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35-245 (2) 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. If 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 resulting change order or new replacement contract as requested by Lowe's. Nc 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 ruies 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- fying 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. 314093731 for JENIFER URFF Page 5 of 7 STORE COPY MIT TO SUCH ARBITRATION AS PROVIDED IN M.G.L. c.142A. Date: c L(zz 4 Lowe's Home Centers, I c. By: _ �. Date: 127A) Owner / By Date: Spouse THE I NAT RES •F THE PARTIE ABOVE APPLY •NLY TO THE AGREEMENT OF THE PARTIE 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 'P2 DAY OF Dec , . Lowe's Home Centers, Inc. By: J � (Seal) Print Name: SG tSt.(Ei■ 2 (L ssc-i ( S� A )4_,„M-- (Seal) Address Owner • Rad( -e oikA 0(035 7 X10 /./ t 2'"" 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 this right. Store 1916 Project No. 3/4093731 for JENIFER URFF Page 4 of 7 STORE COPY 231055 : FCSVAUNIT : SOS : SOS PELLA PATIO DOORS 250/450 : SCREEN : PELLA CORPORATION - QTY 1 Materials Price , $ 1601.3 INSTALLATION DESCRIPTION Stock or SOS : SOS Door Type : Patio Select Location : Back Door Select New Door : Sliding Number of Doors to Install : 1 Side Lights or Transoms : No Hidden Damage Description : None Number of additional holes bored for accessories : None Install Specialized Mortise Hardware : No Lead Safety 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 : Yes 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 $ 504.10 Detail Deduction -$ 35.00 I 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. I Additional Specifications: The Environmental Protection Agency (EPA) has requested that Lowe's notify installation customers that a lead based paint hazard i 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 restriction SUB -TOTAL $ 2070.40 *TAX $ 0.00 DELIVERY $ 0.00 ORDER TOTAL $ 2070.40 Store 1916 Project No. 314093731 for JENIFER URFF Page 2 of 7 STORE COPY INSTALLATION SERVICES CUSTOMER CONTRACT - MWORK - INT /EXT /PATIO VALIDATION AREA DOOR . OWE LOWE'S OF HADLEY, MA, STORE # 1916 STORE PHONE: (413) 588-0270 282 RUSSELL STREET SALESPERSON: ADAM SENSER HADLEY, MA 01035 -0000 SALESPERSON ID: 1446357 Document Print Date : 12/18/2010 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." P_L.EASE 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 JENIFER URFF 413 - 586 - 3917 O Customer Address Other Phone L 27 LADYSLIPPER LN City State / Province Zip / Postal Code D NORTHAMPTON MA 01062 Installation Address T 27 LADYSLIPPER LN Installation City Installation State /Province Installation Zip /Postal ® Code NORTHAMPTON MA 01062 MERCHANDISE AND INSTALLATION SUMMARY MERCHANDISE SUMMARY 1053: 87566 : STK : 1X6X6 RED OAK BOARD : 1X6X6 RED OAK BOARD : BABCOCK LUMBER - QTY 1 67319 : 812021: STK : GALVANIZED LAG SCREW 1/4 X 4 : GALVANIZED HEX LAG SCREWS 1/4 X 4 : HILLMAN GROUP INC - QTY 4 69797 : 11711: STK : 1/8" X 1- 1/2 " -6' WELD STL ANGLE : WELDABLE ANGLE 1/8" X 1 -1/2" - 6' : HILLMAN GROUP INC - QTY 1 95923 : 94440800032 : STK : WHITE CASING 9444 3- 1/4 "X8' : WHITE CASING 9444 3- 1/4 "X8' : LP SPECIALTY PRODUCTS - QTY 1 231055: FCSVAUNIT : SOS : SOS PELLA PATIO DOORS 250/450 : 2 -PANEL SLIDING CONTEMPORARY DOOR PATIO : PELLA CORPORATION - QTY 1 Store 1916 Project No. 314093731 for JENIFER URFF Page 1 of 7 • 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 _ ._ ._1 i _ . .__._ I L ___ __ Frontage _ i ___. 1 4_.._ ._ Setbacks Front F'1 r t 1 r ._ Side L: R:' __ J L: Y R. _ ' l )_ 1 L , 7 Rear .al ) Building Height r.- .--- -, ="" i Bldg. Square Footage r•"-1 fi � ` 1 % ] ; 3 – -� ' '�( x.