29-523 (2) '1 •
...`Y. ..
�y� �yrr- Sold,Fumished and Installed by:
Branch Namei!.M ( Date: t2 ' W THD At-Home Services,Inc.
d/bla The Home Depot At-Home Services
345A Greenwood Street,Worcester,MA 01607
Branch Number; 2101 Job# 2L �`-t Toll Free(800)657-5182; Fax:508.756-2859
Federal ID0 75-269946C ME Lic#C 02439 RI Cont.1,0 116427
Cf Lick 565522; MA Nom:Impm enwat Coatractor R--g.k126$9s
installation Address:
City State Zip
Purchaser s: Lear 4 DI to otrDriv r,1 tie.k&E: .MoNr; Work Plane: Home Ptsone:
7Db`3 (Lid $ -453 1
Hume Address:
(If different from Installation Address) City State Zip
E-mail Address(to receive updates and promotions from The Home Depot):
Pra'ect 19f r ion: IlWelYou("Purchaser"),the owners of the propperty located at the above,iAptTdJ0on.addr ss,.offer to
contract wit Home Depot U.S.A.,Inc Home De of")to furnish,deliver and arrange for the installation of all materials as
described on the attached Spec Sheet 0:���� incorporated herein by reference and,made apart hereof.
Home Depot reserves the tight to cancel this corytt-A 'if,upon re-iospiection ofthe'job,Horne Depot determine$that it
cannot perform its obligations due to a structural probiem.with the home,pricing eaves or because work required to
eompletethe job was not included in the Spec Sheet or Contract.
DEPOSIT PAYMENT OPTIONS
(Subjcd to fund-venficalion andeoreredii sppmvn;.)
CONTRACTAMOUNT S 4�`r�r7 t L Check,Cachiem Chect.ot USPostnl Sttvice Moaey()rder
(Made payable to The Home Depot),
"LESS DEPOSIT S 2• .Crodil Card'and/or otherpaytnemoptions-ChcieoneHelmr
Visa ManaCerd Discover American Fxprett
BALANCE DUE ���''��., 'rho Nome I triprovernentloss The Home Depot Credit Card
ON COMPLETION S;1 �J i - .
0 New Acwirat D Exirting Account (HIL&HDCC ONLY)
`RSinimusn 25%of Contract Amount due upon execution Available Credit S ONLY)
—,,,, ,,,�-
(
f this matract. HIL&HDC�C
A.i S3 d t Q.9 W
AcctB;
Indicate Payment Method For Name es it appears ou card; �It's�
BALANCE DUE ON COMPLETION: eBymyfourtignatsuebebw,.IrWeagreetoal lowHomeDepottochargethaabovc
eferonce,d ed t card for ti 'epoch indicated,
dloldaPs Si.,a ure, - F- Dat' e ,
„�,��' 0 d �at{i ffiL ar HDI+CC'Autilorvation Codes
0-I t w N"1) De"$it Final Payment'
#>7( 35 077 1# tai3t:;;7 t
Purchaser agrees that,immediately upon satisfactory completion of the work,Purchaser will execute a Completion Certificate
and pay any balance due. Purchaser also agrees to bejointly and severally obligated and liable hereunder.
Emti rr ment:This agreement and its attachments,including any financing agreement,contain the complete agreement
tween t e partes and can nct be amended or modified unless in writing in a separate agreement signed by hot parties.
NOTICE TO PURCHASER
Du not sign this contract before you read It. You are entitled to a completely filled-In copy of the contract at the time you sign. Kerp
it to protect your rights. Do not sign a Completion Certificate before this project is complete. Lair prohibits home repair
contractors from requesting or accepting a Completion Certiflcate sipined by the owner prior to the actunl completion of the Avark to
be performed ruder the contract.
You may cancel this transaction at any time prior to midnis tt of the third business day after the date of this contract. See Notice of
Cancellation for an explanation of Ihis tight, There will-bc a,service charge equal to 25%of the contract amount if the jute is
cnnedled M'Purchaser AFTER the third business day.
13Y MYfOUR SIGNATURE BELOW,I/WIi AGRE}i TO BE BOUND BY THE TERMS OF THIS CONTRACT. I/WF ACKNOWLED(JE
RECfifl'T OF A CDPY cw,mIS CONTItACT AND-1'WO COMPLETED COPIES OF THE NOTICE OF CANCELLA'T'ION.
BY MY/OUK SIONA']Ukf,. BELOW, 1/WE UNDERSTAND THAT THE, AGREEMENT IS SIIBIT)CT TO REVIF-.W OF MYtOUR
CRF'Ulf IIIS1'ORY ANT)I(WI'AUTHORIZE IIOME DEPOT'FO VERIFY AND REVIEW MY(OUR CAIIDIT RECORD WITH AN
iNDFiTCNDF.NT CREi U REPORTING AGENCY AND RELEASE THEM FROM ALL LIABILITY fNCIJR'RLf) PRCM
INADVERTENT OMISSION'OR ERROR',. DO NOT SIGN THISCONTRACT IFTHER'I.ARE ATIY'.tLANITSPACES.
SUBMITTED BY::-- Date. 1,
'consult I� S ,�
.ACCEPTED BY: Date: 1
ISomw ar
Date:
Homr�wner
NOTICE:AUmITIONAL TERMS..CONOIIIONS AND WARRANTIES ARK STATYt)ON'rill;REVERSE SIDE AND ARK PART Or TIns MsTRAC-r
White-Braruh Fi)e Y�Ilaw-QubnKr Pink-Sslea CenulAn.
9-27.05 C-SC
S d OOZE 13C?J3Sd� dH "101E SOOZ t+i DigQ
$ � jTirlessxchnseffs
DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR '212 Main Street • Municipal Building
Northampton, MA 01060
ROME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as 1:1s/her construction supw: .P sor. The state defines "Homeowner" as, "Person(s)
who owns a parcel on which he/she resides or intends to be,a one or twoami -
dwelling, attached or detached structures accessory to such use and/or farm structures. A
person who constructs more than one home in a two-year period shall not be considered a
home owner."
TheUuilding department for the City of Northampton wants--any person(s)-who-seek-to -
use the home owner exemption, to act as their own construction supervisor, to be aware
that by doing so you become responsible for compliance with state building codes
and regulations. The inspection process requires that the building department be called
to inspect work at various stages, which include foundation/footings (before backfiIl).
sonotube holes (before pour), a rough buildinE, inspection (before work is
concealed). insulation inspection(if required) and a final building inspection.:The
building department requires these inspections before the work is concealed,failure to
secure these inspections can result in failure to obtain a certificate of occupancy
until the work can be inspected.
If the homeowner hires other trades to perform work (electrical, plumbing& gas) the
homeowner will be responsible to make sure that the trades hired secure their proper
permits in conjunction to the building permit issued, and that they get their required
inspections. Failure of the individual trades to secure the permits and inspections as
required can DELAY the project until such time as the proper permits and inspections are
made
I, understand the above.
(Home owner/resident's signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit
issued-tome.
Date
Address of work
location
af {t�rfl��llt�to)� -
i A � f �Zasatcchrssrlte' -
DEPARTMEK7 OP BUILD0\10 INSPECTIONS -
212 Main Strect DSunicipal Duilding
j Northampton, ATass. 01060
i
WOR-PMRIS CONITENSATTON CNSTJTRA-NCF ?.l'I'M/1VZ7'
- (1lccnsxJpc;a�iitcc) )
v-11th a principal place of businessfresidenc- at: � SC�✓- -
�3y� nA OQ�71 � (Y ��_ N07 5-1121:2
(SI7=t1ci ty/stasrlri p)
do hereby certify, under the.paifls and penzIties of perJw-y, h�I
{ ( am an employer providing die following!worker's coinoensador, coverv,^,e for !n)
j eivplovices wori3ng on Li*s job:
-----
(L2sur�c Corer ) (POEC-, (r:-pir or.Dau)
I
I
O I am a sole proprietor, general contractor or homeowner (c cie ohe) and have hired
the coon actors Gsed below wbo have the follo%V'M¢ worker's compen_t2don pokies:
(i+amc O; Co:,Mcror) On urzncr Coinpui�- Pobc,- ?��un1�C:) l,r':71id:?^i?Datc) -
i -
- (N=c of Contactor) (lns-urancc ComoantivPo6m Nu bzr) (Eaplrnon Dale)
I (Name of CO=Clo:) Qnsuranc--C-ompan)-/PoUcy Numbu) (Expirdos Daic)
(Name of Contractor) (Lasuran= Comp
zay/Policy NI1mb r) (E-xpirtion DatL)
j (.=2c3 addi od tuC.ifnc�_^,-to inform :ioo•,on nip to.11 co=--1.on)
i
( ) I.am_a sore pr-oprietor and have no one wonting for me.
I ( ) I am,a home owner performing all the-work myself.
NOTE:plc=be awart:ti--• +jc bemcwxn.+t.s=play p---,,=w cis -, ^• cs ewo a rgair--ark on of
DOE mote tb�L-e-=3k,in wbicz the bomoa mover r=d=oc oo the Qvs s zapurtea-�the n s r ax�a-liy o�cd ni Lo be
=.ployc-s une the.. iS—e=*c= :uoa Act(GL115Za 1(5)):.ppiiatioo by.bc=o--D=fc a tip_or p==mh r---y c`'id=-tLe
legal n- of en e=ploy.r wader d.e Wo i,r .Coc pom..lioa Act_
II uod_-stead tha>oopy of tb:u=,L�m y be foes sided to tLo D.. u. ¢of Inda.s ,/�.6.wy Mo.of 4s—for tb.
j —QMLe�c-iGc=lioc.ud thre L-iitac to secure)cover.tse uadc soctioo 25A of MOL 151 C=I�w the i--rgas =of eimiasl
of a fiat oC w S 1 300.00 arlNcx
ooas�::xg up mJl o(up to ooc yr:r Lnd evil pm.Yuo in tk foca.of•Slo(.Work Ord-. and• _
i
fim of 5100-00 a day LPIC:2
lFor de9erta'=— u.e only
i
Pcrmll Numbcr -
LOt
Si iurc of Lic=is /Pcm-iuct e
w �
MSECTI514 8<-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
9.Reoisferec7 ornclmof emenl Co hadto `- Not Applicable ❑
�MD kqe 2M) 12 3
Company Name Registration Num ear ——
?�✓I t..
Address Expiration DAtel
u G. fly? Telephone�lbl q����
SECTION 10-WORKERS'COMPENSATION INSURANCE.-JWFIDAVIT(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 buildigg permit.
Signed Affidavit Attached Yes....... No...... ❑
£ Horir
WE
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families
and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts
as supervisor.CMR 780, Sixth Edition Section 108.3.5.1.
Definition of Homeowner:Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there
is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm
structures.A person who constructs more than one home in a two-vear period shall not be considered a homeowner.
Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be
responsible for all such work performed under the building permit.
As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon
completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 1S2(Workers'Compensation) and Chapter 153(Liability of Employers to
Employees for injuries not resulting in Death)of the iviassac,asetts :,.~,:,ral—1—,vs Annotated,You may h_a liable for person(s)
you hire to perform work for you under this permit.
The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of
Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
r
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows [Alteration(s) Roofing
Or Doors A
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks Siding [p] Other[o]
Brief Description of Proposed ,..�• n
Work: _ _ ,a r fia I l �i� c be e �1" �L l'f�')LbS L)C)3 &
Alteration of existing bedroom Yes No Adding new bedroom Yes No .
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
+q.�. ,�^.:m..z�q•- •m�. � �.--" -iw °�� ��., : �- k"m
6ai a W',h,6�se�ala�t r.adr t�oru�o exlstirlg iausfnc�.-corrtptbWthe'#6tfb"W'-f tl:
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 Ta-OWNER AUTHORIZATION TO-BE COMPLETED WHEN
OWNERS AGENTORCONTRACTOkAPPLIES FOR BOIL IN`G"PERMIT
I, C-04 MCI as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature d Owner Date
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.
Print Nam �.
Signature Owner/Agent Date
Section 4. ZONING All Informatioh 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 1
Setbacks Front
Side L. { R L: ` R:=
r----
Rear
Building Height ;------; :. -
Bldg. Square Footage % --t s--
Open Space Footage %
(Lot area minus bldg&paved i
parking)
#of Parking Spaces
Fill:
(volume I&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW 0 YES 0
IF YES, date issued:;
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW YES
IF YES: enter Book Page` and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO k_j DONT KNOW 0 YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 Date Issued: #
C. Do any signs exist on the property? YES 0 NO 0
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO
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 r NO 0
i
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
De ctment use only
City of Nortf ampton 5?wM49RM
Building Departmenteue �� � �
212 Main Street eve 5atla�r
Room 100 �� ��
A Northampton, MA 01060
phone 41 J-587-1240 Fax 413-587-1272 �io tangy WRIF e `
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -S tTE INFORMATION
1.1 Property Address: This section to be completed by office
Map ?Lot llni#
G
Gae!]C>(', L V}Q Zoae � OyerFayDis nct
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Reco11rd: y
�11�11 _ a /
_ 1 Y
Name(Print) Current Mailing Add essj
Telephone
Signature
2.2 Authorized A ent:
Oki-e- LD"
Name ri t) Current Mailing Address:
cj�;s 9403
Sig t r Telephone
SEGT ON 3-ESTIMATED'CONSTRUCTIOM-COSTS
Item Estimated Cost(Dollars)to be Official Use Only
com feted by ermit applicant
1. Building (a)Building Permit Fee
2. Electrical ;(b)Estimated Total Cost of
Construction from 6
3. Plumbing Building,Permit Fee-
4. mecnanicai(ii'vAC)
5.Fire Protection 5
6. Total=(1 +2+3+4+5) t Check Number
This Section For Official Use Only
Date
Building Permit Number Issued:
Signature:
i
Building Commissioner/Inspector of Buildings Date
0 6004
9 GREGORY LANE BP-2006-0773
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 29-523 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2006-0773
Proiect# JS-2006-1183
Est. Cost: $6869.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor., License:
Use Groin HOME DEPOT AT HOME SERVICES 126893
Lot Size(sq.ft.): 5924.16 Owner: YU WEI SHING&WAN CHU YU
Zoning URA Applicant. HOME DEPOT AT HOME SERVICES
AT: 9 GREGORY LANE
Applicant Address: Phone: Insurance:
345 GREENWOOD ST (401) 935-2633 Workers
Compensation
WORCESTERMA01607 ISSUED ON:21212006 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 2/2/2006 0:00:00 $25.0011281
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo