29-232 155558 Piedmont Graphic Services and Global Sourcing
LD W E -:5..° CONTRACT #
MASSACHUSETTS EXTER[Ofl.SOLUT1ONS.INSTALLED SALES;CONT CT
INSTALLED SALES SPECIALIST NUMBER CUSTOMER
STORE NO. STREET ADDRESS STREET ADDRESS
CITY STATE ZIP CITY...° STATE ZIP
TELEPHONE TELEPHONE '
DATE LOWE'S HOME CENTERS, INC'S MA HIC NO.: 148688 CASH a BANK } LCC ' ' REG
FEIN- 56- 0748358 CARD CHARGE ' "
This is only a quote the merchandise and services printed beioW. This bacon agreement upon payment. Sipon payment, the entire agreement, in the Specifically completedpages"of this
document,the Terms and Conditions included W*Mtdhis document and o ther addendaand attachments hereto, shall be referred to herein,a5 this 'Contract'
PLEASE READ ALL TERMS AND. CONDITIONS ONTHE REVERSE SIDE OF THIS PAGEAND FOLLOWSNG PAGESIBEFOI;E SIGNING. `
INSTALLATION STREET ADDRESS CITY - STATE ZIP
Contract Total
•
Are permits required for this installation ?: [ - Yes [ ] No "applicable tax included
NOTICE TO CUSTOMER: Federal law requires Lowe's to provide you with the pamplet Renovate Right: Important Lead Hazard Information for Famil-
ies, 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.
Work is to commence.upon reasonable availability of Contractor and/or availability of,any special order or custom made Goods which is anticipated
to be [fill in date]. Estimated completion date is [fill in date].
Said estimated substantial completion date is not of the essence. Contingencies that may materially change said estimated completion date follow:
(If applicable, insert a statement of such contingencies).
IF THE CONTRACT TOTAL IS $1,000.00 OR LESS Customer must pay in full.
COMPLETE THIS SECTION ONLY WHEN THE CONTRACT TOTAL EXCEEDS $1,000.00:
[ ] Customer to Pay in Full; OR [ ] Customer to use the following payment schedule:
(1) Deposit $ to be paid upon siging 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 $100.00 to be paid upon completion of the installation and both parties' satisfaction.
NOTICE REGARDING ARBITRATION AGREEMENT FOR CLAIMS COVERED BY M.G.L. c,142A
LOWE'S AND OWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT LOWE'S HAS A DISPUTE CONCERNING THIS CONTRACT, THAT
LOWE'S MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUT-
IVE OFFICE OF CONSUMER AFFAIRS AND BUISNESS REGULATIONS AND THE OWNER SHALL BE REQUIRED TO SUBMIT TO SUCH ARBITRATION
AS PROVIDED IN M G.L: d.142A.
By: Date:
Lowe's Home Centers, Inc.
By: Date:
Owner Signature
THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE RESOLUTION INITIATED
BY LOWE'S PURSUANT TO M.G.L. c.142A. THE OWNER MAY BE PERMITTED TO INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THE
SECTION ABOVE IS NOT SEPERATELY SIGNED BY THE PARTIES.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AND UNTIL YOU HAVE RE -' THE TERMS AND
CONDITIONS CONTAINED ON THE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS CONTRACT.
BY SIGNING BELOW, YOU ARE ACKNOWLEDGING THAT YOU HAVE READ, UNDERSTAND AND AGREE TO THE
TERMS AND CONDITIONS SET FORTH ON THE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS
CONTRACT. YOU ARE ENTITLED TO A COPY OF THIS CONTRACT AT THE TIME OF SIGNATURE.
WITNESS OUR HAND(S) AND SEAL(S) BELOW THIS DAY OF - .
Lowe's Home'Centers, Inc.
Specialist or Above Owner Spouse
Customer acknowledges receipt of a true copy of this contract which was completely filled in prior to Customer's execution hereof. You, the buyer, may
7/ 8 /11 /2011 14.01 KW 0roupiCNt; Group Marie Prim 1x- LOWE'S COMPANIES INC 2/3
ACORD CERTIFICATE OF LIABILITY INSURANCE DAT osn 011
) i �Ip_'_R. phone' 015)7f:4-2410 Fa 413.731235N .
INSURANCE CENTER OF NEW ENGLAND THIS CERTIFICATE IS ISSUED As A MATTER or INFORMATION
ONLY AND CONFERS NO RIGHT$ UPON THE CERTO'ICATE
1070 SUFFIELD STREET HOLDER. THIS CERTIFICATE DQEs NOT AMEND, EXTEND OR
P 0 BOX 1230 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
AGAWAM MA 01001
INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURER A: Connecticut Underwriters
MARK S JODOIN
INSURER e•. Comrtlerce Insurance Company 34754
DBA -- �— .
JODOIN IMPROVEMENT INSURER C __
137 PORTER LAKE DRIVE -• •
LONGMEADOW MA 01106 INSURER D:
,INSURER E:
COVERAGES _
TH- rn:;y CIE'. i I, 1 ?ANILE LISTED BELOW I OWE GUN K ;UCD Ti.": TI II NsI JRrr1 NAMTr; ApOVr Ins: TI F Pill 1;7.Y pr - mor , mic.ATI.'b Norma TrrA DMJt_ '- -
ANY ■J 111 .ME 11'. ".E1 C41. CONom:N CIF AM' CONTRACT OR OTHER Fn`1r1 MFNr wi1H kF' - .PICT 'I0 ,H THIR CPRTIFI)ATF woe n1, LSiJ'D OR
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mrr:; -'r''1)'' TYPE DE INSURANCE POLICY NUMBER POUCY EFFECTIVE POLICY EXPIRATION LIMITS
LiN !n0 -L •AT Y:.. ' y NV
GENERAL LIABILITY N NO31125 06/26/11 06/26/12 EA..;H o nail -Ni r _ .. 1 . 500,000
[NMAOL TO N.LNILO 5 50'000
�( = Ob1h,rRl lA �;rlVrk ^.1 I IARII IT, PRLLIUUJ (La wcuir Ar)
0I.AIMS MADE t I li N1ED.L'Il no OA monI t 5,000
A PER: ONAL ,w_ ACV P•IJI_Itr 500,000
I 'JE1 , 1ERAL AC 1 1,000,000
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ALL ...ABED AUTO E'J�DILY INJURY -.. _. _..
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GARAGE LIABILITY
AHTO ONLY. FA ACCIFIFNT 1
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AUTOONL`' A .r•G i
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EXCESS 1 UMBRELLA LIAINILrrY rACl 1 ;A777:1. .RRrjt:r 1
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WORKERS COMPENSATION AND __ I k : F:TATI;. l —
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EMPLOYERS' LIABILITY
TFjTYIiMIT° ,._.._.__... ,
ANY PROPRIETORIPIIRTNE3UE %ECUTNE - E L. EACH AC:LNitNI I S
arrICERMEMBER EXCLODED'I r I rI3rA',7.FA ridpi urn F1
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SPECIAL PROVISIONS blew t L. LI` E A''. E I'i ?LN_Y LINT I 11
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DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
LOWE'S COMPANIES INC. AND ANY AND ALL SUBSIDIARIES ARE NAMED AS ADDITIONAL INSURED AS RESPECTS TO GENERAL LIABILITY AND
AUTO LIABILITY
F #231 -556?
CERTIFICATE HOLDER CANCELLATION .....
;1101r D 1 +)4 OF THE ABOVE CESUIlbtU I 'lJLIUtt Et CAIa1_tLLLLI Eb-03< II1E L }a'IF•'Ai ION
DATE 71tI4tn IHE 1;; ;I Ark: IN ,11RFR' WII I. FNC EAV; 7C! MAIL 20 GAYS ATITTEN Nii1 E TO
THE •TEPTIC o_ r. 1t HOLLCP NANCE'. TO T Ir 1 r7T. MIT FAN , Pr" M1. ?`a`. •iI Al L , IMP %>rr;did•
LOWE'S COMPANIES INC. i 1RI Il;!I.TIC;r. a IlniLIT( of Arrr KIND , TUN I It N`'dJI;hR, I r'S ACEtIT':- CT; REI'a= E iI ;:3
ATTN: I $ INSURANCE (MEZZ)
POST OFFICE BOX 1111 N1 ' i11nR17I F, RrpPE9EN ?ATIVE
NORTH WILKESBOitO NC 286560001 j;411141111264--
• Attention: tephen ..Gallagher
AcQRD 25 (2001 /08) Certificate # 58718 V ACORD CORPORATION 1988
/Z d S31VS 0311VISNI 0990 7 ?.9'tiS I,57 CA, 9o;!+1 , I -gin , ;-
Iu:u1 413 231 5562 4 0660 INSTALLED SALES P 2/2
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137 PORTER LAKE DR
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71 MA 01.14. lindersceretary
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SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction n Supervisor: Not Applicable ❑
Name of License Holder : /Y7/92K 3 ) 02- e 7 1 7?/
7
� / License Number
_I ? ? /o�Te��2 G ,et ,1)4 . /04/67)16,--6 ri 4,4 d /70 /o?/ Q d 0 73
Address Expiration
- ft ' S - 7 /
Signature Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
/oc ES /Wine- ii- j' / yfC
Company Name Registration Number
/3 6 L:ex .Z k 4) T /cry Stirfai i ?0 •' y r o/ 7 7;)_ /6 - - /3
Address Expiration Date
Telephone
SECTION 10- 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 ❑
11. - Home Owner Exemption
The current exemption for "homeowners" was extended to include Owner- occupied Dwellings of one (1) or two(2) families
and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts
as supervisor. CMR 780, Sixth Edition Section 108.3.5.1.
Definition of Homeowner: Person (s) who own 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 homeowner.
Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, that he /she shall be
responsible for all such work performed under the building permit.
As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon
completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to
Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s)
you hire to perform work for you under this permit.
The undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of
Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House n Addition Replacement Windows Alteration(s) El Roofing n
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding [0] Other [0]
Brief De crip on of Proposed
Work: // �4 C
e 714 A.L.rA.J O iA.) 5 A/o ,S'7/71- Tt/X --4 - GcJ tt
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
6a. If New house and or addition to existing housing, complete the following:
a. Use of building : One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction _
i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No .
I. Septic Tank City Sewer Private well City water Supply
SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, X,r/2 ril / •&v .j 2 , as Owner of the subject
property
hereby authorize Z ie) � S
to act on my behalf, in all matters relative to work authorized by this building permit application.
CCev
Signature of Owner Date
1, � f , as Owner /Authorized
Agent ereby declare t at the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
Tk'Dje,5 ( ( pi-eb
Print Name
Signature of IVII Date
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be Tilled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L.: R:_
Rear
Building Height
Bldg. Square Footage
Open Space Footage
( Lot area minus bldg & paved
parking)
# of Parking Spaces
Fill:
(volume & Location)
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DONT KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW O YES 0
IF YES enter Book Page and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO (3 DON'T KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained Date Issued:
C. Do any signs exist on the property? YES 0 NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO 0
IF YES, describe size, type and location:
E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO 0
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
Department use only
RECEIVED City of Northampton Status of Permit:
Building Department Curb Cut /Driveway Permit
15 2012 212 Main Street Sewer /Septic Availability
Room 100 Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Plans
DE°r of Buunt MA01:. • . - ' 13- 587 -1240 Fax 413- 587 -1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Property Address: > This section to be completed by office
,s C t ` t t- ,/F_ Map Lot Unit
0/-e C 0 /0 6 Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record: / I
Q - er /M #6-v r z // f S /7/.../ L ,4
Name (Print) Current Mailing Address:
$tt row r4.4-c Telephone 4 1/3 — 5
Signature
2.2 Authorized Agent:
5<407t /0 t, 69-01
Name (Print) Current Mailing Address:
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building F G� (c /- ) (a) Building Permit Fee
2. Electrical l (b) Estimated Total Cost of
Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) Check Number 3 D yw 3
This Section For Official Use Only
Permit Number:
Date
Building Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
118 SPRUCE HILL AVE BP- 2012 -0802
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 29 - 232 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: window replaced BUILDING PERMIT
Permit # BP- 2012 -0802
Project # JS- 2012 - 001407
Est. Cost: $829.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: LOWE'S 49918
Lot Size(sq. ft.): 16030.08 Owner: HENTZ DAVID E & MARTHA G
Zoning: Applicant: LOWE'S
AT: 118 SPRUCE HILL AVE
Applicant Address: Phone: Insurance:
282 RUSSELL ST (413) 588 -0270 WC
HADLEYMA01035 ISSUED ON:3/16/2012 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL 2 REPLACEMENT 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.
Certificate of Occupancy Signature:
FeeType: Date Paid: Amount:
Building 3/16/2012 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner