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HomeMy WebLinkAboutBuilding Permit #327 - 195 OLYMPIC LANE 10/14/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO:_3!a---- Date Received Date Issued:/ _ /t. IMPORTANT:Applicant must complete all items on this page LOCATION IQ5 aym�ic kgne ' Print PROPERTY OWNER Da rry &-sell, Unit# Print MAP NO- PARCEL: ZONING DISTRICT: Historic District Tno Machine Shop Village 100 year-old structure TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: R oUe lr loam C) e�.is�-+n WAbW• + o»l . (Identification Please Type or Print Clearly) OWNER: Name: arm �uMao Phone: 47�-17_5`1�/�'] Address: 1 R'S Olwinnie 44t"e " Ado, 14A o l rY 5 °. CONTRACTOR Name• Vime4 c6w Phone: 1r'- 2 33 - 0100 r' Address: I At3bUrn COV4 SmoRus AN olao6 Supervisor's Construction License: y9170 Exp. Date: / Home Improvement License: / 6 310 5 Exp. Date: 511,Ll3 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. I, Total Project Cost: $ FEE: $ J Check No.: � a'� O Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to.the guaranty fund �Signature�of Agent/Owner< Signature of,contractorr��� 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 I � Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes I 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. 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 2011 June/mi i Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit o Photo Copy of H.I.C. And/Or C.S.L. Licenses o Copy of Contract ❑ Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit p Addition or Decks ❑ Building Permit Application o Certified Surveyed Plot Plan L3 Workers Comp Affidavit Li Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (if Applicable) o Mass check Energy Compliance Report (If Applicable) o 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) Li Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report L3 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 Location Q1c /` No. f Date /0-8 f N°RTM TOWN OF NORTH ANDOVER ° c a Certificate of Occupancy $ s�cMus`� Building/Frame Permit Fee $ Foundation Permit Fee $ r Other Permit Fee $ TOTAL $ • U Iq q0 Check # rr 1 Building Inspector NORTH T011111111YAM Of , { Andover _ _ _ � .L. F:. 0% . ..... No. o20 1g, LAK , dover, Mass., � � �� % � /`� COCMICMEWICK V 7�AoRATED S BOARD OF HEALTH PERM . IT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.................owre*ru � .. ................................ Foundation has permission to erect........................................ buildings on 6 k,w o` ........ Rough to be occupied as..................... .............. .r... C�,J.1.I�.d�. ......................... ......... Chimney............. h. provided that the person accepting this permit shall m 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 30PERMU EXPMES IN b MONTHS UNLESS �.®NS �...107'IO ,�S ELECTRICAL INSPECTOR Rough . ...................... ............................................................................ Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE-DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/organization/individual): Window Qho1Ge5 I1 �jhGenT Nrow Address: 1 AlLirn Couto I City/State/Zip: Samy% AA' 0110t Phone #: 791-233— O9o0 Are you an employer? Clieckthe appropriate box: 'Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and 1 employees (full and/or part-time).* have hired the sub-contractors 6. F] New construction 2.V i am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. F-1 Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance. t 9. E] Building addition required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a horneowner doing all work officers have exercised their 1 l.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.E] Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Anv applicant that checks box#1 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. IC ontractors 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 theolio ob site P Y andjob J information. Insurance Company Name: T QU117Y1 1n &r0&,P Aieney Policy#or Self-ins. Lie. #: y q 1 F 00 6011 Expiration Date: -17lA Job Site Address: 1% � umnjCLane City/State/Zip: NoA Andom/I'�/} DIM 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 certifyceunder the pains and penalties of perjury that the information provided above is true and correct. Signature- l/,t Date: Phone#: -7 -.233— 0800 Official use only. Do not write in this area, to be completed by city or town official. City or'Town: Perknit/]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#: ------....._.W_-__._________._.__.... W, EM Board of Building Regulations and Standards License or registration valid for individul use only O HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: fil Board of Building Regulations and Standards t_j'�gW b* Registration: 163-1,05 One Ashburton Place Rin 1301 Expiration: 5/1112011 T 284042 Boston,tNls.021108 Type., Private Corp-- L I) WINDOW CHOICES INC vINCENrr KILROW AUBUNN CT, SAUGUS. MA 01906 Adminisuator Not valid without signature of Y::" 1-" L- Cpnse CS SL 99170 RF.WS Sam VINCENT KILROW R� I AU13URN COURT14 2-2 . SAUGUS, MA 01 9CI6 Expiration: 12/27,,20, Tr,-: 99170 i 0/tA� Office of Consumer Affairs and 13usiness Regulation 10 Park Plaza - Suite 5170 Boston, Massa*—setts 02116 Home Improvement gtWtor Registration Registration: 163105 a Type: Private Corporation WINDOW CHOICES INC ` Expiration: 5/1112013 Tr# 211575 .._<., VINCENT KILROW 9 AUBURN CT. — SAUGUS, MA 01906 — --- ———- - - —--- — Update Address and return card.Mark reason for change Dn-C 1 c, 50M-04&94-G10`1216 IJ Address Renewal Empi.oyment — Lost Card office�afoos m r airs sin License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: _, 163105 Type: office of Consumer Affairs and Business Regulation Expiration: .x-110013 Private Corporation 10 Park Plaza-Suite 5170 Boston:,MA 02116 UVW!ICHOICm VINCENT KILROtIrJ. I AUBURN CT. SAUGUS, MA 01906_ Undersecretary Not valid without signature 135/17/2111 11: 57 7813558683 INSURANCE:AGENCIES FADE 131 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDfYYYY) 04/19/2011 TF11$ CERTIFICATE tS !$$ , AS. A, MATTER OF`INF (NATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.- THIS CERTIFICATE DOES 140T AFFIRMATIVELY OR NE(iATIVEtY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY. THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES ,NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE 0R PRODUCER,AND THE CI£RTIFICATE•H4)LOER,- IMP A certl CNe in URED, .fhe cy es musrt I* a UBRO A t the terms and conditions of tho Ic SubjKt to — Policy,y, certain PORCIOS may require an endorsement A staternent on this certificate door (sot confer rights to the Certificate hokior in lieu of such endonmmIliltgs), PRODUCER RALPH J. QUINN INSURANCI! AGENCY NAME RALPH J. QUINN 781-395-8400 15 MAIN STRZICT A/c No,Efil: AKc N.781-395-8083 7 bF0]RD, MA 02755 ADDRE8lk: RJQUI�NSURANC&QNBTSCAPE.NET PRODucm ....