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18C-069 (4) 2 GLEASON RD COMMONWEALTH OF MASSACHUSETTS BP-2021-1928 Map:Block:Lot:18C-069- 001 CITY OF NORTHAMPTON Permit: Exterior Res PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2021-1928 PERMISSIONIS HEREBY GRANTED TO: Project# WINDOW Contractor: License: Est. Cost: 6200 LOWES HOME CENTERS INC 49918 Const.Class: Exp.Date: 12/09/2022 Use Group: Owner: MCNALLY JOHN D&CATHERINE Lot Size (sq.ft.) Zoning: URB Applicant: LOWES HOME CENTERS INC Applicant Address Phone: Insurance: l 000 LOWES BLVD (413)272-8931 0 WC016393105 MOORESVILLE, NC 28117 ISSUED ON:09/24/2021 TO PERFORM THE FOLLOWING WORK: REPLACE 6 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. Signature: .,2 cgi Fees Paid: $40.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner r The Commonwealth of Massachus is ���� '. ki , Board of Building Regulations and St ndar ~1C1P ITY "`a Massachusetts State Building Code, 0 C Sep li, US aa Building Permit Application To Construct,Repair Rertg e Or Demonsl , R 'sed ar 2011 One-or Two-Family Dwel ' �No°`sUrtoi, Q Th' ect' For Official Use On NgMnToN iNs„ Buildin,Permit Number:p�' t^ l 1L Dat pplied: Mq 07000c770Ns Evla &$.5 '�'c1-23--ZZI Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers a GL- 5oN (I,D 1.1a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check ifyes❑ SECTION 2: PROPERTY OWNERSHIP` 2.1 Owner'of Record: 1 N 1 A iPrdN 0 1 0/ Q NOqt ni Mc rya 11 � � /� to Name(Print) City,State,ZIP a GLs 0AI I)b Lir -s iS-.1 f Sdr iC I J. 10 e9, ;).cam-,., No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition ❑ Demolition 0 Accessory Bldg. 0 Number of Units Other 0 S city: Brief Description of Proposed Work Q 1"OV't -4 1 ivi)''mt%( (.v i n d'a't'S No S4-C ic4... .%I C Pp,h5 L SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 6 ),,Do 1. Building Permit Fee: $ Indicate how fee is determined: t ❑ Standard City/Town Application Fee 2.Electrical $ y pp ❑Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All F (.1,_ itilt° Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ G M 0 0 Paid in Full 0 Outstanding Balance Due: r - SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisorp License (CSL) °L(( it( ' -Pt✓� PAA PST_- yc2(N License Nuumber Expiration Date Name of CSL Holder l 5 _o D I List CSL Type(see below) t.' No.and Street Type Description p U Unrestricted(Buildings up to 35,000 Cu.ft.) ���uA f�(�N M Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 4r'i -�f 5 y 5 SoSoi ohms AprouDAe /4 ei0-61:1(41A 1 Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) f Y�C p /U�' � 01,11 `�is� t M, Gat)AS HIC IRegistration n Number l Expiration Date HIC company Name or HIC Registrant Name I L)OU (/ PS r)(. -'f) C.kr 5f-a Ph.-e'• 0 0 l awoS. CCIS No.and Street Email address City/Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes No .0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,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. Print Owner's Name(Electronic Signature) Date SECTION 7b: OWNER1 OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accur to the of my knowledge and understanding. ( 5 (14 ii/Y -(Y) -A / Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" City of Northampton Q-w a+ Massachusetts e4 . ,A . �`-4 DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: Location of Facility: 3 70)-- N-PlaN( I Jr Ptv0Pte&i0 aktvS The debris will be transported by: Name of Hauler: �4.11,1r, 1 NN Signature of Applicant: Date: �) a) 1 t; I • fi-Z:. ....