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Home My WebLink AboutBuilding Permit #308-14 - 990 FOREST STREET 10/2/2013 TOWN OF NORTH ANDOVER x�( APPLICATION FOR PLAN EXAMINATION Permit N0: u v r� Date Received Date Issued: TIM)PORTANT: Applicant must complete all items on this page LOCATION 19D _ 7 P `�f Print PROPERTY OWNER 2 to/ /0 5. —00 Print 100 Year Old Structure yes no MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building *ne family ❑Addition CI Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: kn ma*/reflau Q eNisb-j -*Iffy 6+fucwt&1 worr 6eJ"��onp Identification Please Type or Print Clearly) OWNER: Name: Mitjouil -For(&s4e Phone: 1-73- 976-5gj' Address: 140 --crest S4- CONTRACTOR Name: RonA�d W"Ain Phone: g7tT- 53.�- 635,2- Address: 35Address: I a -Tgc V ers (' - e�bo ,r , Ma o196o Supervisor's Construction License: 71197 Exp. Date: Home improvement License: -Exp. Date: ARCHITECT/ENGINEER NIA Phone: Address: Reg. No. FEE SCHEDULE:BULDIN PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost. $ 2 6 Sa t`/ FEE: $ 3a•0-0 Check No.: Rao4a6y 3� a� 6 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 57 Signature of Agent/Owner Signature of contract _ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Location t i-- No. � Date V . • TOWN OF NORTH ANDOVER • Certificate of Occupancy $ • Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ rTOTAL $ Check# �� +'�WPI'-7, 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 Siqnature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes i Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW To-,,v : Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Mair, Street Fire Department signature/date r 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.$100-$1000 fine NOTES and DATA— For department use El Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department The fohowing 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 subm.tted with the building application Doc: Doc.Building Permit Revised 2012 NORT#1 Town of t EAndover 0 . . No. Z " ' }� � h � ver, Mass 6R 2. 2o 3 Y 0 CLAM. COC "O"IW IC K °RATED Ilk S U BOARD OF HEALTH Food/Kitchen PERM .T T LD Septic System THIS CERTIFIES THAT 1 C'�ly1c Is�'�'S}�- BUILDING INSPECTOR ............................. ....................... .. L, l Foundation has permission to erect .......................... buildings on � l d rpT � st+ ...... .......................... ......................................... Rough to be occupied as �p ........l...T+.. C....... .. 400-tots........................................................ Chimney provided that the person accepting this permit shall in every respect 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final- PERMIT EXPIRES I MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU T N ST TS Rough Service ......... ..... ............ ............................................ Final BUILDING 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 qAORTH own of 1 � : ., Andover 0 . - No. IL = - M C, 4 h ver, Mass 6R 2. 2013 Y O LAN. COC NICN1WIC. V �.Q A�R"ITED APp,�'�y S U BOARD OF HEALTH Food/Kitchen PERM).T Septic System h 1 THIS CERTIFIES THAT .I It. ►„�`+TL,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, BUILDING INSPECTOR ........................ .....ac......... .... has permission to erect buildings on ...9 0 TOT Sirs+ Foundation .......................... .......................... ......................................... Rough 6 tobe occupied as ........ . ........ ....................................................'... Chimney provided that the person accepting this permit shall in every respect 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 I MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU T NST TS Rough --^.. Service ......... ..... ............ ............................................ Final BUILDING 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 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information ,,11 Please Print ULAN Name (Business/Organization/Individual): �bl &JA Wmblin Address:—1.2 —ruc,,K► m C.*- City/State/Zi :'P- 0A I D Phone#: q73-63.2-a-30 An you an employer? Check the appropriate box: Type of project(required): 1. I am a employer with�_ 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. E]New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling shipand have no employees These sub-contractors have 8. F1 Demolition working for me in any capacity. employees and have workers' insurance.$ 9. ❑Building addition comp.[No workers' comp. insurance P• required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑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 13.0 Other employees. [No workers' comp.insurance required.] *Any applicant that checks box 91 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. A Insurance Company Name: AGe A rl're f'i m Th aumm P Coin em y Policy#or Self-ins. Lic. #: u8-y 80 b Po 12"U Expiration Date: 1C%q/13 Job Site Address: 9g0 OreS4 E4, City/State/Zip: nJcut_ l oiN51 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. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Si ng_atury 0& Date Phone#: V 532-035r'L 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#• Massachusetts - Department of Public Safety Board of Building Regulations and Standards mi"truction superN lNor License: CS-071187 RONALD E WACWJN 12 TUCKERS CT;3RD FL PEABODY MA M960 Expiration Commissioner 08104/20.15 Lieensc or rll use onl flice of Co wsij iner A JTHi i's Jt, Rusii,' tgistration valid for individuy l RquNtion before the expiration date, If found r0uril to: IMPROVEMENT CONTRACTOR Pgistration, 1334114 Type; Office ofConsumpr Affairs and Business Regulation tic n;. k7l').015. OSA 10 Nirk Plaza.Sijite 5170 Iloston,MA 02 116 RONCOCONSTRUG7,10N,.: RONALD WACHLIN 12 TUCKERS OT. PLABODY,MA Q19F30 Un(Wrstcretry Not valid without signature Ir 7 F,j PhCERTIFICATE OF LIABILITY INSURANCE 'flFICATE I DATE(MM/Do/yyyy) ISSUED CEIRTIFICATE Do 1111 1111A ES NOT AFFIRMATIVELY OR NEGATIVELY I ER TIF AT SAMATIMIROF AND CONFERS NO RIG-777—WON THE CERTIFICA'llff"QLD-E'Hi� nVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWFF REP T V - PRESENTMnIVE gpgOpUCER,AND TH9CERTIFI E HOLDER. -m THE ISSUING INSURER(S),ACIT"ORIZED IMPORTANT:If the IM 0 1.,.. d ceitillcate holder Is an ADDITIONAL INSURED,the POIICY(IGs)Must be endorsed. if S'UBROGATION IS WAIVED, to he terms and conditloos of the 13011cY,certain poll clos may require and endorsement. A statement ,.ho cortincale holder In lieu of such endorsement(s). on this certificate does not confer rights to PRODUCER CONTACT WC)ODS P J INS AGCY INC. NAIVE: PHONE 10 MAN (AIC,No,Ext): F-AX —�j(A/C,NO): PEABODY, MA 01960 E-MAIL ADDRESS: fNSURffR(%AFFORE)INr#COVERAGE RACE NAIC *7 OV INSURER A: 'FCE"ERICAIZ TN-S`[Ii7�AINUE COMPAIA' MIkCRI-11-4,RONALD DBA ROAR CONS'TRUCTTON INSURER B: INSURER�C. INSURER I?TI K KE PUS CT PEABOD'Y,MA 0196U ffl—SURER E: INSURER F. COVERAGES CERTIFICATE NUMBER; y"18 is To CER IFY TH TH"OLIC REVISION NUMBER. NQTWTHSTA -STEDIWOWMAY UEEN ISSUED TO THE INSURED NAMEO AgOVE RJR THE POLICY PMIOD INDIC NDING ANI REQUIREMENT TERM OR CONDITION a ATED. 6Y THE POLICI�a F ANY CONTRACT OR OTHER DOCUMENT WT"RESPECT TO VWICH THIS CERTIFICATE MAY 13E ISSUro OR MAY PERTAK THE INaURANCE AFFORDED HAVE SEEN REDUCED BY PAID CLAIMS. DESCRIBED HEREIN IS SUBJECT TO ALL THE Tr=AMa,EXCLUSIONS AND COWITIONS OF SUCH POLICIES, LIMITS SHOWN MAY INSR ADO SUB PGLI('YEFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MMWD)YYYY) (MMIODWYYY) CEN UL t- JTY LIMITS COMMERCIAL GENERAL L(AIRILI-I-Y CH OCCURRENCE CLAIMS MADE r OCCUR 7)AMAGE TO RENTED $ REMISES(Ea occurrsnca) WED EXP(Any one pertatv) GENT ENT AGGREGATE LIMIT APPLIES PER: DERSONAL&ADV IN.11.113Y $ POLICY 0 PROJECT LOC '-ENERALAGGREGAI-E :IRODUCT-,-COMP/OP;A AUTOMOBILE LIABILITY ANY AUTO COM13INED SINGLE $ ALL OWNED AUTOS LIMIT(Es--a-cc-10nt) SCHEDULE AUTOS BODILY INJURY $ HIRED AUTOS (Per person) NON-OWNrr)AUTOS BODILY IN.RJAY (Petaccident) PROPERTY DAMAGE (Per accident) UMBRELLA LIAB OCCUR EXCESS LIAR CLAIM-'--MADE EACH OCCURRENCE -6E—DUcrI8LE ;66REGAIF RETENTION $ A WORKER'S COMPENSATION-AND--------- EMPLOYER'S IJA13fLjTy y/N UB4905P012-12 Cf�TATLOQQY 9THER 1"A r,012 10/29/20-1.1 'Imp-i QFFICErZ/MEI,48ER EXCLUD[O'�t'yLtlIVF 71w, —!�—TL I—IC, (Mandatary 1.NH) El NIA F.L EACH ACCIDENT i0c),ow If yo!; (1Q—t-yno-v EA.DISEASE-EA EMPLOYEES F)L'5rr?'PTI':)(j OF 6PERATIONS b0c,v I- — DESCRIPTION OF OPERATTON L.OCA—TIONS/VIEHICt-ESIRESI'RICTION6/SPECIAL ITEMS ;00.000 7T41SPEpt.A(-- SANYMU614te. URTMCA-M JSSILrM To TW-rlfFTIFICATF BOLDER A1-T-r.(--nNcj wrijuLeo.s Cotgp C. v r TW INSTTREDSMA VJORRT�R.q 04W.PENRAMON roucv AND ITS jTmrrr.,r) -Ilmp,SIA CRAO 'THAN [jgp -RHORIZATIO'MAN MA. NO AUTpkNtyrj3 FAR CL,-,[MS MADE 13Y THEINSURLEWS MA vMPI,OyEESIN STATES OTI IC TES EN Nl.;C"TVrN*14)PAY CLAIMS FOR]jrWpn'1N*IN .1.A EDRES.OR HAS MR.IM F'"IMEE-5 OITMDEOF MA TISS 0711r,R . Tjfl��'pr)"Cy DOFS NOTPILOVIT)F 4"OvFRAUR FOR ANTSTATP rl 7 H WORKEPSICOM PENSATTON POLICY DOES NOTPRO�rjDr COVIPTAMI.VOR WACKLM,RONALD. A. CERTIFICATE HOLDER LOWES COMPANIES INC ------- CANCEL CANCELLATION IS INSURj\j\jCF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES HE CANCELLED 11 E BEFORE THE EXPIRATION 6ATE THEREOF.NOTICE'MILLS DELI D IN ACC;ORDANCI!WITH 7 FO 13OX I I I IN ACCORDANCE WITU THE POLICY PRO Z %I ED Rrp H ORTH MLKES80RO,NC 26656 AUTHORIZED RFPRF9rtNTATTVE U' ACO 1] Z5(2U101051 The ACOR---t,allu logo arere(Astered marks kCtORD 1988.201 ACORn CdRPO AF g 5 esq- ved. '0-02-12;20:02 ; patrick- insire rice 178153;5464 ;97853*186'1, # = PRODUCER "' �'C� rrii✓H Ul- LIALSILI I X IiV31.1KAN�.,►E 978.531.2777 FAX 978.531.8617 10/02/2012 P• . Woods Insurance Agency, Inc. TR.s T'171 1010212012 RrE S ISSUED O RIGHTS HTS UPON THE CERTI�tCA ION 40 Main $t, HOLDER,THIS CERTIFlCATE DOES NOT AMEND,EXTEND OR P.0. Box 353 ,� ALTER TWE COVERAGE AFFORDED BY THE POLICIES BELOW. Peabody, MA 01960 INSURERS AFFORDING COVERAGE INSURED Ronco Constr^UCtion, Ronald Wac Tn D b/a INSURER A: NAIL# 12 Tuckers Ct. COMMERCE INSURANCE COMPANY 34754 Peabody, MA 01960 kV8URER INSURER C: INSURER U: IN8URER E: — COVERA THE POLICIES OF INSUR4NCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERPA OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY 13E ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDI POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TIONS OF SUCH IN TYPE OF INSURANCE POLICY NUM9ER POLICV EFFECTME POLICY tXPIRATWH , GENERAL uA COMMERCIAL NV7121 11-11 /03/2012 1.1/03/2013 EAcH OCCURRENCE I:IMITs$ 0:2 : X COMMERCIAL GENERAL LIABILITY _ 5Q(1;(P.�.. DAMAGE TO RENTED CLAIMS MADE OCCUR A MED EXP(Any one paraon) 8 PERSONAL 8 ADV INJURY a GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ x Jt PRO PRODUCTS-COMPtOP AGG $ e X POLICY JECT LOC .....L_._._' .. A�DMOBuneaITy VK0743 02/14/2012 02/14/2013 ANYAUTO EeMINNEnt)SINGLE LIMIT = ALL OWNED AUTOS X StWDULEOAUr08 BODILY INJURY S A (Per person) X HIRED AUTOS lOOOQ X NON-OWNED AUTOS DODILY INJURY S (Pw secWent) PROPERTY DAMAGE -------- (Per awdea) GARAGE LIABILITY 100001 ANY AUTO AUTO ONLY•EA ACCIDENT $ ( OTHER THAN I A ACG S AUTO ONLY: AGO 8 tJ(Cfi9SAIMBRELLA LIAt?✓ILITY OCCUR. FICLAIMS MADE EACH OCCURRENCE $ AGGREqATN; $ t DEDUCTIBLE x RETENTION $ S WORKERS COMPENSATION AND S eMPLOYERS IJAMLITYANY W srATu• DTH- - RERAdEMR EXCLUDED?ECUTIVE OFFICOF_ E.L.EACH ACCIDENT s --- Yea,Aweer SEl DISEASE-EA EMPLOYEE S`_---� SPECIALL P PRO OVISK)NS bebw OTHER ------------- E.L.DISEASE-POLICY LIMIT $ DfiDGRMTION OF OPERATIONS!LOCATIONS/VEHICLES 1 EXCLUSI S 6DDEDBy ENDORB6MENi 1 SPECIAL PROVISI?NS -'""""" owe's Companies,Inc & any and all sufsidiarles are named as add 1 insured as respects to general lability and auto liability 005 Ford FSSO Super Cab IFOAX57YISESS445 2005 CARMATE TRAILER SAK816131451.0104538 000 CARMATE TRAILER 5A3C6105XL0004012 2002 DODGE DURANGO 104H578X62F118138 012 FORD F250 1FT7XZB60CEA7S098 - TION . SHOULD ANY OF THE gBpy♦^OESCfpBEG POLICES BE CANCELLED BEFORE THE EXPIRATION DATE TWjWOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL LONfE I S COMPANIES, INC, 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMEb To THE LEFT, N IS INSURANCE BUT FAILURE TO MAIL SUCH NOTICE SHALL(MPOOL NO OBLIGATION OR uAOIIITY P O BOX 111 OF ANY KIND UPON THE INSURER,ITS A OR i(EPRE9ENTATNE3_ W LLKEHORO , NC 28656 A TH ED REPRESENTATIVE ACORD 25(2001!08)'FAX: 336.658.2308 , CACORD CORPORATION 1988 INSTALLATION SERVICES CWTMAER CONTRACT- MWORK- IN k --'0' t.i I-i1i I't - LOWE'S OF DANVERS, MA., STORE# 1094 �l STORE PHONE: (97£1) 646••9099 �! 153 ANDOVER STREET SALESPERSON: NESSIEM KHOZAM _1 7 A — DANVERS, MA 01923 SALESPERSON ID: 1007883 Document Print Date : 09/2-8/2013 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 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 MIKE FORASTE 978-975-5488 O Customer Address Other Phone 990 FOREST ST L City State/Province Zip/Postal Code D NORTH ANDOVER MA 01845 Installation Address T 990 FOREST ST O Installation City Installation State/Province Installation Zip/Postal Code NORTH ANDOVER MA 01845 MERCHANDISE AND INSTALLATION SUMMARY MERCHANDISE SUMMARY Materials Price $ 0.00 INSTALLATION DESCRIPTION Stock or SOS : Stock Door Type : Exterior Select Location : Back Door Select New boor : Single Pre-hung Number of Doors to Install : 2 Side Lights or Transoms : No 'tore 1094 Project No. 392233206 for MIKE FORASTE Page 1 of 7 na/uvv000 (Mahogany orOak) Door : No Hidden D 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 out iambs 324 Other Work Charge : Yes Comments : No Comment Labor Charges $ 1205.00 Detail Deduction _$ 35.001 Additional Specifications: Notation: Lowe's will not make structural modifications, paint or stain or remove/reinstall security system equipment. Customer is responsibleto 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 $ 1170.00 DELIVERY $ 0.0 ORDER TOTAL $ 1170.0 BALANCE DUE Work is to commence upon reasonable ail I' of Contractor-which is anticipated to be [fill in date]. Estimated completion date is 2 L! 'tore 1 Project No. for �_. �-'--_ ' -~�---_-~ Page 2of7 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 MP TE THIS SECTION ONLY WHEN THE CONTRACT TOTAL EXCEEDS 1 000.00: k_ 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): [_] Charge my/our credit card for the amount of the payment indicated above upon or after the commencement of work; or [_] 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 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 E CUTIV F /CE OF CONSUMER AFFAIRS AND BUSINESS REGULATIONS AND THE OWNER SHALL BE REQUIRED TO SUB- MIT T UC I S PROVIDED IN M.G.L. c.142A. BY' Date: Lo e's ome nters Inc By: r Date: /13 wne 'tore 1094 Project No. 392233206 for MIKE FORASTE Page 3 of 7 ' By: Date: Dato � '--- — ------' -------------- '- -' — Co-owner or Witness THE SIQNA-L UREa_QF-" TLJE-2&RTIES ABOVE APPLY ONLY TO THE-AGREEMENT OF THF PARTIES TO ALTERNATIVE DISPUTE RESOIJUTION INITIATED BY LOWE'S PURSUANT TO M.G.L.—c.142A. THE OWNER MAY BE PERMITTED TO INITIATE ALTERNATIVE DISPUTE Ras—Q—Lurl-0—N EVEN WHERE THE SECTION ABOVE IS NOT SEPERATELY,SIGNED BY THE PAQTIES. WITNESS OUR HAND(S)AND SEAL(S) BELOW THIS DAY OF Lowe's Home Centers, C. Print Nam Aloft)Ale- Ad (Seal) Owner Eity- State l6rovince Zip Postal Code Print Name Co-Owner or Witness (Seal) Print Name 'ustomer acknowledges receipt of a true copy which was completely filled in prior to Customer's execution hereof. You the customer may cancel this transaction it 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 his right. - - tore 1094 N� 3822332OGforK�|KEFORASTE ''°r""^ � ` Page 4of7