-. ...-_,.-......._.. ...-.._...............�.....__. .... ....._......... NSURED _ INSURER(B)AFroRDMG COVERAQF NAIc• - WINDOW CHOICES INC. INBURERAFIRST FINANCIAL IN$URANCE COMPANY _ 1 AUBURN COURT INSURERBPLYMOWM ROCK ASSUPMCB CORPORATION BAUGU8, MA90 ti INSIMER C: INSURER D� �� - MSURER E INSUACR F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THI$ IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FDR THE POLICY PERIOD INOICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WTH 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. XWL V= LTR TYPE OF INSURANCE (NIR TYYD POLICY NUMBER __.W..., GINAL LIABILITY (MMM0ff" (MMMUNTM LIMITS A491FOO5623 04/27/10 04/27/11 EACH OCCURRENCE $300,000 ] DMMERCIAL GENERAL LIABILITv 07dAA0E TO IiERTEp _4915006099 04/27/1104/27/12 PREmists(Eeoccunrne►) $100,000 - CLAIMS-MADE C OCCUR ----- MED EXP(Ary mit pnson) 1 ^5,000 PERSONAL,6 ADV INJURY 5300,000 GENERALA4DREOATE 3600,000 GEN'L AGGREGATE LIMIT APPLIES PER -I I - -• X PQLlcy JEGT LOC i PRODUCTS-COMP10vAGO S600,000 - S A AUTOMOaILE LIABILITY COMt4NED BINDLE LIMIT.,., ANY AUTO S (Ea acmd") ALL OWNED AUTOS SCOLY INJURY(Por person) 5 100,000 -- -- 8 X SCHEDULEDAVTOSI I SOOILYINJURY(Per emldem) S 300,000 PPAOOOOI163343 01/12/11 101/12/12 PROPERTY DAMAGE -- — ^ A X HIREDAUTOS iS 1QQ,000 A 491500562304127/10 04/27/11 (Pera0111W) X -OWNED 441F006099 -- 04/27/11 04/27/12 $ 300 00 0 AGGREGATE s 600,000~ - -J UMBRELLA L(AB OCCUR EACH OCCURRENCE S EXCESS LIAB —CLAIMS-MADE _•^ "" -` - - AOOREOATE S DEDUCTIBLE -•— -- E RETENTION $ --• YY4R1(ERBCOMPENSATION - S AND EMPLOYERS•LIABILITY • i 01 N YIN TORY UMIT$ FR' ANY PROPRIETORIPARTNI;R,'EXECUTIVE --.- OFFICER/MEMSER EY.CLVIOp. I I NIA E.L.EACH AGCIpENT $ (MtndatmY In NH) If yet,dwcmIa under E.L.DISEASE-EA EMPLOYEE $ DESCRIPTION OF OPERATION5balow - -- --gym E L.DISEASE-POLICY LIMIT A DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(Attach ACORD 101,Additional Relfwrks Schsduls,if me•+ qdto t raqwmd) LOW,S C060ANIES INC' AND ANY AND ALL SUBSIDIARIES ARE NAMED I IAS ADDITIONAL 1NSURED AS RESPECT TO GZNEP1 L LIABILITY AND AUTO LIABILITY. CERTIFICATE HOLDER CANCELLATION LOfd&'S CCWAOTES INC. ATTN: IS TNSU;UWCZ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE P. 0- HOX 1111 WILL THE EXPIRAT*N DATE THEREOF. NOTICE L 9E DELIVERED IN ACCORDANCE WITH TH LICY PROVIMNS. NORTH WILKES8ORO, NC 2$656 AUTHORIZED REPRE TA t ACORD 25(2009M91209 AC RD N. All r19hta raaerve The ACORD nate and logo are ragistorod maft of ACO T1. P / o�n�naiuuea�{ a��/ c�euoedb Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registration; W§gg Type: Ex irar -.; 10 Park Plaza-Suite 5170 p X013 Supplement Card �--�-- - - -� : PP Boston,ldlA 02116 LOWE'S HOMES' RICHARD CHAL 136 TURNPIKE SOUTH BOROUGH; 72 Undersecretary of valid without signature ' ,:a, .,.a. ,rac - �.=c,< "a, of t ,f4�i:' ., y,. 15 558 Piedmont Graphic Services and Glob (Son;cmg ., _, ::_ -' s't".'u, :is*s. t'.w5§,- �" },'3+-�r°n', ,:.+'.rx' kt fta.',J+sm ^}.,'.1.w,Ne;^"sz°?' :.L.,&1r z., g<, a., -.°- y ^wr _, .".' t _ ,'', r..r.:.. ' �., ,��. k m.;x. e' ,,,.f ,:...r.� .,.. ,.,r. ,C, e._>„ =a a.r w- m ., .�; c'ax> ,,.� s '�, est .' '. '. `,�.+ �,��TM n• N+� Y' , ' #4 C ,5, y, h-, a"P --� m. 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CITY'' r * ,+ r'T} N yS7 STE +jr,a,r tR 37s,.:LZIPK� x 5 . ,+zyt� r `� 1. , < t D d a -b A at i �rt • o {{ 1. t�{ i 1 It� L 1 1. .p 4 \ i } ! �rNrW �l � �l F Cyt t 5 3 °'k� I k f} *'frk.t } - , � " t �. ; I �Q�, ,. . .I�� � 'r , 1 74- I., C � .Ife- I 11;-i,1X14!:,1 -, I .1, W 311 t j q 5x i♦ ,it b 4 t sc c -hex d. c r ,^ e ' s. s 4 ,� i� R E ra8 2 7 a rr. s e a r , , c v t o y.r i -. s u it f - t`r j •� a' ? u + �` ' .• ; ' F� a`x.ar, .r "tit's L - @ i z s. r r 1 t -' a Ir11 : �. i' 1 y-S it�'i�.sv '.p,� rti , L #r� v I",7 § xyl k n i 5 f t v t A s L}% . -a�"' fr.R :- a`3 ;x r „x $ t r r 1 r r r t t ' F(' h c to 4 r `` ' + Z, i u '' N�'GI y S5 3 J,} �'SF Fd:j�i9 �, �r x 3 v 'k �, t Pt '. e > .sy Ea 2r �, 'sy.rtS"t : ,k§�0 .. •O' r C ym4 t Contract 1"®tai "' 1 3a �t { 3 o § t �� 7t 4 -( a"t t s 1.,.,1 r ar r , t I aF, a.�rr '+ r b a d ,thy it E Are perrrltts're utrtl for �' q this Installation.. ]Yes pp icab9e ax incPutled u; ! o )u �� w�r IS cs54 f i a:tr 3... ,�... 6YOTEGE To-'OU,CiJSi��fIEFi Fedefalllawr'�e ulres C®vv ' ,4 .� '�;� ,� �„r r�� R" ' , S �, 3*�' ."Fl res Ci ild,Caee j*rI. e s to provide you with the pamplet Rearovete ltrght Important L'eaa-Hazard:ln'fiorMation foj�l=airr 1, y s` ovrclers surd Schoo/s`B sl Hing this Contract;Customer ackm.6wiedges having recewect a cq"' of tC�is'. rri'"hist ' '' "'` { Informjng Cus#omer of themPbtim lal risk of the.lead haaard exposuPe from ger ovatior`activi " ' '' w RY}r > befor rk began P e- .11 111.1ty to be perFortned.l%,i Custonierts dwrefiing,unit s,z , - s- n i"!!o`aic�Ps'�o commence upon reasonable avaihblhty of Contractor and/or availatilli .of an i ! to bef �+ Y special orctet�o�cdsto�m�fi5��de�oddsiwrtlyd le anticipated . P ' [fill In date] Estimated com letion date is . lt,.t i e' p ? r f1111fiQ�3t@]! wta� �k�, E `icyc'skt i a0 Saidestimatedsubstantialcom`'letion'dat _ ,` _ " ', � .:;r `�' X �'��:s ' f11 p <e is not". the essence ;Contingencies that may:matenally change''saidaestlma. ,completibla""te follov F r ..q. m 4 I hitt r.. t S q e F,rf 4a s't5f.�� M - "'r,@ ,y.%- ,- ta' :�` .r;bC. ' i �. /F p4Y. -,^�' �`F4 4,. 1. _ f `, F� 1 X 5}1 t4_w �t,s�y'9'�{.t'. 1. {Lr4 }{.'i Sk e*r,.t.} S '+ �tk-::i +;{j-` {fil$S3 r >,lf t ys:. tl, `+,,, ( }P ,mr .r; } t`4�-'°"a� ix.. fu..q !�'tr„�6!.r y:4_ SY^fl z c�U'�i 3r j. +, f - r" �. a Via. 'xt 7.-,i,'t.'�cSx{''"$:'� ,t-" as "' t :, ! "r a f r�.-iK''�Vn" 1F srst r - y';.,. x .z, j .l `(If applicable insert staternentof^ uch cohtmgencles}, s a s 3.5 ,,TI-JEyCONaTRACT TOTAL4IS$1 000 OD OR LESS Customer mus pay in full y is x s ;, qtr ,$ x COWIPL TEHiN!5 SECTION ONLY WHE�°`,H CONTRACTTOTAL>EXCEEDS 1 000.0 i 4; q k� ; x' s *, ! t [t Custometa day in Futl a OR r $ 0 t r k.:.• .. } :.; } .ry r�i 4 M� i-; 7+x'•''Y , t*3''-,9; m F {rs. [ ]Customer to use the..following paym&mschedule a r 4r ? R{,a . '� w11 (1)Depbs► 04.t $ t`, tcj'be pall,upon silting bortract Deposit should be'1'L3 the to ! '' =3° �'�" ,� i; '. , (2}P,gyment"of$ 1 . 1. ta1 il.contra # ipce,and ' � , Y 9 to be pard anytime after this Contract Is si ned 2nd before:commencement'of installation INVe.aufhon h to do one fof the follov,Ing(check appropriate box below} + ze Lowe s t,.i a t y a -t Y r jie t { ]charge,tylour credit card for the amount of the payment Indicated above an ime efter the t li h 1{r 41. a G ` ` �` '. Or'I -, t ¢£ � , r yt date this Gohtraet Is signed , , `` h+-�:ti,f t 4 r• , r r : $ .,� s 4 ,,, ,T' r 4" t }3 '� W. 5� zt >,i D.eOSIt ''�OIYr' {" =r.4� t. z, t +t 4 �- ,t t t -s ': +4 w U{.iX sy �, - - tr I a J „p c eck for fns amount of the payment Indicated`above an'Y 44 `W.-,jl ' r t`r1. r"r °I.' (3 Frpal Q a gient ofr 1" ytime atter the tlate this Contractls+slgned;and , ; _+ `> } Ia y „ $ 00 00 to be pard upon completion of the installationand both parties satisfaction r ' �' "Y t 'r� is-3 nt3a r r i,:"r �"{`•'a t a, r 'r M.. n 5. 1 5n1 y �' r ' r e ri a 'a°l r t ?'t l - Tt NVOTlGE kl ARDiNG A6ZBITRi47BON AdkR ElVT F®R CLAIII�S IbdvE ED 13YdVl G.L..:342.4 f '3°�wf '}> I - 4 ' '�a of , , L�VUE: AN13�OWNEK HEREBY MUTUALLYAGREE IN:ADVANCE THAT t 'TFiE:EVENT."' "'' ' " 'r "` " `� It `' 11 LOINE S HAS A DJSPf�T CONCERNING THIS CONTRACT,THAT ,zW"",",;'6',5,I. ,SU�BIVIIT'S'UCN D'1SPUTE TOA PRIVATE-ARBi!RPTION SEFRVI` 'tNFi1 �1211:1 ' ^ ^ r^CH HAS BEEN^APPROVED BY�T#iE SECRE ARY�OF THE EXECt1T ,.•?- I%tP'(-,)- tC:F.aL1F "?7'0�1.411']itA�:R-,O'C�"A.IDC"'A'k§n".of licnic�.c�ornetS:.nTSr»;n:h' ':: I;�...�,"�,i �z.. � _ ._,>r n i Contract Total r Are permits required for this,installation?: [ ]Yes [ ]No *applicable tax.included 4_ NOTICE TO CUSTOMER-.'F(4 law requires Lowe's to provide you with"the pamplet Renovate Rr ht:'Im octant Lead Hazardanformat R14. A on for Fam►1 ►es, Child Care Providers and:Schoo/s.;;Bysigning this Contract,Customer acknowledges haying"received a copy of this pamphlet before Work,began informing Customer of the pofential risk of the lead hazard exposure from renovation activity to be performed in Customer's dwelling unit �. ence upon reasonable availability.of Contractor and/or availability of any special order or custom made Goods which is anticipated Work is to comm to be F�'y [fill in date].Estimated completion date is "s [fill in date] I Said estimated substantial completion date is.not ofthe essence: Contingencies that may materially change said.estimated completion.date follow: (If applicable insert a statement of such contingencies). { IF THE CONTRACT TOTAL IS$1,000.00 OR LESS Customer must pay in full. 1. , COMPLETE THIS SECTION ONLY WHEN THE CONTRACT TOTAL EXCEEDS$1,000.00:. ( '}"Customer to Pay in Full OR [ I Customer to use the following payment schedule (1j'Deposit $' to be paid upon siging contract:Deposit shoufd'be 1/3 thetotal contract pnce,and` ]]1 (2)Payment of;$ to be paid:anytime after this Contract is signed and before commencement of installation INVe 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$100'00-to be paid upon coinpletiori of the installation and both parties'satisfaction NOTICE REGARDING'ARBITRATION RGREEMENT FOR CLAIMS COVERED BY M.G.L:c.142A LOWE'.S AND.OWNER HEREBY.MUTUALLY.AGREE.IN ADVANCE THAT.IN THE-EVENT LOWE'S HAS A DISPUTE.CONCERNING THIS CONTRACT,THAT . LOWE.S MAY SUBMIT SUCH DISPUTE TO A:PRIVATE ARBITRATION SERVICE WHIbH.HA§BEEN APPROVED BY THE SECRETARY QF THE EXECUT t IVE OFFICE O.F CONSUMER Al FAIRS AND BUISNESS REGULATIONS AND THE OWNE HALL;BE REQUIRED TO SUBMIT TO`SUCH'ARBITRATION ASR GVIDEC7'lid (`L" c 14 , .$"'st`'fF t z.: i > t o 3x •","^-,e �.ws(5j?k >:t•.' Y' ° A d .. ,I Lowe's t Iome CerSfers I e^-^-: Date f , BY R Owner`Signature Date - : T s ' t ! r L THE SIGNATURES OF.THE PARTIES ABOVE ONLY TO THE AGREEMENT OF THE PARTIES TGA DISPUTE RESOLUTION INITIATED BY LOVUE 5 PURSUANT TO M.G`L c 142A THE OWNER MAY BE PERMITTED TO INITIATE ALTERNATIVE DISPUTE RESOLUTIOW LVEN WHERE THE SECTION ABOVE IS NOT SEPERATELY SIGNED BY THE PARI IES:-- x ?s ®O NOT SIGN FRIS•CONTRACT IF:THERE ARE-ANY BLANK SPACES'AND UNTIL YOE1 HAVE REA®THE TERMS AND CONR)ITIONS CONTAINED ON THE-REVERSE SIDE OF THIS`PAGE AND THE FOLLOWING PAGES OF THIS CONTR ACT BY SIGNING BELOW,YOU ARE ACKNOWLEDGING THAT YOU HAVE REA®;llNR)ERSTAN®AN®AGREE. O THE` TERMSAN:®,CONDITIONS SES' FORTH ON THE REVERSE SIDE OF THIS-PAGEAND THt FOLLOWING PAGES OF;THBS CONTRACT YOl1:ARE ENTITLED TOWCOPY OF*'THIS GONTR4CT AT TIE TIMEF SIGNATl1RE o ti R WITNESS OUR HAND(ANDSEAL(S)BELOW THIS DAY OF '"e`F�"F refit r Lowe s H®ene Cefiters,.lrl ' r Specialist or Abode + 9" Owner E , Spouse r Customer acknowledges receipt of a true copy of this contract which was completely`filled in prior-to Custorner's'execition,h cancel this transaction at arly;tirne prior€o midnight`of_the third business da after the date ofth' :form for an explanation of, is right.' ereof You,,the buyer,may Y is transactiort See the attached notice of cancellation a EXTERIOR SOLUTION GENERIC (Rev 12/09), ©2004 by Lowe's:@ Lowes and the gable design Item#90981 r Y are registered trademarks pf LF Corporation.:, FILE.00PY I Quote ll1111.//JJWIV.1VWlJ.WtlllulLv_cuuaw.uau�.uvrv.�ot.t�.�w�..—� ... Back.to Quote LOWE'S HOME CENTERS,INC.#1094 b: 153 ANDOVER STREET DANVERS,MA 01923 USA Dater 09/28/2011 (978)646-9099 Project#: 336930741 Description: Final window Customer Name: DARRYL KUSEK Customer Phone: (978)375-4481 Customer Address: . 195 OLYMPIC LANE NORTH ANDOVER, MA 01845 USA Line Item Product Code Frame SizeDescription Unit Price Quantity. Total Price 001 Manufacturer:Pella Windows&Patio Doors FrameSize=4'8 3/4 W x 4'Division:Millwork 1/4"g Product:Windows 0 Size=571/2"W x 51Type:Fixed Frames/Special Shapes Manufacturer:Pella Windows&Patio Doors aterial:Aluminum Clad Wood ame:Aluminum Clad Wood Frame nergy Star(R)Qualified Products Only:No-I would like o view all available product offering. Product Style:Custom e Product Configuration:r o gu anon:Rectangle Room Location:DINING ROOM Opening Type:Exact Frame Size Width:4'8 3/4" Frame Size Height:4'21/4" Rough Opening Width: 571/2" ough Opening Height:51" xteriorColor:White xterior Paint Grade:Standard EnduraClad ood Type:Pine-Standard Interior Finish:Unfinished-ready for site finishing Glazing:SunDefense(TM)Glass Tempered Glass:No High Altitude:No Gas Filled:Argon Grid Type:None nduraClad Exterior Trim:No Fin Type:Nail Fin Wall Depth:4 9/16"Applied $402.71 1 $402.71: 1 of 2 09/28/2011 11:32 PM Series:Support Will this product be installed by Lowe's?:Yes Lead Time:21 Part Numbers: S.CFVAUNTT Project Total: $402.71 Salesperson: PETER GAYESKI(Sl094PGl) Accepted by: Date:09/28/2011 i All Millwork images are viewed from exterior unless otherwise .Thi I s Millwork-Quote is valid until 10/4/2011 on all regularly priced items.For promotional pricing please seethe disclaimer 4: noted with eachitem above.This.is an estimate only.This estimate does not include tax or delivery charges.Delivery of all materials contained in this estimate are subject to availability from the manufacturer or supplier.All the above quantities, dimensions,specifications and accessories have been verified and accepted. 2 of 2 09/28/2011 11:32 PM