Loading...
HomeMy WebLinkAboutBuilding Permit #159-14 - 29 BLUEBERRY HILL LANE 8/16/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: I ORTANT:Applicant must complete all items on this page 2 . / .�OCATION} _ _ rar� __ �,��,V:eb�nr g c �-L a.►� _= _, -�--� nn -- P,rmt 100 Year Old;Strueture3 yes n0j MAI' NO = PARCELt.g � ZQNLNG)D,IS1T,RICT - Histonc�District yes no) � _ Machm�ShopzVillage�_ yes __ nod. _ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building C16ne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial )ARepair, replacement 0 Assessory Bldg ❑ Others IDD Demolition ❑ Other '^s ©}Septic3 �WeIIT ❑lFloodplaw) ❑M1Netland_s; p" Watershed Distract, ._ . ©j .Water/Sewerr .. _. - DESCRIPTION OF WORK TO BE PERFORMED: Pmoutliqtaq (D 641� T,,wo s 48er. *N D 5+04tMToru- bWIYX don Identi kation Please Type or Print Clea y) OWNER: Name: ��.Ut Giyrer' Phone: g7y-IP-S74� Address: CO,NTRA011i0 Name:' �utd Rt,'4 eino Rhone:ta oo7 .. f Address 56 i� ctn� �� Aeuen, MA 01� �k4 ' _ _ , 4 2 3365 Expi, Date ! 3 4 Supervisorrs�Construction�License- � - • U -725- Home�lmpro.�vement'License: . _ . T-__ _ Exp; Date,v 11' ARCHITECT/ENGINEER Via Phone: Address: Reg. No. FEE SCHEDULE.,BOLDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ ai 5 °.y FEE: $ 30•x° " 122 Check No.: q7GI YReceipt No.. NOTE: Persons contracting with unregistered-contractors do not have access t the guara ty fund Signature of Agent/Qwner Signature of contracto Plans Submitted ❑ Plans Waived 0 Certified Plot Plan ❑ Stamped PGns 11 Location No. J 1 i , Date 9 . - TOWN OF NORTH ANDOVER .a Certificate of Occupancy $ � Building/Frame Permit Fee $ - *r ` Foundation Permit Fee $ Other Permit Fee $ I` D NS TOTAL $ f: i' Check AMI �j11alyv 2 v l J Building inspector k • I Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ TanningWassage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food_Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ I THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS I CONSERVATION Reviewed on Signature 1 j COMMENTS HEALTH Reviewed on Signature COMMENTS r Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments I Conservation Decision: Comments Water & Seger Connection/Signature Date Driveway Permit DPW Town ]Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMiiiT = Temp Dumpster on site yes no Located at 124.Maig'Street. Fire Departmerit-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, roast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes iso MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— For department use B Notified for pickup - Date Doe.Building Permit Revised 2010 Building Department The folawing is a list of the required forms to be filled out for the appropriate permit to be obtained. • L Roofing, Siding, Interior Rehabilitation Permits u Building Permit Application j u Workers Comp Affidavit u Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract u Floor Plan Or Proposed Interior Work u Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks u Building Permit Application o Certified Surveyed Plot Plan u Workers Comp Affidavit u Photo Copy of H.I.C. And C.S.L. Licenses u Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) a Mass check Energy Compliance Report (If Applicable) u Engineering Affidavits for Engineered products VOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) u Building Permit Application u Certified Proposed Plot Plan Li Photo of H.I.C. And C.S.L. Licenses a Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And j Hydraulic Calculations (If Applicable) u Copy of Contract u Mass check Energy Compliance Report o Engineering Affidavits for Engineered products gOTE: 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 subm* ted with the building application l Doc: Doc.Building Permit Revised 2012 NORTH Town of O 0 h , ver, Mass, Mk AM." l ��3 T O LAK! COCMIC Kl WtCK � ADRATED s � BOARD OF HEALTH Food/Kitchen Septic System PER IT T LD 1 0,61 J � BUILDING INSPECTOR THISCERTIFIES THAT ... .... .. ................................................... ............................................. has permission to erect .. ...... buildings on �... ....5. ... ... .. . „�. �. Foundation p. �. , Rough to be occupied as ......... ...... .... 1. �....... . . �!� ............................... Chimney provided that the person accepting this permit shall in every resp ct conform to the terms of the application Final on file in 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough Service ............... .. . . ................................ Final BUIL ING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. Smoke Det. SEE REVERSE SIDE .•� a.vrnrr1vnwe41ir1 UJ lnuasucRuseua' :r;: .�: Depart of Industrial Accidents �'' Department 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/Organixatiott/Individual): -D&ylA P-el�qha Address: G 61 " City/State/Zi 4117 0 ( N4 Phone #: q 71— Are you an employer?Check the appropriate box: 1. I am a employer with_5 ❑ I am a general contractor and I Type of project(required): _ 4. 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' o workers' com coin insurance.= 9. []Building addition [N p.insurance P• � required.] 5. [] We are a corporation and its 10.[]Electrical repairs or additions' . 3.❑ 1 am a homeowner doingall work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152,§1(4),and we have no 12.[]Roof repairs employees.[No workers' 13•❑Other comp.insurance required.] *Any 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 ail 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:__- A7rM MijuciJ Tnsvranct ComP0_nV Policy#or Self-ins.Lic.#: A WC-go0- 7aa733 E-,2oi3A _ Expiration Date: Gkz Job Site Address: �� 3Qb6 city/ ekI�fY1� 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 vioiator.'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 ltf y der a pains and penalties of perjury that the information provided above is true and correct Si ature VV G Date " Phone# Official use only. Do not write in this area,to be completed by city or town official 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#• 1 %lassacnusetts - Department ;f nuc++c Safety �-- Board of Building Reguiauons ana Standards ( n.trurcin tiultcr�i" r :' License: CS-023365 : DAVID REITA-46 56 PLEASANT STREET " METHUEN]yIA 01844 Commissioner 12/04/2013 c r O - w / / � I' n1Ile!( G11e Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 108782 Type: Private Corporation Expiration: 8/25/2014 Tr# 230284 DAVID REITANO REMODEL & BUILD David Reitano 56 Pleasant St __. - --- ---...---- -------- Methuen, MA 01844 - -- - - Update Address and return card.Mark reason for change. SCA 1 L'a 20PA-05/1t jj Address LI Renewal L-] Employment j- Lost Card / —'��C' !('////UI!•iI[/'('CIl/��[ —`GIU.JJC/['>i//ir'r�l :'K-:" Office of Consumer Affairs&Business Regulation License or registration valid for individul use only T E��' 1OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: K_V-,TegIqtratlon: 108782 Type: Office of Consumer Affairs and Business Regulation ;Expiration: 8/25/2014 Private Corporation 10 Park Plaza-Suite 5170 =rY' Boston,MA 02116 DAVID REITANO REMODEL&BUILD David Reitano 56 Pleasant Sty. Methuen, MA 01844 ^� Q_ot Undersecretary valid without signature e �. �.. AC40R"`� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 06/11/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 01571 -001 CONTACT NAME: T A Sullivan Ins Agcy Inc O.N .Ext: (978)683-4700 1 a/c.No.: 135 Merrimack St EMAIL Methuen, MA 01844 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A: A.I.M. Mutual Insurance Company 33758 INSURED INSURER B David Reitano David Reitano Building&Remodeling INSURER C: 66 Pleasant Street Methuen,MA 01844 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT NTH 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. ILTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS INSR WVD MM/DDIYYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ PREMISES Ea occurrence CLAIMS-MADE ❑OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ OLICY r PRO- JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO _ BODILY INJURY(Per person) $ ALL OVVINED SCHEDULED —'— _ ,AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS MADE AGGREGATE $ DED RETENTION $ $ )aeERS COMPENSATIO X WC STATU- OTH- EEMPLOYYERS'LIABBILI Y TORY LIMITS ER AIVy PR pPR IETOR/Pq RTIJER/E xECUTIVE Y/N E.L.EACH ACCIDENT $ 100,000 A OFFICERrMEMBER EXCLUDED? Y NIA AWC-400-7027338-2013A 6/12/2013 6/12/2014 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If Yes clescribe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Workers Compensation Coverage applies to MA employees only.. The workers compensation policy does not provide coverage for David Reitano CERTIFICATE HOLDER CANCELLATION LOWES COMPANIES INC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PO BOX 1111 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN N WILKESBORO,NC 28656 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE _ ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD AC o> CERTIFICATE OF LIABILITY INSURANCE DATEIN(AW4YY'n 1112912012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(SI, AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pollcy(Ies)must be endorsed. if SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsemernys). PRODUCER Paychex Insurance.Agency; Inc. roAM 150 Sawgrass DrN a PHONE . . — I FAX IAlC Nol• Rochester, NY 14620 E-MAIL - — 877-266-6350 INSURER s AFFORDING COY—E NAICA _ ........................ _- IN LIRE-A:o.�n-lun nu in:.�rauc:�:mr r-ry INSURED --- _ Davit:Reilano INsuREae: j dba DAVID REITANO REMODELING AND BUILDING INSURER C 56 Pleasant St INSURERD: _ Methuen.,MA 01844 -- INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 15 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN'$SUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXC._USIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. .. TYPE OF INSURANCE D SURR""- - --"---- FRKIC EFF POLICY NUMBER IMMIDDrYYYYI fV.M1DUfYfY(% LIMrrr A rGF.NFRAL LIABILITY X EACH OCCURRUC.15 $I ccc.rnp _c COMMEFCALGENERALLIABILITY S TYSREtJTED $sncrN,— CLA'M34,4ADE 11:1 CCCUft MED EXP An onePgSonl_ DAB P 303650 12'012012 12,0112012 '---- PERSONAL&.ADVIN.FURY _L111"UDED - - — GENERAL.AGGREGATE S 2.tt:u,(Io '.GENL A,3GR_GATE LIMIT APPLIES PER: PRODUCTS-COMPKW AGG $ PRO 'x FDLICv LOC S AUTOMOBILE LIABILITY U,I ! a accidertGOIASINED _ ANY hUTJ 8OD'LYINJURY(Porpw=) S ALL CIWED J'CHEDULED •�_ - -..i P.U705 AUTOS r900�\'INJURY(Par acd0enq F NON 011MED HIRED.WJTCS AUTOS I PROPER^/OAM.4GE y ;Per a0drieff. __.. UMBRELLA LIAR _ OCCUR I EACH OCCURRENCF F�;CESS LIAR CLAINS•MADE: •' .AGGREGATE _ _3 DED I RE'EtJTION $ WORKERS C041PENSATION NC STAT'J- jOTH-i AND EMPLOYERS'UASIUTY YI NIT AMi PFOPRIET.P./PPRTNEA/EXECUTiVE E.L.EACH AO�DENT $ Orl-k EPJMIDA"ER EXCLUDED'! N(A (Mandatoryin NN) E.L.DISEASE-EA EMpI.CIYEaS ~_ - It yCS.desenbo under .- 0E5GRIPTIUN QF UFER.ATICNS t4ow E.L.DISE49E•POLVG'!LIMIT--T :$ I 1 DESCRIPTION OF OPERATIONS I LOCATIONS r VENtCLES(ABach ACORD 101,AdMonat Remarks Schedule,K more spam K mciored) LOWE'S COMPANIES, INC. AND LOWE'S HIW INC ARE NAMED AS ADDITIONAL INSURED WITH RESPECTS TO GENERAL LIABILITY. CERTIFICATE HOLDER CANCELLATION SHOD-C ADIY'O:-HE AGC''.!E DELA_R GED'C.)LICIES BECAt•10ELLED BEFnRE THE LOWE'S COMPANIES, INC. EBPIRATICN D-%TE THEREOF NCTICEIAALL BE DELI V=-RE]IN ACCORDANCE'd.ITF THE PCL C7�FCIV'ISIONS,EUT FAV•I IRE TO MAIL$UGH NOTICE SHA-L IMPOSE r•10 ATTN: IS INSURANCE OELI-ATOHOR U.AEILIT"OF AY'r KINDUPCN THE C__,WANY,ITS.AGEI.TS,CP. PO BOX 1111 REPRESEtJTATIVES. NORTH WILKESBORO, NC 28656 AUTHORIZED"-PRESENTATIVE ©198&201 CORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD STORE COPY INSTALLATION SERVICES CUSTOMER CONTRACT- MWORK- INT/EXT/PATIO DOOR LOWE'S OF SALEM, NH, STORE#2382 STORE PHONE: (603)681-4218 541 SOUTH BROADWAY SALESPERSON:ANTHONY CORNACCHIO SALEM, NH 03079-0000 SALESPERSON ID:631180 Document Print Date :08/10/2013 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 other addenda or attachments hereto, shall be referred to herein as this"Contract." applicable portion(s) of Lowe's receipt, and any 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 S DAVID GINNER Home Phone 978-984-5766 O Customer Address Other Phone 29 BLUEBERRY HILL LN L City State/Province D NORTH ANDOVER Zip/Postal Code MA 01845 Installation Address T 29 BLUEBERRY HILL LN O Installation City Installation State/Province Installation Zip/Postal Code NORTH ANDOVER MA 01845 MERCHANDISE AND INSTALLATION SUMMARY MERCHANDISE SUMMARY 193569: 35170FJPMD : STK : PFJ CASE 351 2-1/2X11/16X7 : PFJ CASE 351 2-1/2X11/16X7 : EMPIRE COMPANY, INC. (THE) - QTY 3 238345 : 2827-8 : STK : 3/4X5.5X8 RF EMBOSD PVC TRM BOARD : 3/4X5.5X8 RF EMBOSD PVC TRM BOARD : ROYAL MOULDINGS LIMITED -QTY 4 227034 : 71 1/2" X 79 112" : SOS : SOS PELLA 350 PATIO BBG OR SBG : 71 1/2" X 791/2"/2 PANEUPATIO : PELLA 350 SERIES PATIO DOORS- QTY 1 Materials Price $ 1700.99 INSTALLATION DESCRIPTION *'Store 2382 Project No. 383342315 for DAVID GIVNER Page 1 of 7 STORE COPY Stock or SOS : Stock Door Type : Patio Select Location : Back Door Select New Door : Sliding Number of Doors to Install : 1 Side Lights or Transoms : No Hidden Damage Description : None Number of additional holes bored for accessories : None Install Specialized Mortise Hardware : No Lead Safe Practices : No Total Linear Feet of Custom Trim to be Installed : 32 Deliver Door: Yes Customer Understands Scope of the Project : Yes Permit Required : Yes Who Will Obtain Permit : Lowe's Permit Fee : No Additional Miles Traveled over 20 : 0 Bring Up To Code Description : None Local Disposal Fee : Yes Describe Other Work Needed :frame prep Other Work Charge :Yes Comments : viyl sider w blinds Labor Charges $ 884.50 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. TOTAL CHARGES OF ALL MERCHANDISE AND SERVICES *where applicable SUB-TOTAL $2550.4 *TAX $ 0.0 DELIVERY $ 0.0 ORDER TOTAL $2550.4 BALANCE DUE Store 2382 Project No. 383342315 for DAVID GIVNER Page 2 of 7 d STORE COPY Work is to commence upon reasonable ailabli of Contractor which is anticipated to be _[fill in date]. Estimated completion date is [fill in date]. NOTICE TO CUSTOMER All items listed in this contract and specification 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 PLETE THIS SECTION ONLY WHEN THE CONTRACT TOTAL EXCEEDS$1,000.00: ustomer to Pay in Full; OR ] Customer to use the following payment schedule: (1) Deposit of$ to be paid upon signing contract. Any deposit collected at the time this Contract is signed will not exceed one-third (1/3) of the contract price; and (2) Payment of $ to be collected upon or after the commencement of work. I/We authorize Lowe's to do one of the following (check ap- propriate box below): L] Charge my/our credit card for the amount of the payment indicated above upon or after the commencement of work; or L] Deposit my/our check for the amount of the payment indicated above anytime upon or after the commencement of work; and (3) Final payment of$100.00,to be paid upon completion of the installation to 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 OF THIS CONTRACT AT THE TIME OF SIGNATURE. NOTICE REGARDING ARBITRATION AGREEMENT FOR CLAIMS COVERED BY M.G.L. c.1 42A 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- MIT TO CH ARBIT TION AS PROVIDED IN M.G.L. c.142A. Date: I V Store 2382 Project No. 383342315 for DAVID GIVNER Page 3 of 7 STORE COPY Lowe's Home Centers, Inc. By:_ ,� Date: 6 J.)d, Owner —41 By: Date: Co-owner or Witness 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. -�-, WITNESS OUR HAND(S)AND SEAL(S) BELOW THIS DAY OF Lowe's Home Centers, Inc. By: (Seal) Print Name: Address (Seal) Ownery Cit' State/Province Zip/Postal Code Print Name Co-Owner or Witness (Seal) Print Name Customer acknowledges receipt of a true copy which was completely filled in prior to Customer's execution hereof. You the customer may cancel this transaction at any time prior to midnight on the third business day after the date of this transaction. See the attached Notice of Right to Cancel for an explanation of this right. 0 Store 2382 Project No. 383342315 for DAVID GIVNER Page 4 of 7