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30C-073 (2) 568 BURTS PIT RD COMMONWEALTH OF MASSACHUSETTS BP-2021-1927 Map:Block:Lot:30C-073- 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-2021-1927 PERMISSION IS HEREBY GRANTED TO: Project# WINDOWS Contractor: License: Est. Cost: 3000 LOWES HOME CENTERS INC 49918 Const.Class: Exp.Date: 12/09/2022 Use Group: Owner: GEORGES YVES M& NATALIE N Lot Size (sq.ft.) Zoning: WSP Applicant: LOWES HOME CENTERS INC Applicant Address Phone: Insurance: 1000 LOWES BLVD (413)272-8931 O WC016393105 MOORESVILLE, NC 28117 ISSUED ON:09/24/2021 TO PERFORM THE FOLLOWING WORK: NEW 2 WINDOWS 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: vf • CP-1 • II Fees Paid: $40.00 212 Main Street, Phone(413) 587-1240,Fax:(413)587-1272 Office of the Building Commissioner QC .7\1 / • , SEP 2 , The Commonwealth of Massach efts 2 i 202, Board of Building Regulations and tandem FO t. k. Massachusetts State Building Code, 7 pT AM p�NG,�sp M 0N1U E ITY r� Rui1ding Permit Application To Construct,Repair,Renovate Or De ro t4fiised Mar 2011 One-or Two-Family Dwelling ee � This Section For Official Use Only Build' Permit Number: &a- .tit- i 2,7 Da pplied: Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbeysh R i�R75 PIT AD �!, CJ 1.la Is this an accepted street?yes no Mapumber Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private❑ Zone: Outside Flood Zone? Municipal 0 On site disposal system 0 Check ifyes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Nct i(f t? oirieS C=(urehc e1 /!IA e1 o 6 a Name(Print) City,State,ZIP S4(6 (Girl) Pi 4- Ra 161 Al ov e$h 6Q- � (5./ - 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) ❑ Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work'-: 91 eiviavP 4. i n 411.1 $1 1 w,n�'�''5 NJ S 4-64(441.rot I UJnr v's L SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ -'7( 0(90 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost;(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All F 0Check No....be I Check Amount:14° Cash Amount: 6.Total Project Cost: $ 17j 0 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 04p,��(, ��? n Q Tao /1) Licensee Number Expiration Date v'7 Name of CSL Holder �JN�� 1\� List CSL Type(see below) kA No.and Street I� Type Description U Unrestricted(Buildings up to 35,000 Cu.ft.) h'`I 9M P�� ) U Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding LE��ti�5-(3ti5 4 SF Solid Fuel Burning Appliances ,01.y�el r�p,,w�,..�/S(43 ►.c�„ I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) [Ade7 14"e HIC Registration Number Expiration Date HI Company Name or HIC R gistrant Name Duo (. ,✓s k 'o CIAri9Jf/t4✓. Th,o;P p 1/ua.c.Gr No.and Street Email address w00faiuJiif/ ,c.,c tWi1.1 14(17-'2..)•—Aye/ 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 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 acc e to the best of my knowledge and understanding. Print Owner's or Authorized gent'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 Massachusetts w 0�,�� I :-t DEPARTMENT OF BUILDING INSPECTIONS �'. 14 3" J 212 Main Street • Municipal Building ^ Northampton, MA 01060 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: / / Atrifilti‘( c 1T ceR(rv,p'J Id owls The debris will be transported by: Name of Hauler: ata `�� 1 PIP isa' Yt Signature of Applicant: Date: 1,...\\ The Commonwealth of Massachusetts =air i vs=(re Department of Industrial Accidents =Al — Mir ritio I Congress Street,Suite 100 ::: --- r Boston,MA 02114-2017 —..., ._ . www.mass.govidia Workers'Compensation Insurance.1 Murk:Builders/ContractorsfElectriciansfPlumhers. DO BE FILED‘1 I 1 II I'llE PERMITIENG At I 1. Applicant Information Please Print l.ellthlt Name(austracss,' )rgantrationAndividuall: tiAl`ftr21 R°AC- C4/0-e, Address: ( 0 Oa Celt4,0 City/StateiZip:„ 141A.4(#4,(.)4/-e, /Cc- ?Act/2 Phone#: t) — .0)'`--Y 7 ) .. . Are yew an etnialloyer?Owen One itOpperrpriate bac Type of project(required): I.E3 I ani a employ,with _ensployees(MI amine part-time)• 7. 0 New construction 20 lam a a proprietor or paatneeship and have nu ettiplayeet ait,rkuig for WIC an K. C3 Remodeling any opacity.[Nu wurkeri'comp.LITSUIRIlltr required' 9. 0 Demolition I am a homeowner&lint,all work mrielf..(NO workers comp.insurance minuet]]• i 0[3 Building addition 4.0 I ant a hotimmi net:ow will be luting otmetnition in conduct all work on my prupeasy. I will snooty that all ioniragmr.either have workers`emenperimitori insurance or are tole II Electrical repairs or additions proprietor with no empluyet... 12.0 Plumbing repairs or atkiitions 3t7 -arri a general euntmetor and I love hired the aub-eunteletors hated on the attached abcrt 130 Roof repairs Tbene sub•connatanrs have employee.and bane worker.'comp.insimusee. 14.E3 Other 6.0 We are a corporation and IL,utitcer.ha%e ake.umsed their nghtoleacinphon per hiGL c. 1.5.1,t1(4.1.,and n e haw no employees_[No workers'comp.insurance required.) An applicant that clua.i....,but 31 mmt abo till out the acetion below show nig than worker.'elimperuntIon policy inhumation. +litnneurvner4 who subann thn affnho it usdacanny they an:doing all Wink and then hue outside euntraetnea malt i••uhnut a new aft-4u it uxin..n wig such. :Cunt:al:tom that elleci that bon mina attached an additional Meet Mow ins the ziamc of the t.uts-i'ontraetor.and Ante%Litter or not those athlie.Woe employee, It the sub,:oraraeriir,kW,'employees i key mir.1 pnv.a.lc their wor ker.,",Atrip Nile,.nianbei I am air employer that is providing worAers'compensation insurance for nty employees. Below is the policy and fob site information. Insurance Company Name: A ( N--, )-( ut'IP- t c Policy a or Self-ins.Lie.it: (4/C0 t 61111 to 5 Expiration Date: 4.-( —?\ I Job Site Addrem: 9C,t gG,po--41 9 (T- eli z( CityiStateiZip: cf-2ft e" MI-- 6)1(1---, Attach a copy.of the workers'compensation policy declaration page(showing the policy n um!,c r and expiration date). Failure to secure coverage as required under NICE e. 152,*25A is a criminal violation punistabic by a tine up to S1,500.00 arid/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 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. I do hereby certif' nder e 1111iit's and N'll(Mfr.+of perjury drat the information provided abort,is true and correct. St mature: Da I L' Phoned: q(-1)—d-:),,z_ - a-9 / : Official use only. Do not write in this area.to he completed by city or town official City or Town: Permit/License tr --- 1 Issuing Authority (circle one): I. Board of Health 2. Building Department 3.Cky/Town Clerk 4.Electrical Inspector 5. Plumhing Inspector 6.Other (Outset Person: Phune#: _.. ......, .. • ` 1 DATE(MM/DD/YYYY) ACORD CERTIFICATE OF LIABILITY INSURANCE 03292021 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. PHONE FAX 100 North Tryon Street,Suite 3600 (A/C.No.Exti: (A/C,No): Charlotte,NC 28202 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# CN102776519-Loves-SI-21-22 INSURER A:National Union Fire Ins Co of Pittsburgh PA 19445 INSUOweREE S Companies,Inc. INSURER B:Interstate Fire&Casualty Co 22829 Land 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 LIMITS LTR INSR MID 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-COMPlOPAGG $ OTHER: $ A AUTOMOBILE LIABILITY CA7030892 (AOS) 04/01/2021 0,1/01/2022 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 ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N WC016393104(ND,WA.WI,WY) 04/01/2021 04/01/2022 E.L.EACH ACCIDENT $ 2,000,000 OFFICER/MEMBERLXCLUDLD? 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 4/12021 to 4/12022. CERTIFICATE HOLDER CANCELLATION Lowe's Companies,Inc.and Subsiciaries 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 .x- ©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 ACORD 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 r 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 I$35,000,000 Aggre,+tr: TX Employers XS Indemnity(Excess) Policy Number XCB3095 Carrier:Evanston Insurance Company Policy Effective Date:01-4r-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 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 to addtional self-insured retentions excess of limits shown for various perils covered. ACORD 101 (2008/01) C 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ,4coRv® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) �... 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 THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the poiicy(ies) must 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: Marie PrOUIX HUB INTERNATIONAL NEW ENGLAND LLC (Ai No.Ext): (413)750-7106 ac,No): E-MAIL ADDRESS: marie.proulx©hubinternational.com hubinternational.com p 600 LONGWATER DRIVE INSURER(S)AFFORDING COVERAGE NAIC# NORWELL MA 02061 INSURER A AIM MUTUAL INS CO 33758 INSURED INSURER B MARK JODOIN INSURER C: JODOIN HOME IMPROVEMENT INSURER D: 15 JONES DRIVE INSURER E: EASTHAMPTON MA 01027 INSURER F: COVERAGES CERTIFICATE NUMBER: 557741 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTRINSD WVD POLICY NUMBER (MMIDDIYYYY) (MM/DDYY), COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PET LOC PRODUCTS-COMP/OPAGG $ OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL 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 PER OOTH X STATUTE AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 A OFFICER/MEMBEREXCLUDED? N/A N/A NIA 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(ACORD 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 insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on 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 can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/Iwd/wor.kers-compensation/investigations/. Sole proprietor has not elected coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Lowes Companies Inc and any and all subsidiaries ACCORDANCE WITH THE POLICY PROVISIONS. Mail Code A3ESS 1000 Lowes Blvd AUTHORIZED REPRESENTATIVE Mooresville NC 28117 Daniel M.Crowley,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Cor,cume-• & ,t,-,eT 11,0ME IMPROVE'. . RACTOR TYPE • ogist tAtft2/1 ,*rittEgu lbcr 04, .* 0270 MARK jODOIN DiliAJODOE WPROVFMENT t,AAFW,S ‘IODOIN I‘.;JONES E4STHAMPT ON.HA UtYUndk;:rsPcreay VF" Commonwealth of Ma%sachtisefIS My+sdoll t F-lotes5loodl en$tire Board Smitimg ge,quiations Star,daris CS-049918 Expires. 12129120'2 • MARK S JODOIN , . • 'IS JONES OR EASTHAMPTON MA 01027 4......- . CWriMiSStOner " /11?, ,ez • ice of Consumer Affairs&Ruisiness Regulation HOME IMPROVEMENT CONTRACTOR TYPE. individuai Registration gxpiration 159137 04/03/2022 MARK ODOIN 0/B/A J'DON HOME IMPROVEMENT MARKS JODOIN 15 JONE* DR EASTHA PION, MA 01027 Undersecretarl - o x C'i i`" hstps:.madpLrrryfKt>nse Corr Volt.sn-. 1r+?al x�c=afd a h,;:X,: .sty 4. ,....,.,i= '.Search.. P- 0 _Krcnas Wcrkfoice Lentra(c)6. '72z.Searchke>�.is th ta.._ File Edit View Fiecrite, Toth, -.leis Ile na Moreno we err. .One.MFnNFO N.Preen err Aatewiree ticerwee.earl LMeMmMsrmann Public Safety 1a , tee nrwe Were're. a Licensee Details /kmaaeapbh ddnrmasna _._ _ _......_........ Foal Name ..... MARK S J0DOIN__. ... ._..... Owner Name Lemma Address t toraaatton _..... _.._.. C,Y: eastnarnp*On State MA ZIpWOe' 01027 Cerrntry.,._ Unfled Stales License Information LICellSe NO CS UJe'J 18 License Type consilaetao cuperv;sw ProRmlen'. Su101nnpq Licenses Date et Last Renewal: 1]A6.'1020 issue Dale 1229r701D tapeatroir Date 12l9:2022 License Status Active 7ddey'S Oak 1/10/2021 { SeemdarI License Type Do,ng Business As Status Gaanse Reason Latent Renewal vre ouakitetnfortrwp.r _ -- NO Prerequisite intOrn asci _. NO Avallade OOCIan6nts [NKMnNr tt 930116pslnmaeaWr diAeadaNMb ... .�,r. l. '.ate, ..�.,J-rc< °�'i e e.,ax}w. yr_.s 'ae +.. ' d 'uk.'„a',:�;�'•y' `� • Office or Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:Suoa ernent nir llign Bg48688 4P,688 10/17;2021 LOWE`S HOME CENTERS,LLC GHRISTOPhIER MINE , 1000 LOWES BLVD " "�� SERVICES COMPLIANCE Undersecretary MOORESVILLE.MC 28117 . PSE ( MS -- Sold Job Cover Sheet LowE's SERVICES Directions:Fill out the below form completely and upload with all required documents(outlined below). i c) tg h Store Number: 5'-e' 'esCustomerName: N/, -4 ! - PROvider Company Name: i26,d!VT --- Required Documents for Sold Job Below documents must be included for Installer to begin customer project installation. Failure to provide all required documents may result in rejections. FV1# Sold Job Cover Sheet(this document) Signed Customer Contract 1 • Includes all pages from the state-specific contract in Adobe Sign • Uploading partial Contracts will result in a rejection Cy Sold Material List • For SOS Product Only—M2O/Paradigm or appropriate Vendor order sheet : If applicable: RContract Change Order Engineered Drawings for Decking Projects I PSE Required Actions: 7 have confirmed with the ROvider if a permit is a required,and if so,wa sold on invoice: • 1 I have confirmed with the PROvider if Lead Safe Practices will be requiredon the job,and if so,were sold on invoice: ,i,:. .., ,. .- -\,_ /0 By signing this document, I am confirming I have taken all required;actions and uploaded the necessary documents to the IMS Detail for this cust;.onrrer sect: 7.-''''..--------- ; ' 21------1.N ..- 1 i LOWE'S MASSACHUSETTS SERVICES SOLUTIONS I: TAILED SALES CONTRACT E"S AUTHORIZED REPRESLNTATIVL SALLS Iu CAT I CuS"D ER NAME Dan Flaherty 2054066 8/04/202 Nata ie Georges STREET ADDRESS ST EE`ADDRESS 1916 i 282 russell st 568 Burts Pit Rd Z F CITY 3T.ATE Hadley MA 01035 Florence MA 01062 413-325-3625 (413)923-8996 Etv1 A daniel.flaherty@store.lowes.com ngecrgesn@ME.com .C?WES CONTRACTOR LICENS:rt LOWE'S REPRESENTATIVE LICENSE# Ciif1Di 'JE AT CHECK t LCC CARL 5 r 1 "aS. ia4Eas;home,,”,.., vemhcl ,tsarteal,a3>.*+ na (If Applicable) ri This is only a quote for the merchandise and services printed below, Lowe's does not offer services to paint,seal or stain fences. This becomes an agreement upon payment and issuance of a Lowe's receipt,upon pay-ment,the entire agreement,including the specifically completed pages of this document, the Terms and Conditions included with this document and any other addenda and attachments hereto,shall be referred to herein as this-Contract."PLEASE READ THIS ENTIRE DOCUMENT, INCLUDING THE "NOTICES." "TERMS AND CONDITIONS," AND "ADDENDUM" CONTAINED WITHIN THIS CONTRACT ON THE FOLLOWING PAGES BEFORE SIGNING. NSTALLATICN TRESTADDRESS C,ry STATE ZIP 568 Burts Pit Rd Florence MA 01062 MERCHANDISE AND INSTALLATION SUMMARY(I.E. ITEM NUMBERS,COLORS,DIMENSIONS,CONSIDERATIONS): Removal and haul away of two wood slider windows. Installation of two pocket replacement Pella Impervia fiberglass slider windows. black/black, foam filled frames, no grids, dual pane glass, argon filled, Low-E, black clasp locks, full screens. quoted with 15% off product and labor_ CONTRACT TOTAL $2,810.00 (INCLUDING TAX) Work is to commence upon reasonable availability of Contractor andior any special order or customer made Good(s) which is anticipated to be 10/29/2021 [fill in date]. Estimated c+ mpietion date is 11/29/2021 [fill in date]. COVID-19 has affected manufacturers and labor markets, with the prodiuction of fence, deck and generator material experiencing significant delays and installation start dates that are at feast four(4)months away in most cases.Please atso note that weather can delay start dates for these and other exterior categories, particularly in colder climates. Rev.03/02/2021 • LOWE'S SERVICES CONTINUATION OF MATERIALS AND WORK TO BE PERFORMED(I.E. ITEM NUMBERS,COLORS, DIMENSIONS, CONSIDERATIONS): l I � I I � I � Rev.03/02/2021 2 " I LEAD SAFE INFORMATION. Federal and applicable state laws require that ou 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 performed in Your dwelling unit or facility. A copy of the pamphlet is available at the following website: www.lowes.com/EPARRP For more information see: https://www.eoaaov/lead/lead-renovation-repair-and-painting-program. 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 order 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. NOTICE REGARDING ARBITRATION AGREEMENT FOR CLAIMS COHERED 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 CONTRACT, THAT LOWE'S MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUTIVE OFFICE OF CONSUMER AFFAIRS;AND BUSINESS REGULATIONS AND THE OWNER SHALL BE REQUIRED TO SUBMIT TO SUCH ARBITRATION AS PROVIDED IN M.G.L. c.142A. THE SIGNATURES OF THE PARTIES BELOW APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE RESOLUTION INITIATED BY LOWES, PURSUANT TO M.G.L. c. 142A. THE OWNER MAY BE PERMITTED TO INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THIS SECTION IS NOT SEPARATELY SIGNED BY THE PARTIES. If customer has a complaint which cannot be resolved informally, the home Improvement Contactor Law(M.G.L. c. 142A)may provide Customer with the right to request arbitration through a private arbitration program approved by the Director of the Office of Consumer Affairs and Business Regulation, as an alternative to court action. The same right is not afforded to Lowe's unless this Notice is signed and dated by Lowe's and Customer. All claims by Customer or Lowe's concerning this Contract which cannot be resolved informally, and which are not covered by M.G.L. c142A or subject to the jurisdiction of a small claims court, shall be resolved by binding arbitration as set forth in the Terms and Conditions, E'c . c, 07/29/2021 By: Date: Lowe's Authorized Representative By: 'e R:>,:,,,E , Date. 08/04/2021 Customer PRICE CALCULATIONS. If this Contract includes Goods and related Installation Services sold by unit of measurement, such as per square foot, the Price may include more Goods than the actual measurements of Your project area. The Price includes the total amount of Goods required by Lowe's to fulfill the Contract (including surplus materials and overages) (together the "Estimated Product") and the Installation Services required based upon this total amount of Goods. For instance, a 120 square foot room may require 140 square feet of carpet to properly match the carpet seams, pattern, or unique room characteristics, and the Price would include Installation Services based upon the 140 square feet of carpet. The total amount of Estimated Product is based upon the total Goods recommended by the Installer, based on the Installer's assessment of unique characteristics of Your project. If any usable Goods are left over, Lowe's may, at its discretion, initiate a Price adjustment.Lowe's will not adjust the Contract Price for the related Installation Services. By signing this Contract,You acknowledge You are aware of Your project area measurements and the amount of Estimated Product,and that the Estimated Product may exceed Your actual project area. If Your project includes the installation of flooring materials, by signing this Contract You further acknowledge havirg received a completed Flooring Detail Diagram (the "Diagram") prior to execution of this Contract. Upon request, Lowe's can provide You with additional copies of the Diagram, which identifies the square footage of Your project area and the square footage of the Estimated Goods. PHOTO RELEASE. By signing this Contract, You grant to Lowe's, its representatives, and Installer the right to take and use photographs, videos,or other representations of the Premises before and after the Installation Services and all work performed at the Premises related to this Contract(the"Content). Lowe's irrevocably keeps all rights(including thecopyright),title,and interest in the Content for use in all markets and media,worldwide, in perpetuity. Lowe's can use the Content, in;any form or medium, internally for any purpose (e.g., customer service, planning, and claims. NOTICE REGARDING PAYMENT SCHEDULE. If the Contract Price is$1,000 or less, payment of the Price by Customer to Lowe's is due in full upon execution of this Contract if the Contract Price exceeds $1,000, Customer shall use the following payment schedule $936.00 (1) Deposit of $ [enter 1/3 of the contract Price] to be paid upon signing this Contact. Any deposit collected at the time this Contract is signed will not exceed one-third (1/3)of the Contract Price; Rev.03/02/2021 3 (2) Payment of $ $1,774.00 [enter 2/3 of the contract Price minus $100] to be collected upon or after the commencement of work. Customer authorizes Lowe's to charge Customer's credit Ord, or deposit Customer's check, for the amount of the payment indicated in this section anytime upon or after the commencement of the work; and (3) Final payment of$100 to be paid upon completion of the Installation Services to both parties' satisfaction. { NOTICE OF CUSTOMER'S RIGHT TO CANCEL. If this is a "door-to-door sale" as defined by 16 C.F.R. §429.0(a), or if this Contract is signed by Customer at a place other than the address of the seller as set forth in M.G.L. c. 93 § 48, You, the Customer, may cancel this Contract at any time prior to midnight of the third buslrtess day after the date of this transaction. See the notice of cancellation form sent as an attachment to this Contract for an explanation of this right. By executing this Contract, Customer acknowledges receipt of two (2) completed copies of th'e Notice of Right to Cancel form and certifies Lowe's has informed Customer orally of his or her right to cancel. NOTICE TO CUSTOMER. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Lowe's Home Centers, LLC EXECUTED ON 04 DAY OF August 2021 pI LOWS'S AuTHORIZFO REPRESENL rIVt'IGNATURE OWNER'S SIGNATURE CO-OWNER SIGNArURC r �. t . Y:ua okt I EDI) Customer acknowledges receipt of a true copy of this contract which was completely filled in prior to Customer's execution hereof. Rev_03/02/2021 4 D t 0. • 4. «, tEre (TFF�MS AN _.-.���` .. Lowe's Installation Contract defines what You can expect in Your installation experience with Lowe's, what Lowe's expects in return, and how You and Lowe's will resolve any differences. It is a legal agreement. By signing this Contract, clicking "I agree," or by accepting Goods or Installation Services You are agreeing to be bound by th s Contract. IF YOU DO NOT AGREE TO ALL OF THE TERMS OF THIS CONTRACT, YOU MUST NOT SIGN THIS CONTRACT, CLICK "I AGREE. OR ACCEPT THE GOODS OR INSTALLATION SERVICES. 1. COMMON DEFINITIONS. Capitalized terms used in this Contract will either have the following stated meanings or will be defined throughout the Contract. a) "Contract" means Lowe's Installation Contract and includes(a) any applicable State Addendum, (b)these Terms and Conditions, (c) any documents expressly referencing and made a part of this Contract,e.g., fully executed Change Orders, or incorporated by reference in the Contract(d)the cover page, the Merchandise and Installation Summary,and Notices, and (e) any sketches, materials lists,floor plans, or specification sheets provided by Lowe's. If there is any inconsistency between these documents, the first document to appear in this definition shall take precedence; i.e., any State Addendum shall take precedence,whether supplementing or modifying, over any conflicting provision of these Terms and Conditions, and so on. The Contract does not included any correspondence, advertisements, quotes, or estimates. The Contract is the entire agreement between You arid Lowe's concerning the Goods and Installation Services. The Contract replaces and supersedes all earlier written agreements and all oral agreements,whether earlier or at the same time as this Contract, concerning the Goods and related Installation Services. b) "You", "Your(s)",and"Customer"all mean the person executing this Contract to purchase Installation Services. c) "Goods" means the physical items You are purchasing in connection with the Installation Services. A list of the Goods appears on the Merchandise and Installation Summary. d) "Installation Services" means the work, labor, and other services necessary to install the Goods. Some examples of Installation Services include delivery, handling, return, and selection and placement of Goods. e) "Installer" means the independent contractor Lowe's arranges to perform the Installation Services. Installer will be licensed when legally required, and will direct. control, and perform the Installation Services directly or through its employees, agents, and subcontractors using tools and equipment Installer provides. Lowe's does not employ Installer. its employees, or its agents or subcontractors. f) "Lowe's"means Lowe's Home Centers, LLC, a North Carolina L mited Liability Company located at 1605 Curtis Bridge Road, Wilkesboro, NC 28697. Lowe's Employer Identification Number is 56-0748358. g) "Premises" means the Installation Address You identify where the Installation Services will occur. h) "Price'means the Contract Total stated on the Merchandise and Installation Summaryand is the complete payment due for the Goods and Installation Services. 2. SCOPE. This Contract is between You and Lowe's for the purchase of Goods and Installation Services. Lowe's does not perform Installation Services, but arranges for Installer to do so directly or through Installer's employees, agents, or subcontractors. Installer is an independent contractor and is not under the supervision or control of Lowe's. Installation Services do not include architectural or engineering services. Installer will complete Installation Services, subject to any changes, in substantial conformance with the Merchandise and Installation Summary. Lowe's reserves the right to terminate or rescind this Contract if Lowe's decides that any portion of the job is beyond the scope of the Installation Services that Lowe's originally contemplated. 3. EXCLUSION$. Neither Lowe's nor Installer is responsible for start oefinish delays resulting from events beyond their control including but not limited to: Change Orders,acts of nature,governmental actions,manufacturing or delivery delays or damage to merchandise caused by third parties,labor strikes or unrest, Your credit or financing,any incorrect information You provide, legal encumbrances on Your property, Your property's nonconformance with zoning requirements or building code requirements, hidden or unforeseen physical or hazardous conditions (including but not limited to, environmental hazards such as mold,asbestos, lead paint, unsound structures or points of attachment)at the Premises,or Your noncompliance with this Agreement. None of these delays will constitute a breach of this Contract by Lowe's or Installer. Lowe's reserves the right to terminate this Contract and/or require Installer to discontinue Installation Services given any of the conditions listed above. 4. PRICING. The Price includes most applicable taxes, permit fees, and other costs reasonably known to Lowe's at the time You sign the Contract. When the initial Price does not include all applicable charges, for example, if You order online,Lowe's will contact You to obtain further payment. If Lowe's requests an increase in the Price after You sign the Contract You will have the opportunity to cancel any unperformed portion of the Contract and receive a refund for that portion. The Price includes only those Goods and Installation services necessary to complete this Contract. ! 5. GOODS.Title to Goods does not pass to Customer and remain the property of Lowe s until Goods are installed in Customer's home, building, or on Customer's property. Customer agrees Contract is being offered for the total Price. Customer further agrees any surplus materials upon completion of the Installation Services are not the property of customer and, if instructed by Lowe's, such surplus materials shall be returned to Lowe's by the Installer. Upon request from Customer at the time of job completion, Lowe's, in its discretion, may allow all or part of the unused, receipted surplus materials to be retained by the Customer. Rev,03/02/2021 5