24C-038 7/ 8 /II /21)11 14_01 CC41' 6roup1CNE Group Afar Ie Prou1x- ►LOWE'S COMPANIES INC 2/3
•
ACORD CERTIFICATE OF LIABILITY INSURANCE DAT 06/24201 w'
I A,
I' P >lt! IcER Pr** .;4131781 - :410 Fax 413.731 - THIS CERTIFICATE Is ISSUED As A MATTER OF INFORMATION
INSURANCE CENTER OF NEW ENGLAND ONLY AND CONFERS No RIGHTS UPON THE CERTIFICATE
1070 SUFFIELD STREET HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P 0 BOX 1230 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,
AGAWAM MA 01001
INSURERS AFFORDING COVERAGE NAIL #
INSURED INSURER A: Connecticut Underwriters
MARK S JODOIN
INSURER e: Commerce Insurance Company 34754
ORA JODOIN HOME IMPROVEMENT INSURER C
137 PORTER LAKE DRIVE -
LONGMEADOW MA 01106 INSURER D:
INSURER E:
COVERAGES
TNF r'1 C t:: V; IH51_IZANi:E L151ED BELOW I !AVE OCCN ISSUED TC 'n PP311Rr•ri NAMrr? ARwvr '!F: TI IF POI icY PrRIC?r! 11 r!4_i'WITI STAIiCiiJ!;
ANY LMENI, Ern rr CYJNOITIC'N OF ANY CONTFAI'T GR CTHFR Pi)CI JM'IzNf wffu 1 - -.1- C:T 'I0 v -M:H THIS f'FRTIFIC HA1' rir I:>u-r, OR
NAY PF %TAIN, THE I•13'.1PAI r AFFCIRrtrri R'r T! IF Fill ICES LYE- CHIt,tl! HEI+bIN 15 `J IO 4LL 11 Ihi EACLIJ510Ny ANN COr Jr!ITk?N S iiF ;I IC
.1,C ,r..T It;ITS 'ikCANN MAC HAVE HFNIJ Ii L:I I(;HiJ tt'i PAID CLAIMS
na;s Inn'_ TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
t, Iw': -Li "AfIJMNVODrcY DA7 IMbvOrV
GENERAL LIABILITY NNO31125 00/26!11 00/26/12 tA.;H rn:: r;. !I +ItFr6' 500,000
X r r.Ir.IrRClf,l ;ENFPV I IARI T, CAMALL rcFLT,ILU 1; 50.000
- NNLNI,L:: (Le V. CUlrlil:) _._... —_
I CI. AIMS MADE I X I =I:UI h1ED.t l'IAIY/ rac!4I1 S 5,000
A PERSONAL & AEN IIIJI_tl »/ 3 500,000
•
,ENtItAL ;;CAAEC,AIE E 1,000,000
r rrlL ATP I boll Ati I'L PRnDI rT _�tnr.r� Ai•G. L ..... 1,000,000
X P! ,I I.. r .JEC I f Loft
AUTOMOBILE LIABILITY RPJ989 03/26/11 0126112 OFIMETINrn illy rl F I MT
ANT' AUTO
AIJ.. V' AUTOS BODILY IN.NIR;' -.. _. ....
X HtLLILtU AUl i1 F' C T 100,000
B X HIRED AI iT :!e, —....
BLXIILt INJIJP 300,000
X t,I ud_o,wt,rr_, to rr,.,t,
iPrt �yii +.I,,n11
RROPrpT'r?AMA -r 1 100,000
(PVr r;G'OA)
GARAGE LIABILITV
Nrto ONLY . r- 4 /S:!'IDf'rJT I
-
\tfi :_ irHtl' IHAN to A(} $ ....... - --
AUTO ONLY ACC 4
EXCESS !UMBRELLA LIA1- LRY WI I C,C:CI rRrrli F 'I
CLAIM.`; MArir AC:,F'rGASr 'I —
I
r:rr ICTlril r . I_ .
!it I tr1 :IQN .
WORKERS COMPENCATIUN AND I WC: PTATII- I IITHFR
EMPLOYERS' LIABILITY __ T; a`r'lMlrs �
E L. EAI_H ACIIUUNI 4
ANY PROPRIETOR/PARTNER+EXECUTWE ,I
OrrICERIMEMBER EXCLUDED? r I pc rt.ipl
K yoa, doscrlbo °odor
SPECIAL PROVINION9 bobw t L. L'ISE.ASh I''JUL Y LIM I 3
OTHER:
DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT! SPECIAL PROVISIONS
LOWE'S COMPANIES INC- AND ANY AND ALL SUBSIDIARIES ARE NAMED AS ADDITIONAL INSURED AS RESPECTS TO GENERAL LIABILITY AND
AUTO LIABILITY
F#231 -5562
CERTIFICATE HOLDER CANCELLATION
;f 101A
17 MI' OF THE ABi vE DE ( T I E E A I'iJLIi:It: NE I AIJI:tLLEL'I 6E1 - flit IHE ExvkA ird
DATE 'IHEHEUF I HL Iib-,I ANC; Ii,:1IR'FR WIII FNDEAVOR TO MAIL 20 GAYS ,V1.17E'. NC`T1
THE PERTIr IL AIE HJLDECI NATCD To T irrT n1 IT CAII IIPPIC; r %,',� ";'a u I IMC %sr lJ[+
LOWE'S COMPANIES INC. CIII I ANY KIJU '0N IHE NIA ;Er +,II AGENT I I: NAt ,:E rerdTAtl!;S:I
ATTN: I S INSURANCE (MEZZ)
POST OFFICE BOX 1111 AI , TI InFnrn PrPPESENT,4TNE
NORTH WILKESBORO NC 28656d1001
. 4141
Attention: tephen Gallagher
-
ACORD 25 (2001 /08) Certificate # 56718 ® ACORD CORPORATION 1988
J ? d S31VS 03llv.LSNI 0990 *7 e9GG 1, 90: LL-90-1,1.0?,
. t0.11 -06 -20 10:01 413 231 5562 4 0660 INSTALLED SALES P 2/2
. s - De04rtiiiintt E 'it H-4:::
$n).arti i3ttt iii.;;Regyfatlons anti �! ii11'J4
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£ 1 cxiiLta#aa X12 Indlviduet I
;.icrse. CS' 499918
J 7LC.
1 7 PORTER LAKE DR'
-•4 �!VL J ..- _ -- 1 LQNCMEADOW, MA 01106
'- GFh__..7, M.4 U 'Undersecretary 1
Efriiti.or.: ', 2. .:
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x"" � aa � CONTRACT # 0 0 010 2 5
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"> � :.:'Z�,r! : , �
'' INSTALLED SALES SPE IALIS -
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STORE NO. a STREET ADD' SS"
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• +:$2 CnY STATE ., ryZIP�
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TELEPHONE ' 1 TELEPHONE
DATE LOWE S HOME CENTERS INC. 'S MA HID NO.. 148688 5" CASH BANK LCC REG
FEIN: 56-0748358 > T' ; g CARD CHARGE
C:� f ' , 4. e
1'h[Bi& ,BAI> a retched` '93 x �' . 6
ATIL ' O. . �F a '1 F " " "7 den dR 6 13 4 �` g , � ,, , . . , ,
,s. , , .a. •q's, ".- :aiN.u! M`fir+ t x`w 'd
INSTALLATION STREET ADDRESS CITY STATE ZIP
4 ' c 2 5 5 .bo U 'e
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1
Contract Total CDC
Are permits required for this installation ?: [ Prics [ ] No *applicable tax included T -
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.
PHOTO RELEASE: Customer grants to Lowe's and Lowe's employees the right to take photographs of 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 to 0 once upon reasonable availability of Contractor and /or any special orderer cu tourer made Good(s) which is anticipated to be
() f%/ /( Mlle in date]. Estimated completion date is /c)/ / / //( [fill in date].
Said estimated substantial completion date is not of the essence. A statement of any contingencies that would mate i lly change said estimated substantial
completion date is as follows: 1/p ft G r7 . t1 el el- - po/ c I 0 t ei V Ifs- t- ereaaC
�I l (if applicable, inYerta statment of such contingencies).
IF THE CONTRACT TOTAL IS $1,000.00 OR LESS Customer must pay 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:
(1) Deposit $ to be paid upon siging.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 (check appropriate box below):
[ ] Charge my /our credit card for the amount of the payment indicated above anytime after the date this Contract is signed;
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.
NOTICE REGARDING ARBITRATION AGREEMENT FOR CLAIMS COVERED BY M.G.L. c.142A
LOWE'S AND OWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT LOWE'S HAS A DISPUTE CONCERNING THIS CONTRACT, THAT
LOWE'S MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUT-
IVE OFFICE OF CONSU FAIRS AND BUISNESS REGULATIONS AND THE OWNERS LL REQUIRED TO SUBMIT TO SUCH ARBITRATION
AS PR.OVls DIN M.G. • y i g g _
By B� ��"' _ —0•411r 5 !1 Cate: / l � / 2
L. , ,T's me C - In � c. � �,� ` /1 f
By: i� Date: LIUP , 1 1 l f
Owner ignature
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.
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 COPY OF THIS CONTRACT AT THE TIME OF SIGNAT�IRE.
WITNESS OUR HAND(S) AND SEAL(S) BELOW THIS / /f ( DAY OF Tr, -P(' , 0CH
L we's Horn ters, Inc. 7Th -
S ecialist orAb a Co -owner or Witness
Customer acknowledges receipt of a true copy of this contract which was completely filled in priofto Customer's execution here ou, the-buyer, may
cancel this transaction at any time prior to midnight of the third business day after the date,of this transaction. See the attached notice of cancellation
form for an explanation of this right.
#4438 P.001/001
1
1''i'09 )21 2011 20:34
eu 1 -u1 14 :08 lowes 1916 ISM �r1 88 0278 » P 2/2
SECTION 8 • CONSTRUCTION SERVICES
/U jt~ena3ed Construction $u rv;ser: Not Applicable CI
Name of Llaet'3o Holdor :_ (�!l lL ¶_ C�C�t +J -t' - t°{ lc,
License Number
!• t: Dia . Lokic-aN€. . e c 12.29.2 U I
Address
Expiration Date
, -nature Telephone
9. Registered No ee+ Imetgamertt Cant ractQr6 Not Applicable
vronemorram
C)OUlt�l oY�1E `� �1 ECV EIVT I S t �
Cjtn,,eny Na Lsn Registration Number
240 LP., ' Pse 1\ Cater." ZvtZ
Address = , -1 Expiration Date
/// r ----Y Telephone }
SECTION 10• WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 28C(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 builds permit.
Signed Affidavit Attached Yes.,...., No CI
11. - Home Owner Exexnnation
The current exemption for "homeowners" wa:; extended to include ganer7neennIed D etlin . of one (1) or two(2) families
and to allow such homeowner to engage an individual for hire who does not possess a license,13Ct3vir<ied thnh tt]o owner :1cts
assn r• C'MR 7 S xth Ed ition Section 108.3,5),
laefinition_11t' Homeowner: Person (s) who own a parcel ofhand on which he /she reside. or intends to reside, on which there
is. or is intended to be, a one or two tinnily dwelling, attached or detached structures accessory to such use and/ or farm
structures. • • con w 1A c1111Rt' u a s u ore thigi a hn • in a two. !tr a sod strut , . e aeidered , n eowner,
Such "homeowner" Shull submit to the Building Official, on u form acceptable to the Building Oft ciai , t lcMsiae shnit_be
swoons 141. f�':1t1 sttclt work er ccl undc�l' the huildine drools
As acting t'oltslrrre(istn SRi ftcrvi your presence on the job rite will be required from time to time, during and upon
completion of the work for which this pormit is issued.
Also be tadvised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to
Employees fot' injuries not resulting in Death) of the Massachusetts General Laws Annotated, n .iv he li , Inge for per,con(s)
you hire to perform work for you under this permit.
The undersigned '"homeowner" cct'tifies and assumes responsibility for compliance with tine State Building Code, City of
NortJtampton Ordinances. State and Local Zoning Laws and Snite of Massachusetts General Laws Annat. ied,
Homeowner Signature._.., _ _��
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacemen indows Alteration(s) ❑ Roofing n
Or Doors
Accessory Bldg. El Demolition ❑ New Signs [O] Decks [Q Siding [0] Other [0]
Brief Description of Proposed
Work: a- 't"IGvE V-AND l PtF\C. c-'-` CA-1RN(
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
6a. If New house and or addition to existing housing, complete the following:
a. Use of building : One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No .
I. Septic Tank City Sewer Private well City water Supply
SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, 6CAn I EM COW- , as Owner of the subject
property
hereby authorize l.-.CA.N cENT \NC. •
to act on my behalf, in all matters relative to work authorized by this building permit application.
f COT )ZAC'T[ /2
Signature of Owner Date
I, L- JOSEy /GN1 Y1 , as Owner /Authorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
L,INQE ZIEti-'ir
Print Nai
,. I LL) 1 2.05 i i
gnat re of Owne /Agent Date
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg. Square Footage
Open Space Footage
(Lot area minus bldg & paved
parking)
# of Parking Spaces
Fill:
(volume & Location)
A. Hasa Special Permit /Variance /Finding ever been issued for /on the site?
NO Q DON'T KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DON'T KNOW Q YES Q
IF YES enter Book Page and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO Q DON'T KNOW Q YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained Q , Date Issued:
C. Do any signs exist on the property? YES Q NO Q
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO Q
IF YES, describe size, type and location:
E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES Q NO Q
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
s' f
Or • Sit
•.m+aw4wMrww.�.. - .-
• Department use only
City of Northampton Status of Permit:
Building Department Curb Cut /Driveway Permit
212 Main Street Sewer /Septic Availability
Room 100 Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Plans
phone 413 - 587 -1240 Fax 413 - 587 -1272 Plot/Site Plans
Other Specify ., ,, �► ��
ll APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEM + �� + ILY DWELLING
SECTION 1 - SITE INFORMATION • 50
1.1 Property Address: is ction to be c by office
.3 \ t ELM ST. oFev+w'"° Nu,a,oso
.
Map : a,� ��'` Unit
NOV.TI ->f lYIPTOQ ,1\Ak CX,O
Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
'hat, C'ou. ck FAN ST. t\40t tc ,MI:\ n■rxoc)
Name (Print) Current Mailing Address:
X43• (
CCtt,vroOCT Telephone
Signature
2.2 Authorized Agent:
1 - iN'OSE>i Z1F_\ule'R pi � `r - A.k ST, \-\'\t hF- t 4 \ C
Name (Pr i ) Current Mailing Address:
a re Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building -- as 0' U (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection + o�
6. Total = 1 + 2 + 3 + 4 + 5 ) � �fJ � Check Number f � j S
This Section For Official Use Only
Building Permit Number: I sssuu
ed:
Signature:
Building Commissioner /Inspector of Buildings Date
399 ELM ST BP- 2012 -0546
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 24C - 038 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: windows replaced BUILDING PERMIT
Permit # BP- 2012 -0546
Project # JS- 2012- 000916
Est. Cost: $785.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: MARK JODOIN 49918
Lot Size(sq. ft.): 7187.40 Owner: COLE KRISTEN A
Zoning: URB(100)/ Applicant: MARK JODOIN
AT: 399 ELM ST
Applicant Address: Phone: Insurance:
137 PORTER LAKE DR (413) 885 -7361
LONGMEADOWMA01106 ISSUED ON:12/6/2011 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL REPLACEMENT WINDOWS
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House # Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace /Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
FeeType: Date Paid: Amount:
Building 12/6/2011 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner