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32A-058 (6) HOME IMPROVEMENT CONTRACT PLEASE READ THIS i Sold,Fumished and Installed by: Branch Name:Boston North&South Date:bO t THD At-Home Services,Inc. cLWa The Horne Depot At-Home Services Branch Number:31 and 33 908 Boston Turnpike,Unit I,Shrewsbury,MA 01545 Toil Free 877-903-3768 Federal ID#75-2698460;ME Lic 8 C 02139;RI Cont.Lic#16427 \ CT Lic#HIC0565522;MA Home Improvement Contractor Reg.#126893 Installation Address: �1 V V UN `U(';' -t �♦l� City State 'Zip Purchaser(s): Work Phone: Home Phase: Cell Phone: jZ [ l t l [ 1 Home Address: (If different from Installation Address) City State Zip E-mail Address(to receive project communications and Home Depot updates): ❑1 DO TOT wish to receive any marketing emails from The Home Depot Pro' nfor i�rt: Undersigned("Customer")i the owners of the property located at the above installation address,agrees to buy, an THD�-�4t-Home Services,Ina("The Home DepoC)agrees to famish,deliver and arrange for the installation('Installation**)of all materials described op.the below and on the referenced Spec Shcct(s), all of which are incorporated into this Contract by this reference,along with any applicable State Supplement and Payment Summary attached hereto and any Change Orders(collectivey, 'Contract"): Job#: c1—."i Rk P ducts: Spec Sheet(s) #: Project Amount ��>>� Roofing Siding Windows Insulation y 36 7 77 ❑tuners t Covers OEnay Doors ❑ (S SC'„-i G[_ 5 _7 443 Roofing Siding El Windows Insulation ❑Gutters t.Covers ❑Entry Doors rj $ Roofing Siding 0 Windows Ll Insulation ❑Gutters 1 Covers []Entry Doers❑ Rooting EiSiding U Windows in,ulation ❑Gutters)Coms ❑Entry Doors ❑ $ Alinirnum 25'/.Deposit of Contract Amount due upon eimation of this contract. Total Contract Amount $ � Maine Purchasers may not deceit more than one-third of the Contract Amount. Customer agrees that, immediately upon completion of the work for each Product,Customer will execute a Completion Certificate (one for each Product as defined by an individual Spec Sheet)and pay any balance due. As applicable, each Customer under this Contract agrees to be jointly and severally obligated and liable hereunder. � The Home Depot reserves the right to issue it Change Order or terminate this Contract or any individual Product(s)included herein,at its discretion,i[The Home Depot or its authorized service provider determines that it cannot perform its obligations due to a structural problem with the home,environmental hazards such as mold,asbestos or-lead paint,other safety concerns,pricing errors or because work required to complete the job was not included in he Contract. Payment Summary- The Payinent Summary# included as part of this Contract, sets forth the total Contract amount and payments required for the deposits and final payments by Product(as applicable). NOTICE TO CUSTOMER You are entitled to a completely filled-in copy of the Contract at the time you sign. Do not sign a Completion Certificate(note: tbere is one Completion Certificate for each listed Product as defined by individual Spec Sheets)before work on that Product is complete. In the event of termiantion of this Contract,Customer agrees to pay The Hoare Depot the costs of materials,labor,expenses and services provided by The Home Depot or Authorized Service Provider through the date of termination,plus any other amounts set forth in this Agreement or allowed under applicable law. THE HOME DEPOT MAY WITHHOLD AMOUNTS OWED TO THE HOME DEPOT FROM TIME DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Acee lance and Authorization- Customer agrees and understands that this Agreement is the entire agreement between Customer and T to Home Depot with regard to the Products and Installation services and supersedes all prior discussions and agreements,either oral or written,relating to said Products and Installation.This Agreement cannot be assigned or amended except by a writing signed by Customer and The home Depot.Customer a6mowledges and agrees that Cu er has read,understands,voluntarily accepts the terns,of and has received a copy of this Agreement. At c y � � )� Submt d }� X Custom s Siy tore D e Sal Itant's Signature Date X Telephone o. Customer's Signature Date Sales Consultant License No. CANCELLATION: CUSTOVLI:R MAY CANCEL THIS (asappkigbtei AGREEMENT WITHOUT PENALTY OR OBLIGA'T'ION BY DELIVERING WRITTEN NOTICE TO THE HOME DEPOT BY MIDNIGHT ON THE THIRD BUSINESS i DAY AFTER SIGNING THIS AGREEMENT. THE STATE SUPPLEMENT ATTACHED HERETO CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN CUSTOMER'S STATE. nnn•in i, n� 4inv •' � �� t, the+gYhr.nrzan—rncan.gc.ca � "' • rw �• 11 ' 1 t t t ! + L • • � Q�ttitltd aemoV-' labal,aticr RrIZI Inspection; SAVE for tulurc relernce Weather Shield C?Db 050=A-172 NFRC Model'g10B'Douhle Hung Dp:ralinp Alum clad Themi2l Frans 3/6 Inch Glazing rbtt?�C�t ZO—E ,D22 Low—c Argon rill 0rille in Air Space ENERGY PERFORMANCE RATINGS U41:111 scl_ H.ZI wn cOClli-.Al 0.30 1 1 .70 0.18 N S.h—Pf llfelrfl} ADDITIONAL PERFORMANCE RATINGS Ylslblc 1r_•tsntine ; Lrndccs:linn A.cillw,,s: f 0.40 0 ►nut turn ripultCt t,tt Ctsx nLn;c r=brn to .ppne.blt BFRC pncedwrct 6r d.umJatnp ♦h.lt pnCttf.ni ri Pert nnma HF/.0 ntngt to dtit rnJne/ 6r t- Lrrd cl of tartrrntnW rs+41mj tnd pt:Jtt pndrel cr, MFR:dou tot ret�of .ni ptoltitl tnd'dwtr ntt rtn•tnt he ailutltY of�''(�proaott W writ tptCtt uwa, :roe ull mtnv L:r,nt'I ChntLrt br ttnet pnduet pubnry tr 1100R ttea, kttU or cttwtdt N.'_v I.E.C. 1Jr I'it tit rwl>on Rwcutrtmtnic (DP) tcvtd�LkSYLAl1AJrlt,rt71 tULt.:-,� _ H-L:::S t<= �p? �' - tmtrt. uuLnroua,cci }'1 iCin i2+t u0'-CI 3 5 ' � � N_L.ns tl,t::trotu:sa U-r �..�.9.t.n.�t.a.•,..,..r..LSIV IT 1 _ �\ 1„e i ✓u�ncurcrt�cctul U/ JUUSS'llL'l1llS'L'f15 ' Department of Iizdustl•ial,4ccide�. . ` • • 0 'cc of 11;vesti;a ' _ C011;r•ess scree `ulte 100 BostoliZII -2017 nsass.gov/dia Workers' Compensationl>s��ranceAutdavit: Builders/Contractors/Electricians/PIumbers An-D Iicant Information' � Please Print LezibIv �lC Nam°> css/Orgztuz2tionlIndividtnl): %� -�'' `�Y i T2--n g- �s I=yam r City/State/Zip: ) L Tlt / Phone T: Are you an'em,ploycr? Chcck the appropriate bo Type of project(required}: I.❑ I ant a emp)oycr with 4. aam a general contractor and I emp)oyee's (fill and/or past-time). have hired the'sub-contractors 6• New constrvctiori 2.❑ I am a sole'propri eior or partner- listed on the attached she°t. 7. [] kemodcling ship n and have o employ°°s - These sub-contractors have g Demolition worrin; forme Tl any capacity employees and have workers [No workers' comp:insurance comp• ipso ance•x 9. ❑ Building audition ] 6. We are a comoration and its . 10. ' E)ec�t•il repairs or additions regtired. [�. 3.❑ I am a homeowner doing z1'.'wor}: omccrs have exercised their 11.17 Plu.-nbi:.g repairs or additions myself. (1vo workers'.comp" n aht of exeintition per MGL 1_ ❑ Roof,re�p^aI,,s' i surance required.] t c. 162, §114)'; and.we have no 1� then Ism/ employees. [No workers'. KJ comp. insurance required.] 'Any appiicznt ti:.;r�lucls box-l .east alp, fill otit th'c section below showing their work:-S,hompersation policy iniomiac on. t'aomCOR'n:rs who submit t is affidavit indiezting they arc doing all work and then hire outside eon=--tors must submit a new afrdavit indieadng such. tCon1,-2::or3 that--neck this box must attached an adaitional sh::t showing the na.••n-of the svb conGa-to3 and'sutc wheth:r or not those ctitities have :mployr-s. if the sub-con—.z:tors have employees;they must provide their wor}t:rs'comp,policy number. I ant a i employer that is providing avorkers' Conipensaiion insurance for my employees. 3elow is the policy and job site- • "iizformarion. '' �_' y� Ins Na- ant::Company Nae: - Jt/'-� ' Policy T or Self i s. Lic. =xaiiarion Date;. •�-� Job SiteAdaress: /Yf� �L% �'" � / �� - ' Ciry/StatdZip Attach a copy of the workers' compensation policy declaration page(showing the policy number and =piration date). Failure to secure cov=' age as required under Section 25A of MGL c. 152 can 1-ad to the imposition of criminal penalties of a nne'up to 51,500.00 and/or one-year imprisonr ent, as we11 as civil p>nalti°s in the form of a STOP WORK ORD=R and a 5= of up to S250.00 a day agaLst•the violator. Dc advised that a copy of th s s at-tncnt may be forwarded to the Omcc of Invcsti.pa ons of the DLk for insurancc,coverage.vcrincztion ; . .. — . I do hereby Ccrn� : pa's and er alt« f crjury that the infornsation provided above is true and carrccL Phone- I �� — `�I g - --s^ 0121v. Do not write in figs arc=, to be completed by Ciry or sown official. City or Town PentutJI.icense r Issuing Author2ty(circle one): I.Board of 2.Bui]Lnu Depzrtmt—it 3. City/ToN`n Clerk ;.Elec iczl�spcctor S.Plumbin;Laspector 6.0t:ner Contact Person: Phone 4: City of Northampton 212 Main Street, Northampton, MA. 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. Address of the work: Z)xl/p-'-.� The debris will be transported by: The debris will be received by: Building permit number: Name of Perm it A pp licant CIdlDT1211A Date Signature of Permit Applicant City of Northampton Massachusetts r S (` { DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supervisor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends 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 home owner." The building 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 backfill), sonotube holes (before pour), a rough building 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 to me. Date Address of work location i The Commonwealth o Massachusetts Department of Industrial Accidents s 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 (Business/Organization/Indivi dual): Address: City/State/Zip: Phone #: Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general 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. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.1 required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. tHo meowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lie. #: Expiration Date: Job Site Address: City/State/Zip: 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 hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: Phone#: 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#: SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Su,,ee�rvisor: -7�� J y�� '/ /� Not jAppplicablepe E Name of License Holder: /"U / /`/ " /�"��✓ (� C.i �l P�/ License Number� Add res 4Q•• Expiration Date Signature Telephone z/0 f- 6–R istered Home Im rovement Contractor: _ ,, ,': ,;, ,.' Not Applicablei � Comnanv Name Registration Nu er �1 Add s Expiration Date 5 � Telephone W2L2 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 mit. Signed Affidavit Attached ....... £ No...... £ 11' Home Owner Ege"mption'. 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 app licable) New House ❑ Addition ❑ Replacement W' ows Alteration(s) ❑ Roofing ❑ Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs (0] Decks Siding[0] Other[o] Brief Description of Pro osed il�,iDC T�� -J� Work: Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a:If Newhouse and or addition t'o 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 �W as Owner of the subject I, property hereby authorize to act on my behalf, all matters relative to work 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 un he pai and penalties of per' Print Name f Sign re of Owner/Agent Date y / I I I - ---- - ion Must Section 4. ZONING AU Informat Be Completed. Permit Can Be Denied Due To Incomplete Information .41 Existing Proposed Required by Zoning TIiis column to be fillod bp Building Departmen`t' Lot Size Frontage Setbacks Front Rear Building Height Bldg. Square Footage 0110 L—I Open Space Footage % (Lot area minus bldg&payed of Parking Spaces (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DON7KNO\Y 0 YES 0 |F YES, date ioued: IF YES: Was the permit recorded at the Registry ofDeeds? NO K } DON7KNOVY 'ES ~� IF YES: enter Book Page 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 tobeobtai .ed x—\ Dbtained «�� Date Issued: . �-� v_� 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 orioit part ofa common plan thetv�Udisturbover1acna? YEG [ � NO � 0 ' ~�/ `_' IF YES,then a Northampton Storm Water Management Permit from the DPW is required. - r � Department use only RECEIVED City of Northampton Sta#us of Permit s Building Department GtrrFr Gut/Dnveu+ay Perrrf# OCT 2 32014 212 Main Street SewerlSepticAvairabt[cty Room 100 Water/V�feltgvailabil[ty vi N rthampton, MA 01060 Two Sefs of S#ructur'ai Pfans L.Or-91JUM13- o 41 -587-1240 Fax 413-587-1272 P[otlSite Pkans Q�ier spec��y APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION This section to be completed by off ice 1.1 PropertV Address: _ .r, � -Map Lot Unit ;:Zone Overlay District Elm St District' CB District SECTION 2 PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: p (1 Jt/j Dom? /> Name(Print) i _.— Current Mailing Address: Telephone Signature 2.2 Authorized ent: Name(Pri Current Mailing Address: Si ture Tkephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building ' /,, A rl (a)Building Permit Fee 2. Electrical / !Y U (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 0 This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Comm issioner/Inspector'of Buildings Date 50 UNION ST 13 BP-2015-0486 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32A-058 CITY OF NORTHAMPTON Lot: -000 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-2015-0486 Project# JS-2015-000920 Est.Cost: $7466.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: HOME DEPOT AT HOME SERVICES 104327 Lot Size(sq. ft.): Owner: FERRARONE STEPHEN Zoning.URC(I00) Applicant. HOME DEPOT AT HOME SERVICES AT. 50 UNION ST 13 Applicant Address: Phone: Insurance: 5 RIVERVIEW DR (401) 935-2633 O Workers Compensation NORTH PROVIDENCER102904 ISSUED ON.1012812014 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 10/28/2014 0:00:00 $35.00 212 Main Street, Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner