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Home My WebLink AboutBuilding Permit #802 - 92 FRENCH FARM ROAD 6/9/2010BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: ko 21— Date Received Date Issued: fI —/ D IMPORTANT: Applicant must complete all items on this page LOCATION �' "t t°ZV�L 1 Piv 4'y\ d Print _ r PRUPERTY OWNER MAP 210_ti PARCEL:+6-r Print ZONING DISTRICT: Historic District Machine Shop' yes v tt�eo �6*SNC aaaaak TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial � epair, replacement Assessory Bldg Others: emo i ion Other Septic Well Floodplain Wetlands Watershed District Water/Sewer UhbUKIPTION OF WORK TO BE PREFORMED: � 11 . . , I 1 Identification Please T, OWNER: Name:,�� 3 */y Address: 99 Fy-ev<A,\ r4,r0Y\ 12d CONTRACTOR Address: or Print Clearly) __ Phone: �l Supervisor's Conk*uction License: Exp. Date: Home Improverndnt License - ARCH ITECT/ENGI NEER icense: ARCHITECT/ENGINEER Phone: Address: Reg. No -/() V2 - FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ /S ZZ • g FEE: $ ��- Check No.: �s�Y Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor Location _. No. —S oz--- Date a l� "OWT"TOWN OF NORTH ANDOVER •,4O s Certificate of Occupancy $ '+ .•°tn Building/Frame Permit Fee $ Foundation Permit Fee $ L Other Permit Fee $ TOTAL $ Check # Building Inspector Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales Private (septic tank, etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Siqnature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 FIRE DEPARTMENT -Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS Street NORTI� � AA. 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 a No pproval of Electrical Inspector Yes DANGER ZONE LITERATURE: Yes MGL Chapter 166 Section 21A —F and G min.s100--s1000 fine No Mrvrco _. w . - - •b 11—IL ncvjsea zvlu 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/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: Building Permit Revised 2008 The Commonwealth of Massachuseas Department. o f Industrial Accidents Office Of.rnvek-ations 600 FEashington Street Boston, X4 02111 '.mass.gov/dia Workers' Compensation fasurance Aff davit: guildersContractors/Electricians/PI Iicant Informaon / umbers N3IDe (Business/Organization/IndividW): --_ e Address: S city/stat,-,/Zip: V1CS� Q1�t�� Phone #: Are you an employer? Check the appropriate box: I I am a employer with _� 4. ❑ I am a o„ employees (full and/orpart-time}.* 2. ❑ I am a sole have hired contractor and I the sub -contractors proprietor or partner- ship and have no employees listed on e attached sheet x working for me in any capacity. These sub- contractors have workers ' workers, comp: insurance '-'OMP. insurance. 5. ❑ We are a corporation uired req ] 1. ❑ I am a homeowner doing and its officers have exercised their all work myself. [No workers' comp. p right of 'exemption per MGL c. 152, § 1(4), and insurance required_] t we. have no employees. [No workers' comp ' Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11 -0 Plumbing repairs or additions 12.7 Roof repairs ` A.ns iicant that h box �, Durance required-] I 13 ❑ Other .. must also uu out the sectio: h_c Homeowners who submit this affidavit indicating the;, are d ' shox:tr� their wort ms' +Contractors that ch=L- this box must V't in inched dicating n addi�oar dein s owo the thud hire amide contractors must , � name submit a new afnd-if indicating such. of the su�cem-aztm and them__-- "" -w- I �s provututg workers' compensation insurance or m employ CM. informado f Y ees. Below is the ori In P cJ and job site Insurance company Name; e��a � . VCf Policy # or Self -ins. Lic. # i �Q- j Expiration Date: Job Site Address: �i,� G U Attach a copy of the workers' compensation policy declaration tide sho C�/State/Zip, f U, �A�,� M 6, �— Failure to secure coverage as required under Section 25A ofM p b ( � the policy number and expiration date). fine up to $1,500.00 and/or one-year im GL C. 152 can lead to the imposition of criminal Of up to $250.00 a da a prisonment, well as civil penalties in the fonn of a STOP WORK OR-DERallies of a y gainst the violator. Be advised that a copy of this statement and a fine Investigations of the DIA for' coverage verification. may forwarded to the Office of I do hereby under th pains and penalises/ of perjurJ' thctl the informationpro. vided above is true and correct Official use only. Do not write in this area, to be completed, bj CM) or torn off ciaL City or Town: lss g 2'ermit/License # 2, Authority (circle. one): --- _ L Board of Health 2. Building Department 3. City/Town 6. Other Clerk q, Electrical inspector Contact Person: Phone *. �1d 5. Plumbing Inspector Information am d Instructions Massachusetts General Laws chapter 152 requires all employ oers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including t1he legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association os- other legal entity, employing employees. However the owner of a dwelling house having not more than three apart'xLents and who resides therein, or the occupant of the dwelling house of another who employs persons to do mainte;:Xlance, construction or repair work on such dwelling house or on the grounds or budding appurtcnant thereto shall not be: cause of such, employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or lo.ce licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of c03mpliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the. performance of public work uti-t3l acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Lrabiiity Partnerships (LLP) with no employees other than the mcmbers or partners,are not required to carry workers' comp ensation insurance. If an LLC or LLP does have employees, a policy is required_ Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. .Also be sure to sip and date the affidavit. The affidavit should be r„tu-aed to the city or ttswn that the applica on for the perszit or License us beim reaur-,s*».d, not the .. D-maroment of Industrial Accidents. Should you have any questions regardirig the law or if you are req =s and to obtain a worll=s' compensation policy, please call the Department at the numbor listed below. Self-insured companies should enter their self insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly, The Department has provided a space- at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a -reference member. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under `.`Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future per=mits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial ven1ure (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office oflnvestigations would Ince to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call The Department's address, telephone.and,fax-number.._.. The Commonwealtit of Massachusetts Department Of Industrial Accidents Office cif Inyestic;afieous 600 Washington &t wet Boston, MLA 0.2111 Tel. # 617-727-4900 ext4,06 or 1-877-MASSAFE Revised `-26-US Fay: # 617-72.7-7749 • v vw_mass._Qov/dia 08/09/2010 01:37 FAX 9785572130 MICHAUD ROWE RUSCAH tool RANCE �� DATE IMMRIDAM VR CERTIFICATE OF LIABILITY INSU xcCON�-i 06 -AUL' ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICAT END 14ichaud, Rows And Ruscak Ins. A�TER HEHCOCERTIFICATE VERAGE �FOR�DED BY THE POUCIES BE P.O. Box 188 North Andover bin 0184S Phone:978 688 8829 Pax:978 557 2130 INSURERS AFFORDING COVERAGE NAIC It _ M INSURED INSURER A: Ttavalxi xps�aa Ce�iuDf INSURER B: Ver>aont —mut-, In . Co . _ 26018 xc Construction INSURER C: xev�n Carreiro DSA INSURER D: _ 2 Siston d. 03848 Kingston INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTINITHSTANDIN6 ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OYHER 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 POLKVS. AGGREGATE LMTS SHOWN MAY "AVE BBCF.N REDUCED BY PAID CLAVAS. Q �qp _.• .. POLICY NUMBER DATE MMIDWY ATE - DDNVVY LIMITS OBNEML LIABILITY X COMMERCIAL QENERALUABILRY BP11027784 CLAIMS MADE ' J OCCUR X Business &mars GERL AGGREGATE LIMIT APPLIES PCR! X POLICY _ JERL,r LOG AIVTDMOBILe I IABIUTY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON.OWNED AUTOS OARAGE LIABILITY �I ANY AUTO EXCESS r UMBRELLA LIABILITY OCCUR 7 CLAIMS MADE D MCTIBLE RETENTION s WORKERS COMPENSATION AND EMPLOYERS• UABIUTY I A ANY PROPMrTC RIPARTNERA SPECIAL PROVISIONS below OTHER _y_'n' j 6K=07571T78A09 EACH OCCURRENCE Is 1000000 �OxwGI±FIRFMISEs _(Ea ce> S100000 MED EXP (Alryr ens P—) $ 9000 09/01/09 09/01/10 PERSONALS ACV INJURY_ $1000000 GENERAL AGGREGATE s2000000 PROOUcTS . COMPIOP AcG s 2000000 COMBINED SINGLE LIMIT IS Me mkienO BODILY INJURY s (Per Perron) BODILY INJURY $ (Per "Cidond PROPERTY DAMAGE s (Per wcident) AUTO DNLY • EA ACCIDENT s OTHER THAN VA ACC s s AUTO ONLY: AGG EACH OCCURRENCE s AGGREGATE s IS s s 08/05/09 08/05/10 1 E.L.EACHACCIDENT 16100000 [ELL.DISEASE-EAEMPLOY s 100000 F I . DISEASE •POLICY LIMIT S 500000 OF OPERATIONS( LOCATIONS I VENK:LPS I EXCLUSIONS ADDED BY ENOORSeMENT I SPECIAL FICOVMNM3 ATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TKE F-XMRAT14 MORTHI3 DATE THEREOF. THE P96UING INSURER VOLL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFK:ATL' HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO 90 SHALL Town of North Andover IMPOSE NO OBLIOATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Building Dept. REPRESENTATIVES. 1600 Osgood Street AUTHOR REPRE,SENTA North Andover DSL 01845 The ACORD name and logo are registered marks of ACORD 2010-06-09 12:19 unud or WildiingResulatio jj0Mrz IMPROVEMENT C0WWC 1 OR Registration; 160140 Expiration: 612512010 TO 27001- 'Type. DBA KEVIN CARREIRO CONSTRUCTION KEVIN CARREIRO p. 3w.ES,,RD- Y,fON, 14H 03848 0 >> 9786889542 P-1/1 i,.-cerae or regi6tratiownlid for individul use 00 i)v.((jrg tIjL elLpinktion date. if found return W Voilrd 0, Building Regulations and Standards One Ashburton Place R. 1301 ;$oStost, ML 0210$ N valid 0111! 901tur*`� Massachusetts - Department of Public Safety Board it('Buildin-, Regulations and 44atndik.rds Construction. Supervisor Ucerse License: CS 74572 Ra$ftictod to: 00 KEVIN C CARREIRO 2 SIMES RD KINGSTON, NH 03648 -Expiration: 90=10 Tfd: 2301 a 0 0 ' 0 6 $ 'IFf,LO,L 00' 0 $ JHOISUJ 00'05 00'05 M HH3 LIW'dSd SMOQNIM HSd ,LIN'dHd OL£VST T 00'06 00'06 HS3 `IKSOdSIQ SMOQNIM 55.3 'IKSOdSIQ OL£TVST T -------------------------------------------------------------------------------- ZSOD ,LXS ZSOD #std QNRA NIS NOISdIdDSSQ WHLI WHSI 7= 'iSS MN UV ' ZKIQ ODSIONVEJ :HIVIDOSS`d LTO'V-Lt£(£09) UOT-T£8(T8L) :SNOHd ,LOK,LNOo T6LT-L89(8L6) :HNOHd T98T-Tf,Z(8L6) :HNOHd FILM ZZIHdSAVH Hnl'dC 'dHJfIdWOD SZ L8£Z WHH OT/SZ/SO : 72iRAI IHC ,LSH 8T98L :HOIOAMI SHMOZ 9699Z0S6 Od SHMO'I OQH'd-SMOQNIM QOOM FI'I'IHd £ Z 9 9 6 T 9 6 Z LOSP02Id Xv3 8v8£0 HN NOZSONIN J,J,V : SSSdCCV NOI,LOII2d,LSNOO O X s HNVN 'dOCNHA S:�8TO VW 'dRAOQNK H MN QIYOU YddVJ HONHHJ 66 : SSadCCV NOQNIVS JHHEOd : UOZ CaUaCldo 0T/60/90 :HJV(l £ :HOFId oNI ' SUSZNHO aXOH S , SMO'I KS LIMS Bkk to Quote Project #: Customer Name: Customer Phone: Customer Address: Line Item Frame Size 294703364 LOWE'S HOME CENTERS, INC. #2387 25 COMPUTER DRIVE HAVERHILL, MA 01832-0000 USA (978)241-1861 LAURA/ROBERT SAINDON (978)687-1791 99 FRENCH FARM ROAD NORTH ANDOVER, MA 41845 USA Description: sos pelta wood windows Product Code Unit Price Quantity Total Price Description 1001 Manufacturer: Pella Windows & Patio Doors game Size = 27' W x 4' division: Millwork L0" H >Product: Windows t0 Size = 2'7 1/2" W x 4'- ype: Double Hungs [01/2" H `;Manufacturer: Pella Windows & Patio Doors �4aterial: Aluminum Clad Wood game: Aluminum Clad Wood Frame ;Product Family: Renovation product Configuration: Replacement Window !Room Location: DINING ROOM exterior color: White .,Seacoast Color: No Uambliner: Luxury Edition good Type: Pine - Standard 1Opening Type: Rough ;Frame Size Width: 27' game Size Height: 4'10" hough Opening Width: 2'7 1/2" Stough Opening Height: 4'10 1/2" interior Finish: Early American ;Sash Lock: Standard ;Sash Lifts: Yes Hardware Finish: Champagne ?Glazing: Advanced Low E Glass ffempered Glass: No Wigh Altitude: No f ;Gas Filled: Argon 1 ;Sash Style: Even ;Grid Type: 3/4" Wood Removable ;Interior Grid Color: Early American :Exterior Grid Color: Matches Exterior Clad Color 1 $620.73 2 $ Style: Traditional Location: Top and Bottom Sash Pattern: 3W2H iberglass Insect Screen: Full Screen creen Color: White creen Mesh: Vivid View eries: 8S0 Architect Series ead Time: 21 art Numbers: JRDVAUNIT RDWMUN (2) RDSCREEN (1) **This price reflects a 20% off Promotion on SOS ella Windows - 4/14/10 to 4/26/10*** :This quote is good 04/14/10 to 04/26/10.-------------- f Project Total: $1,241.46 Salesperson: FRANCISCO DIAZ , (52387FD1) Accepted by: Date: 04/14/2010 This Millwork Quote is valid until 4/20/2010 on all regularly priced items. For promotional pricing please see the disclaimer noted with each item above. This is an estimate only.This estimate does not include tax or delivery charges. Delivery of all materials contained in this estimate are subject to availability from the manufacturer or supplier. All the above quantities, dimensions, specifications and accessories have been verified and accepted. a REG ,. CHARGE 4. �tMe aParafica9Y Ca� pages of dus NOTICE TO CUSTOMER: Federal law requires Lowe's to provide you with the pamplet Renovate Right., Important 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 c ce upon reasonable availability of Contractor and/or availabilielal 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 NTRACT TOTAL IS $1,000.00 OR LESS Customer must pay in full. COMP ETE 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 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 uponcompletion of the installation and both parties' satisfaction. NOTICE REGARDING ARBITRATION AGREEMENT FOR CLAIMS COVERED BY M.G.L. 042A 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 TOA.PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUT- IVE OFFICE OF CONSUMER AFFAIRS ND UISNESS REGULATIONS AND THE OWNER SHA/ L BE REQUIRED TO SUBMIT TO SUCH ARBITRATION AS PROVIDE W�I.G.L. c.142A. By: ?� 1:. Data: S f. % C� LB� By:We 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 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 COPY OF THIS CONTRACT AT THE TIME OF SIGNATURE. WITNESS OUR HAND(S) AND SEAL(S) BELOW THIS / , DAY OF Lowe's Home Centers, Inc.: , ji Specialisj rAbove Owher 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, 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. EXTERIOR SOLUTION GENERIC (Rev. 12/09) FILE COPY ®ere4regYrstered Vademafks o LF gable (,a �tiin J 5ondj / Contract Total "applicable tax included Are permits required for this installation?: [ i•j'Yes [ ) No NOTICE TO CUSTOMER: Federal law requires Lowe's to provide you with the pamplet Renovate Right., Important 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 c ce upon reasonable availability of Contractor and/or availabilielal 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 NTRACT TOTAL IS $1,000.00 OR LESS Customer must pay in full. COMP ETE 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 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 uponcompletion of the installation and both parties' satisfaction. NOTICE REGARDING ARBITRATION AGREEMENT FOR CLAIMS COVERED BY M.G.L. 042A 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 TOA.PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUT- IVE OFFICE OF CONSUMER AFFAIRS ND UISNESS REGULATIONS AND THE OWNER SHA/ L BE REQUIRED TO SUBMIT TO SUCH ARBITRATION AS PROVIDE W�I.G.L. c.142A. By: ?� 1:. Data: S f. % C� LB� By:We 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 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 COPY OF THIS CONTRACT AT THE TIME OF SIGNATURE. WITNESS OUR HAND(S) AND SEAL(S) BELOW THIS / , DAY OF Lowe's Home Centers, Inc.: , ji Specialisj rAbove Owher 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, 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. EXTERIOR SOLUTION GENERIC (Rev. 12/09) FILE COPY ®ere4regYrstered Vademafks o LF gable • m m m C X m CO) EP m y � d y Cl) 10 0 co n Z CO) CD O ar'F3 � � o CL CO) a(0 -0 O c v CD CD O C7 CD CD O CD 3 C CD �• CLO y O I CG CD S v CO) O 'CD CD Z O CD O CCD VJ n O V/ IM VJ 2 O z cn C O O Z 0 Cl) O m 0 ao c m CD 0 CL ca caN C 0 m Q N C O N CO) O CO'! m n O HCaCC 9. = =r -S. fA _I M= Ot CD� o CO o y c N ` O O N Cf � o m =r N CL %co Cl) m N - C-3- O S. CD CA law D1 N C m O' W C!J d CrtCEJ r z p �C-10 _a N G N® '�iy w CA ei /ti Ry w Gphi Of G C m r, z O h O Cn 9 El O a 7C z GJ j9Oy x CD O CD c m Cl) N : Y CD co O ? C!J d CrtCEJ r z p r y h J . G V yro '�iy w CA 'JCI /ti Ry w Gphi re G C m r, z /ham IIt O Cn 9 El O a 7C z GJ j9Oy x H 0 0 c