-.... The Commonwealth of Massachusetts sta:,!'i TIT Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 WWW.mass.goildia - IS oikers Compensation Insurance AMdavit:BuildersiContractortalectricians/Plumbers. It)HE FILED WITH THE PEKM11-1 INC Alf11111011Eilt% Applicant Information Please Print Lev.ibli Natne(Elusiness,Orpnitation'lndivichnil): Louz.e5 1-40"e Cepl-c, 5 Address:_ City/State/Zip:Wi.)d reioil Ifi tx d-c(I/--) Phone#: 4(5 '''" e71--)0L_ Cr 7 r.... ) Are)114 as employer?Cheek the appropriate hot: Type of project(required): it3 I tun a employes with _ nnyees(full and ni partgiino• 7. a New coristruction 2.0 I am a aide proprietor or santricrahm and bast no employees veodting iiir me in K. 0 Remodeling any capacity.(No winters'comp.insurance reepured.) 9. D Demolition .1:j I ith1311l/rtliNYV.net doing all work myself,(No No workers'emir imitirrnee requtred.r io a Building addition 4.0 1 am a hompeou net and A AI be hums oontrAaUrl il.)1:4141dlila lilt work on my property, I will ensure Mat all contraLiora et 60:1 ildiVe WOltefS'curriperoatton LIISIMUEICe cir are auk II 0 Electrical repairs or additions proprtetors with no einployetst. 12.0 Plumbing repairs or additions .A-4-tarri a general contractor wall hive hued the sub-cuntracton6 listed on the attached Acta. 13.1:1Roof repairs fbcs.mib-cuntr4ctur,love employers and have WOIALTS'Comp.insurtuace•"' 14.E1 Other 6.0 We are it corporalion'and its officers have cservised their ugh]of exemption per Wit 152.tititi_and,..e k....2%<ISO ICTIVIll)iftS.(No worker.'tAttrip Ifl,Lil 3111:C required.] 'An),applicant that chixh.i lx...t 'l mat alai fill out the section ttekok abou ins then workers'eompentiation polsey Inforinatton 3 Hannianatters who mantat this affahic d nulacating tilcs.ate doing all work and then hire outside comma:lora mug subnut a new affidavit inifiLvAing stick :-Cestitraetors that a-tea this(sot must ati.wlied an ablational sheet showing the name of the Milb-ctsgrAelor,.:tad Stare*liether Ur riot those entities has. employee, If die soh-contractors has imply l no :toes.' ey insl pi...tile their A Ork CM.comp.politl numbs. ._. lam an employer that is providing workers'compensation insurance fir my employees. Below is the policy and job site information. Insurance Company Name: ik P) (2 4164 g VI/C Policy#or Self-ins.Lie.#: tA/C 4) I&176/-27 (i) 5 Expiration Date:LI— Job Site Address: ("D\ 6-LeOrsr-A, ff.-A cityistitc'Zip:it/siitiq404)147 P."' 01() 6 Attach a cops of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,*25A is a criminal violation punishable by a tine up to S1.500.00 andlor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a line of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. /do hereby certify under the pains nd mnalties of perjury that the information provided above is true and correct. &panne: C....----7' Datc Phone#: (4(-17 — (6.67'3 I Official use only. Do not write in this area,to be completed by city or fawn official. City or Town: PertniVLicense Ot Issuing Authority(circle one): I. Board of Health 2.Building Department 3.City/Toms Clerk 4.Electrical Inspector 5. Plumbing Inspector ti..Other : Contact Person: Phone it: ...... (MMI ACOE DATE DDIVYYY) R CERTIFICATE OF LIABILITY INSURANCE IMM/, 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 have ADDITIONAL INSURED provisions or 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 Marsh USA Inc. NAME. PHONE FAX 100 North Tryon Street,Suite 3600 (A/C.No.Extt: (A/C,No): Charlotte,NC 28202 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC U CN102776519-Loaves-SI-21-22 INSURER A:National Union Fire Ins Co.of Pittsburgh PA 19445 INSUREeDs Companies,Inc. INSURER B:Interstate Fire&Casualty Co 22829 Low'and subsidiaries INSURER C:AIU Insurance Co 19399 1000 Loaves Boulevard INSURER D:New Hampshire Insurance Company 23841 Mooresville,NC 28117 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: ATL-004976909-08 REVISION NUMBER: 10 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 ADDL SUeR POLICY EFF POLICY EXP LIMITS LTRINS!) WVo POLICY NUMBER (MM/DD/YYYY) (MM!DDIYYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR Self Insured-See below TO RENTED PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATEPO- $ POLICY JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ A AUTOMOBILE LIABILITY CA7030892 (AOS) 04/01/2021 04/01/2022 COMBINED SINGLE LIMIT $ 5,000,000 (Ea accident) A X ANY AUTO CA7030891 (MA) 04/01/2021 04/01/2022 BODILY INJURY(Per person) $ A AUTOS WNE ONLY SCHEDULED CA7030893 (VA) 04/01/2021 04/01/2022 BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ .— AUTOS ONLY _ AUTOS ONLY (Per accident) B X UMBRELLA LIAB X OCCUR USZ00024220 04/01/2021 04/01/2022 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000.000 DED RETENTION$ $ C WORKERS COMPENSATION WC016393105(AOS) 04/01/2021 04/01/2022 X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER D ANYPROPRIETOR/PARTNER/EXECUTIVE YIN WC016393104(ND,WA,WI,WY) 04/01/2021 04/01/2022 E.L.EACH ACCIDENT $ 2,000,000 OFFICER/MEMBER EXCLUDED? N N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 2,000,000 If yes,describe under 2,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Excess Workers'Compensation XWC1647266(FL) 04/01/2021 04/01/2022 (WC per statute) 3,000,000 A Excess Workers'Compensation XWC1647265 (AOS) 04/01/2021 04/01/2022 (WC per statute) 3,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule.may be attached if more space is required) Commercial General Liability policy is Self-Insured,effective 4/1/2021 to 4/1/2022. CERTIFICATE HOLDER CANCELLATION Lowe's Companies,Inc.and Sub sidaries SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1000 Lowe's Blvd THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Mooresville,NC 28117 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN 102776519 LOC#: Charlotte ACORD ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Marsh USA Inc. Lowe's Companies,Inc. and subsidiaries POLICY NUMBER 1000 Lowe's Boulevard Mooresville,NC 28117 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance TX Empoyers XS Indemnity Pdicy Number EPG000016700 Carrier:North American Specialty Pdicy Effective Date:01-Apr-2021 Pdicy Expiration Date:01-Apr-2022 Limits:$8,000,000 Each Occurrence I$35,000,000 Aggregate XS TX Employers XS Indemnity(Excess) Pdicy Number XC83095 Carrier:Evanston Insurance Company Pdicy Effective Date:01-Apr-2021 Pdicy Expiration Date:01-Apr-2022 Limits:$15,000,000 Each Occurrence/$35,000,000 Aggregate XS Workers'Compensation and Excess Workers'Compensation policies indude a self-insured retention of$2,000,000. General Liability The insured is self insured for$10,000,000 each occurrence for the period of 4/1/2021 to 4/112022. The Automobile Liability policy evidenced above is subject to addtionel self-insured retentions excess of limits shown for various perils covered. ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACC)REP DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 07/27/2020 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: Marie FTOUIX HUB INTERNATIONAL NEW ENGLAND LLC (aco."No.Ext): (413)750-7106 FAX No): E-MAIL ADDRESS: marie.proulx@hubintemational.com 600 LONGWATER DRIVE INSURER(S)AFFORDING COVERAGE NAICA NORWELL MA 02061 INSURER A: AIM MUTUAL INS CO 33758 INSURED INSURER B: MARK JODOIN INSURER C: JODOIN HOME IMPROVEMENT INSURER D: 15 JONES DRIVE INSURER E: EASTHAMPTON MA 01027 INSURER F: COVERAGES CERTIFICATE NUMBER: 557741 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 ADDL SUBR POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER (MM/DD/WYY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATEPO- $ POLICY JECTT LOC PRODUCTS-COMP/OP AGG $ OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE _ HIRED AUTOS _ AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X PER H PERTUTE ER AND EMPLOYERS'LIABILITY Y I