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Remove label•after final inspection; SAVE for future reference
Weather Shield
CPD# 050=A--172
NFRC Model 8108 Double Hung Operating
i Alum clad Thermal Frame
rYe><,lF!riOl►:rt 314 inch Glazing
rwvq r c,a%:ra ZO—E .022 Low—E
0:1MMIMS Argon Fill Grille in Air Space
ENERGY PERFORMANCE RATINGS
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ADDITIONAL. PERFORMANCE RATINGS
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HOW IMPROVEiLWGUItiTRAUT
' , Sold,Furnished and lrlstd W by;
Brauxb Name:Sostcu Nm ,dh South Data T—TW)At-Home setvicesi Inc.
d/b/a TbA Home 1]epat At-How Serviaea
Braneh Nuttaber:31 and 33 908 Boston Tampike;unit 1.:Sbzewshuty,MA (31545
Toll Free 877-903-37.68
Federal 1D#7S.269 W. ;ME; Lic#4()2439;RI Cont.-U F IW7
a Lie#HkC.056552 H VQmeyrt Conpotor Reg.#126s9?i
r;
..City state ~ Zip..?
Porclhoser(s)'
Work MOW,, HUM Pit e: Cell Phone,
f
Home Address:
(If different from Installation Address) City State Zap
E-mail Address(to receive project c6mmunications and11ame Depot updates): — — —
d.1 DO NOT-wisb'to receive any,marketing emaila from-The Homdlylcpot
pro°' :' 1i�eesii%e ft'Ctis�om�Y .tfi`Sdnr `a1f'te ideated"iit'the aboi a itistallatioti address
agrees to buy,
and At-Horne Services,Inc.("The Home Depot")agrees to furni delver acrd strange£ai the installation("f�sfallatian")of
all materials desarbed en.the below and on the rcfarenced Spec_Sbeet(s), all.o£which are orated jnto This Contract by this
rck=ce,along,with any applicable State Supplement and Payment SunMary attached bereto avd.any Cb.a*.Olders(collectively,
"t_,ontract"5:
Job sb a)4h Project Am mat
`., ri gelation
Caduttraa$/cave�so[]lSmtry DoaWrs❑ 71- �
Roofing 05iding 1,J Windows EJ WA4afioin ?
QGatM/c C&ay .p - - $
Aaoting 5idirag: Wixadows kaeulation
EIGtutun/Covets 01Entty'Dom C3
. Rochug ng Vdiadivwa losuladon � .
[]Gutters
/C
c'ets [Q]✓ntry -
vau2i4L Depo9ttdGatdradAatatpttdoe e�oecoglas• tldsaaatrer3. ''Total ContractAntount
A78iee Purrhmters tnB,Y net deposit nsa>•e than�thhd oR rite CangaM Amwmk �i ('�J
Customer agrees that,.immc25ate)y upon c.'Aploion d the.work fbr each Product,Custommer will execute g`•Gompleddo Cedificate
(one for eich Product as droned by an individual Spec Sheet)and pay any balance due. As applicabSc,ear h Custbttler under Ibis
Contract agrees to be jointly and severally obligated.and liable hereunder.
7be Home-Depot reserves the right to issue a Cbange Order or terminate this Contract or any individual Product(s)included herein;at
its discretion,if The Horne Depot or its authorized service pmvider detetr�nes that it cannot perform its obligatious due to a structural
problem.with the home,environmental h=rds such as mold,asbestos.ar lead paint,other saf--ty cowcras,pricing errors or bermse
work required to complete.the job was not included in the Contract.
Paymmt-Summmyt The Payment Summary# 44 Un=- included as part of this Contract, sets fcVb the total
Cottract amount and payments required for the deposits wind final payments by Product(as applicable).
NOTICE TO CUSTOMER
Yon are entitled to a co letely filled-in copy of the Cositrect at the time you sign. Do not Alp a CcmtpledWCertft%to(. tike;
there Is one Completion Certificate for each listed Prodltcf ati`deiltied by Wdlvidaal Sper Sheets)'beforc work on that Product
is complete.
Im the event of termination of fibtia Contract,Castoaner agrees to pay The Hoare Depot the costs of materials,labor,expetwes
and services provided by The Home)Depot or Authorized Service Provider through the date of termination,pphts airy other
mt
amounts set forth in this Agment or allowed under applicable law. THE ROME DEk'OT MAY WITHHOLD AMOUNTS
OWED TO THE ROME )DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MAUE, WrMO11T
LIMITING THE ROME DEPOT''S OTHER REMEDIES FOR RECOVERY OT'SUCH AMOUNTS.
A nee a d Aotbqnzad2n. Customer agrees and understands that this Agreement is the entire agreement between Customer
era,Home Depot with regard to the ProducV5 and Installation services and supersedes all prior discussions and agreements,either
oral or written,relating to said Products and Installation.This Agreem€rat cannot be assigned or mended except by a writing signed
by Customer and The home Depot.Customer aclmuMedges and agrees that Customer has read,understwtds,voluntarily accepts the
terms of and has received a copy of this Agreement
Y. Submitted by:
J
ustomet' zgn Date ( Sales Conmiltant's Signature Date
X 'Telephone No.
Customer's Signature Date gales Consultant Lic bnse No.
]CA ELLA N: CUSTOMER MAY CANCEL THIS (45 mppficable)
AGREEMENT Wri'HOUT PENALTY OR OBLIGATION ` G
BY DELIVERING WRITTEN NOTICE TO THE DOME
DEPOT BY MIDNIGOT ON THE T'MD BUSMS
DAY AFTER SIGNING THIS AGREEMENT. THE
STA.'I'E SVPPLEMIENT A'ITACMD HERETO
CON'TA)NS A FORM TO UST IF ONE LS
SPECTFTCALLY PRESCRIBED BY LAW IN
CUS'TOMER'S STAC'I'E.
NOTICE:ADDIT'IONAI,TOM AND COMMONS ARE STAND ON 1 RE REVERSE SIDE M ARE RART OF'S'MS CONITACT
The Commonwealth of Massachusetts
Department of Industrial Accidews
Offr'e of11vestigations
> 600 Washington Street
j Balton,M41 02111
www..i< ass.govldin
0M tiflta Insurwice Affidavit; Build , s/Contractors/ElectriciartsM bers
Apylica' ` aifo ti `,. Please P6Rt Lgjib1-i=
NaiYl (Busiriirsd diianiraiion&dividuat):
Address
LAA
Ac
Ci /Sa1Z><
`r} Phone#:
t3' ani 5q36:4
Abe � rl�ty" , !rQpr7te big Type of project(required):
' tttcactor-and I
_,.4 ❑I out ae�t(t ao
1 a�M. New construction
e lq eks dA � �).* have htrec�rite sub-contractors
Y 7. []Remodeling
211j.I a�a so a o ti i r` �i l ion tee a t cbe s►egt.
slip and haveaPlayees T1ee sib-eetzactors have g. [�Demolition
e>T Ioyees auclaye workers' 9 Buldin addition
worku�tg forte in oily capacity. 0 g
� o wozkets' camp msui'ance comp utsuxancc t '" •
0. Electrical re airs or additions
retlurrecj.] 5. [] W. are a cprporation and.its 1 ❑ p
3 ❑ I am lxt eowner doing all vrtirk of c rs have exercised their 11.El Plumbing repairs or additions
myself. [No workers' comp. right ofx. mptiot per MGL 12.[]Roof repairs
insurance required]t : c..152 and we have no
13.❑Other,
empXayeea,[krjo workers':. -
. ,. ;
•Any applicant that citeclrs hox#Y ttl�st also till out the sectton beiovv ahowtng ihe>r wnikets compensation policy information,
t Fiomeowpgrs vyho'Sdbmrt this affulavrt mdreating they are dots g all raroxiC aitsi then hue Qutsiat contractors must submit a new affidavit indicating such..
Contractors that clCeok$us hoX must attacTtgtl an addittoral sheet showing the name of the gab contractors and state whether or not those entities have
employee;,If the sr�-cgntrac�ora 4a�r�smpio,ycest they must provide theft �irkers comp �o]icy number.
I'ar at(employer that providing�votkers cnmpens4tton Insurance j'or nay employees Below is the policy and job site
tnfortxrriEtan. �— .
Insurance Cgz►ipany Name `
Policy#or,Sell=ms Lic # = Expiration Date: jr r
Job Site Address. . City/State/Zip: ..
�o
A ttacb a copy®i'the rkers'cgrinitensahan palxcy declaration page(slnnwuig the pa►lecy number and a ration date).
Failure to secure coverage as Xegoaed`:linder Sect>on 25A of IvZGL a 152 can lead to the imposition of criminal penalties of a
fine up to$1;500 OQ and/or one year icnprzsorttent,aS.Well as civil penalties in the form of a S rOI''WORK ORDER and a fine
:of up to$25Q 00 a day agautst the ytolator Be adyxsed that:a.copy of this skaternent may be forwarded to the Uffiee of
Inves�igat�ans,�i'the 1?1A farnstuanc�roverage ve�ficatiau: .,
1 do 7nereby certafy y r t rein ra oj;prary t�aat tJee alarm an pr®varied�b®ve as a and correct.
St
.: :.. Date: �.
•Phon
�1 ctal tise'Qttly rp�u dot write in this area,to be completed by city or town of j`iciaL
•
t✓�ty of TQsvn
Perinit/License#
LTssui�g Authan�(eaircle Qne) ,
1 1.3 oui'd of Health 2 $uidmg Department. 3.Ctty/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6 Qther
Confa�f Pexan : .. . •
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction 5gpervison --ter► /N�ott Applicable £
Name of License Holder: D 711/ �-- " ( (-1-/ ^�i/�
License Number
/*A dress Expiration Date
Signature Telephone
..........
9. Re istered H`'me Im'r"vement Contra r: j" r Not Applicable £
Co an a Registration Number
ql)/,f -,4 - 3
ess �.. x iration Date
Telephon
SECTION 10-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 buildin ermit.
Signed Affidavit Attached Yes...... No...... £
11 - Home Owner Exemption
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-year 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 152(Workers'Compensation) and Chapter 153 (Liability of Employers to
Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be 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,
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement ows Alteration(s) ❑ Roofing ❑
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [0 Siding[0] Other[E3]
Brief Descri do ropgse
Work: !�G-
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa:If New house and or''additon to existing housiriq, 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 ,as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters relative authorized by this building permit application. �
Signature of 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 ain nd penalties of per t
Print Name
Signat of Owner/Agent Date
� .
Section 4. ZONING AIL Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
Tliis column to be filled in by
Building Department
Lot Size
Setbacks Front
Rear
Building Height
Bldg.Square Footage
o
Open Space Footage %
(Lot area minus bldg&pwved
#of Parking Spaces
(volume&Location)
A. Has a Special Permit/Variarce/Fi nding ever been issued for/on the site?
�
NO «x~��� DONTKNOW x x���� YES «-�
��
|F YES, date iszued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO � DU� | K�uv /c�
IF YES: enter Book Pager
and/or Document#
B. Does the site contain a brook, body of water orwetlands? NO 0 DONT KNOW 0 YES
IF YES, has permit been or need to be obtained from the Conservation Commission?
Needs tnbeobtained _��~\ x�\Obtained Date Issued:
� «�� '
C. Do any signs exist on the property? YES �~��� NO Y���
�
IF YES, describe size' type and location:
D. Ave there any proposed changes to or additions of signs intended for the property 7 YES 0 NO 0
IF YES, describe size' type and location: | '
E. Will the construction activity disturb(clearing,grading, excavation,or filling)over 1 acre orisit part ofo common plan
' that will disturb over 1 acre? YES NO
IF YES,then a Northampton Storm Water Management Permit from the DPW ia required.
�Departr�eht,use onlx r ' '
--7., ity of Northampton
1 �+::'s r :,a-�;✓} ".y fns r� a .I
ilding Department Curb Cut/Drlye+uay Perini# rL L'
�a 212 Main Street Seyver/SepticPtvaifa6lllty 5ar
MAY 28 2014 Room 100 Water/Nteif +va�l'abllity r
AM,
Northampton, MA 01060 Two Sits of StruG#ural Pfarts f 4
Electr,c P u7;;,In -phpne�l13-587-1240 Fax 413-587-1272 Ploflsife Plans; i 5}' Rl� {i�LKki�L(' L
N1, �� I OthefaSpeClfy ce d �a `�
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE.INFORMATION
1.1 Property Address: This section to be completed by off ice
- 7 Map Lot Unit P/000� C-L.
1
Zone Overlay D►sYhct
Elm St Dastr�ct C8 Distract r
SECTION 2.-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(P�ri%nt�)► Curre jlingAddress- �� r— 2-9//1
Telephone/
Signature
2.2 Authorized A rat: ,/# I) -
�11/ r
Name( ri Current Mailing Address:
Si alure-
r Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building � /}�j (a)Building Permit Feb
2. Electrical !/ (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) Check Number
This Section For Official'Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector'of Buildings Date
89 PINES EDGE DR BP-2014-1266
GIS#: COMMONWEALTH OF MASSACHUSETTS
MM:Block: 18-002 CITY OF NORTHAMPTON
Lot: -000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:window replaced BUILDING PERMIT
Permit# BP-2014-1266
Project# JS-2014-002129
Est. Cost: $2118.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: HOME DEPOT AT HOME SERVICES 67121
Lot Size(sq. ft.): Owner: CORBETT DARLEEN B
zoniny,: Applicant. HOME DEPOT AT HOME SERVICES
AT. 89 PINES EDGE DR
Applicant Address: Phone: Insurance:
24 SUNRISE DR Workers Compensation
PROVIDENCER102908 ISSUED ON.512912014 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL PATIO REPLACEMENT WINDOW
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 5/29/2014 0:00:00 $35.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner