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HomeMy WebLinkAboutBuilding Permit #767 - 165 WAVERLY ROAD 4/25/2012TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: / ('-7- Date Received Date Issued: G1 ) v EUPORTANT• Applicant must comRlete all items on this Dave Print Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes 100 year-old structure ves (Identification Please Type or Print Clearly) OWNER: Name: Phone: �7r" 335-�� Address:_ CONTRACTOR Name: �b,�r►d ��i�-f�n6 Phone: q`l $' �o_q.20 Address: 5L, -pit45u 6/ Supervisor's Construction License: 2 3 3 6 5 Exp. Date: Home Improvement License: I D F7YZ Exp. Date: ARCHITECT/ENGINEER 0 Phone: /.Z Y /2 8Zs/z Address: Reg. No. FEE SCHEDULE: BULDING PERMIT. $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F. Total Project Cost: $ , qg5. � .I, - FEE: $ Check No.: Receipt No.: 2� NOTE: Persons contracting win th Treg 4terecd contractors Flo not have acces hegua�q ty ficnrl Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer El' Tanning/MassageBElody Art Swimming Pools [I well ❑ Tobacco Sales ❑ Food Packaging/Sales El 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 Si nature COMMENTS i 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/ si nature &Date nrivpwav 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. ft.: ELECTRICAL: Movement of Meter location, mast or servicedroprequires approval of Electrical Inspector Yes DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine Doc: -Building Permit Revised 2011 June/mi 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 i ❑ 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 o Flo or/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 o 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 r Location. JF No. � Date t� J f TOWN OF NORTH AN[OVER f Certificate of Occupancy Building/Frame Permit Feeo Foundation Permit Fee Other Permit Fee $ TOTAL Check #10,3S l 25226 dam -- Building Inspector asco u. cn x Om z -a tj. x ED G2 U fi. o a x t� a,. 0 . w0.4 a x C2 m Li. O x G4 [s. � v W z cn v 0 co Gil O z co O CD `'~ E U c cs ; W o � C N O = ►'_7Z F o v V i C.7 ac co m M o Ea m o := w 0 CLAA 2 m cm i-4 c m = E cc • MM b J m 3 M U) m N l�6•��°a, C � ♦ - m o C6) a CO A H G m Amo CD N m m 12 o o, Cf) • V NO. b ca •� Z m c cm Ci Q m !... t 3 •o = m m �, C N H w�.. H yam• 12 m ce Z W �r=.+•pt r•+ s.+ j. •N CD a.0 m Z oc •E U= ;; ama •N o_ . LU b O CD 1E CM C ~ V m ti C_ • 2 co CD � O v Z � d O y � C Cm CA O •� CD — M m m co CD o cc o a a tma c o ccc co CD C Z � V v* c C C •= _c ca 0 Im cn cn W W W cn The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 131 600 Washington Street Boston, MA 02111 wwtv.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): D owl d Re(Aar b Address: 56 PleaSan G4e4 City/State/Zip: Ne i i-hVer , /r1h O i f yy Phone #: g ? y- 360- q zo; Are you an employer? Check the appropriate box: 1. I am a employer with !J 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ 1 am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 3. ❑ I am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152, §1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. F1 Electrical repairs or additions 11.0 Plumbing repairs or additions 12.❑ Roof repairs 13. ❑ Other *Any applicant that checks box #I 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 thepolicy and job site information. Insurance Company Name: . J ' Policy # or Self -ins. Lic. #: tD AVIC,Zzgq Expiration Date: roil-- /a. Job Site Address: Jt— VOe11 City/State/Zip: 6 f �Nr( r 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 c�rtify)uno the p#&' a#d penalties of perjury that the information provided above is true and correct. Phone #: q,71- uv- q2a- /.x -26 )7 Official use only. Do not write in this area, to be completed by city or town official City or Town: Issuing Authority (circle one): 1. Board of Health 2. Building Department 6. Other Permit/License # 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector Contact Person: Phone #: . Fe&5 24 11 02:33p mew <51 ICMXL F. ob a > x C M n SSE. " il m OWI —3 w 040 M ot m 2 lie 0 rN 4 0 0 W CD - 0 CO V7 F (D 7 p. 3 E E \ a \ \ / 2 { \ « L \ cm \�\9�»ok� ,gam /2 `® §22 �a o/§ E E . Paychex, Inc. 12/13/2011 2:56:02 PM PAGE 3/003 Fax Server CORD :::::: �+..�+:+,:..:,.:::.... tt.:.:>:....:::..::.:....:.::.....::.``...,:..>.:...t..;....:..:.::p.�;.:.r;.:........::::::::......:......::::::::::::: A :? ATE MMND 1✓CRT1F1CATE � S. -:U. D !YY , _ L� L I G ::" ;; ? ::;:;';`"' 12!13111 . ;; 7777...::.. ....... 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 COMPANIES AFFORDING COVERAGE PAYCHEX INSURANCE AGENCY, INC. c: 150 SAWGRASS DRIVE A GUARD INSURANCE GROUP ROCHESTER, NY 14620 - -7.7.7-7----- GCYdPAN1' --__. B INSURED DAVID REPANO `'"A ""N 56 PLEASANT STREET METHUE.N, MA 01844 ---- — — -------- C W PAN) D t111.E(iAGES::::::::::::::::::::::::::::::::::::::::;lTlEATE:1It1:IlRB1»ft: ::: ..::::....... :.:7.777,,.; 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 O_ F SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ------ --------...___..___._..._._._. ----...----------7.777---..--------- — — _.. TYPE OF INSURANCE I POLICY NUMBER LTR POLICY EFFECTIVE POLICY EXPIRATION LIMITS DATE (MMIDD'YY) DATE (MMIDDIYY) GENERAL LIABILITY COMNtf RCIAI_ GENERAL LIADII ITY GFNFRAI. AGGRFGAIF $ ------- I LAWSMADE =-)OCULI PRODUCTS -COM PttIP AGG $ PERSONAL & ADV INJURY i$ - EACHoCCUHHENCE ' $ FIRE DAMAGE {Any ono tire? 1$ - MED EXP (AnV �:'�� per;on)$ AUTOMOBILE LIABILITY ANY AUTO CCTMBINED SINGLE LIMIT $ ALL OWNED AUTOS --- BODILY INJURY ------- S SCHEDULED AUTOS' (PBT pets -:•n1 HIRED AUTOS NON OWNED AUTOS BODILY (Per ac•:'INJURYdenti � PROPERTY DAMAGE — $ GARAGE LIABILITY AUTOONLY EA ACCIDENT — j 5 ANY AUTO C)LHER THAN AUTCI ONLY:-- -- — EACH ACCIDENT $ --"'----------- AGGREGATE $ EXCESS LIABILITY UMBRELLA FORM EACH OCCURRE NCE $ AGGREGATE - — S (-)I HLH 1 HAN UAABHLLIA IaJRM ---- $ WORKER'S COMPENSATION AND wC STATi OTH X�r�iMiTI A EMPLOYERS' LIABILITY DAWC226669 06/11/11 06,11/12 EI_ EACH ACCIDENT _— $ 500.000.00 E P.—P •r -T;*,; INCL EL DISEASE - POLICY LIMLL --7777 S 500.000.00 �'AI;1',1F.RS;EXEC!TMC EL DISEASE EA EMPLOYEE S 500.000.00 crF Cer•.S r,=.P X� EXCL OTHER DESCRIPTION OF OPERATIONS ! LOCATIONS % VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required) Gi~f� I I t ca�E M41.a :<::�::>::<:::>::::::::::::: "#�aN 7777 . .................. _ .....:.::::.::.,.:::77.7::7., :.::...:::::............... LOWE'S COMPANIES. INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION PO BOX 1111 DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY NORTH WILKESBORO, NC 28656 PROVISIONS, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES, AUTHO-MZiED REPRESENTAPVE J .........................:..................................:...............................�.•.•.�.�.�.�.�:.�::.�.•.•.�:.�.•:.�.�:::.�.•:::.�.�.•:.•.�.�. acon:2<: . os�as .......:::::......:::::.... 7.7 7 7 ......... ::..: ........................:.•. ..•...�..::...:•:•..::.•...::::.•:::.�::•:::::•:•;:�::::.:.;.:.:.;:�AGflt�fl:CQf#POf�1k`C�bN::�9$$::::::::: .Paychex, Inc 12/15/2011 1:53:39 PM PAGE 2/007 Fax Server AC.. CERTIFICATE INDICATED, NOIWITHSIAN1YNG ANY REC)UiREMENI. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS -- OF LIABILITY INSURANCE 1 12/15/2011YYYY) 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(les) 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 PAYCHEX INSURANCE AGENCY 150 Sawgrass Drive Rochester, NY 14620 1 CONTACT NAME: PHONE — FAX C No. Ezfl: 1�A/C _Noe______ E-MAIL ADDRESS: INSURERS) AFFORDING COVERAGE _ NAICA GENERAL I.IABIL.ITY INSURER A: INSURED David Reitano d/b/a David Reitano Remodeling and Building 56 Pleasant Street INSURER B : Am GUARD Insurance Company 4.2_39.0_____ INSURER C — INSURER 0: Methuen, MA 01844 NSURER E INSURER F ''"dhdEP.CIAL GENERAL LIAPJLITY 1H IS IS TO CERTIFY THAT -HE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOIWITHSIAN1YNG ANY REC)UiREMENI. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THF. INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIOp.'S AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIIVI.S. --- ---- INSR LTR TYPE OF INSURANCE U� BR INSR WVD POLICY NUMBER . pOLICY EFF MM,DDIYYYY I POLICY EXP MWDDIYYYY - LIMIT$ GENERAL I.IABIL.ITY .--- EAC -Ii OCCURTI.GNCC °; 1,000,000 ''"dhdEP.CIAL GENERAL LIAPJLITY _ D MACE TU cN PREh•II6ES(Ea oceurlence 'F 50,000 X__ X]i'.I ;11k':J LIAC£ �••CC I DABP100985 12/01/2010 12/01/2011 .-:UR MERE. P(Ant-cn<per¢•_ri $ 5,000 PLRSONAL S AUV INJURY I i Included GEHERAL AGGREGATE_ Is 2,000,000 i_itN'L.A'.;i;REt_;iTE L INTI T APF LIES DE4.... - ! PRDDIJC T3-c,f1P4Pn.iP Ata I'` 2,000,000 X - I Ia AUTOMOBILE LIABILITY C:CM61^1 D SIN'3LE L IIT I 'La aceldent:. ` ANY AtI'c.;' rY7UILY INJURY (Per person} All:?Lt; NfD �� •i'HCDI!LF; Al A!-'� I PODII.Y INJURY /Per arsidenl? $ ^JCN-''`l"!NFC HIH9U AU TO?; AIJr_�; PROPERTY DAhAAGE 'Par agriden[1 _ . $ UMBRELLA LIAR u; EXCESS LIAR ?Gs3RC3a.TC i WORKERS COMPENSATION -- WC BTATL AND EMPLOYER S'LIAB(LITY YINT-1R 1 E.L. EACH .00CIDENT .' :.Ny Pii::4`RI�'TUR!F7lRTNr.:WEXGaUTf`.rE� .-'FFICF vd.6Si'SEER E?SJLL?'Ic0? �; I NlAI E.L. DISEASE - EA. EMPLOYEc$ (Mandatory in NH) I1 •-es yes ripe untie, Df'iC:z IPTLiN ;.•F. _f'ERATP=NS l:elO`n' F.L DISEASE PgLICY LI MIIT i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101• Additional Remarks Schedule, if more space is required) LOWE'S COMPANIES, INC. ATTN: IS INSURANCE PO BOX, 1111 North Wilkesboro, NC 28656 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE v raoa-/U IV At UKU VUKYURATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 8010290181 ©2011, RR Donnelley. All rights reserved. - 0221 CONTRACT # 0 03 E EXTERIOR SOLUTIONS INSTALLED SALES CONTRACT -y--DSALES �SP)ECIA T: NUMBER: STORE NO. STREET ADD Ll T l� CITY STATE L...SO4ZEM ZIP C301 TELEPHONE 6D3_� (c8 l - 121 CUSTOMER STREET ADDRESS CIN STATE ZIP ANI 01Z IP -78 �S_ S-76-7 CASH CARD LCC � CHARGE DA LOWE'S�C/ONTRACTOR LICENSE ER��� 74.This is only a quote for the merchandise and services printed below. This becomes an agreement upon payment. Upon payment, the entire agreement, including the specifically 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. u�o inw�ilVIV JI RCCI AURtJJ CITY STATE ZIP -_ cov %V N '_. ) Orz w )AJVffI QlM Na') A. 1U '/ Contract Total I7�`'/Cid5� *applicable taxes included � f (,j NOTICE TO CUSTOMER: Federal law requires Lowe's to provide you with the pamphlet 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 19 commence upon reasonable availability of Contractor and/or any special ord r r cu tore, er made Goods) which is anticipated to be [fille in date]. Estimated completion date is [fill in date]. Said a itnated/substantial completion date is not of the essence. A statement.of any contingen ies that would materially change said estimated substantial completion date is as follows: (if applicable, insert a statment of such contingencies). This Contract provides that all claims by Customer or Lowe's will be resolved by BINDING ARBITRATION. Customer and Lowe's GIVE UP THE RIGHT TO GO TO COURT to enforce this Contract (EXCEPT for matters that may be taken to SMALL CLAIMS COURT). Lowe's and Customer's rights will be determined by a NEUTRAL ARBITRATOR and NOT a judge or jury. Lowe's and Customer are entitled to a FAIR HEARING. But the arbitration procedures are SIMPLER AND MORE LIMITED THAN RULES APPLICABLE IN COURT. Arbitrator decisions are as enforceable as any court order and are subject to VERY LIMITED REVIEW BY A COURT. FOR MORE DETAILS: Review the section titled ARBITRATION AGREEMENT, WAIVER OF JURY TRIAL AND WAIVER OF CLASS ACTION ADJUDICATION found in the Terms and Conditions of this Contract. 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 ADRESS CIN _ STATE ZIP Customer acknowledges receipt of a true copybf this contract which was completely filled in prior to Customer's execution hereof. You, the buyer, may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction. See the attached notice of cancellation form for an explanation of this right. I © 2004 by Lowe's.® Lowe's and the gable design #90794 (Rev.12/10) FILE COPY f t are registered trademarks of LF Corporation. Contract Total /�:j�V "applicable taxes included t t (.) • V, NOTICE .TO CUSTOMER: Federal law requires Lowe's to provide you with the pamphlet 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. .J . ..__. ► 01c LAIM 1AJ V 1►�i 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 comrpence upon reasonable availability of Contractor and/or any special ord or cu to er made Good(s) which is anticipated to be Da Fos C Said e i ate substantial completion date is not of the essence. A statement of any contingen ies t t would materially change said estimated substantial completion date is as follows: Customer acknowledges receipt of a true copybf this contract which was completely filled in prior to Customer's execution hereof. You, the buyer, may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction. See the attached notice of cancellation form for an explanation of this right. I © 2004 by Lowe's.® Lowe's and the gable design #90794 (Rev.12/10) FILE COPY f t are registered trademarks of LF Corporation. Contract Total /�:j�V "applicable taxes included t t (.) • V, NOTICE .TO CUSTOMER: Federal law requires Lowe's to provide you with the pamphlet 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 comrpence upon reasonable availability of Contractor and/or any special ord or cu to er made Good(s) which is anticipated to be `f7, ?/1 Z [fille in date]. Estimated completion date is [fill in date]. Said e i ate substantial completion date is not of the essence. A statement of any contingen ies t t would materially change said estimated substantial completion date is as follows: (if applicable, insert a statment of such contingencies). This Contract provides that all claims by Customer or Lowe's will be resolved by BINDING ARBITRATION. Customer and Lowe's GIVE UP THE RIGHT TO GO TO COURT to enforce this Contract (EXCEPT for matters that may be taken to SMALL CLAIMS COURT). Lowe's and Customer's rights will be determined by a NEUTRAL ARBITRATOR and NOT a judge or jury. Lowe's and Customer are entitled to a FAIR HEARING. But the arbitration procedures are SIMPLER AND MORE LIMITED THAN RULES APPLICABLE IN COURT. Arbitrator decisions are as enforceable as any court order and are subject to VERY LIMITED REVIEW BY A COURT. FOR MORE DETAILS: Review the section titled ARBITRATION AGREEMENT, WAIVER OF JURY TRIAL AND WAIVER OF CLASS ACTION ADJUDICATION found in the Terms and Conditions of this Contract. DO NOT SIGN THIS CONTRACT UNTIL COMPLETE AND YOU HAVE READ THE TERMS AJVD CONDITIONS CONTAINED ON ALL 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 ALL POA13ES OF THIS CONTRACT. YOU ARE ENTITLED TO A COPY OF THIS CONTRACT AT THE TIME OF SIGNATURE. AT WITNESS OUR HAND(S) AND SEAL(S) BELOW THIS G 2 DAY OF Lowe's Home Centers, Inc. O , er Special' t or AbO14 Co-owner or Witness Customer acknowledges receipt of a true copybf this contract which was completely filled in prior to Customer's execution hereof. You, the buyer, may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction. See the attached notice of cancellation form for an explanation of this right. I © 2004 by Lowe's.® Lowe's and the gable design #90794 (Rev.12/10) FILE COPY f t are registered trademarks of LF Corporation.