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14 SCENIC AVE - BUILDING INSPECTIONI � The Commonwealth of Massachusetts . Board of Building Regulations and Standard CITY OF Massachusetts State BuildingCode, 780 ECEWED SALEM INSP� IONAL SERVICE Revised Mar 2011 Building Permit Application To Construct, Repair, Renovate Or Demolish a One- or Two-Family Dwelling A This Section For Official Use trnly Building Permit Number: Date Applied: Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 14 Se., _ Ave. I.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 Ill Frontage(R) 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❑ Private❑ Zone: _ Outside Flood Zone? Check ifyes❑ Municipal ❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner of Record: 11 it�rq G c lom, M9 D197° Name(Print) CSty`,'St5 ZIP ly Soenke Aoe- 47S-5r1q_T45o No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction ❑ 1 Existing Building❑ Owner-Occupied ❑ Repairs(s) Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work': t /YID V QtQ lSj t71` G e� $i ZJ SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 751. 3 1. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical $ ❑ Standard City/Town Application Fee ❑Total Project Cost' (Item 6)x multiplier x 3. Plumbing S 2. Other Fees: $ 4. Mechanical (FIVAC) $ List: i 5. Mechanical (Fire Suppression) $ Total All Fees: $ Check No. Check Amount: Cash Amount: 6. Total Project Cost: $ 4, 751,`13 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) —7 11 6 7 8 I Ronk\A � � 'License Number Expiration Date Name of CSL Holder IZTisc,�JAS C>L List CSL Type(see below) No.and Street Type Description ?K, I 4 m P, 0 1 it.D U Unrestricted(Buildings up to 35.000 cu. ft.) R Restricted 1&2 FamilyDwelling CitylTown, State.JIP M Masonry RC Roofing Covering Window WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2Regii;d Home Improvement Contractor(HIC) 1yg�8� lo•►�•/yl l }o me C,vnju-S HIC Comp am Namc e HIC Rg��strant Name HIC Registration Number Expiration Date (3(v '1 o�r�p t� V•c)r rtcb•.rcl.eltsl«+e C 54wm /awts.cot No.and Str�e SJ 1p6(170 v 1 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........... ❑ 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 �i t y�(�r0. CA\,kk&,A to act on my behalf, in all matters relative to work authorized by this building permit application. (��- fi�.ro Osy�� s •�• ter Print Owners Name(Electronic Signature) Date SECTION 7b:OWNEW 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 accurate to the best of my knowledge and understanding. 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/ocrt Information on the Construction Supervisor License can be found at www.rnass.eov;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" - -- ma Department oflndustrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Pluinibers Applicant Information Please Print Leguribhi Name (Business/organizatioir/Individual): AW Address: City/State/Zip: �1 -eabcdy 0I960 Phone #: 7�' ' S3.Z—o35o2 Are you an employer? Check the appropriate box: 1. I am a employer with i 4. ❑ I am a general contractor and i Type of project(requir(d): employees(full and/or part-time).* have hired the sub-contractors 6. ❑ New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' comp. insurance.$ 9. ❑ Building addition [No workers' comp. insurance P• required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs r additions 3.❑ I am a homeowner doing all work officers have exercised their I I.