Loading...
HomeMy WebLinkAboutBuilding Permit #187-11 - 82 MIFFLIN DRIVE 9/2/2010 f "oRr BUILDING-PERMIT oy _ 2 4�pl. T6 TOWN OF NORTH ANDOVER o , p- APPLICATION FOR PLAN EXAMINATION Permit NO:J Date Received �RgpR,TEo A�AL� 5 Date Issued: r �( ✓ �SSACHUS��� IMPORTANT:Applicant must complete all items on this page _., n+:,]'. _ _ :2t•i:. '.:�:... •v mat. - - :ark - r. ^+I:,' .-h9'` _ i* . r "..-uu .. .l•,t'J��NI. Tr_rv_ ..r'� _ ._i•• .•r•v_ �Ih.1 r":�%.,4:a.�A'.1�.�� _ �•a::. - - - `�n.;, - `}tis•. �`2�'' _ 1, - 'S e.�;e- s=ir,--i,•:- -;;s..• - - - ••f - ?rY - ' Al - s¢:n... = .�a�. '._ity,tr�- -''=Y '�"9v� .=1=� - - h:�lr:$-. ?rn:,>s1;.=w,-:::�•....,h.�-.:-y,,,.''.;i: !y6't... ?,•:rfi:,�.. �'Y._ ..;,.�,,;�•l,^vy^�A- •P_ _s.y?�-eti' .5r`rc^,` _ -»Y - '^,c.-:.::� _sse.- -a' - - ..�.��,;,te..f�..a�; ,rTi _ _ ;C•�..�` ;�:ck.,-.. -F•. '��n,➢� F[;�. ,`Q?�!-1 :�.;�• 4Y:Cfi' i'�y:='??if.--_ �-� r'.'.F.,sa"�Z'F'? '�:I�vRi�' _�}r`:"_:^;vh�'4vTxs:c{i�%:ti.v.�.f-' _ a'l� �I!•. at�J•,!: a��e'�'�p��,}�-,•k„;rtS'•�, "�n7 r.:^.r-':1 �+: ..fie-.:,'r�A'3i :ti�-i J?,If'a��,r,�„Jr:d:' n �., y _,�,��2�.._">.t,R = •fin �x...�.c. ,_ _:v_nifiv;,..,F1Y:.%h.�..r,,. . l[n�.'6 .,a'•.ev�,... _ �f E�;S'Y_rt a.L,����,kesb` (14� .oSCF �i{u� �Ii��7�,:. _.L.L`•:��`eI�T..,: li [F��•.,-....�.�-s..s R'.•.,}.. n,i�.n _a ''-^�_+ .y-"?i N.? �� -.�� ,Yrn ,>r!� '�J�{CELS{CrlC�'��:.,cjy��.�i•Ic:alSi ��l.E'�C�i_,_.1� S• /�G'i��.`W. + 9'.Is_. �f'-'�_ y�_ r 1+'}C�r�i s,,�•v:SL��_._ '� �='G�, ..�.���„a�_�J_ '7 '^-e•�:.i„-r- , ��[_r�..a_� -9.s,Y'.:a4�'�,�t Zb"1 .._... �?2`•sr�•'r`.K,-,'�''.:-." y._ �.n �- 5'��:='scz.,, .z,.I*n.r_-L rz� _ - ;F.�,,,.t r aC:?r•;•r�T'r'x m z"- ����• t-ra,�-."`:- ,-:ter ;.;'�,.'.�,.:.., �!r.,,^-s, "sr: pa.-.+'.rt-_�.�:'>•' .'�'_�_�� .../z ��_•�i„_ "r�,:�'= - :h 1 _ ,f c_ -:ar•<�f�F, - - •Cr '�::, .�=- s;.-:?;•:; .r v%:,'"' .:izN„- :AM1•��t�ill:C:I':�...q:y.•: �' ,axi'1- 6^:'.'ik:vYi •��iF:,6._;F��.T-r.5''.-a.�';'M1Y';si�,zS, •7-'�r�.. r�.�_.�Fj. Fi; ,.'7!.,a^:c..4„ C�= ..ti.. ua Vr,�n .91'� •�':Y^' :..a-�.t�h:-,'fm. _'],>:,r-0^.t 1.: S._. 'r:.ECal^11u-J:���v^',� �CRfe'c'.S.aL�.c w.•T,p y:..t,:�.; i'i:^SIF`-".�,i�'•lu-v�'?fl";a��"S�_r�;��:t��^f'r.d. 1�.,..''�.,�"^ F.�,.'.`%p ti,.r�r._.L ^��•'^•� ,.,.sao.:^'•i'�;�"',`� rmr.' r�s .4^.°-L'�. ,.;r.,.izfl '�- ir';,,_,.-..��•,c�v 4'w-�r� I.,.s..n..�y..i�l ..a> �„tae ..�7r`"l+t ,J',:�i•:•n. 'k�?�,-.�-�'�",_� rT! :..rw;-x•= ,Iti•orr - `�` � - .r;-- r ,v7". _7-„�'�,,._.t,,.�:.�..r ..T4_..:..�, ;r._r �r,-u's.-�y`ur?�lS� -,3ria.. :.'•;� , °cq� s,-�d .7 r�/�_`, � .�w`1 y� �y��r�. '�_ .�r���9�P`+:-,{:c.:>;.: ..'�➢=rnN.'-�`.� �t=v;���.Ju ..1V.^ -:,. �r'T�.�.-�I�-3..3:�._T._ .f..a :..�'I'.���';,"��J�r1J.'L•::� �>:. L7i�1:.11U21�31��1Y°nid/����'• u'�v�.r�: F..:✓E= J..J.. -(�. TYPE OF IMPROVEMENT PROPOSED USE R Non- Residential New Building a famil _Acktbon Two or more family Industrial Alteratio No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other _ - "- -lii,�.- - •a«: •�.;;`�i`F?:._u-5q, 5� r';. retvr;: '.- r, ,r. _ .w':'a� :-c-,� x a:K. - ,+v:.-`' '""'E._.^ '�JJC�� kJ ..'rr�'- .. 5' >; �•t.ry, .•fay'",-.�,.,.??--t1"�',r;'Y`ti--•-: -is3r.. H. `'�-" - ���,; wcct-..ti r'.:�f.z:• _-......5:`�,r,,uv,,.:'x,:•:s,y.4,_7'3ty a '`'�r�,`• u.1 � �sI.IL}r�. }` '��,,;.'^�'"arF•7'_,�, '..ec..:,- 7{=n�11' E'' ' O •," 1' '' •� '? ysL'Y,�1f $^�e"✓' t`. ?ro,rp K1'�•t7Sr.Y�' •�r�_nK+(_.4a.1`>*'�"�r-a'.t..f,.�.�.�.-.��R"';���.�hgr;�.�`"t' 'O.�-1iLhr:Y'"�: �i�_4'-J• ��....��.c�.9.te:'�i•�'+li ��tix�' :x•,L��.4^ 'Y a;��'"'_K.�?..T;w�:�,":•r .h�y 0. �.......:.,.,... .. _. .• .,,k ',�:, ::-!'?• ,..��,-;_-wra __.xa:{:c:9 •;5-;;s;=-�.�'L�iSvl sr�'tiy'2 DESCRIPT ON OF WORK TO BE PREFORMED: I(lentificatipn PIease�ype or Print Clearly) L OWNER: Name: (� G(6m ,P, l eseU r Phone Address: t,�_°` "�''c' .�' .-..�: ..a.,tr�i bh..>r.�,;:.,•vh C�'• - :;ryrrct .��w.�a-•,- _r,�yv�;::'!� ==i,�-:;i='c :iC<- _ -,c.::J.;.. - __ Via, '3�'" �� xe�._T�-_tw``-_�».w"T 'J. •�7, _�i;�4- ���1':`�.ce„7 -r.;�;t -Wi^`.�u,x_•„� -- ..a'L.- � •�h,' ,r%5. :s`- �. S-�.r�2''� .,r r�: r�^.vr.�=�::4'ir',_:.:.r-'�`v�i•�_-;•"�` h:1->. s.,;- t 1,.:,;:-_ _ ,'.n`,€1' `xt?�% =������•--`-�-aa,-'-`7'!�,_��i'�-..,,, f,•�.s�.�,�" � � � �r.�r �r e,' � � .c••�k..'. �h _�' _ -'a:ti `,�5:�=:�--^'.., :%��r`�"a...-'4:�:} „v:,�.. Y 'fr>-P: aG'J_••e _.x7..:'b-t��rpik-J'l�'?�� -�x�:L'"'�sL."' �7 urt� -:.re.]n' ,U.r3rrPL1 biro't�.�r -"•-'y^Y` � "�-•'�� , .'}I�a - =��.•'�' �i ;F��u�r��'s-��?.,� u�c�'S,I,= ��,.i Farr �,-�,y" .C._f 5 e:r �t t'-T,w�,nsF-�ca• �ry:�J'i-, 1�„r �-' M' rh,... y� MC �� �,�� � ,r moi. `7 -i�•s,��"r-T��gt•.r"-` ..F'."•,•,Z'i.�a"{���?��� '- - �J ri �S.:s-r'b. _��r,a�a. � =Y`.^' rx,..�- �� '.iKr--,sem.,_.. _ 'r• •_ :%S: �.,_ --M•-.+'n ^��,• �:=�:'":�i?'�'�`(�G�-riii,"v '- ,r'S'-,.- c"L: � r'-, tG.:,.,�._. �ww...�1,'; .^.u'�..- ..,FM1�."S°f� �:�,"`•-;+n ��' k�. il�i�rm ,yo-•'��u��,iv '�°"�s�Y ,p �*-+?�•��31� .�,-' __ °� ��� ��• �� n�yi� �y���'��,•p�sri�:.rd' ,.'jj��+''. yL �Y'rj+��^,��r..." ",,. .F_a...'-�' t ,� � �.y `. �fnlac7�7�+?+c7�r�a` 3���5�� "ci�yF�� 3?ti "i�- ��.�'.���n��i�r'F����5 !'+tr - �"',`t--.L-•;_r. "FY ,._ I+ , �.T�'f}� =,g^ _'�,F7`5.1'�R.'_ k3L''-�,-r' "�+e�iF, .p, 'r✓ya•r..,ar-eY-- vnar- -,,�.,- 'u .I.:,�"r v, r.-,_.::x= -_ _ _ _ __ _ .::,;r. F•_ +o-_F. )'•k_,�: e.".. �= I�r ..'�, ��.'f.l ,ee�Irk``-,c ,.}ra. is i r�s�.:•J�f�r'�. r�=:1'=_,.fix `$'!• - -c 5`r•�-:r-..'�, ,rpsp�,ira.. ?.:_,.......-,_'_"�t^c^n' '..ewr• {r-- .�r., -�,- , a, =„qr, r,']r ,n.'y�n9. .R, h"Yr - "'��+^'+'fir};f '' a� 'Yt�grlay,., •;._! 4.a�`�,z••srP.�„�{.�;;' ,.�.�rh..ncv-^� �s•:,,;4,!':F 7':E;.c s �:.1�?T. v Ya ll.: :F �.:N'1,�•,Yi:1�,. , ,.,Sr, 1 L. •_u`r:F_-,y,S.F�a };u>.. .'IT�:a-kra 7.."�3'„1 -S4_,-Y{�:^xt:�`.Y' Yom•=L "•y:l., _jY1H.L:7. S„!. T ''4 .7'raxii.'Y ..rL y,• -M ;n�er� ,,-.':ezF''�'�7 �rd�`�35, }��'�,, 'y L",, � "{y Mi,i�Fr-+r"f�t _` '.}+'"uw!.s acr�•T a.v7. 4 .'rWi'". <• r:; `0r.��•��-�nyZy]'.JrAh�'a�}7r",(-,,tai��j"!'ishq:-�_ r^ ^'�,, r�'�{�':r�1y� `I -trt} 7� -"''(�i s�"•�= t�;-r,�rryat - -cti �A�,'61`9: c jfZ�. „�'+n�,�g"� i 6� w? :ISJ '1' ."'!aM!� .�y137!C/ J.w �,3•-'i...1� r^.r.:C,-::.ta.s,^Ja;f?.pi.=�..5r "x: 7R�� l•,:�...:,✓ -- �.:'.iL: _ ,:R � !G ;r;,y=.7 _'�'��:��'•-•_+fir. ..�i.. _.r'rr., s'I.'-'s.t r.:-,-r, -.Sr.: •1.�..,.., _ a.,•.1, rt` _ _ �o,�. 'V ^�`.� rt rd Sa' �.y.,...tx•X._ �r.'^'i.'^�.13�✓.�ia`..., r1``i. �.Ti4'_'g.��"`M`.r:;.>:,-- 4•'�.� ,.y;;_= _ _ _ 4:^.r,. �•�.s��'�•t�••r��,� �� '�a:f.;af...._ .s•;1��;�,.-,7e - 'h..r';ae -.��3�._ .'7�-?5'c,>._., �},.;3�`r.�E;�{`: i^te..'• ..i... r.,K.5n-': •�i.��.''r,2i't�-a�, a[+'_ , -,r:+''..,.u.:,. - d r .rte,,; '','^"' ti-r., �._.- ` _ �c_•i,--;;�a.-m.mac.• ,,[ ,,t, �a�,^•-e_.,- �'.oi. ..•,IiY-=--'•,nor. x w .�� ��t ,. � :,>�_...,. .,�cL•. r.. '.'ry. .�..,-r.�.. ,4,-�,yr� ::�.�-3� :k-ti..,s'�:,'-Y.rc'.;,;,;.•.�.:,.-: ,1 .,I:s.,.: z -�'-.'�, 5 .:r.. .� ,�..�. _..,. ,�_ >r:•. ..v�t4 ,s: vii-lk c..n:�.r•`'r '•u-: ,.2 ci r-n 4:'-w-..S�4ri�;'�;rti:. ,.'.5�-Ss':-;x.,a=�:."'z.., -F,i_.�'`+r'-�- S:r':�sW''T4 -C�";•i ,,K:.,�.,r.,=•t�� «. � .}1F,_ .r�?�:^=;;�!.4 •Jjt';•s-1'e'�.e; �� �,. •.� .s.•?, '.^'��. r';J'�.t.=,r.��.'�-f e:.c>�y _ ,r.:,,r.�,.�v:rc>,i'd: -_`i5�?s_�.,,.?_ :ruic`��.�t� ., rt( r� -7-4 :ac;^,i�^.:.�-*"'s�.a''rr�^�'..,3:T.:•- 11�^t=- �e�.�rrcf-�'""'^F�••,��'.:•�<g ��� .a�'�:r..�:s^�u:5.?`xP,�.�,__fir.�nr .,.�_��-.��'--a`��^'�!='ti,� k-.- -cS•R -1.� .'3�=s.�;3�� --��JJ }��, - i'., - � .�.>r.rp^:t.�i". '�u.--�' _!1,: �`�`*�?`k�,:. .y�:'r'= •'?.3 �'F". _�_6�� ��r:'.: � �a•,,a �--a';5:,...i. .k':,�P.r., Y( °i�77.1���r .6 y _ i:.'+' .>-i��f,o-'?JI4r" XE: .=�`rr'�:�✓'a•-^_6Ji ,=�i`ji'�`�-tir' .K''`.t„�:'`�. ::Z:'yY�:r�S,-• +-t"..� :x'2•.:..:",a��,=,x::-:"tom'^'L ' -sn^sT�' � s :ti^ ..r .r..,r.��r�i-:,__......-3zd�fix-;j'�•"• T�St°r:�i�!L�-'P-.,:"+7-�+.'-.:dX.,'c• r�•{�. �4���{f����.,,��a'��i::�' - � - u, .,:'.7: ,Fr-:�,.._:::��tir.<:.;ur.....?Fr.}z.,..L�'`zF•..r1< ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$9000,00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $_41i FEE:Z06ra Check No.: Receipt No.: NOTE: Persons contracting with unrebgistered contractors do not have access to the guar>an fund S34j:Q al U: f•,1{•' - -- ,_ _-ter_; •§ - - �r-_...:, 'cif ..�-,....1.�:'' _ ".,>rF .�.�! 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 o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) 13Mass 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 ❑ ►mel LHI�U Proposed r'IC.I 1 I'11Gln. ❑ 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:Building Permit Revised 2008 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 Sigriature I�IJIV MEIYTJ 1 ' 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/S�nature Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street - .1 .v�-✓::-'�^.v ':.L•h:�`r n.i': '.c:i- ^:2r2:�� i'ir,'t�•- _ _ _ S '-r:s--�?' ^•."x•�'. .,+'e _ - ::':d�::irS�'i_-:�.:'-:s�'S:c_�t'Mrn;., _. :j: : �t OF _ _ - _ gid: - _ - - - ��' ;,�� _ems' - - �i;�:=..•.,.::.,r -.�1'i. ltd!: _ `yte v.. - ' -�...... ... t_..�-•....�:a;: '� °'' t -fit' � .7"•:'t":1'r f�r P 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 1 Doc.Building Permit Revised 2010 NORTH To" O .- 6 Andover No... fl� dover, Mass., 9 t„- LAKE COCMICMEWICK 7� AORATED S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System M46 /� BUILDING INSPECTOR THIS CERTIFIES THAT.......... .�„� #4. 14w............C.'C>.R...�.Com .. ....... ...... ......................................... Foundation has permission to erect........................................ buildings on F-Z........ ......... ... ! ............... Rough to be occupied as.. �,! ?..� .!/ ....' � ... Chimp y e provided that the p a cepting this permit shall in every respec 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCT O TARTS Rough ....... Service BUILDING INSPECTOR Final Occupancy Permit Required to Ocatpy 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. Location No. Date Z ,►ORTq TOWN OF NORTH ANDOVER f � f R P + Y Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ s�cMust 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # Building Inspector CONTRACT# r i/ MASSACHUSETTS EXTERIOR SOLUTIONS INSTALLED SALES CONTRACT INSTALL SALES SPECIALIST NUMBER ✓ CUSTOMER STORE NO. STREETADDRES ^ STREE.JADDRESS CITY f} STATE ZIP CITY STATE ZIP fel} h TELEPHONE^ � � ` TELEPHONE,^ DATE j —]FLOWE'S HOME CENTERS,INC.'S MA HIC NO.: 148688 CASH BANK LCC REG 7:56-0748358 RD — —t—J CHARGE This is only a quote for the merchandise and services printed below.This becomes an agreement upon payment. Upon payment,the entire agreement,including the specifically completed pages of this document,the Terns and Conditions included with this document and any other addenda and attachments hereto,shall be referred to herein as this"Contract." PLEASE READ ALL TERMS AND CONDITIONS ON THE REVERSE SIDE OF THIS PAGE AND FOLLOWING PAGES BEFORE SIGNING. INSTALLAT�QREETADDRESS CITY STATE ZIP r ' r S to 'i ,� Contract Total Are permits required for this installation?: [ 'Yes [ I No *applicable tax included NOTICE TO CUSTOMER: Federal law requires Lowe's to provide you with the pamplet Renovate Right:Importan Lead Hazard Information for Famil- ies,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. Work is to commence upon reasonable availability of Contractor and/or availability of any s ell I order or custom made Goods which is anticipated to be �.� [fill in date]. Estimated completion date is [fill in date]. Said estimated substantial completion date is not of the 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. COM 11TE THIS SECTION ONLY WHEN THE CONTRACT TOTAL EXCEEDS$1,000.00: [ ustomer to Pay in Full; OR [ ]Customer to use the following payment schedule: ( Deposit $ to be paid upon siging contract.Deposit should be 1/3 the total contract price;and (2)Payment of$ to be paid anytime after this Contract is signed and before commencement of installation,I/We authorize Lowe's to do one of the following(check appropriate box below): [ ]Charge my/our credit card for the amount of the payment indicated above anytime after the date this Contract is signed; or [ ]Deposit mylour check for the amount of the payment indicated above anytime after the date this Contract is signed;and (3)Final payment of$100.00 to be paid upon completion of the installation and both parties'satisfaction. NOTICE REGARDING ARBITRATION AGREEMENT FOR CLAIMS COVERED BY M.G.L.c 142A LOWE'S AND OWNER HEREBY MUTUALLYAGREE IN ADVANCE THAT IN THE EVENT LOWE'S HAS A DISPUTE CONCERNING THIS CONTRACT,THAT LOWE'S MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUT- IVE OFFICE OF CONSUMER AFFAIRS AND BUISNESS•REGULATIONS AND THE OWNER SHAL BE REQUIRED TO SUBMIT TO SUCH ARBITRATION AS PROVIDEDJN-M; ft2A. :.•c.14 By: r !s; �c 7 �/ �� ,�-, ^' � Date: c. Lbwtr`so a^Cdn er , Inc. �/ -� / By: I/� /(( i°/r7,lt�•--_ _ Date: l5, 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 PF.RMITTED TO INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THE SECTION ABOVE IS NOT SEPERATELY SIGNED BY THE PARTIES. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AND UNTIL YOU HAVE READ THE TERMS AND CONDITIONS CONTAINED ON THE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS CONTRACT BY SIGNING BELOW,YOU ARE ACKNOWLEDGING THAT YOU HAVE READ, UNDERSTAND 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 COP//Y OF-THIS CONT4C,T AT THE TIME OF SIGNATURE. WITNESS OUR HAND(S)AND SEAL(S)BELOW THIS /0 . DAY OF Lowe's Home-Centers, Inc. `Specialist o�,Above '" vet ' Owner Spouse Customer acknowledges receipt of a true copy of this contract which was completely filled in prior to Customer's execution hereof.You,the buyer,may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction.See the attached notice of cancellation form for an explanation of this right. ©2004 by Lowe's.®Lowe's and the gable design EXTERIOR SOLUTION GENERIC (Rev. 12/09) FILE COPY are registered trademarks of LF Corporation. n 'Installation Services.CUSTOMER SHALL HAVE NO OTHER REMEDY FOR A WARRANTY CLAIM,INCLUDING WITHOUT LIMITATION REMEDY FOR LOSS OR DAMAGE CAUSED BY NORMAL WEAR AND TEAR,LOSS ORAAUi�GE,WHICH HAS NOT BEEN REASONABLY MITIGATED,OR LOSS OR DAMAGE CAUSED BY ACTS OF GOD.IN NO EVENT SHALL LOWE'&BE LIABLE FOR INDIRECT,PUNITIVE,CONSEQUENTIAL OR INCIDENTAL DAMAGES(SUCH AS,WITHOUT LIMITATION,LOST PROFITS,LOST SALES,AND INJURIES TO PERSONS OR PROPER EV P') ^ WHERE LOWE'S HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES.WHERE,DUE TO OPERATION OF LAW,SUCH:DAjv1AGES'/ 7 CANNOT BE EXCLUDED,THEY ARE EXPRESSLY LIMITED IN AMOUNT TO THE PURCHASE PRICE.In connection with any war ranty claim, Customer agrees,at no cost to Lowe's or the Installer,to prepare the Premises and the reinstallation area in the manner described in Section 10 of these Terms and Conditions. 13.DISPUTE RESOLUTION FOR CLAIMS COVERED BY M.G.L.c.142A Most questions or complaints are resolved informally.If Customer has a quest,ign•or complaint,Customer agrees to contact the Lowe's salesperson whose name appears.on.this Contract and the manager of the Lowe's store at the aadress,and/or phone number on the front page of thiA'Contract.If Customer has a complaint4vhich cannotbe resolved inforrnally,;Tge Home Improvement Contractor Law(M.G.L.c.142A)may provide Customer with the right to request arbitration through a private arbitration program approved by the Director of the Office of ConsumerlAffairs and Business Regulation,.as an alternative tg court action:The same right is notafforded to Lowe's unless the"Notice Regarding Arbittation Agreement:for.Claims'Cov�red by MIG;L.c.142K on the front page'of.this Contract is signed and:d'ated by Lowe's and the owner.If allowed by statute or applicable law,the arbitrator may award statutory damages and/or reasonable attorneys'fees and expenses.If Customer fails to pay`Lowe's in accordance with this Contr9ct,�'s shall be entitled to recover its reasonable attorney's fees as provided by N.C.Gen. Stat.Sectiofi/6-21.2'or other applicable'law.-To the fullestexte rraitted by law,Lowe's and-Customer agreethaf no class action arbitration of any type may be ordered by a Courtor arbitrator(s),under this Contract and,in addition,that there shall be no joinder of parties,except for joinder of parties to the transaction covered by thisrContrabt.-If a ourt or arbitrator determines the waiver of the right to class actioia arbitration or-the'prohibition of joinder of parties(other than parties to the transaction covered by this Contract)to be unenforceable,then the party bringing such action will'be required to bring such action 4n a court of law. 14rARg IT TION AGREEMENT AND WAIVER OF JURY TRIAL FOR CLAIMS NOT COVERED BY M.G.L.c.142A All claims by Customer or Lowe's cone r nl's Contract which cannot be resolved informally,and which are not covered by M.G.L.c.'42A or subject to the jurisdiction of a small claims court,shall be resolved by binding arbitration conducted by a single arbitrator under the current applicable rules,procedures and protocols of the American Arbitration Association(as amended). If the dispute falls within the jurisdiction of a small claims court the claimant may,at its option,choose to arbitrate or file a small claims action.Any appeal of a judgment from a small claims court shall be resolved by arbitration as provided herein.Claims to be resolved by binding arbitration include,but are not limited to(1)all claims directly or indirectly related to the signing of this arbitration agreement,the validity or scope of this arbitration agreement,or any attempt to set aside this arbitration agreement,(2)all federal or state law claims relating directly or indirectly to this Contract(includingothis arbitration agreement),the information Customer gave Lowe's before entering into this Contract and/or any past agreement or agreements^betwebn Customer and Lowe's,(3)all counterclaims,cross-claims and third-party claims,(4)all common law claims of any kind including common law;claims ibased,upon contract,tori,fraud,or other intentional torts,,(5)all claims based upon a violation of anystate opfederaltConstltutiott,� statute or re�gulatioA,(6)all claims asserted by Lowe's against Customer,'including claims for money damages to collect any sum'Lowe's claims Customer s Lowe's,(7)all claitns asserted by,Customer individually.against Lowe's and/oT any of Lowe's employees,agents,Adirectors,.officers,shareholders, 8nagers members,parent company or affiliated entities(herein collectively referred to as"related third parties")or the Installer,including claims for money damages and/or equitable or injunctive relief,(8)all claims asserted on Customer's behalf by another person,(9)all claims asserted by Customer as a private attorney general against Lowe's,related third parties and/or the Installer,(10)all claims arising from or relating directly or indirectly to the /disclosure by,L-owe's!related.thir6parties or the Installer of a'ny non-public personal information-about Customer,and/or(11)all other claims arising under or related to this Contracf whether or not'set forth above. f Binding arbitration means that,Customer.waives:(1)any right to a jury trial;(2)any right to bring a lawsuit in a court(other than a small claims court as de's6ibed above); and(3)any right to seek relief in any other forum or from any other agency.Any claim not decided by a small claims /court will be decided by an arbitrator selected by the American Arbitration Association.Lowe's and Customer agree that binding arbitration provides a simple,cost efficient method to resolve disputes quickly.Lowe's and Customer therefore agree that no class action arbitration of any type may be ordered by a Courtor arbitratoc(s).Under this Contract and,in addition,that there shall be no joinder of parties,except for joinder of parties to the ,1 transaction covered by this Contract.If a'court or arbitrator determines the waiver of the right to class action arbitration or the prohibition of joinder of parties(other than parties to the transaction covered by this Contract)to be unenforceable then this entire arbitration agreement shall be rendered null and void,and the party bringing such action will be required to bring such action in a court of law. By agreeing to binding arbitration Customer and Lowe's waive any right to bring or participate in a Class Action lawsuit regarding any,claim. How Arbitration Works: Lowe's may demand arbitrtion by sending written notice to Customer at the address listed in+this qrac , ontt.Customer may demand arbitration by sending written notice to Loy�erIat the following address:Mail code NB6LG, P.O.Box 1000,Mooresville„NC,28115 .The arbitration shall be held in the city or county where the Premiff'es are located or in such other convenient location as the Customer and Lowe's may mutually agree. Lowe's shall pay the filing,administrative,hearing and arbitrator's fees associated with the arbitration.Customer shall not be required to reimburse Lowe's for these expenses even if Lowe's wins the arbitration.Unless the arbitrator's award specifically provides otherwise,Lowe's and Customer will each be responsible for its own attorneys'fees and other expenses,such as witness and expert witness fees.At the timely request of Customer or Lowe's,the arbitrator will provide a written explanation of the award so long as such requirement is consistent with the rules,procedures and protocols of the American Arbitration Association then in effect. The arbitrator's award may be filed with and enforced by any court having jurisdiction. If allowed by statute or applicable Jaw,-th&,arbitrator may award statutory damages and/or reasonable attorneys. es-and expenses.If Customer fails to pay Lowe's in accordancer�vitli•this.Contract,Lowe's shall be entitled to recover its reasonable attorneys'fees''s pro3ided by N.C.Gen.Stat.Section 6-21.2 or other applicable law. The parties agree that this arbitration agreement is made in connection with a transaction involving interstate commerce and shall be governed by the Federal Arbitration Act,but if for any reason the Federal Arbitration Act does not apply,then this arbitration agreement shall be governed by the laws of the State of North Carolina. 15.GOVERNING LAW AND SEVERABILITY.This Contract shall be interpreted under and governed by the laws of the State of North Carolina,without regard to the choice of law rules of any state,except that the Arbitration Agreement and Waiver of Jury Trial in paragraph 14 above is governed by the Federal Arbitration Act,9 U.S.C.Sections 1-16.If any provision of the Contract is contrary to any law to which it is subject,such unlawful provision shall be ineffective without invalidating the other provisions,which shall remain in full force and effect;except that,as stated in paragraph 14,if the waiver of class action arbitration,or the prohibition of consolidation or joinder,is determined unenforceable,then the entire arbitration agreement in paragraph 14 will be 10 Lrendered null and void. 16.CREDIT CARD/FINANCED TRANSACTIONS.If Customer uses a credit card or obtains financing to pay some or all of the Price,then Customer acknowledges that the terms of his or her cardholder agreement or financing documents may change the total amount of money Customer must pay to the credit card provider or lender,including any interest charges and fees.Customer acknowledges that his or her cardholder agreement or financing documents may have other terms and conditions to which Customer will be subject.Customer also acknowledges that Lowe's is not a party to any such cardholder or financing agreement. 17.WAIVER OF LIENS.Because responsibility for paying the Installer on Customer's behalf belongs to Lowe's,Lowe's will require the Installer,on behalf of itself and any of the Installer's subcontractors,materialmen or suppliers,as a condition precedent to payment by Lowe's on Customer's behalf,to fully and unconditionally relinquish,waive and release any and all mechanic's liens,materialman's lien and other liens in the Premises which the Installer or its subcontractors,materialmen or suppliers might have or acquire in the future,by operation of law or otherwise,as a result of this Contract,to the extent permitted by law. 18.UNAVOIDABLE DELAY OR FAILURE IN PERFORMANCE EXCUSED.Any delay or failure by Lowe's or the Installer in performing this Contract because of strike,fire,flood,epidemic,acts of terrorism,acts of God,inability to obtain Goods in a timely or commercially feasible manner,or any other causes beyond the reasonable control of Lowe's or the Installer shall be excused and sial)not bo breaches of this Contract. 19.ENTIRE"AGREEMENT/CHANGES IN WRITING.Customer and Lowe's agree that this.Contrac0accurately states the entire agreement between Customer andLowe's concerning the Goods and Installation Services and replaces and supersedes all prior agreements and understandings relating thereto,both oral and written,and all oral agreements and understandings entered into at-the same time as this Contract.Any additions or changes to this Contract,or any waiver of rights under this Contract,must be in writing signed by Customer avid Lowe's. 20.CAPTIONS.Titles or captions of sections contained in this Contract have been inserted only as a matter of convenience and in no way define,limit, extend,describe or otherwise affect the scope or meaning of this Contract or the intent of any provisions hereof. 21.ADDITIONAL INFORMATION-All-corstractors and subcontractors must be registered by-the Administrator-of the-Board of-Building- Regulations and Standards.Inquiries about a contractor or subcontractor relating to a registration should be directed to the Administrator of the Board at One Ashburton Place,Room 1301,Boston,MA 02108,(617)727-8598. 22.QUESTIONS OR CONCERNS.Customer should speak with the Lowe's salesperson whose name appears on this Contract and the manager of the Lowe's store at the address and/or phone number on the front page of this Contract,regarding routine matters such as scheduling,any requested changes to Customer's order,or any concerns Customer may have about this Contract,the Goods or the Installation Services. i A i INSTALLER COPY 2 VV/VL/GV1V 15!.10 1.1111 VXI UVO1LVO Viti1J151J LINO 111L111111 V1'I VV — — l.A--0 u1�,La11aLLL .�,vvt From: 0413012010 09;18 #071 P.0011002 ACED CERTIFICATE� t LIABILITY INSURANCEDwY@ IMMlppmfYY) 04/30/2010 `R0[1UCER 781-438'-SOOO FAX 781-4.38 502$ THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE New England Heritage Insurance Agency Group, Inc. ONLY THIS CERTIFICATE DOES MOT AMENO,EXTEND OR 335 Main Street ALTER THE COVERAGE AFFOROMU EYTNE POLICIES BELOW. Stoneham, MA OZ190 INSURERS AFFORDING COVERAGE MAIC# i s-uR�n"Greene Tnstalla•hon Cu Inc INSURMA; Safety Insurance Company ---,�� 39454_n. 165 Bow Street ZuRERo: National Grange Mutual _ 14788 �^ Everett, MA 02149 INSURER C. INSURER D: INSURER E: - COVERAGES 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 WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Ip � POLfC r 1 CTIVE PO DRAT OI—N LIMIT$ �R DD LL RT NSR TYPE OP INSURANCE POUOY NUMBER DATE MMIDOlYYY TE MMIOOIYYYY GENERAL uA61LlTY BP00008519 05/08/2010 05/08/2011 EACH OCCURRENCE 1,000,000 Ar-TO RENTI, X CO........MMERGIAL GENERAL LIABILITY PRE I E:S.(Ea—urrenee $�,,,N, ,,__So 100 CLAIMS MADE 1K:J OCCUR MED EXP(Arty arm pereon) $ L,o0o A PERSONAL&ADV INJURY S 3.,000 000 ( ----"---"' — GENERAL AGGREGATE $ 21000,004) G9'rT (3R1j0Aj•G LIMIT APPI I_I:S PER: PRODUCTS-COMPlOP AGG S -__ 2 000 000 X POI,ICY rRq LOC AUTOMOBILE LIABILITY M9B50669 08f26/2010 08/26/2011 COMBINED SINGLE LIMIT s ANY AUTO (En aeeldont) 1,000,00 ALL OWNED AUTOS I BO lILY INJURY S (PoX SCHEDULED AUTOS --^ X HIRED AUTOS BODILY INJURY S (Per accldenq X NOWOVVNEDAUTOS ,..-. PROPERTY DAMAGE S _ —._�—.._,-r---•---•-•�----• (Per accidanL) GARAGE LIABILITY AUTO ONLY-EAACCIONNT S ANY AUTO OTHER YNAN EA ACC 5 I AUTO ONLY: AGG $ EXCESS f UInBRELLA LIABILITY EACH OCCURRENCE $ 000 00 X OCCUR El CLANS MADE CUBS0669 01/30/2010 01/30/2011 AGeIzEOATE ,s 1,000,000 B _ a DEDUCT19LE — "---- � - RETENTION 5 _ S WOR1<ffn4OMPENSAT10N WORKERS COMP r`OVIrRAGE TORYLI?AI7R ER ANo EMP1.0YERS LIAWLITY ANY PROPRIETOWP'ARTNERIEXECVTIVF YrN WILL BE FORWARDED BY E,L,EACHACCIDeN7 ' i OFFICERIMEMP3 REXCLUDED7 CARRIER- E.L,DISEASE-EA EMPLOYEEI (Mandatary in NM) Des duacnoe under E.L.DISEASE-POLICY LIMIT S SPECIAL PROMSIONS Delo! • pTHL1{t DESCRIPTIoN 0P OPRUTIONS 1 LOCATIONS 1 VEMCLES/EXCtOtIONS ADDED BY ENDORSEMENT 1 SPF-CIAL PROVIUION6 hstallation of doors and windows owes Companies InC. and any and all subsidaries are named as additional insured as esper-ts to Ceneral & Auto Liability endor: 32011 - Region; 18 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE AWVI=bFSCRISEO POLICIES Pr CANCELLED BEFORE 7M¢KXPIRATION PAYS THEREOF,THE I"VING INSURER WILL ENDEAVOR TO MAIL 11) DAYS WRITTEN NOTICE TO YNE CERTIFIOATE HOLDER NAMED TO THE LEFT,BUT FAILURE TSI DC$0$HA I Lowe's CoMpani eS, InC. IMPOSE ND 013UGATION OR LIABILITY OF ANY KIND UPON TWE INSURER,ITS AGENTS OR Attn• IS Insurance REPRESENTATIVES, AUTHORIZED REPRESENYATIVE P.O. Sox 117.1 North wilksbora, NC 28656 Jase h DeVinCentis JDA ACORD 26 ia009/01) FAX., 336.658.Z30$ 1988-2009 AC4RO CORPORATIi]N. All rights reserved. The ACORD name and logo are registered marks*f ACORD Vi//VLI LV1V lIII lil rAA V11 1)0v.Lru27 %3ATit,1Vn 11VJ1ALLA11VIN 4V - � LVYTZO 11Z1V An1LL �I VVL From: 04114/2010 14,17 #877 P.001/001 It3 CERTIFICATE 18 ISSUED AO A MATTEF OF INFORMATION ONLYAND CONFPI18 NQ RICA UPAI THE ERTl1=KATE HOLDER,THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER TK COVERAGE AFFORVED Y 7iiE POLICIES BELOW.THIS CERTIFICATE=OF INSURANCE DOES NOT CONSTITUTE ACONTRACT 9E7wi=NN E II3$UING INSUREMAUTHORIZED RFPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER, Ln$ PORTANT. If the CoMflc;ate holder Ia an ADD)TIQNAL INSURED,the policy{lea)must be undoraad. If BUBROGA71ON WAIVM,9144ject to the tetma and conditions of the,policy,certain policies may requlrla and endomemenl. A alatament this oertiflt ate don not confer ri hta b the certificate holder in fiau of such endomement. PRODUCER New England H**%va Inot Agonq 335 mwn St $tanshara,MA2190 COMPANIES AFFORDING INBURANCE INSUREDCOMPANY A GRANITE STATE INSURANCE COMPANY Graane Ingtallatlan Co iric las now 611"t Everett,MA 021411-0010 THS WTO CERTIFY THAT THE POLICIEe OF INSURANCE UMP OELCW HAVE BEEN ISSUED YO THE INSURED NAMED ABOVE POR YHE POUCY MR=tNLUwep,Nor WITMAMINO ANY RWWREMENT,TERM Oft CONPIrIoN OFANY CONTRACT ON OTHER WCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE FSOVED ON MAY PERTAIN,THE INSUItANW AWORClED THE POLICIES MOWED HERON IB SLWE=TO ALL THE TERO,MLUMONB AND CONDITIONS OF SUCH POLICIES.UMrrS$MOWN MAY HAVE PEEN REDUCED BY PA10 CLAIMS. I i-� T>f're Cl Muluugk PaLIR1t MIIeMtl1 I IaYRFIRopyk RArk I'�Jvrl'!{Mlu'rloti VATR A 'h 1. DEEM�OY MS'LLULRY TME PROPUTCR) PAAtx�RIrRJIEGUT1vE I DFP�ceRa Me ' NqtoExc40 4$13213 3!04/2010 V002011 TATuTokrfiMrFe OTHER COMWA00"to MA oPw.aa,.a* ACCIplNT S ��RPduCYUWr S 'JOOQq IIFA -EACH MPLa eE sp EaC1uPTION OF OPl@JRMTh7t�ttllrVaEl�cLB1ltet�C1AL tiEYa CE"FICATiE:HOLDER CANCELLATION — LOWESCOMRPA,NIESINC 511PUWAMYOFTKAbOVE06ICROR POLIOTEIiECMICELLEObIPOREYNE ATTN:IS INSURMCE LOPAT PON DATE TMtgAKF.HUM W1109 Pfi1NERM II A000RDANCE PO BOX 1111 WIMT4TMEPQuGrPROV90NE NORTH WILKIMBOR0,NC 2dese ' AUTHORIZLb RISSEWATIVE 05/02/2010' 14,20 FAX 6173891269 GREENE INSTALLATION CO LOWES HAVERHILL 10003 M11a.sachusctts Department of Pt,blic n Boar(I OfBuilding Regrulations,►nd Standard: Construction Supervisor License License:..CS 61719 Restricted to: 1G RONALD A GREENE 10 RITA DRIVE MEDFORD, MA 02155 i � — Expiration: 10/'27@011 ('nrt,mi.civ�cr Tr—". 6717 a ' Y r • L