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22B-055 (2) BP-2022-0363 56 SPRING ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 22B-055-001 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-2022-0363 PERMISSIONIS HEREBY GRANTED TO: Project# WINDOWS Contractor: License: Est. Cost: 12594 LOWES HOME CENTERS INC 112271 Const.Class: Exp.Date:09/01/2023 Use Group: Owner: ARCHAMBAULT JOAN M Lot Size (sq.ft.) Zoning: WP/WSP Applicant: LOWES HOME CENTERS INC Applicant Address Phone: Insurance: 1000 LOWES BLVD (413)272-8931 O WC016393105 MOORESVILLE, NC 28117 ISSUED ON:04/11/2022 TO PERFORM THE FOLLOWING WORK: 10 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: Gas: Final: Final: Rough Frame: Rough: Fire Department Driveway Final: Fireplace/Chimney: Final: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: V • >9 . 51-11 • Fees Paid: $40.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner 5maill / AA''' '.1-- , A. The Commonwealth of Massachusetts :t ''u Board of Building Regulations and Standards FOR , Massachusetts State Building Code, 780 CMR M CIPALITY -. : USE Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number:B e ?I" s0,3 e Applied: 4,--VI 1....) ' gSS LI-11'2bza Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1,1 Property d ess: 1.2 Assessors Map& Parcel Numbers sty ibis this an accepted street?yes no Map Number Parcel number 1.3 Zoning information: lA Property Dimensions: Zoning District Proposed Use -- Lot Area(sq It) Frontage(Ii) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L e.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private 0 Zone: — Outside Flood/,one? Municipal 0 On site disposal system U Check ifyes❑ SECTION 2: PROPERTY OWNERSHIP' 2..1 Wert of.R ►rd: N 'no City tate,ZIP 8 S�✓M .. f. 413, `1 9176 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check it that apply) New Construction 0 Existing Building U Owner-Occupied 0 Repairs(s) V Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. Number lofUnits 0 Specify: Brief Description of Pro . t Work2; ��M/7' � I f',� aer l YlI tlj,()s4 n 0 r a1,0oa_ ae l 1l A SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs; Official Use Only (Labor and Materials) I. Building $ )o(.�94, ) 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ 0 Standard City/Town Application Fee 0 Total Project Cost(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: S 4. Mechanical (HVAC) $ List: 5.Mechanical (Fire Suppression) $ Total All Fees: 5 r1) Check No. ri jChcck Am)unt:1), LA Cash Amount: 6.Total Project Cost: $ )c9156111' 0 Paid in Full 0 Outstanding Balance Due: w SECTION 5: CONSTRUCTION SERVICES 5.1 Cons u/c�tion Supervisor/ L'eense(CSL) \L�t la#u)/ c i f L� Lic ense Number' l:xpirauo Date Name of CSL l fold 0 1 Pl4'(bo Q 1L.r List Cst.Type(see below) No.and Street Type Description C i A D � . -1�, 6160. 1 '(1�I6 . 1 1LJ Unrestricted(Buildings up to 35,(H)1)cu.ft.).) City/Town,C f3-taCte,ZIP Restricted I&2 Family Dwelling M Masonry RC Rooting Covering WS Window and Siding �/Q�� n / d/� SF Solid Fuel Burning Appliances 7/� [/��� © bt< I Insulation Telephone ail address VI/) i Mk D Demolition 5.2 Registered HomeImprovement Contractor/J IC) 1 �6�p 7 LOIOZ6 ��Y1/ LJ '7 HIC Registration Number E piration Date I11('('om V me i11C saran '� _ is hi 'd, rho J�u.0 )ix . N Q (!f-0"le i �/V/Ga/0/17 7P- /3rJ9 / t:tnailaddress elm City own,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 V 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 Kie � l/k h4-J `' -' to act on my behalf,in all matters relative to work authorized by this building permit application. kl e ha v»beu « — @cnt n9 rf—. �I) 7 z2.. r Owner's Name(Electronic Signature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information conta. ed in this application is true and accurate to the best of my knowledge and understanding. /1iavL I t/ --- y L� Print Owner's or Authorized Agent's Name(Electronic Signature) I 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(flIC)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 halfibaths Type of heating system Number of decks/porches _ Type of cooling system__ Enclosed Open 3. "Total Project Square Footage"may he substituted for`"Total Project Cost" City of Northampton �O0.t H_•MP)py,.. �5 . • SIC �'' •" Massachusetts S �� „ • DEPARTMENT OF BUILDING INSPECTIONS s ` ' 'r'• 212 Main Street • Municipal Building vb D � • Northampton, MA 01060 ssYn 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: rcSaS 1 r� f J , /61M 0/(P/6 The debris will be transported by: Name ofHauler:I r: / ti.20� Signature of Applicant: Date: 477/2, ___ Corninon veva ith of Mats 1..:. :sr,trs III Qn►tt n of Pr of morionat t. rf% i�e Board of Budding Regutattons a?II Starer,latts construe/ CS 112271 !xpirefi: O9i01/2U21 RAILAN M FERREIRA 401 PLEASANT STREET LEICESTER MA 01524 ca Cotnrnissatoraer CL `- . ... . .. a.....0.,,liettr,ii......t.,-.,t,-,,..,-. Public Safety ► • ,t *NJ Mass.Gov Home State Agencies Licensee Mass. Licensee Details Demographic Information Full Name: RAILAN M FERREIRA Owner Name: l it ense.‘ddress Information City: LEICESTER State: MA Zipcode: 01524 Country. United States License Information License No: CS-112271 License Type: Construction Supervisor Profession: Building Licenses Date of Last Renewal: 8/9/2021 Issue Date: 6/8/2018 Expiration Date: 9/1/2023 License Status, Active Today's Date: 9/9/2021 Secondary License Type. Doing Business As: Status Chance Reason: License Issuance Prerequisite Information No Prerequisite Information No Available Documents C Clow window J • /le Oo/mizo ipeee�i/0 / afJeleZGie// Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration i ype: Supplement Card LOWE'S HOME CENTERS,LLC Re 148688 1000 LOWES BLVD Exxppiration:ration: 10/17/2023 SERVICES COMPLIANCE MOORESVILLE, NC 28117 Update Address and Return Card. SCA 1 0 2CM-05,17 •120f4-€'61 C6iretitr rTfld"/s 61(tfStntIelftncJdfit4on HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Supplement Card before the expiration date. If found return to: Registration Expiratiofl Office of Consumer Affairs and Business Regulation 148688 10/17/2023 1000 Washington Street -Suite 710 LOWE'S HOME CENTERS,LLC Boston,MA 02118 RICHARD CHALONE 1 rU3(201/4... 1000 LOWES BLVD -•". — — SERVICES COMPLIANCE UndersecretaryNot valid without signature MOORESVILLE.NC 28117 The Commonwealth of Massachusetts Department of Industrial Accidents wilt— Officecill _ of Investigations —'"iy(IL Lafayette City Center -_ r`/ 2 Avenue de Lafayette. Boston,MA 02111-1750 y wwwmass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le!ibly Name(Business/Organization/Individual: LOWES HOME CENTERS Address: 1000 LOWES BLVD City/State/Zip: MOORESVILLE,NC 28117 Phone #: 860-505-9314 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ® I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. []Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.t 9. El Building addition required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13. XO 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. $Contractors that check this box must attached an additional that showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they mud provide their workers'comp policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: AIU INSURANCE COMPANY Policy#or Self-ins. Lic. #: WC035901712 A�OSS Expiration Date: 4/1/2023 Job Site Address. 30 /) Y i J,Y . City/State/Zip: bitve A b)1)&09, 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 Investigati► T. of the DIA for insurance coverage verification I do hereby under the pains,nd 'en, ,'es of i erjury that the information provided above is true and correct / l0 Signature: / 1 / �� , Date: 7 Phone#: 860-505-9314 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License # Issuing Authority(check one): 10Board of Health 20 Building Department 30City/Town Clerk 4.0 Electrical Inspector 5Elumbing Inspector 6.0Other Contact Person: Phone#: AC4)RL7 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDiVYYY) 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 NAME_ Marsh USA Inc. PHONE rFAX WC.North Tryon Street,Suite 3600 C.No.Ext1: I(A/C.No): . Charlotte,NC 28202 EMAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC CN102776519-LowesSl-22-23 INSURER A:National Union Fire Ins Co.of Pitts!)urao DA 19445 INSURED INSURER B:Interstate Fire&Casually CO ------ 22829 Lcwe's Companies,Inc. and s.lbsidiaries INSURER C:AIU Insurance Co 19399 1000 Lowe's Boulevard INSURER Mooresville,NC 28117 D` . - INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-004976909-11 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 INSDADDL WVD: POLICY NUMBER (NMIDDIYYYY► RIMIDO/YYYY) LIMITS LTR NSD,YWD'� COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR Self Insured-See below 'SAMAGE TO RENTED - - PREMSES(Ea ocanarca) $ MED EXP(My one person) S PERSONAL&ADV INJURY S GENT AGGREGATE LIMIT APPLES PER GENERAL AGGREGATE S POLICY ,EC LOC PRODUCTS-COMP/OP AGG S OTHER: $ A AUTOMOBLEUNARY CA7030892 (AOS) 04/01/2022 04/01/2023 COMBINED SINGLE LIMIT $ 5,000,000 (Ea accident) C X ANY AUTO CA7030891 (MA) 04/01/2022 04/01/2023 BODILY INJURY(Per person) $ A OWNED SCHEDULED CA7030893 (VA) 04/01/2022 04/01/2023 BOD)Ly WNJURy(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) B X UMBRELLA LIAR X occuR USZ00024220 04/01/2022 04/01/2023 EACH OCCURRENCE $ 5,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE S 5,000,000 DED RETENTION$ $ C WORKERS COMPENSATION WC035901712 (AOS) 04/01/2022 04/01/2023 X PER OTH- ER AND EMPLOYERS'LIABILITY Y/N WC035901713 (ND.WA,WI,WY) 04/01/2022 04./01/2023 STATUTE2,000,000 ANYPROPRIETOR.PARTNER/EXECUTIVE EL.EACH ACCIDENT S OFFICERMEMBEREXCLUDED? N N/A (Mandatory In NH) EL.DISEASE-EA EMPLOYEE S Z000,000 II yes.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 2,�'� A Excess Workers'Compensation XWC1647325 (FL) 04/01/2022 04/01/2023 (WC per statute) 3,000,000 A Excess Workers'Compensation XWC1647324 (AOS) 04/01/2022 04/01/2023 (WC per statute) 3,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Add tional Remarks Schedule,may be attached If more space is required) Commercial General Liability policy is Self-Insured,effective 4/1/2022 to 4/112023. CERTIFICATE HOLDER CANCELLATION Lowe's Companies,Inc.and Subsidiaries 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 7freG z44Lr I1Sr� `7eic- ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN102776519 LOC#: Charlotte AcoRo ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Marsh USA Inc. Lowe's Companies.Inc. and suosidianes POLICY NUMBER 1000 Lowe's Boulevard Mooresville,NC 28117 CARRIER 'I 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 Workers'Compensation and Excess Workers'Compensation policies include a self-insured retention of$2.000,000. General Lab ly Tie insured is set insured for$10.000,000 each occurrence for the period of 4/1/2022 to 4/1/2023. The Automobile Liability policy evdenced above is suoiect to addit onal sel(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 The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 •r" Boston, MA 02114-2017 www.mass.gov/dia \G:A:kers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMUTING AUTHORITY. .applicant Information Please Print Legibly' Name (Business/Organization/Individual): OMEGA BUILDING COMPANY INC. Address: 516E FRANKLIN STREET City./State/Zip: WORCESTER,MA 01604 Phone#: 508-314-9431 Are you an enpioye?Check the appropriate bat: Type of project(required): 1.0 I am a employer with 2 employees(full and/or part- i ❑ New construction 20 I am a sole proprietor or partnership and have no employees working for me in t ❑ Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑ Demolition %-❑I am a homeowner doing all work myself.[No workers'comp.insurance required.] 10 ❑ Building addition ❑I am a homeowner and will be hiring contractors to conduct all work on my property.I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5❑I am a general contractor and I have hired the sub-contractors listed on the attached eet.These sub-cuntractuis have employees and have workers'comp.insurance.' 1 CI Roof'epa ins str 6.0 We are a corporation and its officers have exercised their right of exemption per MGI c. 1-1.°Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 'Contractors 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. If the sub contactors have employees.they must provide the r workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees.Below is the policy and job site information. Insurance Company Name: A.I.M Mutual Insurance Company Policy#or Self-ins. Lic.#: 6262634 �{� Expiration Date44i't 2/1/2022 / / (�/� Job Site Address: �lS —'1' � S • City/State/Zip- ` _,/ 14 V I C11 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 1b2 25A is a criminal violation punishable by a tine 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. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. f do hereby certify under 7.aiinns�and penalties of perjury that the information provided above is true and correct. Signature: �- _ : Date. Phone#: 5b8-314-9433' Official use only. Do not write in this area,to be completed by city or town official. 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#: p ACORL)(ft CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDDIYYYY) 1/20/2022 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 NAME: Nachi Souza Shea Marsh &McLennan Agency LLC-New England PHONE FAX 100 Front St, Ste 800 (A/C.No.Ex1J 888-850-9400 (A/C.No):866-795-8016 Worcester MA 01608 ADDRESS: MMA.NewEngland.CLines@marshmc.com INSURER(S)-- IL AFFORDING COVERAGE NAM % INSURER A:Covington Specially Insurance Company 13027 INSURED OMEGABUILDI NSURERa:Nautilus Insurance Company _ 17370 Omega Building Company, Inc. 516b Franklin St INSURER C:Associated Employers Co 99999 Worcester MA 01604 NSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1245085827 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 SUER POLICY EFF POLICY EXP L�� LTR •64D WVD POLICY NUMBER (MMIDWYYYYI IIMMIDDIYYYY) A X COMMERCIAL GENERAL LIABILfTY Y L326000295 6/132921 6/13/2022 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE ,_.X OCCUR PREMISES occurrence) S 100.000 MED EXP(Any one person) $5,000 --- PERSONAL&ADV INJURY $1,000,000 GEM AGGREGATE LIMIT APPLES PER: GENERAL AGGREGATE $2,000,000 POLICY X JJEC LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY (Per accident) S e UMBRELLA UM OCCUR AN1241436 6/13/2021 6I13/2022 EACH OCCURRENCE $3.000,000 X EXCESS L.IAB ^ CLAIMS-MADE AGGREGATE $3,000,000 DED I RETENTION$ $ C WORKERS COMPENSATION N 5024321 2/12022 2/1/2023 X ST X AND EMPLOYERS'LIABILITY ANYPHOPHIETOR/PARTNE R.EXECUTIVE Y/N ACCIDENTN/A El.EACH ACCENT $500,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) EL DISEASE-EA EMPLOYEE S 500,000 If yes.descnbe under DESCRIPTION OF OPERATIONS below EL DISEASE-POUCY LIMIT $500,000 i • DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Certificate Holder is included as additional insured,on a primary and noncontributory basis,as respects the general liability if required by written contract. Waiver of subrogation applies in favor of the additional insured as respects the general liability if required by written contract. Lowe's Companies Inc&any&all subsidiaries are included as additional insured,on a primary and noncontributory basis as respects the general liability if required by written contract,for work performed by named insured.Waiver of subrogation applies in favor of the additional insured as respects the general liability if required by written contract.30 day notice of cancellation except 10 day notice for nonpayment. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Lowe's Companies Inc&any&all subsidiaries Mail Code: ISI 1000 Lowe's Blvd Mooresville NC 28117 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Store 2386 LOWE'S OF WARE, MA 348 PALMER ROAD WARE, Massachusetts 1082 Low Els° Contract Prepared for: Joan Archambault 56 spring st florence, Massachusetts 01062 4132759778 Prepared by: Steven Lockwood (413)277-4000 steven.lockwood@a lowes.corn Store 2386 LOWE_S OF WARE_MA-Contract-295370-Page 1 of 29 LowE's MASSACHUSETTS SERVICES SOLUTIONS INSTALLED SALES CONTRACT LOWE'S AUTHORIZED REPRESENTATIVE SALES ID DATE CUSTOMER NAME Steven Lockwood 3070929 02/15/2022 Joan Archambault SI ORE NO. SIHEEI ADDRESS SIREEI ADDRESS 2386 348 PALMER ROAD 56 spring St CITY STATE ZIP CITY STATE ZIP WARE MASSACHUSETTS 1082 florence Massachusetts 01062 TELEPHONE TELEPHONE (413)277-4000 4132759778 EMAIL EMAIL steven.lockwood@lowes.com noreply@lowes.com LOWE'S CONTRACTOR LICENSE s LOWE'S REPRESENTATIVE LICENSE e CREDIT/DEBIT CHECK LCC CARD GIFT CARD h148688(home improvement contractor),3070929 1,35194 This is only a quote for the merchandise and services printed below.Lowe's does not offer services to paint,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. INSTALLATION STREET ADDRESS CITY STATE ZIP 56 spring st florence Massachusetts 01062 MERCHANDISE AND INSTALLATION SUMMARY (I.E. ITEM NUMBERS, COLORS, DIMENSIONS:CONSIDERATIONS): Windows Product Store 2386 LOWE_S OF WARE_MA-Contract-295370-Page 2 of 29 Windows Project Installation of 10 Pella Lifestyle wood windows. Lifestyle I Double Hung 130.5 X 36.75 I Without HGP Putty. 1: Non-Standard SizeNon-Standard Size Double Hung Equal. Frame Size: 30 1/2 X 36 3/4. Lifestyle Series. General Information: No Package Without Hinged Glass Panel Northern Clad Pine 5" 3 11/16" Gray. Exterior Color/ Finish: Standard Enduraclad Putty. Interior Color/ Finish: Unfinished Interior. Glass: Insulated Low-E AdvancedComfort Low-E Insulating Glass Argon Non High Altitude. Hardware Options: Cam-Action Lock Satin Nickel No Limited Opening Hardware Order Sash Lift No Integrated Sensor. Screen: Full Screen Putty InViewTM. Performance Information: Combination >t 1111111.14 Combination SHGC 0.29 SHGC 0.29 VLT 0.55 CPD PEL-N-35-00430-00001 Satisfied Energy Star Zones Northern,North Central Performance Class LC PG 50 Calculated Positive DP Rating 50 Calculated Negative DP Rating 50 Year Rated 08-11 Clear Opening Width 27.312 Clear Opening Height 15.125 Clear Opening Area 2.868708 Lifestyle I Double Hung 122.75 X 36.5 I Without HGP I Putty Room Location: bathroom 1: Non-Standard SizeNon-Standard Size Double Hung Equal. Frame Size: 22 3/4 X 36 1/2. Lifestyle Series. General Information: No Package Without Hinged Glass Panel Store 2386 LOWE_S OF WARE_MA-Contract-295370-Page 3 of 29 Northern Clad Pine 5" 3 11/16" Gray. Exterior Color/ Finish: Standard Enduraclad Putty. Interior Color/ Finish: Unfinished Interior. Glass: Insulated Tempered Low-E AdvancedComfort Low-E Insulating Glass Argon Non High Altitude. Hardware Options: Cam!Action Lock Satin Nickel No Limited Opening Hardware Order Sash Lift No Integrated Sensor. Screen: Full Screen Putty InViewTM. Performance Information: Combination U-Factor 0.26 Lifestyle I Double Hung 134.25 X 36.75 I Without HGP I Putty Room Location: spare room and living room 1: Non-Standard SizeNon-Standard Size Double Hung Equal. Frame Size: 34 1/4 X 36 3/4. Lifestyle Series. General Information: No Package Without Hinged Glass Panel Northern Clad Pine 5" 3 11/16" Gray. Exterior Color/ Finish: Standard Enduraclad Putty. Interior Color/ Finish: Unfinished Interior. Glass: Insulated Low-E AdvancedComfort Low-E Insulating Glass Argon Non High Altitude. Hardware Options: Cam-Action Lock Satin Nickel No Limited Opening Hardware Order Sash Lift No Integrated Sensor. Screen: Full Screen Putty InViewTM. Performance Information: Combination U-Factor 0.26 LEAD TIMES ON THESE WINDOWS ARE 114 DAYS MINIMUM PLUS TRANSIT TIME. PROPOSAL REQUIRES SECOND MEASURE BY INSTALLER TO FITNESS AND SIZING OF SELECTED WINDOWS. ADDITIONAL WORK OR ISSUES WILL/MAY AFFECT THIS PROPOSAL AND POSSIBLY PRICING. Store 2386 LOWE_S OF WARE_MA-Contract-295370-Page 4 of 29 Clean-uplFinal Inspection • Complete final clean-up and haul away all job-related debris • Test product& perform complete inspection with customer • Review warranty information Installation Process • Remove & haul away existing windows • Check existing windows for leaks and evidence of pest infestation • Install new windows&accessories, including caulk, stops, and fasteners • Follow Lead Safe Practices (if required) • Follow Health and Safety Guidelines Project Preparation Process • Dedicated project support staff keeps you up-to-date through every process • Installer conducts Pre-Installation Inspection • Provides appropriate protection to home during installation • Obtain &post any necessary permits • Perform Lead Assessment(if applicable) Work is to commence upon reasonable availability of Contractor and/or any special order or customer made Good(s)which is anticipated to be 0 4/1112 0 2 2.Estimated completion date is 04/30/2022.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. CONTRACT TOTAL $12,594.00 Paid upon signature of Installed Sales Contract(33%) $4,123.02 Paid upon or after commencement of work(67%) $8,370.98 Paid upon completion of Installed Services to both parties satisfaction $100.00 Store 2386 LOWE_S OF WARE_MA-Contract-295370-Page 5 of 29 NOTICES LEAD SAFE INFORMATION. Federal and applicable state laws require that 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://www.epa gov/lead/lead-renovation-repair-and-paintinq-proqram. 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 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 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: f '( ie ,� 02/15/2022 Date: Lowe's Authorized Representative By: � '+ Date: 02/15/2022 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 $ 4123.02 [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; Store 2386 LOWE_S OF WARE_MA-Contract-295370-Page 6 of 29 Rev.03/02/2021 (2) Payment of $ 8370.98 [enter 2/3 of the contract Price minus $100] 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 EXECUTION DATE: 02/15/2022 LOWE'S AUTHORIZED REPRESENTATIVE SIGNATURE OWNER'S SIGNATURE CO-OWNER SIGNATURE Customer acknowledges receipt of a true copy of this contract which was completely filled in prior to Customer's execution hereof. Store 2386 LOWE_S OF WARE_MA-Contract-295370-Page 7 of 29 Rev.03/02/2021