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Home My WebLink AboutBuilding Permit #445 - 10 PETERSON ROAD 1/30/2011 TOWN OF NORTH ANDOVER S APPLICATION FOR PLAN EXAMINATION Permit NO: " Date Received Date Issued: IMPORTANT:Applicant must com Tete'all items on this page { LOCATION !p -eters bn Print PROPERTY OWNER Kino �0'rK Unit# Print MAP NO: PARCEL)��ZONING DISTRICT: Historic District yes o Machine Shop Village ye n 100 year-old structure yes n TYPE OF IMPROVEMENT PROPOSED USE iaY Residential Non- Resident ❑ New Building One family 0 [I Addition Two or more family 11 Industrial ❑Alteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg 13 Others: ❑ Demolition ❑ Other (] Septic ❑Well Floodplain O Wetl"'ds•. V ❑ Watershgd'D.istrict. - ❑ Water/Sewer. DESCRIPTION OF WORK TO BE ERFORMED•.. em!)crQ. lade. I e Il ed �,emov�f reQlace � ei4's4�' ��n dcor CSlfde.� . p Y4 a 5 rm L (Identification ease Type or Print Clearly) OWNER: Name: Phone: Address: 10 �2t5an Qoo.� CONTRACTOR Name: kyik) Dl�fi Phone: q7p 8�P y61k y Address: Y�'�' rQ 1erkA. O I l Supervisor's Construction License: 9012E Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT.•$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 5179•67 FEE: $ 4 62.07 r� Check No.: &03d-c�l qtr' I Eyf Receipt No.: 8 NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund i nafureaof Agent/Owner Sgnature�of contractors _ 9 - J { i Building Department { The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building:Permit Application � o Workers Comp Affidavit j ❑ Photo Copy of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products .NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg-,Permit f Addition or Decks ❑ Building Permit Application ❑ Certified Surveyed. Plot-Plan ❑ Workers Comp Affidavit - ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Or..ossection/Elevation Plan Of Proposed Work With.'Spr.inkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster.permits require sign off from Fire Department prior to issuance of Bldg.Permit f New Construction (Single and Two Family) ❑ Building Permit Application Li Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses - ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned)to Include Sprinkler Plan And- Hydraulic Calculations (If Applicable) ❑ CopY' of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered-products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg .Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from.the Board of Appeals that the appeal period-is over. The applicant-must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: Doc.Building Permit Revised 2008mi Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBody.Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ . -Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY .INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING-&:DEVELOPMENT ❑ El COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals.-Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision -".E ;' Comments Conservation Decision: Comments Water & Sewer Connection/Signature&Date . Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Departmentsignature/date COMMENTS Dimension - Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector I Yes No DANGER ZONE LITERATURE: Yes No .MGL Chapter 166 Section 21A aid G min.$100-$1000 fine I NOTES and DATA — For department use ❑ Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi Location � �� No. u e Date o NpRTh TOWN OF NORTH ANDOVER F - s s • � ; . Certificate of Occupancy $ �s Building/Frame/Frame Permit Fee $ _ O scmusE 9 — Foundation Permit Fee $ Other Permit Fee $- 11 TOTAL Check # 2 ? Building Inspector �,I _ _. _ { { - .. - - �.. �'i �� __. s I NORTF1 TO" of zAndover . 0 o , dover, mass-p-( a I� COC MICHEWICK �. ATED S ` BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT..................K 1 ..........