HomeMy WebLinkAboutBuilding Permit #461-15 - 209 VEST WAY 11/12/2014BUILDING PERMIT
TOWN OF NORTH ANDOVER
1�j APPLICATION FOR PLAN EXAMINATION
Permit No#:6 1-1 J Date Received
Date Issued: Ili l
IMPORTANT:: Applicant must complete all items on this pag
LOCATION
PROPERTY OWNER
r PNht 100 Year Structure
MAP / y 4 PARCEL:_ ZONING DISTRICT:,- Histo"ric District
:Machine Shop
yes no
yes no
e yes no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
e family
❑ Addition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Commercial
epair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
❑ Septic ❑ Well
❑ Floodplain ❑ Wetlands
❑ Watershed District
El Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
G)
Ide�}tification - Please Type or Print Clearly Sea 2
OWNER: Name: ?dkwe 1 zZ._ ,1 ooW(CPhone: -7 -a 1" � 3
Address: ab q ve`h'
kobxe t 1>0
Contractor Name: P one: t 7�'"S 30
— r
Address: - ,., c-�e� 5 �e�rn� mp, ajcj-70 ,
Supervisor's Construction License: �' a. C. � 3 _ Exp. Date:
Y
Home Improvement License: 16 `_ _. Exp. Date:
ARCHITECT/ENGINEER N P't Phone:
Address: Reg. No.
FEE SCHEDULE: BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATEVOST BASED ON $125.00 PER S.F.
Total Pro'ect Cost: $ �i oto? FEE: $ 30
b
Z
6 2
Check No.: � a S � � � -7� � Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the uaran and
Signature of Agent/Owner Signature of contract
If
Plans Submitted ❑
Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑
Tanning/Massage/Body Art ❑
Swiimning 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 Reviewed On Signature_
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
t_ocatea Jb4 vsgooa 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
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
NOTES and DATA — (For department use
❑ Notified for pickup Call Email
Date Time Contact Name
Doc.Building Permit Revised 2014
No
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/Cross Section/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 I
that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording f
am ust be submitted with the building application
Doc: Building Permit Revised 2014
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Irk Department of Industrial A;
Office of Investigatiol
I Congress Street, Suite
Boston, MA 02114-20
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders
Name (Business/Organization/Individual)
Address: 5 -Bf15-61
M&
City/State/lip:_ 0.dern,_ Mff D 1q 0 Phone #:
Are you an employer? Check the appropriate box:
i . ❑ I am a employer with 4. E]1 am a general contractor
employees (full and/or part-time).'` have hired the sub-contr,
2. I am a sole proprietor or partner- listed on the attached she
ship and have no employees These sub -contractors he
Working for me in any capacity. employees and have wor
(No workers' comp. insurance comp. insurance.$
required.] 5. ❑ We are a corporation an(
3. ❑ I ani a homeowner doing all work officers have exercised t.
myself. [No workers' comp. right of exemption per Iv
insurance required.) t c. 152, j1(4), and we ha,
employees. [No workers
comp. insurance require(
'Any applicant that checks box #�1 must also Iill out the section below showing their workers' ct
Horneowners. who submit this affidavit indicating they are doing all work and then hire outside
°Cnnu-actors that check this box must attached an additional sheet showing the name of the sub-(
employees. I f the sub -contractors have employees. they must provide their workers' comp. poli
1 ant an employer that is providing workers' compensation insurance far
information.
Insurance Company Name:
Motley # or Self -ins. Lic. #:
.lob Site Add
Attach a copy of the workers' compensation policy declaration page (she
Failure to secure coverage as required under Section 25A of MGL c. 152 car
fine up to x;1,500.00 ancUor one-year imprisonment, as well as civil penalties
Of up to $250.00 a day against the violator. Be advised that a copy of this sta
Investigations of the DIA for insurance coverage verification.
idents
00
ontractors/Electricians/Plumbers
pensation policy information.
mtractors must submit a new affidavit indicating, such.
tractorsand state whether or not those entities have
number,
employees. Below is the policy and job site
Expiration Date:
City/State/Zip:
ving the policy number and expiration (late),
lead to the imposition of criminal penalties of a
n the form of STOP WORK ORDER and a fine
ement may be forwarded to the Office of
I do hereby cert L un er t e pAins and enaltiesof perjury that the inform tion provided above is true and correct.
I7tf-.73o-7
Of use only. Do not write in this area, to be completed by city or town official
i
City or Town: Permit/Licen1se #
Issuing Authority (circle one)- i
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical inspector 5. Plumbing inspector
6. Other I
Contart Percnn' Phn�v ft
630-717Y
Type of project (required):
and I
(tors
6. ❑ New construction
et.
7. ❑ Remodeling
Ve
S. ❑ Demohtlotl
vers'
9_ ❑ Building addition
its
10.0 Electrical repairs or- additions
ieir
l l.❑ Plumbing repairs or additions
GL
12.❑ Roof repairs
e no
13.❑ Other
pensation policy information.
mtractors must submit a new affidavit indicating, such.
tractorsand state whether or not those entities have
number,
employees. Below is the policy and job site
Expiration Date:
City/State/Zip:
ving the policy number and expiration (late),
lead to the imposition of criminal penalties of a
n the form of STOP WORK ORDER and a fine
ement may be forwarded to the Office of
I do hereby cert L un er t e pAins and enaltiesof perjury that the inform tion provided above is true and correct.
I7tf-.73o-7
Of use only. Do not write in this area, to be completed by city or town official
i
City or Town: Permit/Licen1se #
Issuing Authority (circle one)- i
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical inspector 5. Plumbing inspector
6. Other I
Contart Percnn' Phn�v ft
r __ � � Q�l�U7I2 (Y12 t!l1G�CliL(i!Z L a&Ij,aduao
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5176
_r Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 162722-
Type:
62722Type: Individual
` Expiration: 4/6/2015
MICHAEL THOMAS DEMILLE
MICHAEL DEMILLE -----
S BRISTOL ST i
SALEM, MA 01970
sr.r, , �• zau•os.•� i
•���/• fl4.a/sirG l/uY/��� i%�'.7(r/.J,7</tU.w'��:
-�_Of'Gce of ConsumerAftairs & Rusineu Rcgulatiou
}OME IMPROVEMENT CONTRACTOR
egastration: 162722
Type:
tration: 4/6/2015 Individual
MICHAEL THOMAS DEMILLE
MICHAFL DEMILLE
5 BRISTOL ST
SALEM, MA 01970
L•d
Undersecretary
Tr# 238965
Updite'Address and return card. Mark reason for ehanoe.
lC1 Address E Renewal 0 Employment I— lost Card
Litense or registratiori valid for iadividul use only
before the expiration date. If found return to: _
Office of Consumer A6airs and Business Regulation
10 Park Plaza - Suite 1170
Boston, MA 02116 I
Not valid without signature
CERTIFICATE t)ATt; (VM10;1lYYVYj
C)F LIA�IL,ITY INSURANCE 08/29/2014
THIS CERTIFICATE IS ISSUEDAS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DUES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, CXTEND 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'. Ir the certificate holder Is an ADDITIONAL INSURED, the rlotley(los) must be endorsed. It SUBROGATION IS WAIVED, subject to the
torins and conditions of tho policy, certain policies may require an ondorsomonl, A statemont on this cortificato does not confer rights to the
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PHIS IS TO CERTIFY THAT THE POLICIES Of INSURANCE LISTED 9ELOW HA`JE BEEN ISSUEU TO THE INSURED -
NAMED ABOVE FUR 'tHF POLICY PERI!DD
INDICATED. NOTWITHSTANDING A 4Y REQUIREMENT, TERM OR CONDITION OF ANY CONI RACT OR OTHER DOCUMENT WITH RESPECT TO IAMICH THIS
C;:Ft'I IFICATE MAY UE ISSUED OR MAY VIrR'l"AtN, THE INSURANCE AfFOROED BY THE POLICIES U
_ESK:ittSCRIi;F.D HEREIN i5 SUBJECT TU Alt. THE TFRFAS,
GENERAL LIAOILITY
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t3EflCRIP71t)N ON tSPEftATI0N3 f IIX:AT10NS /ViiHICLEB (ARach AC.ORD 107, AddKlOnel Rtmerlca Bchtduk, C:nare �I,eta to requ3rs!!I
It is understood ;toll ago cid that Lowe''; Compsni<:s lnc, and it's subsidiaril< are listed ac an Additional insured.
Cdrilc "try ContraCLor.
Lane's Compon(es
Aftn. Is Insurance
Po Boy. Jill
North Wilkesboro
ACORD 75 (2009/09)
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SHOULDANY OF THE ABOVE DESCRIBED POLICIEt3 HE CANCELLED BEFORE
THE "PIRATION DATE TTIEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVIO(ONG,
NO 28656I.Katherine M. Kelley, AM, CIC
The ACORD name and logo are registered marksrof ACORo9 ACORD CORPORATION. All rlghts roservrld•
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LOWE'S AUTHORIZED REPRESENTATIVs,NUMBER
�8 s.
STORE NO.
ST ET ADDRESS.
Q
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CITY STATE ZIP
n f. rfi
'�
TELEPHONE
9.7 S
DATE
LOWE'S HOME CENTERS, LLC'S MA HIC NO. 148688
FEIN: 56-0748358
INSTALLATION STREET ADDRESS
CITY
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CONTRACT # ®O j
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CUSTOkJER
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CARD.... t CHARGE
Von°payrnent--rUpor 0,k' t nt, the erl 4 agreement, including the specifically completed pages of this'.- ,
wments treieto shatl bedefefred to Ierem as this Contract
iiWMG PAGES BE',
FO0E SIGNING
STATE . ZIP
- !"' + rty c, � ',.: C2�' 1Yj`°�°l'1' mit t�!<iK.� fir,} � ' y✓", iei + � /
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NOTICE TO CUSTOMER — PRICE CALCULATIONS: In order to properly perform the installation of certain Goods, the Contract Price may include more
Goods than actually will be installed based on the measured square footage of the Project Area. As a result, the parties agree that the lump -sum Price
stated in this Contract is calculated upon both the value of estimated Goods required to fulfill the Contract (including waste), which may exceed the actual
square footage of the Project Area, and the labor which may be estimated based on the amount of Goods required to fulfill the Contract (including waste).
By signing this Contract below, Customer acknowledges receipt of this notice and agrees and understands that the Price includes these costs which may
not be refunded once the Installation Services are performed.
Contract Total
Are permits required for this installation?: [)Q Yes [ ] No *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 activity to be performed in Customer's dwelling unit.
NOTE: If rotted wood is discovered during installation additional charges will apply. You will be given a quote and a change order
must be completed and signed by the customer for any additional charges. Customer must initial.
'Any work or material not specified is not included in this contract. Any changes or additions will be at an additional charge for the material and labor.
PHOTO RELEASE: Customer grants to Lowe's and Lowe's employees and independent contractors the right to take pnotograpns of the rremises wnere
Installation Services will be performed and 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 cme ce• upon reasonable availability of Contractor and/or any special order or custoyher made Good(s) which is anticipated to be
[fill in date]. Estimated completion date is I.1%9 //C% [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, insert a statement of such contingencies).
IF THE CONTRACT TOTAL IS $1,000.00 OR LESS Customer must pay in full.
COJvIPLETE THIS SECTION ONLY WHEN THE CONTRACT TOTAL EXCEEDS $1,000.00:
[ Customer to Pay in Full; OR ( J Customer to use the following payment schedule:
(1) Deposit $ to be paid upon signing contract. Deposit should be 1/3 the total contract price; and
(2) Payment of $ to be paid anytime after this Contract is signed and before commencement of installation, I/We authorize Lowe's
to do one of the following (check appropriate box below):
[ ] Charge my/our credit card for the amount of the payment indicated above anytime after the date this Contract is signed;
or
[ ] Deposit my/our check for the amount of the payment indicated above anytime after the date this Contract is signed; and
(3) Final payment of $100.00 to be paid upon completion of the installation and both parties' satisfaction.
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 SU R DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUT-
IVE OFFICE_QE CONS04EFj A6GeAND BUSINESS REGULATIONS AND 11HE OWNED SHA L BE REQUIRED TO SUBMIT TO SUCH ARBITRATION
%'-JS,•a
l �.1P .,
NOTICE TO CUSTOMER — PRICE CALCULATIONS: In order to properly perform the installation of certain Goods, the Contract Price may include more
Goods than actually will be installed based on the measured square footage of the Project Area. As a result, the parties agree that the lump -sum Price
stated in this Contract is calculated upon both the value of estimated Goods required to fulfill the Contract (including waste), which may exceed the actual
square footage of the Project Area, and the labor which may be estimated based on the amount of Goods required to fulfill the Contract (including waste).
By signing this Contract below, Customer acknowledges receipt of this notice and agrees and understands that the Price includes these costs which may
not be refunded once the Installation Services are performed.
Contract Total
Are permits required for this installation?: [)Q Yes [ ] No *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 activity to be performed in Customer's dwelling unit.
NOTE: If rotted wood is discovered during installation additional charges will apply. You will be given a quote and a change order
must be completed and signed by the customer for any additional charges. Customer must initial.
'Any work or material not specified is not included in this contract. Any changes or additions will be at an additional charge for the material and labor.
PHOTO RELEASE: Customer grants to Lowe's and Lowe's employees and independent contractors the right to take pnotograpns of the rremises wnere
Installation Services will be performed and 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 cme ce• upon reasonable availability of Contractor and/or any special order or custoyher made Good(s) which is anticipated to be
[fill in date]. Estimated completion date is I.1%9 //C% [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, insert a statement of such contingencies).
IF THE CONTRACT TOTAL IS $1,000.00 OR LESS Customer must pay in full.
COJvIPLETE THIS SECTION ONLY WHEN THE CONTRACT TOTAL EXCEEDS $1,000.00:
[ Customer to Pay in Full; OR ( J Customer to use the following payment schedule:
(1) Deposit $ to be paid upon signing contract. Deposit should be 1/3 the total contract price; and
(2) Payment of $ to be paid anytime after this Contract is signed and before commencement of installation, I/We authorize Lowe's
to do one of the following (check appropriate box below):
[ ] Charge my/our credit card for the amount of the payment indicated above anytime after the date this Contract is signed;
or
[ ] Deposit my/our check for the amount of the payment indicated above anytime after the date this Contract is signed; and
(3) Final payment of $100.00 to be paid upon completion of the installation and both parties' satisfaction.
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 SU R DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUT-
IVE OFFICE_QE CONS04EFj A6GeAND BUSINESS REGULATIONS AND 11HE OWNED SHA L BE REQUIRED TO SUBMIT TO SUCH ARBITRATION
INSTALLATION STREET ADDRESS
CITY
STATE ZIP
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NOTICE TO CUSTOMER - PRICE CALCULATIONS: In order to properly perform the installation of certain Goods, the Contract Price may include more
Goods than actually will be installed based on the measured square footage of the Project Area. As a result, the parties agree that the lump -sum Price
stated in this Contract is calculated upon both the value of estimated Goods required to fulfill the Contract (including waste), which may exceed the actual
square footage of the Project Area, and the labor which may be estimated based on the amount of Goods required to fulfill the Contract (including waste).
By signing this Contract below, Customer acknowledges receipt of this notice and agrees and understands that the Price includes these costs which may
not be refunded once the Installation Services are performed.
Contract Total
Are permits required for this installation?: [� Yes [ ] No *applicable tax included _:} t7
nv r r%.c r v L UO r vmeK: reaerar raw requires Lowe -s to proviae you wrtn the pampfet 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.
NOTE: If rotted wood is discovered during installation additional charges will apply. You will be given a quote and a change order
must be completed and signed by the customer for any additional charges. Customer must initial.
*Any work or material not specified is not included in this contract. Any changes or additions will be at an additional charge for the material and labor.
PHOTO RELEASE: Customer grants to Lowe's and Lowe's employees and independent contractors the right to take photographs of the Premises where
Installation Services will be performed and 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 cqtnme ce upon reasonable availability of Contractor and/or any special order or ustoyher made Good(s) which is anticipated to be
1Z / 141/`y [fill in date]. Estimated completion date is ` ,�9 /�� [fill in date].
Said estimated substantial completion date is not of t • e essence. A statement of any contingencies that would materially change said estimated substantial
completion date is as follows: f s;.oe- f b-0"
(if applicable, insert a statement of such contingencies).
IF THE CONTRACT TOTAL IS $1,000.00 OR LESS Customer must pay in full.
COJNPLETE THIS SECTION ONLY WHEN THE CONTRACT TOTAL EXCEEDS $1,000.00:
[ Customer to Pay in Full; OR [ ] Customer to use the following payment schedule:
(1) Deposit $ to be paid upon signing contract. Deposit should be 1/3 the total contract price; and
(2) Payment of $ 1. 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 SUBMITS JCR,DISRUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUT-
IVE OFFICE QF CONS E AF AIRS'AND BUSINESS REGULATIONS AND THE OWNS SHALL BE REQUIRED TO SUBMIT TO SUCH ARBITRATION
AS P IN . c
By: :r . Date: /�/iY�
Lowe gRome Center C �
BY: i _ _- 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 SEPARATELY 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 CONT CTJJ AT THE TIME OF SIGNAT
WITNESS OUR HAND( ) AND SEAL BELOW THIS --,F �— DAY OF�ohe
Lo�pte's-Heme_C ters L
Lowe's Authorized R*e-s6ril5five Owner ! Co-owner or Witness
Customer acknowledges.receipt o a -true copy of this contract which was completely filled in prior to Customer's execuf ion hereof. You, the buyer, ma
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.
FILE COPY 0 2004 byLowe's.® Lowe's and the gable design
55102 REV. 12/13 are registered trademarks of LF Corporation.
Location�yc)
No.
Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # (`�'� zc�i
Building Inspector