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42-110 STORE COPY 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. 12. MANUFACTURER WARRANTY FOR GOODS.Customer is entitled to any warranty provided by a manufacturer of the Goods sold under this Contract.The Installer will provide Customer with any manu- facturer 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,EXPRESSED OR IMPLIED TO THE FULLEST EXTENT PERMITTED BY LAW 13. LOWE'S WARRANTY FOR INSTALLATION SERVICES/LIMITATIONS OF LIABILITY. 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 required by applicable law governing consumer warranties for workmanship (the "Warranty Period"). LOWE'S WAR- RANTY 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 RESPONS- IBLE 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 INSTALLATION SERVICES SHALL BE IN LIEU OF ANY OTHER WARRANTY EXPRESSED OR IMPLIED 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 11 of these Terms and Conditions. 14. 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 at the address and/or phone number on the front page of this Contract. If Customer has a complaint which can- not be resolved informally,The Home Improvement 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 Affairs 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"on the front page of this Contract is signed and dated by Lowe's and the owner. If allowed by statute or applicable law,the arbitrator may awared statutory damages and/or reasonable attor- neys'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 controlling law.To the fullest extent permitted by law, Lowe's and Customer agree that no class action lawsuit or class action artibration of any type may be pursued by or on behalf of the Custorr er or 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. 15.ARBITRATION AGREEMENT,WAIVER OF JURY TRIAL AND WAIVER OF CLASS ACTION ADJUDICATION FOR CLAIMS NOT COVERED BY M.G.L.c.142A:All claims by Customer or Lowe's con- cerning this Contract which cannot be resolved informally,and which are not covered by M.G.L.c142A 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 JAMS, Inc. (JAMS) (www.jamsadr.com) (as amended) or the American Arbitration Association (AAA) (www.adr.or^,) (as amended).The parties agree that if JAMS or AAA are unable or unwilling to arbitrate the matter,the parties will agree upon a single arbitrator with a nationally recognized arbitration firm to arbitrate the matter. 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 in- cluding claims based upon alleged product defect,contract,tort,fraud,or other intentional torts, (5)all claims based upon a violation of any state or federal constitution,statute or regulation,(6)all claims as- serted 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, parent 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 Customer's behalf by another person, (9) all claims asserted by or on behalf of a 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 indirectly to the disclosure by Lowe's, related third parties or the Installer of any non-public personal in- formation about Customer,and/or(11)all other claims arising under or related to this Contract whether or not set forth above. 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. 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 as set forth immediately above. Lowe's and Cus- tomer agree that binding arbitration provides a simple,cost efficient method to resolve disputes quickly. Lowe's and Customer agree that no class action lawsuit or class action arbitration of any type may be pursued by or on behalf of the Customer or 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.By agreeing to binding arbitration Customer and Lowe's waive any right to bring or participate in a class action lawsuit or class action arbitra- tion 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 NB6LG, 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 mutually 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 arbitration. Unless the arbitrator's award or controlling law specifically provides otherwise, Lowe's and Customer will each be responsible for its own attorneys'fees and other expenses, such as wit- ness 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 then current rules,pro- cedures and protocols of the arbitration entity selected by the parties as set forth above.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,Customer agrees that Lowe's shall be entitled Store 1916 Project No. 446767397 for JUDITH BAXA Page 7 of 8 STORE COPY TERMS AND CONDITIONS 1."LOWE'S" DEFINED.Within this Contract(as defined on the front page of this Contract),the term"Lowe's"shall refer to Lowe's Home Centers,LLC,a North Carolina limited liabity company. 2.GENERAL DESCRIPTION. By executing this Contract, Customer and Lowe's agree that 1) Lowe's shall provide Customer the goods and/or materials (the"Goods"),2) Lowe's shall procure on Customer's behalf,the services to install the Goods(the"Installation Services") in or on the premises identified on the face of this Contract(the"Premises")and 3)Customer shall pay Lowe's the lump-sum Contract Total stated on the face of this Contract(the"Price")and according to the provisions of the"Contract Documents".The Installation Services shall be perfomed in the specific rooms or areas of the Premises identified on the face of this Contract("Project Area").The"Contract Documents"shall consist of(1)the face of this Contract, (2)these Terms and Conditions, (3)the applicable portion(s)of Lowe's receipt and(4)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 obligation 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 Installation Services do not include ar- chitectural/engineering services or structural changes to the Premises or any other services beyond the ordinary and routine installation of the Goods as specifically provided in this Contract. Customer is re- sponsible,at Customer's cost,for providing any necessary architectural/engineering services or structural 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. Customer agrees that title to goods does not pass to Customer until installed in Customer's home, building,or on Customer's prop- erty. Customer agrees Contract is being offered for the total Price(per below).Customer further agrees any surplus materials upon completion of the Installation Services are not the property of customer and, if instructed by Lowe's,such surplus materials shall be returned to Lowe's by the Installer. Upon request from Customer at the time of job completion,Lowe's,in its discretion,will allow all or part of the unused, receipted surplus materials to be retained by the 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(per below).In the event of an Undisclosed Condition or the foregoing,Customer will execute a change order or a new replacement contract upon Lowe's request. 6. DISCOUNTS and PROMOTIONS. From time to time, Lowe's provides various promotions,offers and discounts that may apply to Goods and/or Installation Services. See specific promotion,offer and dis- count for terms and conditions that may apply.All discounts are taken at the time of Customer's purchase.Applicable discounts or discounted Prices will appear on the Lowe's receipt and/or on the Contract. 7. PAYMENT. If the Price is$1,000.00 or less, payment of the Price by Customer to Lowe's is due in full uopon 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.Lowe's will send to Customer by U.S.Mail a receipt evidencing Customer's purchase after Payment is processed. 8. 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, regis- trations and certifications 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 perforri 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.Custom- ers 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 ordinanaces 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 ordinance or other law which requires additonal 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 Installation 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. 9.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. 10.UNDISCLOSED CONDITIONS IN PREMISES. If any defect,weakness or dangerous condition including,but in no way limited to,mold,mildew,rot,asbestos or infestation("Undisclosed Condition") is dis- covered or identified in the Premises'structure,substructure, superstructure or points of attachment at any time prior to commencement or completion of the Installation Services,Customer must remedy the Undisclosed Condition at Customer's sole cost and expense and to Lowe's sole satisfaction. 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 wheth- er 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 Custom- er under this Contract,then at Lowe's option (i)Lowe's may rescind this Contract 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(ii) 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 condition, and custom-made goods, may not be returned. "Custom-made" goods include goods that have been uniquely altered, color-matched, shaped,sized,cut or otherwise 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. Notwithstanding the foregoing, and alternative to rescinding or terminating this Contract as described above, upon discovery or identification of any Undisclosed Condition in the Premises, Lowe's may in limited circumstances and markets, and in Lowe's sole discretion, authorize the commencement or continuation of Installation Ser- vices upon Lowe's receipt of Customer's written agreement(to be furnished to Customer by Lowe's)to release and hold harmless Lowe's and installer from any and all liability arising out of or related to the Un- disclosed Condition and Customer's remedy of Undisclosed Condition. 11.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 areas 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 Store 1916 Project No. 446767397 for JUDITH BAXA Page 6 of 8 STORE COPY Co-Owner or Witness 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. 446767397 for JUDITH BAXA Page 5 of 8 STORE COPY DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AND UNTIL YOU HAVE READ THE TERMS AND CONDITIONS CON- TAINED 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 CONTRACT 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 CON- TRACT, THAT LOWE'S MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRET- ARY OF THE EXECUTIVE OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATIONS AND THE OWNER SHALL BE REQUIRED TO SUB- MIT T PITRATION AS P QED IN M.G.L. c.142A. Date: S` Lowe's Home Cen ers. LLC By: iii 2 i� Dater Owner By: Date: Co-owner or Witness 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. WITNESS OUR HAND(S) AND SEAL(S) BELOW THIS DAY OF A / Lowe's Home Centers, LLC gy; _ �'� (Seal) Print Name: S' / ,[� �.t 1� i AC'S�� (Seal) Address O ner J�5 V 34 City State/Province Zip/Postal Code Print Name y /1 Zf (Seal) Store 1916 Project No. 446767397 for JUDITH BAXA Page 4 of 8 STORE COPY TOTAL CHARGES OF ALL MERCHANDISE AND SERVICES `where applicable SUB-TOTAL $ 855.6 *TAX $ 0.0 DELIVERY $ 0.0 ORDER TOTAL $855.6 BALANCE DUE Work is to commence upon reasonab avail lity of Contractor which is anticipated to be [fill in date]. Estimated completion date is S [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 necessitated by defective substructures, superstructure, points of attachment, or the moving of fixtures or appliances to be billed at extra cost to custom- er. IF THE CONTRACT TOTAL IS $1.000.00 OR LESS. Customer must pay in full. MPLETE THIS SECTION ONLY WHEN THE CONTRACT TOTAL EXCEEDS 1 000.00: i0customer to Pay in Full; OR L] Customer to use the following payment schedule: (1) Deposit of$ to be paid upon signing contract. Any deposit collected at the time this Contract is signed will not exceed one-third (1/3) of the contract price; and (2) Payment of $ to be collected upon or after the commencement of work. I/We authorize Lowe's to do one of the following (check ap- propriate box below): [_] Charge my/our credit card for the amount of the payment indicated above upon or after the commencement of work; or [_] Deposit my/our check for the amount of the payment indicated above anytime upon or after the commencement of work; and (3) Final payment of$100.00, to be paid upon completion of the installation to both parties' satisfaction. Store 1916 Project No. 446767397 for JUDITH BAXA Page 3 of 8 STORE COPY Stock or SOS : Stock Door Type : Exterior Select Location : Side Door Select New Door : Single Pre-hung Number of Doors to Install : 1 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 : No Lead Safe 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 : No Additional Miles Traveled over 20 : 0 Bring Up To Code Description : None Local Disposal Fee : Yes Describe Other Work Needed : 18 lin feet of metal capping supplied and swap out door handle for other door Other Work Charge : Yes Comments : No Comment Labor Charges $517.0 Detail Deduction -$ 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:Federal law requires Lowe's to provide you with the pamphlet Renovate Right: Important Lead Hazard Information for Families, Child Care Providers and Schools. By signing this Contract, Customer acknowledges having received a copy of this pamphlet before work began informing Customer of the potential risk of the lead hazard exposure from renovation activity to be performed in Customer's dwelling unit. PHOTO RELEASE: Customer grants to Lowe's and Lowe's employees and independent contractors the right to take photograghs of the Premises where In- stallation Services will be performed and all work performed at the Premises related to this Contract, and irrevocably grants to Lowe's all right, title, 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,jncchading, but not limited to, marketing, advertising, publi- city, illustration, training and Web content. By initialing here, Customer agrees to the foregoing. -- I , [Customer to initial to the left]. NOTICE TO CUSTOMER-PRICE CALCULATIONS: In order to properly perform the installation of certain Goods, the Contract Price may include more Goods than actually will be installed based on the measured square footage of the Project Area. As a result, the parties agree that the lump-sum Price stated in this Contract is calculated upon both the value of the estimated Goods required to fulfill the Contract (including waste), which may exceed the actual square footage of the Project Area, and the labor which may be estimated based on the amount of Goods required to fulfill the contract (including waste). By signing this Con- tract below, Customer acknowledges receipt of this notice and agrees and understands that the Price includes these costs which may not be refunded once the Installation Services are performed.. Store 1916 Project No. 446767397 for JUDITH BAXA Page 2 of 8 STORE COPY INSTALLATION SERVICES CUSTOMER CONTRACT- MWORK- INT/EXT/PATIO DOOR LOWE'S OF HADLEY, MA, STORE# 1916 STORE PHONE: (413)588-0270 282 RUSSELL STREET SALESPERSON: BRUCE HUNTER HADLEY, MA 01035-0000 SALESPERSON ID: 1508948 Document Print Date :07/09/2015 This is only a Quote for the merchandise and services printed below.This becomes an agreement upon payment and issuance of a Lowe's receipt, upon which the entire agree- ment, including the specifically completed pages of this document, the Terms and Conditions included with this document, the applicable portion(s) of Lowe's receipt, 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, LLC's MA HIC NO.: 148688 Lowe's Home Centers, LLC's FEIN: 56-0748358 Customer Name Home Phone S JUDITH BAXA 413-586-2505 4 Customer Address Other Phone 1007 WESTHAMPTON RD L City State/Province Zip/Postal Code D FLORENCE MA 01062 Installation Address T 1007 WESTHAMPTON RD O Installation City Installation State/Province Installation Zip/Postal Code FLORENCE MA 01062 MERCHANDISE AND INSTALLATION SUMMARY MERCHANDISE SUMMARY 39683 : PRODUCTCODE : SOS : SOS RB COMMODITY FBRGLS-DORFAB TC : ENTRY/EXTERIOR SINGLE UNIT, HALF LITE FLUSH CLEAR ***15%OFF RETAIL ON ALL SPECIAL ORDER ENTRY DOORS FROM 07/01/15 THROUGH 07/14/15*** : DOOR FABRICATION SERVICES INC -QTY 1 14660 : F51 V PLY 505 605 : STK : SCH BB ENTRY KNB PLYMOUTH : SCH BB ENTRY KNB PLYMOUTH : SCHLAGE LOCK-QTY 2 66646 : 07832 : STK : 3/4X1.5X8 RF EMBOSD PVC TRM BOARD : 3/4X1.5X8 RF EMBOSD PVC TRM BOARD : METRIE INDUSTRIES INC -QTY 1 Materials Price $373.65 INSTALLATION DESCRIPTION Store 1916 Project No. 446767397 for JUDITH BAXA Page 1 of 8 C��,�e U�o�m-mo�rursecr�i o�G�tar,�c�el7a ffice of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registration: 148688 Type: 10 Park Plaza-Suite 5170 Expiration: 10118/2015 Supplement card Boston,MA 02116 LOWE'S HOMES CENTERS INC JAMIE SPOFFORD 136 TURNPIKE RD.SUITE 100 of valid without signature SOUTHBOROUGH,MA 01772 Undersecretary r 1 ® DATE(MM/DD/YYYY) ACORD CERTIFICATE OF LIABILITY INSURANCE 03/31/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Marsh USA Inc. FAX 100 North Tryon Street,Suite 3600 A/Nr o E A/C No): Charlotte,NC 28202 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC N 47095-CASUA-ONLY-15.16 INSURER A: National Union Fire Ins Co Pittsburgh PA 19445 INSURED INSURER B: New Hampshire Insurance Company 23841 Lowe's Companies,Inc. and Subsidiaries INSURER C: Steadfast Insurance Company 26387 1000 Lowe's Blvd. INSURER D: Mooresville,NC 28117 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: ATL-002938178-28 REVISION NUMBER: THIS IS TO CERTIFY THAT 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 DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE J POLICY EFF POLICY EXP LTR L UBR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ Self Insured-See Below DAMAGE T RENTED PCO,MERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE � OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO F LOC $ECj A AUTOMOBILE LIABILITY CA5260749 (AIDS) 04/01/2015 04/01/2016 COMBINED SINGLE LIMIT Ea ccident 51000,000 a _ B X ANY AUTO CA5260748 (MA) 04/01/2015 04/01/2016 BODILY INJURY(Per person) $ A ALL OWNED SCHEDULED CA5260760 (VA) 04/01/2015 04/01/2016 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED Per accident)PROPERTY DAMAGE $ HIRED AUTOS AUTOS $ C X UMBRELLA LIAR X OCCUR IPR3792301-01 04/01/2014 04/01/2017 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED I I RETENTION$ $ B WORKERS COMPENSATION WC017731584 (ADS) 04/01/2015 04/01/2016 X WC STATU- OTH- B AND EMPLOYERS'LIABILITY WC039901583 (WI) 04/01/2015 04/01/2016 T R 1 IT R 2,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ __ B OFFICER/MEMBER EXCLUDED? � N/A WC017731585 MN 04/01/2015 04/01/2016 2,000,000 (Mandatory in NH) ( ) E.L.DISEASE-EA EMPLOYE $es B DE SC,RIPTION OF OPERATIONS below WC039901584 (AK,AZ, NH,VT) 04/01/2015 04/01/2016 E.L.DISEASE-POLICY LIMIT $ 2,000,000 A Excess WC XWC9883959 (ADS) 04/01/2015 04/01/2016 WC:Stat/EL:$3mil;xs$2mil SIR A Excess WC XWC9883960(FL) 04/01/2015 04/01/2016 WC:StattEL:$3mil;xs$2mil SIR DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Insured is self insured for General Liability for the period of 4/01/2015 to 4/01/2016. Evidence of coverage. Lowe's self insures for physical damage coverage to rented and leased vehicles. CERTIFICATE HOLDER CANCELLATION Lowe's Companies,Inc. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE and subsidiaries THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 1000 ACCORDANCE WITH THE POLICY PROVISIONS. Mooresville,INC 28115 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Paula Stapleton Pn../.. prOjal�• ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Massachusetts -Department of Public Safety Board of Building Regulations and S+ta-,,daras Construction Supervisor License: CS-iwow MICHAEL W BU#GAMASTER 119 HIGH STREET 1ST FL AGAWAM MA 61001 Expiration Commissioner 09AW2016 AC R CERTIFICATE OF LIABILITY INSURANCE (MM1DD1 YYY) 5/15/15 THS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER INS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AAA END, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policyCes)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: Keri Rusciano CISR Rejean J. Remillard Ins. Agy, PHONE 1�1X UUr 1040 Springfield St E.reA1L (413) 789-3070 N : (413) 786-0193 Feeding Hills, MA 01030 ADM$s: Ruscianok @Aol.com INSURE S AFFORDING COVERAGE NAtC# INSURE'RA:Ma±n Street American Assurance INSURED INSURERS:National Grancre Mutual Michael W. Burgamaster dba INSURER Ins Co Burgers Home Improvement INSURER D 119 High St. 1st Floor INSU E: Agawam, MA 01001 INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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 DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, E)CLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN SR aDDt SUBP POLICY EFF POLICY LTR TYPEOFINSURANCE INSR WVD POLICY NUMBER MKID MONIDDIYYYY ITS LIM A GENERALLIAEUTY MPK6213N 6/8/15 6/8/16 EACH OCCURRENCE S 1,000,000 . X C7ERCiALGENER►LLIABIITY DAMAGE TO RENTED PREMISES(Ea o=mmcel C S 50O 000 LAIMS4AADE ; -- OCCUR MED E7(P(Aryone person) $ 10,000 PERSONAL$ADVINJURY S 11000,000 GENERAL AGGREGATE S 2,000,000 HGXDPOLICY rLAGGREGATELNGTAPPLIESPER PRODUCTS-COMPIOPAGG S 2 000 000 PRO. LOC $ B AUTOMOBILE LIABILITY 141T3385E 6/10/15 6/10/16 asccrtS N , LIMIT S ANYALnC BODILY INJURY(Per pemon) $ 100.000 &L OWPED X SCHEDULED BODILY INJURY(Per=ddent) S 300,000 X HIREDAUTOS X ON WNED PROPERTY DAMAGE S 100,000 S LAiIAB OCCUR EACH OCCURRENCE S SSLIAB CLAIMS-MADE AGGREGATE S DED RETENTION S $ C v=KERSCOMPENSATION WC-20-20-002804-04 10/6/14 10/6/15 X WCSTATII- OTH- ANO EMPLOYERS'LIABILITY YIN —° ANY PROPRIEr)RIPARTNEWEXECUTNE NIA E.L.EACHACCIDENT $ 100,000 OFFKPRIMEMBER EXCLUDED? pYandatory In NH) EL.DISEASE-EA EMPLOYEE S 100,000 Iyes,dow1be under DESCRIPTIONOFOPBRATtONSbebw EL.DLS EASE-POLICY LIMIT $ 500,000 DESCRRMM OF OPERATIONS I LOCATIONS I.VENCLES (Atlach ACORD 101,Add6onal Remarks Schedule,N more space is regr rad) Lowe's Companies, Inc. are named as Additional Insured with respect to General Liability Coverage only. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN i Lowe's Companies, Inc. ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Install Sales Insurance P.O. BOX 1111 AUTHORIZED REPRESENTATIVE� N. Wilkesboro, NC 28656 W1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and Iogo are registered marks of ACORD Phone: Fax: (877) 411-7129 E-Mail: Department of Indurs&W Aceidenbs ` Office.ofInvestrgmdoris 600 Washington Street ,Boston,MA 02111 www mass s ovIdia Workers'-Coiap.ensafion 1. ►surance Affidavit: Builders/Contractors/Electricians/plumbers ,0P icant-1nfor�—&t6n Please Pirirrt Lggibly Name lBltS3nCSS/O[gm&Rtl09NaX1dlVidil; Hoatt r- Gyl V,x "4j f)-ke 2,AN9V"<,s+G1 Addre$S: VVq 'Niel.;;,�E `.1 loot City/State/Zip: 'A�� e►� .t; al Phone#; Are you an'etapioyer? Check the it; ropriate box:• 4. trctt a general contractor and I Type of project(required): I i 1:�..T aru a an la crwith � � 6: ❑New construction � employees (&U.aad/or part-time', * have hired the sub-contractors 2.[] i ant-a.sole proprietor or parbaer listed on the attached sheet.. 7. ❑Remodeling � ship:and have no:employees , 'These sub-contractors have S. [j Demolition working.for me in tmy capacity employees and have workers' com inSsuancc.x 9 ❑Building addition fNo workers'comp. inmmee p• required:) 5. We are a corporation and its 10.[]Electrical repairs or additions officers have exercised their 3. l am.a homeowner doing all wo 11.[I Pltuatbing repairs or additions myself:'�I�io;wor�eis'comp. rat of exemption per MGL . 12 hoof repairs insurance required.] r c. 152,§1(4),and we have no employees. [No workers 13. Cther'���. comp.insurance required.] *Any applicant that chocks box#1 must also fill it the section below showing their workers'compot=don policy informnrion. *liotucowtim who SUbtait this n1Mduvit.indic 61 ►they arc doing alt work and then hire ouisidc eoutmctots must submit a now u£fid v it indicating such. ;contractors that chock ttis box tauet uftchod m utditiotid sheot.showing the name of the wb-contmotors and state whether or not those ernities have anployocs. If the.sub voatar tin bwm ea>ytoyo: ,Wy pause provide Choir workus comp.polieyautabor. 'r am an eaiployw rhvt compmsation insurance for my employees. Below is#be.policy and job site information. Insurance Company.Naiae: l .^�t llrac rl�u�c.�lce Ace�cw -- Policy#or Self-ins.Lie:0: W-C, 28,; i?O-00Q 0H a:� Expiration Dam: 04t / Job Site Addtcss: ooh kx) k NNW City/5mtc/Zip; 2, .kttach a copy of the workers'comps ►sation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required' nder 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 is prisonment,as well as civil.pcnaltics in the form of a STOP WORK ORDER and a fimt of up to$25o.o0 a day agaiw the viol i tor. Be advised that a copy of this statement may be forwarded to the Office of investigations of the DIA for insuranc: coverage verification. I do hereby certify uxder th pains i t 4hies of perjury at the irtforrn4tion provided above is true and correct r' �. i= tore• nett Phan # (.4t 3 .. at use only. Do not write in i its area,to be completed by city or town ofjiciul �`f� y� i h City or Town: Permit/License# ' issuing Authority(circle one ' 1.Boar of Health 2.Building D 1 partment 3.City/Town Clerk 4.Electricaf Inspector S.Plumbing Inspector it 6.Other t Person: phone#: ' Contact i� L/l, d OSI Mi. SarM01 1 +7: at SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Constructi�on�,Supervisor: Not Applicable 0 Name of License Holder: F'�� � W l�►Vl f N t S`+ ` 10-56o- License Nu ber ae- q Kilo Address OVOC \ Expiration Date lllr° Signature Telephone 9. Recilistered Home Improvement Contractor: Not Applicable ❑ RAO- ompany Name Regis ration N mber l l <�S//,.I: Address jJ G Expiration bah k 'G``�e-S CfT'1eIephoneL(�� 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.......Y 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 persons) you hire to perform work for you under this permit. The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Repiacernert windows Alteration(s) ❑ Roofing ❑ Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [0 Siding [O] Other[0] Brief De i tion of Pro osed Work: Alteration of existing bedroom Yes No Adding new bedroom Yes No � J 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 I as Owner of the subject property hereby authorize to act on my behal7in all matters relative to work authorized by this building per it applic tion. Signature of Owner Date U �J as Owner/Authorized Agent hereby declare that the statements and information on t e foregoing application are true nd accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Prin me ure o r/ gent Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be tilled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage % Open Space Footage 0/o (Lot area minus bldg&paved pal-king) #of Parking Spaces Fill: (volume&Location) A. Hasa Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DON'T KNOW 0 YES 0 IF YESs date issued: IF YES Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW 0 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 Q IF YES has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained 0 Date Issued: C. Do any signs exist on the property? YES 0 NO 0 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 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 Q NO O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Department use only _...... ty f Northampton Status of Permit: LW Building Department Curb Cut/Driveway Permit 21 Main Street Sewer/Septic Availabilit� 2 205 �,,J oom 100 Water/Well AvailabilitNorha pton, MA 01060 Two Sets of Structural Plans --, c�fte'�i1�&'s 240 Fax 413-587-1272 Plot/Site Plans m Other Specify ampton,PIA C1 060 APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 7 This section to be completed by office 1.1 Property Address: Map Lot Unit Zone Overlay District Elm St.District CB District SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name S2L(Print) /� ` Curregt'M_ Iin A�dr ss: �, A .OtO(z c, ��..i �\`'� Telephone Signature _ 2.2 Authorized Agent: G`0 S Name rint) Current Mailing Address: �115 igna a Telephone SECT N 3- ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only c m leted by ermit applicant 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. Total = 0 +2+ 3+4+ 5) Check Number ' � o This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date 1007 WESTHAMPTON RD BP-2016-0103 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:42- 110 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-2016-0103 Proiect# JS-2016-000185 Est.Cost: $856.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: LOWE'S 103003 Lot Size(sq. ft.): 19994.04 Owner: BAXA RUSSELL O&JUDITH L zonina: Applicant: LOWE'S AT: 1007 WESTHAMPTON RD Applicant Address: Phone: Insurance: 282 RUSSELL ST (413) 588-0270 WC HADLEYMA01035 ISSUED ON.712812015 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL REPLACEMENT SIDE ENTRY 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 7/28/2015 0:00:00 $40.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner