Loading...
51 WEATHERLY DR - BUILDING INSPECTION G/I The Commonwealth of Massachusetts F O CITY�u l Board of Building Regulations and Standards C ITY I Massachusetts State Building Code, 780 CMR SALEM Revised Mar 2011 Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: Date Applied: " Building Official(Print Name) Signatu rc ,(Date -SECTION 1:SITE INFORM ON 1.1 Pro e�ty Ad r ss: j� 1.2 Assessors Map& Parcel Num s 5I � 1ri I.l a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning.Information: 1.4 Property Di tons: Zoning District Proposed Use Lot (sq ft) Front (ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Pr ed Required ided Required Pr ed 1.6 Wate p 'ply:(M.G.L c.4Q,§54) 1.7 Floo ne Information: 1.8 Sewa posal System: one' P c❑ Private❑ Z _ Outside Flood Zone? M ' 'pal❑ On site disposal system ❑ Check if yes[] :. � R cq� SECTION 2 PROPEE,RTY OWNERSHIP'' 2lYl1) ?-V c dl � C7Vl t�CIIEVYI 1ylQ - C)lg r Name(Print) I� City,State,ZIP S� I�ea� �r �v ��, `�187ag�60►6 No.and Street - Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) ;r l-, New Construction❑ Existing Building❑ Owner-Occupied ❑. Repairs(s)XIAlteration(s) ❑ 1 Addition ❑ Demolition ❑ 1 Accessory Bldg. ❑ Number of Units Other ❑ Specify: 'ef Desert tion of Qroposed WorkZ yr1 i a y SECTION 4: ESTIMATED CONSTRUCTION COSTS Estimated Costs: Item Official Use Only Labor and Materials I. Building $ 4 �[�.� A. Building Permit Fee:$ '<Indicate how_ fee is determined: 2. Electrical $ ❑Standard City/Town Application Fee ❑Total Project Costa(Item 6)x multiplier - -x. 3.Plumbing $ J 2. Other Fees: $ 4. Mechanical (HVAC) $ List: - r" 5. Mechanical (Fire $ Suppression) Total All Fees: $ Check No. Check Amount: Cash Amount: 6. Total Project Cost: $ I q S 0 paid in Full ❑Outstanding Balance Due: { SECTION 5: CONSTRUCTION SERVICES 5.1 Co structonn Supervisor License(CSL) q r q Qg 3 � Z (.1n/�s SVE'C_ '-'SoAar7�> ACt(� License Number Expiration Date Name of CS H ]der Q_ 8C-7 ���{'Y1�5� �al_T List CSL Type(see below)` No.a d Street v 1 .Type..: Description / Q m p 5 0)1 C T o G Z7- U Unrestricted(Buildin s up to 35,000 cu.ft. City/Town,Slat ,ZIP R Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering �^^ WS Window and Siding 1w -�/r /�_',fi(r,�, SF Solid Fuel Burning Appliances 163'OASZ �S�ec5cl G@I. OY erne 1 Insulation Telephone Email address D Demolition 5.2 Re gist r dHome�rove ent ontra r(HIC) HIC Registration Number Expiration Date HIC Compa ame or IC R gis nt Na ra .'�'/W` I-S V1 C C-✓i ZG Olnr'n ei o.an Street r` •' Email address 1� 09(AM0 , FL, Z750 7S.3 04SZ Cit /T nn,S� 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 - - 1 ' ],as Owner of the subject property,hereby authorize to act on my behalf,in all matters relative to work/authof'zed by this uilding/permit application. �rX,Ji )/or) / efifiacC �'rr Ii7a Print O ner's Name(Electronic gnature) f Date SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION T By entering my name below, 1 hereby attest under the pains and penalties of perjury that all of the information contained in this application is true d a urate to th est of my knowledge and understanding. Print Owner's or Authorized gent's Name 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 w1v .mass.eov/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' A CITY OF S.U. M.E N'LkSS.�CHL'SETTS BuILDIRNG DEPARTMENT \ b 120 WASHNGTON STREET, 3" FLOOR TFt.. (978) 745-9595 FAx(978) 740-9846 KINiBERLEY DRISCOLL MAYOR THokw ST.PtEm DIRECTOR OF PCBLIC PROPERTY/BCILDNG CONLINIISSIONER 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 c 40, S 54; Building Permit# is issued with the condition that the 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 transported by: DD - 1rueKt /1� (name of haul The debris will be disposed of in p (name of facility), V,� 36� (,lnt v'e s t y TTTIII Wes-fc'onr/- MC (address of facility) ap ant date Jcbrisall'.Jw A S s The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Btuiness/Orgarrization/BrdividtW): Sears Home Improvement Products Incorporated Address: 1024 Florida Central Parkway City/State/Zip: Longwood, FL 32750 Phone #: 860-753-0452 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am ageneral 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. t 7. ❑ Remodeling ship and have no employees These sub-contractors have S. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑Building addition [No workers' comp. insurance 5. 0 We are a corporation and its required.] officers have exercised their10.E]Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL l l.❑ PI urn repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof rcpa:rs insurance required.] t employees. [No workers' 13.E Other Re' kO.0`'- comp. insurance required.] Any applicant that checks box#1 must also fill out the section below showing(heir workers'compensation policy information.;^' ,"a 0g o t] t Homeownerswho submit this affidavit indicating they ire doing all work and then hire outside contractors must submit anew i avi m Icanng su /— rContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that isproviding workers'compensation insurance for my employees. Below is the policv and job site information. Insurance Company Name: Ace American Insurance Company / Phone: 866-283-7122 Policy#or Self-ins. L^ic. #: WLLLRC46482815 �, , , ,, Expiration Date: 08/01/2012 Job Site Address:J / \/ �t�1 1 V City/State/Zi I [�7 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 Investigations of the DIA for insurance coverage verification. I do her=41 the pains a penalties ofperjury that the information provided above is trueand correct. Si natur (Sears Auth.Agent) Date: ,7 ��� Phone#: 11 Home—Fax : 860-315-7468 / Cell: 860-753-0452 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#: .J DATE(MMIDDIYYYY) ''✓o CERTIFICATE OF LIABILITY INSURANCE 07„92011 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 w certificate holder in lieu of such endorsement(s). c PRODUCER CONTACT 73 NAME' Aon Risk Services Central, Inc. PHONE Chicago IL Office (AIC.No.Exp: (866) 283-111.2 aC.ri (847) 953-5390 V 200 East Randolph EWAIL ADDRESS: S Chicago IL 60601 USA INSURER(S)AFFORDING COVERAGE NAIC4 INSURED INSURER A' Indemnity Insurance CO of North America 43575 Sears Holdings Corporation INSURER 8: ACE American Insurance Company 22667 I Sears, Roebuck and Co. Attn: Risk management E3-219A INSURER C. 3333 Beverly Road INSURER D: Hoffman Estates IL 60179 USA INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:570043294986 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. Limits shown are as requested LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER eXF MMIDDIYYYY MMIDDIYYYY LIMITS B GENERAL LIABILITY HGOG 0 UBIUIIZU12 EACH OCCURRENCE $5,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea pccunence $5,000,000 CLAIMS-MADE ❑% OCCUR MED EXP(Any one Pemon) EXCluded PERSONAL B ADV INJURY $5,000,000 GENERAL AGGREGATE $5,000,000 m GEN'L AGGREGATE LIMIT APPLIES PER'. PRODUCTS-COMPIOP AGG $5,000,000 O X POLICY PRO- LC O r B AUTOMOBILE LIABILITY ISAH08696637 08/01 2011 08 01 2012 COMBINED SINGLE LIMIT $5,000,000 m B ISAH08690649 08/01/20110910112012 Ea accident ANY AUTO BODILY INJURY(Per person) O 2 X ALL OWNED SOHECULED BODILY INJURY(Per awdend N AUTOS AUTOS q NON-OWNED PROPERTY DAMAGE q X NIREO AUTOS % AUTOS Peraccident w 1: d UMBRELLA LIAB OCCUR EACH OCCURRENCE 1.1 EXCESS LIAB CLAIMS-MADE AGGREGATE IH DED1 RETENTION A WORKERS COMPENSATION AND WLRC46482815 08/01/2011 OB/"/"1' WC STATU- OTH- B EMPLOYERS'LIABILITY YIN WLRC464$2$03 OS/O1/201108/O1/2012 X TORV LIMITS ER A ANYPROPRIETORIPARTNERIEXECUTIVE NIA SCFC46482827 0$/01/2011 08/01/2012 E.L.EACH ACCIDENT $2,000,000 OFFICERIMEMBER EXCLUDED] (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $2,000,000 11y s des[nbe under DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT $2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IARdLN ACORD 1 Of,Additional Romano Schedule,it more space is required) asir CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE NTH THE POLICY PROVISIONS. Sears Home Improvement Products, Inc. AUTHORIZED REPRESENTATIVE 1024 Florida Central Parkway Longwood FL 32750 USA aJLddNG'�iLY/�ICN ����Ct ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 26(2010/05) The ACORD name and logo are registered marks of ACORD !i J 6;77 {nom�riaaozuseall�i ��� Office of Consumer Affairs and usiness Regulation 10 Park Plaza-Suite 5170 Boston,Massa c setts 02116 Home Improvement 4 >ry' for Registration L '- x ReRlstralion: 14goof TYPe. POMIc Comorallon SEARS HOME IMP'' VIEMENT Pfyt' Eptration. ton 12019 rm 217797 ..,, A'LFRLO NYNrAN _--- 7024 FLORIOA CENTRAL PkWY � ' 1 LONGW000, FL 32750 E ✓ r-f _.� pdam Add real and Warn leld.Mark".an farhangp. 1.-T' �i Addras rI Renewal "� Employment l7 Lost Card ors-r,..i o u«.o�m.a;ra(,�,ae ,/�(,�( _� — Office fCou mtrArtrin h llQ i'naf < Ii�neeR Lieenre or 11001stion valid for indiridul me only IFNOME IMPROVEMENT CONTRACTOR before th ,j.tien ante It found return in: RIndd.".,dn )) a861, iype: Office of Ca u r Affairs and Rusmas Regnlsn.n E PI atl n: DIVW013 Puhllc Cidponlio: 10 Pork Ptazr 5 ite$170 OM IMPkOCCMEry RWOUCTS INC. Roston MA0'l116 %)) 7 ALrR U M'MAJW, Lt4A44-, k� 102n t w RI(A CENTRAC:V'd1V7 ION WOOD FL 32391� ! f —'lldx<teriry�—. Nm va withe ...._--.._.._. ignns re .'-. 11 to ,relax+en I)L pa rtnrc ni asi Pitbiu 4aftsi Y Royal; �If Batl[Ir+1 hr�z [ u11,11, R '+4xntlarBs ' �.� 4',}i➢strizctt4r; ::,t;;;ae,,.,;�s..r 1_Icr.-Itse license: CS 97512 LUBOS SVEC 827 THOMPSON F )AO THOMPSON. CT 0627 E::peratiow 8/31 2012 f •un¢iv:i;aler T%,L, 2442 Office Location: BOSTON ProposalDate 10/26/2011 lJob# 12674328 Sears Home Improvement Productspinc. arstorrer Name P.O.Box 522290 MARv o1uoN Ills 1024 Florida Central Parkway', Oustoner s Horne Phone Custone(a Work Phone - Longwood,FL 32750.7579 (978) 744-1016 - - Home Improvement.Products Phone 800)4694663 Street Address ESTIMATE AND PROPOSAL Contractor License/Registration Nufter 51 WEATHERLY DR MA(148607) Otv State LpCode Kitchen Remodeling All plumbing..and electrical services performed snLEM MA o197o Is in fallation within city limits? by licensed subconVactors Installation Address CountyESSEx YeslNo: NO FEIN 25-1698591 Billing Address(if different from above) City State Bp Code Pmjeq Cmstitart Nprte Bticense No{ifa�lira6le) AMY PENNYPACKER Description of the Pro ect and Descri lion of the Significant Materials to be Used and Equipment to be installed The work to be done under this contract includes the following: 1. Professional blueprinting and design confirmation;installation of new cabinets per contract and design layout. 4 Customer approved diagram 2. Removal of existing cabinets;countertops,plumbing and appliances where new cabinets are to be installed. of cabinet boxes design;layout 3. Minordrywall repair as necessary for cabinet installation(Tape,mud and sand only;no texture snatching.) is attached to and made,a part 4. installation of all moldings and finish trims around cabinet boxes as specified in this contract. of this contract. 5. installation of hardware and accessories as specified in this contract. e. Installation of sinks,faucets and wail out plumbing when new countertop is purchased with order. 7. Installation ofelectric charges and/or upgrades as specified in this contract. 8. Re-installation of existing appliances and hook up of new appliances as specified in this contract. Installation also includes the following OPTIONAL features(where checked : Cabinets (BestlBetter/Good): Countertops (Stone/Quartz/Solid SurfamJI-aminate/Norie):SOLID SURFACE Door Style: Brand AMC ss Wood Species: Finish: Color PINEHURST Color# HL-604 ❑Highlights Flush Ends(Yes/No): Edge Profile:BEVELED Hardware Backsplash(Check all that apply) Door How.# Drawer Hdw.# 11 None 10 Coved ❑Butt-Jointed ❑Tile ❑Extended height Accessories ❑Appliance Center ❑Pantry Rollout IGt ❑Tilt Tray Sink (New/R&R/Customer Providing): NEW ❑Corbel ❑Pantry Shelves Kit ❑Valance Color ss Model# ML2318D9 #Holes o ❑Solid Glass Door ❑Roll Tray ❑Waste Basket 0 Disposal Model#IBADGER5W ❑ Lotion Soap Dispenser ❑Mullion Door w/Glass ❑.Spice Rack ❑What Not Shelf Temporary Sink: (YestNo):.NO Molding Faucet (New/R&R/CUstomer Providing): CUSTOMER PROVIDING ❑Crown ❑Quarter Round ❑Light Rail Color Model# ❑Full Overlay Crown ❑Base Shoe ❑Rope Tear-out 0 Countedop 0 Backs lash ❑Insert Crown ❑Outside Corner r ❑Dentil Soffit Build-out es/No : Lineal Feet: ❑Cove ❑Other: ❑Traditional Lighting q Low Voltage Appliances Mark the appropdate,code next to each applance(See below)* ❑Other S a : Range R&R DSP INA Oven NA Plumbing O None Electrical ❑None Micro NA Fridge NA Cook Top NA ❑Drop Waste Line 0 New Outlet ❑ Electric Line D/W.R&R Washer NA Dryer NA ❑Supply/Extend Waste Line ❑GFI Outlets ❑ Subpanel Box Codes Legend: ❑Gas Line ❑Additional Breakers INA Install new appliance in existing location. ❑Ice Line ❑20.0 Amp Upgrade R&R Remove.&reinstall existing appliance in existing location. 0 MISC, 1 S/F HOOKUP ❑2 circuit upgrade P&E New/additional plumbing and/or electrical needed. 0 Misc. NA Not Applicable Additional work to be done: NONE FAllof OT to be done: Removal or moving of any walls;flooring, painting,wallpaper work;repairs of water or termite damage to sub-floors or walls; electrical or plumbing work outside of this latchen orbath project. AL INSTRUCT:boxes, S:CUSTOMER WANTS.TO KEEP CUTOUT FROM SINK!! THANKS he above check "Work NOT to be done,""Additional work to be done,"and'Special Customers),initials bn*ucfionss"sections have been reviewed and explained to me. SKI,MA(Dig)Re•05/27,11 Page 1 of 3 Job Number 12674328 APPROXIMATE START DATE and APPROXIMATE COMPLETION DATE-- The work will start approximately 3 WEEKS (Approximate Start Date) It will be substantially completed by approximately 6 WFEKS (Approximate Completion Date) These dates are subject to charge at the time the contract is accepted by Sears Home Improvement Products,Inc.("Sears")or at any other time by mutual written agreement Customer understands that the Approximate Start Data is only an estimated date and the Customer will be contacted prior to this date to schedule the actual start date. The TOTAL PRICE including all labor,material,taxes and any applicable discount is$ 4,145.04 Contract Price $ 4,145.04 Initial Payment(not to exceed 30%of Total Price unless Special Order)$ 1,243.51 State Sales Tax( 0.00 %) $0.00 Final Payment(balance payable upon completion ofjob)$ 2,901.53 Local Sales Tax( o.oo %) $0.00 The Initial Payment is due prior to Sears ordering products. Total Amount Due$ 4,145.04 The form and method by which the Customier(s)will pay is described in a separate Cash(Credit Customer(s)initials Card Payment Addendum made a part of and incorporated into this contract by reference. NOTICE TO BUYER:YOU,THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY (FIFTH BUSINESS DAY IN ALASKA,FIFTEENTH BUSINESS DAY IN NORTH DAKOTA IF YOU ARE AGE 65 OR OLDER)AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. ADDITIONAL PROVISIONS Proposal and Approval.Sears offers to furnish the materials and arrange for their delivery and installation as specified on the first page and/or the attached sketches and specification sheets for the TOTAL PRICE shown. This offer must be approved by the Installation Department. If this is a credit sale or a payment on completion sale,.it must be approved by the Credit.Sales Department, If this proposal is not approved or the installation cannot be made in accordance with the law,this offer will be withdrawn and any payments you have shade will be refunded to you.Any materials left over after the installation has been completed are Sears property and will be removed by Sears. Installation.I understand that Sears will not install the materials but will arrange for the installation.Sears is not responsible for materials orinstallation NOT furnished or arranged by Sears.Sears'installation contractor(s)will obtain all building permits required by local law.For homes located in historic or landmark zoning districts,Customer will be responsible for obtaining required approvals and related permits prior to the commencement of work on this contract. Authorization.I authorize Sears to:(1)arrange for a contractor(licensed where required by low)to make the installation of materials; (2)issue a work order for this installation to a contractor;(3)inspect the installation;and(4)pay the contractor when the installation is complete if I have signed a certificate thatthe installation has been completed to my satisfaction. Delays In Installation.I agree that Sears is not responsible for delays in delivery or installation due to weather,fire,strikes,war,government regulations or any causes beyond ears'control. Oral Agreements and Changes In Contract. I understand that there are no oral agreements,between Sears and me.Everything I expect Sears'to 6 has been included in writing in this contract.Nothing can be changed in'this contractunless it is in writing on a separate form accepted by me and Sears. Rssoonsibllity of Buyer,I agree that any information or measurements that I give to Sears are correct and complete. I am responsible for any special work described in this contract. Electrical&Plumbing Service. I will provide adequate electrical and/or plumbing service(s)to run any newly installed appliances or other fumishings.lithe electrical and/or plumbing service(s)do not meet the standards of the utility company or electrical andfor plumbing codes,I will makethenecessary changes at my expense unless Sears has agreed in this contract to make the changes. Payment.I will pay.Sears the cash price that covers the price of material and installation as shown on the first page. Warranty Information.Appropriate;product warranty documents will be given to me by Sears.Sears'Warranty on Installation is: SEARS'LIMITED WARRANTY ON INSTALLATION In addition to any manufacturer warranty extended to you on the product(s)used(which warranty becomes effective the date the merchandise is irstailed),if the workmanship (or application)of any Sears' arranged installation proves faulty within one year(other),2 years(select), 3 years(ply-select),than upon notice from you Sears will cause such faults to be corrected by repair at no additional cost to you. If Sears determines that repair is not oommerdally practicable or cannot betimely made,then,at Sears'sole discretion,Sears may elect to provide replacement or refund.Service under this Limited Warranty Is available by calling Sears Home Improvement Products aft-800.222--M,Option 4.This warranty gives'you specific legal rights,and you may also have other rights that vary from State to State. SKI-MA(Dig)Rev 051:811 Page"of 3 ,lob Number 12674328 NOTICE TO BUYER 1. DO NOT SIGN THE AGREEMENT IF ANY OF THE SPACES INTENDED FOR THE AGREED TERMS TO THE EXTENT OF THE AVAILABLE INFORMATION ARE LEFT BLANK. 2. YOU ARE ENTITLED TO A COPY OF THIS AGREEMENT AT THE 71ME YOU SIGN IT.KEEP IT TO PROTECT YOUR LEGAL RIGHTS. 3. YOU MAY PAYOFF THE FULL UNPAID BALANCE DUE :UNDER THE AGREEMENT AT ANY TIME, AND IN SO DOING YOU SHALL:BE ENTITLED TO A FULL REBATE OF THE UNEARNED FINANCE AND INSURANCE CHARGES. 4. YOU MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY (FIFTH BUSINESS DAY IN ALASKA, FIFTEENTH BUSINESS DAY IN NORTH DAKOTA IF YOU ARE AGE 65 OR OLDER]AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. FAILURE TO EXERCISE THIS OPTION, HOWEVER WILL NOT INTERFERE WITH ANY OTHER REMEDIES AGAINST THE RETAIL SELLER YOU MAY POSSESS. IF YOU WISH,YOU MAY USE THIS PAGE AS NOTIFICATION BY WRITING'I HEREBY RESCIND" AND ADDING YOUR NAME AND ADDRESS.A DUPLICATE OF THIS RECEIPT IS PROVIDEDSY THE SELLER FOR YOUR RECORDS, 5. IT SHALL NOT BE LEGAL FOR THE SELLER TO ENTER YOUR PREMISES UNLAWFULLY OR COMMIT ANY BREACH OF THE PEACE TO REPOSSESS GOODS PURCHASED UNDER THIS AGREEMENT. NOTICE TO MASSACHUSETTS RESIDENTS ONLY In addition to the Notice to Buyer shown above,Massachusetts law requires that contracts for home improvement work state that all home improvement contractors and subcontractors shall be registered and that anyinquiries about a contractor or subcontractor relating to a registration should be directed to: Director,Home Improvement Contractor Registration P.O.Box 871 Taunton,;MA 02780-0871 Telephone:(508)821-9375 Please note that owners who secure their own construction-related permits or deal with unregistered contractors shall be excluded from access to the Guarantee fund. Notwithstanding any other language in the contract or associated documents, Sears will not remove, replace,or install any heating or air conditioning system, or any portion thereof, if asbestos or asbestos-containing material is known or likely to be present in that heating or air conditioning system, or any portion thereof.If it determined or reasonably suspected that asbestos is present, either before commencement or during performance of,the work, it shall be the customer's responsibility to select, retain and pay all costs of a Division of Occupational SafetyCDOS")licensed Asbestos Contractor to remove all asbestos or verify that none is present in the components involved in the job. If the determination or reasonable suspicion of the presence of asbestos arises after Sears has started the work, Sears wilLimmediately cease performing the work until a DOS licensed Asbestos Contractor, hired by the customer, removes all asbestos from the components scheduled for repair or replacement in accordance with 310 C.M.R. 7.00 and 453 C.M.R. 6.00 or verifies that none is present. By signing the contract the customer agrees that it understands the above. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES f 10/26/2011 10/26/2011 Customer's signature Date Customer's signature � � � Date Accepted by Sears Home Improvement Products,Inc.("Sears")on 10/26/2011 by: ^�'ftt'f/✓ Date Management Representative SKI--MA(Dig)Rr 092W11 Page of 3 I I 11511 9011 2511 h/CO j N 65 , rn 2 2 N -+ i 1 Hi. There is supposed to be backsplash (that's there already) in this 20/20 design on the far left of the 115" wall. IPlease....put this in the drawing...20/20 isn't Pennypacker friendly. ,r W O i I All dimensions size designations This is.an original design and must` Designed:1 02 52 0 1 given are.subject to verification on rot be released or copied unless Printed:10272011 job site and adjustment to fit job applicable fee has been paid or job conditions. order placed. Designl Countertops Drawing N: 1