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29-400 STORE COPY paragraph 13 above is governed by the Federal Arbitration Act, 9 U.S.C. Sections 1 -16. If any provision of the Contract is contrary to any law to which it is subject, such unlawful provision shall be ineffective without invalidating the other provisions, which shall remain in full force and effect; except that, as stated in paragraph 13, if the waiver of class action arbitration, or the prohibition of consolidation or joinder, is determined unenforceable, then the entire arbitration agreement in paragraph 13 will be rendered null and void. 15. CREDIT CARD /FINANCED TRANSACTIONS. If Customer uses a credit card or obtains financing to pay some or all of the Price, then Customer acknowledges that the terms of his or her cardholder agreement or financing documents may change the total amount of money Customer must pay to the credit card provider or lender, including any interest charges and fees. Customer acknowledges that his or her cardholder agreement or financing documents may have other terms and conditions to which Customer will be subject. Customer also acknowledges that Lowe's is not a party to any such cardholder or fin- ancing agreement. 16. WAIVER OF LIENS. Because responsibility for paying the Installer on Customer's behalf belongs to Lowe's, Lowe's will require the Installer, on behalf of itself and any of the Installer's subcontractors, ma- terialmen or suppliers, as a condition precedent to payment by Lowe's on Customer's behalf, to fully and unconditionally relinquish, waive and release any and all mechanic's liens, materialman's lien and other liens in the Premises which the Installer or its subcontractors, materialmen or suppliers might have or acquire in the future, by operation of law or otherwise, as a result of this Contract. 17. UNAVOIDABLE DELAY OR FAILURE IN PERFORMANCE EXCUSED. Any delay or failure by Lowe's or the Installer in performing this Contract because of stike, fire, flood, epidemic, acts of terrorism, acts of God, inability to obtain Goods in a timely or commercially feasible manner, or any other causes beyond the reasonable control of Lowe's or the Installer shall be excused and shall not be breaches of this Contract. 18. ENTIRE AGREEMENT / CHANGES IN WRITING. Customer and Lowe's agree that this Contract accurately states the entire agreement between Customer and Lowe's concerning the Goods and Installa- tion Services and replaces and supersedes all prior agreements and understandings relating thereto, both oral and written, and all oral agreements and understandings entered into at the same time as this Contract. Any additions or changes to this Contract, or any waiver of rights under this Contract, must be in writing signed by Customer and Lowe's. 19. CAPTIONS. Titles or captions of sections contained in this Contract have been inserted only as a matter of convenience and in no way define, limit, extend, describe or otherwise affect the scope or mean- ing of this Contract or the intent of any provisions hereof. 20. ADDITIONAL INFORMATION. All contractors and subcontractors must be registered by the Administator of the Board of Building Regulations and Standards. Inquiries about a contractor or subcontractor relating to a registration should be directed to the Administrator of the Board at One Ashburton Place, Room 1301, Boston, MA 02108, (617)727 -8598. 21. QUESTIONS OR CONCERNS. Customer should speak with the Lowe's salesperson whose name appears on this Contract and the manager of the Lowe's store where Customer entered this Contract re- garding routine matters such as scheduling, any requested changes to Customer's order, or any concerns Customer may have about this Contract, the Goods or the Installation Services, at the address and /or phone number noted on the front page of this Contract. • Store 1916 Project No. 293849522 for DEBORAH ARMSTRONG Page 8 of 8 STORE COPY 11. MANUFACTURER WARRANTY FOR GOODS / LOWE'S WARRANTY FOR INSTALLATION SERVICES /LIMITATIONS OF LIABILITY.Customer is entitled to any warranty provided by a manufacturer of the Goods sold under this Contract. The Installer will provide Customer with any manufacturer consumer warranty information accompanying the Goods, and Customer may also obtain such information by contacting Lowe's. Lowe's does not warrant the Goods AND EXPRESSLY DISCLAIMS ALL WARRANTIES, EXPRESS OR IMPLIED, TO THE FULLEST EXTENT PERMITTED BY LAW. Lowe's does warrant that the Installtion Services will be performed by the installer in a good and workmanlike manner. Lowe's warranty for Installation services shall extend for a period of one year from the earlier of (1) the date the Certificate of Completion is signed by Customer or (2) the date that Lowe's determines that the Installation Services have been completed, or for such greater period as may be re- quired by applicable law governing consumer warranties for workmanship (the "Warranty Period "). LOWE'S WARRANTY THAT THE INSTALLATION SERVICES WILL BE PERFORMED BY THE INSTALLER IN A GOOD AND WORKMANLIKE MANNER DOES NOT COVER, AND LOWE'S WILL NOT BE RESPONSIBLE FOR, ANY DEFECT IN SUCH INSTALLATION SERVICES DUE TO (1) ANY DEFECT, WEAKNESS OR DANGEROUS CONDITION, INCLUDING BUT NOT LIMITED TO, MOLD, ROT, ASBESTOS OR INFESTATION IN THE PREMISES' STRUCTURE, SUBSTRUCTURE, SUPERSTRUCTURE OR POINTS OF ATTACHMENT, OR OTHER PRE - EXISTING PHYSICAL OR ENVIRONMENTAL HAZARD, OR (2) ABUSE, MISUSE, NEGLECT, OR IMPROPER CLEANING. LOWE'S WARRANTY FOR IN- STALLATION SERVICES SHALL BE IN LIEU OF ANY OTHER WARRANTY TO THE FULLEST EXTENT PERMITTED BY LAW. Customer acknowledges and agrees that Customer shall be limited to seeking recourse or remedy exclusively from Lowe's or the Installer (as applicable) and that no affiliate of Lowe's shall have any liability under this Contract. Customer must give Lowe's written notice within the Warranty Period of any warranty claim relating to Installation Services. Customer agrees that its sole and exclusive remedy against Lowe's for a warranty claim is reinstallation in a good an workmanlike manner, including the repair or replacement of any Goods if and to the extent resonably necessary to correct the defective Installation Ser- vices. CUSTOMER SHALL HAVE NO OTHER REMEDY FOR A WARRANTY CLAIM, INCLUDING WITHOUT LIMITATION REMEDY FOR LOSS OR DAMAGE CAUSED BY NORMAL WEAR AND TEAR, LOSS OR DAMAGE WHICH HAS NOT BEEN REASONABLY MITIGATED, OR LOSS OR DAMAGE CAUSED BY ACTS OF GOD. IN NO EVENT SHALL LOWE'S BE LIABLE FOR INDIRECT, PUNITIVE, CONSEQUENTIAL OR INCIDENTAL DAMAGES (SUCH AS, WITHOUT LIMITATION, LOST PROFITS, LOST SALES, AND INJURIES TO PERSONS OR PROPERTY), EVEN WHERE LOWE'S HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. WHERE, DUE TO OPERATION OF LAW, SUCH DAMAGES CANNOT BE EXCLUDED, THEY ARE EXPRESSLY LIMITED IN AMOUNT TO THE PURCHASE PRICE. In connection with any warranty claim, Customer agrees, at no cost to Lowe's or the Installer, to prepare the Premises and the reinstallation area in the manner described in Section 10 of these Terms and Conditions. 12. DISPUTE RESOLUTION FOR CLAIMS COVERED BY M.G.L. c.142A. Most questions or complaints are resolved informally. If Customer has a question or complaint, Customer agrees to contact the Lowe's salesperson whose name appears on this Contract and the manager of the Lowe's store where Customer entered into this Contract. If Customer has a complaint which cannot be resolved informally, The Home Impovement Contractor 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 Af- fairs and Business Regulation, as an alternative to court action. The same right is not afforded to Lowe's unless the "Notice Regarding Arbitration Agreement for Claims Covered by M.G.L. c.142A" above is signed and dated by Lowe's and the owner. If allowed by statute or applicable law, the arbitrator may award statutory damages and /or reasonable attorneys' fees and expenses. If Customer fails to pay Lowe's in accordance with this Contract, Lowe's shall be entitled to recover its reasonable attorneys fees as provided by N.C. Gen. Stat. Section 6 -21.2 or other applicable law. To the fullest extent permitted by law, Lowe's and Customer agree that no class action arbitration of any type may be ordered by a Court or arbitrator(s) under this Contract and, in addition, that there shall be no joinder of parties, except for joinder of parties to the transaction covered by this Contract. If a court or arbitrator determines the waiver of the right to class action arbitration or the prohibition of joinder of parties (other than parties to the transac- tion covered by this Contract) to be unenforceable, then the party bringing such action will be required to bring such action in a court of law. 13. ARBITRATION AGREEMENT AND WAIVER OF JURY TRIAL FOR CLAIMS NOT COVERED BY M.G.L. c.142A. All claims by Customer or Lowe's concerning this Contract which cannot be resolved in- formally, and which are not covered by M.G.L. c.142A or subject to the jurisdiction of a small claims court, shall be resolved by binding arbitration conducted by a single arbitrator under the current applicable rules, procedures and protocols of the American Arbitration Association (as amended). If the dispute falls within the jurisdiction of a small claims court the claimant may, at its option, choose to arbitrate or file a small claims action. Any appeal of a judgment from a small claims court shall be resolved by arbitration as provided herein. Claims to be resolved by binding arbitration include, but are not limited to (1) all claims directly or indirectly related to the signing of this arbitration agreement, the validity or scope of this arbitration agreement, or any attempt to set aside this arbitration agreement, (2) all federal or state law claims relating directly or indirectly to this Contract (including this arbitration agreement), the information Customer gave Lowe's before entering into this Contract and /or any past agreement or agreements between Customer and Lowe's, (3) all counterclaims, cross - claims and third -party claims, (4) all common law claims of any kind including common law claims based upon contract, tort, fraud, or other intention- al torts, (5) all claims based upon a violation of any state or federal constitution, statute or regulation, (6) all claims asserted by Lowe's against Customer, including claims for money damages to collect any sum Lowe's claims Customer owes Lowe's, (7) all claims asserted by Customer individually against Lowe's and /or any of Lowe's employees, agents, directors, officers, shareholders, managers, members, par- ent company or affiliated entities (herein collectively referred to as "related third parties ") or the Installer, including claims for money damages and /or equitable or injunctive relief, (8) all claims asserted on Cus- tomer's behalf by another person, (9) all claims asserted by Customer as a private attorney general against Lowe's, related third parties and /or the Installer, (10) all claims arising from or relating directly or in- directly to the disclosure by Lowe's, related third parties or the Installer of any non - public personal information about Customer, and /or (11) all other claims arising under or related to this Contract whether or not set forth above. Binding arbitration means that Customer waives: (1) any right to a jury trial; (2) any right to bring a lawsuit in a court (other than a small claims court as described above); and (3) any right to seek relief in any other forum or from any other agency. Any claim not decided by a small claims court will be decided by an arbitrator selected by the American Arbitration Association. Lowe's and Customer agree that binding arbitration provides a simple, cost efficient method to resolve disputes quickly. Lowe's and Customer therefore agree that no class action arbitration of any type may be ordered by a Court or arbitrator(s) under this Contract and, in addition, that there shall be no joinder of parties, except for joinder of parties to the transaction covered by this Contract. If a court or arbitrator de- termines the waiver of the right to class action arbitration or the prohibition of joinder of parties (other than parties to the transaction covered by this Contract) to be unenforceable then this entire arbitration agreement shall be rendered null and void, and the party bringing such action will be required to bring such action in a court of law. By agreeing to binding arbitration Customer and Lowe's waive any right to bring or participate in a Class Action lawsuit regarding any claim. How Arbitration Works: Lowe's may demand arbitration by sending written notice to Customer at the address listed in this Contract. Customer may demand arbitration by sending written notice to Lowe's at the following address: Mail code 2ELG, P.O. Box 1000, Mooresville, NC 28115. The arbitration shall be held in the city or county where the Premises are located or in such other convenient location as the Customer and Lowe's may mu- tually agree. Lowe's shall pay the filing, administrative, hearing and arbitrator's fees associated with the arbitration. Customer shall not be required to reimburse Lowe's for these expenses even if Lowe's wins the arbitra- tion. Unless the arbitrator's award specifically provides otherwise, Lowe's and Customer will each be responsible for its own attorneys' fees and other expenses, such as witness and expert witness fees. At the , timely request of Customer or Lowe's, the arbitrator will provide a written explanation of the award so long as such requirement is consisent with the rules, procedures and protocols of the American Arbitration Association then in effect. The arbitrator's award may be filed with and enforced by any court having jurisdiction. If allowed by statute or applicable law, the arbitrator may award statutory damages and /or resonable attorneys' fees and expenses. If Customer fails to pay Lowe's in accordance with this Contract, Lowe's shall be entitled to recover its reasonable attorneys' fees as provided by N.C. Gen. Stat. Section 6 -21.2 or other applicable law. The parties agree that this arbitration agreement is made in connection with a transaction involving interstate commerce and shall be governed by the Federal Arbitration Act, but if for any reason the Federal Arbitration Act does not apply, then this arbitration agreement shall be goverened by the laws of the State of North Carolina. 14. GOVERNING LAW AND SEVERABILITY. This Contract shall be interpreted under and governed by the laws of the State of North Carolina except that the Arbitration Agreement and Waiver of J ury Trial in Store 1916 Project No. 293849522 for DEBORAH ARMSTRONG Page 7 of 8 STORE COPY TERMS AND CONDITIONS 1. "LOWE'S" DEFINED. Within this Contract (as defined on page 1), the term "Lowe's" shall refer to Lowe's Home Centers, Inc., a North Carolina corporation. 2.GENERAL DESCRIPTION. By this Contract, Customer and Lowe's agree that (1) Customer shall purchase and Lowe's shall sell the goods and /or materials (the "Goods "); and (2) Lowe's shall procure on Customer's behalf, and Customer shall pay for, the services to install the Goods (the "Installation Services ") in or on the premises identified on the face of this Contract (the "Premises ") for the Order Total stated on the face of this Contract (the "Price ") and according to the provisions of the Contract documents. The Contract documents shall consist of (1) the face of this Contract, titled "Installed Sales Contract," (2) these Terms and Conditions, and (3) any attached sketches, materials lists, floor plans, and /or specification sheets and other addenda or attachments hereto. The Contract documents do not include any correspondence, advertisements, estimates or other documents that are not attached. 3. INSTALLATION SERVICES. Customer authorizes Lowe's on Customer's behalf to (a) arrange for the Installation Services to be performed by an independent contractor (the "Installer ")(licensed when leg- ally required), (b) issue a work order to the Installer to perform the Installation Services, (c) have the Installer's work inspected, should Lowe's in its discretion choose to do so (it being agreed that Lowe's has no obiligation to do so), and (d) pay the Installer after completion of the work and after receipt of a certificate, signed and dated by Customer, that the work has been satisfactorily completed (the "Certificate of Completion "). Customer understands that Lowe's will rely upon the Certificate of Completion in paying the Installer for the Installation Services. CUSTOMER AGREES THAT THE INSTALLER WILL PER- FORM THE INSTALLATION SERVICES ACTING AS AN INDEPENDENT CONTRACTOR FOR CUSTOMER AND NOT UNDER THE SUPERVISION OR CONTROL OF LOWE'S. Customer agrees that the Installation Services do not include architectural /engineering services or structual changes to the Premises or any other services beyond the ordinary and routine installation of the Goods as specifically provided in the Contract. Customer is responsible, at Customer's cost, for providing any necessary architectural /engineering services or structual changes to the Premises or any other services not specifically identified in this Contract. 4. GOODS. Lowe's will arrange for delivery of the Goods to the Premises. Any surplus materials upon completion of the Installation Services shall be the property of Customer. 5. PRICE. The Price covers the Goods, Installation Services, and applicable taxes. The Price assumes sound existing substructures, superstructure and points of attachments. The Price shall be increased by the cost and reasonable profit to Lowe's of having to provide additional Goods and /or Installation Services as a result of defective substructures, superstructures, or points of attachments or the existence of any other Undisclosed Condition (as defined in section 9 of these Terms and Conditions). In the event of an Undisclosed Condition or the foregoing, Customer will execute a change order or a new replace- ment contract upon Lowe's request. 6. PAYMENT. If the Price is $1,000.00 or less, payment of the Price by Customer to Lowe's is due in full upon execution of this Contract. It the Price is over $1,000.00, Customer may choose to pay in full upon execution of this contract, but Lowe's may not require Customer to do so. If the Price is over $1,000.00 and Customer does not pay in full at the time of sale, Customer agrees to pay Lowe's according to the payment schedule set forth in this Contract. Customer agrees to pay a deposit upon execution of this Contract equal to one -third of the Price. Customer agrees to make a payment for the balance of the Price less the final payment at least one day after the date this Contract is executed and prior to the commencement of the Installation Services. Customer agrees to make the final payment upon completion of the Installation Services and Customer's satisfaction. Payment for a new replacement contract is payable according to these Terms and Conditions. Payment for any change order is due at the time of that change order. 7. LICENSES, PERMITS, SAFETY RULES, BUILDING CODES, ZONING ORDINANCES, AND OTHER LAWS. The Installer shall be solely responsible to Customer for obtaining any and all licenses which are legally required to perform the Installation Services. The Installer shall also be solely responsible to Customer for the Installation Services being performed in compliance with all applicable safety rules and all existing buidling codes, zoning ordinances and other laws. Lowe's shall be responsible to Customer for obtaining building permits which are legally required to perform the Installation Services where Lowe's is legally required to obtain such permits. Where Installer is required to obtain such permits then Installer will be responsible to Customer for obtaining such permits. Customers who secure their own building permits will be precluded from claiming against certain state guaranty funds relating to home improvements. Neither the Installer nor Lowe's shall be responsible for any pre- existing violations of safety rules, building codes, zoning ordinances or other laws and shall not be required to address or correct same. If prior to the completion of work a change occurs to any applicable safety rule, building code, zoning or- dinance or other law which requires additional Goods and /or Installation Services to perform this Contract, Customer agrees to pay Lowe's the cost and reasonable profit for such additional Goods and Installa- tion Services and to execute a resulting change order or new replacement contract as requested by Lowe's. No additional work will be performed under this Contract due to any change to any applicable safety rule, building code, zoning ordinance or other law that occurs after the completion of work. 8. CUSTOMER'S WARRANTY AGAINST VIOLATIONS OF EASEMENTS, COVENANTS, AND THIRD PARTY RIGHTS. Customer warrants that performance of Installation Services will not violate any exist- ing real property easements, covenants, homeowner's association rules or rights of third parties holding an interest in the real property being improved. 9. UNDISCLOSED CONDITIONS IN PREMISES. If Installer discovers any defect, weakness or dangerous condition including, but in no way limited to, mold, mildew, rot, asbestos or infestation ( "Undisclosed Condition ") in the Premises' structure, substructure, super- structure or points of attachment, Customer must remedy the Undisclosed Condition at Customer's sole cost and expense and to Lowe's sole satis- faction. If Customer refuses to permit inspection of the Premises as set forth below, Lowe's may terminate or rescind this Contract without remedy or recourse by, or further obligation to, Customer, except as expressly provided below. If Customer and Lowe's disagree as to whether an Undisclosed Condition exists, Lowe's may in its sole discretion obtain the services of an inspector to inspect the Premises at Lowe's sole cost and expense, and if Lowe's chooses to do so, such inspector's report shall be final and conclusive as to whether an Undisclosed Condition exists. In the event of any Undisclosed Condition that Customer does not remedy to Lowe's sole satisfaction, or any failure by Customer to perform any other obligation of Customer under this Contract, then at Lowe's option (1) Lowe's may rescind this Con- tract and return the Price to Customer without further cost or obligation by either Customer or Lowe's if Lowe's notifies Customer of its election to rescind this Contract prior to the earlier of delivery of the Goods and the Installer beginning performance of the Installation Services, or (2) Lowe's may terminate this Contract without remedy or recourse by, or further obligation to Customer, except as expressly provided below if Lowe's notifies Customer of its election to terminate this Contract after the earlier of delivery of the Goods and the installer beginning performance of the Installation Services. In the event that Lowe's terminates the Contract as provided in this Section, then Customer may return the Goods (other than Goods that have been "custom- made ") in their original, unopened condition, to Lowe's for a refund or credit. Any such return must be made within 30 days after Lowe's terminates this Contract. Customer will be charged a 15% restocking fee on any such returns. Goods not in their original, unopened condi- tion, and custom -made goods, may not be returned. "Custom- made" goods include goods that have been uniquely altered, color - matched, shaped, sized, cut or otherwize designed or fitted to accomodate the requirements of a particular space or environment. Examples of custom -made goods include, but are not limited to, cabinets, countertops, floor and wall coverings, and window treatments. If Lowe's terminates this Contract as provided herein, Lowe's shall have no obligation to refund any portion of the Price (except as expressly provided herein) and shall have no obligation to restore the Premises to their original condition. 10. CUSTOMER'S RESPONSIBILITIES: Customer agrees to pay Lowe's according to these Terms and Conditions. Customer agrees to facilitate the location of utility lines. Customer is responsible for identi- tying property lines. Customer agrees to ensure that work area are free of vermin and pre- existing physical or environmental hazards, and building /zoning code violations. Customer agrees to provide the In- staller with access to work areas during working hours and to provide access to sanitary facilities or to pay the rental costs for such facilities. Customer agrees to ensure that any security system at the Premises will not interfere with performance of the Installation Services. Customer agrees to provide power to, as applicable, climate control in, the work areas. Customer agrees not to allow unattended minors at the Premises while the Installer is present. Customer agrees to control and keep pets away from work areas. Customer agrees to keep posted permits on display at all times. Customer agrees that if Cus- tomer or anyone Customer controls interferes with or delays performace of the Installation Services, Customer may be subject to transportation /storeage charges or other resulting charges. Customer agrees not to assign or transfer this Contract. Customer agrees that any claim against Lowe's or the Installer under this Contract should be made to Lowe's within thirty (30) calendar days of the date Customer first becomes aware of a problem. (Lowe's will attempt resolution of any claim(s) within sixty (60) calendar days of receiving Customer's notice.) CUSTOMER ASSUMES THE RISK AND THE FULL LIABILITY OF PHYSICALLY ASSISTING WITH DELIVERY OF THE GOODS OR WITH PERFOMANCE OF THE INSTALLATION SERVICES. Store 1916 Project No. 293849522 for DEBORAH ARMSTRONG Page 6 of 8 STORE COPY this right. Store 1916 Project No. 293849522 for DEBORAH ARMSTRONG Page 5 of 8 STORE COPY 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 AR- BITRATION AS PROVIDED IN M.G.L. c.142A. By: vow,)- ( - z/,-c. Date: t-0 5) D o Lowe's Home Centers. Inc. By: Date: Owner By: Date: Spouse THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE RESOLUTION INI- TIATED 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 Lowe's Home Centers, Inc. By: C (Seal) Print Name: C-01�c � o r W").. 'S I • 9tv IC.,C 7Z lc ti. ��LJ��j � 1+aUld ti� ( Seal ) Address Owner City State / Province Zip / Postal Code Print Name (Seal) Spouse Print Name Customer acknowledges receipt of a true copy which was completely filled in prior to Customer's execution hereof. You the customer may cancel this transaction at any time prior to midnight on the third business day after the date of this transaction. See the attached Notice of Right to Cancel for an explanation of Store 1916 Project No. 293849522 for DEBORAH ARMSTRONG Page 4 of 8 STORE COPY *SALES TAX $ 0.00 DELIVERY $ 0.00 ORDER TOTAL $ 1555.57 BALANCE DUE Work is to commence upon reasonable availablity of Contractor which is anticipated to be 5 / 5 / -c; .Q [fill in date]. Estimated completion date is 6 / [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 ne- cessitated by defective substructures, superstructure, points of attachment, or the moving of fixtures or appliances to be billed at extra cost to customer. IF THE CONTRACT TOTAL IS $1,040.00 OR LESS Customer must pay in full. • MPL T THI TI • • Y HEN THE CONTR CT T • L EX • '. 1 01 1.1 1 : [I,)- 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): [J Charge my /our credit card for the amount of the payment indicated above anytime after the date this Contract is signed; or [J 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 CONTAINED 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 CON- TRACT AT THE TIME OF SIGNATURE. 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, Store 1916 Project No. 293849522 for DEBORAH ARMSTRONG Page 3 of 8 STORE COPY QTY 1 287055 : 883351070614: STK : KWIK SN COMBO SGL CAMERON SMT : SATIN NICKEL ENTRY KNOB WITH DEADBOLT DOOR LOCK : KWIKSET - QTY 1 Materials Price ` $ 955.47 INSTALLATION DESCRIPTION Stock or SOS : SOS Door Type : Exterior Select Location : Front Door Select New Door : Single Pre -hung 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 : Install new storm door Select Storm Door : Storm Door Total Linear Feet of Custom Trim to be Installed : 16 Deliver Door : Yes Customer Understands Scope of the Project : Yes Permit Required : Yes Who Will Obtain Permit : Lowe's Permit Fee : Yes Additional Miles Traveled over 20 : 0 Bring Up To Code Description : None Local Disposal Fee : Yes Describe Other Work Needed : wrap brickmold with coil stock Other Work Charge : Yes Comments : No Comment Labor Charges $ 635.10 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: The Environmental Protection Agency (EPA) has requested that Lowe's notify installation customers that a lead based paint hazard may exist in dwellings built prior to 1978. See pamphlet EPA 747 -K -99 -001 for details. TOTAL CHARGES OF ALL MERCHANDISE AND SERVICES where applicable labor is taxable,check local tax restrictions. SUB -TOTAL 1 $ 1555.57 Store 1916 Project No. 293849522 for DEBORAH ARMSTRONG Page 2 of 8 STORE COPY INSTALLATION SERVICES CUSTOMER CONTRACT - MWORK - INT /EXT /PATIO VALIDATION AREA DOOR Ow ' LOWE'S OF HADLEY, MA, STORE # 1916 STORE PHONE: (413) 588 -0270 282 RUSSELL STREET SALESPERSON: CONERY MORSE HADLEY, MA 01035 -0000 SALESPERSON ID: 1293609 Document Print Date : 04/05/2010 This is only a Quote for the merchandise and services printed below. This becomes an agreement upon payment and an endorsement by a Lowe's register validation. Upon such payment and endorsement, the entire agreement, including the specifically completed pages of this document, the Terms and Conditions included with this document 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 DEBORAH ARMSTRONG 413 320 - 6007 O Customer Address Other Phone 76 SANDYHILL RD L City State / Province Zip / Postal Code D FLORENCE MA 01062 Installation Address T 76 SANDYHILL RD Installation City Installation State /Province Installation Zip /Postal O Code FLORENCE MA 01062 MERCHANDISE AND INSTALLATION SUMMARY MERCHANDISE SUMMARY 326691 : RB- HT14 -SD : SOS : SOS RB PAINTED DECO STL TC TLI : PRE - COLORED STEEL SINGLE DOOR UNIT HAMPTON - PATINA CAMING * **THIS PRODUCT QUALIFIES FOR A FEDERAL INCOME TAX CREDIT * ** : TRU LOGISTICS INCORPORATED - QTY 1 12538 : 68 -310 : STK : ROLL ALUM FLASHING 10 "X10' : ROLL ALUM FLASHING 10 "X10' : AMERIMAX HOME PRODUCTS - QTY 3 101514 : 34652032 : STK : 36" TRADEWINDS FV WHT -BRSHD NKL : 36" TRADEWINDS FV WHT -BRSHD NKL : LARSON COMPANY - QTY 1 124018 : 89720433 : STK : JH WATERPROOF WINDOW FLASH 4 "X33' : JH WATERPROOF WINDOW FLASH 4 "X33' : PROTECTO WRAP COMPANY - Store 1916 Project No. 293849522 for DEBORAH ARMSTRONG Page 1 of 8 • ACORD CERTIFICATE OF LIABILITY INSURANCE DATE PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Richard R Green Insurance Agency, Inc ONLY AND CONFERS NO RIGHT$ UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR 11 Allen Street ALTER THE COVERAGE AFFORDED BY THE POLICIE$ BELOW. Hampden, MA 01036 INSURERS AFFORDING COVERAGE NAIC # INSURED INBUr A; Travelers Insures T _ � Kortekamp Construction LLC INsuasas: Liberty Mutual Bryan Kortekamp INSuRB2c: Commerce Insurance 27 Butler Road , INSURER D: Monson, MA 01057 • imEri g COVERAGES 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 DOCUIuENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND COMMONS of SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. p( �+� YN - . TYPRAPINAMAVIV POUCYNIAIEEN p Oi.7l �N uN /� 43624ERA, LIAI TY EACH OCCURRENCE $ 1 , 000.000 A ] COOAUIEIiCw.GeNERALtsAStLrrY P e sIVAo ' $ 100,000 INN Cl/o$16 IIAD Q (=UR (=U MED EIGPUI y:mopenon) s 5.000 ta non -owned auto 6808565P31A 02/05/2010 02/05/2011 PERSON/LAADYINJURY s 1,000.000 hired auto 6ENERALAGGREGATE _ s 2,000,000 GEM- AGGREGATE UWTAPPUES PRODUcrs- cOM'IOPAOG s 2.000,000 ril POLICY ■ P . IN LOC BI Y • co SINGLE LIMIT III ANY a ■ ALL OWNED AUTOS BODILY INJURY $ 100,000 o SCHE0LIL0AU1C$ (Pu'P.,...) C III HAW .WI BBMMJ07 02/05/2010 02/05/2011 acon-Yi s 300,000 NoN OWNeD EDAMOR (Per midi .t 1111 . III (PRram:WMAD7: 5100,000 GARAGE mature Aura may - EAACCIOeNr S ■ ANY AUTO � Ti A „ ACC S OTHER THAN AUTO ONLY: AGG $ EXOESSAMIBRELLA TY EACH OCCURRENCE S OCCUR E CLAIMS MADE AGGREGATE 6 . $ IN o w s ■ RETENTION 5 s wORHEIrscompetssAitow AND `.:, _4■ "a!' B EMPLOYERs, umun EL EACHACCI *100,000 ANY PROPRIETOINPARTNERIXECL r v6 WC1 S 374661 - 019 09/24/09 09/24/10 OFHC£R7IIFMBERbxi�.UDED? EL. DtBEASE -EA EmPLQVES S 100,000 SPECIAL PROVISIONS below E.L. DISEASE users 6 500,000 OTHER DE$ CRPItmoFOPERAT IoRsi LOCATIDNS /YEHICLES1EXcLuiaONS MAD r TEMDORSEM T /EPeCALPROVISIDHS Lowe's Companies, Inc. and any and all subsidiaries are named as additional insured as respect to General Liability and Automobile Liability" Non- Owned/Hired Auto is included on Travelers Policy 6806565P31A CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF TM ABOVE DESCRIBED YOLICIES SSCANCEIIED BEroRE THEEXPRATION Lowe's Companies, Inc. (Attn: IS Insurance) m„>_ „IE,seor. TILE MUM DIsul st my u. , To NAIL 20 DAYS Exams) P,O. BOX 1111 NOTI To TIE ceRTFIOATE HOLDER NAMED TO THE LEFT, EDT PALLUREsnoop so SHALL North Wilkesboro. NC 28656 Meow No aBUUATI0n OR UABILI Y OF ANY PXND UPON THE Iks1I>f,R Ire AGENTS OR REPRESENTATIVES. 4.10490( y A _. ACORO 20 (2001/08) 6 ACORD CORPORATION 1988 00 - 35,000 cf enclosed space • BoaaBliartgl=tfas IA - Masonry only Construction Supervisor License . 1G -12 Family Homes Ucepritx CS 96999 • Birthatik 45/26/1968 • Failure to possess a current edition of the Massachusetb State Building Code • Tr# 96999 is cause for revocation of this license. - -Auzuta ,t TODD KORTE `"" -0 • 27 BUTLER ROAD MONSON, MA 01057 Commissioner •A' • • • • • SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : TODD Kd _> 1 [� ✓ A- I (O9 ck License Number 9 1 3UITLE o 1-io (no ki , MA- n I05 Glace-, Address Expiration D e sF,e, C.0 l A-C ®I5 S9 I Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ w :5 i 1- 04 0 6) . 6 ompanv Name Registration Number 98a. `usse..t,C sY HAix -c., t MA- ®I 0 S5 ii f A-- Address r� Expiration Date Telephone L / Qd � z'}0 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 cxcmptiot.1;t "1tomm:..wttcrs" 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 a..: s j er: c..ar.. CCMR 7 aaaa a ._.__.... -- . _._.. _ . _. _ -... _ • SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House [ Addition El Replacemen ndmws Alteration(s) Roofing F Or Doors F ^ Accessory Bldg. �— �E:1 Dmmu/Uhon New Signs [0] Decks [[] Siding [0] Other[[] Brief Des i of Proposed Work: IceM CV E � �� � 'DOCSK Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Pans Attached RoU Sheet 8a if New house and or addition bmeximtinqhmuminn.norn*lete the foNnvvin• Uye o/uw|dioA One Family Two Fuomy00e/ NUM ue' v| mead. family v:i/� nLimbe/ orOdUvopx`; • os'20v2olachedr d pnxornd Sn:ae footage cxnew r:onotrorUon o/men/on, e iUe/ u[moAeu| _____________________________ i Method of Fi,ey|accuo; YVond,h/ves Nux`b*rof cad` O Energy Conservation Compliance Masscheck Energy Compliance form ottnrheuv h. Type of construction i Is construction within 100 ft. of wetlands? Yes No. Is construction withn 100 yr. Ooodp/ain Yes No j. Depth ot basement or cellar tloor below finished grade k. Will buitding conform to the Buliding and Zorling regulations? Yes No I. Septic Tank City Sewer Private well City water Suppy SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, - PE15C5 AT-P4 CAVG100 . as Owner of the subiect property to act on my behalf, in all matters rela.ive to work authorized by thisbuikling permit application. 6 /14/c., . Sicylp.torp of Owner 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 filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage Open Space Footage (I AA arca minus bldg & paved { park iny,t _-4 —_.� I i t of Parking Spaces Fill: nine. Lucia A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO ) DON'T KNOW YES lJ IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW Q YES 0 IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO U DON'T KNOW t) YES U IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained ! Obtained ( ) Date issued: i c - any sgns exist on the property? YES (,) NO (` iF YFti, riper - 0)p 07p type ."t.ri1 it afiz�,n' m or iiitions :'ii ` iE ii intoricion tor tilt' ntnr} rry !' YES i ) NO Will me construction activity disturb lclearinc, grading. excavation!. !:r tlliinq) over 1 acre or is It part or a common! plan that : .a tr 1 -s- ; r 1 - YES ( t Nr • 11 f It iGli d I .1 l ull ti. lLV!1 JlVl • 111 VVG (CI IV!c 11_CItI lit ! G I11 tit 11 VI 1.116 LJ! V i.7 telr ilii et.i. . , . . .. i Depailme_nt use ctrity i GO of Northampton Istatus crt Perms: , . Building Department IL Lilt L-LitiLIFIVeWay Permit . , , ., • 4 iViairi ;Doe i:3[ItiitieriSepticia.vai;abilitv [ Room 100 .--..,,,,,;1; ; 1Watc:.[ANctU Av..ttilatt,-ilty Nnrtqrriptr MA nlnAn 1 T Sets of Stritctura! Plans l'.•,.. •':\ 1 phrnle411 Fpx. 413 Irlotisitp Poils lOther So.eciN . , - • APPi ICATION TO CoNSTRI:ICT ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO F.AMILY DWELLING • • ION 1 - SUE INI I ION This seit-tion to be completed b office Pf .,ipt7iii • DEY:›OTCP4 POZI-ASAIZCAO C.r• Map Lot 76 SAKYM HILL. ICk> Tone Overlay District i P-0 MA- 010(;d, , - rtrtet_ .. t-6 District ____ SErTiON 7 - PROPERTY nWNFRSHIPIAUTHORiZEr. AGENT • • [ i . [ z.1 Owner of Record: • ! DEASOKAA, A ‘ 1 T 4 o SakipYtfLk- '1?3, _F._ .14KA_.W.d ,_/-(A 1 itilift) t1136007 1 Sf.. Col•rcv-Ac [ 2.2 Acicfnt, . , I-VIDL-EY. 1-1/1- 0) O -,- : f::::7::..T:t. %`:;:1;;:ir,ci i',:if:::=: : ; LitS -5 9 I i?" -- 0(910 • „,. . ECTiON 3 - ESTIMATED -CONSTRUCTION COSTS - ! es' i (7■;'Hiff'fd i71 T. irti.)p[ii:itrti ,-- , 1 1 F I /555.5V- 1(,) :u Peri Fe:a t — _-- ----z-- ---t- -i- E.,— --I-- i •,.2 Fitx i i [JD L i c[ta; l_:ipst :Di' i , . i Centfti.iction ;Tom ( i edino Pert F.f.e , I . I i .• 4 McIch ;! NAG) ; ; . 1 ', I•-;irr Pmtc; • -..... This fcc_•tiori For Official Use Only . [ t -'iairn l\ii.:Timit•,:-.[;-: . • _ . . . . . . S[T • .. . , . . .. , . . . _ . -- -- — — '.: i0 BP- 2010 -0896 GIS #: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit # BP- 2010 -0896 Project # JS- 2010 - 001327 Est. Cost: $1556.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: LOWE'S 96999 Lot Size(sq. ft.): 11761.20 Owner: ARMSTRONG DEBORAH A Zoning: URA(100) / /WSP Applicant: LOWE'S AT: 76 SANDY HILL RD Applicant Address: Phone: Insurance: 282 RUSSELL ST (413) 588 -0270 WC HADLEYMA01035 ISSUED ON :4/13/2010 0 :00 :00 TO PERFORM THE FOLLOWING WORK: INSTALL REPLACEMENT 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 4/13/2010 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo ,,,. ' ' ~/ ,+~ . e —' y / / / 0 /?�� / —~ 4 —~ ' ^ / ° ' //_/ '7�/�1 �- . ���-- i /� ` ~~ ' � ? ~/ � �` ~^�J ��( � ' _-` � - / ., , , . . . y ' ; ' ' ' ( ' � �,_� J ,/ ,I. � ` t` k } ' | � � / . `/ --- ' � --~-^ /` ' ' , -° - ~' __-_____'--______ � -'_________'_ � ' T / i _-_ / / K/� -_ . ( ' . ■ | ^---- / ■ | - | ■ L---- � , _` I - // _ ^( , , HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 1 08.3.4 to act as his/her construction supervisor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends 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." The building department for the City of Northampton wants person(s) who seek to use the hone owner exemption, act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation /footings (before back sonotube holes (before pour), a rough building inspection (before work is concealed), insulation inspection (if required) and a final building inspection. The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform. work (electrical, plumbing & gas) the homeowner will be responsible to make sure that the trades hired secure their proper jermits in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made 4 ' i d e , !1 l" understand the above. o me owner /resident's signature r ting exemption) I will call to schedule all required building ections necessary for the building permit issued to Date Address of work location • The Commonwealth of Massachusetts Department of Industrial Accidents . , iii _ / t" _'- 1 Office of Investigations ' G_ = tt ��_ j 600 Washington Street • Boston, MA 02111 �. , www.massgov /dia . . _ -Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information - Please Print Legibly Name ( Business /Orgarization/Individual): , • Address: r • City /State/Zip: - . Phone. #: • - Are you an employer? Check the appropriate•boz: • . Type of project (required): / 1. ❑ I am a employer with 4.. 0 I am a general contractor and I employees (full and/or part-time).* have hired the sub- contractors 6. ❑New construction . 2D I ani a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodelin ship and have *_+o ioyee These sub - contractors ha ve. .8. ❑ Den olidon - workiag for me in any capacity. loo and have workers' _ • • [No workers' comp. insurance • �_ du ng a their ] 5. We are a corpoiation and its 10.0 Electrical repairs or additions re officers have e ratio ci 0 mg repairs or additions 3.I am a homeowner doing ill work r 11 Plumb' r myself o workers' co of exem per MGL ys � comp. 12:0 Roof repairs insurance required:] t • . : c. 152, § 1(4), and we have no . employees: [ No workers'- 13.0 Other • • . . comp. insurance required.]. : • 'Any applicant that checks box #1: must, also fin out the section beiawshowing t en wodters'- compensation policy information. t Homeowners wIm subunit this affidavit:indicatmg they are doing all work and then: his outside contractors must submit it anew affidavit indicating such. IContractars that rlv4 this box mustattached an additional sheet showing the name of the sub-contractors and state wbether-or notthoseentities have employees. If the sub-contractors have empioyees, they must provide their makers' comp. polity number. • . I am an employer that isproviding workers' compensation insurance for my employees Below i the policy andjob :site information • . Insurance Company Name: - Policy # or Self ins. Lic. #: Expiration Date: - . Job Site Address: City/State/Zip:' . - - Attach a copy of the workers' compensation policy declaration page •(showing the pelicy numbe nd_ and date). Faie to secure coverage r . ` :T under.Sectibi 25?i ofMGL c: 152 can lead to` the iml osrtitnn of'camaI penalties of a equn-ed -. - - fine up to 51,500.00 and/or one - year imprisonment;' as well as civil penalties in the form of a STOP WORK - -ORDER and a fine • of up to 3250.00 a day against the violator Be advised that a copy of this statement maybe forWarded forwarded to th e Office of , InviestiQations of the bIAfbr insurance' coveraie v ery ication: ,. , `_ ..,. .: , _:. - .. - . - ..:.,.„ e I" o hreb - cti under the r - . v . - - _ .Y cr . �Y Pains a ofperjur}' that "the cnfornratioa�vrovirled�ov�rssrur _aredcorr -_, _ - -. i.4I tire: / mot .. / / � / /�1/a .�.t.I - _ to - - ' . . Phone it: - . ' _ Official l use only. Do not write fri this area, to be completed - b Y � y city or town official City or Town: .. Permft/License # _ Issuing Authority (circle one): :1. Board of Health 2. Building Department 3. City/Town Clerk .4. Electrical Inspector 5. Plumbing Inspector 6. Other . . . Contact Person: Phone #: • SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : License Number Address Expiration Date Signature Telephone 9. Registered Home improvement Contractor: Not Applicable ❑ Company Name Registration Number 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-vear 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 North pton Ordinances, State and Local Zoning Laws tate of Massachusetts General Laws Annotated. omeowner Signature , % Section 4. ZONING Alt information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled 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 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO © DONT KNOW ® YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained ,Date Issued: C. Do any signs exist on the property? YES O NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO Q 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 © NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [p Siding [0] Other [DJ Brief Description of Proposed Work: A V 1,10 ,at ...- VL NiDttiCI>el 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 existinla housing. comniete 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, , 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. Signature of Owner Date 1, , as Owner /Authorized Agent hereby declare that 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. Print Name iii fS of OwnerlAgent Date 1 ti, vir - 41111 Ilk IF G w1 ►-^�" Department use only Ci of Northampton Status of Permit: 't,Qi\• = uil ing Department Curb Cut/Driveway Permit ' Main Street Sewer /Septic Availability ' ' oom 100 Water/Well Availability • ` hampton, MA 01060 Two Sets of Structural Plans -' phone 413 - 587 -1240 Fax 413 - 587 -1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOUSH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: This section to be completed by office ( }to soJ - k Rcfkd Map Lot Unit Zone Overlay District A o e A- Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: H4 �N. .1il A-. 4kk4Rofle � ` t11 1� Piogt,,ce. H4 clog , Name (Print) Curr Mailing Address: x� � 4= QL l r /R!/ G Telephone Signature 2,2 Authorized Anent: 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 43 b (a) Building Permit Fee 2. Electrical /� (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 /$4_75 #3 —.- This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2011 -1025 APPLICANT /CONTACT PERSON ARMSTRONG DEBORAH A ADDRESS/PHONE 76 SANDY HILL RD FLORENCE PROPERTY LOCATION 76 SANDY HILL RD MAP 29 PARCEL 400 001 ZONE URA(100) //WSP THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid 09v IY3 Typeof Construction: REPLACE FRONT STEPS M ti ST (&fET (0 Jk New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFQIMATION PRESENTED: Approved Additional permits required (see below) PLANNING BOARD PERMIT REQUIRED UNDER: § Intermediate Project: Site Plan AND /OR Special Permit With Site Plan Major Project: Site Plan AND /OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received & Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission _ Permit DPW Storm Water Management Demolition Delay l 6/,/if Signature of Building Official Date g g Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health, Conservation Commission, Department of public works and other applicable permit granting authorities. * Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning & Development for more information. 76 SANDY HILL RD BP- 2011 -1025 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 29 - 400 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit # BP- 2011 -1025 Project # JS-2011-001656 Est. Cost: $300.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 11761.20 Owner: ARMSTRONG DEBORAH A Zoning: URA(100) //WSP Applicant: ARMSTRONG DEBORAH A AT: 76 SANDY (°- lL=L RD Applicant Address: Phone: Insurance: 76 SANDY HILL RD FLORENCEMA01062 ISSUED ON: 6/9 /2011 0:00:00 TO PERFORM THE FOLLOWING WORK: REPLACE FRONT STEPS 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: 0 r\ e-7(-11 QV THIS PERMIT MAY BE REVOKED BY THE CITY OF N • t THAMPTON UPON VIOLATION OF ANY OF ITS RULES AND ' c 1 NV V, , ;00 /I ' 144 Ay 4071444 Certificate of Occupan.1 , G V ature: Fee Date Paid: Amount: Building 6/9/2011 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner