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31A-173 (6)
BP-2022-0640 40 MAYNARD RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31 A-173-00I CITY OF NORTHAMPTON Permit: Exterior Res PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit # BP-2022-0640 PERMISSION IS HEREBY GRANTED TO: Project# WINDOWS Contractor: License: Est. Cost: 10309 PELLA PRODUCTS, INC 096558 Const.Class: Exp.Date:03/01/2024 Use Group: Owner: B SMITH STEPHEN E &JOLIE Lot Size (sq.ft.) Zoning: URB Applicant: PELLA PRODUCTS, INC Applicant Address Phone: Insurance: 155 MAIN ST 6H15382 GREENFIELD, MA 01301 ISSUED ON:06/06/2022 TO PERFORM THE FOLLOWING WORK: REPLACE 5 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: Q � I Fees Paid: $40.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner RECEIVED • s, The Commonwealth of Massachuse s 3 202 'LlVf c' Board of Building Regulations and Sta dar MU ICI ALITY Massachusetts State Building Code, 78 C T aF eur� U r, orNr INgp� 'Ming Permit Application To Construct, Repair, Renovate �` Ti +o Deed ar 2011 One-or Two-Family Dwelling -- This Section For Official Use Only Building Permit Number: AP' 4).3-"C6`t D Date Applied: eau ii--) 71?0,5 ,i/ Z to' 61402Z Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers U 0 Mount(lard f_ck N N 04 M WI AT) C. 1"1 '' t_V 60 d.. 1.1 a Is this an accepted street?yes ✓ no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: eXiShncl reSi�/lff�l Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building 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 isposal System: Public 17 Private 0 Zone: Outside Flood one? MunicipaY6 On site disposal system 0 Check ifyesDI SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: o 1 e SM 1 th .NU t i r)ck(r,e trx-) MA 01 0 fo o Name(Print) City,State,ZIP LID M Win ord. rtd LI13-320—$546 Jobe bsM;t oFN►a.11.ca,y, No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(chec all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work': 9-RpicLG(•net 5 w:ndow's vs;rlol ctci3V:net opening) Willrt no chor'cec is by ildcngs hpadu. U= •SC) SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ t(),30q • B(p I. Building Permit Fee: $ Indicate how fee is determined: ❑ Standard City/Town Application Fee 2.Electrical $ 0-UC) ❑Total Project Cost3(Item 6)x multiplier x 3. Plumbing $ 0. 0 0 2. Other Fees: $ 4. Mechanical (HVAC) $ 0. 0 0 List: 5. Mechanical (Fire Suppression) $ O- 00 Total All Fees: $ 6. Total Project Cost: $ Oct•$� Check No:74(a7(theck Amount: '� Cash Amount: U1 3 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CAS— 0 y 62557 3/i r 2 —rrQ-JU( ex os_, License Number Expiration Date Name of CSL Holder List CSL Type(see below) J 155- Nto n S} T Description No.and Street (7-0,u1F 21 Cal M 0 4(801 U Unrestricted Restricted1&2(BuFamily Dweildings up toll 35ing,000 cu.ft.) City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances U13_sIz-get fig fed'Mt Vpek1aScaes•cot^ I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) ?Mg Qrootuefs Znc (c�( Zz �q 3/2y/Z2 HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name ISM ail rwi'C SI•- P�iri;}Scape11 ckacku,s-cc,,,,, No.ap d Street Email address 6-pet) 1 d, Oi3 01 ti/3-57 -,S'r ce City/Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issu e of the building permit. Signed Affidavit Attached? Yes No .0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize pe P\1 sa Qcoc c)C to act on my behalf,in all matters relative to work authorized by this building permit application. atku 3( f 6/ZZ Print Owner's Name(Electronic Signature) Date SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this 'cation is true d a o the best of my knowledge and understanding. 3/ I 612z Print Owner's or thorized Agent's Name(Electronic Signature) Date NOTES: 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 www.mass.gov/oca Information on the Construction Supervisor License can be found at www.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"may be substituted for"Total Project Cost" DocuSign Envelope ID:2B629FEC-1 B33-4BA3-B377-DOB54E4B1219 Pella Products Inc. 155 Main Street Greenfield, MA 01301 To Whom it may Concern: Joile Smith , as property owner, give permission to our contractor, Pella Products Inc. to obtain a building permit for the installation of windows and/or doors in my home. Located at; 40 Maynard Rd Northampton, MA 01060 Please accept this letter in place of my signature on the permit application. Thank you, DocuSigned by: Signature: J61(4, D4372D2FBB134A7... Date: 3/4/2022 PELLPRO-01 CHRISTINE ,ACoRO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/Y 12/6/2021 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 Christine Sullivan NAME: Phillips Insurance Agency,Inc. PHONE FAX 97 Center Street (A/C,No,Ext):(413)594-5984 (A/C,Nam(413)592-8499 Chicopee,MA 01013 Miss:chrIstineephillIpsinsurance.com INSURER(S)AFFORDING COVERAGE NAIC N INSURERA:EMC Insurance Companies 21415 INSURED INSURER B:Union Insurance Co of Providen Pella Products,Inc INSURER C: 155 Main St INSURERD: Greenfield,MA 01301 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: 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. I TR TYPE OF INSURANCE IN SD Y VD POLICY NUMBER POLICY EFF POLICY EXP UMW A X COMMERCIALGENERALL1ASIUTY DIMIDDnYYY) IMNUDD/YYY111 000, ,1000 EACH OCCURRENCE � CLAIMS-MADE X OCCUR 6A15382 1/1/2022 1/1/2023 DAMAGETORENTED 500,000 PREMISES lEa occurrence) ; MED EXP(Any one person) _3 10,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLI S PER: GENERAL AGGREGATE S 2,000,000 X POLICY X JET LOC PRODUCTS-COMP/OP AGG 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY (Ea accIdeeDrnSINGLE LIMIT X ANY AUTO 6Z15382 1/1/2022 1/1/2023 BODILY INJURY(Per person) $ OWNED SCHEDULED 1,000,000 AURTEO�S ONLY AUTOS BODILY pBODILY INJURYRTY p (Per accident) $ _ AUTOS ONLY _ AUTOS ONLY (Peracccldent)A � $ A X UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 4,000,000 EXCESS LIAB CLAIMS-MADE 6J15382 1/1/2022 1/1/2023 AGGREGATE $ DED X RETENTION$ 10,000 Aggregate $ 4,000,000 B WORKERS COMPENSATION AND EMPLOYERS'LIABILITY PER ER'* ANY PROPRIETOR/PARTNER/EXECUTIVE YIN 6H15382 1/1/2022 1/1/2023 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBEREXCLUDED? NIA (Mandatory In NH) 500,000 E.L.DISEASE-EA EMPLOYEE $ If es,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) Installation Floater$50,000 Included Operations usual to the sale and installation of doors&windows. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Williamsburg(Cityof Northampton) THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P ) ACCORDANCE WITH THE POLICY PROVISIONS. 212 Main St. Northampton,MA 01060 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ,! The Commonwealth of Massachusetts Department of Industrial Accidents �' Office of Investigations =� Lafayette City Center 2 Avenue de Lafayette, Boston,MA 02111-1750 '. -' 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 St City/State/Zip:Greenfield,MA 01301 Phone#:413-7744)153 Are you an employer?Check the appropriate box: Type of project(required): 1.El] I am a employer with 50 4. 0 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. 0 Remodeling ship and have no employees These sub-contractors have 8. El Demolition working for me in any capacity. employees and have workers' 9. El Building addition [No workers' comp.insurance comp.insurance.: required.] 5. 0 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 12.0 Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.0 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. tContractors 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. _.. ._ .... -._ .. ._ _.._ "_. __ ... _ .. _. ----- .. ... . r --. . - . --'-- - - C I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: EMC Insurance Companies Policy#or Self-ins.Lic.��#:6H15382 Expiration Date:01-01-2023 L Job Site Address: 40 "` C\U d d City/State/Zip: IJa i -hc&iitp l t MA O(0 aio 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 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 he pains and penalties of 'ury that the information provided above is true and correct v' Z Signature: �' /� _ Date: a J 1 h i Phone#: 0 \fp()'‘/L- Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(check one): 10Board of Health 20 Building Department 30City/Town Clerk 4.0 Electrical Inspector 5E1'lumbing Inspector 6.0Other Contact Person: Phone#: PELLA PRODUCTS INC. 155 MAIN STREET GREENFIELD, MA. 01301 Date: 3f (5/2 To: C t\-to Of N'Ct`tt u,n.e-oft 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. Denise Chartier Accounting Manager Pella Products, Inc. 155 Main Street Greenfield, MA 01301 Office:413-512-5968 Cell: 413-834-8799 To: Building inspector From: Trevor Bross—Installation Manager Date: February 17, 2022 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 Construction Supervisor �t Division of Occupational Licensure Unrestricted -Buildings of any use group which contain Board of Building Regi rations and Standards less than 35,000 cubic feet(991 cubic meters)of enclosed i Const t ion S*Avisor space. CS-096558 s , "' M �jl,pires:03101/2024 P�. TREVOR BRASS i i . 'L 10 GEORGE STREET t GREENFIELO-JNA 0 4 ,11 �0ff`\d.t l Failure to possess a current edition of the Massachusetts Commissioner ditta > 74+t auk. State Building Code is cause for revocation of this license. For information about this license ,_.-...,. Call(617)727.3200 or visit www.rnass.gov/dpl THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE:Supplement Card Office of Consumer Affairs and Business Regulati Registration Expiration 1000 Washington Street -Suite 710 142279 -, 03/23/2024 Boston,MA 02118 'ELLA PRODUCTS,INC. ': .ti 11 _ ry 17i t3 : kd: +� _ -REVOR BROSS -Pr y (- "'�- 55 MAIN STREET , �'" '�`a(�i . 3REENFIELD,MA 0130 `+, Undersecretary of valid without signature , 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 Christian Lambert C5065102 Robert Kairnes CS113305 Igor Kravchuk CS094911 DocuSign Envelope ID:2B629FEC-1833-4BA3-B377-D0B54E4B1219 Contract - Detailed ?°1- Sales Rep Name: Lukomski, Adam Sales Rep Phone: (413) 335-3237 Sales Rep Fax: 413-774-6348 Phone: Fax: Sales Rep E-Mail: alukomski@pellasales.com Customer Information Project/Delivery Address Order Information Jolie Smith Smith Jolie 40 Maynard Rd Northampton MA Quote Name: Lifestyle Series Living and Dining 413-320-8596 40 Maynard Rd 40 Maynard Rd Order Number: 739X2DL011 NORTHAMPTON,MA 01060-2810 Lot# Quote Number: 15125959 Primary Phone:(413)3208596 NORTHAMPTON, MA 01060-2810 Order Type: Installed Sales Mobile Phone: County: HAMPSHIRE Payment Terms: GreenSky Financing Fax Number: Tax Code: MASS E-Mail: joliebsmith@hotmail.com Quoted Date: 2/11/2022 Great Plains#: 1006587205 Customer Number: 1010400990 Customer Account: 1006587205 Line# Location: Attributes 10 Dining Room Lifestyle, Double Hung, 35.75 X 53.25, Without HGP, White Item Price Qty Ext'd Price $2,437.82 2 $4,875.64 ME1:Non-Standard SizeNon-Standard Size Double Hung,Equal MINI PK# Frame Size: 35 3/4 X 53 1/4 Cr:/j��, 2108 General Information: No Package,Without Hinged Glass Panel,Clad,Pine,5",3 11/16",Jambliner Color: Gray i_ '1■�� Exterior Color/Finish: Standard Enduraclad,White Interior Color/Finish: Bright White Paint Interior Glass: Insulated Low-E Advanced Low-E Insulating Glass Argon Non High Altitude Hardware Options: Cam-Action Lock,Champagne,No Limited Opening Hardware,No Sash Lift,No Integrated Sensor Viewed From Exterior Screen: Full Screen,White,InViewn" Performance Information: U-Factor 0.30,SHGC 0.27,VLT 0.50,CPD PEL-N-35-00426-00003,Performance Class LC,PG 35,Calculated Positive DP Rating 35,Calculated Negative DP Rating 35,Year Rated 08111,Clear Opening Width 32.562,Clear Opening Height 23.375,Clear Opening Area 5.285672,Egress Does not meet typical United States egress,but may comply with local code requirements Grille: SDL w/Spacer, No Custom Grille,7/8",Traditional(3W2H/3W2H) Wrapping Information: No Exterior Trim,3 11/16",5",Factory Applied,Pella Recommended Clearance,Perimeter Length=178". Frame Size:35.75"X 53.25" LP-1 -Lead safe practices this opening Qty 1 PF-2-Exterior Pocket Installation Qty 1 EXTTRIMIO-PVC Ripped for stops 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 3/2/2022 Contract-Detailed Page 1 of 7 DocuSign Envelope ID:2B629FEC-11333-4BA3-B377-DOB54E4B1219 Uuswrner.June Jrnlln rrulecr Name: Smith Jolie 40 Maynard Rd Northampton MA Order Number: 739X2DL011 Quote Number: 15125959 Line# Location: Attributes 15 Living Room Lifestyle, Double Hung, 35.75 X 53.25, Without HGP, White Item Price Qty Ext'd Price -l �� $2,437.82 3 $7,313.46 ■ i '■MO 1: Non-Standard SizeNon-Standard Size Double Hung,Equal PK# Frame Size: 35 3/4 X 53 1/4 cr:•j.�� 2108 General Information: No Package,Without Hinged Glass Panel,Clad,Pine,5",3 11/16",Jambliner Color: Gray t, .�� Exterior Color/Finish: Standard Enduraclad,White f Interior Color/Finish: Bright White Paint Interior r 1 Glass: Insulated Low-E Advanced Low-E Insulating Glass Argon Non High Altitude •`' Hardware Options: Cam-Action Lock,Champagne,No Limited Opening Hardware,No Sash Lift,No Integrated Sensor Viewed From Exterior Screen: Full Screen,White,InViewTM Performance Information: U actor 0.30,SHGC 0.27,VLT 0.50,CPD PEL-N-35-00426-00003,Performance Class LC,PG 35,Calculated Positive DP Rating 35,Calculated Negative OP Rating 35,Year Rated 08111,Clear Opening Width 32.562,Clear Opening Height 23.375,Clear Opening Area 5.285672,Egress Does not meet typical United States egress,but may comply with local code requirements Grille: SDL w/Spacer,No Custom Grille,7/8",Traditional(3W2H/3W2H) Wrapping Information: No Exterior Trim,3 11/16",5",Factory Applied,Pella Recommended Clearance,Perimeter Length=178". Frame Size:35.75"X 53.25" LP-1 -Lead safe practices this opening Qty 1 PF-2-Exterior Pocket Installation Qty 1 EXTTRIM10-PVC Ripped for stops Qty 1 Line# Location: Attributes 40 None Assigned BPC - Permit-subject to change if actual cost greater than shown Item Price Qty Ext'd Price $90.00 1 $90.00 For more information regarding the finishing, maintenance, service and warranty of all Pella®products, visit the Pella®website at www.pella.com Printed on 3/2/2022 Contract-Detailed Page 2 of 7 DocuSign Envelope ID:2B629FEC-1B33-4BA3-B377-D0B54E4B1219 i..usturr'er:Julie ornlui rrojeet'Jame: Smith Jolie 40 Maynard Rd Northampton MA Order Number: 739X2DL011 Quote Number: 15125959 [$Project Checklist has been reviewed Joile Smith Adam Lukomski Order Totals Customer Name (Please pant) Pella Sales Rep Name (Please print) Taxable Subtotal $7,788.10 ,—Doeuslgned by: c—DoeuSigned by: ih1b. SlMlrtl ''II. [OA1M tplenvAl Sales Tax @ 6.25% $486.76 \__D > gg4tjgnature \__.DBigllkAglit@cfReP Signature Non-taxable Subtotal $2,035.00 3/4/2022 3/2/2022 Total $10,309.86 Date Date Deposit Received $10,309.86 Amount Due $0.00 Credit Card Approval Signature ** The date given for installation is an approximate date. Due to unprecedented demand and global shortages of raw materials, your installation date is subject and likely to change. Pella Products Inc. cannot be held responsible for any additional costs, or lost time associated with manufacturing delays outside of our contract. Although we will do our very best to meet these dates, we ask for your understanding and patience during these times ** JDs S Initials: For more information regarding the finishing,maintenance,service and warranty of all Pella®products,visit the Pella®website at www.pella.com Printed on 3/2/2022 Contract-Detailed Page 7 of 7