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Home My WebLink AboutBuilding Permit #880 - 103 FARRWOOD AVENUE 6/8/2012 TOWN OF NORTH ANDOVER 8floAPPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: 64- /�— IMPORTANT:Applicant must complete all items on this page LOCATION /0 3 QVoe'd # oZ Print PROPERTY OWNER Q,hr-s c nP �+ 1 Print MAP NO: �d PARCEL:/O ZONING DISTRICT: Historic District y s no. Machine Shop Village y s no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ;nwo or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other [];Septic 0 Well DT-i-t plan (_]Wetlands � 'Watershed District 0 Water/Sewer DESCRIPTION OF WORD TO BE PERE ORMED: emou� t'wol acro 1 ew's4�n� c�-��6 s(i�pr (Identification Please Type or Print Clearly) OWNER: Name: Address: 101 &rw064 �+ a- , CONTRACTOR Name: Mft6el_AIQ ooh Phone: 1 zk-6Ftf-,6a7',,9- Address: I q j-3e ArS1e AvY 11�e�huen AW al Supervisor's Construction License: 2 6 6 Y S Exp. Date: 5/13 Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ 1 36/. 7f FEE: $- =-?D Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature'of Agent/Ownere '_ _ _ `_ Si" nature_of'�contractor Location No. Date W,-" (0L • ' TOWN OF NORTH ANDOVER • . �. � . Certificate of Occupancy $ Building/Frame Permit Fee $� e Foundation Permit Fee $ ,t Other Permit Fee TOTAL $ Check#/dam' 25390 Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body 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 ❑ ❑ 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: 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 Department signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. i.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— For department use ® Notified for pickup - Date Doc:.Building Permit Revised 2008mi ■ 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 o Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit 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/Crossection/Elevation Plan Of Proposed Work With Sprinkler 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 New Construction (Single and Two Family) ❑ Building Permit Application ❑ 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 MOTE: 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 N0RTH TOMM Of No. ` o dower, IVMass., /An O LAKE 1. COCMICHEWICK DRATED BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.............. .. .R.�A.........��.. .... .....a........................................................... Foundation ...... a.has permission to erect.......... buildings on .....'. ...... .r.�.b ►................2.r Rough Da. ca Chimney to be occupied as...... .....�.........0........ ......ir4wr................... provided that the per•on accepting 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 PERMrr EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTn ST TS Rough ....................... .......... ....................... Service BUILDING INSPECTOR Final Occupancy Permit Required t0 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 Smoke Det. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 131 a 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information _ - I Please Print Legibly r Name(Business/organization/Individual): A n ooh- )j OV it a y Con ST-Ilycj7Oy1� To C Address: I y '.e'Rrse Ave City/State/Zip: pLryy Phone#: q 7�-1?8 6 a 7,2_ Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with S 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. E]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' [No workers' comp. insurance comp. insurance.: 9. ❑Building addition required.] 5. E] We are a corporation and its 10.❑Electrical repairs or additions q ] 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152,§1(4),and we have no 13.❑ Other employees. [No workers' comp. insurance required.] *Any applicant that checks box 41 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. M Insurance Company Name: M o a ,_rn s u 1,n,P Policy#or Self-ins.Lic.#: 70 Z6 00 q61 o 1-2- Expiration Date: Job Site Address: 163 Fi ftwooa dV-- a City/State/Zip: ffarklin, t /1'!i4 6(PK— 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 the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: Phone#: -621 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#: �aonna vozzella Fax: +1(603)6814226 page 3 of 3 1/1912012 9.25 1 so 0 Sat n!rixtsw�rs. �, - 3f R:",tryS,a'kdla.h'aP ar-rrYe"L1A.m:r s ata #` ami rds ticaxtr Vii: ' :sense; CS,Q28W,, At xpi r ati,ror! Vnrestr cte,�z,� . ding� of�Y� use ri WOUP which n 35,000 cuhi,� feet (99 c� space. f e �� edition of the.Maswhu setts t is s fo►revOCa lOn of this license. For vFS.U>`ens"ng"Mra tion visit: www.mass. v. /DDS c� 0 Dv-parituvot of Public sativv% iRestricted to: 00 O LO t - UE1rest cted C7 O ik. 00` co w MICHAEL J AITOON � M Failure t€� possess a current edition of the a 14 BF SE AVE _ usetts State SulkUng Code x METHUENfA+I is cause for tion of MIS lieertse. O I � Refer to: WWW.Mass.Gov :<s I i=bier TrIt: 10684 N V) w _ a License or registration vslid for iridal we only O ,:_ before the expiration elate. if found return to:MPROVEMEAT n 1` CONTRACTOR Tom. Office of Consumer affairs and Basins Re atiaa F 10 Park plaza- Suite 5170 ,- 1:bcpkafkm ?- moron Boston, [A 02 b t �E1_ �tiETgf a+ N 14 BE#SRE RV LO _ - - o Mme€ i'ei, 01b" C e e tat Nod id without sign m \ O � N N l0 I T Al- _,* T, 7 2 0 12 4.5 RIM 8975 0 02102' CERTIFICATE OF LIABILITY INSURANCE DAI IT F(1AMJ.lD,1Y','Y) 03 16.e iJ DOES NOT AFFIRMATIVELY OR nEGATIVELY AMEND, CERTIFICATE HOLDER.HOLDER. THIS CERTIFICATE '0 RIGHTS OW THE CERTi THIS CERTIFICATE S ISSUED AS A ER OFIWFORbETIO ONLY EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW THISCERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING jvsvRER(S), AUTHORIZED REPREsEff CERTIFICATE HOLDER. TATIVE OR PRODUCER: AND THE IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the poli4cy(ies) must be endorsed. If SURROGATION IS WAIVED, suj t to the terms and conditions of the policy; certain policies may require an endorsement. A statement on this certificate does bnotec confer rights to the certificate holder in lieu Of such endorsement(s) PropucEF camel Ins Agcy Inc 15 Central street (A,!C No. E-1): T4_ LHIL Andover, m •oi8lo IDM .................................................................................... .......................................................................... ................ # Antoon Boudreau Construction Inc IRS11MR A:A.I.M. Mutual Insurance Co 1 DIS11PER B:4 Bears Ave ....................I............................................................................ Methuen, MA 01844 iusH v. ----------------- --------------------- ------ COVERJkGES CERTIFICATE NUMBER: REVISION NUMBER: fs'f5 giffFlsii "JiE NiFiftili�lffwii ............ 7107AITHST.;NDING ANY rEQUIRExENT, W;.11OR CONDITION(T ANY CONTRACT OF OTHER DOCUX'JENT WITH RESPECT TO',*MICH THIS CEgTlrXr ISSUED Or, I�IAj x DESCRIBED HEREIN IS SUBJECT V, ALL THE TEX,1S. EXCLUSIONS ICI PERTA! , THE INSURANCE AFFORDED BY THE POLICIES CERTIFICATE tgvi BE I-Mv HAVE BEEN REDUCED BY PAID CLAIMS. AND CONDITIONS OF SUCH PUL ES LIMITS SHOWN TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICY EZE LTMIT.R wx ackwAUCE NEAGE lo FEUTCD 'reur..... ❑ HED ERP (Iln'y 6 PERSONAL 6 ADV 19JJWZ ;Pp:.;v,-.p. PRDDUTS C01dPlOP AW. S CWWIRED 1"CL, 'DITT BODILY IllikRy (P'L perx-) rODILY IHJURyflerC1,1MI) ::_Rorm y ........................................... .............. 11t, WORXERSC&IFENSATI61F AND EMPLOYEES LIABILITY P rt'a't1P4`/ XE-" 71 FRS AR.1 A 500;000 7026009012012E*L, DISEASE-POLICI L11111 500,000 03`0/2012 03/20/2013 P.A. t1SRASF EA FXPI.011t. lW@IlNTS DL i•'R1FLl UD OP 0012-41163 RF. 500,000 WORKERS' COMPENSATION COVERAGE APPLIES TO MASSACHUSETTS EMPLO',EES ONLY CERTIFICATE HOLDER CANCELLkTION.I ---------------- ------------------ -- j LOWS' COMPANIES INC --------------------------------------------------------------------------------- -----------—-------------------------------- ---- ATTR: IS INSURANCE SHOULD Any OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITHTHE P.O. BOX 1121 POLICY PROVISIoss. N. WILRESBOR0,1 NC 23656 Alf"11ATnA FPPPF.%FXTATT1,T `:'' _I,'I_ 1:!': i'FI FF:)II: aT,a1 :rr:uc„rr.� z'.:::r.a1 :nuL.3r.- ::qui,;”; T:: 1-'-'1-';�'' d`•,1 F £ F ACO_ t[J CERTIFICATE OF LIABILITY INSURANCE DATE (MM'DDNYYY) ' 06107!2012 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 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). Agency,JONATHAN M SAMEL CIC LIA "gin+r Samel Insurance 9 Y.Inc. r" 978.474-0810 SAMEL INSURANCE AGENCY,INC. �-�� I'I�E�s�— 978-474-0890 E-`'raL info@samel-ins.com y - 15 CENTRAL STREET -•c'L,PE;s -- — F'F,',rl FF ANDOVER MA 01810 -,T--(,Fr Ir, 7048 — -------- -----.-_—_.—_.—_ —. —, INSURER(S)AFFORDING COVERAGE N_A_I_C# •r..-Fr - --- -- ANTOON BOUDREAU CONSTRUCTION INC Ii:I:I,r'EP p. ARBELLA PROTECTION 14 BEARSE AVENUE rJSIJPL'F. Norfolk&Dedham Group METHUEN MA 01844 I :_IPLP iN.l!FeP E ltd;-IF•F COVERAGES CERTIFICATE NUMBER: 33808 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. II_i I: TYPE OF INSURANCE Ar DL SI E'P; POUCYEFF POLICYEXP ud'3F ,a'_-y- POLICY NUMBER (t✓Iv690;'YYYYI LIMITS _LNM�D 'YYYY A GENERAL LIABILITY - D _�_ - 8500053771 01/01/12 01/01/13nFFEra E _ 1,000,000 X 1 A'atF =1 TIFF' FII 11 a --`T PFI Fr - FH,t•C H w _ 100,000 — IE' E —iI -n:l,.__,n1 5,000 1,000,000 2,000,000 ,:•ErJI"-,,r'E.-TF I_IP-0I "d-'"L'E:`.rER -- - - „ a 2,000,000 B AUTOMOBILE LIABILITY -- - BA90918816A 11103/11 11/03/12 11,r.i IT,' ;La B�rl�4l�lit' 1,000,000 F:, iFr L:,•,,ni =.r H--in II_rf .-1 iT — — X 1 HiFFF,LI IT',[ - X ,UMBRELLA LIAR l —"—' ----- EXCESS SS LIAR ;•f 1. f I'..L FE rEt IT!',t, .p 'r WORKERS COMPENSATION -----. _ AND EMPLOYERS' LIABILITY I T,� UU r: F- -� __ 'r ANY PROPRIETOR•PARTNEREXECUTIVE i,N — OFFICERT.EMBER EXCLUDED? I I N'q - I F�'�I' 1r-Ftj[ (Mandatory,.NH) _--_.—_.— I>-s ;•„c,r i„Jcl _ r'..:F^;SF.Ft.Fr':IF'I r-rri F P=�,%P-;1 Ira,,-,F'. - - — -- ---- E t lralT -- I•i DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Operations Usual to a General Contractor Lowe's Companies Inc and"any and all subsidiaries are added as an additional insured only as their interest may appear as per written contract with respect to the General Liabiltiy and Auto Liability Policies. 30 Day notice is provided except for cancellation for non-payment of premium which is 10 days notice. CERTIFICATE HOLDER CANCELLATION Lowe's Companies Inc SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Attn:IS Insurance THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P.O. Box 1111 ACCORDANCE WITH THE POLICY PROVISIONS. N.Wilkesboro, NC 28656 Attention: /Jonathan M.Samel The ACORD name and logo are registered marks of ACORD r1g s reserve , STORE COPY_ INSTALLATION SERVICES CUSTOMER CONTRACT- MWORK- INT/EXT/PATIO DOOR LOWE'S OF SALEM, NH, STORE#2382 STORE PHONE: (603)681-4218 541 SOUTH BROADWAY SALESPERSON:ANDREW LULA SALEM, NH 03079-0000 SALESPERSON ID: 1326519 Document Print Date : 05/22/2012 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 CHRIS JANES 781-307-1260 O Customer Address Other Phone 103 FARWOOD, UNIT 2 617-563-4754 L City State/Province Zip/Postal Code D NORTH ANDOVER MA 01845 Installation Address T 103 FARWOOD UNIT 2 O Installation City Installation State/Province Installation Zip/Postal Code HAVERHILL MA 01845 MERCHANDISE AND INSTALLATION SUMMARY MERCHANDISE SUMMARY 1161 : 1161 : STK : 1X8X8' SELECT PINE : 1X8X8' SELECT PINE : PRECISION LUMBER - QTY 1 193569 : 35170FJPMD : STK : PFJ CASE 351 2-1/2X11/16X7 : PFJ CASE 351 2-1/2X11/16X7 : EMPIRE COMPANY, INC. (THE) - QTY 3 238347 : 2827-12 : STK : 3/4X5.5X12RF EMBOSD PVC TRM BOARD : 3/4X5.5X12RF EMBOSD PVC TRM BOARD : ROYAL MOULDINGS LIMITED - QTY 3 310622 : 02021 : STK : PVC INSIDE CORNER WHITE 8FT : PVC INSIDE CORNER WHITE 8FT : EAST COAST MILLWORK DISTRIBUTI - QTY 1 330285 : NEW CONSTRUCTION 313 : SOS : SOS UNITED WIND. RPL VYL PATIO DR : NEW CONSTRUCTION 3131 PATIO 8068 : UNITED WINDOW & DOOR MFG.INC. - QTY 1 Materials Price $ 737.79 "Store 2382 Project No. 354314964 for CHRIS JANES Page 1 of 7 STORE COPY INSTALLATION DESCRIPTION Stock or SOS : SOS 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 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 : cut/ install ext jambs Remove/ replace blinds/ New trim/ remove aluminum around door put up pvc/ brick opening around new slider/ may have to remove pergo by door. Other Work Charge : Yes Comments : No Comment Labor Charges $ 659.00 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. F_ TOTAL CHARGES OF ALL MERCHANDISE AND SERVICES where applicable SUB-TOTAL $ 1361.7 "TAX $ 0.0 DELIVERY $ 0.0 ORDER TOTAL $ 1361.7 Store 2382 Project No. 354314964 for CHRIS JANES Page 2 of 7 STORE COPY BALANCE DUE Work is to commence upon reasonable availablity of Contractor which is anticipated to be N10— [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 $1,000-00: >PCustomer 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- Store 2382 Project No. 354314964 for CHRIS JANES Page 3 of 7 STORE COPY MIT TO S CH ARWrRATJO OVIDED IN M.G.L. c.142A. By: _ --'� Date:_ Lo s Home, enter I By:_ _ Date: _ Owner By: Date: Souse THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THEAGREEMENT 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 DAY OF Lowe's Home Centers, Inc. By: , c (Seal) Print Name: G �L Address (Seal) ,� �,�/J,� 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. Store 2382 Project No. 354314964 for CHRIS JANES Page 4 of 7