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HomeMy WebLinkAboutBuilding Permit #832 - 11 WALKER ROAD 5/21/2012 OORTH BUILDING PERMIT ou60 ,�"o ? y-4 ... ., e O TOWN OF NORTH ANDOVER 0 ' APPLICATION FOR PLAN EXAMINATION �17 Permit N0: / vI Date Received SACHUS Date Issued: IMPORTANT:Applicant must complete all items on this page t t '..f LOCATION �,6 -P. -+ aFF d'T-'nn� F +: tibih )1 S .! s t F. ,J ) t v`' tax r. r Jef as < �e r j1r PRDPER3�'� Og1�1lNER,t'�' y s a, Y 6 Y 2 R+ t w^ S' w.5 :'C 17��t 't � ri 4 >'X �H V y,�F^. i,l+t'.. 2 fk •, _ ac trle., rhop�Villag ,. TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family [IAddition ❑ Two or more family . El Industrial ❑Alteration No. of units: u Commercial Repair, replacement ElAssessory Bldg El Others: (5`p emolition ❑ Other ® ept�cz ❑xlNelt '=F x, 9Ys1 <` Cf Floodpldin,j, ; �Wetla ds 3 ;����11/atershed`District f 'h Y .❑UVa�ter/Sewer< 9 4 �: 'I y"5 1 7- 'i�t i Y DCRIPTION F WORK TO BE PREFORMED. Pe 114 AIAA It I 147r"'n 111/1(16 . ..1"AA1 .1s - r 20 S'er(43 V 0d 0,26MOI Wf hAOLPS 5 (A br� boei a Identification Please Type or P t Clearly) OWNER: Name: Phone: Address: rxr , P CONTRACTORa Narne .trt� Ph 4 MT y, 6'N Exp Date F Supervisor's Construction tr�censeY 5 Y Y f I t i Horne,lmproveriment license, ;_- �: 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. S Total Project Cost: $ 3a. FEE: $ �1 � 5 > Check No.: ZQ 3 k � � ���% 7.� � Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to guaranty fund Signature of Agent/Qwn ignature of contracto i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ T TYPE OF SEWERAGE DISPOSAL r Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ i THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ 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 .Located at 384 Osgood Street a FIRE DEPARTMENT Temp Dumpstet`on site yes no Erre Deparfinentaignature/date � _ Y COMMENTS x , 1 n 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 Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.s1oo-$1000 fine NOTES and DATA— (For department use) ❑ Notified for pickup - Date Doc.Building Permit Revised 2007 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 ❑ 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 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 All Location V V(M 4 Date t • TOWN OF NORTH ANDOVER 0 ti Certificate of Occupancy $ - °° Building/Frame Permit Fee $ �Pf� Foundation Permit Fee7771 $ ' � Other Permit Fee $ ' ` TOTAL $ Check#R&3 a tc Zz6zw 25320 Building Inspector NORTH TONM Of 0 0% 3 - - �,D o , dower, Mass., S A- COCMICMEWICK ��. ADRATED PP�t-`C $ ` BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System i BUILDING INSPECTOR THIS CERTIFIES THAT............. �...... �.iv.�........................................�........... - Foundation � r has permission to erect...........:........ ...... buildings on ...... (........../1,10: C'.C.�i. ..... .... .0+1. ... Rough s to be occupied as..........to...... +�► .........�J��f0M�1 Chimney .... ................ . . . .. . . . . . . ................ provided that the person acceptin this ermlt 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 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUC S Rough Service .............................. ....................... BUILDING INSPECTOR I Final J 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 Smoke Det. • :.. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, Mass. 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/lndivi(luitl): &reehf -lnsfq lto, •ion W -IVIC, L-Fcoqap &reerve Address: 16 S Bow 5 f"-ef City/State/Zi : ft /� o2 i I o p E ver2 l A 9 Phone#: 6 -7 Sq 2—�(3 q Are you an employer?Check the appropriate box: Type of project(required): I I am an employer with _ 4. 1 am a general contractor and 1 6. -1 New construction /employees(full and/or part time).* have hired the sub-contractors 2. .I 1 am a sole propri(tor or partner- listed on the attached sheet. 7. I Remodeling ship and have no employees These sub-contractors have 8. 1 Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance. :h 9. I Building addition required] 5. ! We are a corporation and its 10. l Electrical repairs or additions 3. 1 1 am a homeowner doing all work officers have exercised their myself [No workers' comp. right of exemption perm MGL 1 I• "i Plumbing repairs or additions insurance required] t c. 152, § 1(4),and we have no 12. ! Roof repairs employees. [no workers' comp. insurance required.] 13. ! Other_ "Any applicant that checks box#1 must also till out the section below showing their workers'compensation policy information. •!-Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 1:Contactors that check this box must attach 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 ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and,job site information. insurance Company Name:_ •T. '-1• Mv6A Policy #or Self-ins. t,ic. #: 70 2 S�S�cjy p 1A a(�L Expiration Date:/3 — Job Site Address:__ __ `II (meq Cit /State/Zi p:___ 9,kil�ow YnA. 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 152 can lead to the imposition of criminal penalties of a tine LIP to $1,500.00 and/or one year imprisonment as well as civil penalties in the form of STOP WORK ORDER and a tine of $250.00 a day against violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under the pains andpenalties of perjury that the information provided above is true and correct. Si nature• Date Print Name: Phone# d (? 59A--q3o q Of 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 Heath 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact person: Phone#: N Dclru-ttncnt of Public Sat etN 80ard (if Building-, Re-.mlations and Standards Construction Supervisor License License: CS (11719 RONALD A GREENE 10 RITA DRIVE MEDFORD, MA 02155 , _ o-- l'"G- 'y�J�-` Expiration: 10/27/2013 < mnni.�f nc' Tr—": 5199 i �I.t�.achla�ctt` - Depallment of P11111iv `AO% Bow—d(►f Buildint; Rc,—,uhitit► nd Stan(hwd% Construction Supervis r L' ense License: 61719 Restricted t IG ~ RO LD A GREENE I 1 ITA DRIVE EDFORD, MA 02155 Expiration: 10/27/2011 t t+tstmiivt9et Tr# 6717 > o7rvrnW aiBd (�ag,,,,�atoi L& Officeo onsumer airs mess a ulat�on I HOME IMPROVEMENT CONTRACTOR Registration: 102957 Type: Expiration: 7/3/2012 Private Corporatior GRE INSTALLATION CO.,INC. Ronald Greene 165 Bow Street Everett,MA 02149 Undersecretary 0 From: 03105/'2012 10:52 #272 P.0011001 ACORD,,, CERTIFICATE OF LIABILITY INSURANCE PDATE 03/05/2012(MMIDDrYYYY) 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). PRODUCER NAME: New England Heritage Insurance Agency Group, Inc. PHONE 781.438.5000 78435028 335 Main Street a A"O E'" --- N.):.781._8._M ADDRESS: Stoneham, MA 02180 - _ —......_.................__..-__-�--INSURERS)AFFORDING AFFORDING COVERAGE NAIC p INSURERA: Safety Insurance Company !39454 INSURED Greene Installation Co. Inc. — -- - ---- ------- INSURERB: Safety Indemnity Ins. Co. ;33618 165 Bow Street ---- --- - - - _._ INSURER C: Everett, MA 02149 INSURER D: --- - - INSURER E: INSURER F: ...-------•- - ----...._ ------- COVERAGES CERTIFICATE NUMBER:Master 11-12-13 Revised 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. YNSR -------------- - -........ ADDC U6R ... - - - --------- _..-----._...._ ...._.......-.__..._.__��-- LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMIDDIYYYY MM DD�hY�yy LIMITS GENERAL LIABILITY I XBMA000851 05/0812011 05/08120121 EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIAB DAMAGE'lO'RENTEO' - L. -- _.. ... ......._._. ..._..... X ! LITY PREMISES (Ea occurrence) $ _ 1QQ,QQQ ` CLAIMS-MADE I X ll OCCUR —� - A ;.._..... _._ _I MED EXP(Any one person)- it$ 10,000 - -— --.. PEONAL 8 ADV INJURY 1,000,000 RS _....__._.___.-_--._-.-.__-- -- 'GENERAL AGGREGATE s 2_,_000,000 1 GLN'L AGGREGATE LIMIT APPLIES PER: '---'� -- PRO• r I PRODUCTS-COMP/OP AGG S 21000.000 POLICY JECT i LOC r— -..._ �-------..-_ AUTOMOBILE LIABILITY 6208932 01/30/2012 01/30/2013 Ea accident $ 1,000,000 ANY AUTO BODILY INJURY(Per person) l$ B - AUTOS LL OWNED X� SCHEDULED _------ _ i BODILY INJURY(Per accident) $ _......; AUTOSNON-ONEO l RIIPERTS'DAN(A - .X J HIRED AUTOS J AUTOS $ (Per accident)— UMBRELLA LIAB OCCUR A EXCESS LIAR 01/30/2012 01/30120131 EACH OCCURRENCE is 1,000,000 Qo _ .. CLAIMS-MADE (_.. ._._. _._._._........ .__... ..._..---. j AGGREGATE $ D X RETENTION$ 10,000 � s 19000,00 AND EMPLOYERS' SEPARATE CERTIFICAT AND EMPLOYERS'LIABILITY YIN TORY LIMITS E_R I A RIETORIPARTNER/EXECUTN - TO BE PROVIDE OFF, CERlMEMBER EXCLUDED? N] NIA E.L.EACH ACCIDENT $ 1 (Mandatory In NH) BY CARRIER ......__.....---...... IfNs.describe under E.L.DISEASE-EA EMPLOYEE'$ DESCRIPTION OF OPERATIONS below 1 E.L.DISEASE-POLICY LIMIT $ —� i t � I I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Addltlonal Remarks Schedule,It more space Is required) Installation of doors and windows. Subject to the terms, conditions, endorsements, and exclusions A the policies. 10 day cancellation clause for non payment, 30 days for all other regarding General /'ability. Lowe's Companies Inc. and any and all subsidiaries are named as additional insured er written contract for General Liability and Auto Liability purposes only. CERTIFICATE HOLDER CANCELLATION FAX: 781.537.5464 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Lowe's Companies Inc. IS Insurance AUTHORIZED REPRESENTATIVE P.O. Box 1111 North Wilkesboro, NC 28656 William Kelly/JAL ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD From: 03/05/2012 11 :57 #275 P.001/001 CERTIFICATE OF LIABILITY INSURANCE DATF,(NMf/DD/YYY) 03/05/2012 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) PRODUCER CURT ACT New England Heritage Insurance H PHONE..--............. — FAL! ._ Agency Group Inc (A/C. No. Ext): (A/C. No): e-HA[L 335 Main Street ADDRESS: P0.4'1UCER -' .Stoneham, MA 02180 CUSTOMER ION. i1U:11kF.i� - INSDRED(S) AFFORDING COVERAGE _.. NA[C Green Installation Co Inc INSURER A: A.I.M. Mutual Insurance Co 33758 1165 Bow Street INSURER B: �[ ,} INSVPER C: Everett, MA 02149 :NSURER D: i :xcURaa E: IN.UPIR P! _ ----... COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: T THT5 SS TO CERTIFY THAT 7}iE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN !SS 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 ALI. THE TERMS, ErACLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Lt. TYPE OF INSURANCE POLICY NLIMER POLICY EFF POLICY EXP LIMITS Dn7DD/rrvt� nxiDO/rvwi GENERAL LIABILITY EACH OCCURANCE $ �.::•M!I:Iv'J A1.•,;F71FJiRL LI FR7I.J T'i IXTI11..11S 11I%7i? r Ui, PREMISES(Ea.ocNrranca) MED ETP (Any one Parson) $ ❑ PERSONAL I ADV INJURY $ GEE' w:vA E.:RTE LIHiT APPLE, 3'.: GENERAL AGGRRCATE $ PRODUCTS-COMP/OP ACC $ 1 ' AI$`OMOBiLE LIABILITY COMBLHED 6INGLR LZHIT ae ALL C'..TJCO NJTr, BODILY INJURY (pat pars—i $ BODILY INJURY(Par—1dant) $ �HIFF.C•A;'TiS PROPERTY DAMAGE • _-..................._...... ..".._ �1+-,A-•..nJrr•A ,.i-. (Per crldeat) S ❑I!Y I:k 1!1.i�1 .•.JRA ❑ .:._i,iiA EACH OCCURRENCE $ ❑E';LE:F LIAY ❑ :LN:`-15 MRDE AGGREGATE $ ❑I%FFA 1r;;T i F I.F. s- - 4fOR[CHRS COMPENSATION -----" i ® eC TTATU- ---......._.._.._..._................ AND FMPLOYF,ES LIABTJ,ITY MX- AaaY LSMITf ER TNG F'H�FRIF.TOF.;`FARTtJEP.'_! - EXE.,,:IIT'VE "FFICER:i ARE E.L.. , EACH ACCIDENT $ 500,000 _ ❑ excl 7025594012012 03/04/2012 03/04/2013 t.L. DISEASE -POLICY LIMIT s 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 COMMENTS DESCRIPTION OF ODF.RATLONE OR IOCATIONS; WORKERS' COMPENSATION COVERAGE APPLIES TO MA EMPLOYEES ONLY i CERTIFICATE HOLDER _i CANCELLATION LOWE'S COMPANIES INC IS INSURANCE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE P 0 BOX 1111 EXPIRATION DATF THEREOF, NOTICE WILT. BE DF-LTVERED IH ACCORDANCE: WITH THE POLICY PROVISIONS. NORTH WILKESBORO, NC 28656 — AUTHORIZED REPRESENTATIVE: C\��11"'�� — 8010290169©2011,RR Donnelley.All rights reserved.-0221 1 CONTRACT# o t f 0 f..4 6 MASSACHUSETTS EXTERIOR SOLUTIONS INSTALLED SALES CONTRACT INSTALLED SALES SPECIALIST NUMBER CUSTOMER illi A' t[Ac),P,4;.::- � 1f d� � �?7 VG14 STORE NO. STREET ADDRESS STREET ADDRESS CIN STATE ZIP CIN STATE ZIP is ` t�v F C.t'v M 0 TELEPHONE TELEPHONE f DATE LOWE'S HOME CENTERS,INC.'S MA HIC NO.:148688 CASH BANK LCC REG FEIN:56-0748358 CHARGE This is only a quote for the merchandise and services printed below.This becomes an agreement upon payment.Upon payment,the entire agreement,including thespecifically completed pages of this document,the Terms and Conditions included with this document and any other addenda and attachments hereto,shall be:referred to herein as this"Contract' PLEASE.READ ALL TERMS AND CONDITIONS ON THE REVERSE SIDE OF THIS PAGE AND FOLLOWING PAGES BEFORE SIGNING. INSTALLATION STREET ADDRESS JCITY STATE ZIP (.�!Gl)ti•^-' {/, i !1. L'f F't � �Ut A 0/U �,_ '�'1 ti".., 7/ t�4�� j}T f!<,r 7 Jv:�d...�,,..;f, ✓ ..� Cf iY l t/', psi 6''r`e r, w,- ;'i- , .=(.t 1{ AJJ I)F' J U 4- (6/1 t I 7-t.f-``e L PV v {i Contract Total Are permits required for this installation?:[ Yes [ ]No applicable tax included �i v NOTICE TO CUSTOMER: Federal law requires Lowe's to provide you with the pamplet Renovate Right.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. PHOTO RELEASE:Customer grants to Lowe's and Lowe's employees the right to take photographs of all work performed at the Premises related to this Contract,and irrevocably grants to Lowe's all right,title and interest in and to the photographs for use in all markets and media,worldwide,in perpetuity. Customer authorizes Lowe's to copyright, use and publish the photographs in print and/or electronically, and agrees that Lowe's may use such photographs for any lawful purpose, including,but not limited to,marketing, advertising, publicity, illustration, training and Web content. By initialing here,Customer agrees to the foregoing! [Customer to initial to the left]. Work is to commence upon reasonable availability of Contractor and/or any special order or customer made Good(s)which is anticipated to be [fille in date].Estimated completion date is 0 '/. [fill in date]. Said estimated substantial completion date is not of the essence. A statement of any contingencies that would materially change said estimated substantial completion date is as follows: (if applicable,inserts statment of such contingencies). 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: [."]"6ustomer to Pay in Full; OR [ ]Customer to use the following payment schedule: (1)Deposit $ to be paid upon siging 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. 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 CONTRACT,THAT LOWE'S MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUT- IVE OFFICE OF CONSUMER AFFAIRS AND BUISNESS REGULATIONS AND THE OWNER SHALL BE REQUIRED TO SUBMIT TO SUCH ARBITRATION AS PROVUV)ECD IN M.G.Lr,c.142A. -- f J By: /' PL i-7 l-'� iv Date: Lowe's Home Centers_,.Inc. {" By: l ,PT.r.... Date: _. Owner Sig attire ..__ 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. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AND UNTIL YOU HAVE READ THE TERMS AND CONDITIONS CONTAINED ON THE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS CONTRACT. BY SIGNING BELOW,YOU ARE ACKNOWLEDGING THAT YOU HAVE READ,UNDERSTAND AND AGREE TO THE TERMS AND CONDITIONS SET FORTH ON THE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS CONTRACT.YOU ARE ENTITLED TO A COPY OF THIS CONTR/p7C/T AT THE TIME OF SIGNATURE. WITNESS OUR HAND(S)AND SEAL(S)BELOW THIS�_DAY 0. 7 Lowes Home Centers,,Inc. Specialist o Above { -': Owner Co-owner or Witness Customer acknowledges reds^pt of a true copy of this contract which was completely filled in prior to Customer's execution hereof.You,the buyer,ma .__.____..___.s_.. f o ...true.,.„.:a..f th R.te r f thi.trar.eactinn Soo the attached notice of cancellation