❑ Plumbing repairs c r additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] 't a 152, §1(4), and we have no employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. r Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicati ig such. Contractors that check this box must attached an additional sheet showing the name of the sub-connzctom and state whether or not those entitie have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and ob site information. Insurance Company Name: Au AyrtrkAA vroj Policy#or Self-ins. Lic. #: U B-y 805Po[ -!3 Expiration Date: Job Site Address: Iy 5c e.nlC. 04 City/State/Zip: Pwi /l M 0970 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expirat on date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal pen lties 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 ORDE 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 Offic of Investigations of the DIA for insurance coverage verification. I do hereby certi r the ains and enalties o e 'u that the in ormation provided above is true and corre t Si nature: Phone 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 Insp ctor [.Other Contact Person: Phone#: \- trice of Consumer Affairs&Bosiaess Re ulatioo B License or registration valid for individul use only before the expiration ME IMPROVEMENT CONTRACTOR date. If found return to: x "Registration: 146b88 T e Office of Confumer Affairs and Business Regulation YP 10 Park Plaza-Suite 5170 Expiration::-j0/1 tS/2015. Su lement �and - PP Boston,MA 02116 LOWE'S HOMES CENTERS INC. RICHARD CHALONE -. 136 TURNPIKE RD.SUITE 100 SOUTHBOROUGH, MA 01772 Undersecretary Not valid without signature Massachusetts -Department of Public Safety Board of Building Regulations and Standards C LMtruction Super.n:rr License. CS-071187 4 RONALD E WACOUN - _- 12 TUCKERS CT;3RD FL _ pEABODy MA 61960 �� •' " Expiration Commissioner 08/04/2015 b t %/F '(<•n,.mnr:m+<Hx,/l/c<+�.!n2+{aedro<�u�nC/, License or registration valid for individul use only ''`' Itttic<uf Cnavunter Affairs&itasiSrse ReCulnfinn K Y ME IMPROVEMENT CONTRACTOR hel'ore the expiration date. If found return to: , egrstratlon� 13?.�tta Type: Office ur Cousnmer Affairs and Business Regulation FExplratlon:. G/I7/291-5. DBA 10 Park Plaza-5uilu 517U 4 Boston,MA 112116 R0NC0 CONSTRUO'LION: RONALD WACHLIN 12 TUCKERS CT.PLABODY,MA 01960 `Ilndrrsec rm Ary Not valid without vignntnre CERTIFICATE OF LIABILITY INSUKANI+t f -71FIGATE IS ISSUED AS A MATTER . INFORMATION ONLY AN TE D CONFERS NO RIGHTS UPON THE CERTIFICA HOLDER. TH CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES FLOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(Sh AUTHORIZED REPRE3 NTATIVE P D E N CE If T O E IMPORTANT:If the Certificate holder Is an ADDITIONAL INSURED,the poflcy(ie6?most be endorsed. If SU6ROGATION IS WAIVED,sUhJec to the terms and conditions of the policy,certain policies may require and endoreement. A statement on this certt icats does not confer rights t the certificate holder In lieu of such endorsements. CONTACT PRODUCER NAME: I'ATItICK 1 WOOD'S fNS nOC:I' PHONE FAX (AID,No,Ext): (A/C,No): 40 IVIAIN S"I REL 1 E-MAIL PEABODY.MLA 01960 ADDREss: 725YY INSURER(S)AFFORDING COVERAGE NAIL# --'---'-- "'— INSURER A: ACI!AAMRICAN MSt1RANC,•.COMPANY INSURED WACHLIN.RONALD DBA RONCO CCT�STRUCTION INSURER 6: INSURER C: INSURER D: 12 T CKERS CT INSURER E. PEASODY,MA 01960 INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: Isis CE FTF TT 11.3701915 NSU NCEL TEO BELOW HAVE BEEN ISSVEP TO THEIN3URED NAMED ABOVE FOR THE POLICY PERIOp INDICATED- NDTW7H ANDPNG FF REQUIREMENT, ER IEI WHICHMAY �M, THE IN E AFFORDED By THE POLICIES DESCRIBED HEREIN S 3UBJFCT TO ALL THE TERMS.EXCLUSIONS AND CONDITIONSOF SUCH POLICIES LIMITS 3HOW MAY HAVEBN RFD CEO BY PAID CLAIMS- ADDSUE P(MMM PF DATE PODCYEXPDATE DES ILIR L R POLICY NUMBER (MM10mYYYY) (MMIDOtYm') LIE TYPE OF INSURANCE -ACH OCCURRENCE S GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY AMAGE TO RENTED $ CLAIMS MADE OCCUR. REMISES(EA OCC'nance) — 7ER EXP L 8. one IN It IR S PERSONAL&ADV INJURY '•$ GEN'L AGGREGATE LIMIT APPLIES PER: ENERALAGGREGATE $ POLICY 0 PROJECT a LOC RODUCTS-CONIPIOP AGG S AUTOMOBILE LIABILITY COMBINED SINGLE S LIMY(Ea au:ident)_ ANY AUTO BODILY INJURY $ ALL OWNED AUTOS (Pei-person) SCHEDULE AU IOS - BODILY INJURY $ HIRED AUTOS (Per accident) NON-OWNEDAUTOS PROPERTY DAMAGE S (Per accident) EACH OCCURRENCE S UMBRELLA LIAS OCCUR AGGREGATE $ EXCESS LIAB CLAIMS-MADE g DEDUCTIBLE $ REI"ENTION S _ WC STATUTORY OTHER A WORKER'S GOMPENSATIONAND UR4805PO12-13 10/2912013 10129l701A LIMITS EMPLOYER'S UABILFf1' YM ANY pROFERITORIPARTNEWEXEOLITNE E.L EACH ACCIDENT $ 100000 OFFICEWA�NBER EXCLUDED, Q wA E.L DISEASE-EA EMPLOYEE $ 1a0,600 (Mmiiawq In NH) EL-DISEASE-POLICY LIMIT s 500,000 Iryea,deeDlba under DESCRIPTION OF OPERATION'Dalow DESCRIPTION OF OPERAnot4SII-OCATIGNSNEHICLESIRESTRICTIONS!SPECIAL ITEMS THIS REPLACES ANY PRIOR CER'j IFICATE ISSUED TO"rHE CERTIFICATE HOLDER AFFRCTING WORKf RS COI 9 CCVHNAGE. THE EJSIIRED'S MA.WORKERS COMPENSATION POLICY AND ITS LIME LF)CTILLiR STATUS ENDORSEMENT AUTHORIZES THE PAYMENT OF BENEI'ITS FOR C AIMS MADE BY THE INSURLD S MA EMPLOYEES IN STA'1'FS O'niLk THAN MA NO AUTI IURIZAT'ION IS OI"VEN 7U NAY CLARYIS FOR AENE7:"r3 INSTATES OTHER THAN MA IF THE INSURED HIRES,OR HAS FBRIiU EMPLOYEES OUTSIDE OF W. THIS In 1LICY DOES NT PROV IOE COVRRAGE FOR ANY STATE O1 HBR THA MA THE WORK,16,COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR WACHUI CANCELLATION CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANOE lED LOWGS COMPANIES INC BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL■ DE Iv ED AfTN:IS TNSURANCP IN ACCORDANCE WITH THE POLICY PROV A PO BOX III AUTHORIZED REPRESaNTATIVE! NO W ILKESBORO ,NC 26656 ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORO COR RA�. St I r emed. rJ . STORE COPY INSTALLATION SERVICES CUSTOMER CONTRACT- MWORK- INT/EXT/PATIO DOOR LOWE'S OF DANVERS, MA.,STORE# 1094 STORE PHONE: (978) 646-9099 DANVERS, MA 01923 SALESPERSON ID: 794346 Document Print Date :05/04/2014 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 TARA OSGOOD 978-594-8450 O Customer Address Other Phone 14 SCENIC AVE L City State/Province - Zip/Postal Code D SALEM MA 01970 Installation Address T 14 SCENIC AVE O Installation City Installation State/Province Installation Zip/Postal Code SALEM MA 01970 MERCHANDISE AND INSTALLATION SUMMARY MERCHANDISE SUMMARY 1046 : 87544 : STK : 3/4-IN X 3-1/2-IN X 4-FT RD OK BID : 3/4-IN X 3-1/2-IN X 4-FT RD OK BD : BABCOCK LUMBER - QTY 2 111088 : 31570FJPMD : STK : PFJ CASE 315 2-1/2 X 11/16 X T : PFJ CASE 315 2-1/2 X 11/16 X 7' : EMPIRE COMPANY, INC. (THE) - CITY 3 131207 : 131207 : STK : 1X8X16 PRIMED FNGR JNT (+333358) : 1X8X16 PRIMED FNGR JNT(+333358) : IRVING FOREST PRODUCTS (MAINE) - QTY 3 106126 : 6000C : SOS : SOS PELLA STORM/SCREEN DOORS : SINGLE STORM DOOR FULLVIEW STORM : CLO LARSON MANUFACTURING COMPA - QTY 1 106126 : 6000C : SOS : SOS PELLA STORM/SCREEN DOORS : SINGLE STORM DOOR FULLVIEW STORM : CLO LARSON MANUFACTURING COMPA- QTY 1 326798 : PRODUCTCODE : SOS : SOS RB PNT/PNT DECO SM FG TC DFAB : ENTRY/EXTERIOR SINGLE UNIT, LAUREL FAN LITE : DOOR FABRICA- Store 1094 Project No. 408513655 for TARA OSGOOD Page 1 of 8 STORE COPY TION SERVICES INC - QTY 1 326798 : PRODUCTCODE : SOS : SOS RB PNT/PNT DECO SM FG TC DFAB : ENTRY/EXTERIOR SINGLE UNIT, HAMPTON CENTER ARCH : DOOR Materials Price $2783.93 INSTALLATION DESCRIPTION Stock or SOS : Stock Door Type : Exterior Select Location front and side Select New Door : Single Pre-hung Number of Doors to Install : 2 Side Lights or Transoms : No Hardwood (Mahogany or Oak) Door: No Hidden Damage Description : None Number of additional holes bored for accessories : None Install Specialized Mortise Hardware : No Install Storm Door : No Lead Safe Practices : No Total Linear Feet of Custom Trim to be Installed : 0 Deliver Door : Yes Customer Understands Scope of the Project : Yes Permit Required : No Additional Miles Traveled over 20 : 0 Bring Up To Code Description : None Local Disposal Fee : Yes Describe Other Work Needed : fix sill add oak,cut wedges,custom trim with trim coil,install in masonary opening/work on foundation, build out for storm door, build in jamb on entry. Other Work Charge : Yes Comments : 2 entry and two storms Labor Charges $2011.00 Detail Deduction -$ 35.0 Additional Specifications: Notation: Lowe's will not make structural modifications, paint or stain or remove/reinstall security system equipment. Customer is responsible to advise if prop- erty is governed by Historic District Regulations. Additional Specifications:Federal law requires Lowe's to provide you with the pamphlet Renovate Right: Important Lead Hazard Information for Families, Child Care Providers and Schools. By signing this Contract, Customer acknowledges having received a copy of this pamphlet before work began informing Customer of the potential risk of the lead hazard exposure from renovation activity to be performed in Customer's dwelling unit. PHOTO RELEASE: Customer grants to Lowe's and Lowe's employees and independent contractors the right to take photograghs of the Premises where in- stallation Services will be performed and all work performed at the Premises related to this Contract, and irrevocably grants to Lowe's all right, title, interest in and to the photographs for use in all markets and media, worldwide, in perpetuity. Customer authorizes Lowe's to copyright, use and publish the photographs in print and/or electronically, and agrees that Lowe's may use such photographs for any lawful purpose, including, but not limited to, marketing, advertising, publi- Store 1094 Project No. 408513655 for TARA OSGOOD Page 2 of 8 4' STORE COPY 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.. TOTAL CHARGES OF ALL MERCHANDISE AND SERVICES 'where applicable SUB-TOTAL $4759.9 'TAX $ 0.0 DELIVERY $ 0.0 ORDER TOTAL $4759.9 BALANCE DUE Work is to commence upon reasonable availablity of Contractor which is anticipated to be [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 Ray in full COMPLETE THIS SECTION ONLY WHEN THE CONTRACT TOTAL EXCEEDS $1 000 00• [_] Customer to Pay in Full; OR [_] Customer to use the following payment schedule: Store 1094 Project No. 408513655 for TARA OSGOOD Page 3 of 8 STORE COPY (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 [_j 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. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AND UNTIL YOU HAVE READ THE TERMS AND CONDITIONS CON- TAINED IN THIS CONTRACT AND WHICH FOLLOW THE SIGNATURE PAGE(s). BY SIGNING BELOW, YOU ARE ACKNOWLEDGING THAT YOU HAVE READ, UNDERSTAND AND AGREE TO THE TERMS AND CONDITIONS SET FORTH IN THIS CONTRACT. YOU ARE ENTITLED TO A COPY OF THIS CONTRACT AT THE TIME OF SIGNATURE. NOTICE REGARDING ARBITRATION AGREEMENT FOR CLAIMS COVERED BY M.G.L. c 142A LOWE'S AND OWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT LOWE'S HAS A DISPUTE CONCERNING THIS CON- TRACT, THAT LOWE'S MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRET- ARY OF THE EXECUTIVE OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATIONS AND THE OWNER SHALL BE REQUIRED TO SUB- MIT TO SUCK ARB�-tON AS`PROVIDED IN M.G.L. c.142A. i By: � �', - .. .. . Date: L we's Home Ce rs Bye Date: wn r By: Date: Co-owner or Witness THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE RESOLUTION INITIATED BY LOWE'S PURSUANT TO M.G.L. c 142A THE OWNER MAY BE PERMITTED TO INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THE SECTION ABOVE IS NOT SEPERATELY.SIGNED BY THE PARTIES. WITNESS OUR HAND(S) AND SEAL(S) BELOW THIS DAY OF a r Lowe's Home Centers, LLC By. (Seal) Store 1094 Project No. 408513655 for TARA OSGOOD Page 4 of 8 STORE COPY Print Name: z v eIQ Address Ow r City State/Province Zip/Postal Code Print Name Co-Owner or Witness (Seal) 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. 408513655 for TARA OSGOOD Page 5 of 8