extenaea to mctuae Uwner uweumgs or one t t) or twotz) 'amines and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. CMR 780, Sixth Edition Section 108.3.5.1. Definition of Homeowner: Person (s) who own a parcel of land on which he /she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/ or farm structures. A person who constructs more than one home in a two -year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, that he /she shall be responsinle for au sucn worts performed under the buttering permit. As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to Lmployees for injuries not resulting in ueatn) o'tne Massachusetts General Laws Annotatea, you may ue name for person(s) you hire to perform work for you under this permit. The undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature ., SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Wpdows Alteration(s) 0 Roofing 0 Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [C] Siding [CO Other 10] Brief Description of Proposed /\ / Work: - TnCta (lrv�coi 01 -J `� , , ) /t a li T�T:'4 11 V111 2 ( 7 1 ' " GUI car , VSi 1 6c.(S n Alteration of existing bedroom Yes l� r / No Adding new bedroom Yes No /f, Attached Narrative Renovating unfinished basement Yes , / No j � c k Plans Attached Roll - Sheet C, p� 6a. If New house and or addition to existing housing, complete the following: a. Use of building : One Family 1 Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No . I. Septic Tank City Sewer Private well City water Supply SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT - I, Fe_6( Gn ( n v)e, � , as Owner of the subject property �I hereby authorize TR L (c - d (L G .t �✓t C - to act on my behalf, in all matters relative to work authorized by this building permit application. L c'ee , Str 1 aZ i S '/ Signature of Owner Date I, ' ),('tA (;j') 6 , as Owner /Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Da t1d (v +e___ Print Name" - II / .) , L...1 Signatur- o Owner /Agent Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be tilled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage Open Space Footage (Lot area minus bldg & paved parking) # of Parking Spaces Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW 0 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO ® DONT KNOW 0 YES 0 IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW © YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained , Date Issued: C. Do any signs exist on the property? YES © NO 0 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES NO IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. "� - City of Northampt•. RE • - mit: Department use only Building Departm t • . D veway Permit 212 Main Stree Amy I r Sewe , Se • "c Availability Room 100 I' at- /We Availability Northampton, MA I 106p .oF �_,. Two - ts if Structural Plans phone 413 - 587 -1240 Fax 41 R •y ' /ioiv,n ~ite 'fans • - . -city APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: This section to be completed by office .S .--- 6 Z Ke n n ed Zi APO c �S3�Map Lot Unit I� A �' Zone Overlay Lee�. i � 0 ss y District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: '� C ma 11 0 e Name (ITrint) Curre Itilylpjliq�,Address: 0/1/ _ qs L Telephone Signature 2.2 Authorized Agent: -- attli A (Ai, •,t /S-S / ,cired i attf,v) .Peil MA Name (Pf�t) ` (� Current Mailing Address: G 13U tJQI C �� 41 3 — 77 Z — 0S,- Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building 412 O0 6 00 (a) Building Permit Fee �S V /lO - T 1 2. Electrical (b) Estimated Total Cost of 0 Construction from (6) 3. Plumbing 0 Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 0 6. Total= (1 +2 +3 +4 +5) 4 /2,600.0) /�3 _ (t23 36 Check Number 94 This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date 562 KENNEDY RD BP- 2012 -0975 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 09 - 008 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: REPLACEMENT DOOR BUILDING PERMIT Permit # BP- 2012 -0975 Project # JS- 2012- 001693 Est. Cost: $42000.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: PELLA PRODUCTS, INC 091496 Lot Size(sq. ft.): 277477.20 Owner: GRINNELL FRED B JR TRUSTEE Zoning: RR(100) /WSP(100)/ Applicant: PELLA PRODUCTS, INC AT: 562 KENNEDY RD Applicant Address: Phone: Insurance: 155 MAIN ST (413) 772 -0153 WC GREENFI ELDMA01301 ISSUED ON:5/10/2012 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL REPLACEMENT DOORS & WINDOWS POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House # Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace /Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 5/10/2012 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner 562 KENNEDY RD BP- 2012 -0975 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 09 - 008 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: REPLACEMENT DOOR BUILDING PERMIT Permit # BP- 2012 -0975 Project # JS- 2012 - 001693 Est. Cost: $42000.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: PELLA PRODUCTS, INC 091496 Lot Size(sq. ft.): 277477.20 Owner: GRINNELL FRED B JR TRUSTEE Zoning: RR(100) /WSP(100)/ Applicant: PELLA PRODUCTS, INC AT: 562 KENNEDY RD Applicant Address: Phone: Insurance: 155 MAIN ST (413) 772 -0153 WC GREENFIELDMA01301 ISSUED ON:5/10/2012 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL REPLACEMENT DOORS & WINDOWS POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House # Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace /Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 5/10/2012 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner