Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
25-007 (8)
142 RIVERBANK RD COMMONWEALTH OF MASSACHUSETTS BP-2021-1914 Map:Block:Lot:25-007-001 Permit: Exterior Res CITY OF NORTHAMPTON PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2021-1914 PERMISSION IS HEREBY GRANTED TO: Project# DOORS Contractor: License: Est. Cost: 6000 LOWES HOME CENTERS INC 103003 Const.Class: Exp.Date:09/08/2022 Use Group: Owner: NEUBERT ALEXIS J& TYSON J HOLUB Lot Size (sq.ft.) Zoning: SC Applicant: LOWES HOME CENTERS INC Applicant Address Phone: Insurance: 1000 LOWES BLVD (413)272-8931 O WC016393105 MOORESVILLE, NC 28117 ISSUED ON:09/22/2021 TO PERFORM THE FOLLOWING WORK: PATIO DOOR AND NEW GLIDER 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. Signature: ar / • I ' Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner t CAN sF,0 Vi t, The Commonwealth of Massachuse D.4> "e �w !a ~ ' Board of BuildingRegulations and Standar��o � ` 1 I Massachusetts State Building Code, 780 CMR 9rg4,/,()% MUSE• LI r O / Building Permit Application To Construct,Repair,Renovate Or De *l � Re ised r 2011 One-or Two-Family Dwelling 1°;o0T/c/ This Section For Official Use Only 3 Building ermit Number: 61%i) '/ft V lied: K'a'i ) /Nte Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: p j 1.2 Assessors Map&Parcel Numbers 1.1a 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 it) Frontage all 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 Owner'of Record: AMA 15 /UN Pier )- /Vvf*vvIP'm,✓t /t1 h c)lO('0 Name(Print) City,State,ZIP I'{ L vey-bioc Ad 4( 5-7 S_SC(S4 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: 11 ew -ei (by r cod VI Pc.., nc4 i•tv !Z 11d iv_ NJ ei 1--rN c./4--c-co c m.o,-., It SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 0 CJ o 1. Building Permit Fee: S Indicate how fee is determined: / ❑Standard City/Town Application Fee 2.Electrical $ ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees. ' Z s3 Check No. b Check Amount: OCash Amount: 6.Total Project Cost: $ r!pc v J 1 0 Paid in Full 0 Outstanding Balance Due: I SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) (03 OC)'`7 R,—q 01`. Yv,k( 'i a 0)v4(-C 4>we,/J License Number Expiration Date Name of CSL Holder rr__ t V�v'`�e Rc List CSL Type(see below) (di No.and Street l Type Description L, / U Unrestricted(Buildings up to 35.000 Cu.ft.) `oK �v�� 0l O~ R Restricted 1.4t2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding 1113 t 3 e 415 t/1 SF Solid Fuel Burning Appliances t sa ,/�c(ryer . co" 1 Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) ( c{c C t CU,.f 7,21 L'e"1 dci S I HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name oIr v £ t4,eS /.{c-vI C( C No.and Street Email address WIrJu rttrc.;t te, ,c c kcu) L((-17 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 yeti 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 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 true and ate e of my knowledge and understanding. CAP tt Th Irl � a-10 2 Print Owner's r 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.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" CITY OF NORTHAMPTON SETBACK PLAN MAP: LOT: LOT SIZE: REAR LOT DIMENSION: REAR YARD SIDE YARD SIDE YARD FRONT SETBACK FRONTAGE City of Northampton Massachusetts i DEPARTMENT OF BUILDING INSPECTIONS at �f � 14 ® 212 Main Street • Municipal Building 04., ' Northampton, MA 01060 "Sfyy •�t 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: d� ( ldzt Location of Facility: /14CI‘V\ 74cAmippil The debris will be transported by: Name of Hauler: �" ' `�� 074,744, 1v Signature of Applicant: Date: 9,(0 g Pp The Commonwealth of Massachusetts Department of Industrial Accidents Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gor/dia - ot kers' 'orticrena tills] Insurance-11fidavit:BuilderContractorsfEkctricians/Plumbers. IC)13t.FILET) !Eli UHL PERMEITING AUTHORITY. Applicant Information Please Print Legiblv Name rausintss,`Orlianizationfltarityniunl): j•ket< Ceti kt Address: I ()tit) _ /17 ( C ivy/State/Z i p: 111.NJUiPcpli 1°/ )•-6(1)Phone#: Are you all onipia:4er Cheek the spiweprlite box: Type of project(required): 1.E3 am ti empkryer employees thilt anitor pttiUk1• 7 Ej New construction I am a*ai iot pmetnership and have no enintoyem working tor are at 8. 3 Remodeling any L•apasaty..[Nu wort amp.instiramr requarod.] 9. El Demolition am a homeowner Joins all vo.iri.triyself.[No workrt%'emir,1tkAtrant,e required.]° 10 Building addition 4.C1I am 6.310001411e/and will bi.taxis];oorhntetori to conduct JIwork un my property. 1 will onus,:that all oantrintturr either have workers.'ommisrmation insurance LI are sole ID Electrical repairs or additions prupnoturr with no onployera. I 2.0 Plumbing repairs or additions 5g14-11 varietal contractor and I hal-e hired the bob-contractor%hated on the etteited ACCI. ileac 1mb-contractors have employee%arid have%voritaira'c omp.unorance.: 130 Roof repairs 14.to Other ha We are a wpm-anon and as officers have exercised then nee of Exemption pet ARIL c. 152.§104.and set:haw no employees.[No workers"comp.insurance required.' Any appikaint not checks boa.al Mtkil also fill out the section below shoo ins then worker.`compensation polic'y onennation. lionteownen:who submit data atrida.,it ardicahriir the!,are doing alt work and thin hoe outside contraetkir%nunt aubmit a new affidavit indicating audi :L.antraidom that rika.-1.ttur ba mug atto:lred aia madatitortai shtet abuwirts Ile name of the sub-contractors and state oliether or not those',limier haw caployce, tithe sub-cularactin a inaac.oarluyets. tiva iu.iaii.their worker;,..oirtp. I am an employer that is providing workers'compensation insurance for rny employees. Below is the"Policy and job site information. insurance Coinpany Name: /11 fl4 A/C/ Policy#or Self-ins,Lie.#: t/Co ( 1 6 / (a Expiration Date: 3—I —• Job Site Address: ), A(vor-(,..1.,‹ City/StatelZip: itiejf 1T4 0(d6 Attlheil a rap,'of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure losoure coverage as required under MUL c_ 152.§25A is a criminal violation punishable by a line up to SI,5(/0.00 andior one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S2541.00 a day against the violator.A copy of this statement may be forwarded to the Office of investigations of the DIA for insurance coverage verification. Id*hereby certily ui r the dos and pe ies of perjury that the information provided above is true and correct. Signature: l)nte.. q-cl- A f2N-2 t. Official use only. Do not write in this area,to be completed fry city or town officiaL City or Tow n: Permit/License N Issuing Authoritl.(circle one): I I.Board of health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: City of Northampton 0 Massachusetts .,,e fx' tr s tilt DEPARTMENT OF BUILDING INSPECTIONS S Ig a. % 212 Main Street • Muni.cipal Building Jay -1, �_14. Northampton, MA 01060 ,� j�'� HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT I, (insert fill legal name), born _ (insert month, day,year), hereby depose and state the following: 1. I am seeking a building permit pursuant to the homeowners' exemption to the permit requirements of the Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or work on a parcel of land to which I hold legal title. 2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeowners'exemption, does not involve the field erection of manufactured buildings constructed in accordance with 780 CMR 110.R3. 3. 1 qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one-or two-family dwelling, attached or detached structures accessory to such use and/or farm structures.A person who constructs more than one home in a two-year period shall not be considered a home owner. 4. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I qualify for and will abide by the Massachusetts State Building Code's requirements for the supervision of the project or work on my parcel, I am not engaged in construction supervision in connection with any project or work involving construction, reconstruction, alteration, 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) INSTALLER COPY INSTALLATION SERVICES CUSTOMER CONTRACT-MWORK-INT/EXT/PATIO DOOR • OWES OF HADLEY.MA,STORE#1916 STORE PHONE:(413)588-0270 LOWE"S. - -_ 82 RUSSELL STREET SALESPERSON:BRUCE HUNTER ADLEY, MA 01035-0000 SALESPERSON ID:1508948 Document Print Date:09/04/2021 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 ALEXIS NEUBERT 413-575-5934 O Customer Address Other Phone 142 RIVERBANK RD L City State/Province Zip/Postal Code D NORTHAMPTON MA 01060 Installation Address T 142 RIVERBANK RD O Installation City Installation State/Province Installation Zip/Postal Code NORTHAMPTON MA 01060 MERCHANDISE AND INSTALLATION SUMMARY MERCHANDISE SUMMARY 6057:26SCP.92 5/8:STK:2-6-92-5/8 KD WW SELECT STUD:2-6-92-5/8 KD WW SELECT STUD:CANFOR WOOD PRODUCTS MARKETING-QTY 1 15634:230612:STK:12OZ DOOR AND WINDOW FOAM:12OZ DOOR AND WINDOW FOAM:DOW CHEMICAL COMPANY THE-QTY 1 145691 :145691 :STK:1-5-8 TOP CHOICE EWP PREM S4S:1-5-8 TOP CHOICE EWP PREM S4S:IRVING FOREST PRODUCTS(MAINE)-QTY 1 333358:1X8-PFJ8:STK:1-8-8 PRIMED PINE:1-8-8 PRIMED PINE:METRIE INDUSTRIES INC-QTY 3 395003:48961 :STK:78-IN UNFINISHED OVER REDUCER:78-IN UNFINISHED OVER REDUCER:M-D BUILDING PRODUCTS,INC-QTY 1 403545:690BL 15 CP K6:STK:KW SN COMBO SGL BALBOA:KW SN COMBO SGL BALBOA:KWIKSET-QTY 1 485010:5/4X6-PFJ12:STK:5/4-6-12 PRIMED PINE:5/4-6-12 PRIMED PINE:METRIE INDUSTRIES INC-QTY 3 615268:266-PFJ8:STK:1-1/2-IN X 8-FT PFJ LATT S4S 266:1-1/2-IN X 8-FT PFJ LATT S4S 266:METRIE INDUSTRIES INC-QTY 3 Store 1916 Project No.697196778 for ALEXIS NEUBERT Page 1 of 4 INSTALLER COPY 231061 :NA:SOS:SOS ATRIUM VINYL PATIO DOORS:332 2 LITE PATIO(70 1/4-IN W X 78 1/2-IN H):ATRIUM WINDOWS-QTY 1 913242:20297817:SOS:QUICKFIT HARDWARE:Brushed Nickel Handle Kit:LARSON MANUFACTURING CO INC-QTY 1 913278:14604095:SOS:WTS TRADEWINDS FULLVIEW STORM DRS:34 x 81 Aluminum Storm Door:LARSON MANUFACTURING CO INC-QTY 1 986124:SOS:WTS TT BENCHMARK ENTRY UNF:35.5 x 81.5 Single Door:TRU LOGISTICS INCORPORATED-QTY 1 Materials Price I $3331.42 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 Door type:Patio Location of new door(s):Back 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 Fee:Yes Additional Mileage:0 Access fee:None Dump entry Fee:Yes Additional Work:build up and support sill exterior trimwork. Additional Work Charge:Yes Comments:No Comment Labor Charges $1678.75 Detail Deduction -$ 0.01 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 eoa.govlsites/oroduction/files/documents/renovaterightbrochure.odt.For more information see:https://www eoa,gov/lead/lead-renovation-repair-and-painting-Program. PHOTO RELEASE:Customer grants to Lowe's and Lowe's employees and independent contractors the right to take photographs 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]. Store 1916 Project No.697196778 for ALEXIS NEUBERT Page 2 of 4 INSTALLER COPY 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 $5010.16 *TAX $ 0.00 DELIVERY $ 0.00 ORDER TOTAL $5010.16 BALANCE DUE Store 1916 Project No.697196778 for ALEXIS NEUBERT 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 Customers 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 Customers premises. If applicable to the performance of the work required for this project,I,the undersigned installedIndependent 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 stale 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.697196778 for ALEXIS NEUBERT Page 4 of 4 f AC`ci� GATE(MM/DDIYYYY) l.._ 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. 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 NAME: Marsh USA Inc. PHONE FAX 100 North Tryon Street,Suite 3600 (A/C.No.Extl; (A/C,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 W LIMITS LTR INSD VD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR Self Insured-See below DAMAGE TO RENTED PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ 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 - 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- ER EMPLOYERS'LIABILITY STATUTE ER D Y/N WC016393104(ND,WA,WI,WY) 04/01/2021 04/01/2022 2,000,000 ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N NIA (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) 04/012021 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 4/12021 to 4/12022. 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 -.r-L .�..,, - --3�---ter n-.--aAG-, I ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN102776519 LOC#: Charlotte A`ORD 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 Cartier:Ncrth American Specialty Policy Effective Date:01-Apr-2021 Policy Expiration Date 01-Apr-2022 Limits:$8,000,000 Each Occurrence I$35,000,000 Aggregate XS TX Employers XS Indemnity(Excess) Policy Nester XCB3095 Cartier:Evanston Insurance Company Policy Effective Date:01-Apr-2021 Policy Expiration Date:01-Apr-2022 Limits:$15,000,000 Each Occurrence/$35,030,000 Aggregate XS Workers'Compensation and Excess Workers'Compensation policies indude 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 io adcitional self-insured retentions excess of limits shown for canoes perils covered ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Ac:N11��U DATE(MMlDDNYW) �✓ CERTIFICATE OF LIABILITY INSURANCE 06/02/21 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 CON IACr NAME: Ked Rusciano,CISR Rejean J.Remillard Ins Agency (PAHO,NN/c .Ext): 413-789-3070 (NC,No): 413-786-0193 1040 Springfield Street E-MADDRESS: Keri@RejeanRemillard.com Feeding Hills,MA 01030 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Main Street American Assurance INSURED INSURER B: National Grange Mutual Burgers Home Improvements INSURER C: Chubb Group 119 High St. 1st Floor INSURER D: Agawam,MA 01001 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. INSRXP TYPE OF INSURANCE INSD BWVD POLICY NUMBER (UBR MM/DDNY YYY) (MM/DD//YYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEDAMAGE TO RENTBD $ 1,000,000 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 AUTOS ONLY X SCHEDULED AUTOS Y Y M1T3385E 06/10/21 06/10/22 BODILY INJURY(Per accident) $ 300,000 HIRED v NON-OWNED PROPERTY DAMAGE $ X AUTOS ONLY x 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 /N N/A 6S62UB-4N50542-5-20 10/06/20 10/06/21 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/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If 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 ACCORDANCE WITH THE POLICY PROVISIONS. Lowe's Companies,Inc. and any and all Subsidiaries Mail Code:A3ESS / 100 Lowe's BLVD AUTHORIZED REPRESENTATIVE . Mooresville,NC 28117 © PORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ,..7„-•:,-?•--4. ,,:'--'':„-q.---•r;',fi.- -•,,,, -•'-,,,-.,--„:,•„i;-,--,'-•,---' ',.-,;'-,'.'•,'_';:,q-,:-,':„i.,'i-'•-...,-'•-;;,',_T--:,,;'-:* -;--t,t-'---;i:•-''••.'il,•-•... ---,2„.,r-:.:----414.).4,4'1 .4,,- '?41i,- ;,,,4-i-i',..t4:1Siv4,1.1*•;:fiZii'„,:z „,„-- ,'4-7,„•-',kc i'...'"'ic.:;„•,.;:,--i., -- :--:-1,,,---'4i,„--7i',:e3'; . :„',„'.t$'-'410)t*'iIt-,t,?-kk4:44'*$f„:iZ..i4 - k.t.:: ,•' ,'''.2;t'',':l„:'':'''.'„!,.:,'''' ,'it;:1 %,. '„,!„T.„4$0::.1„Sil'.„'„,. .,i t,*" 4„:e.ikli..'..4tt4N:V-**110.itqt. .,,,-"A'--k;,,i', N•,',. ..,;-,:' !--t:'''.."':,.-". :;:'''":",-:."•• .,-- ••••.,,,.:..,,,•,:,..„,„;,,,:::)1,,,,,•,:e„,;i:;",,,t....„,,,!Sni„:4,e,*:,:z;.‘ff,.....4:40grfitp:14.:AL.t.iiktY--,. ., .!,47:***ii.;:#....:-.,:i.."- e.,:,„.:':`,4.114:ili4e.'zt":.74k,),44„;',.. .Virk4., . -• „,,,,3.t tr:„.":„'401:. ..:'.:•.:':.:..'.'-,,s;''.'..:1'':...':'";..,l.':.',ZAi'al:',.'':'„?''-:'.t-:;;:„'4fi$$';g!''''"tti*"'Pjlf-'k4Q!-SO:V'';„*;*i.-'.'-'-;„$14W.91.-...„::::'',-;,,t..4,4,!*&14,-:r4lt,':.:;',4).0„4-;441itigkii4iitliviZliik'-'-'--'?ic;,f ., ,„,..,•,...:„!--.,, ,„":"..• , „ • .. .,.,,.,,,,.4„..,,,:„4::,,,,,,,,,,,4,,„,„,,A.,,,,,,,,,,,,,,„„4,14--... ",v,t„,„0,,p,‘,„,,,ir....,..,':Z1:4,44.,,,,,,,.. .—".., -.1,-,”Np..e, Ntx.' ''^t Y 'Til*0. t Il• -tV-S, „ .. . .... • ' . ..' t i... ,, ',-...--:,,i ti.:, ..,'•2•:::.•' ti!.iti-tt„tq::',. .3t4',-Vilf..040-1,11';'VZi-1;;-7.2.... .'0ZIV•ii2Iiti14,11:$,K,Okt;k4•Irii -10.44•14i0,--g'"itf-04401*i'S-.-- lt• .. t-t:*-it''- „ , . . , , , . .i, • '„ . ... i , tt i t0-•?-,....„'..:tit.... 4••• -',4„:1,t'.1.1-eit.".0.tte,i-...:•-:A.t...;‘,..',A0::,!.-,Vii'..!•;?tt:S!Aki•tit!' "* "'*i"t,•'t•-:',40741S-'8":"0:-'t• -::-.*•'------ i --- .Tilh.tV '-,-*; •••.•--i;-A , , , , , . , -',: . •' •":. ., ' i, '1!i,'; '_•',..::-,„:'.-;-",."•'::!il,•;„,••••-,•:'.'",t:1.*:'•:!;/,:0-'••:1-01-t',,,,),Ii!-3.if.iVi '1,',.:: :'4)1.:te`I'A-•:',1/4•Z.VK.**ifk:130....kil:ti-UN''.,,•*tti'l.:-.'. .. ..-.::--,.- --..-:•••:•::(-',:--, * '- -*' -'-'-'----;: ,1' ''- -t"• ---\ ' -'1-::•,? '.11."''5'i.,:•'=:,,:'......: :----' -:i.".'4.%,,:i,-f',:c'.-VIY.,•-.W:l.:-`';'.• :•:'•-•:{tq-k, .;N:', .',4•‘"'q%1;',.Li.'S$4/%:: .•'AVA..4*--•''',4k••*,,,',.....47•••:•-'-4'. ' • '- --- -'--- -- 'it's •-..--1.--k l'-•'..-$. -:':'!:::-",•;,..fs;.'h''').!;:i..!•',',1.1',:2 -.,-t-'i.-.:i'7-•,1-?, '":11,`,!..*f,,V*•!..7,4&:•4liV10.'"'.e.r ..1:•:t1 .:,I.".„.' ':-.`::•‘-.--''''''''—- .'•-• - . .,-*‘•.4,„ '•! .'• t 0".„-.1,'•''''-" •:,:::',''''''•:::.,L.....:-,--0,•'.:A,4•••i f•-"%i--.,.,:-,-....',,,:-.'",,,?'!':::'-,"e?.1:7-P,:..'.40,',-.."*-",--'''''''.' • •' . •., -.,,....„.....-- _ .. . . . 0 - ith f Massachusetts • onwea Comm . - , - fession& l Licpnsure . of pro- • - - Standards !-,.'s ..:':"•,--4 DiVI SIC)n '''''' • i 4.; .,.....,-.r. and ..-.'i'''.4•,::•,:-......,..".„, • . ,!!..::,.. .i.4 .„:,.,,,•4:4,-.,...." ?.... .,.,ii.,.*. f 5:2.,:z u i 1 d t n g Regthau"" :1 , ...-.. ...-",,,,, . ., . Board 0 4°-- ' --n- n S u r V s o . ...,...,::...:.:.. . .. r 1 1,---ir I,0 ' ...,„ itt'tt, -il S t 0600't1/4"---. . Li 1- t"-• t' •„ ' . ' Expires , • *-'044-10 8„..„....:„. „,,„,.:.y.,,.!,:•:.:::-,,, ,,,.„. . .. ......, ., „.......,,,,„, „.„, . .. . , ....„.......,....„..„.,..„ .„,.. . ... ..„ . . „..„„.„„. ..,.....„.„,„„,„.. ::„...„ ..:„„;*„:„..,...„:. ,,,,..„,::-:.--.,,.. • ,,,-,„,:,4•-,v ::,,,v,.1..• -,„ 03 rs - 103- •• •,.,.. .„::...... :•:...,••:,„,„::::„. ,,,,..:„,,::,.... ,,,., , , ,i,; ,..,:,::i,,, ,,;,,, .., ....„, ........... ,..,„',--- 12020 BURG AMAsTE-: - R . •--,:.- --,...;:.,•_-: .,:.•. .::: .: , . :..: •.. ,,..-t „•,. NI--.. -,,„. •',' ,•„,„• mICHAEL —tAl RAN 22 G - -- V -,,-..... ILI F - ROAD "---.„... ....,..:,.. , _,.. ...„----,•-::::---.:. ...:..„... __ ,,,•,..:. sOUTHWICK MA 01077 .,..••_:„. . . • .. .. ... ::,......,......„.,„ ..,.,:„. ..,!..,:•.. .....: -...-.;--,::, • • ..• . 2.,. . • •,:::. •/-' , . . :„..,-..•-•,••• ._ ..4_,,i,e,• :...„.„--..---,•:• •:_:,,:,,,,,a,,,--.-„,::,......,,,,,,-„:,•:, ,., ....„..„.•...........,,,•„....,..„ ... ...., •,:.:, ..,,,,-,-,-,-::-::•-i,"-- • ....4„:•,•••••,,r-, ,,:::,..r. ..‘rit:v:4.4-ty..:4_,, ;.1,,;,$,,,%:,i4e,,,..,,:,.,-*,40.-1:„.,..sr.,.. ...:,.,.i..,•,„:„.„..t.4-4.4„:„-:„..-„,..,„-i,.::_•:::,.,,,-::*,:•,-e-,...-0-- ,04,3.7: 1,-4,-0:„ ..-::-..,,=..:;.,•.,...: :;,..::, ,..,,,,,,:,,,,:,., ,/,;,:r7i,l, ,41.••,.,:t„,•06.•;,;:.„,t04,,,.:" r!:::••,,,,:f...,.:,.7.4.:7.47.,..„.;r::.,.,,..;..,,,:•;,,,,,,F,74,:.:•,:,,•,.; ;••,:::•;„.i.,:,.,;„„:....i,•:.•••,,,:it,,..:,,,,,.:',..,;.:::'.. ,:;,,fS,:iiit;•••,,fii;:-,•,• ,::',....:•,,,!::f.:•;:",,',-::st!:-.,1:41:::•';i1,,,A.':.:: - tc, i 0 n e r mmis. .-?, , - C 0— '" - ,„...,.....:74.„...,-....1,. .. :-.::,..f-,,-7,-.--,:?:,....:....,,,:-:::yi--'.,„•-•;„,,-,.:,;:,.:-.;:,--,:::::.:-;:,,,;:,;; ,:,!.;:::i-z...7,-.-:,:„,;•4;-,,:,:::::::...:,42-,!::;;;;Ti]!,:t;:fi;,:,:i4,,,i,.,:i';-ig;4;:him-gAeotiffxittkg14t,onigiatiir--"ze-:":-'-'-- - .... ---,-;....':.:7 ,-,'-'---'7:::'-!''";::-;::::;:...:.il'.:--- '.:' '-.'• •:.:-'•,;"--,:;'•'••7;e:?,.:'••:;i-1.-;:t:•<:•„:1-:;J.----.:5-1" 1:t::::iN: ri:-!:%ii:IPI]t--,;: ::,,;',-,:•;i0itii107,-;,; ••]el::4;;;;;;!-4484''''V''':':•:4°'•:''''''''' ' ,- , ,••• . , ...,••„. -'' •- - „: .:• , .••• ••:•., „. ..- - nazon.coin esay Bookinq,.om:Chea C 1 1ripAdvisor ("aceAtsrjrak: w Office of Consumer 2.111taiirs & Business s Requiatioti Standardsdi Ai g �. Office of Ptit is tt ty afIt • Menu L;c n it ,�,�Page Duplicate License Application Logout Select the license you would like to submit a duplicate request for from the list below. If you have multiple duplicate requests. you can only submit one request at a time. Complete the process for each license you would like to duplicate After completion of this application process you will be redirected to an external payment processing site.Acceptable payments methods are Visa, Mastercard, or a Funds Transfer from your bank account. There is a 2.49% processing fee if you pay by creditidebit card. There is a $0.40 processing flee if payment is made by Funds Transfer.This is a REQUIRED fee. Eligible Licenses Construction Supervisor Continue r_ co Building Licenses CS-103003 License Si€:ste_s Active isviic 8/10,12009 C. 9!812022 Office of Consumer Igloos&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:Suor it n R g t48688688OL 10=17'2(321 LO'vVE`S HOME CENTERS.LLC CHRISTOPHER MIME" ✓ '• 10f34 LOW ES BL'roIANCE Undersecretary SERVICES COMP L MOORESVILLE,NC 28117