^0........... ................... ......................... .................................... Foundation has permission to erect............::.......................... buildings on ..'o....... .....`.........��..�...... ........................ Rough nwa to be occupied as........� O,ti ....:.................................................................................................... Chimney provided that the person a cepting this permit shall in every respect conform,to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 ONTHS ELECTRICAL INSPECTOR b UNLESS CONSTRU T TS Rough - Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry wall To. Be Done FIRE-DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner - Street No. SEE REVERSE SIDE r Smoke Det. The Commonwealth of111assachusetts Department oflndustrial Accidents Office of Investigations d 600 Washington Street ;.t Boston,M4'02111 www.mas&gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Ltpilbly Name usiness/or (B g ni�ation/Individual); Address: -ror , & c� City/State/Zip:__ a f(leh , iN A 019A( Phone#: f 7k --Y6 Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 2.�emplyees(full and/or part-time).* have hired the sub-contractors 6. ❑ New construction l am oa sole proprietor or partner- listed on the attached sheet 1 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers'comp, insurance. 9. Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its - required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.[] Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑ Roof repairs insurance required.]t employees. [No workers' I13. ❑ Other camp.insurance required.] Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information: t Homeowners wbo submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this box must,attached an additional sheet showing the name of the subcontractors and their workers'comp.policy infomTnation I.am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:_ A TM t�to ii meoL Policy#or Self-ins.Lic. #: 6 a—U BY 62, {33Aq -- I( Expiration Date: V J41 Z Job Site Address: 10 ¢-}�QP�g►-� Qn, City/State/Zip: & Ay1Aovtr1 ffi) _ Oi$(4s 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.452 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 ins ce coverage verification. I do herebyeertify unde' a 't s penalties of perjury that the information pr141714 ided ' true and correct Si ature: Date Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town Permit/License# Issuing,Authorlty.(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspect 6. Other or S. Plumbing Inspector Contact Person: _ Phone#: Apr 18 1106:31 p p.2 ,�. ✓src Lam•�iw7aux(rll� pvG�rax[cr�u6e�6 Office of Consumer Affairs&BdSiness Regulation rl _� , HOME IMPROVEMENT CONTRACTOR Registration: .166327 Type; •. Expiration: 2/3/2013 DBA K. O'BRIEN CONSTRUCTION KEVIN O'BRIEN 17 TOM GRACE WAY BILLERICA,MA 01821 Undersecretary #a�,.rclrust'tt.- 1)r rti t;l�i r:? a �'ttiTlic safel} Bart/ of Building #2c% ul:rtinns:Inti 4tandard• License: CS 90128 KEVIN C OBRIEN 17 TOM GRACE WAY BILLERICA, MA 01821 Expiration: 8/31/2012 t ntrt011�ln�h'r Trt: 3062 RO® DATE(MMUDVNYYY) CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE,.CERTIFICATE HOWER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, 0CMNID OR ALTER THE COVERAGE AFFORDED BY THE,POLICIES BELOW.- THIS CERTIFICATE OF INSURANCE DOES,NOT coNsTl'CUTE A CONTRACT BETWEEN THE ISSUING INSURER(S); AUTHORIZED REPRESENTA'"VE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: .If the certificate holder is an ADDITIONAL INSURED,the pollcy(les)must be endorsed. If SUBROGATION IS WAIVED,&L b)ect to .the terms and conditions of the policy,certain polfdes may require an endorsement. A statement on this certificate does not coWer rights to the certificate holder,In iteu of such endorsement s. PRODUCER - 00 ACT NAW— MiChele Mtif-ra MTMBrainerd Inc .PHONlo,; ; (970)667,9031 _ F(AL�,tdr]:(9793ssr aA AJgdoTrer Road AD ss:mmurray@brainerdinsare.com PRODUCER 00005337 .CUSTOMOLMD 1:... . Billerica NA 01821 INSURER(SI AFFORDING COVERAGE _ NAIC k INSURED a WSMERA:Travelers Casualty Ins Co of 19046 u1SuRIR B XZV= O'EMEN DBA 9 C O t BRIEN CONSTRUCTION INSURER C; .'•T 17 TOM GRACE WAY INSURER D BILLERICA NA 01821. INSURER E COVERAGES CERTIFICATE,NUMBER•:MSTER GL 2011 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLIC`!PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER,DOCUME14T WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDEO I3Y THE POLICIES DESCRIBED HEREIN IS SUBJECT To ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PIVD CLAIMS. INSR ._.....,..,...,..«...,......_.. TYPe OF IMURANCE Pt Y POLICY E.7CP LIMITS POLIer NUMBER ceNERAL UAeu.mr ; EAC14 OCCURRENCE $ 1,000,000 X COMMERCIAL OENERAI_UAe(L17Y A CLAIMS•MADE XI OCCUR I6806424N45AACS11 /3/2011 6/3/2012 PREMISES En neeuwmw S 300,000 MED G Awry ons phr on 8 5,000 It Blanket Addt1 insured PERSONAL BADVINJURY $ 1,000;000 GENERAL AGGREGATE $ 2,000,000 '0EN'L AGORFCiATE LIMIT AFK ES PER: PRODUCTS-COMPIOP AGO $ 2,000,000 X POLICY M%O Lor $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Fe acddrolll) 130DILY R MRY(Prr pmson) $ ALL OWNED AUTOS BODILY INJURY(Per eoddent) S SCHEDULED AUTOS HIRED AUTOS PROPERTY DAMAGE w $ (Per nxleent) NON•OWNEOAUTOS "•, ""'". $ UMBRELLA LEAH OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIM&MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ WORIMRB COMPI HCATIQN WC STATU• DTH• AND EMPLOYERS'LUMILnY Y 1114 ANY FROfR IETORIPAWMER/ExECUTIYE $ OFFICER/MEMBER MCLUDED7 ❑ NIA E.L.EACH ACCIDENT (A14triartt s In NN) E.L.DISEASE-EA EMPLOYE $ rr Yyee&netsalbe ender � _ DESCRIP ION OF OPERATIONS below E,L.tM&A&E-PORION LIMIT DESCRIPTION OF OPERATKM I LOCATIONS I VEMCLES(Aturch ACORD tet,AddWarml Remwits schedule,A*..pc.Iq mgtdmd) LO"'s Ca>npahi4A8, Inc- and any and all subsidiaries are named as an additional insured as respect to the above: referenced General Liabi i;tp Insurance Policy, as regMi.><eed by uxitten contract or agreement- CER'T'IFICATE BOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLEtI BEFORE THE EXPWA110M DATE THEREOF, NOTICE WILL BE DELIVERED IN Lowe's COMpanies, Inc ACCORDANCE VMH THE POLICY PWASIONS. Attn: YS InBuranCe PO Box 111.1 AUTHORiM REPRESENTATw North ilkesborq, NC 28656 S Leavitt, CSC, LXA/S ACORD 25(2009109) (�1988-2009 ACORD CORPORATION. All rights reserved. INS025(7,oriq m) The ACORD name and logo ars registered meet of ACORD ' a 06/02/2017 15:0 4873898006 ST PALLS PAGE 01/01 1B8r1�DAT& on -IM �„ ObJ�Mlblt f,UTIIt1CA1'6>s ASA MTMCn Tw Pft�101FCEit ATS AUvw WD 4M AL7U 11 CW1«A kin MA Zf AIl 1NC CQ�JVLF'J,, Al 10 MMM CO Mr RAGE IAAIWDVMRD GUMUdA 1A 01621f, A AGS SCAN1Nsumwc`E CO AIC#22667 Ater R ` vow C ,KgrRNms » DRAKC08RM i�1�01M(iRAG'RvVA�1 _ Commula BRtCAlidA01R21 MWIM Oleo Y�? ,�.ti„mv, •if:ayrti'.r.• F8R1t1D6;Fdl�. 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':Mi�hif .'(7q*�'�'�`SE"^1"A(1•f^. w��l•.;{ �:w:.,.«!�,�I A x _ . t -. � ' � � �, STORE COPY INSTALLATION SERVICES CUSTOMER CONTRACT- MWORK- INT/EXT/PATIO DOOR LOWE'S OF SALEM, NH,STORE#2382STORE PHONE: (603)681-4218 541 SOUTH BROADWAY SALESPERSON: FRANK SIMONE SALEM, NH 03079-0000 SALESPERSON ID: 1502071 Document Print Date : 11/13/2011 This is only a Quote for the merchandise and services printed below. This becomes an agreement upon payment and issuance of a Lowe's receipt, upon which the entire agree- ment, including the specifically completed pages of this document, the Terms and Conditions included with this document, the applicable portion(s) of Lowe's receipt, and any other addenda or attachments hereto, shall be referred to herein as this"Contract." PLEASE READ THIS ENTIRE DOCUMENT,INCLUDING THE "TERMS AND CONDITIONS." BEFORE SIGNING Lowe's Registration or Contractor License Number/Lowe's Contractor Name Lowe's Home Centers, Inc.'s MA HIC NO.: 148688 Lowe's Home Centers, Inc.'s FEIN: 56-0748358 Customer Name Home Phone S KINO CLARK 978-557-9991 ® Customer Address Other Phone 10 PETERSON RD 617-662-1985 L City State/Province Zip/Postal Code D NORTH ANDOVER MA 01845 Installation Address T 10 PETERSON RD ® Installation City Installation State/Province Installation Zip/Postal Code NORTH ANDOVER MA 01845 MERCHANDISE AND INSTALLATION SUMMARY MERCHANDISE SUMMARY 39683 : PRODUCTCODE : SOS : SOS RB COMMODITY FBRGLS-DORFAB TC : ENTRY/EXTERIOR SINGLE UNIT W 2 SIDELITES, 6 PANEL : DOOR FAB- RICATION SERVICES, INC - QTY 1 312933 : 60FS1 LLERH : SOS : SOS RB JELD-WEN FIBERGLASS PATIO : SLIDING RETRO SLIDING PATIO : JELD-WEN,MILLWORK MASTERS-KNOX- QTY 1 312933 :.60FS1 LLERH : SOS : SOS RB JELD-WEN FIBERGLASS PATIO : PATIO SCREEN SYSTEM - QTY 1: :JELD-WEN,MILLWORK MASTERS-KNOX - CITY 1 312933 : 60FS1LLERH : SOS : SOS RB JELD-WEN FIBERGLASS PATIO : SILL PAN ADD-ON: : JELD-WEN,MILLWORK MASTERS-KNOX -QTY 1 313896 : 510FSF10LER : SOS : SOS PROBILT FRENCH DOOR TC : DOOR UNIT RETRO FRENCH PATIO : JELD-WEN,MILLWORK MASTERS-KNOX - QTY 1 J ' ! Store,2382 Project No. 333001729 for KINO CLARK Page 1 of 8 STORE COPY 313896 : 51 OFSF10LER : SOS : SOS PROBILT FRENCH DOOR TC : FRENCH SCREEN SET-QTY 1: : JELD-WEN,MILLWORK MASTERS-KNOX -QTY 1 313896 : 510FSF1 OLER : SOS : SOS PROBILT FRENCH DOOR TC : SILL PAN ADD-ON: : JELD-WEN,MILLWORK MASTERS-KNOX - QTY 1 1209 : 1209 : STK : 1X3X8' SELECT PINE : 1X3X8' SELECT PINE : PRECISION LUMBER - QTY 3 188879 : 34952032 : STK : 36" SIGNATURE CLEAR WHT-BRSHD NKL : 36" SIGNATURE CLEAR WHT-BRSHD NKL : LARSON COMPANY - QTY 1 193584: EC444 : STK : PFJ CASE 444 3 1/2 X 11/16 X 8 : PFJ CASE 444 3 1/2 X 11/16 X 8 : EAST COAST MILLWORK DISTRIBUTI - QTY 9 326139 :.54X81 OARMWD : STK : 5/4X8X10 ARMOUR WOOD : 5/4X8X10 ARMOUR WOOD : FLETCHER WOOD SOLUTIONS -QTY 6 Materials Price $3376.6 INSTALLATION DESCRIPTION Stock or SOS : Stock Door Type : Patio Select Location : Back Door Select New Door : Hinged/French Number of Doors to Install : 1 Side Lights or Transoms : No Hidden Damage Description : None Number of additional holes bored for accessories : None Install Specialized Mortise Hardware : No Lead Safe Practices : No Stock or SOS : Stock Door Type : Patio Select Location : Back Door Select New Door : Sliding Number of Doors to Install : 1 Side Lights or Transoms : No Hidden Damage Description : None Number of additional holes bored for accessories : None Install Specialized Mortise Hardware : No Lead Safe Practices : No Stock or SOS : SOS Door Type : Exterior Select Location : Front Door Select New Door : Single Pre-hung Number of-Doors to Install : 1 Side Lights or Transoms : Yes Total Number of Side Lights and Transoms : 2 Hardwood (Mahogany or Oak) Door: No Hidden Damage Description : None Number of additional holes bored for accessories : None Install.Specialized Mortise Hardware : No Install Storm Door : Install new storm door Select Storm Door : Storm Door Lead Safe Practices : No Total Linear Feet of Custom Trim to be Installed : 0 Deliver Door: Yes Customer Understands Scope of the Project : Yes Permit Required : Yes Who Will Obtain Permit : Lowe's Permit Fee : No Additional Miles Traveled over 20 : 0 Bring Up To Code Description : None Local Disposal Fee : Yes Describe Other Work Needed Custom work $30.00, Extension Jam bs,.Exterior Trim $60.00 Other Work Charge : Yes Comments : Contractor KC O'Brien wants Lowe's to deliver material '' Store 2382 Project No. 333001729 for KINO CLARK Page 2 of 8 STORE COPY Labor Charges $ 1831.00 Detail Deduction -$ 35.00 Additional Specifications: Notation: Lowe's will not make structural modifications, paint or stain or remove/reinstall security system equipment. Customer is responsible to advise if prop- erty is governed by Historic District Regulations. Additional Specifications:Federal law requires Lowe's to provide you with the pamphlet Renovate Right: Important Lead Hazard Information for Families, Child Care Providers and Schools. By signing this Contract, Customer acknowledges having received a copy of this pamphlet before work began informing Customer of the potential risk of the lead hazard exposure from renovation activity to be performed in Customer's dwelling unit. TOTAL CHARGES OF ALL MERCHANDISE AND SERVICES *where applicable SUB-TOTAL $5172.6 "TAX $ 0.0 DELIVERY $ 0.0 ORDER TOTAL $5172.6 BALANCE DUE Work is to commence upon reasonable availablity of Contractor which is anticipated to be l C [fill in date]. Estimated completion date is �• [fill in date]. NOTICE TO CUSTOMER All items listed in this contract and specification sheet(s) are to be installed under conditions agreed upon at time of purchase and at the price appearing on this contract form. This assumes sound existing substructures, superstructure and points of attachments. Extra labor or material incident to installation necessitated by defective substructures, superstructure, points of attachment, or the moving of fixtures or appliances to be billed at extra cost to custom- er. IF THE-CONTRACT TOTAL IS $1,000.00 OR LESS Customer must pay in full COMPLETE THIS SECTION ONLY WHEN THE CONTRACT TOTAL EXCEEDS$1.600.00: r' Store 2382 Project No. 333001729 for KINO CLARK Page 3 of 8 STORE COPY Customer to Pay in Full; OR [_] Customer to use the following payment schedule: (1) Deposit$ to be paid upon signing contract. Deposit should be 1/3 the total contract price; and (2)'Payment of $ to be paid anytime after this Contract is signed and before commencement of installation, I/We authorize Lowe's to do one of the following (check appropriate box below): [_] Charge my/our credit card for the amount of the payment indicated above anytime after the date this Contract is signed; or [_] Deposit my/our check for the amount of the payment indicated above anytime after the date this Contract is signed; and (3) Final payment of$100.00 to be paid upon completion of the installation and both parties' satisfaction. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AND UNTIL YOU HAVE READ THE TERMS AND CONDITIONS CON- TAINED IN THIS CONTRACT AND WHICH FOLLOW THE SIGNATURE PAGE(s). BY SIGNING BELOW, YOU ARE ACKNOWLEDGING THAT YOU HAVE READ, UNDERSTAND AND AGREE TO THE TERMS AND CONDITIONS SET FORTH IN THIS CONTRACT. YOU ARE ENTITLED TO A COPY OF THIS CONTRACT AT THE TIME OF SIGNATURE. NOTICE REGARDING ARBITRATION AGREEMENT FOR CLAIMS COVERED BY M.G.L. c.142A LOWE'S AND OWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT LOWE'S HAS A DISPUTE CONCERNING THIS CON- TRACT, THAT LOWE'S MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRET- ARY OF THE EXECUTIVE OFFICE OF CONSUMER AFFAIRS-AND BUSINESS REGULATIONS AND THE OWNER SHALL BE REQUIRED TO SUB- MIT TO SUC .BITRATION AS PROVIDED IN M.G.L. c.142A. By- " Date: ,3 l L we' Home Cels Inc. �Y: J.� Own Date: By: Date: Spouse THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE RESOLUTION INITIATED BY LOWE'S PURSUANT TO M.G.L. c.142A. THE OWNER MAY BE PERMITTED TO INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THE SECTION ABOVE IS NOT SEPERATELY SIGNED BY THE PARTIES. WITNESS OUR HAND(S)AND SEAL(S) BELOW THIS--/ 'r'y DAY Lowe's Home Centers, Inc. Store 2382 Project No. 333001729 for KING CLARK Page 4 of 8 STORE COPY BY (Seal) Print Name: _ 4/ cl, Address t� (Seal) Owner City State/Province Zip/Postal Code Print Name Co-Owner or Witness (Seal) Print Name Customer acknowledges receipt of a true copy which was completely filled in prior to Customer's execution hereof. You the customer may cancel this transaction at any time prior to midnight on the third business day after the date of this transaction. See the attached Notice of Right to Cancel for an explanation of this right. µ Store 2382 Project No. 333001729 for KINO CLARK Page 5 of 8