HomeMy WebLinkAboutZP-23-304 - 0108 Upswept Lane 8/18/2023Contract - Detailed
Phone:Fax:Sales Rep E-Mail:(802) 864-5435 (802) 864-5309
South Burlington, VT 05403
340 Dorset Street Suite 3 Sales Rep Phone:
Sales Rep Name:
Sales Rep Fax:
Blount II, Michael
802-373-5740
mblount@pellasales.com
Pella Window and Door Showroom of South Burlington
Customer Information Project/Delivery Address Order Information
Customer Notes:** Need to schedule OV**
Fiberglass Replacement Side Entry Door w/Transom
Smooth Finish - White Int/Ext - White frame
Blinds Between the glass
Mill Finish Sill / Antigue Brass Hardware (no handle set)
New Exterior 5/4" PVC Trim with PVC Kickplate & new J-channel
New 2.5" Colonial 2 Interior Trim (prefinished white)
Includes all sales tax, local and VTRBES Building Permits
LIfetime warranty on the door / 10-year service agreement on install
Deposit: $3976.60
Balance Due: $3976.30
Primary Phone:
Mobile Phone:
Fax Number:
E-Mail:
County:
Order Number:
Quote Number:
Quote Name:
Quoted Date:
Order Type:
Payment Terms:
Hawkins Jeff 108 Upswept Ln South Burlington VT Side Entry Door
739Y5HB35I
(717) 5172220
Jeff Hawkins
108 Upswept Ln
South Burlington, VT 05403-4453
jphawk83@gmail.com
C.O.D.
Installed Sales
108 Upswept Ln
16983954
6/21/2023
South Burlington, VT 05403
Lot #
Great Plains #:1007319251
Tax Code:VTSBURL
Customer Number:
Customer Account:1007319251
1011063606
For more information regarding the finishing, maintenance, service and warranty of all Pella® products, visit the Pella® website at www.pella.com
Printed on 7/10/2023 Contract - Detailed Page 1 of 8
DocuSign Envelope ID: B582BF43-BEDE-4CE7-BD5B-FAAB995C3F0E
Frame Size:
Viewed From Exterior
Item Price Ext'd PriceQty
1
None Assigned Pella Entry Doors, Entry Door, Inswing, 37.5 X 81.625, White, 4 9/16"
$6,768.69 $6,768.69
10
1: 37.581.625 Entry Door
Frame Size: 37 1/2 X 81 5/8
Unit Type: Right Inswing, Standard Sill, No Fire Rating, No Fire Rating Dimensions: 36, 80
Dimension Options: No Cut Down
General Information: Standard, 4 9/16", 4 9/16"
Panel Style: Flush Glazed Full Light
Glass: Tempered Blinds-Between-The-Glass Air Filled Panel Selection: Smooth, Painted, White, Painted, White
Frame Selection: Composite, Black Threshold, No Panel Reinforcement, Smooth, Painted, White, Composite, Smooth, Painted, White
Hardware Options: Latch Bore with Deadbolt, 2 3/8", 2 1/8", No Integrated Sensor, No Handle Set, Standard Steel Ball Bearing, Brass, Mill Finish Sill
Performance Information: U-Factor 0.30, SHGC 0.12, VLT 0.18, CPD PEL-M-258-77343-00001, Calculated Positive DP Rating 50, Calculated Negative
DP Rating 50Wrapping Information: 4 9/16", Pella Recommended Clearance, Perimeter Length = 239".
37.5" X 81.625"
Location:AttributesLine #
PK #
2137
EXTTRIM19 - 5/4 x 4 Exterior Style PVC 1Qty
ED-5 - Entry Door Install w/Sidelight/Transom 1Qty
EXTTRIM15 - Kick board to match ext trim PVC 1Qty
EXTTRIM18 - Strip and Reuse Vinyl siding w/New J-channel (3 pcs)1Qty
Frame Size:
Viewed From Exterior
Item Price Ext'd Price
Customer Notes:
Qty
1
Side Entry Lifestyle, Direct Set, Fixed Frame, 37.5 X 14, Without HGP, White
Shop Mull Transom
$1,415.10 $1,415.10
15
1: Non-Standard Size Fixed Frame Direct Set
Frame Size: 37 1/2 X 14
General Information: No Package, Without Hinged Glass Panel, Clad, Pine, 5", 3 11/16"
Exterior Color / Finish: Standard Enduraclad, White
Interior Color / Finish: Prefinished White Paint Interior
Glass: Insulated Dual Tempered Low-E Advanced Low-E Insulating Glass Argon Non High Altitude
Performance Information: U-Factor 0.28, SHGC 0.32, VLT 0.62, CPD PEL-N-18-03365-00001, Performance Class CW, PG 90, Calculated Positive DP
Rating 90, Calculated Negative DP Rating 90, Year Rated 08|11
Grille: No Grille,
Wrapping Information: Foldout Fins, Factory Applied, No Exterior Trim, 4 9/16", 5 7/8", Factory Applied, Pella Recommended Clearance, Perimeter
Length = 103".
37.5" X 14"
Location:AttributesLine #
PK #
2137
SHOPMULL - Shop mull charge per composite 1Qty
Customer:Quote Number:Project Name:Jeff Hawkins Hawkins Jeff 108 Upswept Ln South Burlington VT 16983954Order Number:739Y5HB35I
For more information regarding the finishing, maintenance, service and warranty of all Pella® products, visit the Pella® website at www.pella.com
Printed on 7/10/2023 Contract - Detailed Page 2 of 8
DocuSign Envelope ID: B582BF43-BEDE-4CE7-BD5B-FAAB995C3F0E
EXTTRIM19 - 5/4 x 4 Exterior Style PVC 1Qty
Frame Size:
Viewed From Exterior
Item Price Ext'd PriceQty
4
Interior Casings Wood Products 2 1/2 Colonial 2, Length: 96, Prefinished White. Wood Type: Pine
$44.48 $177.92
20
1: Accessory
Frame Size: 1 X 1
General Information: Pine, 2 1/2 Colonial 2
Interior Color / Finish: Prefinished White Paint Interior
Wrapping Information: Perimeter Length = 0".
0" X 0"
Location:AttributesLine #
PK #
2137
Item Price Ext'd Price
Customer Notes:
Qty
1
Ext. Trim PFP - PC to order Prompt for Price (detail in line notes)
PVC Head Casing Cornice Millwork
$100.00 $100.00
21
Location:AttributesLine #
Item Price Ext'd PriceQty
1
None Assigned VTBPC - VT Permit/RBES subject to change if cost is more than shown
$215.00 $215.00
25
Location:AttributesLine #
Customer:Quote Number:Project Name:Jeff Hawkins Hawkins Jeff 108 Upswept Ln South Burlington VT 16983954Order Number:739Y5HB35I
For more information regarding the finishing, maintenance, service and warranty of all Pella® products, visit the Pella® website at www.pella.com
Printed on 7/10/2023 Contract - Detailed Page 3 of 8
DocuSign Envelope ID: B582BF43-BEDE-4CE7-BD5B-FAAB995C3F0E
Item Price Ext'd PriceQty
1
None Assigned OVP - Order Verification - non negotiable
$125.00 $125.00
30
Location:AttributesLine #
Item Price Ext'd PriceQty
1
Local/National Promotions
($1,200.16)($1,200.16)
35
Location:AttributesLine #
Thank You For Purchasing Pella® Products
Customer:Quote Number:Project Name:Jeff Hawkins Hawkins Jeff 108 Upswept Ln South Burlington VT 16983954Order Number:739Y5HB35I
For more information regarding the finishing, maintenance, service and warranty of all Pella® products, visit the Pella® website at www.pella.com
Printed on 7/10/2023 Contract - Detailed Page 4 of 8
DocuSign Envelope ID: B582BF43-BEDE-4CE7-BD5B-FAAB995C3F0E
Customer:Quote Number:Project Name:Jeff Hawkins Hawkins Jeff 108 Upswept Ln South Burlington VT 16983954Order Number:739Y5HB35I
PELLA WARRANTY:
Pella products are covered by Pella's limited warranties in effect at the time of sale. All applicable product warranties are incorporated into and become a part of
this contract. Please see the warranties for complete details, taking special note of the two important notice sections regarding installation of Pella products and
proper management of moisture within the wall system. Neither Pella Corporation nor the Seller will be bound by any other warranty unless specifically set out in
this contract. However, Pella Corporation will not be liable for branch warranties which create obligations in addition to or obligations which are inconsistent with
Pella written warranties.
Clear opening (egress) information does not take into consideration the addition of a Rolscreen [or any other accessory] to the product. You should consult your
local building code to ensure your Pella products meet local egress requirements.
Per the manufacturer’s limited warranty, unfinished mahogany exterior windows and doors must be finished upon receipt prior to installing and refinished annually,
thereafter. Variations in wood grain, color, texture or natural characteristics are not covered under the limited warranty.
INSYNCTIVE PRODUCTS: In addition, Pella Insynctive Products are covered by the Pella Insynctive Products Software License Agreement and Pella Insynctive
Products Privacy Policy in effect at the time of sale, which can be found at Insynctive.pella.com. By installing or using Your Insynctive Products you are
acknowledging the Insynctive Software Agreement and Privacy Policy are part of the terms of sale.
Notice of Collection of Personal Information: We may collect your personal information when you interact with us. Under the California Consumer Privacy Act
(CCPA), California residents have specific rights to request this information, request to delete this information, and opt out of the sharing or sale of this information
to third parties. To learn more about our collection practices and your rights under the CCPA please visit our link https://www.pella.com/california-rights-policy/at
pella.com.
ARBITRATION AND CLASS ACTION WAIVER ("ARBITRATION AGREEMENT")
YOU and Pella and its subsidiaries and the Pella Branded Distributor AGREE TO ARBITRATE DISPUTES ARISING OUT OF OR RELATING TO YOUR
PELLA PRODUCTS (INCLUDES PELLA GOODS AND PELLA SERVICES) AND WAIVE THE RIGHT TO HAVE A COURT OR JURY DECIDE DISPUTES. YOU
WAIVE ALL RIGHTS TO PROCEED AS A MEMBER OR REPRESENTATIVE OF A CLASS ACTION, INCLUDING CLASS ARBITRATION, REGARDING
DISPUTES ARISING OUT OF OR RELATING TO YOUR PELLA PRODUCTS.You may opt out of this Arbitration Agreement by providing notice to Pella no later
than ninety (90) calendar days from the date You purchased or otherwise took ownership of Your Pella Goods. To opt out, You must send notice by e-mail to
pellawebsupport@pella.com, with the subject line: “Arbitration Opt Out” or by calling (877) 473-5527. Opting out of the Arbitration Agreement will not affect the
coverage provided by any applicable limited warranty pertaining to Your Pella Products. For complete information, including the full terms and conditions of this
Arbitration Agreement, which are incorporated herein by reference, please visit www.pella.com/arbitration or e-mail to pellawebsupport@pella.com, with the subject
line: “Arbitration Details” or call (877) 473-5527.D'ARBITRAGE ET RENONCIATION AU RECOURS COLLECTIF ("convention d'arbitrage") EN FRANÇAIS SEE
PELLA.COM/ARBITRATION.DE ARBITRAJE Y RENUNCIA COLECTIVA ("acuerdo de arbitraje") EN ESPAÑOL VER PELLA.COM/ARBITRATION.
Seller shall not be held liable for failure or delay in the performance of its obligations under this Agreement, if such performance is hindered or delayed by the
occurrence of an act or event beyond the Seller’s reasonable control (force majeure event), including but not limited to earthquakes, unusually severe weather and
other Acts of God, fire, strikes and labor unrest, epidemics, riots, war, civil unrest, and government interventions. Seller shall give timely notice of a force majeure
event and take such reasonable action to mitigate the impacts of such an event.
Product Performance Information:
U-Factor, Solar Heat Gain Coefficient (SHGC), and Visible Light Transmittance (VLT) are certified by the National Fenestration Rating Council (NFRC).
Manufacturer stipulates that these ratings conform to applicable NFRC procedures for determining whole product performance. NFRC ratings are determined for a
fixed set of environmental conditions and a specific product size. NFRC does not recommend any products and does not warrant the suitability of any product for
For more information regarding the finishing, maintenance, service and warranty of all Pella® products, visit the Pella® website at www.pella.com
Printed on 7/10/2023 Contract - Detailed Page 5 of 8
DocuSign Envelope ID: B582BF43-BEDE-4CE7-BD5B-FAAB995C3F0E
Customer:Quote Number:Project Name:Jeff Hawkins Hawkins Jeff 108 Upswept Ln South Burlington VT 16983954Order Number:739Y5HB35I
any specific use.
Design Pressure (DP), Performance Class, and Performance Grade (PG) are certified by a third party organization, in many cases the Window and Door
Manufacturers Association (WDMA). The certification requires the performance of at least one product of the product line to be tested in accordance with the
applicable performance standards and verified by an independent party. The certification indicates that the product(s) of the product line passed the applicable
tests. The certification does not apply to mulled and/or product combinations unless noted. Actual product results will vary and change over the products life.
For more performance information along with information on Florida Product Approval System (FPAS) Number and Texas Dept. of Insurance (TDI) number go to
www.pella.com/performance.
Refer to Pella Corporate Warranty
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. 3-01-24 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 salesperson(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.
6A. All units are special order from the manufacturer. These units are sized and specified for your specific project. No units are of "stock" nature.
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 homeowner’s 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 owner’s 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
For more information regarding the finishing, maintenance, service and warranty of all Pella® products, visit the Pella® website at www.pella.com
Printed on 7/10/2023 Contract - Detailed Page 6 of 8
DocuSign Envelope ID: B582BF43-BEDE-4CE7-BD5B-FAAB995C3F0E
Customer:Quote Number:Project Name:Jeff Hawkins Hawkins Jeff 108 Upswept Ln South Burlington VT 16983954Order Number:739Y5HB35I
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 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.
When Pella Products, Inc. is the Builder or Contractor, as defined by the Vermont Residential Energy Standards (RBES) it agrees to meet or exceed the Vermont RBES then in
effect with the products it installs. Unless the customer requests greater energy efficiency targets be met in writing prior to the execution of this contract, Pella Products Inc. will
at its sole discretion determine how to best satisfy the basic RBES then in effect at the time of installation. Pella Products Inc. shall not be responsible for any windows or doors
installed by third parties or the homeowner independently of the Pella Products, Inc. installation and it cannot certify that the project will meet or exceed the RBES when other
parties install windows or doors that do not individually or collectively meet the RBES standards then in effect. The customer agrees to indemnify, defend and hold harmless
Pella Products, Inc. from any and all claims related to the RBES related to windows and doors installed by third party installers or the homeowner.
SERVICE LABOR WARRANTY: The standard Pella Service Warranty applies. Please note that any costs for equipment, scaffolding and safety equipment that is
required to obtain access for large or to inaccessible units will be at cost of homeowner, even if these costs are incurred during the labor warranty period.
This form constitutes a contract between Buyer and Seller. Prices are subject to change any time after 5 days following date of estimate and does not guarantee availability of any
product listed. Pella Products Inc. management has final authority on acceptance of this order. Your signature confirms the accuracy of the product(s) chosen.
For more information regarding the finishing, maintenance, service and warranty of all Pella® products, visit the Pella® website at www.pella.com
Printed on 7/10/2023 Contract - Detailed Page 7 of 8
DocuSign Envelope ID: B582BF43-BEDE-4CE7-BD5B-FAAB995C3F0E
Customer:Quote Number:Project Name:Jeff Hawkins Hawkins Jeff 108 Upswept Ln South Burlington VT 16983954Order Number:739Y5HB35I
Customer Signature
Date
Pella Sales Rep Signature
Date
Customer Name Pella Sales Rep Name(Please print)(Please print)
Credit Card Approval Signature
Project Checklist has been reviewed
Order Totals
Taxable Subtotal
Sales Tax @
Non-taxable Subtotal
Total
Deposit Received
Amount Due
$5,023.55
$2,578.00
$7,953.20
$0.00
7%$351.65
$7,953.20
For more information regarding the finishing, maintenance, service and warranty of all Pella® products, visit the Pella® website at www.pella.com
Printed on 7/10/2023 Contract - Detailed Page 8 of 8
DocuSign Envelope ID: B582BF43-BEDE-4CE7-BD5B-FAAB995C3F0E
Michael Blount II
7/10/2023
** 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**Initials:
7/10/2023
Jeff Hawkins
Project Name: __________ Today’s Date: _______________
Quote#: __________________
This is a “Do-it-Yourself” project all dimensions, attributes, installation, and
disposal are the responsibility of others.
Signature: ___________________________
We cannot guarantee that existing window treatments (i.e. Shades, Blinds, and Interior Shutters)
will fit on new Pella Windows/Doors.
This is an Installed project
Condition of Work:
1. 50% Deposit required at time of order.
2. Final payment is to be made to installation team on the final 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. We cannot guarantee/will not your existing shades and blind will fit in your new windows.
6. Due to inclement weather or site conditions, it may be necessary to reschedule.
7. We cannot and will not guarantee specific dates or days of the week for installation.
8. Time given to complete a job is an estimate, extension of time is possible.
9. An install appointment will be confirmed at Verification. A courtesy reminder call will be placed 3-days prior.
10. Unforeseen rot repair will be quoted on site as additional work via a Field Change Order. Rot repair or additional installation
charges are due at the time of installation and cannot be financed through GreenSky Financing, Check or Credit Card Payments only.
11. Upon Substantial Completion final payment is due, 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.
12. In the event 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.
13. Pella will secure all necessary Building Permits.
For more information regarding the finishing, maintenance, service and warranty of all Pella® products, visit the Pella® website at www.pella.com
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)
___ Remove interior or exterior window stops, install new window in existing sash opening, re-use existing or replace
window stops. Some glass loss will occur.
Lead Paint Discloser:
___ 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.
___ Are there children under the age of 6 or women who are pregnant?
DocuSign Envelope ID: B582BF43-BEDE-4CE7-BD5B-FAAB995C3F0E
X
X
16983954
7/10/2023Jeff Hawkins
Condition of Work (Continued):
Owner Will:
___ Authorize installation of Yard Sign 7 -10 days prior to installation date and removed after installation is complete.
___ Ensure someone over age 18 is present at all times while Pella Employees are in the home
___ Cut-back or tie trees, bushes, shrubs from exterior wall (Grass and Shrubs may be damaged during construction)
___ Have alarm system disconnected and reconnected - Pella Products can re-route wires but cannot reconnect
___ Have any plumbing or electrical repairs by appropriate licensed contractor - $500 charge if unprepared on 1-Day job
___ Remove and reinstall window treatments, wall hangings and A/C Units - 4-5 feet in front / 1 foot to side with clear path
___ Remove and reposition furniture in work area
___ Secure pets in a safe manner
___ Remove valuable / breakable items from work area
___ Remove snow from area of worksite if necessary
Pella Products Will:
___ Deliver and unload products
___ Place drop cloths in work areas
___ Remove and reinstall interior and exterior trim if applicable
___ Remove and reinstall existing shutters and awnings by contract
___ Remove existing product and adjust or modify opening as needed
___ Provide all equipment necessary to install products
___ Cut all wood and other materials outside of home
___ Install all products purchased
___ Insulate and caulk around products
___ Remove stickers and perform initial cleaning of all glass surfaces
___ Demonstrate proper operation of products
___ Confirm that all products are in working order
___ Remove drop cloths, vacuum and remove all old products from premises
___ Installer will collect balance due on final day of installation
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.
Signature: _______________________________ Today’s Date: _________________________
DocuSign Envelope ID: B582BF43-BEDE-4CE7-BD5B-FAAB995C3F0E
7/10/2023
O
Pella Products Inc.
155 Main Street
Greenfield, MA 01301
To Whom it may Concern:
I, __________________________________, 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; ____________________________________________
____________________________________________
Please accept this letter in place of my signature on the permit application.
Thank you,
Signature: ______________________________________________
Date: ____________________________________________________
DocuSign Envelope ID: B582BF43-BEDE-4CE7-BD5B-FAAB995C3F0E
South Burlington, VT 05403
108 Upswept Lane
7/10/2023
Jeff Hawkins
YEAR OF CONSTRUCTION (check one) ACTUAL YEAR HOME CONSTRUCTED ______
I certify that my home was built BEFORE ____ AFTER Dec. 31, 1977 ____ PRESUMED LEAD ____
Property Address: _____________________________________________
_____________________________________________
If BEFORE is selected, continue to LEAD TESTING APPROVAL.
If AFTER is selected, proceed to the PRINT NAME/ SIGNATURE section.
LEAD TESTING APPROVAL
I agree to have Lead Testing performed in my home by Pella Products, Inc.
I understand the Lead Testing protocol may cause:
Cuts and chips through the existing finish on and around the windows and doors included with this project; including interior
and exterior trim, painted walls, and exterior siding.
Staining or discoloration of the existing interior and exterior finishes occurring in the tested areas.
Interior and exterior trim to be damaged due to removal to provide access for the Lead Testing Protocol.
TESTING RESULTS
I have reviewed the results of the Lead Testing accomplished by the above named Certified Renovator.
I understand the results of my test will be sent to be me, via U.S. mail, within 30 days of the renovation. I have been shown the
testing swabs as used for this testing and understand if any test swab indicates a shade of red, lead is assumed present and EPA
Renovation, Repair and Painting Guidelines apply.
CHECK ONE OF THE FOLLOWING:
(A) My home tested positive for lead. I request that Pella Products, Inc use the lead-safe work practices required
by the EPA’s Renovation, Repair and Painting Rule and will be supplied a pamphlet on lead hazard.
(B) My home tested negative for lead. I understand that Pella Products, Inc will not be required to use the lead-
safe work practices required by the EPA’s Renovation, Repair and Painting Rule and will not be supplied with a
pamphlet on lead hazard.
PAMPHLET RECEIPT [IF POSITIVE OR PRESUMED LEAD IS PRESENT] I have received a copy of the lead hazard information pamphlet informing me of the potential risk of the lead
hazard exposure from renovation activity to be performed in my dwelling unit. I received this pamphlet before the
work began. [Tenant occupied dwellings require a separate notification process.]
Printed Name of Owner-Occupant
Signature of Owner-Occupant
Signature Date
PRE-RENOVATION FORM
Occupant Confirmation
RENOVATOR’S SELF-CERTIFICATION
(for tenant-occupied dwellings only)
Instructions to Renovator: If the lead hazard information pamphlet was delivered
but a tenant signature was not obtainable, you may check the appropriate box
below:
Declined by tenant; a copy was left with the tenant
Unavailable for signature; good faith effort made and have left a copy
at the residence for the tenant
Mailing Option; pamphlet must be mailed at least 7 days before
renovation and mailing must be documented by a certificate of mailing
from the Post Office.
[This is an alternative to delivery in person to the owner and/or tenant.]
DocuSign Envelope ID: B582BF43-BEDE-4CE7-BD5B-FAAB995C3F0E
2008
South Burlington, VT 05403
Additional Notes:
X
108 Upswept Lane
Jeff Hawkins
7/10/2023