N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 A OFFICER/MEMBER EXCLUDED? N/A N/A NIA AWC40070296132020A 08/31/2020 08/31/2021 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/Iwd/workers-compensation/investigations/. Sole proprietor has not elected coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Lowes Companies Inc and any and all subsidiaries ACCORDANCE WITH THE POLICY PROVISIONS. Mail Code A3ESS 1000 Lowes Blvd AUTHORIZED REPRESENTATIVE Cl Mooresville NC 28117 Daniel M.Crow)ey,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD • a Of title n'CerumTAll Fars&Et.ttness Reip.:S=t1U1; FOME MPROVtfJEt f4TRACTOR TYPE:oKi,vglial Rggistratto1 EsstirstEcia •0117 04;e?..r40 MAHIE..10 DO IN DiVAJODOUNI HOW-CelP ' T MARK S If: S Df4 E HAMP10&.MA 0, Und.,rseere'a'y CornmnweRiof Massatriti set ts " 0-ivIsiouQfF';ciressienal Litcetm.ire Board of Et Loicfmg Rooufaloans.and Standards ",,,5 cs.o4sa18 Expires' 12129;20:2 MARKS JODOIN 15 JONES DR EASTHAMPION MA 01027 Gimissoner 4_, t r/ram,,,%" 0, 14.,744eV?" ✓J- • - cc of Consumer Affairs&Business Reguiation HOME IMPROVEMENT CONTRACTOR TYPE: Individual Registration kowirati9n 159137 O4;03/ O 2 MARK '0DCAN 0/WA J O DON HOME IMPROVEMENT MARK S JUD0IN 1 ,..,IONEy. DR `ASTH . PION, MA 01027 Undersecretary ty 3 ... - ii Search. f.". Fe tt.t.Itt. Vsw fov,..mte. racis tiel,D PUt)I1C Safeyt , - - 0Mass. , . . ,,, ...„‘„ ....., .... Lictmace Details limns',a phle hdannuffmk ''' ' ''''...''''''',i,diVi"' , '., ' 1,1hnhe Address infonnation Xz, 4;. ',,,,,:•'', '>..,.S''Z'... otv eastoarvon state MA • ''''XA.,,,..,,'..''',..,,,-'.',.'..-.":".., 27COde. 01027 :'...,„:,, ',:".'..",„VOC, ''""?....‘<,',4'... cantry untied Statea ' ' „,,,z.,,-.7,r''','...,.•,''',.','-*,, • •,,.',4,4,1,,,vii • . tirettor Informsflon ,• uceese NO. C3.049918 Lwense Type VVVV Proteson rt7igensesv ".". lirn 7:,:vt..,,,,it,,,iior,,.,z6;:•-1'o-t,‘<,i,,,:o•i•A.,l;#it2 zletzac ,? A oday't haft ItIOY1021 Socondary Loom.Type . stasis c;oange ReOSOn t'f•ose Renewal '-:,.,.,2:"<,.'-',. .;,,.-ViVt& "4 No Preloqutsoe information , ... ..... ,No ANAMON DOrlentS ...,,.. ,. . ,.... •i' .,,''',' '''''''''' ' SAI,'.nALW,i:a.,.•.o':,..S.',",..!1?;,%•, ,.(°:::Ulakt414*,,&.'".3.',:,'„:!'k,„: , :.'' '". . -, , ' ' :',,1 ‘`‘,'.',i0,.,Q0't',. V!,',:,;!'1,'''...:,10.4",,,,,,'.i',.<...5i4:',%,k!:; rru�r��airut�>l�/f � /4114x'.)«,1,-/ : Office of Consumer Atiairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:Socc.ernent Card MiLe' Egg) gn 688 10 17 2021 ta�ssa LOWE`S HOME CEN-EHS,LLC CHRISTOPHER MIME 'zap StkRV LOVES BLVD Undersecretary SERVICES COMPLIANCE MOORESVILLE.NC 28117 • PSE IMS — Sold Job Cover Sheet 5- LOWE'S SERVICES Directions: Fill out the below form completely and upload with all required documents(outlined below).U Store Number: ) //6 Customer Name: /v)4 Mr/I a I(y PROvider Company Name; 12.9d0'1 Required Documents for Sod Job Below documents must be included for Installer to begin customer project installation. Failure to provide ail required documents may result in rejections. CSold Job Cover Sheet(this document) Signed Customer Contract I • Includes all pages from the state-specific contract in Adobe Sign • Uploading partial Contracts will result in a rejectionSold Material List • For SOS Product Only—M20/Paradigm or appropriate Vendor order sheet I If applicable: ontract Change Order Z44C Jngineered Drawings for Decking Projects PSEq-_,Required Actions; I have confirmed wit ROvider If a permit is a required,and if so,wrs sold on invoice: I have c me with t ROvider if lead Safe Practices will be required on the job,and if so,were sold on invoice:ii By signing this document, I am confirming I have taken all required actions and uploaded the necessary documents to the IMS Detail for this customer's project: 7.7":/ ,,,. I • LOWE'S' MASSACHUSETTS SERVICES SOLUTIONS)NSTALLED SALES CONTRACT �w YT'SAUTHORIZEUREPRESENTATIVE .t: CATE CUSTOlvIERNAf'1E Dan Flaherty 2054066 7/30/202 John Mcnally STORT.NC iT t E.T ADDRESS STREET ADDRESS 1916 282 russet! st 2 Gleason rd Clf'• STATE LiF CITY ESTATE ZIP Hadley MA 01035 Northampton 'MA 01060 OM I 413-325-3625 (41 ) 575-1524 -r" EMAIL' daniel.flaherty@store.lowes.com jdmp1210@gmail.com Cr�TRICTQR KINK'R LOWE'S REPRESENTATIVE LICENSE zr CREEDIVJDEBIT CHECKLI LCC CARE. DIET CARD .a,4c,C,I 43519.I NA (If Applicable) & This is only a quote for the merchandise and services printed below Lowe's does not offer services to palni, seal or stain fences. This becomes an agreement upon payment and issuance of a Lowe's receipt,upon pay-ment,the entire agreement,including the specifically 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 THIS ENTIRE DOCUMENT, INCLUDING THE "NOTICES," "TERMS AND CONDITIONS." AND "ADDENDUM" CONTAINED WITHIN THIS CONTRACT ON THE FOLLOWING PAGES BEFORE SIGNING. ATION STRIA TAL)URLSK C , 2 Gleason rd Northampton MA 01060 MERCHANDISE AND INSTALLATION SUMMARY(LE. ITEM NUMBERS,COLORS.DIMENSIONS,CONSIDERATIONS): Removal of six wood windows, Installation of Pella 250 vinyl windows, white/white, clasp locks (white), full screens, no grids, dual pane glass, Argon filled, Low-E. Two pocket style replacement double hung windows one full tear out conversion - from double hung to single wide casement over kitchen sink. one full tear out of picture with double hung flankers, replace with one factory mulled picture with double hung flankers ( Hankers 28" wide) New interior colonial primed finger-joined casing and exterior finger joined primed brick mold for full tear outs. primed interior stops for pocket CONTRACT TOTAL $6,130.00 (INCLUDING TAX) Work is to commence upon reasonable availability of Contractor andfor any special order or customer made Good(s) which is anticipated to be 09/23/2021 [fill in date]. Estimated completion date is 10/23/2021 [fill in date]. COVID-19 has affected manufacturers and labor markets, with the production of fence, deck and generator material experiencing significant delays and installation start dates that are at least four(4) months away in most cases. Please also note that weather can delay start dates for these and other exterior categories,particularly in colder climates. Rev.03/02/2021 LOWE'S SERVICES CONTINUATION OF MATERIALS AND WORK TO BE PERFORMED(LE. ITEM NUMBERS, COLORS, DIMENSIONS, CONSIDERATIONS): { Rev.03/02/2021 2 - LEAD SAFE INFORMATION. Federal and applicable state laws require tha'You be provided with a lead hazard information pamphlet such as the Renovate Right: Important Lead Hazard Information for Families, Child Care Providers and Schools. By signing this Contract,You acknowledge having received a copy of this information pamphlet before work began informing You of the potential risk of the lead hazard exposure from renovation activity performed in Your dwelling unit or facility. A copy of the pamphlet is available at the following website: www.lowes.com/EPARRP For more information see: https:iIwww.epa.govileadilead-renovation-repair-and-painting-program. NOTICE OF ARBITRATION AGREEMENT: This Contract provides that all claims by Customer or Lowe's will be resolved by BINDING ARBITRATION. Customer and Lowe's GIVE UP THE RIGHT TO GO TO COURT to enforce this Contract (EXCEPT for matters that may be taken to SMALL CLAIMS COURT). Lowe's and Customer's rights will be determined by a NEUTRAL ARBITRATOR and NOT a judge or jury. Lowe's and Customer are entitled to a FAIR HEARING. But the arbitration procedures are SIMPLER AND MORE LIMITED THAN RULES APPLICABLE IN COURT. Arbitrator decisions are as enforceable as any court order and are subject to VERY LIMITED REVIEW BY A COURT. FOR MORE DETAILS: Review the section titled ARBITRATION AGREEMENT, WAIVER OF JURY TRIAL AND WAIVER OF CLASS ACTION ADJUDICATION found in the Terms and Conditions of this Contract. NOTICE REGARDING ARBITRATION AGREEMENT FOR CLAIMS COVERED BY M.G.L C. 142A: LOWE'S AND OWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT LOWE'S HAS A DISPUTE CONCERNING THIS CONTRACT, THAT LOWE'S MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUTIVE OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATIONS AND THE OWNER SHALL BE REQUIRED TO SUBMIT TO SUCH ARBITRATION AS PROVIDED IN M.G.L. c.142A. THE SIGNATURES OF THE PARTIES BELOW APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE RESOLUTION INITIATED BY LOWES, PURSUANT TO M.G.L. c. 142A. THE OWNER MAY BE PERMITTED TO INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THIS SECTION IS NOT SEPARATELY SIGNED BY THE PARTIES. If customer has a complaint which cannot 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 tie 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 this Notice is signed and dated by Lowe's and Customer. All claims by Customer or Lowe's concerning 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 as set forth in the Terms and Conditions. By: Cate: 07/23/2021. Lowe's Authorized Representative I BY a•-- Cate: 07/30/2021 Customer PRICE CALCULATIONS. If this Contract includes Goods and related Installation Services sold by unit of measurement, such as per square foot, the Price may include more Goods than the actual measurements of Your project area. The Price includes the total amount of Goods required by Lowe's to fulfill the Contract (including surplus materials and overages) (together the "Estimated Product") and the Installation Services required based upon this total amount of Goods. For instance, a 120 square foot room may require 140 square feet of carpet to properly match the carpet seams, pattern, or unique room characteristics, and the Price would include Installation Services based upon the 140 square feet of carpet. The total amount of Estimated Product is based upon the total Goods recommended by the Installer, based on the Installer's assessment of unique characteristics of Your project. If any usable Goods are left over, Lowe's may, at its discretion, initiate a Price adjustment. Lowe's will not adjust the Contract Price for the related Installation Services. By signing this Contract, You acknowledge You are aware of Your project area measurements and the amount of Estimated Product,and that the Estimated Product may exceed Your actual project area. If Your project includes the installation of flooring materials, by signing this Contract You further acknowledge having received a completed Flooring Detail Diagram (the "Diagram") prior to execution of this Contract. Upon request, Lowe's can provide You with additional copies of the Diagram, which identifies the square footage of Your project area and the square footage of the Estimated Goods. PHOTO RELEASE. By signing this Contract, You grant to Lowe's, its representatives, and Installer the right to take and use photographs, videos,or other representations of the Premises before and after the Installation Services and all work performed at the Premises related to this Contract(the"Content"). Lowe's irrevocably keeps all rights (including the copyright),title, and interest in the Content for use in all markets and media, worldwide, in perpetuity. Lowe's can use the Content, in any form or medium, internally for any purpose(e.g., customer service, planning, and claims. NOTICE REGARDING PAYMENT SCHEDULE. If the Contract Price is $1,000 or less, payment of the Price by Customer to Lowe's is due in full upon execution of this Contract. If the Contract Price exceeds $1,000, Customer shall use the following payment schedule: (1) Deposit of $ $2,043.00 [enter 1/3 of the contract Price] to be paid upon signing this Contact. Any deposit collected at the time this Contract is signed will not exceed one-third (1/3) of the Contract Price; Rev.03/02/2021 3 (2) Payment of $ $3,987.00 [enter 2/3 of the contract Price minus $1001 to be collected upon or after the commencement of work. Customer authorizes Lowe's to charge Customer's credit card, or deposit Customer's check, for the amount of the payment indicated in this section anytime upon or after the commencement of the work;and (3) Final payment of$100 to be paid upon completion of the Installation Services to both parties' satisfaction. NOTICE OF CUSTOMER'S RIGHT TO CANCEL. If this is a "door-to-door sale" as defined by 16 C.F.R. §429.0(a), or if this Contract is signed by Customer at a place other than the address of the seller as set forth in M.G.L. c. 93 § 48, You, the Customer, may cancel this Contract at any time prior to midnight of the third business day after the date of this transaction. See the notice of cancellation form sent as an attachment to this Contract for an explanation of this right. By executing this Contract, Customer acknowledges receipt of two (2) completed copies of the Notice of Right to Cancel form and certifies Lowe's has informed Customer orally of his or her right to cancel. NOTICE TO CUSTOMER. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Lowe's Home Centers, LLC EXECUTED ON 30 , DAY OF July 2021 LOWESAU1HORIZEDRFPRESEN SIGNATURE OWNER'S SIGNATURE CO-OW rJERSIGNATURE s;Em Q 6!ttiniIYt 013fl,iC?I MI,' Customer acknowledges receipt of a true copy of this contract which was completely filled in prior to Customer's execution hereof. Rev 03/02/2021 4 TERMS ANCVCON Lowe's Installation Contract defines what You can expect in Your installation experience with Lowe's, what Lowe's expects in return, and how You and Lowe's will resolve any differences. It is a legal agreement. By signing this';Contract, clicking "I agree,' or by accepting Goods or Installation Services You are agreeing to be bound by this Contract. IF YOU DO NOT AGREE TO ALL OF THE TERMS OF THIS CONTRACT, YOU MUST NOT SIGN THIS CONTRACT, CLICK "I AGREE', OR ACCEPT THE GOODS OR INSTALLATION SERVICES. 1. COMMON DEFINITIONS. Capitalized terms used in this Contract will either have the following stated meanings or will be defined throughout the Contract. al "Contract" means Lowe's Installation Contract and includes (a)any applicable State Addendum, (b)these Terms and Conditions, (c)any documents expressly referencing and made a part of this Contract, e.g., fully executed Change Orders,or incorporated by reference in the Contract(d)the cover page,the Merchandise and Installation Summary, and Notices, and (e)any sketches, materials lists, floor plans, or specification sheets provided by Lowe's. If there is any inconsistency between these documents, the first document to ippear in this definition shall take precedence; i.e., any State Addendum shall take precedence, whether supplementinc or modifying, over any conflicting provision of these Terms and Conditions, and so on. The Contract does not include any correspondence, advertisements, quotes, or estimates. The Contract is the entire agreement between You and Lowe's concerning the Goods and Installation Services. The Contract replaces and supersedes all earlier written agreements and all oral agreements, whether earlier or at the same time as this Contract, concerning the Goods and related Installation Services. b) "You", "Your(s)", and"Customer all mean the person executing this Contract to purchase Installation Services. c) "Goods" means the physical items You are purchasing in connection with the Installation Services. A list of the Goods appears on the Merchandise and Installation Summary. d) "Installation Services" means the work, labor, and other services necessary to install the Goods. Some examples of Installation Services include delivery, handling, return, and selection and placement of Goods. e) 'Installer" means the independent contractor Lowe's arranges to perform the Installation Services. Installer will be licensed when legally required, and will direct, control, and perform the Installation Services directly or through its employees, agents, and subcontractors using tools and equipment Installer provides. Lowe's does not employ Installer. its employees, or its agents or subcontractors. 1) 'Lowe's" means Lowe's Home Centers, LLC, a North Carolina Limited Liability Company located at 1605 Curtis Bridge Road, Wilkesboro, NC 28697. Lowe's Employer Identification Number i3 56-0748358. g) "Premises" means the Installation Address You identify where the Installation Services will occur. h) "Price"means the Contract Total stated on the Merchandise and Installation Summary and is the complete payment due for the Goods and Installation Services. 2. SCOPE. This Contract is between You and Lowe's for the purchase of Goods and Installation Services. Lowe's does not perform Installation Services, but arranges for Installer to do so directly or through Installer's employees, agents, or subcontractors. Installer is an independent contractor and is not ender the supervision or control of Lowe's. Installation Services do not include architectural or engineering services. Installer will complete Installation Services. subject to any changes, in substantial conformance with the Merchandise and Installation Summary. Lowe's reserves the right to terminate or rescind this Contract if Lowe's decides that any portion of the job is beyond the scope of the Installation Services that Lowe's originally contemplated. 3. FXCLUSIONE. Neither Lowe's nor Installer is responsible for start o-finish delays resulting from events beyond their control including but not limited to: Change Orders,acts of nature,governmental actions, manufacturing or delivery delays or damage to merchandise caused by third parties,labor strikes or unrest, Your credit or financing,any incorrect information You provide, legal encumbrances on Your property, Your property's nonconformance with zoning requirements or building code requirements, hidden or unforeseen physical or hazardous conditions (including but notimited to, environmental hazards such as mold,asbestos,lead paint,unsound structures or points of attachment)at the Premises,or Your noncompliance with this Agreement. None of these delays will constitute a breach of this Contract by Lowe's or Installer. Lowe's reserves the right to terminate this Contract and/or require Installer to discontinue Installation Services given any of the conditions listed above. 4. PRICINQ. The Price includes most applicable taxes, permit fees, and other costs reasonably known to Lowe's at the time You sign the Contract. When the initial Price does not include all applicable charges,for example, if You order online,Lowe's will contact You to obtain further payment. If Lowe's requests an increase in the Price after You sign the Contract You will have the opportunity to cancel any unperformed portion of the Contract and receive a refund for that portion. The Price includes only those Goods and Installation services necessary to complete this Contract. 5. GOODS. Title to Goods does not pass to Customer and remain the property of Lowe's until Goods are installed in Customer's home, building, or on Customer's property. Customer agrees Contract is being offered for the total Price. 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, may allow all or part of the unLsed, receipted surplus materials to be retained by the Customer. Rev.03/02/2021 5