„..... F 1. _._ 3 � .3 Lam...... F � D Open Space Footage rt % 1--- (Lot area minus bldg & paved i t I , p parking) # of Parkin • S . aces 1 `•---- -----•._ Fill: I _--_ .... _.. _....... _. _ . i f volume & Location < u ...._. —_ —. ..,- ....__? t ._. _...._... _...___. 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:I j IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW a YES 0 IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO 3 DONT KNOW Q YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained 0 , Date Issued C. Do any signs exist on the property? YES 0 NO a IF YES, describe size, type and location: w_ __ _ __ .. __ D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO 8 IF YES, describe size, type and location: t 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 a. IF YES, then a Northampton Storm Water Management Permit from the DPW is required. we SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor. Not Applicable ❑ Name of License Holder : l a ( _ �' r � License Number ✓' /tit Addres Expiration Date Signature Telephone ,c. . a " Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c152, § 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 ❑ 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 HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 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 home owner exemption, to 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 backfill) sonotube holeskbefore 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 iermits 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 I, .-- Cron Tit , understand the above. (Home owner /resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date Address of work location 2010-12-21 10:32. 413 231 5562 4 0660 INSTALLED SALES P 1/2 ...:-- • - The Cornnionnigalth of Mas:sacliusett5 . • :— --. - '-. ,Departmeni of Industrial Accidents Office of rn . • (10 WasItineon Street 4, .,'7,--'-ii,_::,•_„:' ,7 Boston, J.114 01111 -.7 e.: -.. " " ;■' ; ' , :tc . ' '' www.inass.govidia _ -;-„, -, • Orl -E .,--,3 iZZIr k- n-lponsati.on Toisarztaacc.' AfEda )3 rtilcier sitolitt4cterNIE1tc.tricians::211TA" tei .A.tiviica:At firf.erinatioti . . Please Print Le . ibl'ir q i ::VI.:5;1.CSSi Or . illii . ,ZIUS c M acliVidtial) . : (5 C 6/ & LC'. frti LI Yr'. f.... 1/0 ,ILITi(AktviA. Rd , ... • __. , .... _ _ _ zi,:-. 4.9,m.pei je vt 6 PhOne #: .• , ,, •-•-- - _ _ ..._ -- --. -- - . - - .--- ..1z „ Check the Approprigte bur: 1 - -,, 1 , pa ti21 p creQ1 _ - . : . _ _: 27: L , .=.',r_nplOyeT With 4 E . 1 am suntze.lw an.d.I 0. ; 1 ;:,= - 2. . ; au palt-tme).* b.a hieci. the snip- contraztors .. .____., • ,.- - ; - , ,...r - • . • , ,, L. :I I bin a sole Tsoprietir or liattaez- )istOd- 6 11 the athtebea sileet 7 t, • slic: apd. hale Do erc.Ployil These sub--contractors live -- 1 8, j] DO.:Lt.: 7..4 "MI Lae in any capacity, workers'. comp, insaance, 1 9 : Bu ad±t worker.s conic_ insurance 5. 0 We are a corporation 44C1, itS 10_1 - , 7" t•Ct. 1 - &Mom's have etercisect thkr 7 c17.71_ aoins a:ii work- right of ememption. per 1 • 11. El Phirhbing repaL 3:: ad61 - 22y6t7if,., Ti' 7 0. , C Otillip. c. 152, §1(4), arid. WO 1 no 12,111 Roof re • ! '.iismalac refazir.F..id.:1 l' • • ploys. [NO-wok ers' • .1171 ( comp. itigrat.10req* '.. ■.p:p1.1 tilezIcs'bwa tt also fia tit pecos0)8.10vshrilYiltA:thei TreactTe zomponggiioni+0.1.i.cy iltizraztior, .:;To.u3".:-.0 - c4 - hti stilimit this 3.15ritvit ititliczkingifiq:m t4oilig all walk ap4 thailtii-e 0 Ocifta..6tors mast 3Tabrait a Isinv tair'avit ttallet,Titg T-C.carnw.w - ,thad chAr.,4': this. bctr, nrast afts4;h416i at:4*0)34000 klipsfint file ia eitlexiilibar%trAci.Thybir 1,70.41zr6 Doxap_ paiicy fr,:f_ _.,.., I aTrit rz;z ivri that is providing workers' compeziScrtion 1 for my olpioyees., low is tile policy ar.l.E li4) :size inforrfation. . - strancx Co'in:paly 11an3.e: 4,45, kura,i)Ce 6/1 ' oe Alfzid fri j i 4...-1Ci , , , .),r S z11-ins., Lic... iii: 1013S:4i ' . ,t- 7 In '.-Y z -'1 472 P 1. A/ ," -------- i 1 1./ /`9 • , d. 'T / c,,,,wistaier,,,: , : e/eiz (if the worliers compenstvtion, policy iiCclitrAtion., page showing the policy riarn.-Ar aro:1 e: 7e rf,'i..'.- trage as 1 im.C..if. 5tc...tici,, 25A of me c. 152 ['Agi itad to if/Inc) sitcL. of 5,1,500.00 a-clic c,ne im0thieni, -as well as civil pr..al bate fora of a STOP' 7, 6'4): againsi. `It: ?Iola Be acl;riscci tliat a COD3T Of l'hiS 8tattn..A. ea rxity be for7,7. to - 2. - .:4-. :.2. ......_ ... _ ._..... ...._ . a ie " . . ti TOViCied ab0 .'-6 2 ;14•E ar-fe .2:c...772:Z.:L. :- ; ":.: i2,r;:. 3:1• , "e•i.'...fiz4pains , 1 , - that 07F lilfOrtnaOn p LLI•...._=- 1.. - ', '-''-' :,. , — - • --- • r- . ..., ..-. . -; - -.1. i . -_,.L_,L.1... ',_,_,t • --= ,-- _____ . ____. -__..- -------- - • _ :„.,__________ ___-_,_:=7 . , ;: 2 . ... -L..: - =.:7. - .: ---=7, . ..-..-- .. ' I a C.;111V, .DO no wc in this orrea. to be coTrglieted by city or to officia i.; - . Permiti k _ . ____ -- - ' issuing A (circle one): 1! 1 1 . B Gf:IRI ealth 2 b uilding Depart:m.6a+ 3. .C;itylT o Ckr.k 4. Electrical Lisp e Pl ct.or. 5_ um iaz- SECTION.5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House D Addition ❑ Replacement W doves Alteration(s) ❑ Roofing ❑ Or s Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [[] Siding [0] Other [0] Brief Descripti of Proe p s X Work: `" fC� ``X .� �L De)e) _ Alteration of existing bedroom Yes .moo Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet „� :'F+N r W � gy, — PO 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 . 1. 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 I, J ��/ A�� f ` 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. CCIA /ri �= / / //( Signature of Owner Date I .S Z117 G ✓ , as Owner /Authorized Age ereby declare that the statements a • formation on the egoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. f�i )4 41 ' /A,v_iils Q Si re of OwnerfAgent / mate 9� 9 • City of Northampton`. Building Department � .r (10 12 Main Street Room 100 , �� 6rthampton, MA 01060 I phon 413 - 587 -1240 Fax 413-587-1272 $ g 41"(o APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION .. This section to be completed by office 1.1 Property Address :: ,�/ 1J.�G //f t / ` Map Lot lJnit, . /9 �/7 6rl �yt ©‘r Zone OiverlayDistrict Elm St District Cs District SECTION 2 PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: :rig41 j / j vt/7 1 ' p? i-no71 / / 1 7)//09- 60? Name (Print) Current Mailing Address: -' p � /U (2)17: /l g G Teieph6ne 3- ,<� L Signature 22 Authorized Agent: ri le/. / .5 r4 c, v 7802 u, ST 1//9pl P `�'fJ o/e 3s Name (Pn t) / t Current Mailing dress: i . te L aid S � X02 Signa re / Teleph ne SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed b •ermit a• •licant 1. Building (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. Tota! _ (1 + 2 + 3 + 4 + 5) p 7(9 � � �' e(0 Check Number /NC./ s This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date Aviv 27 1...AD S ER BP- 2011 -0647 GIS #: COMMONWEALTH OF MASSACHUSETTS Mig4tisiti5.14.6 r 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- 2011 -0647 Project # JS- 2011- 001047 Est. Cost: $2070.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: LOWE'S 74606 Lot Size(sq. ft.): 38202.12 Owner: URFF JENNIFER Zoning: SR(100) //WSP II Applicant: LOWE'S AT: 27 LADYSLIPPER LN Applicant Address: Phone: Insurance: 282 RUSSELL ST (413) 588 -0270 WC HADLEYMA01035 ISSUED ON:1/20/2011 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 1/20/2011 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner