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128 NORTH ST - BUILDING INSPECTION y $33. 47,oq� Ut T CEIVTIONAL ERVICES The Commonwealth of Massachusetts Department of Public SaM AUG 2b A 0 44 N1assachusettsShtte Building Cole(780 CMR) Building Permit Application for any Building other than a One-or Two-Family Dwelling (This Smffon For Official Use only) Budding Permit Number: Date Applied: Building Official: =:: ase indicate Block fl and Lot N for locations for which a street address is not available) �ZJQ1970No.aTown Zip Code Name of Building(if applicable) SECTION 2:PROPOSED WORK Edition of NIA State Code used_ If New Construction check here❑or check all that apply in the two rows below Existing BLlildillg❑ Repair Alteration ❑ Addition❑ Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ Change of Occupancy Cl­ Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No ❑ 15 an Independent Structural Engineering Peer Review required? Yes ❑ No ❑ Brief Description of Proposed Work: QE 104/R f3 I/(_to � />F p/ ICE SECTION 1 COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANCE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑ Existing Use Group(s): IProposed Use Group(s): SECTION C BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) Total Area(sq.ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as a licable) A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A4❑ A-5 O B: Business ❑ E: Educational ❑ R Facto F-I ❑ F2❑ ►i: Hi h Hazed H-1❑ H-2❑ H-3 ❑ F4d❑ H-5❑ L- Institutional f-l❑ I-2❑ I-3❑ f-a❑ Nh Mercantile❑ --FR.- Residential R-t❑ R-2❑ R-3❑ R4❑ S: Storage S-t ❑ S-2❑ U: Utility❑ Special Use❑and please describe below: - Special Use: SECTION 6:CONSTRUCTION*TYPE(Check as a licable) IA ❑ IB ❑ !IA ❑ IIB 13 IHA ❑ [[Ill ❑ IV ❑ VA O VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CNIR 111.0 for details on each item) Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: Public❑ Cheek if outside Flood Zone❑ Indicate municipal❑ A trench will not be Licensed Disposal Site❑ Private❑ or indentify Zone: or on site system❑ required Cl or trench or specify: permit is enclosed❑ Railroad right-of-way: II"ards to Air Navigation: ,l I rn ( n nu!Ii.vo11 I(.0•q.l r y_-_s Not Applicable❑ Is Structure within airport approach area? Is their review completed? or Consent to Budd enclosed❑ Yes O or No❑ Yes❑ No ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s):_ I .type of Cunstntdion:. Occupant Load per Plooe Does the building contain ao Sprinkler System?:/_�_,� � ,�.Special Stipulations: r � SECTION'). PROPERTY OWNERAUTHORIZATION Name and ekldress of Property Owner} L I N D j})I L�'N f o U =i+i �L S— l28 Na�ztN S� S AGSM 00 9 � Name(Print) No.and Street City/Town Zip Property Owner ContAict Information: Title Title Telephone No.(business) Telephone No. (cell) a-mad address If applicable,the property owner hereby authorizes Narne - Street Address City/Town State Zip to act on the property owner's behalf,in all matters relative to work authorized by this budding permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) If building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here O and skip Section 10.1 10.1 Registered Professional Responsible for Construction Control joka Ros47aNP 6/2 92/ 6?ct9/ TSh-1r Ni:uRne��(R a R 12 Rd 573 L— eg e-mail address Registration Numb 5T 2 'pqoZNZ l c rL 0 4� o f Sr2VCtVr(z Co I Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor Company Name Name of Person Responsible for Construction License No. and Type if Applicable Street Address City/Town State Zip Telephone No. business Telephone No. cell e-mail address SECTION 11:WORREKS'COMPENSATION WSURANC1i AITIDAVff M.G.L.c.152. 25C 6 A Workers Compensation Insurance Affidavit from the MA Department of Industrial Accidents 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. Is a signed Affidavit submitted with this application? Yes❑ No 0 SECTION 12•CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) - Total Construction Cost(from Item 6)_$ I. Building $ Building Permit Fee-Total Construction Cost x_(Insert here 2.Electrical $ appropriate municipal factor)=$ 3.-Plumbing 5. d. Mechanical (HVAC) $ .Note:Minimum fee=$ (contact municipality) 5. Mechanical Other $ y p• � Enclose check payable to ?') 6.Total Cost $ — (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT 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 accurate to the best of my knowledge and understanding. 6/11I ase print and sign name Title Telephone No. Date Street Address City/Town State Zip Municipal Inspector to fill out this section upon application approval: Name IVDate 2 � ( kv rl r • ��.®R>� CER1I6'Icl1flG OF LIABILITY fYtlsulrl�lVcG DAT[IRN "!1^'Yt DA -aat:__ 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 INSURERIS), AUTHORIZED i REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: H 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). Mi0WLLR Npute, Rick Jr D r Of sa -__... ...._.. — FAX R ry III .IranrA Clan c In'. 15..Lb..FZU 1803]4371a92_ _.- J1ArC Pb1L603)4R]-0BaE_,. Iundo d:ry,NII/A103IJ A�aRFS.4Lrirklr@bmvmrllmw ViV1RERLSI AFFORDING cOVERAGF I rvAC AM Tms' _.._._ ._._. INatIRFHAq . Arlon CDrtlµ:mes,Inc mSURER R;Me1nC MuL:Ei Group 1 De,aroadway msnReR c;The Hartford Revere,MA 02151 INSURER p- INSURER F: COVERAGES CERTIFICATENUMBER: 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 I IND GATED. NOT'NATHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WfCH THIS CERTIFCATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN W SUBJECT TO A.-).THE TEIRMS. EXCLUSIONS AND CONDITIONS OF SUCH POUCIES.I IMITS HOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS. LTRRI PdLICY EFF POLICY ORTYPE OF Pl5URM10E —AWrTWVO Ml1.IGY NUNRER �y�D WonYYYL I L JMnSI ..NIMERCIAL GENERAL I3ARILRY AE$Y02a946 3�311 0 5 A � D/3ZB 14 z � I I nw cw wwl N: _,Dix m u ' i �onMnc;f TC RLr.�EG ,UIM&MADE x GtiCUR i , YRFMISESL rc.)__ S TOO J4l,. I __ it FIAE0=tP1 Y rzonl $ _PAIN 1 I _ �PERSONAL A ADV NWURY_I S 1"0000 I'"G�ENILAGGREGAIELmn nPFD PER_ r ! Ir6ENEP.AL AGGREGATE S 2,000 p00 X I MILKY Jela I�Ll`C F=000Gr COMP(OP AGC 5 2000.000 PRG I L O'nIER: _ _ r B JCNCGUEUALTY KAD11%516 ! T,90/20TA T(IID/10t IIOMBINED SrvG IIU't(J.1PcrH1L) 5 11".1POr , AM V AIfI'/J BOOILYINIUP, F w rl $ ALL DWNED _�SCHEDULED AUTOS _X i AUTOS BODILY 4JURY IPI, HIRED AUTOS PROPERTY DAMAGE AUTOS S I IMSMADE II IXCESS LIAR -�O Lllfl -! FACII OLCURRENCE Vtl9nCL1 A AR i� _I AGGREGATE DEDi RETENTIONS r. S (, WORKERS CONPftL.A11BN J-_ .L �D01 SE1,16 --.-- .- I 2/2TT014 31 IM1� PER OTHH AND FIRLDYERS'UARILRY YINI JS�ATIRF k 1 ANY PROPRIETORPAR MER1E4ECUTVf I—TI - I OF CERMTUNIB E%0.LRIED? N14 &etlion 3A_MA E L FACH ACCIDENT I S l,Pi00 0 hl_ (N 'rl twY NM 1— E.L.DISEASEEA EMPIDY�F{S 1.000,DMT II}mom dnscmc ntln ...._ .__ _ DE SfRIPDgNOFOPERATIONS tc4vry 1 _ L.DISEASE IDLIfYLIMIT Ib IB lrin .— �_ .. _......_ 1 CESLPopIpN OF OPLAAPONS I LDCA'nON.S/VEMCLES(ACOFD 1D1,4Edrtw,gl Fmmkc SCF.CtlYk,mry Cc.Ebtl,eC it more ep¢w k rtpulmE) I I i CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Of BOston lrs ional Sem,As THE EXPIRATION DATE THEREOF, NOTICE WILL RE DELIVERED IN I 1010 COmlronweafth Ave ACCORDANCE WITH THE POLICY PROVISIONS. Roston,MA 02215 - AUTNORQEDREPRESENTATIYE @ 19W2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD ?\� fw ,.# sC » 4 � • . /w �y 2 ®9# #:&� &/$& V MA QkF \ s u m�; .yME,� \ , ¥a o r ~ f\ 3 �21 OA s© e � »��ƒ . . .% � . . a k6AEi k w\o \ /\ ® � . �w , y <�A• � . :y. - © r QTY OF SALEM, MASSACHUSETTS BUILDING DEPARTMENT 120 WASHNGTON STREET,31D FLOOR TEL. (978) 745-9595 KIMBERLEY DRISCOLL FAX(978) 740-9846 MAYOR THOMAS ST.PIERRE DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 CMR, Section 111.5 Debris, and the provisions of MGL c40, 5 54; Building Permit# is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste deposit facility as defined by MGL c 111, S 150A. The debris will be transported by: (name of hauler) The debris will be disposed of in: (name of facility) (address of facility) Signature of applicant Date ene wrrrmomveuurr aJ rrru .i'trcntrsertN - tt_^^�.-g- .��a=+� -.� Departinerrt of ludustrial A ccidents 1Ofrce of Investigate s / Congress Street,Snit 100 U Boston, MA 02114-2 1 i www.mass gml/dia ; - Workers' Compensation Insurance Affidavit: Builder /Contractors/Fiectricians/Plumbers A tlicant information Please Print Le ibiv i �f-� i\18.r11e (BusinesslOrganization/Individual): two •� Address: 1,aTl kP(fS C,}n City/State/Gip: FT2AAVCJV, /ntt 01%q Phone #: 7�' '53�-0 50, Are you in employer? Check the appropriate box: I. I am a employer with ( ❑ I am a general contractor and I Type of project(required): employees(fidl'andlor parr-time}.* have hired the sub-cont actors 6. ❑ New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sl eet. 7. ❑ Remodeling ship and have no employees ' These sub-contractors have S. ❑ Demolition working for me to any capacity: i employees and have w rkers' [No workers' comp. insurance coop. insurance rt 4. ❑ Building addition required.] S. ❑ We are a corporation at d its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I i.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MG1- . 15_ §1(4 , 12.❑ Roof repairs insurance required.] c _ r �. ) and we hi ve no employees. [No worker;' 13.0 Other comp, insurance requir ld.] *Any applicant that checks box Sl 'mist also till out the%onion below showing their workers'rinmpensation policy infomtation. r Horucownors who submit this affidavit indicating they are doing all work and then hire oil' contractors must Submit a new affidavit indicating such, 'Cnnlractors that check this hox,nusl attached:m additional slicer showing the nanx-of the sub •onuecoN and state whether or not those emitics have enhployecs. If llrc sub-contractors have employees,they must provide their workers'comp.pot cy number, / rdorkers'durrry�ensatiotr insurance for y employees. Below is the policy and joh site all] nrr emplgl:cr that is providing igfornmtion. i l f Insurance Company Namc:___a� Policy I or Self ins. Lic. th I-a _ Expiration Date i Job Site Address:— t (I IS Lan+C I City/State/7ip:_E6 (n1+ 61 4710 Attach a copy of,thc wo kcr. compensatioil poliev declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 cat lead to the imposition of criminal penalties of a Fine up to S 1.500.00 and/or one-year imprisonment as well as civil penaltie•in the form of it STOP WORK ORDER and a fine of up to$250,00 a day against the violator. Bed advised that a copy of this sh tement may be forwarded to the Office of Investigations of the DIAL for insurance coverage verification. /rfo herehv ce'rtifr r u 11i the pains and penalties'p1'rejw�that the hi arm tion provided ahove is true and correct. i Signature: Date 70t � �se onfp. Do'I tot write in this areatotbe completedby city or town official.own: ! Permit/Licet se4 uthority (circle one): of Health 12., Building Department 3.City/Town Clerk 4 E�ectrical Inspector 5. Plumbing Inspector Ierson: Pho a H: p 7/1 r It al Li(:I,el"', Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OMEIMPROVEMENT CONTRACTOR before the expiration date. If found return to: F. Office of Consumer Affairs and Business Regulation Registration: lggggg Type 10 Park Plaza-Suite 5170 Expiration: 10/18/2015 Supplement and Boston,MA 02116 LOWE'S HOMES CENTERS INC 136 TURNPIKE RD.SUITE 100 SOUTHBOROUGH,MA 01772 Undersecretar y - Not valid without signature i6 t i i I I i I ' ' Massachusetts -Department of Public Safety S Board of Building Regulations and Standards !i (Cwi,tru:iwn Super.i I* License: CS-071187 RONALD E wAC$LIN I2 TUCKERS CT,:3RD FL PEABODY MA 1Pf960 J..L.�� .., .xpiranon I Commissfonef 08/0412015 a _ i %f�, '•n„Hiuyuwn,/,d< ift�rtara<�r>Ur�/Y Licen� istrntion valid for individul use only MEIMPROVEMENT CONTRACTOR LClbrchor rege ex piration date. if found return to: egistration: 1334114 1 Type: Office ICConsamor Affairs and Business Regulation xxplratlon:. 6/27/2015. �I DeA 10 Pur I Plaza-Suite 5170 T t Bosto MA021% ROP:Ct)CONS TRUC71oNlr RONALD WACHLIN / 12 TUCKERS CT. i$AC,OOy.,M``A 01950 llntlersecrrury Not valid without si{{nnture i f t i I d tl i ' I f i , CERTIFICATE OF LIABILITY IN URANCE f 71FICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO IGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER HE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN TN ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE t P O CE N T 'CE "IF O ER �I IMPORTANT:II the Certlficatolholder Is an ADDITIONAL INSURED,the POkAies)nulat be qndorsed. It SUBROGATION IS WAIVED,sU6Ject to the tones and conditions of the Policy,Cerlaio Policies may require and endorsement A slate{nent on this Ceri iCate does not Confer rights to the certificate holder In liou of such Ondorsemenlls. I --- NAME:CONTACONTACT i'P.000CHi � � NAME; PATti1CK J 1':0017S INS nGC:Y ?NONE (I F (A/C,No,E%U__L.._�___.__ A C,NO): EMAIL IN it.1 PE U3f.)1 �'.17A 0196U AOORESS: 71'YY 1 INS RER(S)AFFORDING COVERAGE NAIC# INSURER A: AM AMmzRIC.AN INTMA.YCN:CON'SPANV NSURFO WACHLIAI,RONALD I)B.k RONCQ CONSJ*RU:`TIUN INSURER B: �— ! j INSURER C: .INSURER D: 12'I'UCKER1,;CT INSURER E: PFAHODY.MA 01960 !NSURERF: ' COVERAGES J } CERTIFICATE NUMBER: REVISION NUMBER: 1914 CF. FY TTr - L tl NSU NOEL TEQ eELOW NAVE BEEN ISSUED TQ TNEINSURED NAMED ABOVa FOR TREPOLICYPER100 tN01CATE0. NOMTTM9TANDmO ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUNF EXCIL RE6PECTTOWWCHI CERTIFICATE MAY 9E ISSIlE00R NAY PERTAIN. THE REDUCED ByE AFFORDED DY TIE PO'_ICIER OF.DCninEU HEREIN IS SUBJECT TO ALL THE TERMS.E%CLUSION6 AND CONDITIOI S OF SUCH POLICIES. LIMITS SHO'•YN MAY HAVE 6REN REDUCED 6Y PAID CLAIMS. INSR ADO 6Ua POLICv EFF DALE POLICY E%P OAIE LIMJTS LTR TYPL OF PISURANOE L R. POLICY humors tMMIDOtM'YI I(MMibMYYYYI -ACH OCCURRENCE 5 GENERAL LIABILITY ----� COMMERCWL GENERAL LWBILIIV AMAGE TO RENTED !S CtA!MSrAAGE p(=UR. REMISCS(Ea omnance) — J tED E%P(Ally INAIR S Y � ERSGNAL&ADV INJURY I$ ENERAL AGGREGATE ItGEN'L ACGREGATE LIMIT APPLIES PERT POLICY 0PROJECT QLOC RODUCTS-COMP/OP AGG S AUTOMOBILE LIABILITY OMBINED SINGLE I5 ANY AUTO LIMIT(Ea RU� DOOILY INJU'DRYY S ALL O'AMED AUTOS (Per person; SCHEOULL AU rOS i BODILY INJURY I5 HIRED AUTOS iPEr ac,:idenq _ NON-OYJNEDAUTOS PROPERTY DAMAGE S i (Per acdlent) I ! EACHOCCURRENCE 5 UMBRELLA LIAR j OCCUR 1 `OGREGATE 5 EXCESS UAS GLAIMS4ViAOE i S DEDUCTIBLE t S P,ETENT:ON 5OTHER YJC STATUTGRv A WORKER'S COMPENSATION AND —_ Ug-0yD5P0t2-10 t0/2ffi2013 10rz0!%DfA x Lmtrrs EMPLUYER'S LIABIL6Vi YIN Any PRCFERITOR,PARTREAIFJ4EGUTNE rY"! NrA E I.EACH ACCIDENT 5 ?00,000 OFFICERR&MMR E%CLUDED4 I:J E.L.DISEASE-Es.EMPLOYEE E 100,000 immmw,m NH) I I E.L.DISEASE.POLICY LIMIT is 500,000 Ryes, 0£SCRIPTIOI.OF OPERATIDNT Wtvo DESCRIPTION OF OPFRATIONSII UCATIDNSIVCHICLESIRESTRICTIONSBPECIAL ITEMS THIS REPLACE-S ANY PRIOR CFR I iFICATE ISSUFDTO fHE CUtTIFIC ATE HOI OFR AIT r CTIN J%YORK�S CU.tP CCYSI A TPJ fNSI7RJ3-FSMA v'0[UCERS COU'ENSATtON POLICY ACID 113 LINU1CD OOU:k STAILS ENDOkSE. !•f AUfuORIPES 1NE PAYMENT OF BE"NEPITS FOR CS_AIMS MADE BY Tlfd INSOREIYS N,A�6MYLUYEES IN STA'fF..S OND!R TKAN MA NO AUTIIORIZ,T ION IS OIVFti TO PAY CLARnS FOR BENEPTI'S tN STATES GTI1F.lt 'rHANW. .IFI'm INSUMEHISEI.OR HAS HI.KLO EMPLOYEES(RITSIDdOFM.A. TH15 yi7LICY 17C:FS. n'PROVICiE COVERAGE FOR ANY STATE GTFtEA THAN NA. THE k'ORKE7tS'CMPPNSknI)N POLICY DOES NOT PROVIDE COVERAGE FOR WACHUN,RONA D, CERTIFICATE HOLDER I ! CANCEL TION L01Y$SCOriNIEStNC { SHOULDAIiIYOFTHEABOVEDESCRIBEOPOLICIESBECANCELLED BEPORET E EXPIRA71ON DATE THEREOF,NOTICE MLB DEI.IV EO AI-I'N:IS INSURANCE IN ACCOR ANCE WITH THE POLICY PROV PO BOX I I I 1 AUTHORIZE REPRESENTATNE N0 WILKF$SOR0.NC 26656 ACORD'2S(2010105) The ACORD name and logo are re0i9tered marks of ACORD 1.sR"10 ACORO GOR R I r eroed. I f �CAD STORE-COPY INSTALLATION SERVICES CUSTOMER CONTRACT- MWORK- INT/EXT/PATIO DOOR LOWE'S OF DANVERS, MA., STORE# 1094 STORE PHONE: (978) 646-9099 153 ANDOVER STREET SALESPERSON: BERNARD STUBBS DANVERS, MA 01923-1450 SALESPERSON ID: 1503347 Document Print Date : 08/09/2014 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 RENATE CURRIE 978-594-5897 O Customer Address Other Phone 3 ADMIRALS LN 978-594-5897 L City State/Province Zip/Postal Code D SALEM MA 01970 Installation Address T 3 ADMIRALS LN O Installation City Installation State/Province Installation Zip/Postal Code SALEM MA 01970 MERCHANDISE AND INSTALLATION SUMMARY MERCHANDISE SUMMARY 1049 : 87548 : STK : 1X4X8 RED OAK BOARD : 1 X4X8 RED OAK BOARD : BABCOCK LUMBER -QTY 1 31143 : J : STK : PFJ BKMD 180 2 X 1 1/4 1 OFT : PFJ BKMD 180 2 X 1 1/4 1OFT : EMPIRE COMPANY, INC. (THE) - QTY 3 131207 : 131207 : STK : 1 X8X16 PRIMED FNGR JNT (+333358) : 1 X8X16 PRIMED FNGR JNT(+333358) : IRVING FOREST PRODUCTS (MAINE) - QTY 2 327377 : 7481 71 61 321 5 : STK : 6 PELLA DR XO(LH) ADV LOWE ARG : 6 PELLA DR XO(LH) ADV LOWE ARG : PELLA CORPORATION -QTY 1 327777 : 748171613253 : STK : 6-FT PELLA DR XO (LH) INVIEW SCR : 6-FT PELLA DR XO (LH) INVIEW SCR : PELLA CORPORATION - QTY 1 Materials Price $ 1158.1 Store 1094 Project No. 417982097 for RENATE CURRIE Page 1 of 8 STORE-COPY INSTALLATION DESCRIPTION Stock or SOS : SOS Door Type : Patio Select Location : Back Door Select New Door : Sliding Number of Doors to Install : 1 Side Lights or Transoms : No Hidden Damage Description : None Number of additional holes bored for accessories : None Install Specialized Mortise Hardware : No Lead 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 : No Additional Miles Traveled over 20 : 0 Bring Up To Code Description : None Local Disposal Fee : Yes Describe Other Work Needed : B/I jamb. Cut in brick all around, fix sill add flash- ing, basement foundation. Other Work Charge : Yes Comments : No Comment Labor Charges $ 877.00 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 Lo e'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 I� ing, but not limited to, marketing, advertising, publi- city, illustration, training and Web content. By initialing here, Customer agrees to the foregoing. / [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 1094 Project No. 417982097 for RENATE CURRIE Page 2 of 8 STORE-COPY TOTAL CHARGES OF ALL MERCHANDISE AND SERVICES •where applicable SUB-TOTAL $2000.1 'TAX $ 0.0 DELIVERY $ 0.0 ORDER TOTAL $2000.1 BALANCE DUE Work is to commence upon reasonable vaila lity/of Contractor which is anticipated to be G [fill in date]. Estimated completion date is �! [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. CO ETE THIS SECTION ONLY WHEN THE CONTRACT TOTAL EXCEEDS 1 000.00: Customer to Pay in Full; OR [_] Customer to use the following payment schedule: (1) Deposit 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 1094 Project No. 417982097 for RENATE CURRIE Page 3 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 FFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATIONS AND THE OWNER SHALL BE REQUIRED TO SUB- MIT TO S H I/TR I AS PROVIDED IN M.G.L. c.142A. By: �/L ? Date: /QC/ Lowe's Home Centers. LLC /l / By: ,r, 2 n c;k 6 1 + t� Date: x r i G. Own 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 TOM 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 0 DAY OF \ Lowe's Home Centers, LL By: (Seal) Print Name: /� ✓� 6< �e Ccc�s; t� (Seal) Ad a Owner la f��n✓l4�4 � l�� � -' n a� Ott < City State/Province 2ip/Postal Code Print Name (Seal) Store 1094 Project No. 417982097 for RENATE CURRIE Page 4 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 1094 Project No. 417982097 for RENATE CURRIE Page 5 of 8