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12C-121 112 RICK DR BP-2019-0397 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 12C- 121 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: window replaced BUILDING PERMIT Permit# BP-2019-0397 Project# JS-2019-000637 Est.Cost: $2700.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: PELLA PRODUCTS, INC 096558 Lot Size(sg.ft;): 11194.92 Owner: MOREHOUSE ANDREW E&LUZ ADRIANA CASTILLO MOREHOUSE Zoning: RI(100)/URA(100)/WSP(100) Applicant. PELLA PRODUCTS, INC AT. 112 RICK DR Applicant Address: Phone: Insurance: 155 MAIN ST (413) 772-0153 WC GREENFIELDMA01301 ISSUED ON:10/1/2018 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL 3 REPLACEMENT 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 1)enartmeut Fireplace/Chimney- Rough: Oil: Insulation: Final: Smo e: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy $ienature: FeeType: Date Paid: Amount: Building 10/1/2018 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck--Building;Commissioner _ ev1N00&/- Department use only yr_ City of North mpt n of P rmit; Building Dep rtme t Curb Cut/D iveway Permit t 212 Main S reet SEP 2 s 201 ew r/yep is Availability t Room 1 0 Wat r/Wel Availability Northampton, A 0 ets f Structural Plans ., SPF 4ffftXc, Qt�• phone 413-587-1240 ax 13rN,MA n, 6�" ite Pns er pe ify APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION d� �� 3P 1.1 Property Address: This section to be completed by office I1� R�c4 ,r. Map Lot ),I Unit ��oter.ct MA GIo0, Zone Overlay District Elm St. District CB District SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 OwnRrr of 1Record: C ,• Ty JOV Y`� S�. \P i kk qvv�s by r� MA CJI C)q 6 Name(Pr' Currant ailing Address: lti 1-5� SS `(- -7 11 to Telephone Si 2.2 Authorized Age ttnt: rprur, prod-J5 Grtit .�� 41A Gi3G� Name(Print) Current Mailing Address: Cy 3� �7 7 3 IIS 7 Signatu Telephone SECTION 31-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building �cc) Lj (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee #zj7)4. Mechanical(HVAC) 7 U 5. Fire Protection Of 6. Total = 0 +2+3+4+5) of `1 U C' C' Check Number This Section For Official Use Only Building Permit Number: Date Issued: lob � Q Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) { f t P i w v Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column be filled in by �.. Building Department Lot Size N Frontage Setbacks Front Side NI/� L: R: . L:. R: Rear Building Height Bldg. Square Foota Open Space Footage % (Lot area minus bldg&paved parking) /Y #of Parking S ace /A Fill: N volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DON'T KNOW YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO ® DON'T KNOW (D YES 0 IF YES: enter Book Pageand/or Document#' B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW Q YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained 0 , Date Issued: C. Do any signs exist on the property? YES ® NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,a cavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES ® NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. i � SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement windows Alteration(s) ❑ Roofing ❑ Or Doors 119 1 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding[0] Other[o] Brief Description of Proposed 1 J / UF4�� G•'3C� Work: Vt0`t�< t C 'r t.a lJ� lJ5 `^f QX S�:hF Cb rpt•KhS /JO l�g�l"LS ro 4,41— Alteration r��41 - Alteration of existing bedroom Yes _No Adding new bedroom Yes �( No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a.If New house and or addition to existing housing.complete the following: a. Use of building : One Family 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, �3 as Owner of the subject property hereby authorize PFS A r--_P�vc7-, ..L-AJG to act on e a in all matters relative to work authorized by this building permit application. Sign er Date 1, Ctvcx �r G c�S \r c _ 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. Wktk �i r"IJ'5 Print Name g, 1 Signature o er/Agent Date r ,, � ,► SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction iSupervisor: Not Applicable ❑ Name of License Holder: 1 r�k_V'C� `e�S j C.S� Q & 11 License Number Address Ex�n Date Signature elephone 9. Registered Home Impro11vement Contractor: Not(Applicable ❑ (," II�, rppc�vC'15 'hC I `r �,-;;2 1 � Company Name Registration Nu fiber 1s5 /11 .,C, S�- Crre�, �p(�1� rf/} 11130 I 3b 3 /,-C_-_o Address Expiration nate Telephone 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 building permit. Signed Affidavit Attached Yes....... No...... ❑ r. , .. 4. - ./' Pella Products, Inc. 155 Main Street Greenfield, MA 01301 Office:413-773-1157 Ext. 317 Cell:413-834-8799 To: Building inspector From: Trevor Bross—Installation Manager Date: March 5, 2018 Subject: Building Permit Applications & Designees Pella Products Incorporated is in the business of replacing windows and doors for our customers. Our process includes providing a building permit for each and every project. I am a licensed Construction Supervisor. Building Permits will be applied for using my CSL# CS-096558 and my HIC#142279. Please find a copy of my licenses below. ® Commonwealth of Massachusetts k' Construction Supervisor Division of Professional Licensure Restricted to Board of BuddiftibilgiiiWAm and Standards Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991 cubic meters)of f, enclosed space. CS-096558 ftpires�03/0112020 TREVOR BROSS - 10 GEORGE STREr GREENFIELD M,"_ Failure to possess a current edition of the Massachusetts /`� State Building Code is cause for revocation of this license. Commissioner �.�"'— DPS licensing information visit:WWW.MASS.GOV/DPS ..�;.,,.,......... //�.I^/fin. ..•dux/J� office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Supplement Card before the expiration date. If found return to: RRtglstration ExRiraU,on Office of Consumer Affairs and Business Regulation 142279 03/23/2020 One Ashburton Place- e1301 PELLA PRODUCTS,INC. Boston, 0z TREVOR BROSS HCl 155 MAIN STREET ` ' Not valid without signature GREENFIELD,MA 01301 Undersecretary Each Installation will be staffed by our installers who are all licensed in accordance with current building codes. Below listed are our installers and their license numbers. Please accept these individuals as my designees. Willard Brown CS106010 Vladimir Shevchuk CSSL099209 Scott Bowdish CSSL100232 Bill Leger CS89338 David Ruffner CS57308 Brian Thompson CS67121 Igor Kravchuk CS094911 i PELLA PRODUCTS INC. 155 MAIN STREET GREENFIELD, MA. 01301 J Date: a 1 1 To: 'bWr ori ��c�c��Cj� Subject: Disposal of Debris The purpose of this letter is to certify that all debris from any project undertaken by Pella Products, Inc. in your town will be transported to a dumpster at our main facility; 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 Department of Industrial Accidents VOffice of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Pella Products, Inc. Address: 155 Main Street City/State/Zip:Greenfield, MA. 01301 Phone #:413-772-0153 Are you an employer? Check the appropriate bog: Type of project(required): 1. I am a employer with 52 4. Q I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' 9 ❑ Building addition [No workers' comp. insurance comp. insurance.: required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or addition: 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or addition: 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.El Other comp. insurance required.] *Any 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: Hanover Insurance Group Policy#or Self-ins. Lic. #:WHND376502 Expiration Date:01/01/2019 Job Site Address: `(Z r-. City/State/Zip: .F\oma Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fin 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 un r tl pains and penalties erjury that the information provided above is true and correct. Si ature: Date: Ct �t Phone#: Above 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#: +h � -` ` �� ,d►`�oma® CERTIFICATE OF LIABILITY INSURANCE DA7E(MM/DD/YYYY) 2/28/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must 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 Robin Sargent NAME: Berkshire Insurance Group,Inc. AH/CONN Exti: (413)773-9913 A� No: (413)774-3872 117 Main StreetE-MAIL rsargent@berkshireinsurancegroup.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC 0 Greenfield MA 01301 INSURERA: Citizens Ins.Company ofAmer 31534 INSURED INSURER B: Allmerica Financial Benefit 41840 Pella Products,Inc. INSURER C: Hanover Insurance Company 22292 155 Main Street INSURER D: INSURER E: Greenfield MA 01301 INSURER F COVERAGES CERTIFICATE NUMBER: 18GL,AL,WC REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE �OCCUR PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 10,000 A ZBND45939500 01/01/2018 01/01/2019 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 POLICY �PRO �LOC PRODUCTS-COMP/OP AGG $ 2,000,000 JECT OTHER: Damage to Rented $ 100,000 AUTOMOBILE LIABILITY COMBINER SIHGLE•LM/IT $ 1,000,000 Ea accident X ANYAUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED AWND45948700 01/01/2018 01/01/2019 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X STER ATUTE EORH AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 C OFFICERIMEMBEREXCLUDED? N/A WHND376502 01/01/2018 01/01/2019 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Operations usual to the sale&installation of doors&windows. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. 212 Main St AUTHORIZED REPRESENTATIVE Northampton MA 01060 • ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Contract - Detailed Pella Window and Door Showroom of West Springfield Sales Rep Name: Lukomski,Adam 69 Ashley Avenue Sales Rep Phone: (413) 335-3237 West Springfield, MA 01089 Sales Rep Fax: 413-774-6348 Phone: (413) 736-9239 Fax: (413) 736-3390 Sales Rep E-Mail: alukomski@pellasales.com Customer Information Project/Delivery Address Order Information Andrew Morehouse Morehouse Andrew 112 Rick Dr Florence MA Quote Name: 2158702 Vinyl 250 413-559-7116 34 South St 112 Rick Dr Order Number: 739R2JL131 WILLIAMSBURG, MA01096-9726 Lot# Quote Number: 10598475 Primary Phone: (413)5597116 FLORENCE, MA 01062-1048 Order Type: Installed Sales Mobile Phone: County: HAMPSHIRE Payment Terms: C.O.D. Fax Number: Tax Code: MASS E-Mail: a4house@comcast.net Quoted Date: 9/13/2018 Great Plains#: 531-15597116 Customer Number: 1006787982 T" Customer Account: 1002227900 Line# Location: Attributes 10 Front Bedroom Vinyl Windows I Doors By Pella, Double Hung, 40.25 X 49.25, White Item Price Qty Ext'd Price 1 $888.87 1 $888.87 Li; 19 1: Non-Standard SlzeNonStandard Size Double Hung, Equal c-� PK# Frame Size: 40 1/4 X 49 1/4 C� 2016 General Information: Standard,Vinyl, Block Frame With Mull Groove,31/4",3 1/4", Sill Adapter Included, No Head Expander 7r- Q Exterior Color/Finish: White Interior Color/Finish: White 1P 477T Glass: Insulated Low-E Advanced Low-E Insulating Glass Argon Non High Attitude Hardware Options: White, Standard Vent Stop, No Limited Opening Hardware Viewed From Exterior Screen: Half Screen Performance Information: U-Factor 0.30, SHGC 0.28,VLT 0.53,CPD PEL-N-108-00116-00001, Performance Class LC, PG 25,Calculated Positive DP Rating 25,Calculated Negative DP Rating 25,Year Rated 08111, Egress Does not meet typical United States egress, but may comply with local code requirements Grille: No Grille, Wrapping Information: Pella Recommended Clearance, Perimeter Length=179". Frame Size:40.25"X 49.25" EAC-1 -Exterior Aluminum Capping(Coll Stock) Qty 1 PF-1 -Interior Pocket Installation Qty 1 LP-1 -Lead safe practices this opening Qty 1 For more information regarding the finishing, maintenance, service and warranty of all Pella®products, visit the Pella®website at www.pella.com ••. _-_ n.r NnA0 n--- A -t ! lip Customer: Andrew Morehouse Project Name: Morehouse Andrew 112 Rick Dr Florence MA Order Number: 739R2JL131 Quote Number: 10598475 Line# Location: Attributes 15 Back Bedroom Vinyl Windows I Doors By Pella, Double Hung, 31.75 X 49.25, White Item Price Qty Ext'd Price 1 $855.70 1 $855.70 1: Non-Standard SlzeNon-Standard Size Double Hung, Equal Lr, 4PK# Frame Size: 31 3/4 X 49 1/4 CV 2016 General Information: Standard,Vinyl, Block Frame With Mull Groove,3 1/4",3 1/4",Sill Adapter Included, No Head Expander - Exterior Color/Finish: White Interior Color/Finish: White f Glass: Insulated Low-E Advanced Low-E Insulating Glass Argon Non High Altitude Hardware Options: White, Standard Vent Stop, No Limited Opening Hardware Viewed From Exterior Screen: Half Screen Performance Information: U-Factor 0.30, SHGC 0.28,VLT 0.53, CPD PEL-N-108-D0116-00001, Performance Class LC, PG 35,Calculated Positive DP Rating 35,Calculated Negative DP Rating 35,Year Rated 08111, Egress Does not meet typical United States egress, but may comply with local code requirements Grille: No Grille, Wrapping Information: Pella Recommended Clearance, Perimeter Length=162". Frame Size:31.75"X 49.25" EAC-1 -Exterior Aluminum Capping(Coil Stock) Qty 1 LP-1 -Lead safe practices this opening Qty 1 PF-1 -Interior Pocket Installation Qty 1 Line# Location: Attributes 20 Bathroom Vinyl Windows I Doors By Pella, Double Hung, 23.75 X 37.25, White Item Price city Ext'd Price i $878.75 1 $878.75 rr. a 1: Non-Standard SizeNon-Standard Size Double Hung, Equal c-� PK# Frame Size: 23 3/4 X 37 1/4 r'- 2016 General Information: Standard,Vinyl, Block Frame With Mull Groove,3 1/4",3 1/4", Sill Adapter Included, No Head Expander p; Exterior Color I Finish: White Q Interior Color/Finish: White l Glass: Insulated Tempered Low-E Advanced Low-E Insulating Glass Argon Non High Altitud( Hardware Options: White, Standard Vent Stop, No Limited Opening Hardware Viewed From Exterior Screen: Half Screen Performance Information: U-Factor 0.30,SHGC 0.28,VLT 0.53,CPD PEL-N-108-00105-00001, Performance Class LC, PG 35, Calculated Positive DP Rating 35,Calculated Negative DP Rating 35,Year Rated 08111, Egress Does not meet typical United States egress, but may comply with local code requirements Grille: No Grille, Wrapping Information: Pella Recommended Clearance, Perimeter Length= 122". Frame Size:23.75"X 37.25" EAC-1 -Exterior Aluminum Capping(Coil Stock) Qty 1 LP-1 -Lead safe practices this opening Qty 1 PF-1 -Interior Pocket Installation Qty 1 For more information regarding the finishing, maintenance, service and warranty of all Pella®products, visit the Pella®website at www.pelia.com Customer:Andrew Morehouse Project Name: Morehouse Andrew 112 Rick Dr Florence MA Order Number: 739R2JL131 Quote Number: 10598475 Order Totals Customer me (Pleaseprint) Pella Sales Rep Name ase pr ) ------� � print) Taxable Subtotal $739.76 ^— Sales Tax @ 6.25% $46.2 er Signature Pei-Sales Rep Signature J Non-taxable Subtotal $1,914.00 Total $2,700.00 Date ---1Date Deposit Received $1,350.00 mount Due $1.350.00 Credit Card Approval Signature For more information regarding the finishing, maintenance, service and warranty of all Pella®products,visit the Pella(&website at www.pella.com Prin}oiinn 01'N1f)01A n...,4., 4 n..+..;i...+ M__ ^ -1 ..