29-454 NOTICE OF RIGHT TO CANCEL
Your Right to Cancel •
You are entering into LOWE'S Installed Sales Contract Number 3 ?.1_3'i (f -• (the "Contract ") that
may result in a lien or security interest on your home in which pmperfy (the "Property" ) is to be in-
stalled pursuant to the Contract. You have a right to cancel the i orfraet, without cost, penalty or ob-
ligation, at any time ppr to midnight of the thiro business day after the latest of (i) the date of the
w
Contract, which is :. - te -) , ` ,3011 . (year), (ii) the date you received this Notice
of Right to Cancel, and (iii) if you have paid or will be Laying for the Contract by using your LOWE'S
private label credit card, the date you received your Truth -ln- Lending disclosures in connection with
such credit card.
Effects of Cancellation
If you cancel the Contract, the lien or secL;y 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 muet return t) /c , C. property you have given us
or anyone else in connection with the Coritracf..
How to Cancel
If you decide to cancel the Contract, you may do so by notifying in wriiino. by mail, telegram, or personal delivery, at:
LOWE'S
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 coiniairis 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 iLter. tlrar� r }iar of ___----- - - - -__
(year) (or midnight of the Third busiries_y dug th i titsf. < ,t : o 3, "ee events listed above).
I WISH TO CANCEL.
(Customer's /Resident Owner's Signature) (date)
Print Name
ACKNOWLEDGEMENT OF RECEg OF DISCLOSURES AND CERTIFICATION
On this 25th day of June, 2011 (year), talc c ;J yc i eioby o:.knowlodges receipt of two (2) copies of
the foregoing Notice of Right to Oancei; eoc.:: of t to ;: a Contract hereby acknow-
ledges receipt of one (1) copy of the fully Coll.rac; if any of you has paid or will
pay for the Contract by using your LOWE'S p'ivate label credit card, you hereby acknowledge having
received the Truth -ln- Lending disclosures in cc•;nnaction with such credit card; and you certify, repres-
ent and warrant to LOWE'S that your are all of the customer::, who signed the Contract and all of the
persons who own and reside in the home in which the Property is to be installed pursuant to the Con-
tract.
1 _
' /. ' , %, ��_�.', ��_ �.1 (SEAL)
ilk -e.Li \ A ,L&_.\i
Print Name
,
NOTE : Each Customer who is a party tc the r. onl ci „ 7d ;_ a ,h es den' Owner of t ,e home must sign above.
, .
2010-12-21 ' 10:32 413 231 5562 4 0660 INSTALLED SALES P 1/2
,•' •-., . I'lie Canunonwealth of MasS•achusetts
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SECTION 5: CONSTRUCTION SERVICES
5.1 1.11eensed Construction Supervisor (CSL)
Cor:Is ,C
license Number Expiration Data
Nana of CSir Hpltier List C1„ Type (sec below)
A' d _ r
TYPe _ npdon _
U Unrestricted D. to 35 0000a. Nt.)
ltestrioteu F dkZ Family Dwelling
outhature “13. - �? Old NEM la
Telephone �' naadeob • Roam Covcrin:
Residential Windo ' : r. Sidi ,
SF Residential Solid Fuel Burning Agpliauce installation
D lirsidential Demolition .�
5.2 Registered Home Improvement Contractor (HIC)
S` A-RILF W19 i I F 1 0141 -1 1 2.:7)f ..-_
` f Co • any Name or RIC tie; 'aunt Name Registration Number
o G _ ttr AAA. %tit 2(.`\" Address O • . U \ • Oc�
nlibk 1 41?}?1oZ- ice? F.apiration late
Signature [ /,''I�RTi' Telephone
SECTION ; WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.0.1 c. X52, § ZSC(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 .,.,. ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED Wl( ty
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1,
_31 3„1t i Z. as Owner of the subject property hereby
authorize ._ l 1. _ KC`�rn , C -� i Lt�tt > to act on my behalf, in all mantas
relative to work authorized by this building permit application.
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siSnatum of Own Dare
SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION
I, I �� } t X�1 1 f C) f)C �? \Za7]C , 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.
Li JO': y Zt Ernk�F� _
Prin
of Owner 4 Au • 'zed Agent Date
d under the ' s and .sties of -
NOTES:
•
1. - An Owner who obtains a building permit to do h1s/lter awn work, Or alt awncc who hires as Unregistered contractor
(not registered in the Home Improvement Contractor (H1C) Program), will not have access to the arbitration
program or guaranty fund under lstG,L. a. 142A, Other important information on the RIC Program and
Construction Supervisor Licensing (CSL.) can be Round in 780 C1v1R Regulations 1 I0.k6 and '110.11 y, respectively,
2. When substantial work is planned, provider the information below:
Total floors area (Sq. Pt.) (including garage, finished basement/attics, deck.} or porch)
Gross living area (Sq. Pt) __._W Habitable room count
Number of fireplaces Number of bedrooms .. ..
Number of bathrooms Number of half/baths
Typo of boating system Number ofdccks/ porches
Type of cooling system., Enclosed Open
3, 'Total ' Total Project Square Footage" may be substituted for "Total Project Cost" Y
Z/2 d 9£Z4995£4 '4 « 8L ?O 885 £4/ OSI 9464 s°MO1 £L 04 0EM90
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The Commonwealth of Massachusetts
�Board of Building Regulations and Standards ;��# ,
Massachusetts State Building Code, 780 CMR, 7 edition • �r
Building Permit Application To Construct, Repair, Renovate Or Demolish a "'
One- or Two - Family Dwelling
This Section For Official Use Only pit 3 1 2,011
Building Permit Number: Date Applied:
OF BUILDING INSPECTIONS
M!4 01080 .. W i
Signature:
Building Commissioner/ Inspector of Buildings Date
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map & Parcel Numbers
C1Q.C.ST∎IWA VI p T1 o NC..., rnn 0No2
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:
Zone: Outside Flood Zone?
Public ❑ Private ❑ Check if yes!: Municipal ❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner' of Record:
`j NPAIC 112 Ps .i el (J\ De- . -- ( cl'CNC . t Rlc ot n(02.
Name (Print) Address for Service:
Cf31.11r3P1C 2 4l • H78.1U60
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': c2(Y1C Ica F D eF- 0,TF`>1ae,t,'PRTtO Occ • 1,30 CTk.X2nl.,
C.-NC .
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ I,8qCo C\ 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 (IIVAC) $ 1''' — rri
Total All F°m $
5. Mechanical (Fire $ Check No. `�' I/Check Amount. Cash Amount:
Suppression)
6. Total Project Cost: 8 1, (25(1(0 (43 ❑Paid in Full ❑Outstanding Balance Due:
A
56 CRESTVIEW DR BP- 2012 -0218
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 29 - 454 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 -0218
Project # JS- 2012- 000325
Est. Cost: $1897.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: LOW E'S 74606
Lot Size(sq. ft.): 10018.80 Owner: ALVAREZ - FERRER SHAKIRA & TIMOTHY D ARMSTRONG
Zoning: URA(100) //WSP Applicant: LOW E'S
AT: 56 CRESTVIEW DR
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 PATIO 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
56 CRESTVIEW DR BP- 2012 -0218
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 29 - 454 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 -0218
Project # JS- 2012- 000325
Est. Cost: $1897.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: LOWE'S 74606
Lot Size(sq. ft.): 10018.80 Owner: ALVAREZ - FERRER SHAKIRA & TIMOTHY D ARMSTRONG
Zoning: URA(100) //WSP Applicant: LOWE'S
AT: 56 CRESTVIEW DR
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 PATIO 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