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HomeMy WebLinkAboutBuilding Permit #885 - 175 MAIN STREET 6/22/2011BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: 6 a -) // Date Received Date Issued: �� 6 IMPORTANT: Applicant must complete all items on this page LbCfATIyQNr_ _ L_7 _S . l'^ aih :...,... ___ __ _ _ RRO,PERT�Y OWNER1 QhQ1f iVeqY1 _- .�,.._,,.. _-._r.:.. a r.. Pnnt� _ _ `A _ HistocDtncf I-MAPNO PRZ DIST, o wnrhina::4hnn'\Yillaria TYPE OF IMPROVEMENT PROPOSED USE �s Residential Non- Residential ❑ New Building %One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial I Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 'Septic ®Well ❑,Floodplain ®�VI/etlands . ❑;'Vl/aterstied©istr"ict DESCRIPTION OF WORK TO BE PREFORMED: ge"y el �•eo21ac..e -9ycvi��ndows, do &c�k Wok 4� b s Identification Please Type or Print Clearly) OWNER: Name: C -"Vi* /'ll-e(JkY\ Phone: Address: 115 Nla�h ` A,ndov er CONTRACTOR Name V.ince�n� Mow hone: 7 $l- 233- cgco rAOress: 1._ vk ucn.r r .��. wx us,. +l.A... Q_t9ob Supervisor's .Con""struct'ion'License° 9 917_°e.. -1 Home•Improyemefit-.License:.-__ ARCHITECT/ENGINEER NIA Phone: Address: Reg. No FEE SCHEDULE. BULDINIG PERMIT. • $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F. Total Project Cost: $ is Ito _ FEE: $ O Check No., Receipt No.: e) ��� -0 NOTE: �ersons=ontr�acfing�iithunr glistered contractors do not have access to the guaranty fund SignaturezofrAgent/Ovvner:_. _ ___ aSignature,ofcontractor --�� 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 PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS DATE REJECTED DATE APPROVED El Reviewed on Signature HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comme Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE;DEPARTMENT -Temp Dumpster onsite yes tno. Located at 1ain Stfeet F�retDepar`tmerit{signature%da#e 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 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 2008 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 DEPARTMENTMFORM07 Revised 2.2008 Location r 1v . 4La E: No. 4&r-- Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ ca --7 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ —6 Check # 7 2 4 %-.) L u Building Inspector .r N � 9. O q. < �' •.+ O Y= O = V C 0 CD N J p ti Omc . � • O. is �;,, ym Cp C � � H N y m 3z CO CD f m S Cc 94 N CIO ' M :ave m y m ' V r L o cm •coa � e• act �� M :; o c a o A •O C ++ COD .y "ns `� c Z m 0ui�E C3,r o .0 C W L 'O V O H m10 E � Cl z m CLFE w cmA ` y' O I- .0 $ CL*- In �lm 0 s co O CD L O � v Z m CL O y cm I C C co.MM W CL ~ 'C-.• O O C O _O O a CL v�Q c C3 c O R COD Cl CL O C Z O V CO) � C C COD 0 U) Y/ W W ce W Cd c o :arc o ` : c N O : �CJ o Cc 000 m c s �m U O GO U W 12 00 c ' 'CA0 m W D0 o ° a C c w w w U w n°' a4 U) w°' rA U) cn N � 9. O q. < �' •.+ O Y= O = V C 0 CD N J p ti Omc . � • O. is �;,, ym Cp C � � H N y m 3z CO CD f m S Cc 94 N CIO ' M :ave m y m ' V r L o cm •coa � e• act �� M :; o c a o A •O C ++ COD .y "ns `� c Z m 0ui�E C3,r o .0 C W L 'O V O H m10 E � Cl z m CLFE w cmA ` y' O I- .0 $ CL*- In �lm 0 s co O CD L O � v Z m CL O y cm I C C co.MM W CL ~ 'C-.• O O C O _O O a CL v�Q c C3 c O R COD Cl CL O C Z O V CO) � C C COD 0 U) Y/ W W ce W Cd c o :arc o ` : c N O : �CJ 1w. ;.QC Cc 000 m c s �m N � 9. O q. < �' •.+ O Y= O = V C 0 CD N J p ti Omc . � • O. is �;,, ym Cp C � � H N y m 3z CO CD f m S Cc 94 N CIO ' M :ave m y m ' V r L o cm •coa � e• act �� M :; o c a o A •O C ++ COD .y "ns `� c Z m 0ui�E C3,r o .0 C W L 'O V O H m10 E � Cl z m CLFE w cmA ` y' O I- .0 $ CL*- In �lm 0 s co O CD L O � v Z m CL O y cm I C C co.MM W CL ~ 'C-.• O O C O _O O a CL v�Q c C3 c O R COD Cl CL O C Z O V CO) � C C COD 0 U) Y/ W W ce W _do The Commonwealth of Alassachusetts Department of Industrial Accidents Office of Investigations a { 600 Washington Street 4V Boston, ,MA 02111 www.mass.gor/din Workers' Compensation Insurance Affidavit: Builders/Contractors/Flectricians/Plumbers Name tliusinessror,anizatiun-Individual►: v t lays-iSr?-_:�._�t Address:. City/Stale/Zio: ' i qG, Are you an employer' Check the appropriate box: 1. ❑ I am a employer with _ =1• ❑ t am a general contractor and I - employees (lull and/or part-time).` have hired the sub -contractors _ [ 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. - nsurance.-required.I required. I • ❑ We are a corporation and its 3. ❑ 1 am a homeowner doing all work officers have exercised their myself. (No workers' comp. right of exemption per MGL. insurance required.1 ' c. 1.52. § 1(4), and i+e have no employees. [No workers' comp. insurance required] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions i i.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.0 Other_ ... . ;tppFcanf that checks hog':1 must alto fill out the section below showine their worker. • compeusation policy intbrminion. ti+areowners who submit tins aftid:lyit indicating they are doing alt wort and then hire outside contracfon must submit a new aftidu%it indicating such. *Contractor that check this bo% must attached an additional .hest showing the name of the uh-contractor and state whether or not those eatitie� has e emplo%cc,. If the sub -contractors ha%e employees. they must Provide their workers' comp. polis. number. r. am an empl(trer that is providing workers' compensation instcrance for n{t• eniplgrees. Below is the polio• and job site information. Insurance Company Nantes---,------------ Polio or Self -ins. isle. 'I: (} L) i Lxpiration ate: WY'� 1 ,lob Site Address:.. _.....___.._._. /-7 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 tine 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 tine of up to 5350.00 a day against the violator. Be advised that a copy of this statement may be fonaarded to the Office of investigations of the DiA for insurance coveraee verification. I do hereky certify under the pains and penalties of perjury that the information provided above is trite and correct Signature: %r- c� t �— Date: Official use only. Do not write in this area, to be completed Ar city or town official. Cit-- or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Tou-n Clerk 4. Ele 6. Other ctrical inspector 5. Plumbing Inspector Contact Person: Phone ACX J/"� -6.7..'/d /'' TKuZ"X"'W4 Board of Building Regulations and Standards ` HOME IMPROVEMENT CONTRACTOR Registration: 183105 • Expiration: 5/11/2011 Tr# 284042 Type: Private Corporation WINDOW CHOICES INC VINCENT KILROW 1 AUBUNN CT..��x, SAUGUS, MA 01908 Administrator "' l� ' '• , Pratt tin[ i t Elf• Public Si Bard of Building Regulation..tfct} Construction Su and Standards /er:asor SPec+aItY License License: CS SL 99170 Restrieied to RF,WS VINCENT KILROW 1 AUBURN COURT SAUGUS, MA 019W (' nNrmi E,>nrr Expiration: 12/2712012 Tr#: 99170 License or registration valid for irdividul use only before the expiration date, if found return to: Board of Building Regulations and Standards One Ashburton Place Rin 1301 Boston, A'ta. 02108 Lum MA i Not valid without signature s r Z' r7K Wk t" 0 n ZM n _ k x �o O_ S ' N C�Z O C A C: O n o�m tD M 00 'R a A (3) Cn W CSD .,e 0 V \` CDD tz O e3 C G b 1 eoopQ 7 tp eb t^gC6 J a 4e vl I ¢ G O1 C/2 a -% o 6 pd = -T l $ m C4 !6R 0 a. ro 5 4- is `i w 4 RL i o a ,II ,05/17/2011 11:57 . v 7513958083 INSURANCE:AGENCIES PAGE 01 CERTIFICATE OF LIABILITY INSURANCE DATEIMMODIYYYY) o4t19/xoli THIS CERTIFICATE t8'.ISS D, AS. A MATTER OF `IpF MATION 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 DOE$ , NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE C)=RTIFICATE•1 6101.PER., IMP A cofflficaii holder Is an AVDITIONAL INSURIO, the po cy es must be If SUBROGATION, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate doss not confer rights to thr certificate holder In lieu of such andorsemNtgs). PRODUCER ItALPE J. QUINN INSURANCE AGENCY761-395-94007 15 MAIN STREETADDRESS: tp► 02155 A UUMUTNAME: ItALpg J. QUINN Afc No, Ext : AI81-395-8083 Nl. G v _ RJQUINNZII' SURANC1L@NETSCAPE _NET "PAODUcL44 Cus?OuSTOMPR 10 k w.. _ INSURER(e) AFFORDING COVERAOE NAKI r , _ INSURED'... WINDOW CHOICES INC- _ INSURERABIR$T FINANCIAL INSURANCE COMPANY — IUSURERBFLYMOUTH ROCK ASSURANCE CORPORATION 1 AUBURN COURT „- INSURER C : �Y SAUGUS , MA 01906 491FOO6099 04/27/11 04/77/12_ _ INSURER D ; INSURER E. N CLAIMS -MADE C OCCUR --- - INSURER F: MED EXP (Any arm Parson) THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. N01WTHSTANDING 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. LTR TYPE OF INSURANCE 0188 y„ I,D _ _ POLICY ,NUMBERIMM/DDmlVY) (MMroDmrr) LRAITS A GENERAI.UABIUTY 491FOO5623 04/27/10 04/27/11 VACHOCCURRENCE 1300,000 X , COMMERCIAL GENERAL uaealTY 491FOO6099 04/27/11 04/77/12_ -DAMAGE TO RENTED ' PREM18E5 (Ea occurtanCY) $100,000 CLAIMS -MADE C OCCUR MED EXP (Any arm Parson) 1 5,000 PERSONAL. & ADV INJURY $300,000 _ ,...... _ GENERAL AGGREGATE 3 600, 000 'LAGGREGATELIMPIITAPPLJESPER. FX-6 iPRODUCTS-COMPIOPAGO 3600,000 POLICY 1 JEGT LOC AUTOMOBILE LIABILITY COMBINEDSINOLE OMIT .. I ANY AUTO tEa acddonQ 3 _ ._...) I BODILY INJURY (Por Person) w. 3 100,000 ALL OWNED AUTOS _ _ BODILY INJURY (Per ecclde,it) _ _. S 300,000 $ X SCHEDULEOAVTOE PRA00001163343 01/12/11 101/12/12 PROPERTY DAMAGE (paad*nt) 100,000 A X HIREDAUTOS 491FOO5623 04/27/10 104/27/11 A R NON -OWNED AUTOS 491FOD6094 X04/27/11 09/27/12. 1 300,000 AGGREGATE 3 600,000 _ UMBRELLA LIAe OCCUR EACH OCCURRENCE 3 EXCESS l.lAe CLAIMS -MADE AGGREGATE S DEDUC-TI13LE _.S 1 RETENTION 1 WORKERS COMPENSATION VVr- , AND EMPLOYERS' LIABILITY YIN ,,, _TORYUMIrS iI ER E.L. EACH ACGtpENT 1 ✓ ANY PROPRIETORIPARTNERIEAECUTWE OFFlCERIMEMSER EXCLUDED? NIA ` E.L. DISEASE - EA EMPL.OYEE .-., 1 zndd"In NHI I if tt yea, dexc11tm under __ E.L. DISEASE - POLICY LIMIT S DESCRIPTION OF OPERATION$ Wow DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES lAttaeh ACORD 101, AddltImml Remarks Sehadule, if m -m apse+ Is required) LOWE'S COMPANIES INC. AND ANY AND ALL SUBSIDIARIES A" NAMED AS ADDITIONAL INSURED AS RESPECT TO GENERAL. LIABILITY AND AUTO LIABILITY. nenrrrrnerer un, nes L60%1 IVry LOM'S COMPANIES INC. ATTN, IS INSURANCE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION CATS THEREOF, NOTICE WILL BE DELIVERED IN P. 0- BOX 1111 ACCORDANCE WITH TH LICY F'ROVI51ON$. NORTH WIL"SBORO, NC 28656 AUTHORIZED f - `✓ r 4VVa Ma.VRtJ 1rVRYVRAI IVEV. All rigMto reserve ACORD 25 (2009108) The ACORD name and logo are registered marks of ACOR 8010290169 ©2011, RR Donnelley. All rights reserved. - 0221 INSTALLED SALES SPECIALIST NUMBER ti - �' % �7 . STRE ADDRESS Mkf CIN STATE ZIP Contract Total *applicable tax included Dgnjt V Z TELEPHONE DATE LOWE'S HOME CENTERS, INC.'S MA HIC NO.: 148688 FEIN: 56-0748358 - CASH k3ANK LLL REG _ CARD CHARGE This is only a quote for the merchandise and servicbs'printed below. This becomes an agreement upon -payment. Upon payment, the entire agreement; "including the specifically oompteted'pages of this document, the Terms and Conditions included with this documentarid:any other addenda and attachments hereto, shall be referred to herein as this ;Contract.' PLEASE READ ALL TERMS'AND CONDITIONS ON THE;REUERSE'SIDE OF THIS PAGE AND FOLLOWING PAGES BEFORE SIGNING, INSTALLATION STREET ADDRESS Jr CITY f � / STATE ZIP 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 activityto be performed in Customer's dwellingunit. 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 "�-R.D [fille in date]. Estimated completion date is � !Z /-, [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: I e (if applicable, inserta 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: [ Customer to Pay in Full; OR [ ] Customer to use the following payment schedule: (I�f]D-eposit $ 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 MUTUALLYAGREE IN ADVANCE THAT IN THE EVENT LOWE'S HAS A DISPUTE CONCERNING THIS CONTRACT, THAT _-.... ...... ____---...--.,- ..,i.r.n.,—.911An—hI Annnnj/Cn oVTUC CCr DCTADVr)CTWC:GGYCr`IIT- ti - �' Are permits required for this installation?: ] Yes [ ] No Contract Total *applicable tax included :Ni 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 activityto be performed in Customer's dwellingunit. 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 "�-R.D [fille in date]. Estimated completion date is � !Z /-, [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: I e (if applicable, inserta 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: [ Customer to Pay in Full; OR [ ] Customer to use the following payment schedule: (I�f]D-eposit $ 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 MUTUALLYAGREE IN ADVANCE THAT IN THE EVENT LOWE'S HAS A DISPUTE CONCERNING THIS CONTRACT, THAT _-.... ...... ____---...--.,- ..,i.r.n.,—.911An—hI Annnnj/Cn oVTUC CCr DCTADVr)CTWC:GGYCr`IIT- 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 activitv to be Derformed in Customer's dwellina 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 [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, inserta 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: Customer to Pay in Full; OR [ ] Customer to use the following payment schedule: eposit $ 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 mylour 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 MNSUM FF RS'AND`BUISNESS REGULATIONS.AND TFiE OWNED SHALL BE REQUIRED TO SUBMIT TO SUCH ARBITRATION AS PROVTD'E15"I",G.La .1"4 A. /� J By..,�^ �`"�, // Date: L Home Cente t By,lfi2'�`y �"r rr`f=r�•�C..) Date: Owner Signature" 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 ANDAGREE 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 CONTRACT AT THE TIME OF SIGNATURE. WITNESS OUR HAND.. S) AND SEAL(S) BELOW THIS . DAY OF Low" -H Celate , Inc. Specialist or Above7-0,ner t t Co-owner or Witness Customer acknowle-dges receipt of a true copy of 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. #90981 (Rev. 12/10) FILE COPY ©2 i Lowe'sLowe's and the gable design arere registered trademarks of LF Corporation. - rYIN %� -e Are permits required for this installation?: ] Yes [ ] No Contract Total *applicable tax included 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 activitv to be Derformed in Customer's dwellina 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 [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, inserta 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: Customer to Pay in Full; OR [ ] Customer to use the following payment schedule: eposit $ 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 mylour 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 MNSUM FF RS'AND`BUISNESS REGULATIONS.AND TFiE OWNED SHALL BE REQUIRED TO SUBMIT TO SUCH ARBITRATION AS PROVTD'E15"I",G.La .1"4 A. /� J By..,�^ �`"�, // Date: L Home Cente t By,lfi2'�`y �"r rr`f=r�•�C..) Date: Owner Signature" 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 ANDAGREE 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 CONTRACT AT THE TIME OF SIGNATURE. WITNESS OUR HAND.. S) AND SEAL(S) BELOW THIS . DAY OF Low" -H Celate , Inc. Specialist or Above7-0,ner t t Co-owner or Witness Customer acknowle-dges receipt of a true copy of 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. #90981 (Rev. 12/10) FILE COPY ©2 i Lowe'sLowe's and the gable design arere registered trademarks of LF Corporation.