The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #192-12 - 28 DUNCAN DRIVE 9/7/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: 2 Date Received Date Issued: 'f " IMPORTANT:Applicant must complete all items on this page LOCATION 1)uh C°-n !fir Print PROPERTY OWNER Unit# Print MAP NO: PARCEL: _ZONING DISTRICT: Historic District yes Machine Shop Village yes no 100 year-old structure yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building One family ❑Addition ❑Two or more family D Industrial 0 Alteration No. of units: ❑ Commercial Repair, replacement 0 Assessory Bldg ❑ Others: 11 Demolition ❑ Other ❑ Septic ❑ Well ❑Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: ?Awuel rephtLe e�vS149� iron f Jeer 4- AID - bei c�O(� (Identification Please Type or Print Clearly) OWNER: Name: L it _ �ckJ1rn J4 Phone: Address:_ pulacae, CONTRACTOR Name: 'R«,dId Phone: Address: 12 Tvxw GA• Pewxdu t to of 9L C) Supervisor's Construction License: -7117-1 Exp. Date: 8 `� Home Improvement License: 3314 N Exp. Date: Z? f 3 ARCHITECT/ENGINEER AIA 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. Total Project Cost: $ ;z 9y'-73 FEE: $ s Check No.:Z)O3 d tS iq (v 2,56 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund Signature of Agent/Owner ll( Signature of contractor Locationt?Lq No. L Date SORT►, TOWN OF NORTH ANDOVER f � 3:o�•t`'D • hO O � w 9 # Certificate of Occupancy anc $ ♦ i s„CNUs<� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check � G/(� X70' ca,9-- 24, 551 Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans 0 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 USS ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Siqnature COMMENTS t; 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 Con nection/si nature& Date Driveway Permit DPW Town Engifteer: Signature: FIRE DEPARTMENT -Temp,Dumpster on site yes Locatedno384 Osgood Street 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.$1o0-$1000 fine NOTES and DATA — For department use ❑ Notified for pickup - Date 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 o 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 Addition or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit o 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: Doc.Building Permit Revised 2008mi r The Commonwealth of Massachusetts Ads = 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): Address: Ix 'TuaKt� • City/State/Zip: A o t`w Phone#: 9 53a- 03 52 Are you an employer?Check the appropriate box: Type of project(required): 1.[A I am a employer with 1 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. [:]New construction 2.❑ I am a.sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g• ❑ Demolition working for me in any capacity. employees and have workers' 9 ❑ Building addition [No workers' comp. insurance comp. insurance.t required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.E]Plumbing repairs or additions myself. [No workers' comp. right.of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other ® comp. insurance required.] *Any applicant that checks box#t 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 the policy and job site information. Insurance Company Name: Woe46 � _=mUranc.0 A94OS./ --Tk Policy#or Self-ins.Lic. #: 99 y 3 5'7� Expiration Date:_L0 A Job Site Address: Z g Vuhc 401 City/State/Zip: N.A r,��utn ► at 8'4 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 'r I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Sit;nature-,oe7 �!/� Date: Phone#: G?�--53a- o3sa Official use only. Do not write in this area,to be completed by city or town official e City or Town: Permit/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#: NORT►y L ONM Of . }}(� � o , dover, Mass., �(- - Y LAKE COCMICHEWICK AO 'QATED p'P�,`�� S U BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System I �, / 1 ✓1�.` BUILDING INSPECTOR THISCERTIFIES THAT................. ...... .........rs�................................. ..Cr.!1�..................................................................... Foundation has permission to erect....... ... buildings on .......Q ...... ........................... ....�'!� ......................................... Rough to be occupied as............. ......... . .......Q.,fd a..f ......... chimney .. ............ . ....... ............................................................... provided that the person accep ing this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final 3S� — PERMIT EXPIRES IN 6 ?MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI0 S TS 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. f 11-09-10; 16:42 ; patrick-j-woods-insurence 17815375464 ;9785318617 # 1/ 3 7ERVICATE TIFICATE IS 186UED AS A MATTER OF INFORMATION ONLY AND CONFERS NO MRIGHT$UPON THE HOLDER. THIS CERTIFICATE DOER NOT AMEND, EXTEND OR ALTER THE cOYET89E AFFORDED OLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOE$NOT CONSTITUTE A CONTRACT BETWEEN ING INSURER AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. L NT, If"C holder 1S an ADDITIONAL INSURED, the 1WAIVED,eubJect to the terms and conditions of the pogcy,certain lig m(iae)must be endtused. If SUBROGATION this cedw=te does not confer hto tD the oertificate holder in Eau such endo ms BrId endorsement A statement PRODUCER ! Woods P J Inwwanoe Agency Ina Po Box 363 Peabody, MA 1580 COMPANIES AFFORDING INSURANCE INSURED COMPANY A GRANITE STATE INSURANCE COMPANY Ronald Wachlln Dbe Ronan Can"Ion 13 TUCKERS CT Peabody,MA 010"18 TH6 IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED 6110W HAVE BEEN ISSUED TO THE INSURED NAMED ADM FOR THE POLICY PERIOD'INDICATED,NOT WrrNBTANMNO ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DQCUMEW WITH RESPECT TO WHICH THIS CERTIFICATE MAY BC ISSUED OR MAY PERTAIN,THE INSURANCE A"ORDED THE POLICIES DESCRIBED INeREIN IS SUBJECT TO ALL THE TERMS,IMUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED by PAID CLAW, VII TTNB CIF 111111011M in FOLIM WEBER POUOYeFPearne DATA POLl07 eJfPBtATION DA7! A oRMPLO`�fERB'LY BZrFY PROPRIETOR, LJMIT5 ARTNER111E1tECUTNE K�/RJiARk INCL 13 w feta o I 8943878 10120 010 10120 011 ATUTORY LIMfiS AppRoeluMAapwdmsQ y, CH ACCWD NT $ 10% NIM POLICY Uwr $ 7THE TID LMON -EACH OAK WilRB COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR RONALD WACHLIN. CERTMATE HOLDERCANCELLATION SHOULD ANY OF THEAM DESCRIBED POL ICIES SE CANCELLED V&FORE THE EXPIRATION DATE THEREOF,NOTICE WU BE OS WERED IN ACCORDANCE WHITE THE POLICY PROVISION& I AUTHORIZED RP_MMEWAYn i I I ' �• 11-09-10; 16:42 - . ;patrick-i-woods-insurence 17815375464 ;9785318617 # 2/ 3 Vr L1J%t31L,!1 T iN.��l �� UA��►°w°mn'"I 7��; 978.531.2777 FAX 978.531,8617 11/09/2010 ods YhSTdrance THIS CERTIFICATE 18 ISSUED AS A MATTER OF INFORMATION 8t. Agency, Iqc^ ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOIDFR THIS CiSZT1FICATEDOESNOT AMGENp,EXTEND ORx 3 53 ALTER THE COVERAGE AFFORDED BY THE pp�Eg Pe Y. 14A 01960 MlatiREp 16 C itrIICt INSURERS!AFFORDMIG COVERAGE Oil, Ronald c iii a INSURERA; � NAIC91 � TtIcFCers Ct. � COMPANY 34755 Peabody, RA 01960 INSURER a INSURER C: RGUMM b: MURER E. THE POLICIES OF INSURANCEMLM"yy EERANY REQUIREMENT,TERM!OR OF ARY UEEMSURED NANGD pFOR THE POLICY PERIOD INDICATED.NMAY PERTAIN,THE INSURANCD F THE PON OR OTHEROOCUAIENT WITH RESPECT TO WHICH THIS OTM'HSTANDING POLICIES.AGGRMATE LNITSY HAVE BN RED E19Rg� pE�SPECTTO ALL THE TERMI�EXCLUSIONS AND�CON�D171SSUED ONS O O CH TYPE OF WSURAGENERA.LIA�Iry POLICYNUM86R FFECTNE POLICYNV7121 11/03/2010 11/03/2011 EACHOCCUR uMnsX COABwERC1AL GENERAL �� : S0090 C[AIM8 MADE ®OCCUR DAMAGE TO RENTED $ AI MED EXP Vow my vormo B 50' 5, PERSONAL a ADV MIJuRY i GEN'L AGGREGATE LMrrAMIES AER GENERAL AGGREGATE $PRO- 1,000 s POLICY ! JECT Loc PRODUCTS COh P-AW a 1,000 00 AUTOINDBRE uaenm ANY AUTO COMBINED SINGLE LYIT ALLOWNEDpuTO3 (Eescodenq i SCFIEDULBU w o8 BODILY INJURY HIRED AUTOS (P�PWSC11) $ WON-OWNED AUTO$ � (Per aeei?eeki?'eekl)R1f i GAkAGE LUMLITY (Pd' _ ANY AUTO AUTO ONLY-EA ACCIDENT ! —_ OTNER THAN EA ACC 6 6ORUtkL1A&LTTY AUTO ONLY: AGG ! OCCUR CLAIMS MADE EACH OCCURRENCE S AGGREGATE $ DEDUCMLE i RETENTION i WORKER$COWPENSA7IDN AND $ UmwvEANY _ LMBRIYY I WC ARI. OFFIGEM MBER EX1 w IETOWtARTW' .IITRIE E-L EACH ACCIDENT $ If Pas.AL PRra ender I SPECIAL PROVISE.L.DISEASE-EA EMPLOYE $ SIOPI3 below E-L D*FM-POLICY LUT i DiitWMM Op OPkRATICKM9 A 60CATKINB!VlIIICLEB I= UWM ADDED BY SIT!WE=PRdVR WN9 IC Q SHOULD ANY OF TME ADM DEPOLICIES 8E EXPIRATION DATE THEREOF 7Ne ��ARE THE =UING MISURM YNLL ENDEAVOR TD MAIL L0 DAYS YYRl,NOTICE TO THE CERTIFICATE HOLDER NAMED To THE LEFT, BUT FA`URE TO MAL SUCH WME SHALL IMPOSE NO OBLIGATION OR LIABRnY OP ANY KIND UPON TRE WtNIEK nS AGENTB OR AU REPRESBITATNE REPRESENT'ATAIES. ACORD 25(2009108) GACORD WRPOkATKN 9988 L\ Office of Consume Affairs&Bsines Regul ponce g `, License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 133414 Type: Office of Consumer Affairs and Busihess Regulation Expiration: 6/27/2013 DBA 10 Park Plaza-Suite 5170 RONCO CONSTRUCTION -��6 � Boston,MA 02116 RONALD WACHLIN , 12 TUCKERS CT. � ,% .:-' PEABODY, MA 01960 Undersecretary Not valid without signature �l:r�sachu�ett.- Dcp:u'trttcru rrf Puhlic ti:rfct� Bourtl Of BUilding Construction Supervisor Licenserrtrl�rr cls License: CS 71187 RONALD E WACHLIN 12 TUCKERS CT, 3RD FL PEABODY, MA 01960 i; Expiration: 8/4/2013 l ummi..inir Tru: 20503 STORE COPY INSTALLATION SERVICES CUSTOMER CONTRACT- MWORK- INT/EXT/PATIO DOOR LOWE'S OF DANVERS, MA., STORE 41094 STORE PHONE: (978) 646-9099 153 ANDOVER STREET SALESPERSON: DAVID MCCARTHY DANVERS, MA 01923 SALESPERSON ID: 135953 Document Print Date : 09/05/2011 This is only a Quote for the merchandise and services printed below. This becomes an agreement upon payment and issuance of a Lowe's receipt, upon which the entire agree- ment, including the specifically completed pages of this document, the Terms and Conditions included with this document, the applicable portion(s) of Lowe's receipt, and any other addenda or attachments hereto, shall be referred to herein as this "Contract." PLEASE READ THIS ENTIRE DOCUMENT INCLUDING THE "TERMS AND CONDITIONS." BEFORE SIGNING Lowe's Registration or Contractor License Number/Lowe's Contractor Name Lowe's Home Centers, Inc.'s MA HIC NO.: 148688 Lowe's Home Centers, Inc.'s FEIN: 56-0748358 Customer Name Home Phone S DEBORAH SCHMITT 978-689-4347 Customer Address � -28 DUNCAN DR Other Phone L 978-771-8050 City State/Province Zip/Postal Code D NORTH ANDOVER MA 01845 Installation Address T 28 DUNCAN DR Installation City Installation State/Province Installation Zip/Postal Code NORTH ANDOVER MA 01845 MERCHANDISE AND INSTALLATION SUMMARY MERCHANDISE SUMMARY 180826 : CH5006 "611 : SOS : SOS CHEMCREST POLYURETHANE MLDG : DENTIL MOULDING : CHEMCREST CORPORATION LIMITED -QTY 1 161417 : PEDASINGLEDR : SOS : SOS PELLA ENTRY 850 SERIES TC : SINGLE DOOR : PELLA - ENTRY DOORS - QTY 1 1046 : 87544 : STK : 1X4X4 RED OAK BOARD : 1X4X4 RED OAK BOARD : BABCOCK LUMBER - QTY 1 19238 : 444 8PINE : STK : PNE CASE 444 5/8"X3-7/16"X8' : PNE CASE 444 5/8"X3-7/16"X8' : EMPIRE COMPANY, INC. (THE) - QTY 3 109513 : 90998 : STK : PELLA ANTQ BRASS STM DOOR HANDLE : SELECT ANTIQUE BRASS STORM DOOR HANDLE : CLO LARSON MANUFACTUR- ING COMPA - QTY 1 134048 : E591 : STK : PLY PILA E591 5-1/4"X7-1/2' : PLY PILA E591 5-1/4"X7-1/2' : EAST COAST MILLWORK DISTRIBUTI - QTY 2 147639 : 90562 : STK : 36" SELECT STM DR FRAME-BROWN : 36" SELECT STM DR FRAME-BROWN : CLO LARSON MANUFACTURING COMPA - QTY 1 ;tore 1094 Project No. 333874467 for DEBORAH SCHMITT Page 1 of 8 STORE COPY 251220 : 91316 : STK : PELLA CLEAR SEL STM DOOR GLASS : PELLA CLEAR SEL STM DOOR GLASS : CLO LARSON MANUFACTURING COMPA - QTY 1 320797 : F60SK V PLY 609 FLA : STK : AB HANDLESET LEV PLY/FLA (133628) : SECUREKEY ANTIQUE BRASS RESIDENTIAL SINGLE-CYLINDER ENTRY DOOR LEVER WITH DEADBOLT : SCHLAGE LOCK COMPANY- QTY 1 Materials Price $ 2074.73 INSTALLATION DESCRIPTION Stock or SOS : Stock Door Type : Exterior Select Location : Front Door Select New Door : Single Pre-hung Number of Doors to Install : 1 Side Lights or Transoms : No Hardwood (Mahogany or Oak) Door : No Hidden Damage Description : None Number of additional holes bored for accessories : None Install Specialized Mortise Hardware : No Install Storm Door : Install new storm door Select Storm Door : Storm Door Lead Safe Practices : No Total Linear Feet of Custom Trim to be Installed : 0 Deliver Door : Yes Customer Understands Scope of the Project : Yes Permit Required : No Additional Miles Traveled over 20 : 0 Bring Up To Code Description : None Local Disposal Fee : Yes Describe Other Work Needed : Build in Jamb, build out for storm door, install Other Work Charge : Yes trim, fix sill and add oak Comments : No Comment Labor Charges I $ 855.0 Detail Deduction -$ 35.00 Additional Specifications: Notation: Lowe's will not make structural modifications, paint or stain or remove/reinstall security system equipment. Customer is responsible to advise if prop- erty is governed by Historic District Regulations. Additional Specifications:Federal law requires Lowe's to provide you with the pamphlet Renovate Right. Important Lead Hazard Information for Families, Child Care Providers and Schools. 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. -3tore 1094 Project No. 333874467 for DEBORAH SCHMITT Page 2 of 8 STORE COPY TOTAL CHARGES OF ALL MERCHANDISE AND SERVICES where applicable SUB-TOTAL $ 2894.7 *TAX $ 0.001 DELIVERY $ 0.0 ORDER TOTAL $ 2894.7 BALANCE DUE Work is to commence upon reasonable availablity of Contractor which is anticipated to be.. -05Lf r f [fill in date]. Estimated completion date is r 0 C-,S_ ° i t [fill in date]. NOTICE TO CUSTOMER All items listed in this contract and -pecificaiion sheet(s) are to be installed under conditions agreed upon at time of purchase and at the price appearing on this contract form. This assumes sound existing substructures, superstructure and points of attachments. Extra labor or material incident to installation necessitated by defective substructures, superstructure, points of attachment, or the moving of fixtures or appliances to be billed at extra cost to custom- er. IF THE CONTRACT TOTAL IS $1,000.00 OR LESS Customer must pay in full COMPLETE THIS SECTION ONLY WHEN THE CONTRACT TOTAL EXCEEDS $1,000.00: Customer to Pay in Full; OR [_] Customer to use the following payment schedule: (1) Deposit$ 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): L] 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. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AND UNTIL YOU HAVE READ THE TERMS AND CONDITIONS CON- TAINED IN THIS CONTRACT AND WHICH FOLLOW THE SIGNATURE PAGE(s). BY SIGNING BELOW, YOU ARE ACKNOWLEDGING THAT YOU HAVE READ, UNDERSTAND AND AGREE TO THE TERMS AND CONDITIONS SET FORTH IN THIS CONTRACT. YOU ARE ENTITLED TO A COPY tore 1094 Project No. 333874467 for DEBORAH SCHMITT Page 3 of 8 STORE COPY OF THIS CONTRACT AT THE TIME OF SIGNATURE. 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 CON- TRACT, THAT LOWE'S MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRET- ARY OF THE EXECUTIVE OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATIONS AND THE OWNER SHALL BE REQUIRED TO SUB- MI'1% SUCH ARBITRATION AS PROVIDED IN M.G.L. c.142A. By, % Date: "-, Lowe's ome Centers. Inc By: -1 & t el'C'6? 172-e-C, �C) Date: Owner _ By: Date: Spouse ThE SIGi4A.TuA!ES 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 PE SOLUTION EVEN WHERE THE SECTION ABOVE IS NOT SEPERATELY SIGNED.BY THE PARTIES. WITNESS OUR HAND(S) AND SEAL(S) BELOW THIS DAY OF Lowe's Home Centers, Inc. By: ` rr ' - (Seal) Print Name: ` �`'� t L r-L- �� .� •_ s-,.�.n �-r— JCS L:.=� , r.:�_�t.� ��G �zt.�,: `a `l Address O er (Seal) t �Gi--I City State/Province Zip/Postal Code Print Name Co-Owner or Witness (Seal) ;tore 1094 Project No. 333874467 for DEBORAH SCHMITT Page 4 of 8