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12C-013 (3)
BP-2022-0294 91 MOUNTAIN ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 12C-013-001 CITY OF NORTHAMPTON Permit: Exterior Res PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit # BP-2022-0294 PERMISSIONISHEREBYGRANTED TO: Project# DOOR Contractor: License: Est. Cost: 2328 LOWES HOME CENTERS INC 103003 Const.Class: Exp.Date:09/08/2022 COIA KRISTIN &SYLVIA CLEMIENS-COIA & Use Group: Owner: ROBERT H CLEMENS Lot Size (sq.ft.) Zoning: RI/WSP Applicant: LOWES HOME CENTERS INC Applicant Address Phone: Insurance: 1000 LOWES BLVD (413)272-8931 0 WC016393105 MOORESVILLE, NC 28117 ISSUED ON:03/25/2022 TO PERFORM THE FOLLOWING WORK: REPLACE FRONT DOOR POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House # Foundation: Gas: Final: Final: Rough Frame: Rough: Fire Department Driveway Final: Fireplace/Chimney: Final: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: • ),2d' y • Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner ' . nQ ko - sob (ozei& , or--- �_1J The Commonwealth of Massachusetts C-/�1 FOR S o . 1 1 Board of Building Regulations and Standards MUNICIPALITY y c Massachusetts State Building Code, 780 CMR USE vv iv 1 Building Permit Application To Construct,Repair, Renovate Or Demolish a Revised Mar 2011 °z One-or Two-Family Dwelling n in �_ This Section For Official Use Only 9 2 " i P' Build ermit Number: 60 � . .> 9 Li Date Applied: C—UiA.-) 1 v” //)---2 3.25-zo2Z Building Cfficial(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Prgplerty Add p /. s- 1.2 Assessors Map& Parcel Numbers 1.I a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 9.wneyl of Recor ii1V►e. a�w `�)OV'fy L J(w 0to&2 Name(Pn t) , City,State,ZIP 4, L—Al0 Until iL 4113'aio. 93#3 No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) VI Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg.0 Number of Units Other 0 Specify: Brief Description of Pro sed Work: 0 Y / SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) o1. Building $ °t . .L 1. Building Permit Fee:$ Indicate how fee is determined: �1�� 0 Standard City/Town Application Fee 2. Electrical $ 0 Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees j 1/.. Check No. ___Check Amount6 Cash Amount: 6.Total Project Cost: $ A3 ?G• `'7`lY 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) /030°3 _girlia.A f eihai�.J W . isu 6 m1�.lt� License Number Expiration Date Name of CSle Holder ��� n� r�� ���� � List CSL Type(see below) N •nd St eet 0/0 f 10/ Type Description C e1 7 U Unrestricted(Buildings up to 35,000 Cu.ft.) 1l R Restricted I&2 Family Dwelling City/Town,State,ZIP < M Masonry RC _ Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances [� _I f 3'A "U3G91 I _ Insulation Telephone Email address D Demolition 5.2 Registered Home Improve ent ContractorCotr (HIC) ` ,J C/„-Q 16111)�D,2n l obau .e �w'-� HIC Registration Number Expiration Date J HIC Cour obNa a rtRz gt, ie NACM li rte. ✓V V db i r % l . 73 . QU 7 Email address City/Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes V No 0 SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize f I chard 1ht/nte to act on my behalf,in ll matters relative to work authorized by this building permit application. 9qi v L'bia ( rwI-v,,c 3- Print Owners &Name(Electronic Signature) Datc SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION 13y entering my name below,I hereby attest under the pains and penalties of perjury that all of the information conta ed ' this licati n is t e and accurate to the best of my knowledge and understanding. Print wner's or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HiC)Program), will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.inass.gov/oca Information on the Construction Supervisor License can be found at ww‘v.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost' City of Northampton _' MassachusettsfiC .t. s DEPARTMENT OF BUILDING INSPECTIONS ar y r 212 Main Street • Municipal Building Northampton, MA 01060 jsl'fv CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: Location of Facility: _ .21..rli'G#tti9le 100Cet SOlaityS r 10ia12d , a 01 U The debris will be transported by: Name of Hauler: that UW. f)VpYn4S?i/ Signature of Applicant: Date: 3 16(22 The Commonwealth of Massachusetts Department of Industrial Accidents + Office of Invesliguiums Lafayette City Center 2 Avenue de Lafayette, Boston,MA 02111-1750 wwwmass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): LOWES HOME CENTERS Address: 1000 LOWES BLVD City/State/Zip: MOORESVILLE,NC 28117 Phone #: 978-735-5907 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ElI am a general contractor and I 6. ❑New construction employees(full and/or part-tune).'k have hired the sub-contractors 2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp. insurance comp. insurance. 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 employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. fi Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. insurance Company Name: NEW HAMPSHIRE INSURANCE COMPANY Policy#or Self-ins. Lic. #: XWC65559367 AOS Expiration Date: 4/1/2022 Job Site Address: City/State/Zip: 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. Q Signature: Ilt Date: Phone#: 978-735-5907 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License # Issuing Authority(check one): 10Board of Health 20 Building Department 30City/Town Clerk 4.0 Electrical Inspector 5E:Plumbing Inspector 6.0Other Contact Person: Phone#: ACOD DATE(MM/DD/YYYI� R CERTIFICATE OF LIABILITY INSURANCE ATE(MM/ ��. 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 have ADDITIONAL INSURED provisions or 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 CONTACT Marsh USA Inc. NAME: 100 North Tryon Street,Suite 3600 (A/C.No.Ext): FAX No): Charlotte,NC 28202 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# CN102776519-Lowes-SI-21-22 INSURER A:National Union Fire Ins Co.of Pittsburgh PA 19445 INSURED INSURER B:Interstate Fire&Casualty Co 22829 Lowe's Companies,Inc. and subsidiaries INSURER C:AIU Insurance Co 19399 1000 Lowe's Boulevard INSURER D:New Hampshire Insurance Company 23841 Mooresville,NC 28117 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-004976909-08 REVISION NUMBER: 10 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 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP/YY LIMITS LTR INSD WVD POLICY NUMBER (MM/DDYY) (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR Self Insured-See below DAMAGE TO PREMISES EaENTED occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATEPR $ POLICY JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ A AUTOMOBILE LIABILITY CA7030892 (AOS) 04/01/2021 04/01/2022 COMBINED SINGLE LIMIT $ 5,000,000 (Ea accident) A X ANY AUTO CA7030891 (MA) 04/01/2021 04/01/2022 BODILY INJURY(Per person) $ A OWNED SCHEDULED CA7030893 (VA) 04/01/2021 04/01/2022 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) B X UMBRELLA LIAB X OCCUR USZ00024220 04/01/2021 04/01/2022 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED RETENTION$ $ C WORKERS COMPENSATION WC016393105(AOS) 04/01/2021 04/01/2022 X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER D IY�/N WC016393104 (ND,WA,WI,WY) 04/01/2021 04/01/2022 2,000,000 ANYPROPRIETOR/PARTNER/EXECUTIVE I I N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 2,000,000 If yes,describe under 2,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Excess Workers'Compensation XWC1647266 (FL) 04/01/2021 04/01/2022 (WC per statute) 3,000,000 A Excess Workers'Compensation XWC1647265 (AOS) 04/01/2021 04/01/2022 (WC per statute) 3,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Commercial General Liability policy is Self-Insured,effective 4/1/2021 to 4/1/2022. CERTIFICATE HOLDER CANCELLATION Lowe's Companies,Inc.and Subsidiaries SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1000 Lowe's Blvd. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Mooresville,NC 28117 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: ON 102776519 LOC#: Charlotte AR ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Marsh USA Inc. Lowe's Companies,Inc. and subsidiaries POLICY NUMBER 1000 Lowe's Boulevard Mooresville,NC 28117 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance TX Employers XS Indemnity Policy Number:EPG000016700 Carrier:North American Specialty Policy Effective Date:01-Apr-2021 Policy Expiration Date:01-Apr-2022 Limits:$8,000,000 Each Occurrence/$35,000,000 Aggregate XS TX Employers XS Indemnity(Excess) Policy Number:XCB3095 Carrier:Evanston Insurance Company Policy Effective Date:01-Apr-2021 Policy Expiration Date:01-Apr-2022 Limits:$15,000,000 Each Occurrence/$35,000,000 Aggregate XS Workers'Compensation and Excess Workers'Compensation policies include a self-insured retention of$2,000,000. General Liability:The insured is self insured for$10,000,000 each occurrence for the period of 4/1/2021 to 4/1/2022. The Automobile Liability policy evidenced above is subject to additional self-insured retentions excess of limits shown for various perils covered. ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD A��--� DATE(MM/DD/YYYY) �L7R� CERTIFICATE OF LIABILITY INSURANCE 10/12/21 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 have ADDITIONAL INSURED provisions or 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 CONtAC! NAME: Keri Rusciano,CISR AX Rejean J.Remillard Ins Agency (A/CNN ,Eel): 413-789-3070 (A//C,No): 413-786-0193 1040 Springfield Street E-MAIL Feeding Hills,MA 01030 ADDRESS: Keri@RejeanRemillard.com INSURER(S)AFFORDING COVERAGE NAIC B INSURER A: Main Street American Assurance INSURED INSURER B: National Grange Mutual Burgers Home Improvements INSURER C: Ace American-Travelers Ins Co. 22 Granville Rd INSURER D: Southwick,MA 01077 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 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLEUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MMIDD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 500,000 MED EXP(Any one person) $ 10,000 A Y Y MPK6213N 06/08/21 06/08/22 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ 100,000 B OWNED X SCHEDULED Y Y M1T3385E 06/10/21 06/10/22 BODILY INJURY(Per accident) $ 300,000 AUTOS ONLY AUTOS HIRED Ni X NON-OWNED PROPERTY DAMAGE $AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER C OFFICER/MEMBERANY EXCLUDED?PROPRIETOR/PARTNER/EXECUTIVE Y/N N/A 6R09227AUB 10/02/21 10/02/22 E.L.EACH ACCIDENT $ 100,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required) Lowe's Companies,Inc.and Lowe's Home Centers LLC are named as Additional Insured with respect to General Liability and Automobile Liability Coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Lowe's Companies,Inc. ACCORDANCE WITH THE POLICY PROVISIONS. and any and all Subsidiaries Mail Code:ISI / 1000 Lowe's BLVD AUTHORIZED REPRESENTATIVE Mooresville,NC 28117 y" l 1� ©1 5 AC PORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD STORE COPY INSTALLATION SERVICES CUSTOMER CONTRACT- MWORK - INT/EXT/PATIO DOOR L��E� LOWE'S OF HADLEY, MA,STORE# 1916 STORE PHONE: (413)588-0270 282 RUSSELL STREET SALESPERSON:CHASE FORBUSH HADLEY, MA 01035-0000 SALESPERSON ID:2195341 Document Print Date:03/13/2022 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, LLC's MA HIC NO.: 148688 Lowe's Home Centers, LLC's FEIN: 56-0748358 Customer Name Home Phone S SYLVIA COIA 413-210-9343 O Customer Address Other Phone 91 MOUNTAIN ST L City State/Province Zip/Postal Code D FLORENCE MA 01062 Installation Address T 91 MOUNTAIN ST O Installation City Installation State/Province Installation Zip/Postal Code FLORENCE MA 01062 MERCHANDISE AND INSTALLATION SUMMARY MERCHANDISE SUMMARY 15634 : 230612 : STK : 120Z DOOR AND WINDOW FOAM : 12OZ DOOR AND WINDOW FOAM : DDP SPECIALTY ELECTRONIC -QTY 1 234228 : 7526 : STK : PVC BRK MLD EXT DOOR SET 3-PC : PVC BRK MLD EXT DOOR SET 3-PC : METRIE INDUSTRIES INC -QTY 1 333358 : 1X8-PFJ8 : STK : 1-8-8 PRIMED PINE : 1-8-8 PRIMED PINE : METRIE INDUSTRIES INC - QTY 1 913245 : 5600032E : SOS : WTS ROLSCREEN STORM DOORS : 36 x 80.5 Aluminum Storm Door : LARSON MANUFACTURING CO INC - QTY 1 913292 : 9136305 : SOS : PELLA SELECT HARDWARE : Matte Black Handle Kit : LARSON MANUFACTURING CO INC - QTY 1 999243 : SOS : WTS TT REEB ENTRY HOM UNF LLT : 37 5/8 x 82 Single Door : REEB MILLWORK OF NEW ENGLAND - QTY 1 Materials Price S 1603.21 Store 1916 Project No. 721979288 for SYLVIA COIA Page 1 of 8 STORE COPY INSTALLATION DESCRIPTION Door type : Exterior Location of new door(s) : Front Door Select new door : Single Pre-Hung Hardwood door : No Sidelights or transoms : No Number of additional holes bored for accessories : None Install specialized mortise hardware : No Install storm door : Install new storm, screen or security 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 Fee : Yes Additional Mileage : 0 Access fee : None Dump entry Fee : Yes Additional Work : exterior trim and sill suport Additional Work Charge : Yes Comments : pella storm door, Masonite exterior door Labor Charges $ 760.25 Detail Deduction -$ 35.00 Additional Specifications: Notation: Lowe's will not make structural modifications,remove cabinetry to accommodate new appliance,or upgrade electrical service. Additional Specifications: LEAD SAFE INFORMATION: Federal and applicable state laws require that You be provided with a lead hazard information pamphlet such as the Renovate Right:Important Lead Hazard Information for Families. Child Care Providers and Schools.By signing this Contract.You acknowledge having received a copy of this information pamphlet before work began informing You of the potential risk of the lead hazard exposure from renovation activity to be performed in Your dwelling unit or facility.A copy of the pamphlet is also available at the following website: httos://www.epa.gov/sites/production/files/documents/renovaterightbrochuretadf. For more information see:https://www.epa,gov/lead/lead-renovation-repair-and-paintinkorograni. PHOTO RELEASE:Customer grants to Lowe's and Lowe's employees and independent contractors the right to take photograghs of the Premises where Installation Services will be performed and all work performed at the Premises related to this Contract, and irrevocably grants to Lowe's all right, title, interest in and to the photographs for use in all markets and media. worldwide, in perpetuity. Customer authorizes Lowe's to copyright, use and publish the photographs in print and/or electronically,and agrees that Lowe's may use s c p tographs for any lawful purpose, including, but not limited to,marketing.advertising,publicity,illustration,training and Web content.By initialing here,Customer agrees to the foregoing. (Customer to initial to the left]. NOTICE TO CUSTOMER-PRICE CALCULATIONS: In order to properly perform the installation of certain Goods,the Contract Price may clude more Goods than actually will be installed based on the measured square footage of the Project Area.As a result,the parties agree that the lump-sum Price stated in this Contract is calculat upon both the value of the estimated Goods required to ful- fill the Contract(including waste),which may exceed the actual square footage of the Project Area,and the labor which may be estimated based on the amount of Goods required to fulfill the contract (including waste). By signing this Contract below. Customer acknowledges receipt of this notice and agrees and understands that the Price includes these costs which may not be refunded once the Installation Services are performed.. NOTICE OF ARBITRATION AGREEMENT This Contract provides that all claims by Customer or Lowe's will be resolved by BINDING ARBITRATION. Customer and Lowe's GIVE UP THE RIGHT TO GO TO COURT to enforce this Contract (EXCEPT for matters that may be taken to SMALL CLAIMS COURT). Lowe's and Customer's rights will be determined by a NEUTRAL ARBITRATOR and NOT a judge or jury. Lowe's and Customer are entitled to a FAIR HEARING. But the arbitration procedures are SIMPLER AND MORE LIMITED THAN RULES APPLICABLE IN COURT.Arbitrator decisions are as enforceable as any court or- der and are subject to VERY LIMITED REVIEW BY A COURT. FOR MORE DETAILS: Review the section titled ARBITRATION AGREEMENT, WAIVER OF JURY TRIAL AND WAIVER OF CLASS ACTION ADJUDICATION found in the Terms and Conditions of this Contract. Store 1916 Project No. 721979288 for SYLVIA COIA Page 2 of 8 r STORE COPY TOTAL CHARGES OF ALL MERCHANDISE AND SERVICES •whereapplicable SUB-TOTAL $2328.46 'TAX $ 0.00 DELIVERY $ 0.00 ORDER TOTAL $2328.46 BALANCE DUE Work is to commence upon reasonable avail blity of /C ntractor which is anticipated to be �P � _[fill in date]. Estimated completion date is / / cA" [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. COMPLETE THIS SECTION ONLY WHEN THE CONTRACT TOTAL EXCEEDS $1,000.00: [Customer to use the following payment schedule: (1) Deposit of $ 7 7 6 7 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 3f (2) Payment of $ l y 5' _ 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$100.00, to be paid upon completion of the installation to both parties' satisfaction. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AND UNTIL YOU HAVE READ THE TERMS AND CONDITIONS CON- TAINED IN THIS CONTRACT AND WHICH FOLLOW THE SIGNATURE PAGE(s). BY SIGNING BELOW, YOU ARE ACKNOWLEDGING THAT YOU HAVE READ, UNDERSTAND AND AGREE TO THE TERMS AND CONDITIONS SET FORTH IN THIS CONTRACT. YOU ARE ENTITLED TO A COPY Store 1916 Project No. 721979288 for SYLVIA COIA Page 3 of 8 r STORE COPY OF THIS CONTRACT AT THE TIME OF SIGNATURE. NOTICE REGARDING ARBITRATION AGREEMENT FOR CLAIMS COVERED BY M.G.L. c.142A LOWE'S AND OWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT LOWE'S HAS A DISPUTE CONCERNING THIS CON- TRACT, THAT LOWE'S MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRET- ARY OF THE EXECUTIVE OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATIONS AND THE OWNER SHALL BE REQUIRED TO SUB- MIT TO SUCH ARBITRATION AyS.P OV`.,-I IN M.G.L. c.142A.IBy: Date:_—/$ d/1G'lcA -2- L L w9's Home Centers. LLC By• c Date:_ .3 t 3k 2 Z_ caner 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 PATIES. WITNESS OUR HAND(S)AND SEAL(S) BELOW THIS /'' DAY OF f" 2 Lowe's Home Centers, LLC By: " ��--t_ s7 (Seal) �� //,--7.71C 7- Print Name: (� 2 8 �i/S2' �// S Q (Seal) Address � Owner d-�/y ` `9 i(Of f V S City State/Province Zip/Postal Code Print Name (Seal) Co-Owner or Witness Store 1916 Project No. 721979288 for SYLVIA COIA Page 4 of 8 r Commonwealth of Massachusetts ®` Division of Professional LKMSure Board of Budding Regulations and Standards C o nst ructiOA iSuperv,sor CS-103003 Euplres: 09/08/2022 MICHAEL W BURGAMASTER,t 22 GRANVILLE ROAD = SOUTHWICK MA 010T7 0�b `'ls1 1�i�k/h- COmmissIoner i p Dli►(ha, ._`//I' /ill/»/i?i-Y//C fe{/1/ 2 e :i IGC SC' Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Supplement Card LOWE'S HOME CENTERS,LLC Registration: 148688 1000 LOWES BLVD Expiration: 10/17/2023 SERVICES COMPLIANCE MOORESVILLE,NC 28117 • Update Address and Return Card. SCA 1 0 20%4.05,117 • •7/:014eleC6'rf ifiWiltsV�&eif4ffr6fs'itEKJUfafion HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Supplement Card before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 148688 10/17/2023 1000 Washington Street •Suite 710 LOWE'S HOME CENTERS,LLC Boston,MA 02118 RICHARD CHALONE Si✓ha `V,Ouggieg.. 1000 LOWES BLVD !.•n :! ':z1e:-/= SERVICES COMPLIANCE Undersecretary Not valid without signature MOORESVILLE.NC 28117