36-239 I LOWES CONTRACT #0000158
MASSACHUSETTS EXTERIOR SOLUTIONS INSTALLED SALES - CONTRACT
INSTALLED SALES t sp,r,i ALIST - NUMBER CU TTOMER (]��"
� , n, (p..tck5 /5-6. /97t��� R i c
STORE NO. STREET D ss S--I' STREET ADDRESS
C �lC� 64
1116 an cify STATE ZIP - CITY STATE ZIP
TELEPHONE `(�'f `!/, Q . _....
DA FEIN: 56-0748358 7ENTERS, INC'S MA HIC Na. 148688 CASH SA f LCC REG SANK GE
/
This is only a quote for the merchandise and services printed below. This becomes an agreement upon payment Upon payment, the entire agreement;. including thespectically completed pages of this
document, the Terms and Conditions Included with this document and any other addenda and attachments hereto, shall be referred to herein as this "Contract .°
PLEASE READ ALL TERMS AND CONDITIONS ON THE REVERSE SIDE OF THIS PAGE AND FOLLOWING PAGES BEFORE SIGNING. -
INSTALLATION STREET ADDRESS { \ CITY STATE ZIP
�Cn 4N-Ue GS 6 l l ,a r: ipf'f ff Q
_ _ A
- In - -) IS m t ) 4 i , aum, � frsb ! k
Tu ,t1 f V1 -(• & AI 6rciDeI1
1tallation?: [/
3s Contract Tota
Are permits required fort is installation?: [ j No *applicable tax included ,. 3-CC,
NOTICE TO CUSTOMER: Federal law requires Lowe's to provide you with the pamplet Renovate Right. By signing this Contract, Customer
acknowledges having received a copy of this pamphlet before work began informing Customer of the potential risk of the lead hazard exposure
from renovation activity to be performed in Customer's dwelling unit.
PHOTO RELEASE: Customer grants to Lowe's and Lowe's employees the right to take photographs of all work performed at the Premises related to this
Contract, and irrevocably grants to Lowe's all right, title and interest in and to the photographs for use in all markets and media, worldwide, in perpetuity.
Customer authorizes Lowe's to copyright, use and publish the photographs in print and /or electronically, and agrees that Lowe's may use such
photographs for any lawful purpose, including, but not limited to, marketing, advertising, publicity, illustration, training and Web content. By initialing
here, Customer agrees to the foregoing. [Customer to initial to the left].
Work i tocommence upon reasonable availability of Contractor and /or any special outer clr customer made Good(s) which is anticipated to be
/3//(3 [fille in date]. Estimated completion date is 7 , t I l 3 [fill in date].
Said estimated substantial completion date is not of the essence. A statemnt of any cone gencies that would materially cha ge said estimated substantial
completion date is as follows: %,. - S j - , r t p eto.
(if applicable, insert-a - -tment of such contingencies).
IF THE CONTRACT TOTAL IS $1,000.00 OR LESS Customer must pay in full.
COMPLETE THIS SECTION ONLY WHEN THE CONTRACT TOTAL EXCEEDS $1,000.00:
[ ] Customer to Pay in Full; OR [ ] Customer to use the following payment schedule:
(1) Deposit $ to be paid upon siging contract. Deposit should be 1/3 the total contract price; and
(2) Payment of $ to be paid anytime after this Contract is signed and before commencement of installation, I/We authorize Lowe's
to do one of the following (check appropriate box below):
[ ] Charge my /our credit card for the amount of the payment indicated above anytime after the date this Contract is signed;
or
[ 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.
NOTICE REGARDING ARBITRATION AGREEMENT FOR CLAIMS COVERED BY M.G.L. c.142q
LOWE'S AND OWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT LOWE'S HAS A DISPUTE CONCERNING THIS CONTRACT, THAT
LOWE'S MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUT-
IVE OFFICE OF - CON MER AFFAIRS' AND BUISNESS REGULATIONS AND THE OWN BHRLL t3E REQUIRED SUBMIT TO SUCH`ARB1TRAT1QN -
AS P IDED IN M j/142A. /
By: � Date: 3 / d 7 J
L6 e's Home enters, Inc. / ! / 7 / 2�3
By: v i � Date: (// T( /�/
Owner Signature f
THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE RESOLUTION INITIATED
BY LOWE'S PURSUANT TO M.G.L. c.142A. THE OWNER MAY BE PERMITTED TO INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THE
SECTION ABOVE IS NOT SEPERATELY SIGNED BY THE PARTIES.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AND UNTIL YOU HAVE READ THE TERMS AND
CONDITIONS CONTAINED ON THE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS CONTRACT.
BY SIGNING BELOW, YOU ARE ACKNOWLEDGING THAT YOU HAVE READ, UNDERSTAND AND AGREE TO THE
TERMS AND CONDITIONS SET FORTH ON THE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS
CONTRACT. YOU ARE ENTITLED TO A COPY OF THIS CONTRACT AT THE TIME OF SIGNATURE.
WITNESS OUR HAND(S) AND SEAL(S) BELOW THIS 7) DAY OF W L) / ,, O) 3 .
Lowe's Ho nters, Inc. t f� /
t
•ecia ist orA•ove Owner Co -owner or Witness
Customer acknowledges receipt of a true copy of this contract which was completely filled in prior to Customer's execution hereof. You, the buyer, may
cancel this transaction at any time prior to midnight of the third business day after the date of this transaction. See the attached notice of cancellation
form for an explanation of this right.
® 2004
are r by Lowas L and the C gable design
�eOflOOl rae,, n oN M FILE COPY egistered ramarks of LF orporation.
# 4/24/2012 15:05 ICNE Group Marie Proulx -0- 1/2
ACORD CERTIFICATE OF LIABILITY INSURANCE DATE 2M/p
TM
PRODUCER Phone (413) 781 -2410 Fax 413 -731 -9539 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
INSURANCE CENTER OF NEW ENGLAND INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
1070 SUFFIELD STREET HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P 0 BOX 1230 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
AGAWAM MA 01001
INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURER A: Nautilus Insurance Company
MARK S JODOIN INSURER B: Commerce Insurance Company 34754
DBA JODOIN HOME IMPROVEMENT INSURER C: Aim Mutual Ins Co- Assigned Work Comp
137 PORTER LAKE DRIVE
LONGMEADOW MA 01106 INSURER D: ,
INSURER E:
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 CONDfTION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT T: VVHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EYOLUSONS AND CONDITIONS OF SUCH
POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS –
INSR ADO'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION
LTR INSRD DATE (MM/DO/YY) DATE (MM/DD/YY) LIMITS
GENERAL LIABILnY NNO31125 06/26/11 06/26/12 EACH OCCURRENCE $ 500,000
X COMMERCIAL GENERAL LIABILITY DAMAGES E R oN TE D nce) $ 50,000
CLAIMS MADE X OCCUR MED ExP Any one person) $ 5,000
A PER'SONAL 3 ADV INJL IRY $ 500,000
GENERAL AGGREGATE $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS -C! OMPfOP AGG $ 1,000,000
X POLICY — PRO-
JECT LOC
AUTOMOBILE LIABILITY RPJ989 03/26/12 03/26/13 COMBINED SINGLE LIMIT
ANY AUTO (Ea accident) $
ALL OWNED AUTOS BODILY INJURY
X SCHEDULED AUTOS (Per person) $ 100,000
B X HIRED AUTOS _
BODILY MJURY $ 300,000
X NON -OWNED AUTOS (Per accident)
PROPERTY DAMAGE $ 100,000
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY AGG $
EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE '$
OCCUR CLAIMS MADE AGGREGATE $
$
DEDUCTIBLE
$
RETENTION $ $
WORKERS COMPENSATION AND TBD 04/23/12 04/23/13 x (TOPY UM un.-
1 l OTHER
EMPLOYERS' LIABILITY
c ANY PROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT $ 100,000
OFFICER/MEMBER EXCLUDED?
E L DISEASE - EA EMPLOYEE $ 100,000
Myes, doseribe under
SPECIAL PROVISIONS below E L DISEASE - POLICY LIMIT $ 500,000
OTHER:
I
DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
LOWE'S COMPANIES INC. AND ANY AND ALL SUBSIDIARIES ARE NAMED AS ADDITIONAL INSURED AS RESPECTS TO GENERAL LIABILITY AND
AUTO LIABILITY
F #231 -5562
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSG SUER WILL ENDEAVR MIL WRITTEN NOTICE TO
THE CERTIFICATE HOLDER UIN NAM ED R TO THE LEFT, BUT O FAIL URE A TO 20 DO SO DAYS SHALL IMPOSE NO
LOWE'S COMPANIES INC. OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, IT'S AGENTS OR REPRESENTATIVES
ATTN: IS INSURANCE (MEZZ)
POST OFFICE BOX 1111
NORTH WILKESBORO NC 28656 -0001 AUTHORIZED REPRESENTATIVE NN �
lilt 444,%.
•
Attention: tephenGailagher
ACORD 25 (2001/08) Certificate # 62477 @ ACORD CORPORATION 1988
•
Massachusetts • Department of Public Safety
Board of Building Regulations and Standards„
Construction Supervisor
License: CS -049918
11
MAIL S JOAOIN"
137 PORTER )LAKE D'.
LO.NG&IEADOwMA �;
r
111
J�,,, �j► f "" Expiration
Commissioner 12/29/2014
The Commonwealth of Massachusetts
6 Department of Industrial Accidents
u S
Office of Investigations
t f — ' 600 Washington Street
IOW s
Boston, MA 02111 1:7
Q � :l e � i wwW. rnass gov /dia
Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians /Plumbers
Applicant Information Please Print Legibly
Name ( Business /Organization/Individual): Jo DOJN 1 / P,Cd ji7 eit/7`
Address: / 7 PG tni- be-.
City /State /ZipLc,e".464 4/4 dt'0 6 Phone #: 10 a l - 2J' /
Are ou an employer? Check the appropriate box: Type of project (required):
I
1. I am a employer with ,. 4. ❑ 1 am a general contractor and 1 1
employees (full and/or part- time).* have hired the sub - contractors 6. ❑ New construction
2. i am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
I ship and have no employees These sub contractors have g_ ❑ Demolition
working for me in any capacity. employees and have workers'
9. ❑Building addition
[No workers' comp. insurance comp. insurance.t
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
officers have exercised their 11. Plumbing re
. ❑ 1 am a homeowner doing all work g airs or additions P
myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required.] t c. 152, §1(4), and we have no
employees. [No workers' 130 Other
comp. insurance required.]
`Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
iContractors that check this box must attached an additional sheet showing the name of the sub - contractors and state whether or not those entities have
employees. lithe sub - contractors have employees, they must provide their workers' comp. policy number.
1 am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
in formation. , /
Insurance Company Name: �.V,.SO/1_ -90 re 6 /VGJ Le L /¢7416 ."--"-) e-
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 policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the II f "urance cov age verification.
I do hereby certi and the pains an ecalties o f perjury that the irrfonnation provided above is true and correct
,Signature. Date:
Phone i-': 03 — e FS — 73 4
•
1 Official use only. Do not write in this area, to be completed by city or town officiaL
1 City or Town: Permit/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 : Jo DU l 4/ 5' - D 9/ F
,� License Number
/27 lot. `2 14-7/L , , V 64-i.4.-61dvc/ /44 0/(06 ,o (a- �/ /
Address Expiratioh Date
¥{/3 -8 s- 73 /
Signature Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
Company Name Registration
Nu ber
b
//4 N P Sa 7 - u7/4 I✓ 7 7 c7 / c/ /
Address Expiration Date
Telephone W3 -Sn' a g7 9
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 LB No ❑
11. - Home Owner Exemption
The current exemption for "homeowners" was extended to include Owner - occupied Dwellings of one (1) or two(2) families
and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts
as supervisor. CMR 780, Sixth Edition Section 108.3.5.1.
Definition of Homeowner: Person (s) who own a parcel of land on which he /she resides or intends to reside, on which there
is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/ or farm
structures. A person who constructs more than one home in a two -year period shall not be considered a homeowner.
Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, that he /she shall be
responsible for all such work performed under the building permit.
As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon
completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to
Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s)
you hire to perform work for you under this permit.
The undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of
Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
Section 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
(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 DONT KNOW YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW YES 0
IF YES enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO Q DON'T KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained Q , Date Issued:
C. Do any signs exist on the property? YES Q NO l
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO
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 to
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 ❑ Replacementelows Alteration(s) n Roofing
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [El] Decks [Q Siding [0] Other [0]
Brief Description of Prop sed //� � /,,
Work: f/E L t4C I -'1 1‹,9 7c/.dO 'S //e) �7 7 U/`r4 —� 6LJO e4
Alteration of existing bedroom Yes No Adding new bedroom Yes /- No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
6a. If New house and or addition to existing housing, complete the following:
a. Use of building : One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No .
I. Septic Tank City Sewer Private well City water Supply
SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, ALE/ q -r(/,d lL Y U6 , as Owner of the subject
property
hereby authorize O
to act on my behalf, in all matters relative to work authorized by this building permit application.
-' EE 69/VT'4 -C7
Signature of Owner Date
1 �� 41.' • A , as Owner /Authorized
Agen • -re.y declare that the stat: ents and information on the foregoing application are true and accurate, to the best of my knowledge
an.elief.
Signed under the pains and penalties of perjury.
Print N-
Signatur- • . wner /Agent Date
RECEIVED i
Department use only
City of Northampton Status of Permit:
FEB 1 5 2013 Building Department Curb Cut/Driveway Permit
i 212 Main Street Sewer /Septic Availability
f__
oar �, s G IN Room 100 WaterNVell Availability
NORTHAMPTON, MA 01060 Northampton, 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 DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Property Address:
This section to be completed by office
2)z-'`'1S4V2 GT Map Lot Unit
Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
k' Pc/ 6 4 _2). n1 ) r2t.
Name (Print) Current Mailing Address: 0/D6 '2_
Telephone
Signature
2.2 Authorized Agent:
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
23 5 7 0. (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) 3 3 7. G Check Number / get‘
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
5 DIAMOND CT BP- 2013 -0763
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 36 - 239 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: windows replaced BUILDING PERMIT
Permit # BP- 2013 -0763
Project # JS- 2013- 001312
Est. Cost: $3357.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: MARK JODOIN 49918
Lot Size(sq. ft.): 30753.36 Owner: PUGACH ALEKSANDR & LYUDMILA GORITCHENKO
Zoning: Applicant: MARK JODOIN
AT: 5 DIAMOND CT
Applicant Address: Phone: Insurance:
137 PORTER LAKE DR (413) 885 -7361
LONGMEADOWMA01106 ISSUED ON:2/15/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL REPLACEMENT WINDOWS
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House # Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace /Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
FeeType: Date Paid: Amount:
Building 2/15/2013 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner