04-004 (3) STORE COPY
NOTICE REGARDING ARBITRATION AGREEMENT FOR CLAIMS COVERED BY M.G.L. c.142A
LOWE'S AND OWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT LOWE'S HAS A DISPUTE CONCERNING THIS CON-
TRACT, THAT LOWE'S MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRET-
ARY OF THE EXECUTIVE OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATIONS AND THE OWNER SHALL BE REQUIRED TO SUB-
MIT TO SUCH AAR AS PROVIDED IN M.G.L. c.142A.
By: /A"F�' - 41 /901 Date: / / /
Lowe's Ho e enters, Inc. , •
By: - __._ :me I / Date:
Owner
By: Date:
Spouse
THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE RESOLUTION
INITIATED BY LOWE'S PURSUANT TO M.G.L. c.142A. THE OWNER MAY BE PERMITTED TO INITIATE ALTERNATIVE DISPUTE RESOLUTION
EVEN WHERE THE SECTION ABOVE IS NOT SEPERATELY SIGNED BY THE PARTIES. --� ,
WITNESS OUR HAND(S) AND SEAL(S) BELOW THIS - DAY OF ) 0 S fi , I t .
Lowe's Home Centers, Inc. ✓
By: —4411 • - (Seal)
Print Name: ' C ( 6456A r + r
( 4..5' t t (Seal)
Address Owner
City State / Province Zip / Postal Code Print Name
(Seal)
Co -Owner or Witness
Print Name
Store 1916 Project No. 332578033 for PAUL KELLIHER Page 4 of 8
•
STORE COPY
SUB -TOTAL $ 2879.94
*TAX $ 0.00
DELIVERY $ 0.00
ORDER TOTAL $ 2879.94
BALANCE DUE
Work is to commence upon reasonable availablity of Contractor which is anticipated to be _2/ t t [fill in date].
Estimated completion date is � 1 ! [fill in date].
NOTICE TO CUSTOMER
All items listed in this contract and specification sheet(s) are to be installed under conditions agreed upon at time of purchase and at the price appearing
on this contract form. This assumes sound existing substructures, superstructure and points of attachments. Extra labor or material incident to installation
necessitated by defective substructures, superstructure, points of attachment, or the moving of fixtures or appliances to be billed at extra cost to custom-
er.
IF THE CONTRACT TOTAL IS $1.000.00 OR LESS Customer must pay in full.
C9 MPLETE THIS SECTION ONLY WHEN THE CONTRACT TOTAL EXCEEDS $1.000.00:
Customer to Pay in Full; OR
[_] Customer to use the following payment schedule:
(1) Deposit $ to be paid upon signing contract. Deposit should be 1/3 the total contract price; and
(2) Payment of $ to be paid anytime after this Contract is signed and before commencement of installation, I/We authorize Lowe's to do
one of the following (check appropriate box below):
[_] Charge my /our credit card for the amount of the payment indicated above anytime after the date this Contract is signed; or
[_] Deposit my /our check for the amount of the payment indicated above anytime after the date this Contract is signed; and
(3) Final payment of $100.00 to be paid upon completion of the installation and both parties' satisfaction.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AND UNTIL YOU HAVE READ THE TERMS AND CONDITIONS CON-
TAINED IN THIS CONTRACT AND WHICH FOLLOW THE SIGNATURE PAGE(s). BY SIGNING BELOW, YOU ARE ACKNOWLEDGING THAT YOU
HAVE READ, UNDERSTAND AND AGREE TO THE TERMS AND CONDITIONS SET FORTH IN THIS CONTRACT. YOU ARE ENTITLED TO A COPY
OF THIS CONTRACT AT THE TIME OF SIGNATURE.
Store 1916 Project No. 332578033 for PAUL KELLIHER Page 3 of 8
STORE COPY
INSTALLATION DESCRIPTION
Stock or SOS : SOS Door Type : Exterior
Select Location : Side Door Select New Door : Single Pre -hung
Number of Doors to Install : 1 Side Lights or Transoms : No
Hardwood (Mahogany or Oak) Door : No Hidden Damage Description : None
Number of additional holes bored for accessories : None Install Specialized Mortise Hardware : No
Install Storm Door : Replace existing storm door Lead Safe Practices : No
Stock or SOS : SOS Door Type : Exterior
Select Location : Front Door Select New Door : Single Pre -hung
Number of Doors to Install : 1 Side Lights or Transoms : No
Hardwood (Mahogany or Oak) Door : No Hidden Damage Description : None
Number of additional holes bored for accessories : None Install Specialized Mortise Hardware : No
Install Storm Door : Replace existing storm door Lead Safe Practices : No
Total Linear Feet of Custom Trim to be Installed : 0 Deliver Door : Yes
Customer Understands Scope of the Project : Yes Permit Required : Yes
Who Will Obtain Permit : Lowe's Permit Fee : No
Additional Miles Traveled over 20 : 0 Bring Up To Code Description : None
Local Disposal Fee : Yes Describe Other Work Needed : None
Comments : No Comment
Labor Charges $ 935.25
Detail Deduction -$ 35.00
Additional Specifications:
Notation: Lowe's will not make structural modifications, paint or stain or remove /reinstall security system equipment. Customer is responsible to advise if prop-
erty is governed by Historic District Regulations.
Additional Specifications:Federal law requires Lowe's to provide you with the pamphlet Renovate Right: Important Lead Hazard Information for Families,
Child Care Providers and Schools. By signing this Contract, Customer acknowledges having received a copy of this pamphlet before work began informing
Customer of the potential risk of the lead hazard exposure from renovation activity to be performed in Customer's dwelling unit.
TOTAL CHARGES OF ALL MERCHANDISE AND SERVICES *where applicable
Store 1916 Project No. 332578033 for PAUL KELLIHER Page 2 of 8
STORE COPY
INSTALLATION SERVICES CUSTOMER CONTRACT - MWORK - INT /EXT /PATIO DOOR
LOWE'S OF HADLEY, MA, STORE # 1916 STORE PHONE: (413) 588 -0270
LOWEt RUSSELL STREET SALESPERSON: ERNEST GASBARINO
HADLEY, MA 01035 -0000 SALESPERSON ID: 777403
Document Print Date : 08/03/2011
This is only a Quote for the merchandise and services printed below. This becomes an agreement upon payment and issuance of a Lowe's receipt, upon which the entire agree-
ment, including the specifically completed pages of this document, the Terms and Conditions included with this document, the applicable portion(s) of Lowe's receipt, and any
other addenda or attachments hereto, shall be referred to herein as this "Contract."
PLEASE READ THIS ENTIRE DOCUMENT. INCLUDING THE "TERMS AND CONDITIONS," BEFORE SIGNING.
Lowe's Registration or Contractor License Number / Lowe's Contractor Name
Lowe's Home Centers, Inc.'s MA HIC NO.: 148688 Lowe's Home Centers, Inc.'s FEIN: 56 0748358
Customer Name Home Phone
S PAUL KELLIHER 413 - 584 -7326
O Customer Address Other Phone
520 AUDUBON RD
L City State / Province Zip / Postal Code
D LEEDS MA 01053
Installation Address
T 520 AUDUBON RD
O Installation City Installation State /Province Installation Zip /Postal Code
LEEDS MA 01053
MERCHANDISE AND INSTALLATION SUMMARY
MERCHANDISE SUMMARY
48552: PEDMSINGLEDR : SOS : SOS PELLA ENTRY 650 SERIES TC : SINGLE DOOR : PELLA - ENTRY DOORS - QTY 1
48552: PEDMSINGLEDR : SOS : SOS PELLA ENTRY 650 SERIES TC : SINGLE DOOR : PELLA - ENTRY DOORS - QTY 1
131139: 131139: STK : 1X8X8 TOP CHOICE EWP PREM S4S : 1X8X8 TOP CHOICE EWP PREM S4S : IRVING FOREST PRODUCTS (MAINE) - QTY 2
193569: 35170FJPMD : STK : PFJ CASE 351 2- 1/2X11/16X7 : PFJ CASE 351 2- 1/2X11/16X7 : EMPIRE COMPANY, INC. (THE) - QTY 6
287039: 97402 -555 : STK : KWIKSET PB ENTRY CAMERON SMT : POLISHED BRASS RESIDENTIAL ENTRY DOOR KNOB : KWIKSET - QTY 4
Materials Price I $ 1979.69
Store 1916 Project No. 332578033 for PAUL KELLIHER Page 1 of 8
NOTICE OF RIGHT TO CANCEL
•
Your Right to Cancel
You are entering into LOWE'S Installed Sales Contract Number 33,2 S ?c3 3 (the "Contract ") that
may result in a lien or security interest on your home in which property (the "Property" ) is to be in-
stalled pursuant to the Contract. You have a right to cancel the Contract, without cost, penalty or ob-
ligation, at any time prior to midnight of the third business day after the latest of (i) the date of the
Contract, which is Al 051 3', c2 D (( (year), (ii) the date you received this Notice
of Right to Cancel, and (iii) if you have paid or will be paying for the Contract by using your LOWE'S
private label credit card, the date you received your Truth -In- Lending disclosures in connection with
such credit card.
Effects of Cancellation
If you cancel the Contract, the lien or security interest on your home is also canceled. Within 20 cal-
endar days (except in Connecticut where the period is 10 business days) of receiving your notice of
cancellation, we must take any necessary steps to reflect the fact that the lien or security interest on
your home has been canceled, and we must return to you any money or property you have given us
or anyone else in connection with the Contract.
How to Cancel
If you decide to cancel the Contract, you may do so by notifying us in writing, by mail, telegram, or personal delivery, at:
LOWE'S /9/6 r 2 F-05 j e 97 4 'W / cl /c y J to D .
You may use any written statement that is signed and dated by you and states your intention to can-
cel, or you may use this notice by dating and signing below. Keep one copy of this notice no matter
how you notify us because it contains important information about your rights. To be effective, you
must drop your cancellation notice in the mailbox, file it for telegraphic transmission, or deliver it to us
by other means at the above address no later than midnight of A rJ 051 g, 07o i 1
(year) (or midnight of the third business day after the latest of the thrte events listed above).
1 WISH TO CANCEL.
(Customer's /Resident Owner's Signature) (date)
Print Name
ACKNOWLEDGEMENT OF RECEIPT OF DISCLOSURES AND CERTIFICATION
On this 3rd day of August, 2011 (year), each of you hereby acknowledges receipt of two (2) copies of
the foregoing Notice of Right to Cancel; each of you who is a party to the Contract hereby acknow-
ledges receipt of one (1) copy of the fully executed and dated Contract; if any of you has paid or will
pay for the Contract by using your LOWE'S private label credit card, you hereby acknowledge having
received the Truth -In- Lending disclosures in connection with such credit card; and you certify, repres-
ent and warrant to LOWE'S that you are all of the customers o signed the Contract and all of the
persons who own and reside in the home in which the P ►.- is to be installed pursuant to the Con-
tract.
(SEAL) �'' ,t " • A . - (SEAL)
Print Name Print Name
—
Witness
Print Name
NOTE : Each Customer who is a party to the Contract and each Resident Owner of the home must sign above.
2010-12-21 10:32 413 231 5562 4 0660 INSTALLED SALES P 1/2
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Departmetzt of Indzairial Accidents
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to be elopvieted by eity or town officia
(i or '1: own: - Perrandic ens k ... _.
' Issuing ,4..littutity (cii elle):
)1 •
1 1 . B af, Health 2. B Departratrt 3. City/Town Clerk 4. Electrical bispedor, 5_ PlUrn.bra'j 22•:;..9
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Phorte f?: ._
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor (CSL)
License Number &pirntion Data
Name of CSI.- bolder CSL Type (sae below)
Ad T ype Descu ptur
tiarestricted (uo to. Cu. let.)
• Sitrnutu o R . Restricted 1&,2 Family Dwelling `
1 i 1) Masonry Cady
RC Residential Rgqoarrekcovering
Telephone WS Aasidantiat Window 00
SF Residential Solid Fuel Burning Appliance Installation
,� • D 'Residential Demolition . V.
n et ua.a te red aotrp limprovcmcant Contractor (WC)
y d�8 �� � 173\
Ca n Na HIC �
� t .t,if2�ko:It.1?Is � 41 Registration Number
Address \
A Expiration bate
Signature orwira►/ �1, vir Telephone
SECTION ' WORKERS' COMPENSATION INSURANCE AFFIDAVIT c. I52. § 25C(6))
Workers Compensation lnSUran ce 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 7at OWNER AUTHORIZATION TO BE COM 'tETED WREN
OWNER'S AGENT OR; CONTRACTOR APPLIES FOR BUILDING PERMIT
1, , us Owner of the subject property hereby
authorize o — &Ala, t 4 1. - to act on my behalf, in sIl mutters
relative to work authorized by this building permit application.
Signature of Own __ Date
SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION
I, �C f 2- \`( \C�f-'� , as Owner or Authorized Agent hereby declare
that the Statements and information on the foregoing application are true and accurate, to the boss of my knowledge and
behalf.
L ttv o 2\ 7.
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Si a of Own -. or A. 'zed Agent !sate
i d under the , ' s and • .. tries of
NOTES:
1. An Owner who obtains to building permit to do his/her own work. or an owner who hint. 411 unregiatorad Contractor
(not registered in the Home Improvement Contractor (MC) Program), will _gat have access to the arbitration
program or guaranty fund under M.G.L. e. 142A, Ober important information on the MC Progrtmt and
Construction Supervisor Liceii ing (Ca) can be found in 7$0 CMR Regulations 1 t0.17.6 and 110.RS, respcetivnly.
2. When substantial work is planned, provide the information below:
Total floors area (Sq. Ft.) . , (including gatxtge, finished basement/attics, dcelki or porch)
Gross living area (Sq. Ft.) _.,_ _ _ Habitable room count .
Number of fireplaces Number of bedrooms
Wurnber of bathrooms � Number of half/baths
Type of hcntirrg system Number of decks/ porches ._ .....
Type of cooling systcrr_
3. `Total Project Square Footage" may be substituted for 'Total Project Cost"
V? d 9£Z1,995£M «.< 8LZO 885 £L ' (BSI 91,66 saMol £b:OL O8 9O
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The Commonwealth of Massachusetts
Board of Building Regulations and Standards,
4.y}
Massachusetts State Building Code, 780 CMR, 7 edition ''r :
• -Y ED
Building Permit Application To Construct, Repair, Renovate Or Demolish I
One- or Two - Family Dwelling AV 3 1 2011
This Section For Official Use Only
Building Permit Number: Date Applied: . of : • NO UNs
Mrrtjg MA01060 4
Signature:
Building Commissioner/ Inspector of Buildings Date
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map & Parcel Numbers
521) qk a )t v 'X). (f.PX, mA r.AC .>3
1.la 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 Closest Side Yard 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 ❑ Private ❑ Zone: Outside Flood Zone? Municipal ❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner' of Record:
1 PAt 1t,WHEY - S2) f4 vOU'Rnt.3 C'O, L ? Err) , rn A tO55
Name (Print) Address for Service:
Stp, COTZ c tile. 3 -\.132 D
Signature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK (check all that apply)
New Construction ❑ Existing Building ❑ Owner- Occupied ❑ Repairs(s) Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work TYLCDv t, T
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ a ,j� �'1 . �`� 1. Building Permit Fee: $ Indicate how fee is determined:
❑ Standard from Fee Schedule: Sq. Ft. x =
2. Electrical $
3. Plumbing $ ❑ Total Project Cost (Item 6) x $5.00 /k =
4. Mechanical (HVAC) $ li 6ttti�t�tt . Inc t (e V 5.0(1
Total All F
5. Mechanical (Fire $ Check No. Check Amount:i Cash Amount:
Suppression)
6. Total Project Cost: $ Q. ' .9" ❑ Paid in Full 0 Outstanding Balance Due:
,.
520 AUDUBON RD BP- 2012 -0219
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 04 - 004 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- 2012 -0219
Project # JS- 2012 - 000326
Est. Cost: $2880.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: LOWE'S 74606
Lot Size(sq. ft.): 81021 .60 Owner: KELLIHER PAUL G & JOANNE F
Zoning: RR(100) //WSP Applicant: LOWE'S
AT: 520 AUDUBON RD
Applicant Address: Phone: Insurance:
282 RUSSELL ST (413) 588 -0270 WC
HADLEYMA01035 ISSUED ON:8/31/2011 0:00:00
TO PERFORM THE FOLLOWING WORK: REPLACE ENTRY DOOR
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House # Foundation:
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.
Certificate of Occupancy Signature:
FeeType: Date Paid: Amount:
Building 8/31/2011 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner