04-009 (4) Sold.Furnished and installed by;
Branch N'ame. [late.- THD At-Home Services.Inc.
d 1)a The Home Dcpol At-Home Services
30A(ITeetMood.Street.Woreesict,NLA 01607
Branch Number: _ Job 9: AAMV/ Toll Frcc 1600)657-5182: Fax:508-756-2859
r.&_i to '-'!1-40ii-A ME G. C P2 U9 FU t'1 14 U'J^
Lic-W-522: MA Home I nirvokiment Contokloy Rey.=12,03
Installation Address! C- n04MA-1Q) Z 6m
AX
State Zip
—poeol4w(w I.J%t-k D!ht Of Drilt.r'g Lic.4&E,p.%to r: %%ork Phone: H Wlt pliont;
W-��
Home:Address',__ mil
(Ifdjffcr�m 1rom InsillialiollAddiQ.a C11.\ Slaw zip
E-mail.\d4rgs%t to reeeix e up ewe:and promoiion%from The Monic DepoL?:--.
contract„ith Home Depw L. Inc. o Iurnih.deli\ec )id;i1T;u11;e Im the inmallmion of all inwrink ns
LCScrinca on the attached Spec Sheet
i,worporay,:d herein b, relaencv and made a part hereof'.
Home Deput resicries the right to cancel this contract if.upon re-inspection of the joh.Rome Delint determines that it
evinnm perform Its obligations due to a structural problem••itb the home,pricing errors or because work required to
COMI)I •the Job%*As not ilicluded In the Spec Sheer or('0111tTaCt.
DEPOSIT PAYMENT OPTIONS
I h,I-tlgi%Vrirwgii,m and orCreJLL;g114110A.f
heel h ek.i jA,wr., k ,r Vl� Order Order CON MACTANIOVNT S_&_6 1.�xj ,\Wdt lm}ahlr ,,1'ho 11"'no DQr"It.
*LESS DEPOSIT S 2 C redi(C:trX init or oiim jii\nwni opti—A-Circle One Helq%
Vi'a Nld,Lcr'ard Dkr ,%v iamyiein Lxpre<.
BALANCE Df E
ON CUMPLE'll ION S L711w i ii:w-ws home 1.P cnt L,w, Ll h.v H„me n%e 1 f3ey—C.redt,Card
. .7 1. -
V Uvou.[ JC%Isr1ng temawt I Hit.d HVU( 0--L)
"Minimum 3.1%of •outTsict Amount due upon A%wilofilt Crtilit:A. (111L&MY ONLY)
e%ecution of this contract,
%Qcpy,.e, Dwe.
J',
Indicate Pai-ment.Method For -13% my vor sigrwnlra heltm-1 1\'s'acres'to altos HkMile Depot to
BALANCE DUE ON COMPLETIOW' chori: I)%:oboe,:wf,:rv9ced credit card for the deposit indicated,
-e
If"LC CG:
"*Nfa} be subject to Credit Approv at,Fund HIL or HDCC Authorization CodW-
er1ficiitiOU 3fldiff Credit(and Authorization Final Payment
# #
llurcha, r ngri-e:chat,inimckliaufly upon compietion oi'the\1 otjk,PkALI1.1.1Cr\%it(C-1'eL:oqe;J C0111JIlCtiOn Certificate and pag am
balance due.e PUrch-,"OT itllt) TO bCJ01r11N and sc,crall�obligiied ind hibic hereunder.
Entire vureement., The.agreement and it,wnlchiwwr , 01011ding any rimuiciog ngrccrncnx.contain the complete agreennew
een the piirlkv>and can not N;anwndeQ or modificd unless in kvrffin-in a 4,pavaw qrcement signed bN both panics.
\OTICE TO PURCHASER
Do not sign this contract before ion read it. You are entitled to u completely fillvd4n cop-. of the contract at the time
gnu sign. Keep it in protect tour rights. Do not slogn a Completion Certificate before thI%prDlect is complete, ll,a%s
prohibits home repair contractors from requesting or accepting it Completion Certificate signed by the a"ner prior to
the actual completion ofthr Mork to be performed under the cudirAM
10o mai cancel this transaction sirti dine priarta midnight ofthr Writ bitAness day after the date ofthis cunirnet. See
Notice of Cancellititiun lur an v\pla'nation of this right, "There sill let a wmlwe Aargtr equal to IV. of the contract
2MOUut ifJoh IN cancell•d h'"\1 FurMilwr At I LK the third business dsd.but OF-FORE mairrittle are ordered.There Hill
he a service charge equal to 25*u of the contract amount if job Is cancelled b% Purchaser AFTER materials are ordered.
B) MY W.R SIGN\rL PF. BELOW. I WE AGREE' TO 13F 901-ND BY THE TERM% OF THIS CONTIZACT. I\\L
ACKNOWLEDOE REC EIPT OF A (MY 01:THIS(DN I RAC T .NNF)TWO COMPLETED cOPIL-S OF THE. NQ HCE
01-C'.-%NCE.,Ll..kTI0N.
14) \IN Ot."R SIGNATURE BELOW, I INT L_XTWR5'I-%ND THAT THE AGREEMENT IS SUBJECT TO R17VIEW OF
NlY QL R(Rbl.)i I I-IISTOR'i, AND I WE ALTHORIZE HOME DEPOT TO VFRIFY AND REVIEW NIN OUR('111,A)IT
RL(ORD kk ITH f)�.NT CREDIT REPqRTENG MiFNCY AND PLLE.%SE THFM FROM ALL LIABILITY
IM L RRED FR0NH:,"1)F\F.RTENT ONIISSIOINS I ERRORS
Dai,:7 !/—mow —Zk.
Sk.BMITTED BY
AC CF PTFD AV: Date, 4 —,Cc
Date:
NOTICE:ALDDITIONAL TERMS AND CONDITIONS ARE STATED ON THE REVERSE SIDE
AND ARE PART OF THIS CONTRACT
SIS d SHY << 904Z OZ-11-900Z
0��1iAMp�O
(rtt-P of 3Ozt4alilptan s
1�ASEACtt liSttlE
n` DEPARTMENT OF BUILDING; INSPECTIONS
INSPECTOR 212 Main Street • Munic;ipal Building
Northampton, MA 01060
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CNM 108.3.4 to
act as 1-11s/her construction super ..-i:;or. The state defines "Homeowner" as, " Person(s)
who owns a parcel on which he/she resides or intends to be, a one or two fanuly
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 fnal 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
¢Ytv.�•r pT
R `E Tort a))1 toll
R J E -M AchnC.c1161' _ —
v; -
DEPARTMEI-T OF BUILDI�\,C INSPEC71011's
212 plain Strect Municipal Building
Northampton, Mass. 01000
WOR CER'S C0'iVTENSATTCDN MSURA1,C- AITD-),A V1T
(li�xlpermiricc) --- ---
%I.rlLh a prZncipa-1 place ofbusiness/residence, at:
Qj(zO7 (_phonc') qC D Co Wf�. J
(sa-=llci ry/siau 1a P)
do hereby certify, under Lhc.painS and penalties of perjury, _h?.l
( am an employer providing the follo%ving %voriccr's comDcnsZL)G covemSe For In),
employees wortang on Lies job:
(LnSUT---0c onpr c)) (Pobc-. Nu--Lb--r) — (t :pi •ci n Da z)
O I 2m a sole proprietor, general contractor or homeowner (crcie one) and have hired
the conuactors listed below who have the following workers comner>s2tion policies:
(1,47amc o;Conc77!cwr) (lnsumncc Comoan--if)cUc Datc)
(Name of Contramor) (UisDranc amoaz-v/Polim Num. -r) (-ExDir.:rioa Date)
(Name ofCottn-ano:) (Int�trancz Co ipao)'/POUq- Numb i (Espiraoo Dalc)
(blame of Cootraelor) (Insurance Comral y/Pobcy Numbu) (Etipitaaoa Date).
(--4' ricer.ifnoo ry to c�cru�iaforata�oo perts.iai.ns to..0 co=_.e.on) - q
{ ) I am a sole proprietor and have no one worldog for me.
( } I am,a home owner perfor m- a all the work myself.
NOTE:ple=sc be nw-xrt tt—k2 lc 6cmen+acra .bo =p1cy peom to c5o —e oo c rcp.-ir w•orz oa c d-1-z of
nnc mete t ..o tt7o:—,1 is tc�d�the bomoo raid,.or oa the p-ounc:;z,7 • tbcco t-r ox C= .Uy cc=daod to be
cirpioycs uric the An(GLI 52.n 1(5)�=4)plin6on by n bomco -oc fv:bc==or pama ray—6—tL"c
IcO—of en¢ploy-<under di W ocicolc Co=pj i AcL
t une�.ad t >--py of mi.m�em m.y 1�f--�nrde.e t.tb.tx�n�of i-,&,xrij OM-or 1- m r6f
Dove x��t7ir1c71ioo rLtd th l Lil sc w so�uc bovcra�undue=Cxioa 25A of 1.10L 152 m Ia_d w tbo=P=i6ou or==ia l P--Uh
oo=L,:Li�of a Lwe of up to 51-SMoo armor iapy-iloamccd of up b co ye LDd 0v11 pcoiric in tsc form of Stott Wort;Order nod.
fire o(S 1 .00.d_y. me
Fo d yu - ,J—only
Permit Number
Lot
S P)Mt rc o Lic=zcc/Pcmm6Ucc e -J
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
_ ,� ~° Not Applicable ❑
9 4,kiasteted=Nome=impi=o ernent oritcacioi' _
Company Name Registration Number
Address a 401 q Expiration Date
')t�a�—F i-� ?elephone
SECTION 10-`WORKERS'COMPENSATION-'INSURANCE AFFiDAvIT(M.GL.c.152,:§,:25C(6)j
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...... ❑
Y4�4°mgy
'a,
me �e��
The current exemption for"homeowners"was extended to incNde Owner-occu_nied 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 Homeow-ner:Person(s)_who_o_vri-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,(c heck all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [o] Decks [0 Siding[0] Other[0]
Brief Description of Proposed 7�
Work: � C)
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa<lfi�tev ..oase arrcfraaddiron.- ex>IS%a hotstn am ewe€ocvlrr
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.
1. Septic Tank City Sewer Private well City water Supply
SECTION Ta-OWNE-RAUTIiORIZATION-,TO BE COMPLEl ED=VIEkiEN
OWNERS AGENT OR..CONTRACTOR APPLIES.FOR BUILDING PERMIT
I,
coo C� as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit applic tion.
Al
Signature of Owner Date
1, � J'�EU'I✓`- as Owner/Authorized
Agent hereby decl r that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed un r the pains and penalties of perjury.
�-
Print me
Signatur of wner/A ent 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
Rear
Building Height
Bldg.Square Footage %
Open Space Footage %
(Lot area minus bldg&paved 17-7
#of Parking Spaces
(volume&Location)
A. Has a Special Perm it/Variance/F i ridi ever been isxuedfor/nn the site?
NO �_��/ DONT �� ��KND� \�� YES �,/
IF YES, date issued:'
IF YES: Was the permit recorded at the Registry n[Deeds?
NO � ) D0N7KN0 YES
,� VV
IF YES: enter Book Page and/or Document#\ }
B. Does the site contain abrook, body of water urwetlands? NO �_� DON'T KNOW ��� YES
IF YES, has a permit been or need tuUe obtained from the Conservation Commission?
Needs tobeobtained Obtained /—� Date
�
\��0 '
C. Do any signs exist on the property �� ��� YES \�� NO \_�
IF YES, describe size, type and location: |
D. Are there any proposed changes to or additions of signs intended for the property? YES NO /3
IF YES' describe size, type and location:
E. Will the construction activity disturb(clearing,gradingexcavation,nr filling)over 1 acre orioit part ufa common plan
that will disturb over 1acre? YEG [��) NO (���
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Departmentuse onl�
City of Northampton atus ai�eiiiirt�
Building Department urb -Y477,rew� e ��
212 Main Street ' Se
Room 100E p
Northampton, MA 01060 Twpto a �
phone 413-587-1240 Fax 413-587-1272 P1 a S
u
APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 SITE INFORMATION `
M i hoTh m face
1.1 Property Address:
iota Unit
wZOOe A OYerlay DIStCICt
-70d �P-
f lei,
SECTION'2 PROPERTY OWNERSHIP/AUTHORIZED-AGENT.
2.1 Owner of R rd:
Name(Print) Current Mailing Address: 34
Telephone
Signature
2.2 Authorized A ent: '
Name(Prin Current Mailing Address:
Sign atu a r Telephone
-7 SECTION -'ESTIMATED-CONSTRUCTION-COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by-perm Building o(a)Building-Permit'Fee
2. Electrical (b)Estimated.--Total Cost of
Construction from 6J
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=0 +2+3+4+5)
Check Number
This Section For 0fficiaLUse-Only
Date
Building Permit Number.: Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
702 KENNEDY RD BP-2007-0619
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 04-009 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit# BP-2007-0619
Protect# JS-2007-000929
Est. Cost: $6663.00_
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: HOME DEPOT AT HOME SERVICES 126893
Lot Size(sq. ft.): 261360.00 Owner: GRIMM A RONALD&MARY H
Zoning:RR Applicant: HOME DEPOT AT HOME SERVICES
AT. 702 KENNEDY RD
Applicant Address: Phone: Insurance:
345 GREENWOOD ST UNIT 1 (508) 341-9401
Workers Compensation
WORCESTERMA01607 ISSUED ON.121512006 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL 6 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 Occupant Signature:
FeeType: Date Paid: Amount:
Building 12/5/2006 0:00:00 $25.0016305
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo