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64 CRESTVIEW DR BP-2021-1279 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:29-455 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: REPLACEMENT DOOR BUILDING PERMIT Permit# BP-2021-1279 Project# JS-2021-002114 Est.Cost:$1300.00 Fee:$40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: LOWES HOME CENTERS INC 049918 Lot Size(sq.ft.): 10018.80 Owner: ZANVETTOR GINA J Zoning: Applicant: LOWES HOME CENTERS INC AT: 64 CRESTVIEW DR Applicant Address: Phone: Insurance: 1000 LOWES BLVD (413) 272-8931 () WC MOORESVILLENC28117 ISSUED ON:5/3/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:PATIO SLIDER 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: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. `' 3-11 • Certificate of Occupancy Sinatnre: b 1 FeeType: Date Paid: Amount: Building 5/3/2021 0:00:00 $40.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner r"----r., I 1 --------—..,..ct'..R,TI 13--,,..... The Commonwealth of Massachusetts ,_ 4 I Board of Building Regulations and Stands s ' 4 ' FOR/ I Massachusetts State Building Code,780 �; ` `� �Q�� M IC[PALITY �'; '''_c- U Tn Building Permit Application To Construct,Repair, Renou 4�1► • h a R vised ar 2011 'a, ql?nT.lo'nJ One-or Two-Family Dwelling -' cN Mi(1 c ,��J This Section For Official Use Only �'°o'°N� Building Permit Number: !✓1r' .g MM. /41 'j q Date Applied: Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Proper4 Address: . 1.2 Assess rs Map& Parcel Numbe s 1.1 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 ❑ On site disposal s\strm ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: p(c,,p�f P� j1" O I 0 (p �— Cr n A Zen V•e �- /L Name(Print) City,State,ZIP V( C.099-t.:P . 0 ti 4()- K-(06 16 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) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg.0 Number of Units Other 0 Specify: Brief Description of Proposed Work':./ n .v 'I 1 aCr . /V`I SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ ("L/0 G 1. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical $ 0 Standard City/Town Application.Fee 0 Total Project Costa(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Total All Fees: $ tl Suppression) y�. Check No( elieck Amount: 6.Total Project Cost: $ (11 a 0 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 / 1rT Constructiont/ Supervisor License(CSL) O 1c1 q/ t "\ RRic_ 1 is Ji)O( License Number Expiration Date Name of CSL Holder 1 61 ,-/)nP 0 22 List CSL Type(see below) No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu. ft.) ",r uc n)t/h. � C� `��`� R Restricted 1&2 Family Dwelling City/Town,State.ZIP I M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances L{1'7-V656'gr5 NJOoo,k ci!hl?I/Lciti e 1 Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) C(t(6(bc/ (v- Cate k�IP C♦ S HIC Registration 3Number Expiration Date HIC Company Name or HIC Registrant Name (ovv Cc S C Nr;-,3-0 Nev. pi;n. e e IDS No.and Street 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 , �f� No . ❑ 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 to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information contained in this application is tr e and ac rst o the best of my knowledge and understanding. Print Owner's or Authorized nt's Name(Electronic tgnature) Date NOTES: I. 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.mass.gov/oca Information on the Construction Supervisor License can be found at www.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" The Commonwealth of Massachusetts Department of Industrial Accidents ,_V►,, Office of Investigations _i'�;= 600 Washington Street �it Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): ICGA-e Address: ( b City/State/Zip: l<<'5u.`l(C / (lfl Phone #: `�( '�-)� ) Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. am a general contractor and I 6. n New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. * 7• n Remodeling ship and have no employees These sub-contractors have 8. Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' comp. insurance required.] 13.0 Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. v Insurance Company Name: '60i `'1 54- � c_ /� Policy# or Self-ins. Lic. #: ( CG (6179l �1 U Expiration Date: `t `'(� °� 1 Job Site Address: ey. 0 d " P( o& City/State/Zip: { `"e ct' '`K C CC, 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 'ns and penalties of perjury that the information provided above is true and correct. aignature: Date: 02-1 -0L Phone#: C4 n d`��` I• 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#: City of Northampton E,4 a Sys Massachusetts ,g DEPARTMENT OF BUILDING INSPECTIONS fir 4 4.1eo 212 Main Street • Municipal Building 9J1 �~ --- Northampton, MA 01060 �41 ,O1"` 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: 3 40fiii) / 'f/'-7t- I c The debris will be transported by: �; -� Name of Hauler: Li � '`e I (n() Signature of Applicant: Date: City of Northampton ?Y • Massachusetts �� AN, 'ram • ; a DEPARTMENT OF BUILDING INSPECTIONS -a 212 Main Street • Municipal Building <ND ;SeNorthampton, MA 01060 �'fiy �"�� HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT I, (insert full legal name), born (insert month, •ay, year), hereby depose and state the following: 1. I am seeki = ' building permit pursuant to the homeowners'exemption to the permit requirements of the Massachusetts - .'te Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or work on a parcel of ' •' to which I hold legal title. 2. 1 am not engaged in, and tV,. roject or work for which I am seeking the aforementioned homeowners' exemption, does not involve th• eld erection of manufactured buildings constructed in accordance with 780 CMR 110.R3. 3. I qualify under the State Building Cod.' definition of"homeowner"as defined at 780 CMR 110.R5.1.2: Person(s) who owns a parcel of land . which he/she resides or intends to reside, on which there is, or is intended to be, a one-or ' o-family dwelling, attached or detached structures accessory to such use and/or farm structu : . A person who constructs more than one home in a two-year period shall not be considered a h. e owner. 4. I do not hold a valid Massachusetts construction s ervision license and, except to the extent that I qualify for and will abide by the Massachusetts State Bu 'ing Code's requirements for the supervision of the project or work on my parcel, I am not engaged in con uction supervision in connection with any project or work involving construction, reconstruction, a •ration, repair, removal or demolition involving any activity regulated by any provision of the Massachusetts State Building Code. 5. If I engage any other person or persons for hire in connection with the aforementioned project or work on my parcel, I acknowledge that I am required to and will act as the supervisor for said project or work. Signed under the pains and penalties of perjury on this day of , 20 . (Signature) AC' p , ® DATE(MM/DD/YYYY) `BOLL! CERTIFICATE OF LIABILITY INSURANCE 03/29/2021 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.i 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 cert icate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER I CONTACT Marsh USAi Inc. NAME: _. PHONE FAX 100 North Tryon Street,Suite 3600 (A/C.No.Extl: (A/C,No): _ Charlotte,NC 28202 EMAIL 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 Cor(Ipanies,Inc. and subsidi ries INSURER C:AIU Insurance Co 19399 1000 Lowe's Boulevard 23841 Mooresville:NC 28117 INSURER D:New Hampshire Insurance Company INSURER E: ' INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-004976909-08 REVISION NUMBER: 10 THIS IS l(O CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUITEMENT, 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 IANSD SUBR LTR WVD POLICY NUMBER (MM/DDIYYYY) (MM/DD/YYYY). LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE _$ CLAIMS-MADE OCCUR Self Insured-See below DAMAGE PREMISES O RENTED (Ea occurrence) $ IMED EXP(Any one person) $ PERSONAL&ADV INJURY $ _ 1 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO-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 AUTOOWNED ONLY SCHEDULED CA7030893 (VA) 04/01/2021 04/01/2022 BODILY INJURY(Per accident) $ 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 t D♦*D RETENTION$ $ C WORKERS COMPENSATION WC016393105(AOS) 04/01/2021 04/01/2022 x I PER I OTH- AND EMPLOYERS'LIABILITY )STATUTE ER D Y/N WC016393104 (ND,WA,WI,WY) 04/01/2021 04/01/2022 2.000,000 ANYPROPRIETORWARTNER/EXECUTIVE E.L.EACH ACCIDENT $OFFICER/MEMBEREXCLUDED? N N/A -- ____ (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 4/142021 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. I Manashi Mukherjee _3+4co.,.,._a.�...: _.Aa-...-�,..,_',a-n-- ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) Tie ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN102776519 LOC#: Charlotte ACO'121:1 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 I 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 Cartier:Notch American Specialty Policy Effedtive Date:01-Apr-2021 Policy Expiration Date:01-Apr-2022 Limits:$8,0b0,000 Each Occurrence/$35,000,000 Aggregate>S TX Employers XS Indemnity(Excess) Policy Num er:XCB3095 Cartier:Ev nston Insurance Company Policy Effedtive 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 poIlicies 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 Autombbile Liability policy evidenced above is subject to additional set-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 �__.,-...imilk JODOHOM-01 MPROULX ,a►ile. CERTIFICATE OF LIABILITY INSURANCE DAT/23/2E D"YYY) �� 612312020 I THIS CERTIFICATE IS ISSUED AS A MA-TER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS 1 CERTIFIATE DOES NOT AFFIRMATIVEL" 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. I 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). _ 1 CONTACT PRODUCER I NAME: HUB International New England LLC PHONE No.Ext):(800)243-8134 1(A//C,No):(413)731-9539 11070 Suffield Street E-MAIL Agawam,MA 01001 ADDRESS: INSURER(S)AFFORDING COVERAGE _ NAICa_,___,_J INSURER A:Nautilus Insurance Co _. 17370 INSURED INSURER B:Commerce Insurance Company 34754 Jodoin Home Improvement INSURER C: c/o Mark 5 Jodoin 137 Porter Lake Drive INSURER D: Longmeadow,MA 01106-1246 INSURER E: INSURER F: COVERA9ES 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PER-AIN. 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 i ADDL SUER POLICY EFF POLICY EXP LTR 1TYPE OF INSURANCE INSD WVD POLICY NUMBER IMM/D0/YYYYI (MM/DD/YYYY) LIMITS A I X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 i CLAIMSMADE X I OCCUR X NN1119917 16/26/2020 6/26/2021 PREM SES(Ea ocAGE TO currence) $ 100.000 ', 5.000 MED EXP(Any one person) $ i I 1.000,000 PERSONAL&ACV INJURY $ GEN1 AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000.000 PRO- 2,000.000 POLICY .;ECT LOC PRODUCTS-COMPIOP AGO $ OTHER $ B AUTOMOBILE LIABILITYC Ea acBINEDt SINGLE LIMIT $ 1,000,000 ANY AUTO X RPJ989 3/26/2020 3/26/2021 BODILY INJURY;Per person) $ OWNED — X SCHEDULED AUTOS ONLY _ AUTOS BODILY INJURY Per acc,denti $ X HIRED X NON-OWNED PROPERTY TY DAMAGE AUTOS ONLY ^ AUTOS ONLY I - UMBRELLA LIAB OCCUR EACH OCCURRENCE $ _ ____H ~— EXCESS LAB CLAIMS-MADE AGGREGATE S � DED RETENTION$ WORKERS COMPENSATION I PER 0TH- AND EMPLOYERS'LABILITY Y/N S TATUTE ER ANY PRJPRIEETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT __J nFFICERIMEMBER EXCLUDED? N/A (Mandarlory in NH) E.L.DISEASE-EA EMPLOYEE € If ves de^_cnbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ — I DESCRIPTIO OF OPERATIONS/LOCATIONS 1 VEHICLES ()[,CORD 101,Additional Remarks Schedule,may be attached if more space is required) Vendor#97 26 ILowe's Companies Inc.and any and all subsidia lies are named as additional insured as respects to General Liability and Auto Liability per Mass Business ;Auto Forms CA0001 and MM9911 an applicable Mass.State Laws as per written contract only. CERTIFICATE HOLDER CANCELLATION I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Lowe's Companies Inc. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P ACCORDANCE WITH THE POLICY PROVISIONS. and any and all subsidiaries Mail Code A3ESS — — 1000 Lowe's Blvd AUTHORIZED REPRESENTATIVE Mooresville,NC 28117 9 7.t{ 7 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. Th ACORD name and logo are registered marks of ACORD Ac R CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 07/27/2020 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 TF E CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the term,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 endorseme it(s). PRODUCER CONTACT Marie Proulx NAME: _._ HUB INTERNATIONAL NEW ENGLA VD LLC IA/C.N.eR): (413)750-7106 (A/C,No): _ ADDRE marie. roulx hubinternational.com ADDRESS: p @ 600 LONG NATER DRIVE INSURER(S)AFFORDING COVERAGE NAIC# — NORWELL; MA 02061 INSURERA: AIM MUTUAL INS CO 33758 _ INSURED I INSURER B: _ MARK JODOIN INSURERC: JODOINI,HOME IMPROVEMENT INSURERD: 15 JONES DRIVE INSURER E: EASTHAMPTON MA 01027 INSURER F: COVERAGES CERTIFICATE NUMBER: 557741 REVISION NUMBER: THIS IS TiO 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 EFF POLICY EXP TR INSD TYPE OF INSURANCE INSD,WVD ADDL SUER POLICY NUMBER (MM/DDPOLICYYYYY) (MM DDIYYYY), LIMITS LT COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ __ DAMAGE TO RENTED $ CLAIMS-MADE OCCUR PREMISES(Ea occurrence) I MED EXP(Any one person) $ N/A _PERSONAL&ADV INJURY $ GEN'L/AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ _-_ POLICY PRO JECT LOC PRODUCTS-COMP/OP AGG $ OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ AL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X STATUTE OTH- ER AND EM LOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 500,000 A OFFICE♦{/MEMBER EXCLUDED? WA N/A N/A AWC40070296132020A 08/31/2020 08/31/2021 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(PCORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the iisured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force n the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage an be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/Iwd/workers-compensation/investigate ns/. Sole proprietor has not elected coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE I THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Lowes Companies Inc and any and all subsidiaries Mail Code1A3ESS 1000 Lowes Blvd AUTHORIZED REPRESENTATIVE Mooresville NC 28117 Daniel M.Crow)ey,CPCU,Vice President—Residual Market—WCRIBMA I ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) T e ACORD name and logo are registered marks of ACORD • • • • • • •; • • I; " ''• ;2'7 f1-4,ztWt qT.• • • -:•;'• • . •• ..tr; • •• . . 0'44; V, A" • S lice of consumer Affairs g Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE: Individuai Registratioj Expiration 15917 04/03/2022 . MARK 000IN • D/BA J*DOM HOME IMPROVEMENT • • t 7' MARK S JODC)!N 15„IONE. DR FA HA PTON, MA 01027. •-• .• Undersecretary • ' • • • 11 • • cmi:e 01 Co, rAfir...,:& POME IMP R • -.,..?MTRACTOR TYPE:it' -I BggitarAtal th4137 MARK jOIX)IN DWA JOE/01N HOME ' OVFMENT MAR , 000114 .101,1ES OR :71 0.7.; Commonwealth.at ra5sarnetsit1N Owl stet;of Rotes stem's:Lit:ow:5(4N I.1ca•n of ettlItImg aro$:•erniAr rig -04'??1i3 F xpir 12,19;202 • MARK S JODOIN 15 JONES DR EASTHAMPTON MA 01027 .44/ evirx Office of Consumer Affairs&Business Regulation HOME IMYRRE 5 MENT CONclement TRACTOR TReEa:align 1466 148E88 1007 202i LOWE'S HOME CENTERS.LLC CHRISTOPHER MINIE t000 LOW ES BLVt7 SERVICES COMPLIANCE NC2C 7 Undersecretary MOOFIESV - ❑ x Cr httpss' ._i;,>i_mylicense.com „r ,t,; +t;of �t ;_ ..1 9�' Search... f3 Kronos Workforce Centr l{R;8... 'SearchResults Details� fig File Edit View Favorites Tools Help The Olfaai tVebffie of the Ex ewe Mace of EOHED.the Demon of Prdessoole LKerrstee and the Denson of Standards Public Safety a •�,v Nmpensal, MBSS.l ._ )r1all Denaograph1e InlOriildl i•m Full Name: ... . I': Owner Name License Address Information City. eastttampton State MA Zipcode. 01027 Country.............. United States License Information License No _ CS-049918License Type Construction Supervisor ---� Profession: Buildingg Licenses Date of Last Renewal 12I162020 Issue Date 12!29120i0 Expuatwn Date. 12r292022 License Status: Active Todays Date. i7192021 Secondary License Type Doing Business As Sta[usCnange Reason License Renewal Prerr<piisite tttformet iun No Prerequisite Information No Available Documents Oche Yelnelnw I 120t l Gmanonneann d Massadssetts 59e Panes Ccri3e:!�_ • INSTALLER COPY INSTALLATION SERVICES CUSTOMER CONTRACT-MWORK-INT/EXT/PATIO DOOR LOWE'S OF HADLEY,MA,STORE#1916 STORE PHONE:(413)588-0270 LOUIE'S 82 RUSSELL STREET _ SALESPERSON:CHASE FORBUSH HADLEY, MA 01035-0000 SALESPERSON ID:2195341 Document Print Date:04/22/2021 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 GINA ZANVETTOR 413-668-6566 O Customer Address Other Phone 64 CRESTVIEW DR L City State/Province Zip/Postal Code D FLORENCE MA 01062 Installation Address T 64 CRESTVIEW DR O Installation City Installation State/Province Installation Zip/Postal Code FLORENCE MA 01062 MERCHANDISE AND INSTALLATION SUMMARY MERCHANDISE SUMMARY 193569:351-PFJ7:STK:PFJ CSE351 2-1/2-INX11/16-INX7-FT:PFJ CSE351 2-1/2-INX11/16-INX7-FT:METRIE INDUSTRIES INC-QTY 3 238343:2826:STK:1-4-8 ROYAL PVC BOARD:1-4-8 ROYAL PVC BOARD:METRIE INDUSTRIES INC-QTY 3 238345:2827:STK:1-6-8 ROYAL PVC BOARD:1-6-8 ROYAL PVC BOARD:METRIE INDUSTRIES INC-QTY 1 1504921 :1000008972:STK: 150 SPD 72X80 SUNDEF AR:150 SPD 72X80 SUNDEF AR:PELLA CORP-150 EAST PATIO DO-QTY 1 Materials Price $ 441.33 Store 1916 Project No.678647002 for GINA ZANVETTOR Page 1 of 4 • • • INSTALLER COPY INSTALLATION DESCRIPTION Door type:Patio Location of new door(s):Front Door Select new door:Sliding Sidelights or transoms:No Number of additional holes bored for accessories:None Install specialized mortise hardware:No Lead safe practices:No Total linear feet of custom trim to be Installed:0 Deliver door:Yes Customer understands scope of the project:Yes Permit:Independent Contractor Permit Fee:Yes Additional Mileage:0 Access fee:None Dump entry Fee:None Additional Work:None Comments:No Comment Labor Charges $ 884.00 • 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: Jtttos://www.eoa.aov/sites/production/files/documents/renovateriahtbrochure.odt.For more information see:httos://www.eoa.aov/lead/lead-renovation-reoair-and-oaintina-oroarant. 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 such photographs 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 include 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 calculated 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. TOTAL CHARGES OF ALL MERCHANDISE AND SERVICES -where applicable SUB-TOTAL $1290.33 Store 1916 Project No.678647002 for GINA ZANVETTOR Page 2 of 4 INSTALLER COPY "TAX $ 0.00 DELIVERY $ 0.00 ORDER TOTAL $1290.33 BALANCE DUE Store 1916 Project No.678647002 for GINA ZANVETTOR Page 3 of 4 INSTALLER COPY WAIVER OF LIEN and ONE YEAR WARRANTY(TO BE SIGNED BY CONTRACTOR) I,the undersigned Installer/Independent Contractor,having been employed by the Customer who signed the Certificate of Completion below do hereby certify that the work for this project will be or has been completed in a workman like manner and to the Customer's satisfaction.In consideration of the receipt of one dollar and other good and valuable consideration,and to the extent permitted by ap- plicable law,I hereby waive and relinquish all liens and all rights and claims of liens which I,the undersigned,now have or may hereafter have for labor or materials furnished,and Further certify that all work performed and materials furnished,if any,by any other party or parties upon the order of the undersigned,have been fully paid for.Further,I the undersigned,agree to cause the prompt release of any mechanic's lien(s)which may be filed against the Customer's premises by any subcontractor,laborer,mechanic or material supplier claiming the right to file such a lien through work related to Customer's Contract with Lowe's.In addition to any warranties provided by law or specified elsewhere,including the Customer's Contract with Lowe's,the undersigned further warrants that all work fur- nished for this project shall be free from defects either in material or workmanship.If any defects in material or workmanship shall be discovered in the work furnished or material used during the course of the work or within one year from the date of the Certificate of Completion,the undersigned agrees to replace or correct such deffective work or material,free from all expense to Lowe's and the Cus- tomer in a manner satisfactory to the Customer. I further represent that I have given Customer the option of retaining some or all of the surplus materials or having some or all of such surplus materials removed from the Customer's premises. If applicable to the performance of the work required for this project,I,the undersigned installer/Independent Contractor,do hereby certify that I have complied with all requirements of the Lead Renov- ation,Repair,and Painting Program Rule("LRRPP RULE"),40 C.F.R.sec 745.80et seq.,or any applicable state laws or program regulating lead-based paint safe work practices,including compliance with all information distribution,notice requirements and work practice standards in performing the work required for this project.I certify that I have provided the Customer with all documentation re- quired to be supplied under the LRRPP Rule or state program,shall retain all records required by law,and have attached to this document copies of all the records required to be retained by the LRRPP Rule or applicable state program. Signed and delivered this day of • (Seal) SubContractor Print Name • CERTIFICATE OF COMPLETION 1. I,the Customer,certify that the Installers/Independent Contractors or their sub-contractors,have furnished all Goods and/or services,that installation,repairs and alterations or improvements("the installation services")have been completed as set forth in my/our contract with Lowe's,and that I have been offered the oppor- tunity to request that Lowe's allow me to retain some or all of any unused,receipted surplus materials rather than have such surplus materials remain the property of Lowe's. 2. Buyer's initials(Buyer INITIAL ONE only) There were no such surplus materials. I accepted all surplus materials I wanted. I declined to receive any surplus materials. Date: Owner's Signature Owner's Printed Name Store 1916 Project No.678647002 for GINA ZANVETTOR Page 4 of 4