Loading...
12 HARTFORD ST - BUILDING INSPECTION (2) CAs lA 2S� The Commonwealth of Massachusetts INSPECTION L SEEN Board of Building Regulations and Standards kQg" Massachusetts State Building Code,780 CMR SALEM 1614 (( pp b `l 'lF 1 2011 Building Permit Application To Construct,Repair,Renovate Or Demo`Iis 3 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: D e Applied: 9 Building Official(Print Name) Signature Date Date/ _ SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 1� NaN-�Rl S< 1.1a Is this an accepted street?yes_ no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq R) Frontage(it) 1.5 Building Setbacks(it) 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? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner of Record: IMcaK_ Name(Print) City,State,ZIP 12 garltord 5t • 771 - 72q•eY4�' No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) Alteration(s) ❑ Addition ❑ Demolition ❑ 1 Accessory Bldg.❑ Number of Units_ Other b Specify: Brief Description of Proposed Work': Rt2 j-t 1.J1 ' OwJ— J ¢ SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1.Building $ 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 $ 2. Other Fees: $���� 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ / Total All Fees: $ Suppression) p Ou Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ 0 � 6 7d ❑Paid in Full ❑Outstanding Balance Due: N� ll,e:-'D �zz. w 1 i SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) br halal &f4t+u License NumberIq ?I {, Z- r Expiration Date Name of CSL Holder List CSL Type(see below) 10 41-C&- Dr- No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) D R Restricted 1&.2 Family Dwelling /Town,S to M Masonry RC Roofing Coverin WS Window and Sidinia SF Solid Fuel Burning Appliances 617-3Y2- 413CA I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) �at•�ei ohte C'.Pi w-s 19868� to rd 1 HIC Registration Number H}}C Company N��e or HI Registrant Name Ex aho Date l3t, TtrMp Lle No.and Street Email address l�j �(,rynZIPt� ot-t•t� b1'I-354-oq�d Ci /Town,St e, 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 GLt" to act on my behalf,in all matters relative to work authorized by this building permit application. /y 1 ACC, Townnl 4•�t 1� Print Owner's Name(Elecifonic 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. Q f• Ic •rt� t 1pr6A-�� AsriL Pn rn s or Authorizrd�ed 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.eov/oca Information on the Construction Supervisor License can be found at www.masS.eov/dos 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" The Got»monwealth of Massa,!husetts Dep'artinent oflndustria/Accidents ° 6fftce of Investigation 600 Washington Street Boston, MA 02111 v- www.massgov/dia Workers' Compensation Insurance.Affidavit: Builders/ ontractors/Electricians/Plumbers Applicant Information i � ( Please Print Legibly Name(Business/Organi tiou0ndividual): �0;bg C CMav 4 i Address: 10 R1.4q UAive City/State/Zip: MIC4"t Mel Q.21155 Phone#: (,1-7'S9a-4,3oq Ar to an employer?Check the appropriate box: Type of project(required): I. 1 am a employer with q — 4. ❑i 1 am a general contractor ind employees(full an�or part-time).* have hired the sub-contractors 6. New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached shee . 7. ❑ Remodeling ship and have no employees These sub-contractors hav g, ❑ Demolition working for mein lany capacity. employees and have work rs' 9. ❑ Building addition [No workers' comp.insurance comp. insurance.: required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work E officers have exercised their I LEJ Plumbing repairs or additions myself. [No workers' comp. f .right of exemption per M L 12.❑ Roof repairs insurance required.)t 'c. 152, §1(4),and we haveno (( employees. [No workers' 13.0 Other comp.insurance required. 'Any applicant that checks box tl I must also fill out the section below showing their workers'w nation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hive outside ntractors must submit anew affidavit indicating such. 'Contractors that check this box must attached an additional°sheet.showing the name of the sub-rw tractors and state whether or not those entities have employees. If the sub•contmeton have employees,they must provide their workers'comp.policy number. I ant an employer that is providing workers'compensation insurance for my mployees. Below is the policy and jab site information. ( I I Insurance Company Name: Policy#or Self-ins. Lic.#: /l{lt)G'I{Q0= 702 56 J* AO13e+ Expiration Date: Job Site Address: 12. k( � � ,S( • City/State/Zip: G06kYh1 th& o1d1"jo Attach a copy of the workers'compensation politc'y declaration page(sho ing 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$1,500.00 and/or one-year imprisonmetnt,las well as civil penalties i the form of a STOP WORK ORDER and a tine of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify_unde the pains and penal ies of perjury that the informal on provided above is true and correct. Si nature: l Date: Phone#: 617= 59a-y3o4 Official use only. Do q1ol write in this area,to be completed by city or tow I official I ' City or Town: I Permit/Licenst # Issuing Authority(circle one): 1.Board of Health 2.Building Departmen! 3! City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phon #: ,� '��q�r'ninNrc;uita+ujl�rj C's1��far�o�EY�.i ffiee of Coosumcr A fairs:&Business Re ulatiou r - - B License or registration Valid for individul use only I `,,``�,, ME IMPROVEMENT CONTRACTOR- before the expiration date: If found'return to: "7tegis . .Type Office of Consumer Affairs and Business Regulation b"atl0n: 148688l0 Park Plaza-Suite 5170 Expiration; 1 0/1 812 0 1 5 Supplemenh?ard Boston,MA.02116' LOWE'SHOMES.CENTERS INC RICHARD CHALONE" , TURNPIKE SUITE72 s�. SOUTBOROUGH,MA 0177 Undersecretary Not valid without signature s 'ni a Massachusetts • Departm t ofPubltezSafety} Board of Building Regulations and Standards ' g License: CSFA-061719 4 s$ RONALDACREEI4E r, . •10RITADRIVE < .ay MEDFORDMA`0215 x Expirrwtlon rommrssraner 10/2a1J1$< I %"/��•'(rourr+ururrvr�(li r.�^.��<;:n:/ru�r(/' _"^` ^Rice ut Consumer Affoirs&Business Regulation License or registration valid for individul use only „;X?.f`6E IMPROVEMENT CONTRACTOR before the expiration date. If found return to: j 'Registration: 148688 Type Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Expiration: 10/1W015 Supplement and Boston,MA 02116 LOWE'S HOMES CENTERS INC RICHARD CHALONE 136 TURNPIKE RD.SUITE 100 SOUTHBOROUGH,MA 01772 Undersecretary _ - - Not valid without signature ,d GREEINS-01 LCARUSO AFRO' I DATEMMTDYYWj CERTIFICATE OF LIABILITY I SURANCE sltyzola THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND r-ONF ERS 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 CONTFU CT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER IMPORTANT: H the certificate holder is an ADDITIONAL INSURED,the policy(les)mi ist be endorsed. H SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement 0 statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s. I PRODUCER rrr CONTACT Salem Five insurance Services,LLC k PHONE 1 FAX 445 Main Street N 8 1;� 9333100 (LAIC.Not:(781)933-9D48 Wobum,MA 01801 �BINESR, 4 INSURER AFFORDING COVERAGE I NMCa 1! INauRERA:S ty insurance Company 39454 MSURED f t muss a, ty Indemnity Ins.Co. _ 338i8[ I I Ron Greene InstallCo.Inc. ,INSURER c:AI Mutual Insurance Co. 0913 Ron Greene INSURER O: 10 Rita Drive ��. I Medford,MA 02155 INSURER s: _ I I I SURER F: I COVERAGES 1 I CERTIFICATE Nt ER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISS ED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CON IRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCEE BY PAID CLAIMS. POLICY 11 M&R Ty9EOFMSURNNCE I I POLICY NUMBERWMADIV= rN=oYYYnLIYITS A I X I CeMYERCUL GENERAL LIAsUrn, E k f EACH OCCURRENCE S 11000,00 cwMaMAOE I X OCCUR ISMAOOCB519 051 14 g510812015' TiRERrE7- 1 PREMISES Enorourerca S _ 100A0 IE { I j MED ExP(al .F ) s 10,00 ' I• III (PERSONAL&ADVINURY s 1,000,0 GENt AGGREGATE UW APPLIES PER: GENERAL AGGREGATE S 2,000,BO I�POLICY J 0ECT (I I LOC PRODUCTS.COMPWAGG S 2,000.00 I (OTHER: I S AUTOMOBILE LIABILITY LOMBM SINGLE LIMIT S 1,000,00 I{ ( I lFa erOMM B i SANY AUTO i 6208= 011301214 01130MOIS I BODiLYIUURY(Pn Fe'son, s IALL OWNED ((�X SCHEDULED I A I ((AUTOS r (SODIY INJURY(Per am ) S 40,00 LI HIRED AUTOS X I OTOS N-OINNED ` I II fPRO TY DAMAGE S F I I UMBRELLALNB ` ^� t=i1 OCCUR I (EACH OCCURRENCE S IrI EXCESS LAB ] i i CLNMSMAOEI I (AGGREGATE $ DED I RETENTIONS ( S WOAIU:RS COMPENSATION I F. III X SERTUTE ERK AND EMPIAYERB'LIABILITY J ! C ANY PROPRIETORPARTNERI ECUTIVE YQI AWC400.7025594.2013A 03 14 OWW201S E.L.EACH ACCIDENT s 500,00 OF EXCLUOED? N NIA 1 (yes 1.NN) I I (El.DISEASE-EAEMPLO S 500,00 Or Of OPERATIONS below. I E.L.DISEASE-POLICY LIMIT S 500,000 I I DesrnPnoN OF OPeuTaxsl LdcAnoNSI VENICLFS IAcalo tot ADaiuomrRomars,smmup.may esanxroe mo,.ePxeNspwraul Lowe's Companies Inc,and any and ail subsidiaries are named as additional Insured per written contract or Bgreeemem. 10 day cancellation clause for non payment,30 days for all other regarding General Liability t CERTIFICATE HOLDER I' I CANCELLAnbN tSHOULD AN OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Lowe's Companies Inc.and any and all Subsidiaries THE ECPI N DATE THEREOF, NOTICE WILL BE DELIVERED IN IS Insurance I ACCORDANCE WITH THE POLICY PROVISIONS. P.O.Box 1111 North Wilkesboro,NC 28656 AunNon® ATnre I �� I G _. i O 1gr8&2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered mfarks of ACORD I u- + /ire. 't. �1,. LC.. 'ZsJ e.. `hJ 'eJ '� '�J ' .1 ir,i '�' .� + :s O A0lUWlf RR Donnelley02013.All rights maned.—D56] T - CONTRACT# 0004836 MASSACHUSETTS SERVICES SOLUTIONS-INSTALLED SALES CONTRACT LOWE'S AU1TLHORIZED REPRESEN�gJ�IVE - NUMBER $ CUSTOMER STO� STREET ADDRESS S%BEET ADDRES�C✓�� S�. - . CITY STATE ZIP � _ CITCY �Iljj��__ _ STATE/.�t_,,; _-' ZIPp TELEPHONE - - . TELEPHONE DATE ' LOWE'S}tOME CENTERS LLC'S rvTA HIC NO. 148686 -M:f"v c^ ," "' '- 00.rvK y`?" CCC � ReG ?) t FEIN:56 0748355 4 I� cAxo CHARGE , This is only a quote for the merchandise and services printed below. This becomes an agreement upon payment Upon payment,the entire agreement,including the specrtically 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"Contact". - PLEASE READ ALL TERMS AND CONDITIONS ON THE REVERSE SIDE OF THIS PAGE AND FOLLOWING PAGES BEFORE SIGNING. - INSTALLATION STREET ADDRESS CITY STATE ZIP 2 1 �v� 0L sa S, ed/li. ILIV6-,t tom, _ Vr Lc ci.. G Irt+ sr — f 4 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 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 Contract 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. Contract Total p Are permits required for this installation?: rfYes [ ] No *applicable tax included NOTICE TO CUSTOMER: Federal law requires Lowe's to'provide you with the pamplet Renovate Right. 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. - NOTE: If rotted wood is discovered during installation additional charges will,�qgpply. You will be given a quote and a change order must be completed and signed by the customer for any additional charges. rJ/Z—Customer must initial. 'Any work or material not specified is not included in this contract.Any changes or additions will be at an additional charge for the material and labor. PHOTO RELEASE: Customer grants to Lowe's and Lowe's employees and independent contractors the right to take photographs of the Premises where Installation Services will be performed and all work performed at the Premises related to this Contract, and irrevocably grants to Lowe's all right,title and 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, publicity, illustration,training and Web content. By initialing here,Customer agrees to the foregoing. [Customer to initial to the left]. Work !c7m pence-upon reasonable availability of Contractor and/or any special orderI �orper made Good(s)which is anticipated to be `/ S /[fill in date]. Estimated completion date is �t [fill in date]. Said a imated substantial completion date is not of the essence. A statement of any contingencies that would materially change said estimated substantial t.. completion date is as.follows: (if applicable, insert a statement of such contingencies). IF THE CONTRACT TOTAL IS$1,000.00 OR LESS Customer must pay in full. COMP THIS SECTION ONLY WHEN THE CONTRACT TOTAL EXCEEDS$1,000.00: [-I-Customer to Pay in Full; OR [ ]Customer to use the following payment schedule: (1)Deposit $ ! to be paid upon signing contract. Deposit should be 1/3 the total contract price;and (2)Payment of$ to be paid anytime after this Contract is signed and before commencement of installation,I/We authorize Lowe's to.do one of the following-(c]ieck awpropriale bowbelow]: , Y. „T, [ ]Charge illy/our credit card for the amount of.3h"e payment odicate']7 above anybm aR'er tti d to this on ract inigned; or [ ]Deposit my/our check for the amount of the.payment indicated'above anytime after the date this Contract is signed;and (3) Final payment of$100.00 to be paid upon completion of the installation and both parties'satisfaction. mnilcF RFrARnINr.ARBITRATION AGREEMENT FOR CLAIMS COVERED.BY-M.G,L.o.142A This is onlya quote for merchan ise and services printed below Thi es n agreement upon _ ent. Upon Payment,the entire agreement including'the s specifically com letetl pages of this docu P the tl p s becomes a ag ma p peym p pay g L Pe N P P 9 PLEASE the READ ALL and ConditionsN included.with this E REVERSE and any other addenda and attachments hereto,shall be FORE tl to harem as Mrs"ConGacl." -' PLENSE READ ALL TERMS AND CONDITIONS ON THE REVERSE SIDE OF THIS PAGE AND FOLLOWING PAGES BEFORE SIGNING INS ELATION STREET ADDRESS 5� CITY f H. STATE 26 k o 1 A) r t .wu r�U �VI - IrtL s, f 4 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 estimated Goods required to full 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 Contract 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. Contract Total $� p Are permits required for this installation?: [-fYes ( ] No "applicable tax included ` D Q L( 0 NOTICE TO CUSTOMER: Federal law requires Lowe's to-provide you with the pamplet Renovate Right. 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 tobe performed in Customer's dwelling unit. NOTE: If rotted wood is discovered during installation additional charges wilily. You will be given a quote and a change order must be completed and signed by the customer for any additional charges. Customer must initial. `Any work or material not specified is not included in this contract.Any changes or additions will be at an additional charge for the material and labor. PHOTO RELEASE: Customer grants to Lowe's and Lowe's employees and independent contractors the right to take photographs of the Premises where Installation Services will be performed and all work performed at the Premises related to this Contract,and irrevocably grants to Lowe's all right,title and _ 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, publicity, illustration,training and Web content. By initialing here,Customer agrees to the foregoing. [Customer to initial to the left]. Work is tp cgm,Tence upon reasonable availability of Contractor and/or any special order rcl�sto er made Good(s)which is anticipated to be 47/�j' TV [fill in date]. Estimated completion date is f y/ y7[fill.in date]. Said estimated substantial completion date is not of the essence.A statement of any contingencies that would materially change said estimated substantial completion date is as.follows: (if applicable, insert a statement of such contingencies). IF THE CONTRACT TOTAL IS$1,000.00 OR LESS Customer must pay in full. COMP 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 $ to be paid upon signing contract. Deposit should be 1/3 the total contract price;and (2)Payment of $ to be paid anytime afterthis Contract is signed and before commencement of installation,I/We authorize Lowe's to do one of the following(check appropriate box-below:' V . "'ry. [ ]Charge my/our credit card for the amount of the payment indicated above ariytimelafter the date this Contract Is sibnedjor [ ]Deposit my/our check for the amount of the.payment indicated above anytime after the date this Contract is signed;and - (3)Final payment of$100.00 to be paid upon completion of the installation and both parties'satisfaction. NOTICE REGARDING ARBITRATION AGREEMENT FOR CLAIMS COVERED BY M.G.L.042A 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 SUC D)SPUTE TO A PRIVATE ARBIJAATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUT- IVE OFFICE OF yyONSUME FAIRS AND USINESS RE LATIONS AND THE OWNER SHALL BE REQUIRED TO SUBMIT TO SUCH ARBITRATION AS PROVID V L. d+_ 3 By: Date: Lowe' o Centers;LLC By Date: Ow rSigna THE SIGNA S PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE RESOLUTION INITIATED BY LOWE'S PMN;T1 M.G.L.c.142A.THE OWNER MAY BE PERMITTED TO INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THE SECTION ABOVE IS NOT SEPARATELY SIGNED BY THE PARTIES. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AND UNTIL YOU HAVE READ THE TERMS AND CONDITIONS CONTAINED ON THE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS CONTRACT. BY SIGNING BELOW, YOU ARE ACKNOWLEDGING THAT YOU HAVE READ, UNDERSTAND AND AGREE TO THE TERMS AND CONDITIONS SET FORTH ON THE REVERSE SIDE.OF THIS PAGE AND THE FOLLOWING PAGES OF THIS CONTRACT.YOU ARE ENTITLED TO A COP�OF THIS CONT,,RACT AT THE TIME OF SIGNATURE. WITNESS OUR HAND(S)AND SE L(S)BELOW THIS DAY OF Lowe' o e C ers, low s oozed a resentattve O e Co-owner or Witness Customer acknowledges receipt of a true co y of this ra rich was completely filled in prior to Customer's execution hereof.You,the buyer,may cancel this transaction at any time prior to midnight dt the third business day after the date of this transaction..See the attached notice of cancellation, form for an explanation of this right. FILE COPY ®2004 by Lowe's.®Lowe's and the gable dosign 551�2 REV. 12/13 are.registered trademarks of LF Corporation.